FUNDAMENTALS OF NURSING
HISTORY OF NURSING
HISTORY OF NURSING   Early Civilization     Cause of Disease     Medicine Man     Mother Surrogate       Cause of Dis...
HISTORY OF NURSING   Early Christian Period     Deaconesses, Crusaders, Hospitals, Good      Samaritan Law       Parabo...
HISTORY OF NURSING   Throughout history, wars have accentuated the    need for nurses:       WWI, WWII, American Civil W...
HISTORY OF NURSING   Florence Nightingale       1836          Theodor Fliedner, a German pastor in           Kaiserwert...
HISTORY OF NURSING   1853      Nightingale trained in the Sisters of Charity      Paris      Returning to London, she ...
HISTORY OF NURSING   1860       Nightingale opened the Nightingale Training        School for Nurses       Served as mo...
HISTORY OF NURSING
HISTORY OF NURSING   Nightingales biggest contributions in    Nursing:       Sanitation Practices       Nursing Educati...
HISTORY OF NURSINGIN THE PHILIPPINES   Earliest Hospitals       Hospital de Real de Manila (1577)       San Lazaro Hosp...
HISTORY OF NURSING         IN THE PHILIPPINES   Earliest Nursing Schools       Iloilo Mission Hospital School of Nursing...
HISTORY OF NURSING         IN THE PHILIPPINES   Earliest Nursing Universities       University of Santo Tomas College of...
HISTORY OF NURSINGIN THE PHILIPPINES     Nursing Leaders         Anastacia Giron - Tupaz           - Nurse Chief Superin...
HISTORY OF NURSING         IN THE PHILIPPINES   Nursing Organizations       Philippine Nurse’s Association (PNA) – Natio...
NURSE
NURSE   Came from the Latin word       “Noutrix”   Meaning of the word       “To Nourish”
AS A PROFESSION   Body of specific and unique knowledge   Strong service orientation   Recognized authority by a profes...
LEVELS OF NURSES
LEVELS OF NURSES   5 Levels of Nurses       Level I          No experience          Novice       Level II          H...
LEVELS OF NURSES     Level III        Has 2 to 3 years of experience        Competent           Employed overseas    ...
LEVELS OF NURSES     Level V        Highly proficient        Does not require guidance and rules        Expert        ...
FIELDS OF NURSING PRACTICE
FIELDS OF NURSING PRACTICE                    1)Institutional or                     Hospital Nursing                    ...
FIELDS OF NURSING PRACTICE                     2) Community /                      Public Health                      Nur...
FIELDS OF NURSING PRACTICE                    3) Private Duty                     Nursing                         One to...
FIELDS OF NURSING PRACTICE                   5) Military Nursing
FIELDS OF NURSING PRACTICE                     6) Company /                      Industrial Nursing
EXPANDED EDUCATIONAL ANDCAREER ROLES
EXPANDED EDUCATIONAL ANDCAREER ROLES   Clinical Nurse Specialist       A nurse with an advanced degree,        education...
EXPANDED EDUCATIONAL ANDCAREER ROLES   Nurse Practitioner       A nurse with an advanced degree,        certified for a ...
EXPANDED EDUCATIONAL ANDCAREER ROLES   Nurse Anesthetist       A nurse who completes a course of study        in an anes...
EXPANDED EDUCATIONAL ANDCAREER ROLES   Nurse midwife       A nurse who completes a program in        midwifery         ...
EXPANDED EDUCATIONAL ANDCAREER ROLES   Nurse Educator       A nurse usually with an advanced        degree, who teaches ...
EXPANDED EDUCATIONAL ANDCAREER ROLES   Nurse Administrator       A nurse who functions at various levels        of manag...
EXPANDED EDUCATIONAL ANDCAREER ROLES   Nurse Researcher       A nurse with an advanced degree who        conducts resear...
EXPANDED EDUCATIONAL ANDCAREER ROLES   Nurse Entrepreneur       A nurse, usually with an advance degree        who may m...
NURSING ROLES
NURSING ROLES   Caregiver       Primary role of the nurse       The provision of care       MOTHER SURROGATE ROLES    ...
NURSING ROLES   Communicator       With Patients             To establish Therapeutic              Communication       ...
COMMUNICATION
COMMUNICATION                   It is the                    interchange of                    information               ...
ELEMENTS OF COMMUNICATION   Sender      Originator of the information   Message      Information being transmitted   ...
LEVELS OF COMMUNICATION   Intrapersonal      Occurs when a person communicates       within himself   Interpersonal    ...
MODES OF COMMUNICATION   Verbal Communication   Non-verbal Communication
NON-VERBAL MESSAGES   They carry more meaning than verbal    messages and involves the following:       Body movement or...
NON-VERBAL MESSAGES   Proxemics – use of personal or social space      Intimate Distance – actual contact to 1.5 feet   ...
THERAPEUTIC RESPONSES INCOMMUNICATING WITH PATIENTS
THERAPEUTIC RESPONSES    Identify therapeutic and non-therapeutic     phrases    Open-ended or Closed-ended question?  ...
THERAPEUTIC RESPONSES   Use direct questions for suicidal cases   Avoid the ‘Authoritarian Answer’      Giving advices...
COMMUNICATING WITH HEALTHCARE PROFESSIONALS
COMMUNICATING WITH HEALTH CAREPROFESSIONALS   Documentation   Reporting   Conferring   Referring
COMMUNICATING WITH HEALTH CAREPROFESSIONALS   Reporting       Endorsement       Transferring pertinent information     ...
COMMUNICATING WITH HEALTH CAREPROFESSIONALS   Conferring       To verify information       Rephrasing          To   va...
COMMUNICATING WITH HEALTH CAREPROFESSIONALS   Referring       To endorse patient’s special concern to a        higher au...
NURSING ROLES   Teacher/Educator       Providing education about a client’s        health and health care procedures the...
NURSING ROLES   Teaching Strategies       Assess client’s          Readiness to learn          Assess the client’s kno...
NURSING ROLES   Teaching Strategies       One to One Discussion or Group        Discussion          Explanation  and De...
NURSING ROLES   What is the best method of teaching?    (December 2007 NLE)   What is the best indicator of client learn...
NURSING ROLES   Counselor       Facilitates the patient’s problem solving        and decision – making skills       By ...
NURSING ROLES   Researcher       The participation in or conduct of        research       To increase knowledge in nurs...
NURSING ROLES   Advocate       Safeguarding the rights of the patients       Patients Bill of Rights
THEORIES OF NURSING
THEORIES OF NURSING   Theory       A hypothesis or system of ideas that is        proposed to explain a given phenomenon...
THEORIES OF NURSING              Nightingales              Environmental Theory                  The act of utilizing t...
THEORIES OF NURSING   Nightingales Environmental Theory       Addition:          Education   of nurses          Keepin...
THEORIES OF NURSING                    Hildegard Peplau’s                    Interpersonal Relations                    ...
THEORIES OF NURSING   Hildegard Peplau’s Interpersonal Relations    Model       Four Phases of the Nurse – Patient      ...
THEORIES OF NURSING                    Virginia Henderson’s                    14 Fundamental Needs                     ...
THEORIES OF NURSING   Virginia Henderson’s 14 Fundamental Needs    of a Person       1) Breathing normally       2) Eat...
THEORIES OF NURSING   Virginia Henderson’s 14 Fundamental Needs of a    Person       8) Keeping the body clean and well ...
THEORIES OF NURSING                    Dorothy Johnson’s                         Seven Subsystems                       ...
THEORIES OF NURSING               Faye Abdellah’s                   21 Nursing Problems                        good hyg...
THEORIES OF NURSING   Faye Abdellah’s 21 Nursing Problems       nutrition       elimination       fluid and electrolyt...
THEORIES OF NURSING   Faye Abdellah’s 21 Nursing Problems       self awareness       optimum possible goals       use ...
THEORIES OF NURSING                    Martha Roger’s                    Science of Unitary                     Human Be...
THEORIES OF NURSING   Martha Roger’s Science of Unitary Human    Beings       Man is composed of energy fields, which   ...
THEORIES OF NURSING                   Dorothea Orem’s                   Self Care and Self Care                    Defic...
THEORIES OF NURSING                    Imogene King’s                    Goal Attainment Theory                    Pati...
THEORIES OF NURSING                    Betty Neuman’s                    Health Care Systems                     Model  ...
THEORIES OF NURSING                    Sister Callista Roy’s                    Adaptation Model                       ...
THEORIES OF NURSING   Sister Callista Roy’s Adaptation Model       The goal is to enhance life processes        through ...
THEORIES OF NURSING               Madeline Leininger’s               Transcultural Nursing                   Emphasizes...
CONCEPT OF MAN
CONCEPT OF MAN   Nurse’s Clients       Individuals       Families       Communities
CONCEPT OF MAN   BIOLOGIC like ALL other men   PSYCHOLOGICAL like NO OTHER man   SOCIAL like SOME OTHER men   SPIRITUA...
ABRAHAM MASLOW’SHIERARCHY OF NEEDS                    5 Human Needs
ABRAHAM MASLOW’SHIERARCHY OF NEEDS                 Physiologic needs                     Oxygen                     Flu...
ABRAHAM MASLOW’SHIERARCHY OF NEEDS                    Safety and security                     (Physical and              ...
ABRAHAM MASLOW’SHIERARCHY OF NEEDS                   Love and                    Belongingness                        Fa...
ABRAHAM MASLOW’SHIERARCHY OF NEEDS                  Self-esteem                     Feeling good about one’s            ...
ABRAHAM MASLOW’SHIERARCHY OF NEEDS                  Self-actualization –                   essence of mental             ...
ABRAHAM MASLOW’SHIERARCHY OF NEEDS   Self Actualization       Judges people correctly       Superior perception       ...
ABRAHAM MASLOW’SHIERARCHY OF NEEDS    Open to new ideas       Not adopts new ideas       Not one track mind    Highly ...
ABRAHAM MASLOW’SHIERARCHY OF NEEDS   Additional needs:       Need to know and understand       Aesthetic needs       T...
ABRAHAM MASLOW’SHIERARCHY OF NEEDS   Need to know and understand or Cognitive    needs is supported by Richard Kalish who...
ABRAHAM MASLOW’SHIERARCHY OF NEEDS   Aesthetic needs:       Beauty       Balance       Form
ABRAHAM MASLOW’SHIERARCHY OF NEEDS   Transcendence:       Helping others to self-actualize
ILLNESS, WELLNESS AND HEALTH
DEFINITIONS OF HEALTHObject 5                           World Health                            Organization             ...
DEFINITIONS OF HEALTH   Health is individually defined by each    person   On a personal level, individuals define    he...
DISEASE   Objective pathologic process   Pathologic change in the structure or function    of the mind and body
DISEASE Acute     Rapid onset of symptoms     Some are life threatening     Many do not require medical treatment
DISEASE   Chronic       Broad term that encompasses many        different physical and mental alterations in        heal...
ILLNESS             Highly subjective              feeling of being sick              or ill             How the person ...
ELEVEN STAGES OF ILLNESS ANDHEALTH-SEEKING BEHAVIOR BY SUCHMAN     1. Symptom Experience         Client realizes there i...
ELEVEN STAGES OF ILLNESS AND HEALTH-SEEKING BEHAVIOR BY SUCHMAN     3. Assuming a Dependent Role         Accepts the dia...
CONCEPTS ON DISEASE AND ILLNESS   Illness without disease      is possible   Disease without illness     is possible
MODELS OF HEALTH AND ILLNESS
DUNN’S HIGH-LEVEL WELLNESSAND GRID MODEL   X-axis is HEALTH   Y-axis is ENVIRONMENT
DUNN’S HIGH-LEVEL WELLNESSAND GRID MODEL Quadrant 1             Quadrant 2- High Level Wellness   - Protected Poor Health ...
HEALTH BELIEF MODEL BYROSENTOCK   Concerned with what people perceive about    themselves in relation to their health   ...
FOUR LEVELS OF HEALTH BY SMITH1. Clinical Model      Man is viewed as a Physiologic Being      If there are no signs and...
FOUR LEVELS OF HEALTH BY SMITH2. Role Performance Model     As long as you are able to perform      SOCIETAL functions an...
FOUR LEVELS OF HEALTH BY SMITH3. Adaptive Model     Health is viewed in terms of capacity to      ADAPT     Failure to a...
FOUR LEVELS OF HEALTH BY SMITH4. Eudaemonistic Model     This is the BROADEST concept of health     Because health is vi...
AGENT, HOST, ENVIRONMENT MODELBY LEAVELL AND CLARK   Also known as the Ecologic Model   Triad is composed of the agent, ...
NURSING PROCESS
THE NURSING PROCESS   Definition:       The Nursing Process is a systematic,        organized, rational method of planni...
Nursing process   foundation of the nursing profession   central to nursing actions   a process to deliver care to pati...
   Synonymous with the problem solving approach    for discovering the healthcare and nursing care    needs of clients. (...
PURPOSES OF THE NURSING PROCESS   To identify health status      Actual health problems      Potential health problems...
CHARACTERISTICS OFTHE NURSING PROCESS   Client-centered    Cyclical (sequence), dynamic (moving)     rather than static ...
CHARACTERISTICS OFTHE NURSING PROCESS   Adaptation of problem-solving techniques    and decision making principles in all...
CHARACTERISTICS:   Problem – Oriented   Goal Oriented   Orderly planned step by step   Open in accepting additional   ...
BENEFITS FROM THE NURSING PROCESS   Improves quality of care   Ensures continuity and appropriate level    of care     ...
BENEFITS FROM THE NURSING PROCESS   Feedback allows nurse to evaluate care   Serves as a framework for accountability   ...
PARTS OF THE NURSING PROCESS   Assessment Phase   Diagnosing Phase   Planning Phase   Intervention Phase   Evaluation...
ASSESSMENT PHASE
ASSESSMENT PHASE   Is the systematic and continuous collection,    organization, validation, and documentation of    data...
ASSESSMENT PHASE   What to assess       Clients perceived needs       Client’s responses to health problems          A...
FOUR TYPES OF ASSESSMENT
FOUR TYPES OF ASSESSMENT   Initial Assessment   Focus Assessment or On-going    Assessment   Emergency Assessment   Ti...
FOUR TYPES OF ASSESSMENT   1. Initial Assessment      When performed:         At specified time after admission       ...
FOUR TYPES OF ASSESSMENT   2. Focus Assessment or On-going    Assessment       When performed:          Integrated thro...
FOUR TYPES OF ASSESSMENT   3. Emergency Assessment      When done:         During acute physiologic and          psycho...
FOUR TYPES OF ASSESSMENT   4. Time-Lapsed Assessment       When done:          Several months after initial           a...
ASSESSMENT PHASE   Nursing Activities in the Assessment    Phase       Data Collection       Data Organization       D...
CRITICAL THINKING•   It is how the        Over time the    nurse uses the        nurse learns to                         ...
To use this process, the nurse must     demonstrate other fundamental     abilities of:3. Knowledge4. Creativity5. Adaptab...
DATA COLLECTION
DATA COLLECTION   Is the process of gathering information or    data   Data gathering
RECORDED DATA   Types of Data   Sources of Data   Methods of Data Collection
TYPES OF DATA
TYPES OF DATA   1. Subjective or Covert Data       Felt by the patient       During the recording of data, this should ...
TYPES OF DATA   2. Objective or Overt Data       Capable of being observed by use of        senses – sight, touch, smell...
SOURCES OF DATA
SOURCES OF DATA   1. Primary Source       Patient himself, except when:          Patient is unconscious          Patie...
SOURCES OF DATA   2. Secondary Source       Patient’s record       Health care members       Significant others
METHODS OF DATA COLLECTION
METHODS OF DATA COLLECTION   Observing   Interviewing   Examining
METHODS OF DATA COLLECTION:OBSERVING   To gather data by using the senses       Vision          Overall appearance    ...
METHODS OF DATA COLLECTION:OBSERVING   Two (2) aspects of observation process:       Noticing the stimuli using the sens...
METHODS OF DATA COLLECTION:INTERVIEWING   Is a planned conversation with a purpose       To get or give information    ...
METHODS OF DATA COLLECTION:INTERVIEWING   Two types of Interview       Directive Type of Interview       Non-directive ...
DIRECTIVE TYPE OF INTERVIEW   Structured   Uses closed-ended questions calling for    specific data       Yes or No    ...
NON-DIRECTIVE TYPE ORRAPPORT-BUILDING INTERVIEW   Uses more open-ended questions   Advantage is that it allows the patie...
PLANNING THE INTERVIEW SETTING   Concepts:       Before the interview, determine what        information you already kno...
PLANNING THE INTERVIEW SETTING   Concepts:       When is it done?          When patient is available          When pat...
STAGES OF THE INTERVIEW   1. Opening Stage       This is the most important part of the        interview       Rational...
STAGES OF THE INTERVIEW   2. Body of the Interview       Occurs when patient responds to        questioning       The m...
STAGES OF THE INTERVIEW   3. Closing Stage       The nurse terminates the interview when              Theneeded inform...
STAGES OF THE INTERVIEW STAGES OFTHE INTERVIEW   3. Closing Stage       How to close the interview:          Summarizin...
METHODS OF DATA COLLECTION:EXAMINING   The physical examination or assessment   Use of senses   Use of inspection, palp...
METHODS OF DATA COLLECTION:EXAMINING   Cephalocaudal   Proximodistal   IPPA   IAPP
ORGANIZING DATA
ORGANIZING DATA   Clustering of data       Example       Nursing Health History          Current health problem       ...
VALIDATION OF DATA
VALIDATION OF DATA   Act of double-checking the data   Purposes of Data Validation       To ensure the:          Corre...
DATA RECORDING
DATA RECORDING   Data Recording COMPLETES the    Assessment Phase       Complete       Factual          Don’t interpre...
DOCUMENTATION
DOCUMENTATION   It is a written, formal document   A record of client’s progress
PURPOSES OF DOCUMENTATION   Planning Care   Communication   For legal documentation purposes   For research   For edu...
GUIDELINES ON DOCUMENTATION   Timing      Document patient care as soon as possible   Observe confidentiality   Observ...
GUIDELINES ON DOCUMENTATION   Signature      Sign full name and append R.N.   Accuracy      Ensure that data is correc...
GUIDELINES ON DOCUMENTATION   Completeness   Use standard terminology   Brevity      Make it concise yet meaningful  ...
TYPES OF RECORDS   Source-Oriented Clinical Record   Problem-Oriented Clinical Record
PROBLEM-ORIENTEDCLINICAL RECORD   Same as Problem Oriented Medical Record   Entry of data is based on CLIENT’S    PROBLE...
FOUR BASIC COMPONENTS OFPROBLEM-ORIENTED CLINICAL RECORD     1. Baseline Data         All information gathered from a pa...
FOUR BASIC COMPONENTS OFPROBLEM-ORIENTED CLINICAL RECORD    2. Problem List        Contains only ACTIVE problems (and   ...
FOUR BASIC COMPONENTS OFPROBLEM-ORIENTED CLINICAL RECORD    3. Initial list of orders or Care Plans
FOUR BASIC COMPONENTS OFPROBLEM-ORIENTED CLINICAL RECORD     4. Progress Notes         Includes:            Nurses’ nar...
SOURCE-ORIENTED CLINICAL RECORD   Classification of information is based on    SOURCE   Each person or department mainta...
COMPONENTS OF ASOURCE-ORIENTED CLINICAL RECORD    Admission Sheet    Nursing Notes    Medical History and Physical Exam...
ASSESSMENT
DIAGNOSING PHASE
DIAGNOSING PHASE   Nurses use critical thinking skills to    interpret assessment data and identify    client strengths a...
DIAGNOSING PHASE   Diagnostic Process       Analyze the data       Identify health problems, risk, and        strengths...
PARTS OF A NURSING DIAGNOSIS   1. Problem Statement      Example:         Fluid Volume Deficit   2. Presumed Etiology ...
TYPES OF DIAGNOSTIC STATEMENTS   Basic Two Part Statements (PE)       Problem and Etiology       Altered Nutrition Less...
TYPES OF DIAGNOSTIC STATEMENTS   Basic Three Part Statement (PES)       Problem       Etiology       Signs and Symptom...
TYPES OF DIAGNOSTIC STATEMENTS   One Part Statements       Problem       Rape Trauma Syndrome
TYPES OF NURSING DIAGNOSIS
DIFFERENT TYPES OF NURSINGDIAGNOSES DIFFERENT TYPES OFNURSING DIAGNOSES   1. Actual Nursing Diagnosis       Problem pres...
DIFFERENT TYPES OF NURSINGDIAGNOSES   2. High-Risk Nursing Diagnosis       A diagnosis that a patient is more        vul...
DIFFERENT TYPES OF NURSINGDIAGNOSES   3. Possible Nursing Diagnosis       Not enough evidence about a problem       Exa...
DIFFERENT TYPES OF NURSINGDIAGNOSES   4. Wellness Nursing Diagnosis       A positive statement       Indicates a health...
PLANNING PHASE
PLANNING PHASE   Planning is a deliberative, systematic phase    that involves decision making and problem    solving   ...
ACTIVITIES DURINGTHE PLANNING PROCESS   Set priorities      Client’s problems   Set goals and objectives   Identify al...
PURPOSES OF GOAL-SETTING   To set direction   To provide a time span   To have a criteria for evaluation   To enable t...
TYPES OF PLANNING
TYPES OF PLANNING   1. Initial Planning       Done by the nurse       When done:          At specified time upon or af...
TYPES OF PLANNING   2. On-going Planning       Who are involved:          Done by all nurses who worked with           ...
TYPES OF PLANNING   2. On-going Planning       Purposes of On-going Planning          To determine if the client’s heal...
TYPES OF PLANNING   3. Discharge Planning       Purpose of Discharge Planning            To ensure continuity of care  ...
CHARACTERISTICS OFTHE PLANNING PROCESS   S       Specific   M       Measurable   A       Attainable   R       Real...
IMPLEMENTING PHASE
IMPLEMENTING PHASE   Consists of doing and documenting the    nursing care given to the patient   Putting the care plan ...
IMPLEMENTING PHASE   Purpose of Implementation       To carry out planned activities       To help the client
IMPLEMENTING PHASE   Requirements for Implementation       Adequate knowledge       Technical Skills       Communicati...
IMPLEMENTING PHASE   Reassess the patient      Rationale         To determine if the procedure is still          needed...
NURSING ACTIVITIES DURING THEIMPLEMENTATION PHASE   Communicate the procedure    performed by documenting the    procedur...
GUIDELINES FOR IMPLEMENTATION OFNURSING STRATEGIES   It should be based on scientific knowledge,    research, professiona...
GUIDELINES FOR IMPLEMENTATION OFNURSING STRATEGIES   It should always be safe. Do not compromise   It should be holistic...
EVALUATION PHASE
EVALUATION PHASE   Purpose of the Evaluation Phase       To determine client’s progress       To determine the effectiv...
EVALUATION PHASE   Importance of doing an Evaluation       It determines if the care plan will be:          Continued  ...
EVALUATION PHASE   Activities during the Evaluation Phase       Identify the OUTCOME CRITERIA to be        used as measu...
TYPES OF EVALUATION   1. On-going Evaluation       When done:          During or immediately after the           interv...
TYPES OF EVALUATION   2. Intermittent Evaluation       When done:          At a specified time       Purpose:         ...
TYPES OF EVALUATION   3. Terminal Evaluation       When done:          At or immediately before discharge       Import...
PROMOTING REST AND SLEEP
PROMOTING REST AND SLEEP   Sleep is the altered level of consciousness    in which the individual’s perception of and    ...
PROMOTING REST AND SLEEP   What regulates sleep and wakefulness?       Reticular formation on the Brain Stem       Asce...
PROMOTING REST AND SLEEP   Types of Sleep       NREM          Non-Rapid Eye Movement Sleep       REM          Rapid E...
PROMOTING REST AND SLEEP   NREM (Non-Rapid Eye Movement Sleep)       When the RAS is inhibited          Sleep       BO...
PROMOTING REST AND SLEEP   NREM (Non-Rapid Eye Movement Sleep)       Stage I (Very Light Sleep)          Lasts only a f...
PROMOTING REST AND SLEEP   NREM (Non-Rapid Eye Movement Sleep)       Stage II (Light Sleep)          Lastsfor 10-15 min...
PROMOTING REST AND SLEEP   NREM (Non-Rapid Eye Movement Sleep)       Stage III          The HR and RR, as well as other...
PROMOTING REST AND SLEEP   NREM (Non-Rapid Eye Movement Sleep)       Stage IV (Delta Sleep or Deep Sleep)          HR  ...
PROMOTING REST AND SLEEP   REM (Rapid Eye Movement Sleep)       Occurs about every 90 minutes       Lasts from 5 to 30 ...
PROMOTING REST AND SLEEP   For sleep to be normal       The person must pass through the NREM and        REM       1 Cy...
PROMOTING REST AND SLEEP   What is/are the longest type or stage of    sleep?       Stages II and III
PROMOTING REST AND SLEEP   A sleeper who is awakened at any stage    must begin a new cycle   In a 7 to 8 hours of sleep...
PROMOTING REST AND SLEEP   To restore the body
PROMOTING REST AND SLEEP   Normal Sleep Requirements       Newborns          16 to 18 hours a day       Infants       ...
PROMOTING REST AND SLEEP   Normal Sleep Requirements       Preschoolers          11 to 13 hours       School Aged     ...
PROMOTING REST AND SLEEP   Normal Sleep Requirements       Adults          7 to 9 hours       Elders          7 to 9 ...
PROMOTING REST AND SLEEP   Factors Affecting Sleep       Illness          Pain or physical distress             Arthri...
PROMOTING REST AND SLEEP   Factors Affecting Sleep       Environment          Noise          Absence of usual stimuli ...
PROMOTING REST AND SLEEP   Factors Affecting Sleep        Emotional Stress           Considered  by sleep experts as th...
PROMOTING REST AND SLEEP   Factors Affecting Sleep       Stimulants and Alcohol          Caffeine containing beverages ...
PROMOTING REST AND SLEEP   Factors Affecting Sleep       Smoking         Nicotinehas a stimulating effect on          t...
COMMON SLEEP DISORDERS
COMMON SLEEP DISORDERS   Insomnia       Inability to fall asleep or remain asleep       Acute Insomnia          Last 1...
COMMON SLEEP DISORDERS   Insomnia       Chronic Intermittent Insomnia          Difficulty sleeping for a few nights    ...
COMMON SLEEP DISORDERS   Excessive Daytime Sleepiness       Hypersomnia       Narcolepsy
COMMON SLEEP DISORDERS   Hypersomnia       The affected individual obtains sufficient        sleep at night       Canno...
COMMON SLEEP DISORDERS   Narcolepsy       Disorder of excessive daytime sleepiness          Sleep attacks          Cat...
COMMON SLEEP DISORDERS   Sleep Apnea       Frequent short breathing pauses during        sleep       10 seconds to 2 mi...
COMMON SLEEP DISORDERS   Sleep Apnea       Obstructive Apnea          Blockage   of the flow of air       Central     ...
COMMON SLEEP DISORDERS   Parasomnias       Arousal Disorder          Sleep               Walking            Somnambulism
COMMON SLEEP DISORDERS   Parasomnias       Sleep Wake Transition Disorder          Sleep   talking              Exhaus...
COMMON SLEEP DISORDERS   Parasomnias       Associated with REM Sleep          Nightmares
COMMON SLEEP DISORDERS   Parasomnias       Others          Bruxism
NURSING INTERVENTIONSTO PROMOTE REST AND SLEEP
NURSING INTERVENTIONSTO PROMOTE REST AND SLEEP   Sleep Hygiene       Referring to interventions to promote        sleep
NURSING INTERVENTIONSTO PROMOTE REST AND SLEEP   Supporting Bedtime Rituals       Most people are accustomed to bedtime ...
NURSING INTERVENTIONSTO PROMOTE REST AND SLEEP   Supporting Bedtime Rituals       Children          Need  to be sociali...
NURSING INTERVENTIONSTO PROMOTE REST AND SLEEP   Supporting Bedtime Rituals       Massage       Warm drink          Mi...
NURSING INTERVENTIONSTO PROMOTE REST AND SLEEP   Creating a Restful Environment       Minimal noise       Comfortable r...
NURSING INTERVENTIONSTO PROMOTE REST AND SLEEP   Promoting Comfort and Relaxation       Provide loose fitting nightwear ...
NURSING INTERVENTIONSTO PROMOTE REST AND SLEEP   Promoting Comfort and Relaxation       Emotional stress interferes with...
PROMOTING NUTRITION
PROMOTING NUTRITION   Nutrition       Is the sum of all the interactions        between an organism and the food it     ...
PROMOTING NUTRITION   Essential Nutrients       The body’s most basic nutrient need is            Water       Nutrient...
MACRONUTRIENTSCARBOHYDRATES   CHO   Two Basic Types       Simple Sugars       Complex Carbohydrates          Starches...
MACRONUTRIENTSCARBOHYDRATES                    Simple sugars                        Water soluble                      ...
MACRONUTRIENTSCARBOHYDRATES   Simple sugars        Disaccharides             Two Monosaccharide
MACRONUTRIENTSCARBOHYDRATES                    Food Sources of                     Simple Sugars                        ...
MACRONUTRIENTSCARBOHYDRATES                    Complex Sugars                        Starches                          ...
MACRONUTRIENTSCARBOHYDRATES                    Complex Sugars                        Fibers                            ...
MACRONUTRIENTSCARBOHYDRATES   Digestion       In the mouth          Ptyalin (Salivary Amylase)       In the small inte...
MACRONUTRIENTS CARBOHYDRATES    Metabolism        CHO is Major Source of Body Energy        GO FOODS                   ...
MACRONUTRIENTSPROTEINS   CHON   Amino acids       Essential amino acids          Those that cannot be produced by the ...
MACRONUTRIENTSPROTEINS   May be Complete, Partially Complete and    Incomplete
MACRONUTRIENTSPROTEINS                    Complete Proteins                        Contains all                         ...
MACRONUTRIENTSPROTEINS   Partially Complete       Less than the required amount of one or        two essential amino aci...
MACRONUTRIENTSPROTEINS               Incomplete                    Lack of one or more                     essential ami...
MACRONUTRIENTSPROTEINS   Digestion       In the mouth          Pepsin       In the intestines          Trypsin
MACRONUTRIENTSPROTEINS   Storage       Protein is stored in the body as tissue       Growth and Development       GROW...
MACRONUTRIENTSPROTEINS   Metabolism       Anabolism          Construction          All body cells manufacture proteins...
MACRONUTRIENTSLIPIDS   Organic substances that are greasy and    insoluble in water   Fats      Lipids that are solid a...
MACRONUTRIENTSLIPIDS   Classified as       Saturated       Unsaturated       Which is healthier?
MACRONUTRIENTSLIPIDS                    Saturated fats                        coconut oil, and                         p...
MACRONUTRIENTSLIPIDS                    Unsaturated                        Avocado                        Nuts         ...
MACRONUTRIENTSLIPIDS   Digestion       Starts in the mouth       Mainly in the stomach          Bile          Pancrea...
MACRONUTRIENTSLIPIDS   They become       Glycerol and Fatty acids          Energy       Cholesterol (Lipids plus prote...
TYPES OF LIPOPROTEINS   1. High Density Lipoproteins (HDL)       Good cholesterol       Function of HDLs          Tran...
TYPES OF LIPOPROTEINS   2. Low Density Lipoproteins (LDL)       Bad cholesterol       Function of LDLs          They  ...
ENERGY INTAKE
ENERGY INTAKE   The amount of energy that nutrients or    foods supply to the body is their caloric    value       CHO  ...
ENERGY INTAKE   Recommended Calorie Intake per Day       Varies       Generally          Men             2000 – 2500 ...
ENERGY INTAKE   Compute       800 grams of CHO       600 grams of CHON       400 grams of FATS
MICRONUTRIENTS
MICRONUTRIENTS   Required in small amounts       Vitamins       Minerals
VITAMINS
MICRONUTRIENTS   Vitamins       Organic compounds that cannot be        produced by the body          Water   Soluble  ...
WATER SOLUBLE VITAMINS
WATER SOLUBLE VITAMINS   Vitamins that cannot be stored by the body      Excess?       Vitamin C       Vitamin B Complex
WATER SOLUBLE VITAMINS   Vitamin C   Ascorbic Acid       synthesis of collagen          an important protein used to m...
WATER SOLUBLE VITAMINS                   Vitamin C                   Fruits                      Guava                 ...
WATER SOLUBLE VITAMINS   Vitamin C Deficiency       Scurvy          Bruising  easily          hair and tooth loss     ...
WATER SOLUBLE VITAMINS   Vitamin B Complex       Vitamin B1          (thiamine)       Vitamin B2          (riboflavin...
WATER SOLUBLE VITAMINS   Vitamin B Complex       Vitamins B1, B2, B3          energy production       Vitamin B6      ...
WATER SOLUBLE VITAMINS                   Vitamin B Complex                      fish, milk, eggs,                       ...
WATER SOLUBLE VITAMINS   Vitamin B Deficiency       Vitamin B1 (Thiamine)          Beriberi             Wernickes ence...
WATER SOLUBLE VITAMINS   Vitamin B Deficiency       Vitamin B3 (niacin)          Pellagra             Aggression      ...
WATER SOLUBLE VITAMINS                  Vitamin B Deficiency                      Vitamin B9 (folic acid)               ...
FAT SOLUBLE VITAMINS
FAT SOLUBLE VITAMINS   The body can store these vitamins       A       D       E       K
FAT SOLUBLE VITAMINS   Vitamin A       Retinol       Normal Vision       Maintaining normal skin health       Deficie...
FAT SOLUBLE VITAMINS                    Vitamin A sources                        liver (beef, pork,                     ...
FAT SOLUBLE VITAMINS   Vitamin D       Calciferol       To maintain normal blood levels of calcium          Vitamin D ...
FAT SOLUBLE VITAMINS                    Vitamin D                        Fish                        Eggs              ...
FAT SOLUBLE VITAMINS   Vitamin E       Tocopherol       Antioxidant
FAT SOLUBLE VITAMINS                  Vitamin E sources                      Vegetable oils, nuts,                      ...
FAT SOLUBLE VITAMINS   Vitamin K       K          Koagulation   Vitamins       Clotting factors          Stops bleeding
FAT SOLUBLE VITAMINS                    Leafy green                     vegetables,                     particularly the ...
MINERALS
MINERALS   Organic or inorganic compounds       Macrominerals          Over 100 mg       Microminerals          Less ...
MACROMINERALS
MACROMINERALS    Calcium    Sodium    Potassium    Phosphorous    Magnesium    Chloride    Sulfur
MACROMINERALS   Calcium       Normal growth and maintenance of        bones and teeth       Deficiency          Ricket...
MACROMINERALS                   Calcium Sources                       Dairy products, such                        as mil...
MACROMINERALS   Sodium       Regulation of blood and body fluids          Water Retention       Transmission of nerve ...
MACROMINERALS            Potassium                muscle contraction and the                 sending of all nerve impuls...
MICROMINERALS
MICROMINERALS    Iron    Iodine    Flouride    Manganese    Cobalt    Selenium
MICROMINERALS   Iron       Ferrous Sulfate       Hemoglobin          Oxygen carriers       Forms of supplement       ...
MICROMINERALS   Iron Sources       Dark Green, Leafy Vegetables       Dried Beans and Peas       Dried Fruits       E...
MICROMINERALS   Iron       Oral Form          Take  on an empty stomach          If with GI distress, take with food  ...
MICROMINERALS   Iron       Parenteral Form       Site          Deep IM          Z Track          Don’t massage      ...
MICROMINERALS   Iodine       As element of the thyroid hormones,        thyroxine (T4) and triiodothyronine (T3)       ...
MICROMINERALS                   Iodine Sources                       Sea creatures                       Seaweeds
NUTRITIONAL ASSESSMENT
NUTRITIONAL ASSESSMENT   Anthropometric Measurements       Height       Weight          (best indicator of nutritional...
NUTRITIONAL ASSESSMENT   Weight       Weighing Technique       Ideal Body Weight          Rule of 5 for Women         ...
NUTRITIONAL ASSESSMENT   Ideal Body Weight       Rule of 5 for Women          100  lbs for 5 ft of height          Plu...
NUTRITIONAL ASSESSMENT   Ideal Body Weight        Rule   of 6 for Men           106 lbs for 5 ft of height           P...
NUTRITIONAL ASSESSMENT                   Anthropometric                    Measurements                       Skin Fold ...
NUTRITIONAL ASSESSMENT                   Anthropometric                    Measurements                       Mid-upper ...
NUTRITIONAL ASSESSMENT   Body Mass Index       BMI = weight in kg             (height in meter)2
NUTRITIONAL ASSESSMENT   BMI       Height in Meter          1 Meter = 3.3 feet or 39.6 inches       1 Kg = 2.2 Lbs
NUTRITIONAL ASSESSMENT   BMI Results       Underweight = Less than 18.5       Normal = 18.5 – 24.9       Overweight = ...
NUTRITIONAL ASSESSMENT   BMI       Compute          Weight = 65 kg          Height is = 62 inches       Compute      ...
NUTRITIONAL ASSESSMENT   Biochemical Data       Serum Albumin
NUTRITIONAL ASSESSMENT   Serum Albumin       Provide an estimate of protein stores       Albumin          Serum protein
NUTRITIONAL ASSESSMENT   Dietary Data       24 hour food recall       Food Diary          Obesity          Eating   D...
NUTRITIONAL VARIATIONSTHROUGHOUT THE LIFE CYCLE
NUTRITIONAL VARIATIONS    THROUGHOUT THE LIFE CYCLE   Neonate       Nutritional requirements are met by        breastmil...
NUTRITIONAL VARIATIONSTHROUGHOUT THE LIFE CYCLE   Infant      Solid foods are added when?         4 to 6 months        ...
NUTRITIONAL VARIATIONSTHROUGHOUT THE LIFE CYCLE                   Toddlers                       Toddlers can eat       ...
NUTRITIONAL VARIATIONSTHROUGHOUT THE LIFE CYCLE                   Preschooler                       These children eat  ...
NUTRITIONAL VARIATIONSTHROUGHOUT THE LIFE CYCLE                   School Aged Child                       Watch out for ...
NUTRITIONAL VARIATIONSTHROUGHOUT THE LIFE CYCLE   Adolescents       Growth spurt       Self Identity and Peer pressure ...
NUTRITIONAL VARIATIONSTHROUGHOUT THE LIFE CYCLE   Young Adults and Middle Adults       Maintain normal diet of healthy f...
NUTRITIONAL VARIATIONSTHROUGHOUT THE LIFE CYCLE   Elderly       They have many problems associated with        nutrition...
SPECIAL DIETS
SPECIAL DIETS                   Clear Liquid Diets                       Limited to                          Water     ...
SPECIAL DIETS   Clear Liquid Diets       This provides water and CHO (in the        form of sugar)       After surgery
SPECIAL DIETS                   Full Liquid Diet                       Foods that are liquids                        or ...
SPECIAL DIETS   Full Liquid Diet       For clients who have gastrointestinal        problems and cannot tolerate semi so...
SPECIAL DIETS   Soft Diet       All foods in the Clear and Full Liquid Diet       Meat: Lean, Tender          Fish, gr...
SPECIAL DIETS   Diet As Tolerated (DAT)       When the client’s appetite, ability to eat        and tolerate food       ...
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
NURSING PROCESS, SLEEP, REST & NUTRITION
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NURSING PROCESS, SLEEP, REST & NUTRITION

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NURSING PROCESS, SLEEP, REST & NUTRITION

  1. 1. FUNDAMENTALS OF NURSING
  2. 2. HISTORY OF NURSING
  3. 3. HISTORY OF NURSING Early Civilization  Cause of Disease  Medicine Man  Mother Surrogate  Cause of Disease  Temples Code of Hammurabi: Oldest Sanitation Code - 1760 BC - Law codes - Sanitation
  4. 4. HISTORY OF NURSING Early Christian Period  Deaconesses, Crusaders, Hospitals, Good Samaritan Law  Parabolani Brotherhood  Teutonic Knights  Knights of St. John of Jerusalem  Knights of Lazarus
  5. 5. HISTORY OF NURSING Throughout history, wars have accentuated the need for nurses:  WWI, WWII, American Civil War, Vietnam War (Recruitment of Nurses)  Free Education for Nurses  Crimean War  Sir Sidney Herbert  Florence Nightingale
  6. 6. HISTORY OF NURSING Florence Nightingale  1836  Theodor Fliedner, a German pastor in Kaiserwerth, opened a hospital with a training school for nurses  Training School of Deaconesses  1847  Florence Nightingale went to train as a nurse in Kaiserwerth, Germany  Where she stayed for 3 months
  7. 7. HISTORY OF NURSING 1853  Nightingale trained in the Sisters of Charity  Paris  Returning to London, she worked as administrator and director of nurses at the Establishment for Gentlewomen During Illness where she remained  Until she was called into service during the Crimean War
  8. 8. HISTORY OF NURSING 1860  Nightingale opened the Nightingale Training School for Nurses  Served as model for other nursing schools  Its graduates traveled to other countries to manage hospitals and nurse training schools
  9. 9. HISTORY OF NURSING
  10. 10. HISTORY OF NURSING Nightingales biggest contributions in Nursing:  Sanitation Practices  Nursing Education  First Nurse Theorist  Notes on Nursing: What It Is And What It Is Not
  11. 11. HISTORY OF NURSINGIN THE PHILIPPINES Earliest Hospitals  Hospital de Real de Manila (1577)  San Lazaro Hospital (1578)  San Juan de Dios Hospital (1596)
  12. 12. HISTORY OF NURSING IN THE PHILIPPINES Earliest Nursing Schools  Iloilo Mission Hospital School of Nursing (1906)  St. Luke’s Hospital School of Nursing (1907)  Mary Johnston Hospital and School of Nursing (1907)  Philippine General Hospital School of Nursing (1910)
  13. 13. HISTORY OF NURSING IN THE PHILIPPINES Earliest Nursing Universities  University of Santo Tomas College of Nursing  Manila Central University College of Nursing  University of the Philippines College of Nursing, Manila  FEU Institute of Nursing  UE College of Nursing
  14. 14. HISTORY OF NURSINGIN THE PHILIPPINES  Nursing Leaders  Anastacia Giron - Tupaz - Nurse Chief Superintendent of PNA - Founder of PNA
  15. 15. HISTORY OF NURSING IN THE PHILIPPINES Nursing Organizations  Philippine Nurse’s Association (PNA) – National  First President  Rosario Delgado  Current President  Leah Samaco Pacquiz
  16. 16. NURSE
  17. 17. NURSE Came from the Latin word  “Noutrix” Meaning of the word  “To Nourish”
  18. 18. AS A PROFESSION Body of specific and unique knowledge Strong service orientation Recognized authority by a professional group Code of ethics and laws Professional organization Ongoing research Autonomy CARE
  19. 19. LEVELS OF NURSES
  20. 20. LEVELS OF NURSES 5 Levels of Nurses  Level I  No experience  Novice  Level II  Has acceptable performance and has experienced enough situations  Advanced beginner
  21. 21. LEVELS OF NURSES  Level III  Has 2 to 3 years of experience  Competent  Employed overseas  Level IV  Has 3 to 5 years of experience  Proficient
  22. 22. LEVELS OF NURSES  Level V  Highly proficient  Does not require guidance and rules  Expert  Capable of managing hospital units
  23. 23. FIELDS OF NURSING PRACTICE
  24. 24. FIELDS OF NURSING PRACTICE  1)Institutional or Hospital Nursing  Employment in hospitals and health institutions  Biggest field of nursing practice  Staff Nurse  Nurse Managers
  25. 25. FIELDS OF NURSING PRACTICE  2) Community / Public Health Nursing  Subdivision:  School Nursing
  26. 26. FIELDS OF NURSING PRACTICE  3) Private Duty Nursing  One to one care  Total nursing care or Case Management  Home or hospital based
  27. 27. FIELDS OF NURSING PRACTICE  5) Military Nursing
  28. 28. FIELDS OF NURSING PRACTICE  6) Company / Industrial Nursing
  29. 29. EXPANDED EDUCATIONAL ANDCAREER ROLES
  30. 30. EXPANDED EDUCATIONAL ANDCAREER ROLES Clinical Nurse Specialist  A nurse with an advanced degree, education, or experience  Considered to be an expert in a specialized area of nursing  Example: Geriatric Nurse, Oncology Nurse, Maternal and Child Nurse
  31. 31. EXPANDED EDUCATIONAL ANDCAREER ROLES Nurse Practitioner  A nurse with an advanced degree, certified for a special area or age of patient care  Delivers independent practice to make health assessments and deliver primary care  Diagnose  Prescribe medications
  32. 32. EXPANDED EDUCATIONAL ANDCAREER ROLES Nurse Anesthetist  A nurse who completes a course of study in an anesthesia school  Carries out preoperative visits and assessments  Administers and monitors anesthesia during surgery  Evaluates postoperative status of patients
  33. 33. EXPANDED EDUCATIONAL ANDCAREER ROLES Nurse midwife  A nurse who completes a program in midwifery  Provides prenatal and postnatal care  Delivers babies for women with uncomplicated pregnancies
  34. 34. EXPANDED EDUCATIONAL ANDCAREER ROLES Nurse Educator  A nurse usually with an advanced degree, who teaches in educational or clinical settings
  35. 35. EXPANDED EDUCATIONAL ANDCAREER ROLES Nurse Administrator  A nurse who functions at various levels of management  Responsible for management and administration of resources and personnel involved in giving patient care
  36. 36. EXPANDED EDUCATIONAL ANDCAREER ROLES Nurse Researcher  A nurse with an advanced degree who conducts research relevant to the definition and improvement of nursing practice and education
  37. 37. EXPANDED EDUCATIONAL ANDCAREER ROLES Nurse Entrepreneur  A nurse, usually with an advance degree who may manage a clinic or health related business
  38. 38. NURSING ROLES
  39. 39. NURSING ROLES Caregiver  Primary role of the nurse  The provision of care  MOTHER SURROGATE ROLES  Complete Assistance  Partial Assistance  Supportive/Educative
  40. 40. NURSING ROLES Communicator  With Patients  To establish Therapeutic Communication  To identify health problems  With Health Care Professionals  Documentation  Reporting / Endorsements
  41. 41. COMMUNICATION
  42. 42. COMMUNICATION  It is the interchange of information between two or more people  It is the exchange of ideas or thoughts
  43. 43. ELEMENTS OF COMMUNICATION Sender  Originator of the information Message  Information being transmitted Receiver  Recipient of information Channel  Mode of communication Feedback  Return response Context  The setting of the communication
  44. 44. LEVELS OF COMMUNICATION Intrapersonal  Occurs when a person communicates within himself Interpersonal  Takes place within dyads (groups of two persons) and in small groups. Public  Communication between a person and several other people
  45. 45. MODES OF COMMUNICATION Verbal Communication Non-verbal Communication
  46. 46. NON-VERBAL MESSAGES They carry more meaning than verbal messages and involves the following:  Body movement or kinetics  Voice quality (pitch and range) and non- language sounds (sobbing or laughing)
  47. 47. NON-VERBAL MESSAGES Proxemics – use of personal or social space  Intimate Distance – actual contact to 1.5 feet  Personal Distance – 1.5 to 4 feet or 3 to 4 feet for interviews  Social Distance – 4 to 12 feet  Public Distance – 12 feet and beyond Cultural Artifacts – items in contact with interacting persons that may act as non-verbal stimuli (i.e., clothes, cosmetics, jewelry, cars)
  48. 48. THERAPEUTIC RESPONSES INCOMMUNICATING WITH PATIENTS
  49. 49. THERAPEUTIC RESPONSES  Identify therapeutic and non-therapeutic phrases  Open-ended or Closed-ended question?  ‘Why’ or ‘What’ questions?  Avoid false reassurances
  50. 50. THERAPEUTIC RESPONSES Use direct questions for suicidal cases Avoid the ‘Authoritarian Answer’  Giving advices In initiating conversation  Use Broad Openings In ending conversation  Summarizing
  51. 51. COMMUNICATING WITH HEALTHCARE PROFESSIONALS
  52. 52. COMMUNICATING WITH HEALTH CAREPROFESSIONALS Documentation Reporting Conferring Referring
  53. 53. COMMUNICATING WITH HEALTH CAREPROFESSIONALS Reporting  Endorsement  Transferring pertinent information regarding a patient to a concerned person  Outgoing nurse to a incoming nurse  Staff nurse to physician
  54. 54. COMMUNICATING WITH HEALTH CAREPROFESSIONALS Conferring  To verify information  Rephrasing  To validate doctor’s orders  To validate a nurse’s endorsement
  55. 55. COMMUNICATING WITH HEALTH CAREPROFESSIONALS Referring  To endorse patient’s special concern to a higher authority or a specialized department or personnel A community nurse referring a client to a hospital or a doctor A staff nurse to a dietitian
  56. 56. NURSING ROLES Teacher/Educator  Providing education about a client’s health and health care procedures they need to perform to restore or maintain their health
  57. 57. NURSING ROLES Teaching Strategies  Assess client’s  Readiness to learn  Assess the client’s knowledge  Simple to complex
  58. 58. NURSING ROLES Teaching Strategies  One to One Discussion or Group Discussion  Explanation and Description  Answering Questions  Visual Assisted Learning Programs  Demonstration  Actual performance of an activity
  59. 59. NURSING ROLES What is the best method of teaching? (December 2007 NLE) What is the best indicator of client learning?
  60. 60. NURSING ROLES Counselor  Facilitates the patient’s problem solving and decision – making skills  By providing information, make appropriate referrals
  61. 61. NURSING ROLES Researcher  The participation in or conduct of research  To increase knowledge in nursing and improve patient care
  62. 62. NURSING ROLES Advocate  Safeguarding the rights of the patients  Patients Bill of Rights
  63. 63. THEORIES OF NURSING
  64. 64. THEORIES OF NURSING Theory  A hypothesis or system of ideas that is proposed to explain a given phenomenon  Purpose:  Directs and guide nursing practice
  65. 65. THEORIES OF NURSING  Nightingales  Environmental Theory  The act of utilizing the environment of the patient to assist him in his recovery  Linked health with 5 environmental factors  Pure or fresh air  Pure water  Efficient drainage  Cleanliness  Light
  66. 66. THEORIES OF NURSING Nightingales Environmental Theory  Addition:  Education of nurses  Keeping the client warm  Maintaining a noise free environment  Attending to the client’s diet
  67. 67. THEORIES OF NURSING  Hildegard Peplau’s  Interpersonal Relations Model  Peplau is a psychiatric nurse  Focus: Therapeutic process  Attained through: Healthy Nurse Patient Relationship
  68. 68. THEORIES OF NURSING Hildegard Peplau’s Interpersonal Relations Model  Four Phases of the Nurse – Patient Interaction  Preorientation  Orientation  Working / Exploitation  Termination/Resolution
  69. 69. THEORIES OF NURSING  Virginia Henderson’s  14 Fundamental Needs of a Person  Assisting sick or healthy individuals to gain independence in meeting 14 fundamental needs
  70. 70. THEORIES OF NURSING Virginia Henderson’s 14 Fundamental Needs of a Person  1) Breathing normally  2) Eating and drinking adequately  3) Eliminating body waste  4) Moving and maintaining a desirable position  5) Sleeping and resting  6) Selecting suitable clothes  7) Maintaining body temperature within normal range by adjusting clothing and modifying the environment
  71. 71. THEORIES OF NURSING Virginia Henderson’s 14 Fundamental Needs of a Person  8) Keeping the body clean and well groomed to protect the integument  9) Avoiding dangers in the environment and avoiding injuring others  10) Communicating with others in expressing emotions, needs, fears, or opinions  11) Worshipping according to one’s faith  12) Working in a such way that one feels a sense of accomplishment  13) Playing or participating in various forms of recreation  14) Learning, discovering, or satisfying the curiosity that leads to normal development and health, and using available health facilities
  72. 72. THEORIES OF NURSING  Dorothy Johnson’s  Seven Subsystems  Attachment  Affiliative  Dependency  Ingestive  Eliminative  Sexual Achievement  Aggressive
  73. 73. THEORIES OF NURSING  Faye Abdellah’s  21 Nursing Problems  good hygiene  optimal activity  safety  good body mechanics  oxygen
  74. 74. THEORIES OF NURSING Faye Abdellah’s 21 Nursing Problems  nutrition  elimination  fluid and electrolytes balance  physiologic response of the body to disease  regulatory mechanisms  sensory function.  positive and negative expressions, feelings and reactions.  accept the interrelatedness of emotions and illness
  75. 75. THEORIES OF NURSING Faye Abdellah’s 21 Nursing Problems  self awareness  optimum possible goals  use community resources  role of social problems
  76. 76. THEORIES OF NURSING  Martha Roger’s  Science of Unitary Human Beings  Views the person as a irreducible whole, the whole being greater than the sum of its parts
  77. 77. THEORIES OF NURSING Martha Roger’s Science of Unitary Human Beings  Man is composed of energy fields, which are in constant interaction with the environment  Seek to promote harmonic interactions between the two energy fields (Human and Environmental)
  78. 78. THEORIES OF NURSING  Dorothea Orem’s  Self Care and Self Care Deficit Theory  Identified three nursing systems  Wholly compensatory systems  Partial compensatory systems  Supportive – Educative systems
  79. 79. THEORIES OF NURSING  Imogene King’s  Goal Attainment Theory  Patient has THREE (3) interacting systems  Individuals / Personal systems  Group systems / Interpersonal systems  Social systems
  80. 80. THEORIES OF NURSING  Betty Neuman’s  Health Care Systems Model  The concern of nursing is to prevent Stress Invasion  Physiological  Psychological  Developmental  Sociocultural  Spiritual
  81. 81. THEORIES OF NURSING  Sister Callista Roy’s  Adaptation Model  Man is a Biopsychosocial Being that requires a feedback cycle
  82. 82. THEORIES OF NURSING Sister Callista Roy’s Adaptation Model  The goal is to enhance life processes through adaptation in four adaptive models  The Physiologic Mode  Self Consent Mode  Role Function Mode  Interdependence Mode
  83. 83. THEORIES OF NURSING  Madeline Leininger’s  Transcultural Nursing  Emphasizes human caring varies among cultures  Culture Care Preservation and Maintenance  Culture Care Accommodation and Negotiation  Culture Care Restructuring and Repatterning
  84. 84. CONCEPT OF MAN
  85. 85. CONCEPT OF MAN Nurse’s Clients  Individuals  Families  Communities
  86. 86. CONCEPT OF MAN BIOLOGIC like ALL other men PSYCHOLOGICAL like NO OTHER man SOCIAL like SOME OTHER men SPIRITUAL like SOME OTHER men
  87. 87. ABRAHAM MASLOW’SHIERARCHY OF NEEDS  5 Human Needs
  88. 88. ABRAHAM MASLOW’SHIERARCHY OF NEEDS  Physiologic needs  Oxygen  Fluids  Nutrition  Body Temperature  Elimination  Rest and Sleep  Sex
  89. 89. ABRAHAM MASLOW’SHIERARCHY OF NEEDS  Safety and security (Physical and Psychological)  Protection  Security  Order  Law  Limits  Stability
  90. 90. ABRAHAM MASLOW’SHIERARCHY OF NEEDS  Love and Belongingness  Family  Affection  Relationships  Work group
  91. 91. ABRAHAM MASLOW’SHIERARCHY OF NEEDS  Self-esteem  Feeling good about one’s self  Two factors affecting Self-esteem  Yourself  Sense of adequacy  Accomplishment  Self worth & respect  Others  Appreciation  Recognition  Admiration
  92. 92. ABRAHAM MASLOW’SHIERARCHY OF NEEDS  Self-actualization – essence of mental health  Personal growth and fulfillment  Able to fulfill needs and ambitions  Maximizing one’s full potential
  93. 93. ABRAHAM MASLOW’SHIERARCHY OF NEEDS Self Actualization  Judges people correctly  Superior perception  Decisive  Capable of making decisions  Clear notion as to what is right and wrong
  94. 94. ABRAHAM MASLOW’SHIERARCHY OF NEEDS  Open to new ideas  Not adopts new ideas  Not one track mind  Highly creative and flexible  Does not need fame  Problem-centered rather than self- centered
  95. 95. ABRAHAM MASLOW’SHIERARCHY OF NEEDS Additional needs:  Need to know and understand  Aesthetic needs  Transcendence
  96. 96. ABRAHAM MASLOW’SHIERARCHY OF NEEDS Need to know and understand or Cognitive needs is supported by Richard Kalish who says that  Man needs stimulation  Needs to explore  Sex  Activity  New things
  97. 97. ABRAHAM MASLOW’SHIERARCHY OF NEEDS Aesthetic needs:  Beauty  Balance  Form
  98. 98. ABRAHAM MASLOW’SHIERARCHY OF NEEDS Transcendence:  Helping others to self-actualize
  99. 99. ILLNESS, WELLNESS AND HEALTH
  100. 100. DEFINITIONS OF HEALTHObject 5  World Health Organization  Health is the complete physical, mental, social (totality) well-being and not merely the absence of disease or infirmity
  101. 101. DEFINITIONS OF HEALTH Health is individually defined by each person On a personal level, individuals define health according to  how they feel  absence or presence of symptoms of illness  and ability to carry out activities
  102. 102. DISEASE Objective pathologic process Pathologic change in the structure or function of the mind and body
  103. 103. DISEASE Acute  Rapid onset of symptoms  Some are life threatening  Many do not require medical treatment
  104. 104. DISEASE Chronic  Broad term that encompasses many different physical and mental alterations in health  It is a permanent change  Requires special patient education for rehabilitation  Requires long term of care and support
  105. 105. ILLNESS  Highly subjective feeling of being sick or ill  How the person feels towards sickness  Concerns the Nurse
  106. 106. ELEVEN STAGES OF ILLNESS ANDHEALTH-SEEKING BEHAVIOR BY SUCHMAN  1. Symptom Experience  Client realizes there is a problem  Client responds emotionally  2. Sick Role Assumption  Self-medication / Self-treatment  Communication to others
  107. 107. ELEVEN STAGES OF ILLNESS AND HEALTH-SEEKING BEHAVIOR BY SUCHMAN  3. Assuming a Dependent Role  Accepts the diagnosis  Follows prescribed treatment  4. Achieving recovery and rehabilitation  Gives up the dependent role and assumes normal activities and responsibilities
  108. 108. CONCEPTS ON DISEASE AND ILLNESS Illness without disease  is possible Disease without illness  is possible
  109. 109. MODELS OF HEALTH AND ILLNESS
  110. 110. DUNN’S HIGH-LEVEL WELLNESSAND GRID MODEL X-axis is HEALTH Y-axis is ENVIRONMENT
  111. 111. DUNN’S HIGH-LEVEL WELLNESSAND GRID MODEL Quadrant 1 Quadrant 2- High Level Wellness - Protected Poor Health in a favorable in a favorable environment environmentQuadrant 3 Quadrant 4- Poor health in an - Emergent High Level unfavorable Wellness in an environment unfavorable environment
  112. 112. HEALTH BELIEF MODEL BYROSENTOCK Concerned with what people perceive about themselves in relation to their health Consider perceptions (influences individuals motivation toward results)  Perceived susceptibility  Perceived seriousness  Perceived benefit out of the action
  113. 113. FOUR LEVELS OF HEALTH BY SMITH1. Clinical Model  Man is viewed as a Physiologic Being  If there are no signs and symptoms of a disease, then you are healthy
  114. 114. FOUR LEVELS OF HEALTH BY SMITH2. Role Performance Model  As long as you are able to perform SOCIETAL functions and ROLES you are healthy
  115. 115. FOUR LEVELS OF HEALTH BY SMITH3. Adaptive Model  Health is viewed in terms of capacity to ADAPT  Failure to adapt is disease
  116. 116. FOUR LEVELS OF HEALTH BY SMITH4. Eudaemonistic Model  This is the BROADEST concept of health  Because health is viewed in terms of Actualization
  117. 117. AGENT, HOST, ENVIRONMENT MODELBY LEAVELL AND CLARK Also known as the Ecologic Model Triad is composed of the agent, host and environment Based on the interplay of three components of the model
  118. 118. NURSING PROCESS
  119. 119. THE NURSING PROCESS Definition:  The Nursing Process is a systematic, organized, rational method of planning and providing individualized, humanistic nursing care
  120. 120. Nursing process foundation of the nursing profession central to nursing actions a process to deliver care to patients supported by nursing models or philosophies. systematic approach enhances research opportunities adaptable to different clients in different care settings efficient method of organizing thought processes or clinical decision-making and problem-solving
  121. 121.  Synonymous with the problem solving approach for discovering the healthcare and nursing care needs of clients. (UDAN) It is an organized method of giving individualized nursing care that focuses of identifying unique responses of individual or group to actual or potential alteration in health. (KOZIER) It is a method of problem identification and problem solving
  122. 122. PURPOSES OF THE NURSING PROCESS To identify health status  Actual health problems  Potential health problems To establish plans To deliver specific nursing care To evaluate nursing care
  123. 123. CHARACTERISTICS OFTHE NURSING PROCESS Client-centered Cyclical (sequence), dynamic (moving) rather than static  Data from each phase provide input to the next phase Interpersonal and collaborative  Work with patients and relatives  Work with colleagues and other members of the health team
  124. 124. CHARACTERISTICS OFTHE NURSING PROCESS Adaptation of problem-solving techniques and decision making principles in all the phases Problem-oriented, flexible, open to new information
  125. 125. CHARACTERISTICS: Problem – Oriented Goal Oriented Orderly planned step by step Open in accepting additional information during application Universally applicable to al patients family and community that nursing service.
  126. 126. BENEFITS FROM THE NURSING PROCESS Improves quality of care Ensures continuity and appropriate level of care  Long term plans Promotes a positive working atmosphere through collaboration Facilitates client participation through planning with patient
  127. 127. BENEFITS FROM THE NURSING PROCESS Feedback allows nurse to evaluate care Serves as a framework for accountability through documentation
  128. 128. PARTS OF THE NURSING PROCESS Assessment Phase Diagnosing Phase Planning Phase Intervention Phase Evaluation Phase
  129. 129. ASSESSMENT PHASE
  130. 130. ASSESSMENT PHASE Is the systematic and continuous collection, organization, validation, and documentation of data Carried all throughout the nursing process  Diagnosing  Planning  Information in assessment is crucial  Implementation  Before performing nursing care  Evaluation  Assessing the current status to compare with previous status
  131. 131. ASSESSMENT PHASE What to assess  Clients perceived needs  Client’s responses to health problems  Asthma  Difficulty of breathing  Arthritis  Pain  Health practices, values, and lifestyles
  132. 132. FOUR TYPES OF ASSESSMENT
  133. 133. FOUR TYPES OF ASSESSMENT Initial Assessment Focus Assessment or On-going Assessment Emergency Assessment Time-Lapsed Assessment
  134. 134. FOUR TYPES OF ASSESSMENT 1. Initial Assessment  When performed:  At specified time after admission  Purpose of Initial Assessment:  To create a data base for problem identification  For reference and future comparison
  135. 135. FOUR TYPES OF ASSESSMENT 2. Focus Assessment or On-going Assessment  When performed:  Integrated throughout the nursing process  Purpose of On-going Assessment:  To identify problems overlooked earlier  To determine the status of a health problem  Same from database  Ex before implementation
  136. 136. FOUR TYPES OF ASSESSMENT 3. Emergency Assessment  When done:  During acute physiologic and psychologic crisis  Where done:  Emergency Room  Anywhere  On site  Purpose of Emergency Assessment  To identify life-threatening condition
  137. 137. FOUR TYPES OF ASSESSMENT 4. Time-Lapsed Assessment  When done:  Several months after initial assessment  Purpose of Time-Lapsed Assessment  To compare current status of patient with base line data (initial assessment)  Ex  Diabetic
  138. 138. ASSESSMENT PHASE Nursing Activities in the Assessment Phase  Data Collection  Data Organization  Data Validation  Data Recording
  139. 139. CRITICAL THINKING• It is how the  Over time the nurse uses the nurse learns to almost information to simultaneously reason, make review, interpret, inferences and analyze and form mental evaluate picture of what information about is happening to clients.• Facione and Facione (1996) define the client. critical thinking as purposeful self- regulatory judgment that is centrally evident in expert clinical
  140. 140. To use this process, the nurse must demonstrate other fundamental abilities of:3. Knowledge4. Creativity5. Adaptability6. Commitment7. Trust8. Leadership9. Intelligence10.Interpersonal and technical skills.
  141. 141. DATA COLLECTION
  142. 142. DATA COLLECTION Is the process of gathering information or data Data gathering
  143. 143. RECORDED DATA Types of Data Sources of Data Methods of Data Collection
  144. 144. TYPES OF DATA
  145. 145. TYPES OF DATA 1. Subjective or Covert Data  Felt by the patient  During the recording of data, this should be stated using the patient’s own words  “Mommy I feel hot”
  146. 146. TYPES OF DATA 2. Objective or Overt Data  Capable of being observed by use of senses – sight, touch, smell, hearing
  147. 147. SOURCES OF DATA
  148. 148. SOURCES OF DATA 1. Primary Source  Patient himself, except when:  Patient is unconscious  Patient is a baby  Patient is insane  Significant others become the primary source of data (from a secondary source)  Unconscious brought in the ER?  Whoever brought the patient to the hospital
  149. 149. SOURCES OF DATA 2. Secondary Source  Patient’s record  Health care members  Significant others
  150. 150. METHODS OF DATA COLLECTION
  151. 151. METHODS OF DATA COLLECTION Observing Interviewing Examining
  152. 152. METHODS OF DATA COLLECTION:OBSERVING To gather data by using the senses  Vision  Overall appearance  Smell  Body or breath odors  Hearing  Lung, heart, and bowel sounds  Touch  Skin temperature, pulse rate
  153. 153. METHODS OF DATA COLLECTION:OBSERVING Two (2) aspects of observation process:  Noticing the stimuli using the senses  Record the observed stimuli
  154. 154. METHODS OF DATA COLLECTION:INTERVIEWING Is a planned conversation with a purpose  To get or give information  Provide health teachings  Provide support
  155. 155. METHODS OF DATA COLLECTION:INTERVIEWING Two types of Interview  Directive Type of Interview  Non-directive Type of Interview or Rapport-building Interview
  156. 156. DIRECTIVE TYPE OF INTERVIEW Structured Uses closed-ended questions calling for specific data  Yes or No  How many  When When used:  When you need to elicit specific data  When there is little time available
  157. 157. NON-DIRECTIVE TYPE ORRAPPORT-BUILDING INTERVIEW Uses more open-ended questions Advantage is that it allows the patient to volunteer information
  158. 158. PLANNING THE INTERVIEW SETTING Concepts:  Before the interview, determine what information you already know  An interview is a planned conversation with a purpose  An interview is a two-way process
  159. 159. PLANNING THE INTERVIEW SETTING Concepts:  When is it done?  When patient is available  When patient is comfortable  Recommended distance from the patient is three (3) to four (4) feet  Place  Seating Arrangement  Language
  160. 160. STAGES OF THE INTERVIEW 1. Opening Stage  This is the most important part of the interview  Rationale  What was said and done during the opening stage sets the tone all throughout the interview  Establish rapport  Orientation
  161. 161. STAGES OF THE INTERVIEW 2. Body of the Interview  Occurs when patient responds to questioning  The most productive stage
  162. 162. STAGES OF THE INTERVIEW 3. Closing Stage  The nurse terminates the interview when   Theneeded information has been obtained and given  The client can no longer take in information  Provided support
  163. 163. STAGES OF THE INTERVIEW STAGES OFTHE INTERVIEW 3. Closing Stage  How to close the interview:  Summarizing Technique  To verify accuracy  It reassures the client that the nurse listened  Sense of accomplishment  Offer to answer questions  Thank the client  Plan for the next meeting if there is one
  164. 164. METHODS OF DATA COLLECTION:EXAMINING The physical examination or assessment Use of senses Use of inspection, palpation, percussion, and auscultation
  165. 165. METHODS OF DATA COLLECTION:EXAMINING Cephalocaudal Proximodistal IPPA IAPP
  166. 166. ORGANIZING DATA
  167. 167. ORGANIZING DATA Clustering of data  Example  Nursing Health History  Current health problem  Past history of illness  Family history of illness  Lifestyle  Body Systems
  168. 168. VALIDATION OF DATA
  169. 169. VALIDATION OF DATA Act of double-checking the data Purposes of Data Validation  To ensure the:  Correctness  Completeness
  170. 170. DATA RECORDING
  171. 171. DATA RECORDING Data Recording COMPLETES the Assessment Phase  Complete  Factual  Don’t interpret  Man found lying on the floor  Brevity  Short but concise
  172. 172. DOCUMENTATION
  173. 173. DOCUMENTATION It is a written, formal document A record of client’s progress
  174. 174. PURPOSES OF DOCUMENTATION Planning Care Communication For legal documentation purposes For research For education
  175. 175. GUIDELINES ON DOCUMENTATION Timing  Document patient care as soon as possible Observe confidentiality Observe permanence  Use non-erasable ink  Do not use sign pen
  176. 176. GUIDELINES ON DOCUMENTATION Signature  Sign full name and append R.N. Accuracy  Ensure that data is correct  Avoid biases  Avoid ambiguous terms Appropriateness  Write only appropriate information
  177. 177. GUIDELINES ON DOCUMENTATION Completeness Use standard terminology Brevity  Make it concise yet meaningful Legal Awareness  Cross out erroneous entry  Write “Error”  Countersign
  178. 178. TYPES OF RECORDS Source-Oriented Clinical Record Problem-Oriented Clinical Record
  179. 179. PROBLEM-ORIENTEDCLINICAL RECORD Same as Problem Oriented Medical Record Entry of data is based on CLIENT’S PROBLEM  Example:  Problem No. 1: constipation  Increase fluid intake: doctor  Diatabs: pharmacist  NPO: dietitian
  180. 180. FOUR BASIC COMPONENTS OFPROBLEM-ORIENTED CLINICAL RECORD  1. Baseline Data  All information gathered from a patient when he first entered the agency  Assessment of the physician  Assessment of the nurse
  181. 181. FOUR BASIC COMPONENTS OFPROBLEM-ORIENTED CLINICAL RECORD  2. Problem List  Contains only ACTIVE problems (and relevant information about the problem)  Medical Diagnosis  Nursing Diagnosis
  182. 182. FOUR BASIC COMPONENTS OFPROBLEM-ORIENTED CLINICAL RECORD  3. Initial list of orders or Care Plans
  183. 183. FOUR BASIC COMPONENTS OFPROBLEM-ORIENTED CLINICAL RECORD  4. Progress Notes  Includes:  Nurses’ narrative notes (SOAPIE)  Flow sheets  Discharge Notes and Referral Summaries
  184. 184. SOURCE-ORIENTED CLINICAL RECORD Classification of information is based on SOURCE Each person or department maintains a different section on chart
  185. 185. COMPONENTS OF ASOURCE-ORIENTED CLINICAL RECORD  Admission Sheet  Nursing Notes  Medical History and Physical Examination Sheet  Diagnostic Findings Sheet  TPR Graphic Sheet  Doctor’s Treatment and Order Sheet  Therapeutic Sheet
  186. 186. ASSESSMENT
  187. 187. DIAGNOSING PHASE
  188. 188. DIAGNOSING PHASE Nurses use critical thinking skills to interpret assessment data and identify client strengths and problems Positive or Negative?
  189. 189. DIAGNOSING PHASE Diagnostic Process  Analyze the data  Identify health problems, risk, and strengths  Formulating diagnostic statements
  190. 190. PARTS OF A NURSING DIAGNOSIS 1. Problem Statement  Example:  Fluid Volume Deficit 2. Presumed Etiology  Example:  …related to frequent loss of bowel movement 3. Signs and Symptoms Example:  …as manifested by decreased skin turgor
  191. 191. TYPES OF DIAGNOSTIC STATEMENTS Basic Two Part Statements (PE)  Problem and Etiology  Altered Nutrition Less than Body Requirements related to difficulty swallowing
  192. 192. TYPES OF DIAGNOSTIC STATEMENTS Basic Three Part Statement (PES)  Problem  Etiology  Signs and Symptoms  Altered Nutrition Less than Body Requirements related to difficulty swallowing as manifested by body weakness
  193. 193. TYPES OF DIAGNOSTIC STATEMENTS One Part Statements  Problem  Rape Trauma Syndrome
  194. 194. TYPES OF NURSING DIAGNOSIS
  195. 195. DIFFERENT TYPES OF NURSINGDIAGNOSES DIFFERENT TYPES OFNURSING DIAGNOSES 1. Actual Nursing Diagnosis  Problem present at the time the statement was made  Example: Ineffective Airway Clearance related to excessive and tenacious secretions
  196. 196. DIFFERENT TYPES OF NURSINGDIAGNOSES 2. High-Risk Nursing Diagnosis  A diagnosis that a patient is more vulnerable or susceptible compared with others in the same situation  Example: Risk for Impaired Skin Integrity related to immobility secondary to fractured hip.
  197. 197. DIFFERENT TYPES OF NURSINGDIAGNOSES 3. Possible Nursing Diagnosis  Not enough evidence about a problem  Example: Possible Self Care Deficit related to impaired ability to use left hand secondary to presence of intravenous therapy
  198. 198. DIFFERENT TYPES OF NURSINGDIAGNOSES 4. Wellness Nursing Diagnosis  A positive statement  Indicates a healthy response  Examples:  Potential for increased compliance related to increased level of knowledge  Potential for effective coping related to adequate support systems
  199. 199. PLANNING PHASE
  200. 200. PLANNING PHASE Planning is a deliberative, systematic phase that involves decision making and problem solving Formulating client goals with the patient Designing nursing interventions
  201. 201. ACTIVITIES DURINGTHE PLANNING PROCESS Set priorities  Client’s problems Set goals and objectives Identify alternatives of nursing care Select nursing measures Write the nursing care plan
  202. 202. PURPOSES OF GOAL-SETTING To set direction To provide a time span To have a criteria for evaluation To enable the nurse and the patient to determine whether the problem has been resolved or not To help motivate the client and the patient by providing a sense of accomplishment
  203. 203. TYPES OF PLANNING
  204. 204. TYPES OF PLANNING 1. Initial Planning  Done by the nurse  When done:  At specified time upon or after admission/assessment of the patient
  205. 205. TYPES OF PLANNING 2. On-going Planning  Who are involved:  Done by all nurses who worked with the patient  When done: - Before start of shift
  206. 206. TYPES OF PLANNING 2. On-going Planning  Purposes of On-going Planning  To determine if the client’s health status has changed  To decide which problems to focus on during the shift  To set priorities for client care during the shift
  207. 207. TYPES OF PLANNING 3. Discharge Planning  Purpose of Discharge Planning  To ensure continuity of care  M–E–T–H-O–D-S
  208. 208. CHARACTERISTICS OFTHE PLANNING PROCESS S  Specific M  Measurable A  Attainable R  Realistic T  Time bound
  209. 209. IMPLEMENTING PHASE
  210. 210. IMPLEMENTING PHASE Consists of doing and documenting the nursing care given to the patient Putting the care plan into action
  211. 211. IMPLEMENTING PHASE Purpose of Implementation  To carry out planned activities  To help the client
  212. 212. IMPLEMENTING PHASE Requirements for Implementation  Adequate knowledge  Technical Skills  Communication skills  Therapeutic use of self
  213. 213. IMPLEMENTING PHASE Reassess the patient  Rationale  To determine if the procedure is still needed Determine the need for nursing assistance Understand orders  Clarify / verify doctors’ orders
  214. 214. NURSING ACTIVITIES DURING THEIMPLEMENTATION PHASE Communicate the procedure performed by documenting the procedure Encourage patient to participate actively
  215. 215. GUIDELINES FOR IMPLEMENTATION OFNURSING STRATEGIES It should be based on scientific knowledge, research, professional standards of practice (care)  Rationale:  This is done to ensure safe nursing care It should be adapted to the individual patient
  216. 216. GUIDELINES FOR IMPLEMENTATION OFNURSING STRATEGIES It should always be safe. Do not compromise It should be holistic It should be accompanied by support, comfort and teaching
  217. 217. EVALUATION PHASE
  218. 218. EVALUATION PHASE Purpose of the Evaluation Phase  To determine client’s progress  To determine the effectiveness of the care plan  To determine as to what extent the nursing goals have been met
  219. 219. EVALUATION PHASE Importance of doing an Evaluation  It determines if the care plan will be:  Continued  Modified  Discontinued
  220. 220. EVALUATION PHASE Activities during the Evaluation Phase  Identify the OUTCOME CRITERIA to be used as measurement (Planning)  Gather information (data) relevant to the outcome criteria  Compare outcome (data) with the criteria  Assess the reasons for the outcome  Revise the nursing care plan as needed
  221. 221. TYPES OF EVALUATION 1. On-going Evaluation  When done:  During or immediately after the intervention  Importance:  Allows the nurse to decide and make on-the-spot modification/s in an intervention
  222. 222. TYPES OF EVALUATION 2. Intermittent Evaluation  When done:  At a specified time  Purpose:  It shows the extent of progress of the patient  Importance:  Enables the nurse to correct deficiencies and modify the nursing care plan
  223. 223. TYPES OF EVALUATION 3. Terminal Evaluation  When done:  At or immediately before discharge  Importance:  States the status of a health problem at the time of discharge  It determines whether the goals are:  Met  Partially met  Unmet
  224. 224. PROMOTING REST AND SLEEP
  225. 225. PROMOTING REST AND SLEEP Sleep is the altered level of consciousness in which the individual’s perception of and reaction to environment are decreased
  226. 226. PROMOTING REST AND SLEEP What regulates sleep and wakefulness?  Reticular formation on the Brain Stem  Ascending nerve fibers  Reticular Activating System (RAS)  Sleep Wake Cycle
  227. 227. PROMOTING REST AND SLEEP Types of Sleep  NREM  Non-Rapid Eye Movement Sleep  REM  Rapid Eye Movement Sleep
  228. 228. PROMOTING REST AND SLEEP NREM (Non-Rapid Eye Movement Sleep)  When the RAS is inhibited  Sleep  BODY RESTORATION  About 75% to 80% of sleep  Has 4 Stages
  229. 229. PROMOTING REST AND SLEEP NREM (Non-Rapid Eye Movement Sleep)  Stage I (Very Light Sleep)  Lasts only a few minutes  Drowsy and relaxed  Eyes roll from side to side  HR and RR drop slightly  Readily awakened
  230. 230. PROMOTING REST AND SLEEP NREM (Non-Rapid Eye Movement Sleep)  Stage II (Light Sleep)  Lastsfor 10-15 minutes  Body processes continue to slow down  HR and RR decrease furthermore  Body temperature falls  Eyes are still
  231. 231. PROMOTING REST AND SLEEP NREM (Non-Rapid Eye Movement Sleep)  Stage III  The HR and RR, as well as other body processes, slow further  The sleeper becomes more difficult to arouse  The skeletal muscles are very relaxed  The reflexes are diminished and snoring may occur
  232. 232. PROMOTING REST AND SLEEP NREM (Non-Rapid Eye Movement Sleep)  Stage IV (Delta Sleep or Deep Sleep)  HR and RR drop 20 – 30% below that exhibited during waking hours  Sleeper is very relaxed, rarely moves and is difficult to arouse  This stage is thought to restore the body physically
  233. 233. PROMOTING REST AND SLEEP REM (Rapid Eye Movement Sleep)  Occurs about every 90 minutes  Lasts from 5 to 30 minutes  “Paradoxical Sleep”  Resembles wakefulness  Brain is highly active  Dreams are usual  Irregular HR and RR  May be difficult to arouse or wake up spontaneously
  234. 234. PROMOTING REST AND SLEEP For sleep to be normal  The person must pass through the NREM and REM  1 Cycle lasts for 90 to 110 minutes (1 ½ to 2 hours)  1st 3 Stages of NREM (20-30 minutes)  Stage IV (30 minutes)  Back to NREM Stages III and II (20 minutes)  REM (10 minutes)  Very brief  Skipped entirely
  235. 235. PROMOTING REST AND SLEEP What is/are the longest type or stage of sleep?  Stages II and III
  236. 236. PROMOTING REST AND SLEEP A sleeper who is awakened at any stage must begin a new cycle In a 7 to 8 hours of sleep  4 – 6 cycles
  237. 237. PROMOTING REST AND SLEEP To restore the body
  238. 238. PROMOTING REST AND SLEEP Normal Sleep Requirements  Newborns  16 to 18 hours a day  Infants  14 to 15 hours  Toddlers  12 to 14 hours
  239. 239. PROMOTING REST AND SLEEP Normal Sleep Requirements  Preschoolers  11 to 13 hours  School Aged  10 to 11 hours  Adolescents  9 to 10 hours
  240. 240. PROMOTING REST AND SLEEP Normal Sleep Requirements  Adults  7 to 9 hours  Elders  7 to 9 hours  Many sleeping problems  Tendency toward earlier bedtime and wake times  Increase in disturbed sleep  Medical conditions
  241. 241. PROMOTING REST AND SLEEP Factors Affecting Sleep  Illness  Pain or physical distress  Arthritis, back pain and ulcers  Respiratory conditions  Nasal congestion  Need to urinate
  242. 242. PROMOTING REST AND SLEEP Factors Affecting Sleep  Environment  Noise  Absence of usual stimuli or the presence of unfamiliar stimuli  Namamahay  Discomfort from environmental temperature  Too hot or too cold  Comfort and size of the bed
  243. 243. PROMOTING REST AND SLEEP Factors Affecting Sleep  Emotional Stress  Considered by sleep experts as the number one cause of short term sleeping difficulties  Preoccupied with personal problems  May be unable to relax sufficiently to get to sleep
  244. 244. PROMOTING REST AND SLEEP Factors Affecting Sleep  Stimulants and Alcohol  Caffeine containing beverages  Coffee  Tea  Chocolate Drinks  Alcohol  Speed up the onset of sleep  BUT disrupts REM
  245. 245. PROMOTING REST AND SLEEP Factors Affecting Sleep  Smoking  Nicotinehas a stimulating effect on the body  Smoker  Refrain from smoking after the evening meal
  246. 246. COMMON SLEEP DISORDERS
  247. 247. COMMON SLEEP DISORDERS Insomnia  Inability to fall asleep or remain asleep  Acute Insomnia  Last 1 to several nights  Caused by personal stressors  Chronic  Persists for longer than a month
  248. 248. COMMON SLEEP DISORDERS Insomnia  Chronic Intermittent Insomnia  Difficulty sleeping for a few nights  Followed by a few nights of adequate sleep  Difficulty sleeping returns
  249. 249. COMMON SLEEP DISORDERS Excessive Daytime Sleepiness  Hypersomnia  Narcolepsy
  250. 250. COMMON SLEEP DISORDERS Hypersomnia  The affected individual obtains sufficient sleep at night  Cannot stay awake during the day  Caused by  CNS Damage
  251. 251. COMMON SLEEP DISORDERS Narcolepsy  Disorder of excessive daytime sleepiness  Sleep attacks  Cataplexy  Sudden weakness or paralysis  Fragmented nighttime sleep  Cause  Lack of chemical hypocretin
  252. 252. COMMON SLEEP DISORDERS Sleep Apnea  Frequent short breathing pauses during sleep  10 seconds to 2 minutes  ObstructiveApnea  Central Apnea  Mixed
  253. 253. COMMON SLEEP DISORDERS Sleep Apnea  Obstructive Apnea  Blockage of the flow of air  Central  Defect in the respiratory center of the brain  Medulla Oblongata  Mixed
  254. 254. COMMON SLEEP DISORDERS Parasomnias  Arousal Disorder  Sleep Walking  Somnambulism
  255. 255. COMMON SLEEP DISORDERS Parasomnias  Sleep Wake Transition Disorder  Sleep talking  Exhaustion
  256. 256. COMMON SLEEP DISORDERS Parasomnias  Associated with REM Sleep  Nightmares
  257. 257. COMMON SLEEP DISORDERS Parasomnias  Others  Bruxism
  258. 258. NURSING INTERVENTIONSTO PROMOTE REST AND SLEEP
  259. 259. NURSING INTERVENTIONSTO PROMOTE REST AND SLEEP Sleep Hygiene  Referring to interventions to promote sleep
  260. 260. NURSING INTERVENTIONSTO PROMOTE REST AND SLEEP Supporting Bedtime Rituals  Most people are accustomed to bedtime rituals or pre sleep routines  Adults  Hygienic routines  Washing the face  Brushing teeth  Voiding  Relaxation  Listening to music  Reading  Taking a soothing bath  Praying
  261. 261. NURSING INTERVENTIONSTO PROMOTE REST AND SLEEP Supporting Bedtime Rituals  Children  Need to be socialized into pre sleep routine  Bedtime story  Holding onto a favorite toy or blanket  Kissing everyone goodnight
  262. 262. NURSING INTERVENTIONSTO PROMOTE REST AND SLEEP Supporting Bedtime Rituals  Massage  Warm drink  Milk  Tryptophan
  263. 263. NURSING INTERVENTIONSTO PROMOTE REST AND SLEEP Creating a Restful Environment  Minimal noise  Comfortable room temperature  Appropriate lighting
  264. 264. NURSING INTERVENTIONSTO PROMOTE REST AND SLEEP Promoting Comfort and Relaxation  Provide loose fitting nightwear  Assist clients with hygienic routines  Assist or encourage the client to void before bedtime  Offer to provide a back massage  Schedule medications  For clients with pain, administer analgesics 30 minutes before bedtime
  265. 265. NURSING INTERVENTIONSTO PROMOTE REST AND SLEEP Promoting Comfort and Relaxation  Emotional stress interferes with sleep  Relaxation Techniques  Deep Breathing  Muscle Relaxation  Guided Imagery  Meditation
  266. 266. PROMOTING NUTRITION
  267. 267. PROMOTING NUTRITION Nutrition  Is the sum of all the interactions between an organism and the food it consumes Nutrients  Are organic or inorganic substances found in foods that are required for body functioning
  268. 268. PROMOTING NUTRITION Essential Nutrients  The body’s most basic nutrient need is  Water  Nutrients that provide fuel to body cells  Macronutrients  Carbohydrates  Proteins  Fats  Micronutrients  Vitamins  Minerals
  269. 269. MACRONUTRIENTSCARBOHYDRATES CHO Two Basic Types  Simple Sugars  Complex Carbohydrates  Starches  Fibers
  270. 270. MACRONUTRIENTSCARBOHYDRATES  Simple sugars  Water soluble  Produced naturally by plants and animals  Monosaccharide  Glucose  Fructose Galactose
  271. 271. MACRONUTRIENTSCARBOHYDRATES Simple sugars  Disaccharides  Two Monosaccharide
  272. 272. MACRONUTRIENTSCARBOHYDRATES  Food Sources of Simple Sugars  Sugarcane  Table sugar  Sugar beets
  273. 273. MACRONUTRIENTSCARBOHYDRATES  Complex Sugars  Starches  Grains  Legumes  Potatoes  Cereals  Breads
  274. 274. MACRONUTRIENTSCARBOHYDRATES  Complex Sugars  Fibers  Supplies roughage or bulk in the diet  Outer layer of grains  Skin, seeds and pulp of many fruits and vegetables
  275. 275. MACRONUTRIENTSCARBOHYDRATES Digestion  In the mouth  Ptyalin (Salivary Amylase)  In the small intestines  Pancreatic amylase
  276. 276. MACRONUTRIENTS CARBOHYDRATES  Metabolism  CHO is Major Source of Body Energy  GO FOODS CHON GlucoseBloodstream Stored Glycogen Fats
  277. 277. MACRONUTRIENTSPROTEINS CHON Amino acids  Essential amino acids  Those that cannot be produced by the body  Nonessential amino acids  Those that can be produced by the body
  278. 278. MACRONUTRIENTSPROTEINS May be Complete, Partially Complete and Incomplete
  279. 279. MACRONUTRIENTSPROTEINS  Complete Proteins  Contains all essential amino acids plus many non essential amino acids  Derived from animals  Meats, poultry, fish, dairy products, and eggs
  280. 280. MACRONUTRIENTSPROTEINS Partially Complete  Less than the required amount of one or two essential amino acids  Gelatin
  281. 281. MACRONUTRIENTSPROTEINS  Incomplete  Lack of one or more essential amino acids  Usually derived from vegetables  Vegetarians?  Solution  Vegetable combinations  Corn and beans  Vegetables with a small amount of animal protein
  282. 282. MACRONUTRIENTSPROTEINS Digestion  In the mouth  Pepsin  In the intestines  Trypsin
  283. 283. MACRONUTRIENTSPROTEINS Storage  Protein is stored in the body as tissue  Growth and Development  GROW FOODS
  284. 284. MACRONUTRIENTSPROTEINS Metabolism  Anabolism  Construction  All body cells manufacture proteins from amino acids  Catabolism  Destruction  A cell can only accommodate a limited amount of protein  Liver
  285. 285. MACRONUTRIENTSLIPIDS Organic substances that are greasy and insoluble in water Fats  Lipids that are solid at room temperature  Butter Oil  Lipids that are liquid at room temperature  Cooking oil
  286. 286. MACRONUTRIENTSLIPIDS Classified as  Saturated  Unsaturated  Which is healthier?
  287. 287. MACRONUTRIENTSLIPIDS  Saturated fats  coconut oil, and palm kernel oil  dairy products (especially butter, , cream, and cheese)  meat (beef)  dark meat of poultry, and poultry skin  chocolate
  288. 288. MACRONUTRIENTSLIPIDS  Unsaturated  Avocado  Nuts  Vegetable oils such as soybean, canola, and olive oils
  289. 289. MACRONUTRIENTSLIPIDS Digestion  Starts in the mouth  Mainly in the stomach  Bile  Pancreatic Lipase
  290. 290. MACRONUTRIENTSLIPIDS They become  Glycerol and Fatty acids  Energy  Cholesterol (Lipids plus protein)  Is Cholesterol needed in the body?  Important in producing bile  Excessive  Atherosclerosis  GLOW FOODS
  291. 291. TYPES OF LIPOPROTEINS 1. High Density Lipoproteins (HDL)  Good cholesterol  Function of HDLs  Transportsthe bad cholesterol from systemic circulation to the liver for metabolism and eventual elimination
  292. 292. TYPES OF LIPOPROTEINS 2. Low Density Lipoproteins (LDL)  Bad cholesterol  Function of LDLs  They clog the blood vessels
  293. 293. ENERGY INTAKE
  294. 294. ENERGY INTAKE The amount of energy that nutrients or foods supply to the body is their caloric value  CHO  CHON  FATS  * ALCOHOL  7 Calories/Gram
  295. 295. ENERGY INTAKE Recommended Calorie Intake per Day  Varies  Generally  Men  2000 – 2500 calories  Women  1500 – 2000 calories  Pregnant  Plus 300 calories  Lactating  Plus 500 calories
  296. 296. ENERGY INTAKE Compute  800 grams of CHO  600 grams of CHON  400 grams of FATS
  297. 297. MICRONUTRIENTS
  298. 298. MICRONUTRIENTS Required in small amounts  Vitamins  Minerals
  299. 299. VITAMINS
  300. 300. MICRONUTRIENTS Vitamins  Organic compounds that cannot be produced by the body  Water Soluble  Fat Soluble
  301. 301. WATER SOLUBLE VITAMINS
  302. 302. WATER SOLUBLE VITAMINS Vitamins that cannot be stored by the body  Excess?  Vitamin C  Vitamin B Complex
  303. 303. WATER SOLUBLE VITAMINS Vitamin C Ascorbic Acid  synthesis of collagen  an important protein used to make skin, scar tissue, tendons, ligaments, and blood vessels  essential for the healing of wounds, and for the repair and maintenance of cartilage, bones, and teeth  immune function  synthesis of the neurotransmitter, norepinephrine  effective antioxidant
  304. 304. WATER SOLUBLE VITAMINS  Vitamin C  Fruits  Guava  Strawberry  Lemon  Orange  Mangoes  Tomato  Vegetables  Bell Peppers  Broccoli  Cauliflower  Green Cabbage
  305. 305. WATER SOLUBLE VITAMINS Vitamin C Deficiency  Scurvy  Bruising easily  hair and tooth loss  joint pain and swelling  Related to the weakening of blood vessels, connective tissue, and bone, which contain collagen
  306. 306. WATER SOLUBLE VITAMINS Vitamin B Complex  Vitamin B1  (thiamine)  Vitamin B2  (riboflavin)  Vitamin B3  (niacin)  Vitamin B5  (pantothenic acid)  Vitamin B6  (pyridoxine)  Vitamin B7  (biotin)  Vitamin B9  (folic acid)  Vitamin B12  (cyanocobalamin)
  307. 307. WATER SOLUBLE VITAMINS Vitamin B Complex  Vitamins B1, B2, B3  energy production  Vitamin B6  amino acid metabolism  Vitamin B9  Vital for the function and maintenance of the nervous system and red blood cells  400 mcg or 0.4 mg (Pregnant)
  308. 308. WATER SOLUBLE VITAMINS  Vitamin B Complex  fish, milk, eggs, liver, meat, brown rice, whole grain cereals, and soybeans, poultry  Folic acid  Green vegetables  Liver  whole grain cereals
  309. 309. WATER SOLUBLE VITAMINS Vitamin B Deficiency  Vitamin B1 (Thiamine)  Beriberi  Wernickes encephalopathy  Impaired sensory perception  Weakening of the limbs  Irregular heart rate  Korsakoffs syndrome  Amnesia and confabulation
  310. 310. WATER SOLUBLE VITAMINS Vitamin B Deficiency  Vitamin B3 (niacin)  Pellagra  Aggression  Insomnia  Weakness  mental confusion  diarrhea
  311. 311. WATER SOLUBLE VITAMINS  Vitamin B Deficiency  Vitamin B9 (folic acid)  In pregnancy birth defects  Neural Tube Defects  Spina Bifida  Anencephaly
  312. 312. FAT SOLUBLE VITAMINS
  313. 313. FAT SOLUBLE VITAMINS The body can store these vitamins  A  D  E  K
  314. 314. FAT SOLUBLE VITAMINS Vitamin A  Retinol  Normal Vision  Maintaining normal skin health  Deficiency  Blindness
  315. 315. FAT SOLUBLE VITAMINS  Vitamin A sources  liver (beef, pork, chicken, turkey, fish)  carrots  Broccoli leaves  sweet potatoes  butter  spinach  pumpkin
  316. 316. FAT SOLUBLE VITAMINS Vitamin D  Calciferol  To maintain normal blood levels of calcium  Vitamin D aids in the absorption of calcium  Deficiency  In children  Rickets – skeletal deformities  Calcium  osteomalacia  muscular weakness in addition to weak bones
  317. 317. FAT SOLUBLE VITAMINS  Vitamin D  Fish  Eggs  fortified milk  cod liver oil  The sun  as little as 10 minutes of exposure
  318. 318. FAT SOLUBLE VITAMINS Vitamin E  Tocopherol  Antioxidant
  319. 319. FAT SOLUBLE VITAMINS  Vitamin E sources  Vegetable oils, nuts, green leafy vegetables, and fortified cereals  Almonds  Asparagus  Avocado  Nuts  Olives  Seeds  Spinach and other green leafy vegetables
  320. 320. FAT SOLUBLE VITAMINS Vitamin K  K  Koagulation Vitamins  Clotting factors  Stops bleeding
  321. 321. FAT SOLUBLE VITAMINS  Leafy green vegetables, particularly the dark green ones such as  Spinach  Broccoli  Malunggay  Avocado
  322. 322. MINERALS
  323. 323. MINERALS Organic or inorganic compounds  Macrominerals  Over 100 mg  Microminerals  Less than 100 mg
  324. 324. MACROMINERALS
  325. 325. MACROMINERALS  Calcium  Sodium  Potassium  Phosphorous  Magnesium  Chloride  Sulfur
  326. 326. MACROMINERALS Calcium  Normal growth and maintenance of bones and teeth  Deficiency  Rickets  Osteoporosis
  327. 327. MACROMINERALS  Calcium Sources  Dairy products, such as milk and cheese  beans  oranges  Okra  broccoli  fortified products such as orange juice and soy milk
  328. 328. MACROMINERALS Sodium  Regulation of blood and body fluids  Water Retention  Transmission of nerve impulses  Action Potential (Sodium Potassium Pump)  2 to 3 grams/day  Table salts and most condiments  Preserved foods
  329. 329. MACROMINERALS  Potassium  muscle contraction and the sending of all nerve impulses in animals through action potentials  All meats, poultry and fish are high in potassium.  Apricots (fresh more so than canned)  Avocado  Banana  Cantaloupe  Milk  Oranges and orange juice  Potatoes
  330. 330. MICROMINERALS
  331. 331. MICROMINERALS  Iron  Iodine  Flouride  Manganese  Cobalt  Selenium
  332. 332. MICROMINERALS Iron  Ferrous Sulfate  Hemoglobin  Oxygen carriers  Forms of supplement  Oral  Parenteral
  333. 333. MICROMINERALS Iron Sources  Dark Green, Leafy Vegetables  Dried Beans and Peas  Dried Fruits  Eggs  Enriched Breads  Iron-Fortified Cereal  Lean Meats  Nuts  Raisins  Spinach  Tofu
  334. 334. MICROMINERALS Iron  Oral Form  Take on an empty stomach  If with GI distress, take with food  Use dropper or straw  Drink with  Milk or Orange Juice?  Increase water  Decrease fiber
  335. 335. MICROMINERALS Iron  Parenteral Form  Site  Deep IM  Z Track  Don’t massage  Apply firm pressure for 5 minutes
  336. 336. MICROMINERALS Iodine  As element of the thyroid hormones, thyroxine (T4) and triiodothyronine (T3)  Deficiency  Hypothyroidism  Goiter
  337. 337. MICROMINERALS  Iodine Sources  Sea creatures  Seaweeds
  338. 338. NUTRITIONAL ASSESSMENT
  339. 339. NUTRITIONAL ASSESSMENT Anthropometric Measurements  Height  Weight  (best indicator of nutritional status of an individual)  Skin Fold Test (fat folds)  Mid-upper arm Circumference Measurement  Body Mass Index
  340. 340. NUTRITIONAL ASSESSMENT Weight  Weighing Technique  Ideal Body Weight  Rule of 5 for Women  Rule of 6 for Men
  341. 341. NUTRITIONAL ASSESSMENT Ideal Body Weight  Rule of 5 for Women  100 lbs for 5 ft of height  Plus 5 lbs for every inch of height above 5 ft  Example  5 feet 1 inch  Weight = 105 lbs  5 feet 2 inches  Weight – 110 lbs
  342. 342. NUTRITIONAL ASSESSMENT Ideal Body Weight  Rule of 6 for Men  106 lbs for 5 ft of height  Plus 6 lbs for every inch of height above 5 ft  Height = 5 ft 1 inch  Weight  112 lbs
  343. 343. NUTRITIONAL ASSESSMENT  Anthropometric Measurements  Skin Fold Test  Derivedfrom reserved fat of the body
  344. 344. NUTRITIONAL ASSESSMENT  Anthropometric Measurements  Mid-upper arm Circumference Measurement  Obtains the muscle mass of the body  This reflects the protein reserves of the body
  345. 345. NUTRITIONAL ASSESSMENT Body Mass Index  BMI = weight in kg (height in meter)2
  346. 346. NUTRITIONAL ASSESSMENT BMI  Height in Meter  1 Meter = 3.3 feet or 39.6 inches  1 Kg = 2.2 Lbs
  347. 347. NUTRITIONAL ASSESSMENT BMI Results  Underweight = Less than 18.5  Normal = 18.5 – 24.9  Overweight = 25.0 – 29.9  Obese Type I = 30.0 – 34.9  Obese Type II = 35.0 – 39.9  Obese Type III = 40.0 plus
  348. 348. NUTRITIONAL ASSESSMENT BMI  Compute  Weight = 65 kg  Height is = 62 inches  Compute  Weight = 150 pounds  Height = 5 feet 3 inches
  349. 349. NUTRITIONAL ASSESSMENT Biochemical Data  Serum Albumin
  350. 350. NUTRITIONAL ASSESSMENT Serum Albumin  Provide an estimate of protein stores  Albumin  Serum protein
  351. 351. NUTRITIONAL ASSESSMENT Dietary Data  24 hour food recall  Food Diary  Obesity  Eating Disorders
  352. 352. NUTRITIONAL VARIATIONSTHROUGHOUT THE LIFE CYCLE
  353. 353. NUTRITIONAL VARIATIONS THROUGHOUT THE LIFE CYCLE Neonate  Nutritional requirements are met by breastmilk or formula milk  Total daily requirements of the newborn  80 to 100 ml of milk per kg  Stomach capacity = 90 ml  Feedings are required every 2 to 4 hours  Demand feeding  Burping
  354. 354. NUTRITIONAL VARIATIONSTHROUGHOUT THE LIFE CYCLE Infant  Solid foods are added when?  4 to 6 months  Cereals (Rice)  Fruits  Vegetables (Yellows before Greens)  Foods are introduced 1 at a time  Every 5 to 7 days  Honey is not given  May contain small amount of Clostridium botulinum
  355. 355. NUTRITIONAL VARIATIONSTHROUGHOUT THE LIFE CYCLE  Toddlers  Toddlers can eat most foods  Meals short be short  Environmental distractions must be eliminated  Rituals  Attractive foods  Avoid sweet desserts
  356. 356. NUTRITIONAL VARIATIONSTHROUGHOUT THE LIFE CYCLE  Preschooler  These children eat at school  Children at this stage are very active and may rush through meals to return to playing  Often require healthy snacks  Fruits  Milk  Yogurt
  357. 357. NUTRITIONAL VARIATIONSTHROUGHOUT THE LIFE CYCLE  School Aged Child  Watch out for the foods the child are eating at school  High CHO and High CHON  Prolonged physical and mental effort  Breakfast is important
  358. 358. NUTRITIONAL VARIATIONSTHROUGHOUT THE LIFE CYCLE Adolescents  Growth spurt  Self Identity and Peer pressure  Eating disorders
  359. 359. NUTRITIONAL VARIATIONSTHROUGHOUT THE LIFE CYCLE Young Adults and Middle Adults  Maintain normal diet of healthy food options  Milk
  360. 360. NUTRITIONAL VARIATIONSTHROUGHOUT THE LIFE CYCLE Elderly  They have many problems associated with nutrition  Difficulty chewing  Denture  Chopped and soft foods  Loss of appetite  SFF  Loss of senses of smell and taste  Favorite foods  Limited income  Substitution  Substitute meat with milk or beans  Difficulty sleeping at night  Promote sleep
  361. 361. SPECIAL DIETS
  362. 362. SPECIAL DIETS  Clear Liquid Diets  Limited to  Water  Tea  Coffee  Clear broths  Strained and clear juices  Plain gelatin  Hard Candy
  363. 363. SPECIAL DIETS Clear Liquid Diets  This provides water and CHO (in the form of sugar)  After surgery
  364. 364. SPECIAL DIETS  Full Liquid Diet  Foods that are liquids or foods that turn to liquid at body temperature  All foods in the Clear Liquid Diet  Milk  Puddings and custards  Ice cream and sherbets  Yogurt
  365. 365. SPECIAL DIETS Full Liquid Diet  For clients who have gastrointestinal problems and cannot tolerate semi solid or solid foods
  366. 366. SPECIAL DIETS Soft Diet  All foods in the Clear and Full Liquid Diet  Meat: Lean, Tender  Fish, grounded meat  Vegetables: Mashed or cooked for a very soft consistency  Fruits: Cooked or canned  Breads and oatmeals  Soft cakes
  367. 367. SPECIAL DIETS Diet As Tolerated (DAT)  When the client’s appetite, ability to eat and tolerate food  Gag  Bowel Sounds

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