The document describes the five stages of illness:
1) Symptom experience and reaction
2) Assumption of the sick role and seeking validation
3) Medical care contact and confirmation of illness
4) Becoming a dependent patient and compliance with treatment
5) Recovery, rehabilitation, and relinquishing the sick role
It also lists the rights of dying persons and Filipino patients, including the right to treatment with dignity, informed consent, privacy, and continuity of care. Finally, it outlines the nursing process as assessment of data, diagnosis of actual or potential problems, planning interventions, implementation, and evaluation of outcomes.
the ot nursing is an essential concept that every student nurse must have an adequate knowledge in order to counteract the issues related to OT nursing.
Professional Nursing Concept And Practic - Presented By Mohammed Haroon Rashid Haroon Rashid
Subject Foundation of Nursing and topic is Professional Nursing Concept And Practice. This slide is presented by Mohammed Haroon Rashid Basic B.Sc Nusing 4th Year In Florence College of Nursing
the ot nursing is an essential concept that every student nurse must have an adequate knowledge in order to counteract the issues related to OT nursing.
Professional Nursing Concept And Practic - Presented By Mohammed Haroon Rashid Haroon Rashid
Subject Foundation of Nursing and topic is Professional Nursing Concept And Practice. This slide is presented by Mohammed Haroon Rashid Basic B.Sc Nusing 4th Year In Florence College of Nursing
Briefly describe stages of illness behaviour as described by Suchman:
- The symptom experience stage
- Assumption of the sick role
- The medical care contact stage
- The dependent patient role
- The operative phase
- The post-operative phase
- The recovery and rehabilitation
- The terminal phase
- Briefly discuss the stressful experiences associated with hospitalisation and contact - with other health facilities under the following headings:
- Loss of privacy
- Loss of independence
- Depersonalisation and the loss of identity
A description of the five successive stages of disease and the corresponding stages of prevention for each of these. The new model can be useful in healthcare planning, public health, and counseling of individual patients.
ICD-10 is an unknown terrain that the country is going toward. No one knows what to expect. Some expect productivity to decrease by as much as 50% due to its implementation. Some predict this new system will result in a shortage of coders. Is any of this true? This presentation will investigate the impacts – both foreseen and unforeseen – that ICD-10 implementation will have on radiology billing companies and radiology groups.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
2. I. Describe the diff. stages of illness
Stage 1: Symptom Experience-includes awareness of physical change; assessment of change
related to severity; form of emotional reaction associated with assessment
Reaction
- Denial
- Acceptance of symptoms and entering the second stage
- Delay individual cannot make the decision waits for further development of symptoms – –
Stage 2: Assumption of the Sick Role –decision on adaptation to the sick role; illness
becomes a social phenomenon-the ill person seeks validation for sick role from other persons
other persons in lay referral system deny request for sick role
acceptance of illness and provisional sick role -leading to the third stage-medical care contact
Stage 3: Medical Care Contact-ill person leaves lay remedies and enters the professional care
system
physician denies confirmation of request for sick role -patient accepts-patient refuses (‘shopping’
phenomenon)
confirmation of illness–confirmation of request for sick role -entering the next stage-dependent-
patient role
Stage 4: Dependent-Patient Role –ill person makes decision on illness treatment and becomes
a patient
patient resistance to treatment regimen–uncompliant patient–‘shopping’
dependent patient strives insufficiently for recovery
3. patient and physician working together on recovery–gradual resuming of normal roles
Stage 5: Recovery and Rehabilitation–
recovery–patient accepts normal activities
gradual recovery
recovery process-relinquishing sick role -chronic patients/malingerers
positive treatment outcome–patient joins the healthy
II. Enumerate the Bill of Rights
A. The Dying Person's Bill of Rights
The following "Bill of Rights" was created at a workshop (The Terminally Ill Patient and the Helping
Person) in Lansing Michigan, sponsored by the South Western Michigan In-service Education Council and
conducted by Amelia Barbus (1975), Associate Professor of Nursing, Wayne State University:
I have the right to be treated as a living human being until I die.
I have the right to maintain a sense of hopefulness however changing its focus may be.
I have the right to express my feelings and emotions about my approaching death in my own
way.
I have the right to participate in decisions concerning my care.
I have the right to expect continuing medical and nursing attention even though cure goals must
be changed to comfort goals.
I have the right not to die alone.
I have the right to be free from pain.
I have the right to have my questions answered honestly.
I have the right not to be deceived.
I have the right to have help from and for my family in accepting my death...
I have the right to die in peace and with dignity.
I have the right to retain my individuality and not be judged for my decisions which may be
contrary to the beliefs of others.
I have the right to be cared for by caring, sensitive, knowledgeable people who will attempt to
understand my needs and will be able to gain some satisfaction in helping me face my death.
The American Journal of Nursing, January 1975, vol. 75, no. 1, p. 99 lists three more:
I have the right to be cared for by those who can maintain a sense of hopefulness, however
changing this might be.
I have the right to expect that the sanctity of the human body will be respected after death.
I have the right to discuss and enlarge my religious and/or spiritual experiences, whatever these
may mean to others.
B. Filipino Patient’s Bill of Rights
The patient has the right to considerate and respectful care irrespective of socio-economic
status.
The patient has the right to obtain from his physician complete current information concerning
his diagnosis, treatment and prognosis in terms the patient can reasonably be expected to
understand. When it is not medically advisable to give such information to the patient, the
information should be made available to an appropriate person in his behalf. He has the right to
know by name or in person, the medical team responsible in coordinating his care.
The patient has the right to receive from his physician information necessary to give informed
consent prior to the start of any procedure and/or treatment. Except in emergencies, such
information for informed consent should include but not necessarily limited to the specific
procedure and or treatment, the medically significant risks involved, and the probable duration
of incapacitation. When medically significant alternatives for care or treatment exist, or when
4. the patient requests information concerning medical alternatives, the patient has the right to
such information. The patient has also the right to know the name of the person responsible for
the procedure and/or treatment.
The patient has the right to refuse treatment/life – giving measures, to the extent permitted by
law, and to be informed of the medical consequences of his action.
The patient has the right to every consideration of his privacy concerning his own medical care
program. Case discussion, consultation, examination and treatment are confidential and should
be conducted discreetly. Those not directly involved in his care must have the permission of the
patient to be present.
The patient has the right to expect that all communications and records pertaining to his care
should be treated as confidential.
The patient has the right that within its capacity, a hospital must make reasonable response to
the request of patient for services. The hospital must provide evaluation, service and/or referral
as indicated by the urgency of care. When medically permissible a patient may be transferred to
another facility only after he has received complete information concerning the needs and
alternatives to such transfer. The institution to which the patient is to be transferred must first
have accepted the patient for transfer.
The patient has the right to obtain information as to any relationship of the hospital to other
health care and educational institutions in so far as his care is concerned. The patient has the
right to obtain as to the existence of any professional relationship among individuals, by name
who are treating him.
The patient has the right to be advised if the hospital proposes to engage in or perform human
experimentation affecting his care or treatment. The patient has the right to refuse or
participate in such research project.
The patient has the right to expect reasonable continuity of care; he has the right to know in
advance what appointment times the physicians are available and where. The patient has the
right to expect that the hospital will provide a mechanism whereby he is informed by his
physician or a delegate of the physician of the patient’s continuing health care requirements
following discharge.
The patient has the right to examine and receive an explanation of his bill regardless of source
of payment.
The patient has the right to know what hospital rules and regulation apply to his conduct as a
patient.
III. Describe the different Steps of Nursing Process
The nursing process is the framework for providing professional, quality nursing care. It directs
nursing activities for health promotion, health protection, and disease prevention and is used by nurses in
every practice setting and specialty. “The nursing process provides the basis for critical thinking in nursing”
(Alfaro-LeFavre, 1998, p. 64).
Assessment
Assessment is the first step in the nursing process and includes collection, verification,
organization, interpretation, and documentation of data. The completeness and correctness of the
information obtained during assessment are directly related to the accuracy of the steps that follow.
Assessment involves several steps:
Collecting data from a variety of sources
Validating the data
Organizing data
Categorizing or identifying patterns in the data
Making initial inferences or impressions
Recording or reporting data
5. Diagnosis
The second step in the nursing process involves further analysis (breaking the whole down into
parts that can be examined) and synthesis (putting data together in a new way) of the data that have
been collected. Formulation of the list of nursing diagnoses is the outcome of this process. According to
the North American Nursing Diagnosis Association (NANDA) a nursing diagnosis is a clinical judgment
about individual, family, or community responses to actual or potential health problems/life processes.
Nursing diagnoses provide the basis for selection of nursing interventions to achieve outcomes for which
the nurse is accountable. (Carroll-Johnson, 1990, p. 50)
The nursing diagnoses developed during this phase of the nursing process provide the basis for
client care delivered through the remaining steps.
Types of Nursing Diagnoses
Analysis of the collected data leads the nurse to make a diagnosis in one of the following
categories:
• Actual problems
• Potential problems (including those where risk factors exist and there are possible problems)
• Wellness conditions
• Collaborative problems
Outcome Identification and Planning
Planning is the third step of the nursing process and includes the formulation of guidelines that
establish the proposed course of nursing action in the resolution of nursing diagnoses and the
development of the client’s plan of care. Once the nursing diagnoses have been developed and client
strengths have been identified, planning can begin.
The planning phase involves several tasks:
• The list of nursing diagnoses is prioritized.
• Client-centered long- and short-term goals and outcomes are identified and written.
• Specific interventions are developed.
• The entire plan of care is recorded in the client’s record.
Implementation
The fourth step in the nursing process is implementation. Implementation involves the execution
of the nursing plan of care derived during the planning phase. It consists of performing nursing activities
that have been planned to meet the goals set with the client. Nurses may delegate some of the nursing
interventions to other persons assigned to care for the client—for example, the licensed practical nurses
and unlicensed assistive personnel.
Implementation involves many skills. The nurse must continue to assess the client’s condition
before, during, and after the nursing intervention. The nurse must also possess psychomotor skills,
interpersonal skills, and critical thinking skills to perform the nursing interventions that have been planned.
The implementation step also involves reporting and documentation.
Evaluation
Evaluation, the fifth step in the nursing process, involves determining whether the client goals
have been met, partially met, or not met. If the goal has been met, the nurse must then decide whether
nursing activities will cease or continue in order for status to be maintained.
Evaluation is an ongoing process. Nurses continually evaluate data in order to make informed
decisions during other phases of the nursing process.
6. V. Discuss in general concept the different Nursing
Responsibilities/Care of the nurse
a. Preoperatively
The preoperative phase begins when the decision to proceed with surgical intervention is made
and ends with the transfer of the patient onto the OR table. The scope of nursing activities during this time
involves establishing a baseline evaluation of the patient before surgery by carrying out a preoperative
interview (which includes a physical and emotional assessment, previous anesthetic and medical history,
and identification of known allergies or genetics issues that may affect the surgical outcome), ensuring
that necessary tests have been or will be performed in PAT, arranging appropriate consultations, and
providing education about recovery from anesthesia and postoperative care (Garcia-Miguel, Serrano-
Aguilar & Lopez-Bastida, 2003).
Examples of Nursing Activities in the Preoperative Phase of Care
Preadmission Testing
Initiates initial preoperative assessment
Initiates teaching appropriate to patient's needs
Involves family in interview
Verifies completion of preoperative testing
Verifies understanding of surgeon-specific preoperative orders (e.g., bowel preparation,
preoperative shower)
Assesses patient's need for postoperative transportation and care
Admission to Surgical Center or Unit
Completes preoperative assessment
Assesses for risks for postoperative complications
Reports unexpected findings or any deviations from normal
Verifies that operative consent has been signed
Coordinates patient teaching with other nursing staff
Reinforces previous teaching
Explains phases in perioperative period and expectations
Answers patient's and family's questions
Develops a plan of care
In the Holding Area
Assesses patient's status, baseline pain and nutritional status
Reviews chart
Identifies patient
Verifies surgical site and marks site per institutional policy
Establishes intravenous line
Administers medications if prescribed
Takes measures to ensure patient's comfort
Provides psychological support
Communicates patient's emotional status to other appropriate members of the health care team
b. Intraoperatively
The intraoperative phase begins when the patient is transferred onto the OR table and ends with
admission to the PACU. In this phase, the scope of nursing activities includes providing for the patient's
safety, maintaining an aseptic environment, ensuring proper function of equipment, providing the surgeon
with specific instruments and supplies for the surgical field, and completing appropriate documentation.
Nursing activities may include providing emotional support by holding the patient's hand during induction
of general anesthesia; assisting in positioning the patient on the OR table using appropriate principles of
body alignment; or acting as scrub nurse, circulating nurse, or registered nurse first assistant (RNFA).
Examples of Nursing Activities in the Intraoperative Phase of Care
Maintenance of Safety
Maintains aseptic, controlled environment
Effectively manages human resources, equipment, and supplies for individualized patient care
Transfers patient to operating room bed or table
Positions the patient
o Functional alignment
o Exposure of surgical site
Applies grounding device to patient
7. Ensures that the sponge, needle, and instrument counts are correct
Completes intraoperative documentation
Physiologic Monitoring
Calculates effects on patient of excessive fluid loss or gain
Distinguishes normal from abnormal cardiopulmonary data
Reports changes in patient's vital signs
Institutes measures to promote normothermia
Psychological Support (Before Induction and When Patient Is Conscious)
Provides emotional support to patient
Stands near or touches patient during procedures and induction
Continues to assess patient's emotional status
c. Postoperatively
The postoperative phase begins with the admission of the patient to the PACU and ends with a
follow-up evaluation in the clinical setting or home. The scope of nursing care covers a wide range of
activities including maintaining the patient's airway, monitoring vital signs, assessing the effects of the
anesthetic agents, assessing the patient for complications, and providing comfort and pain relief. Nursing
activities also focus on promoting the patient's recovery and initiating the teaching, follow-up care, and
referrals essential for recovery and rehabilitation after discharge. Each phase is reviewed in more detail in
this chapter and in the other chapters in this unit.
Examples of Nursing Activities in the Postoperative Phase of Care
Transfer of Patient to Post-Anesthesia Care Unit
Communicates intraoperative information
o Identifies patient by name
o States type of surgery performed
o Identifies type of anesthetic used
o Reports patient's response to surgical procedure and anesthesia
o Describes intraoperative factors (e.g., insertion of drains or catheters; administration of
blood, analgesic agents, or other medications during surgery; occurrence of unexpected
events)
o Describes physical limitations
o Reports patient's preoperative level of consciousness
o Communicates necessary equipment needs
o Communicates presence of family and/or significant others
Postoperative Assessment Recovery Area
Determines patient's immediate response to surgical intervention
Monitors patient's physiologic status
Assesses patient's pain level and administers appropriate pain relief measures
Maintains patient's safety (airway, circulation, prevention of injury)
Administers medications, fluid, and blood component therapy, if prescribed
Provides oral fluids if prescribed for ambulatory surgery patient
Assesses patient's readiness for transfer to in-hospital unit or for discharge home based on
institutional policy (e.g., Alderete score)
Surgical Unit
Continues close monitoring of patient's physical and psychological response to surgical
intervention
Assesses patient's pain level and administers appropriate pain relief measures
Provides teaching to patient during immediate recovery period
Assists patient in recovery and preparation for discharge home
Determines patient's psychological status
Assists with discharge planning
Home or Clinic
Provides follow-up care during office or clinic visit or by telephone contact
Reinforces previous teaching and answers patient's and family's questions about surgery and
follow-up care
Assesses patient's response to surgery and anesthesia and their effects on body image and
function
Determines family's perception of surgery and its outcome