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Albumin is a large molecule protein found in the blood, under normal circumstances it does not pass into the urine. If albumin occurs in the urine it could indicate infection of the urinary tract, kidney damage as in nephritis and toxemia in pregnancy. A urine for albumin test is a screening test to look for the presence of albumin in the urine .An albumin test cheeks urine for a protein called albumin for urine . Albumin is normally found in blood and filtered by kidneys. When the kidneys are working as the slow, there may be very small amount albumin in the urine .But when the kidneys are damage ,abnormal amounts of albumin leaks in the urine. This is called albuminuria.
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Airborne Precautions
Droplet Precautions
Three more elements have been added to standard precautions. They are:
4.1 Respiratory hygiene/cough etiquette
4.2 Safe injection practices
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Albumin is a large molecule protein found in the blood, under normal circumstances it does not pass into the urine. If albumin occurs in the urine it could indicate infection of the urinary tract, kidney damage as in nephritis and toxemia in pregnancy. A urine for albumin test is a screening test to look for the presence of albumin in the urine .An albumin test cheeks urine for a protein called albumin for urine . Albumin is normally found in blood and filtered by kidneys. When the kidneys are working as the slow, there may be very small amount albumin in the urine .But when the kidneys are damage ,abnormal amounts of albumin leaks in the urine. This is called albuminuria.
The nursing technique by which a patient with an infectious disease is prevented from infecting other people is called barrier nursing.Hand hygiene is the simplest, most effective measure for infection control.Contact Precautions
Airborne Precautions
Droplet Precautions
Three more elements have been added to standard precautions. They are:
4.1 Respiratory hygiene/cough etiquette
4.2 Safe injection practices
4.3Use of masks for insertion of catheters or injection into spinal or epidural areas
A brief awareness and knowledge about the insertion of NGT nasogastric Tube and feeding through it.
It contains an introduction, procedure, equipment needed, method of feeding etc
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Proper perineal care allows for inspection of the skin. It keeps the perineal area clean and less likely to break down. It also decreases the risk for urinary tract infections.
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It contains an introduction, procedure, equipment needed, method of feeding etc
CHN Process Includes 6 Steps such as Community assessment, Community Diagnosis, Planning, Implementation, Evaluation & Re-planning.
Topic of F.Y.GNM
Subject - CHN I
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Clinical examination of Radial pulse by Pandian M, Tutor, Dept of Physiology,...Pandian M
Introduction
Ideal graph which represented radial pulse
Importance
Method of examination
Procedure
The following aspects (parameters) of the pulse are studied
Precautions:-
Discussion
Applied aspects
Other peripheral pulses
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Basic Life Support, or BLS, generally refers to the type of care that first-responders, healthcare providers and public safety professionals provide to anyone who is experiencing cardiac arrest, respiratory distress or an obstructed airway.
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Defecation
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The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
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IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
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1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
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3. Learning Objevtives
At the end of the teaching each student
should be able to –
• Definition of Pulse
• Enlist the Indication of taking pulse
• Understand Physiology of pulse
• Enumerate Characteristic of Pulse
• Elaborate Sites of Pulse
• Discuss Abnormal Pulse
4. Pulse
• Pulse rate:- It is the number of times
the ventricles of heart contract per
minute.
It is an indicator of the circulatory
status.
• Pulse rate can be determined by:-
Palpating the pulse.
Electrocardiograph.
5. Assessing Radial Pulse
• Left ventricle contracts causing a wave
of blood to surge through arteries –
called a pulse.
• It reveals amount of blood enters the
arteries with each heart contraction.
• Peripheral Pulses:- Pulse is palpable
on various sites i.e. peripheral arteries
around the body e.g. Carotid, brachial,
radial, femoral, popliteal, posterior
tibial, dorsalis pedis
• Apical pulse:- Pulse monitored at the
apex of heart is termed as apical pulse.
6. Pulse gives information
regarding:-
• Functioning of heart and
circulatory system.
• Client’s health status.
• Client’s metabolic rate.
• Emotional Status.
• Client’s physiologic response to:-
Blood loss.
Tissue damage.
Exercise.
Stress.
Fatigue.
Treatment- Surgery, medication.
7. Normal Heart Rate
Age Heart Rate
(Beats/min)
Infants 120-140/min
Toddlers 90-140/min
Preschoolers 80-110/min
School agers 75-100/min
Adolescent 60-90/min
Adult (Male)
Adult (Female)
50-90/min
55-95/min
8. • Pulse deficit –Insufficient contraction
of heart which does not palpable at
peripheral pulse sites is called as pulse
deficit. It can be detected by comparing
the difference between the radial pulse
and the apical pulse simultaneously –
which reflects abnormal rhythms &
heart conditions i.e.. Atrial fibrillation.
• Tachycardia:- Heart rate above normal
limits is termed as tachycardia.
• Bradycardia:- Heart rate below 60/min
is termed as bradycardia.
9. Physiology of Pulse
• Sino atrial (SA) node present in
heart initiates the cardiac
contraction.
• As ventricle contracts approx-60-
70ml of blood is ejected into aorta
(stroke volume), distending the
heart walls and transmitting a wave
throughout the arterial system.
• This wave can be felt in the distal
arteries
10. Factors Affecting the
Pulse
1. Gender:- After puberty, male
person’s pulse rate is lower than
female.
2. Age:-The very young child have a
rapid pulse rate, the adult has a
normal range in pulse rate of 70-80
per minute and the very old one has
a relatively slow pulse rate.
3. Exercise:- The increased muscular
activity will increase pulse rate
temporarily. But opposite is seen in
laborers and athletic bodies due to
greater cardiac size, strength and
efficiency.
11. Factors Affecting the Pulse
cont...
4. Physique:- The short person with
small body build has a slightly more
rapid pulse than the tall heavy
individual.
5.Food:- Ingestion of food cause a
slight increase in pulse rate for several
hours.
6.Chemicals:- Electrolytes such as
sodium (Na+), Potassium (K+) are
responsible for fluctuation of heart
rate. Medication such as digoxin,
atropine decreases the heart rate
whereas adrenaline increases heart
rate.
12. 7.Emotions:- In extreme emotional
condition, sympathetic nervous system get
stimulated, releases hormones and
norepinephrine causes contraction of blood
vessels and ultimately increases heart rate.
But in case of depression/ grief/sorrows,
cardio inhibitory center release acetyl
choline which slows the heart rate.
13. Factors Affecting the Pulse
cont..
8. Position Change:- Positions sitting ,
standing, lying has effect on heart rate.
While standing, most of the blood
pooled down. Thus decreases in
venous return to heart decreases blood
pressure but increases pulse rate.
9. Basal Metabolic rate:- If BMR is low
pulse rate is low. This must be due to
less requirement of the cells for
oxygen.
14. Factors Affecting the
Pulse cont..
10. Body Temperature:- Increased
body temperature stimulates
electrical changes to heart
ultimately increases heart rate.
11.Blood Pressure:- When B.P is
low the pulse rate increased in order
to increase the blood flow. In high
B.P pulse rate decreases.
15. Contd..
12.Pathology:- Diseases of heart,
other body systems also influences
heart rate. As soon heart begins to
fail, it pumps faster to
compensate. Even problems in
electrical conduction of heart
affects the pulse rate.
13. Other Conditions:- Such as
infection, change in blood volume,
increased intra cranial pressure
also fluctuates heart rate.
16. Scientific Principles of taking
Pulse
1. Exercise ,emotion and anxiety
will cause increased pulse rate.
2. Finger tips sensitive to touch will
feel the pulsation. There is
pulsation in thumb: which may
be mistaken for clients pulse. So
thumb is not used to take pulse.
17. Contd..
3. Moderate pressure allow one to
feel superficial radial artery and
its expansion and contraction
during heart beat. Too much
pressure will obliterate the
pulse. Too little pressure will
imperceptible.
4. Characteristic of the pulse vary
with the individuals and
indicate the function of heart,
condition of the patient and
nature of blood vessels.
18. Characteristics of Pulse
• RATE:- It is the number of times the
heart contracts in one minute.
• Rhythm:- It is the pace or intervals
between two pulse beats.
• Tension:- Indicates the amount of
resistance the artery gives when the
finger is pressing against it .The
amount of tension present is due to
pressure of blood in the arteries.
19. Contd…….
• Volume or Strength:- It reveals the
amount of blood ejected against arterial
wall with every heart contraction. Normal
adult have same strength. It is graded as
weak, thready, feeble, bounding pulse and
stoke volume quality.
• Quality of pulse strength is affected by
drugs, exercise and fear etc.
20. Common sites for assessing
pulse
No. Pulse site Location Reason for use
1. Radial Inner aspect of wrist
along radial bone.
Below base of thumb
Readily accessible
2. Temporal Between lateral eye
and hairline above the
zygomatic
.Increase radial pulse
is not accessible in
adults.
.Infants and children
commonly used.
3. Carotid Between trachea and
sternocleidomastoid
muscles below angle
of jaw
.In case peripheral
pulses are not
palpable.
. Emergencies i.e.
cardiac arrest
21. CONTD…
No Pulse site Location Reason for use
4. Apical Checked through
palpation as well as
auscultation of heart. just
below the left nipple
•To detect accurate
heart rate.
•Dysrhythmia
•Pulse deficient
•Used in conjunction
with medication
•Routinely used for
infants and children of
3 yrs.old
5. Brachial Inner aspect of antecubital
fossa.
•To measure blood
pressure --during
cardiac arrest in
infants
6. Femoral Below inguinal fold
between anterior iliac
spine and symphysis
pubis.
Cardiac arrest.
22. CONTD…
No Pulse site Location Reason for use
7. Popliteal •Palpated in Popliteal
fossa, area behind knee,
just lateral to medial
tendon.
•Palpated by flexing
knee.
•Determine circulation
to lower extremities.
•Used for infants,
children
•Effectiveness of
arterial perfusion
during CPR.
8. Posterior tibial Behind medial
malleolus (ankle bone)
on inside of the ankle.
•Determine circulation
to lower leg.
•A circular blood
pressure in leg.
•Determine circulation
to the foot.
9. Pedal or Dorsalis
pedis
It is palpated on top of
foot, slightly lateral to
the tendon of big toe.
Determine circulation
to the foot.
23.
24. ABNORMAL PULSE
1. Abnormal Rate: -
a. Tachycardia: Rapid pulse over 100 per minute may be caused by
drugs as stimulants or disease like typhoid, heart disease etc.
b. Bradycardia: Slow pulse 60 or less may be caused by drugs as
sedatives or diseases like heart diseases, etc.
2. Abnormal Rhythm: Irregularities in rhythm are called
arrhythmias, the intervals between beats may be of different lengths
or the beats may be of unequal force. Common irregularities in rate
and rhythm include premature beats, pauses tachycardia,
bradycardia and chaotic pulse.
25. CHAOTIC PULSE
• Meaning: An irregular pulse beats
Other irregularities in rhythm and rate are:-
1. Intermittent Pulse: This is one in which pulse
beats are missed at regular intervals. There is
difference between apical and radial pulse
which is known s pulse deficit.
2. Tachycardia: discussed already.
3. Bradycardia: discussed already.
26. Abnormal Pulse
4. Atrial fibrillation: It is the irregular
contractions of the ventricles in rhythm
and force caused by the rapid contraction
of the atrium.
27. 5.
Extra systoles: It is the premature contraction of
the heart before the normal cardiac cycle which
is felt s the premature pulse.
6. Ventricular fibrillation: It is the term
given to rapid chaotic electrical activity
initiated by the ventricular ectopic. It is the
rapid twitching of the ventricles.
29. 8. Bigeminal pulse:
•It is accompanied by an irregular rhythm in which
every other beats come early.
•The second or premature beat feels weak due to
inadequate filling of the ventricles between the two
beats.
•It may be so weak that it fails to produce a
palpable pulse when it is called pulse deficit. It is
seen in myocardial infarction and digitalis toxicity.
30. 9.Pulse alternans: The rhythm is regular
but volume has an alternative strong and
weak character. This may be noticed in the
left ventricular failure, heart block and
digitalis toxicity
31. Abnormal Pulse
10. Bounding pulse: It is an increased stroke
volume usually seen in exercises, anxiety,
anemia, hepatic failure, heart block and water
hammer pulse.
32. 11. Arrhythmia: It is a technical term used for
any variation from normal rhythm.
33. 12. Sinus Arrhythmia: It is the irregularity in the
rhythm and rate of pulse of which the heart rate
speed up during inspiration and slows down during
expiration.
34. ABNORMAL VOLUME
• Pulse may be large or full volume, or
may be of low or small volume (a
fluttering pulse is due to hemorrhage)
a. Collapsing pulse: one which is feeble to
touch, then subsides abruptly. A small
weak pulse that feels like a wire or thread
while touching the arteries. It indicates
decreased stock volume and is seen in
hemorrhagic shock or dehydration.
35. ABNORMAL VOLUME
b. Corrigan's Pulse or water hammer pulse:
Is jerky pulse with full expansion followed by
sudden collapse, e.g. dying patients.
Running pulse is one with weak irregular beats.
36. ABNORMAL TENSION
The pulse may be of high tension or of low
tension.
• Thready pulse is a low tension pulse, e.g.
wiry pulse.
• Dicrotic pulse also is due to low tension.
Dicrotic pulse is one which has two marked
expansions in one beat of the artery. The
contraction is normal but in relaxation, a
second sensation can be felt which resembles
a beat. The first is stronger and the second
sensational is weaker, e.g. Thyroid patients.
37. References
• Potter A.P., Perry A.G. Fundamentals of
Nursing, C.V. Mosby company, Louis 6th
edition ,2013.
• Kozier B et al, Fundamentals of Nursing
concepts, process and practice, Pearson
education , Inc 2nd Indian Print 2014.
• Kaur Lakhwinder ,Kaur Maninder , A text
book of Nursing Foundation , 3rd Edition,
PV Publication.