Download مقرر أسس التمريض المستوى الرابع-إعداد د. فوزية أبوسعد مع أستاذ عمر

Kingdom of Saudi Arabi
Al jouf University
Faculty of applied medical Science
Nursing Department
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List of contents
1- The nature of nursing (historical back ground of nursing).
2- Concept of Health and Wellness.
3- Infection Control. (Aseptic technique).
4- Measurement of vital signs.
5- Administration of Medication.
6- Fluid and electrolyte.
7- Bowel Elimination
8- Urinary Elimination.
9- Personal Hygiene.
10- Skin Integrity care.
11- Nutrition.
.
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The Nature of Nursing
After end of this part ,student will be able to:
-Discuss the historical contemporary factors influencing the development
of nursing.
-Identify Essential aspects of nursing.
-Identify the purpose of nurse practice acts and standards for nursing
practice
-Describe the major roles of the nurse.
-Describe the Importance of professionalization in nursing and nursing
proficiency level.
-Explain the functions of global international nurses associations.
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Historical Perspective
1- Theory of Animism
• Belief that good and evil spirits bring health or illness
• Physician as medicine man
• Nurse portrayed as mother caring for family (nurturing role)
2- Beginning of Civilization
• Belief that illness is caused by sin and gods’ displeasure
• Temples were centers of medical care
• Priest as physician
• Nurse viewed as slave carrying out menial tasks ordered by
priests
3- 16th Century
 Focus on religion replaced by focus on warfare
 Exploration and expansion of knowledge
 Shortage of nurses: criminals recruited
 Nursing considered disreputable
th
4- 18 –19th Century
 Hospital schools organized
 Female nurses under control of male hospital
administrators and physicians
 Male dominance of health care
 Nursing becomes respected occupation
 Modern methods in nursing education founded
5- Historical Perspective/ World War II
 Explosion of knowledge in medicine and technology
 Efforts to upgrade nursing education
 Women more assertive and independent
6- Historical Perspective/ 1950’s to Present
 Varied healthcare settings developed
 Nursing broadened in all areas
 Growth of nursing as a profession
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Nursing Leaders
1- Florence Nightingale (1820- 1910)
 Believed nursing is separate and distinct from medicine
 Recognized nutrition as important to health
 Instituted occupational and recreational therapy for sick
people
 Stressed the need for continuing education for nurses
 Maintained accurate records/beginning of nursing
research
 Identified personal needs of patient and role of nurse in
meeting them
 Established Standards for hospital management
 Established nursing education and respected occupation
for women
 Recognized two components of nursing – health and
illness
2- Clara Barton (1812-1956)
 She was schoolteacher who volunteered as nurse during
American civil war.
 Barton is noted for her role in establishing the American
Red Cross.
3- Lillian wald (1867-1940):
 Is considered the founder of public health nursing.
 She offer trained nursing services to the poor.
4- Liviana dock (1858-1956)
 Her campaigned for legislation to allow nurses rather
than physicians to control their profession.
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Definitions of Nursing:
There are many definitions of nursing.
1-Florence Nightingale defined nursing as: the act of utilizing the
environment of the patient to assist him in his recovery.
2- ANA definition: nursing is the diagnosis and treatment of
human response to actual and potential health problems.
3-Nursing is caring.
4-Nursing is science and art.
5-Nursing is holistic.
6-Nursing is adaptive.
7-Nursing is client centered
Recipients of nursing
1- Consumer: is an individual, a group of people, or a community
that uses a service.
2- Patient: is a person who is waiting for or undergoing medical
treatment and car
3- Client: is a person who engages the advice or services of
another who is qualified to provide this service.
Scope of Nursing
Nurses provide care for three types of clients:
1. Individuals.
2-Families.
3-Communities.
Nursing Practice involves four areas:
1-Promoting health and wellness.
2- Preventing illness.
3-Restoring health.
4- Care of the dying.
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Health promotion
Is increase people’s wellbeing and health potential.
Factors effects on health or illness:
 Genetics,
 educational level and development level.
Examples:
1. Reduce over weight.
2. Stop cigarette smoking.
3. Improving nutrition and physical fitness.
4. Preventing drug misuse.
5-Prevent illness
6-Maintain optimum health by preventing disease.
Examples:
 Educational program (smoking, prenatal care).
 Immunization.
7-Restoring health
Focus of individual with illnesses and range from early detection
to rehabilitation and teaching during recovery.
• Example:
• Direct care ( treatment, medication)
• Performing diagnostic measurement
( Blood pressure, blood glucose)
Setting for Nursing
• In the past, the acute care hospital was the only practice
setting.
• Today nurses works in hospitals, client’s home, community
agencies, education settings, schools, mental health…..etc.
Roles and Functions of the Nurses
1. Caregiver: assist client physically and psychologically.
2-Communicator: support the client through health team and
support people in community.
3-Teacher.
4-Client advocate: protect patient right.
5-Leader.
6-Manager.
Professionalization
• Profession: an occupation that requires extensive education,
special knowledge, skill, and preparation.
• Professionalization: is the process of becoming professional.
Criteria of a Profession
1. Specialized education.
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2.
3.
4.
5.
Body of knowledge.
Ongoing research.
Code of ethics.
Autonomy: is a state of independent and self directed with out
any control from out side.
6. Professional organization.
Types of Nursing Educational Programs
• Diploma programs.
• Community College/associate Degree.
• Baccalaureate Degree Program.
• Graduated Nursing Education (Master’s &Doctoral Programs)
Met paradigm of Nursing
1. Client.
2. Environment.
3. Health.
4. Nursing.
Definitions
• Health: a state of complete physical, social, mental, spiritual
wellbeing not merely absence of disease or infirmity.
• illness: any disturbance of body organs function.
• Illness – wellness continuum
Is one way to measure a person level of health, this model view
health as constantly change state with high level of wellness and
death. The person with chronic illness can attain high level of
wellness if he successful in meeting his health potential within the
limit of his chronic illness.
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WELLNESS CONCEPTS
After end of this part ,student will be able to:
-
Deffrieniate health and wellness
Describe the Five forms of wellness
Describe the major three types of health prevention
Identify factors affecting health
Understanding some crucial health practice
Health
 A state of complete physical, mental and social wellbeing, not merely the absence of disease or infirmity.
Wellness
 A state of optimal health wherein an individual:-Moves
toward integration of human function.
-Maximizes human potential.
-Takes responsibility for health.
-Has greater self-awareness and self-satisfaction.
Forms of Wellness
 Emotional (Being able to understand your own feelings
and express them).
 Mental (Being alert, creative, logical, curious).
 Intellectual (Ability to think, process information, solve
problems).
 Vocational (Satisfied in school and/or job and works well
with others).
 Social (Satisfying relationships).
 Spiritual (Possessed of values, ethics, morals).
 Physical (Exercise, good nutrition, care of one’s body).
Federal Health Objective: Healthy People 2000/2010
Overall goals:
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1-Increasing life span for Americans.
2-Reducing health disparities among peoples.
3-Achieving access to preventive services for all people
The Three Types of Health Prevention
Primary - all practices designed to keep health problems from
developing (e.g. immunizations, proper nutrition, smoke free
environments).
Secondary - early detection, diagnosis, screening, and intervention.
Tertiary - caring for a person already ill.
Factors Affecting Health
1-Genetics and human biology.
2-Personal behavior.
3-Environmental influences.
4-Health care.
Personal Behavior
Diet.
Exercise.
Personal Care.
Sexual Relationships.
Level of Stress.
Tobacco and Drug Use.
Alcohol Use.
Safety.
Crucial Health Practices
1- Diet low in fat, cholesterol and salt.
2- Regular exercise.
3- No tobacco and drugs.
4- Avoid excessive stress.
5- Minimize exposure to environmental hazards.
6- Regular medical care, immunization and screening.
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Infection control
At the end of this part student will be able to :
-Explain the concept of infection and disinfection
-Analyze the chain of infection
-Identify concepts of Medical and surgical asepsis
-Identify concept of sterilization
-Explain Importance of Sterilization
-Determine principles of surgical asepsis
-Explain measurements of infection transferring
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Introduction :Good health depends in part on a safe environment practices or
techniques that control or prevent transmission of infection help to protect
clients and health care workers from disease.
Nature of infection :Infection is the entry and multiplication of an infectious agent
pathogen in the tissue of the host.
Chain Cycle of Infection :The presence of a pathogen does not mean that an infection will begin
development of an infection occurs in a cycle that depends on the
presence of all of the elements :Infectious agent or pathogen.
Reservoir or source of pathogen growth.
A portal of exit.
Mode of transmission.
Portal of entry.
Susceptible host.
1- Infectious agent :- Micro organisms include :- Bacteria.
- Viruses.
- Fungi and protozoa.
The ability of the microorganisms to cause disease depends on the
following factors:Number of organisms.
Virulence or ability to produce diseases.
Ability to enter and survive in the host.
Susceptibility of the host.
2- Reservoir :- Is a place where a pathogen can survive but may or may
not multiply to the rive organisms require a proper environment including
appropriate food, oxygen, water, temperature, P. H. and light.
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3- Portal of exit :- After microorganisms find a site to grow and
multiply, they must find a portal of exit to enter another host and cause
disease such as :- Skin and mucous membrane.
- Respiratory tract such as nose.
- Genitourinary tract such as urine, vaginal secretion.
- Gastrointestinal tract as mouth, vomits.
- Blood and placenta.
4- Modes of Transmission :The way that microorganisms transmit from the reservoir to
the host such as :Direct Mode :- person to person ( fecal – oral ) or physical
contact between source and susceptible host during coughing
sneezing or talking.
Indirect Mode :- as use of contaminated items, water, food,
blood.
5- Portal of entry :Organisms can enter the body through the same routes they
use for exiting.
6- Susceptible host :Susceptibility depends on the individual degree of resistance
to pathogen.
♥ Risk Factors For Infection :I- Inadequate primary defenses :- Broken skin or mucosa.
- Obstructed urine outflow.
- Altered peristalsis.
- Change in P. H. of secretions.
- Decreased mobility.
II- Inadequate secondary defenses :- Reduced hemoglobin level.
- Suppression of ( W Bcs ).
- Suppressed inflammatory response.
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♥ Preventing or Reducing The Transfer Of Micro Organism :The nurse's efforts to minimize the onset and spread of
infection are based on the principles of aseptic technique.
Asepsis :Is the absence of pathogenic micro organisms. Aseptic technique
refers to practices that keep a patient as free from pathogens as possible.
Types of aseptic technique :I- Medical asepsis : or clean technique that includes procedures used to
reduce and prevent the spread of micro organisms such as :a- Hand washing.
b- Using clean gloves to prevent direct contact with blood or body fluids.
c- Cleaning the environment routinely.
II- Surgical asepsis :
Or sterile technique that requires a nurse to use different
precautions from those of medical asepsis. Surgical asepsis includes
procedures used to eliminate all microorganisms including pathogens and
spores from an object or area. Such as sterilization and disinfection, wear
sterile gloves gown.
♥ Disinfection :Describes a process that eliminates many or all microorganisms
with the exception of bacterial spores. Examples of disinfectants are
alcohols, chlorines and phenols.
♥ Sterilization :Is the complete elimination or destruction of all microorganisms
including spores. Steam under pressure, boiling water, gas, hydrogen
peroxide and chemicals are the most common sterilizing agents.
♥ Principles of surgical asepsis :1-A sterile object remains sterile only when touched by another sterile
object. This means that :a- Sterile touching sterile remains sterile.
b- Sterile touching clean becomes contaminated.
c- Sterile touching contaminated becomes contaminated.
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2- Only sterile objects may be placed on a sterile field all items are
properly sterilized before use.
3- A sterile object or field out of the range of vision or an object held
below a person's waist is contaminated.
4-A sterile object or field becomes contaminated by prolonged exposure
to air.
5- When a sterile surface comes in contact with a wet, contaminated
surface, the sterile object or field becomes contaminated.
6- Fluid flows in the direction of gravity. A sterile object becomes
contaminated if gravity causes a contaminated liquid to flow over the
object's surface. To avoid contaminated during downward without
contaminated the nurse's hands and fingers.
7- The edges of a sterile field or container are considered to be
contaminated.
♥ Measures Used to Prevent Transfer of Infection :Isolation precautions for patient with communicable disease.
Collection of specimens of body fluids or drainage from infected body
sites for cultures.
Good wound care to remove infected drainage from wound sites and
support the integrity of wound healing.
Use medical aseptic techniques as frequent hand washing and wearing
clean gloves.
Use surgical aseptic techniques such as scrubbing, disinfection,
sterilization, wear sterile gloves and gown.
Support the patient's body defense mechanisms such as maintain skin
integrity, cleansing the oral cavity and bathing, good nutrition and
proper medication.
The nurse with nasocomal infection should avoid talking directly into
client's faces or talking, sneezing or coughing directly over surgical
wounds and also wearing mask.
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Careful handling of contaminated body fluids, so the nurse should
always wear disposable gloves when handling exudates.
Encourage proper immunization for patient's and staff member who
become exposed to certain infectious microorganisms.
10-The nurse encourage routine coughing and deep breathing keep
lower airway clear of mucus and maintain adequate fluid intake.
11- Disposal of equipment and supplies as linen, disposable needle
and syringes using correct way.
12- the nurse educate the patients about infection and techniques to
prevent or control its spread such as :* Client's susceptibility to infection.
* The chain of infection.
* Hygienic practices that minimize organism growth and spread, as
hand washing.
* Preventive health care as diet, vaccination and exercise.
* Proper methods for handling and storage of food.
* Family members who are at risk for acquiring infection.
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Assessment Of Vital Sings :-
After end of this part student will be able to:
- Identify importance of vital signs assessment
- Define body temperature
- Identify sites of measuring body temperature
- Explain contraindications of taking temperature
orally
- Describe factors increase or decrease heat
production
- Recognize the nursing role with management of
fever
Assessing vital signs is a common but extremely important nursing
skill. Vital signs include temperature, pulse, respiration and blood
pressure.
Measuring body temperature
♣ Definition of body temperature :It’s the balance between heat produced in the tissue and heat lost to the
environment.
♣Sites of measuring body temperature :The thermometer is placed in the mouth to obtain an oral temperature, in
the axilla to obtain an axillary temperature, in anal canal to obtain rectal
temperature, and in ear canal to obtain tympanic temperature.
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♦Scales of measurement :Body temperature is recorded either in degree centigrade (c)Or degree
Fahrenheit (f).
♦ To convert centigrade to Fahrenheit, multiply by 9\5 and add 32
F= (9\5 x C )+32
♦ To change Fahrenheit to centigrade subtract 32 and multiply by 9/5
C= ( F-32 ) x5/9
Contraindication of oral temperature :-
Infant and children
Unconscious patients
Inflammation or surgery of mouth
Persistent frequent coughing
After drinking hot or cold fluids
Contraindication of axillary temperature :- Skin disease
- Axillary operation
Contraindication of rectal temperature :- Patient with surgical operation in the rectum or
perineal region
- Disease or inflammation of the rectum
- Diarrhea
Normal body temperature :-
The average normal temperature for adults is 37 0C
The average normal rectal temperature is 37.5 0C
The average normal axillary temperature is 36.5 0C
The normal range of body temperature is 36.6 0c- 37.2
0
♦ There are four mechanisms by which heat loss takes place :Radiation.
Convection.
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Conduction.
Evaporation.
♦ Factors increasing heat production :Muscular activity.
Ingestion of food.
Time of day.
Emotion.
Hormones.
Infections.
Increased temperature of the environment.
Menstruation and pregnancy.
♦ Factors decreasing heat production :123456-
Prolonged illness.
Fasting.
Sleep.
Depression of the nervous system.
Time of day.
Age.
♦ Disorders of body temperature.
Disorders of body temperature may be either elevation (fever) of
temperature above normal or reduction below normal range (
hypothermia).
♥ Fever (pyrexia) :Is abnormal elevation of body temperature above the normal range.
It is common symptom of illness.
♥ Causes of Fever :1- Damage to heat – regulating center due to head injuries.
2- Acute infectious disease e.g. Malaria.
3- Acute inflammatory conditions.
4- Acute and prolonged pain.
5- Extreme nervousness.
6- Emotional stress.
7- Trauma or injury to body tissues.
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♥ Types of Fever :1- Constant fever ( continuous fever ).
Temperature remains constantly elevated and fluctuates very little
(1.2 0C ).
2- Intermittent fever.
Temperature alternates regularly between a period of fever and a
period of normal or subnormal temperature.
♥ Nursing care of Patient Fever :1- Apply measure to reduce body temperature.
2- Accurate measuring of vital signs at frequent intervals (every 1 to 2
hours) and they should be reported and recorded appropriately.
3- If fever is accompanied by chills. Patient should be covered by
several light blankets.
4- Frequent oral hygiene, to prevent dryness of lips. Cracked lips may
be avoided by the use of petroleum jell or cold cream applications.
5- Hygienic care, body cleanliness, light clean dry cloths, and light
bed covers.
6- Implement safety precautions to protect the patient if restless or
delirious or if convulsions occur.
7- Maintain nutritional status because of the increase in the metabolic
rate brought on by fever, it is important that the patient maintains a
high caloric intake.
8- Supply supplement oxygen if the patient has preexisting cardiac or
respiratory problem.
♥ Hypothermia :
A condition in which temperature is abnormally lower than normal.
♥ Causes of Hypothermia :
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Lowered metabolism.
Decreased activity usually occur in elderly.
Heavy sedation.
Circulatory failure.
Exposure to extremely cold environmental temperature.
♥ Signs and symptoms of hypothermia :1- Pale skin.
2- Cyanosed lips.
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3- Cold hands and feet.
5- Goose skin.
7- Slow pulse rate.
9- Decreased physical and
mental capabilities.
4- Chilling.
6- Drowsiness.
8- Slow respiration.
10- Patient feels sleepy and
May become comatose.
♥ Nursing care of patient with hypothermia :1- Increase physical activity.
2- Warm the patient by :
Use of more blankets, extra clothes, heaters, hot application to the
skin such as hot water bottles and heating pads to the skin, friction
of body surface and warm food and drinks.
Pulse and Blood Pressure
At the end of this part student will be able to;
-Define pulse and blood pressure
-Explain factors affecting pulse and blood pressure
-Identify sites of blood pressure and pulse measuring
-Determine the normal rates of blood pressure and pulse .
-Deffrieniate between increase and decrease of pulse and
blood pressure
-Discuss factors affecting blood pressure and pulse
-Deffrieniate between increase blood pressure and
decrease blood pressure.
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Definition of Pulse :An alternate expansion and recoil of an artery as the wave of blood
is forced through it by the contraction of the left ventricle. It is felt by
palpating a superficial artery that has a bone behind it.
- Counting pulse is an indirect measure to asses heart
rate.
- Normally pulse rate is equal to heart rate.
Definition of Blood Pressure :It is the force or the amount of pressure exerted by the blood
against walls of the arteries when the left ventricle contracts.
Factors controlling Blood Pressure :1- Pumping action of the heart (myocardial strength).
a- Weak pumping --------- decrease in blood pressure.
b- Strong pumping action --------- increase blood pressure + full and
strong pulse.
2- Peripheral vascular resistance.
a- Small blood vessel caliber -------- increase blood pressure.
b- Large caliber of blood vessel --------- decrease blood pressure and
decrease in
volume of pulse.
3- Elasticity of Blood Vessels.
a- Decreased elasticity --------- increase in blood pressure as in old age
and
arteriosclerosis and weak pulse.
b- Relaxation of arteries as in case of shook --------- decrease in blood
pressure and
rapid weak pulse.
4- Blood Volume :
Decrease volume as in hemorrhage --------- decrease in blood pressure
and rapid
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Weak pulse.
5- Viscosity of Blood :
Viscosity of blood increases in case of decreased blood volume. Increase
in viscosity of the blood is an attempt to increase blood pressure.
Common Sites For Palpating the Pulse
● Radial Artery: at the wrist, is the most commonly used for palpating the
pulse rate,
Because it is easily accessible and it can pressed against the radius
bone.
● The superficial temporal artery in the temporal region.
● The external carotid artery in the neck.
● The subclavian artery, behind the inner end of the clavicle against the
first rib.
● The facial artery, about an inch forward of the angle of the jaw.
● The internal maxillary artery, in front of and slightly below the ear.
● The brachial artery, on the inner aspect of the upper arm about halfway
between the
Shoulder and the elbow.
● The femoral artery, in the mid – groin.
● The popliteal artery, behind the knee.
● The dorsalis pedis artery, blow the ankle on the dorsum of the foot.
♥ APICAL PULSE
A more accurate estimate of the heart beat, per minute. It is obtained by
listening with a stethoscope over the apex of the heart, between fifth and
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sixth rib about 3 inches (8 cm) to the left of the median line and slightly
below the nipple.
Assessment ,Recording and Reporting of Pulse :Assessment of pulse
Rate
Normal
60-90 b./m.
Rhythm
Force
Volume
Regular
Strong
Full
Abnormal
Tachycardia or
bradycardia
Irregular
Weak
Empty
Assessment of Blood Pressure
Normal blood Pressure
When the ventricle contracts, pressure of the blood in the arteries
become at its highest point this yields the upper systolic blood pressure
reading. When the ventricle relaxes. Pressure of blood within the arteries
becomes at its lowest point, this yields the lower or diastolic blood
pressure reading. Thus the reading is recorded as fraction.
=
Systolic
____________
Diastolic
Definition of Systolic Pressure :
It is the greatest amount of pressure exerted by the blood against
the walls of arteries during maximum ventricular contraction.
Definition of diastolic pressure:
It is lowest amount of pressure exerted by the blood against the
walls of arteries during the resting period of the heart i.e. during
relaxation of the ventricle.
Normal Range of Blood Pressure :
=
120 + 20
____________
mm Hg.
80 + 15
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Pulse Pressure :
Is the difference between systolic and diastolic blood pressure.
- Pulse pressure = Volume of pulse beat.
- e.g. if blood pressure is 130 mm Hg.
85
Pulse Pressure is (130 – 85 = 45 mm Hg.)
* The pulse pressure is normally from (30—50 mmHg.) it gives an idea
about the volume of pulse.
Abnormalities of Blood Pressure :
a-Hypertension: abnormal elevation of blood pressure. The increase in
blood pressure is symptom of a disease. It may be due to increase in the
force of the heart, peripheral vascular resistance, loss of elasticity of the
blood vessel.
The blood pressure is increased more than 120 + 20 mm Hg.
80 + 15
b- Hypotension: abnormal decrease in blood pressure, it may be due to
hemorrhage, shock wasting or debilitating diseases.
The blood pressure will be less than 120 - 20 mm Hg.
80 - 15
Factors Affecting Pulse and Blood Pressure
1- age
4-body built
7- obesity
2- sex
5-exercise
8- Anemia
3- Drugs
6-emotion
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RESPIRATION AND OXYGEN NEED
At the end of this part student will be able to;
-Define respiration
-Explain three basic activities must occur during
respiration
-Explain assessment of respiratory function
-Determine the normal rates of respiration.
-Deffrieniate between abnormalities in respiration
-Discuss factors affecting Respiration
-Explain recording of respiration
Normal means for meeting oxygen needs :Oxygen intake and elimination of carbon dioxide is achieved
through respiration.
Respiration : is the gas exchange between the individual and the
environmental air in which the individual takes in oxygen and eliminates
carbon dioxide and water vapor.
Three basic activities must occur during normal
respiration :1- Ventilation.
2- Diffusion of gases between blood and body cells.
3- Perfusion.
1- Ventilation :
Is the exchange of air between the atmosphere and the alveoli
within the lung. It consists of inspiration and expiration (respiratory
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cycle). This is achieved by pressure changes within the lung. Air moves
from higher pressure to lower pressure.
During inspiration ( Inhalation ) :
- The diaphragm contracts and moves down toward the abdomen.
- The intercostals muscles of the chest contract and pull the ribs up and
outward.
- This expansion of the thoracic cage decrease the pressure within the
lung than atmospheric pressure so air is drawn into the lung.
During expiration (Exhalation) :
- The muscle of the diaphragm is pushed upward.
- The intercostals muscles relax.
- The recoil of the elastic tissue within the lungs decreases the volume
increases the pressure within the alveoli so air is forced out of the lungs.
2- Diffusion of gases between the alveoli and the blood.
Is the exchange of the carbon dioxide ( Co 2 ) and oxygen ( O2 )
between the lung alveoli and the blood. It is the process of moving
oxygen into the alveoli of the lungs and its diffusion across the alveolar
membrane to the blood capillaries, while carbon dioxide diffuses from the
capillaries back to the alveoli and then outside to the atmosphere.
3- Transport of gases between blood and body cells (
perfusion ).
It is the transport and utilization of oxygen by cells and the
exchange of carbon dioxide or oxygen in the blood capillaries. The body
cells utilize oxygen for the production of heat through oxidation and
liberation of energy from food we eat.
Assessment of Respiratory Functions :
A normal respiration must be automatic, regular of normal rate
depth and rhythm, noiseless, painless and without effort. Can be achieved
through physical assessment and laboratory investigations.
1- Respiratory Rate :
Healthy adult breathes approximately 14 to 20 time or cycle/minute.
Abnormalities of Respiratory Rate :
Tachypnea or Polypnea :
It is a rapid breathing. The respiratory arte is above the normal level.
Bradypnea : It is a slow breathing. The respiratory rate is below normal
level.
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2- Normally Respiration is Painless Without Effort :
Dyspnea : Difficulty in breathing in any position.
Orthopnea : Difficulty in breathing in horizontal dorsal (lying) position.
Cyanosis : blue discoloration of skin and mucous membrane.
It is seen on lips, conjunctival sac of the eye, tips of the lopes. It is due to
defective oxygenation of the blood.
Factors Affecting Respiration :
1- Age.
2- Sex.
3- Exercises.
4- During digestion. 5- Emotion.
6- Discomfort and pain.
7- Drugs.
8- Changes in atmospheric pressure.
9- Hemorrhage.
10- Shock
11- Fever.
♦ Recording of vital signs :Special graphic flow sheets exist for recording vital signs, the nurse
identifies the institution's procedure for recording on the vital sings flow
sheet. In addition the nurse records in the nurses notes any accompanying
symptoms.
Medication Drug Administration
At the end of this part student will be able to;
-Define terms related to drug medication administration
-Explain factors affecting medication drug administration
-Describe routes of medication administration
-Determine parts of mediation order
-Describe five rights of medication
-Discuss clinical guidelines of medication administration
-Calculate drug formula
-Explain important abbreviation related to medication
administration
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Definitions : Medication : is a substance administered for the diagnosis, cure,
treatment, relief or prevention of disease.
 A prescription : the written direction for the preparation and
administration of a drug.
 Chemical names : is the name by which the chemist knows it.
 Trade mark : or brand name, is the name given by the drug
manufacture.
♥ Effects of Drugs :1- Therapeutic effect : - Is the primary effect intended or the reason
of the drug is prescribed.
2- Side effect : Is secondary effect that is united, are usually
predictable. It may be either harmless or potentially harmful.
3- Drug toxicity : Deterious effect of a drug on an organ or tissue
resulting from an over dosage.
4- A drug allergy : Is an immunologic reaction to a drug – severe
allergic reaction usually occurs immediately after the
administration of the drug is called anaphylactic shock.
5- A drug interaction : Occurs when the administration of one drug
before, at the same time, or after another drug alters the effect of
one or both drugs, drug interaction may be beneficial or harmful.
♥ Factors Affecting Medication Action :1- Developmental factors (Age)
2- Gender ( sex)
3- Diet :4- Environment
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6- Psychological Factors
7- Illness and Disease
8- Time of Administration.
Medication Orders :♥ Types of medication orders :1- A state order :- the medication is given immediately and only once.
2- The single order : is for medication to be given once at a specified
time.
3- The standing order : may or may not have a termination date such
as : multiple vitamins daily.
4- A prn order ( as needed order ) : permits the nurse to give drug
when the client require it.
♥ Routes of administrating drugs :1- Orally.
2- Sublingual.
3- Buccle.
4- Parenteral, such as SC, IM, ID, IV.
5- Topical as ointment, instillation and irrigations and inhalations.
♥ Essential parts of a drug order :1- Full name of the client.
2- Date of time the order is written.
3- Name of the drug to be administered.
4- Dosage of administration.
5- Rout of administration.
6- Frequency of administration.
7- Signature of the person write the order.
♥ Five rights of drug administration :1- Right drug.
2- Right dose.
3- Right time.
4- Right route.
5- Right client ( patient)
Clinical Guidelines In Administering Medication.
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1- Nurses who administer medications are responsible for their own
actions. Question any order that consider incorrect.
2- Be knowledgeable about medications you administer.
3- Laws govern the uses of narcotics and barbiturates keep these
medication s in locked place.
4- Use only medications that are in a clearly labeled container.
5- Do not use liquid medications that are cloudy or have changed
color.
6- Before administrating a medication, identify the client correctly
using the appropriate means of identification.
7- Do not leave the medication at the bedside.
8- If a client vomits after taking an oral medication report this to the
nurse in charge or the physician.
9- When a medication is omitted for any reason, record the fact
together with the reason.
10-When a medication error is made, report it immediately physician
or to the nurse in charge.
11- Hand washing before and after.
12- Observe for expiration date.
13- Do not mix two medicine together.
14- Do not give medicine that you don't prepare.
15- Have presence of mind when you give medicine.
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Abbreviations
Frequency :1- Q D : once a day.
2-B I D : two times a day.
3-T I D : three times a day.
4-Q I D : four times a day.
5-Q 4 H : every four hour.
6-Q 6 H : every six hour.
7- Q 8 H : every eight hour.
8-Q O D : every other day.
9- H S : hour of sleep or at bed time. 10- P R N : when necessary.
11- Stat : now, immediately.
♥ Calculation of Drugs :-
Formula :
D
Dose ordered
________ X (Q) = ____________ X Amount on hand
A
Dose on hand
= Amount to administer.
D = desired dose.
A = available dose.
Q = quantity.
((E. g.)) Pethidine : 50 mg. IM now from 75 mg ( A 2 cc ).
D
50 mg
________ X ( Q ) = ________
A
75 mg
100 mg
X 2 cc = ______ = 1.3 cc
75 mg
________________________________________________________
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Fluid and electrolytes
After end of this part student will be able to:
- Explain distribution and composition of body
fluids
- Describe movement of body fluids
- Identify regulation of body electrolytes and
fluids
- Note Normal rates of adults venous blood
- Describe factors affecting fluids and electrolytes
Introduction :Fluid, electrolyte and acid- base balances within the body
are necessary to maintain health and function in all body systems. These
balances are maintained by the intake and output of water and electrolytes
and regulates by the renal and pulmonary systems.
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Distribution of body fluids :Body fluid are distributed in two compartments :1- Intracellular fluid ( ICF ) : comprise all fluid within body cells,
approximately 40% of body weight .
2- Extra cellular fluid : is all the fluid outside a cell which is divided
into three compartments :
a- Interstitial fluid : is the fluid between the cells and outside
the blood vessels.
b- Intravascular fluid is blood plasma.
c- Tran cellular fluid consists of cerebrospinal, pleural,
peritoneal and synovial fluids.
Composition of body fluid :1- Electrolytes : is an element when
dissolved in water or another solvent
separates into :
a- Ions : is able to carry an electrical current. Negatively
charged electrolytes such as chlore and bicarbonates.
b- Cations : positively charged electrolytes such as sodium,
potassium and calcium.
2- Minerals : such as iron, zinc and
magnesium.
Movement of body fluids :1- Osmosis :- movement of pure solvent as water
through a semi permeable membrane from an area of
lesser solute concentration to an area of greater solute
concentration in an attempt to equalize concentration
on both sides of the membrane.
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2- Diffusion : is the movement of a solute in a solution
across a semi permeable membrane from an area of
higher concentration to an area of lower
concentration.
3- Filtration : is the process by which water and
diffusible substances move together in response to
fluid pressure from an area of higher pressure to an
area of lower pressure ( hydrostatic pressure ).
Regulation of body fluids :Body fluids are regulated by :1- Fluid intake :- is regulated primarily through the thirst mechanism.
The thirst control center is located within the hypothalamus in the
brain.
♥ Normal fluid intake= 1500ml-2500ml /day through :
a- Oral route either by mouth or NGT.
b- Food ingestion.
c- Parenteral fluid.
2- Fluid output : in the form of : urine
 insensible loss the skin as in expired air.
 Noticeable loss through the skin as sweating.
 Loss through the intestine in feces.
Normal urine output is 2500ml /day.
3- Hormonal control:- such as
♥ Ant diuretic hormone (ADH ).
♥ Aldosterone.
♥ Renin.
Regulation of electrolytes :Electrolytes generally are measured in
mill equivalents per litter (mEq/ L ) or mg/100mille litters.
Most electrolytes enter the body through dietary intake and excreted
in the urine, some electrolyte such as sodium and chloride are not
stored by the body ,it must be consumed daily to maintain normal
levels. While potassium and calcium are stored in the cells and bone
respectively.
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Function of electrolytes :1234-
Maintain fluid balance.
Regulate acid- base balance.
Facilitate enzyme reactions.
Neuromuscular reactions.
Normal electrolyte values for adult's venous blood :




Sodium :135--------145meq/L.
Potassium : 3.5--------5meq/ L.
Chloride :95-------105meq/ L.
Calcium : 4.5--------5.5meq/ L.
Phosphate : 1.8-------2.6meq/ L.
Factors affecting fluid and electrolyte balance :1234567-
Age.
Diet.
Environmental temperature.
Gastrointestinal loss.
Medications ( steroids, diuretics, IV therapy ).
Trauma ( burns, head injuries )
Chronic disease ( cancer, malnutrition ).
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Bowel Elimination
After end of this part student will be able to:
- Identify bowel elimination
- Describe factors affecting bowel elimination
- Identify common problems of bowel elimination
- Describe causes of bowl elimination disorders
- Discuss nursing role in bowel elimination
disorders
INTRODUCTION :Regular elimination of bowel waste products is essential for normal
body functioning. Alteration in elimination are often early signs or
symptoms of problems within either the gastrointestinal or another body
system.
Definition :Bowel elimination or defecation is the expulsion of feces from the
anus and the rectum. The frequency of defecation is highly individual
varying from several times per day to tow or three times per week.
♥ Factors affecting bowel elimination :1- Age.
2-Dite
4-Physical activity.
6-Personal habits (life style).
8-Pain.
3-Fluid intake.
5-Psychological factors.
7- Position during defecation.
9-Pregnancy.
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10- Surgery and anesthesia.
11- Medication.
12- Diagnostic tests.
♥ Common Bowel Elimination Problems :12345-
Constipation.
Diarrhea.
Fecal impaction.
Fecal incontinence.
Flatulence air of gases in the GIT.
I – CONSTIPATION :
 Causes :1234567-
Insufficient fiber in diet.
Decrease fluid intake.
Lack of exercise.
Medication.
Changes in life routine as pregnancy, travel.
Psychological of GIT.
Irregular defecation habits.
Management – ( Nurses role ) : 1- Increase fluid intake and fiber in diet.
2- Provide privacy and give enough time to defecate.
3- Change life style as drinking enough water, Juice, Eating fruit and
Vegetables and encourage daily exercise.
4- Don’t ignore the urge to defect.
5- Use of medication as ordered like laxatives.
6- Give enema as needed.
II – DIARRHEA :
Definition :Increase in the number of stools and the passage of liquid, unformed
feces.
Causes :1- Allergy to food causes irritation with the colon.
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Medication as some of antibiotics.
Food – borne diseases.
Psychological stress.
Some parasitic diseases.
Nurses role ( Management ) :123456-
Encourage taking balanced diet and avoid spicy food.
Increase fluid intake to prevent dehydration.
Clean the perineal area carefully and apply skin agent as needed.
Measure intake and output.
Administer anti diarrhea as ordered.
Take specimen for analysis.
Nurses role for bowel elimination alteration :1- Promoting normal defecation :* encourage patient to enter toilet (bathroom) when need.
* if patient unable provide bedpan and help him to sit on it.
* provide privacy to patient during defecation.
2- Medication : used to facilitate bowel elimination such as laxative and
enema used to control constipation while ant diarrheal preparations assist
the client in solving diarrhea.
3- Digital removal of stool patient with impaction through using your
finger to manipulate the feces in the rectum.
4- Teach patient bowel training program especially for patient with
incontinence.
5- maintenance of proper fluid and food intake.
6- Promoting regular exercise.
7- Maintain good skin care.
8- Educate patient about different types of food that used in constipation
and diarrhea.
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Urinary Elimination
After end of this part student will be able to:
- Identify urinary elimination
- Describe factors affecting urinary elimination
- Identify common disorders of urinary
elimination
- Identify urine production alterations
- Discuss nursing role in urinary elimination
disorders
Introduction :Normal elimination of urinary wastes is a basic
function of the urinary system. Kidneys remove wastes from the blood
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to form urine. Ureters transport urine from the kidneys to the bladder.
The bladder holds urine until the urge to urinate develops. client's with
alterations in urinary elimination may suffer emotionally from body
image changes.
Definition :Urinary elimination is the process of emptying the
urinary bladder. It called micturation, urination, voiding.
 Normal urine output :Urine output varies according to fluid intact but it
usually about : 30 – 50 Cc / hour
1500 – 2000 / day in adult.
♥ Factors affecting urinary elimination :1- Age.
2- Fluid and food intake.
3-Medication as diuretics
4- Muscle tone and activity.
5-Psychosocial factors
6- Pregnancy.
7-Disease of the urinary system. 8- Surgery.
♥ Altered urine production :1- Polyurea : Excessive excretion or urine E – G diabetes.
2-Oliguria : Decrease urine output, less than 500 ml / day.
3-Anuria : Absence of urine output, less than 100 ml / day.
♥ Altered urinary elimination :1- Dysuria : Painful or difficult urination.
2- Urinary Frequency : Voiding at frequent intervals more than
usual, due to increase fluid intake, urinary tract infection, stress and
pregnancy.
3- Urgency : Immediately need to void.
4- Hematuria : Presence of blood in urine.
5- Urinary incontinence : Involuntary urination.
6- Urinary retention : Accumulation of urine in the bladder
associated with inability of the bladder to empty itself.
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♥ Nursing Care For Patient Urinary Elimination :1- Maintaining normal urinary elimination :* Promote adequate fluid intake.
* Maintain normal voiding habits.
* Assist with toileting.
* Measure intake and output.
2- Preventing urinary tract infection :* Teach cleanliness of genital area.
* Do catheterization aseptically.
* Keep skin clean and dry.
* Good hygienic care for incontinent patient.
3- Educate patients about bladder training program.
4-Maintaining elimination habits : by providing patient time to void.
* Provide privacy for normal voiding.
* Use special measures that patient used to void easily as reading or
listening to
Music or water.
5- Medication : Drug therapy given alone or with other therapies can
help problems of incontinence or retention.
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Pain Management
After end of this part student will be able to:
- Identify Pain
- Describe types of pain
- Describe factors affecting pain perception and
pain response
- Identify classification of pain according duration
and location
- Discuss nursing care for pain
Introduction :Traditionally, pain has been viewed simply as a
symptom of an illness or condition, however pain itself is now considered
to be a separate disease.
Definition :Pain is subjective, highly unpleasant, very personal
sensation and emotional experience associated with actual or potential
tissue damage.
Types of pain :I - According to duration and intensity :a- Acute :- sudden pain, slow onset range from mild to sever and last for
short period of time.
b- Chronic :- last 6 months or longer and often limit normal functioning.
II – According to location ( part exparenad in the body ).
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a- Radiating pain as cardiac pain.
b- Referred pain as appendicitis pain.
c- Phantom pain as ambulated leg pain.
♥ Factor affecting pain perception and pain response.
1- Physiological factors such as :- Age
- Fatigue.
- Genes ( genetic information ).
- Neurological function as in DH or Neurological disease.
2- Social factors such as :-Attention (client focuses attention on pain can influence pain perception)
- Previous experience to pain.
3- Spiritual factors such as : - RELIGION.
4- Psychological factors such as : - anxiety, coping style.
5- Cultural factors such as meaning of pain, cultural beliefs and values.
♥ Responses to pain :1- Physiological responses.
* Increase heart rate.
* Increase blood pressure.
* Increase respiratory rate.
* increase blood glucose level.
* Diaphoresis.
* Dilatation of pupils.
* Muscular tension.
2- Behavioral responses include :* Typical body movements and facial expressions that indicate pain
include clenching the teeth.
* Holding the painful part.
* bent posture and grimaces.
* Shouting and crying.
♥ Management of Pain :1- Pharmacologic pain relieve such as :* Narcotic and analgesic.
* N S A I D (Non – Steroid – Anti – Inflammatory – Drug ).
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2- Non – Pharmacological pain relieve :a- Physical measures Such as :- positioning and hygiene.
* Cutaneous stimulation (touch).
* Massage.
* Heat and cold application.
* Transcutaneous electronic nerve stimulation.
* relaxation technique.
b- Cognitive measures such as :* Distraction technique.
* Guided imagery.
* Hypnosis.
NURSING CARE OF PAIN
Reassess verbal and non verbal cues frequently.
Change position and do massage.
Administer analgesic.
Acknowledge client pain.
Help in reducing client pain and anxiety.
Teach relaxation technique.
Teach distraction technique.
Apply hot cold compress when needed.
Personal Hygiene
After end of this part student will be able to:
- Identify Hygiene
- Describe factors affecting personal hygiene
- Identify types of personal hygiene
- Discuss nursing care for patients need personal
hygiene
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Definition :Hygiene is the science of health and its maintenance.
Personal hygiene : is the self – care by which people attend
to such
Functions as bathing, toileting, general body hygiene and
grooming.
It is important for nurses to know exactly how much assistance a client
needs for hygienic care, as hygiene is a highly personal matter determined
by individual values and practices.
♥ Factors Influencing Personal Hygienic Practices :1- Culture .
2- Body Image.
3- Religion .
4- Environment :.
5- Physical Condition . 6- Health and Energy :7- Personal Preferences
♥ Kinds of Hygienic Care :1- Early Morning Care :- Provided to client as they awaken in the
morning.
2- Morning Care :- Provided after client have breakfast.
3- Afternoon Care :- are given to refresh the patient in the afternoon.
4- As – Needed ( P R N ) Care :- Is provided as required by the
patient any time.
For any patient hygienic care include the following as needed : Skin care ( bathing – dressing – perineal care ).
 Feet care.
 Nail care.
 Mouth care ( oral care – teeth hygiene ).
 Eye care ( eyeglass care – contact lens care ).
 Nose care.
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Purpose ( GOALS ) of Hygienic Care :Provide comfort and relaxation.
Improve self image.
Remove microorganisms and secretions.
Stimulate circulation.
Supporting a Hygienic Environment :The following measures must be taking into consideration for supporting
a hygienic environment : Room temperature : a suitable temperature is comfortable for most
patents.
 Ventilation : good ventilation is important to remove odors and
stale air.
 Noise : ill persons are usually sensitive to noise so nurses should
try to control noise in health care setting.
 Hospital beds : must be designed to permit the head and foot to be
elevated separately and provide comfort so the hospital beds must
include :- Mattress that covered with water resistant material.
- Bed rails to protect the patient from falling.
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Skin Integrity care
After end of this part student will be able to:
- Identify skin importance to the body
- Identify skin integrity
- Describe function of skin
- Identify skin disorders with patients admitted to
the hospital
- Describe factors affecting skin integrity
- Discuss nursing care of impaired skin integrity
and bed sores
Introduction :The skin is the largest organ in the body and serves a
variety of important function in maintaining health and protecting the
individual from injury.
Function of the skin :-
defg-
4- It protect the underlying tissues from injury by
preventing the passage of microorganisms.
5- It regulate the body temperature.
6- It secretes sebum, an oily substance that :Softens and lubricates the hair and skin.
Prevent the hair from becoming brittle.
Decrease water loss from the skin when external injury
occurs.
Sebum also has a bactericidal action.
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7- It transmit sensations through nerve receptors which
are sensitive to pain.
8- It produce and absorb vitamin (D ) in conjunction
with ultra violet rays from the sun.
Skin Integrity ( Intact skin ) :Intact skin refers to the presence of normal skin and skin layers
uninterrupted by wounds.
Factors affecting skin integrity :




1- Internal factors such as :
Genetics and heredity.
Age.
Chronic illness and their treatment.
Some medications such as corticosteroids.
Poor nutrition.
2- External factors such as activity and exercise
Methods used to maintain skin intact :1- Bed bath.
2- Back care and massage.
3- Heat and cold application.
4- Dressing wounds.
Impaired skin integrity
♦Pressure ulcers :Is also called decubitus ulcer. Pressure sores or bedsores.
Definition :- A pressure ulcer is any lesion caused by unrelieved pressure
that results in damage to underlying tissue..
Sites of pressure ulcer :-
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Bony prominences area such as sacrum, coccyx,
shoulders, back of head, elbows, hips, heels, lumber region, ankle and
rest.
Factors that help in developing bedsores :
1-Moisture : due to urine and stool, prolonged wetting of the
skin reduce the resistance of skin to bacteria.
2- Hygiene :- poor hygiene will increase the number of
bacteria.
3- Poor nutrition : such as anemia, low protein level increase the
possibility of developing pressure ulcer.
4- Immobility : the development of pressure ulcer is directly
related to the duration of immobility.
Patient's at risk of developing pressure ulcer :1- Paralyzed patient.
2- Unconscious patient.
3- Malnourished patient whose diet is insufficient in protein and vit
C.
4- Obese patient.
5- Patient with urinary and stool incontinence.
6- Patient with circulatory system problems.
7- Elderly patient.
Treatment of pressure ulcer :Minimize direct pressure on the ulcer, change patient's position
every two hours.
Clean pressure ulcer daily using aseptic technique.
If the pressure ulcer is infected, obtain sample of drainage for
culture and sensitivity to antiseptic agents.
Use pressure relieving devices such as egg crate mattress.
Teach patient to move to relieve pressure.
Encourage ambulation or sitting in a wheelchair.
Provide range of motion exercise when the patient's condition
permits.
Provide proper nutrition.
Maintain skin clean.
Prevention of pressure ulcer :6- Inspect skin at regular interval to obtain base line data.
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7- Keep skin clean and dry and avoid moisture.
8- Instruct patient to change position if conscious or change every
two hours if unconscious.
9- Use appropriate pressure reliving devices such as air mattress.
10Bed linen should be free from any wrinkles.
11Increase circulation by reposition and massage to the
unaffected area.
12Good nutrition which involve vit C and protein.
13Teach patient's and their families about causes of pressure
ulcer and the importance of skin care.
Nutrition
After end of this part student will be able to:
- Identify nutrition importance
- Describe basic element of food
- Identify types of diet
- Discuss factors affecting nutritional status
- Describe alternative methods of feeding
- Explain nursing responsibilities in nutrition
-
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Introduction :Nutrition consider as a sum of all the interaction
between an individual and the food consume.
Definition :Nutrition is the food which people eat and how their bodies
use it.
Importance of nutrition to our bodies :1- The body requires fuel to provide energy for organ function and
body movement.
2- Maintain body temperature.
3- Maintenance and repair of body cells.
4- Provide raw materials for enzyme function.
5- It is basic for reproduction and lactation.
Basic elements of food :123456-
Carbohydrate .
Protein.
Fat.
Vitamin.
Minerals.
Water.
Types of diet :5- Regular or normal diet : don't have special meal, it is
comparable to adequate diet.
6- Soft or light diet : easily chewed and easily digested.
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7- Liquid diet : only liquid or food that turn to liquid, it may be
:a- Full liquid as milk.
b- Clear liquid as water and tea.
2- Special diet :- used to treat a disease process such as :a- Diabetic diet for diabetic patient
b- Low salt diet for hypertensive patient
c- Low protein diet for patient with renal failure.
d- Low fat diet for patient with high cholesterol.
e- Small frequent meal for patient with vomiting.
f- Low caloric diet for overweight patient.
♥ Factors Affecting Nutritional Status :123456-
Age – related gastrointestinal changes that affect digestion of food.
Adverse effects of medications such as anorexia.
Beliefs about food.
Religious practices.
Psychological factors.
Disease as chronic diarrhea, malnutrition, colon disease peptic
ulcer.
♥ Alternative Methods Of Feeding :1- Vegetarian diet : is the consumption of a diet consisting of plant
foods.
2- N G T feeding ( Gavage feeding ) instillation of especially
prepared food into the digestive tract through the tube.
3- Gastrostomy feeding : instillation of liquid through the abdominal
wall into the stomach ( by surgery ).
4- Parenteral feeding : I V method.
 TPN : Total parenteral nutrition : is a mixture of 10 – 50 %
dextrose in water,
amino acid, Vitamins, minerals and trace elements.
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♥ Nursing Responsibilities :2- Health teaching about healthy food, daily food elements
requirement.
3- Observe signs of good nutritional status that include normal body
weight, height and body mass index, general condition and skin.
4- Stimulating the patients appetite through : Providing familiar food
that the person likes.
- Relieve illness symptoms by giving analgesic or antipyretic.
- Avoid unpleasant or uncomfortable treatment before or after meal.
- Provide tidy and clean environment.
- Provide oral hygiene.
4- Be sure that the patient take his recommended meal.
5- Assist patient's to take his meal especially :- elderly patient.
- Handicapped patient.
- immobilized patient.
6- Providing enteral nutrition as ordered.
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