1. By: RandelDalauta, RN
www.nursendoutfield.blogspot.com

2. Nurse Maria Olivia engages in activities of teaching a client to protect an incision and change a surgical dressing and assisting handicapped individuals to attain the highest level of physical strength to which they are capable. Olivias health care activities focuses on:
Nursing action help client maintain health status
Helping people improve following a health problem or illness
a. Health maintenance
b. Health restoration
Develop resources to maintain well being
c.Health promotion
d. Health care of the dying
Hospice care
(comfort & Caring
3. 2. Nurse Supervisor jacqueline assigns Nurse Abegail to give comprehensive care to a group of maternity clients with pregnancy induced hypertension during her 8 hours shift. The model for the delivery of nursing care as exemplified in this situation is:
Advantages:

Nurseassumesa responsibility

for a certain task

Task focused; not client focused

4. Nurse is highly competent w/ less complex care requirements
Disadvantage:

Fragmentation of care

24/7 care or 1 on 1

1 nurse responsible for total care of

client

solely accountable & responsible

5. role of other nurse: continue plan made by the main nurse during
break/off
client centered
Advantages:

Case focused

6. Care from admission to discharge 7. Classification of cases handleda. with specific physician
b. geographical proximity to unit
c. by diagnosis
Disadvantage:

discrimination of care

a. Functional Method
b. Primary nursing
c.Case Method
collaboration

solution to functional nursing

8. individualized care by team,members: a. RN-headc. Nurse aid
b. Practical Nurse
Disadvantage: team lacks qualified personnel, always require supervision;
Also non continuity of care
d. Team Nursing
9. Doctrinal Conversion Model(Davis 1966)
I. Initial Innocence
II. Labeled recognition of incongruity
- identify, articulate& share concerns
III. Psyching out and role simulation
- identify behavior expected to demonstrate
IV. Increasing role simulation
Provisional Internalization
- choose between previous & current
VI. Stable Internalization
- behavior reflects educational &professional approved
model
10. Nursing Roles
Cant
Catch
The
Cat
Coz
Catwoman
Loves
Me,
Run
Cat
Cat!
CareGiver
Communicator
Teacher
Councilor
Clients Advocate
Change Agent
Leader
Manager
Researcher
Case Manager
Collaborator
11. Nursing Theorist
FLORENCE NIGHTINGALE
Environmental Adaptation Theory
21 Nursing Problems
FAYEGLENN ABDELLAH
14 Basic Needs
HENDERSON, VIRGINIA
Behavioral Systems Model
DOROTHY E. JOHNSON
Goal Attainment Theory
IMOGENE KING
Trans-cultural Nursing
MADELEINE LEININGER
MYRALEVINE
Four Conservation Principles
BETTY NEUMAN
Health Care Systems Model
Self Care Theory, Self Care Deficit Theory
DOROTHEA OREM
12. Nursing Theorist
IDA JEAN ORLANDO
Nursing Process Theory or Dynamic Nursing
Helping Art Theory of Clinical Nursing
ERNESTINE WEIDENBACH
Human Caring Model
JEAN WATSON
Interpersonal Model
HIDELGARD PEPLAU
Science of Unitary Human Being
MARTHA ROGERS
Adaptation Model
SISTER CALLISTA ROY
LYDIA HALL
Care, Core, Cure Theory
ROSEMARIE RIZZO PARSE
Theory of Human Becoming
Stages ofNursing Expertise/Novice to Expert
PATRICIA BENNER
13. Models Of Health
1. Clinical Model (smith) health is absence of signs &
symptoms of disease or injury
2. Ecological Model (leavell & clarks) relationship of
humans to the environment
3 elements
a. the host
b. the agent
c. the environment
3. Role Performance Model (smith) ability to fulfill
societal roles even if clinically ill
(parsons)-state of optimum capacity for the effective
performance of roles & task
illness inability to perform ones work
14. 4. Adaptive Model (smith & roy)
principle: humans are continuously adapting to their
environment
- disease is a failure in adaptation
5. Eudaemonistic Model (maslows)
- health is a condition of actualization/realization of persons potential
15. Stages of Illness (suchman)
Symptom Experiences starts to believe something is wrong
Assumption of the Sick role acceptance of sick role, Seek help signs and symptoms is real
Medical Care Contact seek professional advice, assurance one is alright
4. Dependent Patient Role client becomes dependent on professional help,Regression
5. Recovery and Rehabilitation gives up sick roleand return to former old self.
16. Blood pressure
17. Blood pressure
Facts:
Position arm at heart level, extend elbow with palm turned upward
Apply cuff snugly and smoothly over upper arm, 2.5 cm (1 inch) above ante-cubital spacewith center of cuff over brachial artery
Inflate cuff to 30 mm Hg above point where palpated pulse disappears
Deflating cuff at a rate of 23 mm Hg per second, noting reading when pulse is felt again and when it finally disappears
Remove cuff or wait 2 minutes before taking a second reading
Do not take an apical blood pressure on an arm with an AV shunt, IV, or if the client has a history of surgery or injury to the breast, axilla, or arm.
Length ofbladder should long enough to cover at least 2/3 of limbs
Width of cuff must be 40% of the limbs circumference
18. Blood pressureSelected Sources of Error in Blood Pressure Assessment
19. Otoscopic Examination
Purpose: a procedure that
a. examine the auditory canal and tympanic membrane for infection
b. examine for blockage due to the presence of a foreign object or build up of wax
c. forthe tympanic membrane for signs of rupture, puncture, or hearing loss,
d. the canal for any variations from normal. Note: some otoscopes can deliver a small puff of air to the eardrum to determine if the eardrum will vibrate (which is normal)
Preparation?
No PreparationRequired
Normal:
Auditory canal: Some hair, often with yellow to brown cerumen.
Ear drum:
Pinkish gray in color , translucent and in neutral position.
Malleus lies in oblique position behind the upper part of drum.
Mobile with air inflation.
20. Breast
21. Rombergstest
a test used by doctors:
a .neurological examination, and also as;
b. test for drunken driving.

procedure:

1. patient stands with feet together, and maintains balance with eyes
open
2. eyes are then closed.
3. loss of balance with the eyes closed is a positive, abnormal response.

Result findings:

1. (+) Romberg test suggests that the ataxia is sensory in nature
2. (-) Romberg test suggests that ataxia is cerebellar in nature
22. Interviewplanned communication or a conversation
Types:
a. Directive
- highly structured
- elicits specific information
-nurse establishes the purpose of the interview
-nurse controls the interview
-used during limited time (emergency)
disadvantage: client has limited
b. Non-directive
-aka rapport building interview
-nurse allows the client the purpose, subject matter, & pacing
most appropriate: combination of both type
23. 24. 25. 26. Blood
Albumine 3.5-5 g/dl
COP Edema
H2O 90%
Globuline
Antibody Formation
Plasma55%
CHON 10%
Waste /Electrolytes
Fobrinogen
Clotting Factor
Pro-thrombine
Blood
5 L TBW
Formed
Elements 45%
RBC 4.5 5.5M/mm
formation thru Erythropoiesis
Platelet 150-450T/mm
role clotting - Hemorrhage
WBC 5-10T/mm
immune responses
Basophils0-1% for inflamation
1. Granulocytes
Eosinophils1-6% for allergic rxn
Neutrophils50-70 1st to arrive
Monocytes2-6%
2.Agranulocytes
T cells
Lymphocytes 25-25%
B cells
27. Fluids
16 % TBW
Interstitial Fluid
ECF
Plasma
4% TBW
20% TBW
28. 29. 30. 31. Enema
Prepare the solution, assure temperature within range of 99 to 102F by using a thermometer or placing a few drops on your wrist.
Wash hands and don gloves.
Assist patient to left side-lying position/sims, with right knee bent.
Hang bag of enema solution 12 to 18 inches above anus.
Lubricate 4 to 5 inches of catheter tip.
Separate buttocks, insert catheter tip into anal opening, slowly advance catheter approximately 4 inches.
Slowly infuse solution via gravity flow
If client complains of increased pain or cramping, or if fluid is not being retained, stop procedure, wait a few minutes, then restart
Clamp tubing when fluid finishes infusing; remove catheter tip.
Assist client to bedpan, commode, or toilet;
32. Enema
If enema till clear is ordered, no more than 3 L fluid should be administered in any one series of enemas. Repeated enemas produce irritation of bowel mucosa and perianealarea, as well as electrolyte loss and exhaustion. If returns are not clear, consult physician for further instructions.
33. 34. Colostomy
Normal stoma: red or pink
- Pale pink
- Purple-black
Fecal matter should not be allowed to remain on the skin
Empty pouch when half to one-third full
Avoid gas-forming foods
Avoid irrigating colostomy
35. Colostomy
Irrigation
to empty the colon of feces, gas, or mucus, cleanse the lower intestinal tract, and establish a regular pattern of evacuation so that normal life activities may be pursued.
performed at the same time each day, preferably 1hr after a meal
lie on side/sit on the toilet itself
500 to 1500 mL of lukewarm tapwater
hung 18 to 20 in above the stoma (shoulder height when the patient is seated)
Insert the catheter no more than 3 inches
Never force the catheter!
Allow tepid fluid to enter the colon slowly. If cramping occurs, clamp off the tubing and allow the patient to rest before progressing.
36. Colostomy
37. Centigrade vs Fahrenheit
Rule:
1. Centigrade to Fahrenheit
multiply by 1.8 and add 32
2. Fahrenheit to Centigrade
subtract 32 and divide 1.8
Solution:
99.8F = ____C
(maliit to malaki = multiply & add)
(malaki to maliit = subtract & divide)
(99.8 32 / 1.8)
37.7
38. Nasogastric Tube
Insertion:
- NEX
- High Fowlers position
- Sips of water and advance tube as client swallows
- Do not force the tube!
Confirm placement of NGT
Monitor and record residual volume q4h by aspirating stomach content with a syringe. A residual volume of >100-150 ml indicates delayed gastric emptying. Notify MD.
During and after feeding keep HOB 30 degrees to prevent aspiration; For continuous feedings, keep the patient in a semi-Fowlers position at all times
Flush/Irrigate tube feeding with 30-60ml of PNSS q4h during continuous feeding, before and after each intermittent feeding, before and after administering meds, after each time you check residual volume
Feeding set changed q24h. Bag rinsed q4h.
39. QUESTION?