FUNDAMENTALS OF NURSING  Sink

PRACTICE (SKILLS)  To effectively reduce the growth germ

on hand, medical handwashing must last
HANDWASHING 40-60 seconds.
 To prevent infection from others SURGICAL HANDWASHING
DEFINITION:  Process of removing or decreasing, from
the hands and the forearms as a many
 A vigorous short rubbing together of all
number of bacterial count and resident
the surfaces of soap lathered hands
skin flora as possible to a safe level of
followed by rinsing under stream of
surgical acceptance by MEDICAL
running water.
BRUSH with the help of SCRUB
 Single most important and basic BRUSH and with a CHEMICAL
preventive technique for possible ANTISEPTIC SOAP.
infection process.
PUROSE OF SURGICAL
PURPOSE OF HANDWASHING:
HANDWASHING:
1. To reduce the number of microorganism
-To remove soil and more transient
to hands.
microorganism from the skin.
2. To prevent possible transfer of
microorganism to clients. TWO (2) SURGICAL SCRUB PROCESS
3. To reduce risk of cross-contamination
among clients. 1. MECHANICAL SCRUBBING
4. To reduce risk of transmission of
infections organism to oneself. -Removes microorganism by friction and reduce
resident flora and bacterial count from the skin.
WHY SHOULD CLEAN YOUR HANDS
2. CHEMICAL PROCESS
1. To protect your patient
2. To protect yourself - This process inactivates microorganism with
chemical antiseptic or an antimicrobial agent.
ACCORDING TO WHO, THERE ARE:
- This presents growth of a microorganism by its
5 MOMENTS OF HAND HYGIENE
antiseptic action but may not kill organism
1.Before touching the patient
EQUIPMENTS:
When: Before you touch patient, clean your
 Brush
hands
 Sink with faucet and running water
Why: To protect the patient against harmful  Liquid soap
germs carried on your hands  Sterile water
STEPS:
2.Before clean or aseptic procedure
A. Scrub the nail of the hands – 30 strokes
Why: To protect the patient from harmful
B. Scrub the palm of the hands – 10 strokes
germs, including the patient from entering
C. Scrub the back of hand – 10 strokes
his/her body.
D. Scrub side of each finger – 10 strokes
3. After body fluids exposure risk/after E. Scrub the forearm – 10 strokes
glove removal
4. After touching patient
5. After touching a patient’s NURSING PROCESS
surrounding
 Critical thinking five-step process that is
EQUIPMENTS: professional nurses use to apply the best
available evidence to caregiving and
 Liquid soap/soap bar with soap dish
promoting human functions and
 Hand towel responses to healthiness.
 Tissue paper
  FUNDAMENTAL BLUEPRINT for 1. Collection of information from primary
how to care for a patient. source (a patient) and secondary sources
 Sytesmatic, rational method of planning (family, friends, health professionals).
and providing individualized nursing 2. The interpretation and validation of data
care. to ensure a complete database.
 INDIVIDUALIZED NURSING SOURCES OF DATA
CARE – each patient have different
needs. 1. CLIENT
PURPOSE OF NURSING PROCESS  Best source of data unless client is to ill,
young, confused to communicate
1. To identify the health status of the clearly.
patient.  They can provide subjective data that no
2. To identify the actual or potential one else can offer.
problem of the patient. 2. SUPPORT PEOPLE
3. Establish plans to make identify need  Family members, friends, caregivers,
4. To deliver (kueang da) who know the client well often can
supplement or provide information
Patient – centered care approach
provided by the client.
 Holistic and essential when applying  Are important source of data for a client
nursing process who is very young, unconscious and
confused (mental or with Alzheimer’s)
 Enhances patient assessment and
3. CLIENT RECORDS
education, family, centeredness, patient
adherence to interventions and patient  Information document by various health
outcomes care professionals like medical records
and laboratory records/results.
 Recognizing a patient as a source of
control WHERE SHOULD YOU BEGIN?
5 STEP NURSING PROCESS 1. Start by taking a quality time to the
patient even in a few minutes.
1. ASSESS
2. DIAGNOSIS  Establish a nurse-patient therapeutic
3. PLAN relationship allows you to know a
4. IMPLEMENT patient to your unit, during rounds
5. EVALALUTE – determine if the goal when you begin a shift of a care, or
any encounter with a patient.
NURSING ASSESSMENT  CUE – Is information that you obtain
through the use of sense (what you can
WHAT IS ASSESSMENT? see, feel, touch)
 INFERENCE – Is your
 Deliberate and systematic collection of
judgment/interpretation of these cues.
information about a patient to determine
the patient’s current and past health and PRIMARY SOURCES OF DATA
functional status and his/her present and
past coping pattern. 1. SUBJECTIVE
 Assess every time because it may have  Referred as symptoms
changes.  Verbal description of the patient
 Continuous collection carried out during on their health problems
all phases of nursing process 2. OBJECTIVE
 Continuous collection, organization,  Referred as signs
documentation of data.  Are observations and measurements
of a patient’s health status.
NURSING DIAGNOSIS

 Clinical judgment made on the basis of

TWO(2) STEPS OF NURSING information concerning a human
ASSESSMENT response to health conditions/life
process or vulnerability.
  SECOND STEP OF NURSING 2. IMPAIRED – made worse, weakened,
PROCESS damaged.
 Client’s problem statement, consisting 3. DECREASE – lesser in size
of the diagnostic label plus etiology 4. INEFFECTIVE – not producing the
(causal relationship between a problem desired effect
and its related risks factors) 5. COMPRIMISED – To make
vulnerable to threat
TYPES OF NURSING DIAGNOSIS
3.PLANNING
1. ACTUAL DIAGNOSIS
 Client problem is present at the time of -A deliberative, systematic phase of nursing
the nursing assessment.
- Formulate goals and expected outcome to
 Describe a clinical judgment concerning
a undesirable human response. prevent, reduce or eliminate the client’s health
 Defining characteristics (observable problem.
assessment cues such as patient PATIENT-CENTERED GOAL
behavior, physical sign)
 Includes related factor – etiological/  Reflects a patient’s highest possible of
causative factor wellness and independence in function.
 Actual diagnosis includes a related  It is realistic and based on patient’s
factor is an etiological/causative factor needs, abilities and resources.
for diagnosis.  GOAL – described a desired change in
2. RISK-NURSING DIAGNOSIS a patient’s condition, perceptions, or
 Clinical judgement that a problem does behavior.
not exist, but the presence of risk factors  GOAL MUST BE SMART
indicated that a problem is likely to
develop unless nurses intervene SPECIFIC – Need to be precise; direct
 A clinical judgement concerning the to the point
vulnerability of an individual, family,
group or community for developing an MEASURABLE – Need to measure or
undesirable human response to health observe if change take place in patient’s
conditions. status.
 These diagnosis do not have defining
ATTAINABLE – A goal and outcome
characteristics or related factors because
likely are attainable when mutually set
they do not occurred yet.
with the patient.
 Has risk factors (the environment,
physiological, genetic or chemical REALISTIC – Set goals and expected
elements) that place a person at risk
outcomes that a patient is able to
factor for a health problem.
realistically reach.
 Ex. Risk for infection
3. HEALTH PROMOTION TIME-BOUND – Each goal and
DIAGNOSIS outcome is time limited so the health
 Relates to client’s preparedness to care team has common time frame for
implement behaviors to improve their problem solution.
health condition.
 Concerning a patient’s motivation and Expected outcomes – provided the
desire to increase well being and actual desired physiological, social
human health problems. development or spiritual responses that
 You make this type of diagnosis when indicate resolution of the patient’s
patients in any health state. health problem.
 Ex. Readiness for enhanced nutrition.
SHORT-TERM GOAL – Is an
QUALIFIERS – words that have been added to
objective behavior/ response that you
some NANDA labels to give additional meaning
expect a patient to achieve in a short
to the diagnostic statement.
time, usually less than a week in an
1. DEFICIENT – inadequate in amount. acute care setting, you often set goals
for over a course of just FEW HOURS.
 LONG-TERM GOAL- Longer period,  A statement of high risk or actual
usually several days, weeks or month. problems in the client’s health status.
Timeframe help you and patient
MEDICAL DIAGNOSIS
determine if the patient is making
progress at a reasonable rate.  Deals with condition or pathology.
4. IMPLEMENTATION
 Action phase in which the nurse perform
the nursing intervention.
 4th, formally begins after you develop
the care
 Render the nursing intervention PUPOSE OF NURISNG DIAGNOSIS
 INDEPENDENT –
Interventions you give to patient 1. CLIENT
without the doctor’s order. Ex.  Individualization of care, appropriate
Vital sings selection of interventions, establishment
 COLLABORATIVE – Needs goal.
the doctor’s order. 2. NURSE
Ex. Medicine  Facilitate communication,
5. EVALUATION documentation and continuity of care
 FIFTH (5TH) SHAPE among health care providers.
 Planned, ongoing purposeful activity in
THREE PARTS STATEMENT OF
which the client and healthcare
NURSING DIAGNOSIS
professional determine:
a. The client’s progress toward 1. PROBLEM (P) – Statement of the
achievement of client’s response (NANDA label)
goals/outcomes 2. ETIOLOGY (E) – Factors contributing
b. Effectiveness of the nursing to or probable causes of the response.
care plan. 3. SIGN AND SYMPTOMS (S) –
-Ongoing process that occurs whenever you Defining characteristic manifested by
have contact with a patient once you deliver an the client.
intervention, you continuously examining results #________________r/t_______aeb____
by gathering SUBJECTIVE AND
OBJECTIVE DATA from family, patient and
healthcare team member.
ABC- ALWAYS BREATHING
- Start once you start to render nursing CIRCULATION
intervention.
DOB- DIFFICULTIES OF BREATHING
EVALUATION:
Ex. Impaired breathing pattern related to (r/t)
1. GOAL WAS MET – The client accumulation Ō (of) secretion aeb difficulty of
response is the same as the desired breathing (DOB), wheezing and episode of
outcome. productive cough.
2. GOAL WAS PARTIALLY MET –
Either a short-term outcome was Example:
achieved or the long term was not, or the
#1: paint r/t crushed tissue aeb patient complains
desired goal was incompletely.
3. GOAL WAS MET – No charge with of pain 7/10 and facial grimacing when moving
the patient’s condition. arm.

NURSING CARE PLAN #2: Risk for injury r/t generalized weakness.

NURSING DIAGNOSIS HOW TO CREATE NCP

 Deals with human response 1. DATA: “diagnosis of COPD

 Rot medical diagnosis exacerbation”
 s/sx: wheezing on bilateral upper lobes After 3hrs, the patient will have
during expiration tolerable pain aeb patient having pain scale of
2/10 or lower to the right upper quadrant of the
 O2 saturation of 90% abdomen.
 Patient respiration is 266pm
VITAL SIGNS:
-Ineffective airway clearance r/t inflammation of
airways secondary to COPD aeb patient having  Body temperature
wheezing on bilateral upper lobes during  Pulse rate
expiration O2 saturation of 90% and patient
 Respiratory rate
having respiration of 260bpm.
 Blood pressure
 Pain assessment
In rationale – you explain the disease
BODY TEMPERATURE – reflects the balance
 Define based on the symptoms of the between the heat produced and the heat from the
patient. body, and is measured in heat units called
degrees.
2.DATA: “S/P laparoscopic cholecystectomy
patient complaining 8/10 acute aching pain to PURPOSES:
the right upper quadrant of the abdomen.
1. To establish baseline data for
Diagnosis: subsequent evaluation.
2. To identify whether the core
 Acute pain r/t status (post removal of the temperature is with the normal range.
gallbladder) aeb patient complaining 3. To determine changes in the core
8/10 acute aching pain to the right upper temperature in response to specific
quadrant (RUQ) of the abdomen. therapies (e.g antipyretic medication
(paracetamol), immunosuppressive
RISK FOR ND: therapy (pampanaba it immune system
Data: Patient has history of HPN and patient- for cancer patients), invasive pressure)
4. To monitor clients at risk for imbalance
having multiple BP medications.
body temperature (e.g clients at risk for
Medications are: Narrasic 5mg OD, Atenolol infection or diagnosis of infections,
25mg BND Clonidine 75mg, 8L 964 prn for BP those who have been exposed to
> 160/90mmHg vital signs are 130/70 with pulse temperature examples)
of 88bpm 2 KINDS OF BODY TEMPERATURE

Risk for fall r/t side effects of multiple blood 1. CORE TEMPERATURE – Is the
pressure medications. temperature of the deep tissues of the
body, such as the abdominal cavity and
General: goal pelvic cavity; it remains relatively
constant.
 After 4 hours, the patient will have
2. SURFACE TEMPERATURE Is the
effective airway clearance.
temperature of the skin, the
subcutaneous tissue, and fat. By
contrast, rises and falls in response to
Specific: the environment.

 Having clear lung sounds on bilateral HEAT BALANCE - When the amount of
upper lobes during expiration heat produced by the body equals the
 Patient having O2 saturation of greater amount of the heat lost
than 94% and patient having 16-2bopm
5 FACTORS THAT AFFECT THE
Acute pain r/t status post surgical removal of the BODY’S HEAT PRODUCTION
gallbladder aeb patient complaining of 8/10
acute aching pain to the right upper quadrant of 1. BASAL METABOLIC RATE –
the abdomen. Required to maintain essential activities
 2. MUSCLE ACTIVITY – Includes vaporization accounts for greater heat
shivering; increases metabolic rate loss.
3. THYROXINE OUTPUT – Increased
4 METHODS OF HEAT LOSS:
thyroxine output increases the rate of
cellular metabolism throughout the 1. RADIATION
body. 2. CONDUCTION
4. EPINEPHRINE, 3. CONVECTION
NOREPINEPHRINE, AND 4. EVAPORATION
SYMPATHETIC
STIMULATION/STRESS REGULATION OF BODY TEMPERATURE
RESPONSE – These hormones
immediately increase the rate of cellular  The system that regulates body
metabolism in many body tissues. temperature has three main parts:
5. FEVER – increases the cellular o Sensors in periphery and in the
metabolic rate and thus increases the core
body’s temperature further. o Integrator in the hypothalamus
o Effector system that adjusts the
production and loss of heat.
HEAT – Is lost form the body through radiation, Most sensors or sensory receptors are in the
conduction, convection, and evaporation. skin. The skin has more receptors for cold than
warmth.
RADIATION – Is the transfer of heat from the
surface on one object to the surface of another When skin becomes chilled over the
without contact between the two objects, mostly entire body, three physiological processes to
in the form of infrared rays. increase the body temperature take place:
CONDUCTION – Is the transfer of heat form 1. Shivering – increases heat production
one molecule to a molecule of lower 2. Sweating – inhibited to decrease heat
temperature. loss
3. Vasoconstriction – Decreases heat loss
 Cannot take place without contact
between the molecules and normally Hypothalamic integrator – the center that
account for minimal heat loss, except for controls the core temperature.
example when a body is immersed in
cold water. The amount of heat  When the integrator detects heat, it
transferred depends on the temperature sends out signals intended to reduced
difference and the amount and duration temperature, that is to decrease the heat
of the contact. production and increase heat loss.
 In contrast, when the cold sensors are
CONVECTION – Is the dispersion of heat by stimulated, the integrator sends out
air current. signals to increase heat production and
decrease heat loss.
 The body usually has a small amount of
warm air adjacent to it. This warm air FACTORS AFFECTING BODY
rises and is replaced by cooler air, so TEMPERATURE
people always lose a small amount of
heat through convection. 1. AGE – Infants are greatly influenced by
the temperature of the environment.
EVAPORATION – Is continuous vaporization Many older people particularly those
of moisture from the respiratory tract and from over 75 years, are at risk of
the mucosa of the mouth and from the skin. HYPOTHERMIA (temperature below
36◦C, or 96.8◦F)
 INSENSIBLE WATER LOSS – 2. DIURNAL VARIATIONS (circadian
Continuous and unnoticed water loss rhythms) – Body temperatures normally
 INSENSIBLE HEAT LOSS – change throughout the day, varying
Accompanying heat loss; accounts for much as much as 1.0◦C (1.8◦F)between
about 10% of basal heat loss. When the the early morning and the late afternoon.
body temperature increases,
 -The point of highest body temperature Hyperthermia (in lay terms), FEVER.
is usually reached between 1600 and
1800 hours (4-6PM) Hyperpyrexia – high fever, such as 47◦C
-The lowest point is reached during (105.8◦F)
sleep between 0400 and 0600 hours (4- Febrile – the client who has a fever
6am)
-Older adults’ temperature may vary less Afebrile – the client who does not have a
than those of younger persons due to the fever
changes in autonomic functioning
common in aging. FOUR COMMON TYPES OF FEVER:

3. EXERCISE – Hard work or strenuous 1. INTERMITTENT FEVER – The body

exercise can increase body temperature as high temperature alternates at regular
as 38.3◦C to 40◦C (101◦F to 104◦F) measured intervals between periods of fever and
periods of normal or subnormal
rectally.
temperatures. An example is with the
4. HORMONES – Women usually experience disease malaria.
more hormone fluctuations than men. 2. REMITTENT FEVER – Such as with
a cold or influenza, a wide range of
- In women, progesterone secretion at the time temperature fluctuations (more than 2◦C
of ovulation raises body temperature by about (3.6◦F) occurs over 24-hour period, all
0.3◦C to 0.6◦C (0.5◦F to 1.0◦F) above basal of which are above normal.
temperature. 3. RELAPSING FEVER – Short febrile
periods of a few days are interspersed
5. STRESS – Stimulation of the sympathetic with periods of 1 or 2 days normal
nervous system can increase the production of temperature.
epinephrine and norepinephrine. 4. CONSTANT FEVER – The body
temperature fluctuates minimally but
6. ENVIRONMENT - Extremes in always remains above normal. This
environmental temperature can affect a person’s occurs on typhoid fever.
temperature regulatory systems. 5. FEVER SPIKE – Temperature that
rises to fever level rapidly following a
- If the temperature is assessed in a very warm normal temperature and then returns to
room and the body temperature cannot be normal within a few hours.
modified by convection, conduction, o radiation, BACTERIAL BLOOD INFECTIONS
the temperature will be elevated. often caused fever spikes.

-If the client has been outside in cold weather In some conditions, an ELEVATED
without suitable clothing, or if a medical TEMPERATURE IS NOT A TRUE FEVER.
condition prevents the client from controlling Two examples are:
the temperature in the environment (e.g the
1. HEAT EXHAUSTION – Is a result of
client has altered mental status or cannot dress excessive heat and dehydration. Signs of
self), the body temperature may be low. heat exhaustion: paleness, dizziness,
nausea, vomiting, fainting and a
ALTERATION IN BODY TEMPERATURE
moderately increased temperature
The normal range for adults is considered to be (38.3◦C to 38.9◦C)
between 36◦C and 37.5 ◦C (96.8◦F to 99.5◦F). 2. HEAT STOKE – generally have been
exercising in hot weather, have warm,
THESE ARE THE TWO PRMARY flushed, skin, and often do not sweat.
ALTERATION IN BODY TEMPEATURE: Usually have a temperature of 41.1◦C
(106F) or higher, and may be delirious,
1. PYREXIA unconscious or having seizures.
2. HYPOTHERMIA
HPOTHERMIA – A core body
PYREXIA temperature below the lower limit of
normal.
 A body temperature above the usual
range
 The three physiological mechanism of ensure the temperature of the mouth is not
hypothermia are: affected by the temperature of the food, fluid, or
warm smoke.
a. Excessive heat loss
b. Inadequate heat production to Rectal temperature – readings are considered
counteract heat loss to be very accurate. Rectal temperature are
c. Impaired hypothalamic contraindicated for clients who undergoing
thermoregulation. rectal surgery, have diarrhea or diseases of
Hypothermia may be induced or accidental. rectum, are immunosuppressed, have a clothing
disorder, or have significant hemorrhoids.
INDUCED HYPOTHERMIA – Is the
deliberate lowering of the body temperature to Axilla- often the preferred site for measuring
decrease the need for oxygen by the body tissues temperature in newborns because it is accessible
such as during surgeries. and safe. It is lower then rectal temperatures.

ACCIDENTAL HYPOTHERMIA – Can Before (clean bulb to stem)

occur as a result of:
After (clean stem to bulb)
1. Exposure to a cold environment
Tympanic membrane – or nearby tissues in the
2. Immersion in cold water
ear canal . is a frequent site for estimating core
3. Lack of adequate clothing, shelter,
body temperature. However, it have been shown
or heat.
as imprecise.
In older adults, the problem can be compounded
by a decreased metabolic rate and the use of  If the probe fits too loosely in the ear
sedative medications. canal, the reading can be lower than the
true value.
TEMPERATURE SCALES
Temporal artery – The temperature may also
FAHRENHEIT TO CELCIUS measured in the forehead using a chemical
thermometer or a temporal artery thermometer.
C = (F - 32) x 5/9
 This is more useful for infants and
Example: children when a more invasive
measurement is not necessary.
C = (100-32) x 5/9 = 68 x 5/9 = 37.8 ◦C
 However, it is shown as inconsistent.
CELCIUS TO FAHRENHEIT TYPES OF THERMOMETERS
F = (C x 9/5) +32 1. GLASS/MERCURIAL
THERMOMETER
Example:
2. DIGITAL THERMOMETER
(40 x 9/5) + 32 = (72+32) =104 3. ELECTRONIC EAR
THERMOMETER
ASSESING BODY TEMPERATURE 4. FOREHEAD THERMOMETER
5. PLASTIC STRIP THERMOMETER
The most common sites for measuring – the color indicates fever
body temperature are: 6. PACIFIER THERMOMETER

 Oral Traditionally, body temperatures were measured

 Rectal using mercury-in-glass thermometers. Such
 Axillary thermometers, however can be hazardous due to
 Tympanic membrane exposure in mercury, which is toxic in humans.
 Skin/temporal artery
Electronic thermometers – can provide a
The body temperature may be measure orally. If reading in only 2 to 60 seconds, depending on
a client has been taking cold or hot food or the model.
fluids or smoking, the nurse should wait 30
minutes before taking the temperature orally to
TWO SPECIAL TYPES OF ORAL as can happen with age, greater pressure is
THERMOMETERS ARE: required to pump blood into the arteries.

1. BASAL THERMOMETER – CARDIAC OUTPUT – The volume of

Calibrated with 0.1◦Fm intervals and is blood pumped into the arteries by the heart
for fertility purposes, indicating the and equals the result of the stroke volume
temperature rise that is associated with (SV) times the heart rate (HR) per minute.
ovulation. For example, 65Ml X 70 beats per minute =
2. HYPOTHERMIA THERMOMETER 4.55 L per minute. When the adult is
– have a greater low range than resting, the heart pumps about 5 liters of
everyday thermometers usually measure
blood each minute.
temperatures form 27.2◦C to 42.2◦C
(81◦F to 108◦F) In a healthy person, the pulse reflects the
CHEMICAL DISPOSABLE heartbeat, that is the pulse rate is the same
THERMOMETERS – Are also used to as the rate of the ventricular contractions of
measure body temperatures. Chemical the heart.
thermometers have liquid crystal dots or bars
The nurse should assess the heartbeat and
that change color to indicate temperature. To
the peripheral pulse.
read the temperature, the nurse nots the highest
reading among the dots have changed color.  Peripheral pulse – a pulse located away
These thermometers can be used orally, rectally, from the heart, for example in the foot
or in the axilla. or wrist.
 Apical pulse – In contrast, is a central
Temperature-sensitive tape – may also be used pulse; that is located at the APEX OF
to obtain general indication of body surface THE HEART also referred to as the
temperature. It does not indicate core POINT OF MAXIMAL IMPULSE
temperature. The tape contains liquid crystals (PMI)
that change color according to temperature. The
FACTORS AFFECTING THE PULSE
skin are should be dry. Particularly useful at
home and for infants. 1. AGE – As age increases, the pulse rate
gradually decreases overall.
Infrared thermometer – sense body heat in the
2. SEX –After puberty, the average males
form of infrared energy given off by a heat
pulse rate is slightly lower than males.
source,which, in ear canal, is primarily the 3. EXERCISE – The pulse rate normally
tympanic membrane. The infrared thermometer increases with activity. The rate of
makes no contact with the tympanic membrane. increase in the professional athlete is
often less than in the average person
Temporal artery thermometer – Determine
because of the greater cardiac size,
the temperature using a scanning infrared
strength and efficiency.
thermometer that compares the arterial 4. FEVER – The pulse rate increases (a) in
temperature in the room and calculates the heat respond to the lowered blood pressure
balance to approximate the core temperature of that results from peripheral vasodilation
the blood in the pulmonary artery. associated with elevated body
temperature
(b) Because of the increased metabolic
rate.

PULSE 5. MEDICATIONS – Some medications

decrease the pulse and other increase. For
 A wave of blood created by contraction example, cardiotonics, decrease the heart rate;
of the left ventricle of the heart. epinephrine increases the heart rate.

COMPLIANCE OF THE ARTERIES – 6. HYPOVOLEMIA/DEHYDRATION – Loss

Is their ability to contract and expand. When of blood from the vascular system increases the
a person’s arteries lose their dispensability, pulse rate.
7. STRESS – In response to stress, sympathetic TEEN 75 (50-90) 18 (15-20)
nervous stimulation increases the overall activity
ADULT 80 (60-100) 16 (12-20)
of the heart. Stress increases the rate as well as
the force of heartbeat. Ex. Fear and anxiety OLDER 70 (60-100) 16 (15-20)
ADULT
8. POSITION – When a person is sitting or
standing, blood usually pools in the dependent
vessels of the venous system. Pooling results in
a transient decrease in the venous blood return to
ASSESSING TH PULSE
the heart a subsequent reduction in blood
pressure and increase in heart rate. - A pulse is commonly assessed by
palpation (feeling) or auscultation
9. PATHOLOGY – Certain disease such s (hearing). The middle three fingertips
some heart conditions or those that impair are used for palpating all pulses sites
oxygenation can alter the resting pulse rate. except for the apex of heart. A
stethoscope is used in assessing for
apical pulses.
PULSE SITES - The nurse should be aware of: Any
medication that could affect heart rate.
1. TEMPORAL - Whether the client has bene physically
2. CAROTID active If so, wait 10 to 15 minutes until
3. BRACHIAL the client has rested and the pulse has
4. APICAL – 5TH INTERCOASTAL slowed to its usual rate.
SPACE - Any baseline data about the normal
5. RADIAL heart rate of the client.
6. FEMORAL - Whether the client should assume a
7. POPLITEAL particular position.
8. POTSTERIOR TIBIAL
TACHYCHARDIA – a excessively fast rate
9. DORSALIS PEDIS
(over 100 beats/min in an adult)
ASSESING THE PULSE : 3 MIDDLE
FINGERTIPS BRADYCHARDIA – a heart rate in an adult of
less than 60 beats/min
BEFORE 4 – LEFT OF MCL
(MIDCLAVICULAR LINE) PULSE RHYTHM- Is the pattern of the beats
and the intervals between the beat.
BETWEEN 4- 6- MIDCLAVICULAR LINE
DYSRHYTHMIA OR ARRHYTMIA – A
7-9 – FOURTH OR FIFTH INTERCOASTAL pulse with an irregular rhythm. It ma consists of
SPACE random, irregular beats or predictable pattern of
irregular beats (documented as “regularly
DOPPLER ULTRASOUND STETOSCOPE irregular”
– Used for the pulses that are difficult to asses.
Usually in femoral, popliteal. -When a dysrhythmia is detected, the apical
pulse should be assessed. An
TABLE 1. VARIATIONS IN PULSE AND electrocardiogram (ECG) is necessary to
RESPIRATIONS BY AGE: define the dysrhythmia.
AGE PULSE RESPIRATIO PULSE VOLUME – ALSO CALLED PULSE
AVERAGES NS AVERAGE
STRENGHT; refers to the force of blood with
(AND (AND
RANGES) RANGES) each beat. Usually, the pulse volume is the same
NEWBORN 130 (80-180) 35 (30-60) with each eat. It can range from absent to
bounding.
1 YEAR 120 (80-140) 30 (20-40)
RESPIRATION
5-8 YEARS 100 (75-120) 20 (15-25)
10 YEARS 70 (50-90) 19 (15-25) -The act of breathing which includes output of
carbon dioxide.
INHALATION OR INSPIRATION -Respiration may also be assessed after exercise
to identify client’s tolerance to activity.
-Refers to the intake of air into the lungs
-Respiration are assessed by:
EXHALATION OR EXPIRATION
1. respiratory rate
-Refers to breathing out or the movement of 2. depth
gases from the lungs to the atmosphere. 3. rhythm
4. quality
VENTILATION 5. characteristics

-Also used to refer the movement of air in and ASSESSING RESPIRATION

out of the lungs.
Eupnea – Normally described in breaths per
There are basically two types of breathing: minute. Breathing that is normal in rate and
depth.
- Costal (thoracic) breathing
- Diaphragmatic (abdominal) breathing Bradypnea – Abnormally slow respirations
COSTAL BREATHING Tachypnea/Polypnea – Abnormally fast
respirations
-Involves the external intercostal muscles and
other accessory muscles, such as the Dyspnea – Difficult labored breathing during
sternocleidomastoid muscles. It can be observed which individuals has persistent, unsatisfied
by the movement of the chest upward and need for air and feels distressed.
outward.
Orthopnea – ability to breathe only in upright
DIAPHRAGMATIC BREATHING sitting or standing positions.

-Involves the contraction and relaxation of the Apnea – the absence of breathing.
diaphragm, and it observed by the movement of
the abdomen, which occurs as a result of the Cheyne-stroke breathing – rhythmic waxing
and warning of respiration, from very deep to
diaphragm contraction and downward
very shallow breathing and temporary apnea.
movement.

MECHANICS AND REGULATION OF

FACTORS AFFECTING RESPITATIONS
BREATHING
Several factors influence respiratory rate
-During inhalation, the following process
 Exercise (increases metabolism)
normally occur: The diaphragm contracts  Stress (readies the body for “fight or
(flattens), the ribs move upward and outward, flight”
and the sternum moves outward, thus enlarging  Increased environmental temperature
the thorax and permitting the lungs to expand.  Lowered oxygen concentration at
increase altitudes
During exhalation, the diaphragm relaxes, the  Factors that may decrease respiratory
ribs move downward and inward, the sternum rate include: decreased environmental
moves inward, thus decreasing the size of the temperature, certain medication, and
thorax as the lungs are compressed. increased intracranial pressure.

NORMAL BREATHING – Is automatic The depth of a person’s respirations can be

effortless. A normal adult inspiration last 1 to established by watching the movement of the
chest.
1.5 seconds, and expiration lasts 2 to 3 seconds.

ASSESSING RESPIRATION RESPIRATORY DEPTH is generally

described as normal, deep, or shallow.
-Resting respiration should be assessed when the
a. DEEP RESPIRATION – are those
client is relaxed because exercise affects
in which a large volume of air is
respirations, increasing their rate and depth. inhaled and exhaled, inflating most
of the lungs.
-Anxiety can affect respiratory rate
 b. SHALLOW RESPIRATION –  To obtain baseline measurement of
Involve the exchange of a small arterial blood pressure for subsequent
volume of air and often the minimal evaluation
use of lung tissue. During a normal  To determine client’s hemodynamic
inspiration and expiration, an adult status
takes in about 500ml of air. This (e.g cardiac output stroke volume of the
volume is called tidal volume. heart and blood vessel resistance)
 To identify and monitor changes in
HYPERVENTILATION – refers to very deep, blood pressure resulting from a disease
rapid respirations. process or medical therapy (e.g presence
or history of cardiovascular disease,
HYPOVENTILATION – refers to very renal disease, circulatory shock or acute
shallow respirations. pain, rapid infusion of fluids or blood
products)
RESPIRATORY RHYTHM – Refers to the
regularity of the expirations and the inspirations. MEAN ARTERIAL PRESSURE (MAP) –
-Normally respirations are evenly spaced. this represents pressure actually delivered to
-Respiratory rhythm can be described as: the body’s organs. It can be calculated in
REGULAR AND IRREGULAR. several different ways, one of which is to
-An infant respiratory rhythm may be less add two-thirds of diastolic pressure to one-
regular than adults. third of the systolic pressure. A normal
MAP is 70 to 110mmHg.
REPSIRATORY QUALITY OR
CHARCATER – Those aspects of breathing DETERMINANT OF BLOOD
that are different from normal, effortless PRESSURE
breathing.
1. PUMPING ACTION OF HEART
LABORED BREATHING – Clients can 2. PERIPHERAL VASCULAR
breathe only with substantial effort. RESISTANCE
3. BLOOD VOLUME
SOUND OF BREATHING IS ALSO 4. BLOOD VISCOSITY
SIGNIFICANT. PUMPING ACTION OF HEART
-Normal breathing is silent, but a number of - When the pumping action of heart is
abnormal sounds such as wheeze are obvious to weak, less blood is pumped into the
the nurse’s ear. circulation increases (higher cardiac
output), the blood pressure increases.
BLOOD PRESSURE
PERIPHERAL VASCULAR
ARTERIAL BLOOD PRESSURE – A RESISTANCE
measure of the pressure exerted by the blood as - Peripheral resistance can increase blood
it flows through the arteries when the left pressure. The diastolic pressure
ventricle of heart pushes blood into the aorta. especially is affected.
-Because the blood moves in waves there are - Some factors that create resistance in the
two blood pressure measurements: arterial system are the capacity of the
-Systolic pressure – the pressure of the arterioles and capillaries, the compliance
blood as a result of contraction of the ventricles, of the arteries, and the viscosity of the
that is the pressure of height of the blood wave. blood.
Diastolic pressure – Is the pressure - The internal diameter or capacity of the
when the ventricles are at rest. arterioles and the capillaries determine
PULSE PRESSURE – The difference between in great part the peripheral resistance to
diastolic and systolic pressure. the blood in the body. The smaller the
space within a vessel, the greater the
A normal pulse pressure is about 40mmHg but resistance.
can be high as 100mmHg during exercise. - Normally, the arterioles are in the a state
of partial constriction. Increased
BLOOD PRESSURE is measured in vasoconstriction, such as occurs with
millimeters of mercury (mmHg) and recorded as smoking, raises the blood pressure,
a fraction: systolic pressure over diastolic whereas decreased vasoconstriction
pressure lowers the blood pressure.

PURPOSE: ARTERIOSCLEROSIS - If the elastic and

muscular tissues of the arteries are replaced
with fibrous tissue, the arteries lose much of compliance of the arteries has a direct
their ability to constrict and dilate. This effect on the blood pressure.
condition, most common in middle-aged and 10. TEMPERATURE – Because of
older adults. increased metabolic rate, fever can
increased blood pressure. However,
BLOOD VOLUME external heat causes vasodilation and
-When the blood volume decreases (for decreased blood pressure. Cold causes
example, as a result of a hemorrhage or vasoconstriction and elevated blood
dehydration), the blood pressure decreases pressure/
because of decreased fluid in the arteries.
Conversely, when the volume increases (for HYPERTENSION – A blood pressure that is
example, as a result of a rapid intravenous persistently above normal
infusion), the blood pressure increases
because of the greater fluid volume within CATEGORIES OF HYPERTENSION
the circulatory system. 1. PRIMARY HYPERTENSION- Also
called essential hypertension. This kind
BLOOD VISCOSITY of hypertension develops overtime with
- Blood pressure is higher when the blood no identifiable cause. Most people have
is highly viscous. this type of high blood pressure.
- That is, when the proportion of red 2. SECONDARY HYPERTENSION –
blood cells to the blood plasma is high. Often occurs quickly and can become
- The proportion is referred to as the more severe than primary hypertension.
HEMATOCRIT. The viscosity It is due to several conditions that may
increases markedly when the hematocrit cause hypertension.
is more than 60% to 65%.
Individuals with a diastolic blood pressures of
FACTORS AFFECTING BLOOD 80 to 89 mmHg or systolic blood pressures of
PRESSURE 120 to 139mmHg should be considered
prehypertensive, and without intervention, may
1. AGE – Newborns have a systolic develop cardiac disease.
pressure of about 75mmHg. The
pressure rises with age. HYPOTENSION – A blood pressure that is
2. EXERCISE – Physical activity below normal, that is a systolic reading
increases the cardiac output and hence consistently between 85 and 110 mmHg in an
blood pressure. adult whose normal pressure is higher than this.
3. STRESS – Stimulation of the
sympathetic nervous system increases ORTHOSTATIC HYPOTENSION/
cardiac output and vasoconstriction of POSTURAL HYPOTENSION – Sudden low
the arterioles. blood pressure that happens when changing in
4. RACE – African American older than position such standing up from siting or lying
35 years tend to have higher blood down.
pressure than European Americans of - Can make you feel dizzy or lightheaded,
the same age although the exact reasons and maybe even faint.
for these difference are unclear.
5. SEX- After puberty, females usually CLASSIFICATION OF BLOOD PRESSURE
have lower blood pressure than males of Category Systolic Diastolic
the same age; this difference is thought BP BP (mmHg)
of be due to hormonal variations. After (mmHG)
menopause, women generally have Normal <120 <80
higher blood pressures than before. Prehypertension 120-139 80-89
6. MEDICATIONS – Many medications, Hypertension, stage 1 140-159 90-99
including caffeine Hypertension, stage 2 >160 >100
7. OBESITY –Both childhood and adult
obesity predispose to hypertension ASSESSING BLOOD PRESSURE
8. DIURNAL VARIATIONS – Pressure -Measure with a pressure cuff, a
usually lowest early in the morning, sphygmomanometer, and a stethoscope.
when the metabolic rate is lowest then
rises throughout the day and peaks in the SPHYGMOMANOMETER –Indicates the
late afternoon or early evening pressure of air within the bladder.
9. MEDICAL CONDITIONS – Any
condition affecting the cardiac output, TWO TYPES OF
blood volume, blood viscocity, and/or SPHYGMOMANOMETER:
 1. Aneroid sphygmomanometer – has a 1. Education
calibrated dial with a needle that point to 2. Research
the calibrations 3. Administrative
2. Digital sphygmomanometer – should
be calibrated periodically to check
accuracy. HEALTHCARE DELIVERY OF NURSING

DOPPLER ULTRASOUND HISTORY OF NURSING

STETHOSCOPES – Also used to assess
blood pressures. -A female before, low-level

When taking a blood pressure using a ROLES OF FEMALE BEFORE:

stethoscope, the nurse identifies phases in
series of sounds called KOROTKOFF’S -wife, mother and household
SOUNDS.
-mother and females are expected to took care
AUSCULTORY GAP – Occurs their husbands, children.
particularly in hypertensive clients, is the
temporary disappearance of sounds normally NURSING – Rooted at home (nagsimula at
heard over the brachial artery when the cuff home)
pressure is high followed by the
reappearance of the sounds at lower level. NURSING MOTHER – main job –
breastfeeding

FUNDAMENTALS OF NURSING The care provided is physical comfort and

PRACTICE maintenance

(LECTURE) TRADITIONAL ROLE OF A NURSE:

BEING A NURSE IS A CALLING 1. COMFORTING – Provide comfort patient

to lessen pain
Volunteerism – Nurses can’t accept money,
reward, this is where volunteerism started. 2. NURTURING – To develop, enhanced,
improved
NURSE – Came from the word “nur” nutrix
which means to nourish 3. SUPPORTING – Ex. Mastectomy – removal
of breast; the patient experiencing anxiety
- Defined as art and science
- Nursing is an art – caring, compassion, -Talk about the facts, advantages, educate the
having respect to the dignity of other patient
people.
RELIGION SIDE:
Nursing is a science – nursing practice
uses a body of knowledge Being a nurse is anchored to Christian values:
- Science – systematic may procedure
“Love thy neighbor as thy self”
-As a nurse, we have to be willing to have new
discoveries The Good Samaritan –a parable

Nursing is a quality of care you provide for the - All nurses are expected to do good
patient is the level science because we are using Samaritan.
the technology
3rd and 4th CENTURIES
Art – Comfort
FABIOLA – A nursing leader
Client who are center of client’s service
-Wealth man from a royal family, he converted
1. Individual to Christian
2. Family
3. Community -Gave up all his money and nagpatindog it baeay
AS A PROFESSION BEING A NURSE HAS for poor, sick and need healing
MANY COMPONENTS
CRUSADES AND KNIGHTS (Knights of factors for illnesses, and helping people take
Saint Lazarus) measures to prevent these illnesses occurring.
Examples are:
-Build hospital for the sick especially for people  Smoking Cessation campaigns
with Leprosy  Environmental programs

THEODER FLIEDNER SECONDARY PREVENTION: DIAGNOSIS

AND TREATMENT
-Build hospital
-Hospitals and physicians’ of fices have been
-build a training school for nurse the major agencies offering these complex
secondary prevention services. Hospitals
-KAISERSWERTH’S – Name of school continue to focus significant resources who
require emergency, intensive, and around-the-
-his first trainee is FLORENCE clock acute cure.
NIGHTINGALE
Also, included as a health promotion service is
TRICKY AREAS OF NURSING: early detection of disease. Accomplished
through routine screening of the population and
Knowledge, Skills, Attitude focused screening of those at increased risk of
developing certain conditions. Examples
HEALTHCARE DELIVERY SYSTEM Ex.
-Clinics in some communities provide
HEALTH CARE SYSTEM – The totality of mammograms and education regarding the early
services offered by all health disciplines. It is detection of cancer of the breast.
one of the largest industries in the United States. -Voluntary HIV testing and counseling
-Screening for cholesterol and high blood
Major purpose: Provide care to people who are pressure
ill or injured.
TERTIARY PREVENTION:
TYPES OF HEALTH CARE SERVICES REHABILIATION, HEALTH
RESTORATION, AND PALLIATIVE CARE
1.Primary Prevention: Health Promotion and
Illness Prevention -The goal of tertiary prevention is to help people
2. Secondary Prevention: Diagnosis and move to their previous level of health (i.e to
Treatment their previous capabilities) or to the highest level
3. Tertiary Prevention: Rehabilitation, Health they are capable of given their current health
Restoration, and Palliative Care status.

-Rehabilitative care emphasizes the importance

PRIMARY PREVENTION: HEALTH of assisting clients to function adequately in the
PROMOTION AND ILLNESS physical, mental, social, economic and
PREVENTION vocational areas of their lives.

-The World Health Organization (WHO) Ex.

developed a project called HEALTH PEOPLE. -Someone with an injured neck or back from an
automobile crash may have restriction in the
-The current U.S Department of Health and ability to perform work or daily activities. If the
Human Services (2010) project has four injury is permanent, rehabilitation assists the
client in adjusting the way activities are
overarching goals:
performed in order to maximize the client’s
1. Increase quality and years of healthy life abilities.
2. Achieve health equity and eliminate health -Rehabilitation may begin in the hospital, but
disparities will eventually lead clients back into the
3. Create healthy environments for everyone community for further treatment.
4. Promote health and quality life across the life -tertiary mental health prevention
span.
TYPES OF HEALTH CARE AGENCIES
Illness prevention programs may be directed at AND SERVICES
the client or the community and involve such
practices such as immunizations, identifying risk 1. PHYSICIANS OFFICES
-In North America, the Physicians’ office is a -may be for-profit or not-for-profit
significant care setting. The majority of institution.
physicians either have their own offices or with -Hospitals are classified with services they
several other physicians in group practice. provide:
-Client usually go to a physicians’ office for -GENERAL HOSPITALS- admit
routine health screening, illness diagnosis, and clients requiring a variety of services, such as
treatment. People seek consultation from medical, surgical, obstetric, pediatric, and
physicians when they are experiencing psychiatric services.
symptoms of illness or when a significant other -Other hospitals offer only specialty
considerers the person to be ill. services such as psychiatric or pediatric care.
-ACUTE CARE HOSPITAL –
2. AMBULATORY CARE CENTERS Provides assistance to clients whose illness and
-Used in many communities. Most have need for hospitalization are relatively short term,
diagnostic treatment facilities that provide for example, several days.
medical, nursing laboratory, and radiologic
services, and they may or may not be associated 5. SUBACUTE CAER FACILITIES
with an acute care hospital. -Variation of inpatient care designed for
-Some provide services to people who require someone who has an acute illness, injury, or
minor surgical procedures that can be performed exacerbation of a disease process.
outside the hospital. -Requires the coordinated services of an
-After surgery, the client returns home, often the interprofessional team including physicians,
same day. nurses, and other relevant professional
-Two advantages: They permit the client to live disciplines.
at home while obtaining necessary health care, -More intensive than long-term care and less
and they free up costly hospital beds for intensive than acute care.
seriously ill clients.
-the term AMBULATORY CARE CENTER 6. EXTENDED (LONG-TERM) CARE
HAS REPLACED THE TERM CLINIC in FACILITIES
many places. -formerly called nursing homes are now often
multilevel campuses that include independent
3. OCCUPATIONAL HEALTH CLINICS living quarters for seniors , assisted living
-Gaining importance as a setting for employee facilities, skilled nursing facilities (intermediate
health care. The importance of employee health care), and extended care(long-term care)
to productivity has been recognized. facilities that provide levels of personal care for
-Community health nurse in the occupational those who are chronically ill or are unable to
setting have a variety of roles. Today, nursing care for themselves without assistance.
functions in industria health acre include work
safety and health education, annual employee 7. RETIREMENT AND ASSISTED LIVING
health screening for tuberculosis, and CENTERS
maintaining immunization information. -Consist of separate houses, condominiums, or
-Other functions may include screening for such apartments for residents.
health problems as hypertension and obesity, -Provide limited care to residents, usually
caring for employees following injury, and related to the administration of medications and
counseling. minor treatments, but conduct significant care
coordination and health promotion activities.
4. HOSPITALS
-Vary in size from 12-bed rural hospital to the 8. REHABILITATION CENTERS
1,500 bed metropolitan hospital. -Usually independent community center or
-Can be classified according to their ownership special units.
or control as governmental (public) or -Plays an important role in assisting clients to
nongovernmental (private). restore their health and recuperate. Drug and
-In the United States, governmental hospitals are Alcohol rehabilitation centers, for example help
either federal, state, county or city hospitals. The free clients of drug and alcohol dependence and
federal government provides hospital facilities assist them.
for veterans and merchant mariners (VA -Today, the concept of rehabilitation is applied
hospital). to all illness and injury (physical and mental)
-Military hospital –provide care to military
personnel and their families 9. HOME HEALTH CARE AGENCIES
-Private hospitals – often provide operated by -The implementation of prospective payment
churches, companies, communities, and programs and the resulting earlier discharge of
charitable organization. clients from hospitals have made home care an
essential aspect of the health care delivery the client, who also need education, guidance
system. and support.

10. DAY CARE CENTERS NURSING LEADERS

-Provide care for infants and children while
parents works. Other centers provide care and 1. FLORENCE NIGHTINGALE (1820-1910)
nutrition for adults who cannot be left at home “Lady with the Lamp”
alone but do not need to be in an institution. -Improved the standards for the care of war
-Older adult care centers often provide care casualties in the Crimea.
involving socializing, exercise, programs and -Reforming hospitals and in producing and
stimulation. Some center provide counseling implementing public health policies also made
and physical therapy. her an accomplished political nurse.
-Nurses who are employed in day care centers -The first nurse to exert political pressure on
may provide medications, treatments and government. Through her contributions, to
counseling. nursing education perhaps her greatest
achievement.
11. RURAL CARE -Recognized as nursing’s first scientist-theorist
-Created as result of the 1987 Omnibus Budget for her work: “Notes in Nursing: What It Is, and
Reconciliation Act to provide emergency care to What It is Not (1860/1969)
clients in rural areas. -Born in a wealth and intellectual family.
-In 1997, the Balanced Budget Act authorized -Believed she was “called by God to help
the Medicare Rural Hospital Flexibility Program others” to improve the well-being of mankind.
in order to continue to make available care -Visited Kaiserswerth in 1847, where she
access and improve emergency care for rural received 3 months training in nursing.
residents. This program established a new -1853- she studied in Paris with the Sisters of
classification called CRITICAL ACCESS Charity.
HOSPITAL, which receive federal funding to -Returned to England from Crimea, a grateful
remain open and provide the breadth of services English public gave Nightingale an honorarium.
needed for rural residents. She later used this money to develop the
Nightingale Training School for Nurses, opened
12. HOSPICE SERVICES in 1860.
-Originally, hospice,was place for travelers to -died at age 90.
rest. Recently, the term has come to mean -Referred as first nurse researcher.
interprofessional health care service for the -Believed in personalized and holistic client
dying. Provided in home or another health care care.
setting.
-The hospice movement subsumes a variety of 2. CLARA BARTON (1821-1912)
services given to clients who are terminally ill, (Established American Red Cross)
their families, and support persons. -A schoolteacher who volunteered as a nurse
-Concept is not of the hospice movement, as during the American Civil War.
distinct form the acute care model is not saving -Her responsibility was to organize the nursing
life but improving or maintaining the quality of services.
life until death.
3. LINDA RICHARDS (1841- 1930)
13. CRISIS CENTERS (First American trained nurse)
-Provide emergency services to clients -Graduated from the New England Hospital for
experiencing life crises. These centers may Women and Children in 1873.
operate out of a hospital or in the community, -Known for introducing nurses’ notes and
and most provide 24-hour telephone service. doctor’s orders.
Some also provide direct counseling to people at -She also initiated the practice of nurses wearing
the center or in their homes. uniforms.
Primary purpose: Help people cope up with an -Credited for her pioneering work in psychiatric
immediate crisis and then provide guidance and and industrial nursing.
support for long-term therapy.
4. MARY MAHONEY (1845-1926)
14. MUTUAL SUPPORT AND SELF-HELP (First African American Professional Nurse)
GROUPS -Graduated form the New England Hospital for
-In North America today, there are more than Women and Children in 1879.
500 mutual support or self-help groups that -She constantly worked for the acceptance of
focus on nearly every major health problem or African Americans in nursing and for the
life crisis people experience. These groups may promotion of equal opportunities.
be for the client or for the friends and family of 5. LILIAN WALD (1876-1940)
(Founder of Public Health Nursing) free- standing nursing
-Wald and Mary Brewster were the first to education; published
offer trained nursing services to the poor in the books about nursing and
New York slums. Their home among the poor health care
on the upper floor of tenement called: HENRY -Founder of MODERN
STREET SETTLEMENT AND VISITING NURSING
NURSE SERVICE, provided nursing services, Clara Barton -Volunteered to care for
social services, and organized educational and wounds and feed Union
cultural activities. soldiers during Civil
war.
6. LAVINIA L. DOCK (1856- 1956) -Served as the
-AN ACTIVE PROTEST MOVEMENT FOR supervisor for nurses for
WOMEN’S RIGHTS that resulted in the the army of the James,
constitutional amendment in 1920 that allowed organizing hospitals and
women to vote. nurses
-feminist, prolific writer, political activist, -Established the Red
suffragate, and friend of Wald. Cross in the United
-Participated in protest movements for women’ States in 1882.
right that resulted in the 1920 passage of the 19 th Dorothea Dix -Serve as superintendent
Amendment to the U.S. Constitution, which of the Female Nurse of
granted women to vote. the Army during the
--Campaigned for legislation to allow nurses Civil War
rather than physicians to control their -Was given the authority
profession. and the responsibility for
-With the Assistance of Mary Adelaide Nutting recruiting and equipping
and Isabel Hampon Robb, founded the American a corps of army nurses.
society of Superintendents of Training Schools -Was pioneering
for Nurses the United States a precursor of the crusader for the reform
current National League for Nursing. of the treatment of the
mentally ill.
7. MARGARET HIGGINS SANGER (1879- Oor of the Lower
1966) Mary Ann -Organized diet
(Founder of Planned Parenthood) Bickerdyke kitchens, laundries, and
-Imprisoned for opening the first birth an ambulance service
control information clinic in America. and supervised nursing
-A public health nurse in New York staff during the Civil
-Had a lasting impact on women’s health care. War.
Louise Schuyler A nurse during the Civil
8. MARY BRECKINRIDGE (1881-1965) War, returned to New
(Established the Frontier Nursing Service York and organized the
(FNS) New York Charities Aid
-In 1918, she worked with the American Association to improve
Committee for the Devastated France, care of the sick in
distributing food, clothing and supplies to rural Believue Hospital.
villages and taking care of sick -Recommended
children.Breckinridge, and two other nurses standards for nursing
began the FNS in Leslie Country, Kentucky. education.
-Within this organization, Breckinridge started Linda Richards -Graduated in 1873 from
one of the first midwifery training schools in the the New England
United States. Hospital for Women and
Children in Boston,
Massachussets
-FIRST TRAINED
NURSE in the United
SUMMARY: States.
-Became the night
PERSON CONTRIBUTION superintendent of
Believue Hospital in
Florence Nightingale Defined nursing as both 1874
art and a science, -Began the practice of
differentiated nursing keeping records and
from medicine, created writing orders.
Jane Addams Provided social services ASSOCIATION)
within a neighborhood Mary Adelaide The FIRST
setting Nutting PROFESSOR OF
-A leader for women’s NURSING IN THE
right WORLD as faculty
-recipient of 1931 Nobel member of the Teacher’s
Peace Prize College, Columbia
Lilian Wald -Established a University; with Lavinia
neighborhood nursing Dock
service for the sick poor -Published the four-
of the Lower East Side n volume History of
New York City Nursing
-FOUNDER OF Elizabeth Smellie -A member of the
PUBLIC HEALTH original Victorian Order
NURSING for Nurses for Canada (a
Mary Elizabeth -Graduated from New group who provided
Mahoney England Hospital for public health nursing)
Women and Children in -Organized the
1879 Canadian Women’s
-America’s FIRST Army Corps during
AFRICAN World War II
AMERICAN NURSE Lavinia Dock A nursing leader and
Harriet Tubman -A nurse and an women’s right activist;
abolitionist -Instrumental in the
-Active in the Constitutional
underground railroad amendment giving
movement before women right to vote.
joining the Union Army Mary Breckenridge Established the
during the Civil War FRONTIER
Nora Gertrude Established a training NURSING SERVICE
Livingston program for nurse at the and one of the first
Montreal General midwifery schools in the
Hospital (the first 3-year United States.
programs in North Margaret Sanger Founder of PLANNED
America. PARENTHOOD.
Mary Agnes Snivley Director of the nursing
school at Toronto
General Hospital and
one of the founders of
the Canadian Nurses
Assocation.

Isabel Hampton -A leader in nursing and

Robb nursing education
-Organized the nursing THERAPEUTIC COMMUNICATION
school at John Hopkin’s
Hospital -An interaction between two or more persons
-initiated policies that that involves the exchange of information
included limiting the between a sender and a receiver.
number of hours in a
day’s work and wrote a ELEMENTS OF COMMUNICATION
textbook to help student
learning. 1. Sender
-The FIRST 2. Message
PRESIDENT OF THE 3. Channel – medium of communication
NURSES 4. Receiver
ASSOCAITED 5. Feedback
ALUMNAE OF THE Context – environment where the message is
UNITED STATES happening
AND CANADA (later
became the THERAPEUTIC COMMUNICATION
AMERICAN NURSE
-Application of the process of communication to -Nurses do not share intimate details of their
promote well-being of the client personal lives with their clients

2 TYPES OF COMMMUNICATION Goal: to promote wellness and personal growth

in clients.
1. VERBAL COMMUNICATION
BARRIERS TO THERAPEUTIC
-Includes both spoken and written word COMMUNICATICON
-The sender of the verbal communication must 1. Giving an opinion
be aware of the volume, and cadence (pace and 2. Offering false reassurance
rate) of voice to send an accurate message 3. Being defensive
4. Showing approval or disapproval
2. NON-VERBAL COMMUNICATION 5. Stereotyping
6. Asking “WHY”
-Describes all behavior that convey messages
without the use of words. THERAPEUTIC COMMUNICATION
TECHNIQUES
-Includes body movement, physical appearance,
personal space 1. LISTENING
- An active process of receiving and examining
-language includes body posture and facial reaction to message sent.
expression.
Ex. With in the cultural practice of your client,
ASPECTS ON NON-VERBAL maintain eye contact and be receptive to non-
COMMUNCIATION verbal communication.

1. Kinetic – body movement, gesture, facial Therapeutic value: Give interest and
expression, posture acceptance
Non-Therapeutic value: Failure to listen
2. Proxemics – Refers to the distance between 2. BROAD OPENING
communicator - Encouraging the patient to select topics for
discussion.
 Intimate (0-18 inches) Ex. “What are you thinking about?”
Therapeutic value: Indicates acceptance by
 Personal (18 inches-4 feet)
nurse and value of clients initiative
 Social (9-12 feet) Non-therapeutic value: Domination of
 Public (more than 12 feet) interaction by nurse
Threat: rejecting response
3. Touch – haptic communication such as
handshake, gentle pat on back or high five. 3. RESTATING
-Repeating the main thought, the patient
4. Silence – One of the effective tools in expressed, verbalizing the implied.
communication. Ex:
Patient: I’m awake most of the night
5. Paralanguage – Tone of voice, volume, Nurse: You have difficulty of sleeping
deflection/inflection
Therapeutic value: Helps to clarify client’s
NURSES uses communication skills in caring feelings, ideas and perceptions and to provide
for clients by providing information, providing and explicit correlation between them and the
comfort, promoting understanding clarifying client’s action
Non-therapeutic value: Failure to probe
misinformation.
4. REFLECTION
THERAPEUTIC NURSE-CLIENT
-Directing back to client’s ideas, feelings,
RELATIONSHIP questions, or
Ex.
-Considered foundation of nursing care and Patient: I trusted the wrong guy
involves client-centered goal-directed interaction Nurse: Wrong guy?
using therapeutic communication.
Therapeutic value: Validate nurse
Non-therapeutic value:
 14. OFFERING SELF
5. HUMOR -Unconditional willingness to be available
- Discharge of energy through comic enjoyment Therapeutic value: Offering nurse’s presence
of the imperfect Non-therapeutic value: I’ll stay with you for a
Therapeutic value: Can promote insight by while.
making conscious repressed material resolving
pradoxes 15. GENERAL LEADS
Non-therapeutic value: -Encourage the individual continue in the
direction of conversation already begin.
6. INFORMING Ex. “Go on”, “next”, “continue”
-Skill and informing client with available Therapeutic value: Indicates the nurse is
listening and encourages client.
Therapeutic value: Helpful in client education 16. DESCRIPTION OF PERCEPTION AND
Non-therapeutic value: Giving advice FEELING
-Learn how the person perceives a feeling or
7. SILENCE interpret events.
-Lack of verbal communication for a therapeutic Ex.
reason Patient: They don’t love them anymore
Nurse: Who are they?
8. FOCUSING Therapeutic value: This make client feel free to
-Questions or statement that help the patient to express
expand on a topic importance
Therapeutic value: Allows the client to discuss
important issues
Non-therapeutic value: 17. ENCOURAGING COMPARISON
-Client is asked to compare experience, ideas,
9. SHARING PERCEPTIONS relationships.
-Asking client to verify nurse’s understanding of Ex. Was that something like?
what client’s thinking or feeling, making Therapeutic value: Helps bring out recurrent
observation. themes.

10. THEME IDENTIFICATION 18. PLACING EVENT IN SEQUENCE OR

-Underlying issues or problems experienced by TIME
client that emerge repeatedly during nurse-client -Seeing events to in perspective in relation to
relationship. time, and their order.
Ex. “When did this happen” is it before or after?
Therapeutic value: Allow the nurse to best
promote client’s exploration 19. VOICING DOUBT
Non-therapeutic value: Giving advice, -Let individual know that others don’t perceive
reasoning, disapproving in the same way.
Ex. Really?
11. SUGGESTING “That is hard to believe”
-Presentation of alternative ideas for client’s Therapeutic value: Allows client to reconsider
consideration relative to problem solving. or reevaluate.
Therapeutic value: Increases client’s perceive
options
Non-therapeutic value: No advice

12. SHOWING ACCEPTANCE

-Indicate that the nurse has and is following the
communication thread
Ex. “Uhm” “Yes” “Uh huh”

13. RECOGNITION
-Greeting the patient or acknowledgement of
efforts made by the client.
Ex. “Good morning Mr. Jawel. I see you’ve
change your hairstyle.”

Therapeutic value: Increases client’s self-

esteem.