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chapter 13 & 36

CH.13 ANA Definitions of Nursing #1 Attention to the range of human experiences and responses to health and illness within the patient’s physical and social environments Application of scientific knowledge to the processes of diagnosis and treatment by using judgment and critical thinking Provision of a caring relationship that facilitates health and healing Integration of assessment data with knowledge gained from an appreciation of the patient or group’s subjective experience PROBLEM-IMPLEMENTATION
ANA Definitions of Nursing #2 Advancement of professional nursing knowledge through scholarly inquiry Influence on social and public policy to promote social Assurance of safe, quality, and evidence-based practice
Thoughtful Person-Centered Practice=HOLISTIC CARE-NURSE COMPASSIONATE AND CONSIDERED The person ( Promote dignity, humanity, and well-being)The professional nurseReflective practice leading to personal learning-PROMOTE HEALTH AND PREVENT ILLNESS The nurse’s action in response to individual clinical needPerson-centered nursing process-FOCUS ON PT Clinical reasoning, judgment, and decision making The components of thoughtful practice are all interrelated and function together to create thoughtful, person-centered care.
10 Guiding Principles of Person-Centered Nurses focus on people, not problems or tasks. The nursing process is person centered, not task centered.Knowledge and information are freely shared between and among patients, care partners, physicians, and other caregivers. .Care is based on continuous healing relationships.Care is customized and reflects patient needs, values, and choices. CUSTOMIZE CARE TO MEET PT NEEDS Care is provided in a healing environment of comfort, peace, and support. All team members are considered caregivers
10 Guiding Principles of Person-Centered DOCUMENT=SAFETY IS KEY Families and friends of the patient are considered an essential part of the care team.Patient safety is a visible priority. All caregivers cooperate with one another through a common focus on the best interests and personal goals of the patient. The patient is the source of control for their care. Transparency is the rule in the care of the patient.
Beliefs of the International Association of Human Caring #1 Caring is the human mode of being.Caring is the essence of nursing and the moral imperative that guides nursing practice. Caring is both spiritual and human consciousness that connects and transforms everything in the universe.Caring in nursing is action and competencies that aim toward the good and welfare of others. Through caring humans are valued respected nurtured understood and assisted – accept patient as they are
Beliefs of the International Association of Caring in nursing is a special way of being, knowing, and doing with the goal of protection, enhancement, and PRESERVATION OF HUMAN DIGNITY . Care is culturally diverse and universal and provides the broadest and most important means to study and explain nursing knowledge and nursing care practices.
The Professional Nurse (Pg. 307, Box 13-4) Personal attributes Knowledge base=PATHOPHISIOLOGY -NORMAL VS. ABNORMAL Blended competencies-KNOWLEDGE BASED AND TECNICAL SKILLS ETHICAL KNOWLEDGE
Blended Competencies #1 Developing the method of critical thinking-ABNORMAL VS-RETAKE THEM-IDENTIFY PROBLEM-COLLABORATE WITH OTHER TO SOLVE THE ISSUE Purpose of thinkingAdequacy of knowledgePotential problemsHelpful resourcesCritique of judgment/decision Developing cognitive competencies Developing the personal attributes to think critically
Blended Competencies #2 Developing technical competenciesDeveloping interpersonal competenciesPromoting human dignity and respectEstablishing caring relationships Enjoying the rewards of mutual exchangeInterpersonal caring enriches the lives of everyone participating, providing a mutual exchange of giving and receiving. Nurses work collaboratively with patients when using the nursing process to plan and deliver care.Developing ethical/legal competencies PATIENT'S ADVOCATE WORK W/IN OUR SCOPE NEVER CHANGE MED OR ROUTE W/O MD APPROVAL
QSEN Competencies GOAL ORIENTED Patient-centered care Teamwork and collaboration Evidence-based practice Quality improvement Safety Informatics-SHARE INFO AMOUNG HEALTH CARE-ISBAR-COMPUTERIZED-PROVIDED-ENTRY
Problem-Solving and the Nursing Process Scientific problem solving-NURSING PROCESS SUBJECTIVES-PATIENT COMPLAINTS OBJECTIVES-COLLECTED MYSELF FROM ASSESSMENT-LAB RESULTS ANALYZE-NURSING DX PLAN-INTERVENTION IMPLEMENT-ACTION EVALUTION-WORKED, DIDNT WORK=WHY? Intuitive problem solving Critical thinking: intuitive, logical, or both? Trial-and-error problem solvinG
Potential Errors in Decision Making Errors in Decision Making Bias-KNOW WHAT MINES ARE(SPIRITUALLY - PROFESSIONAL) Failure to consider the total situation Impatience
Historical Development of the Nursing Process 1955: Nursing process term used by Hall1960s: Specific steps delineated1967: Yura and Walsh published first comprehensive book on nursing process 1973: ANA Congress for Nursing Practice developed Standard of Practice 1982: State board examinations for professional nursing uses nursing process as organizing concept
Five Steps of the Nursing Process SYSTEMATIC-INTERPERSONLA-DYNAMIC-OUTCOME ORIENTED AND PT CENTERED Assessing: collecting, validating, and communicating patient dataDiagnosing: analyzing patient data to identify patient strengths and problems Planning: specifying patient outcomes and related nursing interventions Implementing: carrying out the care planEvaluating: measuring extent to which patient achieved outcomes
The Steps of the Nursing Process are Dynamic and Interrelated person-centered, outcome-oriented nursing process are dynamic and interrelated. Each of the five steps depends on the accuracy of the preceding step.See page 319, Table 13-2
Characteristics of the Nursing Process Systematic: part of an ordered sequence of activitiesDynamic: great interaction and overlapping among the five steps Interpersonal: human being is always at the heart of nursingOutcome oriented: nurses and patients work together to identify outcomes Universally applicable: a framework for all nursing activities
Benefits of the Nursing Process Patient Scientifically based, holistic individualized patient careContinuity of careClear, efficient, cost-effective plan of action Nurse Opportunity to work collaboratively with other health care workersSatisfaction of making a difference in lives of patientsOpportunity to grow professionally
Concept Mapping CREATE DIAGRAM(BSED ON INFO)LINK INFO=OUTCOME A critical-thinking approach to care planning. Concept mapping involves representing and organizing interrelated knowledge visually and hierarchically. They are a specific type of graphic organizer. Concept maps have 4 key parts. 1. Concepts – usually written within rectangles or ovals2. Relationships between them – often represented by labelled arrows 3. Create a diagram showing problems and nursing actions4. Key concepts include nursing process, holism, safety, and advocacy
Reflective Practice Reflection in actionHappens in the here and now of the activity and is also known as “thinking on your feet.” Reflection on actionOccurs after the fact and involves thinking through a situation that has occurred in the past. Reflection for actionHelps the person to think about how future actions might change as a result of the reflection.
NUTRITION CH.36 Nutrition and Health #1 Good nutrition vital for health and life •Poor nutrition decreases health •Nutrients – biochemical substances used by the body for growth, development, reproduction, healing, health maintenance and repair
Nutrition and Health #2 Essential nutrients - not MADE ENOUGH IN BODY-GET FROM FOOD (vital for disease prevention, growth, and good health) Macronutrients supply energy and build tissue : carbohydrates, fats, proteins Micronutrients- regulate and control body processes : vitamins and minerals
Nutrition and Health #3 Nonessential nutrients•MADE by the body•not supplied through dietary sources •synthesized in large supply by the body (biotin, vitamin K, cholesterol, etc. ) Six Classes of Nutrients SUPPLY ENERGY CARBOHYDRATES, FATS AND PROTEINS NUTRIENT THAT REGULATE BODY PROCESSES WATER, MINERALS AND VITAMINS
Energy Balance Energy measured in kilocalories (calories) •Energy provided by carbohydrates, protein and fat •Energy metabolized by vitamins and minerals Energy needed to carry out body functions •Daily intake and expenditure of energy determine body weight . Intake = Expenditure = stable weight •Intake greater than expenditure = weight gain •Intake less than expenditure = weight loss
Factors Affecting Basal Metabolic Rate BMI = ratio of weight in kilogram to height in meters •Males have a higher BMR due to larger muscle mass •BMR is about 1 cal/kg of body weight per hour for men •BMR is about 0.9 cal/kg of body weight per hour for women Factors that increase BMR •Growth, infections, fever, emotional tension, extreme environmental temperatures, elevated levels of certain hormones(GROWTH-INFECTION-ENVIRONMENTAL FACTORS •Factors that decrease BMR •Aging- prolonged fasting, and sleep
Carbohydrates #1 MAIN SOURCE OF ENERGY SUPPLY DIGEST 90% Sugars and starches •Organic compounds composed of carbon, hydrogen, and oxygen •Serve as the structural framework of plants; lactose is the only animal source Most abundant and least expensive source of calories in the world•Classified as simple or complex sugars•Converted to glucose for transport through the blood•Cells oxidize glucose to provide energy, carbon dioxide, and water. Easily and quickly digested than protein and fat •Total daily calories recommended is 45 – 60% •PRIMARY FUNCTION = SUPPLY ENERGY
Protein Required for the formation of all body structures•Labeled complete (high quality) or incomplete (low quality), based on amino acid composition Animal proteins are complete; plant proteins are incomplete. •Protein tissues are in a constant state of flux. Tissues are continuously being broken down (catabolism) and replaced (anabolism). RDA for adults is 0.8 g/kg of body weight, 10% to 35% total calorie intake NURSING DX=IMPAIRED HEALING, RELATED TO LOW ALBURIN AS EVIDENCE BY OPEN WOUND W/ HISTROY OF DIABETES
Fats #1 Insoluble in water and blood•Composed of carbon, hydrogen, and oxygen•95% of lipids in diet are triglycerides Contain mixtures of saturated (raise cholesterol levels) and unsaturated (lower cholesterol levels) fatty acids •Most animal fats are saturated (raised serum cholesterol levels) SOLID AT ROOM TEMP •Most vegetable fats are unsaturated (lower serum cholesterol levels) LIQUID AT ROOM
Fats #2 Digestion occurs largely in the small intestine .•Most concentrated source of energy in the diet The Dietary Guidelines for Americans 2015–2020 recommends that individuals should limit intake of saturated fats and trans fats, with less than 10 % of calories per day from saturated fats and intake of trans fats to as low as possible. 10-25%
Vitamins Organic compounds needed by the body in small amounts•Most are active in the form of coenzymes. Needed for metabolism of carbohydrates, protein, and fat •Classified as water soluble or fat soluble •Absorbed through the intestinal wall directly into bloodstream
Minerals Organic elements found in all body fluids and tissues•Some function to provide structure in the body, others help regulate body processes Contained in the ash that remains after digestion•Macrominerals include calcium, phosphorus (phosphates), sulfur (sulfate), sodium, chloride, potassium, and magnesium. Microminerals include iron, zinc, manganese, chromium, copper, molybdenum, selenium, fluoride, and iodine.
Water Accounts for between 50% and 60% of adult’s total weight. •Two-thirds of body water is contained within the cells (intracellular fluid [ICF]). The remainder of body water is extracellular fluid (ECF), body fluids (plasma, interstitial fluid). •Provides fluid medium necessary for all chemical reactions in the body Acts as a solvent and aids digestion, absorption, circulation, and excretion
Factors Affecting Food Habits Physiologic and physical factors: stage of development, state of health, medications Physical, sociocultural, and psychosocial factors influencing food choices Economics, culture, religion, tradition, education, politics, social status, food ideology
Developmental Considerations Growth: infancy, adolescence, pregnancy, and lactation increase nutritional needs •Activity increases nutritional needs. Age-related changes in metabolism and body composition•Nutritional needs level off in adulthood. Fewer calories required in adulthood because of decrease in BMR.
Risk Factors for Poor Nutritional Status Developmental factors •Gender •State of health •Alcohol abuse environment, socioeconomic culture and religion •Medications-NUTRIENT ALTER MED •Megadoses of nutrient supplements •Food Intake: •Increased: Obesity (BMI ≥30) •Decreased: anorexia (lack of appetite)
Components of Nutritional Assessment •History taking •Dietary, medical, socioeconomic data •Physical assessments(HEIGHT, BODY CIRCUMFERENCE) •Anthropometric and clinical data Laboratory data •Protein status, body vitamin, mineral, and trace element status
Dietary Data 24-hour recall method •Food diaries/calorie counts •Food frequency record •Diet history
Nursing Interventions Teaching nutritional information •Monitoring nutritional status-HBP RETAIN H20=EDEMA •Stimulating appetite •Providing oral nutrition •Providing long-term nutritional support •Assisting with eating
Consistency and Therapeutic Consistency: •Regular•Clear Liquid •Full Liquid •Pureed •Mechanical soft Therapeutic •Low Carb. Diabetic diet Cardiac diet •Low sodium •Renal diet •Fat restricted •High/low fiber diet
Short-Term Nutritional Support GOES TO LUNG- ASPIRATION=XRAY TO CHECK FOR NG TUBE -PLACEMENT FLUSH TUBE BEFORE AND AFTER Enteral Nutrition - Using the nasogastric or nasointestinal route •Confirming NG feeding tube placement •Radiography Examination - standard procedure •Measurement of aspirate pH and visual assessment of aspirate•Measurement of tube length and tube marking•Carbon dioxide monitoring•Confirming nasointestinal tube placement bowel sound is present Parenteral Nutrition (PN) – Nutrition intravenously (PPN or TPN)
Long-Term Nutritional Support An enterostomal tube may be placed through an opening created into the stomach (gastrostomy) or into the jejunum (jejunostomy). A gastrostomy is the preferred route to deliver enteral nutrition in the patient who is comatose. Placement of a tube into the stomach can be accomplished by a surgeon or gastroenterologist via a percutaneous endoscopic gastrostomy (PEG) or a surgically (open or laparoscopically) placed gastrostomy
Promoting Patient Safety # 1 Check tube placement before feeding, administering medications or fluids•Check gastric residual before feeding or q4 – 6 hrs or per policy Used sterile water to flush the tube in critically ill or immunocompromised patients •Provide comfort measures ( secure tube, provide oral hygiene, control local irritation, keep nares clean)•Provide instructions for home use
Parenteral Nutrition check lab values prior to getting the nutritious mixture Nutritional support intravenously •Comatose patients, patients with non-functional GI tract, high caloric and nutritional needs Concentrated/hypertonic solution (Total parenteral nutrition – TPN -Pt cant get any intake Peripheral parenteral nutrition - PPN: less concentrated/isotonic -pt can eat some)-short term •Through central venous catheter or peripheral vein Components include protein, carbohydrates, fats, vitamins, minerals, electrolytes and trace elements . See Table 36-6
Complications of TPN TPN Insertion problemsInfection and sepsisMetabolic alterationsFluid, electrolyte, and acid–base imbalances Phlebitis, pneumothorax HyperlipidemiaLiver and gallbladder disease REQUIRES CONSTANT MONITORING to prevent complications 45 DEGREE STAY 1 HOUR AFTER EATING
Q.1 A nurse is caring for a patient in the ICU who is being monitored for a possible cerebral aneurysm following a loss of consciousness in the emergency department (ED). The nurse anticipates preparing the patient for ordered diagnostic tests. What aspect of nursing does this nurse’s knowledge of the diagnostic procedures reflect? The science of nursing Q.2 Nurses today complete a nursing education program, and practice nursing that identifies the personal needs of the patient and the role of the nurse in meeting those needs. Which nursing pioneer is MOST instrumental in this birth of modern nursing? Florence Nightingale
Created by: Seka_nurse
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