Nursing at a Glance Leena Myrtle Gomez
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From Here and There1

Nursing is a service which includes ministration to the sick, care of the whole patient, his environment health education and health services to the individual family and society for the prevention of disease and promotion of health.
N—Nobility, Knowledge
U—Usefulness, Understanding
R—Righteousness, Responsibility
S—Simplicity, Sympathy
E—Efficiency, Equanimity
A Profession is defined as an occupation with ethical components or with a code of ethics that as devoted to the promotion of human and social welfare.
Etiquette is a code of good manners.
Hospital is an integral part of social and medical organization, the function of which is to provide for the population, the complete health care, both curative and preventive and whose out patient services reach out to the family and its home environment.
Communication means the interchange of thoughts or informations conveyed to a person or persons in such a way that the meaning received is equivalent to those which the initiator of the message is intended (verbal or written).
Euthanasia or mercy killing in order to end his suffering. It is a murder.2
Body mechanics is the efficient use of the body as a machine and as a means of locomotion (posture and balance).
Normal room temperature
68–72°F or
20-22°C
Humidity
40–60 percent
Velocity of the air movement
15–45 feet per minute or
1-3 miles per hour.
 
 
Standard Hospital Measurement
1. Size of a bed
190 cm long 90 cm width.
2. Pillow 60 cm long
45 cm wide and 10 cm thick.
3. Sheets
108 “long and 76” wide.
4. Draw sheets
150 cm long and 110 cm wide.
5. Pillow covers
65 cm long 50 cm wide.
6. Counter pane
3 meters long and 2 meters wide.
7. Rubber sheets
37 cm from head end.
8. Draw sheets
25 cm from head end.
 
Mitred Corner
When you make the bed the folds at the head and foot end is tucked tightly and the sheet is made to form a 90° triangle and tucked first the down portion and then the top portion to form box plete. This formation at the corner is called the mitred corner.
  1. Observation is the act of taking notice of something.
  2. Percussion tapping an area to elicit sounds.
  3. Auscultation listening with stethoscope for various sounds.
  4. Inspection observing with eyes and is associated with light and seeing.
  5. Temperature is the degree of heat maintained by the body or is the balance between the heat produced and heat lost. This is regulated by mechanisms.
  6. Thermogenesis chemical regulation by the production of heat.
  7. Thermolysis a physical regulation by loss of heat.
3
 
Heat
Heat regulating center → Hypothalamus
  • 1 gm of carbohydrates gives 4 calories
  • 1 gm of protein gives 4 calories
  • 1 gm of fat gives 9 calories
An increase in the production of energy or heat after taking food is not due to the work of diagestion or absorption but is due to the stimulating effect of food on basal metabolism. This is called a specific dynamic action of food.
Example:
Fat specific dynamic action
4 percent
Carbohydrate
5-6 percent
Protein
30 percent
Mixed diet
12 percent
 
Heat is Produced
  1. By oxidation of food.
  2. Specific dynamic action of food.
  3. Exercise.
  4. Strong emotions.
  5. Hormones: Increased activity of thyroid gland and adrenal gland and progesterone.
  6. Environmental and atmospheric.
  7. Deseases: Fever.
Heat is less: When sleeping, fasting, long illness and depression.
Heat is lost: By conduction, convection (transfer of heat by circulating air or liquid) vasodilatation, radiation, evaporation through lungs, kidneys and bowels. 300 mL of goes from lungs.
 
Temperature
Normal body temperature—97-99 °F (361–372°C)
Normal variations morning less evening more, during menstruation low, young people high, old people low.
Rectum
1°F higher than oral
Axilla
1°F lesser than oral
Emotions, exercises increases temperatures.4
 
Varieties of Thermometer
  1. Oral.
  2. Rectal.
  3. Electronic.
  4. Tympanic.
  5. Digital.
  6. Fore head electronic one.
  7. Axillary electronic one.
    Conversion of:
    I. Centigrade to Fahrenheit
    C = (F-32) x 5/9
    • = 104°F Temp = (104-32)x5/9
    • = 72 × 5/9 = 40°C
    II. Fahrenheit to Centigrade
    F = Cx9/5 + 32
    37°C/F=(37×9/5) + 32
    Temp F = 66.6 + 32
    = 98.6°F
 
Types and Phases of Fever
Rise in temperature in the body is called fever.
  1. Onset or invasion: When the temperature is rising and it may be sudden or gradual process.
  2. Fastigiums or stadium: When the temperature has reached its maximum and remains constant at a high level.
  3. Defervescence or decline: When temperature is returning to normal. It may be sudden then it is called Crisis and it may be gradual then it is called Lysis. Crisis occurs within a day or with in few hours. When it touches normal with in few hours accompanied by a marked improvement in patient's condition it is called True Crisis. When not accompanied by improvement in patient's condition then its is called False Crisis.
Lysis: When temperature falls in a zigzag manner for two or three days or week before reaching normal during which time the other symptoms also disappear.
Constant or continuous: Temperature varies not more than 2° between morning and evening and it does not reach normal for days or weeks. Then it is said to be constant or continuous.5
Remittant fever: When there is variations of more than 2° between morning and evening but does not touch normal then its termed as remittant fever.
Intermittent or quotidian fever: Here the temperature rises from normal or subnormal to high fever and back at regular intervals. The interval may vary from few hour to 3 days. Also high temperature will be shown in evening.
Inverse fever: High in the mornings and lowest in the evenings.
Hectic or swinging: When the difference between the high and low points is very great.
Relapsing fever: There are brief febrile periods followed by one more days of normal temperature.
Irregular fever: When irregular in its entire course. It cannot be classified under anyone of the above.
Rigor: Sudden severe attack of shivering.
Low pyrexia: Temperature does not rise above 100°F.
Moderate pyrexia: Temperature remains 100°-103°F.
High pyrexia: Temperature remains 103°F-105°F.
Hyper pyrexia: When temperature goes above 105°F.
Subnormal temperature: Temperature falls below normal between 95°–98°F.
Hyperthermia: Above 105°F. Hypothermia: Below 95°F.
Various stages of rigor: Cold stage, hot stage, sweating stage.
 
Pulse
Pulse: It is the contraction and relaxation of the heart which is transmitted and felt on an artery over a bony prominence.
What we note in a pulse: Rate, rhythm, volume and tension.
  1. Variations of rate: Tachycardia and bradycardia
    Increased-Decreased6
    Factors affected:
    1. Age
    2. Sex
    3. Exercise
    4. Physique
    5. Food
    6. Posture
    7. Emotions
    8. Applications of heat
    9. Pain
    10. Fever
    11. Diseases
    12. Drugs
    13. Cold applications.
  2. Variations in rhythm:
    1. Arrythmias: Variations from normal rhythm.
    2. Intermittent pulse: Difference between the apical (heart rate) and the radial pulse. It is known as pulse deficit.
    3. Extra systole: When the cardiac contraction occurs prematurely.
    4. Atrial fibrillation: Rapid contraction of atrium causing irregular contraction of the ventricles both in rhythm and force
    5. Ventricular fibrillation: Is the rapid twitching of the ventricles or fluttering.
    6. Sinus arrythmia: Rapid pulse during inspiration and slow pulse during expiration.
    7. Dicrotic pulse: There is one heart beat and two arterial pulsations giving the sensation of double beat.
  3. Variations in volume: Fullness of artery.
    Water hammer pulse or corrigan's pulse or
    1. Collapsing Pulse: It is a full volume pulse but rapidly collapsing. Occuring in aortic regurgitation or in incompetence, where the blood having been forced into the artery by the ventricular contraction, regurgitates back into the ventricle owing to the nonclosure of the aortic value.7
    2. Bounding pulse: An increase stroke volume due to exercise or anxiety or anemia, hepatic failure, or heart block or water hammer pulse.
    3. Pulsus alternans: The rhythm is regular but the volume has an alternative strong and weak character. Left ventricular failure, heart block and digitalis toxicity.
    4. Bigeminal pulse: This is accompanied by irregular rhythm in which every other beat comes early. The second or premature beats feels weak due to inadequate filling of the ventricles between the 2 beats. It is so weak to produce a peripheral pulse causing a pulse deficit. It occurs in myocardial Infarction.
    5. Weak, wiry, thready pulse: This signifies a decreased stroke volume and is seen in hemorrhagic shock and dehydration.
    6. Paradoxical pulse: The force or the strength of the pulse wave varies feeling weaker when the patient takes in a deeper breath. During inspiration less blood returned to the left side of the heart, so the stroke volume is reduced and their force decreases the strength of the pulse.
    7. Apical pulse: Thrust of the left ventricle located at the 4th or 5th inter costal space in the mid clavicular line.
  4. Tension: The tension is the degree of compressibility of the artery.
    High tension is said when a artery is full and difficult to compress.
    Low tension is said when it can be easily compressed.
 
Respiration
  1. Respiration is controlled by the respiratory center in medulla oblongata.
    1. Eupnea: This is normal, effortless, automatic, regular, even and without noise.
      In respiration we inhales and exhales 500 cc of air If more than 500 cc of air passes.
    2. In and out of lungs. It is said to be deep respiration. If the air going in and out of lungs are less than 500 cc, then it is said to be shallow.8
    3. Deep breathing is called hyperpnea.
    4. Polypnea: When the breathing is rapid.
    5. Dyspnea: When the breathings very difficult.
  2. Rhythm: When the respiration is not regular.
    1. Tachypnea: When the rate of respiration is increased.
    2. Bradypnea: When the rate of respiration is decreased.
    3. Apnea: Total cessation of breathing.
    4. Hyperpnea: Increase in the depth of respiration.
    5. Orthopnea: The person is able to breathe only when he is in an upright position.
    6. Stertorous respiration: Noisy breathing produced by air passing through the secretions in the respiratory tract.
    7. Stridor: Harsh, vibrating, shrill sound produced during respiration seen in upper respiratory obstruction.
    8. Rale: An abnormal rattling or bubbling sound caused by mucus in the air passages in bronchitis.
    9. Wheez: The high pitched, musical, whistling sound that occur with the partial obstruction of the smaller bronchi and bronchioles in asthma.
    10. Sigh: A deep inspiration followed by a prolonged expiration.
    11. Air hunger: Deep sighing respirations.
    12. Cheyne stokes respiration: Consists of a respirations that gradually becomes deeper and noicer until a climax is reached when a pause occurs (apnea), then the cycle is repeated. An increased in the rate and depth of respiration alternate with a period of apnea.
    13. Anoxia or hypoxia: Lack of O2 in the tissues.
    14. Anoxemia or hypoxemia: Lack of O2 in the blood stream.
    15. Asphyxia: A state of suffocation or obstruction for the entry of air into the lungs due to various factors.
 
Blood Pressure
Blood pressure recording. For this there are two type of apparatus
  1. Mercury which is accurate and
  2. Aneroid
In BP Apparatus the width of the cuff bladder, should be 20 percent greater than the diameter of the extremity.9
To measure venous pressure water manometer is used. The manometer containing saline is attached by a stopcock to a venipuncture needle.
Stethoscope has the following parts:
  1. Earpiece
  2. Binaurals-steel tubes
  3. Diaphragm
  4. Bell
  5. Rubber tubing
  6. Chest piece.
 
Neurological Examination
 
Reflexes
  1. Bicep's reflex: Doctor's thumb on the biceps tendons and gently tapping with a percussion hammer.
  2. Tricep's reflex: Support the patient's arm and gently tap with hammer just above the olecranon process. Normally it will straighten.
  3. Patellar reflex: Lower leg will kick back when patella is tapped.
  4. Achille's reflex: When tap the Achille's tendon there will be downward jerk of the foot.
  5. Plantar reflex or Babinski reflex: When the sole of the foot is stroked with a sharp instrument normally the toes bend downward is said as negative. When the toes spread outward and the big toe moves upward it is said to be positive.
  6. Co-ordinations test: Looking straight and bringing finger to nose.
  7. Equilibrium test: Stand with the eyes open and feet together.
    If he does not fall close eyes and do.
  8. Tests for sensations: With dotpins and cotton, two test tubes one with hot and one with cold water.
  9. Muscle strength: Asking the patient to push against your hand.