Nursing FundamentalsCHAPTER 1

The era of modern nursing commences with the work of Florence Nightingale in the Crimean war (1854–1856). She was born in Italy in 1820. She was the second daughter of wealthy English parents. In 1851, Nightingale entered the Deaconess school in Kaiserswerth. She was 31 years old and her family and friends were strongly opposed to her becoming a nurse. After her graduation in 1853, she became superintendent of charity hospital for the government.

“The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge and to do this in such a way as to help him gain independence as rapidly as possible.”

Profession has been defined as an occupation that requires extensive education or a calling that requires special knowledge, skill and preparation. A profession is generally distinguished from other kinds of occupations by:

A process is a series of steps that is used to perform any activity to meet the desired outcome. Nursing process is a five step process for providing professional and quality nursing care to the patients.

Assessment is the first step in nursing process. In this phase the nurse assess the condition of the patient by collecting data from the patients or relatives. The data is collected by variety of means such as personal interview, physical examination, health history, family history, and so on. There are two types of data, subjective data and objective data. Subjective data are data from patient's point of view or verbal report, e.g. I have fever. Objective data are observable and measurable data, what the nurse observes, e.g. monitoring temperature to assess the severity of fever.

Diagnosis is the second step in nursing process. In this phase the nurse makes a judgment about the potential or actual problems based on the assessment findings. Multiple diagnosis are sometimes made for a single patient, among that we have to pick the most priority one first. After analyzing the collected data (high temperature), we will come to the conclusion that patient is having fever. The diagnosis is a critical step as it is used to determine the course of treatment.

Planning is the third step in nursing process. Once a patient and nurse agree on the diagnosis, a plan of action can be developed. If multiple diagnosis need to be addressed, the head nurse will prioritize each assessment and devote attention to severe symptoms and high risk factors. Each problem is assigned a clear, measurable goal for the expected beneficial outcome. After selecting the diagnosis (fever) nurse plan the actions to reduce the fever such as cold sponge, medications, fluids, diets, etc.

Implementation is also called as working phase. The nurse works through the desired plan. This plan is specific for each person and focus on the achievable outcome. Implementation can take place over the course of hours, days, weeks or even months. After planning the activities for the desired diagnosis (fever) nurse implement the plan such as administering medications, health education, fluids, etc.

Evaluation is the last step of nursing process. Once all nursing intervention actions have taken place, the nurse completes an evaluation to determine the goals for patient wellness has been met. The possible patient outcomes are generally described under three terms: patient's condition improved (fever decreased), patient's condition stabilized and patient's condition deteriorated, died or discharged.

Ethics are the rules or principles that govern right conduct and are designed to protect the rights of human beings.

In 1953 ICN adopted its first code of ethics for nurses and was revised in 2000. The four principle elements contained within the ICN code involve standards related to nurses and people, practice, profession and co-workers.

The nurse's primary responsibility is to those people who require nursing care. The nurse in providing care promotes an environment in the values, customs and spiritual beliefs of the individual are respected. The nurse holds in confidence personal information and uses judgment in sharing this information.

The nurse carries personal responsibility for nursing practice and for maintaining competence by continual learning. The nurse maintains the highest standard of nursing care possible within the reality of a specific situation.

The nurse maintains a cooperative relationship with co-workers in nursing and other fields. The nurse takes appropriate action to safeguard the individual when his care is endangered by a co-worker or any person.

The nurses play a major role in determining and implementing desirable standards of nursing practice. The nursing is active in developing a core of professional knowledge. The nurse acting through the professional organizations participates in establishing and maintaining equitable social and economic working conditions in nursing.

Statutory Law is created by elected legislative bodies such as state or provincial legislatures, the U.S. Congress, administrative bodies such as state boards of nursing or the Canadian Parliament.

Common Law is created by judicial decisions made in courts when cases are decided.

Criminal Law is concerned with relationships between individuals and governments and with acts that threaten society and its order. Misuse of controlled substances is an example of criminal conduct for nurses. A crime is an offense against society that violates a law. Criminal acts are prosecutes in the criminal justice system. A felony is a crime of a serious nature that usually carries a penalty of imprisonment or death.

Civil Law is concerned with the relationships among people and the protection of a person's rights. Although violations of civil law might cause harm to an individual or property, society as a whole is usually not affected. For example, defamatory statements made about an individual might lead to interpersonal problems, but they do not threaten society as a whole.

Torts: A tort is a civil wrong committed against a person or property. Torts may be subtle and difficult to define; they may be classified as intentional or unintentional. Unintentional torts include negligence. Malpractice is one 4example of an unintentional tort or negligence. Intentional torts are willful acts that violate another`s rights. Examples are assault, battery and defamation, invasion of privacy, false imprisonment and fraud.

Assaults: Assault is any willful attempt or threat to harm another, coupled with the ability to actually harm the other person. The victim believes harm will come as a result of the threat. Assault may be subtle; for example, a nurse might attempt to coerce a client into taking a drug he or she does not wish to take. A more blatant example might involve a nurse handing an uncooperative client in the emergency room, e.g. “If you don't take off those filthy clothes, I am going to rip them off you!” and moves toward the client, a claim of assault could be made.

Battery: Battery is any intentional touching of another's body or anything the person is touching or holding without consent. Injury is not a requirement. There have been instances of battery of confined clients by personnel in mental institutions.

Invasion of privacy: Clients have claims for invasion of privacy when their private affairs, with which the public has no concern, have been publicized. A client is entitled to confidential health care. All aspects of care should be free from unwanted publicity or exposure to public scrutiny.

Defamation of character: Defamation of character is the holding up of a person to ridicule, scorn or contempt within the community. There are two types of defamation: slander and libel. For example, if a nurse tells a client that his physician is incompetent; the nurse could be held liable for slander. If the nurse writes such a comment, the charge would be libel. The important issues in a claim of defamation of character are whether the information was shared with third persons (other than the client) and if harm has been done to the reputation of the plaintiff (legal short hand).

Negligence: Negligence is conduct that falls below the standard of care. It is established by law for the protection of others against unreasonable risk of harm and it is characterized chiefly by inadvertence, thoughtlessness or inattention.

Malpractice: Malpractice is one type of negligence. It is defined as professional misconduct, unreasonable lack of skill or fidelity in professional duties, evil practice or illegal or immoral conduct. In a malpractice law- suit against a nurse, the following criteria must be established.

There are mainly four acid-base imbalances.

Nursing care: Administer oxygen5

Nursing care: Limit oxygen

Nursing care: Administer sodium bicarbonate

Nursing care: Administer chloride

The energy sources are carbohydrates, fats and protein. Carbohydrates are the base of food pyramid and fats are the top of food pyramid.

Potatoes, whole grains, citrus fruits, berries, water melon, nuts and legumes, cereals, dried fruits, bread, banana and green leafy vegetables.

Eggs, milk, yogurt, fish and sea foods, soya, nuts, meats, chicken, etc.

Beef, poultry, butter, cream, milk, cheese, etc.

Total Parenteral Nutrition (TPN) is feeding the patient intravenously; nutrients are infused directly into the veins through a central line catheter.

There are two categories:

1 drain = 60 grains

1 ounce = 30 mL

1 liter = 1000 mL

1 grain = 60 mgm

1 pint = 500 mL

1 kg = 2.2 lbs

1 mgm =1000 mcg

1 teaspoon = 4–5 mL

1 teaspoon = 60 drop

1 mL = 16 drop

1 inch = 2.5 cm

qd = everyday

qod = every other day

d = daily

bid = twice a day

tid = three times a day

qid = four times a day

q4h = every 4 hrs

q6h = every 6 hrs

q8h = every 8 hrs

q4–6h = every 4–6 hrs

prn = as needed

C = (F – 32) × 5/9 (For converting Fahrenheit to Celsius)

F = (C × 9/5) + 32 (For converting Degree to Fahrenheit)

Child's dose = [(Age of child/(Age of child + 12)] × Average adult dose

Example:

A 10 year old girl/60 Lbs with 300 mg Average adult dose is given for the girl. Calculate the child's pediatric dose.

Given,

Age of child = 10 years

To find,

Child's pediatric dose

Solution:

Child's dose = [(Age of child/(Age of child + 12)] × Average adult dose

Child dose = (weight in pounds/150) × adult dose.

Example:

11-year-old girl/70 lbs, adult dose is 500 mg

500 mg × (70 ÷ 150) = Child's dose

500 mg × (.47) = Child's dose

500 mg × .47 = 235 mg

Pulse pressure = Systolic BP–Diastolic BP

MAP (mean arterial pressure) = [(Systolic BP + 2 (Diastolic BP)]/3

Cerebral perfusion Pressure (CPP) = MAP–ICP

Drops per minute = (order dose/overdose) × drop factor