Introduction

FUNDAMENTALS OF NUSRING
24 January 2020 / Prof. Dennis Cuadra

OUTLINE
I. Introduction
A. Nursing Concepts
B. Concepts of Nursing in
the Past and Present II. Models of a Thomasian
C. Management and Nurse
leadership A. St. Elizabeth
D. Research B. St. Thomas Aquinas
E. The Personal Qualities C. St. Martin de Porres
of a Professional Nurse
F. Core Value of a
Thomasian Nurse

Stat (now) within 30 minutes

I.INTRODUCTION  Helping profession: anticipating the needs
 Adaptive: if laws not broken pabigay
A. NURSING CONCEPTS  Concerned with health promotion health maintenance and
January 24, 2020 health restoration:
Nursing Propositions in the Nursing paradigm
 Person-environment interaction are the focus of the Recipients of Nursing
nursing care  Consumer
 Health and illness behavior are a product of person-  Patient
environment interaction  Client
 The focus of the intervention is the patient’s environment
 Environment is a composite of energy fields Scope of Nursing
 Promoting Health and Wellness
Nursing from  Engages activities and behaviors that enhance quality
 Nutrix-to nourish of life
 Florence nightingale  Ex. Lifestyle, misuse of drugs and medicines,
 An act of utilizing the environment of the patient to assist restricting smoking
him in his recovery  Preventing illness
 Ex. Asthmatic patient  Maintain optimal health by preventing diseases
 Ex. immunization, prenatal and infant care,
Remember/recall the preventing of STD
 Virginia Henderson  Restoring Health
 (assisting the sick gradually and well to he or she  Focuses on the ill clients and extends from early
can be well he who can perform unaided detection of disease by helping client during recovery
 Dorothea Orem period
 (directly provide the needs of the patient)  Providing direct care, performing diagnostic and
 Helping and assisting the patient assessment procedure, consultation, health
 Anticipating the needs education and rehabilitation
America’s Nursing Association 2003  Caring for the dying
Nursing  Comforting and caring for people of all ages
 Protection, promotion and optimization of health and  Helping clients live comfortably as possible death
abilities  Support person cope with death
 Prevention of illness and injury
 Alleviation of suffering through the diagnosis and treatment
of human response (direct response) B. CONCEPTS OF NURSING IN THE PAST AND PRESENT
 Individuals, families, communities and populations Past: TFFIF
 Ex. Ma’am/Sir can you please do some stretching exercises 1. Taking care of ill patients
2. Focused on the physical aspect of care and environmental
cleanliness (task-oriented)
Nursing is an art and science
3. Focused on the curative aspect of care
 Art
4. Is a dependent function
 Care is delivered artfully thru skills requiring
5. Focused primarily on the disease condition not on the
proficiency and dexterity with compassion, caring,
patient
and respect for the client’s dignity and personhood
 Science
Present: ICCFWPTIC
 Nursing is based on a body of knowledge that is
1. Includes the sick and health
changing with new discoveries and innovations
2. Considered the holistic nature of the individuals
Nursing is
3. Client- centered (Karl rogers) the verbal complain will be
 Caring: concern for the patient
prioritized
 Art
4. Focus is on the preventive and promotive aspect of care
 Science
5. With expanding consciousness and changing role in the
 Holistic: chief complain then check system related to GI
society
Npo (nothing per orem)
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 Introduction THEORETICAL FOUNDATIONS OF A NURSE
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6. Performs more highly specialized tasks  Practiced ancestors’ worship

7. Takes increasing responsibilities from the physician  Knowledge of materia medica
8. Involves close, personal, contact with the recipient of care  Care of the sick was done by female
9. Conducts research to improve nursing practice  India
 Men of medicine-built hospitals
Profession  Intuitive form of asepsis
Is an occupation, a calling in which its members profess to have  Sushurutu-list of function and qualification of nurses
acquired special knowledge and skills, by training or experience or  Ancient Greece
both, so that they may guide or advice or serve others in that special  Nursing task of untrained slave
field.  Introduced ”father of scientific medicine”
 caduceus
Primary Characteristics of a Profession : RHPMH  Hippocrates “fathere of scientific medicine
1. Requires basic liberal foundation and extended education  Rome
of its members  Transition from pagan to Christian philosophy
2. Has a theoretical body of knowledge leading to defined  Care of the ill was left to the slaves or Greek
skills, abilities and norms physicians
3. Provides specific service  Fabiola her home was the 1st hospital in the Christian
4. Members have autonomy in decisions making and practice world
5. Has a code of ethics for practice

Professional Nursing
Is an art and a science, dominated by an ideal of service in which Apprentice period
certain principles are applied in the skillful care of the well and the ill  Founding of religious nursing orders
and through relationships with the client and patient, significant  Pastor Fliedner and his wife established the
others and other members of the health team Kaiserwerth Institute for The Training Of
Deaconesses
Professional Nurse  Period of “on the job: training
A licensed nurse who possess a body of nursing knowledge and skill
through formal education and who utilizes sound judgment and  The Rise of the Secular Orders
critical thinking and research when giving care to her clients  Rise of religious nursing orders for women
 St. Clare- founder of the second order of St. Francis of
A. HISTORICAL DEVELOPMENT OF NURSING Assisi
 St. Elizabeth of Hungary-patron saint of nurses
 St. Catherine of Siena “1st lady with the lamp”
Intuitive period
 Beliefs and practices of pre-historic Man
The Dark Period Of Nursing
 The best for the most
 Sairy Gamp and Betsy Prog nursing character in Charles
 Laws of self-preservation
Dickens Novels
 Nursing-women
 Nursing in America
 Illness-evil spirit (black magic/voodoo)
 Mdme. Jeanne Manca -1st laywoman who worked as a
 Healing shaman witch doctor
nurse in North America
 White magic/tephing
 Mrs. Elizabth Seaton -founded the sisters of charity
 Dorothea Lynde Dix -established the nurse corps of the
INQUITVIVEPERIOS
United Stated Army;
Nursing in the Near East
 Clara Barton : Founder of American red cross
 From nomadic style to an agrarian society to an urban
community life
 Developed a meanes of communication
Educative Period
 Astrology and numerology were used in medical practe
 Florence Nightingale
 Mother of modern nursing
Religious ideologies
 The lady with the lamp
 Judaism
 First nurse -epidemiologist
 Christianity
 Islam
 Born on May 12, 1820 in Florence Italy
 Published 2 books
Nursing in the near east
 Notes on nursing: what is it and what it is not
 Babylonian
 Code of Hammurabi – provided laws  Notes on hospitals
 Egypt  Nightingale Traing school of nurses at st Thomas
 Art of embalming hospital in London -school founded by Florence
 250 recognized diseases nightingale
 slaves and patients’ families nursed the sick  Specialization in nursing started
 Israel Private duty nursing
 Moses “father of sanitation” MCN
 Practice of hospitality and acts of charity School Nursing
 Ritual of circumcision of the male child
 Referred nurses as midwives, wet nurses or child’s  Linda Richards
nurses 1st graduate nurse in the US
 Caroline Hampton Robb
Nursing in the Far East 1st nurse to wear rubber gloves in the OP
 China  Isabel Hampton Robb -1st principal of the John Hopkins
 Strongly believed in spirits and demons Hospital School of Nursing

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 Clara Louise Maas-engaged in medical research on yellow Lets just say may patient that will suddenly say sana namatay ako
fever what should a nurse say
 Edith Cavell took care of the wounded soldiers during WW1
Nursing functions
Contemporary period Jan 27, 2020
 Started after WWII
 WHO was established by the UN 1. Independent Functions
 Health became a fundamental human right  Actions of which the nurse initiates herself
 Advances in science and technology  Requires nurse’s judgment or decision making
 Atomic / nuclear energy Example
 Space medicine  Nursing assessment
 Roles of the nurse expanded and were developed o Patient interview
 Community health nursing established o Bed making
 Utilization of computers  Client supervision
 Use of sophisticated equipment for dx and therapy o Ambulate
 Development of disposable supplies and equipment o Hair shampoo
 Application and execution of nursing procedures and

 Pre-Spanish Regime
I. HISTORY OF NURSING IN THE PHILIPPINES
 Beliefs about causation of disease techniques
 Evil spirits o Insulin injection
 Enemy or witch
 Misconceptions
 Word doctors/ herbolarios 2. Dependent Function
 Actions which the nurse performs on someone’s
 Spanish Regime else’s orders
 Hospital Real de Manila (1577) founded by Gov.  Ex. Administration of a legally ordered
Francisco de Sande o Difficulty in swallowing
 San Lazaro Hospital (1578) founded by bro. juan o Insertion of nasal tube
Clemente o Iv insertion
 Hospital de indio (1586) established by the Franciscan o Paracetamol
order o Laboratory test
 Hospital de aguas santas (1590) founded by bro. J. o Diagnostic functions
Bautista o Hair shampoo (in the case of
 San Juan de dios Hospital (1596) founded bu the neurological disfunction of EEG)
brother hood of misericordia o More on CURING
American regime 3. Interdependent Function
 Dona Hilaria Deaguinaldo  Actions which the nurse performs together with
Organized the Filipino red cross other members of the health team
 Dona Maria Agoncillo De Aguinaldo  Collaborative
President of the Filipino red cross in Batangas  Ex. Making referral

Hospitals and Schools of Nursing o Can I ask the patient to do this doc (this happens because
 Iloilo Mission Hospital School of Nursing (iloilo city (1906) you have made an assessment and you are asking the
ms rose nicolet was the 1st sperintenent for nurses doctor if you can follow on thru or include with the
 St. pauls hospital of school of nursing (manila1907) under prescription therefore is COLLABORATIVE
the supervision of the sisters of st. paul de charted
 Phil. General hospital school of nursing (1907) SPECIFIC ROLES AND FUNCTION OF NURSES
 Anastacia Giron Tupas became the 1st filipino nurse with the  Caregiver/ Care Provider: Physical care for the client
position of Chief nurse and superintendd in the phils  Patient Advocate: Intercedes for or works on behalf of the
 St lukes hospital school of nursing (quezon city,1907)mrs. client
vitaliana beltran was the 1st filipino superinintended of o Let’s just say if the meds that the doc suggest is pricey
nurses you may suggest a generic on the market but ask the
 Mary johnson hospital and school of nursing (Mnila, 1907) doctor first
ms. Librada Jva`3 l o Or let’s just say you know what the patient is allergic to
from the health history
Values Basic to Advocacy
 1ST. College of Nursing  Client is a holistic, autonomous being who has the right to
 University of Santo Tomas College of Nursing (1946) make choices and decisions
-Sor Taciana Trianans, 1st directress  Clients have the right to expect a nurse-client relationship
 Manila Central Univeristy College of Nrsing (1947) that is based on shared respect, trust and collaboration
Ms. Consuelo Gimeno, 1st principal 2 SLIDES GONE
 University of the Philippines College of Nursing (1948) Lers just say the medicine is expired so that the meds cannot be given
Ms. Julita Sotejo, 1st dean BUT expired the doctor wont give it and the patient knows why and
allows it YOU MUST DOCCUMENT IT

 Teacher: Provides health teaching

POTENTIAL QUESTIONS o Educate patient what to do before during and
If shampoo is a independent function then which category does it after
belong to ?

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o Let’s just say drug for stimulation for woman  Responsible for classroom and often clinical teaching
however to increase blood flow
 For health promotion disease prevention and  Nurse Entrepreneur
rehabilitation  With advance degree and manages a health-related
 Counselor: helping the client to become aware of his business
feelings and to deal with them in a constructive manner  May be involved in education, consultation or research
 Role model: Nurses are considered knowledgeable about o Those who own review centers
health and needs to observe healthful practices of daily o Nursing homes
living
 Coordinator/collaborator: nurse works in a combined II. CONCEPTS OF MAN AND HIS BASIC HUMAN NEEDS
effort with all those involved in care delivery 4 Major Attributes of Human Being
 Leader: influence the client make decisions in achieving  Capacity to think or conceptualize on the abstract level
goals  Family formation
 Clinician: Technical expertise to recognize clues to initiate  Tendency to seek and maintain territory
and modify care according to client’s needs and to o To I want to be nurse or doctor, which field of
administer nursing care nursing swill I look forward to everyday
 Manager: plans, develops staff, monitors operations  Ability to use verbal symbols as language, a means of
 Change agent: initiates changes and modifies behavior developing and maintain culture
o There is a group for smokers to make the o If someone cannot write or signature, then
smoker stop smoking thumb mark
 Researcher: Participates in scientific investigation and o If person has done tubing and cannot talk
research o Charting with potential symbol needs of patient
 Nurse practitioner for those who cannot talk nor point nor write
 With advanced education and is a graduate of a nurse
practitioner program Concepts of Man
 Deal with nonemergency acute or chronic illness  Man is a BIOPSYCHOSOCIAL and SPIRITUAL being who is in
 Examples pediatric nurse, practitioner, school nurse constant contact with the environment
practitioner, family nurse practitioner  As a biologic being, man is like other men
 As a psychologic being, man is like no other man
Expanded Specialists  As a social being, man is like some other men
 Clinical nurse specialist
 With advanced education or expertise, a specialized
area of practice Basic Human Needs
 Provides direct care, educates others, manages care  Each individual has a unique characteristic, but certain
 Ex. Gerontology, oncology needs are common to all people
 Human needs are physiologic and psychologic conditions
 Nurse Anesthetist (MOST EXP IN STATES) that an individual meet to achieve a state of well being
 Completed advanced education in an accredited Human Needs
program in anesthesiology  Needs
 Responsibilities  Necessary useful or desirable to maintain well-
 Carries out preoperative visits and assessment being and life; motivation for behavior
 Administers general anesthetics for surgery  May be met consciously or unconsciously
under supervision of anesthesiologist (doctor)
 Assess post-operative status of clients
Characteristics of Basic Human Needs
 Nurse Midwife Needs may be
 An RN with a completed midwifery program  Needs are universal
 Responsibilities  met in different ways
 Gives prenatal and post-natal are  stimulated by external and internal factors
 Manages deliveries in normal pregnancies  Altered by individual priorities
 Conducts routine pap’s smear, family planning  Deferred
and routine breast examination  Interrelated
 Unmet human need results in disruption of normal body
 Nurse Researcher activities and frequently leads to eventual illness
 Investigate nursing problems to improve care and
refine nursing knowledge
 Employed in academic institutions teaching hospitals III. HEALTH ANND ILLNESS
and research centers Health
 Have advanced education at the doctoral level  State of being well and using every power the individual
 Nurse Administration possesses to the fullest extent (nightingale)
 Manages client care including the delivery of nursing  State of complete physical, mental and social well-being
service and note merely the absence of disease or infirmity (WHO)
 Functions  A dynamin state of being in which the developmental and
 Budgeting behavioral potential of an individual is realized to the fullest
 Staffing extent possible (ANA 1980)
 Planning programs  Free from signs of disease and pain as much as possible;
 With master’s degree being, active and able to do what they want/must; being in
 Nurse educator good spirits most of the time (lay/definition)
 Employed in nursing programs educational
institutions and hospital staff education Wellness
 With expertise in a particular area of practice

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 An integrated method of functioning oriented towards  Usual characteristics of each age group and how
maximizing the potentials of an individual within the they interact and react to situations
environment where he is (Dunn)  Social and cultural influences
 Previous experiences
Well-being  Expectation of self
 A subjective perception of balance, harmony and vitality.  Perception of self
(Leddy and Pepper)

Illness
 It is a personal state in which the person’s physical, Models of Health
emotional, intellectual, social developmental or spiritual
functioning is thought to be diminished  Leavell and Clark model
 Disturbance in normal functioning

Classification of illness
 Acute illness
 Characterized by severe symptoms of relatively short
duration
 Chronic illness
 The one that lasts for an extended period. 6 months or
longer
 Has slow, onset and often have period of remission,
when the symptoms disappear and exacerbation, when agent host
symptoms reappear

Disease
 Alteration in body functions resulting in a reduction of
capacities or shortening of normal life span

Common Causes of Disease

 Leavell and Clark model
 Biological agents
 Inherited genetic defects
 Developmental defects
 Agent
 Physical agents
 Chemical agents  Environmental factor. Stressor that by presence
 Burnt injury /absences can lead to disease eg: lack of essential
 Prompt treatment/ therapeutic regimen nutrients etc.
 If not will form scar  Host
 Tissue response to irritation/injury  Person who may/may not be a risk of acquiring a
 Faculty chemical/metabolic process disease
 Emotional/physical reaction to stress  Environment
 physical and social factors external to the host that
Sickness may/may not predispose the person to
Status or social entity associated with disease or illness development of disease eg: living conditions,
Wellness (Figure 17.2 the seven components of wellness (from economic status, etc.
wellness concepts and Applications 6th edition)
 Environmental (clean water, sufficient food, clean air)
 Occupational (engaged in activities that produces personal
satisfaction and enrichment of life)
 Intellectual (engaging in stimulating and creative mental
activities to increase knowledge
 Spiritual (seeking measure and purpose in human life
 Physical (ADLs, self-care ,NTN no vices, etc
 Emotional (positive feeling of self, enthusiasm toward life
 Social (relationship w/others contributions to society )

Dimensions of health /wellness

 Environmental (clean water, sufficient food, clean air)
 Occupational (engaged in activities that produces personal
satisfaction and enrichment of life)
 Intellectual (engaging in stimulating and creative mental
activities to increase knowledge
 Spiritual (seeking measure aELL AND CLARK MODEL nd
purpose in human life
 Physical (ADLs, self-care, NTN no vices, etc.  Dunn’s High-Level Wellness
 Emotional (positive feeling of self, enthusiasm toward life
 Social (relationship/others and contributions to society)
Ex.
Factors influencing definition of health
 Developmental status The intersection of the two axes from four health/wellness quadrants

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1. High level wellness in a favorable environment A. Internal variables

 Healthy lifestyle with resources to support 1. Biologic dimensions
2. Emergent high-level wellness in a unfavorable environment  Developmental level
 knowledge in lifestyle but cannot implement because of some  Genetic make up
factors (such that there is no time and energy or money) 2. Psychologic dimension
3. Protected poor health in an favorable environment  Mind-body interactions
 Needs are met by health care system  Self-concept
4. Poor health in an unfavorable environment 3. Cognitive dimensions
 As future health care professional that is where our extra time is  Life-style choices
donated to them  Spiritual and religious beliefs

Factors influencing health and health beliefs and practices

B. External variable
1. Family practices
2. Socio-economic factors
3. Cultural background

 Travis’ Illness-Wellness Model

 Health Promotion Model,

 Not disease orient
 Motivated by personal , positive approach to wellness
 Seeks to expand positive potential for health

Nurse’s Role in Health promotion

1. Model healthy lifestyle
2. Facilitate client environment
3. Teach self-cate strategies
4. Assist clients to increase levels if health
5. Educates clients to be effective health care consumers
6. Assists clients to develop and choose health-[promoting
options
7. Guide development f effective problem-solving and decision
making
 Rosenstock-Becker’s Health Belief Model
8. Reinforce clients’ personal and family health-promoting
behaviors
 Would not use preventive health services (ex. Flu shot, HIV
9. Advocate in the community for change that promote a
testing, hypertension screening.)
health environment
 Based on motivational theory
Other health models
 Assumption: Rosenstock-good health is an objective common to
 Holistic health model
all people; Becker -consider positive health motivation
 Promotes the active involvement of the client in the
improvement and maintenance of his health
Individual perceptions
 Clinical model
1. Perceived susceptibility: high risk due to family history of a
 Role performance model: can so everyday activities
disorder
however in cannot accomplish then there is an illness
2. Perceived seriousness: based on the perception of the
 Adaptive model (whatever manifestation did I educate
individual
myself about it ..did I drink water…symptomatic treatment
3. Perceived threat: combination of perceived susceptibility
 Eudemonistic model (more on applicating health
and seriousness
promotion and disease prevention
Variable Influencing Health and Health Beliefs and Practices
Levels of Prevention
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1. Primary IMPORTANCE OF BIOLOGIC SAFETY

 Health promotion programs  Microorganisms are naturally present in the environment;
 Specific protection some are beneficial, and some are not some are harmless
2. Secondary to most people and others are harmful to many persons.
 Early diagnoses and prompt treatment Still others are harmless except in certain circumstances
 Disability limitations
3. Tertiary Terms
 Respiration and rehabilitation  Infection: successful entry and multiplication of
microorganisms into the body
 Disease: abnormal functioning of the disease

Factors That Cause Illness

 Etiologic factors Types of Infection
 Cause of particular disease 1. Nosocomial (hospital acquired infection brought by doctor
 Predisposing factors or procedure)
 A previous condition that influence susceptibility or  Iatrogenic
tendency to illness  From endogenous (natural present from person
 e.g family history of heart disease-may predispose to body) or exogenous sources (from external sources)
heart attack 2. Subclinical/ asymptomatic
 Contributory factors 3. Infectious disease
 A condition that helps bring about illness A. non-communicable (PTB treatment for 2 weeks)
 e.g. smoking, sedentary life, obesity -contributed to heart B. communicable
attack
 Precipitating Factors
 A condition that hastens activates or aggravates the
illness Epidemiologic/Ecologic Triad (Clark)
 Heart attack brought about by sudden death of a loved
one Agent
Risk factors
 Any situation habit or environmental condition
physiological condition, developmental, intellectual spiritual
variables that increases the vulnerability of an individual to
an illness to accidents
1. Genetic and physiological factors
2. Age environment host
3. Environment
4. Lifestyle

Stages of health behavior change

 Stages Stages of the Infectious Process
1. Pre-contemplation no change 1. Incubation Period
2. Contemplation -considers a change  Interval between the initial injection and the first
Preparation -plans to change appearance of any signs or symptoms
3. Action-changes in actions  time of infection depends on
4. Maintenance: changes in actions become a habit  specific microorganism involved
5. Termination: convinced health problem is no longer a  virulence
threat  number of infecting microorganisms
 resistance of the host
Stages of Illness Behavior 2. Prodromal Period
1. Symptoms experience -awareness of s/sx - Self diagnose-  Relatively short period that follows the incubation
self medicine period in some diseases
2. Assumption of sick role- sick leave, free form social  Characterized by early, mild symptoms of diseases
obligations such as headaches and malaise
3. Medical care contact: consultation: medical shopping 3. Period of illness
4. Dependent client role (sick role): self-care deficit  Disease is most acute
5. Recovery/rehabilitation: restoration: relinquishes the sick  The person exhibits overt (observable) signs of the
role symptoms of the disease
 Patients’ immune response and the other defense
Impact Of Illness On The Client And Family mechanisms overcome the pathogen and the period of
 Behavioral and emotional changes illness ends
 Impact on body image  When the disease is not successfully overcome the
 Impact on self-concept patient will die in this period
 Impact on family roles 4. Convalescence
 Impact on family dynamics  Person regains strength and the body returns to its
pre-diseased state
 Recovery state
Feb 3, 2020
PREVENTION TRANSFER OF MICROORGANISM

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3. Stress
4. Disease process
5. Medical therapy

Body’s Defense Against Infection

 Non-specific Defense
 anatomic and physiologic barriers
 Inflammatory response
 Specific defenses
 immune system
a. humoral immunity
b. cell-mediated defenses

Figure 1.A Chain of Transmission or Infectious Cycles

Agent Immunity
 Bacteria, viruses, fungi,protozoa  Natural
 Factors affecting microorganisms capability to cause 1. Active: exposure/experience (had it before you cant have it
disease now)
1. Number (dose) of organisms present 2. Passive: placental/breastfeeding)
2. Virulence  Acquired/Artificial
3. Ability to enter and survive in the host 1. Active: antigens (vaccines/toxoid)
4. Susceptibility/resistance of the host 2. Passive: antibody (ATS, HRIG)

ADD PICTUURE
Reservoir OF 8 CIRCLES PURPLE AND YELLOW :CHAIN OF INFECTION
 Environment area body where pathogenic organisms is
found dependent for survival may or may not multiple Breaking the Chain of Infection
1. human  Isolation
 frank cases  Separation of the infected person based on the longest
 subclincall infected period of communicability of the disease
 carrier
 CDC Isolation precautions
2. Animals  Standard precautions
3. Plants  All hospitalized persons regardless of their
4. Soil diagnoses or probable infection status
5. Fomites  Designed to reduce risk of transmission of
microorganisms form recognized and
Portal of Exit unrecognized sources
 Respiratory tract( exhalation,coughing, etc  Apply to
 GIT (vomiting, defection □ Blood
 Genito-urinary (voiding, sexual intercourse( □ All body fluid, excretions and
 Wounds (boil, scabies, etc) secretions except swear
 Mechanical stahe escape (I&D, needle aspiration, □ Non-intact (broken) skin
bites/sting) □ Mucous membranes
 Practices
Mode of Transmission 1. Wash hands whether or not gloves are worn
 Direct a. Wash hands immediately after removing loves
 droplets (with in 3ft) b. Use a non-antimicrobial soap for routine hand
 touching washing
 biting c. Use an antimicrobial agent or an antiseptic agent
 kissing for the control of specific outbreaks of the
 sex infection
 Indirect 2. Wear Clean gloves when touching blood, body fluid
 (vehicles of transmission: vectors) secretions excretions and contaminated items
 beddings, stuff toy, eating utensils a. Clean gloves can be unsterile unless their use is
 Airborne ((more than 3 ft) dust particles; droplet nuclei intended to prevent the entrance of
microorganisms into the body
Portal of Entry b. Remove gloves before touching non
 Respiratory (inhalation) contaminated objects items and surfaces
 Git (Ingestion) c. Wash hands after immediately removing gloves
 Genito-urinary (sex 3. Wear a mask, eye protection, or face shield if splashes
 Skin (needle prick, body piercing) or sprays of blood, body fluid, secretions, or excretions
 Blood (blood transfusion, sharing in the works) can be expected
 Placental entry 4. Wear a clean, non-sterile gown if client care is likely
to result in splashes of sprays of blood, body fluid,
Susceptible hosts secretions or excretions. The gown is intended to
Factors influencing susceptibility of the host protect clothing
1. Age a. Remove a soiled gown carefully to avoid transfer
2. Nutrition of micrograms to others
b. Wash hands after removing gown
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 Transmission-based precaution b. Make sure uniform does not contact possible

 Airborne precaution contaminated surfaces
 Droplet precaution 5. Limit movement of client outside the room
 Contact precaution 6. Dedicate the use of noncritical client care equipment to a
5. Handle client care equipment that is soiled with blood, single client or to clients infected with the same infecting
body fluid, secretions or excretions carefully microorganisms
a. Make sure reusable equipment is cleaned and
reprocessed correctly
b. Dispose of single-use equipment correctly  Cleaning
6. Handle, transport and process linen that is soiled with Steps that ensure cleanliness of an object
blood, body fluid, secretions or excretions in a manner 1. Rinse a contaminated objects or article with cold running
to prevent contamination of clothing and the transfer water to remove organic material
of microorganisms to others and the environment 2. After rinsing wash the object with soap and warm water.
7. Prevent injuries from used scalpels needs or other Rinse thoroughly
equipment and place in puncture-resistant containers 3. Use a brush to remove dirt or material in grooves or sems
4. Dry the object and prepare for disinfection or sterilization
Celaon as indicated by the intended use of the item
Donfeciton 5. The brush, gloves and sink in which the equipment is
Sterilization cleaned should be considered contaminated and should be
cleansed and dried

 Transmission-Based Precautions  Disinfection

 are used in addition to standard precautions for clients with Methods
known or suspected infections 1. Concurrent
 Airborne precautions 2. Terminal
 used for client suspected or known to have serious illnesses
transmitted by airborne droplet nuclei small than 5 microns Agents used
 Contact Precautions 1. antiseptics (alcohol, betadine,etc)
 Used for clients suspected or known to have serious illness 2. disinfectants (Lysol, purex,cidex, etc)
easily transmitted by direct client contact or by contact with 3. Moist heat
items in the client’s environment a. Boiling
 Droplet Precautions  Most practical and inexpensive
 Used for client suspected or known to have serious  Time 15 minutes from boiling pint
illness transmitted by airborne disease transmitted  Sharp instruments not boiled
by particles larger than 5 microns  Does not destroy spores
a.1 Autoclaving (steam under pressure)
Practices most dependable and practical
Airborne Precautions supplies steam under pressure of 15-17 ibs/sq incg
1. Place client in private room that has negative air pressure (ppsi) and temperature of 121-123C
2. If a private room is not available place client with another
client who is infected with the same microorganism
3. Wear a respiratory device (N95 respirator) when entering  Sterilization
the room of a client who is known or suspected of having 1. Physical (heat and radiation)
tuberculosis 1.1 Heat (dry)
4. Susceptible people should not enter the room of a client  Destroys germs by oxidation
who has rubeola (measles) or varicella (chicken pox) of they  Maybe done at home (oven, ironings)
must enter, they must wear a respirator  Disadvantage; penetration ability may not be
5. Limit movement of client outside the room to essential sufficient to kill all germs
purposes. Place a surgical mask on ye client during 
transport 1.2 Radiation
Droplet Precautions 1.2.1 Non-ionizing radiation
1. Place client in a private room  like UV (sunlight)
2. If a private room is not available, place client with another  But does not penetrate deeply
client who is infected with the same microorganisms 1.2.2 Ionizing Radiation
3. Wear a mask if working within 3 feet of client  Used to sterilize food, drugs and other items
4. Limit movement of client outside the room to essential sensitive to heat
purposes. Place a surgical mask on ye client during 2. Chemicals
transport 2.1 Ethylene oxide gas
Contact precautions  Used in fumigation (fogging patient’s room
1. Place client in private room and for some rubber/plastic materials
2. If a private room is not available, place client with another oxygen and pressure gauges
client who is infected with the same microorganism 2.2 Chemical Solutions
3. Wear gloves as described in Standard precautions 2.2.1 Phenolic compounds
a. Change in gloves after contact with infectious material  Used as a housekeeping disinfectant
b. Remove gloves before leaving client’s room 2.2.2 Chlorine compounds
c. Wash hands immediately after removing gloves. Use  Used in disinfecting water and in
antimicrobial agent housekeeping (chlorox)
d. After hand washing, do not touch possibly 2.2.3 Iodine Compounds
contaminated surfaces or items in the room  Effective bactericides commonly used as
4. Wear a gown when entering a room antiseptics. May cause staining of articles
a. Remove gown in client’s room (betadine)
2.2.4 Glutaraldehydes
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 Effective as bactericides and disinfectants a. Done before and after any procedure ans after
(cidex) contact with patient
2.2.5 Alcohols b. Done after removing the gloves
 Used as antiseptics and disinfectants c. Remove jewelries
2.2.6 Quartenary ammonium compounds d. Apply friction , paying attention to interdigit sans
 Used as infectant and antiseptics (zephiran surfaces under the nails
chloride) e. Flow of water when rinsing is from elbow down to
finger tips
Asepsis
II. Surgical aseptic techniques
Surgical or “sterile“ technique 1. Handling pick up forceps
Medical or “clean” technique 2. Preparing/opening a sterile field
Medical asepsis 3. Opening a sterile pack
Techniques 4. Transferring objects to a sterile fie
1. Handwashing 5. Pouring solution into a sterile container
2. Concurrent disinfection 6. Putting on gloves
3. Personal protective equipments (PPEs)
4. Barrier cards or placards
Handwashing
Principles of surgical asepsis Interlocking
1. A sterile area or object remains sterile when touched by Back of hands (2)
another sterile object Nails (2)
a. Use sterile forceps/wear sterile gloves to handle Thumb (2)
articles on a sterile tray Tips (2)
b. Touch a sterile surface only with another sterile object Wrist (2)
2. A sterile area or object becomes contaminated when
touches by an unsterile object Feb 7, 2020
a. When the edge or rim of a sterile area is adjacent to or FRB 10, 2020
in contact with an unsterile surface, consider the STRESS, HOMEOSTASIS AND ADAPTATION
rim/edge as contaminated DEFINITION OF TERMS
b. If there is a break or tear on the cover of a sterile
object, consider the content contaminated Definition of terms
c. Always keep the sterile area and sterile objects in view Homeostasis
si that you can detect possible or actual contamination  Balance/equilibrium while continually changing (canon)
d. Keep sterile objects above waist level to increase Stress
visibility and lessen possibility od unintentional  an experience a person is exposed to through a stimulus or
contamination stressor (potter)
e. A sterile object or field out of range of vision or held Stressor
below waist line is considered contaminated  Disruptive forces operating within or on any system (potter)
3. A sterile object or area becomes contaminated by Adaptation
prolonged exposure to air  A process of modifying to meet new/changing cognitions
a. Keep air current at a minimum by avoiding any (Kozier)
unnecessary movement of people, linens, curtains and
so forth. MODELS OF STRESS
b. Do not reach across a sterile field Models of stress
c. Avoid laughing, coughing ,sneezing and excessive Response-based (seyle)
taking across a sterile surface  A nonspecific response of the body to any demand made
d. Once a sterile tray has been opened there’s a change upon it
that it has been contaminated by air currents. Thus,
articles not used forma sterile tray should not be Stimulus-based (Holmes, rank)
returned  A “life change” a disturbing or disruptive characteristics
4. A sterile area or object becomes contaminated when a within the environment
sterile object comes in contact with a wet surae thru
capillary action Transaction-based (Lazarus,folkmas)
a. A sterile porous material will serve as a barrier  Views the stressor as an individual perceptual response
between an unsterile surface and sterile object only is rooted in psychological and cognitive process- events have
the porous material remain dry different meaning to different individuals
b. If a porous wrapper or barrier becomes wt, do nto
used the article inside Adaptation model
c. Used a sterile,waterprood (non-prous) material as a  An anxiety provoking stimulus
barrier  People experience anxiety and increased stress when they
5. A sterile are or object becomes contaminated when gravity are unprepared to cope with stressful situations
causes a contaminated liquid to flow over a sterile area
a. When you do a surgical scrub hold hands above level TYPES OF STRESS
of elbows to keep water on arms form flowing back Types of Stress
over hands Distress
b. Keep the tip of transfer forceps pointed downwards  Damaging stress
Eustress
Procedures  Stress that protects health
1. Handwashing  Happiness, hopefulness and purposeful movement
Post-traumatic stress disorder (PTSD)
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Acute stress disorder (ASD)

MODELS OF ADAPTATION
SOURCES OF STRESS Models of adaptation
 Physiologic
Extrinsic of external stressors  GAS & LAS
 Originate from outside of the person  Contemporary physical changes
 e.g. hot room temperature, quarrel, a death in the family  Psychologic
Intrinsic or internal stressors  Involves a change in attitudes or behavior
 originate within a person  Sociocultural
 cancer feelings or depression, guilt  Involves changes in the person’s behavior in accordance
Developmental stressors with norms, conventions and beliefs of various groups
 occur at predictable times throughout an individual’s life  Technological
 achieving independedable, choosing a career, getting  Involves the use of modern technology
married
Situational stressors
 are unpredictable and may occur at any time during life
 death of a family member, marriage or divorce
CHARACTERISTICS OF THE ADAPTIVE MECHANISMS
CHARACTERISTICS OF STRESS
Characteristics Of Stress Characteristics of the adaptive mechanisms
1. Fabric of daily life 1. Are attempts to maintain homeostasis
2. Is not a nervous energy 2. Is a whole body or total organism
3. Man tends to adapt to stress 3. Response
4. Not always something to be avoided (eustress-protects 4. Has limits
health) 5. Requires time
5. Does not always leads to distress (damaging stress) 6. Vary from person to person
6. A single stress does not cause a disease 7. May be inadequate or excessive
7. Stress may lead to another stress 8. May be egocentric and tiring
8. A stress, whenever prolonged or intense may lead to
exhaustion General Adaptive syndrome
Stages
FACTORS INFLUENCING MANIFESTATION OF STRESS 1. Alarm
Factors influencing manifestation of stress  Awareness of stressor
1. Nature and intensity of stressor 2. Increase vital signs
2. Perception of the stressors  Mobilization of defenses
3. Duration of exposure to stressor 3. Decrease body resistance
4. Number of stressors experienced at a time  Increase hormonal level
5. Previous experience with a stressor
6. Age General Physiological adaptive Mechanisms
7. Support people
SAMR
Homeostasis (W.B Cannon) Sympathoadreno-medullary response
 Tendency of the body to maintain a state of balance or Flight or fight
equilibrium while constantly changing
Sympathetic nervous system Adrenal medulla
Classification Of Homeostasis Epinephrine
Physiologic norepinephrine
 Internal environment of body is stable and constant
Psychologic
 Refers to emotional psychological mental balance state of
well being Increase in physiological activities

Characteristics Of Homeostatic Mechanisms

1. Self - Regulatory (come automatically) Adrenocortical Response
2. Compensatory (counter balancing) Anterior pituitary gland
3. Regulated by feedback mechanism
4. Require several feedback mechanisms to correct one Adrenocorticotropic hormone
physiologic imbalance
Adrenal cortex
2 Major Homeostatic Regulators
 Automic nervous system
 Sympathetic and parasympathetic Aldosterone Cortisol
 Endocrine system
 Pituitary thyroid, parathyroid, pancreas and adrenal Fats & CHON
Kidneys catabolism
glands
 Plus, organ systems as respiratory cardiovascular, GI n H2O reabsorption
adrenal Glucose
Blood Volume
Urine output
Adaptation
 Adjustments that a person make in different situations BP

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 Scar formation
 Primary healing
Neurohypophyseal Responses  Secondary healing
 Tertiary intention
Posterior Pituitary Gland  Intentional delay in would closure

Systemic Manifestation of LAS

Anti-Diuretic Hormone Oxytocin
1. Leukocytosis
2. Fever
Kidneys Uterine
3. Lymphadenopathy
contraction
4. Body malaise
H2O Reabsorption 5. Anorexia

Urine output Blood volume Other responses to injury

1. Necrosis-death of tissue
BP 2. Hypertrophy -increase in cell size
3. Hyperplasia -increase in cell number
4. Metaplasia -replacement of one mature cell with another
RESISTANCE mature cell, the new cell is not one normally seen in the
 Repel of stressor area
 Adaptation Nursing intervention for clients with inflammation
Normalization of hormone levels 1. Promotes rest
 Normalization of vital signs 2. Reduce swelling
 Elevate part to promote venous return
EXHAUSTION  Heat and cold application-cold during 1st 72
 decrease energy level hours; heat application after 72 hours
 Breakdown in feedback mechanism 3. Relieve pain
 Organ or tissue damage 4. Adequate hydration
 Decrease physiological function  Increase excretion of microorganism
 Exaggerated BLAH BALH 5. Adequate nutrition
 Hi caloric, CHON with Vit A and C rich foods
PHYSIOLOGIC INDICATORS OF STRESS 6. Drugs
1. Increases mental alertness  Analgesics/antipyretic
2. Dilated pupils  Anti-inflammatory
3. Dryness of mouth; thirst  Antimicrobials
4. Tachycardia: increased cardiac output
5. Bronchodilation; hyperventilation 7. Surgery
6. Peripheral vasoconstriction; increased BP  Incision and drainage -to remove inflammatory
7. Pallor, cold clammy skin, diaphoresis exudate and promote healing
8. Hyperglycemia due to glycogenolysis and glconegensis  Debridement- to remove necrotic tissue
9. Decrease peristalsis; constipation or flatus
10. Decrease secretion of insulin and pancreatic enzymes HEAT AND COLD APPLICATION
11. Urinary output decreases Heat and cold Application
12. Muscle tension increases ready for defense Done for 30 mins average 15-20 min
 Dry heat
LOCAL ADAPTIVE SYNDROME  Hot water Bags-temp 110-125F
Local adaptive syndrome  Disposable hot packs
Inflammatory response  Floor lamp/gooseneck lamp/ heat cradle
A. Vascular stage  Bulb-25 watts
 Vasoconstriction  Distance 18-24 inches
 Vasodilation
 Warmth: CALOR  Dry cold application
 Redness: RUBOR  Ice collar
 Capillary permeability  Ice cep
 Swelling: TUMOR  Disposable cold packs
 Pain: DOLOR

Temporary loss of function

B. Cellular Stage
 Margination
 Diapedesis
 Emigration
 Chemotaxis

Exudative
 Serous plasma
 Sanguineous blood
 Purulent pus

Reparative
 Regeneration
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