bsc nursing assignment

13 MOST COMMON ASSIGNMENTS IN BSC NURSING

As a nursing student, you need to understand the subjects you are taught. How do you ensure you get this right? Take advantage of the assignments as they help you determine whether or not you can respond to the questions asked, or even come up with the needed information or hold a discussion regarding a particular topic. Assignments in BSC nursing are not new, as your professor or instructor will no doubt expose you to them. They do this either mid-way through the topic or after you are done. The beauty of these assignments is that they help prepare you for becoming a registered nurse. So, having an idea of what to expect can help go a long way. Below are the 13 most common assignments in BSC Nursing and the guidelines you can follow.

Fundamental Communication Skills in Nursing

The assignments here usually come in the form of essays. Therefore, you will need to reference your work in the end. Under this topic, you can be asked why effective personal communication is a key skill in nursing. So, how should you answer?

You can respond to it by outlining a communication theory related to nursing. Also, you can identify two essential communication skills in building a rapport and then further analyze their value. Importantly, your essay should answer the question and be supported by evidence. Also, referencing the sources can help you support your answer. Don't forget you are doing the academic style.

Nonetheless, your essay should be balanced such that two-thirds comprises a detailed analysis. Another important thing not to forget is how you structure the essay from the introduction to the conclusion. Put it in a way that guides your reader through. Before you submit, ensure you proofread to confirm the terminologies and grammar is on point.

Professional Identity

Nurses need to establish their status in society. They can do this by protecting the public image of their profession. However, there are still stereotypes despite the efforts they put in. Therefore, the true nature of nursing is masked, and the nurses' professional identity is challenged.

As a student, you may encounter a question related to stereotypes. Your professor may require you to discuss how the professional identity of nursing is affected by its public image. How do you go about this?

You can begin by talking about the professional identity of nursing. What does it mean? Ensure you outline this. Moreover, you can give an example of how the media portrays a stereotype of nursing. Further, you can explain how the media's representation challenges the professional identity of nursing.

Since this is a matter of concern, ensure you give suggestions on what you feel should be done to improve the professional identity of nursing.

Once again, support your essay with related references from different publications and articles.

The Good Nurse

Have you ever wondered what being a good nurse entails? There could be one value that makes you one. Therefore, as an assessment, your professor may require you to first respond to the question, "what makes a good nurse?" Next, he may need you to pick a single attribute, value, or behavior portrayed by a good nurse. Further, you may need to discuss how you have developed and demonstrated this value/behavior/ attribute in your practice. Sounds like a heavy task there.

You can respond to such a question by briefly outlining the values, behaviors, and attributes expected of a good nurse. You can go ahead and choose one and explain it. Moreover, you can show how other stakeholders, such as colleagues and clients, view your chosen value, behavior, or attribute.

Since these values are set standards, you can assess your potential concerning these standards. If you learn or observe anything about the value, you've chosen during your practice, ensure to discuss it. Lastly, don't mention the effects of learning this value, behavior, or attribute to your practice.

Long-Term Conditions

Under this topic, you may be required to assess how effective one approach is for self-management of specific long-term conditions (LTC). You can analyze self-management principles, realized benefits, and potential challenges.

When responding to such essays, ensure you outline the key self-management principle. You can then connect it with wider initiatives and policies. Also, you should choose and outline the pathophysiology of a long-term condition and the patient's social, physiological, and physical needs.

Additionally, you should use relevant sources to discuss the benefits and challenges of using the one approach in self-management concerning the LTC you have chosen. Don't forget to recommend how the self-management approach is used in long-term conditions. Your summary is incomplete without this important bit.

Once you are done, proofread and correct any grammar or terminology mistakes; you may have a committee in the course of writing the academic essay. Accuracy is key in BSC nursing, and never should you ignore this.

Core Values, Knowledge & Skills for Mental Health Nursing

Have you ever used a mental assessment tool? There are high chances you have in the course of your practice. Therefore, your instructor may require you to give a detailed analysis of how you used it and carry on with the analysis to assess how useful the tool is. How do you respond to this sample assessment?

You can begin by having an overview of the impact of mental illness on individuals and their families. Having briefly given this overview, you can link it to the need for a mental health assessment tool.

Since your professor requires you to give your encounter with the tool, you should describe in detail the context in which you deployed this assessment tool and how you established your professionalism.

Remember to reference your analysis with related academic literature on mental health. In your conclusion, have a backed-up recommendation on the assessment tool and mention whether or not it has any implications in your further practice.

Safety in Adult Nursing Care

As a nursing student, you may have interacted with a vulnerable adult client during your practice. Therefore, based on this experience, your professor or instructor may require you to analyze the proper approach toward medicine management and the probable or actual patient safety risks involved.

When responding to such, base your essay on risks on medicine management and administration, as well as self-management of medication. They range from adherence, concordance and crushing tablets, and so on. Importantly, don't forget to mention the vulnerable adult patients who include those suffering from confusion, dementia, physical disabilities, mental health issues, unconsciousness, stroke, Parkinson's Disease e.t.c

In your case study, ensure your introduction outlines what you are talking about and its importance. After the introduction comes the major part of the essay, where you outline your adult client's situation, the specific vulnerabilities and related risks, and how you managed your client and maintained safety.

In your conclusion, have evidence-based recommendations on medicine management with vulnerable clients. If this has implications for your future practice, add it to the conclusion.

Person-Centred Communication

 Your essay may be for you to outline the communication strategies a person with a disability can use with others; family members, friends, caregivers, or their partners. How do you tackle such?

It would be best if you had several barriers to communication, such as individuals and those they communicate face. Explore these factors extensively. Moreover, you should include several approaches that can come in handy to assess the needs of these individuals with learning disabilities.

As a nurse, you need to know these individuals, and this calls for building a relationship. How do you do this? Include that as well in your essay. If there are other alternative communication approaches you can employ to know the individuals better, ensure you outline them too.

Other people's values and beliefs about people with learning disabilities impact their communication effectiveness. So, explore this area in your essay. If there are support services designed to help promote effective communication with such persons, talk about the same.

What should you have in your conclusion? Briefly identify how you can monitor how the communication strategies are implemented and how to determine whether they will be successful.

Complex Presentations in Mental Health Care

A sample assignment may require you to write an essay that examines and critiques an intervention with a client with issues related to complex mental health. In your essay, you should show you are knowledgeable and understand the related concepts per the module.

How should you structure such an assignment? Your introduction can have what you aim at in the essay, such as the intervention you will explore and the rationale behind its selection. Also, give your reader its context, and you can discuss how common the complex mental health issue the intervention addresses is.

As you explain the intervention, be clear. Why is this important? It helps convince your reader that you understand what you are talking about. Moreover, for your essay to be balanced, ensure you have both strengths and weaknesses of the intervention.

Remember to include related references in the essay and as a part of your conclusion, bring out the main points of what you consider important regarding the intervention.

Exploring The Nurse Patient/Client Partnership

You may get an assignment that requires you to write an essay reflecting and exploring the clinical instances where nurses and other healthcare professionals interact or have discussions with their clients (the patients). In this essay, ensure you pay attention to the specific aspects of their discussions, such as the language and terminology used and how they represent the nurse's behavior, attitude, and values. Besides, ensure you discuss how this influences the relationship between the nurse and the patient/client.

Nonetheless, let your essay reflect on what implications such interactions have on the nurse's practice. What's more, if there is something of importance you can apply in your future practice from the same, ensure you discuss it.

Notably, be sure to leave an example of a discussion between a nurse and a patient you observed in the appendix section of your essay. Once again, reference your essay with related academic literature and other recent health disciplines. Don't submit your assignment without proofreading.

Communication in Adult Nursing Practice

You need to express your communication skills as a nurse in practice. Thankfully, there is a topic that helps you understand that. You can get a related assignment to help you determine whether you are knowledgeable enough on the same. For instance, you may be required to write one that reflects your communication skills in practice. The key thing is to use the modules as a source of the concepts you will use to respond to such a question.

For instance, you can link your points to the module and show how you can safely communicate with patients and be effective. As expected, it won't always be smooth. Rather, you may get involved in complex and challenging situations with your client. Thankfully, effective communication can be of help.

Moreover, you can discuss your practice's positive and negative aspects. You can also make recommendations regarding your future practice. Whatever reflections you have in the essay, ensure you have their pieces of evidence. Therefore, reference and proofread your work before you submit it.

Principles of Effective Care Delivery

This is another area of physical and mental health you can get assignments from. Your professor or instructor will give you a timeline on when to submit your essay. Some of the questions you can come across will cover the contemporary care delivery models available, service delivery, and an evaluation to enhance mental health recovery. On the other hand, your assignment may involve nursing management and leadership, risk management, promoting service users' mental and physical needs, and clinical supervision for quality care and performance.

Regardless of the specific area tested, your instructor may give you a reference list earlier. With this provision, you can research from the sources provided, gather knowledge and learn, then write your essay. Also, you can reference other readable sources you can find. The reference is important to help support your essay.

To be safe from grammar, definition, and other similar mistakes, ensure you proofread your work before submitting it.

Ethical Principles in Nursing Practice

Ethical issues are arising in different fields, and nursing is no exception. Therefore, you may be required to write an essay discussing the ethical decisions or actions in nursing practice. If this is the case, you must choose an ethical decision or action to focus on in the essay. Remember, it could be from observation, on an area of interest from the recent media reports, or you can make it yourself.

The ethical decision or action you focus on could have either a positive or negative outcome. If you are to work in groups, ensure you consult with the facilitator to suggest which one to take. What are some of the things you should cover in the essay? They include; the ethical and legal issues arising in nursing practice, the course of action the involved health officials in the issues can take, and the arguments either supporting or disputing the actions.

Nonetheless, the essay should have an ethically sound decision in the end. If you have any recommendations on what should take place instead, include them in your conclusion.

Personal Philosophy For Nursing

In this topic, you may be given the assignment to write an essay on philosophy for nursing that can guide your future practice. Well, how do you maneuver around this? As a BSC Nursing student, you look forward to a point when you will be registered, and you no doubt have a certain vision. What exactly is it? You can explain all these in your essay. Also, how do you individually interpret nursing? What does it mean to you as a person? Include this as well.

Moreover, discuss some of your values and beliefs about your nursing career. You may also consider your role in nursing as a practitioner or what they mean. Also, why not include the tension between the service priorities and the patient and how well they can be addressed personally?

Remember, you should back up your essay with nursing literature and other appropriate references. You are developing into a professional nurse so express that knowledge.

Nursing students have a lot to learn, writing reports and exams. On the other hand, professors and instructors also do their part to avail the modules and any beneficial and important reference links for more information. Therefore, a student can take advantage of these. Also, if you are a BSC nursing student, there are assignments you can make good use of them to gauge yourself and your level of understanding. If you feel like there is still more knowledge and information you need to discover, utilize the available related resources.

Nonetheless, your professors or instructors may have different rules regarding their assessments. However, when you go through them early and know what is expected of you, there's nothing to worry about. These 13 common assignments in the BSC nursing list are a great starting point.

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• 1. NURSING FOUNDATIONS-BASIC BSc NURSING I YEAR QUESTION BANK UNIT I INTRODUCTION SHORT ANSWERS 1.Define health? A) World Health Organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. 2.Define illness? A) “Illness is a condition characterized by a deviation from a normal health state which is manifested by physical & psychological symptoms.” – Kozier 3.Define hospital? A) Hospital is an institution for the care, cure, and treatment of the sick and wounded, for the study of diseases and for the training doctors and nurses. (Steadman’s medical dictionary) 4.List out four risk factors for developing illness? A) The major risk factors include: • tobacco use • the harmful use of alcohol • raised blood pressure (or hypertension) • physical inactivity • raised cholesterol. • overweight/obesity • unhealthy diet • raised blood glucose. 5.Define immunity? A) Immunity is referred to the resistance exhibited by the host towards injury caused by microorganisms and their products.
• 2. 6.Differentiate between active and passive immunity? A) Active immunity is created by the antibodies by the individual’s body. Passive immunity, on the other hand, is mediated by antibodies produced outside. Passive can be used to generate a rapid immune response. Antibodies were among the primary tools used to treat specific infectious diseases. At the moment, antibodies play a vital role in fighting infectious diseases. 7.Enlist the healthcare team members? A) The health care team consists of Physicians, nurses, social workers ,auxiliary personnel ,village health guides, trained dais, health assistants, radiologist. 8.Define primary health care? A) Primary healthcare is a term used to describe the first contact a person has with the health system when they have a health problem or issue that is not an emergency. It is the part of the health system that people use most and may be provided, for example, by a general practitioner (GP), physiotherapist or pharmacist. 9.List down any four functions of hospital? 1) Provides quality medical care services to as many out- patient as possible. 2) Provides the widest coverage of quality health care for the people not for curative only. 3) Ensures that health services are always available to the people. 4) Provides health services that is within the financial capability of the people. 10.Mention the levels of prevention? A) 1) Primordial Prevention 2) Primary Prevention 3) Secondary Prevention 4) Tertiary Prevention
• 3. UNIT II NURSING AS A PROFESSION SHORT ESSAYS 1. Describe characteristics of nursing profession? A) a. specialized education b. body of knowledge c. servicesD.autonomy E. code of ethics F. research orientation G. service orientation H. professional organization a) Body of knowledge: - as a profession, nursing is establishing a well - defined body of knowledge and expertise. A number of nursing conceptual frameworks contribute to the knowledge base of nursing and give direction to nursing practice, education, and ongoing research. b) Service orientation: -nursing as a tradition of service to others. These services, however, must be guided by certain rules, policies, or code of ethics. Today, nursing is also an important component of the health care delivery system. c) Code of ethics: - ethical code change as the needs and values of society change. Nursing has developed its own code of ethics and is most instances has set up means to monitor the professional behavior of its members. d)Autonomy: - a profession is autonomous if it regulates itself and sets standards for its members. Providing autonomy is one of the purposes for a professional association.to the autonomous, e) A professional group must be granted legal authority to define the scope of it practice, describe it particular function and roles and determine its goals and responsibilities in delivery of its services.
• 4. 2. Explain the functions of Nurse? A) a. Care giver – i) as a care giver, the nurse helps the client to regain health through healing process. ii) she preserves dignity of client. Ili) nurse address the holistic health care needs of client. Iv) she accepts client as person not merely as mechanical beings. B. Clinical and ethical decision maker i) nurse use critical thinking skill thought out the nursing process to provide effective care Ii) nurse make decision in collaboration with client & family. Iii)she also collaborate & be consult with other health professionals. C. Protector i) she provides safe and conductive environment to the clients Ii) she takes step to prevent injury for client. Iii) she asks about any allergy to medicine or food. Iv) she provides immunization against diseases. D. Manager i) as a manager, nurse co- ordinates the activities of other members of health care team. Ii) she manages the nursing care of not only one client but also of families and in communities. Iii) she delegates the nursing activities to auxiliary worker & worker & another nurse. E. Communicator – i) she covey information verbally as well as through documentation.
• 5. Ii) nurse communicates verbally at change of shift. Iii) she reports while shifting the client from one unit to another. F. Comforter i) as a comforter, nurse provide comfort to the client by considering him as an individual with unique feelings and needs. Ii) she motivates clients to reach therapeutics goals. Iii) she promotes comfort to client by staying near the patient. G. Leader i) nursing leadership is defined as mutual process of interpersonal influence through which nurse helps the client in making decisions for establishing and for achieving the goals. J. Teacher i) she determines that the clients fully understood. Ii) she also evaluates client’s progress in learning. Iii) she gives health education on diet, about preventive measure of diseases. 3. Describe qualities of Nurse? A) Nurse should have following qualities: i) Self confidents: A professional nurse have elf confidence. Because of this, she is able to take decision and provides holistic care. ii) Humble and Honest: with these qualities, nurse develops rapport and gains trust of the client. iii) Loyal: Nurse accept the as he is. she recognizes the client as a person and understands empathically his feelings. iv) Co – operative: As an individual, nurse plays many role in hospital. She works cooperatively with health team members as well as with family member.
• 6. v) Good Listener – This is the best quality of nurse, by which she understands clients view. By active listening, she identifies client’s needs provides care accordingly. vi) Keen observer – while dealing with client a nurse, by which she understands client’s as nonverbal commands / behavior. vii) Good administration – Because of this quality a professional / registered nurse executes and evaluates the junior nursing staff. viii) Good supervisor –A professional nurse work works as supervisor to the junior nursing staff as well other employees while performing their duties. ix) Impartial – professional nurse treats each client without any prejudice / personal interest. She provides care fairly to every client. x) Capable – A nurse is competent enough and has a capability to give care effectively xi) Advocate – A nurse supports and speaks in favour of client and provide information to client / family for making informed decision. 4. Justify Nursing as Profession? A. professions are those occupation based on specialized intellectual study and training the purpose of which is supply skilled service with ethical components to others, for definite fee or salary. B. Professional is a type of occupation that is meets certain criteria that raise it to a level above that of an occupational C. Nursing is the protection, promotion, and optimization, of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis treatment of human response and advocacy in Carew of individuals, families, communities, and populations. a. The services provided are vital to humanity and the welfare of society. b. There is a special body of knowledge that is continually enlarged through research. c. The services involve intellectual activities; individuals responsibity is a strong feature.
• 7. d. Practitioners are relatively independent and control their own policies and activities. e. Practitioners are motivated by service and consider their work an important component of their lives. f. There is a code of ethics to guide the decision and conduct of practitioners. g. There is an organization that encourages and supports high standards of practice. 5.Enumerate ethical principles of Nursing? A) Autonomy – It refers to right to make one’s own decision. Respect for autonomy means that nurse recognize the individual’s uniqueness, the right to be what that person is and the right choose personal goals people may have “inward autonomy” if they have the ability to make choice s as well as may have “outward autonomy” if their choices are not limited or imposed by others. Nurses should follow the principle of autonomy and respect a client’s right to make decision even when those choices seem not to be client’s best interest. Justice – The principle of fairness is the basis for the obligation to treat all clients equally and fairly. Justice is the foundation for decisions about resources allocation throughout the society or a group. Health care system provides care on the basis of medical need rather than ability to pay, social status, race or gender. Non maleficence – non-maleficence is the avoidance of harm or hurt. So, it is an obligation to nerve deliberately harm another. The nurse tries to balance the risk and benefits of plan of care. In health care ethics, it is important to remember that ethical practice involves not only they will do good but also equal commitment not to do harm. Beneficence – It means promoting good or doing good. In others words, refers to taking positive actions to help others. SO, practice of beneficence encourages the urge to do good for other. For example, a child’s immunization may cause discomfort during administration, but the benefit of protection from diseases both for the individual and for the society, outweigh the temporary discomfort.
• 8. Fidelity- It means to keep promise. Nurse have an obligation to follow through with nursing care She should avoid abandonment of clients, even when clients goal differs from health care provide goals. For example, pain management plan. 6.Classify and explain importance of values in Nursing? A) TYPES OF VALUES We can speak of universal values, because ever since human being have lived in community, they have had to establish principles to guide their behavior towards others. In this sense, honesty, responsibility, truth, solidarity, cooperation, tolerance, respect, and peace, among others are considered universal values. However, in order to understand them better it is useful to classify values acc. To the following criteria : I. Personal values: these considered essential principles on which we build our life and guide us to relate with other people. They are usually a blend of family values and social cultural values, together with our own individual ones. To our experiences. Ii. Family values: these are valued in a family and are considered either good or bad. these derive from fundamental beliefs of the parents who, use them to educate their children. They are the basic principles and guidelines of our initial behavior in society, and are conveyed through our behavior in the family, from the simplest to the most complex. Iii. Social cultural values: these are the prevailing values of our society, which change with time, and either coincide or not with our family or personal values. They constitute a complex mix of different values, and at times they contradiction another, or pose a dilemma. For example, if work is not valued socially as a means of personal fulfillment, then the society is directly fostering ‘ anti values’ like dishonesty, irresponsibility, or crime. Iv. Material values: these values allow us to survive, and are related to our basic needs as human beings, such as food and clothing and protection from the environment. They are web that is created between personal, family, and social cultural values.
• 9. V. Spiritual values: they refer to importance we give to non – material aspects in our lives. They are part of our human needs and allow us to feel fulfilled. They add meaning and foundation to our life, as do religious beliefs. Vi. Morals values: the attitudes and behaviors that a society considers essential for coexistence, order, and general well. values in professional nursing: Professional values are the guiding beliefs and principles that influence your work behavior. Your professional: values are usually an extension of your personal values such honesty, generosity, and helpfulness. Nurse professional values are acquired during socialization in nursing from codes of ethics, nursing experiences teacher s and peers. the American association of college of nursing ( acne, 1998) identified five values essential for nursing: I) altruism Ii) autonomy Iii) human dignity Iv) integrity V) social justice 7.Describe Professional conduct of a nurse? A) CODE OF PROFESSIONAl CONDUCT FOR NURSES- I) PROFESSIONAL RESPONSIBILITY AN ACCOUNTABILITY- a. Carries out responsibility within professional boundaries. b. Practices healthful behavior. c. Is responsible for own decision and actions. d. Is responsible for continuous improvement of current practices.
• 10. ii) NURSING PRACTICE- a. Provides care in accordance with set standards of practice b. Respect’s individual and families need to promote healthy practices and discouraging harmful practices. c. Promotes participation of individuals and significant others in the care. iii) COMMUNICATION AND INTERPERSONAL RELATIONSHIP- a. Establishes and maintains effective interpersonal relationship with individual, families, and communities. b. Co –operates with other health professionals to meet the needs of the individual, families, and communities . iv) VALUING HUMAN BEING – a. Takes appropriates action to protect individuals from harmful unethical practice. b. Encourage and supports individual in their right to speak for themselves on issues affecting their health and welfare. c. Respect and support choices made by individuals. v) MANAGEMENT- a. participates appropriates allocation and utilization of available resources. b. participates in evaluation of nursing services. 8.Discuss on scope of Nursing? A) Staff nurse: It provides direct patient care to one patient or a group of patients. Assist ward management and supervision. II) Ward sister or nursing supervisor – she is responsible to the nursing superintendent for the nursing care management of ward or unit. Take full charge of ward.
• 11. III) Department supervisor /assistant nursing superindent: she is responsible to the nursing superindent and deputy nursing superindent for the nursing care and management. IV) Deputy nursing superindent: she is responsible to the nursing superintendent and assists in the nursing administration of the hospital. V) Nursing superintendent: she is responsible to medical superintdent for safe and efficient management of hospital nursing services. VI) Director: she is responsible for both nursing service and nursing education within a nursing teaching hospital. VII) Community health nurse (CHN): services rendered mainly focusing reproductive child health programme. 9.Discuss categories of Nursing Personnel in hospital? A) Types of nursing in hospital- I) Registered Nurse (RN) A. Education requirement: associates degree or Bachelor of Science degree B. Expected job growth: 15% increases C. Employment locations: Hospitals, residential care facilities, etc. D. Relevant certificate: State Nursing License E. Salary range: $60,000 - $75,900 Registered nurse (RN) provides and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to the patients and their family members. Most registered nurses work team with physician and other health care specialists in various setting. Ii) Cardiac nurse- A. Education requirement: associates degree or BSc, registered nursing license (RN)
• 12. B. Expected job growth: 16% increase C. Employment locations: hospitals, in home care and rehab centers D. Salary range: $67, 490 medsian annually One of the leading causes of death in the United States today is heart diseases. The demand for cardiac nurses continues to grow with the rising number affected with heart problems. Iii) Certified registered nurse anesthetist (CRNA)- A. Education requirement: master’s degree (MSN) , registered nurse license (RN) and one year in acute care setting. B. Salary -$153,780 A certified registered nurse anesthetist (CRNA) is highly trained nurse that specializes in assisting with anesthesia during surgeries. CRNA’s make up some of the highest – paid nurse specialties in the medical field due to high demand of these nurses in surgical setting. Iv) Clinical nurse specialist (CNS)- A. Education requirement: master’s degree and sometime a doctoral degree. B. Expected job growth: 15% (much faster than average) C. Relevant certification: N/A D. Salary range: $ 85,723 Clinical nurse specialty are type of advanced practice registered nurse (APRN), who provide direct patients care by working with other nurses and staff to improve the quality care of patient receives. 10.Discuss on contribution of Florence Nightingale in Modern Nursing? A) Florence’s nightingale. The era of modern nursing commences with the work of Florence Nightingale in the Crimean war (1854-1856.) She was born on May 12, 1820. She was the second daughter of wealthy English parents. She felt that God had called
• 13. her to fulfil ‘mission of Mercy”. She thought of nursing or education work. She observed the life of poor and tried to relieve the sick. Nursing contributions – A. Appointed resident lady superintendent of an establishment for Gentle women During illness B. In 1854 assembled party of 38 nurses to serve in Crimean war C. Founded the Nightingale school and home for nurses at saint Thomas hospital in London. D. Wrote Notes on nursing, the first textbook for nurse.
• 14. UNIT-III HOSPITAL ADMISSION AND DISCHARGE SHORT ANSWERS 1. Expand LAMA Ans. LAMA: Leave Against Medical Advice. The patient will leave the hospital against the Doctors advice even though after explains patient health condition. Consent for LAMA I am leaving the hospital ward against medical advice. Doctor explained me about my disease condition and ill effects of discharge against medical advice. Doctors and Nursing staffs will not be responsible for any ill effects happening after my departure”. 2. Define abscond Ans. ABSCOND: Abscond from Hospital Absconding refers to the departure of patients from hospital wards without permission. The definition of absconding can vary depending on the length of time required for an absence to be considered absconding, and on the method of departure (e.g. leaving a locked ward, leaving the hospital grounds, or failing to return from day leave). Absconding status is influenced by the patient’s admission, whether it be voluntary, involuntary, or legally detained. There are significant implications of absconding for patients, carers and family members. Absconding: where patients under an involuntary mental health order leave hospital without permission, can result in patient harm and emotional and professional implications for nursing staff. Patients absconded early in admission. 3. Expand MLC ANS. Medico-legal cases (MLC) are an integral part of medical practice that is frequently encountered by Medical Officers Definition: MLC is defined as “any case of injury or ailment where, the attending doctor after history taking and clinical examination, considers that investigations by law enforcement agencies (and also superior military authorities) are warranted to ascertain circumstances and fix responsibility regarding the said injury or ailment according to the law”.
• 15. 4. List down the types of discharge Ans. Types of Discharge 1. PLANNED DISCHARGE: Patient completes the initial, actual management in the hospital and now he or she need not to be under direct supervision of that hospital.’ 2. DAMA/LAMA: Discharge/Leave Against Medical Advice 3. TRANSFER: Transfer to other unit or hospital 4. ABSCOND: Abscond from Hospital 5. REFFERAL: Referred for further management 5. What is the meaning of referral? Ans. Any hospital, including a district hospital, will receive referrals from lower levels of care. Indeed, referral can be defined as any process in which health care providers at lower levels of the health system, who lack the skills, the facilities, or both to manage a given clinical condition, seek the assistance of providers who are better equipped or specially trained to guide them in managing or to take over responsibility for a particular episode of a clinical condition in a patient. The process of directing or redirecting(as a medical case or a patient) to an appropriate specialist or agency for definitive treatment. 2 : an individual that is referred. 6.List down any four medico legal issues in admission of a patient ? Ans. ✓ Attempted suicide ✓ Sexual Offences ✓ Burns and Scalds ✓ Poisoning, Alcohol Intoxication ✓ Cases of trauma with suspicion of foul play ✓ Electrical injuries ✓ Accidents like Road Traffic Accidents 7. Mention any two responsibilities of a nurse in discharge procedure Ans.. • Planning in the beginning. • See doctor’s written order • Teach nursing procedures to be continued at home, get it’s practice done. • Inform other departments regarding discharge
• 16. • Confirm bill paid. • Check and receive any hospital property. • Hand over personal belongings. • Explanations.. • Plan for rehabilitation and follow-up need. • Arrangement for transport. 8. Enlist medico legal issues in discharge of a patient ans. Police have to be informed before the said patient leaves the hospital. • If the patient is not serious and can take care of himself, he may be discharged on his own request, after taking in writing from him that he has been explained the possible outcome of such a discharge and that he is going on his own against medical advice. • Failure to do so renders the doctor liable for “negligence” and “deficiency of service”.  • While discharging or referring the patient, care should be taken to see that he receives the Discharge Card/Referral Letter, complete with the summary of admission, the treatment given in the hospital and the instructions to the patient to be followed after discharge.  It is always better to inform the police through the casualty of the hospital where the medico-legal register is usually maintained and necessary entries can be made in it.  • Whenever a medico-legal case is discharged, the same should be intimated to the nearest police station at the earliest.  9. Enlist types of referrals? Ans. They are mainly two types of referral systems 1. Internal referral 2. External referral Internal referrals indicates transfer of patient in same hospital from one speciality to another speciality for diagnostic purpose and for treatment External referral indicates transfer from hospital to other higher centers for advanced treatment with good skilled staff and high technology equipped technology. 10. What is planned discharge? Ans. Planned Discharge: Patient completes the initial, actual management in the hospital and now he or she need not to be under direct supervision of that hospital. Patient can go to home with follow up instructions.
• 17. UNIT IV COMMUNICATION AND NURSE PATIENT RELATIONSHIP SHORT ANSWERS 1. Define communication? A) Communication is sending and receiving information between two or more people. The person sending the message is referred to as the sender, while the person receiving the information is called the receiver. The information conveyed can include facts, ideas, concepts, opinions, beliefs, attitudes, instructions and even emotions. 2. Enlist the levels of communication? A) 1. Intrapersonal 2. Interpersonal 3. Small Group Communication 4. Public Communication 5. Mass Communication 6. Intrapersonal Communication 3. List down the elements of communication? A) 1. Source 2. Message 3. Channel 4. Receiver 5. Feedback 6. Environment 7. Context 8. Interference 4. Enlist types of communication? A) • Interpersonal communication • Intrapersonal communication • Group Communication • Mass Communication
• 18. • Verbal Communication • Non-Verbal Communication • Meta- Communication • Formal communication • Informal communication • Downward communication • Upward communication • Horizontal communication • Diagonal communication 5. Define empathy? A) Empathy is the ability or practice of imagining or trying to deeply understand what someone else is feeling or what it’s like to be in their situation. Empathy is often described as the ability to feel what others are feeling as if you are feeling it yourself. To feel empathy for someone is to empathize. 6. List out the modes of communication? A) There are three modes of communication: • Interpretative Communication • Presentational Communication • Interpersonal Communication 7. Enlist steps of communication process? A) Sender, Message, Encoding, Media, Receiver, Feedback, Noise. 8. List down factors influencing communication. 1. Cultural Diversity. 2. Misunderstanding of Message. 3. Emotional Difference. 4. Past Experiences. 5. Educational and Intellectual Difference. 6. Group Affiliations. 7. Positional Differences among the Personnel. 8. Functional Relationship between Sender and Receiver.
• 19. 9. List down any four purposes of patient teaching A) ◘ The system establishes a unit of measure for nursing. ◘ Program costing and formulation of the nursing budget. ◘ Tracking changes in patients care needs. ◘ Determining the values of the productivity equations ◘ Determine the quality. 10.Enlist four barriers to effective communication. A) Language Barriers, Psychological Barriers, Physiological Barriers, Attitudinal Barriers, Systematic barriers, Cultural Barriers of Communication, Perceptual Barriers, Technological Barriers & Socio-religious Barriers.
• 20. UNIT –V THE NURSING PROCESS SHORT ESSAYS 1. Explain ASSESMENT as first step of nursing process Ans. ASSESSMENT Definition Assessment is the systematic and continuous collection, organization, validation, and documentation of data (information). Types of assessment: The four different types of assessments are; 1. Initial nursing assessment 2. Problem-focused assessment 3. Emergency assessment 4. Time-lapsed reassessment 1. Initial nursing assessment: Performed within specified time after admission.To establish a complete database for problem identification. Eg: Nursing admission assessment 2. Problem-focused assessment: To determine the status of a specific problem identified in an earlier assessment. Eg: hourly checking of vital signs of fever patient 3. Emergency assessment: During emergency situation to identify any life threatening situation. Eg: Rapid assessment of an individual’s airway, breathing status, and circulation during a cardiac arrest. 4. Time-lapsed reassessment: Several months after initial assessment. To compare the client’s current health status with the data previously obtained. 2. Explain the types and sources of Data collection Ans. Data collection is the process of gathering information about a client’s health status. It includes the health history, physical examination, results of laboratory and diagnostic tests, and material contributed by other health personnel. Types of Data Two types: subjective data and objective data.
• 21. 1. Subjective data, also referred to as symptoms or covert data, are clear only to the person affected and can be described only by that person. Itching, pain, and feelings of worry are examples of subjective data. 2. Objective data, also referred to as signs or overt data, are detectable by an observer or can be measured or tested against an accepted standard. They can be seen, heard, felt, or smelled, and they are obtained by observation or physical examination. For example, a discoloration of the skin or a blood pressure reading is objective data. Sources of Data collection: Sources of data are primary or secondary. 1. Primary: It is the direct source of information. The client is the primary source of data. 2. Secondary: It is the indirect source of information. All sources other than the client are considered secondary sources. Family members, health professionals, records and reports, laboratory and diagnostic results are secondary sources. 3. Describe various methods of the data collection Ans. Methods of the data collection: The methods used to collect data are observation, interview and examination. Interview method: An interview is a planned communication or a conversation with a purpose. There are two approaches to interviewing: directive and nondirective. • The directive interview is highly structured and directly ask the questions. And the nurse controls the interview. •A nondirective interview, or rapport building interview and the nurse allows the client to control the interview. STAGES OF AN INTERVIEW: An interview has three major stages: 1. The opening or introduction 2. The body or development
• 22. 3. The closing Observation Method: It is gathering data by using the senses. Vision, Smell and Hearing are used. Examination Method: The physical examination is a systematic data collection method to detect health problems. To conduct the examination, the nurse uses techniques of inspection, palpation, percussion and auscultation. 4. Differentiate between medical and nursing diagnosis with examples. Ans. Difference between Nursing Diagnosis from Medical Diagnosis Nursing diagnosis Medical diagnosis A nursing diagnosis is a statement of nursing judgment that made by nurse, by their education, experience, and expertise, are licensed to treat. A medical diagnosis is made by a physician. Nursing diagnoses describe the human response to an illness or a health problem. Medical diagnoses refer to disease processes. Nursing diagnoses may change as the client’s responses change. A client’s medical diagnosis remains the same for as long as the disease is present. Ex: Ineffective breathing pattern Ex: Asthma Activity intolerance Cerebrovascular accident Acute pain Appendicitis Disturbed body image Amputation 5. Explain the steps of nursing care plan for the client with suitable examples Ans. The are 5 steps of nursing care plan: 1. Assessment 2. Nursing diagnosis
• 23. 3. Planning 4. Implementation 5. Evaluation EX. 1 : the patient with fever planed the nursing care plan assessment Nursing diagnosis Planning Implementation Evaluation Subjective data: the client complained that he feels warm and producing heat out from body. Objective data: Body temperature highly recorded by measuring temperature Hyperthermia related to illness as evidenced by body temperature recording. ➢ Assess the vital signs of the client. ➢ Provide hygienic care. ➢ Administer medications like antipyrutics. ➢ Give cold compression for 15 min ➢ Provide plenty of fluids. ➢ Educate on nutritious diet and personal hygiene. ➢ Encourage rest and sleep ➢ Assessed the vital signs of the cltent. ➢ Provided hygienic care. ➢ Administered the medication tab. Pct 650 mg. ➢ Given cold compression for 15 min . ➢ Provided plenty of fluids ➢ Educated on nutritious diet and personal hygiene ➢ Encouraged to take rest and sleep ➢ Reassessed the vital signs and recorded. Body temperature reduced after implementing all measures.
• 24. ➢ Reassess the vital signs. 6. Explain the steps in planning as a part of nursing process Ans. The planning process 1. Setting priorities 2. Establishing client goals /desired outcome 3. Selecting nursing interventions 4. Writing individualized interventions on care plan Setting priorities • The nurse begin planning by deciding which nursing diagnosis requires attention first, which second, and so on. • Nurses frequently use Maslow’s hierarchy of needs when setting priorities. Establishing client goals/desired outcomes • After establishing priorities, the nurse set goals for each nursing diagnosis. Goals may be short term or long term. Nursing interventions • A nursing intervention is any treatment, that a nurse performs to improve patient’s health. TYPES OF NURSING INTERVENTIONS 1. Independent interventions are those activities that nurses are licensed to initiate on the basis of their knowledge and skills. 2. Dependent interventions are activities carried out under the orders or supervision of a licensed physician. 3. Collaborative interventions are actions the nurse carries out in collaboration with other health team members Writing Individualized Nursing Interventions • After choosing the appropriate nursing interventions, the nurse writes them on the care plan. • Nursing care plan is a written or computerized information about the client’s care. 7. Define nursing diagnosis and discuss the types of nursing diagnosis with examples
• 25. Ans. Definition • The official NANDA definition of a nursing diagnosis is: “a clinical judgment concerning a human response to health conditions/life processes, or a vulnerability for that response, by an individual, family, group, or community.” Status of the Nursing Diagnosis: The status of nursing diagnosis are actual, health promotion and risk. 1. An actual diagnosis is a client problem that is present at the time of the nursing assessment. 2. A health promotion diagnosis relates to clients’ preparedness to improve their health condition. • A risk nursing diagnosis is a clinical judgement that a problem does not exist, but the presence of risk factors indicates that a problem may develop if adequate care is not given. Components of a NANDA Nursing Diagnosis A nursing diagnosis has three components: (1) The problem and its definition (2) The etiology (3) The defining characteristics. 1. The problem statement describes the client’s health problem. 2. The etiology component of a nursing diagnosis identifies causes of the health problem. 3. Defining characteristics are the cluster of signs and symptoms that indicate the presence of health problem. Formulating Diagnostic Statements The basic three-part nursing diagnosis statement is called the PES format and includes the following: 1. Problem (P): statement of the client’s health problem (NANDA label) 2. Etiology (E): causes of the health problem 3. Signs and symptoms (S): defining characteristics manifested by the client. Example: Acute pain related to abdominal surgery as evidenced by patient discomfort and pain scale.
• 26. 8. Define nursing process. Explain the purpose and importance of nursing process Ans. Definition: Nursing process is a critical thinking process that professional nurses use to apply the best available evidence to care giving and promoting human functions and responses to health and illness. Purposes of nursing process ❖ To identify a client’s health status and actual or potential health care problems or needs. ❖ To establish plans to meet the identified needs. ❖ To deliver specific nursing interventions to meet those needs. Importance of nursing process: ➢ The nursing process is important to ensure quality care and to get the preferred outcome. ➢ In the nursing process, critical thinking is used to recognize the issue and come up with a logical solution to solving it. ➢ One important aspect of the nursing process is that the plan is not set in stone; it is meant to be manipulated in order to better suit the patient. ➢ Nurses must be able to think critically in order to recognize the issue, develop a way to correct it, and be able to communicate the issue to others. ➢ Throughout the nursing process, critical thinking is used to determine the best plan of care for a patient based on their diagnosis. 9. Define nursing intervention and discuss the types of nursing intervention Ans. Health system nursing interventions are actions nurses take as part of a healthcare team to provide a safe medical facility for all patients, such as following procedures to reduce the risk of infection for patients during hospital stays. i)Types of Nurse Intervention: • Intensive: is reserved for catastrophic cases where medical recovery is expected to extend over long or indefinite periods of time • Moderate: combines both phone calls and face-to-face interaction (Field Nurses). • Limited: consists of telephone interaction only (COP Nurses).
• 27. ii)Types of nursing interventions I. Independent interventions Activities nurses are licensed to initiate (i.e., physical care, ongoing assessment) II. Dependent interventions Activities carried out under primary care provider's orders or supervision, or according to specified routines III. Collaborative interventions Actions nurse carries out in collaboration with other health team members. 10. Explain the steps of evaluation in nursing process Ans. Evaluation is defined as the judgment of the effectiveness of nursing care to meet client goals; in this phase nurse compare the client behavioral responses with predetermined client goals and outcome criteria. 1. Collecting the data related to the desired outcomes 2. Comparing the data with outcomes 3. Relating nursing activities to outcomes 4. Drawing conclusion about problem status 5. Continuing, modifying, or terminating the nursing care plan Collecting the data: The nurse collects the data so that conclusion can be drawn about whether goals have been met. It is usually necessary to collect both subjective & objective data. Data must be recorded concisely and accurately to facilitate the next part of the evaluating process. Comparing the data with outcomes: If the first part of the evaluation process has been carried out effectively, it is relatively simple to determine whether a desired outcome has been met. Both the nurse and client play an active role in comparing the client’s actual responses with the desired outcomes. Relating nursing activities to outcomes The third aspect of the evaluating process is determined whether the nursing activities had any relation to the outcome.
• 28. Drawing conclusion about problem status: The nurse uses the judgement about goal achievement to determine whether the care plan was effective in resolving, reducing or preventing client problems. When goals have been met the nurse can draw one the following conclusions about the status of the client’s problem. Continuing, modifying , or terminating the nursing care plan: After drawing conclusion about the status of the client’s problems , the nurse modifies the care plan as indicated. Whether or not goals were met, a number of decision need to be made about continuing, modifying or terminating nursing care for each problem. Before making individual modification, the nurse must first determine why the plan as a whole was not completely effective. This require a review of the entire plan.
• 29. T. PAVITHRA M.Sc (N), M.Sc (psy) UNIT-VI DOCUMENTATION AND REPORTING SHORT ANSWERS 1. List down types of records in hospital ANS. Types of Records 1) Patients Clinical Record. 2) Individual Staff Records 3) Ward Records 4) Administrative Records with Educational Value. 2. What is incidental Report Ans. In a health care facility, such as a hospital, nursing home, or assisted living, an incident report or accident report is a form that is filled out in order to record details of an unusual event that occurs at the facility, such as an injury to a patient. The purpose of the incident report is to document the exact details of the occurrence while they are fresh in the minds of those who witnessed the event. This information may be useful in the future when dealing with liability issues stemming from the incident. 3. Differentiate Record and Report Ans. RECORDS A record is a permanent written communication that documents information relevant to a client’s health care management, e.g. a client chart is a continuing account of client’s health care status and need. REPORTS can be compiled daily, weekly, monthly, quarterly and annually.• Report summarizes the services of the nurse and/ or the agency.• Reports may be in the form of an analysis of some aspect of a service. 4. State four guidelines for Reporting Ans. Provide only essential background data on patient (e.g name, age, gender, diagnosis, and history) • Describe objective measurements about patient condition an response of health problem • Evaluate results of nursing or medical care measures.
• 30. T. PAVITHRA M.Sc (N), M.Sc (psy) • Be clear on priorities to which oncoming staff must attend. • Don’t review all routine care and procedure or tasks • Don’t review all biographical data already available in written form 5. What is transfer Report Ans. Transfer report: Transfer report is given whenever the patient is transferred to other health care unit. It can happen between: • Nursing unit-to-nursing unit transfer • Nursing unit to diagnostic area. • Special settings (operating room, emergency department). • Discharge and inter-facility transfer 6. What is progress note Ans. Progress Notes are the part of a medical record where healthcare professionals record details to document a patient's clinical status or achievements during the course of a hospitalization or over the course of outpatient care. 7. State four guidelines for recording Ans. ➢ Use complete, concise descriptions of care. ➢ Record all facts and enter only factual data. ➢ Correct all errors promptly, to avoid error, avoid rushing to complete charting. ➢ Do not write critical comments about client or care by other health care professionals. ➢ Enter only objective description of client’s behavior, client comments should be quoted. ➢ Do not erase, apply correction fluid, or scratch out errors made while recording. So for any error, just strike over it and sign the name or initials. 8. What is the meaning of documentation Ans. Document is described as any written or electronically generated information about a patient status or the care or the service provided to that patient. Nursing documentation is the record of nursing care that is planned and delivered to individual client.
• 31. T. PAVITHRA M.Sc (N), M.Sc (psy) 9. What is the meaning of computerized Documentation Ans. Computerized clinical documentation systems (CDS) provide for the documentation of patient care using computers. For example, the CDS records the vital signs directly from the cardio-respiratory monitors, while other documentation, such as nursing assessments are entered by the clinician. 10. List the cases to be included under medico legal records. Ans. Cases that are to be treated as medico legal are: (1) All cases of injuries and burns - the circumstances of which suggest commission of an offense by somebody (irrespective of suspicion of foul play); (2) all vehicular, factory, or other unnatural accident cases specially when there is a likelihood of patient′s death .
• 32. UNIT-VII VITAL SIGNS SHORT ESSAY 1. Define pyrexia. explain nursing care of a client with pyrexia Ans. When body temperature rises above 99 degree f. or 37 degree c. It is called pyrexia or fever. Nursing Care of patient With Pyrexia OBJECTIVES- • Promoting balance between heat production and heat loss. • Prevent complication • Reduce heat production • To increase heat loss Objectives ASSESSMENT- • Assess for contributing factors such as dehydration, infection environmental temperature • Obtain frequent temperature reading • Assess for presence of thirst, malaise • Assess skin colour and temperature • Obtain all vital signs • Identify physiological response to fever • Observe for shivering and diaphoresis • Assess clients comfort and wellbeing NURSING INTERVENTION OF FEVER- • minimize heat production- reduce the frequency of activities that increases oxygen demand, such as excessive turing and ambulation, allow rest period, limit physical activity • Maximize heat loss-minimize external covering on clients body, keep clothing and bed linen dry, prevent patient from getting draughts. Expose patient to cool air by an electrical fan • Maximize heat loss- Administration of cool drinks • Application of cold compress and ice bags • Cold sponging and cold packs. • Cold bath • Use of hypothermic blanket
• 33. • Prevent shivering-shivering is prevented because it increases metabolic activity Produces heat, increases oxygen demand, and circulation. May cause hyperventilation and respiratory alkalosis. • Promote client comfort • Encourage oral hygiene, • Prevent dehydration • Control temperature of environment. Provide complete bed rest • The clothing should be light, loose, smooth, cotton, non irritating. • Satisty supplement for increased metabolic rate- provide supplemental oxygen therapy . • Replace fluid lost • Provide high caloric diet- because oxygen consumption in body tissues increases. • Diet should be easily digestible and palatable • Fluid intake upto3000ml. • Encourage patient to take plenty of fluid. • Maintain intake output chart. • Provide small frequent feeds. • Make food palatable. • Plenty of fluid and fruits will help to evacuate bowel regularly. • Maintenance of personal hygiene—Frequent mouth care Care of skin and pressure points. • Give sponge bath daily. If temperature remains high cold sponging is given to bring down the temperature. • Safety of patient—Never leave a patient alone. • Rigor and convulsions may occur at any time constant observation is important Evaluate urine output periodically. 2. Explain characteristics and factors affecting pulse Ans. Pulse is a wave of blood created by the contraction of left ventricle. pulse reflects the heart beat. Characteristics of pulse 1. Pulse rate: It is the number of pulse beats per minute. Normal pulse rate in adults varies from 72 to 80 beats per minute. 2. Rhythm or regularity: It is the time interval between pulse beats. Normally the time intervals between pulse beats are equal or regular.
• 34. 3. Tension: It is degree of compressiblty and depends upon the resistance of the wall of the artery. 4. Strength/volume: It is the fullness of artery. It is force of blood felt at each beat. Factors affecting pulse 1. Age • The normal range of the pulse in an adult is 60 to100 BPM • The average pulse rate of an infant ranges from100 to 160 BPM 2. Sex: • After puberty the average males PR is slightly lower than female • Autonomic Nervous system activity • Stimulation of the parasympathetic nervous system results in decrease in the PR • Stimulation of sympathetic nervous system results in an increased pulse rate • Sympathetic nervous system activation occurs on response to a variety of stimuli including ✓ Pain , anxiety ,Exercise ,Fever ✓ Ingestion of caffeinated beverages ✓ Change in intravascular volume 3. Exercise: PR increase with exercise 4. Fever: increases PR in response to the lowered B/P that results from peripheral vasodilatation – increased metabolic rate 5. Heat: increase PR as a compensatory mechanism 6. Stress: increases the sympathetic nerve stimulation 7. Position changes: • a sitting or standing position blood usually pools in dependent vessels of the venous system. B/c of decrease in the venous blood return to heart and subsequent decrease in BP increases heart rate 8. Medication • Cardiac medication such as digoxin decrease heart rate • Medications that decrease intravascular volume such as divretics may increase pulse rate • Atropine in habits impasses to the heart from the parasympathetic nervous system, causing increased pulse rate • Propranolol blocks sympathetic nervous system action resulting in decreased heart rate sites used for measuring pulse rate.
• 35. 3. Explain characteristics and factors affecting respiration. Ans. Respiration is the act of breathing and includes the intake of oxygen and removal of carbon-dioxide. Characteristics The client should be at rest Assessed by watching the movement of the chest or abdomen. • Rate, • Rhythm, • Depth and special characteristics of respiration are assessed Rate: Is described in rate per minute (RPM) Healthy adult RR = 15- 20/ min. is measured for full minute, if regular for 30 seconds As the age decreases the respiratory rate increases Apnea - temporary cessation of breathing Tachypnea - fast breathing Bradypnea- slow respiration Eupnea- normal breathing rate and depth Rhythm: Is the regularity of expiration and inspiration Normal breathing is automatic & effortless. Depth: Described as normal, deep or shallow Deep: a large volume of air inhaled & exhaled, inflates most of the lungs. Shallow: exchange of a small volume of air minimal use of lung tissue. Factors affecting respiration: • Medications Narcotics decrease respiratory rate • Age Normal growth from infancy to adult hood results in a larger lung capacity. As lung capacity increases, lower respiratory rates are sufficient to exchange • Stress or strong emotions increases the rate and depth of respirations
• 36. • Exercise increases the rate & depth of respirations • Altitude The rate & depth of respirations at higher elevations (altitude) increase to improve the supply of oxygen available to the body tissues • Fever increases respiratory rate • Gender Men may have a lower respirations rate than women because men normally have a larger rung capacity than women. 4.. Explain characteristics and factors affecting blood pressure Ans. Blood pressure is the force exerted by the blood against the wall of blood vessel Characteristics ➢ Cardiac output : It is the amount of blood ejected by heart in 1 minute ➢ Stroke volume: It is the amount of blood ejected by heart in 1 cycle. Normally heart eject 70-80 ml blood in 1 cycle ➢ Cardiac output = stroke volume Χ heart rate ➢ Peripheral vascular resistance: It is the resistance to the blood flow determined by the tone of vascular muscle’s & the diameter of blood vessels ,smaller the lumen greater the resistance ,ultimately blood pressure raises. That is why vasoconstriction leads to elevation of blood pressure ➢ Blood volume : as soon as the blood volume increases, pressure exerted against arterial wall also increases. That is why giving intravenous fluid in hypotension increases the blood pressure .with hemorrhage & bleeding , blood volume decreases & automatically Blood pressure falls Factors affecting blood pressure • Age: blood pressure varies throughout the age. As age increases, BP also raises. ❖ Infant blood pressure: 65-115/42-80 mm Hg ❖ 7 year child: 87-177/48-64 mmHg ❖ Normal adult: 120/80 mmHg ❖ Older people, systolic pressure rises with decreased elasticity • Body size/obesity: It is observed that as the body size increases, BP also fluctuates. Heavier & taller child have higher BP than the smaller child of same age • Emotions/stress: anxiety, fear , pain , stress, sympathetic nervous system get activated, causing vasoconstriction , increases heart contraction & ultimately raises blood pressure • Gender: After puberty , male have higher blood pressure than females. But after menopause , women tend to have high BP than male of same age • Ethnicity: African – Americans have higher incidence of high blood pressure than European- Americans
• 37. • Diet: people taking diet rich in salt & unsaturated fatty acids, having higher blood pressure. Cocaine use also increases blood pressure. Caffeine intake also increases blood pressure. • Smoking: due to nicotine blood pressure increases • Exercise: Regular exercise, decreases the blood pressure. Helps in keeping BP normal • Diurnal variations: usually, person have low BP in early morning & gradually rises & peaks in evening • Medications: medications such as opioid analgesics, antihypertensive drugs have greater effect on BP • Chemicals: such as epinephrine, ADH , Angiotensin II cause vasoconstriction , thus elevating BP. Histamine, kinens cause vasodilation , thus decrease BP. 5. Define hypothermia. Discuss nursing measures for hypothermia. Ans. 1. Hypothermia occurs when the body temperature drops below 36.5 degree Celsius (97.7 degree F), the lower limit of normal range of 36.5 - 37.5 degree Celsius (97.8-99.5 degree Fahrenheit) 2. If the temperature falls below 95degree f. Or 35 degree c. The condition is called hypothermia. Nursing care for hypothermia • Patient is re-warmed by placing him in a warm room, with warm blankets and drinks. • Prevent a further decrease in body temperature removing wet clothes, replacing them with dry cloth. • If possible give hot liquids such as soup. • Avoid alcohol and caffeinated fluid . keep the head covered. • For a new born: An important objective of appropriate care of the newborn is to avoid hypothermia from the moment of birth, by using procedures that will prevent heat loss and maintain the temperature within the normal range, thus conserving the infant’s energy for growth and development. • Placing indirect skin-to-skin contact with mother. Covering both (mother & baby) with heavy and clean blanket. • Maintain input output chart frequently • Promote client comfort • Safety of patient—Never leave a patient alone. 6. Discuss on abnormal pulse?
• 38. Ans. Abnormal Findings In Pulse Abnormality can be in the: ❖ Rate ❖ Rhythm ❖ Volume ❖ Character ❖ Condition of vessel wall ❖ Radio femoral delay RATE Tachycardia(Pulse Rate>100 bpm) .Bradycardia(Pulse Rate<60 bpm) RHYTHM IF IRREGULAR: Irregularly Irregular Regularly Irregular Occasionally irregular ✓ Occasionally Irregular Pulse • Extrasystole ✓ Regularly Irregular Pulse • Ectopic beat occurring at a regular interval • Second degree atrioventricular block • Sinus arrhythmia ✓ Irregularly Irregular Pulse • Atrial Fibrillation • Multiple ectopics VOLUME High Volume Pulse Low Volume Pulse Varying Volume ✓ High Volume Pulse Physiological causes:  Increased Environmental Temperature  Advanced Age  Pregnancy  Exercise ✓ Low Volume Pulse Causes:
• 39. Pericardial Effusion  Severe Aortic Stenosis  Shock  Peripheral arterial disease  Hypovolemia  Left Ventricular Failure ✓ Varying Volume:  Ventricular Tachycardia  Atrial fibrillation  Seen in:  Combination of low, normal or high volume pulse in varying manner CHARACTER OF PULSE  Dicrotic pulse  Anacrotic pulse  Pulsus paradoxus  Pulsus alternans  Pulsus bigeminus  Pulsus parvus et tardus  Pulsus bisferiens  Slow rising pulse  Collapsing pulse CONDITION OF VESSEL WALL CAN BE:  Elderly due to arthrosclerosis  Thickened-firm to hard and cord-like  Normal-Soft RADIO-FEMORAL DELAY Most common cause: Coarctation of aorta Children: : Reduced volume lower limb pulses Upper limb pulses are usually normal Adults  Usually presents hypertension and heart failure Other causes: • Atherosclerosis of aorta
• 40. • Thrombosis or embolism of aorta 7. Discuss on pattern of abnormal respiration? Ans. pattern of abnormal respiration: They are different patterns of respiration listed billow: ➢ Apnea : Absence of breathing. (Ap-knee-a) ➢ Eupnea : Normal breathing (Eup-knee-a) ➢ Orthopnea: Only able to breathe comfortable in upright position (such as sitting in chair), unable to breath laying down, (Or-thop-knee-a) ➢ Dyspnea : Subjective sensation related by patient as to breathing difficulty. Paroxysmal nocturnal dyspnea - attacks of severe shortness of breath that wakes a person from sleep, such that they have to sit up to catch their breath - common in patient's with congestive heart failure. ➢ Hyperpnea: Increased volume with or without and increased frequency (RR), normal blood gases present. ➢ Hyperventilation: "Over" ventilation - ventilation in excess of the body's need for CO2 elimination.Results in a decreased PaCO2, and a respiratory alkalosis. ➢ Hypoventilation: Decreased rate (A) or depth (B), or some combination of both. • "Under" ventilation - ventilation that is less than needed for CO2 elimination, and inadequate to maintain normal PaCO2. Results in respiratory acidosis. • Can be a slow rate with normal tidal volumes such that the total minute ventilation is inadequate. • Can be a normal rate but with such low tidal volumes that air exchange is only in the dead space and not effective. ➢ Tachypnea: Increased frequency without blood gas abnormality ➢ Kussmaul's Respiration: Kussmaul's respiration. Increased rate and depth of breathing over a prolonged period of time. In response to metabolic acidosis, the body's attempt to blow off CO2 to buffer a fixed acid such as ketones. Ketoacidosis is seen in diabetics. ➢ Cheyne-Stokes respirations (CSR): • Gradual increase in volume and frequency, followed by a gradual decrease in volume and frequency, with apnea periods of 10 - 30 seconds between cycle. Described as a crescendo - decrescendo pattern. Characterized by cyclic waxing and waning ventilation with apnea gradually giving way to hyperpneic breathing. • Seen with low cardiac output states (CHF) with compromised cerebral perfusion
• 41. • Creates lag of CSF CO2 behind arterial PaCO2 and results in characteristic cycle. Delayed sensitivity to CO2 changes- during apnea the CO2 increase above the threshold for stimulus but the brain is slow to respond, then it over shoots by hyperventilating and the signal to reduce ventilation is slow to be recognized. ➢ Biot's respiration: • Similar to CSR but VT is constant except during apneic periods. Short episodes of rapid, deep inspirations followed by 10 - 30 second apneic period. • Seen with patients with elevated ICP as seen in meningitis ➢ Apneustic breathing (previously described): Indicates damage to pons ➢ Central neurogenic hyperventilation: • Persistent hyperventilation • May be caused by head trauma, severe brain hypoxia, or lack of cerebral perfusion • Mid brain and upper pons damage ➢ Central neurogenic hypoventilation: • Medulla respiratory centers are not responding to appropriate stimuli. • Associated with head trauma, cerebral hypoxia, and narcotic suppression ➢ CO2 and Cerebral Blood Flow (CBF): • CO2 plays an important role in autoregulation of CBF mediated through its formation of H+ . • Increased CO2 dilates cerebral vessels and vice versa. • In traumatic brain injury (TBI), the brain swells acutely. Head is a fixed volume container - cannot expand. When bleeding or swelling occurs in the brain pressures rapidly increase. Raising ICPs exceed cerebral arterial pressure and brain perfusion stops. • Cerebral hypoxia/ischemia - brain death • Mechanical hyperventilation can lower PaCO2, which results in vasoconstriction in cerebral vessels, reduction of swelling and ICP. • Controversial as reduces O2 and CBF to injured brain. • Only effective for the first 24 hours. • Current practice is to treat perfusion pressures pharmacologically rather then use hyperventilation. • All agree must avoid hypoventilation in TBI patients. 8. Discuss on types of fever
• 42. Ans. Fever: a body temperature abovethe normal ranges 38 0c – 410 c (100.4 – 105.8 F) Types of fever 1. Intermittent fever: the body temperature alternates at regular intervals between periods of fever and periods of normal or subnormal temperature. 2. Remittent fever: a wide range of temperature fluctuation (more than 2 0c) occurs over the 24 hr period, all of which are above normal 3. Relapsing fever: short febrile periods of a few days are interspersed with periods of 1 or 2 days of normal temperature. 4. Constant fever: the body temperature fluctuates minimally but always remains above normal 9. Classify cold and hot application. Discuss on purpose and indication of both? Ans. Classification of cold and hot applications :
• 43. PURPOSE OF COLD APPLICATION: Cold application is the application of a cold agent cooler than skin either in a moist or dry form, on the surface of the skin; ➢ To reduce pain and body temperature ➢ To anaesthetize an area ➢ To control hemorrhage ➢ To control the growth of bacteria ➢ To prevent gangrene ➢ To prevent edema and ➢ To reduce inflammation. PURPOSE OF HOT APPLICATION: Hot application is the application of a hot agent , warmer than skin either in a moist or dry form on the surface of the body; ➢ To relive pain and congestion ➢ To provide warmth ➢ To promote suppuration ➢ To promote healing ➢ To decrease muscle tone and ➢ To soften the exudates.
• 44. INDICATION OF COLD AND HOT APPLICATION: ➢ Cold application assists with extra-vasation following canulation of an AV fistula or graft. ➢ Heat may relieve muscle cramps that can occur in 20 % of haemo- dialysis treatments, due to rapid fluid shifts. ➢ The application of heat is a non-medically prescribed therapy, used with therapeutic intent. Dialysis Unit ➢ Therapeutic effects of heat can assist in relieving sore, stiff muscles or joints. ➢ Safe heat or cold applications will be provided to patients / residents as part of pain management programs wherever these applications are appropriate and effective. 10. Define blood pressure. Explain steps in measuring blood pressure. Ans. Definition: Blood pressure is the force exerted by the blood against the wall of blood vessel. Two measurements: • Systolic blood pressure: is force exerted by arterial walls during systole. It is the maximum pressure during ventricle contraction • Diastolic blood pressure: is the force exerted by blood against arterial wall during diastole. It is the maximum pressure when the ventricles are relaxed • Unit of measuring blood pressure is (mmHg) millimeters of mercury • Normal blood pressure is 120/80 mm of Hg • Here , systolic pressure is 120 mmHg & diastolic pressure is 80 mmHg • Pulse pressure is the difference between systolic & diastolic pressure • Normally, The pulse pressure is 40 mmHg Steps in measuring blood pressure: ➢ Collect all the articles ➢ Wash hands ➢ Explain procedure to the client. Ex: you are going to monitor his BP ➢ Provide comfortable position. Ex : sitting , supine while keeping his upper arm at heart level ,palm up ➢ Ensure that mercury level of sphygmomanometer is at zero ➢ Ensure cuff width against client’s arm
• 45. ➢ Ensure mercury meniscus is at your eye level ➢ Palpate brachial artery pulse ➢ Ensure no air in the cuff & wrap it evenly around client’s arm centering arrow over brachial artery ➢ Place lower edge of cuff about 1 inch above antecubital fossa ➢ Tuck the end of wrap under cuff ➢ Ensure that connecting tubings are free of each other. Estimate systolic pressure by palpating the artery with finger tips of one hand while inflating cuff, rapidly to pressure 30 mmHg above point when pulse reappears. Deflate cuff fully & wait for 30 secs ➢ Place earpiece of stethoscope in ears & bell/diaphragm on brachial artery ➢ Close valve of pressure bulb clockwise until tight ➢ Rapidly inflate cuff to 30mmHg above palpated systolic pressure ➢ Slowly release the pressure bulb valve & allow the mercury to fall at rate of 2-3 mmHg/sec ➢ Listen & watch mercury level drop. when first clear :”tap tap” (karot koff) ➢ Sound is heard , note the systolic blood pressure ➢ Continue to deflate the bulb & when sound disappears, note the diastolic blood pressure ➢ Listen for 10-20 mmHg after the last sound & then escape air quickly ➢ Remove cuff ➢ Inform client of his BP reading as needed ➢ Reposition client comfortably ➢ Record reading immediately ➢ Replace articles: Clean earpiece & bell/diaphragm of stethoscope with alcohol swab. Discard used alcohol swabs . Place articles to their correct place. ➢ Wash hands Add on points: ➢ As record is a legal document, It protects the hospital as well as client. ➢ Nurse must document the reading of vital signs any deviations ➢ While documenting vital signs, she should follow organizations policies procedure ➢ Vital sign can be documented on graphic sheet notes in case of abnormality detected. Such as elevated temp, tachycardia, shortness of breath. Also document the actions taken for identified problems. ➢ Recording vital signs & Vital signs are documented on vital chart as well as graphic sheet.
• 46. UNIT –VIII HEALTH ASSESSMENT SHORT ESSAY 1)Explain the purpose of health assessment Definition A health assessment is a plan of care that identifies the specific needs of a person and how those needs will be addressed by the healthcare system or skilled nursing facility. Health assessment is the evaluation of the health status by performing a physical exam after taking a health history. It is done to detect diseases early in people that may look and feel well. Health assessment helps to identify the medical need of patients. Patients health is assessed by conducting physical examination of patient. A health assessment is a plan of care that identifies the specific needs of a person and how those needs will be addressed by the healthcare system or skilled nursing facility. Purpose of Health Assessment  Establish a data base o strengths/weaknesses o physiological status o knowledge base o motivation o support systems & coping ability o other factors that may influence health positively or negatively 2) Explain the preparation of patient unit for physical examination? Preparing Patients for Physical Examination: This duty entails the following:
• 47.  Escorting patients from the waiting room to the examination rooms  Interviewing the patient, including leading a discussion of medical history and recent tests performed  Recording the patients’ vital signs  Measuring the patients’ heights and weights  Measuring the patients’ blood pressure as needed  Conducting one’s self in a polite and professional manner at all times with patients Purpose of Physical Examination:  To understand the physical and mental health of the patient.  To detect disease in its early stage.  To find out the cause and the extent of disease.  To understand the changes in the condition of diseases, any improvement or regression.  To define the nature of the treatments or nursing care needed for the patient.  To safeguard the patient and his family by noting the early signs especially in case of a communicable disease. 3) Discussion on methods of physical examination physical assessment, will use four techniques: inspection, palpation, percussion, and auscultation. Use them in sequence—unless you're performing an abdominal assessment. Palpation and percussion can alter bowel sounds, so you'd inspect, auscultate, percuss, then palpate an abdomen. Inspection Performed first, inspection is the most repeated of the four physical examination methods. Teaching students about inspection emphasizes using sight and smell to check specific areas for normal color, shape, and consistency. Sight
• 48. Make sure that your students arrange clothing accordingly and use adequate lighting to fully observe the body parts they are inspecting. Smell Because certain infections give off a stench, smell is vital to inspection. You may simulate smell by using a scent-laden cheese to give students real-life experience with smell inspection. Palpation Palpation is the act of touching a patient to feel for abnormalities anywhere in the body. There are two different types: light and deep palpation. Light Palpation As the name suggests, light palpation is soft and gentle. Nurses may find information on skin texture and moisture, masses, fluid, muscle guarding, and superficial tenderness by using light palpation. Deep Palpation Deep palpation explores the body’s internal structures to a depth of 4-5 centimeters. This technique can inform nurses about the position of organs and masses, as well as their size, shape, mobility, consistency, and areas of discomfort. Percussion Percussion includes tapping one’s hands on a patient’s body to produce sound vibrations. The sounds made can confirm the presence of air, fluid, and solids, along with organ size, shape, and position. Percussion can be practiced almost anywhere to analyze the intensity, duration, pitch, frequency, quality, and location of sound. Auscultation The final method is auscultation, which is listening to the heart, lungs, neck, or abdomen to gather information. There are two types of auscultation: direct and indirect.
• 49. Direct Auscultation Listening with the unaided ear. This may include listening to the patient from a distance or right on the patient’s skin. Indirect Auscultation Using amplification or a mechanical device, such as a stethoscope. An acoustic stethoscope does not amplify the body sounds but blocks out environmental sounds. 4) Discuss the significance of History collection in Health assessment Plan strategies to encourage continuation of healthy patterns, prevent potential health problems and alleviate or manage existing health problems. Establish a data base for the clients normal abilities risk factors, and any current alterations in function. Purposes of health assessment 1. To idientify need for health teaching 2. To identify client’s strengths  To identify the health problems 3. To organize the collected information 4. To determine client’s normal function 5. To gather information regarding client’s health Formulating conclusion or a problem statement such as a nursing diagnosis. 6. Provide the holistic view of the clients TYPES OF ASSESSMENT INTIAL ASSESSMENT It is performed within specified time after admission to a hospital. The establish a complete data base for problem identification , reference and future comparison. e.g. Nursing admission assessment.e.g. Hourly assessment of client’s fluid intake and output chart Purpose The main purpose of ongoing or focused assessment to determine
• 50. the status of a specific and to identify new or overlooked problem  on going or focused assessment is ongoing process integrated with nursing care. FOCUS or ONGOING ASSESSMENT E.g a rapid asessment of person’s airway b breathing ,and cirulation during cardiac arrest Purpose . To identify life- threatining problems  Emergency assessment is life saving assessment the major purpose of emergency assessment is save the patient or client’s life. EMERGENCY ASSESSMENT Purpose. To compare the client’s current status to baseline data previously obtained. e.g Reassessment of a client’s functional health patterns in a home. Time lapsed assessment involves assessment several days after first initial assessment. 5) Explain the assessment of Gastro intestinal system using techniques of physical examination? Inspection The patient is placed supine on an examining table or bed. It is helpful to place a small pillow beneath the knees to relax the abdominal musculature. The head should rest comfortably on a small pillow. The patient's arms should rest comfortably at the sides. Drapes should be placed over the breasts and groins just below the inguinal regions to preserve modesty. The examiner stands on the patient's right. Palpation Palpation of the abdomen involves using the flat of the hand and fingers, not the fingertips to detect palpable organs, abnormal masses, or tenderness. Again, an orderly approach is necessary to prevent oversights. One should begin in the right upper quadrant with palpation of the liver. The flat of the right hand is placed on
• 51. the abdominal wall with the fingertips pointing toward the right shoulder. The fingertips should be 2 to 3 cm below the costal margin The patient is asked to inspire deeply, bringing the liver edge down to the fingertips. One should note the consistency of the liver and whether there is tenderness. It should be noted whether the edge of the liver is sharp, blunted, or nodular. Percussion Percussion of the abdomen is performed to check liver size, spleen size, and any abnormal gas collections. The size of the liver is estimated by determining the span of liver dullness by percussion. This is performed by percussing just below the breast in the midclavicular line. A resonant note should be obtained because of the underlying air Percussion then proceeds caudally from the dome of the liver until dullness is noted. Percussion is then continued caudally until resonance returns, indicating that the examiner has reached the hepatic flexure of the colon at the hepatic edge). A normal liver span is 10 to 12 cm. If dullness is absent over the liver, this may be a sign of intra-abdominal gas, as might occur with a perforated viscus. Auscultation In abdominal examination auscultation is performed before palpation, as palpation may alter the bowel sounds. Starting in the right upper quadrant, the examiner listens over the liver for rubs or bruits and over the free abdominal wall for bowel sounds. One moves next to the left upper quadrant, again listening for bowel sounds and then over the spleen to detect rubs or bruits. One should next auscultate in the periumbilical regions for aortic or renal bruits and for bowel sounds and then in the left and right lower quadrants for bowel sounds or iliac bruits. If, during the course of auscultation, no bowel sounds are detected, one should auscultate in the periumbilical region for 3 full minutes before determining that bowel sounds are
• 52. absent. Important points to note on bowel sounds are the pitch, intensity, and duration of the sounds. 6) Explain the assessment of respiratory system using techniques of physical examination? Palpation is the use of physical touch during examination. During palpation, the physician checks for areas of tenderness, abnormalities of the skin, respiratory expansion and fremitus. The four steps of the respiratory exam are inspection, palpation, percussion, and auscultation of respiratory sounds, normally first carried out from the back of the chest Inspection The examiner then estimates the patient's respiratory rate by observing how many times the patient breathes in and out within the span of one minute. This is typically conducted under the pretext of some other exam, so that the patient does not subconsciously change their baseline respiratory rate, as they might do if they were aware of the examiner observing their breathing. Adults normally breathe about 14 to 20 times per minute, while infants may breathe up to 44 times per minute Palpation Palpation is the use of physical touch during examination. During palpation, the physician checks for areas of tenderness, abnormalities of the skin, respiratory expansion and fremitus.[
• 53.  To assess areas of tenderness, palpate areas of pain, bruises, or lesions on the front and back of the chest. Bruises may indicate a fractured rib, and tenderness between the ribs may indicate inflamed pleura.[16]  Palpate any abnormal masses or structures on the front and back of the chest. Abnormal masses or sinus tracts may point to infections. Chest percussion Percussion over different body tissues results in five common "notes". 1. Resonance: Loud and low pitched. Normal lung sound. 2. Dullness: Medium intensity and pitch. Experienced with fluid. o A dull, muffled sound may replace resonance in conditions like pneumonia or hemothorax. 3. Hyper-resonance: Very loud, very low pitch, and longer in duration. Abnormal. o Hyper-resonance can result from asthma or emphysema 4. Tympany: Loud and high pitched. Common for percussion over gas-filled spaces. o Tympany may result in pneumothorax. 5. Flatness: Soft and high pitched. Ascultation The areas of the lungs that can be listened to using a stethoscope are called the lung fields, and these are the posterior, lateral, and anterior lung fields. The posterior fields can be listened to from the back and include: the lower lobes (taking up three quarters of the posterior fields); the anterior fields taking up the other quarter; and the lateral fields under the axillae, the left axilla for the lingual, the right axilla for the middle right lobe. The anterior fields can also be auscultated from the front
• 54. 7) Write in detail regording of physical examination findindgs from head to toe? Definition A head-to-toe assessment refers to a physical examination or health assessment, and it becomes one of the many important components of understanding a patient’s needs and problems. The Order of a Head-to-Toe Assessment 1. General Status  Vital signs  Heart rate  Blood pressure  Temperature  Pulse oximetry  Respiratory rate  Pain 2. Head, Ears, Eyes, Nose, Throat  Observe color of lips and moistness  Inspect teeth and gums  Assess buccal mucosa and palate  Examine Tongue  Examine at uvula  Examine tonsils  Palpate nose and assess symmetry  Check Septum and inside nostrils  Verify patency of nares  Check patient’s sense of smell  Palpate sinuses
• 55.  Assess patient hearing with whisper test  Tuning Fork test (Weber’s test, Rinne test)  Look inside ear  Assess ear discharge and tympanic membrane  Check conjunctive and sclera  Assess eye symmetry  PERRLA  Check vision with Snellen Chart  Check six cardinal positions of the gaze 3. Neck  Palpate lymph nodes  Observe and palpate trachea and neck  Check for Jugular Venous Distention  Check neck range of motion  Check shoulder shrug with resistance 4. Respiratory  Listen to lung sounds front and back  Assess respiratory expansion level  Ask about coughing  Palpate thorax 5. Cardiac  Palpate the carotid and temporal pulses bilaterally  Listen to heartbeat 6. Abdomen  Inspect abdomen  Listen to 4 quadrants of abdomen for bowel sounds  Palpate 4 quadrants of abdomen for pain/tenderness
• 56.  Ask about problems with bowel or bladder 7. Pulses  Check pulses in arms/legs/feet including, o Radial o Femoral o Posterior tibial o Dorsalis pedis 8. Extremities  Assess range of motion and strength in arms/legs/ankles  Assess sharp and dull sensation on arms/legs  Check capillary refill on fingernails/toenails 9. Skin  Check skin turgor  Check for lesions, abrasions, rashes  Check for tenderness, lumps, lesions  Check if patient is pale, clammy, dry, cold, hot, flushed 10. Neurological  Oriented x3  Assess gait  Check coordination  Assess reflexes  Check Glasgow Coma Scale score 8) Explain the assessment of cardio vascular system using techniques of physical examination The cardiac examination consists of evaluation of (1) the carotid arterial pulse and auscultation for carotid bruits; (2) the jugular venous
• 57. pulse and auscultation for cervical venous hums; (3) the precordial impulses and palpation for heart sounds and murmurs; and (4) auscultation of the heart. Examination of the Heart Carotid Arteries Begin the cardiovascular examination by assessing the carotid arterial pulses . They are ordinarily examined while the patient is breathing normally and reclining with the trunk of the body elevated about 15 to 30 degrees. In order to examine the carotid arteries, the sternocleidomastoid (SCM) muscle should be relaxed and the head rotated slightly toward the examiner. The examiner places the forefinger or thumb, depending on individual preference, slightly over the artery in the groove just lateral to the trachea. Care should be taken always to palpate in the lower half of the neck in order to avoid the area of the carotid bulb, lest a hypersensitive carotid sinus reflex be evoked with resultant bradycardia and hypotension. Jugular Veins The jugular venous pulse is usually examined next. It includes observation of venous wave form, assessment of the response of the venous pressure to abdominal compression, estimation of the central venous pressure (CVP), and auscultation for cervical venous hums. Venous pulsations are examined by inspection of either the external or internal jugular veins, although the latter are generally more reliable because they more directly reflect right atrial hemodynamics. Precordial Movements and Thrills The precordial examination, performed next, consists of inspection and palpation of the anterior chest wall. Precordial movements should be evaluated at the apex (left ventricle), lower left parasternal edge (right ventricle), upper left (pulmonary artery) and upper right (aorta) parasternal edges, and epigastric and sternoclavicular areas It is best to examine the precordium with the patient supine because if the patient is turned on the left side, the apical region of the heart is
• 58. displaced against the lateral chest wall, distorting the chest movements. Inspect the chest wall by positioning yourself on the patient's right side and looking tangentially across the fourth, fifth, and sixth intercostal spaces. Ask the patient to take a deep breath and then to exhale slowly as you look for a discrete area of apical movement. The following are the factors to be considered about any precordial movement that can be seen or felt: (1) location; (2) amplitude; (3) duration; (4) time of the impulse in the cardiac cycle; and (5) contour. 9) What are the methods of health assessment explain in detail any one method Purpose of health assessment  The purpose of health assessment is to get a general understanding of the state of your healt  5 Principles health assessment techniques  Accountability. ...  Performance-Based Assessment. ...  Evidence-Based Assessment. ...  Validity and Reliability in Assessment. ...  Participation and Collaboration. AUSCULTATION  The final method is auscultation, which is listening to the heart, lungs, neck, or abdomen to gather information. There are two types of auscultation: direct and indirect.  Direct Auscultation  Listening with the unaided ear. This may include listening to the patient from a distance or right on the patient’s skin.  Indirect Auscultation
• 59.  Using amplification or a mechanical device, such as a stethoscope. An acoustic stethoscope does not amplify the body sounds but blocks out environmental sounds. 10) Explain methods of palpation with examples Palpation Palpation is the act of touching a patient to feel for abnormalities anywhere in the body. There are two different types: light and deep palpation. Light Palpation As the name suggests, light palpation is soft and gentle. Nurses may find information on skin texture and moisture, masses, fluid, muscle guarding, and superficial tenderness by using light palpation. Deep Palpation Deep palpation explores the body’s internal structures to a depth of 4-5 centimeters. This technique can inform nurses about the position of organs and masses, as well as their size, shape, mobility, consistency, and areas of discomfort. Have students role-play using different scenarios to train them to palpate effectively. Encourage short fingernails and warm hands to boost patient comfort during palpation.
• 60. UNIT: 9 MECHINARY, EQUIPMENT, AND LINEN SHORT ANSWER 1. Define inventory ANS: Inventory means all the materials, parts, supplies, expenses, and in process or finished products recorded on the books by an organization and kept in its stocks, warehouse, or plant for some period of time. 2. What is the meaning of indent? ANS: An indent is an official order or requisition for medicine and supplies from the medical store. The nurse acquires the equipment and supplies based on the need estimation, availability, and the budget. 3. Distinguish between disposable and reusable articles. ANS: Disposable articles means the items used only once, discarded after use and new items are used for every patient. On the other hand, Reusable equipment’s means the items and equipment’s used for a very long time, they are cleaned, disinfected, and sterilized before and after each use. More care should be given to reusable items than disposable items. 4. Mention types of Equipment’s. ANS: A. Self-care equipment’s (for patients’ daily life) B. Electronic equipment’s (ECG Monitor, ventilator etc.) C. Diagnostic equipment’s (tools used to test) D. Surgical equipment’s (stainless steel tools, OT tools)
• 61. E. Acute care equipment’s (dressing material etc.) F. Storage and transport equipment’s. 5. Mention any four equipment’s used in oral care. ANS: Articles needed for conscious patient: a. Face towels b. Toothbrush c. Toothpaste d. Disposable gloves Log of tepid water Articles needed for unconscious patient: a. Face towel b. Disposable gloves c. Artery forceps d. Dissecting forceps e. Tongue depressor 6. Name any dour rubber goods? Ans. The rubber goods in common use are: 1. Mackintosh 2. Hot water bottles 3.Rubber tubes and Clothier 4.Gloves 7. Lost down types of rubber catheter? Ans. There are three types of catheters:
• 62. 1. Indwelling catheters (urethral or suprapubic catheters) 2. External catheters (condom catheters) 3. Short- term catheters (intermittent catheters) 8. what is the meaning of condemnation of article? Ans. Condemnation is the act of declaring something awful or evil. If your little brother does, something unspeakably awful, express your condemnation so he will learn not to do it again. 9. Expand CSSD? Ans. CSSD- The central sterile services department (CSSD), also called sterile processing department (SPD), or central supply, is an integrated place I'm hospital and other health care facilities that performs sterilization and other actions on medical devices, equipment and consumable. 10. What is Autoclaving? Ans. Autoclaving- The autoclave is a pressure cooker that sterilizes or kills all microorganisms and their spores. Autoclaves are used in hospital by surgeon's to sterilizes surgical tools. They are also used in medical facilities and dentist's offices in order to sterilize instruments such as speculums, scopes, and scrappers.
• 63. UNIT X MEETING NEEDS OF THE PATIENT LONG ESSAYS 1. a. Enlist effects of neglected mouth? Ans. Some of the effects of neglected mouth are. *Leading to bad breath. *Gum disease *Tooth abscesses and infections *Loss of teeth. Complication of Neglected Mouth care *Halitosis *Stomatitis *Pyorrhea *Root abscess *Tonsillitis *Sinusitis *Parotitis *Glossitis
• 64. *Sores and crust *Inhalation pneumonia *Joint disease *Rheumatic heart disease *Loss of appetite b. Explain the procedure of oral care in an unconscious patient. Ans. The patient is unconscious, oral care will be needed more frequently. Unconscious patients usually breathe through the mouth, causing secretions to dry. It is a vital aspect of patient care that needs to be carried out consistently by a nurse. The nurse plays an important role in providing effective oral care and promoting oral hygiene of an unconscious patient. Nurses should be aware of risk factors associated with poor oral health and be able to assess and help patients maintain oral hygiene. Supplies and Equipment for Unconscious Patient: A tray containing supplies and equipment needed for oral care or mouth care are listed in the following: 1. Small mackintosh 1, 2. Towel—1, 3. Kidney tray 2, 4. Gauze piece or cotton balls, 5. Mouth wash solution (0.12% Chlorhexidine or 05% Cetylpyridinium Chloride), 6. Galipot-1(Denture soaking solution), 7. Gloves, 8. The aseptic syringe or irrigating bulb,
• 65. 9. A suction catheter with a suction apparatus, 10.A cotton ball with artery forceps, 11.Gauze padded tongue depressor, 12.Mouth gag (if patients unconscious to open the mouth), 13.Plain water in a mug, 14.Paper bag. Mouth Care Procedure for Unconscious Patient: Oral care procedures are used for patients who are unconscious or who are not able to eat or drink. 1. Arrange all equipment on the bedside cabinet or an overbed table. 2. Set the patient’s bed in a comfortable position and lower one side rail. 3. Place a bulb syringe or suction machine with a suction machine nearby. 4. Place the client in a side-lying position and raise the level of the bed on one side so that the patient is in a partial sitting position. 5. Rinse your hands properly with antiseptic soap and lukewarm water. 6. Wear gloves after drying hands. 7. Place towel or waterproof pad under the client’s chin and wrap the patient’s chest. 8. Keep the kidney tray under the patient’s cheek or remove secretions from the mouth by the suction catheter. 9. Use a padded tongue blade to open teeth gently. Never put your fingers in an unconscious patient’s mouth. 10.Turn the head of the patient towards you in a very gentle manner. 11.A clean mouth, gums, teeth, and tongue with toothbrush and toothpaste. 12.Use an Asepto syringe or irrigating bulb without a needle to rinse the oral cavity. Swab or use oral suction to remove pooled secretions. 13.Clean immediately after brushing and Suction the saliva and toothpaste from the mouth of the patient. 14.Wipe out the extra water on the mouth with a clean small towel.
• 66. 15.Removes basin dries face and mouth and applies water-soluble lip moisturizer. 16.Bring the patient back to a comfortable position. 17.Raise side rail and lower bed position. 18.Dispose of gloves in a paper bag and wash hands properly. 19.Report & documents oral findings and procedure. 2.a. Mention types of bed making. Ans. TypeS of bed making : a) closed bed : • Made following discharge of patient • purpose to keep clean untill new patient admitted b) open bed : • fan fold the tapsheets to foot of bed to convert closed bed to open bed • Fanfold means to fold the sheets like accerdian plats • done to welcome patient or for patient who are ambulatory or out of the bed c) occupied bed: • bed is made while patient is in it • usually done after morning bath d) admission bed: • This bed prepared to receive the newly admitted patient. Purpose: 1. To welcome patient
• 67. 2. To provide the immediate care,safety and comfort 3. To protect the bed linen while giving with on admission. b. Explain preparation of post-operative bed in detail? A) Bed which is prepared for the patient you are in the effect of anesthesia and following surgery. Purpose: 1. To recive patient conveniently 2. To Prevent of shock 3. To prevent Injury. 4. To prevent soiling of the bed 5. To meet an emergency. PROCEDURE: Postoperative bed-making is to permits easy patient transfer from surgery and promotes cleanliness and comfort. To make such a bed takes the following steps: 1. A simple bed is made as per normal procedure making. 2. Strip on the bed and turn the mattress. 3. The upper bedding is fan-folded to one side accurate the stretcher. 4. The top sheet does not tuck at the foot part. (In cold weather the hot water bottle is placed in the middle of the bed and covered with fan-folded top bedding). 5. The temperature of water in a hot water bottle should not exceed 50°C. 6. Fanfold together the top sheet and blanket towards the side away from the door. 7. The small mackintosh sheet covered with a towel is open side at top of the bed. 8. Place the bath towel over the small mackintosh sheet. 9. Instead of a pillow, place a small protective sheet and a towel on the head end of the bed.
• 68. 10.The basin for the collection of vomits is placed on the bed stand. 11.The transfusion stand is kept ready at the bedside. 12.BP instrument, pulse meter can be kept ready at bed stand. 13.Place the necessary articles on the bedside table and the irrigating stand, suction machine, and oxygen set-up adjacent to the bed. 14.Keep the tray on the locker or table nearby and shock blocks on the floor near the foot end of the bed ready in case of necessity. 15.Adjust the height of the bed to the level of the stretcher. 16.After the patient is transferred to the bed, position the pillow for patient comfort. 17.Ensure safety cover by pulling the top point of the sheet and blanket over the patient. 18.Open the folds after covering the patient tuck in the linens at the foot of the bed and miter the corners. 19.Bottom sheet useful to absorb moisture and stop dislocation of the bottom sheet. 20.When the patient is transferred to bed, keep a kidney tray on the bed near the mouth, and pin-up the paper bag with the bottom sheet on the side. 3. Discuss the procedure of bed bath in a bed ridden patient? A) Definition of Bed Bath: Bed Bath Means cleaning Patients Body from Head to toe, or Removing of dirt and Promoting Skin Care and Promote Personal hygiene. Types of Bed Bath  Partial Bed Bath  Complete Bed Bath  Towel Bath  Tub Bath  Bag Bath PURPOSE OF BED BATH: 1. To remove accumulated waste products and dirt from the skin. 2. To stimulate the functions of the skin. 3. To sooth and refresh the body. 4. To observe and to detect abnormalities. 5. To stimulate circulation of Skin.
• 69. 6. To Promote relaxation and comfort EQUIPMENT: Bed Bathing Equipments need for Procedure 1.A tray containing: – Spirit or skin lotion – Powder – Comb – Coconut oil – Kidney tray with paper bag – Sponge bag or wash clothes – 2 – Soap dish with soap – Nail cutter or scissors – Nail brush – Duster – Bath towel
• 70. – Equipment for mouth care if needed – Paper squares – Basin – Jugs 2 (One with hot water and other with cold water) – Bucket – Lotion thermometer – Patient clothes and linen for making if required. Bed Bath Nursing Procedure Steps 1. Explain the procedure to the patient. 2. Collect articles, take to bed side, and provide privacy. 3. Switch off the fan. 1. Place the patient in comfortable position. 2. Give mouth care if needed. 3. Remove the counter pane, and blanket, fold and place over the foot end of the bed if weather permits. 4. Undress the patient, fold and place it over railing of head end if needed. 5. Take water half full in a basin, test the temperature of water by placing the back of the hand in the water. 6. Place towel on the chest, wash rinse and dry the eyes, face, ears and neck. Place towel under the far arm wash, rinse and dry forearm, upper arm and axilla. 1. Place basin or towel, dip the hand in water wash, rinse, and dry. Repeat the arm nearest to the nurse provide nail care if needed.
• 71. 1. Fold the top sheet upto the waist. Cover chest with towel wash. 2. Fold the top sheet up to pubis. Wash rinse and dry abdomen. Replace the sheet. 3. Place the towel under the a leg. Wash rinse and dry the thigh and repeat for the leg nearest to the nurse. 4. Place basin on the towel. Flex the far knee and place the foot in the basin wash with the brush rinse and dry. Repeat for the foot nearest to the nurse. 5. Turn the patient to the side facing away from the nurse. If the assistants available otherwise turn the patient to the side facing towards the nurse. Place the towel to the bed along with side line of the back, wash rinse and dry back and rub with spirit(sacrum to medial area of the back shoulder, sides and buttocks with circular movements) or skin lotion or powder or oil depending upon condition of the skin and policy of the institution. 6. Make half of the bed. 7. Let the patient wash, rinse and dry the public area. 8. Help the patient to put on clothes. 9. Complete the bed. 10.Assist with the care of hair if needed. 11.Remove screen. 12.Take equipment for cleaning to the dirty area wash dry and replace. Boil the sponge bags. Dry and replace them. 13.Record observation and reactions of the patient. 4. A.What is the meaning of nasogastric tube feeding? A) DEFINITION. Nasogastric tube feeding is defined as the delivery of nutrients from the nasal route into the stomach vein of feeding . B.Explain the steps of nasogastric tube feeding PROCEDURE _ NASOGASTRIC INSERTION:
• 72. 1. wash hands thoroughly. 2. measure distance of tube from tip of patient's ear lobe to nose to tipoff xiphoid process . 3. Mark the distance of the tube . 4. Lubricate the tube of about 6 to 8 inches with the lubricate using a ring pieces or a paper square . 5. Hold the tube coiled in the right hand introduce the tip into the left nostril . 6. Pass the backwards momentary resistance may occur as the tube is passed into the naso_ pharynx. 7. When the tube reaches to pharynx the patient may gag . Allow him to rest for a movement. 8. Have the patient lake the sips of water on command advance the tube 3_4 _ inches each Time swallows . 9. Make sure tube is in stomach . 10. Once location of NG tube insured close other end of with spigot sec adhesive in T or butter. 5. A.Define urinary catheterization? A) DEFINITION: A urinary catheter is a tube placed in the body to drain and collect urine from the bladder. B.Explain the steps of urinary catheterization in a female patient? A) Place the patient in the supine position with the knees flexed and separated and feet flat on the bed, about 60 cm apart. If this position is uncomfortable, instruct the patient either to flex only one knee and keep the other leg flat on the bed, or to spread her legs as far apart as possible. A lateral position may also be used for elderly or disabled patients.
• 73. With the thumb, middle and index fingers of the non-dominant hand, separate the labia majora and labia minora. Pull slightly upward to locate the urinary meatus. Maintain this position to avoid contamination during the procedure. With your dominant hand, cleanse the urinary meatus, using forceps and chlorhexidine soaked cotton balls. Use each cotton ball for a single downward stroke only. Place the drainage basin containing the catheter between the patient’s thighs. Pick up the catheter with your dominant hand. Insert the lubricated tip of the catheter into the urinary meatus. Advance the catheter about 5-5.75 cm, until urine begins to flow then advance the catheter a further 1-2 cm. Note: If the catheter slips into the vagina, leave it there to assist as a landmark. With another lubricated sterile catheter, insert into the urinary meatus until you get urine back. Remove the catheter left in the vagina at this time.  Attach the syringe with the sterile water and inflate the balloon. It is recommended to inflate the 5cc balloon with 7-10cc of sterile water, and to inflate the 30cc balloon with 30-35cc of sterile water.  Improperly inflated balloons can cause drainage and leakage difficulties.  Gently pull back on the catheter until the balloon engages the bladder neck. 6. A.Define enema : During a cleansing enema, a water-based solution with a small concentration of stool softener, baking soda, or apple cider vinegar is used to stimulate the movement of the large intestine. A cleansing enema should stimulate the bowels to quickly expel both the solution and any impacted fecal matter. Classify enema: