Lesson 2

Fundamentals of Nursing

1
Nursing as a Profession
 Criteria of a profession
 Extended education
 Body of knowledge
 Provides a specific service
 Autonomy in decision-making and practice
 Code of ethics
 Professional organization and publication
 Disciplinary course of action

2
Definition of a Profession
Discussion
 How do you define the term profession?
 What does the term professional mean
to you? What behaviors would you
expect?
 How would you define
nursing?

3
Definitions
 Profession
 Type of occupation that meets certain criteria
that raise it above the level of an occupation
 Professional
 A person who belongs to and practices a
profession
 Nursing
 The diagnosis and treatment of human
responses to actual or potential health
problems (ANA, 1980)
4
Nursing Education
Requirements
 Associate degree
 Diploma
 Baccalaureate degree
 Master’s degree
 Doctoral Degree

5
Role of the Professional
Nurse
 Provider of care
 Assists the patient physically and
psychologically
 Communicator
 Communicates verbally and in writing to
patients, significant others, health
professionals and the community

6
Role of the Professional
Nurse
(continued)

 Teacher
 Assists patients to learn and perform at
a level necessary to restore, improve
and maintain health status
 Client Advocate
 Represents the patient’s needs/wishes to
others; acts to protect the patients by
assisting them to exercise their rights

7
Role of the Professional
Nurse (continued)
 Counselor
 Assists patients to recognize and cope
with stressful problems, develop
improved interpersonal relationships
and promote personal growth
 Change Agent
 Assists patients to make modifications in
their own behavior

8
Role of the Professional
Nurse
(continued)

 Leader
 Influences others to work together to
accomplish specific goals
 Manager of Care
 Manages the care of individuals, families
and communities

9
Role of the Professional
Nurse (continued)
 Member of the Discipline of
Nursing
 Models and values nursing, commits to
professional growth, abides by the
standards of practice and legal/ethical
principles, conducts research, and
strives to advance the profession of
nursing.

10
Legal Basis for Nursing
Practice
 Nurse Practice Act
 Provides laws that control the practice
of nursing in each state
 Mandates that, under the law, only
licensed professionals can practice
nursing
 All states now have mandatory nurse
practice acts

11
Legal Basis for Nursing
Practice (continued)
 Standards of Practice
 Identify the minimal knowledge and conduct
expected from a professional practitioner based
on education and experience
 Nursing practice is guided by legal restrictions
and responsibilities regulated by state nurse
practice acts
 General standards have been developed by the
American Nurses’ Association (ANA)
 Practice is also guided by professional
obligations
12
Types of Law
 Statutory
– created by legislators at state and federal level
 Regulatory
– created by administrative groups (ex: Board of
Registered Nursing)
 Common
– used to resolve disputes between 2 persons based
on principles of justice, reason and common
good

13
Types of Law
(continued)

 Criminal law
 Public law that deals with the safety and
welfare of the public
 2 types include misdemeanors or
felonies

14
Types of Law
(continued)

 Civil Law
 Protects the rights of individuals in
situations which generally involve harm
to an individual or property
 Negligence is failure to use care that a
reasonable person would use under
similar circumstances
 Malpractice is professional negligence,
misconduct, or unreasonable lack of skill
resulting in injury or loss
15
Types of Law
(continued)

 Good Samaritan Act

 Protects health practitioners against
malpractice claims for care provided in
emergency situations
 Nurse is required to perform in a
“reasonable and prudent manner” and
within accepted standards

16
Legal Infractions Terms
 Assault
 Unjustifiable threat or attempt to touch
or injure
 Battery
 Any intentional touching or injury
without consent

17
Legal Issues Related to
Nursing Practice

 Review and discuss Legal

Responsibilities of the Nurse on
Study Guide 3

 Review and discuss the Patient’s

Bill of Rights

18
Legal Issues Related to
Nursing Practice

 Informed Consent
 Agreement to the performance of a
procedure/treatment based on knowledge
of facts, risks, alternatives

19
Informed Consent
continued
 Person giving consent must:
 Be of sound mind and physically
competent and legally an adult
 Consent must be voluntary
 Consent must be thoroughly understood
 Must be witnessed by an authorized
person such as the physician or a nurse

20
Informed Consent
(continued)

 The physician is responsible for

obtaining the consent.
 The nurse may witness the signing
of the consent.

21
Consent of Minors
 Consent of Minors
 Minors 14 years of age and older must
consent to treatment along with their
parent or guardian
 Emancipated minor
 Is a person age 14 or older, who has been
granted the status of adulthood by a court
order or other formal arrangement
 They can consent for treatment
themselves
22
Potential Liability for
Nurses

 See Study Guide 5 “Areas of

Potential Liability for Nurses”

 Choose several to discuss as a class

23
Restraints

 Restraints
 A device used to immobilize a patient
or extremity and restrain the level of
activity

24
Restraints

 2 justifications for using

restraints
 To protect patients from injuring
themselves
 To protect others from the patient

25
Alternatives to Using
Restraints
 Before restraining a patient,
alternatives must be used and
documentation must state that
these were tried and failed
 Try to determine the cause(s) of
the patient’s behavior
 Eg: medication

26
Alternatives to Using
Restraints (continued)
 Physiological alternatives
 Reposition the patient
 Adjust medications to relieve pain
 Cover IV tubes to “hide” the tube

 Psychological alternatives
 Provide appropriate visual/auditory
stimuli
 Increase visits from friends and family
27
Alternatives to Using
Restraints (continued)

 Environmental alternatives
 Put items within easy reach
 Place patient near the nurses’ station
 Hire private duty nurse to stay with
patient

28
Documentation of
Restraint Use
 Follow facility policies which protect
you and them from legal actions

 Document the patient evaluation

process
 Why restraint was needed
 List behaviors
 Alternatives tried

29
Documentation of
Restraints
(continued)

 Document the requirement for an

order or protocol authorizing the
restraints
 Physician’s order must be time limited
 Verbal orders must be signed within time
specified in facility policy
 A PRN (as needed) order is never allowed

30
Documentation of Restraints
(continued)

 Document your on-going assessment

and care of the patient
 Nutrition
 Hydration
 Elimination
 Special nursing services (ex: private duty
nurse)
 Follow policy regarding
frequency/documentation of on-going
assessment
31
Applying Restraints
 Follow the manufacturer’s
instructions
 Apply to provide for as much
movement as possible
 Be careful that vest restraints are not
put on backwards
 Adjust the restraint so it is not so tight
to reduce circulation or cause
pressure ulcers
32
Applying Restraints
(continued)

 Tie the restraint to the bed frame,

not the bed rail
 Use a knot that will not tighten
when pulled (ex: clove hitch)
 Pad bony prominences when
needed

33
Monitoring the Patient in
Restraints
 Follow facility protocol
 Assess every 30 minutes
 Remove the restraint for 10 minutes
at least every 2 hours; assess for
skin and neurological impairment;
perform range of motion
 Document restraint assessment on
appropriate restraint assessment
tool provided by the facility
34
Types of Restraints

 Mitt restraint
 Belt restraint
 Jacket restraint
 Wrist or ankle restraint

35
Using Restraints in Behavioral
Health

 Strict time limits

 Adults: 4 hour limit
 Children age 9-17: 2 hour limit
 Children under age 8: 1 hour limit

36
Unusual Occurrence
Incidents

 Also known as incident reports

 An incident is “any event that is
not consistent with the routine
operation of a healthcare unit or
routine care of a patient” (Perry and
Potter 2005)

37
Unusual Occurrence Incidents
(continued)

 Examples:
 Accidental needle stick
 Medication error
 Patient or visitor fall
 A physician’s order not being carried out
by the nurse
 Equipment malfunction

38
Unusual Occurrence Incidents
(continued)

 The report is a confidential record

between the observer of the
incident and the agency Risk
Manager that documents the facts
of the incident
 It is an objective account of the
occurrence and does not include
opinions, judgments or blame
39
Unusual Occurrence Incidents
(continued)

 Complete a report even if there is

no injury
 Never document in the nurses’
notes that an incident report was
completed.

40
Unusual Occurrence
Incidents

 Class Discussion:
 Give some examples of incidents in
which you would complete a report.

41
Ethical Terms
(continued)

 Code of Ethics – a written list of

professional values and standards of
conduct which provide a framework
for decision-making
 There are several codes of ethics
that may be adopted; in the U.S. the
ANA Code of Ethics is generally
accepted (see study guide)

42
Ethical Issues in Nursing
Practice

 Making ethical decisions is a

common part of every day nursing
care
 Ethical decision-making is a skill
that can be learned

43
Ethical Terms
 Ethics – systematic study of what
“ought” to be done, the
justification of what is right or
good
 Ethical Dilemma – situation that
required a choice between two
equally favorable alternatives

44
Ethical Concepts That Apply
to Nursing Practice

 Define and discuss the following

concepts from the study guide
 Morals
 Values
 Autonomy
 Beneficence

45
Ethical Decision-Making
Process
1. Clearly identify the problem
2. Consider the causative factors,
variables, precipitating events
3. Explore various options for action
4. Select the most appropriate plan for
dealing with the ethical dilemma
5. Implement decided course of action
6. Evaluate results/consequences
46
Ethical Decision-Making
Activity
 Choose an ethical dilemma from the
study guide (Common Ethical Issues
Involving Nurses)
 Discuss your chosen dilemma using
the 4 steps for solving an ethical
dilemma on the previous slide.

47
Confidentiality
 Nurses are legally and ethically
obligated to keep information about
patients confidential.
 The tort invasion of privacy
protects the patient’s right to be free
from intrusion into their private
affairs.
 The ANA Code of Ethics also provides
for a patient’s privacy.
48
Confidentiality - HIPAA
 The American Health Insurance
Portability and Accountability Act
(HIPAA) was passed in 1996 and
was required to be instituted in
April 2003
 Requires that patient health
information be available only to
those with the right and need to
have this information
49
Confidentiality
 Nurses role in maintaining
confidentiality
 Don’t discuss information where others
might overhear
 Protect computer screen from being viewed
by visitors
 Protect patient charts from being viewed
 Do not share your computer ID or password
 Access/transmission of patient information
via internet requires strict scrutiny 50
The Joint Commission’s
National Patient Safety Goals
 Introduced in 2003; updated annually
 Written by a group of experts who
review all of the sentinel events
(unexpected occurrences involving
death or serious physical or
psychological injury)
 Experts define problem areas and
advise The Joint Commission on how to
remedy these problems
51
National Patient Safety Goals
for Hospitals
 In 2007, there are 8 goals that
hospitals must follow
 Goal # 1: Improve the accuracy
of patient identification
 Use at least 2 patient identifiers
 Includes assigned ID number, social
security number, name, date of birth as
options
 Follow organizational policy
52
National Patient Safety
Goals
(continued)

 Goal #2 Improve the

effectiveness of caregiver
communications
 Includes guidelines for verbal orders
 Hospitals must develop a list of
abbreviations, symbols, and dose
designations that are not to be used
 Must develop guidelines regarding
abnormal test results and time for reporting
 Must create a standardized, consistent
approach to “hand-off” communication
53
National Patient Safety
Goals
(continued)

 Goal # 3 Improve safety of using

medications
 Standardize and limit the number of drug
concentrations
 Identify and review look-alike/sound-alike
drugs
 Create list of high-risk medications and
have them labeled
 Patient identification must be on all
medication containers
54
National Patient Safety
Goals
(continued)

 Goal # 7 Reduce the risk of

healthcare-associated
infections
 Proper handwashing
 Review infections leading to death or
major permanent loss of function while a
patient

55
National Patient Safety
Goals
(continued)

 Goal # 8 Accurately and

completely reconcile
medications across the
continuum of care
 Compare current medications with those
ordered when admitted
 Communicate complete list of meds to
next provider of service

56
National Patient Safety
Goals
(continued)

 Goal # 9 Reduce the risk of

patient harm resulting from
falls
 Implement a fall reduction program
 Implement evaluation of the
effectiveness of the program

57
National Patient Safety
Goals
(continued)

 Goal # 13 Encourage patients’

active involvement in their own
care
 Encourage patients and their families to
report concerns about safety
 Teach about preventing infection by
washing hands
 Encourage self-care

58
National Patient Safety
Goals
(continued)

 Goal # 15 Identify safety risks

inherent in your patient population
 Hospital should review all of its own sentinel
events and assess trouble spots in the care
environment
 Complete assessment and follow-up on every
patient admitted for behavioral/emotional
problems. *According to The Joint
Commission, suicide has been the most
frequently reported sentinel event in staffed,
round-the-clock facilities since The Joint
Commission began its reporting policy in 1996.

59
Patient Falls

 Falls are the leading cause of

accidents among older adults
 Electronic devices are available to
detect patients attempting to get
out of bed

60
Fall Risk Assessment
 Identify clients at risk on admission and
throughout hospital stay
 Fall Risk Assessment Tools identify the
risk level based on the following:
 Physical condition
 Mental status
 Medications
 Age
 History of previous fall
 Ambulatory devices used

61
Nursing Interventions to
Prevent Falls
 Identify clients at risk
 Implement fall prevention precautions
 Place items within easy reach of client
 Assist with ambulation; use
ambulatory aids
 Teach client and family members of
precautions used in the hospital
 Non-skid footwear
 Use of handrails

62
Body Mechanics
 Safe and efficient body movements
depend upon balance and the
interrelationship of the center of
gravity

63
Body Mechanics

 Review Summary of Guidelines

and Principles Related to Body
Mechanics in the study guide

64
Body Mechanics When Moving
Patients
 Assess the situation; get help if
needed
 Ensure patient safety by engaging
locks and brakes
 Bring the patient close to your
center of gravity
 Face in the direction of movement
to prevent spinal twisting
65
Body Mechanics When
Moving Patients

 Establish a broad base of support

 Lower your center of gravity by
bending your knees
 Tighten gluteal, abdominal, leg
and arm muscles

66
Applications of Cold and Heat
 Cold applications
 Cause vasoconstriction
 Reduce blood supply
 Remove oxygen, metabolites, and waste
 Slow bacterial growth
 Decreases inflammation

67
Cold Applications
(continued)

 Dry cold: cold pack, ice bag, ice

collar

 Moist cold: compress or sponge

bath

68
Applications of Cold and
Heat
 Heat applications
 Cause vasodilation
 Increase blood supply
 Brings oxygen, nutrients, antibodies and
leukocytes
 Increases inflammation
 Helps rid body of waste (via
polymorphonculear levkacytes)

69
Heat Applications
(continued)

 Dry heat: aqua pad, disposable

heat pack, electric pad (K-Pad)

 Moist heat: compress, soak, sitz

bath

70
Nursing Care
Cold and Heat Applications

 Re-assess every 15 minutes after

starting treatment
 Evaluation: examine area to which
cold or heat was applied and
document client response on the
medical record

71
Medical vs. Surgical
Asepsis
 Asepsis is the absence of
pathogenic microorganisms
 Medical asepsis - maintaining a
patient and the environment as
free from pathogens as possible
 Surgical asepsis - eliminating all
microorganisms, non-pathogenic
and pathogenic
72
Surgical Asepsis Principles
 Use a sterile field for sterile
materials
 Keep hands in front of you and
above your waist
 Edges of sterile containers are not
sterile once opened
 A dry field is necessary to maintain
sterility of the field
73
Nosocomial Infections
 An infection acquired while a
patient
 Caused by bacteria, viruses, fungi
or parasites
 Patients are at high risk
 Multiple illnesses
 Elderly
 Lowered resistance

74
Iatrogenic Infection
 An iatrogenic infection is a type of
nosocomial infection resulting
from a diagnostic or therapeutic
procedure

 Example: a urinary tract infection

(UTI) that develops after a
catheter insertion
75
Chain of Infection
 6 links in the chain of infection
 Infectious agent
 Reservoir
 Portal of exit
 Mode of transmission
 Portal of entry
 Susceptible host

76
Nurses Role in Preventing
Infection
 Infection does not occur or spread
when one of the links is broken

 Discuss ways in which health care

practitioners can break each link

77
Medical Asepsis Principles
 Also known as clean technique
 Includes
 Handwashing
 Standard precautions
 Isolation technique
 Cleaning/disinfecting of equipment

78
Infection Control
 Standard precautions are the
primary strategies for prevention
of infection transmission
 Handwashing
 Gloves
 Mask, eye protection
 Gown

79
Change in a Patient’s
Condition
 The Nurse Practice Act requires that
the nurse observe and appropriately
report a change in a patient’s
condition.
 Reporting should include
 assessment data including vital signs,
behaviors of the patient
 nursing interventions
 pertinent background information
 other related information (lab work, x-ray,
etc.)
80
Change in Patient’s
Condition
(continued)

 Changes might include:

 Sudden respiratory depression or
difficulty
 Change in cardiac status
 Sudden unexpected pain
 Sudden confusion
 Critical change in vital signs
 Anything out of the “expected behavior”
of a patient
81
Therapeutic
Communication
 Types of communication include
 Verbal
 Non verbal
 Active listening

82
Variables That Influence
Communication
 Perception
 Values/beliefs
 Culture
 Gender
 Age
 Developmental level
 Environmental factors
83
Characteristics of
Therapeutic Relationships
 Mutually determined goals
 Goal-directed toward meeting
patient’s needs
 Provision of environment to maximize
patient’s potential for growth
 Patient learning new coping skills
 Predictable phases of the relationship

84
Essential Conditions for
Therapeutic Communication

 Rapport
 Trust
 Respect
 Empathy
 Genuineness

85
Cultural Considerations for
Therapeutic Communication

 It is important to review the

characteristics associated with a
specific culture
 These include
 Personal space
 Eye contact
 Use of touch
 Silence
86
Therapeutic Communication
Techniques
 Review the techniques listed in the
study guide. Practice using
several of these with a classmate.

 Review Blocks to Therapeutic

Communication in the study guide.
Practice using these with a
classmate.
87
Assessment and Interventions
for Safe Fluid Therapy

 Measuring intake and output (I & O)

is an independent nursing function
 Patients on intravenous (IV) therapy
or who have a urinary catheter are
automatically on I & O
 I & O is used to determine the fluid
and electrolyte status

88
Intake and Output

 Intake includes
 All fluids taken my mouth
 All fluids taken by nasogastric and
jejunostomy tubes
 All parenteral fluids (intravenous, blood)

89
Intake and Output
 Output includes
 Urine
 Emesis (vomit)
 Diarrhea
 Gastric suction
 T-tube drainage
 Drainage from surgical wounds/other
drainage tubes

90
Nursing Diagnoses for Fluid
Volume

 Fluid Volume Deficit

 Dehydration
 Hypovolemia
 Fluid Volume Excess
 Hypervolemia

91
Nutrition
 5 food groups
 Breads, cereals, rice, pasta
 Vegetables
 Fruits
 Milk, yogurt and cheese
 Meat, poultry, fish, dried beans and
peas, eggs, nuts

92
Culture and Nutrition

 Visit the web site listed in the

patient study guide to view and
discuss food pyramids from a
variety of cultures

93
Common Therapeutic Diets
 Discuss foods that are and are not
allowed on the following diets
 Regular
 Soft
 Mechanical soft
 Clear liquid vs. full liquid
 No added salt (NAS)
 High fiber
 American Diabetes Association diets

94
Nutritional Assessment
 Gather baseline data
 Include client’s weight
 Identify specific nutritional deficits
 Establish nutritional needs
 Identify physical and psychosocial
factors that may influence
nutritional needs

95
Nursing Diagnoses for
Nutrition
 Body image disturbance
 Altered nutrition: less than body
requirements
 Altered nutrition: more than body
requirements
 Self-care deficit: feeding

96
Nursing Interventions to
Promote Nutritional Well-
Being
 Assist with food choices
 Refer to dietician if needed
 Provide comfortable environment
 Free of odors, noise
 Promote appealing food presentation
 Hot/cold food
 Offer to open containers
 Assist with feeding as needed

97
Enteral Tube Feedings
 Enteral feeding involves the
delivery of formula via a tube into
the stomach or jejunum
 Includes
 Nasogastric tube (NG tube)
 Gastric tube (G-tube)
 Jejunal tube (J-tube)

98
Nursing Care with Enteral
Tubes
 Check for placement according to
hospital policy
 An x-ray is the only positive method for
placement
 Assess bowel sounds
 Assess skin around insertion site
 Keep the head of the bed elevated for
continuous feedings and during
intermittent feedings to prevent
aspiration
99
Nursing Care With Enteral
Tubes (continued)
 When delivering medications
through a NG or G tube:
 Dissolve the tablet in water
 Flush the tube before and after delivering
the medication
 Blood glucose monitoring is often
done during enteral feedings as the
solutions can be high in glucose

100
Total Parenteral Nutrition
(TPN)

 A form of nutritional support in

which nutrients are given
intravenously
 The patient must have a central
venous access system in place

101
TPN Complications

 Complications can be reduced by

meticulous care of the venous
access device
 Prevent infection
 Prevent metabolic, electrolyte, fluid
balance complications
 Maintain parenteral system
102
Nursing Care of the Client
on TPN
 Change tubing every 24 hours
using strict aseptic technique
 Assess for signs of infection
 Monitor blood glucose
 Daily weight
 Intake and output

103
Health Care of the Older
Adult
 Older adults are 65-years-old and
older
 65-74 young old
 75-84 middle old
 85-99 old-old (fastest growing
subgroup)
 100 + elite old

104
Health Care of the Older
Adult (continued)

 50% of hospitalized clients on

med-surg units are older than 65
 8% of elderly have 1 or more
chronic illnesses
 50% have 2 or more chronic
illnesses
 5% live in institutional settings
105
Assessment Guidelines for
Older Adults

 Adjust to physiologic changes

 Be familiar with sensory changes,
changes in each body system
 Adapt assessment techniques to
diminishing energy and ability
 Allow for frequent breaks if a lengthy
assessment is needed

106
Assessment Guidelines
(continued)

 In addition to physical assessment, the

older adult may need assessment of:
 Ability to perform ADL’s (Activities of Daily
Living - functional assessment)
 Network of support (family and friends)
 Health beliefs in nutrition, exercise, etc.
 Sleep patterns
 Living arrangements
 Financial assessment
 Self-esteem
 View of life and acceptance of death

107
Reminiscence/Life Review
 An adaptive function that allows
them to recall the past and assign
meaning to these experiences
 Can be a nursing intervention to
encourage self-esteem, increase
communication skills, and increase
social interaction

108
Pain and the Older Adult
 May not report pain as feels it is a
part of aging
 85% of patients in nursing homes
have pain
 Pain response: have similar pain
tolerance as young adults

109
Pain Assessment
 Use methods as with adults (pain scale)
 Don’t assume that if patient is busy or
sleeping, they don’t have pain; need to
ask them
 If cognitive impairment is present,
watch for non-verbal cues
 Agitation
 Aggression
 Wandering
 Change in vital signs
 Grimacing
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Pain Management
 Ask what they usually use for pain
and is it working
 If acute pain, can use narcotics but
may need a decreased dose

111
Medications and the Older
Adult
 25% of all prescriptions are
written for people older than 65

 Physiologic changes caused by

aging affect the activity and
response of drugs
 Absorption, distribution, metabolism,
excretion

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Polypharmacy
 Many older adults are using
multiple medications, use multiple
pharmacies, have multiple
physicians
 Multiple drugs may lead to adverse
reactions

113
Polypharmacy

 Most common adverse reaction in

the elderly is confusion
 Confusion in the absence of
disease is
not normal!!

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Nursing Interventions for
Polypharmacy

 Assess medications they are

taking
 Encourage client to use one
pharmacy for all medications
 Encourage client to review with
primary caregiver all medications
they are taking
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Medication Noncompliance in
the Older Adult

 May be non-compliant due to:

 Not understanding how to take
medication
 Forgetful
 Don’t like the side effects
 Don’t have the money to purchase
medications

116
Nutrition and the Older
Adult
 Risk of nutritional problems
increases with age
 Energy needs decrease but nutrient
needs remain the same

117
Causes of Malnutrition in the
Older Adult

 Loss of teeth
 Digestive system changes
 Loss/decrease of appetite
 Lactose intolerance
 Fixed income
 Lack of socialization during meals

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Nursing Interventions to
Improve Nutrition
 Small, frequent meals
 Assist with food choices
 Identify causes of decreased appetite
 Refer to dentist for teeth issues
 Refer to social services for financial
problems
 Discuss ways to improve
socialization during meal time
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Goals for Older Adults
 Follow therapeutic plan of care
 Ensure transportation to MD visits
 Ensure primary physician is aware of all
medications currently taking
 Maximize independence in self-
care activities
 Educate about resources to assist them
with care if needed

120
Goals
(continued)

 Maintenance of ability to
communicate
 Educate about assistive devises such as
hearing aids
 Assist with financial counseling to help
pay for these aids if needed

121
Goals
(continued)

 Maintenance of positive self-image

 Assist the patient to participate in
appropriate social activities to enhance
the feeling of worth
 Encourage open expression of concerns
such as feelings of hopelessness

122
Goals
(continued)

 Remain free of injury

 In the hospitalized patient
 Perform fall risk assessment
 Orient to surroundings and re-
orient as needed
 Provide assistance with ADL’s

123
Goals
(continued)

 Maintain bowel and bladder

elimination patterns
 Discuss nutrition to promote
elimination
 Discuss use of medications if prescribed
 Urinary incontinence (loss of bladder
control) is a symptom, not a disease.

124
Goals
(continued)

 Maintain adequate nutritional

status
 When hospitalized
 Intake and output
 Daily weight
 Dietary referral for preferences
 Socialization
 Assist with feeding
 Liquid supplements as needed

125
Goals
(continued)

 Maintain adequate fluid and

electrolyte status
 Place water within easy reach of the
client
 Offer fluids every 1-2 hours
 Monitor electrolytes
 Intake and output
 Administer and monitor IV fluids if
needed
126
End-of-Life Issues
 Death and Dying
 Nurses must recognize influences on the
dying process
 Legal
 Ethical
 Religious
 Spiritual
 Biological

 Provide sensitive, skilled and supportive

care
127
End-of-Life Issues
(continued)

 Both the patient who is dying and

the family members grieve as they
recognize the loss
 Nursing Diagnosis of Anticipatory
Grieving includes: Feelings of guilt
 Denial  Inability to
worthlessness concentrate
 Anger
concentrate
128
End-of-Life Legal Issues
 Medical Directive to Physician (Living
Will)
 Addresses only the withholding or withdrawal of
medical treatment that would artificially prolong
life
 Becomes effective when the primary physician
and one other doctor say in writing that an
individual is in a terminal or irreversible
condition and that death will occur if life-
sustaining medical care is not given
 Some states allow for personal instructions to be
added to this document
129
End-of-Life Legal Issues
(continued)

 Advanced Health Care Directive

 Used to be called Durable Power of Attorney
 An Advance Directive that allows an individual to
appoint representatives to make health care
decisions if they become incapacitated
 This document affects only health care and should
not be confused with granting power of attorney
for other matters
 Becomes effective when the person becomes
terminally ill or incapacitated.

130
Nursing Responsibility for
Advance Directives

 Each state varies; nurses need to be

aware of requirements for their state
 Be prepared to answer questions from
the patient about these directives
 Ask if your patient has these and make
sure copies are placed in their charts
 Advance Directives must be honored

131
End-of-Life Issues
(continued)

 Artificial Nutrition and Hydration is

another important ethical and legal
issue
 Feelings about withholding food and
fluids are emotionally charged and
often have religious connotations.
 U.S. Supreme Court has upheld the
right of patients to accept or reject the
administration of artificial nutrition
and hydration.
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End-of-Life Issues
(continued)

 Hospice Care
 Focuses on support and care of the
dying person and family
 Goal: to facilitate a peaceful and
dignified death
 Based on holistic concepts
 Improve quality of life rather than cure
 Support patient and family

133
Hospice Care
(continued)

 Principles of hospice care can be

carried out in a variety of settings
 Home and hospital are the most
common settings
 Palliative care: differs from
hospice in that the client is not
necessarily believed to be dying
134
Nursing Care of the Dying
Patient

 Provide personal hygiene

measures
 Relieve pain
 Essential for patient to maintain some
quality in their life
 Assist with movement, nutrition,
hydration, elimination
135
Nursing Care
(continued)

 Provide spiritual support

 Arrange access to individuals who can
provide spiritual care
 Facilitate prayer, meditation and
discussion with appropriate clergy or
spiritual advisor

136
Nursing Care
(continued)

 Support patient’s family

 Use therapeutic communication to
facilitate their feelings
 Display empathy and caring
 Educate family on what is happening
and what the family can expect
 Encourage family members to
participate in the physical care of the
patient

137
Do Not Resuscitate

 Also called DNR, No Code

 Must be written
 Must be reviewed regularly as per
policy
 May have specific requests
 Example: may okay vasopressors and
fluids but no chest compressions or
intubation
138
Photo Acknowledgement:
Unless noted otherwise, all photos and
clip art contained in this module were
obtained from the 2003 Microsoft
Office Clip Art Gallery.

139