Fundametals of Nursing

Download as docx, pdf, or txt
Download as docx, pdf, or txt
You are on page 1of 26

UNIT I: CONCEPT OF HEALTH OF MAN, HEALTH AND Some Philosophy Regarding Health

ILLNESS 1.Health is a fundamental human right.


2.Health is the essence of productive life, and not the result of ever increasing
DEFINITIONS OF HEALTH expenditure of medical care.
There is no consensus about the definition of health. There is knowledge in how 3.Health is inter-sectoral.
to attain a certain level of health, but health itself cannot be measured. 4.Health is an integral part of development.
Traditionally, health has been defined in terms of the presence and absence of a 5.Health is in central to the concept of quality of life.
disease. 6.Health involves international responsibility and individual state.
Nightingale defined health as a state of being well and using every power the 7.Health and its maintenance is a major social investment.
individual possess to the fullest extent. 8.Health is world-wide social goal.
State of being well and using every power the individual possesses.
"Health is a state of complete physical, mental, and social well-being and not View’s on Health
merely the absence of disease" (WHO, 1974). 1.Biomedical scientists: they stress mainly on germ theory that is they believe
"Health is not a condition, it is an adjustment. It is not a state, but a process. The disease occur as a result of microorganisms’ invasion. Their thought is rejected
process adapts the individual not only to our physical, but also our social, as it doesn’t solve some major health problems as malnutrition, accidents
environments" (President’s Commission). mental illness.
Most individuals define health as the following: – being free of symptoms of 2.Ecologists: they view health as a harmonious equilibrium between man and
disease and pain as much as possible – being able to be active and able to do his environment. Disease is said to be the individuals’ maladjustment to his
what they want or must do – being in good spirits most of the time. environment.
Health is a dynamic state that continually change as a person adapts to changes 3.Sociologists: they believe health is not only biomedical phenomenon but is
in the internal and external environment. Illness is an abnormal process in also influenced by social, psychological, cultural, economical and political
which functioning of a person is diminished or impaired in one or more factors.
dimensions. 4. Holistic View: this view is synthesis of views of all experts. This views
H.S. Hayman defines “health as a state of feeling should in body, mind and health as a multidimensional process involving well-being of the whole person
spirit, with a sense of reserve power”. in the context of his environment
Health is a function of adjustment as adaptation (R. Dubois).The American
Nurses Association Defined Health A dynamic state of being in which the Various Model of Health
developmental and behavioral potential (possible) of an individual is realized to Health and illness are complex that is dynamic. A model is theoretical way of
the fullest extent possible understanding a complex phenomenon. Health models help to understand
client’s health behavior and belief so that effective health care can be provided.
Health models helps nurses to understand the relationship between health of the
client and various variables affecting it such as nutrition, life style, health
practice etc. Model represent various ways of approaching complex wishes.
Models of health and illness contain a combination of biological characteristics Travi’s Illness – Wellness Continuum
behavioral factors and social conditions. •Composed of two arrows pointing in opposite directions and joined at a neutral
1.Health – Illness Continuum Model point
•Measure person’s perceived level of wellness 1.Movement to the right on the arrows (towards high-level wellness) equals an
•Health and illness/disease opposite ends of a health continuum increasing level of health and well-being
•Move back and forth (forward) within this continuum day by day Achieved in Three Steps:
•Wide ranges of health or illness  Awareness
•Health and illness can be viewed as the opposite ends of a health continuum  Education
•From high level of health a person’s condition can move through good health --  oGrowth
normal health -- poor health -- extremely poor health -- to death. 2.Movement to the left on the arrows (towards premature death) equates a
•People move back and forth within this continuum day by day. progressively decreasing state of health
•How people perceive themselves and how others see them in terms of health Achieved in Three Steps:
and illness will also affect their placement on the continuum  Signs
Characteristics of Health-Illness Continuum Model  Symptoms
•At any time any person’s health status holds a place on certain point between  Disability
two ends of health-illness continuum 3.Most important is the direction the individual is facing on the pathway
•Any point on the health-illness continuum is a synthetically representation of  If towards high-level health, a person has a genuinely optimistic or positive
various aspects of individual in physiology, psychology and society. outlook despite his/her health status
Nurses Responsibilities  If towards premature death, a person has a genuinely pessimistic or
•To help the client to identify their place on the health-continuum. negative outlook about his/her health status
4.Compares a treatment model with a wellness model
 If a treatment model is used, an individual can move right only to the
neutral point Example: a hypertensive client who only takes his
medications without making any other life-style changes
 If a wellness model is used, an individual can move right past the neutral
point Example: hypertensive client who not only takes his medications, but
stops smoking, looses weight, starts an exercise program, etc.

2.High Level Wellness Model


It shows a method of functioning oriented
towards maximizing the potential of an individual
while maintaining balance and purposeful direction
•To assist the clients to adopt some measures in order to reach a well state of with environment.
health. This is holistic in nature. It allows nurse to care for
individual with regard to all dimensional factors. It emphasizes health  Incorporates the processes of being, belonging, becoming and befitting.
promotion and illness prevention rather than only treatment. It defines process
that help individual to know who and what he/she is
 Being- recognizing self as separate and individual
 Belonging- being part of a whole 3.Agent-Host-
 Becoming- growing and developing • Befitting- making personal changes Environment Model
to belief the self for the future  Each factor
constantly interacts with the
 Dun (1961), recognizes health as an ongoing process toward a person’s others
highest potential of functioning. This process involves the person, family  When in balance,
and the community. health is maintained
 It describe high level wellness as the experience of a person alive with the  When not in
glow of good health, alive to the tips of their fingers with energy to burn, balance, disease occurs
tingling with vitality at times like this the world is a glorious place.  Used primarily in
 Two axes – X- axis is health: it extends from peak wellness to death – Y- predicting illness rather than
axis is environment: it extends from very favorable environment to very promoting wellness
unfavorable environment.  Model is composed
 Quadrant 1 – High-level wellness in favorable environment e.g., a person of three dynamic,
who implements healthy life- style behaviors and has the interactive elements
biopsychosocialspiritual resources to support this life-style  By Leavell and Clark (1965)
 Quadrant 2 – Protected poor health in favorable environment e.g., an ill  Useful for examining causes of disease in an individual
person whose needs are met by the health care system and who has access  The agent, host and environment interact in ways that create risk factors
to appropriate medications, diet, and health care instruction and understanding these are important for the promotion and maintenance
 Quadrant 3 – Poor health in unfavorable environment e.g., a young child of health
who is starving in a drought ridden countryoQuadrant 4 – Emergent high  An agent is an environmental factor or stressor that must be present or
level wellness in unfavorable environment e.g., a woman who has the absent for an illness to occur
knowledge to implement healthy life-style practices but does not  A host is a living organism capable of being infected or affected by an
implement adequate self-care practices because of family responsibilities, agent
job demands, or other factors.  The host reaction is influenced by family history, age, and health habits
 Encourages the nurse to care for the total person  The environment is the situation of circumstances where host live.
 Involve functioning to one’s maximum potential while maintaining balance
and a purposeful direction
 Regards wellness as an active state oriented toward maximizing the
potential of the individual, regardless of his or her state of health
4.Health Belief Model Health Belief Model by Rosentock 5.Holistic Health Model
 Based on motivational theory •A comprehensive view of the person as a bio psychosocial and spiritual being
 Concerned with what people perceive about themselves in relation to their and sometime holistic health model is said to be alternative medicine.
health •The holistic health care model comes from a variety of scientific philosophical,
 Consider perceptions (influences individuals’ motivation towards results) social bases that describe similar phenomenon
– Perceived susceptibility – Perceived seriousness – Perceived benefit out of the •The model empowers patients to engage in their own healing power which
action. comprises of concepts of energy, holism, the mind body connection, and
balance in order to expand the definition of health
Modifying Factors (factors that modify an individual’s perceptions), •The holistic health model uses the different techniques that in the past the
1.Demographic variables e.g., age, gender, race, ethnicity, etc. health community viewed as experimental or alternative
2.Socio-psychologic variables e.g., personality, social class, peer and reference •Alone it is realized that personal health choice has intensive and powerful
group pressure, etc. impact of an individual health
3.Structural variables e.g., knowledge about the disease, prior contact with the •Some of widely used holistic interventions include aromatherapy, meditation,
disease, etc. music therapy, and relation therapy, therapeutic touch, applied in health care
4.Cues to action e.g., mass media campaigns, advice from others, reminder setting such as meditation, breathing exercise
postcard from a physician or dentist, illness of family member or friend,
newspaper or magazine article
Likelihood of Action
1.Perceived benefits of the action MINUS
2.Perceived barriers to action EQUALS
6.Health Promotion Model Other Models of Health
•Model is proposed by Pender (1996)
•It define health as a positive, dynamic state, not merely the absence of disease 1.Clinical Model
•The model was proposed as a framework for integrating the perspectives of Provides the narrowest interpretation of health
nursing and behavioral science and the factors that influence health behavior People viewed as physiologic systems
•Health promotion is desire to increase well-being and actualize human health Health identified by the absence of signs and symptoms of disease or injury
potential, whereas health protection is behavior that is motivates by a desire to State of not being “sick”
avoid illness, detect it early or maintain function within the constraints of an Opposite of health is disease or injury
illness. 2.Role Performance Model
Ability to fulfill societal roles
•The model describes the multidimensional nature of people as they interact in Healthy even if clinically ill if roles fulfilled
their environment to pursue health. Sickness is the inability to perform one’s role
•The model emphasizes on the three function of patient’s cognitive perceptual – 3.Adaptive Model
Individual characteristics experiences – Behavior specific cognitions and affect Creative process
– Behavioral outcome. Disease is a failure in adaptation or maladaption
Extreme good health is flexible adaptation to the environment
Focus is stability
The aim of treatment is to restore the ability of the person to adapt.
4.Eudemonistic Model
Comprehensive view of health
Condition of actualization (make real) or realization of a person’s potential
Illness is a condition that prevents self- actualization
Actualization is the apex of the fully developed personality Dictionary:
Eudemonism: morality evaluated according to happiness

Wellness is a developing awareness that there is no end point but that health and
happiness are possible in each moment here and now.
It is holistic concept, looking at the whole person, not just their blood pressure,
body fat, exercise behavior or what a person had lunch and involves all possible
dimension. The state of being in good health, especially as an actively pursued
goal, measures of a patient’s progress toward wellness. The health system
focused on wellness not sickness.
Wellness is a dynamic process that is ever changing. The well person usually
has some degree of illness and the ill person usually has some degree of
wellness. This concept of a health continuum negates the idea that wellness and beliefs about education, employment, and home influence personal satisfaction
illness are opposite because they may occur simultaneously in the same person and relationships with others.
in varying degrees. 7.Environmental
Wellness is an active dimensional process of becoming aware of making The ability to promote health measures that improve the standard of living and
choices towards higher level of well- being and towards a more successful quality of life in the community.
existence.
Wellness further describes health status. It allows health to be placed on a
continuum from one’s optimal level (“wellness”) to a maladaptive state
(“illness”)
“Well-being is a subjective perception of vitality (energy) and feeling well. It
can be described objectively, experienced, and measured and can be plotted
(design) on a continuum.”
It is a component of health. Well- being is vitality considered as a subjective
perception of balance harmony and stability. It is state rather than a process

Dimensions of Wellness
1.Physical
The ability to carry out daily tasks, achieve fitness (e.g. pulmonary,
cardiovascular, gastrointestinal), maintain adequate nutrition and proper
body fat, avoid abusing drugs and alcohol or using tobacco products, and
generally to practice positive lifestyle habits. Component of High Level of Wellness
2.Social  High level of esteem and positive outlook.
The ability to interact successfully with people and within the environment  A foundation philosophy and a sense of purpose.
3.Emotional  A strong sense of personal responsibility.
The ability to manage stress and to express emotions appropriately, Emotional  A good sense of human and plenty of fun in life.
wellness involves the ability to recognize, accept, and express feelings.  A concern for others and respect for the environment.
4.Intellectual  A conscious commitment to personal excellence.
The ability to learn and use information effectively for personal, family, and  A sense of balance and an integrated lifestyle.
career development  Freedom from addictive behavior or negative health inhibiting nature.
5.Spiritual  A capacity to cope with whatever life presents and to continue to learn.
The belief in some force (nature, science, religion, or a higher power) that  Highly conditioned and physically fit.
serves to unite human beings and provide meaning and purpose of life  A capacity to love and an ability to nature.
6.Occupational  A capacity to manage life’s demands.
The ability to achieve a balance between work and leisure time, A person's  A capacity to communicate effectively.
Illness is an abnormal process in which any aspect of a person’s functioning is
Factors Influencing Health Status, Beliefs, and Practices: diminished or impaired as compared with his previous condition.
1.Internal Factors Illness not only refers to the presence of specific disease, but also to the
Biologic dimension genetic makeup, sex, age, and developmental level all individual perception and behavior in response to the disease as well as the
significantly influence a person's health. impact of the disease on the psychosocial environment.
Psychological dimension emotional factors influencing health include mind- Illness is subjective state of the person who feels aware of not being well. It is
body interactions and self-concept. just opposite to health. It goes through certain stages which may occur slowly
Cognitive dimension includes lifestyle choices and spiritual and religious and are highly individualized.
beliefs.
2.External factors Main Stages of Illness
Environment 1.Transition from Health to Illness
Standards of living. Reflecting occupation, income, and education. This stage starts when person considers that he or she might be ill and ends
Family and cultural beliefs. Patterns of daily living and lifestyle to offspring when others acknowledge that the person is ill. Illness may begin with vague,
(children). nonspecific symptoms that a person initially attempts to deny. The symptom is a
Social support networks. Family, friends, or confidant (best friend) and job subjective indication of organic or psychic malfunctioning or changes in a
satisfaction helps people avoid illness. person’s condition that indicates some physical or mental state of disease
When symptoms persist a person may seek medical consultation but still not
Health Care Adherence admit to being ill. – Recognition of symptoms (unpleasant sensations) pain,
Adherence (obedience) is the extent to which an individual's behavior for fever, rashes, indigestion etc. – Loss of energy/stamina or feeling or weakness –
example, taking medications, following diets or making lifestyle changes. Decreased ability of function – Fear of diagnosis or treatment.
Degree of adherence may range from disregarding (ignoring) every aspect of
the recommendations to following the total therapeutic plan. 2.Acceptance of Illness
This stage occurs as the person stops denying illness and takes on a ‘sick role.’
Disease This stage may be a tie of considerable physiologic and psychological
Disease can be described as an alteration in body functions resulting in a dependence, when the ill person becomes unusually focused on the self. –
reduction of capacities or shortening of the normal life span. The causation of a Define himself/herself as being sick – Seeks validation of this experience from
disease is called its etiology. others – Gives up normal activities and assumes sick role – On the basis of
health belief and practice, the person may choose to do nothing, takes
Illness medication to relieve symptoms and seeks medical care – Expresses anger, guilt
Illness: Is a highly personal state in which the person's physical, emotional, towards own illness – Accepts the diagnosis – Increase dependency.
intellectual, social, developmental, or spiritual functioning is thought to be
diminished. Illness is usually associated with disease but may occur 3.Convalescence
independently of it. Illness is a highly personal state in which the person feels As convalescence takes place a person passes through a transition from illness
unhealthy or ill. to health. Usually resolution of physical illness proceeds the individual’s return
to normal psychological and functioning. The person new sense of worth and  Becoming aware that there may be a problem
reduce anxiety enable him/her again to use those abilities typical of health. –  Giving label and meaning to the symptoms
Recovery and rehabilitation – Gives up dependent role – Resumes normal  Responding with fear or anxiety
activities and responsibilities 2.Self- treatment
3.Communication significant with others
Task of Convalescence 4.Assessment of symptoms
During this period of convalescence there is a great need of psychological 5.Assumption of the sick
adjustment. 6.Expression of concern
Following are the tasks which completed to return the previous state 7.Assessment of probable efficacy of treatment or appropriateness of treatment
 Reassessment of life’s meaning sources
 Reintegration of body image 8.Selection of treatment plan
 Resolution of role change 9.Implementation of treatment
10.Evaluation of the effects f the treatment
There are many ways to classify illness and disease: 11.Recovery or rehabilitation
 Acute illness is typically characterized by severe symptoms of relatively short
duration. Impact of Illness On the Client
 Chronic illness is one that lasts for an extended period, usually 6 months or  Behavioral and emotional changes
longer, and often for person's life.  Loss of autonomy
 Self-concept and body image changes
There are several approaches to health maintenance:  Lifestyle changes
 Health promotion
 Health protection Impact of Illness On the Family
 Disease prevention  Depends on: – Member of the family who is ill – Seriousness and length of the
illness – Cultural and social customs the family follows.
Suchman Describes Five Stages of Illness
 Stage 1 symptoms experiences. Impact of Illness: Family Changes
 Stage 2 assumption of the sick role confirmation from family and friends.  Role changes
 Stage 3 medical care contact.  Task reassignments
 Stage 4 dependent client role.  ncreased demands on time
 Stage 5 recovery or rehabilitation.  Anxiety about outcomes
 Conflict about unaccustomed responsibilities
 Financial problems
Eleven Stages of Illness Igun proposed eleven stage of illness  Loneliness as a result of separation and pending loss
1.Symptoms experience  Change in social customs
 Experiencing the actual symptoms
national health goals in its best manner possible.
UNIT II: CONCEPT OF NURSING 5.Nursing is committed to personalized services for all persons without regard
to color, creed, or social or economic status.
NURSING AS A PROFESSION 6.Nursing is committed to involvement in ethical, legal, and political issues in
Nursing is gaining recognition as a profession based on the criteria that a the delivery of health care.
profession may have:
Personal Qualities of a Nurse:
Nursing is a disciplined involved in the delivery of health care to the society. 1.Must have a Bachelor of Science degree in Nursing.
Profession is a calling that requires special knowledge, skill and preparation. An 2.Must be physically and mentally fit.
occupation that requires advanced knowledge and skills and that it grows out of 3.Must have a license to practice nursing in the country.
society’s needs for special services.
A professional nurse therefore, is a person who has completed a basic nursing
Criteria of a Profession: education program and is licensed in his country to practice professional
1.To provide a needed service to the society. nursing.
2.To advance knowledge in its field. Roles of a Professional
3.To protect its members and make it possible to practice effectively. 1.Caregiver/ Care Provider
The traditional and most essential role.
Characteristics of a Profession: Functions as nurturer, comforter, provider.
1.A basic profession requires an extended education of its members, as well as a “mothering actions” of the nurse.
basic liberal foundation. Provides direct care and promotes comfort of client.
2.A profession has a theoretical body of knowledge leading to defined skills, Activities involves knowledge and sensitivity to what matters and what is
abilities and norms. important to clients.
3.A professional provides a specific service. Show concern for client welfare and acceptance of the client as a person.
4.Members of a profession have autonomy in decision-making and practice. 2.Teacher
5.The profession has a code of ethics. Provides information and helps the client to learn or acquire new knowledge
and technical skills.
Nurse- originated from a Latin word NUTRIX, to nourish. Encourages compliance with prescribed therapy.
Promotes healthy lifestyles.
Characteristics of Nursing: Interprets information to the client.
1.Nursing is caring. 3.Counselor
2.Nursing involves close personal contact with the recipient of care. Helps clients to recognize and cope with stressful psychologic or social
3.Nursing is concerned with services that take humans into account as problems; to develop an improve interpersonal relationships and to promote
physiological, psychological, and sociological organisms. personal growth.
4.Nursing is committed to promoting individual, family, community, and Provides emotional, intellectual to and psychologic support.
Focuses on helping a client to develop new attitudes, feelings and behaviors as a clinical instructor.
rather than promoting intellectual growth. 6.Military Nurse- nurses working in a military base.
Encourages the client to look at alternative behaviors recognize the choices 7.Clinic Nurse- nurses working in a private and public clinic.
and develop a sense of control. 8.Independent Nursing Practice- private practice, BP monitoring, home service.
4.Change agent
Initiate changes or assist clients to make modifications in themselves or in the
system of care. The 6 C’s of Nursing
5.Client advocate 1.Care that is right for the patient and consistent.
Involves concern for and actions in behalf of the client to bring about a 2.Compassion is care based on empathy respect and dignity.
change. 3.Competence is the ability to understand individuals’ health and social needs,
Promotes what is best for the client, ensuring that the client’s needs are met and the expertise, clinical and technical knowledge to deliver effective care and
and protecting the client’s right. treatments based on research and evidence.
Provides explanation in clients’ language and support clients decisions. 4.Communication is central to successful caring relationships and to effective
6.Manager team working.
Makes decisions, coordinates activities of others, allocate resource. 5.Courage to do the right thing for the people we care for to speak up when we
Evaluate care and personnel. have concerns, and to have the personal strength and vision to innovate and to
Plans, give direction, develop staff, monitors operations, give the rewards embrace new ways of working
fairly and represents both staff and administrations as needed. 6.Commitment is to improve the care and experience of patients.
7.Researcher
Participates in identifying significant researchable problems. Communication and Nurse-Patient Relationship
Participates in scientific investigation and must be a consumer of research
findings. Communication is the use of words and behaviors to construct, send and
Must be aware of the research process, language of research, a sensitive to interpret messages. It conveys varied messages like information, emotions,
issues related to protecting the rights of human subjects. human acceptance or rejection.

Fields and Opportunities in Nursing Communication is a dynamic, reciprocal process of sending and receiving
1.Hospital/Institutional Nursing- a nurse working in an institution with patients. messages. This messages may be Verbal, non – Verbal or both and may involve
two or more people. Thus, communication forms the basis for sharing meaning
2.Public Health Nursing/ Community Health Nursing- usually deals with and building effective working relationship among individuals, families and the
families and communities health care team.
3.Private Duty/ Special Duty Nurse- privately hired.
4.Industrial/ Occupational Nursing- a nurse working in factories, offices and Communication is at the heart of nursing and is essential in conveying, caring
companies. and applying nursing skills and knowledge.
5.Nursing Education- a nurse working in school, review center and in hospital
Levels of Communication 3.The Message
The Message is the content of the communication or conversation, including
1)INTRAPERSONAL COMMUNICATION verbal and non-verbal information the sender express.
Intrapersonal communication, also called self – talk, is a powerful form of 4.The Channel
communication that occurs within individual. Communication occurring within The channel is the means of conveying and receiving the message through
the mind of person or individual. The communication within oneself or the visual, auditory, and tactile senses.
sound of your thinking. 5.The Receiver (Decoding)
2)INTERPERSONAL COMMUNICATION The Message acts as one of the receivers’ referents, promoting a response.
It is most often face to face communication, it can also be exchange of ideas, 6.The Environment
knowledge, information, instruction between two people. Now we see The Environment is the physical and emotional climate in which the interaction
technology mediated IPC through computer, telephone, internet and mobile take place. The more positive an environment, the more successful the
phones. communication exchange.
3)PUBLIC COMMUNICATION 7.The Feedback
Public communication is the interaction of one individual with large groups of The message the receiver returns to the sender is feedback. Feedback indicates
people. You will have opportunities to speak with groups of people. You will whether the receiver understood the meaning of the sender message.
make special adaptations in eye contact, posture, gestures, voice and use of
media materials to communicate effectively. Types of Communication
1.Verbal Communication
Mass communication. The process where media organizations produce and Verbal communication involves the spoken or written world. Verbal
transmit messages to large public and the process by which those messages are communication is the use of spoken and written words to send a message. It is
sought, used, and consumed by audience. influenced by factors such as educational background, culture, language, age
•Examples (Radio, TV, Newspaper, Internet) and past experiences.
Basic Elements of the Communication Process Verbal communication is generally a conscious act, in which the sender is able
to select the most effective words to communicate a message
The elements of communication process are the steps we take in order to
successfully communicate. Factors Affecting Verbal Communication
1.Referent
The referent motivates one person to communicate with another. In health care 1.Vocabulary: Communication is the unsuccessful if the receiver cannot
environment, sights, sounds, odors, time schedule, emotions, sensations, translate a sender’s words and phrases.
perceptions and other cause initiate communication. 2.Denotative and Connotative Meaning: A single word sometimes has several
2.Sender (Encode) meanings.
The sender is the person who delivers the message.
3.Pacing: The pace and rhythm of the delivery can alter the receivers’ Effective communication is essential for successful interpersonal relationship.
interpretation of the message. Talking rapidly, using awkward pauses, or Therefore, it is necessary to take steps for effective communication
speaking slowly and deliberately conveys an unintended message.
4.Intonation: Tone of voice dramatically affects a messages meaning, and 1.Listen carefully
emotions directly influence tone of voice. Listen carefully what the other person is saying. Don’t interrupt don’t get
5.Clarity and Brevity: Effective communication is simple, short, and to the point defensive. Good listener has to be a good observer.
to minimize confusion. Avoid phrases such as “you know” or OK at the end of 2.Stay focused
every sentence. Give examples to clarify messages for the receiver. Mutual understanding is important. Stay focused on the present, feelings,
6.Timing and Relevance: Timing is critical in communication. Even if message friendliness, understand one another and finding a solution.
is clear, poor timings prevents it from being effective. Don’t begin routine 3.Try to see their point of view
teaching when a patient is in severe pain or emotional distress. The best time for Talk less and focus more on other point of view so that one can gain more
interaction is when a patient expresses an interest in communicating. information.
4.Respond to criticism with empathy
2. Non-verbal Communication Listen for the other person’s pain and respond with empathy feeling and look
for what is true and what they are saying.
Non- verbal communication includes messages sent through the language is the 5.Use I messages
body, without using words. Use I messages rather than saying “you”. It helps other person to understand
rather than feeling attacked. example (I feel frustrated when this happens)
Non-verbal communication or body language is a method a sending a message 6.Look for compromise
without using speech or writing. Communication without words is done in 7.Take a time out
many ways including gestures, facial expressions, posture, gait, tone of voice, Take a break when others start to get too angry to be constructive or showing
Silence, touch, eye contact and Physical appearance. some destructive communication. Sometimes good communication means
knowing when to take a break.
Factors Influencing Communication
1.Environmental 8.Avoid arguments
2.Physical health Sometimes healthy conversation may turn into an argument. Arguing does
3.Emotional status nothing but wastes the time.
4.Growth and development status
5.Gender 9.Be confident
6.Attitude, values, and beliefs 10.Think before you speak
7.Self-concept and self-esteem 11.Be updated
12.Don’t pretend
Methods of Effective Communication 13.Stay away from gossip
14.Feedback
pineal gland in the brain is secreted in enormous quantities during sleep. Its
activity is influenced by the relationship of darkness and light. Hormonal ACTH
UNIT IV: REST AND SLEEP is also high during the early period of sleep and cortisol rises toward the end of
Rest is a state of calmness, relaxation without emotional stress, and freedom the nighttime sleep period. Growth hormone and prolactin also increase during
from anxiety. deep sleep.

Sleep is an altered state of consciousness in which the individual’s perception of FUNCTIONS OF SLEEP
and reaction to the environment are decreased.
1. Restores normal
This can be discussed simply by considering the three basic research
levels of activity
approaches:
and normal balance
1. ELECTROPHYSIOLOGIC. The among parts of the
Electrophysiological approach centers on the polygraph nervous system
recordings of electrical changes in the brain waves 2. Necessary for
(EEG), eye movements (EOG) and muscle activity protein synthesis
(EMG). This approach characterizes sleep as Non- TYPES OF SLEEP
Rapid Eye Movement sleep (NREM) and the Rapid-
Eye movement sleep (REM). 1. THE NREM SLEEP. Also referred to as the SLOW wave sleep, because the
brain waves of the client are slower than the alpha and beta waves of an awake
2.NEURAL. The Neural approach views sleep as an or alert person. It is a deep, restful sleep There is a decreased physiologic
active process involving the reticular activating functions All metabolic processes are reduced.
system (RAS) and the interaction of
neurotransmitters. Four Stages
The RAS is a network of neurons in the medulla, STAGE 1 - the stage of very light sleep, sleeper can readily be awakened, lasts
pons and midbrain with projections to the spinal for a few minutes. The eyes tend to roll slowly from side to side, and muscle
cord, hypothalamus, cerebellum and cerebrum.Neural tension remains absent.
serotonin is said to be the major neurotransmitter STAGE 2 - the stage of light sleep, body processes continues to slow down, and
associated with sleep, produced in the median raphe nuclei of the brainstem. lasts about 10-15 minutes. Constitutes 40-45% of total sleep!
Serotonin decreases the activity of the RAS inducing sleep. REM sleep appears STAGE 3 -refers to a medium-depth sleep where vital signs and metabolic
to be due to the influence of norepinephrine. processes slow further because of the PARASYMPATHETIC nervous system
influence. The sleeper is difficult to arouse.
3.HORMONAL. The Hormonal approach views sleep STAGE 4 -this is the deepest sleep or delta sleep. It is the stage where the heart
as a pattern affected by hormones. Melatonin from the rate and respiratory rate drop 20-30% below those exhibited during waking
hours. This stage is thought to restore the body physically. Some dreaming may sleep.
occur here. This stage may be absent in the elderly. Young adults and middle aged adults need about 7 to 9 hours of sleep.
Older adults over 65 years of age tend to require slightly less sleep than the
2.THE REM SLEEP. This sleep type usually recurs about every 90 minutes and middle age adults and only 7 to 8 hours of sleep per night.
lasts 5 to 30 minutes.
Other name: PARADOXICAL Sleep The EEG pattern resembles that of the Nursing Interventions
“awake” state. This is not as restful as NREM sleep. Most dreams take place Assessment relative to a client’s sleep includes a sleep history, sleep diary,
during this period and the dreams are usually remembered or consolidated to physical examination, and a review of laboratory studies. The single most
memory. important criterion for adequacy of sleep/rest is the patient’s statement.
The brain is highly active with metabolic rate increasing as much as 20%. The 1.Client Health Teaching. Nurses should teach the client about the importance
sleeper may be very difficult to arouse. There are rapid conjugate eye of rest and sleep. The following are needed to be taught- the conditions that
movements, muscle tone is depressed, but gastric secretions increase, HR and promote sleep, the safe use of sleep medications, the effects of meds on sleep
RR are increased and IRREGULAR. and the effects of the diseased states in their sleep.
2.Supporting Bedtime Rituals. Nurses can promote sleep by supporting the
Assisting the Client’s Need for Sleep and Rest and Intervening as Needed rituals like an evening stroll, music, TV, bath and prayer. Children should
How much sleep is needed depends upon the individual, their age and their level promote pre-sleep routines like bedtime stories, holding the favorite toys,
of wellness. For example, some individuals just simply require and need more drinking warm milk etc.
or less sleep than others do even when the person is not affected with a health 3.Creating A Restful Environment
related problem or disorder and it varies according to age and well-being. Darkened room or dim-lit room can be provided for the patients.
Clients who are ill and who are experiencing signs and symptoms related to the Noise should be reduced to minimum environmental distractions.
illness will need more sleep than they did prior to the illness. The amount of Placing beds in low positions, using night-lights and placing call beds within
sleep that is needed also varies among the age groups. Below are some easy reach.
guidelines that you can use to determine whether or not a client is getting People with impaired physical mobility should be assisted with voiding
enough sleep and rest for physiological and psychological health. before retiring.
Neonates through 3 months of age typically sleep 14 to 17 hours a day. Fluids may need to be restricted in the evening.
Infants from 4 months of age to 11 months of age should normally sleep 4.Providing Comfort and Relaxation
about 12 to 15 hours a day. Comfort measures are essential to help the client to fall asleep and stay
Older infants and toddlers up to 3 years of age should sleep 11 to 14 hours a asleep.
day. Providing loose-fitting nightwear, hygienic routines providing clean dry
Preschool children from 3 to 5 years of age should sleep 10 to 13 years of linens offering back massages positioning patients in a comfortable position,
age. correct medication administration to avoid sleep interruptions, etc.
School age children from 6 to 12 years of age need 9 to 11 hours of sleep 5.Enhancing Sleep with Medications
each day. Sleep medications are prescribed on a PRN basis for clients.
Adolescents from 13 to 17 years of age should sleep about 8 to 10 hours of Medications include- sedatives, hypnotics, anti-anxiety drugs, and
tranquilizers. Hypnotics may be used as a short term intervention during support to help alleviate concerns
Adolescents  Advise parents that complaints of
situational induced sleep pattern disturbance. fatigue or inability to do well in
Sleep Interventions school may be related to not enough
sleep.
Sleep Patterns of: Nursing Interventions: Excessive daytime sleepiness may make
teenagers more vulnerable to accidents and
Infants  Tech parents to position infant ON
behavioral problems.
THE BACK. Sleeping in PRONE
position increases the risk for Young Adults  Reinforce that developing good
sudden infant death syndrome. sleep habits has a positive effect on
 Advise parents that eye movements, health.
groaning, grimacing and moving are  Suggest use of relaxation techniques
normal. and stress reduction.
 Encourage parents to have infant  If loss of sleep is a problem, explore
sleep in a separate crib not their bed. lifestyle demands and stress as
 Caution parents about placing possible etiologies
pillows, quilts, stuffed animals in the Middle-aged adults  Encourage adults to investigate
crib which may pose suffocation consistent sleep difficulties to
hazards exclude pathology or anxiety-
Toddlers  Establish a regular bedtime routine. depression as the causes.
 Advise parents about the value of a Older adults  Emphasize concern for SAFE
routine sleeping pattern with environment because it is common
minimal variation. for older people to be temporarily
 Encourage attention to safety once confused and disoriented when they
child moves from crib to bed. first awake.
 A gate may be needed across the  Use sedative with EXTREME
door if the child will wander around. caution because of declining
Preschoolers  Encourage parents to continue physiologic function and poly-
bedtime routines. pharmacy.
 Advise parents that waking from  Encourage them to discuss sleep
nightmares or terrors are common. concerns to the physician.
 Waking the child and comforting
him generally helps. SLEEP DEPRIVATION
 A nightlight that is soothing can be
also utilized.
 A prolonged disturbance in amount, quality and consistency of
School-age  Discuss the facts that the stress of sleep.
beginning school may interrupt  Restlessness, irritability, withdrawal, speech deterioration.
normal sleep.
 Advise that a relaxed, bedtime
routine is most helpful. ALTERED SLEEP PATTERNS: COMMON SLEEP
 Inform parents about child’s DISORDERS
awareness of the concept of death
possibly occurring at this stage.
 Encourage parental presence and Parasomnias is a behavior that may interfere with sleep or a
behavior that occurs normally during waking hours but disorders like diabetes and hypothyroidism.
abnormally during sleep. 3. Narcolepsy – is a sudden wave of overwhelming or irresistible sleep
o Bruxism- commonly called night teeth-grinding attacks and sleepiness that occurs during the day. The person with
occurring during stage 2 sleep. narcolepsy literally fall asleep standing up, while driving a car, in the
o Nocturnal Enuresis - bedwetting occurring during middle of conversation or even while swimming.
sleep in children over 3 years old. It occurs in the The cause is UNKNOWN. Hypothesis includes the decreased
following- 1-2 hours after falling asleep, and when HYPOCRETIN in the CNS that regulates sleep. The sleep
rousing from NREM stages 3 to 4. starts directly with REM phase. The patient may have
o Nocturnal Erections/Emissions - “wet dreams” cataplexy (sudden loss of motor tone), hypnagogic
occurring during adolescence. hallucinations (nightmare or vivid dream) and sleep paralysis.
o Periodic Limb Movements Disorders - the legs jerk Drug therapy includes MODAFINIL and Ritalin (stimulants)
twice or three times per minute during sleep and is that may cause wakefulness.
most common among elders. 4. Sleep Apnea - is the periodic cessation of breathing during sleep.
o Sleep-talking - talking during sleep occurs during Usually, the period of apnea lasts from 10 seconds to 2 minutes
NREM sleep before the REM sleep. occurring at least 5 times per hour. This usually gives rise to oxygen
o Somnambulism - “sleepwalking” occurs during stage desaturation and carbon dioxide retention.
3 and 4 of NREM. It is episodic and occurs 1-2 hours Polysomnography is the only method that can confirm sleep
after falling asleep. apnea.
Obstructive Sleep Apnea - occurs when the structures of the
PRIMARY SLEEP DISORDERS pharynx or oral cavity block the airflow.
 Defined as disorders in which the person’s sleep problem is the Central Apnea - involves a defect in the respiratory center in
main disorder. the brain with neurological failure to trigger respiratory effort.
1. Insomnia- most common chronic sleep disorder, is the perceived Mixed Apnea- a combination of central and obstructive apnea.
difficulty or inability to obtain an adequate amount or quality of sleep;
usually a result of physical discomfort, and often due to mental over-
stimulation due to anxiety. Treatment includes developing new
behavior pattern that induce sleep.
Initial Insomnia - difficulty in falling asleep.
Intermittent Insomnia - difficulty in staying asleep because of frequent
or prolonged waking.
Terminal Insomnia- early morning or premature waking.
2. Hypersomnia- excessive sleep, particularly in the daytime. Causes can
be medical conditions like CNS damage, kidney, liver or metabolic
newly formed urine from the bladder to the kidneys.

3. Urinary bladder
UNIT V: URINARY ELIMINATION Bladder is a muscular sac that serves
as a reservoir for urine; bladder
 The urinary system consists of organs that stretches to accommodate urine.
produce and excrete urine from the body.
 Urine contains waste, mostly excess water,
salts and nitrogen compounds.
 Normal adult bladder can store up to 0.5 liters
of water. 4. Urethra
 Also responsible for regulating blood volume A tube extends from the bladder
and blood pressure. to the external opening of the urinary
Regulates electrolytes. system, the urinary meatus

Organs of the Urinary System

1. Kidneys
Physical Characteristics of Urine
The kidneys are bean-shaped
organs located at the back of the
abdominal cavity.  Odor
They lie on either side of the spinal Fresh urine is slightly aromatic.
column. This area is known as the flank Standing urine develops an ammonia odor.
area and is against the muscles of the Some drugs and vegetables (asparagus) alter the usual odor.
back.  pH
The external kidney has a notch at the concave Slightly acidic (pH 6) with a range of 4.5 to 8.0.
Diet can alter pH
border known as the hilum. The hilum is the
 Specific Gravity
entrance for renal artery, veins, nerves and lymphatic vessels Ranges from 1.010 to 1.025
Dependent on Solute Concentration
2. Ureters
Tubes that carry
Chemical Characteristics of Urine wall that is stimulated when pressure is felt from the collection of urine.
 Urine is 95% water and 5% solutes Adult: 250-450mL of urine
 Nitrogenous wastes (organic solutes) include urea, ammonia, uric Children: 50-200mL of urine
acid, and creatinine Other normal solutes include: Sodium, Factors Affecting Voiding
potassium, phosphate, and sulfate ions Calcium, magnesium, and 1. Growth and development
bicarbonate ions 2. Psychosocial factors
 Na Cl is the most abundant inorganic salt in the urine. 3. Fluid and food intake
 Urea is the chief organic solute. 4. Medications
 Abnormally high concentrations of any urinary constituents may 5. Muscle tone and activity
indicate pathology 6. Pathologic conditions
 Disease states alter urine composition dramatically. 7. Surgical and diagnostic procedures

Altered Urine Production


Lifespan Considerations
o Polyuria
 also known as diuresis
 production of abnormally large amounts of urine by
the kidneys
 2500mL/day for adults
 Causes:
 Excessive fluid intake
 Intake of alcohol and caffeine
 Diabetes mellitus
 Hormone imbalances
 CKD
 Other signs associated with diuresis: polydipsia,
dehydration and weight loss
o Oliguria
 Voiding scant amounts of urine
 Less than 500mL/day
o Anuria
Urination  Voiding less than 100mL/day
Micturation, voiding, and urination all refer to the process of emptying the  May result from low fluid intake, kidney disease,
urinary bladder Stretch receptors- special sensory nerve endings in the bladder severe heart failure, burns and shock
 Usually accompanied by fever and heavy respiration acquired (4-5yrs)
o Frequency o Urinary incontinence
 voiding at frequent intervals that is more often than  is considered a symptom, not a disease.
usual.  Types:
 Total amount of urine voided may be normal but 1. Functional incontinence- involuntary unpredictable passage of urine
amount of each voiding is small---50-100mL 2. Reflex incontinence- involuntary loss of urine occurring at somewhat
 May result from increased fluid intake, cystitis, stress, predictable intervals when a specific bladder volume is reached.
or pressure on the bladder 3. Stress incontinence- loss of urine of less than 50cc occurring with
o Nocturia or nycturia increased intra-abdominal pressure
 increased frequency at night that is not a result of an 4. Total incontinence- continuous and unpredictable loss of urine.
increased fluid intake 5. Urge incontinence- involuntary passage of urine occuring soon after a
 Expressed in terms number of times the person gets strong sense of urgency to void.
out of bed to void * urinary retention with overflow- dribbling incontinence that results
o Urgency when the bladder is greatly distended with urine because of an
 feeling that the person must void. obstruction
 Usually accompanies psychologic stress, and irritation * Neurogenic bladder- describes any voiding problem related to
of the urethra neurologic impairment or dysfunction.
 Common in young children who have poor external Urinary retention- accumulation of urine in the bladder (as much as
sphincter control 3L) with associated inability of the bladder to empty itself.
o Dysuria  Adult- can hold 250-450ml of urine in the bladder before micturation
 voiding that is either painful or difficult reflex in triggered.
 May result from stricture of the urethra, urinary  Prolonged retention leads to stasis (slowing of the flow of urine) and
infections, injury to the bladder and/ or the urethra. stagnation of urine which increases the possibility of UTI.
 Described as a burning sensation during voiding  Retention if distinguished from oliguria or anuria by the distention of
Burning during micturation if often due to an irritated the bladder.
urethra.  Characterized by small, frequent voiding or absence of urine output
 Burning following urination may be a result of
bladder infection Assessment
 Often associated with urinary hesitancy (delay and
difficulty in initiating voiding) Nursing History
o Enuresis 1. Data about voiding patterns and habits, any problems voiding,
 repeated involuntary urination in children beyond the and past or present problems involving the urinary system
age when voluntary bladder control in normally 2. Data about any problems that may affect urination
Collecting Urine Specimens Cystoscopy
1. Clean catch or midstream specimens must be free as possible Intravenous pyelogram (IVP)/ excretory pyelogram
from external contamination by MO near the urethral opening. Retrograde pyelogram
2. About 120ml of urine is generally required for examination. CT scan
General Guidelines: UTZ
The specimen must be free of fecal contamination Diagnosing:
Female clients should discard toilet tissue in the toilet Possible nursing diagnoses:
or trash bins rather than in the bedpan 1. Incontinence
Put lid tightly on the container to prevent spillage of  Functional incontinence
the urine and contamination of other objects  Reflex incontinence
If the outside of the container has been contaminated,  Stress incontinence
clean it with a disinfectant.  Total incontinence
Collecting a Timed Urine Specimen  Urge incontinence
May short periods (1-2hrs) or long periods (12-24hrs) 2. Altered urinary elimination
Steps: 3. Urinary retention
1. Place alert signs about the specimen collection at the client’s 4. High risk for infection
bedside or bathroom 5. Self-esteem disturbance
2. Label specimen containers to include date and time of each 6. High risk for impaired skin integrity
voiding as well as the usual client ID data. Containers may be 7. Social isolation
numbered sequentially 8. Self- care deficit: toileting
3. Explain to the client the purpose of the test, when it begins, or Implementing
what to do with it. Maintaining Normal Urinary Elimination
Measuring Residual Urine 1. Promoting normal fluid intake
 residual urine- urine remaining in the bladder following the 2. Maintaining normal voiding habits
voiding.  Relaxation
 Purposes of measuring residual urine:  Provide privacy
 To determine the degree to which the bladder is emptying  Allow client sufficient time to void
 Assess the need to establish therapy that will empty the  Suggest the client to read or listen to music
bladder.  Provide sensory stimuli
* To measure the residual urine, the nurse asks the client to  Pour warm water over perineum or have the client sit
void then immediately catheterizes the client. in a warm bath to promote muscle relaxation
Diagnostic Tests  Apply hot-water bottle to the lower abdomen
Urinalysis  Turn on running water within hearing distance
Blood tests: (BUN and Creatinine clearance)  Relieve physical or emotional discomfort
3. Timing
 Assist clients to have the urge to void immediately
 Offer toileting assistance at usual times of voiding
4. Positioning
 Assist client in a normal position for voiding
 Use bedside commodes as necessary for females and UNIT VI: BOWEL ELIMINATION
urinals for males standing at bedside
 Encourage client to push over the pubic area with
hands or to lean forward Elimination is the complete removal or destruction of
Managing Urinary Incontinence (UI) something.
 Continence (bladder) training The expulsion of waste from body is known as elimination
 Bladder training- requires that the client postpone voiding,
resist or inhibit the sensation urgency, and void according to a
timetable rather than according to the urge to void. The goal is
to lengthen the intervals between urination to correct the
client’s habit of frequent urination
 Habit training- also referred to as timed voiding or scheduled
toileting. There is no attempt to motivate the client to delay
voiding is the urge occurs.
 Prompt voiding- supplements the habit training by encouraging
the client to use the toilet and reminding the client when to
void
Pelvic Muscle Exercises (PME)
 Referred to as perineal muscle tightening or Kegel’s BOWEL ELIMINATION. It is also known
exercises as defecation. Bowel elimination is a natural
 Strengthens pubococcygeal muscles and can increase process critical to human functioning in
the incontinent female’s ability to start and stop the which body excretes waste products of
stream of urine digestion. It is an essential component of the
Positive reinforcements healthy body functioning.
Maintaining skin integrity Defecation (bowel elimination) is the act of expelling feces (stool) from
Applying external urinary devices the body. To do so, all structures of the gastrointestinal tract, especially
Urinary catheterization the components of the large intestine must function in a
coordinated manner.
Review of Physiology of Bowel Elimination
6. Use of narcotics or antibiotics
o GI tract also known as alimentary canal. It is a hollow
muscular tube that extend from the mouth to the anus. Assessment of Bowel Elimination
o Food is broken down in the stomach in to a semiliquid mass
called chyme. Elimination Patterns
o Chyme leaves the stomach and enter in to the small intestine
which is divided in to three part i.e Duodenum (10 inches long.
Receive bile and pancreatic enzyme), Jejunum (it mixes with Because various elimination patterns can be normal, it is essential to
digestive enzyme and most nutrients are absorbed) and ileum determine the client's usual patterns, including characteristics,
(unabsorbed chyme enters in to the intestine through ileum). frequency of elimination, effort required to expel stool, and what
o Through large intestine and colon chyme expel out from the elimination aids, if any, he or she uses.
body through anus.
o Peristalsis means the rhythmic contractions of intestinal
smooth muscle that facilitate defecation (movement of bowel).
o Peristalsis moves fiber, water, and nutritional wastes along the
ascending, transverse, descending, and sigmoid colon toward
the rectum.
o Peristalsis becomes even more active during eating.

Factors Promoting Bowel Elimination


1. Stress free environment
2. High fiber diet
3. Normal fluid intake
4. Exercise
5. Squatting exercise
6. Laxatives

Factors Impaired Elimination


1. Emotional Stress
2. Lack of time
3. High fat diet
4. Low fluid intake
5. Inability to squat
COMMON ALTERATIONS IN BOWEL ELIMINATION

1. Constipation. Constipation is an elimination problem characterized


by dry, hard stool that is difficult to pass. Various accompanying signs
and symptoms include the following:
Complaints of abdominal fullness or bloating
Abdominal distention
Complaints of rectal fullness or pressure
Pain on defecation
Decreased frequency of bowel movements
Inability to pass stool
Changes in stool characteristics such as hard small stool

Four Types of Constipation

1. Primary or Simple Constipation


Primary or simple constipation is well within the treatment
domain of nurses. It results from lifestyle factors such as
inactivity, inadequate intake of fiber, insufficient fluid intake,
or ignoring the urge to defecate
2. Secondary Constipation
Secondary constipation is a consequence of a pathologic
disorder such as a partial bowel obstruction. It usually resolves
when the primary cause is treated.
3. Iatrogenic Constipation
Iatrogenic constipation occurs as a consequence of other
medical treatment. For example, prolonged use of narcotic
analgesia tends to cause constipation. These and other drugs
slow peristalsis, delaying transit time. The longer the stool
remains in the colon, the drier it becomes, making it more
difficult to pass.
4. Pseudoconstipation
Pseudoconstipation also referred to as perceived constipation,
is a term used when clients believe themselves to be
constipated even though they are not. Mobility may be evaluated by observing the client undress or
move onto a table, chair or bed.
2. Fecal Impaction. Hardened stool that is stuck in the rectum or lower Dexterity assessed by observing the client remove clothing;
colon due to chronic constipation. It occurs in that people who’ve been particular attention paid to the manipulation of zippers,
constipated for a long time. buttons, shoestrings and snaps.
Inspection:
3. Flatulence. Flatulence or flatus (excessive accumulation of intestinal Rectal examination is particularly important for both men and
gas) results from swallowing air while eating. women. The cheeks of the buttocks should be pulled apart and
the anus & surrounding area visually inspected.
4. Diarrhea. Diarrhea is the urgent passage of watery stool and The client may asked to bear down and anus inspected for
commonly is accompanied by abdominal cramping. Simple diarrhea usually prolapse gapping, indicating significant weakness of anal
begins suddenly and lasts for a short period. Usually diarrhea is a means of sphincters.
eliminating an irritating substance such as tainted food or intestinal pathogens. 3. Diagnostic Test
Defecography:
5. Fecal Incontinence. Fecal incontinence is the inability to control the X-rays images of rectum and anal sphincter obtained during
elimination of stool. defecation.
Anorectal ultrasonography:
ASSESSMENT It is vital accepted popular imaging motility for evaluating
lower rectum, inner sphincter and pelvic floor in patient with
1. Health History various anorectal disease
Elimination habits: Colonoscopy:
Determine patient’s usual pattern of bowel elimination. It is used to visualization of the colon.
Determine the frequency and time.
Find out the characteristics of the stool like stool is watery,
soft, hard and typical color. Lifestyle Prevention
2. Physical Examination 1. Avoid chocolate and spicy food
Mental status examination: 2. Avoid alcohol and smoking
It can be evaluated by listening to the client’s responses to Avoid alcohol and smoking because alcohol irritates the
questions and by observing interaction with others intestine and bowel, causing inflammation. This effect
causes increased elimination of fluid into the stool, resulting
diarrhea.
Smoking stimulates the bowel through the action of nicotine
caused increased bowel tone and motility result is diarrhea.
Mobility & Dexterity: 3.Stress Management
4Positioning o Oil enema: it is used to soften the feces and relief the
5. regular Exercise constipation.
6. Elimination habits: o Astringent enema: it is used to reduce inflammation, bleeding
maintain your elimination habit. and mucus discharge in colon eg. Dysentery. 2% silver nitrate
with tannic acid and alum solution must be used in this enema
Methods of Emptying the Colon of Feces 3. Purgative enema. It helps to improve peristalsis to empty
the bowel.
1. ENEMA Solution: Glycerin, castor oil and water
 A procedure in which liquid or gas is injected in to the rectum, to expel its 4. Antihelminthic enema: It is used to kill intestinal parasitic
contents or to introduce drugs like Anti- helminthic. worms.
 An enema is the injection of fluid into the lower bowel by way of the Solution: Soap water and hypertonic saline solution
rectum. 5. Carminative enema: It is also known as antispasmodic
 USES OF ENEMA anema, it is used to remove the gaseous accumulation in abdomen.
a. To relieve constipation. Solution: Milk, asafetida in soap water and turpentine.
b. For bowel cleansing before a medical. examination or
procedure. 3. Cold Evacuant Enema. It is used to reduce the body
c. To administer drugs. temperature during high fever.
d. To relieve the gaseous distension of abdomen  RETAINED ENEMA
TYPES OF ENEMA  It means injecting a solution into the rectum
a. EVACUANT ENEMA specially in sigmoid colon and holding for a
It is designed to prompt the bowel to expel fecal matter or specific period of time.
flatus, together with the contents of the enema.  Retained enema is classified into five parts:
1. Simple Evacuant Enema. It is used to remove fecal martial Stimulant Sedative Emollient Anesthetic
and gaseous distension. It is also used to clean the bowel and rectum Nutrient
before investigations, surgeries and childbirth. Solution:- Soap water or TYPES OF RETAINED ENEMA USES SOLUTION
normal saline are used Quantity:- For adult:- 500-1000ml solution is
used. For children:- 250-500ml solution is used For infant:- <250ml is 1. STIMULANT ENEMA
used. Shock, Collapse and Some Poisoning Cases Black coffee/
Brandy -300ml with water and tea spoon of coffee powder
2. Medicated Evacuant Enema. It is used to administration of 2. SEDATIVE ENEMA
medication through the rectum. Induce Sleep or Sedation Paraldehyde and Potassium Bromide
It is classified into five parts: 3. EMOLLIENT ENEMA
1. Oil enema 2. Astringent enema 3. Purgative enema 4. Anti- Soften a hardened fecal mass Oil based fluid- 250 ml
helminthic enema 5. Carminative enema 4. ANESTHETIC ENEMA
Produce anesthetic effect in patient Avertin- 150 to 300mg/kg Purpose of Colostomy
5. NUTRIENT ENEMA
Administration of intent of nutrition when normal eating is not 1. Blockage
possible. 2. Injury
3. Colorectal cancer
ARTICLES USED IN ENEMA 4. Colonic polyps

1. Catheter size according to patient need Types of Colostomy


2. Lubricant
3. Selected solution 1. Sigmoid Colostomy
4. Left lateral position 2. Descending Colostomy
3. Transverse Colostomy
2. RECTAL SUPPOSITORIES 4. Ascending Colostomy
 It is a solid dosage that is inserted into 5. Ileostomy
the rectum, where it dissolved or melts
and exerts local or systemic effect.  Providing Peristomal Care
The effect usually results in a bowel
movement with in 15-60 minutes.   Preventing skin breakdown is a major challenge in ostomy
Glycerin belongs to a class of drugs care. Enzymes in stool can quickly cause excoriation (chemical
known as hyperosonate laxatives. It is injury of skin).
used to relief constipation and  Washing the stoma and surrounding skin with mild soap and
hemorrhoids. water and patting it dry can preserve skin integrity.

3. COLOSTOMIES
 A c o l o s t o m y i s a s u r g i c a l
drawing the healthy end of the large
intestine or colon through an incision in the
anterior abdominal wall.
-
During this procedure, one end
of the colon is diverted through
an incision in the abdominal wall to create a stoma. A stoma is the
opening in the skin where a pouch for collecting feces I attached.

You might also like