Fundametals of Nursing
Fundametals of Nursing
Fundametals of Nursing
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
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
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.