Ch 29.

 Infection is the invasion of a susceptible host by pathogens or microorganisms, resulting in

disease.
 Colonization occurs when a microorganism invades the host but does not cause infection.
 Communicable disease is the infectious process transmitted from one person to another.
 If pathogens multiply and cause clinical signs and symptoms, the infection is symptomatic.
 If clinical signs and symptoms are not present, the illness is termed asymptomatic.
 Hand hygiene is the most important technique to use in preventing and controlling transmission
of infection.
 Immunocompromised means having an impaired immune system.
 Virulence is the ability to produce disease.
 Aerobic bacteria require oxygen for survival and for multiplication sufficient to cause disease.
 Anaerobic bacteria thrive where little or no free oxygen is available.
 bacteriostasis—prevention of growth and reproduction of bacteria.
 bactericidal—destructive to bacteria
 Four stages: incubation  prodromal  illness  convalescence
 Localized versus systemic infection  Use PPE to block the spread of infection
 Exudates: the accumulation of fluid, dead tissues, and WBCs that forms at the site of infection.
The lymph system usually carries this fluid away.
o serous = clear, watery plasma
o sanguineous = bright red, containing red blood cells, active bleeding
o serosanguineous = pale red/pink, watery, mixture
o purulent = thick, yellow/green/tan/brown, containing WBCs and bacteria
 Health Care–Associated Infection
o Iatrogenic – from a procedure
o Exogenous – from microorganisms outside the individual
o Endogenous – when the patients flora becomes altered and an overgrowth result
 Asepsis = Absence of pathogenic (disease-producing) microorganisms.
 Aseptic technique = Practices/ procedures that assist in reducing the risk for infection.
o Medical asepsis, or clean technique, includes procedures for reducing the number of
organisms present and preventing the transfer of organisms.
o Surgical asepsis or sterile technique prevents contamination of an open wound, serves
to isolate the operative area from the unsterile environment, and maintains a sterile
field for surgery.
 Hand hygiene includes using an instant alcohol hand antiseptic before and after providing
patient care, washing hands with soap and water when they are visibly soiled, and performing a
surgical scrub.
 Handwashing is the act of washing hands with soap and water, followed by rinsing under a
stream of water for 15 seconds.
 Disinfection: a process that eliminates many or all microorganisms, with the exception of
bacterial spores, from inanimate objects
 Sterilization: the complete elimination or destruction of all microorganisms, including spores
 Isolation precautions: airborne, droplet, contact, and protective environment
 Contact Precautions: MRS. WEE

M – multidrug resistant organism

R – respiratory infection

S – skin infections

W- wound infections

E – enteric (c. diff)

E – eye infection – conjunctivitis

 Air borne: MTV

o Private room: negative pressure with 6-12 air exchanges/hr, mask, N95 for TB

M – measles

T – TB

V – Varicella

 Droplet: SPIDERMAN

S – sepsis / scarlet fever

P – parvovirus B19 / pneumonia

I – influenza

D – diphtheria (pharyngeal)

E – epiglottis

R – rubella

M – mumps/meningitis

AN – adenovirus

 Principles of Surgical Asepsis:

o 1. A sterile object remains sterile only when touched by another sterile object.
o 2. Only sterile objects may be placed on a sterile field.
o 3. A sterile object or field out of the range of vision or an object held below a person’s
waist is contaminated.
o 4. A sterile object or field becomes contaminated by prolonged exposure to air
o 5. When a sterile surface comes in contact with a wet, contaminated surface, the sterile
object or field becomes contaminated by capillary action.
o 6. Fluid flows in the direction of gravity.
o 7. The edges of a sterile field or container are considered to be contaminated.
CH 6:

 Healthy People 2020: Goals are to decrease health disparities

o Achieve health equity, eliminate disparities, and improve the health of all groups
 Health behaviors
o Positive (maintaining, attaining, or regaining good health and preventing illness)
o Negative (practices actually or potentially harmful to health)
 Health Belief Model
o Relationship between beliefs and behaviors
o Change behaviors by helping patients to realize health benefits
 Health Promotion Model: 3 areas
1. Individual characteristics
2. knowledge
3. behavior outcomes
 Maslow’s Hierarchy of Needs
o Used to understand the interrelationships of basic human needs
 Holistic Health Model
o Attempts to create conditions that promote optimal health
 Internal Variables
o Developmental Stage  Intellectual Background Perception of Functioning 
Emotional Factors (stress)  Spiritual Factors
 External Variables
o Family Practices  Socioeconomic Factors  Cultural Background
 Levels of Preventative Care:
o Primary Prevention
 True prevention that lowers the chances that a disease will develop
 Active VS Passive Prevention
o Secondary Prevention
 Focuses on those who have health problems or illnesses and are at risk for
developing complications or worsening conditions
o Tertiary Prevention
 Occurs when a defect or disability is permanent or irreversible
 Acute Illness - Short duration and severe
 Chronic Illness - Persists longer than 6 months
 Stress increases risk for illness

Ch 7

 Watson’s Transpersonal Caring - Promotes healing and wholeness, Rejects the disease
orientation to health care, Places care before cure, Emphasizes the nurse-patient relationship
 Swanson’s Theory of Caring - Defines caring as a nurturing way of relating to an individual,
States that caring is a central nursing phenomenon but is not necessarily unique to nursing
practice
 Understand and advocate for your patient
 Providing Presence
 o Being with /Eye contact /Body language/ Tone of voice/ Listening /Positive and
encouraging attitude
 Listening
o Creates trust/ Opens lines of communication/ Creates a mutual relationship

CH 9

 Eliminating disparities in the health status of people from diverse racial, ethnic, and cultural
backgrounds has become one of the two most important priorities of Healthy People 2020.
 In every culture: ➢
o Health, illness, and caring have meanings that are unique. ➢
o Groups interpret and define experiences relevant to birth, illness, and death through a
certain context.
 Culture & life transitions:
o Rites of passage  pregnancy  childbirth  newborn  postpartum period  rites
of passage  grief and loss
 Culture-bound syndromes are illnesses that are specific to one culture.
 Cultural care preservation or maintenance—Retain and/or preserve relevant care values so
patients maintain their well-being, recover from illness, or face handicaps and/or death.
 Cultural care accommodation or negotiation—Adapt or negotiate with others for a beneficial or
satisfying health outcome.
 Cultural care repatterning or restructuring—Reorder, change, or greatly modify patients’
lifestyles for a new, different, and beneficial health care pattern.

Ch 22

 Autonomy – commitment to include patients in decisions

 Beneficence – taking positive actions to help others
 Nonmaleficence – avoidance of harm or hurt
 Justice – being fair
 Fidelity – agreement to keep promises
 Ethically appropriate criteria ● likelihood of benefit ● urgency of need ● change in quality of life
● duration of benefit
 Non-medical criteria that should not be considered ● ability to pay ● age ● social worth ●
perceived obstacles to treatment ● patient contribution to illness ● past use of resources
 Denotology – defines actions as right or wrong
 Utilitarianism – proposes that the value of something is determined by its usefulness
 Feminist ethics – focuses on the inequality between people
 Ethics of care – emphasizes the importance of understanding relationships, especially as they
are revealed in personal narratives
 Casuistry – case based reasoning
 Processing an Ethical Dilemma ADPIE
o Step 1: Ask if this is an ethical dilemma.
o Step 2: Gather all relevant information.
 o Step 3: Clarify values.
o Step 4: Verbalize the problem.
o Step 5: Identify possible courses of action.
o Step 6: Negotiate the outcome.
o Step 7: Evaluate the action.
 Quality of life – central to discussions about end – of – life care, cancer therapy, physician-
assisted suicide, and DNR
 Disabilities – antidiscrimination laws enhance the economic security of people with physical,
mental, or emotional challenges
 Care and the end the life – interventions unlikely to produce benefit for the patient
 Health care reform – facilitated access to care for millions of uninsured Americans

Ch 23

 Statutory law (Nurse Practice Act)

o Criminal law (felonies or misdemeanors)
o Civil law
 Regulatory law (administrative law)
 Common law (judicial decisions)
 Americans with Disabilities Act (ADA) - Protects rights of people with physical or mental
disabilities
 Emergency Medical Treatment and Active Labor Act - When a patient presents to an emergency
department, they must be treated
 Mental Health Parity Act as Enacted Under PPACA - Strengthens mental health services
 Patient Protection and Affordable Care Act: (PPACA)
o Consumer rights & protections
o Affordable health care coverage
o Increased access to care
o Stronger Medicare to improve care for those most vulnerable
 Living wills: represent written documents that direct treatment in accordance with a patient’s
wishes in the event of a terminal illness or condition
 Heath care proxies or durable power of attorney for health care: a legal document that
designates a person or people of ones choosing to make health care decisions when the patient
is no longer able to make decisions on his or her own behalf
 Uniform Anatomical Gift Act – 18 y/o in writing with signature, DL
 Health Insurance Portability and Accountability Act (HIPPA): confidentiality & privacy for
patients, portability for providers
 Health information Technology Act (HITECH): extends HIPPA to further protect PHI
 Restraints:
o Only to ensure the physical safety of the patient or other patients
o When less restrictive interventions are not successful
o Only on written order of a health care provider
 Licensure: NCLEX – RN state board of nursing will suspend or revoke a license if need be
  Good Samaritan laws: laws limit liability and offer legal immunity for nurses who help at the
scene of an accident
 Public health laws: protect populations advocate for the rights of the people, regulate health
care and health care financing, and ensure professional accountability for care provided
 Torts: a civil wrong made against a person or property
 Intentional torts: willful acts that violate another’s rights
o Assault – harmful, imminent, or unwelcome contact
o Battery – intentional offensive touching without consent or lawful justification
o False imprisonment – unjustified restraint of a person without a legal reason
 Quasi – intentional torts:
o Invasion of privacy – release of a patient’s medical info to unauthorized person
o Defamation of character: slander (spoken) & libel (written) talking down
 Unintentional torts:
o Negligence – conduct bellow the generally accepted standard of care & responsibility
o Malpractice – professional negligence
 1973 roe vs wade – women’s right to have an abortion
 1989 Webster vs reproductive health services – some require viability test if the fetus is more
than 28 wks.
 Nurses follow an order UNLESS they believe an order is given in error or is harmful


Ch 24

 Communication is the means to establish helping-trust relationships.

 The ability to relate to others is important for interpersonal communication.
 Developing communication skills requires an understanding both of the communication process
and of one’s own communication experience.
 Levels of Communication
o 1. Intrapersonal Occurs within an individual
o 2. Interpersonal One-to-one interaction between two people
o 3. Transpersonal Interaction within a person’s spiritual domain
o 4. Small group Interactions with a small number of people
o 5. Public Interaction with an audience
 Basic Elements of the Communication Process
o 1. Referent Motivates one to communicate with another
o 2. Sender and receiver One who encodes and one who decodes the message
o 3. Message Content of the message
o 4. Channels Means of conveying and receiving messages
o 5. Feedback Message the receiver returns
o 6. Interpersonal variables Factors that influence communication
o 7. Environment The setting for sender-receiver interactions
 Vocabulary - Denotative and connotative meaning
 Intonation - Clarity and brevity
 Pacing - Timing and relevance
  Nurse patient relationship:
o Preinteraction phase: occurs before meeting the patient
o Orientation phase: when the nurse and the patient meet and get to know each other
o Working phase: when the nurse and the patient work together to solve problems and
accomplish goals
o Termination phase: occurs at the end of a relationship
 Therapeutic communication techniques are specific responses that encourage the expression of
feelings and ideas and convey acceptance and respect.
 Active listening means being attentive to what a patient is saying both verbally and nonverbally.
o Use “SOLER”: Sit facing the patient; observe an open posture, lean toward the patient,
establish and maintain intermittent eye contact; relax
 Purposes of the Medical Record: Communication / Legal documentation / Reimbursement /
Education / Research / Auditing & monitoring
 Nurses are responsible for protecting records from all unauthorized readers.
 Methods of Documentation
o Narrative ➢ The traditional method
o Problem-oriented medical record (POMR) ➢ Database ➢ Problem list ➢ Care plan ➢
Progress notes
o SOAP ➢ Subjective, objective, assessment, plan
o SOAPIE ➢ Subjective, objective, assessment, plan, intervention, evaluation
o PIE ➢ Problem, intervention, evaluation
o Focus charting (DAR) ➢ Data, action, response

CH 40

 Physical hygiene is necessary for comfort, safety, and well-being.

 Ill patients require assistance with personal hygiene.
 Several factors influence a patient’s hygiene practices, such as culture and age.
 Good hygiene techniques promote normal structure and function of tissues.
 Apply knowledge of pathophysiology to provide preventive hygiene care.
 Xerostomia—dry mouth
 Gingivitis—inflammation of the gums
 Dental caries—tooth decay
 Social patterns Ethnic, social, and family influences on hygiene patterns
 Personal preferences Dictate hygiene practices
 Body image A person’s subjective concept of his or her body appearance
 Socioeconomic status Influences the type and extent of hygiene practices used
 Health beliefs and motivation - Motivation is the key factor in hygiene.
 Cultural variables People from diverse cultures practice different hygiene rituals.
 Developmental stage Affects the patient’s ability to perform hygiene care
 Physical condition May lack physical energy and dexterity to perform self-care

Ch 27
  Physical hazards in the environment threaten a person’s safety and often result in physical or
psychological injury or death.
o Motor vehicle accidents, Poison, Falls, Fire, Disasters

Ch 28

 Body mechanics - Coordinated efforts of the musculoskeletal and nervous systems

 Alignment and balance - Also refers to posture
 Friction - Force that occurs in a direction opposite to movement
 Gravity - Weight force exerted on the body
 Pathological Influences on Mobility
o Postural abnormalities
o Impaired muscle development
o Damage to central nervous system (CNS)
o Musculoskeletal trauma
 Mobility - Ability to move about freely
 Immobility - Inability to move about freely
 Bed rest - An intervention that restricts patients for therapeutic reasons
 Metabolic - Endocrine, calcium absorption, and GI function
 Respiratory - Atelectasis and hypostatic pneumonia
 Cardiovascular - Orthostatic hypotension, Thrombus
 Musculoskeletal changes - Loss of endurance and muscle mass and decreased stability and
balance
 Muscle effects - Loss of muscle mass, Muscle atrophy
 Skeletal effects - Impaired calcium absorption, Joint abnormalities
 Urinary elimination - Urinary stasis, Renal calculi
 Integumentary- Pressure ulcer, Ischemia
 Integumentary system - Reposition every 1 to 2 hours. & Provide skin care.
 Elimination system - Provide adequate hydration. & Serve a diet rich in fluids, fruits, vegetables,
and fiber
 Infants, Toddlers, Preschoolers - Prolonged immobility delays gross motor skills, intellectual
development, or musculoskeletal development
 Adolescents - Delayed in gaining independence and in accomplishing skills. Social isolation can
occur
 Adults - Physiological systems are at risk. Changes in family and social structures
 Older Adults - Decreased physical activity. Hormonal changes. Bone reabsorption.

Ch 39 Activity and Exercise

 Recumbent position - Vertebrae in straight alignment without observable curves