MED SURG

Chapter 1
1. Advanced practice registered nurse (APRN): a title that
encompasses certified nurse practitioners, clinical nurse
specialists, certified nurse-midwives, and certified registered
nurse anesthetists
2. Bundle: a set of three to five evidence-based practices that,
when implemented appropriately, can measurably improve
patients’ outcome
3. Clinical nurse leaders: a title conferred upon a certified master’sprepared nurse generalist who supervises the care coordination
of a group of patients while assuring implementation of
evidence-based practices and evaluation of quality outcomes
4. Core measures: benchmark standards of best practices used to
gauge how well a hospital gives care to its patients who are
admitted to see treatment for a specific disease or who need a
specific treatment
5. Evidence-based practice: a best practice derived from valid and
reliable research studies that also considers the health care
setting, patient preferences and values, and clinical judgment
6. Health: according to the WHO, a “state of complete physical,
mental, and social well-being and not merely the absence of
disease and infirmity, often viewed as equivalent to wellness
7. Health-illness continuum: description of a person’s health status
as a range with anchors that include poor health or imminent
death on one end of the continuum to high-level wellness on the
other end
8. Interprofessional collaborative practice: employing multiple
health professionals to work together with patients, families, and
communities to deliver best practices, thus ensuring best patient
outcomes
9. Joint Commission: a nonprofit organization that accredits
hospitals and health care organizations
10.
National patient Safety goals: areas of patient safety
concern identified annually by JCO that, if rectified, may have the
most positive impact on improving patient care and outcomes
11.
Nursing: according to the ANA, “the protection, promotion,
and optimization of health and abilities, prevention of illness and
injury, alleviation of suffering through the diagnosis and
treatment of human response, and advocacy in the care of
individuals, families, communities, and populations.”
12.
Patient: a traditional term used to identify someone who is
a recipient of health care
13.
Pay for performance: a health insurance model that
reimburses health care provider groups, hospitals, and health
care agencies for either meeting or exceeding metrics that
demonstrate that the care and treatments rendered are both

cost-efficient and of best quality; also known as value-based
purchasing
14.
Quality and Safety Education of Nurses: a project whose
aim is to develop curricula that prepare future nurses with the
knowledge, skill, and attitudes required to continuously improve
the quality and safety of the health care system through
demonstrating competency in patient-centered care, teamwork
and collaboration, evidence-based practice, quality
improvement, safety, and informatics
The Nursing Profession and the Health Care Industry
I.
Nursing defined
a. Florence Nightingale: “to put the patient in the best
condition for nature to act upon him.”
b. Social policy statement
c. Code of Ethics for Nurses
d. International Council of Nurses
II.
The Patient
a. Patient is the central figure of health care…duh
b. Essential needs are to be met in order to reach the higher
levels
c. Maslow’s Hierarchy of needs
i. Physiological needs
ii. Safety and security
iii. Belongingness and affection
iv. Esteem and self-respect
v. Self-actualization
III.
Health, Wellness, and Promotion
a. Promotion and illness prevention main goals
b. Health
i. Health-illness continuum: makes it possible to regard
a person as simultaneously possessing degrees of
both health and illness
c. Wellness: equivalent of health
i. Hood and Leddy: 4 components of health
1. The capacity to perform to the best of one’s ability
2. The ability to adjust and adapt to varying situations
3. A reported feeling of well-being
4. A feeling that “everything is together” and harmonious
d. Health promotion
i. Motivate people to improve the way they live, to
modify risky behaviors, and adopt healthy behaviors
IV.
Influences on health care delivery
a. Population growth is attributed in part to improved public
health services
i. 65+  has been increasing
ii. Cultural diversity is growing

V.

VI.

b. AIDS, STIs, and TB on the rise
c. Obesity major health concern
d. Advances in technology and genetics
Quality, safety, and evidence-based practice
a. Six aims
i. Patient care is safe, effective, patient centered,
timely, efficient, and equitable
b. Pay for performance
c. National Patient Safety Goals
i. Id patient correctly
ii. Improving staff communication
iii. Meds safe
iv. Preventing infection
v. Safety risk
vi. Preventing surgery-related mistakes
d. Care coordination failure occurs when a patient is
readmitted to the hospital shortly after discharge with the
same condition for which he or she had been originally
hospitalized
e. CNL: clinical nurse leader
Professional Nursing Practice
a. CNS
i. Clinical practice
ii. Education
iii. Management
iv. Consultation
v. Research
b. Quality and safety education for nurses
c. Interprofessional collaborative practice

Chapter 2
1. Community-based nursing: nursing care of indivudiuals and
families that is designed to promote and maintain health and
prevent disease. It is provided as patients transition through the
health care system to health-related services outside of the
hospital setting
2. Community hub: centralized networks with infrastructure focused
on coordinating health care and social services to reduce health
risks in a given community
3. Primary prevention: health care delivery focused on health
promotion and prevention of illness or disease
4. Secondary prevention: health care delivery focused on health
maintenance and aimed at early detection of disease, with
prompt intervention to prevent or minimize loss of function and
independence

5. Tele-health: the use of technology such as telephones,
computers, video or imaging transmissions, and links to health
care instruments that remove the barriers of time and space to
provide improved access to health care series for communitydwelling patients
6. Tertiary prevention: health care delivery focused on minimizing
deterioration associated with disease and improving quality of
life through rehabilitation measures
7. Third-party payor: an organization or insurance company that
provides reimbursement for services covered by a health plan
I.
Key Components of Community-Based Care
a. Primary concepts: preventive care and self-care within the
context of culture and community
b. Preventing a minimizing the progression of disease and
improving quality of life
c. Prevention
i. Upstream thinking: root cause of given problem
ii. Downstream thinking: treating a health issue once it
becomes problematic
iii. Primary, secondary, tertiary prevention
d. Discharge planning
i. Discharge begins upon admission
e. Community Resources and referrals
i. The community based nurse is responsible for
informing the patient and family about the
community resources available to meet their needs
II.
Home Health Care
a. Interdisciplinary collaboration is required
b. Older adults most frequent visits
c. Services provided
i. Hospice nursing: palliative care
ii. Nursing care includes: patient’s physical,
psychological, social, and environmental status
d. The Home setting
i. Don’t JUDGE
ii. Improvise
iii. Infection control is huge
III.
Home Health visits
a. Review data first
b. Always ask first before you walk into house
c. First visit: crucial in establishing the nurse-patient
relationship
i. Understanding how patient and family are living with
illness
d. At the end: summarize
e. Document: goals and outcome criteria

IV.

Other Community based health care
a. Hospice care
i. Last 6 months of life
ii. Provide education and support and also coordinate
care between various health care agencies
b. Ambulatory Settings
i. Affordable, accessible health care services
c. Occupational Health Programs
i. Safe and healthy work conditions: OSHA
ii. Provide direct care to employees who become injured
or sick
iii. Federal regulations: Americans with Disabilities Act
d. School health programs
i. Interdisciplinary health team
ii. Play several roles: health educator, consultant, and
counselor
e. Community Nurse-Managed Centers
i. Community-based care
ii. Primary health care and serve people who are
vulnerable, underinsured
iii. Community hubs
f. Care for those who are homeless
i. Homelessness increasing in the US
ii. Nurses must be nonjudgmental, patient, and
understanding
iii. Illness usually related to living situation
Chapter 3
1. Assessment: the systematic collection of date to determine the
patient’s health status and any actual or potential health
problems
2. Collaborative problems: specific pathophysiologic manifestations
that nurses monitor to detect onset of complications or changes
in status
3. Critical thinking: a process of insightful thinking that utilizes
multiple dimensions of one’s cognition to develop conclusions,
solutions, and alternatives that are appropriate for the given
situation
4. Deontologic or formalist theory: an ethical theory maintaining
that ethical standards or principles exist independently of the
ends or consequences
5. Ethics: the formal, systematic study of moral beliefs
6. Evaluation: determination of the patient’s responses to the
nursing interventions and the extent to which the outcomes have
been achieved
7. Implementation: actualization or carrying out of the plan of care
through nursing interventions

8. Moral dilemma: situation in which a clear conflict exists between
two ro more moral principles or competing moral claims
9. Moral distress: conflict that arises within oneself when a person
is aware of the correct course of action by institutional
constraints stand in the way of pursuing the correct action
10.
Moral problem: competing moral claim or principle one
clam or principle is clearly dominant
11.
Moral uncertainty: conflict that arises within a person when
he or she cannot accurately define what the moral situation is or
what moral principles apply but has a strong feeling that
something is not right
12.
Morality: the adherence to informal personal values
13.
Nursing diagnoses: actual or potential health problems that
can be managed by independent nursing interventions
14.
Nursing process: a deliberate problem-solving approach for
meeting people’s health care and nursing needs, common
components are assessment, diagnosis, planning,
implementation, and evaluation
15.
Planning: development of goals and outcomes, as well as a
plan of care designed to assist the patient in resolving the
diagnosed problems and achieving the identified goals and
desired outcomes
16.
Teleologic theory or consequentialism: the theoretical basis
of ethics, which focuses on the ends or consequences of action,
such as utilitarianism
17.
Utilitarianisms: a teleologic theory of ethics based on the
concept of the greatest good for the greatest number
I.
Critical thinking
a. Strong formal and informal foundation of knowledge
b. Willingness to pursue or ask questions
c. Ability to develop solutions that are new
d. Metacognition: the examination of one’s own reasoning or
thought process to help refine thinking skills
e. Rationality and insight
i. Skills needed: interpretation, analysis, inference,
explanation, evaluation, and self-regulation
ii. Explanation is justification
iii. Self-regulation: process of examining the care
provided and adjusting the interventions as needed
f. Components of critical thinking
i. Going beyond the basic problem solving
g. Critical thinking and clinical reasoning
i. Draw on personal knowledge and past experiences
II.
Ethical nursing care
a. Ethics vs morality

III.
1.
2.
1.
1.

1.
2.
3.

b. Nurses have a duty to act based on the one relevant
principle
c. Meta-ethics: understanding the concepts and linguistic
terminology used in ethics
d. Applied ethics: identification of ethical problems relevant to
a specific discipline and that discipline’s practice
e. Caring is often cited as the moral foundation for
professional nursing practice
f. Using a family member for translation  violates patient’s
right of confidentiality
g. HIPAA
h. Restraints limit a person’s autonomy
i. Trust issues
i. Placebos
ii. Not revealing a diagnosis to a patient
iii. Revealing a diagnosis to people other than the
patient
j. Refusal of care is illegal
k. DNR
l. When a nurse is faced with two conflicting alternatives
choose the lesser of the two evils
m. Patient self-determination act
i. Advanced directives
ii. Living wills
iii. Physician orders for life-sustaining treatment
The Nursing Process
a. Assessment
i. Health history
Conducted to determine a person’s state of wellness or illness
and is best accomplished as part of a planned interview
Communicate a sincere interest in the patient
ii. Physical assessment
Identify physical, psychological, and emotional state
iii. Ongoing monitoring
Info from family members or other health care members
iv. Recording data
b. Diagnosis
i. Help delineate the scope of practice
ii. NANDA-I
iii. Choosing a Nursing Diagnosis
First Identify the commonalities among the assessment data
collected
Nursing diagnosis are not medical diagnosis
Characteristics and etiology of the problem are identified and
included
iv. Collaborative problems

1. Certain physiological complications that nurses monitor to
detect changes in status or onset of complications
c. Planning
i. Consideration must be given to the most urgent
problem
ii. Maslow’s hierarchy
iii. Outcomes
1. Must be realistic and measurable
2. Expected outcomes define the patient’s desired behavior: used
to measure progress
iv. Establishing goals
1. Immediate, intermediate, and long-term goals
2. Patient and family included in goals
v. Determining Nursing Actions
1. NIC: nursing interventions classification
2. Should be ethical and appropriate to age, culture, blah blah blah
d. Implementation
i. Carrying out the proposed plan
1. Immediate, intermediate, and long-term goals
2. Continue to assess patient
3. Revisions can be made
ii. Direct or indirect execution of planned interventions
e. Evaluation
i. Determine the patient’s response to the nursing
interventions and the extent to which the objectives
have been achieved
ii. Objective data provides these answers
IV.
Documentation
a. Outcomes are documented concisely and objectively
b. Plan may be subject to change
Chapter 4
1. Adherence: the process of faithfully following guidelines or
directions
2. Community: an interacting population of individuals living
together within a larger society
3. Feedback: the return of information about the results of input
given to a person or a system
4. Health education: various learning experiences designed to
promote behaviors that facilitate health
5. Health promotion: the art and science of assisting people to
change their lifestyle toward a higher state of wellness
6. Learning: the act of acquiring knowledge, attitudes, or skills
7. Learning readiness: the optimum time for learning to occur,
usually corresponds to the learner’s perceived need and desire
to obtain specific knowledge

8. Nutrition: the science that deals with food and nourishment in
humans
9. Physical fitness: the condition of being physically healthy as a
result of proper exercise and nutrition
10.
Reinforcement: the process of strengthening a given
response or behavior to increase the likelihood that the behavior
will continue
11.
Self-responsibility: personal accountability for one’s actions
or behavior
12.
Stress management: behaviors and techniques used to
strengthen a person’s resources against stress
13.
Teaching: helping another person learn
14.
Therapeutic regimen: a routine that promotes health and
healing
I.
Purpose of Health Education
a. Health education is an influential factor directly related to
positive health outcome
b. Health education is an independent function of nursing
practice and a primary nursing responsibility
c. Public’s right to comprehensive health care
d. Chronic illness and disabilities need most health
education
e. The goal live life to the healthiest..yolo
f. Factors the influence adherence
i. Demographic
ii. Illness
iii. Therapeutic regimen
iv. Psychosocial
v. Monayy
g. Learning contracts or agreements
i. Realistic and positive
h. Nonadherence is a significant problem for old people
II.
Nature of teaching and learning
a. Active process
b. Facilitate learning
c. Readiness is based on culture, personal values, physical
and emotional status
i. Culture major variable
ii. Emotional readiness
1. Promoted by warm, accepting, positive,
atmosphere realistic learning goals
d. Teaching techniques
i. Lectures
ii. Group teaching
iii. Demonstration and practice
iv. Teaching aids

III.

IV.

v. Reinforcement and follow-up
vi. Motivational interviewing
vii. Successful teaching results in self-care
management, enhanced self-esteem, confidence
The Nursing Process in Patient Education
a. Assessment
b. Diagnosis
i. Teaching is an integral intervention
ii. “Deficient knowledge”
c. Planning
i. Important to identify immediate and long-term goals
ii. Teaching strategies appropriate for attaining the
goals
iii. Outcomes realistic and measurable
d. Implementation
i. Flexibility
e. Evaluation
i. Determine how effectively the patient has responded
to teaching
ii. Measurement is only the beginning of evaluation
Health Promotion
a. Encourage people to achieve as high a level of wellness as
possible so that they can live maximally health lives and
avoid preventable illnesses
b. Overall goals
i. Increase the quality and years of healthy life for
people
ii. Eliminate health disparities among various segments
of the population
c. Active process
d. Purpose: focus on person’s potential for wellness
e. Health promotion models
i. The health belief model
1. Why some healthy people chose actions to
prevent illness while other do not
2. Becker
3. Demographic and disease factors, barriers,
resources, perceptual factors
ii. Resource Model of Preventive Health
1. Addresses the ways in which people use
resources to promote health
iii. Achieving health for all
1. Human biology, environment, lifestyle, and
health care delivery system
iv. Trans theoretical Model of Change

1. Focuses on the motivation of a person to make
decisions that promote healthy behavior
change
f. Components of Health Promotion
i. Self-Responsibility
1. Individualized and depends on person’s desires
and inner motivation
ii. Nutritional Awareness
1. Good nutrition is the single most significant
factor
iii. Stress Reduction and Management
1. Studies show the negative effects of stress on
health
2. Cause-and-effect relationship between stress
and infectious disease
iv. Physical Fitness
1. Regular exercise program can promote health
V.
Health Promotion Strategies Throughout lifespan
a. Starts before birth
b. Includes
i. Immunizations, counseling, health screening
c. Detect health problems at a young age
d. Chronic disease and disability do not preclude health and
wellness
Chapter 5
1. Auscultation: listening to sounds produced within different body
structures created by the movement of air or fluid
2. Body Mass Index (BMI): a calculation done to estimate the
amount of body fat of a person
3. Electronic Medical Record: computerization of medical records
4. Faith: trust in God, belief in higher power or something that a
person cannot see
5. Health History: the collection of subjective data, most often a
series of questions that provides an overview of the patient’s
current health status
6. Inspection: visual assessment of different aspects of the patient
7. Palpation: examination of different organs of the body using the
sense of touch
8. Percussion: the use of sound to examine different organs of the
body
9. Physical examination: collection of objective data about the
patient’s health status
10.
Self-concept: a person’s view of him or herself
11.
Spirituality: connectedness with self, others, a life force, or
God that allows people to find meaning in life

12.
Substance abuse: a maladaptive pattern of drug use that
causes physical and emotional harm with the potential for
disruption of daily life
I.
Considerations for Conducting a Health Assessment
a. Role of Nurses
i. Health History
ii. Physical Examination
b. Effective communication
i. Establish rapport
ii. Take into consideration patient education and culture
iii. Avoid technical terms
c. Ethical use of data
i. Explain purpose of health history and physical exam
ii. HIPAA
d. Role of technology
i. EMR: standardization of medical terms
II.
Health History
a. Focus on impact of psychosocial, ethnic, and cultural
background on a person’s health, illness, and health
promotion
b. Current health problems
c. Past medical history
d. Family history
e. Review of the person’s functional status
f. Informant: may not always be the patient
g. Components of Health History
i. Baseline info
ii. Biographical data: name, birthday…
iii. Chief complaint: “why ya here?”
iv. Present health concerns or illness: physical exam
important, correct selection of appropriate diagnostic
test
v. Past Health History: immunizations, allergies, last
physical exam, previous illness
vi. Family history: genetic, communicable, or
environmental in origin
vii. Review of system: overview of general health,
symptoms related to each body system: negative
and positive answers recorded
h. Patient Profile
i. Past Life events related to health
1. Brief life history
ii. Education and occupation
1. Job tells you education level and occupation
status
iii. Financial resources

III.

1. Insurance?
2. Are you poor?
3. Nah I’m a rich nigga
iv. Environment
1. Where do you live? Is it safe?
2. Spirituality, faith, spiritual environment
3. Culture
4. Family structure: normal or odd
v. Lifestyleee
1. Do you drink…duh drugs…nah
2. Alcohol abuse? Substance abuse?
3. Be a nonjudgmental betch
4. CAM therapies
5. Health promotions and screenings
vi. Disabilities
1. Need to address any limitations
2. Family members might be more helpful
vii. Self-concept
1. How do you feel about your life?
viii. Sexuality
1. Do you have sex?
2. Are you gay or straight? Or confused?
3. Nonjudgmental
ix. Risk for abuse
1. Physical, sexual, and psychological
2. Withhold meds?
x. Stress and coping resources
Physical Assessment: objective data
a. “Complete” exam not necessary every time
b. Health history guides the physical exam
c. Components of the Physical Exam
i. General observations: young, old, sick, healthy
ii. Posture
iii. Body movements: generalized disruption of voluntary
or involuntary movement/ asymmetry of movement
iv. Nutritional Status: obesity?
v. Speech pattern: slurred?
vi. Vital signs: bp, pulse, HR, RR, temp, pain
d. Focused assessment
i. All relevant body systems are tested
ii. Inspection
1. Observation of each relevant body system
iii. Palpation
1. Tactile fremitus and thrills
iv. Percussion
1. Physical force sound

2. Tympany: stomach (air-filled)
3. Hyperresonance: lungs filled with liquid
4. Resonance: lungs (air-filled)
5. Percussion: liver (dull)
v. Auscultation
1. Intensity, pitch, duration, quality
IV.
Nutritional Assessment: obesity and overweight
a. Lifespan considerations
i. Adolescence is a time of critical growth
ii. Older adults at risk for altered nutrition
b. Components of nutritional assessment
i. BMI, Ideal weight, Waist circumference
1. BMI: body height and weight, highly correlated
with body fat (25-29.9 overweight, 30-obesity)
ii. Biochemical Assessment
1. Tissue level of a given nutrient and any
abnormality of metabolism in the utilization of
nutrient
iii. Clinical examination
1. Body weight, hair, skin, gums, thyroid gland
iv. Dietary data
1. 24-hour food recall, dietary interview
V.
Methods of collecting data
a. Food record: record of food consumed over a period of time
(3-7 days)
b. 24-Hour recall: recall of food intake for 24-hours
c. Dietary interview: culturally sensitive
d. Evaluating dietary information: total nutritive value is
compared with recommended
VI.
Factors influencing nutritional status
a. Levels of protein
b. Hospitalized patients
c. Medications
d. Income
VII. Analysis of nutritional status
a. Physical measurements and biochemical, clinical, and
dietary data
VIII. Assessment in the home or community
a. Evaluate the ability of individual and family to cope with
and address their respective needs
Chapter 6
1. Adaptation: a change or alteration designed to assist in adjusting
to a new situation or environment
2. Adrenocorticotropic hormone (ACTH): a hormone produced by the
anterior lobe of the pituitary gland that constricts blood vessels,
elevates blood pressure, and reduces the excretion of urine

3. Antidiuretic hormone (ADH): a hormone secreted by the posterior
lobe of the pituitary gland that constricts blood vessels, elevates
blood pressure, and reduces the excretion of urine
4. Catecholamines: any of the group of amines that serve as
neurotransmitters
5. Coping: the cognitive and behavioral strategies used to manage
the stressors that tax a person’s resource
6. Disease: an abnormal variation in the structure or function of any
part of the body that disrupts function and therefore can limit
freedom of action
7. Dysplasia: bizarre cell growth resulting in cells that differ in size,
shape, or arrangement from other cells of the same tissue type
8. Family: a group whose members are related by reciprocal caring,
mutual responsibilities, and loyalties
9. Fight-or-flight response: the alarm stage in the general adaptation
syndrome described by selye
10. Glucocorticoids: the group of steroid hormones, such as cortisol,
that are produced by the adrenal cortex, they are involved in
carbohydrate, protein, and fat metabolism and have antiinflammatory properties
11. Gluconeogenesis: the formation of glucose by the liver form
noncarbohydrate sources, such as amino acids and the glycerol
portion of fats
12. Guided imagery: the mindful use of a word, phrase, or visual
image to achieve relaxation or direct attention away form
uncomfortable sensations or situations
13. Homeostasis: a steady state within the body, the stability of the
internal environment
14. Hyperplasia: an increase in the number of new cells in an organ
or tissue
15. Hypoxia: inadequate supply of oxygen to the cell
16. Inflammation: a localized reaction of tissue to injury, irritation, or
infection that is manifested by pain, redness, heat, swelling, and
sometimes loss of function
17. Metaplasia: a cell transformation in which there is conversion of
one type of mature cell into another type of cell
18. Negative feedback: Response that decreases the output of a
system
19. Positive feedback: reaction that increases the output of a system
20. Steady state: a stable condition that does not change over time,
or when change in one direction is balanced by change in an
opposite direction
21. Stress: a disruptive condition that occurs in response to adverse
influences from the internal or external environments

22. Stressor: an internal or external event or situation that creates
the potential for physiologic, emotional, cognitive or behavioral
changes
I.

II.

Fundamental concepts
a. Constancy and homeostasis
i. Claude Bernard: there must be a constancy or “fixity
of the internal milieu” despite changes in the
external environment
ii. When changes occur processes are initiated to
restore regular function
iii. Dysfunctional responses can lead to disease = threat
to steady state
b. Stress and Adaptation
i. Change that evokes stress= stressor
ii. Desired goal= adaptation
iii. Desired goals of adaptation: survival, growth, and
reproduction
Overview of stress
a. Types of stressors
i. Physical: cold, heat, and chemical agents
ii. Physiologic: pain, fatigue
iii. Psychological: fear
iv. Stressors: greater health impact than major life
events
1. Cause high BP, palpitations
b. Stress as a stimulus for disease
i. People under constant stress have a high incidence
of psychosomatic disease
c. Psychological responses to stress
i. Mediating process: after recognizing a stressor
person consciously or unconsciously reacts to
manage the situation
ii. Cognitive appraisal: process by which an event is
evaluated with respect to what is at stake (primary
appraisal) and what can be done (secondary
appraisal)
iii. Primary appraisal: nonstressful or stressful
iv. Secondary appraisal: what might and can be done
v. Reappraisal: change of opinion based on information
given
vi. Negative emotions accompany harm/loss appraisals
vii. Positive emotions accompany challenges
d. Coping with the stressful event
i. Emotion-focused coping: lessening the emotional
distress

ii. Problem-focused coping: make direct changes in the
environment
iii. Successful coping reduces the source of stress and
relieves the emotion generated
iv. Resilience: ability of a person to function well in
stressful situations such as traumatic events and
adverse situations
v. Health-promoting lifestyle buffers the effect of
stressors
e. Physiologic response to stress
i. Hans Selye: General adaptation syndrome
ii. GAS: sympathetic fight or flight active with release of
catecholamine and ACTH
1. Alarm: defensive and anti-inflammatory, self
limiting
2. Resistance: adaptation to the noxious stress
occurs, cortisol activity is increased
3. Exhaustion: endocrine activity increases
iii. Local adaptation syndrome
1. Inflammatory response and repair process
local site of tissue injury
iv. Interpretation of stressful stimuli by the brain
1. Neural and hormonal actions that maintain
homeostasis balance hypothalamus
2. Maintains chemical constancy of the internal
environment of body
3. Cerebral hemisphere
a. Thought process
b. Learning
c. Memory
4. Afferent impulses sensory organs and internal
sensors brain
v. Sympathetic Nervous System Response
1. Rapid and short lived
2. Norepinephrine is released: cause increase in
vital organs and a state of general body
arousal
vi. Sympathetic-adrenal-medullary response
1. Stimulates adrenal medulla releasing
epinephrine and norepinephrine
2. Stimulate the nervous system and produce
metabolic effects that increase the blood
glucose level and metabolic rate
3. Flight or fight response
vii. Hypothalamic-pituitary response
1. Longest-acting phase of physiologic response

III.

2. Cortisol-induced metabolic effects provide body
with ready source of energy during a stressful
event
3. Catecholamine and cortisol are the most
important in general response to stress
4. ADH promote sodium and water retention
viii. Immunologic Response
1. Psychoneuroimmunology: study of
neuroendocrine system, CNS and ANS, and
immune system
2. Altered immune function = under stress
ix. Maladaptive responses to stress
1. Maladaptive: chronic, recurrent responses or
patterns of response that do not promote the
goals of adaptation
x. Indicators of stress
1. Subjective and objective measures
2. Psychological, physiologic, or behavioral
3. Blood and urine analysis can be used to show
hormonal levels and breakdown
4. Serum cholesterol and fatty acid levels can
measure stress levels
Stress at the cellular level
a. Changes from one state to another may occur rapidly and
may not be readily detectable
b. Different cells and tissues respond to stimuli
c. Control of the Steady State
i. Negative feedback: restore homeostasis when
conditions shift out of normal range
1. Cells detect a change in the immediate
environment and initiate an action to
counteract its effect
2. Net result: homeostasis
ii. Positive feedback: perpetuates the chain of events
instead of compensating
d. Cellular adaptation
i. Maintenance function: activities that the cell
preforms with respect to itself
ii. Specialized functions: those that the cell performs in
relation to the tissues and organs
iii. Hypertrophy and atrophy
iv. Hyperplasia
v. Dysplasia: tendency to become malignant
vi. Metaplasia: protective function
e. Cellular injury
i. Injury: disorder in steady-state regulation

ii. Structural and functional damage occurs- irreversible
or reversible
iii. Hypoxia: inadequate cellular oxygenation: cell can’t
transform energy
1. Usual cause ischemia
iv. Nutritional imbalance: deficiency or excess of one or
more essential nutrients
1. Under or over nutrition
v. Physical agents
1. Temperature: elevated- hyper metabolism
occurs and RR, HR and BMR increase
2. Radiation: decreases the protective
inflammatory response of the cell
3. Mechanical trauma: wounds that disrupt cells
and tissues of the body
vi. Chemical agents
1. Drugs, alcohol, chemicals
vii. Infectious agents
1. Inflammatory and immune reaction: body’s
physiologic response to viral infection
viii. Disordered immune responses
1. Hypoactive: diseases occur
2. Hyperactive: hypersensitivity disorders occur
ix. Genetic disorders
f. Cellular response to injury: inflammation
i. Nonspecific response, serves as a protective factor
ii. 5 cardinal signs
1. Redness
2. Warmth
3. Swelling
4. Pain
5. Loss of function
iii. Leukocytes: phagocytosis
iv. Chemical mediators of inflammation
1. Histamine: early changes in vasodilation and
vascular permeability
2. Kinins: cause vasodilation and increased
vascular permeability
3. Prostaglandins: increased vascular permeability
v. Systemic Response to inflammation
1. Fever
vi. Types of inflammation
1. Acute: local vascular and exudative changesless than 2 weeks, protective

IV.

2. Chronic: persists, not beneficial or protective,
debilitating and can produce long-lasting
effects
g. Cellular Healing
i. Reparative process begins at approx. the same time
as the injury
ii. Regeneration: labile, permanent, or stable
1. Labile: multiply constantly
2. Permanent: (neurons): destruction of neurons
permanent axons regenerate
3. Stable: some have a latent ability to
regenerate
iii. Replacement: First-, second-, third-intention healing
1. First: wound edges are approximated
2. Second: edges are not approximated wound
fills with granulation tissue
3. Third: wound edges are not approximated
wound healing delayed
Nursing Management
a. Promoting a health lifestyle
b. Enhancing coping strategies
c. Relaxation techniques: goal= produce a response that
counters the stress response
i. Progressive muscle relaxation: tensing and releasing
the muscles of the body in sequence and sensing the
difference in feeling
ii. The Benson relaxation response: combines
meditation with relaxation
iii. Guided imagery: mindful use of a word, phrase, or
visual image for the purpose of distracting oneself
d. Education about Stress management
i. Providing sensory information and providing
procedural information
e. Promoting family health
f. Enhancing social support
i. First: cared for and loved
ii. Second: esteemed and valued
iii. Third: belong to a network of communication and
mutual obligation
g. Recommending support and therapy groups

Chapter 7
1. Culture: the knowledge, belief, art, morals, laws, customs, and any
other capabilities and habits acquired by humans as members of
society

2. Cultural awareness or sensitivity: being alert to and having
knowledge of cultural preferences, aspects, or perspectives that
may impact the health care experience, including communication,
personal choices, or other elements
3. Cultural humility: acknowledging one’s cultural knowledge deficits
using self-reflection, continuous self-evaluation, and consultation
with others to detect barriers to culturally competent are and
address bias, or lack of knowledge or skills related to a culture
other than one’s own, to provide culturally appropriate care
4. Cultural nursing assessment: a systematic appraisal or examination
of individuals, families, groups, and communities in terms of their
cultural beliefs, values, and practices
5. Culturally competent nursing care: effective, individualized care
that demonstrates respect for the dignity, personal rights,
preferences, beliefs, and practices of the person receiving care
while acknowledging the biases of the caregiver and preventing
these biases from interfering with the care provided
6. Ethnocentrism: making a value judgment on another culture from
the vantage points of one’s own culture
7. Minority: a group of people whose physical or cultural
characteristics differ from the dominant culture or majority of
people in a society
8. Subculture: relatively large groups of people who share
characteristics that identify them as a distinct entity
9. Transcultural nursing: nursing care to clients and families across
cultural variations
I.
Cultural Concepts
a. Concept of culture and its relationship to health care
beliefs and practices: FOUNDATION FOR TRANSCULTURAL
NURSING
b. Ethnic culture
i. Learned from birth through language and
socialization
ii. Shared by members of same group, internal sense
and external perception
iii. Influenced by specific conditions- environmental and
technical factors
iv. Dynamic and ever changing
v. Cultural humility: critical step toward becoming
culturally competent
c. Subcultures: can be based on religion, age, geographic
region, etc..
i. Nurses must refrain from culturally stereotyping
d. Minorities

II.

III.

e. Health Disparities: higher rates of morbidity, mortality, and
burden of disease in a population or community than found
in the overall population
i. Receive lower quality of health care
Transcultural nursing
a. Underlying focus: provide culture-specific and cultureuniversal care
b. Culture care Diversity and universality (Leininger):
promoting health care in ways that culturally meaningful
c. Culture care accommodation: professional actions and
decisions that nurses make on behalf of those in their care
to help people of a culture achieve a beneficial health
outcome
d. Culture care restructuring: professional actions that help
patients reorder, change or modify their lifestyles toward
new different or more beneficial health care patterns
e. Culturally competent nursing care
i. Involves a complex integration of attitudes,
knowledge, and skills
f. Cross-cultural communication
i. Translator: cannot be family member
ii. Cues
1. Efforts to change the subject
2. Absence of questions: not grasping message
3. Inappropriate laughter
4. Nonverbal cues
Culturally Mediated Characteristics
a. NOT ALL PEOPLE FROM THE SAME CULTURAL
BACKGROUND SHARE THE SAME BELIEFS
b. TREAT EACH PATIENT AS AN INDIVIDUAL
c. Information disclosure: patient might not want to know or
shouldn’t know
d. Space and distance: amount of space is a cultural thing
e. Eye contact: some consider direct eye contact impolite or
aggressive
f. Time: punctuality, time is relative to many cultures
i. Be flexible
g. Touch: ask permission to touch, some cultures can’t
examine opposite sex
h. Observance of holidays: do not schedule appointments or
major procedures on days of obligation
i. Diet: culture plays a huge role in food, and so does religion
j. Biologic variation: genetic predispositions
k. Complementary and alternative therapies
i. Alternative medical systems: complete systems of
theory and practice (acupuncture)

ii. Mind-body interventions: facilitate the mind’s ability
to affect symptoms and bodily functions (meditation)
iii. Biologically based therapies: natural and biologically
based practices (herbal therapies)
iv. Manipulative and body-based methods: based on
body movements (chiropractic)
v. Energy therapies: interventions that focus on energy
fields within the body
IV.
Causes of illness
a. Biomedical or scientific view
i. Prevails in most health care settings
ii. Cause and effects, all of reality can be observed and
measured
b. Naturalistic or holistic perspective
i. Forces of nature must be kept in natural balance or
harmony
ii. Yin/yang: yin girl and negative forces, cold; yang
men and positive forces, hot
c. Magico-religious view
i. Basic premise is that the world is an arena in which
supernatural forces dominate, and that the fate of
the world and those in it depends on the action of
supernatural forces for good or evil
V.
Folk Healers
a. Several cultures have their own healers, speak the
language, make house calls, and are less expensive than
hospitals
VI.
Cultural nursing assessment
a. Refers to a systematic appraisal or examination of
individuals, families, groups, and communities in terms of
their cultural beliefs, values, and practices
VII. Additional cultural considerations: know thyself
a. Be comfortable with your own culture
VIII. The future of transcultural nursing care
a. Working to increase the number of minority nurses
Chapter 8
1. Carrier: a person who is heterozygous; possessing two different
alleles of a gene pair
2. Chromosome: microscopic structures in the cell nucleus that
contain genetic information and are constant in number in a
species
3. Deoxyribonucleic acid (DNA): the primary genetic material in
humans consisting of nitrogenous bases, a sugar group, and
phosphate combined into a double helix

4. Dominant: a genetic trait that is normally expressed when a
person has a gene mutation on one of a pair of chromosomes and
the “normal” form of the gene is on the other chromosome
5. Genetics: the scientific study of heredity; how specific traits or
predispositions are transmitted from parents to offspring
6. Genome: the total genetic complement of an individual genotype
7. Genomics: the study of the human genome, including gene
sequencing, mapping, and function
8. Genotype: the genes and the variations therein that a person
inherits from his or her parents
9. Human Genome project: an international research effort aimed at
identifying and characterizing the order of every base in the
human genome
10. Mutation: a heritable alteration in a DNA sequence
11. Nondisjunction: the failure of a chromosome pair to separate
appropriately during cell division, resulting in abnormal
chromosome numbers in daughter cells
12. Pedigree: a diagrammatic representation of a family history
13. Phenotype: a person’s entire physical, biochemical, and
physiologic makeup, as determined by the person’s genotype and
environmental factors
14. Predisposition testing: testing that is used to determine the
likelihood that a healthy person with or without a family history of
a condition will develop a disorder
15. Prenatal screening: testing that is used to identify whether a
fetus is at risk for a birth defect such as down syndrome or spina
bifida
16. Presymptomtatic testing: genetic testing that is used to
determine whether persons with a family history of a disorder, but
no current symptoms, have the gene mutation
17. Recessive: a genetic trait that is expressed only when a person
has two copies of a mutant autosomal gene or a single copy of a
mutant X-linked gene in the absence of another X chromosome
18. Variable expression: variation in the degree to which a trait is
manifested, clinical severity
19. X-linked: located on the X chromosome
I.

II.

Genomic Framework for nursing practice
a. Genetics and genomics are the basis of normal and
pathophysiologic development, human health and disease,
and health outcomes
b. Nurses help individuals and families learn how genetic traits
and conditions are passed on within families
Integrating Genetics and Genomic Knowledge
a. Genes and their role in human variation
b. Genes are central components of human health and disease

c. Genes and chromosomes
i. Environmental influences modify every person’s
phenotype
ii. Human growth, development, and disease occur as a
result of both genetic and environmental influences
iii. DNA: adenine, cytosine, guanine, thymine
iv. 46 chromosomes, 22 pairs 23rd pair sex chromosomes
1. XX female
2. XY male
d. Cell division
i. Mitosis: cell growth, differentiation, and repair
1. Chromosomes of each cell duplicate: diploid
ii. Meiosis: reproductive cells and is the process by
which oocytes and sperm are formed: haploid
iii. Down syndrome: 3 copies of number 21
e. Gene mutation
i. Depends on how a protein is altered
ii. Deletion (loss), insertion (addition), duplication
(multiplication), rearrangement (translocation)
iii. Can be inherited or acquired
iv. Acquired mutations take place in somatic cells: occur
after conception
f. Genetic variation
i. Single nucleotide polymorphism: genetic variations
that occur most frequently throughout the human
genome
g. Inheritance Pattern
i. Mendelian patterns: conditions that are inherited in
fixed proportions among generations
ii. Autosomal dominant inheritance
1. Carries a gene mutation for that condition on
one chromosome of a pair: 50% chance of
inheriting the gene mutation
2. Penetrance: percentage of persons known to
have a particular gene mutation who actually
show the trait
3. Incomplete penetrance: the probability that a
given gene will produce disease
iii. Autosomal recessive inheritance
1. Frequently seen in children whose parents are
related by blood
2. D vEach parent carries a gene mutation on one
chromosome of the pair and a normal gene on
the other
3. 25% chance of passing on to child- carriers
iv. X-linked inheritance

III.

1. Conditions may be inherited in recessive or
dominant patterns
2. All males inherit X from moms and Y from dads
v. Multifactorial inheritance and complex genetic
conditions
1. Interactions of multiple gene mutations and
environmental influences
vi. Nontraditional inheritance
1. Various factors influence how a gene performs
and is expressed
2. Imprinting
h. Chromosomal differences and genetic conditions
i. Aneuploidy: chromosomal differences most commonly
involve an extra or missing chromosome
ii. Structural rearrangement within or between
chromosomes
Genetic and Genomic technologies in practice
a. Gene testing
i. Primary tool to identify individuals predisposed to
specific genetic diseases
ii. Genotypic methods: analysis of chromosomes and
genes directly
iii. Phenotypic methods: familial or biological
presentation of disease family history
iv. Prenatal screening
b. Genetic screening: applies to testing of populations or
groups independent of a positive family history or symptom
manifestation
i. First aim: improve management
ii. Second aim: provide reproductive options to people
with high probability of having defective children
iii. Third aim: screen pregnant women to detect birth
defects
c. Testing and screening for adult-onset conditions
i. Genomic or multifactorial
ii. Based on family history, personal and medical risk
factors
d. Single gene conditions
i. Presymptomatic testing
e. Genomic conditions
i. Helps distinguish variations within the same disease
or response to treatment
f. Population screening
i. The use of genetic testing for large groups or entire
populations
1. Sufficient information about gene distribution

IV.

V.

2. Accurate prediction about the development and
progression of disease
3. Appropriate medical management for
asymptomatic people with a mutation
g. The nursing role in testing and screening for adult-onset
conditions
i. Nurses: support informed health decisions and
opportunities for prevention and early intervention,
protecting patient privacy
ii. History of disease: patient is made aware
iii. Predisposition testing
Personalized genomic treatments
a. Targeted therapy: tries to match the treatment to the
specific malfunctioning genes expressed in the tumor
b. Pharmacogenomics: combines pharmacology and genetics
i. Study of the effect of variations in a single gene on
drug response and toxicity
ii. Drug response
1. Poor metabolizers: very little or no drug
metabolism and higher blood levels
2. Ultra rapid metabolizers: increased enzyme
activity, rapid absorption, distribution, and
excretion of drugs, lower blood levels
3. Intermediate metabolizers have reduced
enzyme activity levels and metabolize drugs at
a slower than normal rate
Applications of Genetics and Genomics in nursing practice
a. Nurses have 5 main tasks
i. Help collect and interpret relevant family and medical
history
ii. Identify patients and families who need further
genetics evaluation and counseling
iii. Offer genetic information and resources to patients
and families
iv. Collaborate with genetic specialists
v. Participate in the management and coordination of
care of patients with genetic conditions
b. Genetics and genomics in health assessment
i. Family history assessment
1. Targeted questions to identify genetic and
genomic conditions
2. Includes at least 3 generations
ii. Physical assessment
iii. Ancestry, cultural, social, and spiritual assessment
1. Social and cultural backgrounds determine their
interpretations and values about information

VI.
VII.

obtained from genetic testing influence
perceptions of health
2. Different cultures have different predispositions
iv. Psychosocial assessment
c. Genetic counseling and evaluation services
i. Regardless of the timing, genetic counseling is always
offered
ii. Genetic services
1. Genetic services provide genetic information,
education, and support to patients and families
iii. Advocacy in genetic and genomic decisions
1. Confidentiality is essential
2. Doesn’t need to be divulged to family members,
insurance companies
3. GINA: protect Americans against improper use
of genetic and genomic information in insurance
and employment decisions
iv. Providing precounseling information
1. Cultural issues
2. Additional medical information
v. Preparing patients for genetic evaluation
1. Family history
2. Physical assessment
vi. Communicating genetics and genomic information to
patients
1. Discuss natural history of condition, pattern of
inheritance, implications of condition for general
health and reproduction
vii. Providing support
1. Counseling sessions
d. Follow up after genetic evaluation
i. Educate patients about sources of information related
to genetic and genomic issues
Ethical issues
a. Informed decision making, privacy and confidentiality
Genetics and genomics tomorrow
a. May be used to scan all patient’s genetic material
b. Increasing clinical opportunities for preseymtoactic
prediction of illness based on patients genetic makeup

Chapter 9
1. Chronic disease: medical or health problems with associated
symptoms or disabilities that require long0term management; has
also been referred to as noncommunicable disease, chronic
condition or chronic disorder

2. Chronic illness: the experience of living with a chronic disease or
condition; the individual’s perception of the experience and the
individual’s and others’ responses to the chronic disease or
condition
3. Disability: restrict or lack of ability to perform an activity in a normal
manner; the consequences of impairment in terms of an individual’s
functional performance and activity- disabilities represent
disturbances at the level of the person
4. Impairment: loss or abnormality of psychological, physiologic, or
anatomic structure, or function at the orang level; an abnormality of
body structure, appearance, and organ or system function resulting
from any cause
5. Secondary conditions or disorders: any physical, mental, or social
disorders resulting directly or indirectly from an initial disabling
condition; a condition to which a person with a disability is more
susceptible because of having a primary disabling condition
I.

Overview of Chronicity
a. Some degree of disability is usually present in severe or
advanced chronic illness
b. Acute: curable, short disease
c. Chronic: long disease course, may be incurable
d. Psychological, emotional, and cognitive reactions to
chronic conditions are likely to occur at their onset
e. Definition of chronic diseases or conditions
i. Medical conditions or health problems with
associated symptoms or disabilities that require longterm management
ii. Irreversible, prolonged course, unlikely to resolve
spontaneously
f. As incidence of chronic diseases increases—the cost
associated with theses chronic diseases also increase
g. Most diseases and complications of chronic illness are
preventable: Health promotion
h. Characteristics of chronic conditions
i. Managing chronic illness involves more than treating
medical problem
ii. Usually involve many different phases over the
course of a person’s lifetime
iii. Keeping chronic conditions under control requires
persistent adherence to therapeutic regimens
iv. One chronic disease can lead to the development of
other chronic conditions
v. Affect the whole family
vi. Day-to-day management of illness is largely the
responsibility of people with the disorder and family

vii.
viii.
ix.
x.
xi.

II.

Management is a process of discovery
Must be collaborative
Expensive
Raises difficult ethical issues
Living with chronic illness means living with
uncertainty
i. Implications of managing chronic conditions
i. Health-promoting behaviors
ii. Quality of life is important
iii. Many people with chronic disease or chronic illness
must face additional challenge: need to deal with
more than one chronic illness or disease at a time
j. Phases of chronic conditions
i. The trajectory model of chronic illness: describe the
phases and the role of nurses in the trajectory of
chronic illness
ii. Each phase is characterized by different medical and
psychosocial issue
k. Gerontologic considerations
i. Multiple chronic conditions are at increased risk for
poor functional status
Nursing care of patients with chronic conditions
a. Care may be direct or supportive
b. Direct: assessing patient’s physical status, providing
wound care, managing and overseeing medication
regimens
c. Supportive: ongoing monitoring, education, counseling,
case management
d. Applying the nursing process using the phase of chronic
illness system
i. Step 1: identifying specific problems and trajectory
phase: Assessment
ii. Step 2: establishing and prioritizing goals: prioritize
problems and establish the goals of care
iii. Step 3: Defining the plan of action of achieve desired
outcome: realistic and mutually agreed-on plan for
achieving them
iv. Step 4: implementing the plan and interventions:
help carry out ADLs…1. Adhering to regimens to
control symptoms and keep the illness stable…2.
Dealing with the psychosocial issues that can hinder
illness management and affect quality of life
v. Step 5: Following up and evaluating outcomes:
determine if the problem is resolving or being
managed

III.

1. Primary goal: maintaining the stability of the
chronic conditions while preserving the
patient’s sense of control, identify, and
accomplishment
e. Home and community-based care
i. Educating patients about self-care
1. Promoting healthy-life style, education is
important
2. Knowledge patients are more likely to take
better care
ii. Continuing care
1. Collaborative process
2. Wide-ranging efforts to assess people for risks
of chronic illness
f. Nursing care for special populations with chronic illness
i. Various factors that influence susceptibility to chronic
illness and ways patients respond to chronic
disorders
Overview of Disability
a. Definition of disability
i. ADA (Americans with Disabilities Act 1990)
1. Has a physical or mental impairment that
substantially limits one or more major life
activities
2. Has a record of such an impairment
3. Regarded as having such an impairment
ii. Three disability-related factors
1. The effects of the disabling condition
2. Others’ perceptions of disability
3. The need for and use of resources by the
person with a disability
b. Prevalence of Disability
i. 54 million to 60 million people in the US have
disabilities
c. Characteristics of disability
i. Categories and Types of disabilities
1. Developmental disabilities
a. Occur anytime from birth-22 years old,
results in impairment of physical or
mental health
i. Down syndrome
2. Acquired disabilities may occur as a result of an
acute and sudden injury
a. COPD
3. Sensory disabilities that affect hearing or vision

IV.

V.

4. Learning: ability to learn, remember,
concentrate
d. Models of disability
i. Medical and rehabilitation model
ii. Social model
iii. Biopsychosocial model
iv. Interface model: appropriate for use by nurses to
provide care that is empowering rather than care
that promotes dependence
e. Disability vs. Disabling disorders
i. Nursing management: must be examined to make
sure that people with disabilities receive the same
care as those without
f. Self-reported health status
g. Federal legislation
i. Rehabilitation Act of 1973: protects people from
discrimination based on disability
ii. ADA of 1990 mandates that people with disabilities
have access to job opportunities
Right of access to health care
a. Barriers to health care
i. Structural, transportation, education
b. Federal assistance programs
i. Lack of health insurance
ii. Title II: social security disability insurance
iii. Affordable care act
Nursing care of patients with disabilities:
a. Nursing considerations during hospitalization
i. Help patients with ADLs
b. Health promotion and prevention
i. Lifelong disabilities may not receive encouragement
to participate in health promotion activities
ii. Nurses can provide expert health promotion
education
c. Significance of “people-first” language
i. Conveys the message that the person, rather than
the illness is of greater importance to nurse
1. “The patient with diabetes” instead of “diabetic
patient”
d. Gerontology considerations
i. Age-related disabilities are those that occur in the
older adult population and are thought to be
attributable to the aging process
e. Disability in medical-surgical nursing practice
i. Can live a normal lifespan

ii. Nurses are key positions to influence the
architectural design of health care settings
iii. Patients’ needs should be addressed
f. Home and community based care
i. Every patient is treated and educated
ii. Health promotion strategies is the need for
alternative formats to accommodate people with
various disabilities
g. Continuing care
i. Arrangements for transportation and accessible
facilities may be needed
Chapter 10
1. Activities of daily living (ADLs): activities related to personal care
2. Adaptive device: a type of assistive technology that is used to
change the environment or help the person to modify the
environment
3. Assistive device: a type of assistive technology that helps people
with disabilities perform a given task
4. Assistive technology: any item, piece of equipment, or product
system that is used to improve the functional capabilities of
individuals with disabilities, this term encompasses both assistive
devices and adaptive devices
5. Habilitation: making able; learning new skills and abilities to meet
maximum potential
6. Impairment: loss or abnormality of psychological, physiologic, or
anatomic structure or function at the organ level; an abnormality
of body structure, appearance, an organ, or system function
resulting from any case
7. Instrumental activities of daily livings (IADLs): complex skills
needed for independent living
8. Orthosis: an external appliance that provides support, prevents or
corrects joint deformities, and improves functions
9. Pressure ulcer: localized area of skin breakdown due to prolonged
pressure and insufficient blood supply, usually at bony
prominences
10. Prosthesis: a device used to replace a body part
11. Rehabilitation: making able again; relearning skills or abilities or
adjusting existing functions
12. Sinus tract: course or path of tissue destruction occurring in any
direction from the surface or edge of a wound; results in dead
space with potential for abscess formation
13. Slough: soft, moist avascular tissue; may be white, yellow, tan,
grey, or green; may be loose or firmly adherent
14. Undermining: area of destroyed tissue that extends under intact
skin along the periphery of a wound; commonly seen in shear

injuries; can be distinguished from sinus tract in that there is a
significant portion of the wound edge involved, whereas sinus tract
involves only a small portion of the wound edge
I.

II.

III.

IV.

V.

Rehab: identify, reach, and maintain optimal physical,
sensory, intellectual, psychological, and/or social functional
levels…2. Focus on existing abilities to facilitate
independence, self-determination, and social integration
(special focus on returning patients to optimal functionality
through a holistic approach to care)
The rehabilitation team
a. Rehab is a continuous process
b. Rehab requires active patient participation
c. Rehab is goal directed
d. Rehab requires multiprofessional teamwork
e. PATIENT IS KEY MEMBER of rehab team, families are
dynamic systems
Areas of specialty rehabilitation
a. Stroke recovery programs and traumatic brain injury rehab:
cognitive remediation, helping patients compensate for
memory, perceptual, judgment, and safety deficits as well
as teaching self-care and mobility skills
b. Spinal cord injury rehab: promote understanding of the
effects and complications of spinal cord injury
c. Orthopedic rehab: traumatic or nontraumatic amputation,
bones and joints
d. Cardiac rehab: patients who have had MI begins during the
acute hospitalization and continues on an outpatient basis
e. Pulmonary rehab: patients with restrictive or COPD
f. Comprehensive pain management: people with chronic
pain (lower back)
g. Pediatric rehab: needs of children with developmental and
acquired disabilities
Substance abuse issues in rehabilitation
a. Treatment includes: physical and psychosocial evaluations;
detoxification; counseling; medical treatment
b. Length of treatment and the rehab process depends on
patient needs
Assessment of functional ability
a. Comprehensive assessment of functional capacity
b. Can patient perform ADLs or IADLs
c. Functional Independence Measure: measures 18 self care
items
d. PULSES: assess physical condition
e. Barthel Index: measure patient’s level of independence in
ADLs

VI.

VII.

f. Patient Evaluation Conference System: comprehensive
assessment scale
Nursing process: started as soon as the rehab process begins
a. Assessment: must observe and assess the patient’s ability
to perform ADLs…assisted devices are often essential
b. Nursing diagnosis: based on assessment data
c. Planning and Goals: perform activities independently and
patient expresses satisfaction
d. Nursing interventions: achieve maximum independence
e. Fostering self-care abilities: must help patient identify the
safe limits of independent activity, knowing when to ask for
assistance
i. Self-care needs to be adapted to accommodate the
individual patient’s lifestyle
f. Recommending adaptive and assistive devices: The Able
Data project (offers a computerized listing of commercially
available aids and equipment for patients with disabilities)
g. Helping patients accept limitations: nurse educates the
patient how to take charge by directing his or her care
h. Evaluation: self care in bathing/hygiene,
dressing/grooming, feeing, toileting
The patient with impaired physical mobility
a. Problems with immobility: weakened muscles, joint
contracture, deformity
b. Altered ambulatory/mobility pattern
c. Assessment: assessment of mobility: positioning, ability to
move, muscle strength and tone, joint function, and
mobility limits
d. Nursing diagnosis: based on assessment
e. Planning and goals: absence of contracture and deformity,
maintenance of muscle strength
f. Nursing interventions
i. Deformities and contractures can often be prevented
by proper positioning
ii. Preventing external rotation of the hip
iii. Preventing foot drop (plantarflexed)
iv. Maintaining muscle strength and joint mobility: ROM
exercises
v. Performing ROM exercises: active (pt performs),
assisted (pt with help from nurse), passive (nurse)-2
to 3x a day
vi. Performing therapeutic exercise: passive, activeassistive, active, resistive, and isometric
vii. Promoting independent mobility

VIII.

viii. Assisting patients with transfer: begins once pt is
permitted out of bed, hip precautions! SAFETY
PRIMARY CONCERN
ix. Preparing for Ambulation: regaining muscles used,
assisted devices may be used
x. Ambulating with an assistive device: crutches (partial
weight-bearing or non-weight bearing ambulation),
walker- more support and stability, cane- walk with
balance relieves pressure on weight bearing joints
xi. Assisting patients with an orthosis (brace, splints,
collars, supports) or prosthesis (artificial joints, arms,
legs)
g. Evaluation: improved physical mobility, transfers safely,
ambulates with maximum independence, increased activity
tolerance
The patient with impaired skin integrity
a. Pressure ulcers (erythema initial sign)
b. Assessment risk factors
i. Immobility: weight-bearing bony prominences are
most susceptible
ii. Impaired sensory perception or cognition: may not be
aware of uncomfort
iii. Decreased tissue perfusion: conditions that reduce
the circulation and nourishment of skin and
subcutaneous tissue
iv. Decreased nutritional status: nutritional deficiencies,
anemia, and metabolic disorders
v. Friction (the force of rubbing two surfaces against
one another) and Shear (result of gravity pushing
down on patient’s body and the resistance between
the patient and the chair or bed)
vi. Increased moisture
vii. Gerontologic considerations: aging process causes
decrease in epidermal thickness, dermal collagen,
and tissue elasticity
viii. Assessment of skin and existing ulcers
c. Nursing diagnosis: based on assessment
d. Planning and goals: relief of pressure, improved mobility,
etc.
e. Nursing interventions
i. Relieving pressure: frequent changes of position
ii. Positioning the Patient: semi-fowlers, bridging
technique
iii. Using pressure-relieving devices: wheelchair
cushions, static support devices, soft moistureabsorbing padding,

IX.

iv. Improving mobility: encouraged to stay active
v. Improving sensory perception
vi. Improving tissue perfusion: activity, exercise, and
repositioning improve tissue perfusion
vii. Improving nutritional status: high-protein diet
viii. Reducing friction and shear: raising head of bed
ix. Minimizing irritating moisture: meticulous hygiene
measures
x. Promoting pressure ulcer healing: remove all
pressure
xi. Deep tissue injury: evolve rapidly
xii. Stage I pressure ulcer
xiii. Stage II pressure ulcer: occurs more rapidly
xiv. Stage III pressure ulcer: extensive tissue damage,
slough, tunneling, undermining
xv. Stage IV pressure ulcers: surgical interventions
xvi. Other treatment methods: debridement and wet-todamp dressings
1. Consistency is key
xvii. Preventing reoccurrence: reoccurrence should be
anticipated
f. Evaluation: intact skin, limit pressure on bony
prominences, increase mobility, improved tissue perfusion,
avoids friction and shear
The patient with altered elimination patterns
a. Assessment
i. Urge incontinence: involuntary elimination
associated with a strong perceived need to void
ii. Reflex incontinence: spinal cord lesion
iii. Stress incontinence: weakened perineal muscles
permit leakage of urine
iv. Functional incontinence: intact urinary physiology
who experience mobility impairment—can’t reach the
toilet
v. Total incontinence: cannot control excreta
b. Nursing diagnosis: based on assessment data
c. Planning goals: control of urine and poop
d. Nursing interventions
i. Promoting urinary continence: make a schedule,
measure I&O (2,000-3,000mL), bladder training
(restore the bladder to normal function)
1. Biofeedback, pelvic floor exercises, selfcatheterization
ii. Promoting bowel continence: record defecation time,
character of stool, anorectal reflex
iii. Preventing constipation: high-fiber, exercise, privacy

X.

e. Evaluation: control of bowel and bladder function, urinary
continence, bowel continence, relief of constipation
Promoting home and community-based care
a. Plan for discharge is formulated when patient is first
admitted
b. Educating patients about self care
c. Continuing care: written summary of the care plan is
included in family teaching

Chapter 11
1. Activities of daily living (ADLs): basic personal care activates;
basic, dressing, grooming, eating, toileting, and transferring
2. Advance directives: a formal, legally endorsed document that
provides instructions for care (living will)
3. Ageism: a bias that discriminates, stigmatizes, and disadvantages
older people based solely on their chronologic age
4. Comorbidity: having more than one illness at the same time
5. Delirium: an acute, confused state that beings with disorientation
and if not recognized and treated early can progress to changes
in level of consciousness, irreversible brain damage, and
sometimes death
6. Dementia: broad term for a syndrome characterized by a general
decline in higher brain functioning, such as reasoning, with a
pattern of eventual decline in ability to perform even basic ADLs
7. Depression: the most common affective mood disorder of old age;
results from changes in reuptake of the neurochemical serotonin
in response to chronic illness and emotional stresses related to
the physical and social changes associated with the aging process
8. Durable power of attorney: a formal, legally endorsed document
that identifies a proxy decision maker who can make decisions if
the signer becomes incapacitated
9. Elder abuse: the physical, emotional, or financial harm to an older
person by one or more of the individual’s children, caregivers, or
others; includes neglect
10. Geriatric syndromes: common conditions found in older adults
that tent to be multifactorial and do not fall under discrete
disease categories, such as falls, delirium, frailty, dizziness, and
urinary incontinence
11. Geriatrics: a field of practice that focuses on the physiology,
pathology, diagnosis, and management of the disorders and
disease of older adults
12. Gerontolgic/geriatric nursing: the field of nursing that relates to
the assessment, planning, implementation, and evaluation of
older adults in all environments, including acute, intermediate,
and skilled care as well as within the community

13. Gerontology: the combined biologic, psychological, and sociologic
study of older adults within their environment
14. Instrumental activities of daily living (IADLs): activates that are
essential for independent living such as shopping, cooking,
housework, using the phone, managing medications and fiancés,
and being able to travel by car
15. Orientation: a person’s ability to recognize who and where he or
she is in a time continuum; used to evaluate one’s basic cognitive
status
16. Polypharmacy: the prescription, use, or administration of more
medications than is clinically indicated
17. Presbycusis: the decreased ability to hear high-pitched tones that
naturally beings in midlife as a result of irreversible inner ear
changes
18. Presbyopia: the decrease in visual accommodation that occurs
with advancing age
19. Sundowning: increased confusion and/or agitation at night
20. Urinary incontinence: the unplanned loss of urine
I.

II.

Overview of Aging
a. Americans 65+ has tripled in the past 100 years
b. Life expectancies depends on: gender, race
i. White women!
c. Health status of the older adult
i. Most have at least one chronic illness
d. Nursing care of the older adult
i. Gerontology, geriatrics, geriatric nursing
ii. Acute care, skilled and assisted living, the
community, and home setting
iii. Aging is not synonymous with disease
iv. Functional assessment is a common framework for
assessing older people
e. Theories of aging
i. Functional Consequence Theory (Miller): challenges
nurses to consider the effects of normal age-related
changes as well as the damage incurred through
disease or environmental and behavioral risk factors
Age-related changes
a. Well-being of older people: physical, psychosocial, mental,
social, economic, and environmental factors
b. Physical aspects of aging
i. Intrinsic aging: changes caused by the normal aging
process that are genetically programmed and
essentially universal
ii. Extrinsic aging: influences outside the person

iii. Cardiovascular system: heart disease: leading cause
of death
1. Age-related changes reduce the efficiency of
the heart and contribute to decreased
compliance of the heart muscle
iv. Respiratory system: able to compensate the best for
the functional changes of aging
1. Diminished respiratory efficiency and reduced
maximal inspiratory and expiratory force, lung
mass decreases, residual volume increase
v. Integumentary system
1. Epidermal proliferation decreases and dermis
becomes thinner
vi. Reproductive System
1. Decline in reproductive organs
2. Still can be sexually active
vii. Genitourinary system
1. Functions adequately except kidney mass
decreased
2. Decreased filtration rate, diminished tubular
function
viii. Gastrointestinal system
1. Ability to taste diminishes
2. Difficulty swallowing: dysphagia
ix. Nutritional health
1. Increasing age alters nutrient requirements
2. Goal of nutrition therapy: maintain or restore
maximal independent functioning and health
x. Sleep
1. Average of 7 hours of sleep, more time spent in
light sleep
xi. Musculoskeletal system
1. ADLs and IADLs
2. Alterations in bone remodeling, leading to
decreased bone density
3. Osteoporosis
xii. Nervous system
1. Homeostasis is difficult to maintain with aging
2. Nerve cells in the brain decrease
3. Older people take longer to respond
4. Advise older adults to allow a longer time to
respond
xiii. Sensory system
1. Sensory deprivation: absence of stimuli in the
environment or the inability to interpret
existing stimuli

III.

2. Vision: presbyopia
a. Macular degeneration doesn’t affect
peripheral vision
3. Hearing: presbycusis
4. Taste and smell
a. Sweet tastes are particularly dulled
c. Psychosocial aspects of aging
i. Ability to adapt to physical, social, and emotional
losses
ii. Ageism
iii. Stress and coping in the older adult
1. Impair physical function, activities, and
appearance
iv. Living arrangements
1. Living at home or with family
2. Continuing Care Retirement Communities
a. Independent single-dwelling
b. Assisted living- limited assistance
c. Skilled nursing service
3. Assisted living facilities
a. Minimal supervision or assistance
4. Long-term care facilities: offer continuous
nursing care
d. The role of the family
i. Planning for care and understanding the psychosocial
issues confronting older people
ii. Effective programs: 1. Psychoeducational skill
building 2. Cognitive behavioral therapy 3.
Combination of at least two approaches education,
family meetings, and skill building
e. Cognitive aspects of aging
i. Fluid intelligence- declines
ii. Crystallized intelligence- remains intact
f. Pharmacologic aspects of aging
i. Drug interactions and adverse effects
1. Polypharmacy
ii. Altered Pharmacokinetics
1. Alterations in absorption, metabolism,
distribution, and excretion
iii. Nursing implications
1. Start with a low dose, go slowly, keeping the
medication regimen simple
Mental health problems in the older adult
a. Depression: most common, sometimes confused for
dementia
b. Substance abuse: can be related to depression

IV.

c. Delirium
i. Stupor (hypoalert-hypoactive)
ii. Excessive activity (hyperalert-hyeractive): higher
mortality rate
d. Dementia
i. Alzheimer’s disease: gradual losses of cognitive
function
1. Patho: neuronal damage occurs in the cerebral
cortex, decreased brain size
2. Clinical manifestations: forgetfulness,
personality change, difficulty with everyday
activities
3. Assessment and Diagnostic Findings: autopsy
a. Diagnosis of exclusion
4. Medical management: manage the cognitive
and behavioral symptoms—CHOLINESTERASE
INHIBITORS
5. Nursing management: assess signs, promoting
patients safety
a. Supporting cognitive function: active
participation, physical activity and
communication
b. Promoting physical safety: remove all
obvious hazards
c. Promoting independence in self-care
activities: keeping activities simple
d. Reducing anxiety and agitation
e. Improving communication
f. Providing for socialization and intimacy
needs
g. Adequate nutrition
h. Promoting balanced activity and rest
i. Supporting home and community basedcare
ii. Vascular dementia: cerebrovascular disease
1. Multi-infarct dementia
Geriatric syndromes
a. Geriatric triad: cognitive status, falls, incontinence
b. Impaired mobility
c. Dizziness
d. Falls
e. Urinary incontinence
f. Increased susceptibility to infection
g. Atypical responses: not the same as peds or adults
h. Altered emotional impact
i. Altered systemic response: homeostasis is jeopardized

V.

VI.

Other aspects of health care of the older adult
a. Elder neglect and abuse
i. Neglect most common
b. Social services
i. Medicare, Medicaid, SSI
c. Health Care costs of aging
i. Medicare: federally funded
ii. Medicaid: administered by the state
d. Home health care
e. Hospice service
i. Supportive and palliative service: terminally ill
ii. 6 months to live
f. Aging with a disability
Ethical and legal issues affecting the older adult
a. Advanced directive, durable power of attorney
b. Nurses play an important role in supporting and informing
patients and families when making treatment decisions