Funda medications/surgical o Rome

procedure to cure the disease ▪ Transition from Pagan to

History of Nursing in Other Lands • *No mention of Christian Philo; Pagans =
Period of Intuitive Nursing Nurses materialistic/Christians =
• Untaught/Instinctive; performed out of o Egypt spiritual
compassion for others/ the wish to help others ▪ Embalming = Preservation of ▪ Maintained Vigorous Health
• Primitive Tribes --> Early Christian Era Remains --> Enhanced bc illness was weakness
• Beliefs and Practices of Pre-Historic Man Human Anatomy ▪ Care of the ill = Slaves or
o Nomadic; Best for most/Self- ▪ Recognized 250 Diseases; Greek Physicians; both had a
Preservation Mindset due to keen observation skill bad rep
o Nursing Belonged to Women; Care for ▪ Slaves + Family of Patient ▪ First Hospital in the Christian
the children, sick, and old Nursed the sick World = Fabiola, converted
o Illness from invasion of Evil Spirit thru ▪ *No mention of Nurses, chief nurse, + Marcella and
voodoo/black magic hospitals, hospital personnel; Paula
o Shaman/Witchdoctor can heal w/ white o Israel Period of Apprentice Nursing
magic: ▪ Moses = Father of Sanitation; • From the Crusades (First Religious Nursing
▪ Hypnosis 5 books of the Old Testament orders) to Establishment of the first nursing
▪ Charms ▪ Emphasized the importance school, Kaissesrwerth Institute for the Training of
▪ Dances of Hospitality toward Deaconesses
▪ Incantations strangers + Charity • Considered " OTJ Training Period"
▪ Purgatives ▪ Laws on Communicable • Nursing was done w/o formal edu; ppl directed by
▪ Massage Disease Spread + experienced nurses
▪ Fire Circumcision • Christian Church was Responsible for the
▪ Water ▪ Nurses = Midwives, Wet- development of this kind of nursing
▪ Herbs nurses, child's nurses -->
▪ *Trephining = Drilling a hole Compassionate + Tender acts • Crusades
in the skull w/o anesthetics -- Nursing in the Far East o Holy wars to recapture the holy land
> Drive Evil Spirits Out • China from the Turks; Military Religious
Nursing in the Near East o Belief in spirits + demons; practices orders Est hospitals staffed w/ men
• Beliefs and Practices such as giving male babies girl clothes o Military Religious Orders and Their
o Mode of Living from: Nomadic → to keep spirits away Works:
Agrarian (Farming) → Urban o Ancestor Worship + Prohibited Body ▪ Knights of St. John of
Community Dissection Jerusalem (ITA) = Devoted
o Develop Communication + Beginning o Material Medica = Pharmacology --> Religious life + nursing, Strict
of Scientific Knowledge Prescription and methods of treating Discipline, Organized Ranks
o Nursing Remained for Women/Slaves wounds, infections + muscle affections + Complete and
o Healthcare still related to religion, o Care of the sick done by Female Family Unquestioned Devotion to
superstition, magic, astrology, Members duty and superiors
numerology o *No mention of Nursing ▪ Teutonic Knights (GER) = Est
• Contributions to Nursing • India tent hospitals for wounded
o Babylonia o Men of Medicine built hospitals, ▪ Knights of St. Lazarus =
▪ Code of Hammurabi = Law practiced asepsis + proficient in Practice Nursing care of Lepers (ppl w/
that even covered medical of Medicine and surgery leprosy) after Christian
Practice o Sushrutu = listed functions + Takeover
▪ Med Regulations + Fees Qualifications of Nurses; Combo of
▪ Discouraged Experimentation Pharmacist, Masseur, PT, Cook ▪ Alexian Brothers = Est
▪ Recommended Specific Nursing in Ancient Greece Alexian Brothers Hospital
Doctors for Diseases o Nursing = task of untrained slave School of Nursing, Largest
▪ Patient Right to Choose o Caduceus = Symbol of Medicine Religious Nursing School,
Between, Charms, o Hippocrates = Father of Scientific only for men in the US
Medicine
• Rise of Secular Orders
o In Christianity, all men were equal, but
women were still wives and mothers.
Entering a convent granted the
possibility of careers, education, and
ability for acts of charity
o Religious Taboos + Social Restrictions
Affected Nursing:
▪ Poor Hospital Ventilation
▪ Dirty Beds
▪ Overcrowding (3-4 patients
on one bed)
▪ No Sanitation/Asepsis
o Older nuns prayed + cared for the sick;
younger ones washed the linens
o Secular Orders founded in this period
▪ Orders of St. Francis of Assisi
(1200-Present) = Devoted
lives to poverty + service to
the poor
▪ First Order = founded by st
Francis
▪ Second Order = St Clare of
Assisi
▪ Third/Tertiary Order = ▪
Members who devoted their
time to the communities +
nursing care in homes and
hospitals
o Beguines = Lay nurses who devoted
their lives to suffering humanity;
founded 1170 by Fr. Lambert Le begun
o Obviates (12th century)
o Benedictines
o Urusulines
o Augustinians
o Important Nursing Persons during this
Period
▪ St. Clare = 2nd order st
Francis; vows of poverty,
obedience, service, Chasity;
nursing care to the sick and
affected
▪ St. Elizabeth of Hungary =
Patroness of Nurses; used her
noble background to build
hospitals and care for the
poor, provided for orphans,
employed the unemployed to
provide for the poor
▪ St. Catharine of Sienna = First ▪ England = Hundreds of
Lady with the Lamp; 25th Hospitals Closed
child, pledged her life to • No Provisions for
service. was a hospital nurse, the sick
prophetess, preacher, • No Care for the sick
reformer of society ▪ Nursing Became the "Bad
Women" = Bribes from
• 16th Century Industrial + Political Revolution patients, stole food, alcohol as
halted nursing's progress tranquilizers
o Masses of people huddled in slums bc of • Worked 7 days
famine + Industrial jobs • Slept in a small
o In the slums, people sank to brutal and space near the
immoral lifestyles hospital
o Ambition for power + ward/patient
Antagonism/Hostility against one • Ate scraps of food
another --> Loss of empathy • As portrayed in
o Class lines could be bypassed in some Charles Dicken's,
areas, in others people fought against "Sairey Gamp or
one another for power, wealth, leisure Betsy Prig"
o Skepticism = result of political,
intellectual + ideological revolutions, o Leaders seeking reforms
everything in life based on fact ▪ John Howard = Prison
Reformer, improved prison
o Hospitals were established for the care conditions + prisoners hope
of the sack ▪ Mother Mary Aikenhand -
Gloomy Irish Sister of Charity,
▪ Cheerless brought nursing back to the
▪ Airless dedication during the early
▪ Unsanitary christen era
▪ Considered a "Last Resort" ▪ Pastor Theodore Fliedner +
▪ St. Vincent de Paul = Frederika Munster Fliedner =
Organized Le Charite + Institute for the training of
Community of the Sisters Deaconesses at
Charity --> Dedicated to Kaisserswerth, Ger; First
doing God's Work nurse training school
• Louise de Gras (nee • Requirements:
Marillac) first • Character
superior + co- Reference from
founder clergyman
• Dark Period of Nursing • Health Certificate
o 17th Century (Reformation) - 19th from a Physician
Century (US Civil War)
• Permission from
o Martin Luther = Religious upheaval
their nearest Male
destroyed unity within christens --> Relative
Schools, Orphanages, Hospitals swept
• Nursing in America
away
o Settlers seemed adventure, new
▪ Properties of Hospitals and
conquests + new trade routes
Schools were confiscated
o Miss Jeanne Mance = first laywomen
▪ Nurses fled for their lives
who worked as a nurse in NA, Founded
Hote Dieu of Montreal = Log Cabin
Hospital

o Pre-Civil War Nursing
▪ Protestant + Catholic Nursing
orders carried out nursing
▪ Augustinian Nuns, ursuline
Sisters, Deaconesses of
Kaisserwerth, Protestant
sisters of Charity + many
others helped found + Staff
hospitals
▪ Elizabeth Seton = Sisters of
charity of Emmitsburg, MD
1809
o American Reforms in Nursing
▪ Nurse Society of PA Est a 6-
moth course in nursing to inc
knowledge during practice
• Taught minimum
medial + surgical
nursing
• Material Medica
• Dietetics
o Nursing During the Civil War
▪ American Medical
Association --> Committee on
the Training of Nurses
• Study + make
Recommendations
w/ regards to nurse
training
• *Doctors Realized
the need for
qualified nurses
o Important PPL
▪ Dorothea Lynde Dix =
Superintendent of Female
Nurses in the US
Government, Directed the
nursing of the Injured
▪ Clara Barton = American Red
Cross Founder
Period of Educated Nursing
• Began on June 25, 1860 --> Florence Nightingale
School of Nursing Opened @ St. Thomas Hospital
in London
• Research on Yellow Fever dung Span-
Development of Nursing was influenced by trends
resulting from wars, arousal of social
consciousness, freedom of women + inc
educational opportunities for women
• Facts ab FN o Prep of a Standard Curriculum, based on
o Mother of Modern Nursing/Lady with Educ obj for schools of nursing
the Lamp bc of her work during o Edith Cavell = Mata Hari --> Served the
Crimean war wounded during WWI
o Born May 13, 1820; Florence ITA Period of Cotemporary Nursing
o Raised in ENG, silver spoon • From Post-WWII to Present
o Finished EDuc w/ continental tour
o Didn't conform w/ society, developed Events/Trends
her self-appointed goal, "to change the • Est of WHO by UN to help worldwide health
profile of nursing • Atomic Energy for Med Diagnosis
o Compiled notes of hospital visits + • Utilization of Computers, for collecting, teaching,
observations on sanitation and social establishing diagnosis, maintaining, inventory,
problems payrolls, recordkeeping, billing
o Noted the need for preventative • Spare Medicine --> Aero space nursing
medicine and good nursing o Col. Pearl Tucker = Dev. 1 yr course to
o Advocated care for those affected w/ prep aerospace nurses
disease caused by lack of hygienic • Health is a fundamental human right, law
practices legislated to prove such right
o @age 31 overcame fam pressure --> • Nursing involvement in Community health
Kaisserswerth
• Technology advances relieves the nurses of some
o Superintendent for Gentlewomen
of their duties (disposable supplies + equip)
during illness
• Development of the Expanded Role, formerly
o Disapproved w/ patient admission
belonging only to the physician
restrictions + considered the act
unchristen + incompatible w/ health care
History of Nursing in the Philippines
o Upgraded nursing practice + made it
o Early Beliefs and Practices
honorable
o Diseases were caused/cured by superstitions
o Put her ideas into two books, "Notes on
▪ Beliefs ab causation of disease
Nursing," and, "Notes on Hospitals"
▪ Another person (enemy or witch)
• Other Important Stuff/People ▪ Evil Spirits
o Linda Richards = First Graduate nurse
▪ Beliefs that evil spirits could be
in the US (Sept 1, 1873)
driven away by ppl w. power to
o Dr. William Halsted = Designed wear expel demons
Rubber Gloves ▪ Belief in special gods of healing,
o Caroline Hampton = First to wear
w/ priest-physician (word doctors)
rubber gloves in the OR
as intermediary
o Est of Nurse Orgs: ANA, National
• Herbolarios/Herb
League for Nursing Ed --> Uplifting of
doctors if the priest-
the nursing profession
physician used leaves or
o Isabel Hampton Robb = First Principle
roots
of Johns Hopkins Hospital School of
o Early Care of the sick
Nursing --> Most influential in directing
▪ Early Filipinos were superstitious
the development of nursing during this
in regards to health + sickness
period
▪ Hechicheros = Herban/One who
o Clara Louise Maas = Engaged in Med
practiced witchcraft
▪ Mangkikilam/Manggagaway =
Am War
cause disease on to people
o Development of: Private Duty Nursing,
▪ Pamaoo = Difficult
Settlement House Nursing, School
Childbirth/Some diseases; Caused
nursing Govt services of nurses, rental +
by, "Nonos"
maternal Health Nursing
▪ Midwives = assist during childbirth
o Age of Specialization
 • Mabuting Hilot = "Good
Midwife"; called in
during labor
• If difficult Childbirth,
Witches were the cause
o Gunpowder
was exploded
from bamboo
cane close to
the head of the
ppl suffering
from witches
o Healthcare During the Spanish Regime
o Religious orders-built hospitals in different
parts of the PH
Earliest Hospitals:
o Hospital Real de Manila (1577) = Est to care
for the Spanish King's Soldiers + Spanish
Civilians; Founded by Gov. Francisco de
Sande
o San Lazaro Hospital (1578) = Built
exclusively for patients with leprosy, run by
San Juan de Dios; Br. Juan Clemente
o Hospital de Indios (1585) = General Service,
Supported by alms/contributions from ppl;
Franciscan Order
o Hospital de Aguas Santas (1590) =
Convalescent Hospital in Laguna, named bc
it was near a spring; Br. J. Bautista of
Francian Order
o San Juan de Dios Hospital (1596) = General
Service, supported by alms/rents, run by San
Juan de Dios; Brotherhood of Misericordia
o Nursing During the Philippine Revolution
Prominent Persons:
o Josephine Bracken = Field Hospital in an
estate, provided nursing care to the wounded
day + night; Rizal wife
o Rosa Sevilla de Alvero = House converted
into Filipino soldier quarters during PH-US
war in 1899
o Dona Hilaria de Aguinalo = Organized PH
Red Cross, insp from Apolinaro Mabini
o Dona Maria Agoncillo de Aguinaldo =
Nursing care to PH soldiers during
revolution, President of PH Red Cross
o Melchora Aquino = Nursed wounded soldiers
+ shelter and food; Tandang Sora
o Captain Solomon = Nursing care to wounded
when not in combat; Leader in Nueva Ecija
o Agueda Kahabangan = Nursing Service to
her Troops; Leader in Laguna
o Trinidad Texson = "Ina ng Biac na bato";
cared for wounded soldiers in a hospital @
Biac na bato
o Filipino Red Cross
▪ Malolos = HQ Location
▪ Est. Branches in Provinces
▪ Functions:
• Collection of War Funds
+ Materials thru
concerts, charity bazaars
and voluntary
contributions
• Provision of Nursing
care to wounded PH
soldiers
▪ Membership Requirements
• >14yrs old
• Officers >25yrs
Hospitals and Schools of Nursing
o Iloilo Mission Hospital School of Nursing (Iloilo,
1906)
o Baptist Foreign Mission Society of America
o St. Paul's Hospital School of Nursing (Manila, 1907)
o Archbishop of Manila, in Intramuros
o General Service
o Free Dispensary + Dental Clinic
o Philippine General Hospital School of Nursing (1907)
o Was a Small dispensary for civil officers and
employees
o Mary Coleman Marsters = Advocated for the
idea of training Filipino women for nursing
o Following year, Gov. Gen. Forbes + Director
of Health supported the opening of classes
o Act #1975 put the school directly under the
DOH, given its current name
o Elsie McCloseky-Gatches = Chief nurse that
introduced several improvements in the
school
o Course was more attractive and practical
o St. Luke's Hospital School of Nursing (QC, 1907)
o Episcopalian Institution
o Started as small dispensary, school opened
3yrs later
o Classes were combined w/ Phil Gen Hosp and St Paul’s
SON,
o Vitalinana Beltran = First Filipino Superintendent
o Jose Flores = First Filipino Med Director
o Central School Idea
o Shared Curriculum between St Paul's,
PhilGen, and St. Luke's SON
o Application Reqs
▪ Completion of Grade 7
▪ Sound Physical + Mental Health
▪ Good Moral character
▪ Good Family and Social Standing
▪ Recs from 3 different people, well
known in the community
o Students from the schools would be fused
into one class
▪ Live in the same dorm
▪ Same instruction in:
▪ Anaphy
▪ Massage
▪ Practical Nursing
▪ Material Medica
▪ Bacteriology
▪ English
o Mary Johnston Hospital and School of Nursing
(Manila, 1907)
o Was a small dispensary, funded by Methodist
mission for the relief of the suffering among
women and children?
o Sr. Rebecca Parrish + some RNs -->
Organization of Mary Johnston School of
Nursing
o 1911 Cholera Epidemic --> Philippine
Assembly 500P monthly appreciation
o 11000P for a maternity + milk station, and
dispensary
o WWII --> Emergency Hospital even during
Jap occupation
o Philippine Christian Mission Institute SON
o United Christian Missionary Society of
Indianapolis of the disciples of Christ --> 3
SON
o Sallie Lonog Read Memorial Hospital SON
(Ilocos Norte, 1903)
o Mary Chiles SON (Manila, 1911)
o Started in a small house in Manila
o Frank Dunn Memorial Hospital (Iloccos Sur,
1912)
o San Juan de Dios Hospital SON (Manila, 1913)
o Benito Valdez pushed for the opening of a
school of nursing
o Run by the Daughters of Charity; Sis Taciana
Trinanes was the first directress of the school
 o Reforms by Gregorio Singian
▪ First 6 months = trial periods; fail
in 2-3 subjects --> kicked
▪ Separate building for library
▪ Kitchen Constructed for Dietary
Chemistry
▪ Lab classes for bacteriology +
chem
▪ Anatomic charts + specimens for
Experiments were acquired
▪ A new spacious dormitory for
students + nurses built
o 1945, Battle in Intramuros destroyed the
hospital
o Emmanuel Hospital SON (Capiz 1913)
o American Baptist Foreign Mission Society
Opened the Hospital
o 3yr training course for 100p a year
o Southern Islands Hospital SON (Cebu, 1918)
o Hosp Est 1911 from the Bauru of health
o Anastacia Giron Tupaz Organizer
o Vistitacion Perez First Principle
o Other SON
o Zamboanga Gen Hosp SON (1921)
o Chinese Gen Hosp SON (1921)
o Bagio Gen Hosp SON (1923)
o Manila Sanitariuum + Hospital SON (1930)
o St. Paul's SON Iloilo (1946)
o North Gen HOsp + SON (1946)
o Siliman Uni SON (1947)
First Colleges of Nursing
▪ UST CON (1946)
o Originally a SON
o Separate Entity from UST Hospital
o Course was to follow the latest +
most modern advances in nursing
▪ Along w/ Christian
Charity
o 1947 --> Bureau of Private Schools
gave UST the title of Graduate
nursing
▪ !948 --> BSN was
available
▪ UP CON (1948)
o Julita Sotejo + UP Prez Gonzalez =
Conference led to CON
o 1948 --> Counsel approved the
Curriculum
▪ Nursing had Equal
Standing to: Medicine,
Law, Engineering
o Manila Central Uni CON (1947)
▪ MCU Hospital was
clinical field for practice
▪ Nursing Leaders in the PH
o Anastacia Giron Tupas = first
Chief Nurse and Superintendent of
the PH Gen Hosp + Founder of PH
Nurse's Assoc
o Cesarea Tan = First PH Nurse to
get a degree abroad
o Socorro Sirilan = Chief Nurse in
San LAz
o Rosa Militar = Pioneer in School
Health Ed
o Sor Ricarda Mendoza = Pioneer in
Nursing Edu
o Socorro Diaz = First Editor of PNA
Magazine, "Message"
o Conchita Ruiz = First Full time
editor or new PNA Magazine, "The
Filipino Nurse"
o Loreto Tupaz = "Dean of
Philippine Nursing"; Florence
Nightingale of Iloilo
▪ Health and Nursing ORgs
o Early Institutions of child welfare
▪ Hospicio de San Jose
(Manila 1782)
▪ Asylum of San Jose
(Cebu)
▪ Asylum of Looban
(Manila)
▪ Colegio de Santa ISabel
(Naga)
o Gota de Leche (Manila 1907) =
milk station, promote health in
infants thru proper feeding
o Liga Nacional Filipina para la
proteccion dela primera infancia =
passage of child welfare
legislations
o Public Welfare Board = took over
Liga work in 1915, systematic
campaign on child hygiene in 1917
o Philippine Nurse's Assoc - national
org of Filipino nurses
o National League of Nurses = Assoc
of nurses employed by DOH
o Catholic Nurse's Guild of the PH
Nursing = Nutrix --> to nourish
▪ Nightingale (Enviro)= "An act of utilizing the
enviro of the patient to assist him in his
Recovery"
▪ Henderson (Unaided) = "Assist Individual
gradually step by step"
▪ Orem (self-care def) = "Provide assistance
based on known needs"
▪ ANA (2003) = "Protection, Promotion,
Optimization of health and abilities,
prevention of illness and injury"
Nursing as an Art and Science
▪ Art = care is delivered carefully thru skills
o Requires Proficiency + Dexterity
o Compassion, Caring and Respect
for Client's dignity and personhood
▪ Science = Nursing is based on a body of
knowledge
o Changes with new discoveries and
innovations
▪ Nursing is = caring, art, science, holistic and
helping profession
o Adaptive
o Concerned w/
▪ Health Promotion
▪ Health Maintenance
▪ Health Restoration
Scope of Nursing
▪ Promote Health and wellness
o Engages in activates + Behaviors
that enhance quality of life
▪ Preventing illness
o Maintain optimal health by
preventing diseases
▪ Restoring Health
o Focus on ill clients; from early
signs to recovery
▪ Caring for the Dying
o Comforting and caring for people
of all ages
o Helping clients live comfortably
till death
o Supporting people cope w/ death
Concepts of Nursing in the past and present
▪ Past
o Care of the ill
o Focus on Physical/Curative aspect
o Dependent on Doc Function
o Focused on disease condition not
patient
o Hospital Centered
▪ Present
o Includes sick and healthy
o Holistic nature of the individual
o Focus on Preventative and
Promotive functions
o Expanding and changing role
o Specialized task
o Increasing responsibilities from the
Physician
o Close + Personal contact w/ the
recipient of care
o Conducts research to improve
nursing prac
▪ Profession
o Occupation that requires special
knowledge + skills thru training
and/or Experience
▪ To guide/server others in
that field
o Primary Characteristics of a
Profession
▪ Basic liberal foundation
+ ext. education
▪ Theoretical body of
knowledge --> defined
skills, abilities + norms
▪ Specific Service
▪ Members have
autonomy
▪ Code of Ethics
o Professional Nursing
▪ Art and Science w/ an
idea of service
▪ Principles are applied in
skillful care of the wall
and sick thru a good
nurse/patient relation +
HC team
o Professional Nurse
▪ Licensed nurse w. a body
of nursing knowledge +
skill from formal
education
▪ Utilizes sound
judgement + critical
thinking and research
when giving care to
clients
Nursing Functions
▪ Independent Function (Caring)
o Nurse initiates themselves
o Requires nurse's
judgment/decision making
▪ Dependent Function (Curing)
o Needs someone else's orders
▪ Interdependent Function
o Actions that need the nurse and
healthcare team
o Collaborative
Roles + Functions of Nurses
▪ Caregiver/Care Provider = Physical Care
▪ Patient Advocate = Works on behalf of the
client
o Values Basic to Advocacy
▪ Client is Holistic,
autonomous being, has
the right to make choices
+ decisions
▪ Clients expect that
nurse/client relationship
is based on shared
respect, trust
collaboration
▪ Nurse resp to ensure the
client has access to HC
services
o Effective Client Advocates
▪ Assertive
▪ Recognize the rights and
values of clients +
families, which take
precedence when they
conflict w/ healthcare
providers
▪ Aware that conflicts may
arise over issues
▪ Works with community
agencies + lay PR
actioners
▪ Knows advocacy may
require political action
▪ Teacher = Health teaching
o Health Promotion
o Disease Prevention
o Rehab
▪ Counselor = Helps the client become aware
of his feelings + helps them deal w/ feelings
in a constructive manner
▪ Role Model = Knows + Practices proper
Health/Wellness in daily living
▪ Coordinator/Collaborator = Works in a
combined effort w/ Healthcare Team
▪ Leader = Influence the client to make
decisions in achieving goals
▪ Clinician = Technical expertise to recognize
clues + modify nursing care according to
needs
▪ Manager = Plans, Develops Staff, Monitors
Operations
▪ Change Agent = Initiates changes and
Modifies Behavior
▪ Researcher = Scientific Investigation +
Research
Expanded Career Roles of a Nurse
▪ Nurse PR actioner
o Additional Education
o Non-emergency/Acute or Chronic
illnesses
▪ Clinical Nurse Specialist
o Additional Educ
o Provides direct care, educates
others, manages care
▪ Nurse Anesthetist
o Additional educ
o Responsibilities:
▪ Pre-Operation visits +
Assessments
▪ Administers General
Anesthetics for Surgery;
under supervision by
anesthesiologist
▪ Asses Post-Operative
Patients
▪ Nurse Midwife
o Add. Educ
o Responsibilities:
▪ Prenatal and Post Marital
Care
▪ Manages Delivers in
Normal Pregnancies
▪ Conducts routine pap's
smear
▪ Family Planning
▪ Breast Examination
▪ Nurse Researcher
o Add. Educ
o Investigates a nursing problem to
improve care and to refine nursing
knowledge
o Employed in academic institutions,
teaching hospitals, research centers
 ▪ Nurse Administrator o Chronic
o Manages client care including the Maslow's Hierarchy ▪ Extended Period (6
delivery of nursing service ▪ Self-Actualization = Reaching one's potential months or longer)
o Responsibilities: ▪ Self-Esteem = Respect, Status, Strength, ▪ Periods of Remission/
▪ Budgeting Freedom Exacerbation?
▪ Staffing ▪ Love and Belonging = Friendship, ▪ Disease
▪ Planning Program Relationship [ o Alteration in body functions
▪ Nurse Educator ▪ Safety Needs = Personal Safety/Security resulting in a reduction of
o Employed in Nursing programs, ▪ Physiological Needs = Basic Needs capacities or shortening of normal
schools, hospital staff education (Deficiency Needs) life span
o Expertise in a particular area of Concepts
practice ▪ Health o Common Causes of Disease
o Resp: o State of being wellbeing, and the ▪ Biological Agents
▪ Classroom / Clinical use of every power to the ▪ Inherited Genetic
Teachings individual possesses to the fullest Defects
▪ Nurse Entrepreneur extent (Nightingale) ▪ Developmental Defects
o Add Educ o State of complete, physical, ▪ Physical Agents
o Manages Health Related Business mental, and social wellbeing, and ▪ Chemical Agents
o Involved in not merely the absence of disease ▪ Tissue Response to
▪ Education or infirmity (WHO) irritation/Injury
▪ Consultation o Dynamic state in which the ▪ Faulty
▪ Research development, and behavioral Chemical/Metabolic
Human Needs potential of an individual is Process
▪ 4 Major Attributes realized to the fullest extent (ANA) ▪ Emotional/Physical
o Capacity to Think/Conceptualize o Freedom of signs of disease, and reaction to stress
o Family Formation pain as much as possible. Being in ▪ Sickness
o Tendency to Seek, and Maintain good spirits most of the time (Lay o Status or Social entity associated
o Has the Ability to use Verbal Def) w/ disease or illness
Symbols/Language + Means of ▪ Wellness
Developing and Maintaining o An integrated method of o Factors influencing Health
Culture functioning oriented towards ▪ Developmental Status
Concepts of Man maximizing the potentials of an ▪ Social + Cultural
▪ Biopsychosocial + Spiritual beings who are individual within the environment, Influences
in constant contact w the environment where he is functioning (Dunn) ▪ Previous Experiences
o Biologic Being = Man is like other o A Subjective perception of ▪ Expectations of Self
Men balanced harmony, and vitality ▪ Perceptions of Self
o Psychological Being = Man is like (Ledy & Pepper) Models of Health
No Other Men ▪ Illness ▪ Leavell + Clark Model
o Socializing Being = Man is like o Personal state in which the person's o Triangle w Agent, Enviro, Host
Some Other Men physical, emotional, intellectual,
o Spiritual Being = Man is like All social, developmental, spiritual o Agent = Enviro factors/stressors
other Men functioning is thought to be that by presence/absence can lead
Needs diminished to disease
▪ Universal o Disturbance in Normal o Host = Person who may/may not be
▪ Met in Different Ways Functioning @ risk for obtaining a disease
▪ Stimulated by Different Internal and External o Environment = Physical + Social
Factors Factors external to the host -->
▪ May be altered by Individual Properties predisposition to development of
▪ May be Differed Classification of Illness Disease
▪ May be Interrelated o Acute
▪ *An unmet human need leads to illness and ▪ Severe Symptoms o Predicts Illnesses
disease ▪ Short Time Period o Health = Ever changing state

▪ Dunn's High-Level Wellness (Graph @
Origin)
o Health Axis = Horizontal
o Environmental Axis = Vertical
o Q1 = High Level Wellness
▪ Healthy Lifestyle w
resources to support
o Q2 = Protected Poor Health
▪ Good Enviro protects
individual from their
poor habits
o Q3 = Poor Health
▪ Needs are met by
Healthcare System
o Q4 = Emergent High-Level
Wellness
▪ Knowledge in Lifestyle,
but cannot implement bc
of factors
▪ Travis Illness-Wellness
o 2 Way arrow w Premature Death
on the Left-Most, and High-Level
Wellness on the Right-Most
o Neutral Point @ Middle of the 2-
way arrow
o Letters along the arrow
▪ D = Disability
▪ Sx = Symptoms
▪ S = Signs
▪ *Neutral Point
▪ A = Awareness
▪ E = Education
▪ G = Growth
o Treatment Model: From D --> S
o Wellness Model: D --> G
▪ Rosenstoch-Becker's Health Belief Model
o Individual Perceptions <-->
Modifying Factors --> Likelihood
of Action
o Originally intended to predict
which people would/would not use
preventive health services
o Based on Motivational Theory
▪ (Rosenstock) = Good
health is Objective and
Common to all people
▪ (Becker) = Consider o Nurse's Role in Health Promotion
Positive Health ▪ Model Healthy Lifestyle
Motivation ▪ Facilitate Client
Involvement
Individual Perceptions ▪ Teach Self-Care
o Previewed Susceptibility Strategies
o Previewed Seriousness ▪ Assist Clients to Increase
o Previewed Threat Levels of Health
▪ Educate Clients to be
Variables Influencing Effective Healthcare
o Internal Variables Consumers
▪ Biologic Dimensions ▪ Assist Clients to
▪ Developmental Level Develop + Choose
▪ Genetic Make-up Health Promoting
o Psychologic Dimensions Options
▪ Mind-Body interactions ▪ Guide Development of
▪ Self-Concept Effective Problem-
o Cognitive Dimensions Solving + Decision-
▪ Life-Style Choices Making
▪ Spiritual and Religious ▪ Reinforce Client's
Beliefs Personal + Family
o External Variables Health-Promoting
▪ Family Practices Behaviors
▪ Socio-Economic Factors ▪ Advocate in the
▪ Cultural Background community for changes
that promote a Healthy
▪ Health Promotion Model (Pender) Enviro
o Not Disease Oriented
o Motivated by personal, positive ▪ Other Health Models
approach to wellness o Holistic Health Model
o Seeks to expand positive potential ▪ Promotes active indolent
for health of the client in the
improvement +
Variables maintenance of his
o Individual characteristics health
▪ Prior related behaviors o Clinical Model
▪ Personal Factors ▪ People a physiologic
o Behavior-Specific Cognitions and systems w/ related
Affect functions
▪ Perceived Benefits of ▪ Health = absence of
Action Signs and Symps
▪ Perceived Benefits to
Action o Role Performance Model
▪ Perceived Self-Efficacy ▪ Health = Ability to fulfill
▪ Activity-Related Affect societal roles
▪ Interpersonal Factors o Adaptive Model
▪ Situational Influences ▪ Disease = Failure in
▪ Commitment to plan of adaption/maladaptive
Action behaviors
▪ Immediate competing ▪ Treatment = restore the
demands and preferences ability to adapt/cope
▪ Behavioral Outcome
 o Eudemonistic Model o Termination = Convinced Health
▪ Health = problem is no longer a threat
Actualization/Realizatio
n of one's potential Stages of Illness Behavior Epidemiologic/Ecologic Triad
▪ Symptom Experience --> Awareness of ▪ Triangle: Agent, Host, Environment
Levels of Prevention illness Stages of Infectious Process
▪ Primary o Self-Diagnosis ▪ Incubation --> Interval between initial
o Health Promotion Programs o Self-Treatment infection + First Sing/symp
o Specific Protection ▪ Assumption of Sick Role o Duration depends on
▪ Secondary o Sick Leave ▪ Specific microorganism
o Early Diagnosis + Prompt o Free from Social Obligations ▪ virulence
Treatment ▪ Medical Care Contact ▪ # of infecting
o Disability Limitations o Consultation microorganisms
▪ Tertiary o Medical Shopping ▪ Resistance of host
o Restoration + Rehabilitation ▪ Dependent Client Role (Sick Role) ▪ Prodromal
o Self-Care Deficit o Relatively short period that follows
Factors that cause illness o Recovery/Rehabilitation incubation
▪ Etiologic Factors o Restoration o Early, mild symptoms of diseases,
o Cause of a particular disease o Relinquishes the Sick Role such as headaches, malaise
▪ Predisposing Factors (weakness)
o Previous Condition that influence Impact of Illness on the Client and Family ▪ Illness Period
susceptibility or tendency to illness ▪ Behavioral + Emotional Changes o Disease is most acute
▪ Contributory Factors ▪ Impact on Body Image o person exhibits overt signs of
o Condition that helps bring about ▪ Impact on Self-Concept symptoms
illness ▪ Impact on Family Roles o patient's immune resp + other def
▪ Precipitating Factors ▪ Impact on Family Dynamics mech overcome the pathogen -->
o Condition that hastens, activates, end of period (*Decline)
or aggravates the illness Prevention of transfer of Microorganisms o Patient will die if disease is not
▪ Risk Factors Importance of biologic safety overcome;
o Any Situation, habit, social, or ▪ Microorganisms are naturally present in the ▪ Sepsis = incorrect body
environmental / physiological environment. Some are beneficial and some response to chemicals
condition, developmental, aren’t. released to fight
intellectual, spiritual variables that ▪ Some are harmless to most and others are infection; harmful to
increase the vulnerability of an harmful to many. Others are harmless except organs
individual to an illness or accident in certain cases ▪ Convalescence
▪ Genetic + Physiological Terms o Person regains strength + body
Factors ▪ infection = successful entry + multiplication returns to pre-diseased state
▪ Age into the body o recovery has occurred
▪ Environment ▪ disease = abnormal functioning of the tissue Chain of Transmission/Infectious Cycle
▪ Lifestyle Types of infection ▪ Cycle: Agent, Reservoir, Portal of Exit, MOT,
▪ Nosocomial → Hospital Acquired Infection Portal of Entry, Susceptible Host, Agent; Start
Stages of Health Behavior Change (HAI) again
▪ Stages ▪ iatrogenic → innate ▪ Agent
o Pre-contemplation = No Change o from endogenous or exogenous o Bacteria, Viruses, Fungi, Protozoa
o Contemplation = Considers sources --> external sources o Factors affecting microorganism’s
Change o subclinical/asymptomatic --> no capability to cause disease
o Preparation = Plans to Change manifestation ▪ # of organisms
o Action = Changes in ▪ infectious disease ▪ virulence
Actions/Behaviors o non-communicable → Spread from ▪ ability to enter and survive
o Maintenance = Changes in actions person to person ▪ Susceptibility/resistance of
become habit o communicable → Spread by host
Agents
▪ Reservoir
o Environment, area, body where the
pathogenic organism is found,
dependent for survival,
o may or may not multiply
o Common Reservoirs
▪ Human - frank cases,
subclically infected, carrier
▪ Animals
▪ Plants
▪ Soil
▪ Fomites
▪ Portal of Exits
o Respiratory Tract
▪ Exhalation, Coughing
o Gastro-Intestinal Tract
▪ Vomiting, Defecation
▪ *Cleaning of Patient's butt +
anus to prevent moisture for
reservoir
o Genito-Urinary
▪ Voiding, Sex
o Wounds
▪ Boils, Scabies
o Mechanical Escape
▪ I&D (initial + Drainage),
needle aspiration, bites/sting
▪ Method of Transmission
o Direct
▪ Droplet (<3ft) l touching,
biting, kissing, sex (NCorV)
o Indirect
▪ Vehicles of Transmission;
vectors
o Airborne
▪ (>3ft); dust particles; droplet
nuclei (TB)
▪ Portal of Entry
o Respiratory
▪ Inhalation
o Gastro-Intestinal Tract
▪ Ingestion
o Genito-Urinary
▪ Sex
o Skin
▪ Needle prick, body piercing
o Blood
▪ Blood Transfusion, Sharing
Needles
o Placental Entry
▪ Microorg crosses placenta
into baby
▪ Susceptible Host
o Factors Influencing Susceptibility of the
Host
▪ Age
▪ Nutrition
▪ Stress
▪ Disease process
▪ Medical Therapy
▪ Body's Defense Against Infection
o Non-specific Defenses
▪ Anatomic + Psychologic
barriers
▪ Inflammatory Response
o Specific Defenses
▪ Immune System
• Humoral Immunity
• Cell-mediated
Defenses
▪ Immunity
o Natural
o Acquired
▪ Natural
• Active
Exposure/Experien
ce
• Passive-
Placental/Breastfee
ding
▪ Artificial
• Active = Antigens
(Vaccines/toxoid)
• Passive = Antibody
(ATS, HRIG)
Chain of Infection
▪ Can be Broken in-between pieces
o Infectious Agent + Reservoir -->
Antibiotics
o Reservoir + POEx --> Transmission
based precautions/ Sterilization
o POEx + MOT --> Hand Hygiene
o MOT + POE --> Hand Hygiene
o POE + Suspectable Host --> Hand
Hygiene
o Suspectable Host + Infectious Agent -->
Immunizations
Breaking the Chain of Infection
▪ Isolation
o Separation of the infected person based
on the longest period of
communicability of the disease
o CDC Isolation Precautions Cont. Later
▪ Cleaning
o Steps that ensure cleanliness of an
object
▪ Rinse a contaminated object
or article with cold running
water to remove organic
material
▪ After rinsing, wash the object
w soap and warm water. Rinse
thoroughly
▪ Use a brush to remove dirt, or
material in grooves or seams
▪ Dry the Obj + Prep for
disinfection or sterilization, as
indicated by the intended use
of the item
▪ Brush, gloves, sink where the
equipment is cleaned should
be considered contaminated
= and should be cleaned and
dried
▪ Disinfection
o `Methods
▪ Concurrent
• Currently ill patient
▪ Terminal
• something w death
o Agents Used
▪ Antiseptics (Alcohol,
Betadine)
▪ Disinfectants (Lysol, Purex,
Cidex)
o Moist heat
▪ Boiling
▪ most practical + inexpensive
▪ 15 min after boiling
▪ sharp instruments not boiled
▪ does not destroy spores
o Sterilization
Physical (heat, radiation)
▪ Heat (dry)
• Destroys Germs via
Oxidation
• Can be done @
home
 • Disadv: Not able to o All body fluids, excretions, secretions; o Used for clients suspected or known to have
penetrate certain except sweat serious illnesses transmitted by airborne
areas o non-intact skin droplet nuclei smaller than 5 microns
▪ Heat (moist) o mucus membranes
• Autoclaving Practices Practices
• Most dependable ▪ wash hands immediately after removing gloves o place client in a private room that has
and practical o use non-antimicrobial soap for hand negative air pressure
• Supplies steam washing o if private room is not available, place client
under pressure of o use antimicrobial agent or an antiseptic with another client who is infected with the
15-17 lbs/sqin & agent for the control of specific same microorganism
Temp 121-123C outbakes of the infection o Wear N95 when entering the rom of client
o Radiation ▪ Wear Clean gloves when touching blood, body who is known or suspected of having primary
▪ Ionizing = Short Wavelength, fluids, secretions, excretions, contaminated items TB
High energy; can penetrate + o Clean gloves can be unsterile, unless use o Susceptible people should not enter the room
kill deep microbes is intended to prevent entrance of of a client who has rubeola (measles) or
▪ Non-Ionizing = Longer microorganisms into body Varicella (chicken pox). If they must enter,
wavelength w/ lower energy o Remove gloves before touching non- they must wear a respirator
to kill microorganisms (UV) contaminated objects items + surfaces o Limit movement of client outside the room to
• For Surface o Wash hands after removing gloves essential purposes. Place surgical mask
Sterilization ▪ Wear a mask, eye protection, face shield if Droplet precaution
Chemicals splashes or sprays of blood, body fluids, ▪ Used for clients suspected or known to have serious
▪ Ethylene oxide gas secretions, or excretions can be expected illnesses transmitted by airborne diseases transmitted
o Fumigation ▪ Wear a clean, non-sterile gown if patient care is by particle droplets larger than 5 microns
o Fogging of Patient's Room + Some likely to result in splashes or sprays of blood body
Rubber/Plastic Materials fluids, secretions, or exertions. how is intended to Practices
▪ Phenolic Compounds protect clothing o Client in private room
o Housekeeping Disinfectant o remove soiled gown carefully to avoid o Private room is not available, place client w
▪ Chlorine Compounds transfer of microorganisms to theirs another client who is infected w the same
o Housekeeping + Water Disinfectant o wash hands after removing gown microorganism
(Chlorox) ▪ Handle client care equipment that is solid with o Wear a mask if working within 3 feet of client
▪ Iodine compounds blood, body fluids, secretions, or exertions o Limit movement of client outside the room to
o Effective Bactericides commonly used carefully essential purposes. Place a surgical mask on
as antiseptics; can stain articles o make sure reusable equipment is the client during transport
(Betadine) cleaned and reprocessed correctly Contact precaution
▪ Glutaraldehyde o dispose of single0use equipment ▪ used for clients suspected or known to have serious
o Bactericides + Disinfectant (Cidex) correctly illnesses easily transmitted by direct client contact or by
▪ Alcohols ▪ Handle, transport, process linen that is soiled w/ contact w items in the client's environment
o Antiseptics + Disinfectants blood, body fluids, secretions, or excretions in a
▪ Quaternary Ammonium Compounds manner to prevent contamination of clothing and Practices
o Disinfectants + Antiseptics (Zephiran the transfer of microorganisms to other and the o Client in private room
Chloride) environment o if no private room available, place client with
▪ Prevent injuries from uses scalpels, needles, or another client who is infected w the same
CDC Isolation Precautions (Isolation) other equipment, and place in puncture-resistant microorganism
Standard Precautions (Isolation) containers o wear gloves as described in standard
▪ All hospitalized persons regardless of their precautions
diagnosis or probable infection status ▪ change gloves after contact w
▪ Designed to reduce risk of transmission of infectious material
microorganisms from recognized + unrecognized Transmission-based Precaution (Isolation) ▪ remove gloves before leaving
sources ▪ used in addition to standard precautions, for clients w/ client's room
▪ applies to: known or suspected infections ▪ wash hands immediately after
o Blood removing gloves. use antimicrobial
Airborne precaution agent
 ▪ after hand washing, do not touch ▪ once a sterile tray has been opened o Expected standards of behavior of a
possibly contaminated surfaces or articles from tray should not be particular group’s formal code of
items in the room returned professional ethics
o Wear gown when entering a room o A sterile area or object becomes
▪ remove gown in client's room contaminated when a sterile object comes in o Code of Ethics
▪ make sure uniform does not contact contact with a wet surface thru capillary ▪ Formal Statnett of the group’s
possible contaminated surfaces action ideals and values
o Limit movement of client outside the room ▪ a sterile moisture-proof material ▪ Set of ethical principles that:
o Dedicate the use of noncritical client care will serve as a barrier between an • Is shared by
equipment to a single client or to clients unsterile surface members of the
infected with the same infecting ▪ if a moisture-proof wrapper or group
microorganisms barrier becomes damp, micro- • Redefects their
organisms can enter moral judgment
Asepsis ▪ Replace sterile linen covers, when over time
▪ Surgical/sterile technique (hands up) they become moist and no barrier is • Serves as a standard
▪ Medical/Clean technique (hands down) present for their profess-
o Handwashing o A sterile are or object becomes contained sional actions
o Concurrent Disinfection when gravity causes contaminated liquid to ▪ Morality (Moralis)
o Personal Protective Equips (PPEs) flow to a sterile area o Private, personal standards of what is
o Barriers cards/placards ▪ when doing surgical scrub, hold right and wrong in conduce, character,
o N95 hands above elbow level to keep and attitude
▪ Principles of Surgical Asepsis water on arms from flowing back o Moral Principles
o A Sterile area or object remains sterile when over clean hands ▪ Autonomy
touched by another sterile object ▪ Keep tip of transfer forcep4s • Right to make one’s
▪ use sterile forceps/wear sterile pointed down own decisions
loves to handle articles on a sterile ▪ Procedures ▪ Nonmaleficeince
tray o Handwashing • Do no Harm
▪ touch a sterile surface only with ▪ before/after any procedure w • Intentional/
another sterile object patient contact unintentional
o A Sterile area or object becomes ▪ done after removing the gloves ▪ Beneficence
contaminated when touched by an un-sterile ▪ remove jewelries
• Do Gooding
object ▪ apply friction paying attention to ▪ Justice
▪ When the edge or rim of a sterile interdigit and surfaces under the ▪ Fidelity
area is adjacent to or in contact nails
• Faithful to
with an unsterile surface, consider ▪ flow of water when rinsing is from
agreements +
the rim/edge as contaminated elbow own to the fingertips
promises
▪ If there is a break or a tear on the o Surgical Aseptic
▪ Veracity
cover of a sterile object, consider ▪ Handling pick up forceps
the contents contaminated ▪ preparing/opening a sterile field • Truth-Telling
o Always keep the sterile area and sterile ▪ opening a sterile pack ▪ Accountability
objects in view ▪ transferring objects to a sterile field • Answerable to
▪ Keep sterile objects above waist pouring solution into a sterile one’s own actions
level to inc container and to one’s self
▪ A Sterile obj or field out of range ▪ putting on gloves ▪ Responsibility
of vision of held below the waist Ethico-Moral + Legal Responsibilities in Nursing • Accountability/
line is contaminated ▪ Ethics liability associated
o A sterile obj or area becomes contaminated o Method of inquiry that assists people to with the
by prolonged exposure to air understand the morality of human performance of
▪ keep air currents at a minimum by behavior duties/particular
avoiding any o Beliefs and practices of a certain group role
▪ avoid laughing, sneezing, talking,
over sterile field
 ▪ Legal Concepts o Unconscious Persons ▪ Malpractice
o Laws ▪ Except in Life-Threatening • Act of negligence
▪ Sum total of rules and Situations by a professional
regulations by which a society • Any professional
is governed o *Nurse is NOT Responsible for misconduct/
▪ Created by the people for the explaining the procedure, but for unreasonable lack
people Witnessing the signature of professional
o Types of Laws ▪ Sexual Harassment skills
▪ Public = law that deals w/ o Violation of the Individual’s Rights + Legal Protection in Nursing Practice
relationships between Form of Discrimination ▪ Providing competent Nursing Care
individuals, government, and o Include: ▪ Record Keeping (Charting)
government agencies ▪ Unwelcome Sexual Advances o Legal documentation → Entries must be
• Ex. Criminal Law ▪ Requests for Sexual Favors accurate
▪ Private/Civil Law = Law that ▪ Other Verbal or Physical ▪ Incident Report
deals w/ relationships among Conduct of a Sexual Nature o However Small (Ex. Raising Side Rails)
individuals Civil and Common Law Issues in Nursing Practice ▪ Carrying-Out a doctor’s order
• Ex. Tort Law ▪ Crimes o Seek clarification of ambiguous/
(duties + rights o Crime = Act committed in violation of unreasonable orders
outside of contract) public law and punishable by a fine or ▪ Good Samaritan Acts
• Ex. Contract Law imprisonment o Laws designed to protect those who give
(Agreements ▪ Felony = serious crime assistance @ the scene of an emergency,
between people) ▪ Misdemeanor = offense of against claims of mal practice
less serious nature
Selected Legal Aspects of Nursing Practice • Fine/ short- term
▪ Informed Consent jail time
o Agreement by a client to accept a course o Torts Stress, Adaptation, Homeostasis, Physiologic Responses to
of treatment or a procedure after being ▪ Civil wrong made against a stress + Illness
provided complete Information person or property
• Intentional or Stress
General Guidelines for Obtaining Unintentional ▪ Modern Stress Theory (Hans Seyle)
Informed consent Intentional o Nonspecific response of the body to any
o Purpose of Treatment ▪ Assault demand made upon it
o Client expectations/experience during • Threat o Stress is not a Nervous energy
treatment ▪ Battery ▪ it’s a Psycho-Physiologic
o Intended Benefits • Touching w/o Response
o Possible risk/negative outcomes consent ▪ Psychologic = anxiety fear
o Advantages/Disadvantages of ▪ Fraud ▪ Physiologic = fever,
Alternatives ▪ Privacy Invasion inflammation
▪ Defamation of Character ▪ Man, whenever he encounters stress, he tends to
3 Major Elements of Informed Consent • Libel (Printed) adapt to it
o Must be Voluntary • Slander (Spoken) o Adaptive Mechanisms:
o Must be Given by client or individual w/ Unintentional ▪ Physiologic (Heavy Objects) -
the capacity + competence to understand ▪ Negligence -> Hypertrophy
o Client or Individua must be given • Conduct below the ▪ Psychologic = Defense
enough information to be the ultimate standard of care mechanism (Rationalization,
decision maker • Omission to do Sublimation)
something a ▪ Social
Clients who cannot give consent reasonable person ▪ Technologic Adaptation
o Minor would normally do ▪ Stress is not always something to be avoided
o Mentally-Ill Person o Student - Examination
o Breast Cancer - Surgery
o Diabetic - Insulin
▪ Stress does not always lead to distress
o Pleasant or Unpleasant
o Diarrhea, Fever, Pain
o Distress - Unpleasant
▪ A single stress does not cause a disease
o Stress is Multicausal
▪ Stress may lead to another stress
o Diarrhea = Dehydration
o Fever = Convulsion
o Pain = Neurogenic Shock
▪ Prolonged/Intense leads to exhaustion
o Adaptive mechanisms can no longer
persist
o Illness/Death may occur
▪ Stress is always a part of the fabric of daily life
o Part of the human experience
o Essential, but at time Problematic
▪ Adaptation
o Adjustments that a person makes in
different situations
Types of Adaptation
▪ General Adaptation Syndrome (GAS)
o Man, whenever he responds to stress,
the entire body is involved
o There are many similar manifestations
that characterize different disease
conditions
o There are very few specific
manifestations that characterize a
particular disease
▪ Fever, weakness, fatigue,
headache, anorexia, pain
o 1st: Stage of Alarm (SA)
▪ Person becomes aware of
presence of threat or danger
▪ Decreased level of resistance
▪ Adaptive mechanisms are
mobilized (Fight-or-Flight
Reaction)
▪ If stress is intense enough,
death may follow
• Profuse Bleeding
o 2nd: Stage of Resistance (SR)
▪ Characterized by adaptation
▪ Increased levels of Resistance
▪ Body moves back towards
homeostasis
o 3rd: Stage of Exhaustion
▪ Prolonged exposure to stress
+ adaptive mechanisms can
no longer persist
▪ Unless other adaptive
mechanisms will be
mobilized, death may happen
▪ Local Adaptation Syndrome (LAS)
o Man may respond to stress thru a
particular body part or body organ
o Inflammation, backache, headache,
diarrhea
o Characteristics of Adaptive Responses
▪ Attempts to maintain
homeostasis
▪ Whole-body/total organism
responses
▪ Have limits
▪ Require time
▪ Vary from person to person
▪ Inadequate or excessive
▪ Egocentric, Tiring (Req body
energy + taxes physical and
psychological resources)
Modes of Adaptation
▪ Physiologic/Biologic Adaptive Mode
o Heaving lifting, Dark skin
▪ Psychologic Adaptive Mode
o Ego defense mechanism (Denial
Rationalization)
▪ Socio cultural Adaptive Mode
o Talking, Acting, Dressing
▪ Technologic Adaptive Mode
o Electronic Devices, Computers
Homeostasis
▪ State of dynamic Equilibrium
o Stability
o Balance
o Constancy
o Uniformity
o Hemodynamics (Constant Change)
▪ Negative Feedback Mechanism
o Sympathetic-Adreno-Medullary Responses
(Walter Cannon)
▪ SAMR/Fight or Flight Resp
▪ Stress perceived by Hypothalamus
(Sympathetic Nervous System) -->
Adrenal Medulla Secretes
Adrenaline / Stimulates organs -->
Fight-or-Flight Response
▪ Hypothalamus --> Sympathetic
Nervous Sys --> Adrenal Medulla -
-> Adrenaline + Noradrenaline -->
Fight or flight
Local Physiologic Responses to Stress
▪ Inflammation involves mobilization of specific and no
specific defense mechanisms in response to nary or
infection
o Purposes:
▪ to localize tissue injury
▪ to protect tissue from injury
▪ to prepare tissue for repair
o Manifestations:
▪ Dolor - Pain
▪ Tumor - Swelling
▪ Rubor - Redness
▪ Calor – Heat
Cellular Response
▪ Neutrophils - launched at the site of tissue injury
▪ Monocytes - perform phagocytosis (chronic tissue
injury)
▪ Lymphocytes - Responsible for immune response
▪ Processes Involved
o Marginal/Presentation = phagocytes line up
@ peripheral walls of the blood vessels
o Emigration/Diapedesis = Phagocytes shift
out of the blood vessels
o Chemotaxis = injured tissues release
substances which exert magnet-like force to
the phagocytes to bring them to the area of
injury
o Phagocytosis = Phagocytes ingest or engulf
the antigens
Healing Process (reparative Phase)
▪ Regeneration = Involves replacement of damaged
tissue cells by new cells, identical in struc/func
▪ Scar Formation = involves replacement of
damaged tissue cells by fibrous tissue formation
o First pink/red granulation/gelatinous
tissue forms
o Later Cicatrix/Scar forms bc collagen
fibers → skin contraction
Healing Classification
▪ First intention
o Clean-Cut wound
o primary intention healing
o primary union
▪ Second Intention
o Wound is extensive
o Great amount of tissue loss
o Longer repair time
o More Scarring
▪ Third Intention
o Delayed surgical closure of infected wound

Systemic Manifestations of Inflammation

• Fever
• Leukocytosis
Other resp to tissue injury
▪ Necrosis = death of tissues
▪ Hypertrophy = inc in cell size
▪ Hyperplasia = inc in cell number
▪ Metaplasia = replacement of one mature cell type w
another, new cell isn’t normally seen there
Nursing interventions (Independent to Dependent)
▪ Promote rest to enhance recovery
▪ Reduce swelling
o Elevate the affected body part to promote
venous return
o Heat and cold application (Cold 1st 72hrs,
heat after 72hrs)
▪ Relieve Pain
▪ Inc excretion of microorganism by adequate hydration
▪ Provide adequate nutrition
▪ Pharmacotherapy
▪ Surgery