Fundamentals of Nursing Practice
Medication
Medication
Substance Administered for the diagnosis,
cure, treatment, or relief of a symptom or
for prevention of disease
Drug
has the connotation of an illicitly obtained
substance such as heroin, cocaine, or
amphetamines
crude drugs such as: Opium, Castor Oil, and
Vinegar, were used in ancient times
Prescription
Written direction for the preparation and
administration of a drug
in the PH it is mostly given by Physicians
only.
Kind of Drug names
GENERIC NAME
assigned by United States Adopted Names
(USAN) council
chemical name of a medicine
always the same no matter how many
companies manufacture the medicine
TRADE NAME
aka Brand name
given by drug manufacturer
usually short and easy to remember
OFFICIAL NAME
name in which the drug is listed under one
of the official publishers
CHEMICAL NAME
name by which chemist knows it
describes the constituents of the drug.
Pharmacology
study of the effects of drugs on living
organisms
Pharmacy
art of preparing, compounding, and
dispensing drugs
LISCENCED PHARMACIST
prepare, makes, and dispenses drugs as
ordered by a physician, dentist, nurse,
practitioner or physician assisstant.
Types of drug preparations
AEROSOL SPRAY / FOAM
liquid, powder, or foam deposited in a thin
layer on the skin by air pressure
AQUEOUS SOLUTION
one or ore drugs dissolved in water
AQUEOUS SUSPENSION
one or more drugs finely divided in a liquid.
CAPLET
solid form
shaped like a capsule, coated and easily
swallowed.
CAPSULE
gelatinous container to hold a drug in
powder, liquid or oil form
CREAM
nongreasy, semisolid preparation used on
the skin
ELIXIR
sweetened and aromatic solution of
alcohol used as a vehicle for medicinal
agents
EXTRACTS
concentrated form of a drug made from
vegetables or animals
GEL / JELLY
clear or translucent semisolid that liquefies
when applied to the skin.
LINIMENT
medication mixed with alcohol, oil, or
soapy emollient and applied to the skin
LOTION
medication in liquid suspension applied to
the skin
LOZENGE (TROCHE)
flat, round, or oval preparation that
dissolves and releases a drug when held in
the mouth
OINTMENT (SALVE, UNCTION)
semi solid preparation of one or more
drugs used for application in the skin and
mucous membrane
PASTE
preparation like an ointment, but thicker
and stiff, that penetrates the skin less than
an ointment
PILL
one or more drug mixed with a cohesive
material, in oval, round or flattened shape
POWDER
a finely ground drug
some are used internally or externally
SUPPOSITORY
one or several drugs mixed with a firm base
such as gelatin, and shaped for insertion in
the body
base dissolves gradually in the body due to
temperature releasing the drug.
SYRUP
aqueous solution of sugar often used to
disguise unpleasant-tasting drugs
TABLET
powdered drug compressed into a hard
small disk
some are broken by a scored line and some
are enteric coated to prevent them from
dissolving in the stomach
TINCTURE
alcoholic or water- and - alcohol solution
prepared from drugs derived from plants
TRANSDERMAL PATCH
semipermeable membrane shaped in a
form of a disk or patch that contains a drug
to be absorbed through the skin over a long
period of time.
Drug standard
Drugs can have natural or synthesized
sources
Pharmacopoeia
a book containing list of products used in
medicine, with descriptions of the
products used in medicine, with
descriptions of the product, chemical test
for determining identity and purity, and
formulas and prescription
Legal aspects of Drug
Administrtionn
NURSES NEEDS TO:
know how nursing practice acts in their
areas define and limit their functions
be able to recognize the limits if their own
knowledge and skill.
------------------------------------------------
Nurses are responsible for their own
actions regardless f whether there is a
written order.
Effects of Drugs
THERAPEUTIC
desired effect
intended primary effect
the reason the drug is prescribed
SIDE EFFECT
secondary effect
unintended
usually predictable and may be either
harmless or potentially harmful
ADVERSE
more severe side effects
may justify the discontinuation of a drug.
DRUG TOXICITY
result from overdosage
ingestion of drug intended for external use
buildup of the drug in the blood because of
impaired metabolism of excretion
DRUG ALLERGY
immunologic reaction
due to exposure to foreign substance
(antigen)
ANAPHYLACTIC
severe allergic reaction usually occurs
immediately after administration of drug
DRUG TOLERANCE
exist in persons with usually low
physiological response to a drug and who
requires increases in the dosage to
maintain a given therapeutic effect
CUMULATIVE
increasing response to repeated doses of a
drug that occurs when the rate of
administration exceeds the rate of
metabolism of excretion
IDIOSYNCRATIC
one that is unexpected and differs in every
client
under response and overresponse to a
drug may be idiosyncratic
DRUG INTERACTION
can be beneficial or harmful
when administration of drugs is at the
same time, or immediately after the other.
Additivity: when the effect of two drugs
given in combination equals the
mathematical summation of their effects
when given alone.
Synergism: when the combine effect of two
drugs is greater than the sum of their
effects when given separately.
LATROGENIC DISEASE
caused by medical therapy
Hepatic toxicity resulting in biliary
obstruction, renal damage, and ORAL
malformations of the fetus as a result of
specific drugs
example is drugs taken during pregnancy
SUBLINGUAL
BUCCAL
PARENTERAL
Drug Dependance
person's reliance on or need to take a drug
or substance
physiological- A condition in which a
person takes a drug over time, and
unpleasant physical symptoms occur if the
drug is suddenly stopped or taken in
smaller doses.
psychological- on drugs is the emotional,
motivational, and mental addictive
qualities that come with substance abuse.
Drug Habituation
mild form of psychological dependence
the habituated individual tends to continue
the habit even though it may be injurious
to health.
Illicit Drugs
aka street drugs
sold illegally
drugs unavailable for purchase under any
circumstances
drugs normally available with a
prescription that are being obtained
through illegal channels.
taken due to its mood altering effect.
(narcotic effect)
Routes of administratiom
most common
least expensive and most convenient
drug is swallowed
drug placed under the tongue, where it
dissolves
drug is absorbed into the blood vessels of
the tongue
medication should not be swallowed
medication is held in the mouth against the
mucous membranes of the cheek until the
drug dissolves
aka alimentary or respiratory tract; that is
by needle
SUBCUTANEOUS
IM- intramuscular
IV- intravenous
ID-intraderma

INTRAVENOUS PUSH
aka bolus
IV administration of undiluted drug directly
into the systemic circulation
can be introduced directly into a vein by
venipuncture or into an existing IV line
through the injection port or lock
Syringes
3 PARTS
TIP- connect with the needle
BARREL- outside part, with the scales
printed
PLUNGER- fits inside the barrel
----------------------------------------------------------
Ranges from 1-60mL.
nurses usually uses ones that ranges from 1
to 3 mL for injections
HYPODERMIC
comes in 3-5 mL sizes
choices of syringe depends on many
factors, such as medication, location of
injection, and type of tissue
INSULIN
scales are specially designed for insulin
100 unit calibrated scale intended for use
with U-100 insulin.
INSULIN PEN- injector device, inserts new
needle for every injection
TUBERCULIN
narrow syringe, calibrated in tenths and
hundredths of milliliter
can also be used for ither drugs that needs
small or precise measurement. (pediatric
dosage)
Avoiding Puntures Injuries
Use appropriate-proof disposal of
uncapped needles and sharps
never throw sharps in waste baskets
never bend or break needle before disposal
never recap used needles, except under
specified circumstances
when recapping a needle use a safety
mechanical device that firmly grips the
needle cp and holds it in place until it is
ready to recap
use a one-handed scoop method
Ampules and Vials
used to package sterile parenteral
medications
AMPULES
glass containers usually designed to hold a
single dose of drug
made of clear glass and has a distinctive
shape with a constricted neck
most have colored marks on its neck,
indicating where they are prescored for
easy opening
VIALS
small glass bottle with a sealed rubber cap
Vials come in different sizes
can be single use or multiple-dose
usually have metal or plastic cap
pierced with a needle to access medication
Routes of Medication
TOPICAL
applied to a circumscribed surface area of
the body
DERMTOLOGIC PREPARATION- applied to
skin
INSTILLATIONS AND IRRIGATIONS- into
body cavities or orifices, such as the
urinary bladder, eyes, ears, nose, rectum or
vagina
INHILATION- into respiratory tract by a
nebulizer or positive pressure breathing
apparatus.
INHALED MEDICATION
mostly delivered by nebulizers:
ATOMIZATION & AEROSOLIZATION
METER DOSED INHALER- handheld
nebulizer; pressurized container of
medication
NASOGASTRIC AND GASTROSTOMY
MEDICATIONS
for NPO (Nil per os) patients and have
nasogastric tubes or gastrostomy tube in
place.
NASOGASTRIC- tube through nasopharynx
and is placed into the client's stomach for
the purpose of feeding the client or to
remove gastric secretions
Fundamentals of Nursing Practice
Concepts of Growth and Development
Growth and Development
Dynamic process
interdependent, interrelated process.
starts from the time of conception and
progress until a person dies.
happens in several stages, and each has its
characteristics and particular milestones
that must be completed before moving to
the next one
happens in a cephalocaudal fashion, it
starts in the head and moves downwards
proximodistal growth mean that the
central body parts like heart, develop
before distal parts like arms and legs
basic understanding of this can help nurse
to identify the needs and provide
appropriate care.
every person progresses through definite
phases of growth and development, but
the rate and behaviors vary in each
individual
Growth
physical change: appearance and size
can be measured quantitatively
height, weight, bone size and dentition
varies during different stages of growth
and development
rapid during prenatal, neonatal, infancy
and adolescent stages and slows during
childhood
physical growth is minimal during
childhood
Development
increase in the complexity of function and
skill progression
capacity and skill of a person to adapt to
the environment
behavioral aspect of growth
Psychoanalytical theory
founded by Sigmund Freud
stresses the formative years of childhood
as the basis for later psychoneurotic
disorders, primarily through the
unconscious repression of instinctual
drives and sexual desires
based on the series of psychosexual stages
through in which a person must pass
specific body areas are the primary sites
for expression and achievement of needs,
and these 3 sites changes from every stage
STAGE 1: ORAL (BIRTH TO 12-18 MONTHS)
sucking and oral satisfaction is vital and
pleasurable
later in this stage the infant will realize that
the mother or caregiver is separated from
him
disruption of the physical and emotional
availability of the parent can result to
inadequate bonding and also the infant's
development
STAGE 2: ANAL (12-18 MONTH TO 3 YEARS)
focus changes in the anal zone
through toilet training process, the child
delays gratification to meet parental and
societal expectations
STAGE 3: PHALIC OR OEDIPAL (3 TO 6 YEARS)
genital organs is the focus
time of exploration and imagination as the
child fantasizes about the parent opposite
sex as the 1st love interest known as
OEDIPUS or Electra complex
child avoid conflict by identifying by the
parent of the same sex a way to win
recognition and acceptance
STAGE 4: LATENCY (6 TO 12 YEARS) INITIATIVE VS GUILT (3-6 YEARS)
sexual urges are channeled into productive tries to pretend and try out new roles
activities that are socially acceptable fantasy and imagination allows them to
within the education and social world further explore their environment.
there is much to learn and accomplish development of super ego and conscience
STAGE 5: GENITAL (PUBERTY THROUGH is happening here.
ADULTHOOD) Guilt occurs when the responses are too
sexual urges reawakened and directed to harsh so the children learns to maintain a
someone outside the family circle sense of initiative without imposing of the
freedom of others.
Components of human we need to teach the child impulse control
and cooperative behavior.
personality Direction and Purpose is the result of this
ID
stage.
EGO
INDUSTRY VS INFERIORITY (6-11 YEARS)
SUPER EGO
they learn to work and play with their peers
they thrive through their accomplishments
Psychosocial Development and praise.
founded by Erik Erickson
sense of inadequacy is developed when
described other series of stages as the
there is no proper support or the task is
"EIGHT AGES OF MAN"
too difficult
A person spends his whole life
IDENTITY VS ROLE CONFUSION (PUBERTY)
constructing, shaping, and reshaping his
dramatic psychological changes associated
personality, which is influenced by
with sexual maturation
Psychological, biological, social and
identity develops with a goal of achieving
environmental factors.
some perspective or direction
no core problem is entirely resolved.
INTIMACY OR ISOLATION (YOUNG ADULT)
TRUST VS MISTRUST (BIRTH TO 1 YEAR)
capacity to love others and care for them.
establishing a basic sense of trust is
search for meaningful friendships and an
essential for the development of a healthy
intimate relationship with another person
personality.
GENERATIVITY VS SELF-ABSORPTION AND
this stage requires a consistent caregiver
STAGNATION (MDDLE AGE)
who is available to meet their needs.
focuses on helping future generations
from the basic trust from his parents the
success is achieved by contributing to
infant will be able to trust himself and
future generations through parenthood,
other people around them.
teaching or community involvement.
AUTONOMY VS SENSE OF SHAME AND
caring for others is the result of
DOUBT (1-3 years)
generativity
the new found independence is the result
stagnation is the result of inability to play a
of maturation and imitation
role.
autonomy is developed by making choices
INTEGRITY VS DESPAIR (OLD AGE)
related to relationships, desires and
review life with a sense of satisfaction or
platings
regret.
limiting choices or in acting punishments
external struggles are also met with
can result to feelings of shame and doubt.
internal struggles such as search for
self control and main power is the result of
meaning in life.
success from this stage.
 Cognitive Development
founded by Jean Piaget
focuses on gradual development of
cognitive process, such as problem solving,
and on intellectual growth.
a process by which a child becomes an
intelligent person, acquiring knowledge
and the ability to learn, reason, and
abstract.
SENSORIMOTOR (BIRTH TO 2 YEARS)
constructs understanding of the world by
hearing and seeing, reaching and touching.
through memory they develop object
permanence
PREOPERATIONAL (2-7 YEARS)
when child starts to use language and
symbols.
still unable to use operations
PRECONCEPTUAL- increased used of
verbal representation but speech is
egocentric.
INTUITIVE- speech becomes more social,
less egocentric. base their knowledge on
what they feel, but can't fully explain it.
CONCRETE OPERATIONAL (7-12 YEARS)
concrete use of knowledge
thought becomes more logical and
problems are solved in a systematic
fashion
child is able to consider points of view
other than their own.
FORMAL OPERATIONAL
thoughts are increasingly flexible
developed skill such as, logical thought,
deductive reasoning, as well as inductive
reasoning.
they understand that rules of the game or
society is made by a man and is agreed
upon by the majority.
Growth and Development
There is a sequence, order and pattern to growth
and development. There are certain
developmental tasks that must be accomplished
during each stage. A developmental task is a set of
skills and competencies specific to each
developmental stage, which children must
accomplish to deal effectively with their
environment. Each stage lays the foundation for
the next stage of development. The stages of
development are:
• Prenatal (conception to birth)
• Infancy (birth to 12 months)
• Early childhood (12 months to 5 years)
• Later childhood (5 years to 12 years)
• Adolescence (12 years to about 18 years)
• Adulthood (18 years onward).
Development encompasses various aspects —
motor, vision and hearing, speech and language,
intellectual, emotional, personality, moral and
social. Although there is an orderly pattern to the
processes, the rate of growth and development
varies among individuals.
Fetal Growth Terms
OVUM- ovulation to conception (fertilisation)
ZYGOTE- from conception to implantation
EMBRYO- from implantation to 8 weeks after
conceptions
FETUS- from 8 weeks after conception until
term.
Lyers of Blastocyst
• The outer layer (ectoderm), which develops to
become the skin, hair, nails, brain and nervous
system
• The middle layer (mesoderm), which develops to
become the circulatory, musculoskeletal and
urinary systems, and most of the reproductive
tract
• The inner layer (endoderm), which develops to
become the intestines, internal organs,
respiratory system and the germ cells of the
ovaries or testes (Marieb 2004).
 Embryonic and Fetal Growth
and development
Zygote (5 weeks) - Complete sac 1 cm in diameter
covered with chorionic villi. No recognisable
human characteristics.
Embryo (6 weeks) - Sac 2–3 cm in diameter, weight
1 g. Head enlarges, arm and leg buds forming,
primitive heart beginning to function, circulation in
primitive form, connections made between vessels
in chorion.
10 weeks - Embryo 4 cm long. External genitals
appear, anal membrane breaks down, hands and
feet recognisable, human form apparent.
Fetus (12 weeks) - Fetus 8 cm long, weight 15 g.
Fingers and toes, eyes and ears, circulation and
kidneys developed, nasal septum and palate have
fused, endocrine glands and nervous system begin
to function.
16 weeks - Fetus 16 cm long, weight 110 g. Sex
easily identifiable, fingernails visible, good
heartbeat, fetal movements felt. Basic
development complete — the fetus now has to
mature.
20 weeks - Length 22 cm, weight 300 g. Vernix on
skin, lanugo (fine hair) on body, eyebrows,
fetus now legally viable.
24 weeks - Length 30 cm, weight 600 g. Wrinkled
skin, fat deposited, brain development
continues.
28 weeks - Length 35 cm, weight 1000 g.
32 weeks - Length 42 cm, weight 1700 g. Skin red,
wrinkled.
36 weeks - Length 46 cm, weight 2500 g. Nails
reach fingertips.
40 weeks - Length 50 cm, weight 3400 g. Baby well
covered with fat, skin red, not wrinkled,
all organs functioning with the exception of the
lungs.
Fundamentals of Nursing Practice

Promoting Health From Conception

through adolescence
Intrauterine life
human development proceeds at a
predictive and rapid rate.
the embryo grows from a single cell to a
complex one.
all major organs develop in utero.

Health Promotion during

pregnancy
provide women with education they need
regarding nutrition before conception and
throughout expectant mother's pregnancy
listen carefully to concerns expressed by a
mother and her partner and offer support
Physical changes
An immediate assessment of the newborn’s
through each trimester.
condition to determine the physiological
Adolescents who have been able to
functioning of the major organ systems
participate in prenatal classes may have
occurs at birth. The most widely used
improved nutrition and healthier babies.
assessment tool is the Apgar score
Discussing the physiological causes of these
discomforts and offering suggestions for safe
Psychosocial changes
treatment can be very helpful for expectant
After immediate physical evaluation and
mothers and contribute to overall health
application of identification bracelets, the
during pregnancy.
nurse promotes the parents’ and newborn’s
Promote maternal and fetal health by
need for close physical contact. Early
providing accurate and complete
parent-child interaction encourages parent-
information about health behaviors that
child attachment
support positive outcomes for pregnancy
and childbirth. Newborn
Transformation from
first 28 days of life
mostly reflexive, and stabilization of major
intrauterine to extrauterine life organ systems is the primary task of the
requires profound physiological changes in body
the newborn and occurs during first 24 hours Behavior greatly influences interaction
of life among the newborn, the environment and
caregivers
 Health Promotion for
Newborns
SCREENING
administered before babies leave the
hospital to identify serious or life-
threatening conditions before symptoms
begin
CAR SEATS
essential component of discharge teaching is
use of federally approved car seat for
transporting the infant from the hospital or
birthing center to home.
CRIBS AND SLEEP
cribs should have a slat that are no more that
6cm (2.4 inches) apart.
the crib mattress should fit snugly
crib toys or mobiles should be attached
firmly with no hanging strings or strap.
Infants
the period from 1 month to 1 year of age
rapid physical growth and change happens
only period distinguished by such dramatic
physical changes and marked development
Health Promotion for Infants
NUTRITION
help parents select and provide a
nutritionally adequate diet for their infant
understand that factors such as support,
culture, role demands, and previous
experiences influence feeding methods
IMMUNIZATION
The widespread use of immunizations has
resulted in the dramatic decline of infectious
diseases over the past 50 years and
HEALTH PROMOTION PROGRAMS
therefore is a most important factor in health
promotion during childhood
SLEEP
Carefully assesses the individual problem
before suggesting interventions to address
their concern.
Toddlers
anges from the time children begin to walk
independently until they walk and run with
ease, which is from 12 to 36 months.
The toddler has increasing independence
bolstered by greater physical mobility and
cognitive abilities.
Toddlers are increasingly aware of their
abilities to control and are pleased with
successful efforts with this new skill
Health Promtion forToddlers
GROSS AND FINE MOTOR DEVELOPMENT
The major gross motor skill during the
toddler years is the development of
locomotion.
Fine motor development is demonstrated in
increasingly skillful manual dexterity.
PSYCHOSOCIAL DEVELOPMENT
Differentiation of self from others,
particularly the mother
Toleration of separation from parent
Ability to withstand delayed gratification
Control over bodily functions
Acquisition of socially acceptable behavior
Verbal means of communication
Ability to interact with others in a less
egocentric manner
Early Childhood Stage
Spans the period up to 8 years of age, is
critical for cognitive, social, emotional and
physical development.
Health Promotion for Early
Childhood Stage
Programs that focus on improving the health
and well-being of children in early childhood
may be implemented in homes, childcare
settings, and other community-based
settings
 Adolescence
Developmental transition to adulthood that
includes rapid changes in the brain and
body, often at different rates and is a time
for healthy exploration of identity and
learning independence.

Health Promotion for

Adolescence
SUPPORT SOCIAL AND EMOTIONAL LEARNING
Social and emotional learning can help
children and adolescents develop the skills
they need to recognize and manage
emotions, set and achieve positive goals,
appreciate the perspectives of others,
establish and maintain positive relationships,
and make responsible decisions.
PROMOTE BETTER SLEEP
Sleep is increasingly recognized as a
component of good health. Children who
don’t get enough sleep are at increased risk
for obesity, type 2 diabetes, attention and
behavior problems, poor mental health, and
injuries.
Fundamentals of Nursing Practice
Promoting Health in Older Adults
Introduction
Stages of Man's life: Infancy, Childhood,
Adolescence, Adulthood, and old age.
in each stages the individual has to find
himself in a different situations and face
different problems
in old age, physical strength deteriorates,
mental stability diminishes; money power
becomes bleak coupled with negligence from
younger generation
Elderly
an individual over 60 years old who have
functional impairments
Elderly care
eldercare
where special needs and unique
requirements of senior citizens are met and
fulfilled
includes, assisted living, adult day care, long
term care, nursing homes, hospice care, and
home care services.
Normal Aging Process
aging is not merely the passage of time, but it
is a manifestation of biological events that
occur over a span of time.
it is important to know that people are aging
differently
some systems slow down but some lose their
fine-tuning
slight and gradual changes are common and
not a problem, but sudden and dramatic
changes might indicate serious health
problems.
4 aspects of Normal Aging
BIOLOGICAL ASPECTS OF AGING
individuals are unique in their psychological
and physical aging process
quantitative loss of cell and changes in many
of the enzymatic activities within cells occur
as individual ages.
changes occur at different rate in different
people
Nervous System
Decreased speed of neural conduction
Decreased number of brain cells
Decreased in cells of the nerve fibers
Decreased neurotransmitters
Decline in memory for recent events
Decreased rapid eye movement sleep
Decreased cerebral circulation
Eye:
Diminished ability to focus on close objects
Decreased visual activity
The eye’s external changes give evidence of
advancing age. These changes result from
loss of orbital fat, loss of elastic tissue, and
decreased muscle tone.
The cornea flattens which reduces the
refractory power
The retina of older individuals becomes
thinner because of fewer neural
cells and receives only 1/3rd of the amount
of light that a younger person. Due to this
problem reading, not able to see in dim light
and also have difficulty in color perception.
The lens of the eye loses its elasticity and
increases in density
Ear:
Hearing problem
Cerumen gland are reduced in number dry
and hard ear wax, along with itching.
Degenerative changes occur in ossicles
contributing to hearing loss
Presbycusis is the term used to describe
hearing loss associated with normal aging.
 Musculoskeletal System
Taste and smell:
Decreased bone density
Decreased ability to taste and smell
Decreased muscle size and strength
Very rarely the capacity to smell diminishes;
Decreased joint cartilage
Taste perception and taste discrimination
In aging, the increased parathyroid hormone
decreases as the age advances.
decreased vitamin D, and calcitonin also play
Integumentary System
role in calcium in old people.
Decreased elasticity
In women, estrogen deficiency, calcium
Decreased secretion of natural oil and
malabsorption, and lifestyle factors (calcium
perspiration
intake and exercise) can result in bone loss.
Thinning of skin
Aging brings a decline in the number of
Decreased heat regulation
muscles resulting in reduced muscle mass.
Decreased protection against trauma and
The muscle strength also reduces especially
solar exposure
due to lack of exercise.
The number of pressure and light touch
Urinary System
sensors decreases with age
Decreased blood supply and loss of
Immune, vascular, and thermoregulatory
nephrons
responses of the skin decrease with age.
Less blood can be filtered by the kidney
Loss of hair color and thinning of pubic,
Decreased the bladder capacity, and
axillary, and scalp hair.
concentrating
Cardiovascular System
Decreased diluting ability
Decreased physical demands and activity of
Increased prostate size
the heart.
Delayed sensation to void
Slower heart rate and reduce cardiac output
In females relaxed perineal muscles
Decreased contractility
In men, BPH is associated with aging and
Impaired coronary artery blood flow
leads to urinary incontinence (dribbling).
Less oxygen and blood supply to an organ, so
Increasing age is also associated with an
it affects the function of the organ
increase in involuntary bladder contractions,
Decreased altered preload and after load
a reduction in bladder capacity, and an
Increased atherosclerotic plaques and blood
increase in residual volume. These
pressure
contribute to the development of
Diminished ability to respond to stress.
incontinence in older adults.
Respiratory System
Weak pelvic muscle causes stress
Respiratory muscles atrophy and weaken so
incontinence.
reducing the ability of the chest to enlarge
Gastrointestinal System
Short of breath
Decreased salivary secretions, loss of teeth
Increased rigidity of thoracic cage, residual
Loss of sense of smell and taste so decrease
lung volume
the appetite and desire for food Slowing of
Decreased gas exchange and diffusing
peristaltic action
capacity
Altered nutrition, digestion, and bowel
Decreased elasticity and vital capacity
function
Decreased altered preload and after load
Weakening of lower esophageal sphincter
Decreased cough efficiency
Difficult to chew food because of loose
teeth.
Liver weight and size decreases with age
There is a decrease in the number of hepatic
cells and as a result, a diminished capacity
for the metabolism of drugs and hormones.
 Reproductive System
Changes in women
Decreased breast issue
Sexual dysfunction
Decreased sexual desire
Vaginal narrowing and decreased elasticity
Decreased vaginal secretions
Changes in men
Decreased size of penis and testes
Erectile ability undergoes changes. Takes a
long time
for an erection, the amount of semen is
reduced and the intensity of ejaculation is
lessened.
It is not clear whether the increase in
impotence is age-related
PSYCHOLICAL ASPECT OF AGING
Memory functioning
Short-term memory deteriorates with age,
long-term memory does not show
similar changes.
A well-educated and mentally active person
does not exhibit such changes at a faster
rate.
The time required for memory scanning is
longer for both recent and remote recall
among clear people.
This can be attributed to social or health
factors (stress, fatigue, illness), but it can
also occur with certain physiological changes
due to aging. (decreased blood flow to the
brain)
Intellectual functioning
Fluid abilities or abilities involved in solving
novel problems, tend to decline from the
adult period to old age.
High degree of regularity in intellectual
function present in most of the old age
people
Intellectual abilities of older people do not
decline but do become obsolete.
Their formal educational experience is
reflected in their intelligence performance
Learning ability
The ability to learn is not declined with age.
The slowing of reaction time with age and
over-arousal of the central nervous
system are noted in old age. It may lead to a
lower level of performance in a task that
requires high efficiency.
Ability to learn to continue throughout life,
although strongly influenced by personal
interests and preferences.
Accuracy of performances diminishes.
Loss and grief
By the time individuals reach 60-70 years of
age, they have experienced numerous losses,
and mourning has become a lifelong process.
It is possible for some older age people to
complete the grief process in response to
one loss before the loss occurs.
Because the grief is cumulative, this can
result in bereavement overload.
This can further predispose to depression.
Attachment to others
The need for attachment is consistent
throughout the lifespan
Well being of senior citizens can be
contributed to through socialization and
companionship.
Dealing with death
Death anxiety among the elderly is more of a
myth than reality
The feeling of abandonment, pain and loss
may leads to fear or anxiety in elderly
Psychiatric disorders
later life constitutes a time of especially high
risk for emotional distress
Dementia, depressive disorders, delirium,
sleep disorders etc. are the most
common psychiatric illness seen among
elderly.
SOCIOCULTURAL ASPECT OF AGING
potential negative effects of physical and
mental well-being
protection from hazards and weariness of
daily task
treated with and die with respect and
dignity
aged persons are warded a position of honor
in developing countries
in some industrialized countries negative
stereotypes like aged are always tired, and
sick, slow and forgetful, isolated and lonely
and unproductive are still persisting.
discrimination also persist in hiring and
promoting aged workers
the status of the elderly may improve with
time as the number of elder person increases
worldwide
SEXUAL ASPECT OF AGING
Changes is male
Testosterone production decline gradually
as age increases
As a result of these hormonal changes the
erection takes place slowly and requires
more genital stimulation to achieve.
The volume of ejaculate decreases and the
force of ejaculation lessens
The testis becomes smaller, but most men
continue to produce viable sperm well into
old age.
Changes is female
Menopause may begin anytime during 40s or
early 50s
Gradual decline in the functioning of the
ovaries and subsequent reduction in the
production of estrogen.
The walls of the vagina become thin and
inelastic and vaginal lubrication decreases.
Orgasmic uterine contractions become
spastic.
All these changes result in vaginal burning,
pelvic aching, irritability, etc.
In some women these changes result in
avoidance of sexual intercourse
These symptoms are more likely to occur
with infrequent intercourse of only one time
a month or less
Regular and more frequent sexual activity
result in a greater capacity for sexual
performance
As our population continues to age, the demand
for geriatric care continues to grow. Geriatric
nursing care plans are an essential component in
ensuring the comfort and well-being of our
elderly population. With a focus on personalized
care and addressing the specific needs of the
elderly, geriatric nursing care plans help nurses
to provide the best possible care for their
elderly patients.
Gerontology Nursing
specialized care for the elderly
addresses physiological, developmental,
psychological, socio-economic, cultural, and
spiritual needs of an aging individual
a collaborative effort which includes their
family, community, and other health care
team is needed for specialized care of the
elderly
Through this, nurses may be able to use the
expertise and resources of each team to
improve and maintain the quality of life of
the elderly.
Objectives ofGerontology
Nursing
Maintenance of health function
Detection of disease at early stages
Prevention of deterioration of any existing
problem
General principles of
Geriatric ncare
Consider individuality. Consult his
preferences.
Be patient, kind, and sympathetic.
Communicate effectively, and demonstrate
respect.
Encourage independence and encourage him
to make his choices and decisions.
Assist the elderly to achieve emotional
stability.
Stimulate mental acuity and sensory input
and physical activity to uplift their self-
esteem, self-concept, and confidence.
Make elderly stay in homes interesting and
lively.
Provide diversion/occupational therapy.
Maintain privacy.
Handle them gently.
Make them comfortable by providing a
comfortable bed, bed linen, etc. keep the
bed dry, smooth and unwrinkled.

Encourage them to maintain body hygiene,
thus regulating body temperature.
Assist them to take care of visual, auditory,
and dental aid.
Protect from injuries, falls and accidents, etc.
Ensure adequate nutrition.
Facilitate elimination. Encourage them to
maintain external genitalia hygiene.
Encourage them to do active range of motion
exercises. Maintain body alignment and
posture. Encourage mobility.
Help the elderly to establish good sleep
patterns.
Caution elderly about the use of drugs
Have them physically examined annually and
whenever needed.
Observe any psychophysical changes which
alter their body image and behaviour.
6 Proven Ways to Promote
Physical health
EXERCISE
this helps them maintain their strength and
mobility
its better to incorporate 4 different types of
exercise benefits: strength, endurance,
balance, and flexibility
DON'T SMOKE
smoking causes damage on the lungs, and
increases risk of heart attacks, strokes, and
various forms of cancer
Many tobacco-related diseases, such as
chronic obstructive pulmonary disease, can
cause difficult symptoms for years.
GET ENOUGH SLEEP
chronic sleep deprivation is linked to
increased cardiovascular disease, increased
level inflammatory blood markers, and
decreased immune function.
sleep deprivation causes fatigue
Aging does cause sleep to become lighter
and more fragmented, and may cause people
to need a little less sleep than when they
were younger.
That said, chronic sleep difficulties or often
waking up feeling tired is not normal in aging.
Older adults often suffer from true sleep
problems that can be treated once they are
properly evaluated.
AVOID CHRONIC STRESS
stress has been linked to physical health
problems such as cardiovascular disease,
insulin resistance, and decreased immune
function, it can also accelerate cellular aging
Common causes of stress in older adults
include financial stress, relationship stress,
work-related stress, and caregiving stress. To
reduce chronic stress, it’s best to combine
general approaches (such as improving
sleep, exercising, meditation, relaxation
strategies, etc) with approaches that can
help you cope with your specific source of
stress.
MAINTAIN A HEALTHY WEIGHT
obesity is a major risk factor for disability in
late life
a BMI of 30 or more is defined as obese,
which worsens arthritis.
It’s also been linked to many health
problems, such as cardiovascular disease,
diabetes, and glucose intolerance, certain
types of cancer, and sleep-related breathing
disorders.
If you need to lose weight, you may want to
do some research into various approaches
before discussing with your doctor and
coming to your own conclusions as to which
weight-loss strategy to try. Older adults need
to be especially careful about not losing too
much lean body mass during intentional
weight loss.
EAT A HEALTHY DIET
the way we eat affects certain aspects of
physical health
a healthy diet is the one that doesn't
provoke negative health effects such as
being prone to take on extra weight, develop
insulin resistance, develop atherosclerosis,
or have uncomfortable symptoms in the
belly or bowels.
Fundamentals of Nursing Practice
Promoting Famliy Health
Family Health
the nurse assess the family, from their
history, each member, level of family
functioning, family interaction patterns, and
weaknesses and strengths
Family is the basic unit of society, consist of
male or female, youth or adult or nit legally
related, genetically or nit related.
FAMILY-CENTERED NURSING- considers the
health of the family as a unit in addition to
the health of individual family members
Function of Family
adult members secures economic resources
of the family
family protects the physical health of its
members by providing adequate nutrition
and health care services.
health attitudes and lifestyle practices of the
children is affected by nutritional and
lifestyle practices of the whole family
Family Roles
NURTURING FIGURE
primary caregiver to children or any
dependent member
PROVIDER
provides basic needs of the family
DECISION MAKER
makes decision particularly in areas such as
finance resolution, of conflicts and use of
leisure time etc.
types of family in todays
society
married couple with children
married couple without children and
other family households
Nuclear Family- Parents and Children
Extended Family- Grandparents, aunts and
uncles
Types of Families
TRADITIONAL FAMILY
independent unit
both parents resides in home with their
children
mother assumes nurturing role
father assumes provider role
TWO-CAREER FAMILY
both partners are employed and may or may
not have children
SINGLE-PARENT FAMILY
death of spouse, divorce, birth of child to
unmarried woman or adoption by single man
or woman are some reasons for a single
parenthood
ADOLESCENT FAMILY
often become developmentally, physically,
emotionally and financially unprepared to
assume parenthood roles
children born into this type of family are at
greater risk for health and social problems,
and they have few role models to assist in
breaking out of the cycle of puberty
FOSTER FAMILY
children who can no longer love with their
birth parents may require placement with a
family that has agreed to include them
temporarily
BLENDED FAMILY
couple containing 2 or more children of
whom at least one is natural or adopted child
of both members couple and at least one is
the stepchild of either partner in the couple
INTREGENERATIONAL FAMILY
children still living with their parents despite
having their own family, or the grandparents
moves in with their child's family
COHABITING FAMILY
consist of unrelated individuals of families
who live under one roof
GAY AND LESBIA FAMILY
homosexual adults forms family with same
goal of caring and commitment seen in
heterosexual relationships
SINGLE ADULTS LIVING ALONE
represents significance in the portion of
today's society
Application of theoretical
frameworks to families
helps the nurse to have context and
structure to view health and health
promotion for families across the life span.
nurses use a combination of theoretical
frameworks.
there are 2 major theoretical frameworks in
promoting the health of families : systems
and structural functional theory
Systems theory
helps nurses to understand biological and
systems in families, communities and nursing
and healthcare
family systems members are
interdependent, working toward specific
purposes and goals.
families as open systems, are continually
interacting with and influenced by other
systems in the community.
Structural-Functional theory
focuses on family structure and function
structural component addresses the
membership of the family and relationship to
each other.
the functional aspect examines the effects of
intrafamily relationships on the family
system as well as the effects on other
systems.
developing a sense of family purpose and
affiliation, adding and socializing new
members, and providing and distributing
care and services to members are some of
the main functions of the family.
Nursing Managements
ASSESSING
this determines the family's level of
functioning, clarify family interaction
patters, identify family strengths and
weaknesses, and describe the health status
of the family and each of its members
family living patterns such as
communicating, child rearing, coping
strategies and health practices are also
important
this gives overview of the family process and
helps the nurse identify areas that need
further investigation
assessment begins with a complete health
history, from the whole family to each of its
members, this helps identify existing or
potential health problems
prior to health history is the physical exam of
each members
genograms helps nurses visualize how all
family members are genetically related to
each other and to grasp how patterns of
chronic conditions are present within the
family unit.
Genogram
Visual representation of gender and lines of
birth descent through the generations
a referral is made to the appropriate health
care professional.
an ecomap is also important for family
members and as a group to document the
family unit's energy expenditures within
community setting.
an ecomap provides visuali
Ecomap
an ecomap is also important for family
members and as a group to document the
family unit's energy expenditures within
community setting.
an ecomap provides visualization of how the
family unit interacts with the external
community environment such as schools,
religion commitments and occupational
duties, and recreational pursuits.
 Health Beliefs
knowing the family's health beliefs helps the
nurse to promote health
this may reflect lack of information or
misinformation about health or disease.
may also include folklores and practices
from different cultures
clients knowledge of health, illness,
treatment, and prevention may be outdated
due to many advances in the field.
nurses are to provide and correct
information and misconceptions
Family Communication
Patterns
effective communication in a family
transmits message clearly.
members are free to express their feelings
without fear of jeopardizing their standing in
the family
family supports each other and have the
ability to listen and empathize, and reach out
to one another at time of crisis
when patterns of communication is
dysfunctional , messages are communicated
unclearly
verbal message may be incongruent to non
verbal cues
power struggles may be evidenced by
hostility, anger, or silence.
when family communication is impaired,
growth of the members is stuned
Family Coping mechanisms
behaviors families use to deal with stress or
changes imposed from either within or
without.
use of coping mechanism can be viewed as
an active method of problem solving
developed to meet life's challenge.
Diagnosis and planning
CAREGIVER ROLE STRAIN
difficulty in performing family caregiver role
DISABLED FAMILY COPING
behavior of a member that disables his or her
capacities and the client's capacities to
effectively address tasks essential to either
individual's adaptation to the health
challenge
DYSFUNCTIONAL FAMILY PROCESS
psychosocial, spiritual, and physiological
functions of the family unit are chronically
disorganized, which leads to conflict, denial
or problems, resistance to change,
ineffective problem solving and a series of
self-perpetuating crises
IMPAIRED HOME MAINTENANCE
inability to independently maintain a safe
growth promoting immediate environment
IMPAIRED PARENTING
inability of the primary caretaker to create,
maintain, or regain an environment that
promotes the optimum growth and
development of the child
INTERRUPTED FAMILY PROCESS
change in family relationships and/or
functioning
READINESS FOR ENHANCED FAMILY COPING
effective management of adaptive tasks by
family member involved with the client's
health challenge, who now exhibits desire
and readiness for enhanced health and
growth in regard to self and in relation to the
client
Family Experiencing a Helath
Crisis
illness of one member that affects the entire
family system
Family becomes disrupted as one of them
abandons their usual activities and focus
their energy on restoring family equilibrium
roles of the ill member is passed on other
members
family experiences anxiety because members
are concerned about the sick family, and how
to treat the illness
anxiety is compounded by additional
responsibilities when there is less time or
motivation to complete the normal task of
daily living

Nurse's role with families

experiencing illness
nurses involves both the ill individual and
the family in the nursing process
nurses can give support and information
through their interaction with the family
nurses makes sure that all the members
understand the health condition, its
management and the effect of these two
factors on family functioning
nurses also assess the family's readiness and
ability to provide continued care and
supervision at home when warranted

Death of Family Member

family needs counseling to deal with their
feelings after experiencing loss
they grieve for the lost person, and they
grieve for the family the way that it once was.

Implementing and Evaluating

Nursing interventions are based on the
medical diagnoses, and selected goals or
outcomes
in evaluating the success of the family care
plan, The nurse assess for the presence of
the indicators identifies for the choses
outcomes
Fundamentals of Nursing Practice

Promoting Health in Young Adult and

Middle Aged Adult
HEALTH RISKS
Young adults healthy time of life
20-40 years old
health risk do not occur
busy people who face many challenges
common in this age group include injury and
PHYSICAL DEVELOPMENT
violence, suicide, hypertension, substance
people in their 20s are in their prime physical
abuse, sexually transmitted Infections (STIs),
years.
eating disorders, and certain malignancies.
the body is at its most efficient functioning
behavioral problems can be prevented
at about age 25 years
through appropriate education and other
musculoskeletal system is well developed
primary intervention strategies
and coordinated.
peak period of athletic endeavors
PSYCHOSOCIAL DEVELOPMENT
faces numbers of new experiences and
changes in lifestyle as they progress toward
maturity
they make choices about education and
employment, about whether to marry or
remain single about starting a home, and
about rearing children.
forming new friendships and assuming some
community activities.
COGNITIVE DEVELOPMENT
able to use formal operations, characterized
by the ability to think abstractly and employ
logic.
e.g able to generate hypotheses about what
will happen, given a set of circumstances and
do not have to engage in trial- and -error
behavior
MORAL DEVELOPMENT
masters the previous stages of kohlberg's
theory of moral development, enters the
post conventional level
they are able to separate self from
expectations and rules of others and to
define morality in terms of personal
principles.
they judge according to their principle when
faced with conflict in society's rules and
laws.
 HEALTH RISKS
Middle Aged adults
40-65 years
years of stability and consolidation
their children have grown and moved away
or moving away from home
MATURITY- state of maximal function and
integration, or the state of being fully
developed
mature individuals are open to new
experiences and continued growth; they can
tolerate ambiguity, are flexed and can adapt
to change.
while many remains healthy, the risk of
developing health problem is greater than
that of young adult.
motor vehicle, occupational injuries, chronic
disease such as cancer and cardiovascular
disease, are the leading causes of death in
this age group
lifestyle patterns, aging, family history,
developmental and situational stressors
often lead to rise of health problems
Health assessment and
Promotion
middle aged persons are concerned with
their health and take care of themselves, and
interested in preventing the acceleration of
aging process.

PSYCHOSOCIAL DEVELOPMENT
ages 20-30 tend to be self and family
centered
middle aged people collaborates with others
time where most people become increasingly
aware of the gradual changes in their bodies
that marks the aging process.
some people try to defy the years by
changing the way they dress and even their
actions.
a new freedom to be independent and follow
one's individual interest arises.
prior to this period, the marriage partner or
lover and other individuals were crucial to a
definition of self
COGNITIVE DEVELOPMENT
little changes in cognitive and intellectual
abilities
cognitive process includes: reaction time,
memory, perception, learning, problem-
solving, and creativity