FUNDAMENTAL (LEC) - MODULE 5

COMMUNICATION - A lifelong learning process for nurses.

- Key to nurse-patient relationships.
THE JOINT COMMISSION (TJC) - to promote effective communication for patient-and-family-centered care, cultural
competence, and improved patient safety.

DEVELOPING COMMUNICATION SKILLS

CRITICAL THINKING - you consider a patient's problems.
PERSEVERANCE & CREATIVITY - they motivate a nurse to identify innovative solutions.
SELF-CONFIDENCE - patients respond more readily to a self-confident attitude.
HUMILITY - you need to better communicate and intervene with patients, especially related to their cultural needs.
INTEGRITY - allows nurses to recognize when their opinions conflict with those of their patients, review positions, and decide
how to communicate to reach mutually beneficial decisions.

THINKING is influenced by perception: FIVE SENSES, CULTURE, EDUCATION

PERCEPTUAL BIASES or STEREOTYPES - accurately perceiving and interpreting messages from others.
EMOTIONAL INTELLIGENCE (EI) - an assessment and communication technique that allows nurse to better understand and
perceive the emotions of themselves and others.

LEVELS OF COMMUNICATION
INTRAPERSONAL COMMUNICATION - also called SELF-
TALK, a powerful form of communication that you use as a
professional nurse.
INTERPERSONAL COMMUNICATION - one-on-one
interaction between a nurse and another person that
often occurs face to face.
SMALL-GROUP COMMUNICATION - occurs when a small
number of people meet.
- goal directed and
requires an understanding of group dynamics.
PUBLIC COMMUNICATION - interaction with an audience.
ELECTRONIC COMMUNICATION - use of technology to
create ongoing relationship with patients and health care
team.

ELEMENTS OF THE COMMUNICATION PROCESS

COMMUNICATION - ongoing and continuously changing process.
CIRCULAR TRANSACTIONAL MODEL - the referent, sender and receiver, message, channels, context, or environment
(communication process occurs), feedback and interpersonal variables.
REFERENT - motivates one person to communicate FEEDBACK - the message a receiver receives from
with another. the sender.
SENDER - who encodes and deliver message. INTERPERSONAL VARIABLES - factors within both
RECEIVER - person who receives and decodes the sender & receiver that influence communication.
message. ENVIRONMENT - setting for sender-receiver
MESSAGE - content of the communication. interaction.
CHANNELS - means of sending and receiving
messages through visual, auditory, and tactile senses.

ROLE RELATIONSHIP OF THE COMMUNICATORS

COMPLEMENTARY ROLE RELATIONSHIPS - function with one person holding an elevated position over the other person.
SYMMETRICAL RELATIONSHIP - more equal.

FORMS OF COMMUNICATION
1. VERBAL COMMUNICATION
o VOCABULARY - use spoken or written words.
o DENOTATIVE AND CONNOTATIVE MEANING - individuals who use a common language share the denotative
meaning. Connotative meaning is the shade or interpretation of the meaning of a word influenced by the thoughts,
feelings, or ideas the people have about the word.
o PACING - conversation is more successful at an appropriate speed or pace.
 o INTONATION - Tone of voice dramatically affects the meaning of a message.
o CLARITY AND BREVITY - effective communication is simple, brief, and direct.
- repeating important parts of a message also clarifies communication.
o TIMING AND RELEVANCE - Timing is critical in communication.
- even though a message is clear, poor timing prevents it from being effective.
2. NONVERBAL COMMUNICATION
o PERSONAL APPEARANCE - Physical characteristics, facial expression, & manner of dress and grooming.
o POSTURE AND GAIT - (Manner or pattern of walking) are forms of self-expression.
o FACIAL EXPRESSION - convey emotions such as surprise, fear, anger, happiness and sadness.
o EYE CONTACT - maintaining eye contact during conversations shows respect and willingness to listen.
o GESTURES - emphasize, punctuate, and clarify the spoken word.
o SOUNDS - Sighs, moans, groans, or sobs also communicate feelings and thoughts.
o TERRITORIALITY AND PERSONAL SPACE -needs to gain, maintain, and defend one's right.

METACOMMUNICATION - broad term that refers to all factors that influence communication.
- awareness of influencing factors helps people better understand what is communicated.

ZONES OF PERSONAL SPACE

INTIMATE ZONE • Holding a crying infant
(0 - 8 INCHES) • Performing physical assessment
• Bathing, grooming, dressing, feeding.
• Toileting a patient
• Changing a patient's surgical dressing

PERSONAL ZONE • Sitting at patient's bedside

(18 INCHES - 4 FEET) • Taking a patient's nursing history
• Teaching an individual patient

SOCIO-CONSULTATIVE ZONE • Giving directions to visitors in the hallway

(9 - 12 FEET) • Asking if families need assistance from the
patient doorway.
• Giving verbal report to a group of nurses.

PUBLIC ZONE • Speaking at a community forum

(12 FEET AND MORE) • Lecturing to a class of students
• Testifying at a legislative hearing
SPECIAL ZONES OF TOUCH
SOCIAL ZONE (PERMISSION NOT NEEDED) - hands, arms, shoulders, back.
CONSENT ZONE (PERMISSION NEEDED) - mouth, wrist, feet.
VULNERABLE ZONE (SPECIAL CARE NEEDED) - face, neck, front of body
INTIMATE ZONE - genitalia, rectum

NURSE-PATIENT CARING RELATIONSHIP - caring relationships are the foundation of clinical nursing practice.
Therapeutic relationships promote a psychological climate that facilitates positive change and growth.

FOUR GOAL-DIRECTED PHASES

1. PRE-INTERACTION PHASE - before meeting a patient.
2. ORIENTATION PHASE - nurse and patient meet and get to know one another.
3. WORKING PHASE - nurse and patient work together to solve problems and accomplish goas.
4. TERMINATION PHASE - during the ending of the relationship.

MOTIVATIONAL INTERVIEWING - a technique that holds promise for encouraging patients to share their thoughts, beliefs,
fears, and concerns with the aim of changing behaviors.
NURSE-FAMILY RELATIONSHIP - guide one-on-one helping relationships also apply when the patient is a family unit.
NURSE-HEALTH CARE TEAM RELATIONSHIP - SBAR technique for communication critical information improves perception of
communication and information about patients between health care providers.
▪ SBAR TECHNIQUE - Acronym for Situation, Background, Assessment, and Recommendation, a popular
communication tool that standardizes communication.
▪ LATERAL VIOLENCE - or workplace bullying between colleagues sometimes occurs and includes behaviors such as
withholding information and etc.
NURSE-COMMUNITY RELATIONSHIP - by participating in local organizations, volunteering for community service, or
becoming politically active.

ELEMENTS OF PROFESSIONAL COMMUNICATION

APPEARANCE, DEMEANOR, AND BEHAVIOR - be clean, neat, well groomed, conservatively dressed and odor free.
USE OF NAMES - always introduce yourself.
AUTONOMY AND RESPONSIBILITY - being self-directed and independent in accomplishing goals and advocating for others.
Professional nurses make choices and accept responsibility for the outcomes of their actions.
COURTESY - part of professional communication. Introduce yourself and state your title.
TRUSTWORTHINESS - To foster trust, communicate warmth and demonstrate consistency, reliability, honesty, competence
and respect.
ASSERTIVENESS - allows you to express feelings and ideas without judging or hurting others.

MODULE 6
FACTORS INFLUENCED COMMUNICATION
a. PSYCHOPHYSIOLOGICAL CONTEXT (INTERNAL FACTORS AFFECTING COMMUNICATION)
• Physiological status (pain, hunger, nausea, weakness, dyspnea)
• Emotional status (anxiety, anger, hopelessness, euphoria)
• Growth and development status (age, developmental task)
• Unmet needs (safety/security, love/belonging)
• Attitudes, values, beliefs (meaning of illness experience)
• Perceptions and personality (optimist/pessimist, introvert/extrovert)
• Self-concept and self-esteem (positive or negative)
b. RELATIONAL CONTEXT (NATURE OF THE RELATIONSHIP AMONG PARTICIPANTS)
• Social, helping or working relationship. • Level of self-disclosure among participants
• Level of trust among participants • Shared history of participants
• Level of caring expressed. • Balance of power and control
c. SITUATIONAL CONTEXT (REASON FOR COMMUNICATION)
• Information exchange • Problem resolution
• Goal achievement • Expression of feelings
d. ENVIRONMENTAL CONTEXT (PHYSICAL SURROUNDINGS IN WHICH COMMUNICATION OCCURS)
• Privacy level • Comfort and safety level
• Noise level • Distraction level
e. CULTURAL CONTEXT (SOCIOCULTURAL ELEMENTS THAT AFFECT AN INTERACTION)
• Educational level of participants • Customs and expectations
• Language and self-expression patterns

COMMUNICATION WITH NON-ENGLISH-SPEAKING PATIENTS - provide language access services like interpreters.
GENDER - influences how we think, act, feel, and communicate.
MEN - tend to use less verbal communication but are more likely to initiate communication and address issues more
directly.
WOMEN - tend to disclosure more personal information and use more active listening.
IMPAIRED VERBAL COMMUNICATION - primary nursing diagnostic label used to describe a patient with limited or no ability
to communicate verbally.
CAUSES OF THE COMMUNICATION DISORDER
• Physiological • Psychological
• Mechanical • Cultural or developmental in natur
• Anatomical
THERAPEUTIC COMMUNICATION TECHNIQUE - specific responses that encourage the expression of feelings and ideas and
convey acceptance and respect.
▪ ACTIVE LISTENING - being attentive to what a patient is saying both verbally and nonverbally. Use SOLER:
o S - Sitting posture, conveys the message that you are there to listen and are interested in what the patient is
saying.
o O - Observe an open posture (keep arms and legs uncrossed). You are "open" to what the patient says. A
"closed" position conveys a defensive attitude, possibly provoking a similar response in the patient.
o L - Lean toward the patient. Conveys that you are involved and interested in the interaction.
o E - Establish and maintain intermittent eye contact. Conveys your involvement in and willingness to listen to
what the patient is saying.
o R - Relax. Sense of being relaxed and comfortable with the patient. Restlessness communicates to the patient
lack of interest and a feeling of discomfort.
▪ SHARING OBSERVATIONS - helps a patient communicate without the need of extensive questioning, focusing or
clarification.
▪ SHARING EMPATHY - Empathy is the ability to understand and accept another person's reality, accurately perceive
feelings and communicate this understanding to the other.
▪ SHARING HOPE - appropriate encouragement and positive feedback are important in fostering hope and self-
confidence.
▪ SHARING HUMOR - a coping strategy that can reduce anxiety and promote positive feelings.
▪ SHARING FEELINGS - Emotions are subjective feelings that result from one's thought and perceptions.
▪ USING TOUCH - Touch, one of the most potential and personal forms of communication.
▪ USING SILENCE - Silence, prompts some people to talk. It allows a patient to think and gain insight.
▪ PROVIDING INFORMATION - tells other people what they need or want to know so they are able to make decision,
experience less anxiety, and feels safe and secure.
▪ CLARIFYING - to check whether you understand a message accurately, restate an unclear or ambiguous message to
clarify the sender's meaning.
▪ FOCUSING - centering a conversation on key elements or concepts of a message.
▪ PARAPHRASING - restating another's message more briefly using one's own words.
▪ VALIDATION - use to recognize and acknowledge a patient's thoughts, feelings, and needs.
▪ ASKING RELEVANT QUESTIONS - to seek information needed for decision-making.
▪ SUMMARIZING - concise review of key aspects of an interaction.
▪ SELF-DISCLOSURE - subjectively true personal experiences about the self that are intentionally revealed to another
person.
▪ CONFRONTATION - you help the other person become more aware of inconsistencies in his or her feelings, attitudes,
beliefs, and behaviors.
NONTHERAPEUTIC COMMUNICATION TECHNIQUES - or blocking and often cause recipients to activate defenses to avoid
being hurt or negatively affected.
▪ ASKING PERSONAL QUESTIONS - questions that are not relevant to a situation simply to satisfy your curiosity is not
appropriate professional communication.
▪ GIVING PERSONAL OPINIONS - it takes decision making away from the other person.
▪ CHANGING THE SUBJECT - changing the subject when a person is trying to communicate his or her story is rude and
shows a lack of empathy.
▪ AUTOMATIC RESPONSES - making stereotyped remarks about others reflects poor nursing judgment and threatens
nurse-patient or team relationship.
▪ FALSE ASSURANCE - discourage open communication.
▪ SYMPATHY - concern, sorrow, or pity felt for another person.
▪ ASKING FOR EXPLANATION - asking "why" questions causes resentment, insecurity, and mistrust.
▪ APPROVAL OR DISAPPROVAL - other people have right to be themselves and make their own decisions.
▪ DEFENSIVE RESPONSES - implies the other person has no right to an opinion.
▪ PASSIVE OR AGGRESSIVE RESPONSE - Passive responses, serve to avoid conflict or sidestep issues. Aggressive
responses, provoke confrontation at the other person's expense.
▪ ARGUING - Challenging or arguing against perceptions denies that they are real and valid.
ADAPTING COMMUNICATION TECHNIQUES - interacting with people who have conditions that impair communication (visual,
hearing) requires special thought and sensitivity.
MODULE 7
TEACHING - the concept of imparting knowledge through a series of directed activities.
LEARNING - new knowledge, attitudes, behaviors & skills through experience or external stimulus.
PATIENT CARE PARTNERSHIP OF THE AMERICAN HOSPITAL ASSOCIATION - indicates that patients have the right to make
informed decisions regarding their care.

THE JOINT COMMISSION's (TJC) SPEAK UP

Speak up if you have questions and concerns.
Pay attention to the care you get.
Educate yourself about your illness.
Ask a trusted family member or friend to be your
advocate.
Know which medicines you take and why.
Use a healthcare organization that has been carefully
evaluated.
Participate in all decisions about your treatment.

DOMAINS OF LEARNING:
1. COGNITIVE - includes all intellectual behaviors and requires thinking.
2. AFFECTIVE - deals with expression of feelings and development of attitudes, opinions, or values.
3. PSYCHOMOTOR - involves acquiring skills that require coordination & integration of mental & physical movement.
COGNITIVE LEARNING - requires thinking and encompasses the acquisition of knowledge and intellectual skills.
1. REMEMBERING - learning new facts or information and being able to recall them.
2. UNDERSTANDING - ability to understand the meaning of learned material.
3. APPLYING - using abstract, newly learned ideas in an actual situation.
4. ANALYZING - breaking down information into organized parts.
5. EVALUATING - ability to judge the value of something for a given purpose.
6. CREATING - ability to apply knowledge and skills to create something new.
AFFECTING LEARNING - deals with expression of feelings and development of values, attitudes, and beliefs.
1. RECEIVING - learner is passive and needs only to pay attention and receive information.
2. RESPONDING - requires active participation through listening and reacting verbally and nonverbally.
3. VALUING - attaching worth and value to the acquired knowledge as demonstrated by the learner's behavior.
4. ORGANIZING - developing a value system by identifying and organizing values according to their worth.
5. CHARACTERIZING - acting and responding with a consistent value system.
PSYCHOMOTOR LEARNING - motor skills that require coordination and the integration of mental and physical movements
such as the ability to walk or use an eating utensil.
1. PERCEPTION - being aware of objects or qualities through the use of sensory stimulation.
2. SET - readiness to take a particular action. (Mental, physical, and emotional)
3. GUIDED RESPONSE - involves imitation and practice of a demonstrated act.
4. MECHANISM - a person gains confidence and proficiency in performing a skill that is more complex.
5. COMPLEX OVERT RESPONSE - smoothly and accurately performing a motor skill that requires complex movement
patterns.
6. ADAPTATION - motor skills are well developed, and movements can be modified when unexpected problems occur.
7. ORIGINATION - create new movement patterns and perform them as needed in response to a particular situation or
problem.

BASIC LEARNING PRINCIPLES:

1. MOTIVATION TO LEARN - addresses the patient's desire or willingness to learn.
2. ABILITY TO LEARN - depends on physical and cognitive abilities, developmental level, physical wellness, thought
processes.
3. LEARNING ENVIRONMENT - allows a person to attend to instruction.

TEACHING METHODS BASED ON PATIENT'S DEVELOPMENTAL CAPACITY:

INFANT
• Keep routines consistent. (Feeding, bathing)
• Hold infant firmly while smiling and speaking softly to convey a sense of trust.
• Have infants touch different texture (soft fabric, hard plastic)
 TODDLER
• Use play to teach procedure or activity. (Applying bandage to doll)
• Offer picture books that describe the story of children in hospital or clinic.
• Use simple words such as cut instead of laceration to promote understanding.
PRE-SCHOOL
• Use role play, imitation and play to make learning fun.
• Encourage questions and offer explanations.
• Encourage children to learn together through pictures and short stories about how to perform hygiene.
SCHOOL-AGE CHILD
• Teach psychomotor skills needed to maintain health.
• Offer opportunities to discuss health problems and answer questions.
ADOLESCENT
• Help adolescent learn about feelings and need for self-expression.
• Use teaching as a collaborative activity.
• Allow adolescents to make decisions about health and health promotion.
• Use problem solving to help adolescents make choice.
YOUNG OR MIDDLE ADULT
• Encourage participation in teaching plan by setting mutual goals.
• Encourage independent learning.
• Offer information so the adult understands the effect of health problems.
OLDER ADULT
• Teach when the patient is alert and rested. • Focus on wellness and a person's strength.
• Involve adults in discussion or activity.
LEARNING ENVIRONMENT:
▪ Well-lit ▪ Comfortable temperature
▪ Good ventilation ▪ Quiet
▪ Appropriate furniture ▪ Private

HEALTH EDUCATION – MODULE 1

HISTORICAL FOUNDATIONS FOR PATIENT EDUCATION IN HEALTH CARE TEACHING ROLE OF NURSES
PATIENT EDUCATOR - standard quality services not only focus on care but also educating the sick.
NURSE EDUCATOR - the nurses should educate other nurses for professional practice.
MID 1800s - where responsibility for teaching is recognized as an important role of nurses as caregivers.
FLORENCE NIGHTINGALE - founder of modern nursing and ultimate educator, how to improve the health of people.
EARLY 1900s - PHN's role as nurse teacher in preventing disease and maintaining the health of society was emphasized.
PATIENT TEACHING - recognized as independent nursing function of nurses.
NURSING EDUCATION - educating other patients, families, and colleagues.
1918 NATIONAL LEAGUE OF NURSING PRACTICE (NLE) - NATIONAL LEAGUE FOR NURSING (NLN), observed the importance of
health teaching as a function within the scope of nursing practice.
NURSES AS AGENTS - promotion of health and preservation of illness in all settings which they practiced.
1950 NLNE IDENTIFIED COURSE CONTENT IN NURSING SCHOOL CURRICULA - prepare nurses to assume the role as teachers.
INTERNATIONAL COUNCIL OF NURSES (ICN) - nurse's role as educator as essential component of nursing care delivery.
NURSE PRACTICE ACTS (NPAs) - teaching with scope of nursing practice responsibilities.
1970 PATIENT'S BILL OF RIGHTS - ensure patient's complete and current information concerning their diagnosis, treatment
and prognosis.
1980 NURSE AS EDUCATOR, A PARADIGM SHIFT - focused on teaching for promotion and maintenance of health.
GRUENINGER (1995) TRANSITION TOWARD WELLNESS - from Disease-Oriented Patient Education (DOPE) to Prevention-
Oriented Patient Education (POPE) to ultimately become Health-Oriented Patient Education (HOPE).
ROLE OF THE NURSE (CHANGED) - from one wise health to expert advisor/teacher to facilitator.
FROM SIMPLE INFORMATION DISSEMINATOR - empowering patients to their potentials abilities and resources to the fullest.
1995 TH PEW HEALTH PROFESSIONS COMMISSION - published a broad set of competencies it believed would mark the
success of health professions in the 21st Century.
PROFESSIONAL NURSES - preparation of effective teaching services performance that meet the needs to many individuals
and groups in different circumstances across a variety of practice settings.
CLINICAL INSTRUCTOR - as educator serving students in practical settings.
ROLE OF CLINICAL EDUCATOR - requires teacher to actively engage students to become competent and caring professionals.

• Since 1999, nurses to be ranked No. 1 in Honesty and Ethics among 45 occupations.
PURPOSE - increase the competence and confidence of clients for self-management.
GOAL - increase responsibility and independence of clients for self-care.

EDUCATION PROCESS - systematic, sequential, logical, scientifically based, planned course of action consisting of two major
interdependent operations.
TEACHING AND INSTRUCTIONS - sharing information and experiences to meet intended learner outcomes in the
cognitive, affective, and psychomotor domain according to an education plan.
LEARNING - change in behavior (knowledge, skills, and attitudes) that can occur at any time or in any place as a result
of exposure to environmental stimuli.

ASSURE MODEL - useful paradigm to assist nurses to organize and carry out the education process.
Analyze learner. Use teaching materials.
State objectives Require learner performance.
Select instructional methods and tools. Evaluate/revise the teaching and learning process.

QUALITY AND SAFE EDUCATION IN NURSING (QSEN) - was funded to educate nursing students on patient safety and
healthcare quality.

6 QSEN COMPETENCIES
1. PATIENT-CENTERED CARE - patient has control of and is full partner in the provision of holistic, compassionate, and
comprehensive care based on the patient's values, needs and preferences.
2. TEAMWORK AND COLLABORATION - nurses and other health professionals must collaborate effectively with open
communication.
3. EVIDENCE-BASED PRACTICE - must be integrated to support clinical expertise in providing optimal health care.
4. QUALITY IMPROVEMENT - measure data and monitor patient outcomes to develop changes in method to
continuously improve the quality and safety in healthcare delivery.
5. INFORMATICS - use information technology to effectively communicate.
6. SAFETY - minimize the risk of harm to patients and healthcare providers through self and system evaluation.

PHASE II - dedicated to teaching strategies and resources.

PHASE III - to develop the faculty expertise needed to teach competencies in textbooks and assist in the licensure and
accreditation process.
BARRIERS TO EDUCATION - impeding the nurse's ability to deliver educational services.
OBSTABLES TO LEARNING - negatively affect the ability of the learner to attend to and process information.

MODULE 2
NATURAL LAW - basis (divine law), principles of respect for parents, respect for others, truth telling, honesty, respect for life,
and purity of heart.
DEONTOLOGICAL - golden rule, (Greek word DEON, which means "duty" and LOGOS means "science" or "study"). It is an
ethical belief system that stresses the importance of doing one's duty and following the rules.
TELEOLOGICAL (UTILITARIAN) - greatest good for the greatest number, sacrifice of one or more individuals so that a group of
people can benefit in some important way.

ETHICS - guiding behavioral principles.
ETHICAL - norms or standard of behavior.
ETHICAL DILEMMAS - moral conflict.
IMMANUEL KANT - promulgated the deontological notion
of the "GOLDEN RULE".
JOHN STUART MILL - who purported a teleological
approach.
MORAL VALUES - internal value system.
MORALITY - expressed externally through ethical
behaviors.
LEGAL RIGHTS AND DUTIES - rules governing behaviors PRACTICED ACTS - documents that define a profession.
that are enforceable under threat of punishment or
penalty.

INFORMED CONSENT - the right to full disclosure, right to make one's own decisions. Basic tenet of ethical thought.
RIGHT TO SELF-DETERMINATION - right to protect one's own body to how it shall be treated.

6 ETHICAL PRINCIPLES:
1. AUTONOMY - Greek words AUTO "self", and NOMOS "law". It refers to the right of self-determination.
2. VERACITY - or truth telling, with informed decision making and informed consent.
FOUR ELEMENTS MAKING UP THE NOTION OF INFORMED CONSENT
1. COMPETENCE - capacity of patient to make a reasonable decision.
2. DISCLOSURE OF INFORMATION - sufficient information regarding risks and alternative treatments be provided to the
patient to enable him or her to make a rational decision.
3. COMPREHENSION - individual's ability to understand the information being provided.
4. VOLUNTARINESS - the patient has made a decision without coercion or force from others.
EXPERT WITNESS - final dimension of the legality of truth telling relates to the role of nurses.
PLAINTIFF - the one who initiates the litigation.
DEFENDANT - the one being sued.
3. CONFIDENTIALITY - refers to personal information that is entrusted to and protected.
ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS) - considered to be private information.
4. NONMALEFICENCE - "do not harm" or refers to ethics of legal determination.
a. NEGLIGENCE - below the standard established by law for the protection of others against unreasonable risk
of harm.
PROFESSIONAL NEGLIGENCE - professional standard of due care.
DUE CARE - the kind of care healthcare professionals give patients when they treat them attentively and
vigilantly so as to avoid mistakes.
a. MALPRACTICE - limited class of negligent activities.
b. DUTY
5. BENEFICENCE - "doing good" for the benefit of others.
6. JUSTICE - speaks to fairness and equal distribution of goods and services.

DIRECT COSTS - tangible and predictable, such as rent, food, heating, etc.
INDIRECT COSTS - may be fixed but not necessarily directly related to a particular activity.
COST SAVINGS - money decreased use of costly services.
COST BENEFIT - when the institution realizes an economic gain resulting from the educational program.
COST RECOVERY - occurs when revenues generated are equal to or greater than expenditures.
REVENUE GENERATION - income earned that is above the costs of the programs offered.

MODULE 3
LEARNING - a relatively permanent change in mental processing, emotional functioning and behavior as a result of
experience.
BASIC MODEL OF LEARNING:
NS - Neutral Stimulus UCR - Unconditioned Responses CR - Conditioned Responses
UCS - Unconditioned Stimulus CS - Conditioned Stimulus

BEHAVIORIST THEORY - change the stimulus conditions in the environment and the reinforcement after a response.
RESPONDENT CONDITIONING - association learning or classical/Pavlovian conditioning, as the organism responds to stimulus
conditions and forms associations.
OPERANT CONDITIONING - as the organism responds to stimuli in the environment and is reinforced for making a particular
response.
COGNITIVE LEARNING THEORY - work with the developmental stage and change cognitions, goals, expectations, equilibrium,
and ways of processing information.
COGNITIVE DYNAMICS - organize experiences and make them meaningful.
GESTALT PERSPECTIVE - through reorganization of elements to form new insights and understanding.
INFORMATION-PROCESSING PERSPECTIVE - through guidance, feedback, and assessing and correcting errors.
COGNITIVE DEVELOPMENT PERSPECTIVE - recognize the developmental stage and provide appropriate experiences to
encourage discovery.

INFORMATION PROCESSING MODEL OF MEMORY

SOCIAL CONTRUCTIVIST PERSPECTIVE - through collaboration and negotiation, new understanding is acquired.
SOCIAL COGNITION PERSPECTIVE - individual's perceptions, beliefs, social judgment are affected strongly by social
interaction, communication, groups, and social situation.
COGNITIVE-EMOTIONAL PERSPECTIVE - efforts to incorporate emotional considerations within a cognitive framework.
SOCIAL LEARNING THEORY - utilize effective role models who are perceived to be rewarded, and work with the social
situation and the learner's internal self-regulating mechanisms.
SOCIAL LEARNING DYNAMICS - encourage active learner to regulate and reproduce behavior.

MASLOW'S HIERARCHY OF NEEDS

SELF ACTUALIZATION - need to fulfill one's potential.
ESTEEM - need to be perceived as competent, have
confidence and independence, have status, recognition,
and appreciation.
BELONGING AND LOVE - need to give and receive
affection.
SAFETY - need for security, stability, structure, and
protection as well as freedom from fear.
PHYSIOLOGICAL - to have basic survival needs met (food,
water, warmth, sleep).

NEUROPSYCHOLOGICAL LEARNING - bases of thinking, learning and behavior.

GENERALIZATIONS ABOUT LEARNING - learning is a function of physiological and neurological developmental changes.
MOTOR LEARNING - useful in addition to theories of psychological learning.
STAGES OF MOTOR LEARNING
i. COGNITIVE STAGE - Learner works to develop cognitive maps.
ii. ASSOCIATIVE STAGE - more consistent performance, slower gains, fewer errors.
iii. AUTONOMOUS STAGE - automatic stage, achieving advanced level.

MODULE 4
THREE DETERMINANTS OF LEARNING:
1. The needs of the learner 3. The preferred learning styles for processing
2. The state of readiness to learn. information.
ROLE OF EDUCATING OTHERS - one of the most essential interventions that a nurse performs.
THE LEARNER - most important person in the education process.

GOOD ASSESSMENTS - ensure that optimal learning can occur with the least amount of stress and anxiety for the learner.
FOCUS GROUPS - involve getting together a small number (4-12) of potential learners.
SELF-ADMINISTERED QUESTIONNAIRES - checklists are one of the most common forms of questionnaires.
TESTS - written pretests given before teaching is planned can help identify the knowledge level of potential learner.
OBSERVATIONS - can provide useful data related to needs.
DOCUMENTATION - create patterns that reveal learning needs.
WRITTEN JOB DESCRIPTIONS - what is required to effectively carry out job responsibilities is a source to determine potential
learning needs of staff.

TYPES OF READINESS TO LEARN

1. PHYSICAL READINESS - measures of ability, complexity of task, environmental effects.
2. EMOTIONAL READINESS - anxiety level, support system, motivation, risk-taking behavior, frame of mind.
3. EXPERIENTIAL READINESS - level of aspiration, past coping mechanism, cultural background, locus of control.
4. KNOWLEDGE READINESS - present knowledge base, cognitive ability, learning disabilities, learning styles.

LOCUS OF CONTROL - whether readiness to learn comes from internal or external stimuli can be determined by ascertaining
the learner's previous life patterns of responsibility and assertiveness.
 INTERNAL LOCUS OF CONTROL - patients are internally motivated to learn.
EXTERNAL LOCUS OF CONTROL - they are externally motivated.

DUNN's LEARNING STYLE OPTIONS

• Environmental elements • Sociological patterns • Psychological elements
• Emotional elements • Physical elements
MYERS-BRIGGS TYPE INDICATOR
EXTRAVERSION (E) ------- INTROVERSION (I)
SENSING (S) ---------------- IINTUITION (N)
THINKING (T) -------------- FEELING (F)
JUDGMENT (J) ------------ PERCEPTION (P)

KOLB's MODEL (CYCLE OF LEARNING) - the learner is not a blank.

KOLB's THEORY OF EXPERIENTIAL LEARNING
4 MODES OF LEARNING:
1. CONCRETE EXPERIENCE - learning from actual experience.
2. ABSTRACT CONCEPTUALIZATION - creating theories to explain what is seen.
3. ACTIVE EXPERIMENTATION - using theories to solve problems.
4. REFLECTIVE OBSERVATION - learning by observing others.
2 MAJOR DIMENSIONS:
1. PERCEPTION DIMENSION 2. PROCESS DIMENSION

4 LEARNING STYLES:
1. CONVERGER - learns by AC and AE, good at decision making, problem solving.
2. DIVERGER - stresses CE and RO, people & feeling oriented & likes to work in groups.
3. ACCOMMODATOR - relies heavily on CE and AE, impatient w/other people, risk taker.
4. ASSIMILATOR - emphasized AC and RO, more concerned with abstract idea than people.
4MAT SYSTEM - combination of Kolb's model with right/left-brain research.
GARDNER'S EIGHT TYPES OF INTELLIGENCE:
1. LINGUISTIC INTELLIGENCE 5. MUSICAL INTELLIGENCE
2. SPATIAL INTELLIGENCE 6. LOGICAL-MATHEMATICAL INTELLIGENCE
3. BODILY KINESTHETIC INTELLIGENCE 7. INTRAPERSONAL INTELLIGENCE
4. INTERPERSONAL INTELLIGENCE
VARK LEARNING STYLES:
1. VISUAL 3. READ/WRITE
2. AURAL 4. KINESTHETIC

MODULE 5
DEVELOPMENTAL CHARACTERISTICS
PEDAGOGY - art and science of helping children learn.
ANDRAGOGY - the art and science of teaching adults.
GERAGOGY - teaching of old persons, accommodating the normal physical, cognitive, and psychosocial changes.

STAGES OF CHILDHOOD
STAGE PIAGET ERIKSON SALIENT CHARACTERISTICS TEACHING STRATEGIES

INFANCY AND SENSORIMOTOR STAGE - TRUST VS. MISTRUST COGNITIVE - responds to FOCUS ON: normal
TODDLERHOOD through sensory (BIRTH TO 12 step-by-step commands; development, safety,
experiences and through MONTHS) - building language skills develop health promotion, and
movement of objects. trust and establishing rapidly during this stage. disease promotion.
balance between PSYCHOSOCIAL - aggravated
feelings of love and by personal and external
hate. limits; routines provide sense
of security.
 EARLY PREOPERATIONAL INITIATIVE VS GUILT - COGNITIVE - animistic Build trust; allow for
CHILDHOOD PERIOD - Egocentric; taking on tasks for the thinking; limited sense of manipulation of
thinking is literal and sake of being involved time; egocentric/egocentric objects; use positive
concrete; precaudal and on the move; causation thinking; reinforcement;
thinking. learning to express transudative reasoning. encourage questions;
feelings through play. PSYCHOSOCIAL - separation provide simple drawing
anxiety, play is his/her work; and stories; focus on
fears loss of body integrity; play therapy; stimulate
active imagination; interacts the senses.
with playmates.

MIDDLE AND LATE CONCRETE OPERATIONS INDUSTRY VS COGNITIVE - able to draw Encourage
CHILDHOOD STAGE - developing INFERIORITY - gaining conclusions and intellectually independence; use
logical thought sense of responsibility can understand cause and logical explanations
processes and syllogistic and reliability; effect. and analogies; relate to
reasoning; understand increased susceptibility PSYCHOSOCIAL - fears failure child's experience; use
cause an effect and to social forces outside and being left out of groups; subject-centered focus;
conservation. the family unit; gaining fears illness and disability. use play therapy.
awareness of
uniqueness of special
talents and qualities.

ADOLESCENCE FORMAL OPERATIONS IDENTITY VS ROLE COGNITIVE - propositional Establish trust; identify
STAGE - abstract CONFUSION - thinking; complex logical control focus; use
thought; propositional struggling to establish reasoning; can build on past peers for support and
reasoning; adolescent own identity; seeking experiences; conceptualizes influence; negotiate for
egocentrism (imaginary independence and the invisible. change-contract; make
audience) autonomy. PSYCHOSOCIAL - need for information
belonging to a group need for meaningful to life;
personal space. ensure confidentiality
and privacy.

MODULE 6
COMPLIANCE - a submission or yielding to predetermined goals through regimens prescribed or established by others.
- observable, can be measured, healthcare provider viewed as authority, learner viewed as submissive.
ADHERENCE - a commitment or attachment to a prescribed, predetermined regimen.
- ability to maintain health-promoting regimens, outcomes determined largely by healthcare provider.

PERSPECTIVE ON COMPLIANCE
1. BIOMEDICAL THEORIES
a. Biomedical, including patient demographics, severity of disease, and complexity of treatment regimen.
2. BEHAVIORAL/SOCIAL LEARNING THEORIES
a. Focuses on external factors that influence the patient's adherence such as rewards, cues, contracts, and
social support.
3. COMMUNICATION MODEL
a. Feedback loop of sending, receiving, comprehending, retaining and acceptance.
4. RATIONAL BELIEF THEORY
a. Weighing the benefits of treatment and the risks of disease through the use of cost-benefit logic.

NONCOMPLIANCE - non submission or resistance of an individual to follow a prescribed.

NONADHERENCE - the patient declines to follow a previously agreed-upon treatment recommendation.
LOCUS OF CONTROL - an individual's sense of personal responsibility for behavior and extent to which motivation to act
originates from self.
HEALTH LOCUS OF CONTROL (HLOC) DIMENSIONS
1. INTERNAL
a. Power originates from within and is related to personal abilities.
2. CHANCE EXTERNAL
a. Fate is a powerful outside influence.
3. OTHERS EXTERNAL
a. Others such as family, friends, and associates are powerful influences.
4. DOCTORS EXTERNAL
a. Doctors have the power to control outcomes.

MOTIVATION - to set into motion, from Latin word MOVERE; a psychological force that moves a person toward some kind of
action, positive or negative.

MOTIVATIONAL FACTORS - incentives or obstacles to achieving desired behaviors.

▪ COGNITIVE - thinking process. ▪ PSYCHOMOTOR - skills behaviors
▪ AFFECTIVE - emotions and feelings ▪ SOCIAL CIRCUMSTANCES

MOTIVATIONAL AXIOMS - premises on which an understanding of a phenomenon is based.

STAGE FOR MOTIVATION

o STATE OF OPTIMAL ANXIETY - when a state of
moderate anxiety exists. The learner's ability to
observe, focus attention, learn and adapt is
operative.
o LEARNER READINESS - desire to move towards a
goal and readiness to learn are factors that
influence motivation.
o REALISTIC GOALS - within the person's grasp and
possible to achieve will likely be something toward
which an individual will work.
o LEARNER SUCCESS - success is self-satisfying and
feeds the learner's self-esteem.
o UNCERTAINTY REDUCTION OR MAINTENANCE - a
common experience in the healthcare arena.

COGNITIVE VARIABLES:
• AFFECTIVE VARIABLES - expression of constructive • ENVIRONMENTAL VARIABLES - appropriateness of
emotional state physical environment, social support systems,
• PHYSIOLOGIC VARIABLES - capacity to perform family, group, work, community resources.
required behavior. • EDUCATOR-LEARNER RELATIONSHIP SYSTEM -
• EXPERIENTIAL VARIABLES - previous successful prediction of positive relationship.
experiences.

ARCS MODEL - creating and maintaining motivational strategies used for instructional design.
CONFIDENCE - deals with learning requirements, level of difficulty, expectations, attributions, and sense of accomplishment.
SATISFACTION - pertains to timely use of a new skill, use of rewards, praise, and self-evaluation.

MOTIVATIONAL INTERVIEWING - which you become a helper in the change process and express acceptance of your client.
FIVE PRINCIPLES:
a. Roll with resistance. c. Avoid argumentation. e. Support self-efficacy.
b. Express empathy d. Develop discrepancy.

RESISTANCE - a legitimate concern for the clinician because it is predictive of poor treatment outcomes and lack of
involvement in the therapeutic process.
FOUR TYPES OF CLIENT RESISTANCE
a. Arguing c. Interrupting
b. Denying d. Ignoring
EMPATHY - understanding another's meaning through the use of reflective listening.
DISCREPANCY - raising your client's awareness of the negative personal, familial, or community consequences of a problem
behavior.
SPECIFIC STRATEGIES (OARS)
OPEN-ENDED QUESTIONING - helps you understand your client's point of view and elicits their feelings about a given topic or
situation.
AFFIRMATIONS OF THE POSITIVES - affirming your client supports and promotes self-efficacy.
REFLECTIVE LISTENING - you demonstrate that you have accurately heard and understood a client's communication by
restating its meaning.
SUMMARIZE - summarizing what a client has expressed and communicating it back.

STAGES OF CHANGE MODEL:

1. PRECONTEMPLATION - no intention on changing behavior.
2. CONTEMPLATION - aware problem exists but with no commitment to action.
3. PREPARATION - intent on taking action to address the problem.
4. ACTION - active modification of behaviors.
5. MAINTENANCE - sustained change. New behavior replaces old.
6. TERMINATION - fall back to old patterns of behaviors.
MODULE 7
LITERACY - the ability of adults to read, write, and comprehend information at the 8th grade level or above.
ILLITERACY - the ability of adults to read, write, and comprehend information at the fourth-grade level or below.
LOW LITERACY (MARGINALLY LITERATE OR ILLITERATE) - the ability of adults to read, write, and comprehend information
between the fifth to eight grade levels of difficulty.
FUNCTIONAL ILLITERACY - in adults, the lack of fundamental reading, writing, and comprehension skills needed to operate
effectively in today's society.
HEALTH LITERACY - the ability to read, interpret, and comprehend health information to maintain optimal wellness.
READABILITY - written or printed information can be read.
NUMERACY - the ability to read and interpret numbers.
READING (WORD RECOGNITION) - ability to transform letters into words and pronounce them correctly.
COMPREHENSION - individuals understand and accurately interpret what they have read.

LITERACY RELATIVE TO ORAL INSTRUCTION:

ILORALACY - inability to comprehend simple oral language communicated through speaking of commo vocabulary, phrases,
or slang words.

LITERACY RELATIVE TO COMPUTER INSTRUCTION

• The ability to use computers for communication is an increasingly popular issue with respect to learner literacy.
COMPUTERS - used to convey as well as to access information.

HEALTH ASSESSMENT (LEC) - MODULE 1

HEALTH - a relative state in which a person is able to live to his or her potential.
PHYSICAL HEALTH - how the body works and adapts.
EMOTIONAL HEALTH - positive outlook and emotions channeled in a healthy manner.
SOCIAL WELL-BEING - supportive relationships with family and friends.
CULTURAL INFLUENCES - favorable connections to promote health.
SPIRITUAL INFLUENCES - living peacefully, morally and ethically.
ENVIRONMENTAL INFLUENCES - favorable conditions to promote health.
DEVELOPMENTAL LEVEL - how one thinks, solve problems and make decisions.

NURSING HEALTH ASSESSMENT - entails both a comprehensive health history and a complete physical examination.
FIRST PART OF HEALTH ASSESSMENT - Health History.
2ND PART OF HEALTH ASSESSMENT - Physical Examination.
NURSING PROCESS - ability of the nurse to extrapolate the findings, prioritize them and finally formulate and implement the
plan of care is the overall goal.
o ASSESSMENT - first step of the nursing process. Subjective and objective data gathered.
o DIAGNOSIS - based on real or potential health problems. Nurses use clinical reasoning to formulate diagnoses.
o PLANNING - best course of action to address the patient's diagnoses.
 o IMPLEMENTATION - clearly relates to the nursing diagnosis and the planned goals.
o EVALUATION - continuing process to determine if the goals have been attained.
TYPES OF HEALTH ASSESSMENT:
▪ COMPREHENSIVE HEALTH ASSESSMENT - ▪ FOLLOW-UP HISTORY - form of a focused
complete health data. assessment.
▪ FOCUSED ASSESSMENT - focuses on gathering ▪ EMERGENCY HISTORY - focused on patient's
information about the patient's problem. emergent problem with a systematic prioritization
of need beginning with the ABCs.
MODULE 2
HEALTH HISTORY INTERVIEW - a conversation with a purpose.
• Establish a trusting and supportive relationship. • Offer information.
• Gather information.
HEALTH HISTORY FORMAT - an organize patient information in written, electronic, and verbal form to communicate
effectively with other health care providers.
• Past • Present • Family history

PHASES OF INTERVIEW:
1. PRE INTERVIEW - a smooth interview.
a. SELF-REFLECTION - continual part of professional development in clinical work.
2. INTRODUCTION - put patient at ease and establish trust/rapport.
3. WORKING - obtain patient information.
SEVEN ATTRIBUTES OF A SYMPTOMS
a. ONSET e. ASSOCIATED MANIFESTATION
b. LOCATION f. RELIEVING FACTORS
c. DURATION g. TREATMENT
d. CHARACTERISTIC
4. TERMINATION - summarize important points. Discuss plan of care.

TYPES OF DATA:
▪ SUBJECTIVE DATA - client's point of view (symptoms)
▪ OBJECTIVE DATA - observable and measurable (signs)

HISTORY OF PRESENT ILLNESS (HPI) - complete, clear, and chronologic account of the problems prompting the patient to seek
care.
KEY ELEMENTS OF THE PAST HISTORY:
▪ ALLERGIES - reactions to each medication.
▪ MEDICATION - home remedies, nonprescription drugs, vitamins, mineral/herbal supplements.
▪ CHILDHOOD ILLNESS
▪ ADULT ILLNESS:
o MEDICAL o ACCIDENTS
o SURGICAL o PSYCHIATRIC
▪ HEALTH MAINTENANCE
o IMMUNIZATIONS - whether patient has received vaccines.
o SCREENING TESTS - tuberculin test, cholesterol tests, stool for occult blood.
▪ FAMILY HISTORY - parents, grandparents, siblings, children, grandchildren.
▪ REVIEW OF SYSTEM - series of questions going from "head to toe".
▪ HEALTH PATTERNS - guide for gathering personal/social history from the patient and daily living routines.
▪ MENTAL HEALTH HISTORY

MODULE 3
PHYSICAL EXAMINATION - process to obtain objective data from the patient.

CARDINAL TECHNIQUES OF EXAMINATION:

▪ NOTE: Abdominal Examination - IAPP (Inspection, Auscultation, Percussion, Palpation)
 ▪ NOTE: Physical Examination - IPPA (Inspection, Palpation, Percussion, Auscultation)
INSPECTION - close observation of the details of the patient's appearance, behavior and movement.
PALPATION - tactile pressure from the palmar fingers or finger pads.
PERCUSSION - use of the striking or plexor finger.
AUSCULTATION - use of the diaphragm and bell of the stethoscope to detect the characteristics of heart, lung, and bowel
sounds.

SNELLEN CHART - to measure visual activity.
STADIOMETER - to measure height of a person.
OPHTALMOSCOPE - examine the interior structure of the
eye.
SPHYGMOMANOMETER - to measure a patient's blood
pressure.
STETHOSCOPE - used to listen to the body sounds.
REFLEX HAMMER - test the deep tendon reflexes.
OTOSCOPE - view the ear canal and tympanic membrane.
PULSE OXIMETER - to measure the oxygen saturation level
in the blood.
PLATFORM WEIGHING SCALE - to measure the mass of
patients.
TUNING FORK - used to test a patient's hearing.

MODULE 4
INTERVIEWING FAMILY CAREGIVERS:
▪ Ask questions and note them. ▪ Avoid being judgmental.
INTERVIEWING THE CHILD:
▪ Be age appropriate. ▪ Establish rapport. ▪ Listen
INTERVIEWING THE ADOLESCENT:
▪ Interview in private
OBTAINING A CLIENT HISTORY
• BIOGRAPHICAL DATA • REVIEW OF SYSTEMS FOR CURRENT HEALTH
• CHIEF COMPLAINT PROBLEMS
• HISTORY OF PRESENT HEALTH CONCERN • ALLERGIES, MEDICATIONS AND SUBSTANCE
• HEALTH HISTORY ABUSE
• FAMILY HEALTH HISTORY • LIFESTYLE
• DEVELOPMENTAL LEVEL

VITAL SIGNS - Temperature, pulse, blood pressure, respiration, pain.

▪ TEMPERATURE:
• ORAL TEMPERATURE - 36.4 to 37.4 Celsius (97.6 - 99.3 Fahrenheit)
• RECTAL TEMPERATURE - 0.5 - 0.1 degrees higher than oral.
• AXILLARY TEMPERATURE - 0.5 - 0.1 degrees lower than oral
• TYMPANIC TEMPERATURE
PULSE - Apical pulse, counted for child. Radial pulse, taken on an older child.
- 100 to 180 bpm for neonate, 50 to 95 bpm for 14-18 years old adolescent.
BLOOD PRESSURE
• The most common sites used to obtain a blood pressure in children are the upper arm, lower arm or forearm, thigh,
and calf or ankle.
• Blood pressure is taken by auscultation, palpation, or doppler/electronic method.
RESPIRATION
• Retractions are noted as substernal, subcostal, intercostal, suprasternal, or supraclavicular.

PHYSICAL ASSESSMENT:
▪ HEAD AND NECK
▪ ASSESS THE RANGE OF MOTION - ability to control the head and the range of motion.
▪ ASSESS THE FONTANELS - feel the skull to determine if the fontanels are open or closed.
▪ ASSESS THE EYES - observe the eyes for symmetry and location in relationship to the nose.
▪ ASSESS THE EARS - alignment of the ears by drawing an imaginary line from the outside corner of the eye to
the prominent part of the child's skull.
▪ ASSESS THE NOSE, MOUTH AND THROAT - nose is in the middle of the face.
 ▪ CHEST AND LUNGS
▪ HOW TO MEASURE THE CHEST - take the measurement at the nipple level with a tape measure.
▪ ADOLESCENT - evidence of breast development.
▪ ASSESS RESPIRATORY CHARACTERISTICS - evaluate respiratory rate, rhythm, and depth.
▪ HOW TO ASSESS BREATH SOUNDS - using stethoscope.
▪ HEART
▪ ASSESSING HEART RATE AND RHYTHM - listen for the rhythm of the heart sounds and counts the rate for 1
full minute.
▪ ASSESSING FOR HEART ABNORMALITIES - abnormal or unusual heart sounds should be reported.
▪ ASSESS THE HEART FUNCTION'S EFFECTIVENESS - assesses the pulses in various parts of the body.
▪ ABDOMEN
▪ DIVING THE ABDOMEN - four sections of abdomen, Left Upper Quadrant (LUQ), Left Lower Quadrant (LLQ),
Right Lower Quadrant (RLQ), Right Upper Quadrant (RUQ).
▪ ASSESS BOWEL SOUNDS - using stethoscope.
▪ GENITALIA AND RECTUM
▪ INSPECT THE GENITALIA AND RECTUM - observe the area for any sores or lesions, swelling or discharge.
▪ ASSESS THE TESTES - the testes descend at varying times during childhood; if the testes cannot be palpated,
it should be reported.
▪ BACK AND EXTREMITIES
▪ ASSESS THE BACK - in infants the spine is rounded and flexible.
▪ ASSESS GAIT AND POSTURE
▪ ASSESS THE EXTREMITIES - should be warm, have good color and be symmetrical.
▪ NEUROLOGIC
▪ NEUROLOGIC EXAM - examination of the reflex response, and functioning of each of the cranial nerves.
▪ NEUROLOGIC ASSESSMENT TOOLS - Glasgow coma scale, monitoring permits the comparison of results from
one time to another and from one examiner to another.

MODULE 5
CULTURAL ASSESSMENT - systematic, comprehensive examination of individuals, families, groups and communities regarding
their health-related cultural beliefs, values and practices.
GLOBAL MIGRATION - increased the challenges of providing health care to patients with health care beliefs, practices, and
needs different from healthcare provider.

CULTURE - shared ideas, rules, meanings that influences how we view the world.
ETHNICITY - ethnic group composed of individual who self-identity membership group with shared values, ancestry, and
experiences.
RACE - socially constructed concept of dividing people into population or groups on the basis of various sets physical
characteristics.
CULTURAL COMPETENCE - the need to care for people of different cultures.
CULTURE DESIRE - nurse needs to "want to" and not "need to" become culturally aware.
CULTURE HUMILITY - a lifelong process of self-reflection and self-critique whereby the individual not only learns about
another's culture, but one start with an examination of his/her own beliefs and cultural identities.

3 DIMENSIONS OF CULTURAL HUMILITY

1. SELF AWARENESS - about your own biases.
2. RESPECTFUL COMMUNICATION - work to eliminate assumptions about what is "normal". Learn directly from your
patients.
3. COLLABORATIVE PARTNERSHIP - patient relationships on respect and mutually acceptable plans.
SELF-AWARENESS - explore own cultural identity.
VALUES - to measure our own and others beliefs and behaviors.
BIASES - attitudes or feelings that we attach to perceived differences.

SPIRITUAL ASSESSMENT:
SPIRITUALITY - the most human of experiences that weeks to transcend.
RELIGION - system of beliefs or practice of worship.
SPIRITUAL DISTRESS - an individual’s sense of purpose or meaning of life is threatened, spiritual distress may result.
NURSING PRESENCE - holistic and reciprocal exchange between the nurse and patient's sincere connection and sharing of
human experience.

MODULE 6
MENTAL SYATUS EXAMINATION (MSE) - tools for assessing psychological dysfunction and identifying.
APPEARANCE - record the patient's sex, age, race, and ethnic background, patient's nutritional status by observing the
patient's current body weight and appearance.
ATTITUDE TOWARD THE EXAMINER - patient’s facial expression and attitude toward the examiner.
MOOD - defined as sustained emotion that the patient is experiencing.
AFFECT - patient's affect is defined in the following terms:
▪ EXPANSIVE - contagious ▪ BLUNTED - minimal variation
▪ EUTHYMIC - normal ▪ FLAT - no variation
▪ CONSTRICTED - limited variation.
SPEECH - all aspects of the patient's speech, including quality, quantity, rate, volume of speech during interview.
THOUGHT PROCESS - record the patient's process of thought information.
▪ LOOSENESS OF ASSOCIATION - irrelevance ▪ DERAILMENT - extreme irrelevance
▪ FLIGHT OF IDEAS - change topic ▪ NEOLOGISM - creating new words.
▪ RACING - rapid thoughts ▪ CLANGING - rhyming words
▪ TANGENTIAL - departure from topic with no ▪ PUNNING - talking in riddles.
return ▪ THOUGHT BLOCKING - speech is halted.
▪ CIRCUMSTANTIAL - being vague. ▪ POVERTY - limited content
▪ WORD SALAD - nonsensical responses
THOUGHT CONTENT - whether or not a patient is experiencing hallucinations.
TYPES OF HALLUCINATIONS
a. AUDITORY - hearing things c. GUSTATORY - tasting things. e. OLFACTORY - smelling
b. VISUAL - seeing things. d. TACTILE - feeling sensations. things
TYPES OF DELUSIONS
a. GRANDIOSE - delusions of grandeur
b. RELIGIOUS - delusions of special status with God
c. PERSECUTION - belief that someone wants to cause them harm.
d. EROTOMANIC - belief that someone famous is in love with them.
e. JEALOUSY - belief that everyone wants what they have.
f. THOUGHT INSERTION - belief that someone is putting ideas or thoughts into their mind.
g. IDEAS OF REFERENCE - belief that relatively ordinary or commonplace phenomena refer specifically to them.
ASPECT OF THOUGHT
a. OBSESSION AND COMPULSION - signs of ritualistic type behaviors should be explored further to determine the
severity of the obsession or compulsion.
b. PHOBIAS - any fears that cause them to avoid certain situation/things.
c. SUICIDAL IDEATION OR INTENT - inquire about past acts of self-harm or violence.
d. HOMICIDAL IDEATION OR INTENT - inquiring about homicidal ideation or intent during each patient interview.
e. SENSORIUM AND COGNITION - perform the mini-mental state examination (MMSE) or folstein test.
f. LANGUAGE - spontaneous speech may be noted.
g. COMPREHENSION - simple instruction to patient.
h. CONSCIOUSNESS - Level of Consciousness:
a. COMA - unresponsiveness c. LETHARGIC - drowsiness
b. STUPOROUS - response to pain d. ALERT - full awareness
i. ORIENTATION
j. CONCENTRATION AND ATTENTION
k. READING AND WRITING
l. VISUOSPATIAL ABILITY - have the patient draw interlocking pentagons to determine constructional apraxia.
m. MEMORY
n. ABSTRACT THOUGHT - patient's ability to determine similarities.
 o. GENERAL FUND OF KNOWLEDGE
p. INTELLIGENCE - estimate the patient's intelligence quotient.
INSIGHT - patient's understanding of their condition.
JUDGMENT - patient's judgment based on the history or on an imaginary scenario.
IMPULSIVITY - degree of the patient's impulse control.

MODULE 7
PURPOSE OF THE INTEGUMENTARY HISTORY:
1. Disease of the skin 3. Physical abuse 5. Risk for skin cancer
2. Systematic diseases that 4. Risk for pressure ulcer 6. Need for health promotion
have skin manifestations formation education regarding skin
COMMON/CONCERNING SYMPTOMS:
1. Rash 3. Moles 5. Bruising
2. Non-healing lesions 4. Lesions 6. Hair loss

CYANOSIS - bluish-purple hue to the skin.

• Central cyanosis is best identified in the lips, oral mucosa, and tongue.
CAUSES:
a. Lung disease
b. Congenital heart disease - usually peripheral cyanosis (decreased blood flow)
c. Hemoglobinopathies
d. Pulmonary edema - may also be central cyanosis.
• Cyanosis of the nails, hands, and feet may be Central or Peripheral in origin.
CAUSES:
a. Venous obstruction
• Anxiety or a cold examining room may cause peripheral cyanosis.
JAUNDICE - yellow color seen in the skin.
• May also appear in the palpebral conjunctiva, lips, hard palate, undersurface of the tongue, tympanic membrane and
skin.
CAUSES:
a. Liver disease
b. Excessive hemolysis of red blood cells
• CAROTENEMIA - yellow color that accompanies high levels of carotene. Nurse must look at palms, soles, and face for
this condition.
MOISTURE - excessive dryness, sweating, and oiliness. Skin should
• Perspiration may appear on the face, hands, axillae, or skin folds in response to a warm environment; increased
metabolic activity, such as fever or exercise; and anxiety or pain.
• Excessive dryness, often accompanied by flaking or excessive sweating (diaphoresis) may indicate a problem.
• Dryness in hypothyroidism; oiliness in acne. Dry skin with parched cracked lips, dry mucous membranes, and lack of
tears indicate dehydration.
TEMPERATURE - use the backs of your hands to make this assessment.
• The temperature of any areas with increased • HYPERTHYROIDISM - warmth in fever;
pigmentation or erythema. HYPOTHYROIDISM - coolness
TEXTURE - roughness or smoothness
• HYPERTHYROIDISM - velvety texture; HYPOTHYROIDISM - roughness
MOBILITY AND TURGOR - if skin lifts up (mobility), returns into place (turgor).
• Decreased mobility in edema and scleroderma; • The best area to assess for skin turgor would be
decreased turgor in dehydration. on the abdomen.
EDEMA - presence of excess fluid in the interstitial spaces.
• Systemic Edema - most often occurs in dependent portions of the body, feet, legs, and sacral area.
• Mobility is decreased and cyanosis or jaundice in the skin obscured.
• Edema may be pitting or non-pitting. In PITTING EDEMA, the interstitial water is mobile and can be translocated with
the pressure exerted by a finger.
• A "PIT" or depression is left for 5 to 30 seconds. Degree of pitting is 1 to 4 scale.
SKIN LESIONS: ANATOMIC LOCATION AND DISTRIBUTION
PITYRIASIS ROSEA - temporary rash of raised red scaly patches on the body.
PSORIASIS - patches of thick red skin and silvery scales mainly on the extensor surface.
TINEA VERSICOLOR - common fungal infection of the skin. Tan, flat, scaly lesions.
ATOPIC ECZEMA - causes inflammation, redness, and irritation of the skin, appears mainly on flexor surfaces.

SKIN LESIONS: PATTERNS AND SHAPES

LINEAR - linear epidermal nevus, type of birthmark that is usually present at birth.
GEOGRAPHIC - mycosis fungoides, type of non-Hodgkin lymphoma that first appears on the skin and can spread to the lymph
nodes, spleen, liver or lungs.
CLUSTERED - group lesions of herpes simplex, type of virus that causes herpes infections and has DNA as its genetic material.
SERPIGINOUS - tinea corporis, a rash caused by a fungal infection.
ANNULAR, ARCIFORM - annular lesion of tinea faciale (ringworm), common infection of the skin on the face caused by a
fungus.

PRIMARY SKIN LESION: Flat, Nonpalpable Lesion with changes in Skin Color
▪ MACULE - small flat spot, discolored area of skin, up to 1.0 cm.
a. HEMANGIOMA - birth red birthmark that shows up at birth or in first/second week of life.
b. VITILIGO - skin disease that causes loss of skin color in patches.
▪ PATCH - Flat spot, 1.0 cm or large.
a. CAFÉ-AUALAIT SPOT - Light to dark brown pigmented birthmarks that appear on a newborn's skin.
PRIMARY SKIN LESION: Palpable Elevations - Solid Masses
▪ PLAQUE - elevated superficial lesion 1.0 cm or larger, often formed by coalescence of papules.
a. PSORIASIS
▪ PAPULE - up to 1.0 cm
a. MILA b. ACNE c. VERRUCAE
▪ NODULE - marble-like lesion larger than 0.5 cm, often deeper and firmer than a papule.
a. DERMATOFIBROMA - small, firm, bump, similar to mole. Noncancerous skin growth.
▪ CYST - nodule filled with expressible material, either liquid or semisolid.
a. EPIDERMAL INCLUSION CYST - the surface of the skin becomes implanted below the skin through an injury or
trauma.
▪ WHEAL - a somewhat irregular, relatively transient, superficial area of localized skin edema.
a. URTICARIA - (known as hives, weals, welts, or nettle rash) raised, itchy rash that appears on the skin.
PRIMARY SKIN LESION: Palpable Elevations with fluid-filled Cavities
▪ VESICLE - up to 1.0 cm; filled with serious fluid.
a. HERPES SIMPLEX - Type 1, cold sores on the lips or nostrils; Type 2, sores on the genitals (external and
internal).
b. HERPES ZOSTER - caused by reactivation of the varicella-zoster virus (VZV), the same virus that causes
varicella (chickenpox).
▪ BULLA - 1.0cm or larger; filled with serious fluid.
a. INSECT BITE
▪ PUSTULE - filled with pus.
a. ACNE b. SMALLPOX
▪ BURROW (SCABIES) - tunnels formed in the skin that appear as linear marks, commonly found on the finger webs and
on the sides of the fingers.

HEALTH ASSESSMENT - MODULE 1

INITIAL COMPREHENSIVE-IN DEPT - patient's health status that usually takes place on admission or transfer to a hospital or
healthcare agency.
ONGOING-TIME-LAPSED OR PARTIAL ASSESSMENT - continuous assessment of the patient's health status accompanied by
monitoring and observation of specific problems.
FOCUSED ASSESSMENT/PROBLEM-ORIENTED ASSESSMENT - an assessment of specific condition or problem.
EMERGENCY ASSESSMENT/MINI ASSESSMENT - a snapshot view of the patient based on a quick visual and physical
assessment.

MODULE 3
HEALTH HISTORY - PEDIATRIC CLIENTS/PATIENTS
1. REASON FOR SEEKING CARE
2. PRESENT ILLNESS
3. PAST HISTORY
4. DEVELOPMENTAL HISTORY
▪ GROWTH
• Height and weight at birth and at 1,2,5 and 10 years.
• Process of dentition (age of tooth eruption and pattern of loss)
▪ MILESTONE
• Motor development • Toilet training
• Language
▪ CURRENT DEVELOPMENT
• GROSS MOTOR SKILLS - rolls over, sits alone, walks alone, skips, climbs.
• FINE MOTOR SKILL - brings hands to mouth pincer grasps, stacks blocks, feeds self, uses crayons to
draw, uses scissors.
• LANGUAGE SKILLS - first words, vocabulary, sentences, persistence of baby talk
• PERSONAL-SOCIAL SKILL - smiles, follows movement with eyes, turns head toward sounds, recognizes
own name.
• TOILET-TRAINING SKILL - method used, age of bowel/bladder control, parents' attitude toward toilet-
training, terms used for toileting.
▪ NUTRITIONAL HISTORY
• Breast feeding/Bottle-feeding (for infants).
• Appetite to eat (for children, adolescent)
▪ FAMILY HISTORY

MODULE 4
CAGE TEST SCREENING:
C - CUT DOWN - have you ever thought that you should cut down on your drinking?
A - ANNOYED - have you ever been annoyed by criticism of your drinking?
G - GUILTY - have you ever felt guilty about drinking?
E - EYE OPENER - do you drink in the morning?

INTERPRETATION OD DENVER II DEVELOPMENTAL TEST

ADVANCED - passed an item completely to the right of the age line.
NORMAL - no delays and a maximum of 1 caution. SUSPECT - 2 or more cautions or more delays.

KATZ INDEX of INDEPENDENCE in ACTIVITIES of DAILY LIVING

• Commonly referred as the KATZ ADL, most appropriate instrument to assess functional status as a measurement of
the patient's ability to perform activities of daily living independently.
• The index ranks adequacy of performance in the six functions:
▪ BATHING ▪ TOILETING ▪ CONTINENCE
▪ DRESSING ▪ TRANSFERRING ▪ FEEDING
SCORES:
▪ 6 - Full function ▪ 2 - Severe functional
▪ 4 - Moderate impairment impairment

BARTHEL ACTIVITIES OF DAILY LIVING INDEX

• Consists of 10 items that measure a person's daily functioning and mobility.
i. FEEDING iii. GROOMING v. BOWELS
ii. BATHING iv. DRESSING vi. BLADDER
 vii. TOILET USE ix. MOBILITY (ON
viii. TRANSFERS (BED TO LEVEL SURFACES)
CHAIR AND BACK) x. STAIRS
• Can be used to determine a baseline level of functioning.

MODULE 5
CLASSIFICATION OF HYPOTHERMIA:
MID - 33.1 to 36 Celsius --------------------- 91.5 to 95 Fahrenheit
MODERATE - 30.1 to 33 Celsius ----------- 86.1 to 91.4 Fahrenheit
SEVERE - 27 to 30 Celsius ------------------- 80.6 to 86 Fahrenheit
PROFOUND - Less than 27 Celsius -------- Less than 80.6 Fahrenheit

FACTORS AFFECTING THE PULSE RATE:

▪ CHANGES IN BODY ▪ MEDICATIONS ▪ AGE/POSITION
TEMPERATURE ▪ HEMORRHAGE ▪ EMOTIONS
▪ EXERCISE ▪ HEART DISEASE
ASSESSMENT OF PULSE:
1. By palpating peripheral 2. By auscultating the apical 3. By using a portable doppler
arteries pulse with stethoscope ultrasound

BLOOD PRESSURE - force of the blood against arterial walls.

• Average BP of healthy adult is 120/80 mmHg.
• The numerator is the SYSTOLIC PRESSURE - highest point of pressure on arterial walls.
• The denominator is the DIASTOLIC PRESSURE - lowest pressure present on arterial walls.
FACTORS AFFECTING THE BLOOD PRESSURE:
• ACTIVITY • INTAKE OF FOOD • FLUID RETENTION
• ANXIETY OR STRONG • DISEASE PROCESS • DRUGS
EMOTION • PAIN • BLOOD LOSS/HEMORRHAGE
EQUIPMENTS:
▪ SPHYGMOMANOMETER - device used to measure blood pressure.
▪ STETHOSCOPE - used for listening to body sounds. The BELL HEAD of the stethoscope is usually used for listening
when blood pressure is measured.

MODULE 6
WONG-BAKER FACES SCALE - used to measure pain by facial grimacing, it is to help children effectively communicate about
their pain.
PAIN - a sensation of physical or mental hurt or suffering that causes distress or agony to the one experiencing it.

THEORIES OF PAIN:
PATTERN THEORY - the pain perceived whenever the stimulus is intense enough.
1. SPECIFICITY THEORY - there are specific nerve receptors for particular stimuli.
a. NOCICEPTORS - for noxious stimuli. c. MECHANORECEPTORS - pressure, pulling
b. THERMORECEPTORS - heat or cold. or tearing sensation.
d. CHEMORECEPTORS - for chemicals.
2. GATE CONTROL THEORY - it conceptualizes that there is a gate in the spinal cord called SUBSTANTIA GELATINOSA.
3. AFFECT THEORY - at avers that the pain is emotional.
4. PARALLEL PROCESSING THEORY - the psychologic or neurologic deciphering of pain sensation and the cognitive
emotional properties occur along different nerve fibres.

PAIN TERMS:
▪ PAIN THRESHOLD - minimum amount of pain stimulation a person requires before feeling pain.
▪ PAIN TOLERANCE - maximum amount and the duration of pain that an individual is willing to endure.
▪ PAIN PERCEPTION - the actual feeling of pain.
▪ BRADYKININ - the universal stimulus for pain.
 ▪ HYPERALGESIA - excessive sensitivity to pain.

TYPES OF RESPONSES TO PAIN:

• INVOLUNTARY RESPONSE - physiologic response are mediated by the ANS.
• VOLUNTARY RESPONSE
a. BEHAVIOURAL RESPONSES - crying, moaning, grimacing, tossing in bed, splinting the painful area, assuming
fetal position.
b. EMOTIONAL RESPONSES - depression, withdrawal and social isolation.

CLASSIFICATION OF PAIN:
▪ LOCATION
▪ DURATION
a. ACUTE PAIN - lasts for less than 6 months. b. CHRONIC PAIN - lasts for more than 6
months
▪ CHARACTER/QUALITY
▪ INTENSITY/SEVERITY - 0-10 pain scale, 1-3 mild, 4-6 moderate, 7-10 severe.
▪ RELIEVING FACTORS/AGGREVATING FACTORS
▪ EFFECT TO ADLS

MODULE 7
NUTRITIONAL STATUS - key element for overall health. HYDRATION STATUS - critical to every patient's health.

THE HEALTH HISTORY:

• REVIEW OF SYSTEM (ROS) - asked about weight changes, fatigue, allergies, and problems in the gastrointestinal
system.
• HEALTH PATTERNS - the patients nutrition and exercise patterns are elicited.

PHYSICAL EXAMINATION - general head to toe physical examination.

• GENERAL SURVEY
1. BEGIN TO EXAMINE HEIGHT, WEIGHT AND VITAL SIGNS.
2. PATIENTS BODY FRAME
3. PATIENT'S BODY MASS INDEX (BMI) - can be calculated from height and weight.
4. LARGE MUSCLE MASS - patients may have falsely high calculated BMI.
5. OBESE OR OVERWEIGHT - must document first before assuming the right weight.
• SKIN, HAIR AND NAILS
• HEAD, EARS, EYES, NOSE, AND THROAT (HEENT)
• RESPIRATORY
• CARDIOVASCULAR AND PERIPHERAL VASCULAR
• GASTROINTESTINAL
• NEUROLOGIC

HEALTH PROMOTION AND COUNSELLING

STEP 1: measure the BMI and assess risk factors. STEP 3: assess the patient's motivation to change.
STEP 2: assess dietary intake. STEP 4: provide counselling about nutrition and exercise

THE INTEGUMENTARY SYSTEM

• SKIN is the largest and heaviest organ of the body, accounting for approximately 16% of body weight and covering an
area of roughly 1.2 to 2.3 m2.

COMMON OR CONCERNING SYMPTOMS:

a. RASH d. GROWTHS g. HAIR LOSS
b. NON-HEALING LESIONS e. LESIONS h. NAIL CHANGES
c. MOLES f. BRUISING (ECCHYMOSIS)
FUNDAMENTAL (RLE)
ENVIRONMENTAL CLEANING:
CLEANING - refers to the removal of MICROBACTERIUM TUBERCULOSIS - ESCHERICHIA COLI
visible dirt, dust, and debris. bacteria causes tuberculosis.

GENERAL ENVIROMENTAL CLEANING TECHNIQUES:

• CONDUCT VISUAL PRELIMINARY SITE ASSESSMENT • PROCEED TO HIGH TO LOW (TOP TO BOTTOM)
• PROCEED FROM CLEANER TO DIRTIER • PROCEED IN METHODICAL, SYSTEMATIC MANNER

DAMP DUSTING - method of dusting is employed in the care of hospitals which are not upholstered, and for the removal of
dust from all surfaces above the floor.
DUST - is a potent source of disease especially in hospitals.
TYPES OF DUSTING:
1. LOW DUSTING - all places easily reached by standing on the floor, done daily.
2. HIGH DUSTING - areas over windows, pipes, walls, and ceiling.

MODULE 2
INFECTION - invasion of a susceptible host by pathogen or microorganism.
PATHOGEN - an organism that causes disease.
COLONIZATION - presence and growth of microorganisms within a host but without tissue invasion or damage.
COMMUNICABLE DISEASE - one person to another.
SYMPTOMATIC - if the pathogens multiply and cause clinical signs and symptoms.
ASYMPTOMATIC - if clinical signs and symptoms are not present.

CHAIN OF INFECTION
1. INFECTIOUS AGENT - Include bacteria, viruses, fungi, and protozoa.
2. RESERVIOR - a place where microorganisms survive, multiply and await transfer to a susceptible host.
3. PORTAL OF EXIT - blood, skin and mucous membranes, respiratory tract, genitourinary (GU) tract, gastrointestinal
(GI) tract, and transplacental (mother to fetus).
4. MODE OF TRANSMISSION
a. DIRECT - person to person (fecal, oral)
b. INDIRECT - personal contact of susceptible host with contaminated inanimate object.
c. DROPLET - large particles that travel up to 3 feet during coughing, sneezing, or talking and come in contact
with susceptible host.
d. AIRBORNE - droplet nuclei or residue or evaporated droplets suspended in air during coughing or sneezing or
carried on dust particles.
e. VEHICLES - contaminated items, water, drugs, solutions, blood, food.
f. VECTOR - external mechanical transfer (flies), parasitic conditions with vector (mosquito, louse, flea, tick).
5. PORTAL OF ENTRY - organisms enter the body through the same routes they use for existing.
6. SUSCEPTIBLE HOST - an infectious agent depends on an individual's degree of resistance to pathogens.

COURSE OF INFECTION BY STAGE

1. INCUBATION PERIOD - Interval between entrance of pathogen into body and appearance of first symptoms
a. CHICKENPOX - 14 to c. INFLUENZA - 1 to 4 e. MUMPS - 16 to 18
16 days days days
b. COMMON COLD - 1 d. MEASLES - 10 to 12 f. EBOLA - 2 to 21
to 2 days days days
2. PRODROMAL STAGE - interval from onset of nonspecific signs and symptoms to more specific symptoms
a. HERPES SIMPLEX - begin itching and tingling before lesion appears.
3. ILLNESS STAGE - interval when patient manifests signs and symptoms specific to type of infection.
a. STREP THROAT - manifested by sore throat, pain and swelling.
b. MUMPS - high fever, parotid and salivary gland swelling.
4. CONVALESCENCE - interval when acute symptoms of infection disappear (Length of recovery).
NATURAL DEFENSES THAT PROTECT AGAINST INFECTION:
1. NORMAL FLORAS - maintain a sensitive balance with other microorganisms to prevent infection, inanimate object
without causing disease.
2. BODY SYSTEM DEFENSES - a number of body organ systems have unique defenses against infection.
a. SKIN - intact multilayered surface, shedding of outer layer of skin cells, sebum.
b. MOUTH - intact multilayered mucosa, saliva.
c. EYE - tearing and blinking.
d. RESPIRATORY TRACT - cilia lining upper airway, coated by mucus, and macrophages.
e. GASTROINTESTINAL TRACT - acidity of gastric secretions, rapid peristalsis in small intestine.
f. VAGINA - at puberty normal flora causes vaginal secretions to achieve low pH.
3. INFLAMMATION - the cellular response of the body to injury, infection, or irritation. It is a protective vascular
reaction that delivers fluid, blood products, and nutrients to an area of injury.
o VASCULLAR AND CELLULAR RESPONSES - acute inflammation is an immediate response to cellular injury.
o INFLAMMATION EXUDATES - accumulation of fluid, dead tissue cells, and WBCs forms an exudate at the site
of inflammation.
▪ SEROUS - clear, like plasma.
▪ SANGUINEOUS - containing red blood cells.
▪ PURULENT - containing WBCs and bacteria.

1. HEALTH CARE-ASSOCIATED INFECTIONS (HAIs) - result from the delivery of health services in a health care facility.
▪ EXOGENOUS INFECTION - comes from microorganisms found outside the individual.
o SALMONELLA o CLOSTRIDIUM o ASPERGILLUS
TETANI
▪ ENDOGENOUS INFECTION - part of the patient's flora becomes altered and an overgrowth result.
o STAPHYLOCOCCI o YEASTS
o ENTEROCOCCI o STREPTOCOCCI
▪ IATROGENIC INFECTIONS - caused by an invasive diagnostic or therapeutic procedure.
o BRONCHOSCOPY
o TREATMENT WITH BROAD-SPECTRUM ANTIBIOTICS
2. HOSPITAL ACQUIRED INFECTIONS
3. NOSOCOMIAL INFECTION

ASEPSIS - absence of pathogenic microorganisms.

ASEPTIC TECHNIQUE - refers to the practices or procedures that help reduce.
TWO TYPES OF ASEPTIC TECHNIQUE
a. SURGICAL
b. MEDICAL ASEPSIS - or sterile technique prevents contamination of an open wound, serves to isolate an operative
area from the unsterile environment, and maintains a sterile field of surgery.
DISINFECTION - a process that eliminates many or all microorganisms.
STERILIZATION - eliminates or destroys all forms of microbial life, including spores.

INFECTION PREVENTION AND CONTROL TO REDUCE RESERVOIRS OF INFECTION

▪ BATHING ▪ CONTAMINATED SHARPS ▪ DRAINAGE BOTTLE AND
▪ DRESSING CHANGES ▪ BEDSIDE UNIT BAGS

ISOLATION - a protective procedure that limits the spread of infectious diseases among hospitalized patients.
TWO TIERS OF PRECAUTIONS:
1. STANDARD PRECAUTIONS - used for the care of all patients, in all settings, regardless of risk or presumed infection
status.
2. SECOND TIER PRECAUTIONS - designed for the care of patients who are known or suspected to be infected or
colonized with microorganisms transmitted by droplet, airborne, or contact routes.
FOUR TYPES OF TRANSMISSION-BASED PRECAUTIONS:
1. CONTACT PRECAUTIONS - used for direct and indirect contact with patients and their environment.
 2. DROPLET PRECAUTIONS - focus on diseases that are transmitted by large droplets (greater than 5 microns) expelled
into the air and by being within 3 feet of a patient.
3. AIRBORNE PRECAUTIONS - transmitted by smaller droplets, which remain the in the air for longer periods of time.
4. PROTECTIVE ENVIRONMENT - focuses on a very limited patient population. This form of isolation requires a
specialized room with positive airflow.

PERSONAL PROTECTIVE EQUIPMENT

1. GOWNS - prevent soiling clothes during contact with a patient.
2. MASK - mask provides respiratory protection.
3. EYE PROTECTION - use either special glasses or googles.
4. GLOVES - prevent the transmission of pathogens by direct and indirect contact.

HAND HYGIENE - general term that applies to four techniques.

• HANDWASHING - Using water.
• ANTISEPTIC HAND WASH - using warm water and soap or other detergents containing antiseptic agent.
• ANTISEPTIC HAND RUB - applying an antiseptic hand-rub to all surface of the hands.
• SURGICAL HAND ANTISEPSIS - surgical personnel perform before surgery.

MODULE 3
BODY ALIGNMENT - individual's center of gravity is stable.
FRICTION - force that occurs in a direction to oppose movement.
SHEAR - force exerted against the skin while the skin remains stationary and the bony structure move.

RANGE OF MOTION (ROM) - maximum amount of movement available at a joint in one of the three planes of the body.
a. SAGITTAL - divides right and b. TRANSVERSE - divides upper c. FRONTAL - divides front and
left side. and lower. back.
GAIT - particular manner of style of walking.
EXERCISE - physical activity for conditioning the body.
ACTIVITY TOLERANCE - amount of exercise or work that a person is able to perform.
OTHER POSITIONING TECHNIQUES
1. ORTHOPNEIC POSITION - client sits either in bed or on the side of the bed with an overbed table across the lap.
2. LITHOTOMY POSITION - supine position, both knees are flexed and placed close to the hips, widely separated.
3. KNEE CHEST (GENUPECTORAL) POSITION - client kneels on the bed or tables, then leans forward with the hips in the
air and chest and arms resting on the knees.
4. TRENDELENBURG POSITION - supine position, head of the bed is down, and entire body frame is tilted downward (30
degrees).
5. JACKKNIFE / BOZEMAN POSITION - prone position with the hip directly over the break in the table.

MODULE 5
COMMON BED POSITIONS:
• FOWLER'S POSITION
o While eating o Lung expansion
o During nasogastric tube insertion and o Eases difficult breathing.
nasotracheal suction
• SEMI-FOWLER'S POSITION
o Lung expansion, especially with ventilator-assisted patients
o Receive oral care and for gastric feedings to reduce regurgitation and risk of aspiration.
• TRENDELENBURG
o Postural drainage o Poor peripheral perfusion
• REVERSE TRENDELENBURG
o Promotes gastric emptying. o Prevent esophageal reflux.
• FLAT
o Vertebral injuries and cervical traction
o Hypotensive patients usually prefer sleeping.
MODULE 6
CORE TEMPERATURE - temperature of deep tissues.
THERMOREGULATION - physiological and behavioral mechanisms regulate the balance between heat lost and heat produced.
1. NEURAL AND VASCULAR CONTROL
a. HYPOTHALAMUS - located between the cerebral hemispheres, controls body temperature the same way a
thermostat works in the home.1
2. HEAT PRODUCTION
a. BASAL METABOLIC RATE (BMR) - male sex hormone testosterone increases BMR. Men have a higher BMR
than women.
b. SHIVERING - involuntary body response to temperature differences in the body.
c. NON-SHIVERING THERMOGENESIS - occurs primarily in neonates.
3. HEAT LOSS
a. RADIATION - transfer of heat from one object to another without direct contact.
b. CONDUCTION - transfer of heat from one object to another with direct contact.
c. CONVECTION - transfer of heat away by air movement.
d. EVAPORATION - transfer of heat energy when a liquid turn into gas.
DIAPHORESIS - visible perspiration primarily occurring on the forehead and upper thorax.
4. SKIN IN TEMPERATURE REGULATION
a. VASOCONSTRICTION - affects the amount of blood flow and heat loss to the skin.
b. TEMPERATURE SENSATION
5. BEHAVIORAL CONTROL
a. The degree of temperature extreme c. Thought processes or emotions.
b. The person's ability to sense feeling and d. The person's mobility or ability to remove
comfortable or uncomfortable. and add clothes

FACTORS AFFECTING BODY TEMPERATURE:

1. AGE
a. NEWBORN b. OLDER ADULTS
2. EXERCISE
3. HORMONE LEVEL
4. CIRCADIAN RHYTHM - body temperature normally changes 0.5° to 1°C (0.9 to 1.8°F) during 24-hour period.
5. STRESS
6. ENVIRONMENT
7. TEMPERATURE ALTERATION
a. FEVER OR PYREXIA OR FEBRILE
PATTERNS OF FEVER
• SUSTAINED - body temperature continuously above 38°C (100.4°F).
• INTERMITTENT - fever spikes interspersed with usual temperature levels.
• REMITTENT - fever spikes and falls without a return to acceptable temperature levels.
• RELAPSING - periods of febrile episodes and periods with acceptable temperature values.
b. HYPERTHERMIA - inability of the body to promote heat loss or reduce heat production.
c. HEATSTROKE - heat depresses hypothalamic function. Body temperature of 40°C (104°F) or more.
d. HEAT EXHAUSTION - occurs when profuse diaphoresis results in excess water and electrolyte loss.
e. HYPOTHERMIA - prolonged exposure to cold overwhelms the ability of the body to produce heat.
TEMPERATURE RANGE:
AVERAGE TEMPERATURE RANGE AVERAGE ORAL/TYMPANIC AVERAGE RECTAL - 37.5°C (99.5°F)
36° to 38°C (96° to 100.4°F) 37°C (98.6°F) AVERAGE AXILLARY - 36.5°C (97.7°F)

RESPIRATION:
VENTILATION - movement of gases in and out of the lungs.
DIFFUSION - movement of oxygen and carbon dioxide between the alveoli and the red blood cells.
PERFUSION - distribution of red blood cells to and from the pulmonary capillaries.
FACTORS INFLUENCING CHARACTER OF RESPIRATIONS
▪ EXERCISE ▪ SMOKING ▪ NEUROLOGICAL INJURY
▪ ACUTE PAIN ▪ BODY POSITION ▪ HEMOGLOBIN FUNCTION
▪ ANXIETY ▪ MEDICATIONS

RESPIRATORY RATE - 27 bpm is a risk factor of cardiac arrest.

• NEWBORN - 30 to 60 • CHILD - 20 to 30
• INFANT (6 MONTHS) - 30 to 50 • ADOLESCENT - 16 to 20
• TODDLER (2 YEARS) - 25 to 32 • ADULT - 12 to 20

ALTERATION IN BREATHING PATTERN

BRADYPNEA - regular but abnormally slow (less than 20 breaths/min.)
TACHYPNEA - regular but abnormally rapid (greater than 20 breaths/min.)
HYPERPNEA - labored, increased in depth, and increased in rate, occurs normally during exercise (greater than 20
breaths/min.)
APNEA - cease for several seconds. Persistent cessation results in respiratory arrest.
HYPERVENTILATION - rate and depth of respiration increase. Hypocarbia sometimes occurs.
HYPOVENTILATION - rate is abnormally low, and depth of ventilation is depressed. Hypercarbia sometimes occurs.
CHEYNE-STOKES RESPIRATION - respiratory rate and depth are irregular, characterized by alternating periods of apnea and
hyperventilation.
KUSSMAUL'S RESPIRATION - respirations are abnormally deep, regular, and increased in rate.
BIOT'S RESPIRATION - abnormally shallow for two to three breaths, followed by irregular period of apnea.

PULSE - palpable bounding of blood flow in a peripheral artery.

CARDIAC OUTPUT - the volume of blood pumped by the heart for 1 minute.
ADULT HEART - normally pumps 5000 mL of blood per minute.

PULSE SITES:
SITE LOCATION ASSESSMENT CRITERIA

TEMPORAL Temporal bone of head Used to assess pulse in children

CAROTID Muscle in neck Physiological shock or cardiac arrest

APICAL Midclavicular line Auscultate for apical pulse

BRACHIAL Between biceps and triceps Assess status of circulation to lower arm and auscultate blood
muscles pressure

RADIAL Thumb side of forearm Status of circulation to hand

ULNAR Little finger side of forearm Used to perform an Allen's test

FEMORAL Below inguinal ligaments Used to assess status of circulation to leg

POPLITEAL Behind knee in popliteal fossa Circulation of lower leg

POSTERIOR TIBIAL Inner side of ankle Assess status of circulation to foot

DORSALIS PEDIS Along top of foot Assess status of circulation to foot

CHARACTER OF THE PULSE:

• RATE
o ACCEPTABLE RANGES OF HEART RATE
▪ INFANT - 120 to 160 beats/min
▪ TODDLER - 90 to 140 beats/min
▪ PRESCHOOLER - 80 to 110 beats/min
 ▪ SCHOOL-AGE CHILD - 75 to 100 beats/min
▪ ADOLESCENT - 60 to 90 beats/min
▪ ADULT - 60 to 100 beats/min
o TACHYCARDIA - above 100 beats/min.
o BRADYCARDIA - below 60 beats/min.
o PULSE DEFICIT - inefficient contraction of the heart that fails to transmit a pulse wave to the peripheral pulse
site.
• RHYTHM - a regular interval occurs between each pulse or heartbeat.
o DYSRHYTHMIA - interval interrupted by an early or late beat or a missed beat indicates an abnormal rhythm.
• STRENGTH - or amplitude of a pulse reflects the volume of blood ejected against the arterial wall with each heart
contraction.
• (4) BOUNDING • (1) DIMINISHED OR BARELY PALPABLE
• (3) FULL OR STRONG • (0) ABSENT.
• (2) NORMAL AND EXPECTED
• EQUALITY

MODULE 7
BLOOD PRESSURE - force exerted on the walls of an artery by pulsing blood under pressure from the heart.
SYSTOLIC PRESSURE - the peak of maximum pressure when ejection occurs.
DIASTOLIC PRESSURE - the blood remaining in the arterial walls exert a minimum.
PULSE PRESSURE - difference between systolic and diastolic pressure. EX. 120/80, pulse pressure is 40.
CARDIAC OUTPUT - as cardiac output increases, more blood is pumped against arterial walls, causing the BP to rise.
PERIPHERAL RESISTANCE - peripheral vascular resistance is the resistance of blood flow determined by the tone of vascular
musculature and diameter of blood vessels.
BLOOD VOLUME - the volume of blood circulating within the vascular system affects BP.
VISCOSITY - Hematocrit, percentage of red blood cells in the blood, determines blood viscosity.
ELASTICITY - walls of an artery are elastic and easily distensible.

HYPERTENSION
• most common alteration in BP.
• Associated with thickening and loss of elasticity in the arterial walls.
HYPOTENSION
• When the systolic BP falls to 90 mmHg or below.
• Associated with pallor, skin mottling, clamminess, confusion, increased HR, or decreased urine output is life
threatening and is reported to a healthcare provider immediately.
ORTHOSTATIC HYPOTENSION
• also known as postural hypotension, occurs when a normotensive person develops symptoms and a drop in systolic
pressure by at least 20 mmHg or a drop in diastolic pressure by at least 20 mmHg within 3 minutes of rising to an
upright position.