Bacterial Genetics  Gene – A DNA sequence that carry hereditary

Genetics is the science of heredity information that encodes for a specific product (e.g.

 Nucleic acid structure and organization protein)

 Genome – all genes taken together within an organism.

(e.g. 103 – 106 )

i. Chromosome

▪ Contains all the genes essential for viability

▪ Double stranded, close circular, naked

▪ Folded and twisted

(plasma membrane, cytoplasm, cell wall, DNA,

ribosomes, pili, flagella)

ii. Non chromosomal elements

2 types of Nucleic acid: a. Plasmid

1. RNA 2. DNA ▪ miniature” chromosome

Nucleic acid consists of a: ▪ Encodes products that are determinants of

antimicrobial resistance (not for viability)
1. Base 2. Sugar 3. Phosphate group
b. Transposable elements
Four (4) bases
▪ are pieces of DNA that move from chromosome
1.) 2 Purines to plasmid
(Adenine) and (Guanine) i. Insertion sequence (movement)
2.) 2 Pyrimidines ii. Transposon (drug resistance).
(Thymine) and (Cytosine)

DNA (sugar) Replication and Expression of Genetic Information

▪ Has deoxyribose sugar

▪Exists as double helix (2 nucleotide polymers) 1. Replication

▪ Adenine hydrogen bonds with Thymine i. Unwinding of the chromosome’s supercoiled DNA
▪ Cytosine hydrogen bonds with Guanine ii. Unzipping the complementary strands
RNA iii. Synthesis of New DNA strands
▪ Has ribose sugar iv. Termination of replication
▪ Is single-stranded

▪ Adenine hydrogen bonds with Uracil

▪ Cytosine hydrogen bonds with Guanine

Genes and Genetic code

 3.) Termination

▪ Occurs when a ribosomal A site encounters a stop codon

or stop signal

▪ Protein synthesis dissociates

Regulation and control of gene expression

-Occurs in three levels

1. Transcriptional
2. Expression of Genetic information
▪ Also referred as Genetic Level Control

▪ Genes that encode anabolic enzymes (biosysthesis)

 Repressed

▪ Genes that encode anabolic enzymes(biodegradation)

 Induced

▪Repression of genes that encode anabolic enzymes

(biosysthesis)

▪Repress biosynthesis.

▪The conversion of genes (DNA) to mRNA are blocked.

▪ The products of transcription acts as a co- repressor

that form a complex with a repressor molecule.
i. Transcription ▪Also called as Repression
▪ process of building an RNA (mRNA, tRNA, and rRNA) ▪ Induction of genes that encode catabolic enzymes
from copy of a DNA (biodegradation)
▪ RNA Polymerase ▪ Also called as Induction
▪ detects the promoter sequence 2. Translational
▪ open the dsDNA and, ▪ Inhibition of protein synthesis
▪ add ribonucleotides to the template strand to form a 3. Posttranslational
growing mRNA strand
▪ Decrease the activity of enzymes (proteins)

ii. Translation
Gene Exchange and Genetic Diversity
▪conversion of mRNA sequence into amino acids
1. Mutation
1.) Initiation
▪ Change in the original nucleotide sequence of a gene or
▪ Begins with the association of ribosomal subunits, genes.
mRNA, formylmethionine tRNA (f-met)
▪ Change in genotype or phenotype
▪ Assembly occurs at the ribosomal binding site (RBS)
▪Base substitution (point mutation) - Change in one base

a) Missense mutation - Result in change in amino acid

2.) Elongation
b) Nonsense mutation - results in a nonsense codon
▪ tRNA mediate the sequential addition of amino acids in
a specific sequence . c) Frameshift mutation - Insertion or deletion of one or

▪ Ribosomal Sites more nucleotide pairs.

▪ P (peptide)

▪ A (Acceptor) 2. Genetic Recombination

▪ E (Exit) ▪ Some segment of DNA from one bacterial cell (donor)

enters a second bacterial cell (recipient)

▪ Also known as homologous recombination

 c. Conjugation: Plasmid Transfer

▪ Plasmid is replicated then a copy is transferred to the

recipient.

3. Gene Exchange
c. Conjugation: Transposon Transfer
a. Transformation
▪ Could be incorporated into chromosome of plasmids.
▪ Recipient cell uptake of free DNA releases in the
“Jumping genes”
environment when another donor cell die.

▪ Competent - able to take up free DNA (i.e. Haemophilus,

Streptococcus and Niesseria) 3. Gene Exchange

▪ Transposition

▪ Process by which genetic elements excise from one

genomic location and insert to another.

▪ Plasmid and transposons play a role in establishing

resistance to antibiotics

b. Transduction

▪ Viruses (bacteriophages) integrate their DNA into

bacteria's chromosome.

▪ For viral DNA replication

c. Conjugation: Chromosome Transfer

▪ Due to cell-cell-cell contact

▪ Mobilization of donor bacterium’s chromosome

Critical thinking & The Nursing Process

CRITICAL THINKING

▪The intellectually disciplined process of actively and

skillfully conceptualizing, applying, analyzing, synthesizing
and/or evaluating information gathered from or
generated by, observation, experience, reflection,
reasoning or communication, as a guide to belief and
action.

▪Essential to safe , competent and skillful nursing practice.

Nurses use critical thinking skills in a variety of ways:

▪Nurses use knowledge from other subjects and fields.

▪Nurses deal with change in stressful environments NURSING PROCESS

▪Nurses make important decisions ▪ It is a systematic, client-centered method for structuring
the delivery of nursing care.

▪ It entails gathering and analyzing data in order to

Creativity
identify the client strengths and potential or actual health
▪A major component of critical thinking. problems and developing continually reviewing a plan of
nursing interventions to achieve mutually agreed
▪A thinking that results in the development of new ideas
outcomes.
and product.
▪ At every stage of the process, the nurse works closely
▪The ability to develop and implement new and better
with the client to individualize care and build relationship
solutions.
of mutual regard and trust.
Using creativity, nurses:

▪Generate many ideas properly.

CHARACTERISTICS:
▪Are generally flexible and natural
Data from each phase provides input into the next
▪Create original solutions to problems phase.

▪Tend to be independent and self- confident, even when The nursing process is client-centered.
under pressure.
The nursing process is an adaptation of problem solving
▪Demonstrate individuality. and systems theory.

Decision making is involved in every phase of the nursing

PROBLEM SOLVING
▪ In PROBLEM SOLVING, the nurse obtains information
that clarifies the nature of the problem and suggests
possible solutions.
▪ The nurse then carefully evaluates the possible solutions
and chooses the best one to implement.
▪ The situation is carefully monitored over time to ensure
its initial and continued effectiveness
process.
The nursing process interpersonal and collaborative.
The universally applicable characteristic of the nursing
process means that it is used as a framework for nursing
care in all types of health care settings, with clients of all
age groups.
Nurses must use a variety of critical thinking skills to
carry out the nursing process.

▪ The nurse does not discard the other solutions but holds
them in reserve in the event that the first solution is not PHASE 1 – ASSESSMENT
effective.
ASSESSING is collecting, organizing, validating and
▪ The nurse may also encounter a similar problem in a recording data about a client’s health status.
different client situation where an alternative solution is
It is the systematic and continuous collection,
determined to be the most effective.
organization, validation and documentation of data.
▪ Therefore, problem solving for one situation contributes
Nursing assessments focus on a client’s responses to a
to the nurse’s body of knowledge for problem solving in
health problem.
similar situations.
A nursing assessment should include the client’s
perceived needs, health problems, related experience,
health practices, values and lifestyles.
The assessment process involves four closely related
activities: collecting data, organizing data, validating data
and documenting data.
COLLECTING DATA
Data collection is the process of gathering information
about a client’s health status. It must be both systematic
and continuous to prevent the omission of significant data
and reflect a client’s health status.
A DATABASE is all the information about a client; it
includes the nursing history, physical assessment, primary
care provider’s history and physical examination, results
of laboratory and diagnostic tests and material
contributed by other health personnel.
Types of Data
SUBJECTIVE DATA– also referred to as symptoms
or covert data. These are apparent only to the person
affected and can be described only by that person.
OBJECTIVE DATA – also referred to as signs or overt data.
These are detectable by an observer or can be measured
or tested against an accept standard.
Constant data – information that does not change
overtime.
Variable data – can change quickly, frequently or rarely.
Sources of Data
Client Support People
Client Records Health Care Professionals
Literature
METHODS
1. OBSERVING – gather data using the five senses.
2. INTERVIEWING – planned communication or a
conversation with a purpose.
a. DIRECTIVE INTERVIEW – highly structured and
elicits specific information
b. NON-DIRECTIVE INTERVIEW – or rapport building
interview where the nurse allows the client to control the
purpose, subject matter and pacing of the conversation.
3. EXAMINING – or physical examination that uses
observational skills to detect health problems.
ASSESSING
Identify assessment priorities determined by the
purpose of the assessment and the client’s condition.
Prioritize types of data to be collected systematically.
Establish the data base Nursing history
Physical examination Review of client record
Consultation with health professionals and client’s
support persons
Continuously update the data
Validate the data Communicate data
PHASE 2 – NURSING DIAGNOSIS
Nursing Diagnosis
A clinical judgment about individual, family, community
responses to actual or potential health problems/life
processes.
This provides basis for the selection of nursing
interventions to achieve outcomes for which the nurse is
accountable.
This means that:
1. Professional nurses are responsible for making nursing
diagnosis.
2. Nursing diagnoses describe a continuum of health
states:
a. Actual health problems or deviations from health.
b. Potential health problems or the presence of risk
factors that predispose persons and families to health
problems.
c. Healthy responses or areas of enriched personal
growth.
3. The domain of nursing diagnosis include only those
health states that nurses are able and are licensed to
treat.
4. A nursing diagnosis is a judgment made only after
thorough, systematic data collection.
Health Problem – because diagnosing involves problem
identification, it is important to understand what a
problem is as differentiated from signs, symptoms or
treatments;
a health problem has the following characteristics:
 It is a human response to a life process, event or
stressor.
 It is a health related condition that both the client and
the nurse wish to change.
It requires intervention in order to prevent or resolve
illness or to facilitate coping.
It involves or results in ineffective coping/adaptation or
daily living that is not satisfying to the client.
It is an undesirable client state.
COMPONENTS OF NURSING DIAGNOSIS
1. PROBLEM STATEMENT (DIAGNOSTIC LABEL)
- Describes client’s health problem or response.
- Ex: Impaired swallowing; ineffective thermoregulation
2. ETIOLOGY (RELATED FACTORS & RISK FACTORS)
- identifies one or more probable causes of the health
problem, gives direction to the required nursing
intervention and enables the nurse to individualize the
client’s care; includes client behaviors, environmental
factors or the interaction of the two
Ex. Ineffective breastfeeding related to breast
engorgement; Impaired physical mobility: inability to walk
related to knee joint stiffness and pain.
3. DEFINING CHARACTERISTICS
- Cluster of signs and symptoms that indicate the
presence of a particular diagnostic label.
Ex: Impaired physical mobility: inability to walk related to
knee joint stiffness and pain secondary to muscle atrophy
Self esteem disturbance related to rejection by husband
as manifested by hypersensitivity to criticisms.
BASIC: 2 part statement – PE format
OTHERS: 3 part statement – PES format
: 1 part statement – wellness and syndrome nursing
diagnosis
ex: Rape Trauma Syndrome, Effective breastfeeding
TYPES OF NURSING DIAGNOSIS
1. ACTUAL DIAGNOSIS – judgment about a client’s
response to a health problem at the time of assessment
and signified by the presence of associated signs and
symptoms.
FORMAT: 2 part (problem related to etiology) or
3 part (PES format) – comprising of a problem (P) related
(R/T) to etiology (E) as manifested by signs and symptoms
(S) or presence or defining characteristics.
Ex. Ineffective breathing pattern; Anxiety
2. RISK NURSING DIAGNOSIS – a clinical judgment that a
client is more vulnerable to develop the problem than
others in the same situation.
Format: 2 part statement (diagnostic label R/T risk
factors)
Ex. Risk for disuse syndrome R/T immobility.
3. POSSIBLE NURSING DIAGNOSIS – evidence about a
certain health problem is unclear or the causative
factors are unknown; needs collection of more data either
to support or refute it; not a real type of nursing diagnosis
Format: 2 part statement
Ex. Possible social isolation R/T unknown etiology
4. WELLNESS DIAGNOSIS – is a clinical judgment about an
individual, family or community in transition from a
specific level of wellness to a higher level of wellness
Format: NANDA has specified that wellness diagnosis
should be developed as a one-part statement with:
Potential + desired higher level of wellness Readiness for
+ desired higher level of wellness
Ex. Potential for enhanced parenting
5. SYNDROME DIAGNOSIS – comprises of a cluster of
Problems Format: one part statement
Ex. Rape-Trauma Syndrome
COLLABORATIVE PROBLEMS
(Carpenito)
Certain physiologic complications that nurses primarily
monitor detect onset or changes in status
Nurses manage collaborative problems using physician
prescribed and nursing prescribed interventions to
minimize the complications of the event
ALFARO’S RULE FOR A COLLABORATIVE PROBLEM – To
write a diagnostic statement for a collaborative problem,
focus on POTENTIAL COMPLICATIONS of the problem.

Potential complications + : related to + list of

complications that may occur.

Ex. Potential complication: pneumothorax related to

fractured ribs.
 Medium priority – health threatening problems that
may result in delayed development or cause destructive
physical or emotional changes.

Low priority – problems that arise from normal

developmental needs or those that require minimal
nursing support

Three helpful guides by Atkinson and Murray (1990)

for prioritizing client problems are:

Maslow’s hierarchy of human needs

Client preference

Anticipation of future problems – assigning low priority

to a diagnosis the client wants to ignore when this can

result to harmful future consequences for the client may

be nursing negligence.

PHASE 3 – PLANNING

Planning

Is a deliberative systematic phase of nursing process that

involves decision making and problem solving.

It involves a series of steps in which the nurse and the

client set priorities and goals or expected outcomes to

resolve or minimize the identified client problems.

Types of Planning

1. Initial Planning – the nurse who performs the initial

admission assessment develops the initial

comprehensive plan of care; needs refinements when

missing data becomes available.

2. Ongoing Planning – using ongoing assessment data, the

nurse carries outdaily planning for the following purposes:

To determine whether the client’s health status has

changed.

To set the prioritize for the client’s health care during the
shift.

To decide which problems to focus on during the shift

To coordinate the nurses’ activities so that more than

one problem can be addressed at each client contact.

3. Discharge Planning – the process of anticipating and

PRIORITIZING NURSING DIAGNOSES
planning for needs after discharge ; is becoming a crucial

part of comprehensive healthcare. Effective discharge

PRIORITY SETTING – process of establishing a
preferential order of nursing strategies. planning begins at the time of admission where each
client is assessed for:
FIRST PRIORITY is any threat to the VITAL FUNCTION’S
of ABC’s (Airway, Breathing, Circulation)
Potential health needs,
Availability and ability of the client’s support network to
assist with these needs
How the home environment supports the client, and
4. Enable client and nurse to determine when the
problem has been resolved
5. Help motivate client and nurse by providing a sense of
achievement.

Client, family and community resources.

Planning involves the following

activities:

Establishing priorities

Writing goals/outcomes and developing an evaluative

strategy.

Selecting nursing strategies/interventions

Developing nursing care plans

Communicate the plan of nursing care.

THE PLANNING PROCESS Goals/Objectives/Expected Outcomes should have the

1. PRIORITY SETTING – process of establishing a
preferential order for nursing strategies; life threatening
situations are always high priority.
Other factors to consider in priority setting:
A. Client’s health values and beliefs
B. Client’s priorities
C. Resources available to the nurse and client
D. Urgency of the health problem
E. Medical treatment plan
following characteristics:
1. Client centered
2. Is derived mainly from the first clause of the nursing
diagnosis or the problem statement
3. States only one specific client response or behavior
4. Considered by the client as important
5. SMART
6. Compatible with the work and therapies of other
professionals

3. NURSING INTERVENTIONS or nursing strategies – are

2. ESTABLISHING CLIENT GOALS AND EXPECTED
nursing activities relating to a specific nursing diagnosis
OUTCOMES
that nurses carry out to achieve client goals; focuses on
-A GOAL is a desired outcome or
eliminating or reducing the etiology of the nursing
change in client’s behavior. diagnosis

GOAL versus OBJECTIVE versus EXPECTED OUTCOME Criteria for choosing Nursing Interventions

GOALS are broad statements about the effects of nursing 1. Safe and appropriate for the individual’s age, health,
intervention etc.

OBJECTIVES are more specific statements about the 2. Achievable with the resources available
effects of the nursing intervention
3. Congruent with the client’s values and beliefs
EXPECTED OUTCOMES are the more specific,
4. Congruent with other therapies
measurable criteria used to evaluate whether the goal has
been met. 5. Based on nursing knowledge and experience

or knowledge from relevant sciences or based on a sound

rationale
Purposes of Goals/Expected Outcomes
6. Within established standards of care as determined by
1. Provide direction for planning nursing interventions
the law and by the policies of the institution.
2. Provide a time span for planned activities

3. Serve as a criteria for evaluation of client progress

Types of Nursing Interventions
 INDEPENDENT INTERVENTIONS – those activities that
nurses are licensed to initiate on the basis of their
knowledge and skills.
DEPENDENT INTERVENTIONS – activities carried out
under the physician’s orders or supervisions or according
to specified routines.
COLLABORATIVE INTERVENTIONS – actions nurse carries
out in collaboration with other health team members.
NURSING CARE PLAN
 Written guide that organizes information about a client’s
care into a meaningful whole.
 Contents should include:
1. Cues or defining characteristics of nursing diagnosis
2. Nursing diagnosis (P + E) or problem list
3. Background knowledge (pathophysiologic/psychosocial
explanation or consequences of the nursing diagnosis)
4. Goals and outcome criteria
5. Nursing interventions and rationale
6. Evaluation
Guidelines for Writing Nursing Care Plans (NCP)
1. Date and sign the plan
2. Use category headings stated above
3. Use standardized medical or English symbols and key
words rather than complete sentences.
4. Write references of your entries.
5. Tailor the plan to the unique characteristics of the client
by ensuring that the client's choices
6. Ensure that the nursing plan incorporates preventive
health maintenance aspects as well as restorative.
7. Ensure that the plan contains orders for ongoing
assessment of the plan.
8. Include collaborative and coordination activities in the
plan
9. Include plans for the client’s discharge and home care
needs.
PHASE 4 – IMPLEMENTATION
IMPLEMENTATION
Phase in which the nurse puts the nursing care plan into
action.
Implementation requires from the nurse the following
skills:
COGNITIVE SKILLS (Intellectual Skills)
 INTERPERSONAL SKILLS OR COMMUNICATION SKILLS
TECHNICAL SKILLS OR HANDS-ON SKILLS
Guidelines for Implementing Nursing Strategies
Nursing actions should be based on scientific knowledge,
nursing research and professional standards of care.
Nurses should understand clearly the orders to be
implemented and question any that are nor understood.
Nursing actions should be adapted to the individual
client
Nursing actions should always be safe.
Nursing actions often require teaching, support and
comfort
Nursing actions should be holistic
Nursing actions should respect the dignity of the client
and enhance the client’s self-esteem
Client’s should be encouraged to participate actively in
implementing the nursing actions.
PHASE 5 – EVALUATION
EVALUATION
 It is planned, ongoing, purposeful activity, in which
clients and health care professionals determine:
1. The client’s progress toward goal achievement
2. The effectiveness of the care plan.
TYPES
 ONGOING EVALUATION – done while or immediately
after implementing an order; enables the nurse to make
on-the-spot modifications in an intervention.
 INTERMITTENT EVALUATION – performed at specified
time intervals to show extent of progress toward goal and
enables nurse to correct any deficiencies and modify care
plan.
Also called PROCESS evaluation.
TERMINAL EVALUATION – indicates client condition at
the time of discharge; includes status of goal achievement
and evaluation of the client’s self-care abilities with regard
to follow-up care.
Writing the Evaluation Statement
Conclusion + Supporting Data
Nursing Diagnosis: Ineffective airway clearance related to
viscous secretions and shallow chest expansion
Expected Outcome: Demonstrates adequate air exchange
as evidenced by: absence of pallor and cyanosis
Evaluation Statement: Goal partially met: skin and
mucous membranes not cyanotic, but still pale

Three possible conclusions

Goal met – client response is the same as the expected

outcome

Goal partially met – either a short-term goal was

achieved, but the long term goal was not or the expected
outcome was only partially attained.

Goal not met