2nd sem Nursing Foundations II Notes

Welcome to the 2nd sem Nursing Foundations II Notes, where the art and science of nursing come together to shape compassionate and competent healthcare professionals. As you embark on this journey, you’ll delve deeper into the fundamental principles of nursing, honing your skills, and expanding your knowledge to provide exemplary patient care. These notes serve as your guide through this educational voyage, offering a wealth of information and practical insights to help you become a well-rounded and proficient nurse. Get ready to explore the intricacies of patient-centered care, clinical skills, and the ethical foundations that underpin the noble profession of nursing. Your dedication to this path is commendable, and together, we’ll navigate the exciting challenges and rewards that lie ahead in your nursing career.

Unit-1

Hygiene

• Factors Influencing Hygienic Practice

• Hygienic care: Indications and purposes, effects of neglected care Care of the Skin- (Bath, feet and nails, Hair Care) Care of pressure points Assessment of Pressure Ulcers using Braden Scale and Norton Scale Pressure ulcers- causes, stages and manifestations, are and prevention Perineal care/Meatal care Oral care, Care of Eyes, Ears and Nose including assistive devices (eyeglasses, contact lens, dentures, hearing aid)

Unit-2

The Nursing Process

• Critical Thinking Competencies, Attitudes for Critical Thinking,
  Levels of Critical Thinking in Nursing Nursing Process Overview Assessment
  Collection of Data: Types, Sources, Methods Organizing Data Validating Data Documenting Data
  Nursing Diagnosis Identification of client problems, risks, and strengths Nursing diagnosis statement- parts, types, Formulating, Guidelines for formulating Nursing Diagnosis NANDA approved diagnoses

• Difference between medical and Identifying and meeting the elimination needs of patient nursing diagnosis
• Planning Types of planning Establishing Priorities Establishing Goals and Expected Outcomes- Purposes, types, guidelines, Components of goals and outcome statements Types of Nursing Interventions, Selecting interventions: Protocols and Standing Orders Introduction to Nursing Intervention Classification and
• Nursing Outcome Classification Guidelines for Writing Care Plan Implementation
• Process of Implementing the plan of Care Types of care – Direct and
• Indirect Evaluation Evaluation Process, Documentation and Reporting

Unit-3

Nutritional needs the Nutritional needs of patients

• Importance
• Factors affecting nutritional needs
• Assessment of nutritional status
• Review: special diets- Solid, Liquid, Soft
• Review on therapeutic diets
• Care of patient with Dysphagia, Anorexia, Nausea, Vomiting
• Meeting Nutritional needs: Principles, equipment, procedure, indications Oral Enteral: Nasogastric/ Orogastric, Introduction to other enteral feeds types, indications, Gastrostomy, Jejunostomy Parenteral- TPN

Unit-4

Elimination needs

• Urinary Elimination Review of Physiology of Urine
  Elimination, Composition and characteristics of urine Factors Influencing Urination Alteration in Urinary Elimination Facilitating urine elimination:
• assessment, types, equipment,
• procedures and special
• considerations
• Providing urinal/bed pan
• Care of patients with Condom drainage
• Intermittent Catheterization indwelling Urinary catheter and
• urinary drainage Urinary diversions Bladder irrigation Bowel Elimination
  Review of Physiology of Bowel Elimination, Composition and characteristics of feces Factors affecting Bowel elimination Alteration in Bowel Elimination Facilitating bowel elimination: Assessment, equipment, proceduresEnemas Suppository Bowel wash Digital Evacuation ofimpacted feces Care of patients with Ostomies (Bowel Diversion Procedures)

Unit-5

Diagnostic testing

phase of diagnostic testing (pre-test, intra-test & post-test) in Common investigations and clinical implications
Complete Blood Count Serum Electrolytes LFT Lipid/Lipoprotein profile Serum Glucose- AC, PC, HbAlc Monitoring Capillary Blood Glucose (Glucometer Random Blood Sugar GRBS) Stool Routine Examination Urine Testing- Albumin, Acetone, pH, Specific Gravity Urine Culture, Routine, Timed Urine Specimen Sputum culture Overview of Radiologic & Endoscopic Procedures

Unit-6

Oxygenation needs

• Review of Cardiovascular and Respiratory Physiology
• Factors affecting respiratory functioning
• Alterations in Respiratory Functioning Conditions affecting airway movement of air diffusion Oxygen transport
  Alterations in oxygenation Nursing interventions to promote Oxygenation: assessment, types, equipment used & procedure Maintenance of patent airway Oxygen administration Suctioning- oral, tracheal Chest physiotherapy
  Percussion, Vibration & Postural drainage Care of Chest drainage- principles & purposes Pulse Oximetry- Factors affecting measurement of Oxygen saturation using pulse oximeter., Interpretation
• Restorative & continuing care
  o Hydration
  o Humidification
  o Coughing techniques
  o Breathing exercises
  o Incentive spirometry

Unit-7

Fluid, Electrolyte, and Acid -Base Balances

• Review of Physiological Regulation of Fluid, Electrolyte, and Acid-Base Balances
• Factors Affecting Fluid, Electrolyte, and Acid-Base Balances
• Disturbances in fluid volume: Deficit Hypovolemia Dehydration Excess Fluid overload Edema
• Electrolyte imbalances (hypo and hyper) Acid-base imbalances Metabolic- acidosis & alkalosis
• respiratory acidosis & alkalosis Intravenous therapy
• Peripheral venipuncture sites
• Types of IV fluids
• Calculation for making IV fluid plan
• Complications of IV fluid therapy
• Measuring fluid intake and output
• Administering Blood and Blood components
• Restricting fluid intake Enhancing Fluid intake

Unit-8

Administration of Medications

Introduction-Definition of Medication, Administration of Medication, Drug Nomenclature, Effects of Drugs, Forms of Medications, Purposes, Pharmacodynamics and Pharmacokinetics

• Factors Influencing Medication Action
• Medication orders and Prescriptions
• Systems of measurement
• Medication dose calculation
• Principles, 10 Rights of Medication Administration
• Errors in Medication Administration
• Routes of administration
• Storage and maintenance of drugs and Nurses’ responsibility
• Terminologies and abbreviations used in prescriptions and medication orders
• Developmental considerations
• Oral, Sublingual, and Buccal routes: Equipment, procedure
• Introduction to Parenteral Administration of Drugs- Intramuscular, Intravenous, Subcutaneous, Intradermal:
  Location of site, Advantages and disadvantages of the specific sites,
  Indication and contraindications for the different routes and sites.
  Equipment- Syringes & needles, cannulas, Infusion sets – parts, types, sizes
  Types of vials and ampoules, Preparing Injectable medicines from vials and ampoules
  Care of equipment: decontamination and disposal of syringes, needles, infusion sets
  Prevention of needle-Stick Injuries
• Administration: Types,
• purposes, site, equipment, procedure
• Application to skin & mucous membrane Direct application of liquids, gargling and swabbing the throat
• Insertion of Drug into body cavity: Suppository/ medicated packing in rectum/vagina
• Installations: Ear, Eye, Nasal, Bladder, and Rectal Irrigations: Eye, Ear, Bladde, Vaginal and Rectal Spraying: Nose and throat Inhalation: Nasal, oral, endotracheal/ tracheal (steam, Oxygen, and medications)- purposes, types, equipment, procedure, recording and reporting of medications administered Other Parenteral Routes: Meaning of epidural, intrathecal, intraosseous, intraperitoneal, intrapleural, intraarterial

Unit-9

Sensory needs

• Introduction
• Components ofsensory experience Reception, Perception & Reaction
• Arousal Mechanism
• Factors affecting sensory function
• AssesSment of Sensory alterations sensory deficit, deprivation, overload & sensory poverty
• Management Promoting meaningful communication (patients with Aphasia, artificial airway &
  Visual and Hearing impairment) Care of Unconscious Patients
• Unconsciousness: Definition, causes & risk factors, pathophysiology, stages of Unconsciousness, Clinical Manifestations
• AssesSment and nursing management of patient with unconsciousness, complications

Unit-10

Care of Terminally ill, death and dying

• Loss- Types
• Grief, Bereavement & Mourning Types of Grief responses
• Manifestations of Grief
• factor influencing Loss & Grief
• Responses
• Theories of Grief & Loss-Kubler Ross
• 5 Stages of Dying

• The R Process model (Rando’s) Death- Definition, Meaning, Types (Brain & Circulatory Deaths)
  Signs ofImpending Dcath Dying patient’s Bill of Rights Care of Dying Patient
• Physiological changes occurring after Death
• Death Declaration, Certification, Autopsy, Embalming
• Last office/Death Care
• Counseling & supporting grieving relatives Placing body in the Mortuary
• Releasing body from Mortuary
• Overview- Medico-legal Cases, Advance directives, DNVDNR, Organ Donation, euthanasia

Unit-11

A. Self-concept

• Introduction
• Components (Personal Identity, Body Image, Role Performance, Self Esteem) Factors affecting Self Concept
• Nursing Management

Unit-12

B. Sexuality

• Sexual development throughout life Sexual health Sexual orientation
• Factors affecting sexuality
• Prevention of STIs, unwanted pregnancy, avoiding sexual harassment and abuse
• Dealing with inappropriate sexual behavior

Unit-13

C. Stress and Adaptation-Introductory concepts

• Introduction
  Sources, Effects, Indicators & Types of Stress
• Types of stressors
• Stress Adaptation- General Adaptation
  Syndrome (GAS), Local Adaptation syndrome (LAS)
  Manifestation of stress- Physical & psychological
• Coping strategies/ Mechanisms
• Stress Management
• Assist with coping and
• adaptation
• Creating therapeutic
• environment
• Recreational and diversion therapies

Unit-14

D. Concepts of Cultural Diversity and Spirituality

• Cultural diversity Cultural Concepts- Culture,
  Subculture, Multicultural, Diversity, Race, Acculturation, Assimilation Transcultural Nursing
  Cultural Competence Providing Culturally Responsive Care
• Spirituality
  Concepts- Faith, Hope, Religion, Spirituality, Spiritual Wellbeing Factors affecting Spirituality Spiritual Problems in Acute, Chronic, Terminal illnesses and near-death Experience Dealing with Spiritual Distress/Problems

Unit-15

Nursing theory Introduction

• overview of selected nursing theories- Nightingale, Orem, Roy

• Use of Theories in Nursing Practice
• Meaning &Definition, Purposes, Types of Discussion
  theories with examples,

Unit-16

First Aid & Emergencies *

• Definition, Basic Principles, Scope & Rules
• First Aid Management
  Wounds, Hemorrhage & Shock
  Musculoskeletal Injuries: Fractures, Dislocation, Muscle injuries
  Transportation of Injured persons Respiratory Emergencies & Basic CPR Unconsciousness
  Foreign Bodies- Skin, Eye, Ear,
  Nose, Throat & Stomach Burns & Scalds Poisoning, Bites & stings Frostbite & Effects of Heat Community Emergencies

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