Meet the Nguyens textbook version for fundamentals of nursing PDF

Preview

Summary

textbook version with scenario questions and unit one of textbook also review questions at the end as well, idk what else to say lol...

Description

2778_Ch01_001-022 14/06/13 2:29 PM Page 1

Meet the Nguyens T

hroughout this text, you will be applying what you have learned as you care for the Nguyen family. In Chapter 1, you will meet Nam Nguyen, a construction work supervisor, who arrives at the Family Medicine Center for his first physical exam in 10 years. It is Mr. Nguyen’s knee pain that causes him to seek help because it affects his work. But as you will see, Mr. Nguyen will discover he has other serious health problems that require him to be more vigilant about his health. As you read and work through the exercises in Caring for the Nguyens, you will also get to know Nam’s wife, Yen Nguyen, his grandchild Kim Phan, other members of his extended family, and his friends, as they deal with health issues and life changes. Your experience in caring for the Nguyens will show you that patients come to you with symptoms, but each person brings unique values, lifestyle, and relationships to the encounter. From the Nguyens, you will learn what it means to care for the whole person and how to be a full-spectrum nurse.

2778_Ch01_001-022 14/06/13 2:29 PM Page 2

Mr. Nam Nguyen is a new patient at the Family Medicine Center. He arrives at the center for a scheduled physical exam and completes the following admission questionnaire.

Nam Nguyen

Yen Construction supervisor

Daycare teacher

30, 27, 22

Please list your current medications and dosages. Also list over-the-counter and herbal products you use regularly.

Ibuprofen

Ben-Gay Balm on knees

2778_Ch01_001-022 14/06/13 2:29 PM Page 3

The Diagnosis During the visit, the clinic nurse records the following information in Mr. Nguyen’s chart: Height Weight BP Pulse RR Temp

5 ft 4 in. 165 lb (75 kg) 162/94 mm Hg 84 beats/min 20 breaths/min 98.2°F oral

Pr e s e n t i n g C ompla i n t : Patient states he is here to become established as a patient at the center and that he has not had a physical exam in over 10 years. Wife accompanies. He is currently experiencing bilateral knee pain that is affecting his work performance. “I am a building inspector. To check on things, I have to climb up and down ladders, lift things, and crawl around a lot.” Has not missed any work but has been using increasing amounts of acetaminophen and ibuprofen “to get through the day.” The medications provide only limited relief. States pain occurs daily even if not at work. Describes the pain as “achy” and “dull.” Feels best when he is off his feet. Desires pain relief and checkup. Explains that both parents had heart disease. Wife expressing worry that he may be developing heart problems “because he’s so tired after work and he gets short of breath easy.” The nurse explains to Mr. Nguyen that he will be seen by the nurse practitioner shortly. She asks Mr. Nguyen if he would like his wife to be present for the exam. He answers yes. Zach Jackson, MSN, FNP, is on duty at the center today. Zach worked as an RN for more than 10 years in the local emergency department and urgent care clinic. He has been a family nurse practitioner (FNP-BC) for more than 5 years. Zach enters the room and introduces himself to the Nguyen couple. To begin the exam, Zach reviews the information Nam supplied on the admission form, and then asks him about his family history. Zach: Nam: Zach:

“Are your parents still living?” “Yes, they’re both alive. My father is 80 years old and my mother is 76.” “I’d like to hear a little more about your family history. Tell me about your father’s cancer. How old was he when he was first diagnosed? Has he had treatment?”

Nam:

Zach:

Nam:

Jordan: Nam:

Yen: Zach: Yen:

“He was probably about 60 when he first found out about it. I know he had some kind of surgery and takes medicines but I don’t know the details. He seems all rig though.” “Your father also has high blood pressure an heart disease. Please tell me a little more about that.” “My father and mother both have high blood pressure and heart disease. They both take medicines for their blood pressure. My father had a small heart attack about 10 years ago. My mother has never had a heart attack that I know of, but she sometimes has chest pain.” “Your mother also has diabetes?” “She’s had that for a long time. A lot of people in his family, especially on my father’s side, have diabetes but nobody in my mother’s family.Yet my mother is the one with the diabetes!” “A lot of people in my family have diabetes too. But so far I’m OK, I think. “Have you had a health exam lately, Mrs. Nguyen?” “Not in about a year, but I’m going to schedule an appointment here.”

The Nguyen couple and Zach continue to review the health information. After reviewing the history and discussing current complaints, Zach performs a complete physical exam.

2778_Ch01_001-022 14/06/13 2:30 PM Page 4

un How Nurses Think 1 2 3 4 5 6 7 8

Nursing Past & Present Critical Thinking & the Nursing Process Nursing Process: Assessment Nursing Process: Diagnosis Planning Outcomes Planning Interventions Implementation & Evaluation Theory, Research, & Evidence-Based Practice

1

2778_Ch01_001-022 14/06/13 2:30 PM Page 5

C H A P T E R

1 Nursing Past & Present

Learning Outcomes

Key Concepts

After completing this chapter, you should be able to: ➤ Describe the role of religion in the

➤ Name and recognize the four purposes

development of nursing. ➤ Identify the factors that led to the change of nursing from a vocation of both men and women to a predominantly female profession. ➤ Explain the role of the military in the development of the nursing profession. ➤ Define nursing in your own words. ➤ Discuss the transitions that nursing education has undergone in the last century. ➤ Differentiate among the various forms of nursing education. ➤ Explain how nursing practice is regulated. ➤ Give four examples of influential nursing organizations.

of nursing care. ➤ Delineate the forces and trends affecting contemporary nursing practice.

Nursing Nursing image Contemporary nursing education Contemporary nursing practice

Related Concepts If you were assigned readings in the Expanded Discussion on DavisPlus, you should also be able to demonstrate the following outcomes:

See the Concept Map at the end of this chapter.

➤ Describe the healthcare delivery system

in the United States, including sites for care, types of workers, regulation, and financing of healthcare. ➤ Name nine expanded roles for nursing. ➤ Discuss issues related to healthcare reform.

Caring for the Nguyens This feature allows you to practice the kind of thinking you will use as a full-spectrum nurse. There is usually more than one correct answer to a critical thinking question, so we do not provide answers for these features. It is more important to develop your nursing judgment than to “cover content.” Discuss the questions with your peers. If you are still unsure, consult your instructor.

Review the opening scenario in the front of the book. On the preliminary visit of Nam Nguyen at the Family Medicine Center, he is examined by Zach Jackson, MSN, FNP-BC.

A. How would you respond to Nam’s concern that he was

Go to Caring for the Nguyens Response Sheet on DavisPlus.

examined by someone who is “just a nurse”?

B. What factors might be causing Mr. Nguyen to question care by “a male nurse”?

2778_Ch01_001-022 14/06/13 2:30 PM Page 6

6

UNIT 1

How Nurses Think

Nurses Make a Difference . . . Then & Now Time: 1854, Üsküdar (now part of Istanbul, Turkey) in the Crimea The hospital tent is set up away from the battlefield. The injured and dying soldiers are lying on the bare earth, soiled and covered with crusted blood. The rank odor of disease and death are inescapable in the stifling hospital tent. Scanning the scene, Florence Nightingale and her staff of 38 nurses review the environment in the tent, the health problems of the soldiers, and the supplies and equipment they have. First, they open the tent to allow in fresh air. Then they clean the tent, bathe the wounded, and provide clean bedding. They assess and dress the wounds, feed the soldiers a nutritious meal, and comfort those who are dying or are in pain. They offer encouragement and emotional care to the healthier soldiers and help them to write letters home. Within a brief period of time, the mortality rate drops from 47% to 2% and morale improves immeasurably.

Time: 2014, Your Local Hospital While standing at the bedside mixing an antibiotic solution, Susan listens to the ventilator cycle. She notes that her patient has begun to trigger breaths on his own. In the background she hears the cardiac monitor sounds, which have become more irregular over the past hour. She mentally runs through her patient assessment. “Why is his heart so irritable?” she wonders. She calls the lab for the morning blood work results. When the lab technician e-mails the results, Susan notes that the potassium level is low at 2.9 mEq/L. She notifies the physician of the test results and the cardiac irritability. Susan says, “The patient’s potassium is low from the diarrhea he’s had since we began the antibiotics.” Together they develop a plan to raise the potassium level and check it every 8 hours. Susan administers intravenous (IV) potassium chloride. Several hours later she documents that the ectopy (irregular heartbeat) has decreased to less than 2 beats/min.

ThinkLike a Nurse 1-1 The Quality and Safety Education for Nurses (QSEN) project and the Institute of Medicine (IOM) have identified quality and safety competencies for nurses: (1) patient-centered care, (2) teamwork and collaboration, (3) evidence-based practice, (4) quality improvement, (5) safety, and (6) informatics (Cronenwett, Sherwood, Barnsteiner, et al., 2007). Which

Time: 2030, A Local Home Yesterday, Mr. Samuels underwent cardiac surgery. He was discharged home this morning. As a home health nurse, your role is to assess his condition; provide skilled care; teach Mr. Samuels how to care for himself; instruct his family about his care; and coordinate any required additional services. Mrs. Samuels greets you at the front door. She tells you that her husband is in a lot of pain and that the chest drainage system is full. She looks frightened as she says, “When my father had cardiac surgery 25 years ago, he spent 4 days in the hospital. I don’t understand why my husband got sent home so quickly.” You explain that changes in technology and the healthcare system allow you to take care of clients in the home who would previously have been in the hospital. As you begin your assessments, you tell Mrs. Samuels, “After I’ve gathered more information, we’ll make a plan for his care that will make all of us more comfortable.” In each of these scenarios, the nurses engaged in fullspectrum nursing; that is, they used their minds and their hands to improve the client’s comfort and condition. As the scenarios illustrate, nursing roles have changed over time.Yet nursing remains a profession dedicated to care of the client.

of these did Florence Nightingale demonstrate? Explain your thinking.

ABOUT THE KEY CONCEPTS The overarching concept for this chapter is the definition of nursing. As you come to understand other key concepts (i.e., nursing images, contemporary nursing education, and

2778_Ch01_001-022 14/06/13 2:30 PM Page 7

CHAPTER 1

Nursing Past & Present

contemporary nursing practice), you will grasp how the image of nursing and actual nursing practice have changed over time.

NURSING IMAGES THROUGHOUT HISTORY An understanding of the past can give insight into the present. Throughout history, artwork, television, popular stories, advertisements, and greeting cards have all portrayed nurses in many ways. Whether the images are flattering or demeaning, accurate or inaccurate, they influence how people view nursing. Some of these images may have, in either a positive or negative way, influenced your decision to become a nurse.

Common Images of Nurses In the next few pages you will see how nursing has been portrayed in art and popular culture at different periods in history, and relate the truth and fiction of those images to the practice of contemporary nursing. This will help you appreciate the rich traditions of nursing and the forces that have shaped nursing as it is today. Pay close attention to the rate of change in recent years, and keep in mind that nursing and healthcare are likely to change even more rapidly in the future. When you think of nursing, what images do you think of? As you reflect on each of the three scenarios at the opening of this chapter, what pictures come into your mind? Is this the same image you get when you imagine yourself as a nurse? In the following sections we explore four common nursing stereotypes.

The Angel of Mercy Images of the angel-nurse are usually serene and content, with a halo or other religious symbol. This image grew out of the influence of religion and the risks inherent to the practice of nursing. Influence of Religion. The strong link between nursing and religious orders can be traced back to ancient cultures. In Egypt, Greece, and Rome, temples were health centers as well as places of worship. Priests and priestesses treated the ill with a combination of physical care, prayer, and magic spells. In Asia, some of the earliest writings about a distinct nursing occupation are included in the Vedas, the ancient sacred books of the Hindu faith (circa 1200 BCE). The nurses included in these texts were always men who were part of a priestly order and who possessed knowledge of the preparation, compounding, and administration of drugs; wisdom; purity; and devotion to the patient. In later centuries, lay deacons and deaconesses in the early Christian church visited the sick in their homes and functioned as nurses until the first hospitals were established in the first century. The oldest continuously existing hospital, Hôtel Dieu, in France, was founded in 542 (Fig. 1-1). In the United States, all training programs for nurses were affiliated with religious orders until well after the Civil War. Today, many nursing programs, universities, colleges, and healthcare institutions are affiliated with religious groups. Examples include the University of Notre Dame, the Seventh Day Adventist hospital system, and the American Baptist nursing home system. Effect of the Protestant Reformation.Christianity gradually lost influence in general society over the 15th to

FIGURE 1-1 Hôtel Dieu in France, the oldest continuously existing hospital. the 19th centuries. Catholic religious orders were often secuted, and many monasteries were closed during Protestant Reformation (16th and 17th centuries CE), forc many nurses to flee in order to avoid imprisonmen death. Medicine in this period moved to the universi with major advances in theoretical knowledge of anato physiology, and communicable disease. After the 19th c tury, religious groups gradually regained influence, many modern nursing programs, universities, colleges, healthcare institutions are affiliated with religious grou Although most of these organizations have mission st ments that incorporate charitable values, such as comp sion and caring, they no longer require religious dedica from their nursing students. Risks Involved in Patient Care. Another reason the association between nursing and spirituality is the herent risks involved in patient care, especially in the re past. Before the development of microscopes and te niques for culturing microorganisms in the 19th cent people who entered nursing placed themselves at risk exposure to diseases that were poorly understood and of could not be cured. Even as recently as the 1950s, antibio were not readily available, and the chief cause of morta (death) was infectious disease. Providing care in spite these risks was considered self-sacrificing, much like call to serve in religious life.

ThinkLike a Nurse 1-2 Which aspects of the nurse-as-angel concept appeal to you mo when you think about the way you will practice nursing? Why?

The Handmaiden The validity of this image has changed over time. While nurse’s role was initially limited, nurses now collaborate w all members of the healthcare team, planning and provid care not only at the direction of physicians but also along w them. Many activities that nurses now do independently w once performed only by physicians, including taking v signs, performing physical assessments, and administerin and other injectable medications (Table 1-1). Neverthel while nurses perform these and other critical and comp

2778_Ch01_001-022 14/06/13 2:30 PM Page 8

8

UNIT 1

How Nurses Think

Table 1-1 ➤ Examples of Nursing Activities DEPENDENT ACTIVITIES

INDEPENDENT ACTIVITIES

Administering prescribed medication

Evaluating the patient’s response to medication and withholding the next dose if the patient has a negative reaction

Assisting with a diagnostic test (e.g., opening trays, handing instruments to the physician)

Teaching the patient what to expect from the diagnostic test; preparing the patient for the test (e.g., shaving a site); supporting the patient during the test

Administering IV fluids

Evaluating the patient’s response to treatment; monitoring the flow rate; evaluating the site for redness or leakage

Ensuring that the patient receives the prescribed diet

Teaching a pregnant woman about additional nutrients needed in her diet

tasks, the physician remains the final decision maker for most patient care. ■ Physicians derive much of their power from legal and financial authority. Early physicians from wealthy and educated classes wrote and lobbied for legislation that awarded them extensive power and ensured control of healthcare. Now it is very difficult to change these laws to accommodate the expanded role of modern nurses (Quadagno, 2004; Rockwell, 1994; Safriet, 1994). ■ Without physicians, the institution does not generate income. Most patients—or their insurers—directly pay the facility to provide care that is prescribed by the physician. In contrast, nurses, with the exception of advanced care nurses, are often employees of healthcare institutions. Therefore, they are considered an expense because they cannot bill for the services they provide. To learn more about circumstances that have made it difficult to expand the role of nursing,

Go to Chapter 1, Reading More About Nursing Past and Present, on DavisPlus. ■

In the past, not all nurses considered themselves to be subservient to physicians. The letters and writings of Florence Nightingale (Fig. 1-2), the founder of modern nursing, indicate that she considered nurses the colleagues of physicians rather than their servants. She stated at one time that the standard description of nurses as “devoted and obedient . . . would do well for a porter” and “[i]t might even do well for a horse” (Chambers, 1958, p. 130).

FIGURE 1-2 Florence Nightingale (1820–1910). age of 24. She became a field nurse during the Crimean War, where she became known as “the Lady of the Lamp” because of her nighttime care to the wounded. Upon her return to England, she used her experience in the Crimea to immediately lobby politicians and physicians about the importance of nursing and the need for public health reform. Nightingale’s major contributions include the following: The establishment of nursing as a distinct profession Introduction of a broad-based liberal education for nurses Major reform in the delivery of...