Nursing Unit 1

• Assesment
• Nursing Diagnosis
• Planning
• Implementing 
• Evalutaion

Manipulation of environment of the patient to assist in recovery

Nursing is independent of the pratice of medicine

Higher lever of care, major hospital, surgery

• Pyrimid of human needs 
• Hierarchy of basic humand needs
• self 
• esteem needs 
• social needs 
• safty needs 
• physological needs 

• All aspects of well being
• No pumping rest of the body suffers

Temp, BP, Pulse, Respiration

Amount of oxygen in blood 95%-100%

Central Nervous System

Controls Temp

• Medulla
• Vasoconstriction
• Vasodiliation

Controls pulse

up and down temp

age, hormons, race, diet, weight, medications!!

Leads to kidney failure

• Oral 98.6-100.4f
• Axillary 1 degree lower 
• Rectal 1 degree higher

Lower than normal temp

Fever

Above 104 f 

flush, warm, pirspiration, lathargic, shivvering, increase BP

Tylonel

Assesment, nursing Dx, plan-outcome, intervention, evaluation

• glass
• electronic
• tympanic
• tape
• disposable 

No fever 

creates electrical impulses causing contraction of atria 

60-100

• 5000ml
• amount of blood pumped by heart in a min

amount of blood ejected from left ventrical with each contraction

the number od times the heart contracts 

• Temporal 
• Carotic
• Apical
• Brachial
• Radial
• Femrol
• Popliteal
• Dorsalis Pedis
• Posterior Tibial

About tempal in hair line 

In neck

Below nipple on left

Upside of elbow

Upper part of wrist

Groin

Behind knee

Top of foot

Behind ankle bone on inside

• Rate-beats per min
• Rhythm-pattern of the rate
• Quality-strength of pulse 

Machanical leggings to increase blood flow

Levels stimulate breathing 

Breathing in diaphram contracts-pulls down

Breathing out diaphragm relaxes moves up

Exsessive sweating 

Study the whole individual 

coordinated arms swinging freely

• S-severity
• L-location
• I-influencing factors
• D-duration
• A-associated symtpoms

• O-onset
• P-provocative or pallative-what bring it on
• Q-quality & quantity
• R-region or radiating
• S-seversity scale-pain-1-10
• T-timing-constant ot comes and goes
• U-understanding  

• Epidermis 
• Dermis
• Subcutaneous layer

• no vascular
• basal cells
• keratin & melanin layers
• horney cells-shed every 4 weeks 

• Connective tissue 
• Collagen
• Elastic tissue

• Horney cell layer
• Basal cell layer 
• Melanocytes 

• Connective tissue
• Hair follicle 
• Sebaceous gland
• Eccrine gland 
• Apocrine gland 
• Nerves

• Adipose tissue 
• Blood vessles 
• Fat 

Covers most of body very fine 

Darker thicker hair scalp eyebrow

produces lipid substance through hair follical 

Coiled tubes that open directly to skin surface 

produces think milky substance and opens at hair follicle 

• white skin color-fear, anxiety
• Black people-gray ashy

• red-fever, inflammation
• Black people-hardened skin warm

• blue-decreased oxygen in blood 
• black people-blue lips

• yellow-high amount og bilirubin
• Black people-look in eye for yellowness 

Increase of bilirubin in tissue

Bluish color due to lack of oxygen in reb blood cells 

High BP

BP below 90 systolic

We DONT know what causes it

We KNOW what causes it

120/80

120-139/80-89

140-159/90-99

160 and up/100 and up

Study of all aspects of aging and its consequences

When older people are steryotyped

• Ego integrity vs despair 
• Life review or reminiscence

Maintence of social contacts and relationships

• Confusion & disorientation
• Aizhemers
• Sundowning 
• Loss of lang skills
• Poor judgment 
• Loss of ability to calculate

• Dementia
• Depression
• Delirium

• Insulin Dependent 
• usualy children

Oral med to help body untilize insulin produced by body

TO get Information

• Source (encoder)
• Message
• Channel
• Receiever (decoder)
• Feedback 

• S-situation
• B-backround
• A-assesment
• R-recommendation

an active, organized, cognative porcess used to carefully examine ones thinking ans the thinkgin of others

Recognizing an issue exists, analyzing information, evaluating information, and making conclusion

Head up 45 degress

Flat on back not elevated 

On stomach flat 

Laying on side with upper leg bent out for stability

Loss of hair

circular shape to skin lesion

Elevated cavity containing free fluid larger that 1cm diameter

skin lesion that run together

extrude left on skin

Shallow depression in skin 

Intense redness of skin

self inflicted abrasion on skin due to scratching 

linear crazk in skin extending into dermis

Boil, suppurative inflammatory skin lesiondue to infected hair follicle

skin lesion due to benign proliferation of blood vessels in dermis

hypertrophic scar, elevated behoy site of original injury

softening of tissue by soaking

flat skin lesion with only a color change 

mole, circumscribed skin lesion due to excess melanocytes

elevated skin lesion less 1cm

skin lesion bigger than 1cm

skin lesion in which papules coalasce or come together 

read purple skin lesion due to broken blood vessels 

elevated cavity containing thick turbid fluid

• Severity
• Location
• Influenceing factor
• Duration
• Associated Symptoms

• Onset
• Provacation
• Quality 
• Region
• Severity
• Timing 
• Understanding 

• Inspect
• Palpate
• Percuss
• Asultaion