BASIC CARE AND COMFORT LESSON-5

I. Nutrition
A. Food Guidelines (illustration )
. Nutrition!l needs t"rou#" t"e li$e %&%le
!. In$!nts' $luid !nd (rotein needs ).5* !dults
+. Bre!st ,il- or $or,ul! is !de.u!te $or $irst / ,ont"s o$ li$e
%. C"ild"ood' #r!du!l in%re!sin# o$ !ll nutrients
d. Adults' un%"!n#ed e*%e(t $or
. 0re#n!n%&' !dd (er d!&' 122 %!lories3 5 ,# iron3
12 # (rotein3 422 # %!l%iu,3 !nd )22u# $oli% !%id
). L!%t!tion' !dd 522 %!lories3 ) .u!rts e*tr! $luid
e. Elderl& o5er !#e /5' !de.u!te (rotein to ,!int!in i,,une
s&ste,
). F!%tors !$$e%tin# diet!r& (!tterns
!. 6e!lt" st!tus
+. Culture !nd reli#ion
%. So%ioe%ono,i% st!tus
d. 0erson!l (re$eren%e
e. 0s&%"olo#i%!l $!%tors
$. Al%o"ol !nd dru#s
1. Ener#& Needs
!. B!s!l ,et!+olis, 7 ener#& re.uired $or on#oin# intern!l
(ro%esses su%" !s "e!rt+e!t
+. B!s!l ,et!+oli% r!te (BMR) 7 in$luen%ed +& #ender3 !#e3
!%ti5it& le5el3 +od& %o,(osition
B. Essenti!l Nutrients
. C!r+o"&dr!tes
!. In%lude su#!rs3 st!r%"es !nd %ellulose
+. Si,(le su#!rs (,onos!%%"!rides) !re ,ost e!sil&
,et!+oli8ed
%. St!r%"es !re ,ore %o,(le* in stru%ture !nd ,et!+olis,
d. Fun%tions o$ %!r+o"&dr!tes
. 9ui%-est sour%e o$ ener#& (4. -%!l:#r!,)
). M!in sour%e o$ $uel $or +r!in3 (eri("er!l ner5es3
;BCs3 RBCs3 !nd "e!lin# <ounds
1. 0rotein s(!rer
e. Diet!r& sour%es' (l!nt $oods3 e*%e(t $or l!%tose
$. Re%o,,ended d!il& int!-e'
. F!%tors in$luen%in# re%o,,ended int!-e o$
%!r+o"&dr!tes in%lude +od& stru%ture3 ener#&
e*(enditure3 +!s!l ,et!+olis, !nd #ener!l "e!lt"
st!tus
). Ide!ll&3 52-/2= o$ tot!l %!lories s"ould +e %o,(le*
%!r+o"&dr!tes
#. E*%essi5e %!r+o"&dr!te %!lories !re stored !s $!t
). Li(ids
!. B!si% li(ids !re %o,(osed o$ tri#l&%erides !nd $!tt& !%ids
+. In%ludes s!tur!ted $!tt& !%ids ($ro, !ni,!l sour%es) !nd
uns!tur!ted $!tt& !%ids (5e#et!+les3 nuts !nd seeds)
%. Essenti!l uns!tur!ted $!tt& !%ids - linolei% !%id is t"e onl&
essenti!l $!tt& !%id in "u,!ns> linoleni% !%id !nd
!r!%"idoni% !%id %!n +e ,!nu$!%tured +& t"e +od& <"en
linolei% !%id is !5!il!+le
d. De$i%ien%ies le!d to s-in3 +lood !nd !rter& (ro+le,s
e. Fun%tions
. Most %on%entr!ted sour%e o$ ener#& (? -%!l:#r!,)
). Bod&@s ,!Aor $or, o$ stored ener#&
1. Insul!tion
4. Cell ,e,+r!ne %o,(onent
5. C!rries $!t-solu+le 5it!,ins A3 D3 E !nd B
/. Re%o,,ended diet!r& int!-e' no ,ore t"!n 12=
tot!l %!lori% int!-e !nd lo< in s!tur!ted $!ts
1. 0roteins
!. Co,(le* or#!ni% %o,(ounds %o,(rised o$ !,ino !%ids
+. Bod& +re!-s (rotein do<n into )) !,ino !%ids
%. All +ut C !,ino !%ids !re (rodu%ed +& t"e +od&
d. DCo,(lete (roteinE $ood %ont!ins t"e ei#"t essenti!l !,ino
!%ids not (rodu%ed +& t"e +od& (,ost ,e!t3 $is"3 (oultr&
!nd d!ir& (rodu%ts)
e. DIn%o,(lete (roteinE $ood l!%-s one or ,ore o$ t"e ei#"t
!,ino !%ids (,ost 5e#et!+les !nd $ruits)
$. In%o,(lete (roteins %!n +e %o,+ined to &ield ! %o,(lete
(rotein' $or e*!,(le3 +e!ns !nd ri%e
#. Fun%tions o$ (rotein
. Se%ond!r& ener#& sour%e (4 -%!l:#r!,)
). Essenti!l $or %ell #ro<t"
1. E$$i%ien%& %!n !$$e%t !ll o$ +od& - or#!ns3 tissues3
s-in3 ,us%les
4. Re%o,,ended (rotein int!-e' 2.4) #r!,s (er 2.4
-# o$ +od& <ei#"t
5. T"e +od&Fs onl& sour%e o$ nitro#en
/. Ne#!ti5e nitro#en +!l!n%e %!n o%%ur <it" in$e%tion3
+urns3 $e5er3 st!r5!tion3 !nd inAur&
4. Git!,ins
!. Or#!ni% su+st!n%es essenti!l $or +od& #ro<t" !nd
,et!+olis,
+. Found onl& in (l!nts !nd !ni,!ls> +od& %!nnot s&nt"esi8e
t"e,> de(ends on diet!r& int!-e
%. T&(es (!%%ordin# to t"eir sol5ent)
. ;!ter solu+le (B3 B)3 B/3 B)3 C)
!. C!nnot +e stored in +od&> re.uire d!il&
int!-e
). F!t solu+le (A3 D3 E3 B)
!. C!n +e stored in +od&
Be Prepared
DonFt st!& u( l!te $or l!st ,inute %r!,,in#.
Inste!d3 #et ! #ood ni#"tFs slee(.
5. Miner!ls
!. Inor#!ni% su+st!n%es essenti!l !s %!t!l&sts in +io%"e,i%!l
re!%tions
+. For, ,ost inor#!ni% ,!teri!l in t"e +od&
%. Fun%tions'
. C!t!l&st $or ,!n& +od& re!%tions su%" !s re#ul!tion
o$ !%id-+!se +!l!n%e
). 6el( %ells ,et!+oli8e3 tissues !+sor+ nutrients3 !nd
"e!rt ,us%le res(ond
1. Miner!ls <or- s&ner#isti%!ll&> ! de$i%ien%& o$ one
,iner!l %!n distur+ t"e !%tion o$ ot"er ,iner!ls
4. T&(es - #rou(ed !%%ordin# to !,ount $ound in +od&
!. M!Aor ,iner!ls - %!l%iu,3 ,!#nesiu,3
sodiu,3 (ot!ssiu,3 ("os("orus3 sul$ur3
%"lorine> $un%tion -no<n
+. Tr!%e ,iner!ls - iron3 %o((er3 iodine3
,!n#!nese3 %o+!lt3 8in% !nd ,ol&+denu,>
$un%tion un%le!r
%. Anot"er #rou( o$ tr!%e ,iner!ls> $ound in
e5en s,!ller !,ounts> $un%tion un%le!r
/. ;!ter
!. Criti%!l +od& %o,(onent essenti!l $or %ell $un%tion
+. A%%ounts $or /2-H2= tot!l +od& <ei#"t in !dults> H2-H5=
%"ildren $un%tions
%. 0ro5ides nor,!l tur#or
d. Re#ul!tes +od& te,(er!ture
e. Diet!r& sour%es' li.uids !nd solids3 su%" !s $res" $ruits !nd
5e#et!+les
$. De$i%ien%&' se5ere de$i%ien%& le!ds to de"&dr!tion !nd
de!t"
#. Fluid int!-e nor,!ll& e.u!ls $luid out(ut
4. Fluid !nd Ele%trol&te B!l!n%e
. Tot!l 5olu,e o$ $luid !nd !,ount o$ ele%trol&tes re,!in rel!ti5el&
%onst!nt in t"e +od&
). Fluid +!l!n%e !nd ele%trol&te +!l!n%e is interde(endent
1. Bod& +!l!n%es $luid !nd ele%trol&tes (ri,!ril& +& !dAustin# out(ut3
!nd se%ond!ril& +& !dAustin# int!-e.
4. Fluid +!l!n%e is !lso ,!int!ined +& os,osis (illustration )
5. M!Aor ele%trol&tes
!. C!tions
. Sodiu, - ,ost !+und!nt %!tion in e*tr!%ellul!r $luid
!. Re#ul!tes %ell si8e 5i! os,osis
+. Essenti!l in ,!int!inin# <!ter +!l!n%e3
tr!ns,ittin# ner5e i,(ulses3 !nd %ontr!%tin#
,us%les
%. Re#ul!tes !%id-+!se +!l!n%e +& e*%"!n#in#
"&dro#en ions $or sodiu, ions in -idne&
d. Nor,!l l!+ 5!lue $or seru, sodiu, is 15-
45 ,E.:L
e. Sodiu, is re#ul!ted +& s!lt int!-e3
!ldosterone3 !nd urin!r& out(ut
$. Sour%es in%lude t!+le s!lt3 (ro%essed ,e!ts3
sn!%-s !nd %!nned $ood (illustration )
). 0ot!ssiu, - ,ost !+und!nt %!tion o$ intr!%ellul!r
$luid
!. 0ot!ssiu, (u,( dr!<s (ot!ssiu, into %ell>
essenti!l $or
+. 0ol!ri8!tion !nd re(ol!ri8!tion o$ ner5e !nd
,us%le $i+ers
%. Re#ul!tes neuro ,us%ul!r e*%it!+ilit& !nd
,us%le %ontr!%tion
d. Sour%es in%lude <"ole#r!ins3 ,e!t3
le#u,es3 $ruits !nd 5e#et!+les
e. Re#ul!ted +& -idne&s
$. Nor,!l l!+ 5!lue $or seru, (ot!ssiu, is 1.5
- 5.1 ,E.:L
1. C!l%iu, - essenti!l $or %ell ,e,+r!ne inte#rit&3
%!rdi!% %ontr!%tion3 "e!lt"& +ones !nd teet"3 !nd
$un%tionin# o$ ner5es !nd ,us%les
4. M!#nesiu, - nor,!l %onstituent o$ +one> %o$!%tor
$or en8&,es in ener#& ,et!+olis,3 neuro%"e,i%!l
!%ti5ities3 ,us%ul!r e*%it!+ilit&
+. Anions
. C"loride
!. Most !+und!nt !nion in e*tr!%ellul!r $luid
+. 6el(s +!l!n%e sodiu,
%. Nor,!l l!+ 5!lue $or seru, %"loride is 22-
2/ ,E.:L
). Bi%!r+on!te - (!rt o$ +i%!r+on!te +u$$er s&ste,>
li,its t"e dro( in (6 +& %o,+inin# <it" !n !%id to
$or, %!r+oni% !%id !nd ! s!lt
1. 0"os("!te - (!rti%i(!tes in %ellul!r ener#&
,et!+olis,3 %o,+ines <it" %!l%iu, in +one3 !ssists
in stru%ture o$ #eneti% ,!teri!l
/. M!inten!n%e o$ $luid 5olu,e
!. Os,ore%e(tor s&ste,
. B!l!n%es $luid int!-e 5olu,e +& re#ul!tin# <!ter
out(ut 5olu,e.
). De"&dr!tion sti,ul!tes os,ore%e(tors <"i%"
!%ti5!te t"e t"irst %ontrol %enter> (erson $eels t"irst&
!nd see-s <!ter
1. Also sti,ul!tes AD6 se%retion <"i%" de%re!ses
urin!r& out(ut
+. Cir%ul!tor& s&ste,' drin- ,ore3 !nd 5i! in%re!sed
Glo,erul!r $iltr!tion3 ulti,!tel& de%re!se +lood 5olu,e'
Get a Clue

%. T"irst Center
. Lo%!ted in "&(ot"!l!,us
). Sti,ul!ted +&
!. In%re!sed (l!s,! os,ol!lit&
+. An#iotensin II
%. Dr& ("!r&n#e!l ,u%ous ,e,+r!nes
d. De%re!sed (l!s,! 5olu,e
e. De(leted (ot!ssiu,
$. 0s&%"olo#i%!l $!%tors
H. M!inten!n%e o$ ele%trol&te +!l!n%e
!. Aldosterone - "or,one (,iner!l%orti%oid)
. ;"en e*tr!%ellul!r $luid sodiu, de%re!ses or
(ot!ssiu, le5els in%re!se
). Adren!l %orte* se%retes !ldosterone
1. Bidne&s sti,ul!ted +& !ldosterone to in%re!se
re!+sor+tion o$ sodiu, !nd de%re!sed re!+sor+tion
o$ (ot!ssiu,
4. Results in <!ter re!+sor(tion !nd in%re!sed +lood
5olu,e
+. 0!r!t"&roid
. 0!r!t"&roid se%retes (!rt"&roid "or,one (0T6)3
!lso %!lled (!r!t"or,one
). Sti,ul!tes rele!se o$ %!l%iu, $ro, +one3
re!+sor+tion in s,!ll intestine !nd -idne& tu+ules
1. ;"en seru, %!l%iu, le5el is lo<3 0T6 se%retion
in%re!ses
4. ;"en seru, %!l%iu, le5el rises3 0T6 se%retion $!lls
5. 6i#" le5els o$ !%ti5e 5it!,in D in"i+it 0T6 !nd
lo< le5els or ,!#nesiu, sti,ul!te 0T6 se%retion
D. Nor,!l !nd T"er!(euti% Diets
. Guidelines' I.S. De(t o$ A#ri%ulture Re%o,,ended Diet!r&
Allo<!n%es (RDAs)
!. Desi#ned $or ,!inten!n%e o$ "e!lt"& (eo(le
+. Adult re.uire,ents' 12 %!lories:-# o$ ide!l +od& <ei#"t
Look Closer with Links to Knowledge
Le!rn ,ore !+out nutrition $ro, t"e A,er%i!n
Dieteti% Asso%i!tion.
). T"er!(euti% nutrition
!. Modi$i%!tion o$ t"e nutrition!l needs +!sed on dise!se
%ondition
+. Consider!tions $or !d,inisterin# t"er!(euti% diets
. Condition o$ %lient - ("&si%!l3 e,otion!l3 ,ent!l
!+ilit& o$ %lient to toler!te diet
). ;illin#ness o$ %lient to %o,(l& <it" diet
%. T&(es o$ t"er!(euti% diets
. Di!+eti%
!. Go!l is ,!inten!n%e o$ nor,!l <ei#"t
+. Diet!r& r!tio 5')' (%!r+o"&dr!tes to $!t to
(rotein)
%. Le5el o$ !%ti5it& deter,ines ener#&
re.uire,ents
d. Non-insulin de(endent di!+etes ,ellitus
(NIDDM) %!n usu!ll& +e %ontrolled +& diet
t"er!(&
e. Diet indi5idu!li8ed !%%ordin# to %lientFs !#e3
+uild3 <ei#"t3 !nd !%ti5it& le5el
Look Closer with Links to Knowledge
T"e A,eri%!n Di!+etes Asso%i!tion (ro5ides
in$or,!tion to (eo(le <it" di!+etes3 t"eir $!,ilies3
!nd "e!lt" (ro$ession!ls.
). Lo< (rotein diet
!. For ren!l dise!se su%" !s (&elone("ritis3
ure,i!3 -idne& $!ilure
+. Nor,!l (rotein int!-e 42-/2 #,:d!&
%. Restri%ted $oods' ,e!ts !nd ot"er $oods "i#"
in (rotein su%" !s le#u,es3 $is"3 d!ir&
1. 6i#" (rotein diet
!. For %onditions su%" !s +urns3 !ne,i!3
,!l!+sor+tion s&ndro,es3 ul%er!ti5e %olitis
+. In%lude "i#" .u!lit& (roteins or (rotein
su((le,ents su%" !s sust!#en
4. Lo< %!l%iu, diet
!. 0re5ents $or,!tion o$ ren!l %!l%uli
+. Li,it 422 ,# (er d!& inste!d o$ nor,!l C22
,#
%. Restri%ts dried $ruits !nd 5e#et!+les3 s"ell
$is"3 %"eese3 nuts
5. A%id !s" diet
!. 0re5ents stone $or,!tion
+. Restri%ts %!r+on!ted +e5er!#es3 dried $ruits3
+!n!n!3 $i#s3 %"o%ol!te3 nuts3 oli5es3 (i%-les
/. Lo< (urine diet
!. 0re5ents uri% !%id stone> used <it" #out
%lients
+. Lo<ers le5els o$ (urine3 t"e (re%ursor o$
uri% !%id
%. Restri%ts #l!ndul!r ,e!ts3 #r!5ies3 $o<l3
$is"3 !nd "i#" ,e!t .u!ntities
H. Lo< %"olesterol
!. Ised $or %!rdio5!s%ul!r dise!se3 "i#" seru,
%"olesterol le5els
+. Nor,!l !,ount o$ %"olesterol int!-e - )52
to 122 ,#:d!&
%. Restri%ts e##s3 +ee$3 li5er3 lo+ster3 i%e %re!,
C. Lo< sodiu,
!. Ised in %on#esti5e "e!rt $!ilure3
"&(ertension
+. Ised $or %orre%tin# t"e retention o$ sodiu,
!nd <!ter
%. Le5els o$ restri%tion
i. Mild ()-1 # sodiu,)
ii. Moder!te (222 ,# sodiu,)
iii. Stri%t (522 ,#)
d. Restri%ts t!+le s!lt3 %!nned 5e#et!+les3
s,o-ed ,e!ts3 +utter3 %"eese
?. 6i#" $i+er
!. Ised to %orre%t %onsti(!tion3 lo<er ris- o$
%olon %!n%er
+. 12-42 #, $i+er:d!& re%o,,ended
%. In%re!sed int!-e o$ $ruits3 5e#et!+les3 +r!n
%ere!ls
2. Lo< residue
!. Ised $or %onditions su%" !s di!rr"e!3
di5erti%ulitis
+. Foods "i#" in %!r+o"&dr!tes !re usu!ll& lo<
$i+er
%. In%re!sed use o$ #round ,e!t3 $is"3 +roiled
%"i%-en <it"out s-in3 <"ite +re!d
. Me%"!ni%!l so$t
!. Ised <it" di$$i%ult& in %"e<in#3 su%" !s
(oorl& $itted dentures or endentulous
+. In%ludes !n& $oods <"i%" %!n +e e!sil&
+ro-en do<n +& %"e<in#
). 0uree diet
!. Ised <it" d&s("!#i! or di$$i%ult& in
%"e<in#
+. Ised $or tu+e $eedin#s3 s,!ll +!+ies
%. Food is +lended to s,oot" %onsisten%&
1. Nutrition!l !ssess,ent' e5!lu!te
!. ;ei#"t %"!n#e
+. A((etite
%. Food intoler!n%e
d. C"e<in# !nd s<!llo<in#
e. Indi#estion
$. Eli,in!tion "!+its
#. E!tin# +e"!5iors
". Medi%!tions used
i. Ant"ro(o,etri% ,e!sure,ents
). Feedin# Tu+es
!. Indi%!tions-in!+ilit& to in#est3 %"e<3 or s<!llo< $ood3 +ut
GI tr!%t int!%t
+. Tu+e inserted t"rou#" nose into sto,!%" or s,!ll +o<el> or
inserted endos%o(i%!ll&> #!strosto,& tu+e or 0EG tu+e3
AeAunosto,& tu+e
%. T&(es o$ tu+es !nd $eedin#s
. S,!ll +ore $eedin# tu+e' C-) Fr !nd 1/-41 in%"es
lon#
!. Di$$i%ult to !s(ir!te sto,!%" %ontents
+. M!& +e i,(ossi+le to !us%ult!te !n !ir
+olus> or !ir +olus ,!& +e "e!rd e5en <"en
tu+e is not in sto,!%"
%. Tu+es ,!& +e%o,e dis(l!%ed e5en <"en
se%urel& t!(ed
d. 6!rd to 5eri$& (l!%e,ent> +est ,et"od is +&
*r!&
). Enter!l tu+e $eedin#s
!. Bee( "e!d o$ +ed r!ised3 to (re5ent
!s(ir!tion
+. Assess (l!%e,ent o$ tu+e
%. InAe%t 2 ,l !ir into n!so#!stri% tu+e (n#
tu+e) !nd listen <it" stet"os%o(e $or rus" o$
!ir o5er sto,!%"
i. As(ir!te #!stri% %ontents !nd %"e%-
i$ (6 is !%idi%
ii. R!diolo#i% %on$ir,!tion
d. Ad,inister enter!l $eedin#
i. Continuous
ii. To (re5ent +!%teri!l #ro<t"3 do not
"!n# tu+e $eedin# $or lon#er t"!n C
"ours
e. Assess #!stri% residu!l
i. E5er& $our "ours i$ %ontinuous
$eedin# or
ii. Be$ore &ou +e#in inter,ittent
$eedin#s
1. Tu+e $eedin# $or,ul!s
!. Gi5one*3 Iso%!l3 0ort!#en3 et%.
4. Co,(li%!tions
!. As(ir!tion
+. G!strointestin!l %o,(li%!tions (di!rr"e!)
%. Ele%trol&te or ,et!+oli% (ro+le,s
5. Nutrition!l Su((le,ents:Li.uids
!. De"&dr!tion:Di!rr"e!'
. In$!nts' In$!l&te3 0edi!l&te3 Ri%el&te
). Older %"ildren' s(orts ele%trol&te re(l!%e,ent
drin-s
1. In$!nt $or,ul!s' st!nd!rd !nd "i#"-%!lorie
4. S(e%i!lt& $or,ul!s'
!. 0redi#ested (e.#. 0re#est!,il3 Nutr!,i#en)
+. 6i#"-%!lorie su((le,ents (S%!ndis"!-es3
C!rn!tion Inst!nt +re!-$!sts)
/. 0!renter!l Nutrition' see Lesson C (!#e /4
Study Smart
For, ! stud& #rou( <it" ot"er %!ndid!tes.
II. Mo+ilit&
A. 0re5ent %o,(li%!tions o$ i,,o+ilit&
. S-in %"!n#es - de%u+itus ul%ers
!. Turn %lient e5er& t<o "ours
+. Ise "eel:el+o< (rote%tors
%. Ise !ltern!te (ressure ,!ttress or s"ee(s-in
). Mus%ulos-elet!l %"!n#es
!. St!rt r!n#e o$ ,otion e*er%ises to !$$e%ted Aoints
+. 0ro5ide $oot +o!rd !nd:or $oot %r!dle
%. 0osition !nd turn e5er& t<o "ours
1. Res(ir!tor& %"!n#es - (neu,oni!3 !tele%t!sis
!. Instru%t %lient to %ou#" !nd dee( +re!t"e e5er& t<o "ours
+. Turn e5er& t<o "ours
%. Su%tion i$ needed
d. C"est ("&siot"er!(& !s ordered
4. C!rdio5!s%ul!r s&ste, %"!n#es
!. Ort"ost!ti% "&(otension' instru%t %lient to %"!n#e (osition
slo<l&> es(e%i!ll& (rone to su(ine or st!ndin#
+. In%re!sed %!rdi!% <or-lo!d' dis%our!#e use o$ 5!ls!l5!
,!neu5er
%. T"ro,+us:e,+oli $or,!tion
. A((l& !ntie,+oli% sto%-in#s
). Turn e5er& t<o "ours
1. St!rt !nti%o!#ul!tion t"er!(& i$ indi%!ted
4. Initi!te e*er%ise
5. Irin!r& C"!n#es' ren!l3 %!l%uli3 urin!r& tr!%t in$e%tion
!. In%re!se $luid int!-e ()222 - 1222 %%:d!&)
/. 0s&%"oso%i!l C"!n#es'
!. 0ro5ide sti,uli to ,!int!in orient!tion
B. T&(es o$ e*er%ise
. 0!ssi5e - %!rried out +& t"e "e!lt" %!re (ro5ider <it"out !ssist!n%e
$ro, %lient> (ur(ose is to ret!in Aoint ,o+ilit& !nd +lood
%ir%ul!tion
). Resisti5e - %!rried +& t"e %lient <or-in# !#!inst resist!n%e>
(ur(ose is to in%re!se ,us%ul!r stren#t"
1. Iso,etri% - %!rried out +& t"e %lient <it" no !ssist!n%e> (ur(ose is
to ,!int!in ,us%ul!r stren#t" <"en t"e Aoint is i,,o+ili8ed
4. R!n#e o$ Motion (ROM) - Aoint is ,o5ed t"rou#" entire r!n#e>
(ur(ose is to ,!int!in Aoint ,o+ilit&
C. Ise o$ ,e%"!ni%!l !ids to (ro,ote ,o+ilit&
. Crut%"es
!. Su((ort $eet !nd le#s durin# <!l-in#
+. AdAust "!nd+!rs to !llo< 5-12 de#rees o$ el+o< $le*ion
%. Ise <ell $ittin# s"oes <it" nonsli( soles
d. Ise ru++er su%tion ti(s on %rut%"es
e. M!& +e used te,(or!ril& or (er,!nentl&
$. Te!%" %lient %rut%" <!l-in#
). C!ne
!. 0ro5ides st!+ilit& <"en <!l-in# !nd relie5es (ressure on
<ei#"t-+e!rin# Aoints
+. AdAust %!ne <it" "!ndle !t le5el o$ #re!ter tro%"!nter3
el+o< $le*ed !t 12 de#ree !n#le
%. Te!%" %lient to "old %!ne %lose to +od&3 !nd "old in "!nd on
stron#er side.
d. Mo5e %!ne !t s!,e ti,e !s t"e <e!-er le#.
1. ;!l-er
!. To !ssist in <ei#"t +e!rin# !nd ,o+ilit&
+. Te!%" %lient "o< to sit3 st!nd !nd turn
D. 0rost"eti% de5i%es - used to re(l!%e ! ,issin# +od& (!rt
E. Br!%e - su((ort $or <e!-ened ,us%les
III. Eli,in!tion
A. 0ro,otion o$ nor,!l eli,in!tion
. Irin!tion
!. Ade.u!te $luid int!-e
+. Nor,!l !dult urin!r& out(ut - 12 ,l:"our
). Bo<el eli,in!tion
!. Ade.u!te $luid int!-e
+. Re#ul!r e*er%ise
%. Re#ul!te $ruit Aui%es3 r!< $ruits !nd 5e#et!+les !s needed
d. Nor,!l +o<el e5!%u!tion' 5!ries in "e!lt"& indi5idu!ls> no
,ore t"!n 1 ,o5e,ents (er d!& to t"ree ti,es ! <ee-
B. Irin!r& in%ontinen%e' in5olunt!r& rele!se o$ urine
. T&(es
!. Stress in%ontinen%e - sudden in%re!se in intr!-!+do,in!l
(ressure (su%" !s snee8in#3 %ou#"in#) %!uses urine to le!-
$ro, +l!dder
+. O5er$lo< (re$le*) in%ontinen%e - +l!dder e,(ties
in%o,(letel&3 so urine dri++les %onst!ntl&
%. Ir#e in%ontinen%e - un%ontrolled %ontr!%tion o$ t"e +l!dder
results in le!-!#e o$ urine +e$ore one re!%"es t"e +!t"roo,
d. Fun%tion!l in%ontinen%e - in%ontinen%e not due to or#!ni%
re!sons> $or inst!n%e3 i,(!ired ,o+ilit& ,!& (re5ent t"e
%lient $ro, re!%"in# t"e +!t"roo, in ti,e.
). Di!#nosis o$ urin!r& in%ontinen%e
!. 6istor& !nd ("&si%!l e*!,in!tion
+. Irin!l&sis - tells <"et"er +lood or in$e%tion (resent
%. C&stos%o(& - tells <"et"er !+nor,!lities !re (resent
d. 0ost-5oid residu!l - ,e!sures !,ount o$ urine re,!inin# in
+l!dder !$ter 5oidin#
e. Stress test - deter,ines i$ urine le!-s !$ter +l!dder is
stressed due to %ou#"in#3 li$tin# et%.
1. Tre!t,ent
!. Dru# t"er!(&
. Antis(!s,odi%s !nd !nti%"oliner#i%s - rel!* !nd
in%re!se %!(!%it& o$ +l!dder
). Al("!-!drener#i% !#onists - in%re!se uret"r!l
resist!n%e
+. Be#el e*er%ises - stren#t"en <e!- ,us%les !round t"e
+l!dder
%. Be"!5ior!l tr!inin# - %lient le!rns di$$erent <!& to %ontrol
ur#e to urin!te
d. Bl!dder retr!inin#
e. Sur#er& - re(!ir o$ <e!-ened or d!,!#ed (el5i% ,us%les or
uret"r!
4. Nursin# Inter5entions -
!. 0ro5ide s-in %!re3 (rote%ti5e under#!r,ents
+. Est!+lis" toiletin# s%"edule - (ro5ide e!s& !%%ess to
+!t"roo, !nd (ri5!%&
%. Te!%" %lient Be#el e*er%ises'
. Sto( !nd st!rt urin!r& stre!, <"ile 5oidin#
). 6old %ontr!%tion $or 2 se%onds !nd rel!* $or 2
se%onds.
1. ;or- u( to )5 re(etitions t"ree ti,es ! d!&
d. 0re5ent in$e%tion
. Cle!nse uret"r!l ,e!tus !$ter e!%" 5oid
). A%idi$& urine
1. In%re!se d!il& int!-e o$ $luids
Look Closer with Links to Knowledge
Le!rn ,ore !+out in%ontinen%e $ro, t"e N!tion!l
Asso%i!tion $or Continen%e.
C. C!t"eteri8!tion
. 0ur(oses
!. Relie5e !%ute urin!r& retention
+. Relie5e %"roni% urin!r& retention
%. Dr!in urine (reo(er!ti5el& !nd (osto(er!ti5el&
d. Deter,ine !,ount o$ (ost-5oid residu!l
e. A%%ur!tel& ,e!sure out(ut in t"e %riti%!ll& ill
$. O+t!in sterile urine s(e%i,en
#. Continuous or inter,ittent +l!dder irri#!tion (illustration )
). T&(es o$ C!t"eter !nd Gener!l Guidelines
!. Ind<ellin# C!t"eter
. Ise ! %losed dr!in!#e s&ste,
). Ad5!n%e %!t"eter !l,ost to +i$ur%!tion o$ %!t"eter3
es(e%i!ll& in ,!le (!tients (illustration )
1. In$l!te +!lloon <it"in #uidelines o$ ,!nu$!%turer
onl& !$ter urine is dr!inin# (ro(erl&3 t"en sli#"tl&
<it"dr!< %!t"eter
4. Se%ure %!t"eter to (!tientFs t"i#"3 !llo<in# $or so,e
sl!%- to !%%o,,od!te ,o5e,ent !nd to lessen dr!#
on (!tient
5. Ensure tu+in# is o5er (!tientFs le#
/. C!re o$ ind<ellin# %!t"eter'
!. Cle!nse !round !re! <"ere %!t"eter enters
uret"r!l ,e!tus.
+. Do t"is <it" so!( !nd <!ter durin# t"e d!il&
+!t"in# routine !nd !$ter de$e%!tion
%. Do not (ull on %!t"eter <"ile %le!nsin#
d. Do not use (o<der or s(r!& !round (erine!l
!re!
e. Do not o(en t"e dr!in!#e s&ste,
$. A5oid r!isin# t"e dr!in!#e +!# !+o5e t"e
le5el o$ t"e +l!dder
#. A5oid %l!,(in# t"e dr!in!#e tu+in#
". C!t"eter is onl& irri#!ted <"en !n
o+stru%tion3 usu!ll& $ollo<in# (rost!te or
+l!dder sur#er& (e.#.3 (otenti!l +lood %lots)
is !nti%i(!ted
+. Su(r!(u+i% C!t"eter
. 0l!%ed to dr!in t"e +l!dder
). A%"ie5ed 5i! ! (er%ut!neous %!t"eter or +& <!& o$
!n in%ision t"rou#" t"e !+do,in!l <!ll
%. Inter,ittent Sel$-%!t"eteri8!tion
. 0ur(ose' to dr!in t"e +l!dder
). E,(lo&ed +& t"e %lient <it" S(in! Bi$id! !nd ot"er
neuro,us%ul!r dise!ses> %!n +e t!u#"t to %"ildren
!#es /-C
1. 0ro%edure'
!. G!t"er e.ui(,ent' %!t"eter3 <!ter-solu+le
lu+ri%!nt3 so!(3 <!ter3 urine %olle%tion
%ont!iner
+. ;!s" "!nds
%. Cle!nse uret"r!l ,e!tus !nd surroundin#
!re!
d. Lu+ri%!te ti( o$ %!t"eter
e. Insert %!t"eter until urine $lo<s
$. ;it"dr!< %!t"eter <"en urine $lo< sto(s
#. Cle!n o$$ residu!l lu+ri%!nt $ro, ,e!tus
". Dis(ose o$ urine
i. ;!s" "!nds
D. Osto,ies
. T&(es o$ osto,ies
!. Ileosto,&
. Li.uid to se,i-$or,ed stool3 de(endent u(on
!,ount o$ +o<el re,o5ed
). M!& s-e< $luid !nd ele%trol&te +!l!n%e3 es(e%i!ll&
(ot!ssiu, !nd sodiu,
1. Di#esti5e en8&,es in stool irrit!te s-in
4. Do NOT #i5e l!*!ti5es
5. Ileosto,& l!5!#e ,!& +e done i$ needed to %le!r
$ood +lo%-!#e
/. M!& not re.uire !((li!n%e> i$ %ontinent ile!l
reser5oir or Bo%- (ou%"
+. Colosto,&
. As%endin# - Must <e!r !((li!n%e - se,i-li.uid
stool
). Tr!ns5erse - ;e!r !((li!n%e - se,i-$or,ed stool
1. Loo( sto,!
!. 0ro*i,!l end - $un%tionin# sto,!
+. Dist!l end - dr!ins ,u%ous
%. 0l!sti% rod used to -ee( loo( out
d. Isu!ll& te,(or!r&
4. Dou+le +!rrel
!. T<o sto,!s
+. Si,il!r to loo( +ut +o<el is sur#i%!ll&
se5ered
5. Si#,oid
!. For,ed stool
+. Bo<el %!n +e re#ul!ted so !((li!n%e not
needed
%. M!& +e irri#!ted
). Sto,! !ssess,ent
!. Color - s"ould +e s!,e %olor !s ,u%ous ,e,+r!nes
+. Ede,! - %o,,on !$ter sur#er&
%. Bleedin# - sli#"t +leedin# %o,,on !$ter sur#er&
IG. Slee(
A. F!%tors !$$e%tin# slee(
. 0"&si%!l illness
). Dru#s
1. Li$est&le
4. E*%essi5e d!&ti,e slee(
5. E,otion!l stress
/. En5iron,ent
H. E*er%ise:$!ti#ue
C. Food int!-e
B. Slee( disorders
. Bru*is,' toot" #rindin# durin# slee(
). Inso,ni!' %"roni% di$$i%ult& <it" slee( (!tterns
!. Initi!l inso,ni!' di$$i%ult& $!llin# !slee(
+. Inter,ittent inso,ni!' di$$i%ult& re,!inin# !slee(
%. Ter,in!l inso,ni!' di$$i%ult& #oin# +!%- to slee(
1. N!r%ole(s&' $!ll !slee( <it"out <!rnin#
4. Slee( !(ne!' inter,ittent (eriods o$ not +re!t"in# <"ile !slee(>
usu!ll& due to (ro+le,s <it" u((er !ir<!&> %!n +e tre!ted <it"
C0A0 (%ontinuous (ositi5e !ir<!& (ressure) !t +edti,e
5. Slee( de(ri5!tion' de%re!se in t"e !,ount !nd .u!lit& o$ slee(
/. So,n!,+ulis,' slee(<!l-in#3 ni#"t terrors3 or ni#"t,!res
H. De(ression
!. Se%ond!r& to dise!se (ro%ess
+. C!n o%%ur <it" !n& slee( disorder
C. Gener!l nursin# inter5entions $or (ro,otin# restor!ti5e slee(
. Co,$ort ,e!sures
). Medi%!tions' sed!ti5es3 "&(noti%s
1. Slee( routine
4. En%our!#e d!&ti,e !%ti5it&
5. Eli,in!te n!(s
/. Rel!*!tion te%"ni.ues
H. En5iron,ent!l %ontrol
C. Li,it !l%o"ol3 %!$$eine3 !nd ni%otine in e5enin#
G. 0!in
A. T"eories o$ 0!in
. S(e%i$i%it& t"eor& (ro(oses t"!t (!in %!n +e initi!ted onl& +&
(!in$ul sti,uli.
). 0!ttern t"eor& - sti,ulus #oes to re%e(tors in t"e s(in!l %ord3 <"i%"
si#n!ls t"e +r!in to (er%ei5e (!in !nd ,us%les to res(ond.
1. G!te %ontrol t"eor& - (!in i,(ulses %!n +e !ltered or re#ul!ted +&
#!tin# ,e%"!nis,s !lon# ner5e (!t"<!&s. T"is t"eor& e*(l!ins
"o< (!st !nd (resent e*(erien%es %!n in$luen%e t"e (er%e(tion o$
(!in.
B. G!ri!+les in$luen%in# t"e (er%e(tion o$ (!in
. Culture !nd so%i!l #rou(s s"!(e !ttitude to<!rds (!in
). Reli#ious +elie$s re#!rdin# re!sons $or (!in
1. 0re5ious e*(erien%e <it" (!in
4. A#e
5. Se*
/. Co(in# st&le
H. F!,il& su((ort
C. T&(es o$ (!in
. A%ute - (!in e(isode l!stin# u( to / ,ont"s
). C"roni% - (!in l!stin# lon#er t"!n / ,ont"s. M!& +e inter,ittent or
%onst!nt.
D. Medi%!l tre!t,ent
. 0"!r,!%olo#i% inter5ention - Dis%ussed in Su+%!te#or& C-
0"!r,!%olo#&
). Non("!r,!%olo#i% inter5ention
!. A%u(un%ture
. Orient!l ,et"od' insert $ine needles !t s(e%i$ied
+od& sites
). In-no<n "o< !%u(un%ture <or-s ("&siolo#i%!ll&
+. Rel!*!tion te%"ni.ues - +io$eed+!%-3 5isu!li8!tion3
,edit!tion !nd "&(nosis3 to "el( %lient %ontrol !n*iet&
%. Ele%troni% sti,ul!tion su%" !s Tr!ns%ut!neous Ele%tri%
Ner5e Sti,ul!tion (TENS) - ele%trodes !((lied o5er t"e
(!in$ul !re! or !lon# ner5e (!t"<!&
d. Distr!%tion - $o%usin# %lientFs !ttention on so,et"in# ot"er
t"!n (!in
e. M!ss!#e - #ener!li8ed %ut!neous sti,ul!tion o$ t"e +od&.
M!-es t"e %lient ,ore %o,$ort!+le due to ,us%le
rel!*!tion
$. I%e !nd "e!t t"er!(ies - e$$e%ti5e in so,e %ir%u,st!n%es.
I%e ,!& de%re!se (rost!#l!ndins <"i%" intensi$& t"e
sensiti5it& o$ (!in re%e(tors
#. Guided i,!#er& - usin# oneFs i,!#in!tion in ! #uided
,!nner to !%"ie5e ! s(e%i$i% (ositi5e e$$e%t
1. Nursin# inter5entions in 0!in
!. Assess (!in usin# (!in !ssess,ent s%!le
+. Assess %lientFs %o(in# str!te#ies !nd $!%tors t"!t (rodu%e
ine$$e%ti5e %o(in#
%. Te!%" %lient !((ro(ri!te str!te#ies to de!l <it" (!in
GI. Co,,uni%!tion
A. Cross-%ultur!l %o,,uni%!tion - Guidelines
. Si#ns o$ ! l!%- o$ e$$e%ti5e %o,,uni%!tion
!. E$$orts to %"!n#e t"e su+Ae%t - %lient ,!& not underst!nd
<"!t t"e nurse is s!&in#
+. L!%- o$ .uestions - %lient ,!& not underst!nd <"!t <!s
s!id
%. Non5er+!l %ues su%" !s +l!n- e*(ression3 l!%- o$ e&e
%ont!%t
). Nursin# inter5entions
!. Ise si,(le senten%e stru%ture !nd (!nto,i,e <"ile t!l-in#
+. Ise 5isu!l !ids
%. Dis%uss one to(i% !t ! ti,e
d. Ise !n& <ords &ou -no< in t"e %lientFs l!n#u!#e
e. As- !,on# t"e %lientFs $!,il& !nd $riends i$ !n&one %ould
ser5e !s inter(reter
$. O+t!in ("r!se +oo-s or use $l!s" %!rds
B. Client <it" 6e!rin# Loss
. Si#ns o$ "e!rin# loss
!. S(ee%" deterior!tion
+. Indi$$eren%e
%. So%i!l <it"dr!<!l
d. Sus(i%ion
e. Tenden%& to do,in!te %on5ers!tion
). Nursin# inter5entions
!. S(e!- slo<l& !nd distin%tl&> do not s"out
+. F!%e %lient dire%tl&
%. M!-e sure &our $!%e is %le!rl& 5isi+le
d. Be$ore t"e dis%ussion3 tell %lient t"e to(i% &ou !re #oin# to
dis%uss
e. Insure t"!t %lient "!s !%%ess to "e!rin# !id !nd t"!t it is
$un%tion!l
$. Bee( senten%es s"ort !nd si,(le
#. Ise <ritten in$or,!tion to en"!n%e s(o-en <ord
C. Client <it" !("!si!
. InAured %ere+r!l %orte* +lo%-s so,e l!n#u!#e-rel!ted $un%tions
). Nursin# inter5entions
!. F!%e %lient !nd est!+lis" e&e %ont!%t
+. A5oid %o,(letin# %lientFs st!te,ents
%. Ise #estures3 (i%tures3 !nd %o,,uni%!tion +o!rds
d. Li,it %on5ers!tion to (r!%ti%!l ,!tters
e. Ise t"e s!,e <ords !nd #estures $or o+Ae%ts
$. Bee( +!%-#round noise to ! ,ini,u,
#. Do not s"out or s(e!- loudl&
". Gi5e t"e %lient ti,e to underst!nd !nd res(ond
i. I$ %lient "!s (ro+le,s s(e!-in# !s- J&esJ or JnoJ .uestions
D. Client <it" stro-e
. A((ro!%" %lient $ro, side o$ int!%t $ield o$ 5ision
). Re,ind %lient to turn "e!d in dire%tion o$ 5isu!l loss to
%o,(ens!te $or loss o$ 5isu!l $ield
1. E*(l!in lo%!tion o$ o+Ae%t <"en (l!%in# it ne!r t"e %lient
4. Al<!&s (ut %lient %!re ite,s in s!,e (l!%es
5. 0ut o+Ae%ts <it"in %lientFs re!%"3 !nd on un!$$e%ted side
/. En%our!#e %lient to re(e!t sounds o$ t"e !l("!+et
H. S(e!- slo<l& !nd %le!rl&
C. Ise si,(le senten%es <it" #estures or (i%tures
?. Reorient %lient to ti,e3 (l!%e3 !nd situ!tion
2. 0ro5ide $!,ili!r o+Ae%ts
. Mini,i8e distr!%tions
). Re(e!t !nd rein$or%e instru%tions
E. Client <it" de,enti!
. Be %!l, !nd un"urried
). Bee( %on5ers!tions s"ort !nd $o%used
1. Do not !s- t"e %lient to ,!-e de%isions
4. Be %onsistent
5. A5oid distr!%tions
/. Ise re!lit& orient!tion te%"ni.ues
All indi5idu!ls re.uire t"e s!,e nutrients3 +ut t"e !,ounts 5!r& !%%ordin# to
$!%tors su%" !s !#e3 <ei#"t3 !%ti5it& le5el3 !nd "e!lt" st!te.
T"e ener#& 5!lue o$ $oods is de$ined in %!lories> onl& (roteins3 $!ts !nd
%!r+o"&dr!tes (ro5ide %!lories.
T"e !5er!#e !dult drin-s ) to 1 liters o$ <!ter (er d!&.
T"e nor,!l t"irst ,e%"!nis, in t"e elderl& ,!& +e di,inis"ed !nd t"e& ,!& need
en%our!#e,ent to drin- su$$i%ient <!ter to (re5ent de"&dr!tion.
Dis%ontinue ROM e*er%ises !t (oint o$ (!in.
Ise ru++er su%tion ti(s on %rut%"es !nd %!nes to (re5ent sli((in#.
0re5ent de$or,ities !nd %o,(li%!tions su%" !s %ontr!%tures3 t"ro,+o("le+itis3 !nd
(ressure ul%ers +& turnin# !nd (ositionin# t"e %lient in #ood !li#n,ent.
T"ere s"ould +e !t le!st t<o in%"es +et<een !*ill! !nd to( o$ !r, (ie%e o$ %rut%"
to (re5ent (ressure on t"e +r!%"i!l (le*us.
T"e ,!Aorit& o$ residents in nursin# "o,es !re in%ontinent.
In%ontinen%e is not ! nor,!l se.uel! o$ !#in#.
Initi!te (!in relie$ +e$ore t"e (!in +e%o,es un+e!r!+le.
Essenti!l !,ino !%ids %!nnot +e s&nt"esi8ed. T"e& ,ust +e in#ested d!il&.
;ei#"t is ,!int!ined <"en d!il& $ood int!-e e.u!ls ener#& e*(enditure.
A#e !$$e%ts d!il& re.uire,ents' &oun#3 old3 (re#n!n%&3 l!%t!tion.
;ei#"t loss is ! lon#-ter, (ro%ess !nd (!tients need lon#-ter, su((ort.
Re%onstru%ti5e sur#er& ,!& +e re.uired !$ter l!r#e !,ount o$ <ei#"t loss.
Su((ort #rou(s !re !5!il!+le $or (!tients losin# <ei#"t.
In%re!sed $i+er in t"e diet ,!& %!use $l!tulen%e.
In %onsti(!tion3 in%re!se $luid to 1222 %%:d!& (unless %ontr!indi%!ted).
S,!ll $re.uent loose stools or see(!#e o$ stool !re o$ten indi%!ti5e o$ ! $e%!l
i,(!%tion.
Ise tr!ns(!rent dr!in!#e +!# initi!ll& $or !ssess,ent o$ sto,! !nd dr!in!#e.
A5oid $oods t"!t %!use odor3 #!s3 di!rr"e!3 or ,!& +lo%- ileosto,&.
Allo< t"e %lient to r!te "is de#ree o$ (!in !nd t"e de#ree o$ relie$ $ro, (!in relie$
,e!sures.
Sel$-%ontrol ,et"ods to ,!n!#e (!in' distr!%tion3 ,!ss!#e3 #uided i,!#er&3
rel!*!tion3 +io$eed+!%-3 "&(nosis.
C"!n#e osto,& !((li!n%e !s needed.
A%"!l!si!
An!+olis,
Antio*id!nt
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