Skeleton System

 Part 2

Functions of the bones

* Support and shape

Bone provide a framework of the body.

It gives support and shape of the body.

It also gives attachment to muscles and tendons.

* Protection

The bones protect  inner soft and delicated organs , forming the boundaries of the cranial, thoracic, abdominal and pelvic cavities protecting the organs they contains by external shocks.

* Movement

It provide moment of the whole body and parts of the body by forming joints.

Bones of the body provide attachment to the muscles , these muscles provide motor power for providing movement of the body parts.

* Mineral storage

Bones serve as a reservoir for calcium and phosphate , essential minerals for various cellular activities.

* Blood cell production

The production of blood cell or hematopoiesis, occur in the  red marrow found within the cavity of the certain bone.

* Energy storage

Lipids such as fats , stored in adipose cell of the yellow bone marrow serve as energy reservoir.

General structure of long bone:--

Long bone

These have a diaphysis (shaft)and two epiphysis (extreme).

The diaphysis is composed of compact bone with the central medullary canal , containing fatty yellow bone marrow.

The epiphysis consists of an outer covering of compact bone with spongy (cancellous)bone inside containing red bone marrow.

Red bone marrow are responsible for production of blood cell or  hemopoiesis (RBC ,WBC, platelets).

The metaphysis is the part of bone between the epiphysis and the diaphysis.

It contain the connecting cartilage called epiphysial plates. It is the most actively growing area of long bone.

When  bone  oxicified the epiphysial plate (metaphysis) disappear at adulthood (18 - 20 years of age) as it convert into epiphysial line.

Long bone are covered by vascular membrane called periostium which has two layers.

The outer layer of fibrous rich in blood vessels and the inner layer contains osteoblast , which are involved in bones growth in thickness.

Maintenance and remodeling of bones and it is give attachments  to muscles and tendons and it protect bone from injury.

The periosteum covers the whole bone except for site of articulation ends.

Microscopic structure of bone

Bone are made up of cells and intracellular matrix.

The cellular component is 2% of bone mass

Matrix is made up of 40% of organic substance containing mainly of collagen fibres.

Collagen very strong and gives bone slightly flexibility.

60% of inorganic substance made up of  inorganic salts of calcium and phosphorus . This inorganic matrix gives bone great hardness.

Bones composition

Cellular Components

It consists of following cells........

1. Osteoblast

Osteoblast  is responsible for making new bone and repairing older bone.

It produce protein mixture "osteoid"  which is mineralized and becomes bone.

Osteoid is a type of protein mixture which is formed by collagens.

They are present in the dipper layers of periostium.

In the centres of ossification of immature bone.

At the site of fracture.

2. Osteocyte Cell

As bone develop osteoblast become  trapped within the newly formed bone.

They stop forming new bone and this stage are called osteocytes.

These are the mature bone cells that monitor and maintain bone tissues and are nourished by tissue fluid in the canaliculi,  it present in bone matrix.

3. Osteoclast

Osteoclast are multinucleated cell.

Osteoclast help in the reabsorption during remodelling of bones to maintain the optimum shape.

It is type of gold sale that breaks down bone tissue and releasing calcium and phosphate this process also help to regulate the level of blood calcium.

It present under periosteum and sight of old injured or unneeded bones.

                Matrix

Matrix is the extracellular component of bone which is made up of organic and inorganic components.

Organic component

This is  mostly made up of collagen fibres which are arranged in bundles . They have lamellar arrangement , which is in the form of a regular, parallel , lamilae.

Inorganic Components

The mineral components of bones gives it hardness and rigidity . It consists of calcium and phosphate they are closely packed and arranged along the collagen fibre.

Microscopic structure of compact bone

It is made up of many cube like structures called osteons . ( Habersion system)  

In between osteon a central canal is present .

The central canals contains blood vessels , nerve and lymphatic vessels are present.

 Central canal are connected neighbouring canal by perforated canals. 

If cut a series of osteon are seen  parallel series called lamellae.

 In lamellae present in small small pocket or cavities called  lacuna (containing osteocyte Cell).

Osteocyte cell maintain bone tissue.

Each lacuna are connected by canaliculus (canaliculi).

 Canaliculus are contain in interstitial fluid flow in canaliculus. This fluid provide nourishment to osteocyte cells.

Microscopic structure of spongy bone (cancellous bone)

Cancellous bone and less dense and present with large cavities in between plats of bones giving them a honeycomb appearance bone.

Cancellous bone is made up of  mashwork of bony plates or rods called "trabeculae" .

It does not contains osteons.

Each trabeculae is  made up of number of lamellae between which there are containing osteocytes.

Lacunae are interconnected by canaliculi.

The Trabeculae enclose wide spaces that are filled in by Red Bone Marrow.

They receive nutrition from blood vessels in bone marrow.

The trabecular are covered externally by vascular endosteum.

Endosteum is the lining membrane of the bone marrow cavity.

 

Some terminology

 Some Terminology Related to B.P.P.N

1. Dyspepsia

Indigestion , feeling of fullness, discomfort, nausea and anorexia.

2. Dysphagia

Difficulty in swallowing / painful in swallowing.

3. Nausea

Sensation to vomit.

4. Nutrients

Constituents of food. e.g,  carbohydrates, protein, fat, minerals vitamins and water.

5. Regurgitation

It refers to back flow.

e.g, backflow of parcely digested food into the mouth from the stomach.

6. Vomiting

Expulsion of stomach contain through oesophagus and mouth.

7. Anorexia

Lack of appetite.

8. Anosmia

Loss of sense of smell.

9. Appetite

Psychological stimulus to eat that may be connected with and triggered by emotion stimuli.

10. Asphyxia

Lack of oxygen in the tissue.

11. Body Mass Index

A figure derived from a person height and weight that indicate whether that weight is acceptable.

12. Bulimia Nervosa

It is an eating disorder in which excessively eating is followed by depression and guilt , self induced vomiting and burging .

 

13. Malabsorption

Inadequate or disorder absorption of nutrients from the intestinal canal.

14. Halitosis

Bad breath smell

15. Turgor 

Resistance of skin to  deformation when pinch.

16. Anorexia Nervosa

Psychiatric disorder characterized by intense fear of becoming overweight even when emaciated.

17. Bradycardia

Heart rate less than 60 beats per minute in  adult.

18. Tachycardia

Heart rate more than 100 beats per minute in adult.

19. Eupnea 

It refers to easy respiration with normal breath rate per minute that is age specific.

20.  Bradypnea

Respiratory rate become 10 or fewer breath per minute.

21. Tachypnea

Respiratory rate greater than 24 breath per minute.

22. Hypoventilation

Refers to shallow respiration.

23. Hyperventilation

Refers to deep and rapid respiration.

24.  Cheyne stock respiration

 Respiratory rhythm is irregular , characterized by alternating period of Apnea and hyperventilation.

25. Kussmaul respiration

Respiration are abnormal deep but regular, similar to hyperventilation.

26. Orthopnea

Respiratory condition in which a person must sit or stand in order to breathe deeply or comfortably.

27. Platypnea

Opposite of orthopnea.

Difficult respiration on upright position , a person can laying down and breath comfortably.

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Psychology unit 3

Part 11

Causes of forgetting

1. Inadequate impression at the time of learning.

E.g. improper learning forced learning, etc..

2. Lapse of time

3. Rise of emotion

4. Poor health and defective mental state

5. Inadequate practice of learning

6. Interference of association

Theories of learning

- Trace decay theory

- Interference theory

- Repression theory

Trace decay theory

* According to many psychologists , time is the cause of much forgetting , what is learnt or experienced is forgotten with the lapse of time. This process is explained through a process known as decay of the  memory trace.

* It say that , learning results in neurological changes leaving traces will get  weaker and finally fade away .

* With the passage of the time through disuse, these memory trace will get weaker and finally fade away.

* The conclusion of this is that the older an experience the weaker its memory and as time passes , the amount of the forgetting increase.

Interference theory

* Forgetting is a result of some memories interfering with others.

* Proactive interference.

* Old memories interfere with ability to remember new memories.

* Retroactive interference.

* New memories interfere with ability to remember old memories.

Repression theory

* This theory was put forward by Freud's  psychoanalytical school of psychology

* According to this theory school is a mental function that safeguards the mind from the impact of painful experience.

* As a result of this function , we actually push the unpleasant and painful memories into the unconscious  memory and this leads to forgetting things.

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S.No.	Name
001	Pooja
002	Neha

Nursing diagnosis

 NURSING DIAGNOSIS

 Part 1

 Endocrine System

The endocrine system maintain the stability of internal environment. The endocrine system consists of glands . Glands are the group of epithelial cells. They produce specialised secretion.  Gland are two types:----

1. Exocrine glands

They discharge their secretion  on to the epithelial surface of an organ ,  either directly or through a duct and are called if the exocrine gland.

They vary in shape,size and complexity.

Endocrine gland

Endocrine gland are type of gland which secret hormone into the blood and lymph . Endocrine gland is a ductless  gland.

Hormones

It is a chemical substance , i.e. secreted into the body fluids by one cell or a group of cell. It regulate the body's activity. It is also called as chemical Messengers.

Pituitary Gland and Hypothalamus

* The pituitary gland and Hypothalamus work together.

* The pituitary gland also called hypophysis.

* Their secretion control the function of other gland.

* It is also called master endocrine gland.

* It about 1.2 to 1.5 cm in length it's weight is about 0.5gram.

* The gland has  a stem like stalk called the infundibulum, which connects it to the hypothalamus of the brain. 

* It secretes a different hormones.

* The pituitary look like one gland, but is consist of 2 glands. That are as follows .....

A) Anterior pituitary gland     7 hormones

B) Posterior pituitary gland     2 hormones

Anterior pituitary gland is also known as adenohypophysis.

Growth Hormones (gh)

It is also known as Somatotrophin hormones.

It is synthesis by anterior pituitary gland.

It helps in the growth of muscles and other tissues.

The hypothalamus secretes the growth hormone releasing inhibition hormone(GHRIH ).

2. Thyroid stimulating hormone (TSH)

This hormone synthesized by the anterior pituitary gland.

It is also called thyrotropin

It helped in the growth and development of target glands.

Thyroid stimulating hormone secrete 2 harmons..

Triiodothyronine ( T3 ) and thyroxin (T4) 

Psychology unit 3

 Part 10 

Theories of Memory…

Theories of memory provide abstract representations of how memory is believed to work.

1. Theories of general memory functions

2. Information processing theory

3. Levels of processing theory

1. Theories of general memory functions

Theory of general memory function focuses on three distinct processes of memory these are……

1. Encoding

2. Storage

3.  Retrieval

1. Encoding is the process of receiving sensory input and transforming it into code which can be stored.

2. Studied is the process of putting coded information into memory.

3. The travel is the process of gaining access to stored coded information when it is needed.

2. Information processing theory

This theory was developed by Richard Atkinson and Richard Shiffrin ( 1968 )

according to this theory memory start with memory input from the environment.

This input is held for a very brief time.

Information that is attend into and recognise may be passed on to the short-term memory where it is held for 20 to 30 seconds.

When the short term memory is rehearsed then it pass along Long term memory.

The information which is placed in long term memory , will be organised in categories,  where may  resides for days, months, years or for a lifetime. When we remember something , a representation of the item is retrieved from long term memory.

3. Levels of processing theory

According to this theory , incoming information can be worked on at different levels of analysis, the deeper analysis goes the better the memory.

Perception :- it gives us an immediate awareness of the environment.

Structure :- features of input (what it looks like, or sounds like) are analysed.

Meaning :- meaning of the input is analysed.

* Analysis to the  deep level of meaning gives the best memory.

* Routine happenings of daily life are not process deeply.

Method of memorizing……

Success in the process of learning depends on the methods of learning adopted by the learner. They are ………

1) whole and part method

2)  Spaced and unspaced method

3) Repetition and practice

4) Grouping and rhythm

5) Making use of the principle of association

6) Recitation

7) Utilizing as many senses as possible

8) Pulling at all together

9) Funnel approaching

10) Acronym

11) Acrostic

12) Mnemonics 

      Forgetting

Definition

Forgetting is the lost permanent or temporary of the ability to recall or recognise something learnt earlier.

                       Mann - 1967

Forgetting means failure at any time to recall an experience , when attempting to do so or to perform an action  previously learned.

                               Drever - 1952

Types of forgetting…

1)  Natural forgetting

2) Morbid forgetting (abnormal) 

1) Natural forgetting

It occurs with the lapse of time in a quite normal way without any intention of forgetting on the part of the individual.

2) Morbid forgetting (abnormal) 

Person deliberately tries to forget something is called morbid forgetting (repression).

Psychology unit 3

 Part 9

             Memory

It is regarded as the special ability of our mind to conserve or store what has been previously learned or experienced to recollect or reproduce it after sometime. Memory is  a complex process , which involves learning , retention , recall and recognition.

Definition

Memory consists in remembering what has previously been learned.

                           Woodworth and marquis

                                          1948

The power that we have to store on experiences, and to bring them into the field of consciousness something after experiences have occurred, is termed  memory.

                                      Rayburn 1956

Types of memory………

1. Immediate memory or  sensory

2. Short - term memory

3. Long - term memory

Immediate or sensory memory

It is that memory , which helps an individual to recall something in a split second after having perceived it. Immediate memory is needed , when we want to remember things for a short time then forget it , which help us to learn a thing immediately with speed and accuracy.

Short term memory

It holds a relatively small amount of information, about seven items , for a short period time 20 to 30 second time though not nearly as short-lived as immediately memory.

Long term memory

It has the unlimited capacity to store information , about  store information for days , months , years and even a lifetime.

Nature of memory

Following are the fundamental characteristics of memory process……

1. Memory involves input - registering the information.

2. Storage - it is either temporary or permanent.

3. Output - it involves retrieval.

Other factors involved in memory process are…

* Learning or registration

* Retention

* Recall 

* Recognition

Psychology unit 3

 Part 8

Theories of learning

2. Theory of Operant Conditioning

The theory of learning by operant conditioning was given by BF Skinner. He said that the man is an active organism , and not a victim of his environment. He does not wait for the stimulus ; instead he acts or operates on the environment, so as to change it in some way. Thus , he called it as operant behaviour. 

According to Skinner, operant behaviour is determined by the events or consequences  that follow the response. If the consequences favourable , the individual repeat the same, it this case, the consequences are said to have provided to positive reinforcement and cause repetition of the behaviour. If the  consequences favourable, the individual repeat the same, in this case, the consequences are said to have provided to positive reinforcement and cause repetition of behaviour . If the consequences are unfavourable, they reduced the chance of the same behaviour from getting repeated . In such cases , the  consequences are said to have provided negative reinforcement and reduce the chances of the behaviour  from recurring again.

Operant conditioning is also called a type - R conditioning, to emphasize the effect of the response on future behaviour . In this way, Skinner said that learning is shaped and maintained by its consequences.

Educational implication of operant conditioning theory

1. The key concept of Skinner theory is reinforcement ( the process by which a stimulus increases that probability that preceding behaviour will be repeated ). In order to enable an individual to learn , the correct responses must be suitably rewarded or positively reinforced.

2. The principle of operant conditioning may be successfully applied in behaviour modification. We have to find something , which is rewarding for the individual whose behaviour we wish to modify , wait until the desired behaviour occurs immediately reward him when it does.

3. This theory emphasizes the importance of schedules, in trying to teach a particular behaviour , great care should be taken for the proper planning of the schedules of  training.

4. This theory advocate the avoidance of punishment of unlearning of undesirable behaviour and for shaping the desirable behaviour.

5. This theory also state that......

The learning material is so design that it produces fever chances for failure and more opportunity for success.

6. The learner is given the feedback concerning the accuracy of his learning.

7. The learner is able to learn at his own space.

4. Theory of insightful learning (gestalts psychology)

Gestalt psychology was founded in Germany in 1912 by Max Wertheimer and his colleagues.

 The basic idea behind the registered idea that anything cannot understand by a study of its parts , but only by viewing in its totality.

The learner while learning always perceives the situation as a whole. After studying and evaluating the different relationship in the situation , he takes the proper decision in an intelligent way.

Gestalt psychologist used the term insight to describe the perception of the whole situation by the learner and his intelligence in responding to the proper relationships.

According to this theory insight is depending upon the following factors.....

* Past experiences

* Basic intelligence of learner.

* Repetition

* Trial and error process in the initial stage does not last long.

Educational implications of the theory of insightful learning

This theory states that trial and error learning must be minimised.

Subject must be presented in Gestalt form, also in organisation of the syllabus and planning of the curriculum, the Gestalt principle should be applied.

This theory has bought motivation to the forefront. The child should be motivated by arousing interest and curiosity, in order to make learning goal-oriented and effective.

The learner should give plenty of opportunity to use mental abilities.

5. Cognitive theory of learning (observational learning) or learning through imitation (social learning theory)

According to psychologist Albert Bandurs ,  a major part of human learning consists of observational learning ; learning through observing the behaviour of another person called a model.

According to bandura observational learning takes place in four step........

1. Paying attention to perceiving the features of the another person behaviour.

2. Remembering the behaviour.

3. Reproducing the behaviour.

4. Being motivated and carried out the behaviour.

Summary of various theory of learning

Nutrition

Part 3

Importance of Nutrition and Dietetics in Nursing

The word nursing  from the same root word 'nutritious' means to nourish , to cherish, to protect , to supply . It also means to train , to educate and to supply with the essentials growth. We can define nursing as comprehensive as possible that nursing is process of recognising , understanding , interpreting  and meeting the health needs of any person or society.

Nurses constitute an important component of health care system and they are supposed to provide comprehensive services to community. When we say nursing each meeting the health needs of the people , we must know the health and factors affecting it . Today's nutrition is considered as one of the important factor affecting the human health and malnutrition is one of the leading causes of mortality and morbidity in India. Diet is as important as medicine in the treatment of diseases .

We can say that the diet therapy is very important part of treatment.  Nurses should give more attention to the nutrition of patients, otherwise the prognosis of disease will be poor. In   metabolic disorders, diet plays an important role and to some extent we can control such type of diseases with therapeutic diets without medicines. So it has become very important for nurses and other health personnel to study the subject of nutrition during their education so that they can apply the principles  of nutrition and use their technical skills while working in hospital and community.

Objective of Learning Nutrients in Nursing

After completion of the study of Nutrition student nurses will be able to___

- Apply the principles of nutrition and dietetics in health and sickness.

- Make the nutrition as an integral part of their daily nursing practices.

- Recognise the values of nutrition in maintaining personal and patients health.

- Educate the patient and his family about normal and therapeutic diets.

- Plan and prepare the normal and therapeutic diets for different types of patients.

Function of nutrients in nursing

1. Promotion of health

2. Specific protection

3. Prevention of nutritional deficiency diseases

4. Early detection and treatment of deficiency diseases

5. Modification of diets

6. Preparation of therapeutic diets

7. Health education and counseling

1. Promotion of Health

Health promotion is the process of enabling the people to increase control over and improve health. Nutrition is an important factor affecting our health. So nursing efforts should be directed towards pregnant and lactating mothers. These efforts will include nutrition, education, distribution of supplements ,extra protein, calcium , iron and folic acid these can contribute to promotion of health by the following ways :----

* Promotion of breastfeeding

* Development of low cost weaning

* Measures to improve family diet

* Encouragement for kitchen gardens and Home economies

* Guide about cheap and best sources of nutrition , method of cooking and preservation and feeding practices of the people.

2. Specific Protection

While guiding the parents , nurses should make sure that child's diet must contain bodybuilding and protective foods in required amount milk, cheese, eggs and flesh fruits if possible.

    Nurses can guide them about the methods of food fortification to supplement the nutrients. Proper immunization along with vitamin A a prophylaxis can prevent vitamin A deficiency diseases and provide immunity.

3.  Prevention of Nutritional Deficiency Diseases

Number of nutritional diseases can be prevented in the community by nursing efforts. Premature deliveries , low birth weight , abortion and congenital malformations and stillbirths can be prevented by improving the diet of pregnant women. There number of National Nutritional Programs but people are not aware of these programs . Nurses and other community workers can provide proper awareness about these supplemental programs. This can help to reduce the prevalence of protein energy  malnutrition,  anemia , thyroid , disorders , rickets, osteomalacia and xerophthalmia, etc.

4. Early Diagnosis and Treatment

Because the nurses are direct care provider in the hospitals , health centres and in the families, they can detect the malnourished people   in the families as well as in the baby clinics, antenatal and postnatal clinics.  School health nurses have good opportunity to detect  undernourished children.  There are a number of anthropometric  measurements such as weight, height ,arm circumference, head circumference etc. Which   can be used to assess nutritional status of the children "Road to health" cards can be used for the purpose . Other methods are periodical surveillance, early diagnosis and treatment of infectious diseases , oral rehydration of children suffering from diarrhea, deworming  the infested people , developed of   supplementary feeding programs during endemic.  After diagnosis , nurse can play a vital role in the treatment of such cases . These can guide them to prepare therapeutic diets and the different ways of diet modification as required by the sufferings.

5. Modification of Diets

The normal hospital diet which provides a patient with the energy and nutrients is intended for the patient   whose condition does not required a therapeutic diet . This regular diet may be modified with regard to selection, methods of preparation and consistency for patient who cannot tolerate a regular diet but do not require a therapeutic diet .  These modification are liquid diet , soft diet and semi solid diet. Nurses should know different types of modification of diet in the hospital because they are responsible to prepare and administer the nutritional need according to  types of disease, age ,income,  region, customs and food habits of individual  patients.

6. Preparation of Therapeutic Diets for Patients

For everyone, eating food is an enjoyment. When the person is sick the food intake becomes a problem.  The nurses responsibilities in regard to nutrition can be analysed into these areas.

Assisting the patient with his special problems in preparing and acceptance therapeutic diets salt free diet and bland diet

a) Assisting the patients with special problems in preparing and accepting therapeutic diet , i.e. salt free diet and bland diet . 

b)  Assisting the patients; to obtain nurishment either through  feeding ( tube feeding) or assisting helpless patient in eating.

c) For motivating the patient to eat in therapeutic environment, nurses must know the principle of meal therapy, different types of therapeutic diets for the patients with different disease because diet therapy is a part of treatment in these days.

7. Health Education and Counselling

Health education serve as an important tool for prevention of malnutrition . The aim of education is to get people to choose optimum and balance diets, to remove prejudices  and promote good dietary habits . Some common nutritional problem can be minimized by nutrition education and counseling in case of delayed  weaning, ignorance about breastfeeding  and our traditional misconcept about certain foods. In the recent years , the link between dietary habits and certain chronic diseases  has been recognised i.e. obesity, diabetes and cardiovascular diseases . So nutritional education is a measured intervention in the hand of nurses for prevention of such diseases.

Nutrition

Part 3

Health

Health is defined by the World Health Organisation of United Nations as a "state of complete physical , mental and social well-being and not merely an absence of disease or infirmity.

Food

Food may be defined as anything eaten for drunk which meets for energy , building , regulation and protection of the body . In short food is raw material from which our body is made.

Dietetics

"Dietetics is the practical application of the principles of Nutrition . It includes the planning of meals for will and the sick."

Good nutrition means " maintaining a nutritional status that enable us to grow well and enjoy good health".

Nutrients

Nutrients are organic and inorganic complexes contained in the food we eat daily. These include water proteins carbohydrates vitamins and minerals etc. There are 50 different nutrients which are normally supplied through the food. These are of two types__

 

* Macronutrients

* Micronutrients

Macronutrients

Protein fat and carbohydrates are macronutrients. These are called proximate principles because they form the bulk of our food. In Indian diets , they contribute to the total energy in the following proportions Protein : 10 to 15 % , Fats : 10 to 30% , CHO : 60 to 80%

Micronutrients

Vitamins and minerals are micronutrients because they are required in small amount. Micronutrients do not supply energy but they play an important role in regulation of metabolic activities and helps in utilisation of macronutrients.

Nutritional status

Nutritional status is the condition of health of the individual as influenced by the utilisation of the nutrients or it is a state of our body as a result of food we consume . Nutritional status can be good , fair or poor.

Energy

Energy is defined as the capacity to do work. Energy is a prime requisite for body function and growth . The energy  produced in the body may be measured and expressed in units of work (joule) and unit of heat (kilocalories).

Kilocalories

A Kcal is the amount of heat required to raise the temperature of of 1 litre of water by 1 degree Celsius (1°C).

1 Kcal =4184 joules = 4.184 kJ

The nutritional value of protein CHO , Protein and Fats eaten in the diet may be expressed in kilojoules per gram or kcal per gram.

1 gm of carbohydrates provides 4 Kcal (17kilojoules)

1 gm of Protein provides 4 Kcal (17kilojoules)

1 gm of Fats provides 9 Kcal (37kilojoules)

Metabolism

Metabolism is the sum total of building up reactions (anabolism) and breakdown reactions (catabolism) going on inside the body of a living organism.

Metabolic Rate

Metabolic rate is the rate at which energy is released from the fuel molecules inside the cells. This  rate can be estimated by measuring oxygen uptake or carbon dioxide excretion.

BMR ( Basal metabolic rate)

Basal metabolic rate is the amount of of energy expressed in calories that a person needs to keep the body functioning at rest.

Men = 66 + (13.8 *  weight in kg ) + (5 * Height in cm ) -. 6.8 * Age

Women = 655 + ( 9.6 * weight in kg ) + ( 1.8 * Height) - ( 4.7 * Age )

Psychology unit 3

 Part 7

Theories of learning

1. Trial and error theory of learning

This theory was propagated by Edward Lee Thorndike, according to this theory; learning is nothing but the stamping in the correct responses and stamping out of the incorrect responses through trial and error.

Thorndike said that the following components or elements are involved in the process of learning.....

 Drive 

Goal

Barrier

Random attempts to overcome the barriers.

Selection of the correct responses.

Fixation of the correct responses.

Based on this theory, thorndike put forward the following laws of learning.....

1. The law of readiness

2. The law of exercise or practice

3. The law of multiple responses

4. The law of attitude

5. The law of associative shifting

Educational implication of thorndike theory.......

1. According to this theory , when a child is ready to learn , he learns more quickly and effectively. He warns the child should not be forced to learn when he is not ready and also not to miss any opportunity of providing the right learning experiences , when the child is ready to learn.

2. The task of the teacher is to motivate the students by arousing their attention , interest and curiosity so that they want to learn.

3. The teacher must try to strengthen the connection between the stimuli and responses , through repetition and practice.

4. The child must be provided with learning experience, which gives him a sense of satisfaction. The child must be suitable recorded as relevant to make learning effective.

5. The learner should try to see the similarities and dissimilarities between different kinds of responses to stimuli and by comparison, and try to apply I the learning from one situation to the the problem before arriving the correct one.

6. The learners should be encouraged to perform his task independently , he must try various solution to the the problem before arriving the correct one.

2. Theory of classical conditioning

Theory of classical conditioning was proposed by Ivan Pavlov , a Russian physiologist . Pavlov while studying the physiology of digestion , found that behaviour can be classical conditioned.

Classical conditioning

A type of learning, in which a neutral stimulus comes to bring about a response after it is paired with a stimulus that naturally bring about that response.

Neutral stimulus

Stimulus that before conditioning does not naturally bring about the response of interest.

Unconditioned stimulus

Response that is natural and needs no training.

Conditioned stimulus

A neutral stimulus that has been paired with  an unconditional stimulus ( UCS ) to bring about a response only by unconditional stimulus.

Conditioned response

A response that , after conditioning , a previously , neutral stimulus.

Extension

The decrease in frequency and eventual disappearance , of previously conditioned response ; one of the basic phenomena of learning.

Spontaneous recovery

The re - emergence of an extinguished conditioned response after a period of rest.

Pavlov theory has also been called type S conditioning to give the importance of stimulus. The theory of conditions as advocate by Pavlov, considers learning as habit formation and it is a stimulus - response learning  , where in place of a natural stimulus like food , water , sexual contact , is etc…@ and artificial stimulus like the sound of the well , sight of the light of a definite colour , etc… Can evoke a response when both the artificial  stimulus and natural stimulus are brought together several times , the learner  becomes conditioned to response to the situation.

Educational implication of classical conditioning theory

* Fear , love or hater towards a particular subject is created through conditioning.

* On the other hand , intresting and effective methodology in teaching along with sympathetic treatment can have a desirable impact on the students through the process of conditioning.

* The theory of classical conditioning emphasizes that the students should be exposed to positive stimuli in order to develop desirable habits ,  interests and attitudes in them.

* Condition can also be used to remove  unhealthy attitudes , superstitions , attitudes and fears from the mind of the students by exposing them to positive stimuli.

Hospital admission and discharge

 Part 3

Points to remember___

Ensure that no dues certificate is taken before handing over the step to patient.

Inform relatives about  discharge in audience.

Change the dressing when the patient is ready for discharge.

 

Provide clear instruction regarding use of drugs, diet.

Keep the patients record in safe custody.

Discharge Procedure

* The physician should write the patient name who is being discharged on chart.

* Patient personal belongings should be returned.

* The articles in patient units should be checked and ensure that they are completed.

* Check the payment of hospital bills.

* Arrange wheelchair , if patient is not able to 

walk.

* Complete all records of the patients.

Nurses Responsibility In Discharging Patient

* Inform the patient and relatives a day before discharge.

* Get the discharge slip prepared after checking the vital signs.

* The nurses should be that the patient personal hygiene is maintained.

* Hand over patient belongings.

* Complete the admission unit and discharge register sheet.

* Hand over case sheet and other records to medical record department.

* Hand over the discharge sleep to the patient or relatives.

* Ensure that the patient receive old medicine as for discharge slip.

* Place the patient on wheelchair as per patients condition.

* Immediately after the patient leaves, reorganize the patient's.

Transferring the patients

It refers to the patient may require transfer either from the unit to another or to  other health Care institution according to condition of patient.

 Transferring procedure

* Check the order of transfer to another unit.

* Assess the unit where patient is to be shifted.

* Explain the procedure of transfer to patient.

* Review the checklist of patient belonging so that all things are transferred with patient.

* Transfer patient by using wheelchair.

Assess and gather equipment that will be transferred with patient

E.g. infusion pump

* Document time of transfer and patient condition medications.

Transfer to extended care facility

1. Make sure that physician has written the transfer order on patient chart and transfer form.

2. Complete the nursing summary.

3. Attach a copy of transfer form and nursing notes with patient chair.

Care of unit after discharge

1. After the patient is discharged and before admitting another patient,  the room is cleaned windows and doors are opened.

2. Disposable things are discarded and linens are send to laundry.

3. Hatters pellows, blanket are posed to sunlight .

4. In case of communicable disease fumigation of room and articles is done.

5. Sanititation of bed, cabinet and the general area of the patient care unit with germicidal agent after patient is discharged.

Purpose of cleaning

1. Prevention of spread from microorganism.

 

2. Removal of body waste from mattress .

3. Deodrizing the bed tray mattress and pillows.

Guideline for cleaning

1. Review ward policies.

2. Use only authorised detergent or solution for cleaning.

3. Check bedside cabinet is cleared from any valuable of patient.

 4. Check bed linens for personal cleams ( money, contact lense).

5. Replace torn mattress or pillow.

6. Allowed the mattress and pillow to dry thoroughly before making bed.

7. Prevent spread of microorganism by carefully removing linen from bed.

Medico legal case (MLC)

Medico legal case are the cases requiring medical statement , by the same time involve information to law enforcing authorities is called medico legal case.

Types of MLC_____

* All road traffic accident

 * Bomb blast

* Poisoning

* Sexual offence

* Domestic violence

* Criminal abortion

* Attempts suicide

* Bullet injuries

Skeleton System

 Part 1

Unit 2

        Skeleton System

Introduction

Bone :- It is a strong and durable type of connective tissue.

Skeletal system is composed of bone associated cartilages, ligaments, tendons and joints of human body.

Skeleton provide hard framework of human body for protection of smooth argan.

The study of bone and associated structure called osteology.

Two bone articulate together and forms joints.

Joints make the hard and rigid skeleton allow different types of movement at different location.

Human skeletal system composed of 206 bones is divided into two parts_____

1. Axial skeletal system ( 80 bone )

2. Appendicular skeletal system ( 126 bone )

Components of skeletal system

Human skeletal is composed of five main components bones , cartilages , tendon, ligaments and joints.

Bone :- Bone is a tough and rigid form of connective tissue . It is the weight wearing organ of human body and it is responsible for all  strength of human skeletal.

Cartilage :- It is also a form of connective tissue but it is not tough and rigid as bone

Tendons :- A fibrous band of connective tissue that is bonded to bone and connects muscle to bone.

Ligaments: Bands of strong connective tissue called payments hold bone together.

Joints :- A joint is where two or more bone in the body come together.

Composition of bone

Bone consists of ___

Water = 25%

Organic constituents mainly osteon and bone cell = 25%

Inorganic constituents mainly calcium and phosphate = 50%

Types of Bones____

Bone of The Skeleton are classified as_____

Long bone :- it consists of a shaft and two extremities.

Long bone are found in the limbs.

e.g. femur , tibia and fibula

Short Bone 

These bones have no shaft  but they contain a spongy substance covered by a shell  of compact bone.

 They are cubicle in shape. e.g :- carpels (wrist)

The smallest bone of the body is stapes .  It present in middle ears.

Flat bone

They are thin and flattened bones they contain two layer of compact bone with a sponge substance in between. 

e.g. Sternum, ribs and most of the skull bone.

Irregular Bone :- they don't have regular size, shape.

e.g. vertebral bones and bones of the faces.

Sesamoid :- Sesamoid bone are small bone with developed in tendon of muscles.

e.g. patela bone of knee bone 

Hospital admission and discharge

 Part 2

Nurses responsibility during admission of patient

In outpatient department

When patient comes receive with kindness and courtesy and offer a chair , if very ill patient come for the examination.

Fill the particulars form name, age ,sex, religion, address, husband or father's name date of admission.

Check vital sign and observe general conditions to determine patient condition.

Get the patient examined and admission slip completed by doctor.

Educate patient or relatives and assess the assess the patients body.

Take the patient along with case sheet to the ward.

In wards

When patient come take the case sheet and receive the patient in the admission bade

 

If patient is ill inform the doctor incharge immediately.

 

Complete admission register 

Makes general observation from here to toe.

Give bath to the patient .

Dress the patient in clear hospital  clothes .

Hand over patient belonging to relatives or ward incharge.

 

If patient is admitted for operation or any treatment take the consent.

 

Proper orientation should be done .

 If patient mentally upset , give psychological support.

Discharge The Patients

Discharge is the process when the patient is shifted from the hospital to home.

                  Or

"Discharge means permitting the patient to let go from hospital to his home"

Objectives of Discharge

To ensure medical care after discharge .

To motivate patient and relative .

To promote good public relation.

Types of discharge________

Cured and discharge

This discharge is initiated by physician who advice the patient that he is well enough to leave the hospital, patient is satisfied and leaves.

Discharge to another hospital or another unit (Referral)

In this physician refer the patient to other hospital for better treatment.

When they do not have appropriate staff and equipments.

This is done to just save life of patients.

Discharge against medical advice (DAMA) (LAMA)

In this case the patient leaves the hospital against medical officer advice.

 

When a patient is kept from hospital without knowledge of hospital staff he is treated as absconded in hospital records

Absconded

When patient leaves hospital without any prior information on to staff , and without clearing dues.

DOR (Discharge on Request)

Discharge is given on personal request of client when he/ she is not willing to take treatment from hospital.

Death

When the patient does not recovered from the health problems and dies in hospital the doctors handover body to relatives.

Discharge planning

An effective discharge requires careful planning and continuous assessment of patient needs during hospitalization.

IDEAL discharge planning

I : Include patient and family members as partners in discharge process.

D : Discuss key areas to prevent problems

* Management of disease

* Explain test results

* Medication

* Follow up

E : Educate family and patient about discharge process.

A : Assess whether patient is able to understand the process.

L : Listen to patient and family members respect their difference.

Hospital admission and discharge

  Part 1

        Unit 3

HOSPITAL ADMISSION AND DISCHARGE

Admission to the hospital

The entrance of the patient into the health care agency such as hospital eastern as admission.

Admission

It means allowing a client to stay in the hospital for observation investigation and treatment of disease he is suffering from.

Indication

A patient admitted to hospital with following reason such as diagnostic procedure , surgical  intervention ,condition requiring expert care,  therapeutic  aspect for treatment , etc.,

Types of admission_____

Emergency admission

Client are admitted in acute conditions requiring immediate care .

e.g Client with heart attack

Routine admission

Client admitted for investigation and plant treatment and surgeries.

e.g. Patient with hypertension or pregnant lady 

Purpose of admission

1. To provide immediate care safety and comfort.

 2. To observe and report sign and symptoms of disease condition.

3. To improve general condition of patient.

 4. To reduce fear and anxiety .

Unit and its preparation

It is a place where the patient is kept during hospital stay.

The admission department notify the unit prior to the patient arrival . So that room /bed can be prepared.

Preparations

1. Prepare the treatment table

2. Ensure all the equipments are completed.

3. Check  ventilation properly.

4. Ensure patient airway.

Admitting the patient

The procedure for admitting a client to a health Care facility is very important.

Data required for admission of patient includes____

# Name of patients 

# Age 

# Gender / sex 

# Marital status

 # Occupation 

# Income

# Mobile number

Articles

Admission bed

 Temperature

 Weighing machine

 Kidney tray

 Documentation sheet

 Articles for physical examination

 BP apparatus

Admission Procedure

* Meet and receive the patient 

* Verify the patient data , by checking records sheet.

 

* Introduce personal 

* Assist to treatment care.

 

* Ask the patient to change clothes into hospital gown if necessary .

* Perform examination and evaluation procedure established baseline values like vital signs.

For Routine Admission

OPD ------ Doctor office ----- Admission office --- Ward

For Emergency Admission

In this patient is directly admitted emergency.

 

Bed and emergency equipment should be ready.

 When patient is out of danger , then he is shifted to other wards

Observation of Patient

Nurses should check all vital sign of the patient. 

Patients general facial expression will denote not only his emotions but also presence of pain.   

Any discolouration of skin like jaundice, cyanosis.

Special Consideration

1. Isolate the patient is suffering from communicable diseases.

 

2. Make proper observation of the patients condition record and report.

 

3. Orient the patient and his relatives to hospitals.

 

4. Be kind to patient and family members .

5. Collect information about patient from relatives.

 

6. Never leave the patient alone in  casualty.

Documentation and reporting

 Part 3

              Methods of recording

Records and report must be accurate, factual complete , current and confidential . There are many method used for recording such as______

1. Narrative charting

This is traditional method of recording nursing care is a story format that describe that client status.

2. Problem oriented charting 

This is a method of the human documentation that places emphasis on clients problems.

3. Sources oriented charting 

This is a descriptive recording done by each member of healthcare team or separate records.

4. PIE charting

SOP format is developed on medical models PIE(problem , intervention , evolution) chatting has a nursing origin.

5. Focus charting 

Focus charting is a method of identifying and organising the narrator documentation of clients concerns.

6. Charting by exception (CBE)

Patient is charting method that requires nurse to record only deviations from pre - established norms.

Flow sheets

Highlight important findings and define assessment parameters and findings.

Reference documentation:- Is related to standard of nursing practice.

Bed side accessibility :-Is related to documentation forms.

Patient have four components of problem oriented charting

Database

It contains information recording assessment. E.g. history , physical examination , nurses assessment , laboratory findings.

Problem list

Best of on the database list of problem planning (physiological , social , spiritual , cultural, environmental, etc)

Initial plan

Based upon the identified problems , care is developed with clients active participation is setting goals , outcomes and interventions.

Progress notes

Health team members will evaluate and record the progress of  client's problems information can be expressed in various formats such as SOAPIE or SOAP.

Computerized documentation

Nurse use computer to store the client database , add new data , created and revise care plans and documents client progress.

Advantages

1. Legibility of information 

2. Increased time efficiency , consistency and accuracy in records keeping .

3. Provide database for research.

4. Patient link various sources.

5. Client information , request and result are sent and received quickly.

6. Standard terminology improve communication.

Disadvantages

1. Clients may not have privacy is security measures are not used.

2. System failure can cause an availability of information.

3. System is expensive.

4. Extended training may be required whenever an updated system is installed.

Documentation and reporting

 Part 2

          Types of records___

1. Patient clinical records 

2. Medical /Nursing records

 3. Ward records

 4. Administrative records

Patient  clinical record

It is the knowledge of involved in the patients illness progress in his recovery and the type of care provided by the hospital personnel. All records basically contain the following information ______

1. Client's identification and demography data.

2. The present complaints 

3. Informed content for treatment and procedures 

4. Admission nursing history

 5. Family history

6. Physical examination findings

 7.Nursing diagnosis and problems

 8. Nursing care plan 

9. Medical history 

10. Tentative diagnosis 

11. Medical diagnosis

 12. Therapeutic orders

13. Treatment given

 14. Reports of diagnostic studies

 15. Final diagnosis

 16. Client education

 17. Summary of operative procedures

 18. Discharge plan and summary 

19. Any specific special instruction

Medical records

Medical record is a legal document providing information of a patient medical history and data by physician , nurse practitioner and other members of the health care.

 Some  information contained in the medical records____

Identification information of the patient .

Patient health is information on a patient tell the health care providers about their past and present health status.

Medical examination findings.

Nursing records

Progress notes :- it should be written at least once every 24 hours and for each of the following events.

a) Admission 

b) Transfer

c) Discharge

d) Treatment or procedure 

e) Charge in patients condition.

 f) Patient incident note.

 g) Patient or parent /caregiver education.

Worksheet and kardexes :- nurse use worksheet to organise the care they provide and to manage their time and multiply priorities. Kardexes are used to communicate current orders , upcoming test or surgery is special clients for the use of aids  for independent.

Flow sheets :-  A new flow sheet  is to be initiated for each 24 hours period , by signing and initiating the flow sheets  the RN indicate.

A safety check has been performed the presence of correct ID band 

The presence of an accurate allergy band.

The documentation of the monitor control number and assessment of appropriate alarm limits.

Intake/output section

Hourly IV site/ rate check.

Cumulative IV volume infused hourly. 

Complete description of all IV solutions.

 All medication given.

Vital signs section

Document vital signs in the space provided. Graph by the vital sign using the graph legend symbol and assessment legend.

Client care plan

Care plan outlines of the care for individual clients and make a part of the permanent health records.

Care plan written in ink ,  up-to-date and clearly identify the needs and wishes of the client

E - Health records

There is no doubt that the computerization of the health care records has  many benefits .  The same principle apply whether documentation is completed in the paper health care records or electronically.

Wards records

Ward records include ;-

Admission and discharge record

Line in record

Record of production or increasing beds.

Index books

Round book , attendance book and record book 

Treatment records

Administration records

It includes record of______

Treatment

Admission

Equipment losses and replacement .

Personal performance

Organiszational records