Breastfeeding With a Supplemental Nursing System

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If the patient is hypoglycemic, and they are able to eat or drink, give them some OJ and graham crackers with peanut butter. Also any other comorbidities such as diabetes, thyroid issues, HIV, etc. The provider will place a gloved finger into the rectum and needs to have feces on it when it comes out. The liver is responsible for carrying out many functions for the body, and therefore the list of potential signs and symptoms is quite lengthy. Some nurses follow the traditional role of working in a hospital setting. Antibiotics- if indicated Clindamycin or Metronidazole This may be used as prophylaxis, or because the patient developed pneumonia.

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Upper GI bleeds will come out as dark tarry stools and lower GI bleeds will come out as bright red bleeding. Also, monitor for blood in the vomit, and be aware of coffee ground emesis because blood can curdle in the acidic stomach environment. The bleeding along the GI tract is from a perforation somewhere in the intestines or stomach. Can be caused by too much acid ulcer , an abnormal formation in the colon tumor, polyp, hemorrhoids , inflammation of the lining diverticulitis, colitis or any sort of trauma to the GI tract.

Controlling and stopping of the bleeding, vital signs back to baseline, normal blood counts such as hemoglobin. Glaucoma is group of diseases in which the pathophysiology is not fully understood.

It is also a condition which remains largely asymptomatic until it is in its advanced stages. At its most basic level of understanding, the pressure in the eye on the optic nerve increases, which leads to cellular death and ultimately vision loss. The mechanisms in which the pressure increases differs between the different kinds of glaucoma.

We will discuss the two most common. Open-angle and angle-closure are the most common kinds. It occurs over a long period of time. Slowly, drainage canals become clogged, which results in higher pressure. The second most common kind of glaucoma, angle-closure, is a sudden condition that comes on quickly and requires immediate treatment. It is usually related to some sort of eye trauma. This must be treated immediately and is considered a medical emergency, as permanent blindness can occur without appropriate treatment.

Because the most common kind of glaucoma occurs slowly over years without symptoms, screenings are essential. This is why a glaucoma test is routine in eye exams, even for young adults. The exact cause of glaucoma is unknown. As far as the most common type of glaucoma, open-angle, the theory is that the drainage system of the eye becomes insufficient over time and subsequent pressure builds up.

Decrease intraocular pressure as quickly as possible, prevent further visual damage. Gout is a metabolic disorder and form of arthritis. Uric acid crystallizes and deposits into joints and body tissues, most frequently in the big toe. This results in pain, inflammation, stiffness, and redness. An acute attack can occur, which includes sudden severe pain, frequently in the middle of the night.

Essentially, gout is caused by too much uric acid in the blood. Use of diuretics can also be the cause. The pathophysiology of HTN is quite complex. Blood pressure is essentially the amount of blood the heart pumps, as well as the resistance to blood flow in the actual arteries. When someone has higher pressure for an extended period of time, it begins to cause problems.

HTN is called the silent killer because it can begin to cause problems without any symptoms. Many times it has been happening for years undetected. The way it is detected is with a simple blood pressure screening, hopefully done at an annual physical. However, if someone does not regularly visit a physician and get checkups, then this may go undetected for a long period of time.

There is primary and secondary HTN. Primary HTN is caused by a combination of genetic and environmental factors. Secondary HTN comes from an identifiable cause for example, sleep apnea or hyperthyroidism. Keep in mind, higher blood pressure for a short period of time is normal.

Your blood pressure will naturally increase during times of stress or pain, but the HTN we are discussing is chronically elevated even during times of relaxation. Primary HTN can be caused by many different factors. The older a person is, the higher the likelihood of HTN. Family history, body weight, sedentary lifestyle, not enough of certain vitamins like Vitamin D , not enough potassium, too much sodium, or excessive stress can all be a causative factor of primary HTN. Control blood pressure down to a safe level appropriately.

Please note, if a patient has had chronically elevated blood pressure for years or is in a hypertensive crisis , they may need their blood pressure lowered slowly, as they can have symptoms of hypotension at even normal blood pressure levels. If symptoms present, that means the disease process has most likely progressed significantly. Leukemia is a cancer of the blood. There are many kinds of leukemia, however the basic pathophysiology is that somehow the DNA of immature blood cells is damaged.

This causes those blood cells to develop and divide abnormally. This presents quite a problem, as the abnormal blood cells begin to accumulate and take up a lot of space, eventually crowding out the good and healthy cells.

This impairs the function and growth of healthy cells. The exact etiology of leukemia is unknown, but there seems to be higher likelihood of it developing when certain environmental and genetic factors are present.

Genetics, radiation or chemical exposure, viruses HIV , previous chemotherapy, and also those with Down Syndrome appear to have a higher incidence of leukemia. Minimize complications, resolve and recover from leukemia if possible. Some types of leukemia can be cured, while others cannot.

Maximize the normal blood cells and minimize the abnormal ones. Cardiac muscle tissue death from lack of blood flow. The blood carries oxygen and nutrients to the cells. When this is decreased, cells die also called necrosis. Cardiac muscle cells dying is problematic as they do not regenerate although there is some debate of this topic: Narrowing or occlusion of the cardiac vessels that perfuse the heart. The plaque that causes this could be from poor diet, lack of exercise, or genetics.

It can also be from a deep vein thrombosis DVT that has broken free embolus and landed in the heart. Re-perfusion to cardiac muscle and return of cardiac muscle functionality, or as much as possible. Neutropenia is an abnormally low count of neutrophils, which is a type of white blood cell.

Neutrophils are made in the bone marrow, so anything that inhibits or disrupts that process can result in neutropenia. It also can result if neutrophils are destroyed by medications, for example Neutropenia can be congenital or acquired. Acquired neutropenia result from nutritional deficiencies, infections Hep A, B, C, HIV, and more , medications, chemotherapy, leukemia, alcohol use disorder, rheumatoid arthritis, and more.

Restore neutrophil count, prevent additional destruction, prevent infection. Many patients are unaware until the lab is drawn and the diagnosis is made. Even after bone are done growing after childhood, bones are constantly being broken down and replaced. Bone truly is living tissue. There is primary and secondary osteoporosis. Primary osteoporosis is from the normal age-related bone loss, while secondary osteoporosis is due to some other disease process.

During younger years, bone is regenerated faster than old is broken down. Therefore, the overall bone mass will increase. See the table below for a comprehensive list. Pneumonia is essentially when fluid or pus gets trapped in the alveoli of the lungs pictured below and impaired gas exchange results. This can impact one or both lungs. Below are the important differentiations of pneumonia these definitions, except the first one, are from Cleveland Clinic.

Establishing the kind of pneumonia is essential, in that the treatment course can differ. The first picture below is normal, unobstructed gas exchange. If you look to the second picture, you see the alveoli have an accumulation of fluid in them, which impairs the gas exchange that should occur to provide appropriate oxygenation into circulation.

Inflammation can also occur. Antibiotics are administered, and the choice of which is dependent upon the offending pathogen, any other medical conditions going on with the patient, and if there are any antibiotic resistances present.

Oral antibiotics are given typically for community-acquired pneumonia, however if the patient is hospitalized, they will most likely receive IV antibiotics.

Steroids are typically administered to address inflammation. Pneumonia can be caused by a virus, bacteria, fungus, or from inhaling something a chemical, inhalant, or aspirating on food or fluid. This can be of particular risk to those with a weakened immune system or unable to keep your own airway clear for example, unable to cough or maintain consciousness due to neurological or other injury. Resolve the infection, optimize gas exchange, minimize impact from impaired gas exchange.

Postpartum hemorrhage is the excessive bleeding following delivery of a baby. For vaginal delivery, excessive bleeding would be more than ml and for cesarean delivery, more than ml. This may happen with vaginal or cesarean delivery and occurs in out of women. The hemorrhage may occur immediately after birth, or over several hours following delivery. Normally, the uterus continues to contract after the delivery of the baby and placenta.

These contractions actually help close the vessels that supplied blood from the mother to the baby. When these contractions do not continue, or are not strong enough, hemorrhage occurs. Sometimes, a tear in the cervix, placenta or the blood vessels within the uterus may cause the hemorrhage. Risk factors include obesity, multiple births twins or more , many previous pregnancies, blood clotting disorders, infection, prolonged labor or use of assistive devices such as forceps or vacuum to delivery the baby.

Patient will maintain optimal fluid balance and vital signs within normal limits. Essentially, at its most basic level, respiratory failure is inadequate gas exchange.

Your body desperately needs oxygenated blood to function. Restore oxygen levels of blood as appropriate and remove excess carbon dioxide. Essentially, skeletal muscle is destroyed for various reasons and their intracellular contents in particular myoglobin leak into the bloodstream. Quite a few things can cause this. One that has been discussed more frequently recently is due to the increase in people engaging in high-intensity workouts like CrossFit.

This causes intense muscle breakdown, which can result in this condition. Trauma can also be a cause, as well as conditions of genetic origin, seizures, metabolic issues, temp-regulating issues, and many medications. A few medications that can cause this to occur include statins, diuretics, aspirin overdose salicylate toxicity , recreational drugs like cocaine and amphetamines, and narcotics. The exact patho of RA is not fully understood, although there is thought to be a genetic component leading to more susceptible individuals.

Essentially, something triggers the immune response that something could be an infection, trauma, or something of that nature and this leads to synovial hypertrophy synovial lining of the joint and chronic inflammation of the joint s.

Basically, this inflammation becomes uncontrolled and leads to the destruction of bone, cartilage, and even tendons, ligaments, and blood vessels. Like the pathophysiology, the etiology is unknown. However there are some factors that seem to contribute to its occurrence. These factors include genetics, various infections, sex hormones, as well as immunological factors.

There is no cure for RA, therefore the goal is to manage symptoms and slow the disease progression. Some alternative therapies like fish oil, tai chi, and various plant oils have demonstrated improvement in RA symptoms. Seizures are a very complex neurological issue. Here is the definition from Medscape of a seizure: Basically, abnormal electrical discharges are occurring in the brain. There are different kinds of seizures epileptic, focal-onset, general-onset.

The exact cause of a seizure can be extremely difficult to pinpoint. John Hopkins Epilepsy Center divides seizures into two categories: The etiology of provoked seizures can include: Source link listed below.

Stop any current seizure activity as soon as possible, minimize damage, and prevent it from occurring in the future. The immune system kicks into overdrive, for whatever reason, and cannot be calmed down. As the healthcare team, we are trying to turn the immune response down as best we can… but it is VERY challenging.

The challenge is that it can present with very subtle symptoms and progress quickly. Time is of the essence in sepsis recognition and treatment. Essentially, the cause of sepsis is the original infection. Examples include pneumonia, urinary tract infection, infection in the bloodstream bacteremia , etc. Lessening the immune response, prevention cellular death, resolution of infection, minimizing damage from cellular oxygen deprivation and lactic acid build up, maximizing cardiac output and resolution of the condition.

Hypovolemic shock is a loss of blood volume leading to decreased oxygenation of vital organs. Any condition causing loss of circulating blood or plasma volume. Hemorrhage from any large source. Burns plasma loss due to capillary permeability. Prolonged vomiting or diarrhea. The goal is to restore circulating blood volume, preserve hemodynamics, and prevent any damage to vital organs.

A stroke is essentially a neurological deficit caused by decreased blood flow to a portion of the brain. They will be classified as either hemorrhagic or ischemic. An ischemic stroke is the result of an obstruction of blood flow within a blood vessel.

Both of these can cause edema and cellular death. Lack of blood flow for greater than 10 minutes can cause irreversible damage. Some of those who are at highest risk are those on anticoagulation therapy. People are on anticoagulants therapy for various reasons mechanical heart valves, atrial fibrillation, etc.

Diabetes is also one of the major risk factors, in addition to atherosclerosis, hypertension, cardiac dysrhythmias, obesity, substances abuse, and oral contraceptives. Clot-busting meds can be given to restore blood flow for ischemic strokes. Hemorrhagic strokes are managed by keeping the blood pressure controlled, controlling intracranial pressure, reversing any anticoagulants on board, and even very invasive procedures or surgery to relieve increased intracranial pressure.

You want the patient to gain back as much function as possible. This is done slowly over time by the brain creating collateral circulation around the infarcted area. Physical, occupational, and speech therapy are essential aspects of stroke recovery. Some patients may make a complete recovery, while others may have profound deficits. Syncope is essentially a loss of consciousness, which is typically caused by hypotension. The brain lacks adequate blood flow and a temporary loss of consciousness results.

Syncope typically has a cardiac etiology, but can also be due to many other things like a side effect from a med, neuro issue, psych issue, or lung problem.

When a cardiac etiology is suspected, a cardiac workup is completed. This typically includes cardiac monitoring, labs, and routine vital signs specifically blood pressure and heart rate. No additional syncopal events, no injury, identification of cause and treatment to prevent further episodes. Infection within the genitourinary system, which then causes inflammation. The urinary tract is sterile above the urethra and pathogens gain entrance via the perineal area or the bloodstream.

When these pathogens enter this sterile environment, infection ensues. One can acquire an infection in the bladder itself cystitis , or the an infection in the urethra urethritis , which is essential a urinary tract infection. Females have a shorter urethra and it has a close proximity to the anus and therefore e. Coli, which is normally found in the GI tract.

Males become more susceptible as they age due to urinary stasis. Urinary catheter use particularly indwelling significantly increase the risk for a UTI, sexual intercourse, certain birth control methods spermicide, diaphragms , blockages in the urinary tract, abnormalities in the anatomy of the urinary tract, or a suppressed immune system can all increase the risk for a UTI.

Share on Facebook Share on Pinterest. Abdominal Pain Nursing Care Plan. Pathophysiology Abdominal pain can be a very minor issue that is easily resolved, or a medical emergency. Desired Outcome Cease painful stimuli, resolve underlying cause, minimize any subsequent damage. Nursing Interventions and Rationales Assess pain We must have a detailed baseline so we not only know how to treat appropriately, but also to know if it has changed.

For example, a sudden relief of pain in a patient with appendicitis indicates rupture and an emergency. Assess bowel movements color, consistency, frequency, amount This will aid the provider in making clinical decisions significantly. It is essential to report bowel movement characteristics and frequency accurately to aid in this important decision making.

This also ensure accurate intake and output recording. Ensure adequate hydration; may require intravenous fluids Patients with abdominal pain may have a diminished appetite, be NPO, or not want to drink fluids. Assess and promote appropriate fluid balance, which may requiring notifying the provider of a decreased oral intake and need for intravenous fluids to maintain fluid balance. Assess bowel sounds Essential to know their quality as a baseline and to routinely reassess to detect changes.

If a patient had bowel sounds, but now does not, it is essential to detect that and notify the provider, as the patient may not experience any symptoms. Facilitate normal bowel patterns Abdominal pain can be due to issues with the GI tract. Prevent infection Abdominal pain may have been caused by a pathogen gastroenteritis, for example.

It is essential to promote adequate hand hygiene and infection prevention to prevent the spread to others or preventing the issue from resolving. Assess abdominal distention, report changes in size and quality as appropriate Patients may be experiencing abdominal distention as part of the underlying disease process.

Pathophysiology Also known as acute kidney injury AKI , is measured by the buildup of waste in your body and altered fluid levels because the kidneys are failing to do their job. Etiology There are many causes of kidney failure.

Try to limits these drugs, watch labs and antibiotic troughs. Look out for signs and symptoms of overdose. Here are the most common signs and symptoms of overdose. Hyperinsulinemia from the body building up resistance to insulin. Neuro symptoms like seizures, confusion, neuropathy. Various, depends on the herbal supplement.

Monitor lung sounds and edema You want to make sure fluid balance is carefully monitored. A backup in the lungs would cause crackles and a back up systemically would cause pitting edema in the legs.

Do not under any circumstances administer a diuretic without a bathroom plan. And a word to the wise, have a backup plan. Meaning if you have a walkie talkie patient with functioning arms and a strong call light finger, I still would set up a bedside commode just. Diuretics work on different parts of the nephrons. There are three kinds of diuretics: Loop, Thiazide, and potassium sparing. Most commonly used diuretics in acute kidney failure: Furosemide is potassium wasting.

It plays a role in acid base equilibrium. In states of acidosis hydrogen with enter the cell as this happens it will force potassium out of the cell, a 0. However, if patient is on a potassium wasting diuretic, educate about potassium bananas, sweet potatoes, etc.

When protein is broken down ammonia is formed. Ammonia is converted to urea in the liver and is eventually excreted in the kidneys. Creatinine is created in proportion to muscle mass and usually stays stable.

Anemia Nursing Care Plan. Etiology There are many causes of anemia, the most life threatening is massive hemorrhage, but other causes such as lack of iron, severe burns, cancers, bone marrow disorders like multiple myeloma or leukemia can be just as detrimental.

Some of the types of anemia: Usually caused by hemorrhage or lack of Iron or lack of ability to absorb iron. Due to Folic Acid vitamin B12 deficiency or lack of ability to absorb B Treated with B12 supplements and diet changes. The bone marrow is not producing enough RBCs. Treated with blood transfusions and also bone marrow biopsies to diagnose specific issue with the bone marrow.

Due to RBCs being destroyed. What is causing the lysing of the RBCs can be from a range of problems including infection, autoimmune disorders, etc. Treatment is dependant on the cause. If due to infection, treatment is antibiotics, if autoimmune treatment may be medications that suppress the autoimmune system.

Cardiac and vascular specialists should be consulted for this condition in case it is due to a mechanical factor like the heart valves. This is a genetic disorder where the blood cells become sickle shaped, causing clots, hemolysis, and poor perfusion. Treatment is focused on pain control, fluid resuscitation and sometimes blood transfusions. Give pantoprazole Protonix , potential surgical intervention to stop the bleeding.

The provider will place a gloved finger into the rectum and needs to have feces on it when it comes out. The feces is placed on a hemoccult card where a developing solution is married with the stool giving the provider insight of whether or not there is blood in the stool. If the card turns blue it is positive for blood. This reduces the ulceration which could be and most likely is causing the GI bleed. Apply pressure to any hemorrhage. Can be from a laceration to the liver or the spleen.

Assess for abdominal pain and swelling. Here are the most important. This is the most commonly looked at lab value to assess need for a blood transfusion. Every institution, Doctor, and person is different but as a general rule, a hemoglobin below 8 requires a blood transfusion.

Red Blood Cells RBCs contain hemoglobin which is responsible for oxygen transport throughout the body. RBCs are primarily produced in the bone marrow, they have a life span of days and are destroyed in the spleen and liver. Folic acid is an essential water soluble B vitamin. Ferritin is a protein that stores iron. It is formed in the liver spleen and bone marrow. Ferritin in the blood is usually proportional to stored ferritin.

Ferritin is a more sensitive and specific test for identifying iron-deficiency anemia, however, it is usually measured in conjunction with total iron binding capacity and iron. Iron Fe is an element that is an important component of hemoglobin in red blood cells. Hemoglobin transports oxygen from the lungs to all the cells of the body. Most of the iron in the body is located in hemoglobin, but some iron is located in myoglobin as well as some iron is stored in the liver, bone marrow, and spleen.

The storage form of iron is ferritin. Iron is transported in the blood by a protein called transferrin. Monitor for any changes in ECG, tell the patient to inform you of any new symptoms like chest pain or shortness of breath. Anemic patients are more likely to experience ST depression, QT prolongation, T wave depression, and R wave difference.

Fall Precautions High risk of syncope, especially if the patient is hemorrhaging. Keep the patient lying flat or in trendelenburg position if hypotensive. Oh and call your Respiratory Therapist because they are your best friends and need to monitor the patient too. Iron supplements are likely to decrease absorption of Quinolone and Tetracycline Antibiotics as well as Levodopa, Levothyroxine, Methyldopa, CellCept, Penicillamine, and Bisphosphonates. Folic Acid supplements are likely to increase side effects of 5-Fluorouracil and Capecitabine.

It might also decrease the efficacy of Fosphenytoin, Methotrexate, Phenobarbital, Phenytoin, Primidone, and Pyrimethamine. Aspiration Nursing Care Plan. Pathophysiology Aspiration occurs when something enters into the lungs that is not air.

Desired Outcome Patent airway, oxygenation maintenance, prevention of further complications such as pneumonia. Everything else in this care plan is good too but this trumps it all when it comes to priorities. Prevention is key, but since this patient has already slipped substances past the epiglottis AKA royal lung guard everything that applies to prevention NPO, head of bed greater than 30 degrees, oral hygiene, etc.

Be prepared to intubate, not because the patient will for sure be intubated, but because not being prepared is costly like someones life kind of cost. Lastly have suction ready. Have all the stuff for oxygen ready. Monitor their oxygen levels. If they dip low Suction when necessary Have the suction ready to go to help keep the airway clear and increase the surface area for oxygen absorption.

Perform a Swallow Screen This is a simple, nurse initiated test that should really be performed on any patient that is not NPO. That fever they have, is not going to be treated via oral Tylenol if they cannot swallow. Then you will beg for IV Tylenol and get an order for rectal Tylenol because it is cheaper and the standard of care. After you and the patient cry it out for a minute, you will administer the Tylenol in the no go zone with the promise of blankets as a reward for breaking the fever.

If they do not pass the swallow screen the patient will be NPO, or they should be anyway. Acquire a chest X-ray A chest x-ray helps to differentiate the patient with aspiration as to whether they have acquired pneumonia or not. Antibiotics- if indicated Clindamycin or Metronidazole This may be used as prophylaxis, or because the patient developed pneumonia. Auscultate lung sounds Monitor O2 saturation Assess skin color are they blue? Assess depth, rate, regularity of breathing as well as symmetry of chest rise and fall This should be done on every patient.

But just like for a patient who has stroke like symptoms, you will be checking neuro function more frequently, a patient with aspiration needs to have their respiratory functions assess more frequently. The frequency is based on each patient and the situation-use clinical judgement here. Asthma Nursing Care Plan. Pathophysiology Bronchoconstriction and increased mucus production decreases the ability to bring air into the alveoli, decreasing the amount of oxygenation red blood cells are able to exchange.

Desired Outcome Decreased work of breathing and proper oxygenation to tissues. This is both a comfort measure as well as physiologically helpful. Eliminate hypoxia, move up by 1L if not improving after re-checking every few minutes, call respiratory therapy if they require more than 6L NC.

Make sure the patient knows about their asthma triggers and help them problem solve how to eliminate the trigger from their life. Auscultate lung sounds If wheezy they may need a breathing treatment If you hear crackles they may have pneumonia and potentially could use suctioning. Positioning patient in an upright position Opens lung bases and airway Have the patient perform a peak flow meter Peak flow meters tell us how much air that patient can exhale.

The smaller the number the less amount of air they are moving. Breathing treatments and medication therapy Beta-Agonists: Such as albuterol work as bronchodilators Anticholinergics: Such as Ipratropium work to relax bronchospasms Corticosteroids: Such as Fluticasone work as an anti-inflammatory If the patient is a child or the patient has been working very hard to breath for a long period of time and is getting worse, be prepared with an airway cart.

And for the love of the airway, have your respiratory therapist aware of the patient Safety! Plus you do not want to wait until the impending airway closure happens to try to secure their airway. Sometimes the patient will be sedated and intubated to try to correct any respiratory acidosis or alkalosis. Pathophysiology An electrical activity disturbance in the heart that causes an irregular and often rapid heartbeat.

Etiology The specific cause of atrial fibrillation is unknown but there are risk factors that put someone at higher risk of developing afib. Desired Outcome Decreasing risks of clot formation, a heart rate within normal limits and rhythm control. Objective Data Irregular heartbeat Tachycardia. Nursing Interventions and Rationales Obtain a 12 lead ECG Used to diagnose atrial fibrillation The waves are more chaotic and random The beat is irregular You can see the atria quivering between the QRS ventricles pumping No discernible P waves The ventricular rate is often bpm and the QRS complexes is usually less than ms.

Electrocardioversion, Ablation, Pacemaker -Electrocardioversion: The patient will be shocked on the outside of the chest wall. This treatment is used for patients who have infrequent episodes of atrial fibrillation because if the patient has it frequently, they have a high probability of the afib returning after being cardioverted. This is placed under the skin and is a device that sends electrical signals to the heart to help it beat with the right rhythm and pace.

Using beta blockers, calcium channel blockers and cardiac glycosides will help control the rate of the heart beat. They block beta 1 receptors from being stimulated.

Stimulation of Beta 1 causes positive inotropic force of contraction and chronotropic pace of heart beat effects. If you block beta 1 you will have decreased force of contraction and decreased heart rate.

They block calcium channels… Duh. When calcium enters the cell in causes the cell to contract, thus when the channels are blocked, it decreases the production of electrical activity innately decreasing the heart rate. This medication stimulates the Vagus nerve, which when stimulated slows the heart rate down.

When it is blocked it causes increased contractility of the heart. If your heart is beating stronger it will inherently slow down. Coumadin Aspirin Lovenox Plavix Eliquis Thinning the blood helps to disintegrate and break up the clot as well as increasing flow of blood. The most common are listed to the left. Fall education Being on a blood thinner, the patient needs to be informed of their risk of bleeding out especially if they fall and hit their head. Make sure to go over environmental hazards such as good lighting and eliminating throw rugs.

If a patient does fall and hit their head they need to go to the ER immediately, even if they are not experiencing any adverse effects. Time to call The risk of a blood clot forming and moving to the brain is fairly high. It is important to teach the patient and their family members the signs and symptoms of stroke. Teach the patient that if they feel confused or feel weakness on one side to call for help.

Troponin I Creatine Kinase MB Initial measurement of the cardiac enzymes is important because it helps with any trending information, the sooner you get this information the better. Also getting trending results over specific periods of time is helpful.

Is an enzyme that helps the interaction of myosin and actin in the cardiac muscle. When necrosis of the myocyte happens, the contents of the cell eventually will be released into the bloodstream. Troponin can become elevated hours after in ischemic cardiac event and can stay elevated for up to 14 days. This enzyme is found in the cardiac muscle cells and catalyses the conversion of ATP into ADP giving your cells energy to contract.

When the cardiac muscle cells are damaged the enzyme is eventually released into the bloodstream. CKMB levels should be checked at admission, and then every 8 hours afterwards. Etiology Any issue with the cardiovascular system could potentially cause CHF or put the patient at a much higher risk for CHF , such as myocardial infarction, coronary artery disease, hypertension, cardiomyopathy, heart arrhythmias, etc.

Desired Outcome maximized cardiac functionality as well as decreased stress on the cardiovascular system. Restrict sodium intake Water follows salt! The patient has too much fluid on board and needs to get rid of it, restricting the sodium helps with this. This means educating the patient on dietary changes that need to happen and be adhered to.

Try to stay between mg of salt in a serving. Monitor BNP Normal range: Brain natriuretic peptide BNP: When the heart is stressed or working hard to pump blood, it releases BNP. Listen to breath sounds Monitor O2 saturation Fluid can back up into the lungs and cause shortness of breath, especially upon exertion. Be careful about laying these patients flat as you can put them in respiratory distress. Place the patient on O2 as needed to help them keep their O2 levels adequate.

Furosemide Lasix Bumetanide Bumex Hydrochlorothiazide Microzide Spironolactone Aldactone We need to get all this fluid out of the patient… The best way to do this is administer diuretics. Most commonly used diuretics in congestive heart failure are loop and sometimes thiazides are used with loop diuretics: This can change per patient and per doctor recommendation, so make sure to get a goal from the physician. Cirrhosis Nursing Care Plan. Pathophysiology Liver cirrhosis is a chronic, irreversible liver disease.

Desired Outcome Minimize continued liver damage, optimize nutrition, maximize hepatic circulation, minimize and prevent respiratory complications. Nursing Interventions and Rationales Promote nutrition Many who suffer from cirrhosis have impaired nutrition and require nutritional support with specific vitamins and minerals; enteral or parenteral feedings may be ordered Assist with paracentesis, if needed Patients may require the abdominal fluid that has built up ascites to be drained.

Assist in set-up, positioning, and post-procedure site assessments, and monitoring as needed. Daily weights This indicates if fluid has been accumulating, or if patient is losing weight Dietary adjustments: Monitor for excess fluid volume assess daily weight, JVD, blood pressure Increasing values indicate vascular congestion Note and address electrolyte imbalances Fluid and electrolyte imbalances are common and can result in dysrhythmias Promote oral care Patients are at a higher risk for bleeding gums and mouth sores, which can cause a decreased appetite in an already malnourished individual Complete a careful and comprehensive respiratory assessment vitals, labs, auscultation Essential to note impaired gas exchange and compromised respiratory function early.

Pathophysiology Less air flow is able to flow into and out of the alveoli both trapping CO2 as well as restricting O2 entering. Desired Outcome Clear, even, non-labored breathing while maintaining optimal oxygenation for patient. Nursing Interventions and Rationales Avoid irritants: Quit smoking or being around smoke Be mindful of the weather very cold can aggravate the bronchi Allergens like dust or pollen The key to avoiding a flare up of COPD is to avoid things that make it worse.

If the patient is smoking still this is a priority, they need to quit smoking. Provide education on smoking with COPD and the benefits of quitting.

If the patient has been working very hard to breath for a long period of time and is getting worse, be prepared with an airway cart. And for the love of the airway, have your respiratory therapist aware of the patient! Breathing Treatments and medications Beta-Agonists: Plan the oxygen monitoring with the physician.

Give oxygen as ordered and needed. Obtain an ECG The lungs and the heart are in the same general area, if someone is having problems breathing, make sure their heart is ok. Encourage a healthy weight Can be either overweight or underweight Having access weight on the patient decreases the space for the lungs to expand. Plus, generally those who lose weight are also moving more to lose the weight, double win. Some patients especially those with emphysema can be very thin barrel chested and it is important to make sure they are getting the proper nutrition so their body is at optimal performance for that patient.

Helping the patient move more often helps improve breathing abilities. Pathophysiology Blood clots formed from any source, lodging in the patient leg or arm, impeding blood flow. Etiology Narrowing or occlusion of the vessels in an extremity. Desired Outcome Stabilization of the blood clot or disintegration of the blood clot as well as prophylaxis treatment for future blood clots.

Subjective and Objective Data Subjective Data Painful extremity Numbness and tingling on affected extremity Potential subjective data to be concerned about and monitor for: Chest Pain CP Stroke: Objective Data Warm, red, firm and swollen leg Decreased peripheral pulse on affected extremity.

Nursing Interventions and Rationales Assess a full neuro exam, assess breathing-Pulse oximetry, difficulty in breathing, chest pain, obtain an EKG.

Heparin- initial therapy to break up clot. Transition into a SubQ or oral anticoagulant to prevent future clots. This is an anticoagulant that breaks up blood clots as well as prevents them.

Patient will need to have frequent blood draws to monitor their INR. Therapeutic range is between 2 and 3. Educate about avoiding vitamin K both supplements as well as food Vitamin K works to help increase clotting, this is opposite of what we are trying to do for this patient, unless of course they are bleeding out, in which case the treatment may be vitamin K with Fresh Frozen Plasma FFP Continuous monitoring: This monitors for changes in oxygenation if the clot moves to the lungs.

Nosebleeds are obvious, however, inform the patient that if they bleed through nasal packing for longer than 15 minutes they should go to the ER. Also they they feel dizzy, faint, or are losing color in their face they should go to the ER. Diabetes Nursing Care Plan. Etiology The cause for Type I diabetes is unknown, but hypothesized to be potentially genetic or triggered by a virus.

Desired Outcome Blood sugar control with minimal side effects. Nursing Interventions and Rationales Blood sugar monitoring: The physician will make a target blood glucose level. Teach the patient that they need to monitor their blood glucose. Teach the patient how to use their glucometer and record their results. Insulin administration -Rapid Acting: Each institution has guidelines and each insulin has guidelines.

Following the guidelines, make sure you know the onset, peak and duration of each type of insulin. Up to 12 hours -Intermediate Action Onset: Up to 24 hours -Long Acting Onset: Up to 24 hours To administer insulin, teach the patient to rotate injection sites and to clean the site with alcohol prior to inserting needle.

Educate about nutritional changes and monitoring This would be a good time to get the dietician involved. The patient needs to learn at a minimum, how to count carbs and which foods to avoid such as beer. If the patient is hypoglycemic, and they are able to eat or drink, give them some OJ and graham crackers with peanut butter. Increase water intake if the patient has hyperglycemia Monitor feet and educate about monitoring feet Both decreased blood flow to the feet as well as neuropathy occur to make the feet something the patient really needs to watch.

Wounds are hard to heal so if they are having a hard time feeling their feet and they become injured, the wounds will be worse than with someone without diabetes. Assisting in activities of daily living ADL are skills required in nursing as well as other professions such as nursing assistants.

This includes assisting in patient mobility, such as moving an activity intolerant patient within bed. For hygiene, this often involves bed baths and assisting with urinary and bowel elimination. Nurses do not have the authority to prescribe medications, with some exceptions. All medications administered by nurses must be from a medication prescription from a licensed practitioner.

Nurses are legally responsible for the drugs they administer and there may be legal implications when there is an error in a prescription and the nurse could be expected to have noted and reported error. In the United States, nurses have the right to refuse any medication administration that they deem to be harmful to the patient.

The patient's family is often involved in the education. Effective patient education leads to fewer complications and hospital visits. Nursing is the most diverse of all healthcare professions. Nurses practice in a wide range of settings but generally nursing is divided depending on the needs of the person being nursed.

There are also specialist areas such as cardiac nursing , orthopedic nursing , palliative care , perioperative nursing , obstetrical nursing , oncology nursing , nursing informatics , telenursing.

Nurses practice in a wide range of settings, from hospitals to visiting people in their homes and caring for them in schools to research in pharmaceutical companies. Nurses work in occupational health settings [52] also called industrial health settings , free-standing clinics and physician offices, nurse-led clinics , long-term care facilities and camps.

They also work on cruise ships and in military service. Nurses act as advisers and consultants to the health care and insurance industries. Many nurses also work in the health advocacy and patient advocacy fields at companies such as Health Advocate , Inc. Nurses can work on a temporary basis, which involves doing shifts without a contract in a variety of settings, sometimes known as per diem nursing , agency nursing or travel nursing.

Nurses work as researchers in laboratories, universities, and research institutions. Nurses have also been delving into the world of informatics, acting as consultants to the creation of computerized charting programs and other software. Internationally, there is a serious shortage of nurses.

In a recent review of the empirical human factors and ergonomic literature specific to nursing performance, nurses were found to work in generally poor environmental conditions. Some countries and states have passed legislation regarding acceptable nurse-to-patient ratios. The fast-paced and unpredictable nature of health care places nurses at risk for injuries and illnesses, including high occupational stress.

Nursing is a particularly stressful profession, and nurses consistently identify stress as a major work-related concern and have among the highest levels of occupational stress when compared to other professions.

This stress is caused by the environment, psychosocial stressors, and the demands of nursing, including new technology that must be mastered, the emotional labor involved in nursing, physical labor, shift work , and high workload. This stress puts nurses at risk for short-term and long-term health problems, including sleep disorders , depression , mortality , psychiatric disorders, stress-related illnesses, and illness in general.

Nurses are at risk of developing compassion fatigue and moral distress , which can worsen mental health. Burnout and exhaustion increase the risk for illness, medical error, and suboptimal care provision. It focuses on three high risk and preventable events:. Hospitals and other healthcare facilities can upload the occupational injury data they already collect for analysis and benchmarking with other de-identified facilities, in order to identify and implement timely and targeted interventions.

Nurses are also at risk for violence and abuse in the workplace. There are a number of interventions that can mitigate the occupational hazards of nursing. They can be individual-focused or organization-focused. Individual-focused interventions include stress management programs, which can be customized to individuals. Stress management programs can reduce anxiety, sleep disorders, and other symptoms of stress.

Organizational interventions focus on reducing stressful aspects of the work environment by defining stressful characteristics and developing solutions to them. Using organizational and individual interventions together is most effective at reducing stress on nurses.

Catholic religious institutes were influential in the development of Australian nursing, founding many of Australia's hospitals — the Irish Sisters of Charity were first to arrive in and established St Vincent's Hospital, Sydney in as a free hospital for the poor.

They and other orders like the Sisters of Mercy , and in aged care the Sisters of the Little Company of Mary and Little Sisters of the Poor founded hospitals, hospices, research institutes and aged care facilities around Australia. A census in the s found several hundred nurses working in Western Australia during the colonial period of history, this included Aboriginal female servants who cared for the infirm. Enrolled and registered nurses are identified by the department of immigration as an occupational area of need, although registered nurses are always in shorter supply, and this increases in proportion with specialization.

In there were a number of rolling industrial actions around the country, culminating when five thousand Victorian nurses went on strike for eighteen days. The hospitals were able to function by hiring casual staff from each other's striking members, but the increased cost forced a decision in the nurses' favor [62].

In the European Union, the profession of nurse is regulated. A profession is said to be regulated when access and exercise is subject to the possession of a specific professional qualification. The regulated professions database contains a list of regulated professions for nurse [63] in the EU member states, EEA countries and Switzerland.

Nursing educational program in Iran is similar to the nursing educational program in other countries from some aspects. Holding secondary school diploma and passing the entrance exam is necessary for the admission in this course. Entrance exam to governmental universities and Azad University is held on separate basis. Duration of associate degree course of operating room and anesthesia is 2 years, bachelor's degree in nursing is 4 years and master's degree in nursing is 2- 2.

In the beginning, nursing educational program was the part of medical educational program. On the basis of this structure, the nurse follows the instruction of physician without any question. Nowadays, nursing educational program in Iran has been progressed and after the year considering the community base care, the nursing educational program also has changed.

At present nursing education is held in 43 governmental nursing colleges and 63 nursing colleges of Azad University. Governmental universities' students do not have to pay tuition fee, but in Azad University, which is a private university, the students must pay necessary expenses.

The PhD degree program is held only in governmental universities under the supervision of Ministry of Health and Ministry of Sciences. In bachelor's degree program, nursing students start the clinical work from 2nd term and pass till the completion of 6th term simultaneously with theoretical subjects.

At present nursing educational program in throughout Iran is the same and is compiled under the supervision of Supreme Council of Ministry of Health, Treatment and Medical Education. Nursing students take the theoretical subjects, training and internship courses in various sections of educational hospitals and hospitals that affiliated to universities.

Students' learning, in clinical sections is performed under the direct supervision and guidance of nursing instructors, but in the final year, activities of students mainly performs under the supervision of nursing personnel and alternate supervision of nursing instructors. Students, during the years of study have opportunity to create relation with patients in the various sections especially intensive care units and to achieve experiences.

Students' progress in clinical environments is from simple issues toward harder issues. At present practical nursing degree and associate degree Nursing Program has been canceled and Iranian nurses must hold bachelor's degree to work in Iran from accredited universities confirmed by the Ministry of Health. Nurse is a person who is holding four years university degree and executes works relating to nursing profession including taking care of patients, perform health and medical services, educational, research and managerial affairs.

At present annually persons are graduated in the bachelor's degree program in nursing. A person who is holding secondary school diploma in nursing and have completed 2 years program in nursing and cooperate in activities of nurses in medical sections under the supervision of nurses.

A person who is holding secondary school diploma and passing short term program for the execution of initial cares of patients under the supervision of nurses. These persons after obtaining secondary school diploma and passing university's entrance exam and completing 2 years program are in charge of performing professional duties in operation room for preparing patients for surgery and necessary cooperation with surgeons at the time of surgery.

These persons by passing the exam are eligible to continue uncontinuous bachelor's degree course in nursing. These persons after obtaining secondary school diploma and passing university's entrance exam and completing 2 years program in Anesthesia, are in charge of performing profession duties in the operating room in the field of anesthesia including preparing the patients for anesthesia and necessary cooperation with anesthesiologists at the time of operation.

These persons by passing exam are eligible to continue uncontinuous bachelor's degree course in nursing. These persons after obtaining secondary school diploma and passing entrance exam of university and obtaining technician diploma are in change of performing affairs including rendering first aid services to the patients and emergency victims resulting from accidents with motor vehicles, explosion, debris, falling from height, fractures, burns, poisonings, cuts, drowning, industrial accidents cutting of limbs , patients with heart diseases and baby delivering.

Nurses after obtaining bachelor's degree and passing the entrance exam are eligible to continue their study in geriatric nursing, pediatric nursing, medical surgical nursing, community health nursing, psychiatric nursing and nursing education. These persons after graduation mainly become in charge of nurses' education or management of medical sections. Duration of this program is 2. At present annually persons are graduated in master's degree program in nursing. Nurses by holding master's degree after passing entrance exam, are eligible to continue their study in PhD in the field of Nursing.

Duration of this program is 4 years and the graduates mainly will work in educational and research sections. At present annually 20 persons are graduated in this program. According to the censes at present approximately , nurses are working in Iran in various sections. Also, nurses are working in the hospitals affiliated to social security organization, armed forces, private sector and charity sector.

Within the last years of independence, nurses' activities are established in offices of consultancy and rendering nursing services at home. Nurses by establishment these centers can render consultant and care services to the client. At present to work as a nurse only holding accredited academic degree is sufficient, but there are programs for nurses to take RN examination after graduation.

Also, upon the approval and execution of continuous educational act, the Iranian nurses should obtain score of 15 every year in various educational courses held by the Ministry of Health of Universities, Scientific Associations and Nursing organization. To practice lawfully as a registered nurse in the United Kingdom, the practitioner must hold a current and valid registration with the Nursing and Midwifery Council.

The title "Registered Nurse" can only be granted to those holding such registration. First-level nurses make up the bulk of the registered nurses in the UK.

Second-level nurse training is no longer provided; however, they are still legally able to practice in the United Kingdom as a registered nurse.

Many have now either retired or undertaken conversion courses to become first-level nurses. Many nurses who have worked in clinical settings for a long time choose to leave clinical nursing and join the ranks of the NHS management. This used to be seen as a natural career progression for those who had reached ward management positions, however with the advent of specialist nursing roles see above , this has become a less attractive option. Nonetheless, many nurses fill positions in the senior management structure of NHS organizations, some even as board members.

Others choose to stay a little closer to their clinical roots by becoming clinical nurse managers or modern matrons. Currently, this involves completing a degree , available from a range of universities offering these courses , in the chosen branch specialty see below , leading to both an academic award and professional registration as a 1st level registered nurse.

These courses are three occasionally four years' long. The first year is known as the common foundation program CFP , and teaches the basic knowledge and skills required of all nurses.

Skills included in the CFP may include communication, taking observations, administering medication and providing personal care to patients. The remainder of the program consists of training specific to the student's chosen branch of nursing. As of , the Nursing and Midwifery Council will require all new nurses qualifying in the UK to hold a degree qualification. Midwifery training is similar in length and structure, but is sufficiently different that it is not considered a branch of nursing.

There are shortened 18 month programs to allow nurses already qualified in the adult branch to hold dual registration as a nurse and a midwife. Shortened courses lasting 2 years also exist for graduates of other disciplines to train as nurses.

This is achieved by more intense study and a shortening of the common foundation program. As of [update] student nurses in England and Wales can apply a bursary from the government to support them during their nurse training, and may also be eligible for a student loan, although there has been speculation that this will not be available in the future. Before Project , nurse education was the responsibility of hospitals and was not based in universities; hence many nurses who qualified prior to these reforms do not hold an academic award.

After the point of initial registration, there is an expectation that all qualified nurses will continue to update their skills and knowledge. The Nursing and Midwifery Council insists on a minimum of 35 hours of education every three years, as part of its post registration education and practice PREP requirements.

There are also opportunities for many nurses to gain additional clinical skills after qualification. Cannulation , venipuncture , intravenous drug therapy and male catheterization are the most common, although there are many others such as advanced life support , which some nurses undertake.

Many nurses who qualified with a diploma choose to upgrade their qualification to a degree by studying part-time.

Many nurses prefer this option to gaining a degree initially, as there is often an opportunity to study in a specialist field as a part of this upgrading.

Financially, in England, it was also much more lucrative, as diploma students get the full bursary during their initial training, and employers often pay for the degree course as well as the nurse's salary. To become specialist nurses such as nurse consultants, nurse practitioners etc. Master's degrees exist in various healthcare related topics, and some nurses choose to study for PhDs or other higher academic awards. District nurses and health visitors are also considered specialist nurses, and to become such they must undertake specialist training.

This is a one-year full-time degree. All newly qualifying district nurses and health visitors are trained to prescribe from the Nurse Prescribers' Formulary, a list of medications and dressings typically useful to those carrying out these roles. Many of these and other nurses will also undertake training in independent and supplementary prescribing, which allows them as of 1 May to prescribe almost any drug in the British National Formulary.

This has been the cause of a great deal of debate in both medical and nursing circles. Canadian nursing dates back to in Quebec with the Augustine nuns. The establishment of this mission created the first nursing apprenticeship training in North America. Most nurses were female and only had an occasional consultation with a physician. Towards the end of the nineteenth century, hospital care and medical services had been improved and expanded. Much of this was due to Nightingale's influence.

In the first formal nursing training program was started at the General and Marine Hospital in St. All Canadian nurses and prospective nurses are heavily encouraged by the Canadian Nurses Association to continue their education to receive a baccalaureate degree. They believe that this is the best degree to work towards because it results in better patient outcomes. In addition to helping patients, nurses that have a baccalaureate degree will be less likely to make small errors because they have a higher level of education.

A baccalaureate degree also gives a nurse a more critical opinion, which gives him or her more of an edge in the field. This ultimately saves the hospital money because they deal with less problematic incidents.

All Canadian provinces and territories except for the Yukon and Quebec require that all nurses must have a baccalaureate degree. However, Canada does have a condensed program that is two years long. Nursing specialty certification is available through the Canadian Nurses Association in nineteen practice areas. Canadian nurses hold a lot of responsibility in the medical field and are considered vital.

According to the Canadian Nurses Association, "They expect RNs to develop and implement multi-faceted plans for managing chronic disease, treating complex health conditions and assisting them in the transition from the hospital to the community.

Canadians also look to RNs for health education and for strategies to improve their health. RNs assess the appropriateness of new research and technology for patients and adjust care plans accordingly". Nursing was not an established part of Japan's healthcare system until with the Midwives Ordinance. This established a legal substantiation to registered nurses all over Japan. A new law geared towards nurses was created during World War II: There has been a continued effort to improve nursing in Japan.

In the Nursing Human Resource Law was passed. Those programs were designed to raise the education level of the nurses so that they could be better suited for taking care of the public. This type of nursing is designed to help the public and is also driven by the public's needs. The goals of public health nurses are to monitor the spread of disease, keep vigilant watch for environmental hazards, educate the community on how to care for and treat themselves, and train for community disasters.

Nurses that are involved with midwifery are independent of any organization. A midwife takes care of a pregnant woman during labour and postpartum. They assist with things like breastfeeding and caring for the child. Individuals who are assistant nurses follow orders from a registered nurse. They report back to the licensed nurse about a patient's condition.

Assistant nurses are always supervised by a licensed registered nurse. In Japan established the first nursing university in the country. Soon people began to want nursing degrees at a higher level of education.

Currently Japan offers doctorate level degrees of nursing in a good number of its universities. There are three ways that an individual could become a registered nurse in Japan.

After obtaining a high school degree the person could go to a nursing university for four years and earn a bachelor's degree, go to a junior nursing college for three years or go to a nursing school for three years. Those who attended a nursing university have a bit of an advantage over those who went to a nursing school. They can take the national exam to be a registered nurse, public health nurse or midwife.

In the cases of become a midwife or a public health nurse, the student must take a one-year course in their desired field after attending a nursing university and passing the national exam to become a registered nurse. The nursing universities are the best route for someone who wants to become a nurse in Japan.

These nursing universities train their students to be able to make critical and educated decisions when they are out in the field. Physicians are the ones who are teaching the potential nurses because there are not enough available nurses to teach students. This increases the dominance that physicians have over nurses. Students that attend a nursing college or just a nursing school receive the same degree that one would who graduated from a nursing university, but they do not have the same educational background.

The classes offered at nursing colleges and nursing schools are focused on more practical aspects of nursing. These institutions do not offer many general education classes, so students who attend these schools will solely be focusing on their nursing educations while they are in school.

Students who attend a nursing college or school do have the opportunity to become a midwife or a public health nurse. They have to go through a training institute for their desired field after graduating from the nursing school or college. Once they have passed their exam, they have their license for life. Like the United States, Japan is in need of more nurses. The driving force behind this need this is the fact that country is aging and needs more medical care for its people.

The country needs a rapid increase of nurses however things do not seem to be turning around. Some of the reasons that there is a shortage are poor working conditions, an increase in the number of hospital beds, the low social status of nurses, and the cultural idea that married women quit their jobs for family responsibilities. However, physicians make twice as much as nurses. They are considered lesser and oftentimes negative connotations are associated with nurses.

According to the American Nurses Association article on Japan, "nursing work has been described using negative terminology such as 'hard, dirty, dangerous, low salary, few holidays, minimal chance of marriage and family, and poor image'". Some nurses in Japan are trying to be advocates. They are promoting better nursing education as well as promoting the care of the elderly.

The JNA is not to be confused with a union, it is simply a professional organization for the nurses. Members of the JNA lobby politicians and produces publications about nursing. According to the American Nurses Association's article on Japan the JNA, "works toward the improvement in nursing practice through many activities including the development of a policy research group to influence policy development, a code of ethics for nurses, and standards of nursing practice".

The JNA also provides certification for specialists in mental health, oncology and community health. The [75] JNA is not the only nursing organization in Japan. There are other subgroups that are typically categorized by the nurses' specialty, like emergency nursing or disaster nursing. One of the older unions that relates to nursing is the Japanese Federation of Medical Workers Union, which was created in This organization was involved with the Nursing Human Resource Law.

In the US, scope of practice is determined by the state or territory in which a nurse is licensed. Each state has its own laws, rules, and regulations governing nursing care.

Usually the making of such rules and regulations is delegated to a state board of nursing , which performs day-to-day administration of these rules, licenses nurses and nursing assistants, and makes decisions on nursing issues. In the hospital setting, registered nurses often delegate tasks to LPNs and unlicensed assistive personnel. RNs are not limited to employment as bedside nurses.

Some registered nurses are independent consultants who work for themselves , while others work for large manufacturers or chemical companies. Research nurses conduct or assist in the conduct of research or evaluation outcome and process in many areas such as biology, psychology, human development, and health care systems.

Many employers offer flexible work schedules, child care, educational benefits, and bonuses. About 21 percent of registered nurses are union members or covered by union contract.

Nursing is the nation's largest health care profession, with more than 3. Nurses comprise the largest single component of hospital staff, are the primary providers of hospital patient care, and deliver most of the nation's long-term care. The primary pathway to professional nursing, as compared to technical-level practice, is the four-year Bachelor of Science in Nursing BSN degree.

Registered nurses are prepared either through a BSN program; a three-year associate degree in nursing; or a three-year hospital training program, receiving a hospital diploma. All take the same state licensing exam. The number of diploma programs has declined steadily—to less than 10 percent of all basic RN education programs—as nursing education has shifted from hospital-operated instruction into the college and university system.

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