Mary Sulakshini Immanuel is Former Dean, College of Nursing, Christian Medical College and Hospital, Vellore, Tamil Nadu. She is also Former Principal, College of Nursing, Wanless Hospital, Miraj and Former Dean, Regional Nursing Institute, Nur, Sultanate of Oman.  In 1985, she was sponsored by CMC, Vellore to study at the Teacher’s College, Columbia University from where she obtained an M.Ed and completed her doctoral studies before returning to India. This textbook is based on her vast experience of teaching the foundations of nursing to students of BSc Nursing and general nursing.

Chapter 1: Introduction to Health
Health – Factors influencing Health – Causes and Risk Factors for Developing Illness – Concepts of Health – Indicators of Health – Body Defence: Immunity and Immunisation – Immunisation – The Nature of Infection  –   Infection Control and Levels of Prevention – The Healthcare System – Health Planning – Healthcare Delivery System in India – Healthcare Agencies – Central Government – At the State Level – Panchayati Raj – Five-year Plans – National Rural Health Mission – Healthcare of the Community – Primary Healthcare – Role of the Nurse in Primary Healthcare – National Health Policy – Types of Hospitals – Hospital Organisation –  The Patient’s Bill of Rights
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Chapter 2: Nursing—Professional Practice
Definition of Nursing – Historical Perspective of Nursing – History of Nursing in India – Development of Nursing Education in India –Nursing as a Profession – Definition of a Profession – Role of the Nurse: Advocate, Critical Thinker, Rehabilitator – Expanded Educational and Career Roles: Categories of Nursing Personnel – Personal Qualities and Characterisitics of a Nurse – Standards of Nursing Practice – Concepts and Theories of Nursing – Introduction to Theories in Nursing – Theorists and their Theories of Nursing – The Health Promotion Model  – Professional Nursing Organisations – Ethics – Definitions of Ethical Principles – Code of Ethics and Professional Conduct for Nurses – The ICN Code of Ethics for Nurses –Values – Definition – Classification – Current trends in Nursing in India

Chapter 3: The Nursing Process
Basic Human Needs – Maslow’s Hierarchy o f Human Needs –Activities of Daily Living – Cultural Factors – High-level wellness – Health–illness Continuum – Behaviour in Health and Wellness – The Health Belief Model  – Illness Behaviour – Sick Role Behaviour: Impact of Ilness on Patient and Family – Settings for Nursing Practice – Essential Nursing Actions Common to all Procedures – The Nursing Process – Historical Perspective –         Advantages of the Nursing Process to the Patient – Components of the Nursing Process – Characteristics of the Nursing Process – A Framework for Accountability – Nursing Assessment – Data – Nursing Diagnosis –Formulation of a Nursing Diagnosis – The Diagnostic Process – Identification of the Patient’s Problems – Nursing Diagnosis Format – Characteristics of a Diagnostic Statement – Guidelines for Writing a Nursing Diagnosis – Planning – Setting Priorities – Establishing Patient Goals and Outcome Criteria – Outcome Criteria – Selection of Interventions (or Planning Nursing Interventions) –Writing Nursing Orders – How to write a Nursing Care Plan – Types of Nursing Care Plans – Guidelines for Writing Nursing Care Plans – Consulting –Types of Nursing Actions – Implementation – Implementing Skills – Guidelines for implementing Nursing Strategies –Evaluation – Nursing Assessment Planning Form – Critical Thinking and Nursing Judgement

Chapter 4: Communications and the Nurse–Patient Relationship
Communication – Types/Kinds of Communication – Essentials of the Communication Process – Modes of Communication – Factors that Influence the Communication Process – Techniques for Effective Interpersonal Relationships – Communication at Different Levels – Factors Influencing Communication – Barriers to Effective Communication – Helping Relationship – Phases of a Helping Relationship – Patient Teaching/Education – Planning Patient Education

Chapter 5: Admission, Transfer, Discharge and Documentation
Admission – Classification – Unit and its Preparation – Medicolegal Issues related to Admission – Transfer of Patients – Nurse’s Role in the Transfer – Discharge of the Patient from Hospital – Steps involved in Discharge Planning – Discharge Procedure  – Medicolegal Issues related to Discharge –Care of the Unit after Discharge – Documentation: Reporting and Recording – Purposes of Documentation – Guidelines for Documentation –            Systems and Methods of Documentation – Computerised Documentation – Types of Records – Guidelines to Reporting – Common Methods of Reporting

Chapter 6: The Hospital Environment
Care and Organisation of the Hospital Environment – Principles of Caring for the Environment –Daily Care of the Wards – Preventing infection and the Spread of Diseases – General Cleaning Methods – Care of the Treatment Room – Care of the Medicine Cupboard  –Care and Cleaning of Equipment and Rubber Goods – Care of Linen – Removal of Stains – General Rules for the Removal of Stains – Removal of Specific Stains – Care and Arrangement of Flowers – Providing Patients with a Safe Environment – Home Hazard Appraisal – Fire – Falls – Poisoning – Electric Shock – Excessive Noise – Radiation – Bio-medical Waste Management – Importance of Bio-medical Waste Management –                Hazards associated with Hospital Waste – Responsibilities of Hospitals – Types of Waste – Personal Safety Measures –
Nosocomial or Hospital-acquired Infections – Sources of Nosocomial Infections – CDC Guidelines for Infection Control: Standard and Transmission-based Precautions – Transporting of Infected Patients as per CDC Guidelines

Chapter 7: Mobility and Immobility, Range of Motion and Body Alignment
Structure and Functions of the Musculo-skeletal System – Factors affecting Mobility – Assessing Mobility and Immobility –Immobility: Assessing the Ability to perform the Activities of Daily Living – Pressure Sores –                 Categories of Pressure Sores – Stages in the Development of Superficial Pressure Sores – Factors affecting the Formation of Pressure Sores – Assessing Pressure Sore Points – Guidelines for assesing Pressure Areas and Pressure Sores – Nursing Diagnosis and Mobility Problems – Nursing Diagnosis for Patients at High Risk or Actual Immobility Problems – Planning Care – Implementing Nursing Interventions –    Preventing Pressure Sores – Evaluating Care – Pressure Sores: Risk Assessment and Prevention Strategies – Range of Motion Exercises – Alterations inBody Alignment and Mobility – Maintaining Body Alignment – Common Devices used to Promote Correct Body Alignment

Chapter 8: Personal Hygiene
Personal Hygiene – Oral Hygiene – Oral Care – Morning and Evening Care – Morning Care  – Evening Care  – Care of the Back – Care of the Skin: Bathing – Types of Cleansing Baths –              Bathing in the Bathroom (Tub/Shower) – Bed Bath – Complete or Partial Bed Bath – Home Care Considerations – Care of the Hair – Common Hair Problems – Combing of Hair – Shampooing the Hair  – Pediculosis: Treatment –  Care of the Nails and the Foot – Common Foot and Nail Problems – Universal Precautions – Hand-washing – Gloves – Other Protective Barriers – Infection and Medical Aseptic Practices – Perineal Care – Massage –  Effleurage –  Petrissage  – Skin Rolling – Percussion

Chapter 9: Providing Comfort, Rest and Sleep
Bedmaking and Care of Patients – The Hospital Bed – Bed Making – Post-operative Bed – Cardiac Bed – Plaster Bed – Fracture Bed – Amputation or Stump Bed – Cradle Bed – Renal/rheumatic Bed – Ambulating Patients – Restraints – Lifting and Turning Patients – Transferring the Patient from Bed to Stretcher and Vice-versa – Tranferring the Patient from the Bed to the Wheelchair and Vice-versa –Comfort Devices – Mattresses – Other Devices – Rest and Sleep  – Physiology of Sleep – Factors affecting Normal Sleep – Conditions that Promote Sleep –                Common Sleep Disorders – Nursing Diagnosis for Patients with Sleep Problems

Chapter 10: Care of Equipment and Supplies
Disinfection – Disinfection Procedures – Sterilisation – Methods of Sterilisation –               Moist Heat by Autoclaving – Chemical Sterilisation – Radiation Sterilisation of Biomedical Products and Pharmaceuticals – Dry Heat Sterilisation – CSSD Circuit – Workflow Pattern – Syringes, Needles and Gloves – Care of Rubber Goods – Care of Needles – The Hospital Power Laundry – Care of Electrical Appliances –               Hot Plate – Geyser – Refrigerator – Grinder – Inventory Keeping and Indent Maintanence – Inventory Control and Classification – Hospital Economy

Chapter 11: Meeting Elimination Needs
Bowel Elimination – Defecation – Physiology of Bowel Elimination – Factors affecting Bowel Elimination – Common Bowel Elimination Problems –    Role of the Nurse in Bowel Elimination – Characteristics of Feces – Toilet Utensils – Assessment Interview Form for Bowel Elimination – Urinary Elimination – Physiology: Normal Urination Process – Factors affecting Urinary Elimination – Common Alterations in Urinary Elimination – Common Urinary Elimination Problems – Composition of Urine – Characteristics of Normal and Abnormal Urine – Collection of Urine Specimen – Urine Testing – Maintaining Normal Voiding Habits – Assisting with Toileting – Common Procedures – Providing, Removing and Cleaning a Bedpan – Providing, Removing and Cleaning a Urinal – Use of the Flatus Tube – Suppositories – Colonic Irrigation – Catheterisation – Indwelling or Self-retaining Catheter – Inducing Voiding – Applying a Condom Catheter – Care of Urinary Diversion

Chapter 12: Meeting Nutritional Needs
Factors affecting Nutritional Needs – Factors affecting Nutritional Intake – Nutritional Assessment – Assessment Procedure – Examining the Patient for Clinical Signs of Nutritional Status – Collecting Anthropomorphic Measurements – Nursing Process: Diagnosis, Planning, Implementation – Diagnosing – Planning – Implementing – Counselling about Nutrition – Steps in Nutrition Couselling – Instructing about Diets – Administering Nasogastric Tube Feeding or Gastric Gavage – Routine Hospital Diets – Gastrostomy Feeding – Cookery and Diet Therapy – Principles and Methods of Cooking and Serving –  Storage of Food – Food and Nutrition in Hospital Service – Diet for Patients – Feeding the helpless patient  – Feeding the aged or those with long-term illness – Basic Balanced Diets – Special Instructions for Special Diets  – Soft Diet – Liquid Diet – Tube Feed Diet – Clear Liquid Diet – Menu Plan: Diet Modification for Particular Patients – Nutrition in Pregnancy – Bland Diet – High Fibre Diet – Role of the Nurse in National Nutritional Programmes

Chapter 13: Meeting Psychosocial and Spiritual Needs
Concepts of Cultural Diversity – Self-Concept – Erikson’s Psychosocial Stages – Maslow’s Hierarchy of Needs – Stress – Concepts of Stress – Definition of Stress – Sources of Stress – Responses to Stress – Adaptation – General Adaptation Syndrome – Stress Management – Sexuality – Care of Terminally Ill Patients, Death and Dying – Concepts of Loss, Grief and the Grieving Process – Signs of approaching Clinical Death and the Changes that occur after Death –             Coping with Anxiety about Death – Care of the Terminally Ill Patient and Palliative Care – Care of the Dying Patient – Role of the Nurse in caring for the Dying Patient – Advance Directives – Will – Euthanasia and the ‘Right to Die’ – Organ Donation – Care of the Dead Body and preparing it for Organ Donation, Autopsy or Embalming – Embalming – Autopsy – Organ Donation – Meeting the Spiritual Needs of Patients – Holistic Care

Chapter 14: Assessing Diagnostic Measures
Assessment of Vital Signs – Timing of Assessment – Body Temperature – Regulation of Body Temperature – Factors that affect Body Temperature – Alterations in Body Temperature – Types of Fever – Nursing Diagnosis for Patients with Altered Body Temperature – Potential/at high-risk for altered body temperature – Nursing Interventions/ Management – Assessment of Body Temperature and Sites for Body Temperature Measurement – Types of Thermometers – Pulse – Factors affecting Pulse Rate –Alterations in Pulse – Pulse Sites – Assessing the Pulse – Intervention: Technique – Respiration – Mechanism of Respiration – Factors affecting Respiration – Alterations in Respiration – Assessment of Respiration – Breathing Patterns and Sounds –  Blood Pressure – Physiology of Arterial Blood Pressure – Factors that affect Blood Pressure – Procedure for assessing Blood Pressure – Sites for measuring Blood Pressure – Selected Conditions affecting Blood Pressure – Alteration in blood pressure – Health Assessment: Health History – Types of Assessment – Health History: Components – Assisting with General Physical Examination – Methods: Palpation, Percussion, Auscultation, Olfaction – Positions used in Nursing – A Comprehensive Physical Assessment: Assessment of each Body part – Assisting with Special Exa–minations – Rectal – Vaginal – After-care of Patient and Equipment – Cultures – Smears – Blood Test – Collection and Care of Specimens – Routine Examinations of Urine: Collecting a Random Urine Sample – Collecting a Mid-stream (Clean, Voided) Urine Specimen – Collecting a Time Urine Sample – Routine Examination of Urine for Glucose, Ketones, Protein/Albumin and pH – Measuring Specific Gravity of Urine – Feces Test for Ova, Cyst – Culture – Blood Test – Kahn Test – ESR – Grouping and Cross-matching – Preparation of the Patient for X-Ray Investigation – Chest – Abdomen –Barium Swallow – Barium Enema – Bronchogram – Angiograms –  Ventriculogram – Intravenous Pyelogram – Oral Cholecystogram – Cystogram – Mylegoram –Hysterosalphingography – Splenoportogram – Epidural Venography – Venocavography – Phlebography – PTC by Chiba Needle – Salogram – Renal Ultrasonography – Catheter Irrigation – Continuous Bladder Irrigation – Excretory Urography – KUB  Radiography – Physical Assessment Chart

Chapter 15: Application of Heat and Cold
Heat Therapy: Application of Dry Heat – Filling and Applying a Hot Water Bottle – Heat Cradle – Electric Pad – Infrared Lamp – Diathermy – Heath Therapy: Application of Moist Heat – Hot Wet Pack – Hot Dry Pack – Simple Fomentation – Topical Medication Administration – Topical Administration: Application to the Skin – Counter Irritants – Common Counter Irritants – Medicated Fomentations – Turpentine Stupes – Mustard Plaster – Poultice – Administration of medication into the mucous membrane – Cold Applications – Cold Compresses – Cold Sponge Bath – Cold Pack – Ice Cap – Sedative Wet Sheet Pack – Application of Binders and Bandages – Binders – Types of Binders – Bandages – Types of Bandages

Chapter 16: Administration of Medication
Principles of Medication Administration – Purpose of Medication – Safety and Medication Errors – Common Abbreviations – Common Abbreviatons for Prescribing and Administering Medication – System of Drug Measurement – Classification and Therapeutic Effect of Drugs – Drug Forms – Factors influencing Drug Action – Adverse Drug Effects – Administration of Oral Medicines – Time and Method of Administration of Drugs – Basic Principles – Buccal Administration of Medicine –                Advanced Techniques –                Care of Medicine Cabinet – Charting – New Patients – Pre-operative Patients – Infusions – Herpodermoclysis – Intravenous Infusions or Venoclysis – Blood Transfusion – Blood Bank – Administration of Blood and Blood Products – Blood Transfusion Procedure  or Venipuncture– Blood Reactions – Inhalational Methods – Moist Steam Inhalation – Inhalation for Systemic Effect – Instillation – Instillation of the Eye – Instillation of the Ear –       Nasal Instillation or Nasal Drops – Irrigation – Irrigation of the Eye –             Irrigation of the Ear – Nasal Irrigation  – Other Methods of Medicine Administration – Parenteral Medication – Sites for Injections – Precautions for Biohazard Patients (HIV, AIDS, Hepatitis B and C) – Intradermal Injections  – Subcutaneous or Hypodermic Injections – Fractional Dosages – Procedure for giving Morphine and Atropine – Insulin Administration – Intramuscular Injections – Intravenous Injection – Intravenous Glucose –            Needlestick and Sharps Injuries – Retention Enemas – Radiotherapy – Types of Radiotherapy – The Role and Responsibilites of the Nurse – Calculation of Drug Dosage

Chapter 17: Special Medical Procedures
Oxygen Therapy – Factos affecting alterations in oxygenation – Oxygen Supply – Methods of Oxygen Administration – Pulse oximeter – Hazards of Oxygen Administration – Artificial Respiration – 108 Ambulance Scheme – Self-inflating breathing bag –Termination of Prolonged Mechanical Ventilation – Use of Mechanical Ventilators: IPPB – Deep Breathing and Coughing Exercises – Tracheal or Endotracheal Suctioning – Central Venous Pressure Monitoring – Nebulisation Therapy – Postural Drainage: Percussion – Basic Life Support – Common Emergencies that require BLS – Adult Chain of Survival –               Recognising Life-threatening Emergencies –The Steps of CPR – Bag–mask devices – Adult Foreign Body Airway Obstruction – Maintanence of Patient Airway and Breathing – Isolation Technique – General Principles – How Communicable Diseases are spread – Gown Technique – Mask Technique – Handwashing after Patient Care – Care of Contaminated Linen –        Cleaning after Discharge of Isolated Patient – Isolation Room – Principles of Sterile Technique – Principles for Handling Sterile Supplies – Tidal Drainage – Pain Management – Types of Pain – The Nature of Pain – Components of Pain – Factors that influence the Perception and Meaning of Pain – Assessing Pain – Physiological Basis of Pain – Care of Patient with Pain – Specific Pain Therapies

Chapter 18: Special Surgical Procedures
Definition and Concepts of Perioperative Nursing – Pre-operative Phase: Skin Preparation – Shaving – Operation Bed – Post-operative Phase: Recovery from Anesthesia – When the Patient returns from the Operation Theatre (Post-operative Phase) – Recovery Room – Duty of the Recovery Room Nurse Post-operatively – Shock – Care of Wounds –          Dressing – Wounds: Types, Classification and Wound Healing Process – Factors that affect Wound Healing – Care of Wounds – Wound Irrigation – Sutures and their Removal – Catheterisation – Bladder Irrigation – Artificial Feeding – Colostomy Irrigation – Sitz Bath – Bowel wash – Wangensteen Suction – Gastric Analysis – Gastric Lavage or Gastric Irrigation – Dialysis –Peritoneal Dialysis

Chapter 19: Fluid, Electrolyte and Acid–Base Imbalances: Basic Concepts and Intervention
Review of Physiological Regulation of Fluid, Electrolyte and Acid–Base Imbalances: Body Fluid and Body Water – Factors affecting Fluid and Electrolyte Balance – Electrolytes – Fluid and Electrolyte Movement – Homeostatic Mechanism – Regulation of Electrolytes – Acid–Base Balance –Fluid Imbalances – Fluid Volume Excess (FVE) – Electrolyte Imbalances – Hyponatremia – Hypernatremia – Hypokalemia – Hyperkalemia – Acid–Base Imbalances – Measuring Fluid Intake and Output – Restriction of Fluids – Replacing Fluids: Administering Parenteral or Intravenous Therapy – Changing IV Solutions and Tubing – Changing Infusion Tubing – Administering Blood Transfusion

Chapter 20: Meeting the Special Needs of Patients–
Careof Patients having Alterations in Temperature – Hyperthermia and Hypothermia – Heatstroke – Types of Fever – Clinical Signs of Fever – Nursing Interventions/Management – Care of Patients having Alteration in Sensorium – Unconsciousness – Classification of Unconsciousness  – Causes of Unconsciousness – Assessment – Additional Neuro Checks – Nursing Interventions for the Delirious Patient – Nursing Interventions for the Unconscious Patient/Management – Functioning of Sensory Organs – Visual Impairment – Hearing Loss and Impact on Communication – Assessment of Self-Care and Communication in Hearing Impairment – Mental State: Assessment of Self-Care ability of the Mentally Challenged and Communication Methods – Communication Methods – Care of Vulnerable People – Communication in Vulnerable Groups

Nursing Care Plans
Model Question Papers
Answer Key
Index