1.

Nursing professional
・Development of nursing
A. Nurse should respond to patient, perform the best practices, expand knowledge
through research and participate actively in policy making.
B. #Florence Nigtingale 南丁格爾：貢獻
1. Develop the fundamental of nursing that based on health maintenance and
restoration 恢複;
2. Develop the first organized training program for nurse
3. Improved and promote sanitation in hospitals
C. Nursing is considered in 20 Century a professional that move toward scientific,
evidence-based practice and defined body of knowledge.
D. #Nursing nowadays faces to Curriculum change (Terrorism or Disaster…) and
Stronger need of knowledge (Technology, Aging population and the need of
early discharge…)
E. Nursing should and will changes after the any change (or needs) in society.

・Professionalism 專業性 and standards of Nursing Practice

A. #We are a profession that requires continuing and in-service education 持續學習,
theoretical body of knowledge 理論基礎 and autonomy 自主, provide specific
service, and incorporates the code of ehics 道德準側
B. # Care, Cure Coordination are the Essential components of Nursing practice and it
provide the Standards or Guidelines for implementing and evaluating nursing care
C. Responsibilities and Roles：
1. #Caregiver, Advocate, Educator, Communicator, Leader, Manager.

・Trends in nursing
#Nursing nowadays are perform patient-centered care, teamwork and collaboration,
evidence-based practice, quality improvement, safe and informatics.

2. Health Care Delivery System

There are two type of integrated health care systems:
1. Follows the economic imperatives 經濟需要
2. Support an organized care delivery approach：例如：Patient-centered medical
home model
A. Traditional Levels of Health Care：#6 Level
・Preventive care：Health promotion that focuses on keeping people healthy
resulting in reducing or controlling the risk factors and incidence of disease.
・Primary：Medical health care services, Education, Nutritional counseling,
Maternal/child care, Family planning, and Control of diseases.
・Secondary：Provide by specialist upon referral 轉介 by Primary health care.
・Tertiary：Specialized consultatively Provide upon referral by Secondary：1.
Discharge 出院 planning 2. Intensive Care 重症監護 3.. Mental care 4. Critical
access hospital
・Restorative Care 復康：1. Home care 2. Rehabilitaion 復原：Enables people
with disabilities to reach and maintain their access of Daily activities.
・Continuing Care：A Long term services of Health, personal and Social for those
that suffer a Terminal disease or Permanent disabled THAT provide by Some Home
nursing facilities (Adult day care centers…).
B. Health care Costs and Quality
1. Social Security Act：Insurance
2. Inpatient prospective payment system (IPPS)：Diagnosis-related.
3. Centers for medicare and Medicaid innovation Center 醫療補助創新
中心：Test new payment and service delivery models, Evaluate some
advancing practices and engage the stakeholder to develop additional
models for testing
4. Affordable Care Act：Ties payment to quality ratings
5. Incentivized reforms 激勵改革：Hospital value-based purchasing,
Readmissions reduction program and bundled payments for care
improvement
C. Patient Satisfaction
1. Factors that may affect Patient Satisfaction：Relational
communication techniques, Bedside shift reporting, Courtesy 禮貌 and
Respect; Explanation and clear information.
D. Issues in Health Care Delivery system
1. #Nursing shortage：The need for health care grows, Aging nurses are
retiring from work and Nursing school are struggling to expand capacity.
2. Principles of patient-centered care
3. Magnet recognition program
 4. Technology in health care
5. #Health care Disparities：Inadequate resources, Poor communication
between care giver and patient, Lack of culturally competent to care,
Inadequate access to language services.

#Patients’ Charter 病人約章

Right to KNOW 知情權, DECIDE 決定權, KEEP CONFIDENTIAL 保
密權, ACESS INFORMATION 申領權, COMPLAIN 申訴權,
RESPONSIBILITIES AND OBLIGATIONS 義務
#Payment exemption 豁免 in Macau health care system：
1. Pregnant women and labor within one month.
2. Children under 1p years-old or Student with Student card and BIR
3. Health care card (金卡)
4. Poor citizen (醫療援助衞生護理卡『黃卡』)
5. Persons over 65 years-old
6. Carriers of infectious-contagious diseases, drug-addicts, cancerous patietns and
mentally-disordered (特殊病患衞生護理證『藍卡』)
7. Prisoner
8. Public officials（公職人員及家屬衞生護理證『綠卡』）
-Scope of Services
1. Provide primary healthcare to individuals and families
2. Conduct immunization 3. Plan and initiate health education activities
4. Perform health examination and disease screening
5. Evaluate and refer cases to specialist out-patient

3. Ethics
・Definitions
Ethics 倫理：Standards of conduct, particularly right or wrong behavior
Morals 道德：Judgment about behavior, based of specific beliefs
Values 價值：Personal beliefs about the worth of given idea, custom or
object
Biothics 生物倫理：The study of ethics within the field of health care
・Ethical principles 倫理原則：#Every nursing practice should

consider the follow order：

Autonomy 自主： Self-determination of the best interests up to patient
Justice 正義：Fairly distribute the healthcare resources
Fidelity 忠誠：Faithfulness and Striving to keep promises 誠實守信
Beneficence 善行：Actively seeking the benefits to help patients
Nonmaleficence 不傷害：Actively seeking to do no harm or minimize
the harm when the action may be necessary to promote health.

・#American Nurses association CODE OF ETHICS for

nurse：
-Responsibility 責任：the performance of Duties
-Accountability 問責：The ability to answer for one’s own action
-Respect for confidentiality：Protect patient information
-Competence 能力：the provision of safe nursing care
-Judgment：The ability to from an opinion or conclusion
-Advocacy 代言：Involves speaking up for Patients 為病人發聲

・Ethical issues or dilemma 困境 in Nursing

-# Ethical dilemma will exists when the right thing to do is not clear or members of
the care team cannot agree on the same idea.
- # Ethical dilemma require Negotiation 協商 of differing point of view and first
clarify our own point of view by considering the follow Ethical Theory：
1. Deontology 道義：Defines action as right or wrong based on Truth and Justice
2. Utilitarianism 功利主義：The greatest good for the greatest number of people
3. Virtue ethics 倫理美德 4. Feminist ethics 女權主義 5. Ethics of. Care 護理倫理
6. Casuistry (Case-based reasoning)詭辯

・# We should follow 7 steps When face to Ethical Dilemma

Step 1. Ask “IS THIS AN ETHICAL DILEMMA”
Step2. GATHER all the information relevant to the case
Step3. Examine and determine our own values and opinions
Step4. State clearly the problem
Step5. Consider all the possible action
Step6. Negotiate the outcome
Step7. Evaluate the action
4. Communication
-Basic Element：Sender, Receiver, Message, Feedback, Channel, Interpersonal
variables 人際差異 and Environment
-Forms of Communication:
A. Verbal 語言：Vocabulary use, Connotative meaning 內涵, Intonation 語調
and volume, Clarity and brevity, Timing 時機.
B. Nonverbal 非語言：Appearance 形象, Posture and gait 姿勢和步態，Facial
expression, Eye contact, Gestures 手勢, Personal space 空間
-# Therapeutic communication 治療性溝通 can Empower others and Enables
people to make Health- promoting choices that can be divided into Intrapersonal
(Individual), Interpersonal (within at least two people), AND Public communication.
-Tips for clear communication：
1. Lead actively with the most important information by break down the complex
message to Understandable
2. Plan multiple short teaching session with simple Language and avoid Jargon 術語
-The Nurse-Patient Relationship：AIDET: Acknowledge 承認, Introduce
ourself, Duration, Explanation AND Thanks
1. Preinteraction phase：OCCURS BEFORE meeting the patient
2. Orientation phase：Nurse and patient know more each other
3. Working phase：Work together to solve problem and accomplish goals
4. Termination phase：OCCURS AT THE END of a relationship
-The Healthcare team Relationships: #Effective communication can positively
influences the teamwork and staff satisfaction and improve quality of patient care and
safety by use of HAND-OFF communication and Common Language (SBAR)
-#Essential to Establishing a Therapeutic relationship：Professionalism, Courtesy 禮
貌, Confidentiality, Trust, Acceptance, Respect AND Presence 存在
-Nursing implementation of Therapeutic communication should be：
#・Conveying empathy 傳達同理心, Active listening, Sharing observations, Using
silence, Providing information, Clarifying 澄清, Focusing, Paraphrasing,
Summarizing, Self-disclosure 自我披露 And Instilling hope 灌輸希望
・NOT Inattentive listening, Overusing medical vocabulary, Prying 窺探 or asking
personal question, Giving judgment, Changing the subject, Automatic response, False
reassurance 虛假保證, Arguing 爭論, Being defensive 防禦, Sympathy only.

5. Health and Wellness

-Definition：
1.・#Health（WHO）：The state of complete Physical, Mental, and Social well-
being, not merely 僅僅 the absence of disease or infirmity 虛弱
・Health is a state of being that people define in relation to their own values,
personality, and lifestyle. INCLUDING：Highly individua. Perception, Vary
According to previous experiences, age and sociocultural influences, Being free from
disease and pain, Being able to be active and do everything they want, Being good
spirits most of the time.
2. ・#Wellness：Seven components：
-Social wellness：Ability to connect with other in our world
-Emotional：Ability to understand ourselves and cope with challenges
-Spiritual 精神：Ability to establish Peace and Harmony 和平與和諧 in live
-Environmental：Ability to recognize the responsibility for the quality of AIR,
WATER and LAND
-Occupational：Ability to get personal fulfillment from jobs while maintaining
balance in live
-Intellectual 智力：Ability to open our mind to new ideas and experiences
-Physical：Ability to maintain a healthy life that allows to get through Daily
activities without undue 不當的 Fatigue or Physical stress
3. ・Illness： May resulting in Behavioral and emotional, body image, self-concept,
and family roles and dynamics CHANGE
A. Acute：Rapid and Abrupt 突然 onset of severe symptoms, but short
duration
B. Chronic：Irreversible 不可逆 and Permanent 永久 alterations that persists
longer than 6 months

-Models of Health and Illness：

1. Health Belief model: Addresses the relationship between a person's beliefs and
behaviors
2. Health Promotion model: Directed at increasing the level of well-being
3. Holistic 整體 Health model: Attempts to create Conditions that promote optimal
health
4. #Basic Human Needs model: Attempts to meet the patient’s needs
・Maslow’s Hierarchy of Human Needs 馬斯洛的需求層次理論 （FROM TOP
TO BOTTEM）
A. Self Acttualization 自我實現：Need to realize our fullest potential
B. Esteem 自尊：Achievement, confidence, respect
C. Love and Belonging 歸屬感：Friendship, family, sexual intimacy 性親
密
 D. Safety and Security：Body, employment, resources, health…
E. Physiological needs 生存基本需要：Breathing, food, water, sex, sleep…

-Variables influencing health and health beliefs and practices：

・INTERNAL VARIABLES：Developmental stage, intellectual background,
emotional and spiritual factors.
・EXTERNAL VARIABLES：Family practices, Socioeconomic ,and Cultural
factors

-Risk Factors toward to illness：

・Genetic 基因 and physiological, Age, Environment and Lifestyle
・Identification：Help patients know that must changed to promote wellness or
prevent illness
・Modification and changing health behaviors：Implement health education
programs to change risky health behaviors.

-#Three Levels of Prevention：

1. Primary：TRUE PREVENTION to lower the chances of disease
2. Secondary：Focuses on who have a disease and are at risk for developing a
disease
3. Tertiary：Occurs when defect or disability is irreversibl

6. Safety
National Voluntary Consensus Standards for Public Reporting of Patient Safety
Events forms the “Framework for publicly reporting patient safety events, indicators,
and measures about health care organization to consumers”
-#Safety in the workplace Should be Acknowledges risk 承認風險，Pursures safet
追求安全，Fosters a blame-free environment 營造無責備環境，Commits resources
保證資源
・Avoid CHEMICAL EXPOSURE, FALL, PATIENT-INHERENT 患者固有的,
PROCEDURE-RELATED and EQUIPMENT-RELATED accidents.
*Procedure-related accidents: Patient ID, Communication, Medication safety, Risk of
Infection, usage of checklists.
・Avoid WORKPLACE VIOLENCE 暴力(often from patients)
・Be aware of working in OVERCROWDED, ISOLATION area,
TRANSPORTING patietns, or working with Volatile patients 易變患者
-# Quality and Safety Education for Nurses (QSEN) can be used to minimizes the
risk of harm to both the patient and providers：Nurse should have the ability to
promote safety AND the continuous improvement is essential
-#A safe environment SHOULD BE
1. Meet the basic of human needs：Use of Oxygen (Fire safety and avoid carbon
monoxike 一氧化碳), Nutrition (food safety) , Temperature
2. Reduces physical hazards：Vehicle accidents, Poison, Fire, Falls 跌倒, Disasters
3. Reduces transmission of pathogens：Prevention, Immunization, and Avoid
pollution

-Common Safety Hazards by Developmental Levels related to

lifestyle, sensory impairments, impaired mobility, cognitive impairments, Physical
And emotional health and Awareness of safety
A. Infant 嬰兒, Toddler 幼兒, Preschooler：Choking, drowning, burn, cut, poison
B. School-age：Injuries of all kinds, dangerous Environment that requires education
about safety play, and use protective safety equipment
C. Adolescent：Drug or alcohol abuse, drowning, sport injuries, Motor vehicle
accident…
D. Adult：Safety issues related to lifestyle habits, stress, decline stamina 耐力
E#. Older adult：Age-relate physiological changes (Loss of muscle strength, slow of
reflexes), effects of medication, Falls, burns.

-Common Nursing diagnosis AND Intervention 介入 related to

safety
・Diagnosis：1. Risk for falls 2. Impaired Home maintenance 3. Risk for injury 4.
Deficient Knowledge 5. Risk for poisoning 6. Risk for suffocation 窒息 7. Risk for
trauma
・#Intervention：
1. Specific Health promotion (Passive or active strategies) for different development
level
2. #Acute care to prevent FALLS：
・#Promote safe patient room environment：Keep illuminated 照明 at all
time，Call button within reach, Non-exit side rails up for support, Bed alarm,
Bedside commode 床邊馬桶 placed alongside bed if needed, and Non-skid 防滑
footwear.
・#Restraints 約束 (Should be minimized the number of use, and USE ONLY
every as a LAST method) to prevent Fall (Place two fingers under restraint to check
tightness and with a QUICK-RELEASE tie AND Remove restraints AT LEAST
EVERY 2 HOURS to allow freedom)：Jacket, Belt, Extremity (Ankle or wrist),
Mitten 連指手套, Straps of vest 背心帶 and Elbow Restraint.

7. Infection Control and Asepsis

A. Identify the normal defenses of the body against infection
Infection: The invasion 侵入 of a susceptible host by potentially harmful
microorganisms, resulting in disease.
# NORMAL DEFENSES MACHANISMS：
・Body system defenses: Mouth, Eye, Respiratory track, Urinary tract, GI Tract
and Vagina 陰道.
・Skin integrity 皮膚完整度, and Normal Flora inside the Intestine
・Immune response 免疫應答 AND Inflammation 發炎
B. Discuss the development of the inflammatory response
C. Describe the signs and symptoms of a localized and a systemic infection
-Localized 局部：Inflammatory (Pain, Swelling, Fever, Tenderness 紅腫熱痛)，
Increase WBC
-Systemin (Generalized)全身：Fever, Headache, Increase Pulse and respiratory rate,
Shortness of breathing, Loss of energy (Malaise 全身乏力)，Anorexia 厭食, Nausea
噁心, Vomiting 嘔吐, Enlarged lymph nodes 淋巴結腫大
D. Describe characteristics of each link of the infection chain
・Infection chain：Infectious agent 媒介, reservoir 感染群,
portal of exit, modes of transmission, portal of entry, susceptible host 可疑宿主.
* #Modes of transmission：
A. Contact：Direct, Indirect, Droplet or Airbone
B. Vehicles：Contaminated items, water, food, blood, drugs
C. Vector 蟲媒：Mosquito, louse, tick, flea 虱子, 蜱, 跳蚤
E. Assess clients at risk for acquiring an infection
# Hospital roommate, OVER 70 years Old, Using Antibiotic, Using urinary catheter
導尿管, Prolonged ICU stay, COMA 昏迷, SHOCK 休克, TRAUMA 外傷,
IMPAIRED Immune system，Undergoing Immunosuppression or chemistry
therapies 免疫抑制或化學治療
F. Explain conditions that promote development of health care-acquired infection
(HAIs).
#HAIs MUST be diagnosis ONLY occur：病人因非感染的原因入院後 48 小時內，
出院後 3 日內或手術後 30 日內
HAIs can be Exogenous 外源性 or Endogenous 內源性：Exogenous infection
comes from microorganisms found outside the individual；Endogenous occurs when
part of a patient’s
flora becomes Altered or Overgrowth.
G. Identify principles of medical and surgical asepsis.
・Medical asepsis：1. Control of portals of entry, 2. Protect susceptible host 3.
Infection. prevention and control of the infection agents. 4. Health promotion in
health care worker and patients
・Surgical asepsis is Designed to eliminate all microorganisms, including spores 孢
子 and pathogens 病原體：#1. Sterile 無菌 object remains sterile only. 2. Place
ONLY sterile objects on the sterile field 3. The field OUT OF THE VISION or
HELD BELOW WAIST is considered CONTAMINATED 污染 4. Sterile
becomes contaminated when PROLONGED EXPOSURE to air 5. When sterile
surface contact with a WET surface is considered contaminated 6. Hold our hand
ABOVE THE elbows 7. The edges of 2.5cm (1-inch) border around a sterile towel
 or drape is considered contaminated.
H. Describe strategies for Standard precautions.
#-Hand hygiene, Surgical mask, Use of face shield, gloves and gowns. BUT no need
of Single OR Negative pressure rooms
I. Describe nursing interventions designed to break each link in the infection chain.
HAND WASH (40-60 seconds) OR ALCOHO-RUB,
Sharps container, disposable blood pressure BP cuff
AIRBORNE PRECAUTIONS 空氣傳播預防措施: Droplet nuclei SMALLER than 5
microns
DROPLET PRECAUTIONS 飛沫傳播: Droplet nuclei LARGER than 5 microns
CONTACT PRECATTIONS: Direct or Indirect (environment) precaution,
USING OF PERSONAL PROTITICE EQUIPMENT (PPE)：Gowns, Gloves, Mask,
Goggle 眼罩 or Face shield 面罩.
J. Describe the Five Moments for hand hygiene.
#-BEFORE TOUCHING PATIENT；-BEFORE CLEAN/ASEPTIC
PROCEDURE；-ATFER BODY FLUID EXPOSURE RISK；-AFTER TOUCHING
PATIENT；-AFTER TOUCHING PATIENT SURROUNDING

8. Vital signs
A. Accurately assess body Temperature, pulse, respiration, oxygen saturation, and
Blood pressure.
*Assess WHEN Admission, Routine, Before, During and After some procedure:
Operation, Diagnostic, Transfusion of blood, Therapies that will affect the vital, Pain
or loss of consciousness.
-Temperature：#Heat produced - Heat lost = Body temperature which is CONTRAL
BY HYPOTHALAMUS 下丘腦，and it should be MAINTAIN within a NARROW
range.
*Centigrade to Fahrenheit = {Centigrade * 9/5} + 32
#Measured through Temporal artery 顳動脈, Tympanic membrane, Rectal, Axilla,
Skin, Oral
-Pluse：Can be assessed through #Radial pulse 橈動脈脈搏 OR Apical pulse 心尖
脈搏, AND recorded INCLUDING both the RATE, RHYTHM AND QUALITY 速率，
節奏，質量
 -Respiration：One respiration must be FULLY consists of one inspiration and one
expiration，we Should RECORDED INCLUDING both the RATE, DEPTH and
Rhythm.
*MALE and Child usually demonstrate the Abdominal breathing while the Female is
Thorax
-Oxygen saturation：Frequency attached to the client’s Finger, Toe or Earlobe
-Blood pressure：Compose of Systolic and Diastolic pressure, and The Pulse
pressure means THE difference between Systolic and Diastolic pressure.
• Average adult systolic range: 100 to 140 • Average adult diastolic range: 60 to
90mmHg
• Blood pressure consistently over 140/90 mmHg is considered as HYPERTENSION
•Systolic pressure below 90 mmHg is considered as HYPOTENSION
B. Describe factors that cause variations in vital signs
-#Temperature：AGE related (Inadequatte stored fuel or malnutrition), TIMING,
CIRCADIAN RHYTHM 晝夜節律, EXERCISE, HORMONE LEVEL (Women
generally experience greater fluctuations 波動 in body temperature than men.),
STRESS, ENVIRONMENT（Humidity 濕度，Extremely hot or cold）, IMPAIRED
THERMOREGULATTION (congenital, effect of medication, sepsis…),
INCREASED HEAT LOSS (Skin burn, Acclimatization 水土不服…
-#Pluse：AGE (Opposite with pulse rate), EXERCISE, FEVER, MEDICATION,
HEMORRHAGE of exceed 500ml blood loss, STRESS, POSITION CHANGE
-Respiration：Levels of carbon dioxide, Oxygen, and hydrogenion 氫離子
concentration(pH) in the arterial blood, AGE (Opposite with respiration rate),
MEDICATION, STRESS, EXERCISE, ALTITUDE 海拔, GENDER (Men normally
faster that women)
-Oxygen saturation：/
-Blood pressure：BLOOD VOLUME (lots of blood loss), AGE (increase with BP),
GENDER (female is relatively lower while menstruation 經期), EXERCISE,
CIRCADIAN RHYTHM, OBESIITY, EMOTIONAL, BODY POSITION and
MEDICATION.
C. #Identify ranges of acceptable Vital sign values in an adult.
-Temperature (T): 36oC to 38 oC, (Oral/tympanic 鼓膜 36.5 -37.5 oC，Rectal37-38
o
C，Axillary36-37 oC, Forehead35-37 o)
*HYPOTHERMIA：＜35 oC；HYPERTHERMIA：＞40 oC
-Pulse (P)：60-100 beats/min；
-Respirations (R)：12-20 breaths/min -Oxygen saturation (SpO2): 95%-100%
-Blood pressure (BP): Normal is under 120/80 mmHg， Average：
<140/90mmHg，Pluse pressure 30-50mmHg；
D. Explain variations in techniques used to assess vital signs for an adult.
-Temperature: • Glass mercury 水銀 • Electronic 電子 with heat sensitive probe
for oral, axillary and rectal • Infrared Tympanic 紅外鼓膜 for the SEALED 密閉的
ear canal
1. ORAL Site：2-3 minutes for measuring, but At least 20mins after drinking hot
or cold.
Contraindications 禁忌：Patient under age 6, Unconscious or Paralyzed 癱瘓, with
oral or face injury, NG tube in place, History of seizure 癲癇, confused 困惑
2. AXILLARY Site：Safe and noninvasive that need 5-10 minutes for measuring.
3. RECTAL Site：Position in Sims’ left lateral position that NEED lubricated and
3minutes for the MOST Accurate measuring.
Contraindications 禁忌：Patient with diarrhea, rectal problem or surgery, Certain
heart disease
4. TYMPANIC MEMBRANE Site：Safe and easy that need 2-3seconds for
measuring with pull the ear slightly Upward and Backward, but at least 15mins after
inside from outdoors on cold day,
Contraindications 禁忌：Patient with ear drainage (blood or spinal fluid)
5. Forehead Site：1-3 seconds for measuring
-Pluse：・Finger・Stethoscope 聽診器
1. RADIAL ARTERY Site：The radial bone side of the wrist, CAN BE measure
that pressing lightly with INDEX and MIDDLE finger without disturbing or exposing
the patient
2. APICAL PULSE Site：5th intercostal space directly below center of left
clavicle, Measure by used of a CLEAN and WARM stethoscope
-Respiration：
1. DIRECTLY INSPEC and PALPATE the chest movements.
2. COUNT EACH TIME THE CHEST RISES：Should be
SURREPTITIOUSLY 秘密地 observe the rise and fall while appear to taking their
pulse
-Oxygen saturation：1. Use of noninvasive Pulse Oximeter 脈搏血氧儀
-Blood pressure：・Sphygmomanometer 血壓計（MERCURY 水銀 OR
ELECTRONIC），
The cuff size should be suitable UP to the circumference of the limbs,
normally The width should cover roughly 40% of the arm circumference, and the
height should be Long to cover at least 2/3 of the limb’s circumference：
-The site of measuring：Forearm（Brachial Artery 肱動脈）, Thigh（Popliteal
Artery 膕動脈）or Leg
Contraindications 禁忌：The side of the arm that with INJURY or BLOCKED
ARTERY, History of Mastectomy 乳房切除術, Implanted device is under the skin

9. Immobility
A. Describe the concepts of mobility and immobility.
-When patients experience conditions that seriously threaten their ability to remain
mobile, nurses take actions to reduce or prevent the effects of immobilization
including Prolonged bed rest, Immobilitye 活動制限 and Immobilization 制動
-Postural abnormalities：Acquired or congenital of the functioning of the
musculoskeletal alter functioning and may result in Pain, Impaired alignment, and
Impaired mobility.
-Muscle abnormalities （Muscular dystrophy 肌肉萎縮）：Injuries and disease
can lead to numerous alterations in musculoskeletal function.
-Damage and disorders affecting the central nervous system：
1. Trauma from a head injury, ischemia from a stroke (cerebrovascular accident,
CVA), or bacterial infection such as meningitis that results in impaired movement,
body alignment, balance and coordination.
2. Amyotrophic lateral sclerosis, Parkinson diseas, Multiple sclerosis,
Myasthenia gravis that affect the function of neurons Resulting in loss of control of
the voluntary muscles
B. Discuss the physiological and psychosocial changes associated with immobility
and identify the impact changes have on nursing interventions.
Physiological change：Activity intolerance 活動不耐受 because of pain, impaired
endurance of muscle skeleton system and nutritional chang.
Psychosocial changes：Reduces independence and creates a Sense of loss 失落感,
Depression, Social isolation, Sleep wake disturbances, and Impaired coping Resulting
in Sadness, Hopelessness, Worthlessness, Emptiness 空虛, Helplessness.
！！#PLANING and INTERVENTION: Providing for ROM exercises, Strength
training, Endurance and joint training, Patient repositioning (Turn every 2 hours, Help
patient sitting position in bed or stretch chair), Plan some relevant teaching session to
give health promotion.
-High-Fowler’s Position at 60o, Semi-Fowler’s Position at 30o, Trendelenburg
Position 頭低腳高位, Sim’s position 半俯臥位, Supine position, Prone position,
Lateral position, Dorsal lithotomy, Knee-chest position, Dorsal recumbent position 曲
膝背卧位, Lithotomy position
C. Describe complications associated with the physiological change of immobility.
• Cardiovascular changes：Increased cardiac workload, #Venous thrombosis 靜脈血
栓
• Respiratory changes：Increased secretion, Atelectasis 肺不張，Acid-base
imbalance
• Metabolic changes：Decreased appetite result in poor nutrition, and metabolic
disturbances
• Fluid and electrolyte balances：Diuresis 利尿
• Gastrointestinal changes：Constipation
• Musculoskeletal changes：Decreased muscle Size, Tone 肌張力 and Strength 強
度，Decreased joint mobility and flexibility, Osteoprosis 骨質疏鬆症
• Integument (Skin) changes：Pressure injuries 壓傷
• Urinary elimination changes：Urine retention, UTI, Urinary tract stone
D. Identify appropriate nursing diagnoses for clients with impaired mobility.
• Ineffective airway clearance • Risk for constipation • Risk for disuse syndrome 廢用
綜合徵
• Risk for falls • Impaired bed mobility • Impaired physical mobility • Impaired sitting
• Risk for impaired skin integrity
E. Explain the techniques for assessing body alignment and impaired mobility.
F. Discuss risks for development of deep vein thrombosis.
#• Surgery • Trauma • Long periods of not moving – bed rest •Smoking
• Cancer therapy • Age • Pregnancy • Heart failure • Hypertension
• Hyperlipidemia • Nephrotic syndrome 腎病綜合徵 • Autoimmune disease •
Obesity
G. Applying Antiembolic compression stockings
Purpose：#Promote supplementing the action of muscle contraction to prevent Deep
vein thrombosis.
#Measure length (heel to groin) and width for proper fit before first application

10. Exercise and Activity

A. Describe the role of the musculoskeletal and nervous systems in the regulation of
activity and exercise.
-Function of musculoskeletal system：Skeletal muscle contractions TO MAINTAIN
POSTURE
-Exercise involves physical activity, exerting the body with movement, and
increasing the heart rate that are physical activity used to condition the body, improve
health, and maintain fitness.
-Good posture is essential for proper body alignment 身體線條, Muscles, joints,
and internal organs all function more efficiently when maintain Good posture and
Alignment by proprioception 本體感覺 and sense of balance. They allow you to
protect our body during movements such as lifting, carrying, or changing positions.
B. Discuss how to assess patient body alignment and levels of activity and exercise.
-Proper Alignment： HEAD, SHOULDERS, SPINE, HIPS, KNEES, and ANKLES
relate and line up with each other THAT can be Minimize the stress on the Spine
resulting in Enhancing BODY Balance with the center of gravity 重心平衡 to
decrease the risk of falling
C. Discuss physiological and pathological influences on body alignment and joint
mobility.
-Skeletal abnormalities Muscular impairments Metabolic illness Hypoxemia
Impaired cardiopulmonary function Pain Sleep disturbance
-Anxiety, Depression, Chemical addiction, Motivation
-Age, Gender, Pregnancy
D. Formulate nursing diagnoses for patients experiencing alterations with activity and
exercise.
-#Activity intolerance, Chronic pain, Fatigue, Risk for injury, Impaired physical
mobility, Impaired sitting, Impaired walking
E. Range of motion: active and passive
#JOINT TYPE: Uniaxial joint 單軸 (Pivot 車軸 or Hinge 屈戍), Biaxial joint 雙軸
(Condyloid 髁狀 or Saddle) and Multiaxial joint 多軸 (Gliding 滑動 or ball-and-
socket joint)
ROM (Repeat each exercise 5 times)：Flexion, Extension；Hyperextension；Lateral
flexion；Rotation；Internal and external rotation；Circumduction； Supination 旋
後 Pronation 旋前； Deviation；Abduction, Adduction；Dorsal and Plantar flexion
背屈，蹠屈
-#ACTIVE ROM：Movement of a joint provided ENTIRELY 完全 by the
individual performing the exercise that perform while the patient can Actively and
Entirely contract the muscles of the neck
-#ACTIVE-ASSISTED ROM：Joint receiving partial assistance from an outside
force
 -#PASSIVE ROM：Performed for the client confined to bed after Asses for
redness, tenderness, pain, swelling or deformities around joint, ALSO the level of
consciousness, and history of joint limitations
F. Use safe practices when positioning, moving and lifting clients.
-#Principles：
1. The WIDER the BASE OF SUPPORTt, the LOWER the CENTER OF
GRAVITY improve the STABILITY
2. The balance will maintain as long as the LINE OF GRAVITY passes through its
base
3. Facing the direction of movement, Dividing balanced between arms and legs
reduces the risk of back injury.
4. Leverage, 槓桿 rolling, turning, or pivoting 樞軸轉動 requires less work than
lifting.
5. When friction is reduced, Less force is required
6. Make sure the protection (waist, side rails) in placed AND Enough blankets to
keep warm
7. NEVER leave a client ALONE
G. Describe the interventions for maintaining proper alignment, helping a patient
move up in bed, repositioning a patient needing assistance, and transferring a patient
from a bed to a chair, positioning, ambulation, transferring
-Helping clients to walk with Cane 手杖, Walker 步行器 and Crutches 柺杖.
・Two Points, Three point, Swing-Through and Four points

・Up Stairs and Downstairs with Crutches

1. UP：Hold handrail with one hand while other side with crutches > Step up
unaffected foot first and Straighten 伸直 it to support of body weight > Bring
Crutches and Affected up
2. DOWN：Crutches and Affected down FIRST, and Slowly bring Unaffected
 down.

11. Hygiene
#If client is at high risk for deep vein thrombosis. DO NOT RUB LEGS.
A. Describe factors that influence personal hygiene practices.
#Physical and mental status, Socioeconomic status, Developmental stage, Personal
preferences, Cultural variables, Motivation, Health beliefs, Body image, and Social
practices, Knowledge
B. Perform a comprehensive assessment of a patient’s hygiene needs.
-Assess The personal hygiene habits of TAKING A BATH OR SHOWER,
BRUSHING AND FLOSSING THE TEECH, WASHING THE HAIR,
PERFORMING NAIL CARE TO PROMOTE COMFORT, then Use of
communication skills to promote the therapeutic relationship to Convery caring and
more thoroughly assess the Patient’s need. FINALLY assess THE Protection,
Sensation, Temperature regulation and Excretion and secretion.
#1. Assess the self-care ability.
2. Assess the skin of DRY, ACNE 痤瘡, RASHES, DERMATITIS 皮炎, and
Abrasion 擦傷
3. Assess the feet and nails of DRYNESS, and INFLAMMATION.
4. Assess the oral of GLOSSITIS, HALITOSIS and DENTAL CARIES 舌炎、口
臭和齲齒
5. Assess the hair of LICE 蝨子, and the LOSS OF HAIR
6. Assess the eyes, ears and nose; also the use of sensory aids 感官輔助器
7. Assess the patient’s HYGIENE’S PRACTICES, CULTURAL INFUENCE, AND
risk
C. Discuss factors that influence the condition of the skin, mouth, hair, scalp, nails,
and feet.
#-Patient’s knowledge about the pathophysiologic effect of chronic illness：RA,
Diabetes mellitus…
#IMMOBILIZATION, REDUCED SENSATION, NUTRITION and HYDRATION
status, Secretion and excretions on the skin，VASCULAR INSUFFICIENCY,
EXTERNAL DEVICES, COGNITION.
#-Bony prominences, Skinfolds that may present of dirt or debris 碎屑
#-ORAL, TEETH, and GUMS pain or discomfort that may impairs the oral hygiene
practices
# PARALYSIS, WEAKNESS, DEHYDRATION, NG TUBE, MOUTH
BREATHERS, CHEMCIL DRUG, SURGERY, IMMUNOSUPPRESSION, BLOOD
CLOTTING, ENDOTRACHEAL INTUBATION.
#Presence of lesions, edema and the circulatory status on FEET and NAILS；Poor
foot care, improper fit of footwear, flexibility RESULTING from Aging and
Continued Exposure
#Hormonal and nutrient deficiencies of the HAIR FOLLICLE 毛囊；The hair shaft
毛幹 is lifeless；Hormonal changes, nutrition, emotional and physical stress, aging,
infection
#- The patients’ practices of Safety use of assistive devices, AlSO the environment
condition
#- TOLERANCE OF perform HYGIENE：Pulse, breathing patter, pallor,
diaphoresis 發汗 and pain
D. Identify common problems involving the skin, feet, nails, hair, and scalp.
-DRY SKIN；ACNE 粉刺；SKIN RASHES；CONTACT DERMATITIS；
ABRASION
-FEET and NAIL infection, odor and injury；The nails grow from the root of
the nail bed that hidden by the CUTICLE 角質層；CALLUS 痂；CORNS 雞眼；
PLANTAR WARTS 足底疣；TINEA PEDIS 足癬；INGROWN NAILS 嵌甲；
FOOT ODORS
-DANDRUFF 頭皮屑；TICKS 蜱蟲；PEDICULOSIS (LICE) 蝨子：Capitis,
Pubis, Corporis 頭，陰，體虱病；HAIR LOSS (Alopecia)脫髮
E. Discuss conditions that place patients at risk for impaired oral mucous membranes.
-# Irregular oral hygiene may lead to Residue of Food particles, Dental plaque 牙菌
斑 and Tartar 牙石 that RESULTING IN GINGIVITIS 牙齦炎 and DENTAL
CARIES 蛀牙
-# Decreased saliva secretion that influence the cleanses of mouth and breakdown
of food.

12. Nutrition
A. Recognize the significance of essential nutrients in human nutrition.
#-Everyone must eat to surive.
#-The NUTRIENTS found in food that keep our body functioning to 1. GROWN,
REPAIR, and MAINTAIN BODY CELLS；2. REGULATE BODY PROCESSES；
3. SUPPLY ENERGY
6Type：1. Carbohydrates (Sugar) 2. Proteins 3. Fats 4. Vitamins 5. Minerals 礦物質
6. Water
-#Carbohdratte：Main source of energy and provide dietary fiber 膳食纖維
-Protein：Help to build, maintain, and repair body tissue that call AMINO ACIDS
氨基酸
-#Fat：The most concentrated form of food energy that Provide growth and
healthy skin and carry the “fat-soluble” vitamins
-Vitamins：13 type that #DO NOT provide energy but require to maintain good
health, and separated into FAT & WATER soluble
-Minerals：Calcium, Phosphorus, Magnesium, Sodium, Potassium, Iron…
#-Water：Carries nutrients. To cell and remove waste from body, Regulate body T,
Dissolve the nutrient mentioned above, and Lubricates our joint
B. Explain the important of a balance between energy intake and energy requirements.
* Calories “in” must equal calories “burned”, otherwise will Malnutrition or Obesity
C. Summarize the dietary guidelines used in the United States.
-Regular Diet：BALANCED diet that include whole grains, fruits, vegetables,
proteins, low-fat daily, WITHOUT any dietary restrictions
-Soft Diet：LITTLE chewing and be easy to digest and avoid Spicy, sweet, fried.
food
-Clear Liquid Diet：First step to restarting oral feeding and the REPLACEMENT
intake for those with severe diarrhea, BUT NOT FOR LONG TIME
-Full Liquid Diet：Clear with additionally of milk and small fiber that Second step
to restarting oral feeding and used for those cannot tolerate a mechanical soft diet
BUT NOT FOR LONG TIME also
-Semi-liquid Diet：For those who have swallowing problem that the THIRD STEP
D. Identify the methods of nutritional assessment and describe the nutritional
problems.
#-ABCD：Anthropometric 人體測量, Biochemical, Clinical, Dietary data
A：-#Body mass index (BMI)：𝑩𝒐𝒅𝒚 𝑾𝒆𝒊𝒈𝒉𝒕(𝑲𝒈) /𝑩𝒐𝒅𝒚 𝑯𝒆𝒊𝒈𝒉𝒕𝟐 𝑴 𝟐：
18.5-24.9 Healthy；＜18.5underweight；>25overweight；>30obese；>40 morbidly
病態
- Triceps Skin Fold 三頭肌皮層厚度, Mid-Arm Circumference 上臂中點環圍
B：Indicator of protein status：Albumin 白蛋白，Prealbumin 前白蛋白
C：Fluid balance. (Input and output；Bowel habits…)
D：Ask patient ”Do you avoid. Any particular foods”
E. Describe the procedure for initiating and maintaining tube feedings.
Nutrition support can be divided into ENTERAL 腸內 or PARENTERAL 腸外
nutrition
#ENTERAL nutrition：Supplying nutrients using GI tract, including tube feedings
(NASOGASTRIC Tube 鼻胃管)
1. 適用 Candidate：Severe swallowing difficulties，Little or no appetite for
extended periods, GI obstructions, After intestinal resection AND Coma or
 confusion
2. 禁忌#Contraindications：Inability to gain access 腸道梗阻，Acute GI
hemorrhage，Intractable 頑固的 vomiting or diarrhea
3. Formula are form differently with the diagnosis, age or the medical problems
4. #PROCEDURE：
-INSERTING：Choose the proper size, material of lumen > Estimating
nasogastric tube length (From the tip of nose to earlobe and down to xyphoid 劍突) >
High Fowler’s Position > Insert > Checking the Position with AT LEAST 3 METHOD
> Immobilize
-FEEDING：should be avoid of ASPIRATION 誤吸, NAUSEA and
VOMITING, DIARRHEA, CONSTIPATION, BLOCKED TUBE and
EXCORITATION OF SKIN 脫皮
#Open system (Requires transferred from original to feeding container)
# Closed system (already prepackaged in feeding container)
*PARENTERAL nutrition (more likely IV)：indicate for those do not have
functioning GI tract.

13. Skin integrity and Wound care

A. Describe risk factors for pressure injury development
*BONE PROMINENCE 骨突：The common of the body weight and surface
pressure compress
*Pressure injuries are caused when a force is applied to the skin, causing damage to
the tissue that CAN DEVELOP IN 30mins
#Risk factor: 1. PRESSURE (Most common) 2. Shear force 剪切力 (The force
occur when sliding down) 3. Friction 摩擦力 4. Excess moisture 太濕（sweat, urine
or feces）
5. poor Nutrition statue；6. Age；7. Motor impairments；8. Smoking (will dry out
the skin and reduce blood flow)
B. Describe guidelines for prevention of pressure injuries.
PI management：# Braden Scale: TOTOALLY 23points (23-19 NO RISK, 18-15
MIND, 14-13 MODERATE, 12-10 HIGH, <9 VERY HIGH RISK OFPI)
-Sensory perception；-Moisture；-Activity；-Mobility；-
Nutrition；-Friction/shear
#Prevention：Skin Care； Use of moisturizers；Avoid hot and irritating 刺激的
soap；
Protect skin from incontinent；Use of protective dressing；Use proper position
techniques；Do not massage bony prominences；Change position every 2 or 4 hours
and Keep the Clients as active as possible；Use a 30-degree lateral side lying；Gel-
mattress and Air-bed；Nutritional health promotion
C. Discuss the use of risk assessment tools in the assessment of pressure injuries.
PI Assessmentt：# MEASURE Method
-Measure (M)：size (length, width and depth)
-Exudate 分泌(E)：discharge volume and texture
-Appearance (A)：color, condition of tissues；-Suffering （S）：pain
-Undermining (U)破壞：location；-Reevaluate (R): 1-2 weeks；-Edge (E)：
Stage
D. Describe wound assessment criteria.
-Stage 1 Pressure injury：Superficial reddening of the skin (Non-blanchable
erythema 不可變白的紅斑)
-Stage 2：Partial-thickness skin loss with exposed dermis 真皮
-Stage 3: Full-thickness loss of skin, in which fat is visible
-Stage 4: Full-thickness with exposed all the underlying structure even the bone
-Unstageable：Obscured full-thickness skin and tissue loss and with some black
substances
-Deep Tissue Pressure injury: Persistent non-blanchable 持久不可變白的
E. Discuss common complications of wound healing.
#HEMORRHAGE 出血, INFECTION, DEHISCENCE 裂開, EVISCERATION 內
容物剜除
F. Explain factors that promote wound healing.
*Process：1. Primary intention (little or No tissue loss) 2. Secondary (Loss of tissue)
#3. Tertiary intention：Extensive tissue loss that The skin edges cannot come together
and healing occurs gradually. A layer of granulation tissue 肉芽 is red, moist tissue
consisting of blood vessels and connective tissue, covers the wound base, wound
contraction brings the wound edges together, than closes with scar formation.
#1. Inflammatory phase (止血，吞噬作用) > 2. Reconstruction phase （膠原蛋白
形成，細胞增殖）> 3. Maturation phase (重塑)
G. Describe the purposes of and precautions taken with applying dressings and
binders.
#Purpose：• Promote healing and prevent additional injury • To repair of injured
tissue
• To minimize risk of infection • To restore function • To keep a minimum of
deformity 畸形
• To provide or maintain moist wound healing •To absorb drainage • To splint or
immobilize the wound site
#Cleansing principle：
• Cleanse wound: In a direction from the least contaminated area to the most
• Infected wound: cleanse the outer area first, moving towards the inner area
• Surgical clean wound: cleanse from the middle (suture line 縫合線), then move
outwards
• Avoid scrubbing wound with disinfectant
• Apply povidone-iodine solution or chlorhexidine for skin disinfection but NOT in
the wound.

14. Sleep Nursing

Sleep: a particular state of consciousness that occurs periodically 周期性
的, consists of different phases, and is relatively unresponsive to its
surroundings
A. Can correctly describe the characteristics of each phase of sleep
*NREM 與 REM 之間可互相轉換，但清醒時無辦法直接進入 REM 階段
*一個睡眠周期大約 90 分鐘，成人每晚一般有 4 至 6 個睡眠周期
-Slow wave sleep (SWS, 慢波睡眠)又稱 non rapid eye movement sleep (NREM
sleep 非快速眼球運動睡眠)： 身體修復及生長期
PHASE 1: Sleep phase: Can be awakened by outside sound
PHASE 2. Light Sleep: Falling asleep, but still prone to awake
PHASE 3. Moderate Sleep: Sleep deepen, requires a loud sound to awaken
PHASE 4. Deep sleep: Difficulty to wake up, can appear SLEEPWALKING 夢
遊 and ENURESIS 遺尿，Body will secretes growth hormone

-Fast wave sleep (FWS，快波睡眠)又稱 Rapid eye movement sleep (REM sleep
快速眼球運動睡眠)：精神恢復階段
THE Eye are moving Rapidly, and the DREAM usually occurs,腎上腺素
Adrenaline 升高
B. Can correctly describe the causes and diagnostic criteria of insomnia
#Sleep disorders means the abnormalities in both SLEEP VOLUME (quantity) AND
QUALITY, and THE INSOMNIA 失眠 is considered as a most common NON-
ORGANIC SLEEPING DISORDER 非器質性
#-Cause： 1. AGE 2. CIRCADIAN RHYTHMS 3. Pathological 4. Environmental
(NEW) 5. DRUG 6. EMOTIONAL (anxiety) 7. DIET (Caffeine) 8. Lifestyle and
habits
#-Diagnostic criteria： 1. Auxiliary examination: EEG 腦電波 measurement, 2.
Comprehensive assessment
C. Can correctly explain the sleep characteristics of inpatients
*# With the increase of age, total sleep time decreases，and FAST WAVE SLEEP
ratio is relatively HIGH in infancy.
#CHARACTERISTICS OF INPATIENTS：
1. Sleep rhythm change: desynchronization (昼夜性节律去同步化)
2. Sleep quality changes: SLEEP deprivation 剝奪，Interruption 中斷，
Vulnerability to rebounds 誘發補償現象
#The need for sleep WILL CHANGE in DIFFERENT OCCUPATIONAL AND health
condition
SLEEPING DISORDER:
-Insomnia：Most common that the quality or quantity of sleep cannot meet normal
needs
-Narcolepsy 發作性睡眠：An Irresistible 不可抗拒的 sudden
sleep，Uncontrollable short periods of sleepiness，Sleep degree is not deep and it
can attack SEVERAL TIMES a day
-Sleep apneas：Repeated breathing stops during sleep, OF 10s each and the
number of> 20 stops per hour
-SLEEPWALKING: Avoid hazards
-OTHERS: Hypersomnia 過度睡眠, Sleep deprivation, Bedwetting 遺尿…
D. Can use the correct method to collect the patient's sleep data, ensuring the data
comprehensive and accurate
#-Assessment Focus on
1. The sleep duration and quality；
2. Type, duration of symptoms and the effects to sleep disorders；
3. The cause of sleep disorder；
4. EVALUATION CONTENT: Sleep at night and Nap 小睡 at noon, Sleep
habits, Medication, the depth and abnormal behavior during sleep, AND before sleep
effect.
#-Assessment TOOLS: 1. EEG Measurement, 2. Consultation and Observations
3. Self-Rating Scale of Sleep (SRSS 睡眠狀況自評量表)
#E. Effective nursing measures can be taken to promote the sleep of patients
#1. ENSURE GOOD NIGHT CARE TO REDUCE THE FACTORS AFFECTING
SLEEP:
-Promote personal hygiene and finishing bed units；-Control the pain；-Choose
the right POSTURE；-Reduce stress
#2. HELP TO CREATE A GOOD SLEEP ENVIRONMENT
-Temperature and Humidity；-Reasonable arrangement of our nursing work；-
Patients with severe snoring should be separated；- The bed unit shall be safe and
comfortable
#3. REASONABLE USE OF DRUGS
-Benzodiazepines 苯二氮卓：Pay attention to the medication time and dosage,
AND Not appropriate TO central inhibitory drugs AT SAME TIME
-Zolpidem 唑吡坦 (Stilnox)
4. HELP PATIENT TO ESTABLISH GOOD SLEEP HABITS
-ADJUST WORK AND REST TIME；
-DIET BEFORE SLEEP: Small amount of digestible to prevent hungers, avoid
coffee, caffeine, tea
-EXCRCISE BEFORE BED: Walk and relax
-RELAX BEFORE SLEEP: Read or Listen to music

15. Pain Management

➢Comprehend the concep of pain correctly
*#An unpleasant SENSORY and EMOTIONAL experience related to ACUTAL or
POTENTIAL tissue injury, or SIMILAR EXPERIENCE.
➢Distinguish category of pain and the impact of pain on individuals correctly
-#Catergory：
1. According to the course：a. Acute (Sudden, definite start and short duration)
b. Chronic (lasing at least 3 months, persistent and
repetitive)
2. According to location：A. Somatalgia 軀體痛；B. Psychogenic；C. Visceral
pain
3. According to nature：A. Dull （soreness 酸痛, flatulence 脹氣, tenderness）；
B. Sharp；C. Other pain
 4. Carcinomatous or not
-Impact：1. Elevated blood pressure, Increase heart and respiratory rate,
Neuroendocrine and
metabolic response
2. Attention and memory, depression, anxiety, anger and fear
3. Behavioral reaction
➢Explain the influential factor of pain correctly
-INTERNAL：Demographic characteristics, Religious belief and culture, Attitude,
experience, attention And emotion
-EXTERNAL：Environmental change, Social support, Iatrogenic factors 醫源性
因素
➢Explain the basic principles, timing, contents and methods of pain assessment
correctly
#-BASIC PRINCIPL： COMPERHENSIVE；DYNAMIC；
TIMELY：1. First assess within 8 hrs after admission or comprehensive within 24
hrs；2. Routine assess for stable pain control；3. Assess when new pain occurs for
unstable；4. After application of analgesics
#-Content：General condition and physical examination；PAIN EXPERIENCE and
related health history；Psychosocial factors
-Method：1. Interview of PAIN EXPERIENCE；2. Observation of any Reaction to
pain
3. Health assessment of the cause or imaging finding.
#4. PAIN ASSESSMENT TOOLS：
A. Face pain scale, FPS 面部表情疼痛评定法：Apply to over 3 years old
or elderly with cognitive impairment.
B. Numeric rating scale, NRS 數字評分法：Describe the MOST SERIOUS
pain in the past 24 HOURS
C. Verbal rating scale, VRS 口述評分法：Assess the influence of pain on
the quality of life
D. Visual analogue scale，VAS 视觉模拟评分法
E. #WHO PAIN GRADING STANDARD
F. Behavioral pain scale
G. THE brief pain inventory, BPI 簡明疼痛評估量表：Commonly used in
pain research
➢Describe the content of WHO pain grading and the basic principles and contents of
three- step analgesic method correctly
#WHO PAIN GRADING STANDARD
➢According to the actual situation of patients, take correct analgesic measure
#PRINCIPLE：Apply appropriate analgesic treatment to eliminate pain as soon as
possible, continuously and effectively, AND prevent of ADVERSE DRUG
REACTION, REDUCE THE PSYCHOLOGICAL BURDEN DURING
TREATMENT, AND finally improve the quality of life.
#-Medication：USE ONLY WHEN THE DIAGNOSIS ARE CLEAR
A. Opioid analgesics (Morphine, Fentanyl)；B. Non-opioid (NSAIDs)；C.
Other auxiliary drug.
* Transdermal drug delivery 經皮途徑：ONLY suitable for Chronic and Severe pain,
but nott Acute and Explosive pain 爆發性疼痛
*# THREE STEP PRINCIPLE：Oral administration On time and By steps
Step 1 (Pain Occurs)：NON-OPIOID, and optional Auxiliary drug
Step 2 (Pain persists and worsens)：weak OPIOID, and optional non-opioid and
auxiliary
Step 3 (Severe Pain )：Strong OPOID, and optional non-opioid and auxiliary
#-Non-drug Therapy
A. Treatment of soft tissue and joint pain OR cold and heat therapy.
B. Minimally invasive interventional analgesia
C. Traditional Chinese medicine for CHRONIC STRAIN 慢性勞損
D. #Transcutaneous electrical nerve stimulation 經皮電神經刺激：For
VARIOUS TYPE OF Headache, cervical spondylosis 頸椎病,
scapulohumeral periarthritis 肩周炎, neuralgia 神經痛, lumbago and leg
pain.
E. Operation or Psychotherapy

16. Cold and heat therapy

➢Can correctly understand and explain the concept and purpose of cold and heat
therapy
#-Concept：The use of substances lower or higher than the human body temperature
on the skin surface, through Nerve conduction to cause the contraction or relaxation
of the skin and internal organ blood vessels, to change the body fluid circulation and
metabolism.
➢Can correctly understand the meanings and characteristics of physiological effects
and secondary effects in cold and heat therapy
#Physiological effect：Vascular odilating/ contraction, Cell metabolism rate,
Oxygen demand, Capillary permeability, blood and lymph circulation, Nerve
conduction velocity 神經傳導速度 AND body temperature.
#Secondary effects：Using cold or heat for MORE THAN A CERTEIN TIME
produces phenomena OPPOSITE to physiological effects, THEREFORE the
treatment should be appropriate for 20~30 mins ONLY and 1 hour rest before second
treatment
➢Can correctly analyze the factors affecting the effect of cold and heat therapy
-WAY：The effect of Wet cold, Humid therapy is STONGER than dry cold, dry heat
-AREA：The LARGER the area, the STRONGER the effect
-TIME：Effect will Enhanced in a certain time but AVOID secondary effects
-TEMPERATURE：The GREATER the temperature difference, the Stronger the
body reacts
-POSITION AND INDIVIDUAL DIFFERENCES
➢Can correctly state the purpose, matters needing attention, health education etc. of
the common cold and heat therapy
➢Can correctly identify the indications and contraindications of cold and heat therapy
#-COLD THERAPY：
1. AIM and Indication：
A. Reduce local Congestion or Bleeding: Suitable for initial stage of local soft
tissue injury, after Tonsil removal, Nasal Hemorrhage, etc
B. Reduce pain: Suitable for early stage of acute injury, Toothache, Scald 燙傷, etc
C. Control inflammatory diffusion: Suitable for patients with early inflammation
D. Reduce body temperature: Suitable. For patient with heat fever and heat stroke 中
暑
#2. Contraindication：BLOOD CIRCULATION DISORDER； CHRONIC
INFLAMMATION；TISSUE INJURY, RUPTURE 破裂 AND OPEN WOUND；
ALLERGY TO COLD；SOME BODY PARTS OR STATUS（Coma, Heart disease,
infants, Post-occipital area 枕后區, and scrotum area 陰囊區, Front heart area,
Abdominal, Foot bottom）
 3. Common Method and NOTE：
A. ICE BAGS：Place at the surface with large blood vessels flow (forehead,
neck, groin)
TIME: No more than 30 mins
NOTE：1. Observe at any time, KEEP the bag TIHGT and DRY；2.
Observe skin color to prevent Purple 發紫 and Numbness 麻木
B. ICE CAPS：TIME: No more than 30 mins
NOTE：1. Ensure the cap complete；2. Closely observe the skin color,
AND keep ANAL temperature Maintain at 33oC, not less than 30 to prevent heart
attrack.
C. COLD MOIST COMPRESS：CHANGE every 3~5min for 15-20min and
Keep sterile
D. TEPID WATER 温水 or ALCOHOL SPONGE BATH 试浴 to COOL DOWN
TEMPERATURE：Place ice bags on the head and hot water bags at the foot.
Soak with warm water (32-34oC) or 25~35% 30oC ethanol 乙醇 WITHIN
20mins
NOTE：1. AVOID anterior heart area, abdomen, posterior neck and foot bottom.
2. PROHIBITED in children and patients with hematology 血液病
#-HEAT THERAPY：
1. AIM and Indication：
A. Promote the dissipation 消散 and limitation of inflammation for patient with
blepharitis 瞼緣炎, mastitis 乳腺炎, etc
B. Reduce pain for patients with lumbar muscle strain 勞損, renal colic 腎絞痛 and
gastrointestinal cramps
C. Reduce congestion 充血 in deep tissue
D. Keep warm and comfortable for patients with weak body, premature infants and
with poor peripheral circulation
#2. Contraindication：ACUTE ABDOMINAL PAIN WITH UNKONWN
REASON；ALL KINDS OF ORGAN BLEEDING；INFECTION IN THE FACIAL
TRIANGLE REGION；EARLY STAGES OF SOFT TISSUE INJURIES（within
48hrs；OTHER PATIENT WITH HEART, LIVER AND RENAL INSUFFICIENCY
3. Common Method and NOTE：
A. HOT WATER BAGS: NO more than 30mins, STOP when skin Flushing or Pain
occurs.
NOTE：Strengthen Regular inspection of local skin conditions
B. INFRARED 紅外線 LAMP& HOT LAMPS：KEEP distance at 30-50 cm, and
only 20-30mins. STOP when Palpitation 心悸, dizziness, skin redness, pain
NOTE：1. Avoid direct exposing by wear colored glasses or cover with gauze to
eyes
2. Increase the distance when use for local sensory disorder to prevent scald 燙傷
C. HOT MOIST COMPRESS：change every 3-5min for 15-20min
D. HOT SITE BATH 熱水坐浴：TIME 15-20 mins, STOP when pale face,
accelerated pulse, dizziness, weakness.
NOTE：Female menstruation, late pregnancy, 2 weeks postpartum, vaginal
bleeding and pelvic acute inflammation should not sit bath,
F. WARM SOAK 浸泡：Time 30mins, should be sterile when wound occurs in the
soaking site.

17. Writing medical and Nursing documents

➢Can correctly describe the record principles and management requirements of
medical and nursing documents
Medical and nursing documents include: medical records, doctor’s order sheet,
temperature chart, nursing record, ward shift report, special nursing care record, etc
#PRINCIPLE：Timely 及時；Accuracy；Complete；Concise and to the point 簡
明扼要；Limpid 清晰
#Management Requirement：1. Place as required and be PUT BACK after use；
2. KEEP clean, neat and complete
3. Anyone shall not read or take the record out of the ward without
authorization.
4. Should be properly preserved for long-term preservation of at least 30years
after discharge, OR the outpatient include emergency records should be
preserved at least 15years.
5. Patient, insurance agent…have the right to copy or duplicate
*Arrangement：A. Hospitalized patients：Temperature chare>Medical orders…
Home page of admission>Outpatient medical records
B. Discharged patients：Home page of admission> discharge or death
records…Medical orders> Temperature chart
➢Can Distinguish the TYPES of doctor’s orders correctly
The doctor's written instructions of diagnosis and treatment that should be jointly
executed by the medical staff that the contents should be #INCLUDING Date, Time,
Bed number, Name, Nursing routine or level, Diet, Posture, Drug (dosage, usage,
time)
#TYPE：
1. Long-term：Effective more than 24 hours)；
2. Temporary (Even Immediately [st])：Effective at most 24 hours，Should be
executed in short period of time；
3. Standby order：
-PRN order 長期備用醫囑：Effective more than 24 hours, And it LOSES efficacy
after the doctor indicates the Stop date .
-SOS order 臨時備用：Valid within 12 hours, Loses efficacy as not execute in the
valid time
➢Can correctly state the attention of doctor’s orders handling
*ORDER Input>Handling>Extract>Check>Order generation>Order execution
*Closed-loop management of the whole drug process：Who When Where What

#A. The doctor’s order must be signed by the doctor before being valid and the ORAL
order is normally considered as not valid；
#B. When handling the orders, First Urgent then General, and First Temporary, then
Long-term；
#C. The questionable doctor’s orders must be checked clearly；
*#D. The doctor’s order should be checked every shift and every day, and then sign
the full name；
E. Doctors should Delete or Stop the medical orders that do not need to be carried out
➢Draw the temperature chart correctly and process various doctor’s orders according
to the information provided
Record the Vital signs, Admission and Discharge, Time of transfer or death, Stool
number, Liquid intake and output, Height and Weight.
*DAY AFTER SURGERY：Mark with red pen.
* Should be filled in 24-HOUR SYSTEM with red pen to mark the time of admission,
transfer, surgery, discharge and death BETWEEN 40-42oC horizontal line
* Please MARK down if patient “REFUSE TO MEASURE；GO OUT；LEAVE”
BETWEEN 40-42oC horizontal line
* Pulse rate is indicated as red "●" and heart rate as red"○"
* Body temperature (bule)：Oral "●"；axillary "×"；Anal "○"
* Number of stools：Stool incontinence record "※", artificial anus 人工肛 record
"☆", and enema symbol 灌腸 is indicated by "E"
➢Can accurately write the records of fluid intake and output, special nursing care
records and state the writing Order and Requirements of ward shift report
#- Fluid Intake and Output record：Often used in patients with shock, extensive
burns, major surgery or heart disease, kidney disease, cirrhosis ascites 肝硬化腹水,
AND should be make a summary At every 12 or 24 hours in temperature chart
A. Intake include Drinking water, water content in food, infusion volume, blood
transfusion volume…
B. Output include Urine, Other ways to discharge fluid such as stool, vomit
amount, cough-up amount, bleeding amount…
#-Special nursing care record：Patients in critical condition, emergency treatment,
after major operation, special treatment or those requiring close observation, AND the
content should include vital signs, input and output, disease development, nursing
measures, drug and its effect. AND it should be kept with the medical records after
discharge or death.
#-Ward shift report：
1. Writing order：Fill in the eyebrow bar>About patients Leaving the ward>
Entering the ward> Key patient (Operation；Maternal 產婦；Critical ill；Elderly
and children that cannot take care of themselves…)
2. Requirement：*The handwriting should not be altered or pasted at will，and
MARK "critical(危)" or "※" for Critical patients

18. Nursing Process

➢Retell the concepts and steps of nursing procedures
#A series of purposeful and planned nursing activities aimed at promoting and
restoring the health of nursing objects
*Nursing process involves GENERAL. SYSTEM theory, Basic Human Need,
Communication theory, Emergency And adaptation theory.
- Characteristics：
Objective，Individuality，Scientific，Systematicness，Dynamicity，Interactivity
AND Universality.
#-STEP：
ASSESSMENT>DIAGNOSIS>PLANNING>IMPLEMENTATION>EVALUATION
➢Describe the methods and contents of the assessment
#Methods：Observation；Conversation；Physical assessment；Consulting.
#Content：Including collecting data, arranging data and analyzing data that require
Whole process, Comprehensiveness and Accuracy.
-DATA：1. General information, Health status, Family history, Physical
examination, Laboratory and other examinations；2. Psychological status；3. Social
condition
A. Subjective datac：The patient’s main complain, felt, thought, and worried
about；
B. Objective data：Refer to information obtained from observation,
physical examination…
*Main source of data is from PATIENT
*Data can classified by physical, psychological；OR classified according to
Maslow’s hierarchy of needs.；OR classified by nursing diagnosis.
➢Retelling the definition and components of nursing diagnosis
-#Definition：Nursing diagnosis is a clinical judgment about the response of
individuals, families and communities of existing or potential health problems or life
processes.
-#Components：Label；Definition to diagnosis (clear and accurate description)；
Defining characteristics (signs and symptom, risk factors)；Related factors (the
reason or situation)
➢Explain the Classification of nursing diagnosis
-PES formula：Problem (Label)；Etiology (Related factor)；Symptoms and signs
-PE formula；-P only：
#Classification：-Existing health problems；-Potential health problems
➢Write cooperative questions in the correct format
Format： PC：Arrhythmia；PC: Thrombosis…
➢Distinguish nursing diagnosis from cooperative problems and medical diagnosis
#-Nursing Diagnosis：The reactions of individuals and people to existing or
potential health problems or life processes.
#-Medical Diagnosis：The essence 本質 of an specific disease or pathological
state.
#-Cooperative problems：POTENTIAL COMPLICATION that nurses cannot
prevent and deal with independently，AND Need cooperation with other health care
personnel, NURSE MAINLY provide monitoring care in this kind of problems
➢State the precautions for the formulation, implementation and evaluation of nursing
plan and Write nursing objectives in correct format
#-Label which NANDA approved should be used； Relevant factors should be
stated in the way of “RELATED TO”；Avoid mistaking clinical manifestation as
relevant factors
1. PLANNING
A. #Prioritization of diagnosis：According to the URGENCY and IMPORTANCE
-High-priority problem：The problem threatens immediate the patient’s life
-Medium-priority problem：Problem do not directly threaten patient’ s life,
 BUT lead to physical or emotional unhealthy
-Low-priority problem：Does not belong to the reaction of the disease
B. SET OBJECTIVE (Short or Long term)：Expect the changes of cognition,
behavior, function and emotion
*Subject；Predicate 謂語；Behavior standard；Conditional adverbial 條件狀語；
Evaluation time. 例如：After 4 days, the patient could walk 100 meters with the help
of double crutches
*# 1. Subject must be the nursing object；2. Only one action verb；3. Standard
should be MEASURABLE, EVALUABLE, REALISTIC and FEASIBLE within the
scope of nursing；4. Let patients participate in goal setting.
C. FORMULATE NURSING MEASURES：-Dependent；-Interdependent；-
Independent
#Should be Targeted, Practical, Safety, Specific and Instructive；and based on
Science
D. VALIDATION THE PLAN；and PLAN WRITTEN
2. IMPLEMENTATION
Pay attention to WHAT, WHO, HOW, and WHEN
#RECORD timely, accurate, true and focused (P I O method)
3. EVALUATION
# 1. Modify according to the target realization degree