Term	Definition	Prefix	Root	Suffix
Abduction	Move away from the center	ab	duction
Atrophy	Without nutrition (waste away)	a	troph	y
Bradypnea	Slow breathing	brady	pnea
Cyanoderm	Blue skin	cyan/o	derm
Dyspnea	Painful breathing	dys	pnea
Hematemesis	Vomiting blood	hem/at	emesis
Hemiplegia	Pertaining to being half paralyzed (one side of the body)	hemi	pleg	ia
Insomnia	Pertaining to being without sleep	in	somn	ia
Intravenous	Inside a vein	intra	venous
Sublingual	Below the tongue	sub	lingual

^*A transition syllable or vowel may be added to or deleted from the word parts make the combining form.

Abbreviations for Nursing Careers

Abbreviation	Meaning
AP	Apical
BSN	Bachelor’s of science in nursing
HCA	Home care assistant
I&O	Intake and output
LPN	Licensed practical nurse
NA	Nurse assistant
RN	Registered nurse
PCA	Personal care attendant
PO	By mouth
ROM	Range of motion

Careers

With more than two million jobs, nurses make up the largest group of health care workers (Box 24-1). Nursing is also among the 10 occupations projected to have the largest number of new jobs in the future (Table 24-1). In fact, the American Nurses Association (ANA) and Bureau of Labor Statistics project that employment for registered nurses will grow by 22% from 2008 to 2018. Levels of workers classified as the registered nurse (RN), licensed practical nurse (LPN), and nursing assistant (NA) give nursing care. Nurses and related caregivers work with their patients in a close, or primary, relationship. The function of the nurse is to promote optimal health and provide care during illness. The duties of the nurse focus on the patient’s physical and mental needs.

BOX 24-1 Nursing Careers

Birth attendant

Child care attendant, school

Community health nurse

Counselor

Geriatric nurse assistant

Licensed practical nurse

Occupational health nurse

Orderly

Practical nurse

Registered nurse

TABLE 24-1

Nursing Career Educational Cost and Earnings

Career	Educational Cost*	Earnings^†
Certified nursing assistant	American Red Cross, 171 hours, $1750 Tuition fee includes: Training books Uniforms and supplies Live scan fingerprinting State examination for certification Hands-on real life experience	Median annual salary: Los Angeles, Calif.—$26,060

^*http://redcrossla.org/classes/nurse-assistant-training.

^†http://data.bls.gov:8080/oes/datatype.do.

Brain Byte

New England has the highest concentration of nurses relative to its population according to the ANA, with 1107 RNs per 100,000 people.

Nurses must have the ability to get along with other people and communicate well. They must provide, without prejudice, the best care possible for all patients. Especially during critical moments, the nurse must be self-controlled and efficient and show problem-solving ability. Health care personnel, including student nurses, may be required to undergo a background check to work in a Joint Commission on Accreditation of Health Care Organization (JCAHO) hospital or health care facility. Chapter 33 provides more information about background checks.

Health Careers in Practice

Brijith Y. Diaz CNA

PATIENT CARE ASSISTANT (PCA)

UNIVERSITY OF VIRGINIA MEDICAL CENTER

Educational background

High school degree; some college; I hold a CNA (certified nursing assistant) license.

A typical day at work and job duties include

Assigned a set of patients to oversee and monitor

Take vital signs, blood sugars (accu-test), electrocardiograms

Assist patients with everyday needs such as hygiene, shaving, cleaning, eating, phone calls

Keep the room safe for patients

Report to nurse any abnormalities seen in the patients

The most gratifying part of my job

When a patient who has been on the unit waiting for a heart transplant receives it and comes back in the future to tell us that they are living a normal life. Also, when I am able to do “little” things for patients they normally took for granted and then feeling their gratitude for making their day better.

The biggest challenge(s) I face in doing my job

When you do everything you can for a patient and he or she still does not feel better. Also when a patient is stable but dies unexpectedly.

What drew me to my career?

I want to eventually become a nurse, and this position is a starting point for that goal. I like taking care of people and am comfortable working with people who are sick. I am a natural caretaker, which fits well with this job.

Something I learned in my early education that I currently use in my career or that caused me to be interested in my career is

I learned I wanted to work directly with people when I did volunteer work at a community center in high school. During high school biology class, I became interested in the how the body works. In the back of my mind, I wanted to be a nurse as long as I can remember.

Registered Nurse

The RN may complete a 2-year community college program, 3-year hospital diploma program, or 4-year college or university program to qualify to take the licensing examination. However, the 3-year programs are being phased out in many locations. Registered nursing is the largest health care occupation, employing more than two million people. RNs may hold a bachelor’s, master’s, or doctorate degree. RNs supervise the nursing care of patients. Most nurses work under the supervision of a physician in a hospital, a long-term care facility, home health, or other health care agency.

Brain Byte

A study by the Health Resources and Services Administration found that 404,163 of the 3.1 million nurses in the United States in 2008 held a master’s or doctoral degree.

Community health nursing is concerned with the care of the family and community. The primary focus of community or public health nursing is the prevention of disease and promotion of the highest possible level of health and well-being. The public health nurse identifies needs, determines the plan for care, mobilizes appropriate resources, and evaluates the services given to the patients. Professional public health nursing did not evolve until the twentieth century. Most public health nurses work for government health agencies. They visit people in their homes to provide care and evaluate the environmental conditions that may affect that care. A bachelor’s degree in nursing is required for public health nursing.

Advanced preparation by the RN may lead to work as a nurse practitioner, clinical nurse specialist, nurse anesthetist, or nurse midwife. Nurse practitioners perform physical examinations, order and interpret tests, and may recommend or prescribe medication in some states. Nurse practitioners emerged as a profession to meet the needs of rural communities. They function independently from the physician in these settings and assume primary responsibility for care. Nurse practitioners commonly specialize in the areas of adult, pediatric, family, or geriatric practice. Nurse practitioners are certified by the state in which they practice. Nurse midwives provide perinatal care and deliver infants under the supervision of an obstetrician. Nurse anesthetists provide anesthesia during obstetric and surgical procedures under the supervision of an anesthesiologist.

Areas of specialization for the RN include units, such as the operating room, recovery room (postanesthesia), critical care, and emergency department, as well as practices, such as oncology, cardiovascular, and many others. Nursing opportunities are available all days of the week and all hours of the day.

Brain Byte

Only three of five RNs work in a hospital.

Licensed Practical Nurse

LPNs, or vocational nurses, complete a 1- to 2-year program and provide personal care under the direction of a physician, dentist, or RN. Many LPNs work in a hospital, making beds (Fig. 24-1), taking vital signs, positioning (Fig. 24-2), and providing personal hygiene for patients. Other LPNs provide care in long-term care facilities. LPNs may legally administer certain medications, insert catheters, and dress wounds. In some states they may also take orders from the physician and input the orders in a computer for implementation. They may also assist physicians with procedures and train students at some levels.

FIGURE 24-1 Making beds is just one way a nurse provides for a patient’s comfort.

Nurse Assistant

The nurse assistant (NA) works under the direction of the RN or LPN to provide basic care. NAs may be called orderlies, personal care assistants, personal care attendants, or patient care technicians. In most states, NAs must complete a certification program at least 75 hours long and complete a nationally approved written and skill examination.

Certified nursing assistants (CNAs) work under the supervision of a nurse to provide assistance to patients with activities of daily living. They are responsible for basic care such as bathing, grooming, and feeding. They also assist nurses with the use and security of medical equipment and assessment, such as the patient’s vital signs. They also provide emotional and social support for the patient. The CNA can follow a career ladder to become an LPN or RN with additional education and training.

CNAs may provide care in the patient’s home and are called home care assistants. Their role includes assistance with personal care, such as bathing, bed making, and meal preparation, as well as general maintenance of the home. Home care assistants usually work with a patient over an extended period. The home care assistant may be trained to perform all the functions of the NA.

Brain Byte

Travelling nurses may work in different facilities locally and internationally.

Content Instruction

Nursing Process

One model for delivery of care that is used by the nursing staff is called the “nursing process” (Box 24-2). It is a goal oriented framework for meeting the patient’s needs. The five steps or phases of the nursing process include assessment, nursing diagnosis, planning, implementation or intervention, and evaluation (ADPIE). Data for assessment are gathered by interviewing the patient, physical examination, and observation. The information may be objective (signs) that can be heard, smelt, or felt. It may also be subjective (symptoms) or reported to the nurse by the patient (Fig. 24-3). The nursing process is cyclical (repeating) and ongoing.

BOX 24-2 Nursing Process

Assessment (collect and analyze subjective and objective data to meet patient needs)

Diagnosis (make clinical judgment about needs)

Planning (set short- and long-term goals for patient care)

Implementation (establish a care plan)

Evaluation (continual reassessment of the effectiveness of the care plan and patient status)

Fluid Balance

Within a 24-hour period, the fluid taken into the body and that eliminated from the body should be approximately equal in volume to maintain the balance of the electrolytes and fluid needed to perform body processes. When an individual is unable to eat, has severe diarrhea, or high fever, the output may be greater than intake. In some instances the patient may be unable to ingest adequate liquids because of physical limitations. The order may be given to “force fluids.” Forcing fluids means to offer at least 100 mL of liquid each hour.

Oral intake is considered anything that is liquid at room temperature and taken by mouth (Fig. 24-4). This includes foods such as ice cream and Jell-O. The average adult takes in 32 qt (3.3 L) of fluid daily in food and beverages. Intravenous fluids and tube feeding are considered intake.