HEALTH

CARE
PROCES
S

What is Health Care

Process?
It is a deliberate system for
identifying and solving
health problems in order to
meet a persons health care
and health care needs.

What is Health Care

Process?
It is a planned,
systematic, scientific, goaloriented, problem solving
technique which serves as
framework for health care.

Principle of Health Care

Process
Problem Oriented- Focuses upon
the components of a problem and
its possible solutions.
Scientific- The process of health
care is based on systematic or
methodical approach

 Client-Centered- The plan of care

individualized for each person
wherein the patient is
encouraged to actively
participate.
Dynamic- A patients condition or
health status changes constantly,
therefore in evaluation , new
data is collected and interpreted
and the process will begin again.

 Goal Directed- The effort

between the patient and the
healthcare team to achieve the
desired outcomes in short and
long term goals.
Universally Accepted- A usual
and accepted way of doing
something. In all countries health
care is the same and accepted.

 Orderly, Planned The steps in

healthcare process are organized
and systematic.

STEPS IN
HEALTHCAR
E PROCESS

Assessment
Diagnosis
Planning
Implementation
Evaluation

Assessment

The systematic collection of

data to determine the patients
health status and to identify
any actual or potentil
problems.

Assessment
Conduct health history
Perform health assessment
Interview patients family or
significant others.
Study health records
Organize, analyze, synthesize
and summarize collected data.

Healthcare History
Data about clients wellness,
changes in life patterns, sociocultural role, mental and
emotional reaction to illness.
Types of Data
Objective Data- Observations or
measurements made by data
collector. THE SIGN

 Subjective Data- Information

perceived only by affected
person. THE SYMPTOM
Example:
Objective data

Subjective data

Patient refuses to eat

Patient verbalizes he has no

appetite

Patient temperature is 39c

Patient reports feeling chilly

Diagnosis
is the identification of
the nature and cause
of a certain
phenomenon.

Two Categories of Diagnosis:

1. Healthcare Diagnosis
-Actual or potential health
problems that can be
managed by independent
healthcare interventions.

Two Categories of Diagnosis:

2. Collaborative Problems
- certain physiologic complications that
nurses monitor to detect onset or
changes in status.
- Nurse manages, collaborative
problems using physician-prescribed
and nursing-prescribed interventions to
minimize the complications of the
events

DIFFERENCE BETWEEN
HEALTHCARE DIAGNOSIS AND
MEDICAL DIAGNOSIS
Healthcare Diagnosis- a statement
that describes a patients actual
or potential health problems that
is potentially responsive to
healthcare theraphy.

DIFFERENCE BETWEEN
HEALTHCARE DIAGNOSIS AND
MEDICAL DIAGNOSIS
Medical Diagnosis- is a
pathological condition, a problem
that is potentially reponsive to
medical management.

HEALTHCARE DIAGNOSIS
1. Identify patients healthcare
problems e.g Alteration in
comfort
2. Identify characteristics of the
Heathcare problems e.g. Pain
3. Identify etiology of the
healthcare problems.

4. State healthcare diagnoses

concisely and precisely.
Low Priority
Healthcare diagnoses wherein
client needs that may not be
directly related to a specific illness.
Ex. High Risk for sleep pattern
disturbance

MASLOWS HIERARCHY OF
NEEDS

 Physiological Needs- Oxygen,

food, water, Rest, sunlight,
elimination, Sex.

 Safety and SecurityPrevention of accidents,

infection, Bedsore; Contructures
and shelter

 Love and BelongingnessPresence of sigificant others.

 Self-Esteem- How I feel about

myself; Body image, Role
perfomance, personal identity,
psychosocial development.
;Communication Styles,
coping/defense mechanisms.
Self-ActualizationContenment, inner peace.

3.Planning
The development of goals
and a plan of care
designed to assist the
patient in resolving the
diagnosed problems.

Assign priority to the

Healthcare diagnoses
2. Specify goals/ Objectives
1.

a) Develop immediate, intermediate, and

long term goals.
Immediate goal- goals you will achieved
near future
Intermediate goal- goal that can be achieve
for 1-5 years
Long term goal- goal that is planned to be
achieved over a long period of time
b) state goals in realistic, observable, and
measureable terms

 An effective way to set objectives

is to follow the well known
acronym SMART.
S-pecific
M-easureable
A-chievable
R-ealistic
T-ime scaled

3.Identify Healthcare
interventions appropriate
for goal attainment.
a.Goals must be client-centered
and goal-oriented
b.Interventions may be
independent or interdependent

4. Establish expected
outcomes
a. identify critical times for
attainment of outcomes
b. establish a time frame for
each goal and expected outcome.

5.Develop written Healthcare

plan
a. Include Healthcare diagnosis, goals,
Healthcare interventions, expected
outcomes
b. Write all entries precisely, concisely,
systematically.
c. Mutual goal- setting ensures that the
client and nurse agree on the
direction and time limits of care

5.Develop written Healthcare

plan
d. Keep plan current and flexible to
meet patients changing problems and
needs
e. Short, realistic goals and expected
outcomes can quickly provide the
client and the nurse with a sense of
accomplishment which can increase
clients motivation and cooperation.

6. Involve patient, his

family, and significant
others, healthcare team
members and the other
health members in all
aspect of planning

4. Implementation
Actualization of the plan of care though
healthcare interventions
1. Put healthcare plan in action
2. Coordinate the activities of the client,
family, and significant others,
healthcare team members and the
other health members
3. Record patients response to
healthcare actions

Classification Of Healthcare
Interventions

Independent
Involve aspects of
professional Healthcare
practice encompassed by
applicable licensure and law.

Classification Of Healthcare
Interventions

Dependent
Based on the instruction or
written orders of another
healthcare provider, require
specific Healthcare responsibility
and technical knowledge.

Classification Of Healthcare
Interventions
Interdependent
Duties are carried out by the nurse
with another healthcare
professional in a collaborative
manner through judgment and
recommendations of the
interdisciplinary healthcare team.

5. Evaluation
1. Collect objective data
2. Compare clients behavioral outcomes with
the expected outcomes
3. Include client, family, healthcare team
members and the other health members in
the evaluation
4. Identify alterations that need to be made in
the Healthcare interventions and expected
outcomes
5. Continue all steps in the healthcare process

Characteristic
s of Health
Care Process

1. Within the Legal Scope of

HealthCare
2. Based on Knowledge
3. Planned
4. Patient-centered
5. Goal-Directed
6. Prioritized
7. Dynamic

1. Within the Legal Scope of

HealthCare
Per State Nurse Practice Acts
Independent
problem-solving
role that involves the Dx and Tx
of
Human Responses to actual or
potential problems.

2. Based on Knowledge
-Critical thinking enables nurses to
determine which problems
require collaboration with the Md and
which one fall within the independent
domain of
HealthCare To choose appropriate
HealthCare interventions for
achieving predictable outcomes.

3. Planned
-Steps in Healthcare
process are organized
and systematic.

4.Patient-centered
-Plan
of
care
individualized for each
person where patients
encouraged to actively
participate.

5.Goal-directed
-The effort between the
patient and the Healthcare
team to achieve outcomes
short and
long term goals.

6. Prioritized
-In order of importance
to shorten hospital
stays
to
maximize
efficiency in minimal
time.

7.Dynamic
-Health status of Patient is
constantly
changing,
therefore in evaluation,
new data is collected and
the process begins again.

CLASSIFICAT
ION OF
HEALTHCAR
E PROBLEM

HEALTH THREAT

Conditions that are

conductive to disease,
accident or failure to
realize ones health
potential.

Examples:
Family history of hereditary disease
Threat of cross infection
Accident hazards
Faulty eating habits
Poor environmental sanitation
Unhealthy lifestyle/personal habits

HEALTH DEFICIT
A gap between actual
and achievable health
status. It is also the
instances of failure in
health maintenance.

Possible precursors of
health deficit:
History of repeated infections or
miscarriage
No regular check up

Examples:
ILLNESS states, diagnosed or
undiagnosed
Failure to drive/develop
Disability
Transient (Aphasia or temporary
paralysis after a Cerebral Vascular
Accident)
Permanent (Leg amputation secondary
to diabetes, blindness from measles,

Foreseeable Crisis
It is the anticipated periods
of unusual demand on the
individual or family in
terms of adjustment or
family resources

Examples:
Marriage
Pregnancy
Parenthood

Examples:
Divorce
Loss of Job
Menopause
Death

MAJOR
CLASSIFICATIO
N OF
HEALTHCARE
STRATEGIES

HEALTH PROMOTION
Services designed to
reduce risk of illness,
maintain maximal
function, and promote
good health habits

EXAMPLES
Pre-natal nutrition classes
Exercise classes
Stress management
classes

ILLNESS PREVENTION
Services designed to
reduce risk factors in an
effort to avoid primary,
secondary, or tertiary
health interventions.

EXAMPLES
Support groups to give up
smoking
Controlling the breeding of
insects
Education program on AIDS
prevention
immunization

DIAGNOSIS AND
TREATMENT
Most commonly used
services of health care
Usually sought once a
person feels ill or a
problem indicated.

EXAMPLES
Teaching about breast selfexamination
Vision screening programs at
schools
Treatments provided in any
health care setting

REHABILITATION
The restoration of a person to their
highest level of functioning, maximizing
abilities and independence
Programs have extended beyond helping
those with illness or injuries to the
nervous system
It includes those for cardiovascular,
pulmonary, and chemical-induced
impairments.

REHABILITATION
Involves the client, family, and the
entire health team who individualize
a rehabilitation program for the
client.
Provided in various setting (eg.,
hospital, home, healthcare home,
outpatient setting)

DEATH AND
DYING

What is Death?
Death is defined as:

Cessation of heartlung function or of whole

brain function, or of higher
brain function

THE GRIEVING
PROCESS

Kubler-Ross Theory (1969)

Theory of stages of grief when an
individual is dying has gained wide
acceptance in nursing and other
disciplines. The stages of dying, much like
the stages of grief, may overlap, and the
duration of any stage may range from as
little as a few hours to as long as months.

Kubler-Ross Theory (1969)

The process varies from person to
person. Some people may be in
one stage for such a short time
that it seems as if they skipped
that stage. Sometimes the person
returns to a previous stage.

 According to Kubler-Ross, the

five stages of dying are:
-Denial
-Anger
-Bargaining
-Depression
-Acceptance
*They are widely known in the
acronym DABDA.

1) Denial
-On being told that one is dying,
there is an initial reaction of shock.
-The patient may appear dazed at
first and may then refuse to
believe the diagnosis or deny that
anything is wrong.
-Some patients never pass beyond
this stage and may go from doctor
to doctor until they find one who
supports their position.

2) Anger
-Patients become frustrated,
irritable and angry that they are
sick.
-A common response is Why me?
-They may become angry at God,
their fate, a friend, or a family
member.
-The anger may be displaced onto
the hospital staff of the doctors
who are blamed for the illness.

3)Bargaining
-The patient may attempt to
negotiate with physicians, friends
or even God, that in return for a
cure, the person will fulfill one or
many promises, such as giving to
charity or reaffirm faith in God.

4) Depression
-The patient shows clinical signs of
depression withdrawal,
psychomotor retardation, sleep
disturbances, hopelessness and
possibly suicidal ideation.
-The depression may be a reaction
to the effects of the illness on his
or her life or it may be in
anticipation of the approaching
death.

5) Acceptance
-The patient realizes that death is
inevitable and accepts the universality
of the experience.
-Under ideal circumstances, the patient
is courageous and is able to talk about
his or her death as he or she faces the
unknown.
-People with strong religious beliefs and
those who are convinced of a life after
death can find comfort in these beliefs.

SIGNS AND
SYMPTOMS
OF
APPROACHI
NG DEATH

2 Phases of
Dying
Pre-active phase may
last approximately two
weeks
Active phase may lasts
about three days

PRE-ACTIVE PHASE
increased restlessness, confusion,
agitation, inability to stay content in
one position and insisting on changing
positions frequently (exhausting
family and caregivers)
withdrawal from active participation in
social activities

PRE-ACTIVE PHASE
increased periods of sleep,
lethargy
decreased intake of food and
liquids
beginning to show periods of
pausing in the breathing (apnea)
whether awake or sleeping
patient reports seeing persons who

PRE-ACTIVE PHASE
patient states that he or she is dying
patient requests family visit to settle
"unfinished business" and tie up
"loose ends"
inability to heal or recover from
wounds or infections
increased swelling (edema) of either
the extremities or the entire body

ACTIVE PHASE
inability to arouse patient at all (coma) or,
ability to only arouse patient with great
effort but patient quickly returns to
severely unresponsive state (semi-coma)
severe agitation in patient, hallucinations,
acting "crazy" and not in patient's normal
manner or personality

ACTIVE PHASE
much longer periods of pausing in the
breathing (apnea)
dramatic changes in the breathing pattern
including apnea, but also including very
rapid breathing or cyclic changes in the
patterns of breathing (such as slow
progressing to very fast and then slow
again, or shallow progressing to very deep
breathing while also changing rate of
breathing to very fast and then slow)

ACTIVE PHASE
other very abnormal breathing
patterns
severely increased respiratory
congestion or fluid buildup in
lungs
inability to swallow any fluids at
all (not taking any food by mouth

ACTIVE PHASE
patient states that he or she is going
to die
patient breathing through wide open
mouth continuously and no longer
can speak even if awake
urinary or bowel incontinence in a
patient who was not incontinent
before

ACTIVE PHASE
marked decrease in urine output
and darkening color of urine or
very abnormal colors (such as red
or brown)
blood pressure dropping
dramaticallyfrom patient's
normalblood pressure range
(more than a 20 or 30 point drop)

ACTIVE PHASE
systolic blood pressure below 70,
diastolic blood pressure below 50
patient's extremities (such as hands,
arms, feet and legs) feel very cold to
touch
patient complains that his or her
legs/feet are numb and cannot be felt
at all

ACTIVE PHASE
cyanosis, or a bluish or purple
coloring to the patients arms and
legs, especially the feet and hands)
patient's body is held in rigid
unchanging position
jaw drop; the patient's jaw is no
longer held straight and may drop to
the side their head is lying towards

WHAT HAPPENS
TO OUR PHYSICAL
REMAINS RIGHT
AFTER DEATH
OCCURS?

Primary Flaccidity
Hour 1
All of the muscles in the body
relax.
Eyelids lose their tension, the
pupils dilate
The jaw might fall open
The bodys joints and limbs
are flexible

Pallor Mortis
Human heart beats more
than 2.5 billion times
Circulate blood about 5.6
liters in circulatory
system.

Pallor Mortis
With in minutes of the heart
stops it usually causes the
Caucasian person to grow
pale as blood drains from the
smaller veins in the skin.

Algor Mortis
The body begins to cool from its
normal temperature of 37 Celsius
(98.6 Fahrenheit).
Causes the decrease in the body
temperature follows a somewhat
linear progression.

Livor Mortis
Hours 2-6
Gravity begins to pull the heart to the
areas of the body to the ground.
If the body remains undistributed long
enough, the parts of the body nearest
to the ground can develop a reddishpurple discoloration from the
accumulating blood. Encambalmers
sometimes refer to this as the

postmortem stain.

Rigor Mortis
Beginning in the third hour
after death, causes all the
muscles to begin stiffening.
First the muscles affected
include the eyelids, jaw and
neck.

Rigor Mortis
Next several hours, it
spreads upward into the face
and down through the chest
and abdomen, arms and legs
until it reaches the fingers
and the toes.

Hours 7-12
Maximum muscle stiffness
throughout the body
occurs after roughly 12 hrs.
this will be affected by
decents age, physical
condition, sex, the air
temp. etc.

Hours 7-12
At this point, the limbs of the
deceased are difficult to
move or manipulate.
The knees and elbows will be
slightly flexed and fingers or
toes can appear unusually
crooked.

Second flaccidity
12 hours and beyond
The muscle will begin to loosen due to
continued chemical changes within the
cells and internal tissue decay. This
process occurs over period of one to
three days and will be influenced by
external conditions such as
temperature.
Eventually all of the muscles will again
relax reaching a state known as second

POSTMORTEM
CARE

Post-Mortem care
It is the care provided to a patient
immediately after death
Purpose:
Ensuring proper identification of the
patient
Providing appropriate disposition of
patients belongings
Maintaining vital organs, if donation is
planned

Post-Mortem care
Evaluation
1. Evaluate using the following
criteria:
A. Body cared for and transported
appropriately
B. All necessary notifications
carried out

Post-Mortem care
Documentation
1. Document Post-Mortem activities including:
A. Time of cessation of vital signs
B. Persons notified and time of notification
C. List and documentation of valuable and
personal effects
D. Time body removed from unit, destination
and by whom removed.

THANK
YOU!!!!

GROUP 4:
CRASCO
MAQUERA
MEDENILLA
PAGADDU
PANADO
PINEDA
QUIJANO
SANTOS
ZAMORA