3.11: Halogens
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- Sol Parajon Puenzo
- Cañada College
Learning Objective
- How to name halogenated hydrocarbons
The halogens are elements belonging to Group 7A. Fluorine, chlorine, bromine, and iodine can be added to hydrocarbons through reactions with their diatomic forms or when bound to hydrogen as hydrogen halides.
When a halogen atom is bound to an otherwise saturated carbon atom, the molecule is known as an alkyl halide.
| Substituent | Symbol | Name |
|---|---|---|
| Fluorine | Fl | fluoro- |
| Chlorine | Cl | chloro- |
| Bromine | Br | bromo- |
| Iodine | I | iodo- |
When naming molecules according to the IUPAC system of nomenclature, remember prefix-parent-suffix (like un-believe-able).
- prefix: what are the substituents?
- parent: how many carbons?
- suffix: what is the family of compounds?
Practice Questions
1. This molecule is named 2-chlorobutane.
What is the name of Molecule A?
2. This molecule is named 2-fluoro-3-methylpentane.
This molecule is named 4-iodo-2-methylhexane.
What is the name of Molecule B?
3. This molecule is named 1-chloro-2-butene.
This molecule is named 5-fluoro-2-hexene.
What is the name of Molecule C?
4. This molecule is named 5-fluoro-1,3-cyclohexadiene.
What is the name of Molecule D?
5. Write the steps that you use to name an alkyl halide, in order, as instructions for a student who doesn't know how to do it.
6. Draw any alkyl halide and go through the steps in naming your molecule.


11.20: Job Characteristics that Affect Motivation
- Describe the job characteristics that affect motivation.
When we covered organizational structure, you learned that the way characteristics of a job are organized can act to increase or decrease effort (job characteristics model). Building on that model, you will learn how job rotation, job enlargement, and job enrichment can have a major impact on motivation.
Job Rotation
Job rotation involves periodically shifting an employee from one task or job to another in an effort to decrease boredom. By cross-training employees, companies have also found reductions in repetitive motion injuries and turnover. Lincoln Electric, a manufacturer of welding and cutting parts company, regularly cross-trains all its employees, including salaried management, to weld and operate production machines. This cross-training effort has helped minimize layoffs during downturns and increased job satisfaction.
McDonald’s, the fast food restaurant, uses job rotation. According to a manager in McDonald’s Hong Kong locations, the young staff wants flexible working hours and is easily bored. But McDonald’s job rotation policy makes workers feel like they can learn something new every day. [1]
Job Enlargement
Expanding jobs horizontally by increasing the number and variety of tasks that an individual performs is known as job enlargement. It seeks to motivate workers through reversing specialization. For example, replacing an assembly line with modular work gives each worker more variety and responsibility. Audi, for instance, is experimenting with modular assembly for its cars. [2]
Although some employees may welcome the opportunity to take on more work, a 1993 study had mixed results. The study looked at job enlargement efforts among clerical staff and managers in the financial services industry. For most employees, the extra work resulted in less satisfaction and efficiency, and stressful overload and errors. [3]
Job Enrichment
Job enrichment refers to the vertical expansion of jobs. It increases the degree to which an employee also controls the planning and evaluation of the work that she executes. An enriched job increases the employee’s independence and responsibility. It also provides feedback, making it possible for employees to evaluate and improve their own performance. [4]
- Liana Cafolla. “McDonald's top recipe for loyalty,” cpjobs, June 21, 2011, accessed Aug. 9, 2017, https://www.cpjobs.com/hk/article/mcdonalds-top-recipe-loyalty ↵
- “Modular Assembly,” Smart Factory illustrated. https://audi-illustrated.com/en/smart-factory/Die-Modulare-Montage ↵
- Michael A. Campion and Carol L. McClelland, “Follow-Up and Extension of the Interdisciplinary Costs and Benefits of Enlarged Jobs,” Journal of Applied Psychology 78, no. 3 (1993): 339–351 ↵
- J. Richard Hackman and Greg R. Oldham, Work Redesign, Reading, MA: Addison Wesley, 1980 ↵
Contributors and Attributions
- Job Characteristics that Affect Motivation. Authored by : David J. Thompson and Lumen Learning. License : CC BY: Attribution
- Tokyo Fast Food. Authored by : Danny Choo. Located at : https://www.flickr.com/photos/dannychoo/4861699465/in/photolist-PxCxEq-8pBtSz . License : CC BY-SA: Attribution-ShareAlike


Page 9.5: Case Study - The Aral Sea - Going, Going, Gone
The Aral Sea is a lake located east of the Caspian Sea between Uzbekistan and Kazakhstan in central Asia. This area is part of the Turkestan desert, which is the fourth largest desert in the world; it is produced from a rain shadow effect by Afghanistan’s high mountains to the south. Due to the arid and seasonally hot climate there is extensive evaporation and limited surface waters in general. Summer temperatures can reach 60 ο C (140 ο F)! The water supply to the Aral Sea is mainly from two rivers, the Amu Darya and Syr Darya, which carry snow melt from mountainous areas.
A comparison of the Aral Sea in 1989 (left) and 2014 (right). Credit: This work is in the Public Domain, CC0In the early 1960s, the then-Soviet Union diverted the Amu Darya and Syr Darya Rivers for irrigation of one of the driest parts of Asia to produce rice, melons, cereals, and especially cotton. The Soviets wanted cotton or white gold to become a major export. They were successful, and, today Uzbekistan is one of the world’s largest exporters of cotton. Unfortunately, this action essentially eliminated any river inflow to the Aral Sea and caused it to disappear almost completely.
Figure \(\PageIndex{2}\). Map of Aral Sea Area Map shows lake size in 1960 and political boundaries of 2011. Countries in yellow are at least partially in Aral Sea drainage basin. Source: Wikimedia CommonsIn 1960, Aral Sea was the fourth largest inland water body; only the Caspian Sea, Lake Superior, and Lake Victoria were larger. Since then, it has progressively shrunk due to evaporation and lack of recharge by rivers. Before 1965, the Aral Sea received 2060 km 3 of fresh water per year from rivers and by the early 1980s it received none. By 2007, the Aral Sea shrank to about 10% of its original size and its salinity increased from about 1% dissolved salt to about 10% dissolved salt, which is 3 times more saline than seawater. These changes caused an enormous environmental impact. A once thriving fishing industry is dead as are the 24 species of fish that used to live there; the fish could not adapt to the more saline waters. The current shoreline is tens of kilometers from former fishing towns and commercial ports. Large shing boats lie in the dried up lakebed of dust and salt. A frustrating part of the river diversion project is that many of the irrigation canals were poorly built, allowing abundant water to leak or evaporate. An increasing number of dust storms blow salt, pesticides, and herbicides into nearby towns causing a variety of respiratory illnesses including tuberculosis.
Figure \(\PageIndex{3}\). This abandoned ship lies in a dried up lake bed that was the Aral Sea near Aral, Kazakhstan Source: Staecker at Wikimedia CommonsThe wetlands of the two river deltas and their associated ecosystems have disappeared. The regional climate is drier and has greater temperature extremes due to the absence of moisture and moderating influence from the lake. In 2003, some lake restoration work began on the northern part of the Aral Sea and it provided some relief by raising water levels and reducing salinity somewhat. The southern part of the Aral Sea has seen no relief and remains nearly completely dry. The destruction of the Aral Sea is one of the planet’s biggest environmental disasters and it is caused entirely by humans. Lake Chad in Africa is another example of a massive lake that has nearly disappeared for the same reasons as the Aral Sea. Aral Sea and Lake Chad are the most extreme examples of large lakes destroyed by unsustainable diversions of river water. Other lakes that have shrunk significantly due to human diversions of water include the Dead Sea in the Middle East, Lake Manchar in Pakistan, and Owens Lake and Mono Lake, both in California.
Contributors and Attributions
- Essentials of Environmental Science by Kamala Doršner is licensed under CC BY 4.0. Modified from the original by Matthew R. Fisher.


4.11: Exercises
How do solutions differ from compounds? From other mixtures?
Which of the principal characteristics of solutions are evident in the solutions of K 2 Cr 2 O 7 shown in Figure 11.2?
When KNO 3 is dissolved in water, the resulting solution is significantly colder than the water was originally.
- Is the dissolution of KNO 3 an endothermic or an exothermic process?
- What conclusions can you draw about the intermolecular attractions involved in the process?
- Is the resulting solution an ideal solution?
Give an example of each of the following types of solutions:
- a gas in a liquid
- a gas in a gas
- a solid in a solid
Indicate the most important types of intermolecular attractions in each of the following solutions:
- The solution in Figure 11.2.
- NO( l ) in CO( l )
- Cl 2 ( g ) in Br 2 ( l )
- HCl( g ) in benzene C 6 H 6 ( l )
- Methanol CH 3 OH( l ) in H 2 O( l )
Predict whether each of the following substances would be more soluble in water (polar solvent) or in a hydrocarbon such as heptane (C 7 H 16 , nonpolar solvent):
- vegetable oil (nonpolar)
- isopropyl alcohol (polar)
- potassium bromide (ionic)
Heat is released when some solutions form; heat is absorbed when other solutions form. Provide a molecular explanation for the difference between these two types of spontaneous processes.
Solutions of hydrogen in palladium may be formed by exposing Pd metal to H 2 gas. The concentration of hydrogen in the palladium depends on the pressure of H 2 gas applied, but in a more complex fashion than can be described by Henry’s law. Under certain conditions, 0.94 g of hydrogen gas is dissolved in 215 g of palladium metal (solution density = 10.8 g cm 3 ).
- Determine the molarity of this solution.
- Determine the molality of this solution.
- Determine the percent by mass of hydrogen atoms in this solution.
Explain why the ions Na + and Cl − are strongly solvated in water but not in hexane, a solvent composed of nonpolar molecules.
Explain why solutions of HBr in benzene (a nonpolar solvent) are nonconductive, while solutions in water (a polar solvent) are conductive.
Consider the solutions presented:
(a) Which of the following sketches best represents the ions in a solution of Fe(NO 3 ) 3 ( aq )?
(b) Write a balanced chemical equation showing the products of the dissolution of Fe(NO 3 ) 3 .
Compare the processes that occur when methanol (CH 3 OH), hydrogen chloride (HCl), and sodium hydroxide (NaOH) dissolve in water. Write equations and prepare sketches showing the form in which each of these compounds is present in its respective solution.
What is the expected electrical conductivity of the following solutions?
- NaOH( aq )
- HCl( aq )
- C 6 H 12 O 6 ( aq ) (glucose)
- NH 3 ( aq )
Why are most solid ionic compounds electrically nonconductive, whereas aqueous solutions of ionic compounds are good conductors? Would you expect a liquid (molten) ionic compound to be electrically conductive or nonconductive? Explain.
Indicate the most important type of intermolecular attraction responsible for solvation in each of the following solutions:
- the solutions in Figure 11.7
- methanol, CH 3 OH, dissolved in ethanol, C 2 H 5 OH
- methane, CH 4 , dissolved in benzene, C 6 H 6
- the polar halocarbon CF 2 Cl 2 dissolved in the polar halocarbon CF 2 ClCFCl 2
- O 2 ( l ) in N 2 ( l )
Suppose you are presented with a clear solution of sodium thiosulfate, Na 2 S 2 O 3 . How could you determine whether the solution is unsaturated, saturated, or supersaturated?
Supersaturated solutions of most solids in water are prepared by cooling saturated solutions. Supersaturated solutions of most gases in water are prepared by heating saturated solutions. Explain the reasons for the difference in the two procedures.
Suggest an explanation for the observations that ethanol, C 2 H 5 OH, is completely miscible with water and that ethanethiol, C 2 H 5 SH, is soluble only to the extent of 1.5 g per 100 mL of water.
Calculate the percent by mass of KBr in a saturated solution of KBr in water at 10 °C. See Figure 11.16 for useful data, and report the computed percentage to one significant digit.
Which of the following gases is expected to be most soluble in water? Explain your reasoning.
- CH 4
- CCl 4
- CHCl 3
At 0 °C and 1.00 atm, as much as 0.70 g of O 2 can dissolve in 1 L of water. At 0 °C and 4.00 atm, how many grams of O 2 dissolve in 1 L of water?
Refer to Figure 11.10.
- How did the concentration of dissolved CO 2 in the beverage change when the bottle was opened?
- What caused this change?
- Is the beverage unsaturated, saturated, or supersaturated with CO 2 ?
The Henry’s law constant for CO 2 is 3.4 \times 10^{−2} M /atm at 25 °C. Assuming ideal solution behavior, what pressure of carbon dioxide is needed to maintain a CO 2 concentration of 0.10 M in a can of lemon-lime soda?
The Henry’s law constant for O 2 is 1.3 \times 10^{−3} M /atm at 25 °C. Assuming ideal solution behavior, what mass of oxygen would be dissolved in a 40-L aquarium at 25 °C, assuming an atmospheric pressure of 1.00 atm, and that the partial pressure of O 2 is 0.21 atm?
Assuming ideal solution behavior, how many liters of HCl gas, measured at 30.0 °C and 745 torr, are required to prepare 1.25 L of a 3.20- M solution of hydrochloric acid?
Which is/are part of the macroscopic domain of solutions and which is/are part of the microscopic domain: boiling point elevation, Henry’s law, hydrogen bond, ion-dipole attraction, molarity, nonelectrolyte, nonstoichiometric compound, osmosis, solvated ion?
What is the microscopic explanation for the macroscopic behavior illustrated in Figure 11.14?
Sketch a qualitative graph of the pressure versus time for water vapor above a sample of pure water and a sugar solution, as the liquids evaporate to half their original volume.
A solution of potassium nitrate, an electrolyte, and a solution of glycerin (C 3 H 5 (OH) 3 ), a nonelectrolyte, both boil at 100.3 °C. What other physical properties of the two solutions are identical?
What are the mole fractions of H 3 PO 4 and water in a solution of 14.5 g of H 3 PO 4 in 125 g of water?
- Outline the steps necessary to answer the question.
- Answer the question.
What are the mole fractions of HNO 3 and water in a concentrated solution of nitric acid (68.0% HNO 3 by mass)?
- Outline the steps necessary to answer the question.
- Answer the question.
Calculate the mole fraction of each solute and solvent:
- 583 g of H 2 SO 4 in 1.50 kg of water—the acid solution used in an automobile battery
- 0.86 g of NaCl in 1.00 \times 10^{2} g of water—a solution of sodium chloride for intravenous injection
- 46.85 g of codeine, C 18 H 21 NO 3 , in 125.5 g of ethanol, C 2 H 5 OH
- 25 g of I 2 in 125 g of ethanol, C 2 H 5 OH
Calculate the mole fraction of each solute and solvent:
- 0.710 kg of sodium carbonate (washing soda), Na 2 CO 3 , in 10.0 kg of water—a saturated solution at 0 °C
- 125 g of NH 4 NO 3 in 275 g of water—a mixture used to make an instant ice pack
- 25 g of Cl 2 in 125 g of dichloromethane, CH 2 Cl 2
- 0.372 g of tetrahydropyridine, C 5 H 9 N, in 125 g of chloroform, CHCl 3
Calculate the mole fractions of methanol, CH 3 OH; ethanol, C 2 H 5 OH; and water in a solution that is 40% methanol, 40% ethanol, and 20% water by mass. (Assume the data are good to two significant figures.)
What is the difference between a 1 M solution and a 1 m solution?
What is the molality of phosphoric acid, H 3 PO 4 , in a solution of 14.5 g of H 3 PO 4 in 125 g of water?
- Outline the steps necessary to answer the question.
- Answer the question.
What is the molality of nitric acid in a concentrated solution of nitric acid (68.0% HNO 3 by mass)?
- Outline the steps necessary to answer the question.
- Answer the question.
Calculate the molality of each of the following solutions:
- 583 g of H 2 SO 4 in 1.50 kg of water—the acid solution used in an automobile battery
- 0.86 g of NaCl in 1.00 \times 10^{2} g of water—a solution of sodium chloride for intravenous injection
- 46.85 g of codeine, C 18 H 21 NO 3 , in 125.5 g of ethanol, C 2 H 5 OH
- 25 g of I 2 in 125 g of ethanol, C 2 H 5 OH
Calculate the molality of each of the following solutions:
- 0.710 kg of sodium carbonate (washing soda), Na 2 CO 3 , in 10.0 kg of water—a saturated solution at 0°C
- 125 g of NH 4 NO 3 in 275 g of water—a mixture used to make an instant ice pack
- 25 g of Cl 2 in 125 g of dichloromethane, CH 2 Cl 2
- 0.372 g of tetrahydropyridine, C 5 H 9 N, in 125 g of chloroform, CHCl 3
The concentration of glucose, C 6 H 12 O 6 , in normal spinal fluid is What is the molality of the solution?
A 13.0% solution of K 2 CO 3 by mass has a density of 1.09 g/cm 3 . Calculate the molality of the solution.
Why does 1 mol of sodium chloride depress the freezing point of 1 kg of water almost twice as much as 1 mol of glycerin?
Assuming ideal solution behavior, what is the boiling point of a solution of 115.0 g of nonvolatile sucrose, C 12 H 22 O 11 , in 350.0 g of water?
- Outline the steps necessary to answer the question
- Answer the question
Assuming ideal solution behavior, what is the boiling point of a solution of 9.04 g of I 2 in 75.5 g of benzene, assuming the I 2 is nonvolatile?
- Outline the steps necessary to answer the question.
- Answer the question.
Assuming ideal solution behavior, what is the freezing temperature of a solution of 115.0 g of sucrose, C 12 H 22 O 11 , in 350.0 g of water?
- Outline the steps necessary to answer the question.
- Answer the question.
Assuming ideal solution behavior, what is the freezing point of a solution of 9.04 g of I 2 in 75.5 g of benzene?
- Outline the steps necessary to answer the following question.
- Answer the question.
Assuming ideal solution behavior, what is the osmotic pressure of an aqueous solution of 1.64 g of Ca(NO 3 ) 2 in water at 25 °C? The volume of the solution is 275 mL.
- Outline the steps necessary to answer the question.
- Answer the question.
Assuming ideal solution behavior, what is osmotic pressure of a solution of bovine insulin (molar mass, 5700 g mol −1 ) at 18 °C if 100.0 mL of the solution contains 0.103 g of the insulin?
- Outline the steps necessary to answer the question.
- Answer the question.
Assuming ideal solution behavior, what is the molar mass of a solution of 5.00 g of a compound in 25.00 g of carbon tetrachloride (bp 76.8 °C; K b = 5.02 °C/ m ) that boils at 81.5 °C at 1 atm?
- Outline the steps necessary to answer the question.
- Solve the problem.
A sample of an organic compound (a nonelectrolyte) weighing 1.35 g lowered the freezing point of 10.0 g of benzene by 3.66 °C. Assuming ideal solution behavior, calculate the molar mass of the compound.
A 1.0 m solution of HCl in benzene has a freezing point of 0.4 °C. Is HCl an electrolyte in benzene? Explain.
A solution contains 5.00 g of urea, CO(NH 2 ) 2 , a nonvolatile compound, dissolved in 0.100 kg of water. If the vapor pressure of pure water at 25 °C is 23.7 torr, what is the vapor pressure of the solution (assuming ideal solution behavior)?
A 12.0-g sample of a nonelectrolyte is dissolved in 80.0 g of water. The solution freezes at −1.94 °C. Assuming ideal solution behavior, calculate the molar mass of the substance.
Arrange the following solutions in order by their decreasing freezing points: 0.1 m Na 3 PO 4 , 0.1 m C 2 H 5 OH, 0.01 m CO 2 , 0.15 m NaCl, and 0.2 m CaCl 2 .
Calculate the boiling point elevation of 0.100 kg of water containing 0.010 mol of NaCl, 0.020 mol of Na 2 SO 4 , and 0.030 mol of MgCl 2 , assuming complete dissociation of these electrolytes and ideal solution behavior.
How could you prepare a 3.08 m aqueous solution of glycerin, C 3 H 8 O 3 ? Assuming ideal solution behavior, what is the freezing point of this solution?
A sample of sulfur weighing 0.210 g was dissolved in 17.8 g of carbon disulfide, CS 2 ( K b = 2.34 °C/ m ). If the boiling point elevation was 0.107 °C, what is the formula of a sulfur molecule in carbon disulfide (assuming ideal solution behavior)?
In a significant experiment performed many years ago, 5.6977 g of cadmium iodide in 44.69 g of water raised the boiling point 0.181 °C. What does this suggest about the nature of a solution of CdI 2 ?
Lysozyme is an enzyme that cleaves cell walls. A 0.100-L sample of a solution of lysozyme that contains 0.0750 g of the enzyme exhibits an osmotic pressure of 1.32 \times 10^{−3} atm at 25 °C. Assuming ideal solution behavior, what is the molar mass of lysozyme?
The osmotic pressure of a solution containing 7.0 g of insulin per liter is 23 torr at 25 °C. Assuming ideal solution behavior, what is the molar mass of insulin?
The osmotic pressure of human blood is 7.6 atm at 37 °C. What mass of glucose, C 6 H 12 O 6 , is required to make 1.00 L of aqueous solution for intravenous feeding if the solution must have the same osmotic pressure as blood at body temperature, 37 °C (assuming ideal solution behavior)?
Assuming ideal solution behavior, what is the freezing point of a solution of dibromobenzene, C 6 H 4 Br 2 , in 0.250 kg of benzene, if the solution boils at 83.5 °C?
Assuming ideal solution behavior, what is the boiling point of a solution of NaCl in water if the solution freezes at −0.93 °C?
The sugar fructose contains 40.0% C, 6.7% H, and 53.3% O by mass. A solution of 11.7 g of fructose in 325 g of ethanol has a boiling point of 78.59 °C. The boiling point of ethanol is 78.35 °C, and K b for ethanol is 1.20 °C/ m . Assuming ideal solution behavior, what is the molecular formula of fructose?
The vapor pressure of methanol, CH 3 OH, is 94 torr at 20 °C. The vapor pressure of ethanol, C 2 H 5 OH, is 44 torr at the same temperature.
- Calculate the mole fraction of methanol and of ethanol in a solution of 50.0 g of methanol and 50.0 g of ethanol.
- Ethanol and methanol form a solution that behaves like an ideal solution. Calculate the vapor pressure of methanol and of ethanol above the solution at 20 °C.
- Calculate the mole fraction of methanol and of ethanol in the vapor above the solution.
The triple point of air-free water is defined as 273.16 K. Why is it important that the water be free of air?
Meat can be classified as fresh (not frozen) even though it is stored at −1 °C. Why wouldn’t meat freeze at this temperature?
An organic compound has a composition of 93.46% C and 6.54% H by mass. A solution of 0.090 g of this compound in 1.10 g of camphor melts at 158.4 °C. The melting point of pure camphor is 178.4 °C. K f for camphor is 37.7 °C/ m . Assuming ideal solution behavior, what is the molecular formula of the solute? Show your calculations.
A sample of HgCl 2 weighing 9.41 g is dissolved in 32.75 g of ethanol, C 2 H 5 OH ( K b = 1.20 °C/ m ). The boiling point elevation of the solution is 1.27 °C. Is HgCl 2 an electrolyte in ethanol? Show your calculations.
A salt is known to be an alkali metal fluoride. A quick approximate determination of freezing point indicates that 4 g of the salt dissolved in 100 g of water produces a solution that freezes at about −1.4 °C. Assuming ideal solution behavior, what is the formula of the salt? Show your calculations.
Identify the dispersed phase and the dispersion medium in each of the following colloidal systems: starch dispersion, smoke, fog, pearl, whipped cream, floating soap, jelly, milk, and ruby.
Distinguish between dispersion methods and condensation methods for preparing colloidal systems.
How do colloids differ from solutions with regard to dispersed particle size and homogeneity?
Explain the cleansing action of soap.
How can it be demonstrated that colloidal particles are electrically charged?


9.1: Health Disparities Defined
By the end of this section, you should be able to:
- Define health disparities.
- Discuss how health care disparities affect access to care.
- Describe the Agency for Healthcare Research and Quality priority health disparities.
- Recognize disparities in health as a metric for assessing health equity.
External factors beyond a person’s physical and psychological attributes, such as social, economic, and environmental factors, influence health. When one or more of these factors prevent a group from having full access to the health-related resources they need, health disparities result. With racial and ethnic diversity increasing in the United States, addressing these disparities is essential to improving the population’s health.
Recognizing Health Disparities
Healthy People 2030 defines health disparities as health differences linked to social, economic, and/or environmental disadvantages (Office of Disease Prevention and Health Promotion [ODPHP], n.d.-c). For example, Black adults are more likely to have risk factors for cardiovascular disease, and they are more than twice as likely as White adults to die from the disease (Javed et al., 2022). The CDC (2022c) defines health disparities as preventable differences in disease, injury, or violence or in opportunities to achieve optimal health experienced by socially disadvantaged racial, ethnic, and other population groups. In the United States, individuals who have experienced prejudice or bias because of their racial, ethnic, or cultural identities, without regard for their individual qualities and stemming from circumstances beyond their control, are considered socially disadvantaged (Business Credit and Assistance, 2023).
According to the National Institute on Minority Health and Health Disparities (NIMHD), health disparities can cause:
- Higher prevalence of disease, including earlier onset and more aggressive progression of the disease
- Increased risk of premature death from a disease or other health condition
- More prevalent unhealthy behaviors and practices
- Poorer health outcomes
Table 9.1 provides some examples of health conditions and associated Healthy People 2030 goals.
| Health Condition | Description | Healthy People 2030 Goals |
|---|---|---|
| Infant mortality | Infants born to non-Hispanic Black Americans have an infant mortality rate 2.4 times greater than non-Hispanic White Americans (U.S. Department of Health and Human Services Office of Minority Health [OMH], 2022a). | Prevent pregnancy complications and maternal deaths and improve women’s health before, during, and after pregnancy |
| Maternal mortality | Black women are three times more likely to die from a pregnancy-related cause than White women (CDC, 2023c). | Prevent pregnancy complications and maternal deaths and improve women’s health before, during, and after pregnancy |
| Dementia | Older Black Americans are twice as likely as older White Americans to have Alzheimer's disease or another dementia (Alzheimer’s Association, 2023). | Improve health and quality of life for people with dementia, including Alzheimer’s disease |
| Cancer | Individuals with lower incomes and education levels are more likely to get cancer and die from it compared to those who are more affluent (Singh, 2017; Tabuchi, 2020). | Reduce new cases of cancer and cancer-related illness, disability, and death |
| Obesity | Obesity rates are significantly higher in Black women and Mexican-America men when compared to other groups (Hill et al., 2017; OMH, 2022b). | Reduce overweight and obesity by helping people eat healthy and get physical activity |
| Smoking | Native Americans and Alaska Native men and women have a disproportionately higher rate of smoking than other groups. The same is true for individuals who are below the federal poverty level or unemployed (CDC, 2023a; CDC, 2020; Everding, 2019). | Reduce illness, disability , and death related to tobacco use and secondhand smoke |
| Binge drinking | Young White men are more likely to binge drink than other groups (CDC, 2022d). | Reduce misuse of drugs and alcohol |
Health equity is the state in which everyone has a fair and just opportunity to attain their highest level of health (CDC, 2022b). One of the five overarching goals of Healthy People 2030 is to eliminate health disparities to achieve health equity and attain health literacy to improve the population’s health and wellbeing. Figure 9.2 provides an overview of the Healthy People 2030 goals related to health equity.
The populations that most often experience health disparities include racial and ethnic minorities , people with lower socioeconomic status , underserved rural communities, and sexual and gender minorities (NIMHD, 2023). Each of these populations will be discussed in detail later in this chapter. Table 9.2 describes individual health determinant s and their effect on outcomes (NIMHD, 2023).
| Health Determinant | Description |
|---|---|
| Individual behaviors | The choices one makes have a direct impact on their health outcomes. For example, health-promoting behaviors such as getting regular exercise and eating a nutritious diet may lead to positive health outcomes. In contrast, behaviors that lead to negative health outcomes include smoking tobacco and driving while intoxicated. |
| Lifestyles | Unhealthy lifestyles secondary to individual health behaviors lead to a greater prevalence of negative health outcomes, such as those related to disease processes. |
| Social responses to stress | Individuals without coping skills to deal with stress tend to have less-than-optimal health outcomes, such as the presence of chronic diseases such as diabetes and hypertension. |
| Biological processes | Biology presents unavoidable risk factors for individuals related to health outcomes, such as inheriting certain diseases from parents like diabetes or hypertension. |
| Genetics | Genetics relates to a branch of biology that deals with heredity and genes passed from parent to child. Genetics are factors that cannot be altered by an individual, who can only alter behavioral risk factors such as smoking or unhealthy eating. |
| Epigenetics | Epigenetics refers to how behaviors and environment cause changes that impact how genes work. For example, an individual who lives in a home where other family members smoke may have an increased risk for diseases such as cancer even if the individual’s genetics are not associated with cancer. |
| Physical environment | What individuals are exposed to where they reside has a direct impact on their health outcomes, such as exposure to pollutants in either urban or rural areas. |
| Sociocultural environment | Sociocultural environment relates to the combination of who individuals interact with and what their cultural beliefs, habits, and traditions are. For example, cultural norms associated with various foods can impact health outcomes. When a family is accustomed to eating high volumes of fried foods or high-carbohydrate foods, there is an increased risk for chronic diseases such as obesity, diabetes, and hypertension. |
| Interactions with the health care and other systems | When individuals interact negatively with the health care system, the likelihood that they will continue to utilize that particular service is limited, thus leading to poor health outcomes. |
This video by John Hopkins Medicine features Michelle Simmons, a West Baltimore resident who describes the impact of health disparities on her family and her community and her efforts to reverse their negative effects.
Watch the video, and then respond to the following questions.
- What are some of the health disparities Michelle describes in the video, and how might they negatively affect her health and her community’s health?
- What are some of the root causes of health disparities discussed in the video?
- What choices did Michelle need to make to prioritize her health?
As discussed in Social Determinants Affecting Health Outcomes, the social determinants of health (SDOH) are the environmental conditions that affect health, functioning, and quality of life (ODPHP, n.d.-b). Healthy People 2030 groups these determinants into five categories: economic stability, education, health care access and quality, neighborhoods, and social and community context. Health determinants influence health outcomes. For example, Black women experience lower survival rates related to breast cancer than their White counterparts (NIMHD, 2023). This health disparity is most often related to Black women’s lower rates of breast cancer screening and greater chance of a late-stage diagnosis. Poverty also contributes to this disparity as individuals with lower income levels also have lower rates of breast cancer screening and overall poorer health outcomes regardless of their race (Yedjou et al., 2019). See Structural Racism and Systemic Inequities and Social Determinants Affecting Health Outcomes for more information on the implications of race and poverty on health outcomes.
This video explains the foundational impact of structural racism, social determinants of health and their impact on historically marginalized populations, and steps necessary to achieve health equity in affected communities.
Watch the video, and then respond to the following questions.
- In the video, the narrator uses the story of sick fish to show the tendency of society to blame the individual for their health condition rather than considering the outside determinants of health. Describe an example of this from your own community.
- The narrator describes three strategies for identifying health disparities—pay attention, be aware, and create strategies. In the example from your community, describe how this approach could be used to identify and address the disparities.
Health Care Disparities and Access to Care
While health disparities indicate different health-related outcomes among groups, health care disparities are differences among groups related to health care access and use. When people have full access to health care, they have the timely use of the health services they need to achieve optimal health outcomes. Access to health care consists of four key components (Agency for Healthcare Research and Quality [AHRQ], 2023):
- Coverage — Health insurance facilitates entry into the health care system.
- Services — Having a regular source of care is associated with receiving recommended screenings.
- Timeliness—Health care must be provided when it is needed.
- Workforce—Access to health care depends upon the availability of qualified and culturally competent providers.
Insurance Coverage and Related Socioeconomic Factors
Several studies have identified correlations between having health insurance coverage and positive health outcomes (AHRQ, 2022). Collectively, research has shown that insured individuals have increased financial security, improved access to primary care and screenings for health conditions, and improved compliance with medication regimes and that they are less depressed and perceive themselves to be healthier.
The Affordable Care Act (ACA) of 2010 expanded both affordable health insurance options for Americans and the number of people eligible for Medicaid , and it supported innovation in health care delivery to lower health care costs (U.S. Department of Health and Human Services [HHS], 2022a). As a result, more than 20 million Americans gained access to health insurance (HHS, 2022b). In addition, the ACA established protections for preexisting conditions and mandated coverage for essential health benefits (HHS, 2022b).
Despite the gains made by the ACA, many Americans remain uninsured. Disparities in health insurance coverage exist primarily among individuals under age 65, as almost all adults 65 and older are covered by Medicare (AHRQ, 2022). Individuals under age 65 can be covered by private health insurance or other government-sponsored plans, such as Medicaid or a military health plan . Most of the remaining uninsured individuals are in families with at least one employed worker (Garfield et al., 2019). Not all employers offer health insurance to their employees. For example, agricultural, construction, and service workers are more likely to work for businesses that do not provide employer health plans . Also, part-time workers may not be eligible for coverage. Lastly, some workers are eligible to join an employer plan but cannot afford the premiums.
People in low-income households, minority communities, and some urban and rural communities are less likely to have health insurance. For example, Non-Hispanic American Indian or Alaska Native and Hispanic groups are less likely to be insured (AHRQ, 2022). Additionally, how Medicaid is administered from state to state may create differences in health care treatment and options between beneficiaries according to the state in which they live. For example, one state may have a higher threshold to determine who is eligible for Medicaid benefits than another state. Individuals who live in states with higher eligibility requirements but who have lower incomes will face limitations to health care access if they cannot afford private health insurance or pay out of pocket for their care.
Differences in income levels result in major differences in health outcomes. For example, individuals with limited income tend to have higher incidences of chronic diseases such as diabetes and hypertension. These individuals also have limited access to health care services because of related logistical issues. For example, they are more likely to lack reliable or timely transportation to and from a doctor’s office or medical clinic.
Availability of Health Care Services and Providers
To meet the population’s health needs, the health care delivery system must have adequate infrastructure and resources (AHRQ, 2022). Staffing shortages and the location and capacity of health care facilities are key concerns. The number of health care workers in hospitals and long-term care facilities has decreased since January 2020, and almost 63 percent of U.S. counties have been designated as primary care professional shortage areas. Among these areas, rural counties are disproportionately affected. Living near primary care services can increase clients' likelihood of receiving preventative care and treatment for a chronic health condition (Figure 9.3) (AHRQ, 2022). Further disadvantaging clients living in rural areas, 135 rural hospitals closed between 2010 and 2020 (AHRQ, 2022). These closures force clients to travel farther to receive hospital-related services.
Priority Health Disparities
For over 20 years, the Agency for Healthcare Research and Quality (AHRQ) has monitored health care quality and disparities to identify opportunities for improvement. In the 2022 National Healthcare Quality and Disparities Report (NHQDR), the agency identified four priority issues: maternal health, child and adolescent mental health, substance use disorder, and oral health.
Maternal Health
According to the NHQDR, the United States has the highest maternal mortality rate among industrialized countries. The rate continues to increase, with higher mortality rates among marginalized racial and ethnic groups. The NHQDR notes other disparities relative to prenatal care. Hispanic, American Indian/Alaska Native, Black, and Native Hawaiian/Pacific Islander clients are less likely than White and non-Hispanic White clients to receive prenatal care . Between 2016 and 2019, rates of severe maternal morbidity, eclampsia/preeclampsia, severe postpartum hemorrhage, and venous thromboembolism or pulmonary embolism increased overall, with disparities noted among racial and ethnic groups. Between 2017 and 2019, pregnancy-related mortality ratios (per 100,000 births) differed significantly among groups (CDC, 2023b). The rate for Non-Hispanic Native Hawaiian or Other Pacific Islander was the highest at 62.8, followed by Non-Hispanic Black at 39.9, Non-Hispanic American Indian or Alaska Native at 32, Non-Hispanic White at 14.1, Non-Hispanic Asian at 12.8, and Hispanic at 11.6 (CDC, 2023b). Plans to address maternal health disparities include extending postpartum coverage, investing in rural maternal health services, creating and expanding a more diverse maternal health workforce, and creating stronger workplace protections for caregivers (AHRQ, 2022).
In this video, tennis player Serena Williams describes her postpartum experience with life-threatening complications despite presumably having access to quality health care.
Watch the video, and then respond to the following questions.
- What, if anything, surprises you about Ms. Williams’s story?
- What contributed to the delay in the health care providers’ recognition and treatment of her condition?
- What can you take from this story that you can apply to your practice?
Child and Adolescent Mental Health
Mental health issues are widespread. Almost 20 percent of children and adolescents ages 3–17 in the United States have a mental, emotional, developmental, or behavioral disorder (AHRQ, 2022). However, the increasing mental health issues among this age group do not correspond to an increase in mental health service access and utilization. Recent initiatives to address this issue include the designation of “988” as the universal number for the Suicide and Crisis Lifeline (FCC, 2022). Caring for Vulnerable Populations and Communities discusses the mental health crisis in more detail.
Substance Use Disorder
Substance use disorder s (SUD) are a costly, pervasive health concern. Defined as the misuse of illicit drugs, prescription drugs, and/or alcohol, these conditions negatively affect health, and they cost the U.S. economy billions of dollars. There are significant barriers and disparities related to preventing and treating SUD. Less than 50 percent of people treated for SUD complete treatment, with Non-Hispanic Native Hawaiian/Pacific Islander individuals having the lowest percentage of completion among this group (AHRQ, 2022). Rates of drug overdose deaths involving opioids increased between 2018 and 2020. The largest increases were noted among non-Hispanic Black people in large urban areas. Multiple initiatives, including expanding access to naloxone and to evidence-based treatment, aim to address these issues (AHRQ, 2022). Caring for Vulnerable Populations and Communities discusses SUD in more detail.
Oral Health
Oral health is essential for good nutrition, quality sleep, and school/work attendance and performance (AHRQ, 2022). Poor oral health is associated with chronic health conditions. Oral health care has improved for children but not for adults. Two indicators tracked to measure the quality of oral health care delivery in the United States include the prevalence of untreated dental caries and emergency department visits for dental conditions. Key interventions for improving oral health include fluoridating the public water supply, reducing financial barriers to dental services, and improving proximity to dental care. NHQDR data show gains among children and adolescents. Disparities have decreased between Asian, Black, Hispanic, and multiracial groups and White groups and between low- and high-income households. A key reason for the improvement is the inclusion of dental benefits in Medicaid and CHIP programs. Dental care for adults is generally not included in their health insurance coverage.
Measuring Health Disparities
After health disparities are identified, assessing and monitoring their severity and impact is essential. Researchers and policymakers have identified relevant metrics that correlate with the effects of health disparities. These can be used to track the population’s health and the impact of the disparity as well as to reflect the effectiveness of interventions. Ultimately, addressing health disparities leads to health equity, which Healthy People 2030 defines as the attainment of optimal health for everyone (ODPHP, n.d.-b). As discussed in The Health of the Population, the AHRQ (2022) tracks several metrics across racial and ethnic groups to monitor the effects of health disparities including:
- Life expectancy—In 2020, life expectancy in the United States decreased for the first time due to the COVID-19 pandemic. This decline was more remarkable for Hispanic and non-Hispanic Black groups than for non-Hispanic White groups.
- Leading causes of death—In 2020, the leading causes of death in the United States were heart disease, cancer, COVID-19, and unintentional injuries. Certain racial and ethnic groups have increased risks for these conditions.
- Years of potential life lost (YPLL)—This measures premature death. It adjusts mortality statistics for age at death and estimates the average time the person would have lived. Death from unintentional injuries is the leading cause of YPLL across the age spectrum. In 2020, heart disease, liver disease, and diabetes were rising rapidly as leading causes of YPLL.
Healthy People 2030 monitors progress on all the identified objectives for any differences among age groups and acknowledges that measuring health disparities is fundamental to addressing health equity (ODPHP, n.d.-b). The Health of the Population discusses Healthy People 2030 in more detail.


3.16: Assignment- Pregnancy and Birth
| Criteria | Proficient | Developing | Not Evident | Points |
|---|---|---|---|---|
| Presents a coherent summary between 200-400 words | Writes in clear, descriptive sentences with no or few grammatical errors. Accurately summarizes the information in the TED talk, shares the title and link, and the talk is at least 8 minutes in length. | Does not provide enough detail in the summary or contains several grammatical errors. TED talk is possibly too short or not included. | Incomplete summary or difficult to understand OR poor choice of TED talk. | __/5 |
| Describes interesting points and evidences from the talk | Describes interesting and memorable concepts from the talk. Also explains the research, evidence, or data cited by the presenter in the talk. | Does not fully describe concepts from the talk or does not reference the evidence demonstrated in the TED talk. | Does not describe concepts from the talk and does not explain evidence. | __/6 |
| Explains the psychological perspective fitting the presenter | Makes the connection between the TED presenter and the field and perspective of psychology that he or she is presenting about. Describes this perspective. | Makes a connection with the TED talk and a perspective but does not describe the perspective or demonstrate an understanding of the perspective. | Inaccurately or incompletely describes the psychological perspective that fits the TED talk. | __/6 |
| Examines further areas of interest | Elaborates on other remaining questions for the presenter or about the topic. | Does not fully elaborate on other remaining questions for the presenter or about the topic. | Does not consider other questions for the presenter or questions about the topic. | __/3 |
| Total: | __/20 |
Contributors and Attributions
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CC licensed content, Shared previously


22.7.0: Review Questions
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Review Questions
1 .
On assessment, the nurse notes the patient has an enlarged nose, protruding jaw, and prominent forehead. The patient reports joint pain, headaches, and recent vision changes. The nurse concludes the patient is most likely experiencing what condition?
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acromegaly
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myxedema
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Cushing syndrome
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Raynaud phenomenon
2 .
The nurse is caring for a patient newly diagnosed with a simple goiter. What intervention should the nurse expect the provider to order?
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thyroid-stimulating hormone
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dietary changes to increase iodized salt intake
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surgical removal of the goiter
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chemotherapy
3 .
The nurse is performing an assessment of the patient’s head and neck. What question should the nurse ask to collect objective data?

4 .
The nurse recalls that Cushing syndrome is a condition created by what body organ?
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adrenal gland
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hypothalamus gland
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pituitary gland
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thyroid gland
5 .
The nurse is performing an assessment on a 17-year-old patient who was thrown from a four-wheeler. What symptom is the most concerning and would require the nurse to take immediate action?
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dizziness
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palpable mass and swelling
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sensitivity to light
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severe headache
6 .
The nurse is performing a visual acuity test. What interpretation demonstrates an accurate understanding of the results?
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Visual acuity of 20/50 means the patient can see at 20 feet what a person with normal vision can see at 50 feet.
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Visual acuity of 20/40 means the patient can see at 40 feet what a person with normal vision can see at 20 feet.
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Visual acuity of 20/40 means the patient can see 20 percent of the items that are 40 feet away.
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Visual acuity of 20/50 means the patient can see 50 percent of the items that are 20 feet away.
7 .
The nurse is performing an assessment of the eyes. What action accurately describes how to perform an eye assessment?
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To test convergence, ask the patient to keep their head still and follow a target (your fingertip or a pen) with their eyes only in all six cardinal directions.
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To test extraocular movements, ask the patient to focus on an object (e.g., your fingertip) held about 2 inches in front of their nose, while slowly moving the object toward the patient’s nose.
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To assess the pupils, hold the penlight or flashlight about 5 to 10 inches away from the patient’s face and shine the light directly into one eye; observing both pupils for their initial size and equality.
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To test pupil accommodation, ask the patient to focus on a near object (e.g., your finger) and then switch their focus to a distant object.
8 .
The nurse is reviewing the structures of the eye with a newly graduated nurse. What statement made by the newly graduated nurse would warrant further education?
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“Rods are photoreceptors that are responsible for vision in low-light conditions and for detecting movement.”
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“The optic nerve is the bundle of nerve fibers that carries visual information from the retina to the brain for processing.”
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“The cornea is a small, central area of the retina responsible for central vision and color perception.”
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“The retina is the innermost layer of the eye that contains photoreceptors, which detect light and transmit visual signals to the brain.”
9 .
The nurse is performing an eye assessment on an 86-year-old patient who reports gradual changes in vision. The patient reports, “It looks like I’m looking through the end of a paper towel roll, but everything is blurry.” The nurse recognizes the patient is most likely experiencing what eye abnormality?
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cataracts
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glaucoma
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macular degeneration
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presbyopia
10 .
The nurse is performing an eye assessment on a 40-year-old patient and notices the pupils are unequal in size. How would the nurse denote this eye abnormality in the patient’s chart?
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amblyopia
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anisocoria
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miosis
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ptosis
11 .
Upon assessment, the nurse notes the patient’s ear is elflike in shape. How would the nurse document this ear abnormality?
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cauliflower ear
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ear tag
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microtia
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Stahl ear
12 .
The nurse suspects the patient may be experiencing a perforated eardrum. What assessment would be used to determine if this prediction is accurate?
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Weber test
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inspection with otoscope
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Rinne test
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Romberg test
13 .
The nurse is precepting a newly graduated nurse. What statement made by the newly graduated nurse demonstrates an accurate understanding of symptoms related to ear abnormalities?
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“Vertigo is characterized by ringing or buzzing in the ears.”
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“Individuals working around loud environmental hazards are at risk for tinnitus.”
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“Vertigo can be caused by several factors, such as ototoxic medications.”
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“Tinnitus can be treated with medications to manage the symptoms.”
14 .
The nurse is educating a patient on hearing loss. What statement made by the patient demonstrates an accurate understanding of the teaching?
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“Conductive hearing loss is caused by pathology of the inner ear, cranial nerve VIII, or auditory areas of the cerebral cortex.”
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“Ototoxic medications can also cause conductive hearing loss by affecting the hair cells in the cochlea.”
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“Presbycusis is a sensorineural hearing loss that occurs with aging due to gradual nerve degeneration.”
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“Sensorineural hearing loss occurs when something in the external or middle ear is obstructing the transmission of sound.”
15 .
The nurse is performing a Weber and Rinne test to assess hearing loss. What statement demonstrates a correct interpretation of the test results?
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If the patient hears the sound longer through air conduction than through BC, it is considered a negative Rinne and suggests conductive hearing loss in that ear.
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If the patient hears the sound equally or longer through bone conduction than through AC, it is considered a positive Rinne and suggests normal or sensorineural hearing in that ear.
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If the patient hears the sound equally in both ears during the Weber test, the patient has normal hearing in both ears.
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If the patient hears the sound louder in one ear during the Weber test, it may suggest hearing loss in both ears.
16 .
The nurse is caring for a 9-year-old patient who presents with epistaxis.
The nurse is performing a throat assessment and would like to inspect the tonsils. Where are the tonsils located?
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nasopharynx and laryngopharynx
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nasopharynx and oropharynx
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oropharynx and laryngopharynx
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laryngopharynx
18 .
During an examination of the oral cavity, what technique by the nurse is most appropriate to examine the gums and teeth?
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Ask the patient to open their mouth and say “ah.”
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Use a penlight and tongue depressor to retract the lips.
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Use a gloved hand to retract the lips and cheeks.
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Use gauze to move the tongue to each side.
19 .
A nurse performs an assessment on a patient complaining of a sore throat. Upon assessment, the throat is red, and the tonsils are touching the uvula midline. Using the grading scale of 0 to 4+, how should the nurse document the tonsils?
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grade 1+
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grade 2+
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grade 3+
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grade 4+
20 .
What assessment finding is indicative of candidiasis?
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bleeding gums
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persistent bad breath
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red patches on the oral mucosa
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white patches on the tongue


2.5: Viral Structue and Prions
- Describe the generalized structure of a viral particle including location and molecular make-up of genetic material, capsid, and envelope.
- Recognize and identify the most common capsid shapes.
- Provide two examples of the importance of protein folding and binding specificity in the replication of certain pathogens.
Key Points
- Viruses are classified into four groups based on type of genetic material and capsid shape.
- Viruses attach to their host cells to facilitate penetration of the cell membrane, allowing their replication inside the cell.
- Non-enveloped viruses can be more resistant to changes in temperature, pH, and some disinfectants than are enveloped viruses.
- The virus core contains the small single- or double-stranded genome that encodes the proteins that the virus cannot get from the host cell.
Viral Morphology
Viruses are acellular, meaning they are biological entities that do not have a cellular structure and they rely on a host cell for replication. Therefore, they lack most of the components of cells, such as organelles, ribosomes, and the plasma membrane. A virion (virus particle) consists of a nucleic acid core, an outer protein coating called a capsid, and sometimes an outer envelope made of phospholipid membranes derived from the host cell and embedded with viral proteins (Figure \(\PageIndex{1}\)). The capsid is made up of protein subunits called capsomeres. Viruses may also carry additional proteins, such as enzymes necessary for their replication (Figure \(\PageIndex{1}\)). The most obvious difference between members of viral families is their morphology, which is quite diverse. An interesting feature of viral complexity is that host and virion complexity are uncorrelated. Some of the most intricate virion structures are observed in bacteriophages, viruses that infect the simplest living organisms: bacteria.
Morphology
Viruses of all shapes and sizes consist of a nucleic acid core, an outer protein coating or capsid, and sometimes an outer envelope. Viruses come in many shapes and sizes. In general, the shapes of viral capsid can be helical or icosahedral (Figure \(\PageIndex{2}\)). Viruses with a helical capsid and no envelope are often filamentous in shape. Filamentous viruses are long and cylindrical. Many plant viruses are filamentous, including TMV (tobacco mosaic virus). Icosahedral capsids are roughly spherical, such as poliovirus or herpesviruses . Enveloped viruses have membranes surrounding capsids (which can be either helical or icosahedral). Animal viruses, such as HIV, are frequently enveloped.
Viruses use a specific glycoprotein (protein with attached sugars) to attach to their host cells via specific molecules which act as viral receptors (Figure \(\PageIndex{3}\)). The viral glycoproteins are often referred to as "spikes". These protein spikes must have a precise structure to be able to bind to the receptors on the host cell. Changes to the spike structure can lead to a change in the species or type of cell which the virus can infect. Attachment is a requirement for later penetration of the cell membrane, allowing them to complete their replication inside the cell. The receptors on the host cell that viruses use are molecules that are normally found on cell surfaces and have their own physiological functions. Viruses have simply evolved to make use of these molecules for their own replication.
Overall, the shape of the virion and the presence or absence of an envelope tell us little about what disease the virus may cause or what species it might infect, but they are still useful means to begin viral classification (Figure \(\PageIndex{4}\)). Among the most complex virions known, the T4 bacteriophage, which infects the Escherichia coli bacterium, has a tail structure that the virus uses to attach to host cells and a head structure that houses its DNA. Adenovirus, a non-enveloped animal virus that causes respiratory illnesses in humans, uses glycoprotein spikes protruding from its capsomeres to attach to host cells. Non-enveloped viruses also include those that cause polio (poliovirus), plantar warts ( papillomavirus ), and hepatitis A (hepatitis A virus).
Enveloped virions like HIV consist of nucleic acid and capsid proteins surrounded by a phospholipid bilayer envelope and its associated proteins. Glycoprotein spikes embedded in the viral envelope are used to attach to host cells. Other envelope proteins include the matrix proteins that stabilize the envelope and often play a role in the assembly of progeny virions. Chicken pox , influenza , and mumps are examples of diseases caused by viruses with envelopes. Because of the fragility of the envelope, non-enveloped viruses are more resistant to changes in temperature, pH, and some disinfectants than are enveloped viruses.
Types of Nucleic Acid
Unlike nearly all living organisms that use DNA as their genetic material, viruses may use either DNA or RNA. The virus core contains the genome or total genetic content of the virus. Viral genomes tend to be small, containing only those genes that encode proteins that the virus cannot obtain from the host cell. This genetic material may be single- or double-stranded. It may also be linear or circular. While most viruses contain a single nucleic acid, others have genomes that have several, called segments.
In DNA viruses , the viral DNA directs the host cell’s replication proteins to synthesize new copies of the viral genome and to transcribe and translate that genome into viral proteins. DNA viruses cause human diseases, such as chicken pox, hepatitis B, and some venereal diseases, like herpes and genital warts.
RNA viruses contain only RNA as their genetic material. To replicate their genomes in the host cell, the RNA viruses encode enzymes that can replicate RNA into DNA, which cannot be done by the host cell. These RNA polymerase enzymes are more likely to make copying errors than DNA polymerases and, therefore, often make mistakes during transcription. For this reason, mutations in RNA viruses occur more frequently than in DNA viruses. This causes them to change and adapt more rapidly to their host. Human diseases caused by RNA viruses include hepatitis C, measles, and rabies.
Prions
- Contributed by OpenStax
- General Biology at OpenStax CNX
At one time, scientists believed that any infectious particle must contain DNA or RNA. Then, in 1982, Stanley Prusiner, a medical doctor studying scrapie (a fatal, degenerative disease in sheep) discovered that the disease was caused by proteinaceous infectious particles, or prions. Because proteins are acellular and do not contain DNA or RNA, Prusiner’s findings were originally met with resistance and skepticism; however, his research was eventually validated, and he received the Nobel Prize in Physiology or Medicine in 1997.
A prion is a misfolded rogue form of a normal protein (PrPc) found in the cell. This rogue prion protein (PrPsc), which may be caused by a genetic mutation or occur spontaneously, can be infectious, stimulating other endogenous normal proteins to become misfolded, forming plaques (see Figure \(\PageIndex{5}\)). The pathogenicity of prions relies entirely on the three-dimensional structure the protein assumes.
Today, prions are known to cause various forms of transmissible spongiform encephalopathy (TSE) in human and animals. TSE is a rare degenerative disorder that affects the brain and nervous system.  Infected individuals are mentally impaired and become unable to move or speak. There is no cure, and the disease progresses rapidly, eventually leading to death within a few months or years.
TSEs in humans include kuru, fatal familial insomnia, Gerstmann-Straussler-Scheinker disease, and Creutzfeldt-Jakob disease (see Figure \(\PageIndex{6}\)). TSEs in animals include mad cow disease, scrapie (in sheep and goats), and chronic wasting disease (in elk and deer). TSEs can be transmitted between animals and from animals to humans by eating contaminated meat or animal feed. Transmission between humans can occur through heredity (as is often the case with GSS and CJD) or by contact with contaminated tissue, as might occur during a blood transfusion or organ transplant. There is no evidence for transmission via casual contact with an infected person. Table \(\PageIndex{1}\) lists TSEs that affect humans and their modes of transmission.
| Disease | Mechanism(s) of Transmission 1 |
|---|---|
| Sporadic CJD (sCJD) | Not known; possibly by alteration of normal prior protein (PrP) to rogue form due to somatic mutation |
| Variant CJD (vCJD) | Eating contaminated cattle products and by secondary bloodborne transmission |
| Familial CJD (fCJD) | Mutation in germline PrP gene |
| Iatrogenic CJD (iCJD) | Contaminated neurosurgical instruments, corneal graft, gonadotrophic hormone, and, secondarily, by blood transfusion |
| Kuru | Eating infected meat through ritualistic cannibalism |
| Gerstmann-Straussler-Scheinker disease (GSS) | Mutation in germline PrP gene |
| Fatal familial insomnia (FFI) | Mutation in germline PrP gene |
Prions are extremely difficult to destroy because they are resistant to heat, chemicals, and radiation. Even standard sterilization procedures do not ensure the destruction of these particles. Currently, there is no treatment or cure for TSE disease, and contaminated meats or infected animals must be handled according to federal guidelines to prevent transmission.


6.4: Lean Processes
By the end of this section, you will be able to:
- Discuss the lean process methodology
- Understand the phases of the lean problem-solving process.
You have learned about different problem-solving approaches that entrepreneurs take to lead their startups and work with others. Most of these approaches have had to do with the entrepreneur’s cognitive or creative mindsets. Now we will learn about an approach that is more rooted in process, called lean process . Lean problem solving has been used as an entrepreneurial methodology in new and emerging ventures, and it’s interesting that it comes from a large corporate, manufacturing background that focuses on efficiencies. The Six Sigma methodology, pioneered at Motorola in the 1970s and 1980s, and adopted by many companies, is a disciplined, data-driven approach that provides companies tools to improve the capability of their business processes. According to the American Society for Quality, “Six Sigma views all work as processes that can be defined, measured, analyzed, improved and controlled. A set of qualitative and quantitative tools is used to drive process improvement. This increase in performance and decrease in process variation helps lead to defect reduction and improvement in profits, employee morale, and quality of products or services.” 26 GE copied it and created the “Process Excellence” programs that millions of managers and others have taken to get certified at various “belts.” Although Six Sigma and Process Excellence do not fit strictly in terms of entrepreneurship, as they are used mainly by large, mature companies, many of the methods fit in the lean model.
Toyota pioneered the lean process in the 1980s. The term “lean manufacturing” is the most common, but it is much more than manufacturing. The lean process is a systematic method for the maximizing of continuous improvement and the minimization of surplus or unused material in the production of a process. The entrepreneur begins the startup with a sense the original product will be the product carrying the organization to success in the long term. In most cases, the good or service will require modification to maintain a process, technology, or up-to-date product offering. Lean problem solving means the entrepreneur’s entire team scans both the company’s internal and external environments for continuous improvement and methods for bringing additional revenue to the startup by cost improvement processes that promote sustainable value. The external environment encompasses customers, industry trends, and competition. The internal environment comprises the factors inside the enterprise, such as employees, and internal practices and processes. In lean manufacturing, for example, improving efficiencies in the internal environment should lead to advantages in the external environment (whether that be cost savings to customers, competitive advantage from more output/superior product, etc.).
For example, every mile saved per day per UPS truck driver results in approximately $50 million in savings per year, according to Juan Perez, the company’s chief information and engineering officer. Using customer data and artificial intelligence, the company created a system dubbed ORION, which is an acronym for On-Road Integrated Optimization and Navigation. 27 To date, the system has resulted in $400 million in savings to UPS. By applying the lean process, everything that UPS saves on the input (by reducing mileage) leads to savings on the output, which leads faster deliveries, lower costs for consumers, and more profit for UPS.
Lean Problem-Solving Process
The lean problem-solving process is a cycle of observation, assessment, and continual evaluation. As shown in Table 6.4.1, this cycle typically involves eight specific steps.
| Step | Action |
|---|---|
| Step 1 | Clarify the problem. |
| Step 2 | Analyze the problem (genchi genbutsu is the Toyota practice of thoroughly understanding a condition by confirming information or data through personal observation at the source of the condition; the Japanese phrase essentially means “go and see”). 28 |
| Step 3 | Set targets. |
| Step 4 | Identify root causes. Asking, “Why?” repeatedly can narrow down the factors to a root cause. |
| Step 5 | Develop countermeasures by asking, “What is the specific change we want to make?” and involving others in the problem-solving process. |
| Step 6 | Implement the countermeasures and see them through. |
| Step 7 | Monitor results. |
| Step 8 | Standardize processes that succeed. Lean problem solving is about learning more about the problem itself and its deep causes in context. |
The lean problem-solving, step-wise process allows the business to observe, assess, and continually evaluate.
Too Much Too Late?
Many entrepreneurs create a startup with an idea that they develop without any feedback from potential customers, relying on their own knowledge or assumptions about the market. Consider the story of Rapid SOS: https://hbr.org/2018/05/do-entrepren...eed-a-strategy . What would most likely happen when they decided to go forward with their product? Will it be a fit to the customer’s needs or solve their problems? How is lean process different from this?
Lean Problem-Solving Phases
Observation is the phase in which the entrepreneur studies the challenge and notes all facets of the challenge requiring solution. In this phase, the entrepreneur asks questions and conducts research about the change needed for a successful product, outcome, or service. The entrepreneurs must determine why the change is needed. What is the purpose of the endeavor? Feedback is extremely important in this phase.
For example, a community asked a group of entrepreneurs to help address the youth obesity problem in a middle school. The entrepreneurs began to study the intake of food by the children and determined that both the content of the school lunch menu and the lifestyle of the majority of the children were affecting the obesity rate in the community. They then defined the purpose of the project as finding a low-cost, low-risk method of changing the lunch menu and agreed that the primary outcome would be a 30 percent reduction in the obesity rate of the children. The entrepreneurs began to assess the cost of changing the lunch menu and observing what else the kids ate. The entrepreneurs discovered that the lunch menu change required to reduce the obesity rate was beyond the financial capability of the school district. Research also showed that many of the children, products of single-parent homes, were eating high-calorie, high-fat, take-out foods for dinner. Further observation revealed that the children did not engage in physical activity after hours because the local surroundings were not safe. The community needed a process to transform the wellness of the children, and the entrepreneurs recommended using a lean process approach to help the children as quickly as possible.
After the observation of the problem comes assessment , the phase in which the entrepreneur experiments and analyzes the potential process and its capabilities. The entrepreneur leverages creative tools and resources to arrive at a solution and assesses each step of a possible solution. Each step must add value to the solution, or that step in the solution is unnecessary. In addition, the step must be capable of solving the issue and add flexibility to the solution. How is the process or product being improved? In this phase, a prototype of the product is developed and delivered. The entrepreneur must ask the customer if all needs and wants are satisfied with the prototype. If the prototype is being developed for mass production, surveying customers about potential sales is essential. In the school lunch example, the school system would have been the customer of the new food menu (prototype) in the assessment phase.
Evaluation is the phase in which behaviors are analyzed to assess success. The entrepreneur continually studies each phase of the solution to observe the effectiveness of outcomes desired by the client. The entrepreneur ensures that transformation is built into the habits of the school to obtain, maintain, and develop the desired outcomes.
In a real-world example of a company applying lean processes, the New Balance Company, which designs and manufactures both athletic and casual shoes, used a batching approach in the early 2000s that organized production by departments, so that all of the cutting took place in one department, all of the stitching took place in another, and so forth. While it seems that batching tasks would improve efficiency, at New Balance, it meant that production of one pair of shoes took nine days. Executives observed piles of inventory sitting between floors and departments, and noticed employees waiting while there were delays in the production line. They also noticed that the pay structure contributed to the piles of works in process because employees were paid by the piece, which encouraged them to produce as much as possible.
The company applied lean principles to rearrange the production floor by value streams, or the making of a product by sharing similar processing steps. On one side was “cut and stitch” products using US materials of leather and mesh, while another side used premade products from overseas for soles, inserts, and kits. This change cut the time to make a pair of shoes down to four hours, meaning that domestic plants could ship some orders in twenty-four hours, while competitors may need as much as 121 days to ship when they outsourced manufacturing to Asia.
An often-used lean problem-solving tool is whiteboarding ( Figure 6.16 ). Whiteboarding is a type of graphing that permits the entrepreneur to plot each step in a process to build comprehension and detailing of the process. The entrepreneur draws each step on the whiteboard using a linking-type diagram, and draws arrows to show how processes affect other processes. Seeing the flow of the process allows the entrepreneur to note where functions in the process are duplicated or inconsistent.
For example, in a community garden, storing tools, such as hoes and hand trowels for weeding, in different sheds wastes time when preparing to begin the process of weeding. These tools should be stored collectively to eliminate multiple trips and wasted time. Seeing the process on a whiteboard or other medium brings awareness to how processes can be improved. After the process is changed, it is graphed again for further scrutiny.
The Origin of Lean
Would it surprise you to know the origin of lean, in modern times, is considered to be Henry Ford’s production line? Although we don’t necessarily think of the creation of automobiles as an entrepreneurial venture in today’s world, Henry Ford was truly an entrepreneur for his time when the manufacture of automobiles was just beginning. Not only did he recognize the opportunity inherent in the sale of automobiles, he recognized the need to create an efficient process for automobile production that could decrease costs and, consequently, the selling price of the vehicle. As the first entrepreneur to join the use of interchangeable parts with moving conveyance to develop fabrication processes, Ford was able to turn over inventory in a very short time; however, Ford’s process could not deliver variety. In fact, Ford was quoted as saying of the Model T’s color, “You can have any color as long as it's black.” 29 It had the fastest drying time; hence, it was the only color he used for a number of years.
The Ford system was built around one static product. In the 1930s, when the market demanded product variety, the company was not set up to address this challenge. Kiichiro Toyoda (Figure \(\PageIndex{2}\)), the second president of Toyota Motor Corporation, visited the Ford plant in Michigan to learn more about their application of the assembly line concept. After observing, he proposed a new production system that would strive to “right size” equipment to better match tasks and the volume of work, as well as introducing quality assurance steps in each sequence of the work process. Toyoda’s approach shifted the focus from machinery to process, optimizing efficiency while maintaining quality.


17.3: Types of Plans
- Identify different types of plans and control systems employed by organizations.
From an activity perspective, organizations are relatively complex systems, as they are involved in numerous activities. Many of these activities require management’s attention from both a planning and controlling perspective. Managers therefore create different types of plans to guide operations and to monitor and control organizational activities. In this section, we introduce several commonly used plans. The major categories are hierarchical, frequency-of-use (repetitiveness), time-frame, organizational scope, and contingency. Table 17.1 provides a closer look at many types of plans that fall in each of these categories.
Hierarchical Plans
Organizations can be viewed as a three-layer cake, with its three levels of organizational needs. Each of the three levels—institutional, administrative, and technical core—is associated with a particular type of plan. As revealed in Table 17.1, the three types of hierarchical plans are strategic, administrative, and operating (technical core). The three hierarchical plans are interdependent, as they support the fulfillment of the three organizational needs. In the organization’s hierarchy, the technical core plans day-to-day operations.
| Organizational Plans |
|---|
| Hierarchical Plans |
|
| Frequency-of-Use Plans |
| Standing Plans |
|
| Single-Use Plans |
|
| Time-Frame Plans |
|
| Organizational Scope Plans |
|
| Contingency Plans |
|
Table 17.1 (Attribution: Copyright Rice University, OpenStax, under CC-BY 4.0 license)
Strategic Plans
Strategic management is that part of the management process concerned with the overall integration of an organization’s internal divisions while simultaneously integrating the organization with its external environment. Strategic management formulates and implements tactics that try to match an organization as closely as possible to its task environment for the purpose of meeting its objectives.
Strategic plans address the organization’s institutional-level needs. Strategic plans outline a long-term vision for the organization. They specify the organization’s reason for being, its strategic objectives, and its operational strategies—the action statements that specify how the organization’s strategic goals are to be achieved.
Part of strategic planning involves creating the organization’s mission, a statement that specifies an organization’s reason for being and answers the question “What business(es) should we undertake?” The mission and the strategic plan are major guiding documents for activities that the organization pursues. Strategic plans have several defining characteristics: They are long-term and position an organization within its task environment; they are pervasive and cover many organizational activities; they integrate, guide, and control activities for the immediate and the long term; and they establish boundaries for managerial decision-making.
Operating plans provide direction and action statements for activities in the organization’s technical core. Administrative plans work to integrate institutional-level plans with the operating plans and tie together all of the plans created for the organization’s technical core.
Frequency-of-Use Plans
Another category of plans is frequency-of-use plans. Some plans are used repeatedly; others are used for a single purpose.  For example, managers may be concerned about tardiness, a problem that may occur often in the entire workforce. These managers might decide to develop a standing policy to be implemented automatically each time an employee is late for work. The procedure invoked under such a standing plan is called a standard operating procedure (SOP).
Single-use plans are developed for unique situations or problems and are usually replaced after one use. Managers generally use three types of single-use plans: programs, projects, and budgets. See Table 17.1 for a brief description of standing and single-use plans.
Time-Frame Plans
The organization’s need to address the future is captured by its time-frame plans. This need to address the future through planning is reflected in short-, medium-, and long-range plans. Given the uniqueness of industries and the different time orientations of societies—study Hofstede’s differentiation of cultures around the world in terms of their orientation toward the future—the times captured by short, medium, and long-range vary tremendously across organizations of the world. Konosuke Matsushita’s 250-year plan, which he developed for the company that bears his name, is not exactly typical of the long-range plans of U.S. companies!
Short-, medium-, and long-range plans differ in more ways than the time they cover. Typically, the further a plan projects into the future, the more uncertainty planners encounter. As a consequence, long-range plans are usually less specific than shorter-range plans. Also, long-range plans are usually less formal, less detailed, and more flexible than short-range plans in order to accommodate such uncertainty. Long-range plans also tend to be more directional in nature.
Organizational Scope Plans
Plans vary in scope. Some plans focus on an entire organization. For example, the president of the University of Minnesota advanced a plan to make the university one of the top five educational institutions in the United States. This strategic plan focuses on the entire institution. Other plans are narrower in scope and concentrate on a subset of organizational activities or operating units, such as the food services unit of the university. For further insight into organizational scope plans, see Table 17.1.
Contingency Plans
Organizations often engage in contingency planning (also referred to as scenario or “what if” planning). You will recall that the planning process is based on certain premises about what is likely to happen in an organization’s environment. Contingency plans are created to deal with what might happen if these assumptions turn out to be wrong. Contingency planning is thus the development of alternative courses of action to be implemented if events disrupt a planned course of action. A contingency plan allows management to act immediately if an unplanned occurrence, such as a strike, boycott, natural disaster, or major economic shift, renders existing plans inoperable or inappropriate. For example, airlines develop contingency plans to deal with terrorism and air tragedies. Most contingency plans are never implemented, but when needed, they are of crucial importance.
- Define and describe the different types of plans defined in Table 17.1 and how organizations use them.


8.4: Post-Lab 8 Questions
(3 points)
Last Name: _______________________ First Name: _______________________
-
Describe the pathway food takes upon ingesting it, making sure to include all accessory structures. (0.5 point)
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Explain the differences between the layers of the gastrointestinal tract. (0.5 points)
-
Match the terms with their corresponding descriptions. (0.5 points)
Name of Structure Description No. of Structure 1. Ileum the largest salivary glands that produce approximately 25% of the saliva produced daily 2. Gallbladder passageway for liquids, foods, AND air 3. Fauces the modified muscularis of the large intestine 4. Parotid glands structures on the tongue that provide friction, allowing the tongue to move food in the oral cavity during mastication efficiently 5. Filiform papillae the terminal portion of the small intestine 6. Pulp cavity where bile made in the liver joins the bile stored in the gallbladder 7. Pharynx the opening between the oral cavity and the oropharynx 8. Rugae inner part of the tooth containing nerves and blood vessels 9. Common bile duct storage area for bile 10. Teniae coli folds of the inner wall of the stomach
-
List each type of tooth. How do they function during mastication? (0.5)
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List the accessory and primary structures of the GI tract. Why would accessory structures not be classified as primary organs/structures of the digestive system? (0.5 point)
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A patient with cancerous growths in their salivary glands undergoes surgery to have them removed. How might this affect the digestive processes? (0.5 points)


5.4: Checklist - Insert a Nasogastric Tube
*Disclaimer: Always follow agency policy and manufacturer recommendations
Checklist: Insert a Nasogastric Tube [1] , [2]
Preparation Before Procedure
The following steps should be taken in preparation for the procedure [3] :
- The indication for the procedure, potential complications, and alternative to treatment should be explained to the client by the provider. If an informed consent form is required by agency policy, the nurse should ensure the informed consent form has been signed and is present in the client’s medical record.
- Review the client’s medical record for conditions that may contraindicate insertion of an NG tube (e.g., facial trauma or fractures, deviated or swollen nasal septum).
- If the nasogastric tube is to be connected to suction, attach the NG tube to the suction tubing and suction container before placement of the tube to minimize the risk of spillage of gastric contents.
- Perform a thorough gastrointestinal (GI) assessment.
- Gather and prepare equipment. All supplies should be close at hand to minimize unnecessary movement during the procedure. *Note: Topical use of local anesthetics such as lidocaine has not been shown to be useful for NG insertion, but the evidence does show that nebulized lidocaine relieves discomfort and allows for an increased chance of NG tube placement.
-
Gather the necessary supplies:
- Nasogastric tube per provider order
- Antireflux valve
- Stethoscope
- Pulse oximeter
- Hypoallergenic tape or agency approved securement device
- Cup of water and straw
- Clean gloves
- Suction equipment (if prescribed by provider)
- Penlight
- Tongue blade
- Water-based lubricant
- Oral hygiene supplies
- Fluid-impermeable drape or towel
- Explain the procedure to the client and family members (if appropriate) according to their individual communication and learning needs. Assess client anxiety regarding insertion of the tube. Answer any questions and provide emotional support as necessary.
Procedure
- Verify the provider’s orders for tube insertion and associated premedications.
- Perform hand hygiene.
- Confirm the client’s identity using at least two patient identifiers and check allergies.
- Provide privacy.
- Assess the rigidity of the tube. If you need to increase the tube’s flexibility to ease insertion, coil it around gloved fingers for a few seconds or dip it in warm water. If the tube is too flaccid, stiffen it by filling the tube with water and then freezing it or dipping the tube in ice water.
- Advise the client they may feel some discomfort as the tube moves through the nose but that the tube will be lubricated to ease its passage. Topical anesthetic and nasal vasoconstricting medications may be administered, as prescribed.
- Explain to the client they will be given water to sip once the tube reaches the pharynx. The swallowing action will facilitate passage of the tube and minimize the natural tendency to gag.
- Ask the client to identify a signal they will use to communicate with you if it is necessary to stop briefly during the insertion, such as raising their hand.
- Raise the bed to waist level.
- Perform a focused gastrointestinal assessment.
- Because the dominant hand will be used to insert the tube, stand on the client’s right side if right-handed or on the client’s left side if left-handed.
- Position the client (in high Fowler’s position) with the head of the bed elevated at least 30 degrees; if this position is contraindicated, consider the reverse Trendelenburg position. Assist the client in positioning their head in a neutral position, neither tilted forward nor backward.
- Perform hand hygiene.
- Put on nonsterile gloves and other personal protective equipment as indicated.
- Assess the client’s nares to determine the best choice for insertion. Use a penlight to visualize nares as needed.
- Estimate the insertion length of the tube by measuring from the tip of the nose to the earlobe to the sternal notch of the xiphoid process. Mark this estimated exit point on the tube with a piece of tape or permanent marker.
- Drape a fluid-impermeable pad or towel over the client’s chest. Place an emesis basin within reach because the client may gag or vomit during the procedure.
- Lubricate the proximal tip of the tube about 2 to 3 inches with water-soluble lubricant.
- Encourage the client to hold their head upright. You may wish to support the client’s head with your nondominant hand while inserting the NG tube.
- Grasp the end of the tube with the distal end pointing downward, curve it if necessary, and carefully insert it into the most patent nare.
- Guide the tube at an angle parallel to the floor of the nasal canal and then gently downward as the tube advances through the nasal passage toward the distal pharynx.
- If resistance is met, try to gently rotate the tip until it advances past the nasal passage. If continued resistance is met, don’t force the tube. Instead, withdraw the tube and allow the client to rest, relubricate the tube, and retry or insert the tube in the other nare.
- After the tube reaches the oropharynx, have the client flex their head forward and tuck their chin down. Encourage them to sip water through a straw as you slowly advance the tube (unless contraindicated).
- As the tube is advanced, monitor the client for cues that might indicate that the tube entered the respiratory tract or the tube kinked or coiled in the oral cavity. If the client appears cyanotic or begins coughing severely during advancement of the tube, pull the NG tube backwards until normal breathing resumes. Severe coughing during tube insertion can indicate inadvertent placement in the trachea or bronchi. Reattempt advancement of the tube after the client begins breathing normally. However, never advance the NG tube against resistance because perforation may occur.
- Continue to advance the tube to the predetermined measured length.
- Following insertion, clean any excess lubricant from the client’s skin.
- Secure the NG tube to the client’s nose using a securement device, tape, or semipermeable transparent dressing. When securing the NG tube, use care to avoid applying undue pressure to tissue to reduce the risk of pressure injuries.
- Position the NG tube so the distal end is facing upwards and secure it to the client’s gown according to agency policy. If using a rubber band, place it over the NG tube. Wrap one end of the rubber band behind the NG tube and up through the open half of the rubber band and then continue to pull the end so that the band is tightened around the tube. Use a safety pin to attach the rubber band and NG tube to the client’s gown.
- Remove and discard the fluid-impermeable pad or towel.
- Discard used supplies in the appropriate receptacle.
- Remove and discard gloves and any personal protective equipment worn.
- Perform hand hygiene.
- Follow agency policy to verify correct placement of the NG tube. Do not instill anything through the NG tube or connect it to suction until correct placement has been confirmed.
- After correct placement is verified, document the length of the tube where it exits the nare. If a stylet is present, remove it at this point. Turn on suction, if ordered, to intermittent or continuous suction and typically set it to 30 to 40 mmHg. Ensure the suctioning equipment is working properly.
- Provide oral care, discard any used supplies, and then perform hand hygiene.
- Keep the head of the bed elevated at least 30 degrees.
- In an inpatient setting, help the patient into a comfortable position and place personal items, the tray table, and the call light within easy reach. Make sure the patient knows how to use the call light to summon assistance. To ensure the patient’s safety, raise the appropriate number of side rails and lower the bed to the lowest position. Ensure the bed is locked.
- Assess the client’s status and comfort level; reposition as necessary.
- Update the client’s plan of care, as appropriate.
- Perform hand hygiene.
- Document the procedure.
Documentation Cues:
- Pre-procedure assessments
- Type and size of tube placed
- Location of the distal tip of the tube (external measured length of the tube)
- Client’s tolerance of the procedure
- Confirmation of the tube’s position by X-ray examination
- Any unexpected outcome and related nursing interventions performed
- Pain assessment and management
View a YouTube video [4] showing an instructor demonstration of this skill:
- Clinical skills: Essentials collection (1st ed.). (2021). Elsevier. ↵
- Lippincott procedures. http://procedures.lww.com ↵
- This work is a derivative of StatPearls by Sigmon and An and is licensed under CC BY 4.0 ↵
- Chippewa Valley Technical College. (2023, January 5). Inserting a nasogastric tube [Video]. YouTube. Video licensed under CC BY 4.0 . https://youtu.be/_QA5lpxdbBQ ↵