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The Earliest Hospitals Established were the e.

Melchora Aquino (Tandang Sora) – Nurse the


following: wounded Filipino soldiers and gave them shelter
a. Hospital Real de Manila (1577). It was and food.
established mainly to care for the Spanish King’s
soldiers, but also admitted Spanish civilians. f. Captain Salome – A revolutionary leader in
Founded by Gov. Francisco de Sande Nueva Ecija; provided nursing care to the
wounded when not in combat.
b. San Lazaro Hospital (1578) – built exclusively
for patients with leprosy. Founded by Brother Juan g. Agueda Kahabagan – Revolutionary leader in
Clemente Laguna, also provided nursing services to her
troop.
The Earliest Hospitals Established
a. Hospital de Indio (1586) –Established by the h. Trinidad Tecson – “Ina ng Biac na Bato”,
Franciscan Order; Service was in general stayed in the hospital at Biac na Bato to care for
supported by alms and contribution from the wounded soldier.
charitable persons.
Hospitals and Nursing Schools
b. Hospital de Aguas Santas (1590). Established in 1. Iloilo Mission Hospital School of Nursing
Laguna, near a medicinal spring, Founded by (Iloilo City, 1906)
Brother J. Bautista of the Franciscan Order.  It was ran by the Baptist Foreign Mission
Society of America.
c. San Juan de Dios Hospital (1596) Founded by  Miss Rose Nicolet, a graduate of New
the Brotherhood de Misericordia and support was England Hospital for woman and children
derived from alms and rents. Rendered general in Boston, Massachusetts, was the first
health service to the public. superintendent.
 Miss Flora Ernst, an American nurse,
Nursing During the Philippine Revolution took charge of the school in 1942.
The prominent persons involved in the nursing
works were: 2. St. Paul’s Hospital School of Nursing
a. Josephine Bracken – wife of Jose Rizal. (Manila, 1907)
Installed a field hospital in an estate house in  The hospital was established by the
Tejeros. Provided nursing care to the wounded Archbishop of Manila, The Most Reverend
night and day. Jeremiah Harty, under the supervision of
the Sisters of St. Paul de Chartres.
b. Rosa Sevilla De Alvero – converted their house  It was located in Intramuros and it
into quarters for the Filipino soldier, during the provided general hospital services.
Philippine-American war that broke out in
1899. 3. Philippine general Hospital School of
Nursing (1907)
c. Dona Hilaria de Aguinaldo – Wife of Emilio  In 1907, with the support of the Governor
Aguinaldo; Organized th Filipino Red Cross under General Forbes and the Director of Health
the inspiration of Apolinario Mabini. and among others, she opened classes in
nursing under the auspices of the Bureau of
d. Dona Maria de Aguinaldo- second wife of Education.
Emilio Aguinaldo. Provided nursing care for the  Anastacia Giron-Tupas, was the first
Filipino soldier during the revolution. President of Filipino to occupy the position of chief
the Filipino Red Cross branch in Batangas. nurse and superintendent in the
Philippines, succeded her.
4. St. Luke’s Hospital School of Nursing  Each individual has unique characteristics,
(Quezon City, 1907) but certain needs are common to all people.
 The Hospital is an Episcopalian Institution.  A need is something that is desirable,
It began as a small dispensary in 1903. In useful or necessary.
1907, the school opened with three Filipino  Human needs are physiologic and
girls admitted. psychologic conditions that an individual
 Mrs. Vitiliana Beltran was the first must meet to achieve a state of health or
Filipino superintendent of nurses. well-being.

5. Mary Johnston Hospital and School of Maslow’s Hierarchy of Basic Human Needs
Nursing (Manila, 1907) Physiologic
 It started as a small dispensary on Calle 1. Oxygen
Cervantes (now Avenida) 2. Fluids
 It was called Bethany Dispensary and was 3. Nutrition
founded by the Methodist Mission. 4. Body temperature
 Miss Librada Javelera was the first Filipino 5. Elimination
director of the school. 6. Rest and sleep
6. Philippine Christian mission Institute School 7. Sex
of Nursing.
The United Christian Missionary of Indianapolis, Safety and Security
operated Three schools of Nursing: 1. Physical safety
1. Sallie Long Read Memorial Hospital School of 2. Psychological safety
Nursing (Laoag, Ilocos Norte,1903) 3. The need for shelter and freedom from harm
2. Mary Chiles Hospital school of Nursing and danger
(Manila, 1911)
3. Frank Dunn Memorial hospital Love and belonging
1. The need to love and be loved
7. San Juan de Dios hospital School of Nursing 2. The need to care and to be cared for.
(Manila, 1913) 3. The need for affection: to associate or to belong
4. The need to establish fruitful and meaningful
8. Emmanuel Hospital School of Nursing relationships with people, institution, or
(Capiz,1913) organization

9. Southern Island Hospital School of Nursing Self-Esteem Needs


(Cebu,1918) 1. Self-worth
 The hospital was established under the Bureau 2. Self-identity
of Health with Anastacia Giron-Tupas as the 3. Self-respect
organizer. 4. Body image

The First Colleges of Nursing in the Philippines Self-Actualization Needs


 University of Santo Tomas .College of 1. The need to learn, create and understand or
Nursing (1946) comprehend
 Manila Central University College of 2. The need for harmonious relationships
Nursing (1948) 3. The need for beauty or aesthetics
 University of the Philippines College of 4. The need for spiritual fulfillment
Nursing (1948). Ms.Julita Sotejo was its
first Dean Characteristics of Basic Human Needs
1. Needs are universal.
The Basic Human Needs 2. Needs may be met in different ways
3. Needs may be stimulated by external and interaction, interdependence and integration of the
internal factor subsystems of the behavioral system.(Johnson)
4. Priorities may be deferred
5. Needs are interrelated Illness and Disease
Illness
Concepts of health and Illness  is a personal state in which the person feels
HEALTH unhealthy.
1. Is the fundamental right of every human being.  Illness is a state in which a person’s
It is the state of integration of the body and mind physical, emotional, intellectual, social,
2. Health and illness are highly individualized developmental, or spiritual functioning is
perception. Meanings and descriptions of health diminished or impaired compared with
and illness vary among people in relation to previous experience.
geography and to culture.  Illness is not synonymous with disease.
3. Health - is the state of complete physical, Disease
mental, and social well-being, and not merely the  An alteration in body function resulting in
absence of disease or infirmity. (WHO) reduction of capacities or a shortening of
4. Health – is the ability to maintain the internal the normal life span.
milieu. Illness is the result of failure to maintain Common Causes of Disease
the internal environment.(Claude Bernard) 1. Biologic agent – e.g. microorganism
5. Health – is the ability to maintain homeostasis 2. Inherited genetic defects – e.g. cleft palate
or dynamic equilibrium. Homeostasis is regulated 3. Developmental defects – e.g. imperforate anus
by the negative feedback mechanism.(Walter 4. Physical agents – e.g. radiation, hot and cold
Cannon) substances, ultraviolet rays
6. Health – is being well and using ones’s power 5. Chemical agents – e.g. lead, asbestos, carbon
to the fullest extent. Health is maintained through monoxide
prevention of diseases via environmental health 6. Tissue response to irritations/injury – e.g.
factors.(Florence Nightingale) inflammation, fever
7. Health – is viewed in terms of the individual’s 7. Faulty chemical/metabolic process – e.g.
ability to perform 14 components of nursing care inadequate insulin in diabetes
unaided. (Henderson) 8. Emotional/physical reaction to stress – e.g. fear,
8. Positive Health – symbolizes wellness. It is anxiety
value term defined by the culture or individual.
(Rogers) Stages of Illness
9. Health – is a state of a process of being 1. Symptoms Experience- experience some
becoming an integrated and whole as a person. symptoms, person believes something is wrong
(Roy) Aspects –physical, cognitive, emotional
10. Health – is a state the characterized by 2. Assumption of Sick Role – acceptance of
soundness or wholeness of developed human illness, seeks advice
structures and of bodily and mental functioning. 3. Medical Care Contact - Seeks advice to
(Orem) professionals for validation of real illness,
11. Health- is a dynamic state in the life explanation of symptoms, reassurance or predict
cycle;illness is an interference in the life cycle. of outcome
(King) 4. Dependent Patient Role
12.Wellness – is the condition in which all parts The person becomes a client dependent on the
and subparts of an individual are in harmony with health professional for help. Accepts/rejects health
the whole system. (Neuman) professional’s suggestions. Becomes more passive
13. Health – is an elusive, dynamic state and accepting.
influenced by biologic,psychologic, and social 5. Recovery/Rehabilitation
factors.Health is reflected by the organization,
Gives up the sick role and returns to former roles appear abruptly, intense and often subside after a
and functions. relatively short period.
b. Chronic Illness – chronic illness usually longer
Risk Factors of a Disease than 6 months, and can also affects functioning in
1. Genetic and Physiological Factors any dimension. The client may fluctuate between
 For example, a person with a family maximal functioning and serious relapses and may
history of diabetes mellitus, is at risk in be life threatening. Is characterized by remission
developing the disease later in life. and exacerbation.
2. Age  Remission- periods during which the
 Age increases and decreases susceptibility disease is controlled and symptoms are not
( risk of heart diseases increases with age obvious.
for both sexes  Exacerbations – The disease becomes
3. Environment more active given again at a future time,
 The physical environment in which a with recurrence of pronounced symptoms.
person works or lives can increase the c. Sub-Acute – Symptoms are pronounced but
likelihood that certain illnesses will occur. more prolonged than the acute disease.
4. Lifestyle
 Lifestyle practices and behaviors can also 3. Disease may also be Described as:
have positive or negative effects on health. a. Organic – results from changes in the normal
structure, from recognizable anatomical changes in
Classification of Diseases an organ or tissue of the body.
1. According to Etiologic Factors b. Functional – no anatomical changes are
a. Hereditary – due to defect in the genes of one observed to account from the symptoms present,
or other parent which is transmitted to the may result from abnormal response to stimuli.
offspring c. Occupational – Results from factors associated
b. Congenital – due to a defect in the with the occupation engage in by the patient.
development, hereditary factors, or prenatal d. Venereal – usually acquired through sexual
infection relation
c. Metabolic – due to disturbances or abnormality e. Familial – occurs in several individuals of the
in the intricate processes of metabolism. same family
d. Deficiency – results from inadequate intake or f. Epidemic – attacks a large number of
absorption of essential dietary factor. individuals in the community at the same time.
e. Traumatic- due to injury (e.g. SARS)
f. Allergic – due to abnormal response of the body g. Endemic – Presents more or less continuously
to chemical and protein substances or to physical or recurs in a community. (e.g. malaria, goiter)
stimuli. h. Pandemic –An epidemic which is extremely
g. Neoplastic – due to abnormal or uncontrolled widespread involving an entire country or
growth of cell. continent.
h. Idiopathic –Cause is unknown; self-originated; i. Sporadic – a disease in which only occasional
of spontaneous origin cases occur. (e.g. dengue, leptospirosis)
i. Degenerative –Results from the degenerative
changes that occur in the tissue and organs. Leavell and Clark’s Three Levels of Prevention
j. Iatrogenic – result from the treatment of the a. Primary Prevention – seeks to prevent a
disease disease or condition at prepathologic state; to stop
something from ever happening.
2. According to Duration or Onset  Health Promotion
a. Acute Illness – An acute illness usually has a -health education
short duration and is severe. Signs and symptoms -marriage counseling
-genetic screening
-good standard of nutrition adjusted to unaided if he had the necessary strength,
developmental phase of life will or knowledge.
 Specific Protection  Help the client gain independence as
-use of specific immunization rapidly as possible.
-attention to personal hygiene
-use of environmental sanitation CONCEPTUAL AND THEORETICAL
-protection against occupational hazards MODELS OF NURSING PRACTICE
-protection from accidents A. NIGHTANGLE’S THEORY ( mid-1800)
-use of specific nutrients  Focuses on the patient and his environment
-protections from carcinogens .
-avoidance to allergens  Developed the described the first theory of
b. Secondary Prevention – also known as nursing. Notes on Nursing: What It Is,
“Health Maintenance”. Seeks to identify specific What It Is Not. She focused on changing
illnesses or conditions at an early stage with and manipulating the environment in order
prompt intervention to prevent or limit disability; to put the patient in the best possible
to prevent catastrophic effects that could occur if conditions for nature to act.
proper attention and treatment are not provided  She believed that in the nurturing
 Early Diagnosis and Prompt Treatment environment, the body could repair itself.
-case finding measures Client’s environment is manipulated to
-individual and mass screening survey include appropriate noise, nutrition,
-prevent spread of communicable disease hygiene, socialization and hope.
-prevent complication and sequelae
-shorten period of disability B. PEPLAU, HILDEGARD (1951)
 Disability Limitations Defined nursing as a therapeutic, interpersonal
- adequate treatment to arrest disease process and process which strives to develop a nurse- patient
prevent further complication and sequelae. relationship in which the nurse serves as a
-provision of facilities to limit disability and resource person,
prevent death. counselor and surrogate.
c. Tertiary Prevention – occurs after a disease or
disability has occurred and the recovery process Introduced the Interpersonal Model. She
has begun; Intent is to halt the disease or injury defined nursing as a interpersonal process of
process and therapeutic between an individual who is sick or in
assist the person in obtaining an optimal health need of health services and a nurse especially
status.To establish a high-level wellness. educated to recognize and respond to the need for
“To maximize use of remaining capacities”s help.
 Restoration and Rehabilitation
-work therapy in hospital She identified four phases of the nurse client
- use of shelter colony relationship namely:
1. Orientation: the nurse and the client initially
NURSING do not know each other’s goals and testing the
As defined by the INTERNATIONAL role each will assume. The client attempts to
COUNCIL OF NURSES as written by Virginia identify difficulties and the amount of nursing help
Henderson. that is needed;
 the unique function of the nurse is to assist 2. Identification: the client responds to help
the individual, sick or well, in the professionals or the significant others who can
performance of those activities meet the identified needs. Both the client and the
contributing to health, its recovery, or to a nurse plan together an appropriate program to
peaceful death the client would perform foster health;
3. Exploitation: the clients utilize all available needs energy producing input (food, oxygen,
resources to move toward a goal of maximum fluids) to allow energy utilization output.
health functionality; 2. Conservation of Structural Integrity . The
4. Resolution: refers to the termination phase of human body has physical boundaries (skin and
the nurse-client relationship. it occurs when the mucous membrane) that must be maintained to
client’s needs are met and he/she can move facilitate health and prevent harmful agents from
toward a new goal. Peplau further assumed that entering the body.
nurse-client relationship fosters growth in both the 3. Conservation of Personal Integrity. The
client and the nurse. nursing interventions are based on the
conservation of the individual client’s personality.
C. ABDELLAH, FAYE G. (1960) Every individual has sense of identity, self worth
 Defined nursing as having a problem- and self esteem, which must be preserved and
solving approach, with key nursing enhanced by nurses.
problems related to health needs of people; 4. Conservation of Social integrity. The social
developed list of 21 integrity of the client reflects the family and the
nursing-problem areas. community in which the client functions. Health
 Introduced Patient – Centered care institutions may separate individuals from
Approaches to Nursing Model She their family. It is important for nurses to consider
defined nursing as service to individual the individual in the context of the family.
and families; therefore the society.
Furthermore, she conceptualized nursing as F. JOHNSON, DOROTHY (1960, 1980)
an art and a science that molds the  Focuses on how the client adapts to illness;
attitudes, intellectual competencies and the goal of nursing is to reduce stress so
technical skills of the individual nurse into that the client can move more easily
the desire and ability to help people, sick through recovery.
or well, and cope with their health needs.  Viewed the patient’s behavior as a system,
which is a whole with interacting parts.
D. ORLANDO, IDA  The nursing process is viewed as a
 She conceptualized The Dynamic Nurse – major tool.
Patient Relationship Model. Conceptualized the Behavioral System Model
According to Johnson, each person as a behavioral
E. LEVINE, MYRA (1973) system is composed of seven subsystems namely:
 Believes nursing intervention is a 1. Ingestive. Taking in nourishment in socially
conservation activity, with conservation and culturally acceptable ways.
of energy as a primary concern, four 2. Eliminated. Riddling the body of waste in
conservation principles of nursing: socially and culturally acceptable ways.
conservation of client energy, conservation 3. Affiliative. Security seeking behavior.
of structured integrity, conservation of 4. Aggressive. Self – protective behavior.
personal integrity, conservation of social 5. Dependence. Nurturance – seeking behavior.
integrity. 6. Achievement. Master of oneself and one’s
 Described the Four Conversation environment according to internalized standards of
Principles. Sh Advocated that nursing is a excellence.
human interaction and proposed four 7. Sexual role identity behavior
conservation principles of nursing which
are concerned with the unity and integrity G. ROGERS, MARTHA
of the individual. The four conservation  Considers man as a unitary human being
principles are as follows: co-existing with in the universe, views
1. Conservation of energy . The human body nursing primarily as a science and is
functions by utilizing energy. The human body committed to nursing research.
 Views the client as an adaptive system.
The goal of nursing is to help the person
H. OREM, DOROTHEA (1970, 1985) adapt to changes in physiological needs,
 Emphasizes the client’s self-care needs, self-concept, role function and
nursing care becomes necessary when interdependent relations during health and
client is unable to fulfill biological, illness.
psychological, developmental or social  Presented the Adaptation Model. She
needs. viewed each person as a unified
 Developed the Self-Care Deficit Theory. biopsychosocial system in constant
She defined self-care as “the practice of interaction with a changing environment.
activities that individuals initiate to She contented that the person as an
perform on their own behalf in maintaining adaptive system, functions as a whole
life, health well-being.” She through interdependence of its part. The
conceptualized three systems as follows: system consists of input, control processes,
1. Wholly Compensatory: when the nurse is output feedback.
expected to accomplish the entire patient’s
therapeutic self-care or to compensate for the
patient’s inability to engage in self care or when L.LYDIA HALL (1962)
the patient needs continuous guidance in self care;  The client is composed of the ff.
2. Partially Compensatory: when both nurse overlapping parts: person (core),
patient engage in meeting self care needs; pathologic state and treatment (cure) and
3. Supportive-Educative: the system that requires body (care).
assistance decision making, behavior control and  Introduced the model of Nursing: What Is
acquisition knowledge and skills. It?, focusing on the notion that centers
around three components of CARE,
I. IMOGENE KING (1971, 1981) CORE and CURE. Care represents
 Nursing process is defined as dynamic nurturance and is exclusive to nursing.
interpersonal process between nurse, client Core involves the therapeutic use of self
and health care system. and emphasizes the use of reflection. Cure
 Postulated the Goal Attainment Theory . focuses on nursing related to the
She described nursing as a helping physician’s orders. Core and cure are
profession that assists individuals and shared with the other health care providers.
groups in society to attain, maintain, and
restore health. If is this not possible, nurses M. Virginia Henderson (1955)
help individuals die with dignity.  Introduced The Nature of Nursing
 In addition, King viewed nursing as an Model. She identified fourteen basic
interaction process between client and needs.
nurse whereby during perceiving, setting  She postulated that the unique function of
goals, and acting on them transactions the nurse is to assist the clients, sick or
occurred and goals are achieved. well, in the performance of those activities
contributing to health or its recovery, the
J. BETTY NEUMAN clients would perform unaided if they had
 Stress reduction is a goal of system model the necessary strength, will or knowledge.
of nursing practice. Nursing actions are in  She further believed that nursing involves
primary, secondary or tertiary level of assisting the client in gaining independence
prevention. as rapidly as possible, or assisting him
achieves peaceful death if recovery is no
K. SIS CALLISTA ROY (Adaptation Theory) longer possible.
(1979, 1984)
N. Madaleine Leininger (1978, 1984) preventing or coping with illness,
 Developed the Transcultural Nursing regaining health finding meaning in illness,
Model. She advocated that nursing is a or maintaining maximal degree of health.
humanistic and scientific mode of helping  She further viewed that interpersonal
a client through specific cultural caring process is a human-to-human relationship
processes (cultural values, beliefs and formed during illness and “experience of
practices) to improve or maintain a health suffering”
condition.  She believed that a person is a unique,
irreplaceable individual who is in a
O. Ida Jean Orlando (1961) continuous process of becoming, evolving
 Conceptualized The Dynamic Nurse – and changing
Patient Relationship Model. .
 She believed that the nurse helps patients S. Josephine Peterson and Loretta Zderad
meet a perceived need that the patient (1976)
cannot meet for themselves. Orlando  Provided the Humanistic Nursing
observed that the nurse provides direct Practice Theory. This is based on their
assistance to meet an immediate need for belief that nursing is an existential
help in order to avoid or to alleviate experience.
distress or helplessness.  Nursing is viewed as a lived dialogue that
 She emphasized the importance of involves the coming together of the nurse
validating the need and evaluating care and the person to be nursed.
based on observable outcomes.  The essential characteristic of nursing is
nurturance. Humanistic care cannot take
P. Ernestine Weidanbach (1964) place without the authentic commitment of
 Developed the Clinical Nursing – A the nurse to being with and the doing with
Helping Art Model. the client. Humanistic nursing also
 She advocated that the nurse’s individual presupposes responsible choices.
philosophy or central purpose lends
credence to nursing care. T. Helen Erickson, Evelyn Tomlin, and Mary
 She believed that nurses meet the Ann Swain (1983)
individual’s need for help through the  Developed Modeling and Role Modeling
identification of the needs, administration Theory . The focus of this theory is on the
of help, and validation that actions were person. The nurse models (assesses), role
helpful. Components of clinical practice: models (plans), and intervenes in this
Philosophy, purpose, practice and an art. interpersonal and interactive theory.
 They asserted that each individual unique,
Q. Jean Watson (1979-1992) has some self-care knowledge, needs
 Introduced the theory of Human simultaneously to be attached to the
Becoming. She emphasized free choice of separate from others, and has adaptive
personal meaning in relating value potential. Nurses in this theory, facilitate,
priorities, co – creating the rhythmical nurture and accept the person
patterns, in exchange with the unconditionally.
environment, and co transcending in man
dimensions as possibilities unfold. U. Margaret Newman
 Focused on health as expanding
R. Joyce Travelbee (1966,1971) consciousness. She believed that human
 She postulated the Interpersonal Aspects are unitary in whom disease is a
of Nursing Model. She advocated that the manifestation of the pattern of health.
goal of nursing individual or family in
 She defined consciousness as the developmental stages favorably resolved,
information capability of the system which then an ‘egostrength” or virtue emerges.
is influenced by time, space movement and
is ever – expanding. 3. Kohlberg
 Suggested three levels of moral
V. Patricia Benner and Judith Wrude l (1989) development. He focused on the reason for
 Proposed the Primacy and Caring the making of a decision, not on the
Model. They believed that caring central morality of the decision itself.
to the essence of nursing. Caring creates 1. At first level called the premolar or th
the possibilities for coping and creates the preconventional level, children are responsive to
possibilities for connecting with and cultural rules and labels of good and bad, right and
concern for others. wrong. However children interpret these in terms
of the physical consequences of the actions, i.e.,
W. Anne Boykin and Savina Schoenhofer punishment or reward.
 Presented the grand theory of Nursing as 2. At the second level, the conventional level, the
Caring. They believed that all person are individual is concerned about maintaining the
caring, and nursing is a response to a expectations of the family, groups or nation and
unique social call. The focus of nursing is sees
on nurturing person living and growing in this as right.
caring in a manner that is specific to each 3. At the third level, people make
nurse-nurse relationship or nursing postconventiona l, autonomous, or principal level.
situation. Each nursing situation is At this level, people make an effort to define valid
original. values and principles without regard to outside
 They support that caring is a moral authority or to the expectations of others. These
imperative. Nursing as Caring is not based involve respect for other human and belief that
on need or deficit but is egalitarian model relationship are based on mutual trust.
helping.
Peter (1981)
Moral Theories  Proposed a concept of rational morality
1. Freud (1961) based on principles. Moral development
 Believed that the mechanism for right and is usually considered to involve three
wrong within the individua l is the separate components: moral emotion (what
superego, or conscience . He hypnotized one feels), moral judgment (how one
that a child internalizes and adopts the reasons), and moral behavior (how one
moral standards and character or character acts).
traits of the model parent through the  In addition, Peters believed that the
process of identification. development of character traits or
 The strength of the superego depends on virtues is an essential aspect or moral
the intensity of the child’s feeling of development. And that virtues or character
aggression or attachment toward the model traits can be learned from others and
parent rather than on the actual standards encouraged by the example of others.
of the parent.  Also, Peters believed that some can be
described as habits because they are in
2. Erikson (1964) some sense automatic and therefore are
 Erikson’s theory on the development of performed habitually, such as politeness,
virtues or unifying strengths of the “good chastity, tidiness, thrift and honesty.
man” suggest that moral development
continuous throughout life. He believed Gilligan (1982)
that if the conflicts of each psychosocial
 Included the concepts of caring and  A nurse who has an advanced education
responsibility. She described three stages and is a graduate of a nurse practitioner
in the process of developing an “Ethic of program.
Care” which are as follows.  These nurses are in areas as adult nurse
1. Caring for oneself. practitioner, family nurse practitioner,
2. Caring for others. school nurse practitioner, pediatric nurse
3. Caring for self and others. practitioner, or gerontology nurse
 She believed the human see morality in practitioner.
the integrity of relationships and caring.  They are employed in health care agencies
For women, what is right is taking or community based settings. They usually
responsibility for others as deal with non-emergency acute or chronic
self-chosen decision. On the other hand, men illness and provide primary ambulatory
consider what is right to be what is just. care.
2. Clinical Nurse Specialist
Spiritual Theories  A nurse who has an advanced degree or
Fowler (1979) expertise and is considered to be an expert
 Described the development of faith. He in a specialized area of practice (e.g.,
believed that faith, or the spiritual gerontology, oncology).
dimension is a force that gives meaning to  The nurse provides direct client care,
a person’s life. educates others, consults, conducts
 He used the term “faith” as a form of research, and manages care.
knowing a way of being in relation “to an  The American Nurses Credentialing Center
ultimate environment.” To Fowler, faith is provides national certification of clinical
a relational phenomenon: it is “an active specialists.
made-of-being-in-relation to others in 3. Nurse Anesthetist
which we invest commitment, belief, love,  A nurse who has completed advanced
risk and hope.” education in an accredited program in
anesthesiology.
 The nurse anesthetist carries out pre-
operative visits and assessments, and
ROLES AND FUNCTIONS OF THE NURSE Administers general anesthetics for surgery
 Care giver under the supervision of a physician
 Decision-maker prepared in anesthesiology.
 Protector  The nurse anesthetist also assesses the
 Client Advocate postoperative of clients
 Manager 4. Nurse Midwife
 Rehabilitator  An RN who has completed a program in
 Comforter midwifery.
 Communicator  The nurse gives pre-natal and post-natal
 Teacher care and manages deliveries in normal
 Counselor pregnancies.
 Coordinator  The midwife practices the association with
 Leader a health care agency and can obtain
 Role Model medical services if complication occurs.
 Administrator  The nurse midwife may also conduct
routine Papanicolaou smears, family
Selected Expanded Career Roles of Nurses planning, and routine breast examination.
1. Nurse Practitioner 5. Nurse Educator
 Nurse educator is employed in nursing 1. Simplicity – includes uses of commonly
programs, at educational institutions, and understood, brevity, and completeness.
in hospital staff education. 2. Clarity – involves saying what is meant. The
 The nurse educator usually ha a nurse should also need to speak slowly and
baccalaureate degree or more advanced enunciate words well.
preparation and frequently has expertise in 3. Timing and Relevance – requires choice of
a particular area of practice. appropriate time and consideration of the client’s
The nurse educator is responsible for classroom interest and concerns. Ask one question at a time
and of ten clinical teaching. and wait for an answer before making another
6. Nurse Entrepreneur comment.
 A nurse who usually has an advanced 4. Characteristics of Good Communication
degree and manages a health-related 5. Adaptability – Involves adjustments on what
business. the nurse says and how it is said depending on the
 The nurse may be involved in education, moods and behavior of the client.
consultation, or research, for example. 6. Credibility – Means worthiness of belief. To
become credible, the nurse requires adequate
COMMUNICATION IN NURSING knowledge about the topic being discussed. The
COMMUNICATION nurse should be able to provide accurate
1. Is the means to establish a helping-healing information, to convey confidence and certainly in
relationships. All behavior communication what she says.
influences behavior.
2. Communication is essential to the nurse-patient Communicating With Clients Who Have
relationship for the following reasons: Special Needs
- Is the vehicle for establishing a therapeutic 1.Clients who cannot speak clearly (aphasia,
relationship. dysarthria, muteness)
- It the means by which an individual influences 1. Listen attentively, be patient, and do not
the behavior of another, which leads to the interrupt.
successful outcome of nursing intervention. 2. Ask simple question that require “yes” and “no”
answers.
Basic Elements of the Communication Process 3. Allow time for understanding and response.
1. SENDER – is the person who encodes and 4. Use visual cues (e.g., words, pictures, and
delivers the message objects)
2. MESSAGES – is the content of the 5. Allow only one person to speak at a time.
communication. It may contain verbal, nonverbal, 6. Do not shout or speak too loudly.
and symbolic language. 7. Use communication aid:
3. RECEIVER – is the person who receives the -pad and felt-tipped pen, magic slate, pictures
decodes the message. denoting basic needs, call bells or alarm.
4. FEEDBACK – is the message returned by the 2. Clients who are cognitively impaired
receiver. It indicates whether the meaning of the 1. Reduce environmental distractions while
sender’s message was understood. conversing.
2. Get client’s attention prior to speaking
Modes of Communication 3. Use simple sentences and avoid long
1. Verbal Communication – use of spoken or explanation.
written words. 4. Ask one question at a time
2. Nonverbal Communication – use of gestures, 5. Allow time for client to respond
facial expressions, posture/gait, body movements, 6. Be an attentive listener
physical appearance and body language 7. Include family and friends in conversations,
especially in subjects known to client.
Characteristics of Good Communication 3. Client who are unresponsive
1. Call client by name during interactions 5. flexible enough to retrieve critical data,
2. Communicate both verbally and by touch maintain continuity of care, track client outcomes,
3. Speak to client as though he or she could hear and reflects current standards of nursing practice
4. Explain all procedures and sensations 6. Effective documentation ensures continuity of
5. Provide orientation to person, place, and time care, saves time and minimizes the risk of error.
6. Avoid talking about client to others in his or her 7. As members of the health care team, nurses
presence need to communicate information about clients
7. Avoid saying things client should not hear accurately and in timely manner
4. Communicating with hearing impaired client 8. If the care plan is not communicated to all
1. Establish a method of communication members of the health care team, care can become
(pen/pencil and paper, sign-language) fragmented, repetition of tasks occurs, and
2. Pay attention to client’s non-verbal cues therapies may be delayed or omitted.
3. Decrease background noise such as television 9. Data recorded, reported, or c0mmunicated to
4. Always face the client when speaking other health care professionals are
5. It is also important to check the family as to CONFIDENTIAL and must be protected.
how to communicate with the client
6. It may be necessary to contact the appropriate CONFIDENTIALITY
department resource person for this type of 1. nurses are legally and ethically obligated to
disability keep information about clients confidential.
4. Client who do not speak English 2. Nurses may not discuss a client’s examination,
1. Speak to client in normal tone of voice observation, conversation, or treatment with other
(shouting may be interpreted as anger) clients or staff not involved in the client’s care.
2. Establish method for client o signal desire to 3. Only staff directly involved in a specific
communicate (call light or bell) client’s care have legitimate access to the
3. Provide an interpreter (translator) as needed record.
4. Avoid using family members, especially 4. Clients frequently request copies of their
children, as interpreters. medical record, and they have the right to read
5. Develop communication board, pictures or those records.
cards. 5. Nurses are responsible for protecting records
6. Have dictionary (English/Spanish) available if from all unauthorized readers.
client can read. 6. when nurses and other health care professionals
have a legitimate reason to use records for data
Reports gathering, research, or continuing education,
 Are oral ,written, or audiotaped exchanges appropriate authorization must be obtained
of information between caregivers. according to agency policy.
Common reports: 7. Maintaining confidentiality is an important
1. Change-in-shift report aspect of profession behavior.
2. Telephone report 8.It is essential that the nurse safe-guard the client’
3. Telephone or verbal order – only RN’s are right to privacy by carefully protecting
allowed to accept telephone orders. information of a sensitive, private nature.
4. Transfer report 9. Sharing personal information or gossiping about
5. Incident report others violates nursing
Documentation ethical codes and practice standards.
1. Is anything written or printed that is relied on as 10.It sends the message that the nurse cannot be
record or proof for authorized person. trusted and damages the interpersonal
2. Nursing documentation must be: relationships.
3. accurate
4. comprehensive Guidelines of Quality Documentation and
Reporting
1.Factual 2. Do not write retaliatory or critical comments
1. a record must contain descriptive, objective about the client or care by other health care
information about what a nurse sees, hears, feels, professionals.
and smells.  Enter only objective descriptions of
2. The use of vague terms, such as appears, client’s behavior; client’s comments
seems, and apparently , is not acceptable because should be quoted.
these words suggests that the nurse is stating an 3. Correct all errors promptly
opinion.  errors in recording can lead to errors in
 Example: “ the client seems anxious” (the treatment
phrase seems anxious is a conclusion  Avoid rushing to complete charting, be
without supported facts.) sure information is accurate.
2. Accurate 4. Do not leave blank spaces in nurse’s notes.
1. The use of exact measurements establishes  Chart consecutively, line by line; if space
accuracy. (example: “Intake of 350 ml of water” is is left, draw line horizontally through it
more accurate than “ the client drank an adequate and sign your name at end.
amount of fluid” 5. Record all entries legibly and in blank ink
2. Documentation of concise data is clear and easy  Never use pencil, felt pen.
to understand.  Blank ink is more legible when records are
3. It is essential to avoid the use of unnecessary photocopied or transferred to microfilm.
words and irrelevant details  Legal Guidelines for Recording
3. Complete 6. If order is questioned, record that clarification
1. The information within a recorded entry or a was sought.
report needs to be complete, containing  If you perform orders known to be
appropriate and essential information. incorrect, you are just as liable for
Example: prosecution as the physician is.
 The client verbalizes sharp, throbbing pain 7. Chart only for yourself
localized along lateral side of right ankle,  Never chart for someone else.
beginning approximately 15 minutes ago  You are accountable for information you
after twisting enter into chart.
his foot on the stair. Client rates pain as 8 on a 8. Avoid using generalized, empty phrases such as
scale of 0-10. “status unchanged” or “had good day”.
4. Current  Begin each entry with time, and end with
1. Timely entries are essential in the clients your signature and title.
ongoing care. To increase accuracy and decrease  Do not wait until end of shift to record
unnecessary duplication, many healthcare agencies important changes that occurred several
use records kept near the client’s bedside, which hours earlier. Be sure to sign each entry.
facilitate immediate documentation of information 9. For computer documentation keep your
as it is collected from a client password to yourself.
5. Organized  maintain security and confidentiality.
1. The nurse communicates information in a  Once logged into the computer do not
logical order. leave the computer screen unattended.
 For example, an organized note describes Assessing Vital Signs
the client’s pain, nurse’s assessment, Vital Signs or Cardinal Signs are:
nurse’s interventions, and the client’s  Body temperature
response  Pulse
Legal Guidelines for recording  Respiration
1. Draw single line through error, write word error  Blood pressure
above it and sign your name or initials. Then Pain
record note correctly. I. Body Temperature
 The balance between the heat produced by Contraindications
the body and the heat loss from the body.  Patient with diarrhea
 Recent rectal or prostatic surgery or injury
Types of Body Temperature because it may injure inflamed tissue
 Core temperature –temperature of the deep  Recent myocardial infarction
tissues of the body.  Patient post head injury
 Surface body temperature 3. Axillary – safest and non-invasive
Alteration in body Temperature a. Pat the axilla dry
 Pyrexia – Body temperature above normal b. Ask the patient to reach across his chest and
range( hyperthermia) grasp his opposite shoulder.
 Hyperpyrexia – Very high fever, This promote skin contact with the thermometer
41ºC(105.8 F) and above c. Hold it in place for 9 minutes because the
 Hypothermia – Subnormal temperature. thermometer isn’t close in a body cavity
Normal Adult Temperature Ranges Note:
 Oral 36.5 –37.5 ºC  Use the same thermometer for repeat
 Axillary 35.8 – 37.0 ºC temperature taking to ensure more
 Rectal 37.0 – 38.1 ºC consistent result
 Tympanic 36.8 – 37.9ºC  Store chemical-dot thermometer in a cool
Methods of Temperature-Taking area because exposure to heat activates the
1. Ora l – most accessible and convenient method. dye dots.
a. Put on gloves, and position the tip of the 4. Tympanic thermometer
thermometer under the patients tongue on either of a. Make sure the lens under the probe is clean and
the frenulun as far back as possible. It promotes shiny
contact to the superficial blood vessels and ensures b. Stabilized the patient’s head; gently pull the ear
a more accurate reading. straight back (for children up to age 1) or up and
b. Wash thermometer before use. back (for children 1 and older to adults)
c. Take oral temp 2-3 minutes. c. Insert the thermometer until the entire ear canal
d. Allow 15 min to elapse between client’s food is sealed
intake of hot or cold food, smoking. d. Place the activation button, and hold it in place
e. Instruct the patient to close his lips but not to for 1 second
bite down with his teeth to avoid breaking the 5. Chemical-dot thermometer
thermometer in his mouth. a. Leave the chemical-dot thermometer in place
Contraindications for 45 seconds
 Young children an infants b. Read the temperature as the last dye dot that has
 Patients who are unconscious or change color, or fired.
disoriented Nursing Interventions in Clients with Fever
 Who must breath through the mouth a. Monitor V.S
 Seizure prone b. Assess skin color and temperature
 Patient with N/V c. Monitor WBC, Hct and other pertinent lab
 Patients with oral lesions/surgeries records
2. Rectal- most accurate measurement of d. Provide adequate foods and fluids.
temperature e. Promote rest
a. Position- lateral position with his top legs flexed f. Monitor I & O
and drape him to provide privacy. g. Provide TSB
b. Squeeze the lubricant onto a facial tissue to h. Provide dry clothing and linens
avoid contaminating the lubricant supply. i. Give antipyretic as ordered by MD
c. Insert thermometer by 0.5 – 1.5 inches II. Pulse – It’s the wave of blood created by
d. Hold in place in 2minutes contractions of the left ventricles of the heart.
e. Do not force to insert the thermometer Normal Pulse rate
1 year 80-140 beats/min  Respiratory rates of less than 10 or more
2 years 80- 130 beats/min than 40 are usually considered abnormal
6 years 75- 120 beats/min and should be reported immediately to the
10 years 60-90 beats/min physician.
Adult 60-100 beats/min IV. Blood Pressure
Tachycardia – pulse rate of above 100 beats/min Adult – 90- 132 systolic
Bradycardia- pulse rate below 60 beats/min 60- 85 diastolic
Irregular – uneven time interval between beats. Elderly 140-160 systolic
What you need: 70-90 diastolic
a. Watch with second hand a. Ensure that the client is rested
b. Stethoscope (for apical pulse) b. Use appropriate size of BP cuff.
c. Doppler ultrasound blood flow detector if c. If too tight and narrow- false high BP
necessary d. If too lose and wide-false low BP
Radial Pulse e. Position the patient on sitting or supine position
a. Wash your hand and tell your client that you are f. Position the arm at the level of the heart, if the
going to take his pulse artery is below the heart level, you may get a false
b. Place the client in sitting or supine position with high reading
his arm on his side or across his chest g. Use the bell of the stethoscope since the blood
c. Gently press your index, middle, and ring pressure is a low frequency sound.
fingers on the radial artery, inside the patient’s h. If the client is crying or anxious, delay
wrist. measuring his blood pressure to avoid false-high
d. Excessive pressure may obstruct blood flow BP
distal to the pulse site Electronic Vital Sign Monitor
e. Counting for a full minute provides a more a. An electronic vital signs monitor allows you to
accurate picture of irregularities continually tract a patient’s vital sign without
Doppler device having to reapply a blood pressure cuff each time.
a. Apply small amount of transmission gel to the b. Example: Dinamap VS monitor 8100
ultrasound probe c. Lightweight, battery operated and can be
b. Position the probe on the skin directly over a attached to an IV pole
selected artery d. Before using the device, check the client7s
c. Set the volume to the lowest setting pulse and BP manually using the same arm you’ll
d. To obtain best signals, put gel between the skin using for the monitor cuff.
and the probe and tilt the probe 45 degrees from e. Compare the result with the initial reading from
the artery. the monitor. If the results differ call the supply
e. After you have measure the pulse rate, clean the department or the manufacturer’s representative.
probe with soft cloth soaked in antiseptic. Do not V. Pain
immerse the probe How to assess Pain
III. Respiration - is the exchange of oxygen and a. You must consider both the patient’s description
carbon dioxide between the atmosphere and the and your observations on his behavioral responses.
body b. First, ask the client to rank his pain on a scale of
Assessing Respiration 0-10, with 0 denoting lack of pain and 10 denoting
Rate – Normal 14-20/ min in adult the worst pain imaginable.
 The best time to assess respiration is c. Ask:
immediately after taking client’s pulse d. Where is the pain located?
 Count respiration for 60 second e. How long does the pain last?
 As you count the respiration, assess and f. How often does it occur?
record breath sound as stridor, wheezing, g. Can you describe the pain?
or stertor. h. What makes the pain worse?
i. Observe the patient’s behavioral response to h. Document the appearance, odor, and usual
pain (body language, moaning, grimacing, characteristics of the specimen.
withdrawal, crying, restlessness muscle twitching 2. 24-hour urine specimen
and immobility) a. Discard the first voided urine.
j. Also note physiological response, which may be b. Collect all specimens thereafter until the
sympathetic or parasympathetic following day
Managing Pain c. Soak the specimen in a container with ice
1. Giving medication as per MD’s order d. Add preservative as ordered according to
2. Giving emotional support hospital policy
3. Performing comfort measures 3. Second-Voided urine – required to assess
4. Use cognitive therapy glucose level and for the presence of albumen in
Height and weight the urine.
a. Height and weight are routinely measured when a. Discard the first urine
a patient is admitted to a health care facility. b. Give the patient a glass of water to drink
b. It is essential in calculating drug dosage, c. After few minutes, ask the patient to void
contrast agents, assessing nutritional status and 4. Catheterized urine specimen
determining the height-weight ratio. a. Clamp the catheter for 30 min to 1 hour to allow
c. Weight is the best overall indicator of fluid urine to accumulate in the bladder and adequate
status, daily monitoring is important for clients specimen can be collected.
receiving a diuretics or a medication that causes b. Clamping the drainage tube and emptying the
sodium retention. urine into a container are contraindicated after a
d. Weight can be measured with a standing scale, genitourinary surgery.
chair scale and bed scale. II. Stool Specimen
e. Height can be measured with the measuring bar, 1. Fecalysis – to assess gross appearance of stool
standing scale or tape measure if the client is and presence of ova or parasite
confine in a supine position. a. Secure a sterile specimen container
Pointers: b. Ask the pt. to defecate into a clean , dry bed pan
a. Reassure and steady patient who are at risk for or a portable commode.
losing their balance on a scale. c. Instruct client not to contaminate the specimen
b. Weight the patient at the same time each day. with urine or toilet paper( urine inhibits bacterial
(usually before breakfast), in similar clothing and growth and paper towel contain bismuth which
using the same scale. interfere with the test result.
c. If the patient uses crutches, weigh the client 2. Stool culture and sensitivity test
with the crutches or heavy clothing and subtract To assess specific etiologic agent causing
their weight from the total determined patient’ gastroenteritis and bacterial sensitivity to various
weight. antibiotics.
Laboratory and Diagnostic examination 3. Fecal Occult blood test
I. Urine Specimen are valuable test for detecting occult blood
1.Clean-Catch mid-stream urine specimen for (hidden) which may be present in colo-rectal
routine urinalysis, culture and sensitivity test cancer, detecting melena stool
a. Best time to collect is in the morning, first a. Hematest- (an Orthotolidin reagent tablet)
voided urine b. Hemoccult slide- (filter paper impregnated with
b. Provide sterile container guaiac)
c. Do perineal care before collection of the urine Both test produces blue reaction if occult blood
d. Discard the first flow of urine lost exceeds 5 ml in 24 hours.
e. Label the specimen properly c. Colocare – a newer test, requires no smear
f. Send the specimen immediately to the laboratory Instructions:
g. Document the time of specimen collection and a. Advise client to avoid ingestion of red meat for
transport to the lab. 3 days
b. Patient is advise on a high residue diet c. Rinse the mount with plain water before
c. avoid dark food and bismuth compound collection of the specimen
d. If client is on iron therapy, inform the MD d. Instruct the patient to hack-up sputum
e. Make sure the stool in not contaminated with 2. Sputum culture and sensitivity test
urine, soap solution or toilet paper a. Use sterile container
f. Test sample from several portion of the stool. b. Collect specimen before the first dose of
antibiotic
Venipuncture 3. Acid-Fast Bacilli
Pointers a. To assess presence of active pulmonary
a. Never collect a venous sample from the arm or a tuberculosis
leg that is already being use d for I.V therapy or b. Collect sputum in three consecutive morning
blood administration because it mat affect the 4. Cytologic sputum exam-
result. -to assess for presence of abnormal or cancer cells.
b. Never collect venous sample from an infectious Diagnostic Test
site because it may introduce pathogens into the 1. PPD test
vascular system a. read result 48 – 72 hours after injection.
c. Never collect blood from an edematous area, b. For HIV positive clients, induration of 5 mm is
AV shunt, site of previous hematoma, or vascular considered positive
injury. 2. Bronchography
d. Don’t wipe off the povidine-iodine with alcohol a. Secure consent
because alcohol cancels the effect of povidine b. Check for allergies to seafood or iodine or
iodine. anesthesia
e. If the patient has a clotting disorder or is c. NPO 6-8 hours before the test
receiving anticoagulant therapy, maintain pressure d. NPO until gag reflex return to prevent
on the site for at least 5 min after withdrawing the aspiration
needle. 3. Thoracentesis – aspiration of fluid in the
Arterial puncture for ABG test pleural space.
a. Before arterial puncture, perform Allen’s test a. Secure consent, take V/S
first. b. Position upright leaning on overbed table
b. If the patient is receiving oxygen, make sure c. Avoid cough during insertion to prevent pleural
that the patient’s therapy has been underway for at perforation
least 15 min before collecting arterial sample d. Turn to unaffected side after the procedure to
c. Be sure to indicate on the laboratory request slip prevent leakage of fluid in the thoracic cavity
the amount and type of oxygen therapy the patient e. Check for expectoration of blood. This indicate
is having. trauma and should be reported to MD
d. If the patient has just received a nebulizer immediately.
treatment, wait about 20 minutes before collecting 4.Holter Monitor
the sample. a. it is continuous ECG monitoring, over 24 hours
IV. Blood specimen period
a. No fasting for the following tests: b. The portable monitoring is called telemetry unit
- CBC, Hgb, Hct, clotting studies, enzyme studies, 5. Echocardiogram –
serum electrolytes a. ultrasound to assess cardiac structure and
b. Fasting is required: mobility
- FBS, BUN, Creatinine, serum lipid ( cholesterol, b. Client should remain still, in supine position
triglyceride) slightly turned to the left side, with HOB elevated
V. Sputum Specimen 15-20 degrees
1.Gross appearance of the sputum 6. Electrocardiography
a. Collect early in the morning
b. Use sterile container
If the patient’s skin is oily, scaly, or diaphoretic, g. force fluid after the test to prevent
rub the electrode with a dry 4x4 gauze to enhance constipation/barium impaction
electrode contact. 10.LGIS – Barium Enema
b. If the area is excessively hairy, clip it a. instruct client on low-residue diet 1-3 days
c. Remove client`s jewelry, coins, belt or any before the procedure
metal b. administer laxative evening before the
d. Tell client to remain still during the procedure procedure
7. Cardiac Catheterization c. NPO after midnight
a. Secure consent d. administer suppository in AM
b. Assess allergy to iodine, shelfish e. Enema until clear
c. V/S, weight for baseline information f. force fluid after the test to prevent
d. Have client void before the procedure constipation/barium impaction
e. Monitor PT, PTT, ECG prior to test
f. NPO for 4-6 hours before the test 11. Liver Biopsy
g. Shave the groin or brachial area a. Secure consent,
h. After the procedure : bed rest to prevent b. NPO 2-4 hrs before the test
bleeding on the site, do not flex extremity c. Monitor PT, Vit K at bedside
i. Elevate the affected extremities on extended d. Place the client in supine at the right side of the
position to promote blood supply back to the heart bed
and prevent thrombplebitis e. Instruct client to inhale and exhale deeply for
j. Monitor V/S especially peripheral pulses several times and then exhale and hold breath
k. Apply pressure dressing over the puncture site while the MD insert the needle
l. Monitor extremity for color, temperature, f. Right lateral post procedure for 4 hours to apply
tingling to assess for impaired circulation. pressure and prevent bleeding
8. MRI g. Bed rest for 24 hours
a. secure consent, h. Observe for S/S of peritonitis
b. the procedure will last 45-60 minute 12. Paracentesis
c. Assess client for claustrophobia a. Secure consent, check V/S
d. Remove all metal items b. Let the patient void before the procedure to
e. Client should remain still prevent puncture of the bladder
f. Tell client that he will feel nothing but may hear c. Check for serum protein. Excessive loss of
noises plasma protein may lead to hypovolemic shock.
g. Client with pacemaker, prosthetic valves, 13. Lumbar Puncture
implanted clips, wires are not eligible for MRI. a. obtain consent
h. Client with cardiac and respiratory complication b. instruct client to empty the bladder and bowel
may be excluded c. position the client in lateral recumbemt with
i. Instruct client on feeling of warmth or shortness back at the edge of the examining table
of breath if contrast medium is used during the d. instruct client to remain still
procedure e. obtain specimen per MDs order
9.UGIS – Barium Swallow NURSING PROCEDURES
a. instruct client on low-residue diet 1-3 days 1. Steam Inhalation
before the procedure a. It is dependent nursing function.
b. administer laxative evening before the b. Heat application requires physician’s order.
procedure c. Place the spout 12-18 inches away from the
c. NPO after midnight client’s nose or adjust the distance as necessary.
d. instruct client to drink a cup of flavored barium 2. Suctioning
e. x-rays are taken every 30 minutes until barium a. Assess the lungs before the procedure for
advances through the small bowel baseline information.
f. film can be taken as long as 24 hours later b. Position: conscious – semi-Fowler’s
c. Unconscious – lateral position 7. Foot Care
d. Size of suction catheter- adult- fr 12-18 a. Soaking the feet of diabetic client is no longer
e. Hyper oxygenate before and after procedure recommended
f. Observe sterile technique b. Cut nail straight across
g. Apply suction during withdrawal of the catheter 8. Mouth Care
h. Maximum time per suctioning –15 sec a. Eat coarse, fibrous foods (cleansing foods) such
3. Nasogastric Feeding (gastric gavage) as fresh fruits and raw vegetables
Insertion: b. Dental check every 6 mounts
a. Fowler’s position 9. Oral care for unconscious client
b. Tip of the nose to tip of the earlobe to the a. Place in side lying position
xyphoid b. Have the suction apparatus readily available
Tube Feeding 10. Hair Shampoo
a. Semi-Fowler’s position c. Place client diagonally in bed
b. Assess tube placement d. Cover the eyes with wash cloth
c. Assess residual feeding e. Plug the ears with cotton balls
d. Height of feeding is 12 inches above the tube’s f. Massage the scalp with the fatpads of the fingers
point of insertion to promote circulation in the scalp.
e. Ask client to remain upright position for at least 11. Restraints
30 min. g. Secure MD’s order for each episode of
f. Most common problem of tube feeding is restraints application.
Diarrhea due to lactose intolerance h. Check circulation every 15 min
4. Enema i. Remove restraints at least every 2 hours for 30
a. Check MD’s order minutes
b. Provide privacy
c. Position left lateral Normal Values
d. Size of tube Fr. 22-32
e. Insert 3-4 inches of rectal tube Bleeding time 1-9 min
f. If abdominal cramps occur, temporarily stop the Prothrombin time 10-13 sec
flow until cramps are gone. Hematocrit Male 42-52%
g. Height of enema can – 18 inches Female 36-48%
5. Urinary Catheterization Hemoglobin male 13.5-16 g/dl
a. Verify MD’s order female 12-16 g/dl
b. Practice strict asepsis Platelet 150,00- 400,000
c. Perineal care before the procedure RBC male 4.5-6.2 million/L
d. Catheter size: male-14-16, female – 12 – 14 female 4.2-5.4 million/L
e. Length of catheter insertion Amylase 80-180 IU/L
male – 6-9 inches ,female – 3-4 inches Bilirubin(serum) direct 0-0.4 mg/dl
For retention catheter: indirect 0.2-0.8 mg/dl
Male –anchor laterally or upward over the lower total 0.3-1.0 mg/dl
abdomen to prevent penoscrotal pressure pH 7.35- 7.45
Female- inner aspect of the thigh PaCo2 35-45
6. Bed Bath HCO3 22-26 mEq/L
a. Provide privacy Pa O2 80-100 mmHg
b. Expose, wash and dry one body part a time SaO2 94-100%
c. Use warm water (110-115 F) Sodium 135- 145 mEq/L
d. Wash from cleanest to dirtiest Potassium 3.5- 5.0 mEq/L
e. Wash, rinse, and dry the arms and leg using Calcium 4.2- 5.5 mg/dL
Long, firm strokes from distal to proximal area – Chloride 98-108 mEq/L
to increase venous return. Magnesium 1.5-2.5 mg/dl
BUN 1 0-20 mg/dl breakfast drinks, yogurt, mild cheese sauce
Creatinine 0.4- 1.2 or
CPK-MB male 50 –325 mu/ml pureed meat, and seasoning.
female 50-250 mu/ml Foods Avoided:
Fibrinogen 200-400 mg/dl  nuts, seeds, coconut, fruit, jam, and
FBS 80-120 mg/dl marmalade
Glycosylated Hgb 4.0-7.0% 3. SOFT DIET
(HbA1c) Purpose:
Uric Acid 2.5 –8 mg/dl  provide adequate nutrition for those who
ESR male 15-20 mm/hr have troubled chewing.
Female 20-30 mm/hr Use:
Cholesterol 150- 200 mg/dl  patient with no teeth or ill-fitting dentures;
Triglyceride 140-200 mg/dl transition from full-liquid to general diet;
Lactic Dehydrogenase 100-225 mu/ml and for those who cannot tolerate highly
Alkaline phospokinase 32-92 U/L seasoned, fried or raw foods following
Albumin 3.2- 5.5 mg/dl acute infections or gastrointestinal
disturbances such as gastric ulcer or
COMMON THERAPEUTIC DIETS cholelithiasis.
1. CLEAR-LIQUID DIET Foods Allowed:
Purpose:  very tender minced, ground, baked broiled,
 relieve thirst and help maintain fluid roasted, stewed, or creamed beef, lamb,
balance. veal, liver, poultry, or fish; crisp bacon or
Use: sweet bread; cooked vegetables; pasta; all
 post-surgically and following acute fruit juices; soft raw fruits; soft bread and
vomiting or diarrhea. cereals; all desserts that are soft; and
Foods Allowed: cheeses.
 carbonated beverages; coffee (caffeinated Foods Avoided:
and decaff.); tea; fruit-flavored drinks;  coarse whole-grain cereals and bread; nuts;
strained fruit juices; clear, flavored raisins; coconut; fruits with small seeds;
gelatins; broth, consomme; sugar; fried foods; high fat gravies or sauces;
popsicles; commercially prepared clear spicy salad dressings; pickled meat, fish, or
liquids; and hard candy. poultry; strong cheeses; brown or wild
Foods Avoided: rice; raw vegetables, as well as lima beans
 milk and milk products, fruit juices with and corn; spices such as horseradish,
pulp, and fruit. mustard, and catsup; and popcorn.
2. FULL-LIQUID DIET 4. SODIUM-RESTRICTED DIET
Purpose: Purpose:
 provide an adequately nutritious diet for  reduce sodium content in the tissue and
patients who cannot chew or who are too promote excretion of water.
ill to do so. Use:
Use:  heart failure, hypertension, renal disease,
 acute infection with fever, GI upsets, after cirrhosis, toxemia of pregnancy, and
surgery as a progression from clear liquids. cortisone therapy.
Foods Allowed: Modifications:
 clear liquids, milk drinks, cooked cereals,  mildly restrictive 2 g sodium diet to
custards, ice cream, sherbets, eggnog, all extremely restricted 200 mg sodium diet.
strained fruit juices, creamed vegetable Foods Avoided:
soups, puddings, mashed potatoes, instant  table salt; all commercial soups, including
bouillon; gravy, catsup, mustard, meat
sauces, and soy sauce; buttermilk, ice Use:
cream, and sherbet; sodas; beet greens,  burns, hepatitis, cirrhosis, pregnancy,
carrots, celery, chard, sauerkraut, and hyperthyroidism, mononucleosis, protein
spinach; all canned vegetables; frozen deficiency due to poor eating habits,
peas; geriatric patient with poor intake; nephritis,
 all baked products containing salt, baking nephrosis, and liver and gall bladder
powder, or baking soda; potato chips and disorder.
popcorn; fresh or canned shellfish; all Foods Allowed:
cheeses; smoked or commercially prepared  general diet with added protein.
meats; salted butter or margarine; bacon, Foods Avoided:
olives; and commercially prepared salad  restrictions depend on modifications added
dressings. to the diet. The modifications are
5. RENAL DIET determined by the patient’s condition.
Purpose: 7. PURINE-RESTRICTED DIET
 control protein, potassium, sodium, and fluid Purpose:
levels in the body.  designed to reduce intake of uric acid-
Use: producing foods.
 acute and chronic renal failure, Use:
hemodialysis.  high uric acid retention, uric acid renal
 Foods Allowed: stones, and gout.
 high-biological proteins such as meat, Foods Allowed:
fowl, fish, cheese, and dairy products range  general diet plus 2-3 quarts of liquid daily.
between 20 and 60 mg/day. Foods Avoided:
 Potassium is usually limited to 1500  cheese containing spices or nuts, fried
mg/day. eggs, meat, liver, seafood, lentils, dried
 Vegetables such as cabbage, cucumber, peas and beans, broth, bouillon, gravies,
and peas are lowest in potassium. oatmeal and whole wheat, pasta, noodles,
 Sodium is restricted to 500 mg/day. and alcoholic beverages. Limited quantities
 Fluid intake is restricted to the daily of meat, fish, and seafood allowed.
volume plus 500 mL, which represents 8. BLAND DIET
insensible water loss. Purpose:
 Fluid intake measures water in fruit,  provision of a diet low in fiber, roughage,
vegetables, milk and meat. mechanical irritants, and chemical
Foods Avoided: stimulants.
 Cereals, bread, macaroni, noodles, Use:
spaghetti, avocados, kidney beans, potato  Gastritis, hyperchlorhydria (excess
chips, raw fruit, yams, soybeans, nuts, hydrochloric acid), functional GI disorders,
gingerbread, apricots, bananas, figs, gastric atony, diarhhea, spastic
grapefruit, oranges, percolated coffee, constipation, biliary indigestion, and hiatus
Coca-Cola, orange crush, sport drinks, and hernia.
breakfast drinks such as Tang or Awake Foods Allowed:
 varied to meet individual needs and food
6. HIGH-PROTEIN, HIGH tolerances.
CARBOHYDRATE DIET Foods Avoided:
Purpose:  fried foods, including eggs, meat, fish, and
 to correct large protein losses and raises sea food; cheese with added nuts or spices;
the level of blood albumin. May be commercially prepared luncheon meats;
modified to include lowfat, cured meats such as ham; gravies and
 low-sodium, and low-cholesterol diets. sauces; raw vegetables;
 potato skins; fruit juices with pulp; figs; a. 45-55% carbohydrates
raisins; fresh fruits; whole wheats; rye b. 30-35% fats
bread; bran cereals; c. 10-25% protein
 rich pastries; pies; chocolate; jams with  coffee, tea, broth, spices and flavoring can
seeds; nuts; seasoned dressings; caffeinated be used as desired.
coffee; strong tea; cocoa; alcoholic and  exchange groups include: milk, vegetable,
carbonated beverages; and pepper. fruits, starch/bread, meat (divided in lean,
9. LOW-FAT, CHOLESTEROL- medium fat, and
RESTRICTED DIET  high fat), and fat exchanges.
Purpose:  the number of exchanges allowed from
 reduce hyperlipedimia, provide dietary each group is dependent on the total
treatment for malabsorption syndromes number of calories allowed.
and patients having acute intolerance for  non-nutritive sweeteners (sorbitol) in
fats. moderation with controlled, normal weight
Use: diabetics.
 hyperlipedimia, atherosclerosis, Foods Avoided:
pancreatitis, cystic fibrosis, sprue (disease  concentrated sweets or regular soft drinks.
of intestinal tract 11. ACID AND ALKALINE DIET
characterized by malabsorption), gastrectomy, Purpose:
massive resection of small intestine, and  Furnish a well balance diet in which the
cholecystitis. total acid ash is greater than the total
Foods Allowed: alkaline ash each day.
 nonfat milk; low-carbohydrate, low-fat Use:
vegetables; most fruits; breads; pastas;  Retard the formation of renal calculi. The
cornmeal; lean meats; type of diet chosen depends on laboratory
unsaturated fats analysis of the stone.
Foods Avoided: Acid and alkaline ash food groups:
 remember to avoid the five C’s of a. Acid ash: meat, whole grains, eggs, cheese,
cholesterol- cookies, cream, cake, coconut, cranberries, prunes, plums
chocolate; whole milk and whole-milk or b. Alkaline ash: milk, vegetables, fruits (except
cream products, avocados, olives, cranberries, prunes and plums.)
commercially prepared baked goods such c. Neutral: sugar, fats, beverages (coffee, tea)
as donuts and muffins, poultry skin, highly Foods allowed:
marbled meats  Breads: any, preferably whole grain;
 butter, ordinary margarines, olive oil, lard, crackers; rolls
pudding made with whole milk, ice cream,  Cereals: any, preferable whole grains
candies with chocolate, cream, sauces,  Desserts: angel food or sunshine cake;
gravies and commercially fried foods. cookies made without baking powder or
soda; cornstarch,
10. DIABETIC DIET  pudding, cranberry desserts, ice cream,
Purpose: sherbet, plum or prune desserts; rice or
 maintain blood glucose as near as normal tapioca pudding.
as possible; prevent or delay onset of  Fats: any, such as butter, margarine, salad
diabetic complications. dressings, Crisco, Spry, lard, salad oil,
Use: olive oil, ect.
 diabetes mellitus  fruits: cranberry, plums, prunes
Foods Allowed:  Meat, eggs, cheese: any meat, fish or fowl,
 choose foods with low glycemic index two serving daily; at least one egg daily
compose of:
 Potato substitutes: corn, hominy, lentils, Food Allowed:
macaroni, noodles, rice, spaghetti,  eggs; ground or well-cooked tender meat,
vermicelli. fish, poultry; milk, cheeses; strained fruit
 Soup: broth as desired; other soups from juice (except prune): cooked or canned
food allowed apples, apricots, peaches, pears; ripe
 Sweets: cranberry and plum jelly; plain banana; strained vegetable juice: canned,
sugar candy cooked, or strained asparagus, beets, green
 Miscellaneous: cream sauce, gravy, peanut beans, pumpkin, squash, spinach; white
butter, peanuts, popcorn, salt, spices, bread; refined cereals (Cream of Wheat)
vinegar, walnuts.
Restricted foods:
 no more than the amount allowed each day
1. Milk: 1 pint daily (may be used in other ways PRINCIPLES OF MEDICATION
than as beverage) ADMINISTRATION
2. Cream: 1/3 cup or less daily “Six Rights” of drug administration
3. Fruits: one serving of fruits daily( in addition to 1. The Right Medication – when administering
the prunes, plums and cranberries) medications, the nurse compares the label of the
4. Vegetable: including potatoes: two servings medication container with medication form.
daily The nurse does this 3 times:
5. Sweets: Chocolate or candies, syrups. a. Before removing the container from the drawer
6. Miscellaneous: other nuts, olives, pickles. or shelf
12. HIGH-FIBER DIET b. As the amount of medication ordered is
Purpose: removed from the container
 Soften the stool c. Before returning the container to the storage
 exercise digestive tract muscles 2. Right Dose –when performing medication
 speed passage of food through digestive calculation or conversions, the nurse should have
tract to prevent exposure to cancer causing another qualified nurse check the calculated dose
agents in food 3. Right Client – an important step in
 lower blood lipids administering medication safely is being sure the
 prevent sharp rise in glucose after eating. medication is given to the right client.
 Use: diabetes, hyperlipedemia, a. To identify the client correctly:
constipation, diverticulitis, b. The nurse check the medication administration
anticarcinogenics (colon) form against the client’s identification bracelet
Foods Allowed: and asks the client to state his or her name to
 recommended intake about 6 g crude fiber ensure the client’s identification bracelet has the
daily correct information.
 All bran cereal 4. RIGHT ROUTE – if a prescriber’s order does
 Watermelon, prunes, dried peaches, apple no designate a route of administration, the nurse
with skin; parsnip, peas, Brussels sprout, consult the prescriber. Likewise, if the specified
sunflower seeds. route is not recommended, the nurse should alert
the prescriber immediately.
LOW RESIDUE DIET 5. RIGHT TIME
Purpose: a. the nurse must know why a medication is
 Reduce stool bulk and slow transit time ordered for certain times of the day and whether
Use: the time schedule can be altered
 Bowel inflammation during acute b. each institution has are commended time
diverticulitis, or ulcerative colitis, schedule for medications ordered at frequent
preparation for bowel surgery, esophageal interval
and intestinal stenosis.
c. Medication that must act at certain times are VIII – Before administering medication, identify
given priority (e.g insulin should be given at a the client correctly
precise interval before a meal) IX – Do not leave the medication at the bedside.
6. RIGHT DOCUMENTATION – Stay with the client until he actually takes the
Documentation is an important part of safe medications.
medication administration X – The nurse who prepares the drug administers
a. The documentation for the medication should it.. Only the nurse prepares the drug knows what
clearly reflect the client’s name, the name of the the drug is. Do not accept endorsement of
ordered medication, the time, dose, route and medication.
frequency XI – If the client vomits after taking the
b. Sign medication sheet immediately after medication, report this to the nurse in charge or
administration of the drug physician.
CLIENT’S RIGHT RELATED TO XII – Preoperative medications are usually
MEDICATION ADMINISTRATION discontinued during the postoperative period
A client has the following rights: unless ordered to be continued.
a. To be informed of the medication’s name, XIII- When a medication is omitted for any
purpose, action, and potential undesired effects. reason, record the fact together with the reason.
b. To refuse a medication regardless of the XIV – When the medication error is made, report
consequences it immediately to the nurse in charge or physician.
c. To have a qualified nurses or physicians assess To implement necessary measures immediately.
medication history, including allergies This may prevent any adverse effects of the drug.
d. To be properly advised of the experimental Medication Administration
nature of medication therapy and to give written 1. Oral administration
consent for its use Advantages
e. To received labeled medications safely without a. The easiest and most desirable way to
discomfort in accordance with the six rights of administer medication
medication administration b. Most convenient
f. To receive appropriate supportive therapy in c. Safe, does nor break skin barrier
relation to medication therapy d. Usually less expensive
g. To not receive unnecessary medications Disadvantages
II – Practice Asepsis – wash hand before and a. Inappropriate if client cannot swallow and if
after preparing the medication to reduce transfer of GIT has reduced motility
microorganisms. b. Inappropriate for client with nausea and
III – Nurse who administer the medications are vomiting
responsible for their own action. c. Drug may have unpleasant taste
Question any order that you considered incorrect d. Drug may discolor the teeth
(may be unclear or appropriate) e. Drug may irritate the gastric mucosa
IV – Be knowledgeable about the medication that f. Drug may be aspirated by seriously ill patient.
you administer Drug Forms for Oral Administration
“A FUNDAMENTAL RULE OF SAFE DRUG a. Solid: tablet, capsule, pill, powder
ADMINISTRATION IS: “NEVER b. Liquid: syrup, suspension, emulsion, elixir,
ADMINISTER AN UNFAMILIAR milk, or other alkaline substances.
MEDICATION” c. Syrup: sugar-based liquid medication
V – Keep the Narcotics in locked place. d. Suspension : water-based liquid medication.
VI– Use only medications that are in clearly Shake bottle before use of medication to properly
labeled containers. Relabeling of drugs are the mix it.
responsibility of the pharmacist. e. Emulsion: oil-based liquid medication
VII – Return liquid that are cloudy in color to the f. Elixir: alcohol-based liquid medication. After
pharmacy. administration of elixir, allow 30 minutes to elapse
before giving water. This allows maximum 4. TOPICAL – Application of medication to a
absorption of the medication. circumscribed area of the body.
“NEVER CRUSH ENTERIC-COATED OR 1. Dermatologic – includes lotions, liniment and
SUSTAINED RELEASE TABLET” ointments, powder.
Crushing enteric-coated tablets – allows the a. Before application, clean the skin thoroughly by
irrigating medication to come in contact with the washing the area gently with soap and water,
oral or gastric mucosa, resulting in mucositis or soaking an involved site, or locally debriding
gastric irritation. tissue.
Crushing sustained-released medication – b. Use surgical asepsis when open wound is
allows all the medication to be absorbed at the present
same time, resulting in a higher than expected c. Remove previous application before the next
initial level of medication and a shorter than application
expected duration of action d. Use gloves when applying the medication over
2. SUBLINGUAL a large surface. (e.g large area of burns)
a. A drug that is placed under the tongue, where it e. Apply only thin layer of medication to prevent
dissolves. systemic absorption.
b. When the medication is in capsule and ordered 2. Opthalmic - includes instillation and irrigation
sublingually, the fluid must be aspirated from the a. Instillation – to provide an eye medication that
capsule and placed under the tongue. the client requires.
c. A medication given by the sublingual route b. Irrigation – To clear the eye of noxious or other
should not be swallowed, or desire effects will not foreign materials.
be achieved c. Position the client either sitting or lying.
Advantages: d. Use sterile technique
a. Same as oral e. Clean the eyelid and eyelashes with sterile
b. Drug is rapidly absorbed in the bloodstream cotton balls moistened with sterile normal saline
Disadvantages from the inner to the outer canthus
a. If swallowed, drug may be inactivated by gastric f. Instill eye drops into lower conjunctival sac.
juices. g. Instill a maximum of 2 drops at a time. Wait for
b. Drug must remain under the tongue until 5 minutes if additional drops need to be
dissolved and absorbed administered. This is for proper absorption of the
3. BUCCAL medication.
a. A medication is held in the mouth against the h. Avoid dropping a solution onto the cornea
mucous membranes of the cheek until the drug directly, because it causes discomfort.
dissolves. i. Instruct the client to close the eyes gently.
b. The medication should not be chewed, Shutting the eyes tightly causes spillage of the
swallowed, or placed under the tongue (e.g medication.
sustained release nitroglycerine, j. For liquid eye medication, press firmly on the
opiates,antiemetics, tranquilizer, sedatives) nasolacrimal duct (inner cantus) for at least 30
c. Client should be taught to alternate the cheeks seconds to prevent systemic absorption of the
with each subsequent dose to avoid mucosal medication.
irritation 3. Otic Instillation – to remove cerumen or pus or
Advantages: to remove foreign body
a. Same as oral a. Warm the solution at room temperature or body
b. Drug can be administered for local effect temperature, failure to do so may cause vertigo,
c. Ensures greater potency because drug directly dizziness, nausea and pain.
enters the blood and bypass the liver b. Have the client assume a side-lying position ( if
Disadvantages: not contraindicated) with ear to be treated facing
 If swallowed, drug may be inactivated by up.
gastric juice
c. Perform hand hygiene. Apply gloves if drainage d. Instruct the client to hold breath for 10 seconds.
is present. To enhance complete absorption of the
d. Straighten the ear canal: medication.
 0-3 years old: pull the pinna downward and e. If bronchodilator, administer a maximum of 2
backward puffs, for at least 30 second interval. Administer
 Older than 3 years old: pull the pinna bronchodilator before other inhaled medication.
upward and backward This opens airway and promotes greater
e. Instill eardrops on the side of the auditory canal absorption of the medication.
to allow the drops to flow in and continue to adjust f. Wait at least 1 minute before administration of
to body temperature the second dose or inhalation of a different
f. Press gently bur firmly a few times on the tragus medication by MDI
of the ear to assist the flow of medication into the g. Instruct client to rinse mouth, if steroid had
ear canal. been administered. This is to prevent fungal
g. Ask the client to remain in side lying position infection.
for about 5 minutes 6. Vagina l – drug forms: tablet liquid (douches).
h. At times the MD will order insertion of cotton Jelly, foam and suppository.
puff into outermost part of the canal. Do not press a. Close room or curtain to provide privacy.
cotton into the canal. Remove cotton after 15 b. Assist client to lie in dorsal recumbent position
minutes. to provide easy access and good exposure of
4. Nasal – Nasal instillations usually are instilled vaginal canal, also allows suppository to dissolve
for their astringent effects (to shrink swollen without
mucous membrane), to loosen secretions and escaping through orifice.
facilitate drainage or to treat infections of the nasal c. Use applicator or sterile gloves for vaginal
cavity or sinuses. Decongestants, steroids, administration of medications.
calcitonin. Vaginal Irrigation – is the washing of the vagina
a. Have the client blow the nose prior to nasal by a liquid at low pressure. It is also called
instillation douche.
b. Assume a back lying position, or sit up and lean a. Empty the bladder before the procedure
head back. b. Position the client on her back with the hips
c. Elevate the nares slightly by pressing the thumb higher than the shoulder (use bedpan)
against the client’s tip of the nose. While the client c. Irrigating container should be 30 cm (12 inches)
inhales, squeeze the bottle. above
d. Keep head tilted backward for 5 minutes after d. Ask the client to remain in bed for 5-10 minute
instillation of nasal drops. following administration of vaginal suppository,
e. When the medication is used on a daily basis, cream, foam, jelly or irrigation.
alternate nares to prevent irritations 7. RECTAL – can be use when the drug has
5. Inhalation – use of nebulizer, metered-dose objectionable taste or odor.
inhaler a. Need to be refrigerated so as not to soften.
a. Simi or high-fowler’s position or standing b. Apply disposable gloves.
position. To enhance full chest expansion allowing c. Have the client lie on left side and ask to take
deeper inhalation of the medication slow deep breaths through mouth and relax anal
b. Shake the canister several times. To mix the sphincter.
medication and ensure uniform dosage delivery d. Retract buttocks gently through the anus, past
c. Position the mouthpiece 1 to 2 inches from the internal sphincter and against rectal wall, 10 cm (4
client’s open mouth. As the client starts inhaling, inches) in adults, 5 cm (2 in) in children and
press the canister down to release one dose of the infants. May need to apply gentle pressure to hold
medication. This allows delivery of the medication buttocks together momentarily.
more accurately into the bronchial tree rather than e. Discard gloves to proper receptacle and perform
being trapped in the oropharynx then swallowed hand washing.
f. Client must remain on side for 20 minute after length of the needle depending on the size of the
insertion to promote adequate absorption of the client.
medication. m. For other medications, aspirate before injection
8. PARENTERAL- administration of medication of medication to check if the blood vessel had
by needle. been hit. If blood appears on pulling back of the
Intradermal – under the epidermis. plunger of the syringe, remove the needle and
a. The site are the inner lower arm, upper chest discard the medication and equipment.
and back, and beneath the scapula. Intramuscular
b. Indicated for allergy and tuberculin testing and a. Needle length is 1”, 1 ½”, 2” to reach the
for vaccinations. muscle layer
c. Use the needle gauge 25, 26, 27: needle length b. Clean the injection site with alcoholized cotton
3/8”, 5/8” or ½” ball to reduce microorganisms in the area.
d. Needle at 10–15 degree angle; bevel up. c. Inject the medication slowly to allow the tissue
e. Inject a small amount of drug slowly over 3 to 5 to accommodate volume.
seconds to form a wheal or bleb. Sites:
f. Do not massage the site of injection. To prevent Ventrogluteal site
irritation of the site, and to prevent absorption of a. The area contains no large nerves, or blood
the drug into the subcutaneous. vessels and less fat. It is farther from the rectal
Subcutaneous – vaccines, heparin, preoperative area, so it less contaminated.
medication, insulin, narcotics. b. Position the client in prone or side-lying.
The site: c. When in prone position, curl the toes inward.
 outer aspect of the upper arms d. When side-lying position, flex the knee and hip.
 anterior aspect of the thighs These ensure relaxation of gluteus muscles and
 Abdomen minimize discomfort during injection.
 Scapular areas of the upper back e. To locate the site, place the heel of the hand
 Ventrogluteal over the greater trochanter, point the index finger
 Dorsogluteal toward the anterior superior iliac spine, then
a. Only small doses of medication should be abduct the middle (third) finger. The triangle
injected via SC route. formed by the index finger, the third
b. Rotate site of injection to minimize tissue finger and the crest of the ilium is the site.
damage. Dorsogluteal site
c. Needle length and gauge are the same as for ID a. Position the client similar to the ventrogluteal
injections site
d. Use 5/8 needle for adults when the injection is b. The site should not be use in infant under 3
to administer at 45 degree angle; ½ is use at a 90 years because the gluteal muscles are not well
degree angle. developed yet.
e. For thin patients: 45 degree angle of needle c. To locate the site, the nursedraw an imaginary
f. For obese patient: 90 degree angle of needle line from the greater trochanter to the posterior
For heparin injection : superior iliac spine. The injection site id lateral
h. do not aspirate. and superior to this line.
i. Do not massage the injection site to prevent d. Another method of locating this site is to
hematoma formation imaginary divide the buttock into four quadrants.
For insulin injection: The upper most quadrant is the site of injection.
k. Do not massage to prevent rapid absorption Palpate the crest of the ilium to ensure that the site
which may result to hypoglycemic reaction. is high enough.
l. Always inject insulin at 90 degrees angle to e. Avoid hitting the sciatic nerve, major blood
administer the medication in the pocket between vessel or bone by locating the site properly.
the subcutaneous and muscle layer. Adjust the Vastus Lateralis
a. Recommended site of injection for infant
b. Located at the middle third of the anterior 11.Either spread or pinch muscle when
lateral aspect of the thigh. introducing the medication. Depending on the size
c. Assume back-lying or sitting position. of the client.
Rectus femoris site –located at the middle third, 12.Minimized discomfort by applying cold
anterior aspect of thigh. compress over the injection site before
Deltoid site introduction of medicati0n to numb nerve endings.
a. Not used often for IM injection because it is 13.Aspirate before the introduction of medication.
relatively small muscle and is very close to the To check if blood vessel had been hit.
radial nerve and radial artery. 14.Support the tissue with cotton swabs before
b. To locate the site, palpate the lower edge of the withdrawal of needle. To prevent discomfort of
acromion process and the midpoint on the lateral pulling tissues as needle is withdrawn.
aspect of the arm that is in line with the axilla. 15.Massage the site of injection to haste
This is approximately 5 cm (2 in) or 2 to 3 absorption.
fingerbreadths below the acromion process. 16.Apply pressure at the site for few minutes. To
IM injection – Z tract injection prevent bleeding.
a. Used for parenteral iron preparation. To seal the 17.Evaluate effectiveness of the procedure and
drug deep into the muscles and prevent permanent make relevant documentation.
staining of the skin. Intravenous
b. Retract the skin laterally, inject the medication The nurse administers medication intravenously
slowly. Hold retraction of skin until the needle is by the following method:
withdrawn 1. As mixture within large volumes of IV fluids.
c. Do not massage the site of injection to prevent 2. By injection of a bolus, or small volume, or
leakage into the subcutaneous. medication through an existing intravenous
GENERAL PRINCIPLES IN PARENTERAL infusion line or intermittent venous access
ADMINISTRATION OF MEDICATIONS (heparin or saline
1. Check doctor’s order. lock)
2. Check the expiration for medication – drug 3. By “piggyback” infusion of solution containing
potency may increase or decrease if outdated. the prescribed medication and a small volume of
3. Observe verbal and non-verbal responses IV fluid through an existing IV line.
toward receiving injection. Injection can be a. Most rapid route of absorption of medications.
painful.client may have anxiety, which can b. Predictable, therapeutic blood levels of
increase the pain. medication can be obtained.
4. Practice asepsis to prevent infection. Apply c. The route can be used for clients with
disposable gloves. compromised gastrointestinal function or
5. Use appropriate needle size. To minimize tissue peripheral circulation.
injury. d. Large dose of medications can be administered
6. Plot the site of injection properly. To prevent by this route.
hitting nerves, blood vessels, bones. e. The nurse must closely observe the client for
7. Use separate needles for aspiration and injection symptoms of adverse reactions.
of medications to prevent tissue irritation. f. The nurse should double-check the six rights of
8. Introduce air into the vial before aspiration. To safe medication.
create a positive pressure within the vial and allow g. If the medication has an antidote, it must be
easy withdrawal of the medication. available during administration.
9. Allow a small air bubble (0.2 ml) in the syringe h. When administering potent medications, the
to push the medication that may remain. nurse assesses vital signs before, during and after
10.Introduce the needle in quick thrust to lessen infusion.
discomfort. Nursing Interventions in IV Infusion
a. Verify the doctor’s order
b. Know the type, amount, and indication of IV  Headache
therapy.  Flushed skin
c. Practice strict asepsis.  Rapid pulse
d. Inform the client and explain the purpose of IV  Increase BP
therapy to alleviate client’s anxiety.  Weight gain
e. Prime IV tubing to expel air. This will prevent  Syncope and faintness
air embolism.  Pulmonary edema
f. Clean the insertion site of IV needle from center  Increase volume pressure
to the periphery with alcoholized cotton ball to  SOB
prevent infection.  Coughing
g. Shave the area of needle insertion if hairy.  Tachypnea
h. Change the IV tubing every 72 hours. To  shock
prevent contamination. Nursing Interventions:
i. Change IV needle insertion site every 72 hours  Slow infusion to KVO
to prevent thrombophlebitis.  Place patient in high fowler’s position. To
j. Regulate IV every 15-20 minutes. To ensure enhance breathing
administration of proper volume of IV fluid as  Administer diuretic, bronchodilator as
ordered. ordered
k. Observe for potential complications. 3. Drug Overload – the patient receives an
Types of IV Fluids excessive amount of fluid containing drugs.
Isotonic solution – has the same concentration as Assessment:
the body fluid  Dizziness
a. D5 W  Shock
b. Na Cl 0.9%  Fainting
c. plainRinger’s lactate Nursing Intervention
d. Plain Normosol M  Slow infusion to KVO.
Hypotonic – has lower concentration than the  Take vital signs
body fluids.  Notify physician
a. NaCl 0.3% 4. Superficial Thrombophlebitis – it is due to
Hypertonic – has higher concentration than the o0veruse of a vein, irritating solution or drugs, clot
body fluids. formation, large bore catheters.
a. D10W Assessment:
b. D50W  Pain along the course of vein
c. D5LR  Vein may feel hard and cordlike
d. D5NM  Edema and redness at needle insertion site.
Complication of IV Infusion  Arm feels warmer than the other arm
1. Infiltration – the needle is out of nein, and Nursing Intervention:
fluids accumulate in the subcutaneous tissues.  Change IV site every 72 hours
Assessment:  Use large veins for irritating fluids.
 Pain, swelling, skin is cold at needle site,  Stabilize venipuncture at area of flexion.
pallor of the site, flow rate has decreases or  Apply cold compress immediately to
stops. relieve pain and inflammation; later with
 Nursing Intervention: warm compress to stimulate circulation
 Change the site of needle and promotion absorption.
 Apply warm compress. This will absorb  “Do not irrigate the IV because this could
edema fluids and reduce swelling. push clot into the systemic circulation’
2. Circulatory Overload - Results from 5. Air Embolism – Air manages to get into the
administration of excessive volume of IV fluids. circulatory system; 5 ml of air or more causes air
Assessment: embolism.
Assessment: e. At least 2 licensed nurse check the label of the
 Chest, shoulder, or backpain blood transfusion
 Hypotension Check the following:
 Dyspnea  Serial number
 Cyanosis  Blood component
 Tachycardia  Blood type
 Increase venous pressure  Rh factor
 Loss of consciousness  Expiration date
Nursing Intervention  Screening test (VDRL, HBsAg, malarial
 Do not allow IV bottle to “run dry” smear)
 “Prime” IV tubing before starting infusion. - this is to ensure that the blood is free from blood-
 Turn patient to left side in the carried diseases and therefore, safe from
trendelenburg position. To allow air to rise transfusion.
in the right side of the heart. This prevent f. Warm blood at room temperature before
pulmonary embolism. transfusion to prevent chills.
6. Nerve Damage – may result from tying the arm g. Identify client properly. Two Nurses check the
too tightly to the splint. client’s identification.
Assessment h. Use needle gauge 18 to 19. This allows easy
 Numbness of fingers and hands flow of blood.
 Nursing Interventions j.Use BT set with special micron mesh filter. To
 Massage the arm and move shoulder prevent administration of blood clots and particles.
through its ROM k. Start infusion slowly at 10 gtts/min. Remain at
 Instruct the patient to open and close hand bedside for 15 to 30 minutes.
several times each hour. Adverse reaction usually occurs during the first 15
 Physical therapy may be required to 20 minutes.
Note: apply splint with the fingers free to move. l. Monitor vital signs. Altered vital signs indicate
7. Speed Shock – may result from administration adverse reaction.
of IV push medication rapidly.  Do not mixed medications with blood
 To avoid speed shock, and possible cardiac transfusion. To prevent adverse effects
arrest, give most IV push  Do not incorporate medication into the
medication over 3 to 5 minutes. blood transfusion
BLOOD TRANSFUSION THERAPY  Do not use blood transfusion line for IV
Objectives: push of medication.
1. To increase circulating blood volume after m. Administer 0.9% NaCl before, during or after
surgery, trauma, or hemorrhage BT. Never administer IV fluids with dextrose.
2. To increase the number of RBCs and to Dextrose causes hemolysis.
maintain hemoglobin levels in clients with severe n. Administer BT for 4 hours (whole blood,
anemia packed rbc). For plasma, platelets, cryoprecipitate,
3. To provide selected cellular components as transfuse quickly (20 minutes) clotting factor can
replacements therapy (e.g clotting factors, easily be destroyed.
platelets, albumin) Complications of Blood Transfusion
Nursing Interventions: 1. Allergic Reaction – it is caused by sensitivity
a. Verify doctor’s order. Inform the client and to plasma protein of donor antibody, which reacts
explain the purpose of the procedure. with recipient antigen.
b. Check for cross matching and typing. To ensure Assessments
compatibility  Flushing
c. Obtain and record baseline vital signs  Rush, hives
d. Practice strict Asepsis  Pruritus
 Laryngeal edema, difficulty of breathing
2. Febrile, Non-Hemolytic – it is caused by 3. Place the client in fowlers position if with SOB
hypersensitivity to donor white cells, platelets or and administer O2 therapy.
plasma proteins. This is the most symptomatic 4. The nurse remains with the client, observing
complication of blood transfusion signs and symptoms and monitoring vital signs as
Assessments: often as every 5 minutes.
 Sudden chills and fever 5. Notify the physician immediately.
 Flushing 6. The nurse prepares to administer emergency
 Headache drugs such as antihistamines, vasopressor, fluids,
 Anxiety and steroids as per physician’s order or protocol.
3. Septic Reaction – it is caused by the 7. Obtain a urine specimen and send to the
transfusion of blood or components contaminated laboratory to determine presence of hemoglobin as
with bacteria. a result of RBC hemolysis.
Assessment: 8. Blood container, tubing, attached label, and
 Rapid onset of chills transfusion record are saved and returned to the
 Vomiting laboratory for analysis.
 Marked Hypotension
 High fever
4. Circulatory Overload – it is caused by
administration of blood volume at a rate greater
than the circulatory system can accommodate.

Assessment
 Rise in venous pressure
 Dyspnea
 Crackles or rales
 Distended neck vein
 Cough
 Elevated BP
5. Hemolytic reaction. It is caused by infusion of
incompatible blood products.
Assessment
 Low back pain (first sign). This is due to
inflammatory response of the kidneys to
incompatible blood.
 Chills
 Feeling of fullness
 Tachycardia
 Flushing
 Tachypnea
 Hypotension
 Bleeding
 Vascular collapse
 Acute renal failure
Nursing Interventions when complications
occurs in Blood transfusion
1. If blood transfusion reaction occurs. STOP THE
TRANSFUSION.
2. Start IV line (0.9% Na Cl)

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