FUNDAMENTALS OF NURSING e.

Melchora Aquino (Tandang Sora) –

Nurse the wounded Filipino soldiers
NURSING- As defined by the INTERNATIONAL and gave them shelter and food.
COUNCIL OF NURSES as written by Virginia f. Captain Salome – A revolutionary
Henderson. leader in Nueva Ecija; provided nursing
care to the wounded when not in
“The unique function of the nurse is to assist the combat.
individual, sick or well, in the performance of g. Agueda Kahabagan – Revolutionary
those activities contributing to health, its leader in Laguna, also provided
recovery, or to a peaceful death. The client will nursing services to her troop.
perform these activities unaided if he had the h. Trinidad Tecson – “Ina ng Biac na
necessary strength, will or knowledge. Nurses Bato”, stayed in the hospital at Biac na
help the client gain independence as rapidly as Bato to care for the wounded soldier.
possible. Hospitals and Nursing Schools
1. Iloilo Mission Hospital School of Nursing
The Earliest Hospitals Established were the (Iloilo City, 1906)
following:  It was ran by the Baptist Foreign
a. Hospital Real de Manila (1577). It was Mission Society of America.
established mainly to care for the  Miss Rose Nicolet, a graduate of
Spanish King’s soldiers, but also New England Hospital for woman
admitted Spanish civilians. Founded by and children in Boston,
Gov. Francisco de Sande Massachusetts, was the first
b. San Lazaro Hospital (1578) – built superintendent.
exclusively for patients with leprosy.  Miss Flora Ernst, an American
Founded by Brother Juan Clemente nurse, took charge of the school in
c. Hospital de Indio (1586) –Established by 1942.
the Franciscan Order; Service was in general 2. St. Paul’s Hospital School of Nursing
supported by alms and contribution from (Manila, 1907)
charitable persons.  The hospital was established by the
d. Hospital de Aguas Santas (1590). Archbishop of Manila, The Most
Established in Laguna, near a medicinal Reverend Jeremiah Harty, under
spring, Founded by Brother J. Bautista of the the supervision of the Sisters of St.
Franciscan Order. Paul de Chartres.
e.San Juan de Dios Hospital (1596) Founded  It was located in Intramuros and it
by the Brotherhood de Misericordia and provided general hospital services.
support was derived from alms and rents. 3. Philippine general Hospital School of
Rendered general health service to the Nursing (1907)
public.  In 1907, with the support of the
Nursing During the Philippine Revolution Governor General Forbes and the
The prominent persons involved in the Director of Health and among
nursing works were: others, she opened classes in
a. Josephine Bracken – wife of Jose Rizal. nursing under the auspices of the
Installed a field hospital in an estate Bureau of Education.
house in Tejeros. Provided nursing care  Anastacia Giron-Tupas, was the
to thw wounded night and day. first Filipino to occupy the position
b. Rosa Sevilla De Alvero – converted of chief nurse and superintendent
their house into quarters for the filipino in the Philippines, succeded her.
soldier,during the Philippine-American 4. St. Luke’s Hospital School of Nursing
war that broke out in 1899. (Quezon City, 1907)
c. Dona Hilaria de Aguinaldo – Wife of  The Hospital is an Episcopalian
Emilio Aguinaldo; Organized the Filipino Institution. It began as a small
Red Cross under the inspiration of dispensary in 1903. In 1907, the
Apolinario Mabini. school opened with three Filipino
d. Dona Maria de Aguinaldo- second girls admitted.
wife of Emilio Aguinaldo. Provided  Mrs. Vitiliana Beltran was the
nursing care for the Filipino soldier first Filipino superintendent of
during the revolution. President of the nurses.
Filipino Red Cross branch in Batangas. 5. Mary Johnston Hospital and School of
Nursing (Manila, 1907)
 It started as a small dispensary on Calle
Cervantes (now Avenida)
  It was called Bethany Dispensary and was 4. The need to establish fruitful and
founded by the Methodist Mission. meaningful relationships with people,
 Miss Librada Javelera was the first Filipino institution, or organization
director of the school. Self-Esteem Needs
6. Philippine Christian mission Institute 1. Self-worth
School of Nursing. 2. Self-identity
The United Christian Missionary of Indianapolis, 3. Self-respect
operated Three schools of Nursing: 4. Body image
1. Sallie Long Read Memorial Hospital Self-Actualization Needs
School of Nursing (Laoag, Ilocos Norte,1903) 1. The need to learn, create and understand
2. Mary Chiles Hospital school of Nursing or comprehend
(Manila, 1911) 2. The need for harmonious relationships
3. Frank Dunn Memorial hospital 3. The need for beauty or aesthetics
7. San Juan de Dios hospital School of 4. The need for spiritual fulfillment
Nursing (Manila, 1913) Characteristics of Basic Human Needs
8. Emmanuel Hospital School of Nursing 1. Needs are universal.
(Capiz,1913) 2. Needs may be met in different ways
9. Southern Island Hospital School of Nursing 3. Needs may be stimulated by external and
(Cebu, 1918) internal factor
 The hospital was established under the 4. Priorities may be deferred
Bureau of Health with Anastacia Giron- 5. Needs are interrelated
Tupas as the organizer. Concepts of health and Illness
HEALTH
The First Colleges of Nursing in the 1. Is the fundamental right of every human
Philippines being. It is the state of integration of the
 University of Santo Tomas .College of body and mind
Nursing (1946) 2. Health and illness are highly individualized
 Manila Central University College of Nursing perception. Meanings and descriptions of
(1948) health and illness vary among people in
 University of the Philippines College of relation to geography and to culture.
Nursing (1948). Ms. Julita Sotejo was its first 3. Health - is the state of complete physical,
Dean mental, and social well-being, and not
The Basic Human Needs merely the absence of disease or infirmity.
 Each individual has unique characteristics, (WHO)
but certain needs are common to all people. 4. Health – is the ability to maintain the
 A need is something that is desirable, useful internal milieu. Illness is the result of
or necessary. failure to maintain the internal
 Human needs are physiologic and environment.(Claude Bernard)
psychologic conditions that an individual 5. Health – is the ability to maintain
must meet to achieve a state of health or homeostasis or dynamic equilibrium.
well-being. Homeostasis is regulated by the negative
Maslow’s Hierarchy of Basic Human Needs feedback mechanism.(Walter Cannon)
Physiologic 6. Health – is being well and using one’s
1. Oxygen power to the fullest extent. Health is
2. Fluids maintained through prevention of diseases
3. Nutrition via environmental health factors.(Florence
4. Body temperature Nightingale)
5. Elimination 7. Health – is viewed in terms of the
6. Rest and sleep individual’s ability to perform 14
7. Sex components of nursing care unaided.
Safety and Security (Henderson)
1. Physical safety 8. Positive Health – symbolizes wellness. It
2. Psychological safety is value term defined by the culture or
3. The need for shelter and freedom from harm individual. (Rogers)
and danger 9. Health – is a state of a process of being
Love and belonging becoming an integrated and whole as a
1. The need to love and be loved person.(Roy)
2. The need to care and to be cared for. 10. Health – is a state the characterized by
3. The need for affection: to associate or to soundness or wholeness of developed
belong
 human structures and of bodily and mental 5. Recovery/Rehabilitation
functioning.(Orem) Gives up the sick role and returns to
11. Health- is a dynamic state in the life cycle; former roles and functions.
illness is interference in the life cycle. (King) Risk Factors of a Disease
12. Wellness – is the condition in which all 1. Genetic and Physiological Factors
parts and subparts of an individual are in  For example, a person with a family
harmony with the whole system. (Neuman) history of diabetes mellitus is at risk in
13. Health – is an elusive, dynamic state developing the disease later in life.
influenced by biologic, psychologic, and 2. Age
social factors. Health is reflected by the  Age increases and decreases susceptibility
organization, interaction, interdependence ( risk of heart diseases increases with age
and integration of the subsystems of the for both sexes
behavioral system.(Johnson) 3. Environment
Illness and Disease  The physical environment in which a
Illness person works or lives can increase the
 Is a personal state in which the person feels likelihood that certain illnesses will occur.
unhealthy. 4. Lifestyle
 Illness is a state in which a person’s  Lifestyle practices and behaviors can also
physical, emotional, intellectual, social, have positive or negative effects on
developmental, or spiritual functioning is health.
diminished or impaired compared with Classification of Diseases
previous experience. 1. According to Etiologic Factors
 Illness is not synonymous with disease. a. Hereditary – due to defect in the
genes of one or other parent which is
Disease transmitted to the
 An alteration in body function resulting in i. offspring
reduction of capacities or a shortening of b. Congenital – due to a defect in the
the normal life span. development, hereditary factors, or
Common Causes of Disease prenatal infection
1. Biologic agent – e.g. microorganism c. Metabolic – due to disturbances or
2. Inherited genetic defects – e.g. cleft palate abnormality in the intricate processes
3. Developmental defects – e.g. imperforate of metabolism.
anus d. Deficiency – results from inadequate
4. Physical agents – e.g. radiation, hot and cold intake or absorption of essential
substances, ultraviolet rays dietary factor.
5. Chemical agents – e.g. lead, asbestos, e. Traumatic- due to injury
carbon monoxide f. Allergic – due to abnormal response
6. Tissue response to irritations/injury – e.g. of the body to chemical and protein
inflammation, fever substances or to physical stimuli.
7. Faulty chemical/metabolic process – e.g. g. Neoplastic – due to abnormal or
inadequate insulin in diabetes uncontrolled growth of cell.
8. Emotional/physical reaction to stress – e.g. h. Idiopathic –Cause is unknown; self-
fear, anxiety originated; of spontaneous origin
Stages of Illness i. Degenerative –Results from the
1. Symptoms Experience- experience some degenerative changes that occur in the
symptoms, person believes something is tissue and organs.
wrong j. Iatrogenic – result from the treatment
3 aspects –physical, cognitive, of the disease
emotional 2. According to Duration or Onset
2. Assumption of Sick Role – acceptance of a. a. Acute Illness – An acute illness
illness, seeks advice usually has a short duration and is
3. Medical Care Contact severe. Signs and symptoms appear
Seeks advice to professionals for validation abruptly, intense and often subside
of real illness, explanation of symptoms, after a relatively short period.
reassurance or predict of outcome b. Chronic Illness – chronic illness
4. Dependent Patient Role usually longer than 6 months, and can
 The person becomes a client dependent on also affects functioning in any
the health professional for help. dimension. The client may fluctuate
 Accepts/rejects health professional’s between maximal functioning and
suggestions. serious relapses and may be life
 Becomes more passive and accepting.
 threatening. Is is characterized by -avoidance to allergens
remission and exacerbation. b. Secondary Prevention – also known
 Remission- periods during which the as “Health Maintenance”. Seeks to identify
disease is controlled and symptoms specific illnesses or conditions at an early
are not obvious. stage with prompt intervention to prevent
 Exacerbations – The disease or limit disability; to prevent catastrophic
becomes more active given again at effects that could occur if proper attention
a future time, with recurrence of and treatment are not
pronounced symptoms. provided.
c. Sub-Acute – Symptoms are pronounced  Early Diagnosis and Prompt
but more prolonged than the acute Treatment
disease. -case finding measures
3. Disease may also be Described as: -individual and mass screening
a. Organic – results from changes in the survey
normal structure, from recognizable -prevent spread of
anatomical changes in an organ or tissue communicable disease
of the body. -prevent complication and
b. Functional – no anatomical changes are sequelae
observed to account from the symptoms -shorten period of disability
present, may result from abnormal  Disability Limitations
response to stimuli. - adequate treatment to arrest
c. Occupational – Results from factors disease process and prevent further
associated with the occupation engage complication and sequelae.
in by the patient. -provision of facilities to limit
d. Venereal – usually acquired through disability and prevent death.
sexual relation c. Tertiary Prevention – occurs after a
e. Familial – occurs in several individuals disease or disability has occurred and the
of the same family recovery process has begun; Intent is to halt
f. Epidemic – attacks a large number of the disease or injury process and assist the
individuals in the community at the person in obtaining an optimal health status.
same time. (e.g. SARS) To establish a high-level wellness.
g. Endemic – Presents more or less “To maximize use of remaining capacities’
continuously or recurs in a community.  Restoration and Rehabilitation
(e.g. malaria, goiter) -work therapy in hospital
h. Pandemic –An epidemic which is - Use of shelter colony
extremely widespread involving an
entire country or continent. CONCEPTUAL AND THEORETICAL
i. Sporadic – a disease in which only MODELS OF NURSING PRACTICE
occasional cases occur. (e.g. dengue,
leptospirosis) A. NIGHTANGLE’S THEORY ( mid-1800)
Leavell and Clark’s Three Levels of  Focuses on the patient and his
Prevention environment.
a. Primary Prevention – seeks to  Developed the described the first theory
prevent a disease or condition at a of nursing. Notes on Nursing: What It Is,
prepathologic state; to stop What It Is Not. She focused on changing
something from ever happening. and manipulating the environment in
 Health Promotion order to put the patient in the best
-health education possible conditions for nature to act.
-marriage counseling  She believed that in the nurturing
-genetic screening environment, the body could repair itself.
-good standard of nutrition adjusted Client’s environment is manipulated to
to developmental phase of life include appropriate noise, nutrition,
 Specific Protection hygiene, socialization and hope.
-use of specific immunization B. PEPLAU, HILDEGARD (1951)
-attention to personal hygiene Defined nursing as a therapeutic, interpersonal
-use of environmental sanitation process which strives to develop a nurse- patient
-protection against occupational relationship in which the nurse serves as a
hazards resource person, counselor and surrogate.
-protection from accidents Introduced the Interpersonal
-use of specific nutrients Model. She defined nursing as an interpersonal
-protections from carcinogens
process of therapeutic between an individual who is four conservation principles of nursing
sick or in need of health services and a nurse which are concerned with the unity
especially educated to recognize and respond to and integrity of the individual. The four
the need for help. She identified four phases of conservation principles are as follows:
the nurse client relationship namely: 1. Conservation of energy. The human body
1. Orientation: the nurse and the client initially functions by utilizing energy. The human
do not know each other’s goals and body needs energy producing input
testing the role each will assume. The client (food, oxygen, fluids) to allow energy
attempts to identify difficulties and the amount utilization output.
of nursing help that is needed; 2. Conservation of Structural Integrity. The
2. Identification: the client responds to help human body has physical boundaries (skin
professionals or the significant others who can and mucous membrane) that must be
meet the identified needs. Both the client maintained to facilitate health and prevent
and the nurse plan together an harmful agents from entering the body.
appropriate program to foster health; 3. Conservation of Personal Integrity. The
3. Exploitation: the clients utilize all nursing interventions are based on the
available resources to move toward a goal conservation of the individual client’s
of maximum health functionality; personality. Every individual has sense of
4. Resolution: refers to the termination identity, self worth and self esteem,
phase of the nurse-client relationship. it which must be preserved and enhanced by
occurs when the client’s needs are met nurses.
and he/she can move toward a new goal. 4. Conservation of Social integrity. The
Peplau further assumed that nurse-client social integrity of the client reflects the
relationship fosters growth in both the client family and the community in which the
and the nurse. client functions. Health care institutions may
separate individuals from their family. It is
C. ABDELLAH, FAYE G. (1960) important for nurses to consider the individual
 Defined nursing as having a problem- in the context of the family.
solving approach, with key nursing
problems related to health needs of E. JOHNSON, DOROTHY (1960, 1980)
people; developed list of 21 nursing-  Focuses on how the client adapts to
problem areas. illness; the goal of nursing is to reduce
 Introduced Patient – Centered stress so that the client can move
Approaches to Nursing Model She more easily through recovery.
defined nursing as service to individual  Viewed the patient’s behavior as a
and families; therefore the society. system, which is a whole with
Furthermore, she conceptualized nursing interacting parts.
as an art and a science that molds the  The nursing process is viewed as a
attitudes, intellectual competencies and major tool.
technical skills of the individual nurse Conceptualized the Behavioral System Model.
into the desire and ability to help people, According to Johnson, each person as a
sick or well, and cope with their health behavioral system is composed of seven
needs. subsystems namely:
1. Ingestive. Taking in nourishment in socially
and culturally acceptable ways.
2. Eliminative. Riddling the body of waste in
socially and culturally acceptable ways.
D. LEVINE, MYRA (1973) 3. Affiliative. Security seeking behavior.
4. Aggressive. Self – protective behavior.
 Believes nursing intervention is a 5. Dependence. Nurturance – seeking behavior.
conservation activity, with 6. Achievement. Master of oneself and one’s
conservation of energy as a primary environment according to internalized
concern, four conservation principles of standards of excellence.
nursing: conservation of client energy, 7. Sexual role identity behavior
conservation of structured integrity,
conservation of personal integrity, F. ROGERS, MARTHA
conservation of social integrity.  Considers man as a unitary human being
co-existing with in the universe, views
 Described the Four Conversation nursing primarily as a science and is
Principles. She advocated that nursing committed to nursing research.
is a human interaction and proposed
G. OREM, DOROTHEA (1970, 1985)  Presented the Adaptation
Model. She viewed each person
 Emphasizes the client’s self-care needs, as a unified biopsychosocial
nursing care becomes necessary when system in constant interaction
client is unable to fulfill biological, with a changing environment. She
psychological, developmental or social contented that the person as an
needs. adaptive system, functions as a
 Developed the Self-Care Deficit Theory. whole through interdependence of
She defined self-care as “the practice of its part. The system consists of
activities that individuals initiate to perform input, control processes, output
on their own behalf in maintaining life, feedback.
health well-being.” She conceptualized
three systems as follows: K. LYDIA HALL (1962)
1. Wholly Compensatory: when the  The client is composed of the ff.
nurse is expected to accomplish all overlapping parts: person (core),
the patient’s therapeutic self-care or pathologic state and treatment
to compensate for the patient’s (cure) and body (care).
inability to engage in self care or  Introduced the model of Nursing:
when the patient needs continuous What Is It?, focusing on the notion
guidance in self care; that centers around three
components of CARE, CORE and
2. Partially Compensatory: when CURE. Care represents nurturance
both nurse patient engage in and is exclusive to nursing. Core
meeting self care needs; involves the therapeutic use of self
3. Supportive-Educative: the system and emphasizes the use of
that requires assistance decision reflection. Cure focuses on nursing
making, behavior control and related to the physician’s orders.
acquisition knowledge and skills. Core and cure are shared with the
other health care providers.
H. IMOGENE KING (1971, 1981)
 Nursing process is defined as L. Virginia Henderson (1955)
dynamic interpersonal process  Introduced The Nature of Nursing
between nurse, client and health Model. She identified fourteen basic
care system. needs.
 Postulated the Goal Attainment  She postulated that the unique function of
Theory. She described nursing as a the nurse is to assist the clients, sick or
helping profession that assists well, in the performance of those activities
individuals and groups in society to contributing to health or its recovery, the
attain, maintain, and restore health. clients would perform unaided if they had
If is this not possible, nurses help the necessary strength, will or knowledge.
individuals die with dignity.  She further believed that nursing involves
 In addition, King viewed nursing as assisting the client in gaining
an interaction process between client independence as rapidly as possible, or
and nurse whereby during assisting him achieves peaceful death if
perceiving, setting goals, and acting recovery is no longer possible.
on them transactions occurred and
goals are achieved. M. Madaleine Leininger (1978, 1984)
 Developed the Transcultural Nursing
I. BETTY NEUMAN Model. She advocated that nursing is a
 Stress reduction is a goal of system humanistic and scientific mode of helping
model of nursing practice. Nursing a client through specific cultural caring
actions are in primary, secondary or processes (cultural values, beliefs and
tertiary level of prevention. practices) to improve or maintain a health
J. SIS CALLISTA ROY (Adaptation Theory) condition.
(1979, 1984)
 Views the client as an adaptive N. Ida Jean Orlando (1961)
system. The goal of nursing is to help  Conceptualized The Dynamic Nurse –
the person adapt to changes in Patient Relationship Model.
physiological needs, self-concept,  She believed that the nurse helps patients
role function and interdependent meet a perceived need that the patient
relations during health and illness. cannot meet for themselves. Orlando
 observed that the nurse provides direct S. Helen Erickson, Evelyn Tomlin, and Mary
assistance to meet an immediate need for Ann Swain (1983)
help in order to avoid or to alleviate distress  Developed Modeling and Role
or helplessness. Modeling Theory. The focus of this
 She emphasized the importance of theory is on the person. The nurse models
validating the need and evaluating care (assesses), role models (plans), and
based on observable outcomes. intervenes in this interpersonal and
interactive theory.
O. Ernestine Weidanbach (1964)  They asserted that each individual unique,
 Developed the Clinical Nursing – A has some self-care knowledge, needs
Helping Art Model. simultaneously to be attached to the
 She advocated that the nurse’s individual separate from others, and has adaptive
philosophy or central purpose lends potential. Nurses in this theory, facilitate,
credence to nursing care. nurture and accept the person
 She believed that nurses meet the unconditionally.
individual’s need for help through the T. Margaret Newman
identification of the needs, administration of  Focused on health as expanding
help, and validation that actions were consciousness. She believed that human
helpful. Components of clinical practice: are unitary in whom disease is a
Philosophy, purpose, practice and an art. manifestation of the pattern of health.
 She defined consciousness as the
P. Rosemarie Rizzo Parse (1979-1992) information capability of the system which
 Introduced the theory of Human is influenced by time, space movement
Becoming. She emphasized free choice of and is ever – expanding.
personal meaning in relating value U. Patricia Benner and Judith Wrudel (1989)
priorities, co – creating the rhythmical  Proposed the Primacy and Caring
patterns, in exchange with the environment, Model. They believed that caring central
and co transcending in many dimensions as to the essence of nursing. Caring creates
possibilities unfold. the possibilities for coping and creates the
possibilities for connecting with and
Q. Joyce Travelbee (1966,1971) concern for others.
 She postulated the Interpersonal Aspects
of Nursing Model. She advocated that the V. Anne Boykin and Savina Schoenhofer
goal of nursing individual or family in  Presented the grand theory of Nursing
preventing or coping with illness, regaining as Caring. They believed that all person
health finding meaning in illness, or are caring, and nursing is a response to a
maintaining maximal degree of health. unique social call. The focus of nursing is
 She further viewed that interpersonal on nurturing person living and growing in
process is a human-to-human relationship caring in a manner that is specific to each
formed during illness and “experience of nurse-nursed relationship or nursing
suffering” situation. Each nursing situation is
 She believed that a person is a unique, original.
irreplaceable individual who is in a  They support that caring is a moral
continuous process of becoming, evolving imperative. Nursing as Caring is not based
and changing. on need or deficit but is egalitarian model
R. Josephine Peterson and Loretta Zderad helping.
(1976) Moral Theories
 Provided the Humanistic Nursing 1. Freud (1961)
Practice Theory. This is based on their  Believed that the mechanism for
belief that nursing is an existential right and wrong within the
experience. individual is the superego, or
 Nursing is viewed as a lived dialogue that conscience. He hypnotized that a
involves the coming together of the nurse child internalizes and adopts the
and the person to be nursed. moral standards and character or
 The essential characteristic of nursing is character traits of the model parent
nurturance. Humanistic care cannot take through the process of
place without the authentic commitment of identification.
the nurse to being with and the doing with  The strength of the superego
the client. Humanistic nursing also depends on the intensity of the
presupposes responsible choices. child’s feeling of aggression or
attachment toward the model
 parent rather than on the actual  Included the concepts of caring and
standards of the parent. responsibility. She described three
2. Erikson (1964) stages in the process of developing an
 Erikson’s theory on the “Ethic of Care” which are as follows.
development of virtues or unifying 1. Caring for oneself.
strengths of the “good man” suggest 2. Caring for others.
that moral development continuous 3. Caring for self and others.
throughout life. He believed that if  She believed the human see morality in
the conflicts of each psychosocial the integrity of relationships and
developmental stages favorably caring. For women, what is right is taking
resolved, then an ‘ego-strength” or responsibility for others as self-chosen
virtue emerges. decision. On the other hand, men
3. Kohlberg consider what is right to be what is
 Suggested three levels of moral just.
development. He focused on the
reason for the making of a decision, Spiritual Theories
not on the morality of the decision 1. Fowler (1979)
itself.  Described the development of faith. He
1. At first level called the premolar or the believed that faith, or the spiritual
preconventional level, children are dimension is a force that gives meaning to
responsive to cultural rules and labels of a person’s life.
good and bad, right and wrong. However  He used the term “faith” as a form of
children interpret these in terms of the knowing a way of being in relation “to an
physical consequences of the actions, i.e., ultimate environment.” To Fowler, faith is
punishment or reward. a relational phenomenon: it is “an active
2. At the second level, the conventional made-of-being-in-relation to others in
level, the individual is concerned about which we invest commitment, belief, love,
maintaining the expectations of the family, risk and hope.”
groups or nation and sees this as right.
3. At the third level, people make 2. Westerhof
postconventional, autonomous, or principal Proposed that faith is a way of behaving.
level. At this level, people make an effort to He developed a four-stage theory of faith
define valid values and principles without development based largely on his life
regard to outside authority or to the experiences and the interpretation of those
expectations of others. These involve experienced.
respect for other human and belief that
relationships are based on mutual ROLES AND FUNCTIONS OF THE NURSE
trust.  Care giver
4. Peter (1981)  Decision-maker
 Proposed a concept of rational  Protector
morality based on principles.  Client Advocate
Moral development is usually  Manager
considered to involve three separate  Rehabilitator
components: moral emotion (what  Comforter
one feels), moral judgment (how one  Communicator
reasons), and moral behavior (how  Teacher
one acts).  Counselor
 In addition, Peters believed that the  Coordinator
development of character traits or  Leader
virtues is an essential aspect or  Role Model
moral development. And that  Administrator
virtues or character traits can be
learned from others and encouraged Selected Expanded Career Roles of
by the example of others. Nurses
 Also, Peters believed that some can 1. Nurse Practitioner
be described as habits because they  A nurse who has an advanced
are in some sense automatic and education and is a graduate of a
therefore are performed habitually, nurse practitioner program.
such as politeness, chastity, tidiness,  These nurses are in areas as adult
thrift and honesty. nurse practitioner, family nurse
5. Gilligan (1982)
 practitioner, school nurse  A nurse who usually has an advanced
practitioner, pediatric nurse degree and manages a health-related
practitioner, or gerontology nurse business.
practitioner.  The nurse may be involved in education,
 They are employed in health care consultation, or research, for example.
agencies or community based
settings. They usually deal with non- Nursing Process
emergency acute or chronic illness A deliberate, problem-solving approach to meeting the
and provide primary ambulatory health care & nursing needs of patients” -Sandra
care. Nettina
2. Clinical Nurse Specialist  The most efficient way to accomplish
 A nurse who has an advanced degree or personalized care in a time of exploding
expertise and is considered to be an expert knowledge and rapid social change. It assists in
in a specialized area of practice (e.g., solving or alleviating both simple and complex
nursing problems. Changing, expanding, more
gerontology, oncology).
responsible role demands knowledgeably
 The nurse provides direct client care, planned, purposeful, and accountable action by
educates others, consults, conducts nurses
research, and manages care. Steps in the Nursing Process (ADPIE)
 The American Nurses Credentialing Center 1. Assessment : Collection of personal, social,
provides national certification of clinical medical, and general data
specialists. a. Sources: Primary (client and diagnostic test
results) and secondary (family, colleagues,
3. Nurse Anesthetist Kardex, literature)
 A nurse who has completed advanced b. Methods
education in an accredited program in  Interviewing formally (nursing health
anesthesiology. history) and informally during various
 The nurse anesthetist carries out pre- nurse-client interactions
operative visits and assessments, and  Observation
Administers general anesthetics for surgery  Review of records
under the supervision of a physician  Performing a physical assessment
prepared in anesthesiology. 2. Nursing Diagnosis : Definition of client's
 The nurse anesthetist also assesses the problem: making a nursing diagnosis
postoperative of clients  “A nursing diagnosis is a definitive
statement of the client's actual or
4. Nurse Midwife potential difficulties, concerns, or deficits
 An RN who has completed a program in that are amenable to nursing interventions
midwifery. .
 The nurse gives pre-natal and post-natal  This step is to organize, analyze and
care and manages deliveries in normal summarize the collected data. There are
pregnancies. two components to the statement of a
nursing diagnosis joined together by the
 The midwife practices the association with a phrase "related to"”
health care agency and can obtain medical  Part I: a determination of the problem
services if complication occurs. (unhealthful response of client)
 The nurse midwife may also conduct routine  Part II: identification of the etiology
Papanicolaou smears, family planning, and (contributing factors)
routine breast examination. 3. Planning: the nursing care plan, a blueprint
5. Nurse Educator for action remembering client is the center of the
 Nurse educator is employed in nursing health team; client, family, and nurse collaborate
programs, at educational institutions, and in with appropriate health team members to
hospital staff education. formulate the plan
 The nurse educator usually ha a  The nursing care plan is formulated.
baccalaureate degree or more advanced  Steps in planning include:
preparation and frequently has expertise in  Assigning priorities to nursing Dx.
a particular area of practice. The nurse  Specifying goals
educator is responsible for classroom  Identifying interventions
and clinical teaching.  Specifying expected outcomes
6. Nurse Entrepreneur  Documenting the nursing care plan
IDENTIFY GOALS
  GOALS are general statements that direct 4. FEEDBACK – is the message returned by
nursing interventions, provide broad the receiver. It indicates whether the
parameters for measuring results and meaning of the sender’s message was
stimulate motivation. understood.
 LONG term goal - one that will take time to Modes of Communication
achieve 1. Verbal Communication – use of spoken
 SHORT term goal - can be achieved or written words.
relatively quick 2. Nonverbal Communication – use of
 GOALS should be: (S M A R T) gestures, facial expressions, posture/gait,
 Patient centered, Specific (measurable) body movements, physical appearance
 Realistic, Achievable within a time frame and body language
4. IMPLEMENTATION Characteristics of Good Communication
Actions that you take in the care of your client. 1. Simplicity – includes uses of commonly
- Implementation includes: understood, brevity, and completeness.
 Assisting in the performance in ADLs 2. Clarity – involves saying what is meant.
 Counseling and educating the patient and The nurse should also need to speak
family slowly and enunciate words well.
 Giving care to patients 3. Timing and Relevance – requires choice
 Supervising and evaluating the work of of appropriate time and consideration of
other members of the health team the client’s interest and concerns. Ask one
5. EVALUATION question at a time and wait for an answer
 Final step of the nursing process before making another comment.
 Measures the patient’s response to nursing 4. Characteristics of Good Communication
intervention 5. Adaptability – Involves adjustments on
 it indicates the patient’s progress what the nurse says and how it is said
 toward achieving the goals established depending on the moods and behavior of
 in the care plan. the client.
 It is the comparison of the observed 6. Credibility – Means worthiness of belief.
 results to expected outcomes. To become credible, the nurse requires
adequate knowledge about the topic being
discussed. The nurse should be able to
COMMUNICATION IN NURSING provide accurate information, to convey
COMMUNICATION confidence and certainly in what she says.
 Refers to reciprocal exchange of information, Communicating With Clients Who
ideas, beliefs, feelings and attitudes between 2 Have Special Needs
persons or among a group.
 The need to communicate is universal. People
1.Clients who cannot speak clearly
communicate to satisfy needs. (aphasia, dysarthria, muteness)
 Clear and accurate communication among 1. Listen attentively, be patient, and do not
members of the health team, including the client, interrupt.
is vital to support the client's welfare” 2. Ask simple question that require “yes” and
 Is the means to establish a helping-healing “no” answers.
relationships 3. Allow time for understanding and
 Communication is essential to the nurse- response.
patient relationship for the following 4. Use visual cues (e.g., words, pictures, and
reasons: objects)
 Is the vehicle for establishing a 5. Allow only one person to speak at a time.
therapeutic relationship 6. Do not shout or speak too loudly.
 It the means by which an individual 7. Use communication aid:
influences the behavior of another, -pad and felt-tipped pen, magic slate,
which leads to the successful outcome of pictures denoting basic needs, call bells or alarm.
nursing intervention. 2. Clients who are cognitively impaired
Basic Elements of the Communication Process 1. Reduce environmental distractions while
1. SENDER – is the person who encodes and conversing.
delivers the message 2. Get client’s attention prior to speaking
2. MESSAGES – is the content of the 3. Use simple sentences and avoid long
communication. It may contain verbal, explanation.
nonverbal, and symbolic language. 4. Ask one question at a time
3. RECEIVER – is the person who receives the 5. Allow time for client to respond
decodes the message. 6. Be an attentive listener
 7. Include family and friends in conversations, 6. Effective documentation ensures
especially in subjects known to client. continuity of care saves time and
3. Client who are unresponsive minimizes the risk of error.
1. Call client by name during interactions 7. As members of the health care team,
2. Communicate both verbally and by touch nurses need to communicate information
3. Speak to client as though he or she could about clients accurately and in timely
hear manner
4. Explain all procedures and sensations 8. If the care plan is not communicated to all
5. Provide orientation to person, place, and members of the health care team, care
time can become fragmented, repetition of
6. Avoid talking about client to others in his or tasks occurs, and therapies may be
her presence delayed or omitted.
7. Avoid saying things client should not hear 9. Data recorded, reported, or c0mmunicated
4. Communicating with hearing impaired to other health care professionals are
client CONFIDENTIAL and must be protected.
1. Establish a method of communication CONFIDENTIALITY
(pen/pencil and paper, sign-language) 1. Nurses are legally and ethically obligated
2. Pay attention to client’s non-verbal cues to keep information about clients
3. Decrease background noise such as confidential.
television 2. Nurses may not discuss a client’s
4. Always face the client when speaking examination, observation, conversation, or
5. It is also important to check the family as to treatment with other clients or staff not
how to communicate with the client involved in the client’s care.
6. It may be necessary to contact the 3. Only staf directly involved in a
appropriate department resource person for specific client’s care have legitimate
this type of disability access to the record.
4. Client who do not speak English 4. Clients frequently request copies of their
1. Speak to client in normal tone of voice medical record, and they have the right to
(shouting may be interpreted as anger) read those records.
2. Establish method for client o signal desire to 5. Nurses are responsible for protecting
communicate (call light or bell) records from all unauthorized readers.
3. Provide an interpreter (translator) as needed 6. When nurses and other health care
4. Avoid using family members, especially professionals have a legitimate reason to
children, as interpreters. use records for data gathering, research,
5. Develop communication board, pictures or or continuing education, appropriate
cards. authorization must be obtained according
6. Have dictionary (English/Spanish) available to agency policy.
if client can read. 7. Maintaining confidentiality is an important
Reports aspect of profession behavior.
8. It is essential that the nurse safe-guard
 Are oral, written, or audiotape exchanges of
the client’ right to privacy by carefully
information between caregivers.
protecting information of a sensitive,
Common reports:
private nature.
1. Change-in-shift report
9. Sharing personal information or gossiping
2. Telephone report
about others violates nursing ethical codes
3. Telephone or verbal order – only RN’s are
and practice standards.
allowed to accept telephone orders.
10. It sends the message that the nurse
4. Transfer report
cannot be trusted and damages the
5. Incident report
interpersonal relationships.
Documentation
Guidelines of Quality Documentation and
1. Is anything written or printed that is relied
Reporting
on as record or proof for authorized person.
1.Factual
2. Nursing documentation must be:
 a record must contain descriptive, objective
3. accurate
information about what a nurse sees, hears,
4. comprehensive
feels, and smells.
5. flexible enough to retrieve critical data,
 The use of vague terms, such as appears,
maintain continuity of care, track client
seems, and apparently, is not acceptable
outcomes, and reflects current standards of
because these words suggests that the nurse
nursing practice
is stating an opinion.
  Example: “the client seems anxious” (the 9. If order is questioned, record that clarification
phrase seems anxious is a conclusion was sought.
without supported facts.)  If you perform orders known to be
2. Accurate incorrect, you are just as liable for
 The use of exact measurements establishes prosecution as the physician is.
accuracy. (example: “Intake of 350 ml of 10. Chart only for yourself
water” is more accurate than “ the client  Never chart for someone else.
drank an adequate amount of fluid”  You are accountable for information
 Documentation of concise data is clear and you enter into chart.
easy to understand. 11. Avoid using generalized, empty phrases such
 It is essential to avoid the use of as “status unchanged” or “had good day”.
unnecessary words and irrelevant details 12. Begin each entry with time, and end with your
3. Complete signature and title.
1. The information within a recorded entry or a 13. Do not wait until end of shift to record
report needs to be complete, containing important changes that occurred several
appropriate and essential information. hours earlier. Be sure to sign each entry.
Example: 14. For computer documentation keep your
 The client verbalizes sharp, throbbing password to yourself.
pain localized along lateral side of right  Maintain security and confidentiality.
ankle, beginning approximately 15  Once logged into the computer do not
minutes ago after twisting his foot on leave the computer screen unattended.
the stair. Client rates pain as 8 on a Vital Signs
scale of 0-10. Vital Signs or Cardinal Signs are:
4. Current  Body temperature
1. Timely entries are essential in the client’s  Pulse
ongoing care. To increase accuracy and  Respiration
decrease unnecessary duplication, many  Blood pressure
healthcare agencies use records kept near the  Pain
client’s bedside, which facilitate immediate  Level of consciousness
documentation of information as it is collected
from a client
5. Organized I. Body Temperature
1. The nurse communicates information in a  The balance between the heat
logical order. produced by the body and the heat loss
 For example, an organized note from the body.
describes the client’s pain, nurse’s Types of Body Temperature
assessment, nurse’s interventions, and  Core temperature –temperature of
the client’s response the deep tissues of the body.
Legal Guidelines for recording  Surface body temperature
1. Draw single line through error, write word error Alteration in body Temperature
above it and sign your name or initials. Then record  Pyrexia – Body temperature above
note correctly. normal range ( hyperthermia)
2. Do not write retaliatory or critical comments 1. Hyperpyrexia – Very high fever, 41ºC(105.8
about the client or care by other health care F) and above
professionals. 2. Hypothermia – Subnormal temperature.
3. Enter only objective descriptions of client’s Factors afecting Heat production
behavior; client’s comments should be quoted. 1. Basal metabolism
4. Correct all errors promptly, errors in recording 2. Muscular activity
can lead to errors in treatment 3. Thyroxine and Epinephine
5. Avoid rushing to complete charting, be sure 4. Temperature effect on cell
information is accurate. Normal Adult Temperature Ranges
6. Do not leave blank spaces in nurse’s notes.  Oral 36.5 –37.5 ºC
7. Chart consecutively, line by line; if space is left,  Axillary 35.8 – 37.0 ºC
draw line horizontally through it and sign your  Rectal 37.0 – 38.1 ºC
name at end.  Tympanic 36.8 – 37.9ºC
8. Record all entries legibly and in black ink Methods of Temperature-Taking
 Never use pencil, felt pen. Oral – most accessible and convenient method.
 Black ink is more legible when records 1. Put on gloves, and position the tip of the
are photocopied or transferred to thermometer under the patients tongue
microfilm. on either of the frenulum as far back as
 possible. It promotes contact to the  Use the same thermometer for repeat
superficial blood vessels and ensures a temperature taking to ensure more consistent
more accurate reading. result
2. Wash thermometer before use. Nursing Interventions in Clients with Fever
3. Take oral temp 2-3 minutes. a. Monitor V.S
4. Allow 15 min to elapse between client’s food b. Assess skin color and temperature
intakes of hot or cold food, smoking. c. Monitor WBC, Hct and other pertinent lab
5. Instruct the patient to close his lips but not records
to bite down with his teeth to avoid breaking d. Provide adequate foods and fluids.
the thermometer in his mouth. e. Promote rest
Contraindications f. Monitor I & O
 Young children an infants g. Provide TSB
 Patients who are unconscious or disoriented h. Provide dry clothing and linens
 Who must breath through the mouth i. Give antipyretic as ordered by MD
 Seizure prone
 Patient with N/V II. Pulse – It’s the wave of blood created by
 Patients with oral lesions/surgeries contractions of the left ventricles of the
heart.
2. Rectal- most accurate measurement of Normal Pulse rate
temperature 1 year 80-140 beats/min
a. Position- lateral position with his top legs flexed 2 years 80- 130 beats/min
and drapes him to provide privacy. 6 years 75- 120 beats/min
b. Squeeze the lubricant onto a facial tissue to 10 years 60-90 beats/min
avoid contaminating the lubricant supply. Adult 60-100 beats/min
c. Insert thermometer by 0.5 – 1.5 inches Tachycardia – pulse rate of above 100 beats/min
d. Hold in place in 2minutes Bradycardia- pulse rate below 60 beats/min
e. Do not force to insert the thermometer Irregular – uneven time interval between
Contraindications beats.
 Patient with diarrhea What you need:
 Recent rectal or prostatic surgery or injury a. Watch with second hand
because it may injure inflamed tissue b. Stethoscope (for apical pulse)
 Recent myocardial infarction c. Doppler ultrasound blood flow detector if
 Patient post head injury necessary
Radial Pulse
3. Axillary – safest and non-invasive  Wash your hand and tell your client that
a. Pat the axilla dry you are going to take his pulse
b. Ask the patient to reach across his chest and  Place the client in sitting or supine
grasp his opposite shoulder. This promote skin position
contact with the thermometer  with his arm on his side or across his chest
c. Hold it in place for 9 minutes because the  Gently press your index, middle, and ring
thermometer isn’t close in a body cavity fingers on the radial artery, inside the
4. Tympanic thermometer patient’s wrist.
a. Make sure the lens under the probe is clean  Excessive pressure may obstruct blood
and shiny flow distal to the pulse site
b. Stabilized the patient’s head; gently pull the ear  Counting for a full minute provides a more
straight back (for children up to age 1) or up accurate picture of irregularitie
and back (for children 1 and older to adults) Apical Pulse
c. Insert the thermometer until the entire ear  Perform hand hygiene.
canal is sealed  Use alcohol swab to clean the diaphragm
d. Place the activation button, and hold it in place of the stethoscope. Use another swab to
for 1 second clean the earpieces if necessary.
5. Chemical-dot thermometer  Place patient in sitting or reclining position
a. Leave the chemical-dot thermometer in place and expose the chest area. Expose only
for 45 seconds the apical side.
b. Read the temperature as the last dye dot that  Palpate the space between then fifth and
has change color, or fired. sixth ribs and move to the left
c. Store chemical-dot thermometer in a cool area midclavicular line.
because exposure to heat activates the dye  Place the diaphragm over the apex of the
dots. heart.
Note:  Count the rate.
  Using a watch with a second hand, count sternum at first & second intercostal
the heartbeat for 1 minute. spaces.
 Cover the patient and help him/her to a  Created by air moving to large airways.
position of comfort. Abnormal Breath Sounds
 Clean the diaphragm of the stethoscope 1. Stridor
with alcohol swab for the next use.  A loud, high-pitched crowing sound that is
Doppler device heard, usually w/o a stethoscope, during
a. Apply small amount of transmission gel to inspiration. Stridor caused by an obstruction
the ultrasound probe in the upper airway requires immediate
b. Position the probe on the skin directly over a attention
c. selected artery 2. Rhonchi (also called gurgles)
d. Set the volume to the lowest setting  Low-pitched, snoring sounds that occur when
e. To obtain best signals, put gel between the the patient exhales, although they may also
skin and the probe and tilt the probe 45 be heard when the patient inhales.
degrees from the artery.  Usually changes or disappear w/ coughing
f. After you have measure the pulse rate,  Sounds occur as a result of air passing
clean the probe with soft cloth soaked in through fluid-filled, narrow passages, diseases
antiseptic. Do not immerse the probe where there is increased mucus production
III. Respiration - is the exchange of oxygen and such as:
carbon dioxide between the atmosphere  Pneumonia
and the body  Bronchitis
Assessing Respiration  bronchiectasis.
 Rate – Normal 14-20/ min in adult 3. Crackles ( Rales )
 The best time to assess respiration is  Soft, high pitched discontinuous popping
immediately after taking client’s pulse sounds that occur during inspiration
 Count respiration for 60 second  Can be produced by rubbing a lock of hair
 As you count the respiration, assess and record between the thumb and finger close to the
breath sound as stridor, wheezing, or stertor. ear.
 Respiratory rates of less than 10 or more than  Fluid in the airways
40 are usually considered abnormal and should  Obstructive disease in early inspiration
be reported immediately to the physician.  Bronchitis
 Pneumonia
Reathibg Pattern  CHF
Volume 4. Wheeze
 Hyperventilation- overexpansion of the  deep, low-pitched sounds heard during
lungs characterized by rapid deep breaths. exhalation
 Hypoventilation- underexpansion of the  due to narrowed tracheobronchial passages
lungs characterized by shallow respirations. from secretions
Rate  Continuous, musical, high-pitched, whistle -
 Tachypnea quick, shallow breaths like sounds heard during inspiration and
 Bradypnea- slow respiration exhalation
 Apnea- cessation of breathing  narrow bronchioles, associated with
Rhythm bronchospasm, asthma and buildup of
 Cheyne- stokes breathing- rhythmic secretions
breathing; from very deep to very shallow 5. Friction Rub
breathing and temporary apnea.  Like 2 pieces of rubber rubbed together,
 Biot’s respiration- varying in depth and rate inspiration and exhalation
followed by periods of apnea; irregular.  Inflammation and loss of fluid in the
Normal Breath sound pleural space
1. Bronchial  Associated with:
 Loud and high pitched w/ hollow quality.  Pleurisy
 Expiration lasts longer than inspiration.  Pneumonia
 Best heard over the trachea  pleural infarct.
 Created by air moving through the trachea IV. Blood Pressure
close to chest wall. Adult – 90- 132 systolic
2. Bronchovesicular 60- 85 diastolic
 Blowing sounds that are moderate in pitch Elderly 140-160 systolic
and intensity. Inspiration is equal to 70-90 diastolic
expiration. a. Ensure that the client is rested
 Best heard posteriorly between scapula & b. Use appropriate size of BP cuff.
anteriorly over bronchioles lateral to
 c. If the b/p cuff is narrow an loosely applied- j. Also note physiological response, which
false high BP may be sympathetic or parasympathetic
d. Position the patient on sitting or supine
position Wong’s Pain Scale
e. Position the arm at the level of the heart, if
the artery is below the heart level, you may
get a false high reading
f. Use the bell of the stethoscope since the
blood pressure is a low frequency sound.
g. If the client is crying or anxious, delay Managing Pain
measuring his blood pressure to avoid false- 1. Giving medication as per MD’s order
high BP 2. Giving emotional support
Electronic Vital Sign Monitor 3. Performing comfort measures
a. An electronic vital signs monitor allows you 4. Use cognitive therapy
to continually tract a patient’s vital
sign without having to reapply a blood Height and weight
pressure cuff each time. a. Height and weight are routinely measured
b. Example: Dinamap VS monitor 8100 when a patient is admitted to a health care
c. Lightweight, battery operated and can be facility.
attached to an IV pole b. It is essential in calculating drug dosage,
d. Before using the device, check the client7s contrast agents, assessing nutritional status
pulse and BP manually using the same arm and determining the height-weight ratio.
you’ll using for the monitor cuff. c. Weight is the best overall indicator of fluid
e. Compare the result with the initial reading status, daily monitoring is important for
from the monitor. If the results differ call the clients receiving a diuretics or a medication
supply department or the manufacturer’s that causes sodium retention.
representative. d. Weight can be measured with a standing
V. Pain scale, chair scale and bed scale.
 Is both a protective and an unpleasant sensory e. Height can be measured with the measuring
and emotional experience associated with bar, standing scale or tape measure if the
actual and potential tissue damage.(Porth.2nd client is confine in a supine position.
ed.) Pointers:
Classification of Pain a. Reassure and steady patient who are at
Location risk for losing their balance on a scale.
Cutaneous and deep Somatic b. Weight the patient at the same time each
Visceral day. (Usually before breakfast), in similar
Referred clothing and using the same scale.
Assessment c. If the patient uses crutches, weigh the
 Nature client with the crutches or heavy clothing
 Location and subtract their weight from the total
 Severity determined patient’ weight.
 Radiation of pain Laboratory and Diagnostic
How to assess Pain examination
a. You must consider both the patient’s Urine Specimen
description and your observations on his 1.Clean-Catch mid-stream urine specimen for
behavioral responses. routine urinalysis, culture and sensitivity test
b. First, ask the client to rank his pain on a a. Best time to collect is in the morning, first
scale of 0-10, with 0 denoting lack of pain voided urine
and 10 denoting the worst pain imaginable. b. Provide sterile container
Ask: c. Do perineal care before collection of the
c. Where is the pain located? urine
d. How long does the pain last? d. Discard the first flow of urine
e. How often does it occur? e. Label the specimen properly
f. Can you describe the pain? f. Send the specimen immediately to the
g. What makes the pain worse laboratory
h. Observe the patient’s behave g. Document the time of specimen collection
i. oral response to pain (body language, and transport to the lab.
moaning, grimacing, withdrawal, crying, h. Document the appearance, odor, and
restlessness muscle twitching and usual characteristics of the specimen.
immobility) 2. 24-hour urine specimen
 a. Discard the first voided urine. site for 5 minutes to prevent hematoma
b. Collect all specimen thereafter until the formation
following day Pointers
c. Soak the specimen in a container with ice a. Never collect a venous sample from the
d. Add preservative as ordered according to arm or a leg that is already being use d for
hospital policy I.V therapy or blood administration
3. Second-Voided urine – required to assess because it mat affect the result.
glucose level and for the presence of albumen in b. Never collect venous sample from an
the urine. infectious site because it may introduce
a. Discard the first urine pathogens into the vascular system
b. Give the patient a glass of water to drink c. Never collect blood from an edematous
c. After few minutes, ask the patient to void area, AV shunt, site of previous
4. Catheterized urine specimen hematoma, or vascular injury.
a. Clamp the catheter for 30 min to 1 hour to d. Don’t wipe off the povidine-iodine with
allow urine to accumulate in the bladder alcohol because alcohol cancels the effect
and adequate specimen can be collected. of povidine iodine.
b. Clamping the drainage tube and emptying e. If the patient has a clotting disorder or is
the urine into a container are receiving anticoagulant therapy, maintain
contraindicated after a genitourinary pressure on the site for at least 5 min after
surgery. withdrawing the needle.
Arterial puncture for ABG test
a. Before arterial puncture, perform Allen’s
II. Stool Specimen test first.
1. Fecalysis – to assess gross appearance of stool b. If the patient is receiving oxygen, make
and presence of ova or parasite sure that the patient’s therapy has been
a. Secure a sterile specimen container underway for at least 15 min before
b. Ask the pt. to defecate into a clean, dry bed collecting arterial sample
pan or a portable commode. c. Be sure to indicate on the laboratory
c. Instruct client not to contaminate the request slip the amount and type pf
specimen with urine or toilet paper( urine oxygen therapy the patient is having.
inhibits bacterial growth and paper towel d. If the patient has just received a nebulizer
contain bismuth which interfere with the treatment, wait about 20 minutes before
test result. collecting the sample.
2. Stool culture and sensitivity test III. Blood specimen
 To assess specific etiologic agent causing a. No fasting for the following tests:
gastroenteritis and bacterial sensitivity to various - CBC, Hgb, Hct, clotting studies, enzyme
antibiotics. studies, serum electrolytes, HbA1C
3. Fecal Occult blood test b. Fasting is required:
 are valuable test for detecting occult blood - FBS, BUN, Creatinine, serum lipid
(hidden) which may be present in colo-rectal (cholesterol, triglyceride), blood uric acid
cancer, detecting melena stool IV. Sputum Specimen
Instructions: 1. Gross appearance of the sputum
a. Advise client to avoid ingestion of red meat for a. Collect early in the morning
3 days b. Use sterile container
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 e. Send the specimen immediately
urine, soap solution or toilet paper 2. Sputum culture and sensitivity test
f. Test sample from several portion of the stool. a. Use sterile container
Venipuncture b. Collect specimen before the first dose of
 Venipuncture involves piercing a vein with a antibiotic
needle and collecting a blood sample in a 3. Acid-Fast Bacilli
syringe or evacuating tube. a. To assess presence of active pulmonary
 Typically using the antecubital fossa tuberculosis
 A plebhotomist from the laboratory usually b. Collect sputum in three consecutive
perform the procedure. morning
 Strict asepsis to prevent infection. 4. Cytologic sputum exam-
 If client has clotting disorder or under  -to assess for presence of abnormal or cancer
anticoagulant therapy, apply pressure on the cells.
 Collect sputum in three consecutive morning
Diagnostic Test  Monitor for bleeding
1. PPD test  Monitor for respiratory distress
 read result 48 – 72 hours after injection.  Monitor for complications
 For HIV positive clients, induration of 5 mm is  Prepare for CXR
considered positive 6. PULSE OXIMETRY
 Induration of more than 10 for non-HIV client is - NORMAL VALUE: 95%-100%
considered positive  A sensor is placed: finger, toe, nose,
earlobe or forehead
2. Bronchography  Don’t select an extremity with an
 a radiopaque medium is instilled directly impediment to blood flow
into the trachea and bronchi through  Lower than 91% - immediate treatment
bronchoscope and the entire bronchi tree or  Lower than 85% - hypo-oxygenation
selected areas may be visualized through X-  Lower than 70% - life-threatening
ray. situation
 Secure consent 7.Holter Monitor
 Check for allergies to seafood or iodine or  it is continuous ECG monitoring, over 24
anesthesia hours period
 NPO 6-8 hours before the test  The portable monitoring is called
 NPO until gag reflex return to prevent telemetry unit
aspiration  Avoid magnets, metal detectors, high-
3. BRONCHOSCOPY voltage areas, and electric blankets.
direct visualization of the larynx, trachea and  Stress the importance of logging his usual
bronchi through a flexible fiber-optic bronchoscope activities, emotional upset, fatigue, chest
 Informed consent pain, and ingestion of medication
 NPO 6-12 hrs prior to test 
 Coagulation studies 8. Echocardiogram –
 Remove dentures or eyeglasses  ultrasound to assess cardiac structure and
 IV Sedatives to relax the client mobility
 Lidocaine spray to suppress the gag reflex  Client should remain still, in supine
 Resuscitation equipment available position slightly turned to the left side,
POST-PROCEDURE NURSING CARE with HOB elevated 15-20 degrees
 V/S  The conductive gel is applied to the to the
 Ý Fowler’s left of the sternum, third or fourth
 Check gag reflex intercostal space
 NPO until gag reflex return  The test takes about 30-45 minutes
 Monitor for bloody sputum 9. Electrocardiography-
 Monitor respiration a. If the patient’s skin is oily, scaly, or
 Monitor for complications diaphoretic, rub the electrode with a dry
 Notify the MD if complications occur 4x4 gauze to enhance electrode contact.
4. Thoracentesis – aspiration of fluid in the b. If the area is excessively hairy, clip it
pleural space. c. Remove client’s jewelry, coins, belt or any
a. Secure consent, take V/S metal
b. Position upright leaning on overbed table d. Tell client to remain still during the
c. Avoid cough during insertion to prevent pleural procedure
perforation 10. Cardiac Catheterization
d. Turn to unaffected side after the procedure to  Secure consent
prevent leakage of fluid in the thoracic cavity  Assess allergy to iodine, shellfish
e. Check for expectoration of blood. This indicate  V/S, weight for baseline information
trauma and should be reported to MD  Have client void before the procedure
immediately.  Monitor PT, PTT, ECG prior to test
5. LUNG BIOPSY  NPO for 4-6 hours before the test
PRE-PROCEDURE NURSING CARE  Shave the groin or brachial area
 Secure consent  After the procedure: bed rest to prevent
 Check coagulation bleeding on the site, do not flex extremity
 Have vit K at bedside  Elevate the affected extremities on
 Maintain sterile technique extended position to promote blood supply
 Local anesthetic required back to the heart and prevent
 Pressure during insertion and aspiration thromboplebitis
 Administer analgesics & sedatives as Rx  Monitor V/S especially peripheral pulses
POST-PROCEDURE NURSING CARE  Apply pressure dressing over the puncture
 Pressure dressing to prevent bleeding site
  Monitor extremity for color, temperature, c. Weigh the client before and after the
tingling to assess for impaired circulation. procedure
11. MRI d. Measure abdominal girth before the
 secure consent, procedure
 the procedure will last 45-60 minute e. Let the patient void before the procedure
 Assess client for claustrophobia to prevent puncture of the bladder
 Remove all metal items f. Use gauge 18 trochar or cannula
 Client should remain still g. Check for serum protein. Excessive loss of
 Tell client that he will feel nothing but may plasma protein may lead to hypovolemic
hear noises shock.
 Client with pacemaker, prosthetic valves, h. Position:
implanted clips, wires are not eligible for  sitting on a chair with feet supported
MRI. with footstool or
 Client with cardiac and respiratory  Place in high Fowlers position
complication may be excluded i. Strict aseptic technique to prevent
 Instruct client on feeling of warmth or peritonitis
shortness of breath if contrast medium is j. Local anesthetic is injected
used during the procedure k. The procedure takes about 45 minutes
 Tattoo pigments (body arts), eyeliner, l. Monitor urine output for 24 hours as watch
eyebrow or lip liner may contain metals out for hematuria which may indicate
which create an electrical current that can bladder trauma.
cause redness and swelling to a first degree 16. Lumbar Puncture
burn at the site of the tattoo. a. obtain consent
12.UGIS – Barium Swallow b. instruct client to empty the bladder and
 instruct client on low-residue diet 1-3 days bowel
before the procedure c. position the client in lateral recumbent
 administer laxative evening before the with back at the edge of the examining
procedure table
 NPO after midnight d. instruct client to remain still
 instruct client to drink a cup of flavored barium e. Spinal needle in inserted in the midline
 x-rays are taken every 30 minutes until barium between the spinous process between the
advances through the small bowel 3rd and 4th lumbar vertebrae
 film can be taken as long as 24 hours later f. Using 18G or 20G in adult, 22G in children
 force fluid after the test to prevent g. obtain specimen per MDs order
constipation/barium impaction Post procedure
13.LGIS – Barium Enema  instruct client to remain still during needle
 instruct client on low-residue diet 1-3 days insertion to prevent trauma on the spinal cord
before the procedure  Instruct the client to remain in flat position for
 administer laxative evening before the 8 hours to prevent spinal headache
procedure  obtain specimen per MDs order
 NPO after midnight  Headache is the most common adverse
 administer suppository in AM effects of a lumbar puncture..
 Enema until clear Mgt. for spinal headache
 force fluid after the test to prevent  Bed rest
constipation/barium impaction  Place patient in dark and quiet room
14. Liver Biopsy  Administer analgesics
a. Secure consent,  Fluids
b. NPO 2-4 hrs before the test  note:
c. Monitor PT, Vit K at bedside If the headache continues, epidural patch maybe
d. Place the client in supine at the right side of required. Blood is withdrawn from the client’s
the bed vein and injected into the epidural space, usually
e. Instruct client to inhale and exhale deeply at the LP site.
for several times and then exhale and hold 17.Queckenstedt’s Test
breath while the MD insert the needle  Lumbar manometric test
f. Right lateral post procedure for 4 hours to  Compressing the jugular vein on each side
apply pressure and prevent bleeding of the neck during the lumbar puncture.
g. Bed rest for 24 hours  The increase in pressure caused by the
h. Observe for S/S of peritonitis compression is noted; then pressure is
15. Paracentesis released and pressure reading are made
a. Secure consent at a 10-seconds intervals.
b. check V/S
  Normally – CSF pressure rises rapidly in For retention catheter:
response to compression of the jugular vein  Male –anchor laterally or upward over the
and returns quickly to normal when the lower abdomen to prevent penoscrotal
compression is released. pressure
 A slow rise and fall in pressure indicates a  Female- inner aspect of the thigh
partial block due to a lesion compressing Types of ostomies
the spinal subarachnoid pathways. a. Ileostomy
 If there is no pressure change, a complete  Liquid to semi-formed stool, dependent
bloc is indicated. upon amount of bowel removed
 This test is not performed if an intracranial  May skew fluid & electrolyte balance,
lesion is suspected. especially potassium & sodium
 Digestive enzymes in stool irritate skin
NURSING PROCEDURES  Do NOT give laxatives
1. Steam Inhalation  Ileostomy lavage may be done if needed
a. It is dependent nursing function. to clear food blockage
b. Heat application requires physician’s order.  May not require appliance set; if continent
c. Place the spout 12-18 inches away from the ileal reservoir or Koch pouch
client’s nose or adjust the distance as b. Colostomy
necessary.  Ascending-must wear appliance--semi-
2. Suctioning liquid stool
a. Assess the lungs before the procedure for  Transverse-wear appliance--semi-formed
baseline information. stool
b. Position: conscious – semi-Fowler’s  Loop stoma
c. Unconscious – lateral position  Proximal end-functioning stoma
d. Size of suction catheter- adult- fr 12-18  Distal end-drains mucous
e. Hyper oxygenate before and after procedure  Plastic rod used to keep loop out
f. Observe sterile technique  Usually temporary
g. Apply suction during withdrawal of the
catheter
 Double barrel
 Two stomas
h. Maximum time per suctioning –15 sec
 Similar to loop but bowel is surgically
3. Nasogastric Feeding (gastric gavage)
severed
Insertion:
a. Fowler’s position  Sigmoid
b. Tip of the nose to tip of the earlobe to the  Formed stool
xyphoid  Bowel can be regulated so appliance not
Tube Feeding needed
a. Semi-Fowler’s position  May be irrigated
b. Assess tube placement
c. Assess residual feeding Stoma assessment
d. Height of feeding is 12 inches above the a. Color-should be same color as mucous
tube’s point of insertion membranes
e. Ask client to remain upright position for at (Normal stoma color- Red not dusky or pale: sign
least 30 min. of infection)
f. Most common problem of tube feeding is b. Edema-common after surgery. Bleeding-slight
Diarrhea due to lactose intolerance bleeding common after surgery
4. Enema 6. COLOSTOMY IRRIGATION
a. Check MD’s order  Initial colostomy irrigation is done to stimulate
b. Provide privacy peristalsis; subsequent irrigations are done to
c. Position left lateral promote evacuation of feces at a regular and
d. Size of tube Fr. 22-32 convenient time
e. Insert 3-4 inches of rectal tube  Recommended with sigmoid colostomy
f. If abdominal cramps occur, temporarily stop  Initiated 5 to 7 days postop
the flow until cramps are gone.
g. Height of enema can – 18 inches  Done in semi – Fowler’s position; then sitting
5. Urinary Catheterization on a toilet bowl once ambulatory.
a. Verify MD’s order  Use warm normal saline solution
b. Practice strict asepsis  Initially, introduce 200 mls. of NSS then 500 to
c. Perineal care before the procedure 1,000 mls. Subsequently
d. Catheter size: male-14-16 , female – 12 – 14  Dilate stoma with lubricated gloved finger
e. Length of catheter insertion before insertion of catheter
male – 6-9 inches ,female – 3-4 inches  Lubricate catheter before insertion.
 Insert 3 to 4 inches of the catheter into the  the nurse should keep the soiled linen
stoma away from the uniform
 Height of solution 12 inches above the  place it in the appropriate linen bag or
stoma other designated container.
 If abdominal cramps occur during  Never fan or shake linens, which can
introduction of solution, temporarily stop the spread microorganisms
flow of solution until peristalsis relaxes.  if any of the sheets touch the floor,
 Allow the catheter to remain in place for 5 they should be replaced.
to 10 minutes for better cleansing effect; The categories of Unoccupied bed making
then remove catheter to drain for 15 to 20 include:
minutes.  Open unoccupied: In an open bed, the top
 Clean the stoma, apply new pouch covers are folded back so the patient can
7 . Bed Bath easily get back into the bed.
a. Provide privacy  Closed unoccupied: In a closed bed, the top
b. Expose, wash and dry one body part a time sheet, blanket, and bedspread are pulled up
c. Use warm water (110-115 F) to the head of the mattress and beneath the
d. Wash from cleanest to dirtiest pillows. A closed bed is done in a hospital bed
e. Wash, rinse, and dry the arms and leg using prior to the admission of a new patient.
Long, firm strokes from distal to proximal  Surgical, recovery, or postoperative:
area – to increase venous return. These techniques are similar to the open
8. Bed Making unoccupied bed. The top bed linens are
 The ideal hospital bed should be selected placed so that the surgical patient can
for its impact on patients' comfort, safety, transfer easily from the stretcher to the bed.
medical condition, and ability to change The top sheets and bedspread are folded
positions. lengthwise or crosswise at the foot of the bed.
Purpose  Occupied bed
 The purpose of a well-made hospital bed, as The patient is in the bed while the linens are
well as an appropriately chosen mattress, is to being changed. The nurse should perform the
provide a safe, comfortable place for the following when making the occupied bed:
patient, where repositioning is more easily  Raise the bed to a comfortable working
achieved, and pressure ulcers are prevented. height. Loosen the top linens, and help the
Precautions patient assume a side-lying position.
 Safety factors should also be considered. Unless  Roll the bottom linens toward the patient.
a patient is accompanied by a health care  Place the bottom sheet on the mattress,
professional or other caregiver, the bed should seam side down, and cover the mattress.
always be placed in its lowest position to reduce Miter the corners of any non-fitted sheets.
the risk of injury from a possible fall.  Place waterproof pads and/or a draw sheet
 At its lowest level, a hospital bed is usually on the bed.
about 26–28 inches (65–70 cm) above the floor.  Tuck in the remaining half of the clean
Various safety features are present on sheets as close to the patient as possible.
hospital beds. These features include:  Assist the patient to roll over the linen.
 Wheel locks: These should be used whenever Raise the side rail, and go to the other
the bed is stationary. side of the bed.
 Side rails: They help to protect patients from  Remove the dirty linen and dispose of
accidentally falling out of bed, as well as appropriately.
provide support to the upper extremities as the  Slide the clean sheets over and secure.
patient gets out of bed. Pull all sheets straight and taut.
 Removable headboard: This feature is important  Place the clean top sheets over the patient
during emergency situations, especially during and remove the used top sheet and
cardiopulmonary resuscitation. blanket. Miter the corners of the top linens
Preaparation: at the foot of the bed. Loosen the linens at
 The nurse normally makes the bed in the the foot of the bed for the patient's
morning after a patient's bath, or when the comfort.
patient is out of the room for tests.  Change the pillowcase.
 The nurse should straighten the linens  Return the patient's bed to the appropriate
throughout the day, making certain they are position, at its lowest level.
neither loose nor wrinkled.
 Any sheets that become wet or soiled should be 9. Foot Care
changed promptly. a. Soaking the feet of diabetic client is no
 When changing bed linen: longer recommended
 b. Cut nail straight across Know the usual dosage range of the medication
10. Mouth Care 3. Right Time
a. Eat coarse, fibrous foods (cleansing foods) Give the medication at the right frequency and at
such as fresh fruits and raw vegetables the right time ordered according to agency
b. Dental check every 6 mounts policy.
11. Oral care for unconscious client Medications given within 30 minutes before or
a. Place in side lying position after the scheduled time are considered to meet
b. Have the suction apparatus readily available the right time standard.
12. Hair Shampoo Medication that must act at certain times are
c. Place client diagonally in bed given priority ( e.g insulin should be given at a
d. Cover the eyes with wash cloth precise interval before a meal )
e. Plug the ears with cotton balls 4. Right Route
f. Massage the scalp with the fatpads of the Make certain that the route is safe and
fingers to promote circulation in the scalp. appropriate for the client.
13. Restraints 5. Right Client
 Secure MD’s order for each episode of The patient’s full name is used. The middle name
restraints application. or initial should be included to avoid confusion
 Check circulation every 15 min with other patient.
 Remove restraints at least every 2 hours for Check the clients identification band with each
30 minutes administration of a medication.
Types of Restraints 6.Right Documentation
 Chemical – sedating antipsychotic drugs to Document medication administration after giving
manage or control behavior it, not before.
 Physical – direct application of physical force If medication is not given, follow the agency
to a client, with or without the client’s policy for documenting the reason why.
permission. Sign medication sheet immediately after
 Seclusion – involuntary confinement of a administration of the drug.
client in a locked room 7. Right Education
Explain information about the medication to the
Procedure: client.
 Ensure that face-to face assessment is 8. Right to Refuse
completed on the client Adult client have the right to refuse medication.
 Ensure that the restraint orders are renewed The nurse’s role is to ensure that the client fully
every 24 hours or sooner according to informed of the potential consequences of refusal
hospital policy. and to communicate the client’s refusal to the
 Tie the restraints using clove hitch health care provider.
 Secure the tie in a non-movable part of the 9. Right Assessment
bed Some medication requires specific assessment
prior to administration. ( vital signs, lab results).
PRINCIPLES OF MEDICATION ADMINISTRATION 10. Right Evaluation
Conduct appropriate follow-up ( e.g was the
Medication- Is a substance administered for the desired effect achieved or not?)
diagnosis, cure, treatment, or relief of symptom or
prevention of disease.
Pharmacology – is the study of the effect of drug
on living organism. II – Practice Asepsis – wash hand before and
Pharmacy- is the art of preparing, compounding, after preparing the medication to reduce transfer
and dispensing drugs. of microorganisms.
Medication administration - is a basic nursing III – Nurse who administer the medications are
function the involves skillful technique and responsible for their own action. Question any
consideration of patient’s development and safety. order that you considered incorrect (may be
Ten “Rights” of Medication Administration unclear or appropriate)
1. Right Medication IV – Be knowledgeable about the medication that
T he medication given was the medication ordered you administer
the nurse compares the label of the medication
container with medication form. The nurse does “A FUNDAMENTAL RULE OF SAFE DRUG
this 3 times. ADMINISTRATION IS: “NEVER ADMINISTER
2. Right Dose AN UNFAMILIAR MEDICATION”
The dose appropriate for the client
Double-check calculations that appears V – Keep the Narcotics in locked place.
questionable
VI– Use only medications that are in clearly labeled  Crushing enteric-coated tablets –
containers. Relabelling of drugs are the allows the irrigating medication to come in
responsibility of the pharmacist. contact with the oral or gastric mucosa,
VII – Return liquid that are cloudy in color to the resulting in mucositis or gastric irritation.
pharmacy.  Crushing sustained-released
VIII – Before administering medication, identify the medication – allows all the medication to
client correctly be absorbed at the same time, resulting in
IX – Do not leave the medication at the bedside. a higher than expected initial level of
Stay with the client until he actually takes the medication and a shorter than expected
medications. duration of action
X – The nurse who prepares the drug administers 2. SUBLINGUAL
it.. Only the nurse prepares the drug knows what a. A drug that is placed under the tongue, where
the drug is. Do not accept endorsement of it dissolves.
medication. b. When the medication is in capsule and
ordered sublingually, the fluid must be
XI – If the client vomits after taking the medication, aspirated from the capsule and placed under
report this to the nurse in-charge or physician. the tongue.
XII – Preoperative medications are usually c. A medication given by the sublingual route
discontinued during the postoperative period should not be swallowed, or desire effects will
unless ordered to be continued. not be achieved
XIII- When a medication is omitted for any reason, Advantages:
record the fact together with the reason. a. Same as oral
XIV – When the medication error is made, report it b. Drug is rapidly absorbed in the
immediately to the nurse in-charge or physician. To bloodstream
implement necessary measures immediately. This Disadvantages
may prevent any adverse effects of the drug. a. If swallowed, drug may be inactivated by
gastric juices.
Medication Administration b. Drug must remain under the tongue until
1. Oral administration dissolved and absorbed
Advantages 3. BUCCAL
a. The easiest and most desirable way to a. A medication is held in the mouth against the
administer medication mucous membranes of the cheek until the
b. Most convenient drug dissolves.
c. Safe, does nor break skin barrier b. The medication should not be chewed,
d. Usually less expensive swallowed, or placed under the tongue (e.g
Disadvantages sustained release nitroglycerine,
a. Inappropriate if client cannot swallow and if opiates,antiemetics, tranquilizer, sedatives)
GIT has reduced motility c. Client should be taught to alternate the
b. Inappropriate for client with nausea and cheeks with each subsequent dose to avoid
vomiting mucosal irritation
c. Drug may have unpleasant taste Advantages:
d. Drug may discolor the teeth a. Same as oral
e. Drug may irritate the gastric mucosa b. Drug can be administered for local effect
f. Drug may be aspirated by seriously ill c. Ensures greater potency because drug
patient. directly enters the blood and bypass the
Drug Forms for Oral Administration liver
a. Solid: tablet, capsule, pill, powder Disadvantages:
b. Liquid: syrup, suspension, emulsion, elixir,  If swallowed, drug may be inactivated by
milk, or other alkaline substances. gastric juice
c. Syrup: sugar-based liquid medication 4. TOPICAL – Application of medication to a
d. Suspension: water-based liquid medication. circumscribed area of the body.
Shake bottle before use of medication to 1. Dermatologic – includes lotions, liniment and
properly mix it. ointments, powder.
e. Emulsion: oil-based liquid medication a. Before application, clean the skin thoroughly
f. Elixir: alcohol-based liquid medication. After by washing the area gently with soap and
administration of elixir, allow 30 minutes to water, soaking an involved site, or locally
elapse before giving water. This allows debriding tissue.
maximum absorption of the medication. b. Use surgical asepsis when open wound is
present
“NEVER CRUSH ENTERIC-COATED OR
SUSTAINED RELEASE TABLET”
c. Remove previous application before the next  Nasal instillations usually are
application instilled for their astringent effects
d. Use gloves when applying the medication over (to shrink swollen mucous
a large surface. (e.g large area of burns) membrane),
e. Apply only thin layer of medication to prevent  to loosen secretions and facilitate
systemic absorption. drainage or to treat infections of
2. Opthalmic - includes instillation and irrigation the nasal cavity or sinuses.
a. Instillation – to provide an eye medication  Decongestants, steroids, calcitonin.
that the client requires. a. Have the client blow the nose prior to
b. Irrigation – To clear the eye of noxious or nasal instillation
other foreign materials. b. Assume a back lying position, or sit up and
c. Position the client either sitting or lying. lean head back.
d. Use sterile technique c. Elevate the nares slightly by pressing the
e. Clean the eyelid and eyelashes with sterile thumb against the client’s tip of the nose.
cotton balls moistened with sterile normal While the client inhales, squeeze the
saline from the inner to the outer canthus bottle.
f. Instill eye drops into lower conjunctival sac. d. Keep head tilted backward for 5 minutes
g. Instill a maximum of 2 drops at a time. Wait after instillation of nasal drops.
for 5 minutes if additional drops need to be e. When the medication is used on a daily
administered. This is for proper absorption basis, alternate nares to prevent irritations
of the medication. 5. Inhalation – use of nebulizer, metered-dose
h. Avoid dropping a solution onto the cornea inhaler
directly, because it causes discomfort. a. Semi or high-fowler’s position or standing
i. Instruct the client to close the eyes gently. position. To enhance full chest expansion
Shutting the eyes tightly causes spillage of allowing deeper inhalation of the
the medication. medication
j. For liquid eye medication, press firmly on b. Shake the canister several times. To mix
the nasolacrimal duct (inner cantus) for at the medication and ensure uniform
least 30 seconds to prevent systemic dosage delivery
absorption of the medication. c. Position the mouthpiece 1 to 2 inches from
3. Otic the client’s open mouth. As the client
Instillation – to remove cerumen or pus or to starts inhaling, press the canister down to
remove foreign body release one dose of the medication. This
a. Warm the solution at room temperature or allows delivery of the medication more
body temperature, failure to do so may accurately into the bronchial tree rather
cause vertigo, dizziness, nausea and pain. than being trapped in the oropharynx then
b. Have the client assume a side-lying position swallowed
( if not contraindicated) with ear to be d. Instruct the client to hold breath for 10
treated facing up. seconds. To enhance complete absorption
c. Perform hand hygiene. Apply gloves if of the medication.
drainage is present. e. If bronchodilator, administer a maximum
d. Straighten the ear canal: of 2 puffs, for at least 30 second interval.
 0-3 years old: pull the pinna downward Administer bronchodilator before other
and backward inhaled medication. This opens airway and
 Older than 3 years old: pull the pinna promotes greater absorption of the
upward and backward medication.
e. Instill eardrops on the side of the auditory f. Wait at least 1 minute before
canal to allow the drops to flow in and administration of the second dose or
continue to adjust to body temperature inhalation of a different medication by MDI
f. Press gently bur firmly a few times on the g. Instruct client to rinse mouth, if steroid
tragus of the ear to assist the flow of had been administered. This is to prevent
medication into the ear canal. fungal infection.
g. Ask the client to remain in side lying 6. Vaginal – drug forms: tablet liquid (douches).
position for about 5 minutes Jelly, foam and suppository.
h. At times the MD will order insertion of cotton a. Close room or curtain to provide privacy.
puff into outermost part of the canal. Do not b. Assist client to lie in dorsal recumbent
press cotton into the canal. Remove cotton position to provide easy access and good
after 15 minutes. exposure of vaginal canal, also allows
1. Nasal – suppository to dissolve without escaping
through orifice.
 c. Use applicator or sterile gloves for vaginal c. Needle length and gauge are the same as
administration of medications. for ID injections
Vaginal Irrigation – is the washing of the vagina d. Use 5/8 needle for adults when the
by a liquid at low pressure. It is also called douche. injection is to administer at 45 degree
a. Empty the bladder before the procedure angle; ½ is use at a 90 degree angle.
b. Position the client on her back with the hips e. For thin patients: 45 degree angle of
higher than the shoulder (use bedpan) needle
c. Irrigating container should be 30 cm (12 f. For obese patient: 90 degree angle of
inches) above needle
d. Ask the client to remain in bed for 5-10 g. For heparin injection:
minute following administration of vaginal h. do not aspirate.
suppository, cream, foam, jelly or irrigation. i. Do not massage the injection site to
7. RECTAL – can be use when the drug has prevent hematoma formation
objectionable taste or odor. j. For insulin injection:
a. Need to be refrigerated so as not to soften. k. Do not massage to prevent rapid
b. Apply disposable gloves. absorption which may result to
c. Have the client lie on left side and ask to hypoglycemic reaction.
take slow deep breaths through mouth and l. Always inject insulin at 90 degrees angle
relax anal sphincter. to administer the medication in the pocket
d. Retract buttocks gently through the anus, between the subcutaneous and muscle
past internal sphincter and against rectal layer. Adjust the length of the needle
wall, 10 cm (4 inches) in adults, 5 cm (2 in) depending on the size of the client.
in children and infants. May need to apply m. For other medications, aspirate before
gentle pressure to hold buttocks together injection of medication to check if the
momentarily. blood vessel had been hit. If blood appears
e. Discard gloves to proper receptacle and on pulling back of the plunger of the
perform hand washing. syringe, remove the needle and discard
f. Client must remain on side for 20 minute the medication and equipment.
after insertion to promote adequate Intramuscular
absorption of the medication. a. Needle length is 1”, 1 ½”, 2” to reach the
muscle layer
8. PARENTERAL- administration of medication by b. Clean the injection site with alcoholized
needle. cotton ball to reduce microorganisms in
Intradermal – under the epidermis. the area.
a. The site are the inner lower arm, upper c. Inject the medication slowly to allow the
chest and back, and beneath the scapula. tissue to accommodate volume.
b. Indicated for allergy and tuberculin testing Sites:
and for vaccinations. Ventrogluteal site
c. Use the needle gauge 25, 26, 27: needle a. The area contains no large nerves, or
length 3/8”, 5/8” or ½” blood vessels and less fat. It is farther
d. Needle at 10–15 degree angle; bevel up. from the rectal area, so it less
e. Inject a small amount of drug slowly over 3 contaminated.
to 5 seconds to form a wheal or bleb. b. Position the client in prone or side-lying.
f. Do not massage the site of injection. To c. When in prone position, curl the toes
prevent irritation of the site, and to prevent inward.
absorption of the drug into the d. When side-lying position, flex the knee
subcutaneous. and hip. These ensure relaxation of
Subcutaneous – vaccines, heparin, preoperative gluteus muscles and minimize discomfort
medication, insulin, narcotics. during injection.
The site: e. To locate the site, place the heel of the
 outer aspect of the upper arms hand over the greater trochanter, point
 anterior aspect of the thighs the index finger toward the anterior
 Abdomen superior iliac spine, and then abduct the
 Scapular areas of the upper back middle (third) finger. The triangle formed
 Ventrogluteal by the index finger, the third finger and
 Dorsogluteal the crest of the ilium is the site.
a. Only small doses of medication should be Dorsogluteal site
injected via SC route. a. Position the client similar to the
b. Rotate site of injection to minimize tissue ventrogluteal site
damage.
 b. The site should not be use in infant under 3 8. Introduce air into the vial before aspiration. To
years because the gluteal muscles are not create a positive pressure within the vial and
well developed yet. allow easy withdrawal of the medication.
c. To locate the site, the nurse draws an 9. Allow a small air bubble (0.2 ml) in the syringe
imaginary line from the greater trochanter to push the medication that may remain.
to the posterior superior iliac spine. The 10. Introduce the needle in quick thrust to lessen
injection site id lateral and superior to this discomfort.
line. 11. Either spread or pinch muscle when
d. Another method of locating this site is to introducing the medication. Depending on the
imaginary divide the buttock into four size of the client.
quadrants. The upper most quadrant is the 12. Minimized discomfort by applying cold
site of injection. Palpate the crest of the compress over the injection site before
ilium to ensure that the site is high enough. introduction of medicati0n to numb nerve
e. Avoid hitting the sciatic nerve, major blood endings.
vessel or bone by locating the site properly. 13. Aspirate before the introduction of
Vastus Lateralis medication. To check if blood vessel had been
a. Recommended site of injection for infant hit.
b. Located at the middle third of the anterior 14. Support the tissue with cotton swabs before
lateral aspect of the thigh. withdrawal of needle. To prevent discomfort of
c. Assume back-lying or sitting position. pulling tissues as needle is withdrawn.
Rectus femoris site –located at the middle third, 15. Massage the site of injection to haste
anterior aspect of thigh. absorption.
Deltoid site 16. Apply pressure at the site for few minutes. To
a. Not used often for IM injection because it is prevent bleeding.
relatively small muscle and is very close to 17. Evaluate effectiveness of the procedure and
the radial nerve and radial artery. make relevant documentation.
b. To locate the site, palpate the lower edge of Intravenous
the acromion process and the midpoint on The nurse administers medication intravenously
the lateral aspect of the arm that is in line by the following method:
with the axilla. This is approximately 5 cm (2 1. As mixture within large volumes of IV
in) or 2 to 3 fingerbreadths below the fluids.
acromion process. 2. By injection of a bolus, or small volume, or
IM injection – Z tract injection medication through an existing
a. Used for parenteral iron preparation. To seal intravenous infusion line or intermittent
the drug deep into the muscles and prevent venous access (heparin or saline lock)
permanent staining of the skin. 3. By “piggyback” infusion of solution
b. Retract the skin laterally, inject the containing the prescribed medication and
medication slowly. Hold retraction of skin a small volume of IV fluid through an
until the needle is withdrawn existing IV line.
c. Do not massage the site of injection to a. Most rapid route of absorption of medications.
prevent leakage into the subcutaneous. b. Predictable, therapeutic blood levels of
GENERAL PRINCIPLES IN PARENTERAL medication can be obtained.
ADMINISTRATION OF MEDICATIONS c. The route can be used for clients with
1. Check doctor’s order. compromised gastrointestinal function or
2. Check the expiration for medication – drug peripheral circulation.
potency may increase or decrease if outdated. d. Large dose of medications can be
3. Observe verbal and non-verbal responses administered by this route.
toward receiving injection. Injection can be e. The nurse must closely observe the client for
painful. Client may have anxiety, which can symptoms of adverse reactions.
increase the pain. f. The nurse should double-check the six rights
4. Practice asepsis to prevent infection. Apply of safe medication.
disposable gloves. g. If the medication has an antidote, it must be
5. Use appropriate needle size. To minimize tissue available during administration.
injury. h. When administering potent medications, the
6. Plot the site of injection properly. To prevent nurse assesses vital signs before, during and
hitting nerves, blood vessels, bones. after infusion.
7. Use separate needles for aspiration and
injection of medications to prevent tissue Nursing Interventions in IV Infusion
irritation. a. Verify the doctor’s order
b. Know the type, amount, and indication of
IV therapy.
 c. Practice strict asepsis.  Slow infusion to KVO
d. Inform the client and explain the purpose of  Place patient in high fowler’s position. To
IV therapy to alleviate client’s anxiety. enhance breathing
e. Prime IV tubing to expel air. This will prevent  Administer diuretic, bronchodilator as
air embolism. ordered
f. Clean the insertion site of IV needle from 3. Drug Overload – the patient receives an
center to the periphery with alcoholized excessive amount of fluid containing drugs.
cotton ball to prevent infection. Assessment:
g. Shave the area of needle insertion if hairy.  Dizziness
h. Change the IV tubing every 72 hours. To  Shock
prevent contamination.  Fainting
i. Change IV needle insertion site every 72 Nursing Intervention
hours to prevent thrombophlebitis.  Slow infusion to KVO.
j. Regulate IV every 15-20 minutes. To ensure  Take vital signs
administration of proper volume of IV fluid as  Notify physician
ordered. 4. Superficial Thrombophlebitis – it is due to
k. Observe for potential complications. o0veruse of a vein, irritating solution or drugs,
clot formation, large bore catheters.
Types of IV Fluids Assessment:
Isotonic solution – has the same concentration as  Pain along the course of vein
the body fluid  Vein may feel hard and cordlike
a. D5 W  Edema and redness at needle insertion
b. Na Cl 0.9% site.
c. plainRinger’s lactate  Arm feels warmer than the other arm
d. Plain Normosol M Nursing Intervention:
Hypotonic – has lower concentration than the body  Change IV site every 72 hours
fluids.  Use large veins for irritating fluids.
a. NaCl 0.3%  Stabilize venipuncture at area of flexion.
Hypertonic – has higher concentration than the  Apply cold compress immediately to
body fluids. relieve pain and inflammation; later with
a. D10W warm compress to stimulate circulation
b. D50W and promotion absorption.
c. D5LR  “Do not irrigate the IV because this could
d. D5NM push clot into the systemic circulation’
Complication of IV Infusion 5. Air Embolism – Air manages to get into the
1. Infiltration – the needle is out of nein, and circulatory system; 5 ml of air or more causes air
fluids accumulate in the subcutaneous tissues. embolism.
Assessment: Assessment:
 Pain, swelling, skin is cold at needle site, pallor  Chest, shoulder, or backpain
of the site, flow rate has decreases or stops.  Hypotension
Nursing Intervention:  Dyspnea
 Change the site of needle  Cyanosis
 Apply warm compress. This will absorb edema  Tachycardia
fluids and reduce swelling.  Increase venous pressure
2. Circulatory Overload -Results from  Loss of consciousness
administration of excessive volume of IV fluids. Nursing Intervention
Assessment:  Do not allow IV bottle to “run dry”
 Headache  “Prime” IV tubing before starting infusion.
 Flushed skin  Turn patient to left side in the
 Rapid pulse Trendelenburg position. To allow air to rise
 Increase BP in the right side of the heart. This prevent
 Weight gain pulmonary embolism.
 Syncope and faintness 6. Nerve Damage – may result from tying the
 Pulmonary edema arm too tightly to the splint.
 Increase volume pressure Assessment
 SOB  Numbness of fingers and hands
 Coughing Nursing Interventions
 Tachypnea  Massage the are and move shoulder
 shock through its ROM
 Instruct the patient to open and close
Nursing Interventions: hand several times each hour.
  Physical therapy may be required m. . Administer BT for 4 hours (whole blood,
Note: apply splint with the fingers free to move. packed rbc). For plasma, platelets,
7. Speed Shock – may result from administration cryoprecipitate, transfuse quickly (20 minutes)
of IV push medication rapidly. clotting factor can easily be destroyed.
 To avoid speed shock, and possible cardiac
arrest, give most IV push medication over 3 Complications of Blood Transfusion
to 5 minutes. 1. Allergic Reaction – it is caused by sensitivity
BLOOD TRANSFUSION THERAPY to plasma protein of donor antibody, which reacts
Objectives: with recipient antigen.
1. To increase circulating blood volume after Assessments
surgery, trauma, or hemorrhage  Flushing
2. To increase the number of RBCs and to  Rush, hives
maintain hemoglobin levels in clients with  Pruritus
severe anemia
3. To provide selected cellular components as
 Laryngeal edema, difficulty of breathing
2. Febrile, Non-Hemolytic – it is caused by
replacements therapy (e.g. clotting factors,
hypersensitivity to donor white cells, platelets or
platelets, albumin)
plasma proteins. This is the most symptomatic
Nursing Interventions:
complication of blood transfusion
a. Verify doctor’s order. Inform the client and
Assessments:
explain the purpose of the procedure.
b. Check for cross matching and typing. To  Sudden chills and fever
ensure compatibility  Flushing
c. Obtain and record baseline vital signs  Headache
d. Practice strict Asepsis  Anxiety
e. At least 2 licensed nurse check the label of 3. Septic Reaction – it is caused by the
the blood transfusion transfusion of blood or components contaminated
Check the following: with bacteria.
 Serial number Assessment:
 Blood component  Rapid onset of chills
 Blood type  Vomiting
 Rh factor  Marked Hypotension
 Expiration date  High fever
 Screening test (VDRL, HBsAg, malarial 4. Circulatory Overload – it is caused by
smear)- this is to ensure that the blood is free from administration of blood volume at a rate greater
blood-carried diseases and therefore, safe from than the circulatory system can accommodate.
transfusion. Assessment
f. Warm blood at room temperature before  Rise in venous pressure
transfusion to prevent chills.  Dyspnea
g. Identify client properly. Two Nurses check  Crackles or rales
the client’s identification.  Distended neck vein
h. Use needle gauge 18 to 19. This allows easy
flow of blood.
 Cough
i. j. Use BT set with special micron mesh filter.  Elevated BP
To prevent administration of blood clots and 5. Hemolytic reaction. It is caused by infusion
particles. of incompatible blood products.
j. Start infusion slowly at 10 gtts/min. Remain Assessment
at bedside for 15 to 30 minutes. Adverse  Low back pain (first sign). This is due to
reaction usually occurs during the first 15 to inflammatory response of the kidneys to
20 minutes. incompatible blood.
k. Monitor vital signs. Altered vital signs  Chills
indicate adverse reaction.  Feeling of fullness
 Do not mixed medications with blood  Tachycardia
transfusion. To prevent adverse efects  Flushing
 Do not incorporate medication into the
blood transfusion
 Tachypnea
 Do not use blood transfusion line for IV  Hypotension
push of medication.  Bleeding
l. . Administer 0.9% NaCl before, during or after BT.  Vascular collapse
Never administer IV fluids with dextrose. Dextrose  Acute renal failure
causes hemolysis.
Nursing Interventions when complications
occurs in Blood transfusion Lactic Dehydrogenase 100-225 mu/ml
1. If blood transfusion reaction occurs. STOP Alkaline phospokinase 32-92 U/L
THE TRANSFUSION. Albumin 3.2- 5.5 mg/dl
2. Start IV line (0.9% Na Cl)
3. Place the client in Fowler’s position if with COMMON THERAPEUTIC DIETS
SOB and administer O2 therapy. 1. CLEAR-LIQUID DIET
4. The nurse remains with the client, observing Purpose:
signs and symptoms and monitoring vital  relieve thirst and help maintain fluid
signs as often as every 5 minutes. balance.
5. Notify the physician immediately. Use:
6. The nurse prepares to administer  post-surgically and following acute
emergency drugs such as antihistamines, vomiting or diarrhea.
vasopressor, fluids, and steroids as per Foods Allowed:
physician’s order or protocol.  carbonated beverages; coffee (caffeinated
7. Obtain a urine specimen and send to the and decaff.); tea; fruit-flavored drinks;
laboratory to determine presence of strained fruit juices; clear, flavored
hemoglobin as a result of RBC hemolysis. gelatins; broth, consomme; sugar;
8. Blood container, tubing, attached label, and popsicles; commercially prepared clear
transfusion record are saved and returned to liquids; and hard candy.
the laboratory for analysis. Foods Avoided:
 milk and milk products, fruit juices with
pulp, and fruit.
Normal Values 2. FULL-LIQUID DIET
Bleeding time 1-9 min Purpose:
Prothrombin time 10-13 sec  Provide an adequately nutritious diet for
Hematocrit Male 42-52% patients who cannot chew or who are too
Female 36-48% ill to do so.
Hemoglobin male 13.5-16 g/dl  Use:
female 12-14 g/dl  acute infection with fever, GI upsets, after
Platelet 150,00- 400,000 surgery as a progression from clear
RBC male 4.5-6.2 million/L liquids.
Female 4.2-5.4 million/L Foods Allowed:
Amylase 80-180 IU/L  clear liquids, milk drinks, cooked cereals,
Bilirubin(serum)direct 0-0.4 mg/dl custards, ice cream, sherbets, eggnog, all
indirect 0.2-0.8 mg/dl strained fruit juices, creamed vegetable
total 0.3-1.0 mg/dl soups, puddings, mashed potatoes, instant
pH 7.35- 7.45 breakfast drinks, yogurt, mild cheese
PaCo2 35-45 sauce or pureed meat, and seasoning.
HCO3 22-26 mEq/L Foods Avoided:
Pa O2 80-100 mmHg  nuts, seeds, coconut, fruit, jam, and
SaO2 94-100% marmalade
Sodium 135- 145 mEq/L SOFT DIET
Potassium 3.5- 5.0 mEq/L Purpose:
Calcium 4.2- 5.5 mg/dL  provide adequate nutrition for those who
Chloride 98-108 mEq/L have troubled chewing.
Magnesium 1.5-2.5 mg/dl  Use:
BUN 10-20 mg/dl  patient with no teeth or ill-fitting dentures;
Creatinine 0.4- 1.2 transition from full-liquid to general diet;
CPK-MB male 50 –325 mu/ml and for those
female 50-250 mu/ml  who cannot tolerate highly seasoned, fried
Fibrinogen 200-400 mg/dl or raw foods following acute infections or
FBS 80-120 mg/dl gastrointestinal
Glycosylated Hgb 4.0-7.0%  disturbances such as gastric ulcer or
(HbA1c) cholelithiasis.
Uric Acid 2.5 –8 mg/dl Foods Allowed:
ESR male 15-20 mm/hr  very tender minced, ground, baked
Female 20-30 mm/hr broiled, roasted, stewed, or creamed beef,
lamb, veal, liver,
Cholesterol 150- 200 mg/dl
Triglyceride 140-200 mg/dl
  poultry, or fish; crisp bacon or sweet bread;  Fluid intake measures water in fruit,
cooked vegetables; pasta; all fruit juices; vegetables, milk and meat.
soft raw fruits; Foods Avoided:
 soft bread and cereals; all desserts that are  Cereals, bread, macaroni, noodles, spaghetti,
soft; and cheeses.  avocados, kidney beans, potato chips
Foods Avoided:  raw fruit, yams
 coarse whole-grain cereals and bread; nuts;  soybeans, nuts, gingerbread
raisins; coconut;  apricots, bananas, figs, grapefruit, oranges,
 fruits with small seeds; fried foods;  percolated coffee
 high fat gravies or sauces;  Coca-Cola, orange crush, sport drinks, and
 spicy salad dressings; pickled meat, fish, or breakfast drinks such as Tang or Awake
poultry;
 strong cheeses; HIGH-PROTEIN, HIGH CARBOHYDRATE DIET
 brown or wild rice; Purpose:
 raw vegetables, as well as lima beans and corn;  To correct large protein losses and raises the
spices such as horseradish, level of blood albumin. May be modified to
 mustard, and catsup; and popcorn. include low-fat, low-sodium, and low-
SODIUM-RESTRICTED DIET cholesterol diets.
Purpose: Use:
 reduce sodium content in the tissue and  Burns
promote excretion of water.  Hepatitis
Use:  Cirrhosis
 heart failure, hypertension, renal disease,  Pregnancy
cirrhosis, toxemia of pregnancy, and  Hyperthyroidism
cortisone therapy.  Mononucleosis
Modifications:  protein deficiency due to poor
 mildly restrictive 2 g sodium diet to eating habits
extremely restricted 200 mg sodium diet.  geriatric patient with poor intake
Foods Avoided:  nephritis, nephrosis,
 table salt; all commercial soups, including  liver and gall bladder disorder.
bouillon; gravy, catsup, mustard, meat Foods Allowed:
sauces, and soy sauce;  general diet with added protein.
 buttermilk, ice cream, and sherbet; sodas; Foods Avoided:
 beet greens, carrots, celery, chard,  restrictions depend on modifications added to
sauerkraut, and the diet. The modifications are determined by
 spinach; all canned vegetables; frozen peas; the patient’s condition.
 all baked products containing salt, baking PURINE-RESTRICTED DIET
powder, or baking soda; potato chips and Purpose:
popcorn; fresh or canned shellfish; all  designed to reduce intake of uric acid-
cheeses producing foods.
 smoked or commercially prepared meats; Use:
salted butter or margarine;  high uric acid retention, uric acid renal
 bacon, olives; and commercially prepared stones, and gout.
salad dressings. Foods Allowed:
RENAL DIET  general diet plus 2-3 quarts of liquid daily.
Purpose: Foods Avoided:
 control protein, potassium, sodium, and fluid  cheese containing spices or nuts
levels in the body.  fried eggs, meat
Use:  liver, seafood
 acute and chronic renal failure, hemodialysis.  lentils, dried peas and beans
Foods Allowed:  broth, bouillon, gravies
 high-biological proteins such as meat, fowl,  oatmeal and whole wheat
fish, cheese, and dairy products- range  pasta, noodles
between 20 and 60 mg/day.  alcoholic beverages
 Potassium is usually limited to 1500 mg/day.  Limited quantities of meat, fish, and seafood
 Vegetables such as cabbage, cucumber, and allowed.
peas are lowest in potassium. BLAND DIET
 Sodium is restricted to 500 mg/day. Purpose:
 Fluid intake is restricted to the daily volume  Provision of a diet low in fiber, roughage,
plus 500 mL, which represents insensible mechanical irritants, and chemical stimulants.
water loss. Use:
 Gastritis  donuts and muffins
 hyperchlorhydria (excess hydrochloric acid)  poultry skin, highly marbled meats
 functional GI disorders  butter, ordinary margarines, olive oil, lard
 gastric atony  pudding made with whole milk, ice cream,
 diarrhea candies with chocolate, cream, sauces,
 spastic constipation gravies and commercially fried foods.
 biliary indigestion DIABETIC DIET
 hiatus hernia. Purpose:
Foods Allowed:  maintain blood glucose as near as normal as
 Varied to meet individual needs and food possible; prevent or delay onset of diabetic
tolerances. complications.
Foods Avoided: Use:
 fried foods, including eggs, meat, fish, and  diabetes mellitus
sea food Foods Allowed:
 cheese with added nuts or spices  choose foods with low glycemic index
 commercially prepared luncheon meats compose of:
cured meats such as ham a. 45-55% carbohydrates
 gravies and sauces b. 30-35% fats
 raw vegetables; c. 10-25% protein
 potato skins  coffee, tea, broth, spices and flavoring can be
 fruit juices with pulp used as desired.
 figs, raisins  exchange groups include: milk, vegetable,
 fresh fruits fruits, starch/bread, meat (divided in lean,
 whole wheat; rye bread; bran cereals medium fat, and high fat), and fat exchanges.
 rich pastries; pies  the number of exchanges allowed from each
 chocolate group is dependent on the total number of
 jams with seeds; nuts calories allowed.
 seasoned dressings  non-nutritive sweeteners (sorbitol) in
 caffeinated coffee; strong tea; cocoa; moderation with controlled, normal weight
alcoholic and carbonated beverages diabetics.
 pepper. Foods Avoided:
LOW-FAT, CHOLESTEROL-RESTRICTED DIET  concentrated sweets or regular soft drinks.
Purpose: ACID AND ALKALINE DIET
 reduce hyperlipedimia, provide dietary Purpose:
treatment for malabsorption syndromes and  Furnish a well balance diet in which the total
patients having acute intolerance for fats. acid ash is greater than the total alkaline ash
Use: each day.
 Hyperlipedimia Use:
 Atherosclerosis  Retard the formation of renal calculi. The type
 Pancreatitis of diet chosen depends on laboratory analysis
 scystic fibrosis of the stone.
 sprue (disease of intestinal tract Acid and alkaline ash food groups:
 characterized by malabsorption)  Acid ash: meat, whole grains, eggs, cheese,
 gastrectomy cranberries, prunes, plums
 massive resection of small intestine  Alkaline ash: milk, vegetables, fruits (except
 cholecystitis. cranberries, prunes and plums.)
Foods Allowed:  Neutral: sugar, fats, beverages (coffee, tea)
 nonfat milk Foods allowed:
 low-carbohydrate  Breads: any, preferably whole grain; crackers;
 low-fat vegetables; most fruits; breads; pastas; rolls
cornmeal  Cereals: any, preferable whole grains
 lean meat  Desserts: angel food or sunshine cake;
 unsaturated fats cookies made without baking powder or soda;
Foods Avoided: cornstarch,
 remember to avoid the five C’s of  pudding, cranberry desserts, ice cream,
cholesterol- cookies, cream, cake, coconut, sherbet, plum or prune desserts; rice or
chocolate tapioca pudding.
 whole milk and whole-milk or cream  Fats: any, such as butter, margarine, salad
products dressings, Crisco, Spry, lard, salad oil, olive
 avocados, olives oil, ect.
 commercially prepared baked goods such as
 fruits: cranberry, plums, prunes
 Meat, eggs, cheese: any meat, fish or fowl, two
serving daily; at least one egg daily
 Potato substitutes: corn, hominy, lentils,
macaroni, noodles, rice, spaghetti, vermicelli.
 Soup: broth as desired; other soups from food
allowed
 Sweets: cranberry and plum jelly; plain sugar
candy
 Miscellaneous: cream sauce, gravy, peanut
butter, peanuts, popcorn, salt, spices, vinegar,
walnuts.
Restricted foods:
 no more than the amount allowed each day
1. Milk: 1 pint daily (may be used in other ways
than as beverage)
2. Cream: 1/3 cup or less daily
3. Fruits: one serving of fruits daily( in addition to
the prunes, plums and cranberries)
4. Vegetable: including potatoes: two servings daily
5. Sweets: Chocolate or candies, syrups.
6. Miscellaneous: other nuts, olives, pickles.
HIGH-FIBER DIET
Purpose:
 Soften the stool
 exercise digestive tract muscles
 speed passage of food through digestive
tract to prevent exposure to cancer-causing agents
in food
 lower blood lipids
 Prevent sharp rise in glucose after eating.
Use: diabetes, hyperlipedemia, constipation,
diverticulitis, anticarcinogenics (colon)
Foods Allowed:
 recommended intake about 6 g crude fiber
daily
 All bran cereal
 Watermelon, prunes, dried peaches, apple
with skin; parsnip, peas, brussels sprout,
sunflower seeds.
LOW RESIDUE DIET
Purpose:
 Reduce stool bulk and slow transit time
Use:
 Bowel inflammation during acute diverticulitis,
or ulcerative colitis, preparation for bowel
surgery, esophageal and intestinal stenosis.
Food Allowed:
 eggs; ground or well-cooked tender meat,
fish, poultry; milk, cheeses; strained fruit juice
(except prune): cooked or canned apples, apricots,
peaches, pears; ripe banana; strained vegetable
juice: canned, cooked, or strained asparagus,
beets, green beans, pumpkin, squash, spinach;
white bread;
refined cereals (Cream of Wheat)