FUNDAMENTALS OF NURSING f.

Captain Salome – A revolutionary leader

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