Fundamentals of Nursing Brain Stem

1. Midbrain – pupil reaction , arousal

- Nutrix – latin word means to nourish
2. Pons – (upper pons) Pneumotaxic center
- an art and a science - stops the over distention or
over inflation of the lungs
- (lower pons) Apneustic center
Art – therapeutic use of self - responsible for deep inhalation
- profession that requires dexterity and skills 3. Medulla oblongata
- Heart Rate
Consider correct answer if there are: - Respiration – detects carbon dioxide in the CSF
Sits - swallowing – hiccups (water management)
- coughing – negative coughing = high risk of
Stays
pneumonia
Self - suctioning (10-25 mins) – suction upon
withdrawal using circular motion with
Silence
intermittent suction

Patient tells – catharsis (venting out of emotions) Hyperoxygenate Hyperventilate

AVOID O2 tank – 10 lpm Valve mask ventilator
1. Why? Ventilator – FIO2 – ambu bag
2. It’s ok (Fraction of Inspired O2) 3 inflations – pedia
3. That’s nothing 3 hyperinflations – adult
4. Giving advices (only provide options)
- family planning
Science – specific/ specialized body of knowledge
3 skills required of a nurse:
CARING – compassion
1. Communication skill - committed to promoting individual, family,
- charting P – roblem community and national health in the manner
E – tiology - committed to personalized services for all
S – igns /Sx persons without regards to color, creed, social,
- EMR (electeronic medical record) or economic status.
Advantage:
- more complete Food Tray – ISLAM
Disadvantage: a. Pork, alcoholic beverages, shrimps/crabs
- breach of confidentiality b. Pork/ Haram – forbidden (mud crabs)
a. Chicken/beef – becomes halal if
2. Hands on (manual skill) – RLE properly prayed
3. Cognitive – decision making skill c. Pork / Halal – allowed (blur/true crabs)
Decision making: d. Pork
M.I - call for help
- take note of the time
MVA – check for respiration HISTORY OF NURSING IN THE PHILIPPINES
- stabilize the spine Philippine Revolutiuon
- check for circulation
A. Dona Hilaria de Aguinaldo
Coma – oral care
- side lying position - formulated by Filipno Red Cross
- check pupils – anisocoria
B. Trinidad Tecson
(unequal)
CN II (optic) – snellen’s chart - mother of filipino red cross
Hospitals and Schools of Nursing - first to receive a master's degree abroad
3. ROSA MILITAR
1. Iloilo mission Hospital College of Nursing
- pioneer of school health nursing education
Iloilo City , 1906 – Central Philippine 4. LORETO TUPAZ
University - considered to be the Florence Nightingale of
2. Philippine General Hospital School of Nursing Iloilo
- requested the first NLE to be held outside
Manila, 1907 – UP Manila CON Manila (Iloilo - first NLE outside Manila)
3. St. Paul’s School if Nursing 5. Dean Jolita Sotejo
- Florence Nightingale of the Philippines
Manila, 1907
ST
RN – BSN holder
1 COLLEGE OF NURSING
MAN – humanities (group dynamics – conflict
1. University of Santo Tomas College of Nursing resolution , bargaining, adaptation, role
(1946) shifting)
2. Manila Centra University College MSN – sciences
(1947)
First True Nursing Law (ACT 2808)
SUICIDE – usually happens early in the morning 1919 – created Board of Nursing – gave the first NLE
1920 in Manila
Gloomy/ cool – High risk of depression
1935 - RU RA congress > people
- Seasonal Affective Mood Disorder
- during endorsement – frequent irregular visits
First Philippine Nursing Law – RA 877
CUES:
1953
1. Actual/ Imagined loss
RA – law created by the people
(money, relationship, loved one)
2. Giving away of possession
FILING OF CASE:
3. Tying of loose ends
1. Criminal
- violation of a republic act
Activity of a depressed patient: (low self-esteem) 1. Liability
- minute activities a. Criminal – imprisonment
- simple, easily accomplished b. Civil – pay a fine
Advice to:
- fold clothes 2. Civil (pay a fine)
- take a bath - private person (patient)
TORT – battery, assault, slander, libel
Activity of a manic person: Gross Manual Activity
3. Administrative
- uses energy but non competitive - public office
* Gardening - with license

* Walking A. PERIOD OF INTUITIVE NURSING

Snack: Finger Foods (protein, carbohydrate, fat)  Prehistoric times among primitive tribes
 Out of compassion for others
* Cheeseburger  A function that belongs to women
ICU – Coma – Glascow Coma Scale
NURSING LEADERS IN THE PHILIPPINES: Pain
1. ANASTACIA GIRON TUPAS 1. Sternal Rub
- PNA 2. Nailbed Pressure
2. CESARIA TAN 3. Trapizius Squeeze
 4. Nipple Pinching
 Illness caused evil spirits through the use of
D. PERIOD OF EDUCATE NURSING
magic or voodoo
 Florence Nightingale School of
 Medicine mean “Shaman”
Nursing opened at St. Thomas
 Trephining Hospital in London
 Herbman  Florence Nightingale
 Mabuting Hilot (good midwives)  Mother of Modern Nursing
 Also known as “The lady with the
lamp”
IMMUNOGLOBULINS
 Born on May 12, 1820 in Florence Italy
IgG – transplacental Ig (0-6 mos) viral  Entered the Deaconess School at
IgM – first Ig produced by the fetus Kaiserswerth
 Crimean War
IgA – colostrum (first 10 days of milk in postpartum  Two published books
woman) - Notes in Nursing
- saliva, tears - Notes in Hospitals
IgD – serum (unknown) E. PERIOD OF CONTEMPORARY NURSING
IgE – allergic reaction, smart, allergic rhinitis,  Period of WWII to the present
IQ – asthma April 7, 1948
 Establishment of WHO
Importance:
 Use of atomic energy for medical diagnosis
IgG – chronic diseases (old or past infections) and treatment
IgM – acute infection/diseases, new onset
1. PAXLOVID – combination of:

Dengue Duo 1. Nirmatrelvir – 300mg - covid

Should be taken in
5days after a
2. Ritonavir – 100mg – for aids
1. NS1 – non-specific protein (3days +) positive covid 19

2. IgG, IgM (5 days)

test
Prevents the degredation of
Nirmatrelvir in the liver
- Take it 2x a day for 5 days (12 hours apart)
Normal WBC + Abnormal Lymphocyte
(8am-8pm)
= Chronic Viral Infection
- repeat infection
SGPT = liver damage
- paxlovid mouth (bitter taste)
SGOT = liver, heart, muscle
2. Remdesivir – IV
3. Molnupiravir – 800mg 2x a day for 5 days
Hepa A – has cure, will recover
200mg/cap – 4 caps AM, 4 caps PM
Hepa B - will kill you due to bleeding
Virus – Hep B causes cancer
 Use of sophisticated equipments; computers
HCC – Hepatocellular Carcinoma  Health is perceived as a fundamental Human
HPV – cervical cancer right
 Development of the expanded role of the
nurse
B. PERIOD OF APPRENTICE NURSING
 Most care delivered by members of religious
orders ROLES OF A PROFESSIONAL NURSE
 Dasd 1. Caregiver
 Functions as nurturer, comforter, provider
C. DARK PERIOD OF NURSING  “mothering actions” of the nurse
 17TH -19TH CENTURY  Provides direct care and promotes comfort of
 Nurses Were Women Of Less Desirable client
 2. Teacher 6. Kale
 Encourages compliance with prescribed 7. Brussel Sprouts
therapy
Exercise – maximum 30 mins
 Promotes healthy lifestyle
 Interprets information to the client - 2-3 months > 45mins
- Trained medical interpreter - 2-3 months > 60 mins
- unfamiliar with the pt.
Stress – cortisol = blood sugar
ENCOURAGES COMPLIANCE WITH PRESCRIBED DM – Diet
THERAPY
Medication
Medication Lock / Hep. Lock
Exercise
S-A-S-H
Renal Failure
1. Sterile Saline
2. Administer meds 1. Limit exercise = creatinine
3. Sterile Saline 2. Limit fluid = edema
4. Heparin 3. Limit fruits + veggies = retain potassium

1. H2 blocker – famitidine Cooking Oil – olive oil

- famofidine - cannola oil use instead if no budget for olive oil

> stops secretion of HCL vegetable

palm exercise, activity

2. Proton Pump Inhibitors corn

- omeprazole, pantoprazole, esomeprazole coconut = HDL

- stop production of HCL

Risk AGE 3. Counselor – interpersonal skill
 Helps client to recognize and cope with
stressful psychologic or social problems; to
3. Antacid – aluminum – constipation
develop an improve interpersonal
Magnesium – diarrhea relationships and to promote personal
growth
 Provides emotional, intellectual to and
4. Cytoprotective Agents – sucralfate
psychologic support
- carafate
Increases mucus production; Cytotec (banned; 4. Change agent – initiate changes or assist clients
causes abortion) to make modifications in themselves or in the
system of care
Metronidazole –
Alcoholism – aversion therapy 5. Client Advocate - involves concerns for and
- disulfiram (Antabuse) actions in behalf of the client to bring about a
change.
- promotes what is best for the client,
PROMOTES HEALTHY LIFESTYLE
ensuring that the client’s needs are met
Anti-colon cancer and protecting the client’s right.
Cruciferous Vegetables - provides explanation in clients language
1. Cabbage and support clients decisions
2. Lettuce
3. Broccoli
4. Cauliflower
5. Bokchoy
6. Manager – makes decisions, coordinates EXPANDED ROLES OF A PROFESSIONAL NURSE
activities of others, allocate resources, evaluate 1. Clinical Specialists
care and personnel
a. Master’s degree in specialty
- plans, give direction, develop staff, b. Clinical expertise
monitors operations, give the rewards c. Provides expert care to individuals
fairly and represents both staff and d. Participates in educating health care
administration as needed professionals and ancillary
Levels of Management: e. Clinical consultant and participates in
research
TOP- Chief Nurse / Nursing Director
Nursing Specialist Cert. Program – council = BON
MIDDLE – Supervisors
- 10% of RN
LOW – head nurse / team leaders
- DOH
- Funded > PCSO, PAGCOR
Schedule: - Serve any public hospital – 2 years

1. Centralized – one person (chief nurse)

Ladder of clinical prof – Patricia Benner
2. Decentralized – by department
Novice: 0-1 yr exp – strict (rule-governed
- head nurse behavior)
3. Cyclical – repeated over time Ad. Beginner: 1-2 yrs – based on theory
- 4-6 weeks Competent (30mos): 2-3 yrs – based on client
4. Rotating Work Shift needs
AM – 45% RNs Proficient : 3-5 yrs – based on priorities
PM – 37% RN Wheeze – broncho, steroids
NOC - 18% RN Choke – stay but don’t intervene

Expert: 5 yrs – based on their intuition and

7. Researcher – participates in identifying instinct
significant researchable problems Ventilator Pressure Alarm
Purpose: to enhance /improve the quality of High pressure alarm – kinked, obstruction;
bedside care phlegm > suction
 Participates in scientific investigation and Low pressure alarm – leak in tubing,
must be a consumer of research findings disconnected
 Must be aware of the research process,
language of research, a sensitive to issues
related to protecting the rights of human 2. Nurse Practitioner
subjects.
a. Either as certificate program or a master’s
degree, certified by the appropriate
RRL – Brief and limited specialty organization
b. Skilled at making nursing assessments,
Purpose: performing physical examination,
1. to know what is known and unknown about counseling, treating and teaching minor
the topic of interest and self-limiting illness
2. to know the existing knowledge about the
topics of interest
  homeless  child Kussmaul’s Respiration – hyperventilation
 weeks of cough  non productive cough
 hemoptysis, weight  wheezing DKA – Ketones = Acidic: Metabolic Acidosis
loss, chills  afebrile - kidneys Urine = ketonuria
 XRAY to know the
extent of PTB in the - lungs kussmaul
lungs Acute Asthma
PTB
PKU Phenylalanine = Phenyl Ketones
 febrile Adult Infant Absence of
 productive cough – Confusion Crying S/Sx: Phenylalamine
yellow phlegm Light irritabiilty
(bacterial) headedness - blonde hair Hydroxilase
 Elderly – altered  Elderly - fair skin
mental status  History of smoking
 The current health - blue eyes
Pneumonia
promotion activity
Tyrosine = Melanin = dark
COPD pigment of the skin

COPD Biot’s
Chronic Bronchitis Pulmonary Emphysema - ineffective inhalation shallow breathing
 O2, phlegm prod Lack of recoil (alveoli) - lack of O2, increase carbon dioxide
 BLUE BOATERS Respiratory Acidosis – co2 in the body
- CO2 trapping
Cyanosis peripheral edema
PINK PUFFFER
 cor pulmonale: RV
Co2 exhale = blow off CO2
Hypertrophy- RHF Not done?
Compensatory Pursed Lip
R Sided L Sided Breathing a. Inspection
Systemic Pulmonary b. Palpation
- barrel chest: weight loss
c. Auscultation
d. Percussion
TSE – before 20 years old
Wheezing: musical sound
BSE – 7-10 days after
- narrowed airway
- compare changes from previous examinations
- Suddenly disappear – complete obstruction

Varicella – Zoster Virus (VZV) Chickenpox

Crackles: bubbling sound
Lesion vesicles= fluid filled
1. Fine crackles
Pockmarks – crater
- fluid: heart failure
“dewdrop on a rose petal lesion”
2. Coarse crackles
- more of phlegm: pneumonia
Posterior Horn of Spinal Cord
Reactivation: Herpes Zoster Virus – shingles
Pleural Friction Rub
- unilateral involvement
Grating Sound – they rub into each other
- Zebralike Skin (med stripes)
- PAIN: GABA – calms irritated nerves
Cheyne Stokes Respiration
Anterior: motor
- gradually increasing rate and depth of
respiration with intervals of apnea Posterior: sensory
Herpex Simplex Virus (HSV) Spinal Anesthesia
- sexually transmitted disease - flat on bed
- presence of blisters - 1 pillow
- supine
HSV1 – above the waist
HSV2 – below the waist (blister) General Anesthesia
- head surgery
Human Papilloma Virus (HPV) - bone marrow transplant
- warts
- prioritize: most oncogenic
- strains 16, 18 = causes cervical cancer Malignant Hyperthermia
- strains 6,11 = anugenital warts - reaction to gas anesthesia
- halothane
No warts unless break skin - sevorhorane
Presence of break skin = transmission of warts - hereditary
Syphilis:bacterial – treponemia - rapid muscle spasm
- penicillin - friction = high temp
Primary syphilis – chancre sore: painless ulcer
Secondary syphilis – condylomalatum: Wartlike 4. Nurse Anesthetist
lesions
- a nurse who completed the course of
Tertiary Syphilis – Gammas: Saclike study in an anesthesia school and carries
out preoperative status of clients
3. Nurse Midwife 5. Nurse Educator
- completed a program in midwifery; - with advanced degree, who beaches in
provides prenatal and post-natal care and clinical or educational settings, teaches,
delivers babies to woman with theoretical knowledge, clinical skills and
uncomplicated pregnancies conduct research
6. Nurse Entrepeneur
Episiotomy - to shorten the 2nd stage of labor - a nurse who has an advanced degree, and
manages health-related business.
2nd stage labor: (shortest stage of labor)
7. Nurse Administrator
- limit of one hour
- occurrence of full cervical dilation to the - a nurse who functions at various level of
delivery of the baby management in health settings
1st stage labor: (longest stage of labor)
- occurence of regular contraction to full
cervical dilation
- Primi: 18hrs
- Multipara: 12hrs
Episiotomy Repair – local infiltration
Lidocaine – anesthetic
- premature ventricular contraction
Nursing Theories
180mg/ dl
120
1. Florence Nightingale (environmental theory)
- manipulate the environment to facilitate Store – opened vial= room temp
recovery - unopened vial = fridge
- “maintain cleanliness”
Hypokalemia
2. Faye Glenn Abdellah
- low level of potassium in the blood
- (21 nursing problems)

Mixing of Insulin in a Syringe

 To maintain good hygiene and physical
comfort N – NPH (air)
 To maintain good body mechanics and R - regular (air)
prevent and correct the deformity
R – regular (withdraw)
 To facilitate the maintenance of
elimination N – NPH (withdraw)
 To facilitate the maintenance of fluid and
electrolyte balance
Regular – clear
NPH – cloudy
Ergonomic Principles
- Wide base of support – feet wide apart
- Bend on the knees “Clear first, before cloudy”
- Be as close to the object as possible
- Contract the gluteal, abdominal, arm and
3. Virginia Henderson
leg muscles
- (14 basic needs)
Na – dec brain swell (cerebral edema)
1. breathing normally
- increase BP
2. eating and drinking adequately
- 2500mg – 5000mg
3. eliminating body waste
HPN – 1500mg/ day – intake 4. moving and maintaining a desire
K+ - 90& is excreted via urine
Renal Failure – oliguric = dec urine = Retain K+
- high risk to hyperkalemia
Qualifications for Dialysis:
1. blood crea
2. Fluid retention – edema
3. K+ =6mEg/L

Diabetes Mellitus – insulin

Insulin
– given subq to facilitate a slow
release of insulin to the blood
- burn patient: facilitate the intracellular
onset of potassium
Maslow’s Hierarchy of Needs
IV – regular insulin 1 unit = 30-50 mg/d
First Nsg Priority (four conservation principles)
- do not call the doctor after cataract extraction Con. Principles
Renal Biopsy 1. Con of Energy-
- PAIN call the doctor 2. Con of structural integrity
Decubitus Ulcer
 Stage I – nonblanchable erythema of the
Self- skin
actualization
 Stage II – Dermis and epidermis
Self-esteem
 Stage III – subcutaneous
Love and belongingness  Stage IV – muscle shorthing the bones
Safety and security - joint capsules
Physiologic
Edema
 1+ barely Detectable up to 2 millimeters
 2+ = 2mm-4mm
4. DOROTHY JOHNSON
 3+ = 4mm-7mm – 5-7mm
- (behavioral system model)  4+ = above 7mm – increase 8mm
- behaviors affect health
IMOGEN KING (Goal Attainment Theory)
3. Con Personal Integrity – ego, self worth,
- growth and development dignity
 2 months - social smile 4. Con of Social Integrity – VISITOR
 4 months - turns to the side
 5 months - turns abdomen to back
 6 months - turns back to abdomen BETTY NEUMAN
The model has three interacting systems: (health care system model)
personal, interpersonal, and social Stress
 the concepts for the personal system are Intra - within the individual (pain, fever)
perception, self, growth, and development,
body image, space and time Inter – between persons
 the concepts for the interpersonal system are Extra – cause by the environment
interaction, communication, transaction, role
and stress.
 The concepts for the social system are 7. DOROTHEA OREM
organization, authority power, status, and (self care theory)
decision-making
3 COMPENSATIONS
1 .Wholly Compensatory – comatosed, bed
5. Madeleine Leininger ridden
(transculutural nursing theory) Firm – long strokes – inc venous return – prevent
- Respect the individual’s culture, preferences and clot formulation
beliefs Nitroglycerin – vasodilator = dec venous return
- patch – central (chest)
Avoid extremeties (forearm)
Hair: Clip the hair
6. Myra Levine Chest Physiotherapy
Vibration – shaking (care, core, cure)
Percussion – cupped hands  Core – therapeutic use of self
When – 1 hour before meals  Cure – doc’s orders (IVF, Meds)
 Care - nurturance given by the nurse
- before bedtime/ at bedtime

Stairs
2. Partially Compensatory – assistance
Elderly: Red/Yellow
Semi- dependent: Patient cannot walk but can
dress self - hear low pitch
- cannot see: green and blue
Nurse activity: gathers the items (clothes) – pt
dresses self Infants: Red, black, white

3. Supportive Educative – health teaching pt. - 7-8 months – colors

- hear – high pitch sounds
Pulling of pinna – child: down, back
8. HILDEGARD PEPLAU
Adult: up, back
(interpersonal model)
Catherization
4 PHASES:
- maintain a sterile closed system drainage
1. Orientation - encourage a liberal amount of fluid intake
- where you establish rapport - keep the urine collection bag lower than
the bladder
2. Identification
- patient is cooperative
Residual Urine
3. Exploitation
- catheterize the patient immediately after
- patient takes advantage of the nurse
voiding. Measure the voided and
4. Resolution catheterized urine
- discharge BP Cuff
Narrow – false high
9. Martha Rogers Wide – false low
(science of unitary human beings) Loose – false low
Person is more and difficult than the sum of Above the heart – false low
its parts HOLISTIC
Retake BP: 1-2 minutes
Deflate Cuff: 2-3 mmHg/second
10. Sister Callista Roy
Bronchoscopy
(Adaptation Model)
Nomal: blood streaks sputum
Manipulate the stressors to facilitate coping
Abnormal: Stridor – obstruction
Valves Aortic 2nd ICS
APT M Pumonic 2nd ICS
2245 Tricuspid 4th ICS
Mitral 5th ICS

11. Lydia Hall

Aortic -2nd-3rd ICS to the R
Pulmonic- 2nd to 3rd ICS to the L