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FUNDA LECTURE BY SIR BONDOC

Drug Administration

When administering any drug, regardless of the route, the nurse must do the
following;

1. Identify the client

2. Administer the drug

3. Provide adjunctive interventions as indicated

4. Record the drug administered

5. Evaluate the client’s response to the drug

Basic Five Rights

- Right drug

- Right dose

- Right time

- Right route

- Right client

Approximate Volume equivalents

1 ml = 15 drops
15 ml = 1 tablespoon
5ml = 1 teaspoon

Medications can be inserted through the rectum as a suppository. It is a convenient

and safe method in giving certain medications.

To insert a Rectal suppository

- Assist the client to a left lateral position, with the upper leg flexed
- Fold back the top bedclothes to expose the buttocks
- Don a glove on the hand used to insert the suppository
- Unwrap the suppository and lubricated the smooth rounded end. The
rounded end is usually inserted first
- Lubricate the gloved index finger
- Encourage the client to relax by breathing through the mouth
- Insert gently into the anal canal along the rectal wall using the gloved index
finger.
- Adult insert up to 4 inches, child or infant 2 inches or less

Wet to Dry Dressings

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- Next to wound surface is a layer of wide-mesh cotton gauze saturated with

saline or an antimicrobial solution. This layer is covered by a moist
absorbent material that is moistened with the same solution.
- Necrotic debris is softened by the solution and then adheres to the mesh
gauze as it dries. It is removed when the dressing is removed. Also,
moisture helps dilute viscous exudates.

Dietary considerations in Patients

Low Sodium diet is indicated for clients with edema, Congestive Heart Failure, renal
disease, Hypertension, ascites, and other conditions that necessitate decrease fluid
reabsorption.

Sodium Rich Foods include

Processed foods, bacon, ham, cheese, ketchup, table salt, food additives and
preservatives.

Low Potassium diet is especially indicated for Patients with kidney problems.

Potassium rich foods are the following

- Avocado, carrot, baked potato, raw tomato
- Dried fruits (raisins, prunes) bananas, cantaloupes, apricots , and orange
- Milk, orange juice, apricot nectar

Care for the Older Adult

Accident prevention is a major concern for elderly people.
Preventing falls
Make sure all rooms, hallways, and stairwells are adequately lit
Have an easily accessible light switch next to the bed
Leave a night light on
Get out of bed slowly
Make sure rugs and carpets are firmly attached to floors and stairs
For the hospitalized older adult Bed must be in lowest position, wheels locked, place
bed against wall.

Constipation is a problem in the elderly population. Many elderly believe that

regularity means a bowel movement every day.

Advise client that patterns vary from once a day, twice a day or every other day

Adequate roughage in the diet, adequate exercise and 6 to 8 glasses of fluid daily
are essential preventive measures for constipation.

The older adult should be warned against the use of laxatives because it interferes
with the body’s absorption of certain vitamins and affects electrolyte balance

Immobility
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- When collecting data pertaining to the problems of immobility, the nurse

uses the assessment methods of inspection, palpation, and auscultation;
- It is extremely important to obtain and record baseline assessment data
soon after the client first becomes immobile.
- Clients at risk for complications of immobility include those who are, poorly
nourished, have decreased sensitivity to pain, temperature, or pressure,
have existing cardiovascular pulmonary, or neuromuscular problems; and
are unconscious
- Immobility poses the same problems of muscle atrophy, contractures and
skin breakdown, depressed metabolism and bone demineralization on all
age groups

Pressure ulcers are also called decubitus ulcers, pressure sores, bedsores, or
distortion sores. A pressure ulcer is defined as any lesion caused by unrelieved
pressure ( a compressing downward force on a body area) that results in damage to
underlying tissue.
- Pressure ulcers are due to localized ischemia
- Two factors frequently act in conjuction with pressure to produce the ulcer
- Friction – a force acting parallel to the skin
- Shearing force – a combination of friction and pressure
- Risk factors – immobility and inactivity, inadequate nutrition,
hypoproteinemia, fecal and urinary incontinence, decreased mental status,
diminished sensation, excessive body heat, advanced age
- Treating/Preventing pressure sores
- Minimize direct pressure on the sore. Reposition the client at least two
hours. Make a schedule, and record position changes on the client’s chart
- Clean the sore daily
- Reduce friction
- Reduce shearing force by keeping the head flat and raised for up to 30
degrees
- Encourage ambulation and range of motion exercises
Pain
- Is a universal experience, its exact nature remains a mystery.
- It is the noxious stimulation of threatened or actual tissue damage
- It is whatever the person says it is, existing whenever he (she) says it does
- The client is the real authority about that pain
- To assess a client’s pain, the nurse obtains a pain history and conducts a
physical examination that focuses on the client’s physiologic and behavioral
responses to pain
- The nurse assess for location, intensity, quality, pattern, ..

NGT tube placement

- Is the instillation of specially prepared nutrients into the digestive tract
through a tube that is inserted through a tube that is inserted to one of the
nostrils, down the nasopharynx, and into the alimentary canal.
- The nurse is responsible for verifying tube placement before each
intermittent feeding and at regular intervals
- Methods include
- Apiration of gastric secretions
- Measure Ph of aspirated fluid (PH of 2 to 3) Intestinal fluids ( PH 7.5 to 8)
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- Injection of 5 to 20 ml of air while auscultating the episgastrum or left upper

abdominal quadrant and listening for a whooshing, gurgling or bubbling
sound
- Ask the client to speak or hum
- Observe the client for coughing and choking
- Radiographic verification of tube placement

Gastrostomy/Jejunostomy Feedings
- Is the intilation of liquid nourishment through a tube that enters a surgical
opening (called a gastrostomy) through the abdominal wall into the
stomach.
- A jejunostomy is the instillation of liquid nourishment through a tube that
enters a surgical opening ( a jejunostomy) through the abdominal wall into
the jejunum. These feedings are usually temporary measures. When there is
an obstruction in the esophagus, they may become permanent.

Fecal impaction
- Is a mass or collection of hardened, puttylike feces in the folds of the
rectum. Impaction results from prolonged retention and accumulation of
fecal material.
- In severe impactions the feces accumulate and extend well up into the
sigmoid colon and beyond.
- Fecal impaction is recognized by the passage of liquid fecal seepage
(diarrhea) and no normal stool. The liquid portion of the feces seeps out
around the impacted mass.

Osteoporosis
- Bone demineralization caused by depletion of estrogen, low calcium and
vitamin d levels, and absence of stress of weight bearing activity. The bones
may become spongy and fracture easily.
- Exercise helps maintain joint mobility. Moreover, bone density is maintained
through weight bearing. The stress of weight bearing balances osteoblastic
and osteoclastic activity.
Scoliosis
- Lateral curvature of the thoracic vertebrae.
- A postural deformity
- Is seldom apparent before the age of 10
- More common in females and is usually noticed during pre-adolescent

Fracture
- Break in the continuity of the bone.
- Children are prone because of increased activity
- Long bone fractures lead epiphyseal plate damage.
- The epiphyseal plate is where active bone growth occurs

Infant Nutrition
- The neonate’s fluid and nutritional needs are met by breast milk or formula.
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- The total dialy nutritional requirement of the newborn is about 80 to 100ml

of breast milk or formula per kilogram of body weight. Feedings are required
every 2 ½ to 4 hours.
- The infant needs burping after each ounce of formula or after 5 minutes of
breast feeding.

The Toddler
- Develop from no having no voluntary control to being able to walk and
speak.
- Learns to control bladder and bowel
- Acquire all kinds of information about their environment.
- Psychosocial task is Autonomy vs. Shame and Doubt
- Provide suitable toys
- Make positive suggestions rather than commands. Avoid an emotional
climate of negativism, blame and punishment
- Give the toddler choices, all of which are safe however limit to two or three
- When a toddler has a temper tantrum, make sure that the child is safe, and
then leave
- Help the toddler develop inner control by setting limits
- Praise the toddler’s accomplishments

Minimizing Anxiety
- Clients must first recognize that they are anxious
- If client react negatively, it is important for the nurse to understand this
response and react in a calm, accepting and confident manner.
- Discuss possible reasons for their anxiety
- Support the client and family at a time of illness by conveying care and
understanding
- Provide information when the patient has insufficient information
- Encourage participation in care
- Communicate competence, understanding and empathy
- Encourage humor

Evaluation of Teaching
- Teaching clients and families about their health needs is a major role of the
nurse
- Learning is measured against the predetermined learning objectives that
were selected in the planning phase of the teaching process
- Learning is represented by a change in behavior
- Bloom has identified three learning domains; cognitive, affective, and
psychomotor.

Obtaining a Sputum Specimen

1. Description- a specimen obtained by expoctoration or tracheal
suctioning to assist in identification of organisms or abnormal cells.
2. Preprocedure – Determine the specific purpose of collection check with
institutional policy for appropriate collection of specimen
Obtain an early morning sterile specimen from suctioning or expectoration after a
respiratory treatment, if a treatment is prescribed.
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Obtain 15ml of sputum

Instruct the client to rinse the mouth with water before collection
Instruct the client to take several deep breaths and then cough deeply to obtain
sputum.
Always collect the specimen before client begins antibiotic therapy

Interventions For a client with COPD

C. Interventions
1. Monitor v/s
2. Administer a low concentration of oxygen ( 1 to 2 L/min) as prescribed; the
stimulus to breathe is a low arterial PO2 insteadof an increase PCO2
3. Monitor pulse oximetry.
4. Provide respiratory treatments and CPT.
5. Instruct the client in diaphragmatic or abdominal and pursed lip breathing
techniques.
6. Record the color, amount, and consistency of sputum.
7. Suction fluids from the clients lungs, if necessary, to clear the airway and
prevent infection.

Suctioning procedure
- use aseptic technique
- hyperoxygenate client by a resuscitation bag, increasing the o2 flow rate, or
by asking the client to take deep breaths
- lubricate the catheter with sterile water
- tracheal suctioning- insert 4 inches
- nasotracheal suctioning – insert catheter to initiate coughing reflex
do not apply suction while inserting the catheter
apply suction intermittently for 10 sec ; rotate the catheter and withdraw
hyperoxygenate the client and encourage deep breaths