COMMUNICATION ➢ Playing an increasing role in nursing

By: Prof Zeny Maroma Bautista practice. Many health care agencies are
Definition moving toward electronic medical
➢ Communication is the exchange of records where nurses document their
information, ideas, thoughts, or feelings, assessments and nursing care.
between two or more people. ➢ The nurse ability to established effective
➢ It is the basic components of human communication in nursing is imperative
relationship including nursing. and providing the best care and patient
MODE OF COMMUNICATION outcomes possible.
Verbal Communication ➢ Communication is an integral part of the
➢ Uses methods such as talking and helping relationship
listening. Effective Communication of Nurses
➢ Could also be form of writing, reading, able to:
storytelling or any forms of ➢ Collect assessment data
communication that uses words. ➢ Initiate interventions
Non-Verbal Communication ➢ Evaluate outcomes
➢ Uses gestures, facial expressions, and ➢ Initiate change that promotes health
body movements. ➢ Prevent safety and legal problems
➢ Also includes physical appearance, eye associated with nursing practice
contact, posture, gait and many more. ➢ Effective communication is essential for
Written Communication the establishment of a nurse-client
➢ Uses any forms of written materials such relationship.
as books, magazines, and any written Components
materials. ➢ Trust
PERCENTAGE OF ➢ Genuine interest
COMMUNICATION METHODS ➢ Empathy
➢ Verbal and Non- Verbal Communication ➢ Acceptance (Positive Required)
occur currently. The majority is Non- ➢ Therapeutic use of self
verbal, why? It is because verbal Trust
communication comprises only 10% and
➢ development of trust is the key factor in
non-verbal is 90%.
establishing therapeutic relationship or
➢ Note: Action Speaks Louder Than Words
vital step in the recovery process
(It is this for this reason that when
Genuine Interest
interacting with others, particularly to
➢ when the nurse is comfortable with
your pt. you should observe not only what
himself or herself, aware of his or her
they are (client) saying, but more or so
strengths and limitations, and clearly
with his/her non-verbal communication.
focused, the client perceives genuine
NEW FORM OF COMMUNICATION
person showing genuine interest.
Electronic Communication
➢ The nurse should be open and honest and
➢ Highly beneficial to people,
display congruent behaviour.
organizations, or industry if it is managed
effectively.
➢ Method that we used in online classes

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 Empathy ▪ Feedback – is the return response of
➢ The ability to perceive the meanings and the receiver. (tugon)
feelings of the client and to communicate NOTE: Communication can be described as
that understanding to the client. helpful or unhelpful.
➢ One of the essential skills a nurse must ➢ Helpful – when it encourages sharing
develop. information, thoughts, or feelings bet.
➢ Both the client and the nurse give a “gift two or more people
of self” when empathy occurs. ➢ Unhelpful – when it hinders or blocks
➢ Essential skills must nurse be developed transfer of information and feelings.
Acceptance Consider the ff: when Communicating in
➢ It is a principle of action in which a nurse a face-to-face manner
perceives and work with the pt. as what Pace and Intonation
he really is accepting his congenial and ➢ Manner of speech, rhythm, and tone of
uncongenial attitude and positive and voice
negative feelings while maintaining a Simplicity
sense of pt’s innate worth. ➢ Commonly understood words
Therapeutic Use of Self Clarity
➢ Is forming a trusting relationship that ➢ Saying precisely what is meant
provides comfort, safety, and non- Brevity
judgmental acceptance of clients to help ➢ Using fewest words possible
them improve their health status. Timing and Relevance
➢ It requires self-awareness and use of ➢ Involves in the sensitivity clients’ needs
effective communication techniques. and concerns
Communication Credibility
➢ Is a process it consists of certain steps ➢ Means the worthiness of beliefs, trust
which each step constitutes the essential worthiness and reliability.
of communication. ➢ Most importance criterion in
➢ Goals of communication process is to communication
influence others and facilitates change ➢ Must consistent, dependable, and honest
➢ It is a two-way process involving the Humor
sending and receiving a message ➢ Can be powerful tool in the nurse-patient
▪ Sender – is the source/encoder who relationship but it must be use with care
wishes to communicate the message ➢ To help the client adjust in difficult and
(magbibigay ng mensahe or content) painful situations
▪ Message – is being said or written the Factors that Influence the
body language that accompanies the Communication Process
word in how it is being transmitted Personal Space
(mensahe o yung content) ➢ It is the distance people prefer in
▪ Receiver – is the decoder who will interactions with others
perceive what is the sender intended to ➢ Communication alters w/ the 4 distances;
relate. (ang tatanggap o tumatanggap 1. Intimate – o to 1 ½ feet
ng mensahe) charac. by: body contact ex. Cuddling a
baby or assessing pt. who is blind

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 2. Personal – 1 ½ to 4 feet ➢ Communication is congruent when verbal
charac. by: nurse-patient interaction and and non-verbal communication
providing nursing care harmonize with each other.
3. Social – 4 to 12 feet Helping Relationship
charac. by: group discussion, classes, ➢ A therapeutic nurse pt relationship is
meetings, and etc. defines as a helping relationship that is
4. Public – 12 feet and beyond based on mutual trust, respect, nurturing,
charac. by: conferences, tournaments or being sensitive to others and assisting
other public activities. with gratification of the pt’s physical,
Boundary emotional, and spiritual needs through
➢ are the defining limit of individual to your knowledge and skills.
keep clear boundaries the nurse must Four Phases/Stages in a Helping
maintain the professional boundary bet. Relationship
the nurse-patient relationship. Pre-Interaction Orientation Phase
➢ Respect the client’s boundaries ➢ Gathering information; recognizing
➢ Physical boundaries limitations and seeking assistance as
➢ Social boundaries required
➢ Personal boundaries ➢ Clients name, address, age, medical and
➢ Material boundaries social history
Gender ➢ Nurse should consider her personal
➢ Many lumens communicate differently, strength w/ working w/ the client
and they may interpret the same Introductory/Orientation Phase
communication in a different manner. ➢ Establishing a relationship develop trust
Values and Perception and respect, setting, goals, and security
Values within the nurse-client relationship
➢ Standards that influence behaviour Working Phase
Perception ➢ Working with client on the identified
➢ View of personal events problems and evaluating and modifying
➢ Each person has unique personality traits goals as appropriate
values and life experiences each will Termination Phase
perceive and interpret messages and ➢ Summarizing or review with client, his
experiences in a different way. progress and assessing his ability to
Interpersonal Attitude handle problems independently.
➢ Communicated convincingly and rapidly Therapeutic Communications Techniques
to others ➢ Using silence (Offering self)
➢ Attitude such as caring, warmth, respect ➢ Providing general leads (Giving
and acceptance facilitate communication information)
whereas lack of interest and coldness ➢ Using open-ended questions (Giving
inhabit communication recognition)
Attentive Listening Congruence ➢ Using touch (Clarifying time or
➢ Is listening actively and mindfulness and sequence)
using all senses and paying attention to ➢ Actively listening (Focusing)
what the client is saying, doing or feelings ➢ Seeking clarification (Reflecting)

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➢ Seeking consensual validation People of Different Culture
(Summarizing and planning) ➢ The nurse should speak slowly and use
Barrier to Communication different words to express same ideas.
➢ Nurses need to recognized barriers or ➢ During the interview, the pt maybe
nontherapeutic responses that affects reluctant to reveal personal information
effective communication. Failure to to strangers for various culture base
listen, improperly decoding the client’s reasons
intended message, and placing the nurse’s ➢ The nurse should be aware on client’s
needs above the client’s needs are major culture and understand variations in
barriers to communication. disease perceptions, family roles, and
Non-Therapeutic Communication meaning of non-verbal communication
Techniques such as eye contact, handshaking, and
➢ Stereotyping other gestures.
➢ Agreeing and disagreeing
➢ Being defensive (Yung Therapeutic is sa midterm talaga sya
➢ Challenging kasama, pero last minute na sya inupload
➢ Probing nung midterm day and hindi sya lumabas sa
➢ Testing exam. So, sinama ko sya sa reviewer incase
➢ Rejecting na masama sya sa finals. Huehuheuhe
➢ Changing topics aralwelllzz!!! – Elay)
➢ Unwarranted reassurances
➢ Giving personal opinion MEDICAL ADMINISTRARION
➢ Approving and disapproving By: Ma’am Sharon B. Cajayon, RN
Special Consideration when Definition
Communicating ➢ A medication is a substance administered
Elderly for the diagnoses, cure, treatment, prevent
➢ The nurse should consider the hearing or relief of a symptom or for prevention
ability of the clients and treatment of disease.
➢ The nurse should speak clearly and Types of Medication
clarify statements, as necessary. ▪ Oral – capsule, tablet form or liquid
➢ interview the client with significant form
others if he/she is confused or forgetful ▪ Suspension
Child ▪ Topical Medication – pinapatak sa
➢ The nurse should use symbol words and tenga o mata or ointment
the level of the child’s understanding Purpose of Medication
➢ Maintain eye contact and same eye level 1. Diagnostic Purpose – to identify
with the child disease. (ex. Radio contrast dye -
➢ Parents should be present during the (ina-identify kung ano yung sakit o
interview as required klase ng microbes meron ang pt;
Highly Emotional Clients tuberculosis testing).
➢ The nurse needs a lot of patient 2. Prophylaxis – to prevent the
➢ Should be respectful and accepting occurrence of disease. (ex. Heparin to
regardless on their mood and behaviour. prevent thrombosis, vaccine)

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 3. Therapeutic purpose – to cure the
disease. (umiinom ng gamot ang pt PRN order
para gumaling , for curative process.) ➢ Latin “pro re nata”
(ex. Antibiotics) ➢ Administered as required by the patient’s
4. Suppression – suppresses the signs condition
and symptoms and prevents the ➢ The nurse makes the judgement, based on
disease process from progressing. patient assessment, as to when such a
(hindi man ganun gumaling, pero medication is to be administered.
nabawasan ang mga s/s, para hindi ➢ As needed, as necessary
lumala.) - ex. May lagnat ang patient - temperature
NOTE: All medication must be stored in a 37.9 or above 37.9, ibibigay na yung
cool dry place (usually in cabinets, medicine paracetamol.
carts or fridges) Routine orders
➢ may mga gamot na nagrerequire ng ➢ Orders not written as
higher temperature or malamig na STAT/ASAP/NOW/PRN.
temperature ➢ These are usually carried out within 2
ex. Insulin (ref) hours of the time the order is written by
Abbreviations – Types of the physician.
Drug/Medication Order Standing order
STAT order ➢ Written in advance of situation that is to
➢ refers to any medication that is needed be carried out under specific
immediately and it is to be given only circumstances. ex. Set of postoperative
once. PRN prescriptions that are written for all
➢ Often associated with emergency patients who have undergone a specific
medications that are needed for life- surgical procedure. “Tylenol elixir
threatening situations. 325mg PO every 6 hours PRN sore
➢ Comes from the latin word “statim” throat.”
meaning immediately ➢ Standing orders are no longer permitted
➢ Should be administered within 5 minutes in some facilities because of the legal
or less receiving the written order. implications of putting into a single
ASAP order treatment category.
➢ Not as urgent as STAT - ex. Antibiotic – order q8 hours for one
➢ As soon as possible week, yun yung susundin unless
➢ Should be available for administration to pinatigil o diniscontinue ng physician.
the patient with 30 minutes of the written ▪ ac – before meals
order. ▪ AM – morning
Single order ▪ b.i.d – twice per day
➢ For a drug that is to be given only, once ▪ cap – capsule
and at a specific time, such as a RIGHTS OF MEDICATION
preoperative order. (mga gamot na wala 1. Right Patient – correct identification
ng kasunod one time order) of the client cannot be over
- ex. Mga gamot na binibigay bago emphasized.
operahan at wala ng succeeding doses

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 2. Right Medication – before 9. Right Documentation –
administering any medicine, compare documentation should be done
name on medication chart/medication medication and not before.
order with that on the medication at 10. Right Evaluation – conduct
least 3 times-checking medication assessment to ascertain drug action,
label when removing it from storage both desired an side effect.
unit, compare medication label when ROUTE OF ADMINISTRATION
with that on treatment chart and ➢ Kung saan idadaan ang gamot
medication label and name on - Different route of drug administration
treatment chart with patient’s name are:
tag. ▪ Oral
3. Right Time – drug timing is very ▪ Parenteral
especially with some drugs like ▪ Topical
antibiotics, to achieve cure and ▪ Inhalation
prevents resistance. Some drugs must Tablet
be given on empty stomach. (e.g. ➢ It is the powdered medication
antituberculosis drugs; and some after compressed into hard disk or cylinder.
meal) Capsule
4. Right Dose – careful and correct ➢ Medication covered in gelatin shell.
calculation in important to prevent Gel or Jelly
over or under dosage of the ➢ A clear or translucent semisolid that
medication. liquefies when applied to the skin.
5. Right Route – per orem, IM, Lozenge
Sublingual, IV ➢ A flat, round, or oral preparation that
6. Right to information on drug/client dissolves and releases a drug held in the
education – the patient has the right mouth.
to know the drug he/she is taking, Lotion
desired and adverse effects and there ➢ Drug particles in a solution for a topical
is to know about the medication. use.
7. Right to Refuse Medication – the ➢ Ointment semisolid preparation
patient has the right to refuse any containing a drug to be applied
medication. However, the nurse is externally.
obliged to explain to patients why the Powder
drug is prescribed and the ➢ Single or mixture of finely ground drugs.
consequences refusing medication. ➢ Solution a drug dissolved in another
8. Right Assessment – some substance.
medications require specific Suspension
assessment before their ➢ Finely divided, undissolved particles in a
administration. (e.g. checking vital liquid medium; should be shaken before
signs) use.
NOTE: May gamot na kailangan e check ang Syrup
BP bago ibigay para malaman kung may ➢ Medication combined in a water and
pagbabago. sugar solution. (pediatric patients)

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 Suppository Inhalation Route
➢ An easily melted medication preparation ➢ Administer inhaled medication through
in a firm base such as gelatin that is the nasal and oral passages or
inserted in the body. (vagina, rectum) endotracheal or tracheostomy tubes.
Transdermal Patch ➢ ex. Salbutamol – placing in nebulizer
➢ Unit dose of medication applied directly (difficulty in breathing or asthma)
to skin for diffusion through skin and Step in Oral Medication
absorption into the bloodstream. ▪ check for the doctor’s order for
Oral Route medication administration and
➢ Given by mouth ▪ wash hands and prepare all the materials
▪ Sublingual Administration – some such as medication cup, glass of water
medications are readily absorbed when or juice straw if needed. Applies sterile
placed under the tongue to dissolve. technique during the entire procedure
▪ Buccal Administration – administration ▪ prepare the medication. Read the order
of a medication by placing in the mouth on the medication form and obtain the
against the mucous membranes of the correct medication from the cabinet or
cheek until it dissolves. cart.
CONTRAINDICATION ▪ Identify the client and explain the
➢ Vomiting procedure, read the medication card and
➢ Reduced GI motility (after GAM bowel gain informed consent prior to the
inflammation) procedure.
➢ s/y resection of portion GIT ▪ Be sure that you have 5R’s (right
➢ inability to swallow patient, right medication, right route,
➢ pts with gastric suction/aspiration right dose, and right time).
➢ prior to certain test/surgery ▪ Explain the procedure to allay any fears
➢ unconscious/confused people and anxiety client may have. Ask for
➢ poor gag reflex any allergy to medication and check for
➢ ex. Unconscious patient ginagawang any contraindication of the drugs.
powder or dinudurog ▪ Place the patient in a comfortable and
Steps for Administering Oral Medication right position and provide privacy
➢ pour the required number of pills into the ▪ Give the patient a glass of water or juice
lid then placed medication cup and have the patient place the
➢ the person should be upright preferably medication in the back of his mouth,
sitting take sip of water, and swallow. Most
➢ give the medication and liquids medication dissolves better and causes
➢ be sure to chews, chewable tablet less stomach discomfort when it is taken
completely before swallowing with adequate liquid.
➢ be sure the person has swallowed his/her ▪ Remain in the bedside until the
medication medication is swallowed, do not leave
➢ return the medication to its proper storage medication at the bedside for the patient
location to take later.
▪ Place the client in comfortable position

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 ▪ Dispose all the waste material in a ▪ For bottles with a dropper, check that
proper container the dropper is clean and not cracked or
▪ Wash hands and document the chipped.
procedure done ▪ Position the head so that the ears face
NOTE (Documentation): Date, Time, Name upward. It may be easiest if the person
of medication, Dose, Route, and signature. tilts their head or lies down on their side.
Topical Route ▪ If the bottle has a dropper, draw some
➢ Medications applied to the skin and liquid into the dropper. If the bottle has
mucous membranes (eye, ears, nose, a dropper tip, you’ll just need the bottle
mouth, vagina, urethra, rectum) upside down.
➢ Ito yung mga pinapatak (e.g eye drops) ▪ For adults, gently pull the upper ear up
EAR DROPS – Otic Drops and back. For children, gently pull the
➢ Like ofloxacin lower ear down and back. Squeeze the
➢ It depends on the doctor if how many correct number of drops into the ear.
drops are needed ▪ Gently pull the earlobe up and down to
➢ Manner: allow the drops to run into ear. Keep the
▪ Aldult: pull it up then back head tilted for about two to five minutes
▪ Pediatric: down and back so the drops can spread into the ear.
How to Use Ear Drops Correctly ▪ Wipe away any extra liquid with a tissue
or clean cloth.
▪ Put the cap back on the bottle
▪ Wash your hands to remove any
medication.
▪ Document the procedures.
NOTE (Documentation): Date, Tome,
Name of medication, Dose, Route, and
signature.
Steps in Otic/Ear Drops Steps in Eye Drops
▪ Gather your supplies. These include the ▪ Gather your supplies. This includes
bottle of ear drops and a tissue or other the bottle of eye drops and a tissue or
cloth to wipe away any drips. other cloth to wipe away any drips.
▪ Wash your hands with soap and water ▪ Wash your hands with soap and water
▪ Identify the patient, explain the ▪ Identify the patient, explain the
procedure procedure
▪ Warm the ear drops by holding the ▪ If you need to take more than one type
bottle in your hand for one to two of eye drop at the same time, wait 3 to
minutes. This can help reduce any 5 minutes between the different kinds
discomfort that could be caused by cold of medication.
drops in your ears. ▪ Shake the drops vigorously before
▪ Remove the cap from the bottle. Place using them
the cap of the bottle on a clean, dry ▪ Remove the cap of the eye drop
surface. medication but do not touch the
dropper tip

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 ▪ Tilt your head back slightly and look Site for Intradermal Injection
up. ➢ Common injection sites include the inner
▪ Use on hand to pull your lower eyelid surface of the forearm and the upper back,
down, away from the eye. under the shoulder blade
▪ Hold the dropper tip directly over the NOTE: NO presence of any redness, rash, or
eyelid pocket inflammation.
▪ Don’t touch the bottle to your eye or ➢ Kapag may redness na at doon mo
eyelid ituturok yung drug hindi malalaman sa
▪ Squeeze the bottle gently and let the result kapag cause ba sya ng solution na
eye drop fall into the lid tinurok.
▪ Keep your eyes closed. EQUIPMENT
▪ While your head is still tilted back, ▪ Medication
open your eyes and blink several ▪ Gloves
times until the drop rolls into the eye ▪ Syringe 1cc
▪ Wash hands and document the ▪ Alcohol swab
procedure. ▪ Cotton balls w/ & w/out alcohol
Steps in Eye Ointment ▪ Ballpen – black or blue color (bawal
▪ Hold the tube ointment close (within gumamit ng red ink)
1 inch) of your eye REMEMBER
▪ Gently pull down your lower lid ➢ Don’t choose an injection sites that’s
▪ Squeeze a tiny amount of ointment inflamed, burned, or hairy, or that has a
- Newborn - inner to outer canthus- - lesion or traumatic injury.
- Adult - pwedeng center or inner to ➢ Don’t administer more than 0.1 ml
outer for both eyes, depende sa order intradermally without questioning and
ng doctor. confirming the order.
▪ Allow the patient to close his/her eyes ➢ Don’t massage the site after giving the
for 3-5 minutes injection because doing so can cause a
▪ Kapag may another medication let the false-positive result.
patient rest for 15 minutes (interval MANNER
for next medication) ➢ Kung paano e-inject
▪ Wash your hands and dispose all the ➢ bevel up 10–15-degree angle
soiled materials. ➢ Administer until wheal formed
▪ Document the procedure ➢ Add marking – circle
INTRADERMAL INJECTION ➢ And label
By: Maam Sharon B. Cajayon MAN,RN Preparation of Medication
Definition ▪ Get the chart of the client, verify the
➢ It is often abbreviated ID, is a shallow or medication
superficial injection of a substance into ▪ Prepare the materials needed
the dermis, which is located bet. the ▪ Get the medication card;
epidermis and the hypodermis. ➢ name of the patient,
➢ It is done for diagnostic purposes, such as ➢ name of drug
allergy or tuberculosis testing. ➢ dosage
➢ frequency

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➢ at the back is the name of the nurse and 13. Encircle the site of the wheal using
signature black or blue ballpen and mark the due
▪ hand hygiene date and time
▪ prepare medication 14. Do not recap the needle and dispose it
▪ wear gloves properly
NOTE: kapag nag aspirate ka ng needle sa 15. Explain to patient the possible outcomes
medication, kailangan palitan ito ng bago 16. Place the client in comfortable position
before iturok sa patient. 17. Wash hands and document the
CONCENTRATION procedure done.
➢ Medication – 0.1 RESULTS: after 30 minutes kapag may
➢ Sterile water – 0.9 redness and nangati, ibig sabihin may
Administering Intradermal Injection allergy yung patient sa medication. Dapat
1. Check for the doctor’s order for walang redness, walang itchiness and let
medication administration and prepare the doctor know the results and document
materials and solution for injection. the procedure.
Applies sterile technique during the INTRAMUSCULAR INJECTION
entire procedure. By: Ma’am Sharon B. Cajayon MAN,
2. Identify the client and explain the RN
procedure, read the medication card. Administering Parenteral Medications
3. Allay any fears and anxiety client may ➢ Parenteral administration of medication is
have. the administration of medication by
4. Place the patient in a comfortable and injection
right position. ➢ Parenteral administration is an invasive
5. Identifies the anatomical landmarks by procedure that must be performed with
palpation and inspection and identify aseptic techniques
the injection site correctly. ➢ After needle pierces the skin, the patient
6. Clean the injection site with cotton ball is at risk of infection
with alcohol using circular motion, ➢ Before giving the medication, you need
working from the site of injection verify the doctor’s order and to assess the
outward. skin of the patient, if they have drug
7. Place a dry cotton ball in between allergy or specific drug allergy (e.g., past
fingers, remove needle cap and expel air trauma or shock)
bubbles. ➢ Each type of injection requires the
8. Uses free hand to stretch the skin. application of specific skills to ensure the
9. Insert the needle, bevel up 10 -15- medication reaches the proper location.
degree angle just under the skin ➢ The effect of a parenterally administered
10. Release the skin, anchor the barrel, and medication develops rapidly, depending
injects the medication slowly until on the rate of medication absorption.
wheal is formed. ➢ Always closely observe the patient’s
11. At the same angle, withdraw the needle response.
12. Wipe the excess medication on the - Manner - 90-degree angle
injection site using dry cotton ball
without pressing the wheal

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 - It focuses on injecting the muscle 2. When the clients are unable to take
medicine orally
3. When oral medications are
contraindicated
4. When medication available from of
injectable (vaccines)
Intramuscular Injection Sites
▪ Ventro gluteal muscle
▪ Dorso gluteal muscle – NOT
NEEDLE GAUGE
RECOMMENDED
➢ Needle opening or needle circumference
▪ Deltoid muscle
▪ Vastus lateralis – highly
recommended muscle for pediatric
patient (2 years – below)
ANGLE

➢ Needle diameter is measured by gauge

➢ As the gauge becomes smaller, the needle
diameter become larger
➢ An intramuscular injection usually
requires an 18-to-27-gauge needle,
depending on the viscosity of the
medication.
➢ Syringes come in numerous sizes, from
0.5 mL to 60 mL.
➢ A 1 to 3 mL syringe is usually adequate
for a subcutaneous or intramuscular
injection. The use of a syringe larger than
5 mL is unusual for an injection. The
larger volume creates discomfort. EQUIPMENTS
NOTE: the more na mas mataas ang gauge ➢ Proper size syringe and needle
mas maliit or manipis, th e more na mas ➢ IM: syringe 2-3 mL for adult, o.5-1 mL
maliit ang gauge mas malaki. for infants and small children
Intramuscular Injection ➢ Needle, with length corresponding to the
➢ It is a technique used by Registered Nurse ➢ Site of injection and the age of the patient
Practitioner in introducing Medication ➢ Any site (children): 1.6-3.2 cm
into Muscles Tissues through needle in (depending on the size of the child)
different sites. ➢ Deltoid (adults): 2.53.8cm
Purpose of IM Injection ➢ Ventrogluteal (adults): 3.8cm
1. To introduce drugs into the muscular
tissue for quick absorption

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 7. While maintaining the sterility of the
needle, taut the skin of the injection site
and trust the needle into the muscles at
90-degree angle
8. Check the presence of the blood by
pulling the plunger backward and
verbalizes what to do in case blood is
aspired
➢ Small gauze pad, or alcohol swab, or both 9. If blood is not aspired, inject the
cotton ball with alcohol and dry cotton solution
balls 10. Removes the needle smoothly and
➢ Vial or ampule of medication quickly at 90-degree angle
➢ Clean gloves 11. Applies gentle pressure against
➢ Medication administration record (MAR) injection site using a swab
or computer printout 12. Does not recap the needle and dispose
- 1cc syringe – called tuberculin syringe needle and syringe properly
Intramuscular Injection Deltoid Muscle 13. Position the patient comfortably
➢ The acromion, is a bony process on the 14. Wash hands and document the
scapula (shoulder blade) procedure done
➢ Most typically used for vaccines - Date
➢ Inject, aspirate and no blood - Time
Administering Intramuscular Injection - Name of the drug
(Deltoid) - Dosage
1. Check for the doctor’s order for - Route
medication administration and prepare - Frequency
materials and solution for injection. - Signature of the nurse
Applies sterile technique during the SUBCUTANEOUS INJECTION
entire procedure By: Maam Sharon B. Cajayon MAN, RN
2. Greet and identify the patient and Definition
explain the procedure and read the ➢ It is a method of administering
medication card medication under the skin
3. Place the client in comfortable position ➢ A short is used to inject a drug into the
(sitting or high fowler’s position) tissue layer between the skin and the
4. Identifies the anatomical landmarks by muscle
palpation and inspection and identifies ➢ Abbreviated as:
injection site correctly. - SC
5. Clear the injection site with alcohol - SQ
using circular motion working from site - sub-cu
of injection outward - sub-Q
6. Place cotton ball with alcohol in - SubQ
between fingers, removes needle cap, - subcut
and maintain sterility of the needle

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➢ it is administered in the loose connective NOTE: sa pag inject hindi palagi doon sa
tissue, the layer of the skin directly below same site or same part ang pag i-injection.
the dermis and epidermis
➢ subcutaneous tissue has few blood
vessels
➢ drugs injected by SC are for slow,
sustained rates of absorption
➢ SC – slower than intramuscular injections
➢ Faster than intradermal injections
Subcutaneous Injection Sites
a. Outer aspect of upper arm -IM – 90-degree
b. Abdomen – 4 cm away from the -SubQ – 45 degree
umbilicus, avoiding a 2-inch circle
around the navel, this has the fastest
rate of absorption among the sites.

EQUIPMENT
➢ A 25 (orange) to 30 gauge thick
➢ 3/8 to 1 long needle can be used. The size
c. Anterior aspect of the thigh, 4 inches is determined by the amount of
above the knee. This has a slower rate subcutaneous tissue present, which is
of absorption than the upper arm. based on patient build
d. Upper area of the buttocks, just ➢ Suitable for small volume (0.5ml to 1 ml);
behind the hip bone. This has the water-soluble
slowest rate of absorption among the ADDITIONAL:
sites. ➢ Syringe appropriate for the medication
Medications used in Subcutaneous being given.
Injections ➢ Needle (3/5 or 5/8 inch)
- Insulin for diabetes ➢ Alcohol pad
- Blood thinners, such as heparin ➢ Medication ampule or vial
- Some fertility drugs ➢ Disposable gloves
- Morphine ➢ Kidney tray
➢ One sterile gauze or cotton piece
➢ One tray
PROCEDURE
➢ A 5/8 needle is usually inserted at 45
degrees.
➢ Medication is administered slowly, about
10 seconds/milliliter

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 Administering Subcutaneous Injection - Route
1. Check for the doctor’s order for - Frequency
medication administration and - Signature of the nurse
prepare materials and solution for SUCTIONING: Oropharyngeal
injection. Applies sterile technique Nasopharyngeal
during the entire procedure By: Maam Sharon B. Cajayon MAN, RN
2. Observe the 10 rights in giving Definition
medication ➢ Aspirating secretions through a catheter
3. Identify the client and explain the connected to a suction machine or wall
procedure, read the medication card suction outlet
4. Place the client in comfortable Upper airway suctioning:
position (sitting or supine lying) - Oropharyngeal suctioning
5. Identify the anatomical landmark by (pagtatanggal ng mga secretions sa
palpation and inspection, identify the bibig)
injection site correctly. - Nasopharyngeal suctioning
6. Clean the injection site using cotton (pagtatanggal ng mga secretions sa
ball with alcohol, circular motion, nose)
working from the site of injection MACHINE
outward ➢ Wall mounted – naka dikit sa wall
7. Place dry the cotton ball in between ➢ Portable suction machine – nasa bed
fingers, remove the cap of the needle side lang na pwedeng ma on and off
and maintains the sterility of the kapag kailangan
needle. PURPOSES
8. Grasp the skin firmly between the ➢ To remove secretions that obstruct
thumb and forefinger to elevate the the airway (para makahinga ng
subcutaneous tissue (cushion the maayos)
skin) ➢ To facilitate ventilation (maganda
9. While supporting the injection site, yung pag inhalation and exhalation ng
thrust the needle into the tissue at 45- hangin)
degree angle and inject the solution. ➢ To obtain secretion for diagnostic
10. Remove the needle slowly and purposes (kapag kailangan ipa-
quickly at 45-degree angle (do not laboratory yung mga secretions)
massage) ➢ To prevent infection that may result
11. Apply gentle pressure in the injection from accumulated secretions
site with a swab Assess for Clinical Signs
12. Do not recap the needle, dispose it ➢ Restlessness/anxiety
properly ➢ Gurgling sound during respiration
13. Wash hands and document the ➢ Adventitious breath sound – may mga
procedure done iba’t ibang abnormal sound na
- Date marirning
- Time ➢ Change in mental status
- Name of the drug ➢ Skin color – check the lips and nails if
- Dosage there is poor oxygenation

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 ➢ Rate and pattern of respiration
➢ Pulse rate and rhythm – may
pagbabago or abnormal RR and
rhythm
Indications for Suctioning
➢ Noisy breathing
(if naka connect ang pts a ventilator
SIZES OF SUCTION CATHETER
tutunog ito sign na kailangan e suction
➢ Adult
ang pt)
- French #12 to 18
➢ Audible of visual signs of secretions in
➢ Children
the tube
- French #8 to 10
➢ Signs of respiratory distress
➢ Infants
➢ Suspicion of a blocked or partially
- French #5 to 8
blocked tube
SUCTION DEVICE
➢ Inability by the child to clear the tube by
Wall Unit – Suction Pressure
coughing out the secretions – kapag
➢ Adult – 100 to 120mmHg
conscious yung patient
➢ Child – 95 to 110mmHg
➢ Vomiting
➢ Infants – 5 to 95mmHg
➢ Desaturation on pulse – below 95% ang
Portable Unit – Suction Pressure
pulse
➢ Adult – 10 to 15 mmHg
➢ Oximetry
➢ Child – 5 to 10 mmHg
Conduct a risk Assessment
➢ Infants – 2 to 5 mmHg
➢ Patients with a recent head or neck
Things to Remember
injury
➢ Do not force through nares during
➢ Geriatric and pediatric patients, who
insertion
have more fragile airways
➢ Length of insertion:
➢ People with cognitive or mental health
▪ Oropharyngeal
condition that make it more difficult for
- Measure from the tip of the nose to
them to understand the procedures and
angle of mandible
cooperate
▪ Nasopharyngeal
➢ Patients with loose dental hardware
- Adult 16cm (5-6 inches)
➢ Patient with a difficult airway on history
- Older children – 8 to 12cm (3 to 5
of suctioning complication
inches)
➢ Patients with bradycardia
- Infants and young children – 4 to 8 cm
➢ Patients with hypoxia
(2 to 3 inches)
TYPES OF SUCTION CATHETER
- Hyper oxygenate first prior suctioning
➢ Open tipped
➢ Suction Time:
➢ Whistle tipped – less irritating to
- Each suction: 10-15 seconds
respiratory tissues more effective for
- Interval or in-between suction: 30 sec-
removing thick mucous plugs
1 minute
➢ Yankauer Tube
➢ The maximum suction time should only
- used to suction oral cavity
be 15 seconds
- Reusable

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➢ After suctioning, re-oxygenated the ➢ Place towel/ sterile drape on the chest
patient ➢ Open appropriate suction kit or catheter
➢ Whole procedure: maximum of 5 minutes using sterile technique
NOTE: prolonged suctioning increases the ➢ Open sterile basin and fill which
risk of hypoxia and other complications. approximately 100 ml of sterile normal
saline solution or water.
Oropharyngeal/Nasopharyngeal
Suctioning Procedure
➢ Greet and identify the patient
➢ Ask the patient’s name and check the pt’s
id bracelet
➢ Determine the patient need for
suctioning:
- Audible secretions during respiration
- Adventitious breath sounds ➢ Open lubricant and squeeze small amount
➢ Explain the procedure – to allay anxiety onto sterile catheter package
and tell the importance of suctioning that ▪ Naso – water soluble lubricant
this procedure will relieve breathing ▪ Oro – sterile water or NSS
problems NOTE: use one hand first because your other
➢ Wash hands hand will touch or hold unsterile materials
➢ Provide client’s privacy ➢ Apply gloves
➢ Check the nares (naso) and mouth (oro) - Oropharyngeal – clean gloves
using penlight - Nasopharyngeal – sterile gloves
➢ Position appropriately ➢ Pick up suction catheter with dominant
UNCONCIOUS PATIENT hand without touching non-sterile surface
➢ Lateral position and the patient is facing ➢ Pick up connecting tubing of the suction
you apparatus with non-dominant had and
- This position allows the tongue to fall connect it to the catheter
forward not to obstruct the catheter for ➢ Place tip of catheter into sterile basin and
insertion and facilitates drainage of suction a small amount of NSS. To check
secretion the patency of the tubing
CONCIOUS PATIENT ➢ Apply suction by placing the thumb over
➢ Semi – Fowler’s Position w/ head turned the suction control
to one side for oral suctioning ➢ Measure the catheter to be inserted. Make
➢ For nasal suctioning with the neck a mark
hyperextended OROPHARYNGEAL SUCTIONING
- This position facilitates the insertion ➢ Remove 02 mask if present but keep it
and prevent aspiration near the patient’s
Prepare the Materials ➢ Insert catheter gently into patient’s
➢ Suction tube (size), gloves, towels, gauze mouth
pad, sterile water, goggles, emesis basin ➢ Do not apply suction during insertion –
➢ Set up the suction gauge it may cause trauma in mucous
- Prevent trauma to mucous membrane membrane

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➢ Suction intermittently moving around ➢ Ask patient to deep breath and cough
the mouth including pharynx and gum ➢ Limit suctioning to 5 minutes
line ➢ If using yankauer catheter, place in a
➢ Advance the catheter about 4-6inch clean, dry area for reuse with suction
➢ Apply suction for only 5-10 second turned off
along one side of the mouth to prevent ➢ Disconnect the catheter form
gagging connecting tubing
➢ Slowly remove the catheter in a ➢ Turn off the suction machine
rotational manner ➢ Dispose catheter rolled inside the used
SUCTION AIRWAY – Nasopharyngeal gloves and discard in appropriate
➢ Lubricate distal 6-8cm (2-3 inches) of receptacle
catheter tip with water-soluble lubricant ➢ Remove towel and place in laundry or
➢ Remove 02 device with on-dominant remove the drape and discard
hand while using dominant hand insert ➢ Reposition the patient to promote
catheter into the nares client’s comfort
➢ Have patient take a deep breath and ➢ Do oral hygiene/ nasal hygiene
gently insert the catheter downward and ➢ Discard all soiled materials
advance to pharynx (ipa-inhale and ➢ Evaluate patient
exhale muna ang patient) ➢ VS: RR, HR, lung sounds to assess
➢ Apply intermittent suction 5-10 seconds effectiveness of suctioning, level of
➢ Non-sterile finger in the suction part anxiety, oxygen saturation
➢ Sterile hand in the suction catheter ➢ Return the head of the bed
➢ Alternate nares for repeat suctioning ➢ Obtain specimen if required (sputum
➢ Apply intermittent suction while slowly trap)/gene expert
withdrawing catheter in rotating ➢ Wash hands and document
between thumb and fore finger COMLICATION OF SUCTIONING
SUCTION AIRWAY – Oropharyngeal ➢ Hypoxia
➢ Encourage the patient to cough and ➢ Airway trauma
repeat suctioning if needed. Replace 02 ➢ Psychological trauma
mask ➢ Pain
➢ Rinse catheter with saline or water from ➢ Bradycardia
basin with suction until cleared from ➢ Infection
secretions ➢ Ineffective Suctioning may cause
➢ Cleans the catheter by wiping odd thick STRESS
secretions with gauze pad or rinse SAMPLE CHARTING
catheter and connecting tubing with
normal saline or water until cleared
➢ During suction, if the patient coughs,
withdraw the catheter immediately flush
catheter after each solution with sterile
water
➢ Assess for need to repeat suctioning
procedure

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 - Habang tumatanda, bumababa un
URINARY CATHETERIZATION production ng GFR
By: Ma’am Vilma Reyes Miguel
Urinary System Anatomy
➢ Consist of organs that produce an
excrete urine from the body.
➢ The paired kidneys are situated on either
side of the spinal column, behind the
peritoneal cavity. They are primary
regulators of fluid and acid base balance
in the body.
➢ Kidneys are responsible for removing
waste products, drugs, and excess fluid
from the body.
➢ Blood enters the kidney and goes to the Characteristics of Urine
millions of the functional units to filter ➢ Odor: aromatic – upon voiding
the blood. Called nephrons consist of ➢ pH: slightly acidic (4.6-8; average 6)
glomerulus and tubule. Blood is then (citrus fruits, vegetables and dairy
filtered in the glomerulus, and products raises the pH level. High or low
remaining fluid goes to the tubule and pH can lead to disorders such as
has water or chemicals either added or development of kidney stones)
removed depending on requirement. It ➢ specific gravity: 1.010 – 1.025 (a measure
requires 500-1000mL of water a day as of quantity of solutes for volume of a
a minimum to support this elimination solution and traditionally easier to
processes. measure than osmolarity)
➢ Once the urine is formed in the kidneys, ➢ Color: amber/ straw
it moves through the collecting ducts ➢ Transparency: clear
into calyces of the renal pelvis and from
there into the ureters.
➢ The urinary bladder is a hollow
muscular organ that serves as a reservoir
for urine and as the organ of excretion.
➢ The urethra extends from the bladder to
the urinary meatus.
➢ Functional units of kidneys:
▪ Glomerular filtration rate = 120mL/
min
▪ Kidney form 0.5 to 1 mL/ min = 60
mL/hr
▪ 1500mL/ day of urine
o Adult: 60-120 mL/hr; 720-1440
mL/day
o Child 300-1500 mL/day

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 Altered urine production:
▪ Polyuria: 100 mL/hr or 2500 mL/day
(Diuresis)
▪ Oliguria: < 30 mL/hr or < 500 mL/ 24hr
▪ Anuria: 0 -10 mL/hr
Altered urine elimination:
▪ Frequency – voiding at frequent
intervals that is more often than usual.
▪ Nocturia – increase frequency at night
that is not a result of an increased fluid
intake.
▪ Urgency – feeling that the person must
void.
▪ Dysuria – painful urination.
▪ Hesitancy – delay in initiating voiding
(urinary hesitancy)
▪ Enuresis – repeated involuntary
urination in children.
▪ Pollakiuria – frequent, scanty urination.
▪ Urinary Incontinence – considered as a
Urine components symptom, not a disease.
▪ Normal urine consists of 96% water and a) Functional – involuntrary,
4% solutes. unpredictable passage of urine.
▪ Organic solutes include urea, ammonia, b) Reflex, (spastic bladder) this
creatinine and uric acid. happens when the bladder fills
▪ Urea is the chief organic solute. Sodium with urine and an involuntary
chloride is the most abundant inorganic reflex causes it to contract in an
salt. effort to empty.
URINATION c) Stress – leakage of <50 mL urine
➢ Micturition, voiding and urination all due to intra-abdominal pressure
refer to the process of emptying the d) Total – continuous, unpredictable
urinary bladder. e) Urge – an occasional sudden desire
➢ Urine is a liquid by product of the body to urinate with large volume urine
secreted by the kidneys through a process loss; can also exist without
called urination/ voiding/ micturition. incontinence.
Factors affecting voiding: ▪ Urinary retention with overflow –
▪ Fluid and food intake dribbling incontinence that results when
▪ Medications the bladder is greatly distended with urine
▪ Pathologic conditions because of an obstruction. (you can
▪ Surgical and diagnostic procedures empty your bladder, you may need to
▪ Psychosocial factors urinate but have troubled starting urinate
▪ Growth and development and completely emptying the bladder)
▪ Muscle tone and activity more common in male.

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▪ Neurogenic bladder – describes any ➢ Timing
voiding problem related to neurologic ➢ Relieve physical or emotional
dysfunction. (may problema sa spinal discomfort.
cord, symptoms: trembling, inability to ➢ Assist clients to have the urge to void
fully empty the bladder, there is straining) immediately.
▪ Urinary retention – accumulation of ➢ Offer toileting assistance at usual times
urine in the bladder as much as 3L with of voiding.
associated inability of the bladder to ➢ Positioning.
empty itself. ➢ Dangle fingers to warm water
Assessment ➢ Crede’s Manuever: applying pressure to
Nursing history: suprapubic area.
a) Data about voiding patterns and Managing UI
habits, any problems in voiding, Continence (bladder) training
about past or present problems o Bladder training – requires that the
involving the urinary system. client postpone voiding, resist or
b) Data about any problems that may inhibit the sensation urgency, and
affect urination. void according to a timetable rather
Possible diagnosis than according to the urge to void.
➢ Urinary incontinence The goal is to lengthen the intervals
➢ Functional incontinence – reflex between urination to correct the
incontinence – stress incontinence – clients habit of frequent urination.
total incontinence – urge incontinence. o Habit training – also referred to as
➢ Impaired/ altered urinary elimination. timed voiding or schedules toileting.
➢ Urinary retention There is no attempts to motivate the
➢ High risk for infection client to delay voiding if the urge
➢ Self-esteem disturbance occurs. Prompt voiding supplements
➢ High risk for impaired skin integrity the habit training by encouraging the
➢ Social isolation client to use the toilet and reminding
➢ Self-care deficit: toileting the client when to void.
Nursing interventions o Pelvic muscle exercise (PME) –
➢ Promoting normal fluid intake referred to as perineal muscle
➢ Maintaining normal voiding habits tightening or Kegel’s exercise.
➢ Relaxation Strengthen pubococcygeal muscles
➢ Allow client sufficient time to avoid. can increase the incontinent females
➢ Recommend good handwashing and ability to start and stop the stream of
proper perineal care. urine.
➢ Pour warm water over perineum or have Managing urinary retention
the client sit in a warm bath to promote - Urinary catheterization
muscle relaxation. Catheterization
➢ Apply hot-water bottle to the lower ➢ It is the insertion of a hollow tube
abdomen. through the urethra into the bladder to
➢ Turn on running water within hearing drain urine.
distance.

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 ➢ Maybe used in place for long periods of
time.
o Purposes:
▪ To relive discomfort due to bladder
distention or provide gradual
decompression of distended bladder.
▪ To assess the amount of residual urine if
the bladder empties incompletely.
▪ To obtain urine specimen
▪ To empty the bladder completely prior to
surgery.
▪ To facilitate accurate measurement of
urinary output for critically ill clients
whose output needs to be monitored
hourly.
▪ To provide for intermittent or continuous
bladder drainage and irrigation
▪ To prevent urine from contacting an
incision after perineal surgery.
▪ To manage incontinence when other
measure has failed.
Types of catheters
According to the number of lumens:
▪ Straight catheter (non-retention)
o Single lumen tube
▪ Two-way Catheter (foley, Retention)
o Double lumen catheter
▪ Three-way Catheter Materials
o Triple lumen catheter used in ➢ Latex
bladder irrigation. o Can be used for 2-3 weeks.
o Bakit tatlo? Kasi andyan un pag o Assess client for latex-allergy.
iinflatan ng balloon para hindi ➢ Silver allov (Polyvinyl chloride - PVC)
matanggal un catheter once na o Can be used for 4-6weeks soften at
pumasok doon sa bladder. body temperature and more.
Pangalawa – connection ng o Comfortable use.
tubing para doon sa drainage. ➢ Polyvinyl chloride - PVC
Other one, paglalagyan ng mga ➢ synthetic plastic polymer or are the
irrigating solutions. translucent, they allow to see the color of
the urine easily.
➢ also firm, but fairly flexible for easy
insertion. As PVC materials are usually
(but not always) latex-free, they are

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 preferred by those who have a latex catheterization, most catheters are
allergy. colonized with bacteria, thus leading to
➢ Silicone is fast becoming the material of possible bacteriuria and its
choice as critics claim the production, use complications. Catheters can also cause
and disposal of PVC materials create renal inflammation, nephron-cysto-
toxic chemicals. Silicone is also clear, lithiasis, and pyelonephritis if left in for
meaning patients and medical providers insertion.
can see the urine easily. In terms of ➢ The alternatives to urethral
flexibility, it sits somewhere between catheterization include suprapubic
PVC and latex. As silicone is totally free catheterization and external condom
of latex, it is also a preferable choice for catheters for longer durations.
those with a latex allergy. The material is
also smooth, and some brands even have
an antibacterial coating applied.
➢ Among the three materials, latex is the
most flexible due to the material being
thermo-sensitive, meaning that it will
warm up to the surrounding temperature
and, as such, become more flexible in a Urinary elimination
2000 study by the American Family ➢ Condom catheter:
Physician organization. ➢ Can be used by men with incontinence.
Possible complications ➢ There is no tube placed inside the penis.
o Inability to cathetetize. Instead, a condom-like device is placed
o Urethral injury – by inflating balloon over the penis.
before ensuring correct catheter ➢ A tube leads from this device to a
placement in the bladder. drainage bag. The condom catheter must
o Infection be changed every day.
o Psychological trauma ➢ Considerations: proper way to apply
o Hemorrhage – trauma sustained during condom catheter
insertion or balloon inflation. a) Frequency of checking.
o False passage – by injury to the urethra; b) Frequency of changing.
wall during insertion. c) Attach to where part of the body?
o Urethral strictures – following damage ➢ How to use external condom catheters:
to the urethra – long term problem.
o Paraphimosis due to failure to return
foreskin to normal posit following
catheter insertion.

Complications of Catheterization
➢ The main complications are tissue trauma
and infection. After 48 hours of

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 ➢ Sterile water
➢ Forceps
➢ Sterile cotton balls
➢ Kidney basin
➢ Sterile drape
➢ Tape to secure the catheter.

Special considerations
1. Invasive procedure
2. Strict asepsis
3. Perineal care
4. Size of catheter
a) Male: French 16-18 (Fr. 8-10 Child, Procedures
Fr. 5-8 Infant) Female catheterization
b) Female: French 12-14 1. Assess the patient’s need for
5. Position: Male – frog-like position or catheterization and refer patient to the
supine; Female – dorsal recumbent. doctor.
6. Urinary meatus: 2. Verify the doctors order for
7. Length of catheter insertion: catheterization.
a) Male: 6-9 inches 3. Prepare the necessary materials.
b) Female: 3-4 inches 4. Perform hand washing.
5. Identifies the patient and explains the
procedure.
6. Positions the patient properly and ensures
patients privacy.
7. Applies aseptic technique during the
entire procedure.
8. Opens the catheterization kit aseptically.
9. Add materials to the kit ensuring sterility
the whole time.
10. Dons first glove and fills the syringe with
Materials distilled water.
➢ Catheter 11. Dons second glove applies sterile drapes
➢ Betadine to patient.
➢ Urine bag 12. With the non-dominant hand, separates
➢ KY jelly the labia minora with the thumb and
➢ Syringe (10mL)

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 index finger. Never removes fingers until 10. Dons first glove and fills the syringe with
catheter is inserted. distilled water.
13. With the dominant hand, uses sterile 11. Dons second glove and applies sterile
forcep to pick up swabs. Cleans first from drapes to the patient.
the meatus downward and then on either 12. Grabs the penis firmly behind the glans
side using a new swab for each stroke. with the non-dominant hand and retracts
14. Picks up the catheter and places the the foreskin of the uncircumcised male.
drainage end of the catheter in the urine 13. With the dominant hand, uses sterile
receptacle using uncontaminated hand. forcep to pick up swabs. Cleans first from
15. Lubricates the insertion end or tip of the the meatus and then wipe the tissue
catheter. surrounding the meatus in circular motion
16. Gently inserts the catheter in the direction using a new swab for each stroke.
of the urethra until urine flows. 14. Picks up the catheter and places the
17. Connects the catheter to the urine bag and drainage end of the catheter in the urine
ensures that emptying base of the bag is receptacle using uncontaminated hand.
closed. 15. Lubricates the insertion end or tip of the
18. Inflates the balloon by injecting 5-10cc of catheter.
distilled water and checks the anchor. 16. Lifts the penis to a position at 90 degrees
(before u inject the distilled water, mag angle and inserts the catheter until urine
advance ng 1-2 inches) flows.
19. Tapes the catheter with non-allergenic 17. Connects the catheter to the urine bag and
tape at the thigh of the patient. ensures that emptying base of the bag is
20. Removes drapes and makes the patient closed.
comfortable. 18. Inflates the balloon by injecting 5-10cc of
21. Disposes soiled materials properly. distilled water and checks the anchor.
22. Accurately records the procedure done. 19. Tapes the catheter with non-allergenic
Male Catheterization tape at the lower abdomen of the patient.
1. Assess the patient’s need for 20. Removes drapes and makes the patient
catheterization and refer patient to the comfortable.
doctor. 21. Disposes soiled materials properly.
2. Verify the doctor’s order for 22. Accurately records the procedure done.
catheterization. Reminders:
3. Prepare the necessary materials. ➢ Left left, right right. Left-handed nurse
4. Perform hand washing. must stand on the left side of the patient.
5. Identifies the patient and explains the ➢ Grasp catheter 2-3 inches
procedure. ➢ As nurse inserts catheter – client inhales
6. Positions the patient properly and ensures deeply and exhales
patient’s privacy. ➢ Sterile water in balloon not NSS
7. Applies aseptic technique during the ➢ If urine flows, do not stop, insert 2
entire procedure. inches further into the bladder.
8. Opens the catheterization kit aseptically. ➢ What to do when a urinary catheter
9. Add materials to the kit ensuring sterility accidentally inserted to vagina? – do
the whole time.

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 not remove the catheter in vagina, you
have to acquire one, mag insert ulit.

BOWEL ELIMINATION & ENEMA

By: Maam Rosanna Suva
Introduction – factors that affect
elimination
➢ Regular elimination of bowel waste STOMACH
products is essential for normal body ➢ The stomach performs 3 tasks:
functioning 1. Storage of swallowed food and liquid
➢ Understanding normal elimination and 2. Mixing of food with digestive juice
factors that promote, impede, or cause 3. Regulates emptying of its contents
alteration in elimination help a nurse into the small intestine
manage patient’s elimination problem. ➢ The stomach produces and secrets;
➢ Alteration in bowel elimination are often ➢ Hydrochloric acids
early signs and symptoms of problems in ➢ Mucus
gastric intestinal system. ➢ The enzyme pepsin
Scientific Knowledge Base ➢ Intrinsic factor
➢ The GI tract is the series of the hallow ▪ Hydrochloric acids and pepsin – help
membrane-lines muscular organs digest the protein
➢ These organs absorb fluid and nutrients, ▪ Mucus – help protect the stomach,
prepare food for absorption and use by mucosa from acidity and the enzyme
body cells, and provide temporary storage activity
of feces. ▪ Intrinsic factor – is for absorption of
➢ The GI tract absorb high volume of fluids, vitamin B12
making fluid and electrocyte balance a ▪ Chyme – mixing of food and juices. It is
key function of the GI system the partly fluid which passes from the
➢ The GI also receive secretions from the stomach to the small intestine consisting
gallbladder and pancreas of gastric juices and partly the digested
THE GI SYSTEM food.
▪ Each individual has intake of food SMALL INTESTINE
through the: ➢ It facilitates both digestion and
➢ Mouth absorption
➢ Pharynx ➢ Measure of 6 meter or 20 feet long
➢ Esophagus Three Section of Small Intestine
➢ Stomach ▪ Duodenum
➢ Small intestine ▪ Jejunum
➢ Large intestine ▪ Ilium
➢ Rectum DUODENUM
➢ Anus ➢ Approximately 20 to 28 centimeters or
8 to 11 inches long
➢ Continues to process fluids from the
stomach

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 JEJUNUM Functions of Large Intestine
➢ Approximately 2.5 meter or 8 feet long 1. Absorption
➢ Absorbs carbohydrates and protein 2. Secretion
ILEUM 3. Elimination
➢ Approximately 3.7 meters or 12 feet long ➢ The colon absorbs a large volume of
➢ Absorbs water, fats, and the bile salts and water which up to 1.5 meters, a
absorbs certain vitamins and irons significant amount of sodium and
DUODENUM & JEJUNUM chloride daily
➢ Absorbs most nutrients and electrolytes ➢ The amount of water absorbs depends on
from small intestine the speed at which the colonic content
➢ Digestive enzymes and bile enter the moves
small intestine from pancreas and the ➢ Normally the fecal matter becomes soft
liver to further breakdown nutrients into formed or semi-solid mass
usable by the body ➢ If the peristalsis is abnormally fast there
NOTE: is less is less time to water to be absorb
➢ The digestive process is greatly altered and the stool will be watery
when small intestine function is impaired. ➢ If the peristaltic contractions slow down
➢ Condition such as inflammation, water continues to be absorb and the hard
infection surgical resection, or mass stool forms resulting to constipation
obstruction disrupt peristalsis, reduce ANUS
absorption, or block the passage of fluid, ➢ The body expel feces and flatus from the
resulting in electrocyte and nutrients rectum through the anus
deficiencies. ➢ The anal canal contains a rich supply of
LARGE INTESTINE a.k.a COLON sensory nerves that allow people to tell
(Lower GI Tract) when there is solid, liquid, or gas that
➢ Length is 1.5 to 1.8 meters (5-6 feet) needs to be expelled and aids in
➢ Primary organ of bowel elimination maintaining continence
Six Division of Large Intestine NOTE:
1. Cecum ➢ Normally defecation is painless, resulting
2. Ascending colon in passage of soft, formed stool.
3. Transverse colon ➢ Straining while having a bowel
4. Descending colon movement indicates that the patient may
5. Sigmoid colon need changes in diet (ibig sabihin baka
6. Rectum kulang sya ng fiber) or should increase
➢ The digestive fluid enters the large the fluid intake (dagdagan ang pag inom
intestine by waves of peristalsis through ng water or damihan ang pagkain ng
the ileocecal valve gulay or prutas) or that there is an
▪ Ileocecal valve – a circular muscle underlying disorder in GI function
layer that prevents regurgitation back Factors Influencing Bowel Elimination
into the small intestine AGE
➢ The muscular tissue of the colon allows ➢ Infants – have a smaller stomach
to accommodate and eliminate large capacity, less secretion of digestive
quantities of waste and gases or the flatus

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 enzymes, and more rapid intestinal ➢ Weakened abdominal and pelvic floor
peristalsis (mas madalas mag defecate) muscle impair the ability to increase
➢ Adolescents – experience rapid growth intra-abdominal pressure and control the
and increase metabolic rate external sphincter
➢ Older Adults – may have decreased ➢ Muscle tone sometimes weakened or loss
chewing ability. Partially chewed food is of a result of long-term illness, spinal
not digested as easily. Peristalsis cord injury, or neurological diseases that
declines. This impairs absorption by the impaired nerve transmission
intestinal mucosa. ➢ As a result of these changes the
➢ Muscle tone in the perineal floor and anal abdominal pelvic floor muscle there is an
sphincter weakens which sometime increased risk of constipation (galaw
causes difficulty in controlling defecation galaw din mare!)
DIET PSYCHOLOGICAL FACTORS
➢ Regular daily food intake helps maintain ➢ Prolonged emotional stress impairs the
a regular pattern of peristalsis in the colon function of the almost body system
➢ Fiber in the diet provides the bulk in the ➢ During emotional stress the digestive
fecal material process is accelerated, and peristalsis is
➢ Bulk-forming foods such as whole grains, increased
fresh fruits, and vegetables help remove ➢ Side effects of increased peristalsis
the fats and waste products from the body include diarrhea and gaseous distention
with more efficiency ➢ If a person becomes depressed, the
➢ Some of these foods such as cabbage, autonomic nervous system may slow
broccoli or beans may also produce gas, impulses that decreased peristalsis,
which distends the intestinal walls ands resulting in constipation
increases colonic motility (observe a ➢ A number of disease GI tract are
balance diet, always include vegetables, elaborated by stress including ulcerative
fruits, and meat to help the fecal material colitis, irritable bowel syndrome, certain
to be expelled smoothly) gastric and duodenal ulcers
FLUID INTAKE PERSONAL HABITS
➢ A fluid intake of 3L per day for men/ 2.2L ➢ Personal elimination habits influence
per day for women is recommended bowel function
➢ Reduced fluid and fiber intake slows ➢ Individuals need to recognize the best
passage of food through the intestine and time for elimination
results in hardening of stool contents, ➢ Mas coonvenient ang tao mag defecate sa
causing constipation sariling banyo or cr
PHYSICAL ACITIVITY ➢ A busy works schedule sometimes
➢ Physical activity promotes peristalsis, prevent the individual from responding
whereas immobilization depresses it appropriately to the urge to defecate
➢ Encourage early ambulation as illness ➢ Disrupting personal habits and causing
begins to resolve or as soon as possible possible alteration such as constipation
after surgery to promote maintenance of POSITION DURING DEFECATION
peristalsis and normal elimination ➢ Squatting is the normal position during
defecation

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➢ Lean forward, exert intraabdominal DIAGNOSTIC TEST
pressure, and contract the gluteal muscles ➢ Involving visualization of GI structures
➢ For immobilized patient in bed, place the often a require a prescribes bowel
patient in supine (IF) a patient’s condition preparation (e.g., laxatives and/or
permits, raise the head of the bed to help enemas) to ensure that the bowel is empty
him or her to a more normal sitting ➢ Usually, patients cannot eat or drink
position on a bedpan, enhancing the several hours before examination (NPO)
ability to defecate such as endoscopy, colonoscopy, or other
PAIN testing that require visualization of the GI
➢ Normally the act of defecation is painless tract
➢ However, a number of conditions such as COMMON BOWEL ELIMINATION
hemorrhoids; rectal surgery; anal PROBLEM
fissures, which are painful linear splits in Constipation
the perineal area; and abdominal surgery ➢ Is a symptom, not a disease, and there are
result in discomfort many possible causes
➢ In these instances the patient often ➢ Improper diet, reduced fluid intake, lack
suppresses the urge to defecate to avoid of exercise, and certain medications
pain, contributing to the development of ➢ Signs of constipation include infrequent
constipation bowel movement (less than 3 per week)
PREGNANCY and hard, dry stools that are difficult to
➢ As the pregnancy advances, the size of pass
the fetus increases, and pressure is Impaction
exerted on the rectum ➢ Fecal impaction results when a patient
➢ A temporary obstruction created by the has unrelieved constipation and unable to
fetus impairs passage of feces expel the hardened feces retained in the
➢ Slowing of peristalsis during the third rectum.
trimester often leads to constipation ➢ In case of severe impaction, the mass
➢ A pregnant woman’s frequent straining extends up into the sigmoid colon
defecation or delivery may result in - If not resolved or removed, severe
formation of hemorrhoids impaction results in intestinal
MEDICATIONS obstruction
➢ many medications prescribed for acute ➢ Obvious sign of impaction is the inability
and chronic conditions have secondary to pass a stool for several days, despite the
effect on patient’s bowel elimination repeated urge to defecate
patters. Diarrhea
➢ For example, ➢ Is an increase in the number of stools and
➢ Opioid analgesics – slows peristalsis and the passage of liquid, unformed feces.
contractions, often resulting in ➢ It is associated with disorders affecting
constipation digestion, absorption, and secretion in the
➢ Antibiotics – decreases intestinal GI tract
bacterial flora, often resulting in diarrhea ➢ Intestinal contents pass through the small
intestine and large intestine too quickly to

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 allow for the usual absorption of fluid and
nutrients
Incontinence
➢ Fecal incontinence is the ability to control
passage of feces and gas from the anus
➢ Incontinence harms a patient’s body
image. The embarrassment of soiling
clothes often leads to social isolation
➢ Physical conditions that impair anal
sphincter function or large-volume liquid Sigmoidoscopies
stools cause incontinence ➢ The sigmoid colon and rectum are
Flatulence visualized and may be biopsied
➢ Is a buildup of gas in the digestive Assessment
system that can lead to abdominal ➢ Obtain – obtain diet and medication
discomfort. (fullness, pain, cramping) history
➢ Normally intestinal gas escapes through ➢ Identify – identify signs and symptoms
the mouth (belching) or the anus associated with altered elimination
(passing the flatus) patterns
Hemorrhoids ➢ Determine – impact of underlying illness
➢ Are dilated, engorged veins in the lining activity patterns, and diagnostic bowel
of the rectum. They are either external or elimination
internal Patient Teaching
➢ External hemorrhoids – are clearly ➢ Encourage the patient to set aside time to
visible as protrusions of skin defecate
➢ Internal hemorrhoids – occur in the anal - Sometimes after a meal works the best
canal and may be inflamed or distended ➢ If not contraindicated or restricted,
BOWEL DIVERSION encourage the client to drink plenty of
Ostomies fluids and to consume a diet high fiber to
➢ The location of ostomy determines stool prevent constipation
consistency ➢ Exercise
➢ A person with sigmoid colostomy will ENEMA
have a more forms stool ➢ An enema is solution introduced into the
Transverse Colostomy rectum and large intestine
➢ Stool will be thick liquid to soft ▪ Purposes:
consistency o Relieve constipation, fecal impaction,
DIAGNOSTIC TEST – visualization of and flatulence
the bowel o To soften hard fecal matter
Colonoscopy o Administer medication
➢ Is an exam used to detect changes or o Prepare for diagnostic procedures and
abnormalities in the large intestine surgery
➢ The large colon and sometimes a portion
of the lower small bowel are visualized
and may be biopsied Normal Characteristics of S tool

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➢ Color: Materials
▪ Normal – brown
▪ Abnormal:
o Melena – black tarry stool
o Hematochezia – stool with fresh
blood
o Steatorrhea – stool with excessive
fats
➢ Odor – aromatic
➢ Consistency – forms, soft, semi-solid,
and moist
➢ Shape – cylindrical o Waterproof pad or rubber sheet
o IV pole
o Enema can or bag
o Rectal tube
o Water soluble lubricant
o Bedpan
o Towel
o Clean gloves
o Clamp
o Rectal Tube Sizes – insertion
Contraindications o Adult – fr. 22-30 (3-4 inches)
➢ Appendix are inflamed o Children – fr. 14-18 (2-3 inches)
➢ Diverticulitis – infection or inflammation o Infant – fr. 12 (1.-1.5 inches)
of pouches that can form in your
intestines. Pouches are called diverticula
➢ Pregnant mothers on their third trimester
➢ Clients with cardiac problems
Types of Enema
- Accdg. to purpose
1. Cleansing enema – to remove feces
a. A high enema – cleans as mush of
the colon, 1000 ml of solution, 12-
18 inches
b. Low enema – rectum and sigmoid
colon, 500 ml of solution, 12
inches
2. Carminative enema – to expel flatus 60-
80ml
3. Retention enema – introduces OIL
(mineral oil, olive oil, cottonseed or
VCO) or medication into the rectum and
the sigmoid colon, at least 30 minutes

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 Procedure 18. After care of the unit and materials
1. Verify the doctors order of used
administering enema to the client 19. Document the procedure done, record
2. Prepares the needed materials and the kind and amount of stool and
solutions solution used and the character of the
3. Performs handwashing before and return flow.
after the procedure REMEMBER:
4. Identifies patient and explain the ➢ to reduce defecation, enema solutions
procedure must cause Detention and Irritation in the
5. Provides privacy to the client intestinal mucosa
throughout the procedure ➢ the client must be placed I left sim’s
6. Places the water proof pad under the position
client’s buttocks ➢ minimum heigh of the Enema can is 12”
7. Positions the client in the left Sim’s above the rectum and a maximum height
position of 24” above the rectum
8. Prepares the irrigation can, tubing and ➢ insert rectal tube about 3-4 inches for
solutions hangs the enema cannon the adult clients
IV stand about 18-24 inches above the ➢ abdominal cramps may indicate giving of
level of the patient’s rectum too much solution
9. Lubricates the rectal tube and allows OXYGENATION
a small amount of solution to flow By: Maam Aida V. Garcia, MAN, RN.
through the tubing into the bedpan Anatomy and Physiology
10. Dons glove and lift the upper buttock Upper Respiratory Airway
of the patient
11. Inset the tube slowly and smoothly
around 3-4 inches into the patient’s
anus
12. Administer the solution slowly. If the
pt complains of fullness or pain, use
power to stop the flow for 30 seconds,
and then restart the flow at a slower
rate
13. Closes the clamp after all the
solutions has been administered or
when the client cannot hold anymore
and wants to defecate
14. Removes the rectal tube and places it
in a disposable towel
15. Encourages the pt to retain the enema
solution
16. Assist the pt with the necessary
cleansing
17. Makes the patient comfortable

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➢ Nose – serves as humidifier including o Cover 95% of alveolar surface
warmth’s and filters the air as we breath o Secrete pulmonary surfactant
in. then diff. sinuses which provide - (this is important in reduction of
resonance the sounds we produce surfaces tension of the lungs to prevent
➢ Pharynx – further subdivided to the development of lung collapsed)
nasopharynx, oropharynx, and RESPIRATORY PROCESS
laryngopharynx ➢ Ventilation or breathing
➢ Larynx – also known as the voice box - is the movement of the air into and lungs
➢ Epiglottis – helps prevent developing - Process of inhalation and exhalation
aspiration because it stays open during ➢ Respiration – process of gas exchange
the time of breathing and during the time between individual and environment
of swallowing it closes (udan, 2004)
Lower Respiratory System ➢ Gas Exchange – intake of oxygen and the
➢ Trachea excretion of carbon dioxide
➢ Bronchi
➢ Alveoli
➢ Lungs – consist of left and right lung.
The smaller is the left lung because it
consists of two lobes only. The right lung
has three lobes
ALVEOLI

During Inspiration
➢ Diaphragm descends
➢ (-) intrapulmonary pressure
➢ smallest unit of the respiratory system ➢ Air draws from greater pressure into
located at distant end of the bronchi lesser pressure
➢ 2 types of alveolar cells ➢ once it’s inside the lungs it will move to;
▪ TYPE I Pneumocyte ▪ Trachea
o Squamous and extremely thin ▪ Bronchi
o Cover – 95% of alveolar surface ▪ And alveoli
o Involved in gas exchange
▪ TYPE II Pneumocyte
o Granular and roughly cuboidal

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 Transport of oxygen and Carbon Dioxide
➢ the oxygen will be transported from the
lungs to the tissues so that it will be able
to oxygenate the diff. tissues or the cells
of the tissues and carbon dioxide will be
transported from the tissues back to the
lungs and outside the body

Alveolar-Capillary Gas Exchange DIAPHRAGM

➢ Diffusion of oxygen and carbon dioxide ➢ During the end of inhalation, the lung
between the alveoli and pulmonary will be recoiled, when the lungs recoiled
capillaries the pressure of the lungs will higher than
➢ Air diffuses into capillaries the atmospheric pressure.
➢ The air inside the lungs will move from
the lungs going outside the body

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 TYPES OF RESPIRATION Respiratory Reserve Volume (IRV)
➢ Extra air inhaled
➢ External respiration - is gas exchange
➢ 3000 ml
with in external environment and usually
- Halimbawa kapag umakyat ka ng 50th
happens in alveoli in the lungs.
floor ng building kailangan mo ng extra
air
Expiratory Reserve Volume (ERV)
➢ Extra air inhaled
➢ 1,100ml
➢ The amount of extra air that can be
exhaled beyond the tidal volume
Residual Volume (RV)
➢ Remains in the lungs after forceful
exhalation
➢ Internal Respiration – took place in the ➢ 1,200 ml
cellular level so that involve the gas - Ito yung iniiwan ng lungs mo kahit
exchange bet. the blood and the body galing ka sa forceful exhalation
cells Lung Capacity
➢ Total amount of air that your lungs can
hold
➢ Total Lung Capacity
o Total of volumes (TV + IRV +
ERV+ RV)
➢ 5,800 ml
MUSCLE
➢ Normal breathing we used;
1. Rib Muscle
LUNG VOLUME & LUNG CAPACITY 2. Diaphragm
➢ Lung Volume – volume of gas in lungs ➢ They are the one to contract and relaxes
during respiratory cycle also called ➢ We do it for 16 times
respiratory volume ➢ RR – around 14 to 20 cycles in a minute
➢ Tidal Volume – (V or TV) but in other book the RR is around 16-20
➢ Air w/ each normal breathing cycles in a minute
➢ 500ml or 5ml – 10ml /kg ➢ Eupnea – Normal Breathing Pattern
➢ Volumes – depends on the gender and
age of the client

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 o Increased depth and rate of
ACESSORY MUSCLE respiration
➢ Inspiration o Slight increased in systolic BP
➢ Sternocleidomastoid Late s/s of Hypoxia
➢ Scalene Muscle ➢ Late
➢ Expiration o Decreased respiratory rate
➢ Abdominal (bradypnea)
➢ Internal Intercostal o Bradycardia
o Dyspnea, retractions
o Decreased systolic BP
o Cyanosis
Caring for Patients with Impaired
Oxygenation
➢ Assessing respiratory status
➢ Color of skin and mucous membranes
➢ Respiratory effort
Respiratory Control Centers
➢ Cough
➢ Medulla Oblongata – sends signals to
➢ Chest appearance
muscles
➢ Oxygenation status
➢ Pons – controls rate of breathing
➢ Oxygen saturation
Factors that Influence Respiratory
Nursing Diagnoses
Function
➢ Ineffective breathing pattern –
➢ Age
ventilation not adequate
➢ Environment
➢ Ineffective Airway Clearance –
➢ Lifestyle
inability to clear obstructions
➢ Health status
➢ Impaired Spontaneous Ventilation –
➢ Medications
not able to maintain breathing
➢ Stress
➢ Activity Tolerance – insufficient energy
Abnormal Respiratory Patterns
➢ Risk for Activity Intolerance –
➢ Tachypnea (rapid rate)
possible insufficient energy
➢ Bradypnea (abnormally slow rate)
➢ Impaired Gas Exchange – Alveolar-
➢ Apnea (cessation of breathing)
capillary membrane changes
➢ Kussmaul’s breathing
➢ Cheyne-Stokes Respirations
CONCEPTS AND PRINCIPLES OF
➢ Biot’s Respiration
PARTNERSHIP, COLLABORATION
o Hypoxemia – reduced oxygen levels
AND TEAMWORK
in the blood
By: Maam Norilyn Limchanco
o Hypoxia – low levels of oxygen in
Terminologies
the tissues of your body
Impaired Oxygenation
Collaborative Health Care
Early s/s of Hypoxia
➢ a comprehensive care provided to the
➢ Early
clients through the collaborative efforts
o Restlessness (agitation)
and expertise of each member of the
o Tachypnea

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 health team it is defined as health care in which nurses comes together and form
professionals, assuming complimentary a team to solve a patient care and also to
roles and cooperatively working together, provide a comprehensive service and to
sharing responsibility or problem- deliver the highest quality of care to our
solving, and making decision to patient and also to their family
formulate caring out plans for pt’s caring.
➢ Their coordinating to other health team
para ma-avoid ang redundancies,
deficiencies, and errors
Partnership
➢ A collaborative relationship bet. two or
more parties based on trust, equality, and
mutual understanding for the
achievement of a specifies goal
➢ Brings together tow or more parties so
that they can benefit from the expertise,
resources, power of each team
- In collaboration there is an impact of
➢ The goal of partnership is to enhance the
collaborative relationship, the patient,
efficiencies quality of the services
member of the team, and the
Twinning
organization
➢ Coined by the Topical Health Education
o Patient – it improves the care transitions
Trust (THET)
o Team member – it improves the
➢ The establishment of a formal link
collaborative relationship
between a specified
o Organization – it improves outcome
department/institution…and a
- Halimbawa kapag may nagkaroon ng
corresponding department/institution…,
overlapping the care plan, doon na
to facilitate an accurate assessment of
papasok ang teamwork para ma solve
need and consequently to ensure effective
ang problem
mutual collaboration at all levels
Teamwork
➢ Development model that uses
➢ Is when two or more people are
institutions, include institutions
interacting interdependently with a
partnership and health care relationship to
common purpose, working toward
benefits both sides
measurable goals that benefit from
➢ Emphasizes professional exchanges and
leadership that maintains stability while
monitoring the effectiveness of sharing
encouraging honest discussion and
information, knowledge, and technology
problem-solving
Collaboration
- Para ma ensure and patient satisfaction
➢ As defines by ANA, (1992) refers to the
during how care implementation,
collegial working relationship with
kailangan natin as a health cares,
another health care provident in the
kailangan e-embrace ang teamwork
provision of patient care
approach.
➢ Collaboration in nursing is an
- How? Paano? Wise good
interprofessional, interpersonal process
communication skills and collaborative

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 care coordination’s. By means of that it ✓ Mutual Respect and Trust - mutual
is increasing the nurse workplace respect when two or mote people show or
satisfaction. feel honor or esteem toward one another.
✓ The importance of teamwork to the ➢ Trust is confidence in the actions of
healthcare team another person which must expressed
- It decreases the level of stress in the verbally and non-verbally.
patient ➢ Can be attained through openness and
- Positive outcome honesty
- Reduce the number of issues related to ✓ Shared Goals - there must be a clear
burn out especially the nurses purpose that are mutually agreed upon by
- Increase the efficiency of the services the group, which should reflect patient
Common Principles and family priorities, and can be clearly
✓ Effective Communication – involves articulated, understood, and supported by
commitment of both parties to meet all team members.
regularly, understand each other’s Five Professional goal for Nurses
professional roles and appreciating each - To provide excellent patient centered
other as individuals, sensitivity to care
differences in their communication styles - Increase technologies skills
yet being focused on a common ground; - Focus on continuing education
the client’s needs (it exchanges - Develop continuing education
knowledge, ideas, thoughts, information - Become an expert
that could help to fulfill the best possible ✓ Measurable Processes and Outcomes -
best services. It is about less talking, and these include the protocols and
more listening) procedures necessary for orderly and
✓ Five keys of communication: systematic delivery of care thus,
- Be positive providing a means for reliable and timely
- Be a listener feedback on successes and failures in
- Be an eco both the functioning of the team and
- Be a mirror achievement of the team’s goals.
- Be real ➢ It is an individual and family’s
✓ Clear Roles and Expectations – must be perceptions that is measured in response
related to team member’s functions, to nursing interventions
responsibilities, and accountabilities, thus ▪ Top 7 of Health Care Outcomes
optimizing the team’s efficiency through - Mortality
division of labor. - Safety of care
- Ex. Sa hospital may kanya kanyang - Religions
health care team, as nurses we have - Patient’s experience
several responsibilities and to provide a - Effectiveness of care
high quality care a patients, kailangan - Timeliness of care
each member may kanya-kanyang - Efficient use of medical imaging
responsibilities, accountabilities, ✓ Decision Making - involves shared
functions. responsibility of the team for the
outcome. An important aspect is for the

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 interdisciplinary team to focus on the 9. Quality improvement
client’s priority needs and organizing 10. Management and Resources of
interventions accordingly. environment
- Series of decision-making data 11. Personnel and professional
including subjective and objective data, development
implementation of the actions and o Collaboration and teamwork core
evaluation of the data to achieve the competency:
desired outcome for the client 1. Establishes collaborative relationship
▪ Techniques: with colleagues and other members of
- Pro-active the health team.
- Keep asking questions 2. Collaborates plan of care with other
- Know your team inside out members of the health team
- Think before you act Program Outcomes for BSN Graduates
- Never take chances if you are not a sure (CHED Memo. No. 15, Series of 2017)
about something
Program Outcomes
KEY AREAS OF RESPONSIBILITY FOR BSN
GRADUATES (CHED Memo. No. 5, Series of ➢ Collaborate effectively with inter-, intra-,
2008) and multi- disciplinary and multi-cultural
➢ Nurses also play the role of collaborators, teams.
them being part of the health care team. ➢ With the program outcomes, it describes
Therefore, they must develop this the broad aspects of the behavior,
competency as they assume their knowledge and skills that develop over
professional practice. The importance of the duration of time and experience of our
the concepts of collaboration and BSN graduates.
teamwork had been given emphasis with Performance Indicators
their inclusion in the Key Areas of ➢ Ensure intra- agency, inter-agency, multi-
Responsibility for BSN graduates disciplinary and sectoral collaboration in
(CHED Memo. No. 5, Series of 2008) the delivery of health care.
with the corresponding core ➢ Implement strategies, approaches to
competencies that every nurse should enhance/support the capability of
demonstrate. (this article states the client/care providers to participate in
policies and standards for BSN program, decision making by the inter professional
including the core values, key areas of team.
resposibility) ➢ Maintain a harmonious and collegial
o 11 keys areas of responsibility: relationship among members of the
1. Safe and quality of nursing care health team for effective, efficient, and
2. Communication safe client care.
3. Collaboration ➢ Coordinate the tasks/ functions of other
4. Teamwork nursing personnel (midwife, BHW and
5. Health education utility worker).
6. Legal responsibility ➢ Collaborate with GOs, NGOs, and other
7. Ethico moral responsibility socio civic agencies to improve health
8. Human factors and Record care services, support environment
management protection policies and strategies, and

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 safety and security mechanisms in the madali syang nakaka-move on,
community. nakaka cope up sa nangyari)
➢ Participate as a member of a quality team 2) Anticipatory grief – a feeling of grief
in implementing the appropriate quality occurring before an impending loss.
improvement process on identified The impending loss is the death of
improvement opportunities. someone close due to illness.
DEATH AND DYING (ex. The father diagnoses stage 4
Terminologies cancer, the family member
Loss anticipating that their father soon will
➢ something of value is gone. (process of face death, they are anticipating the
losing someone /something) sadness)
1) Personal loss – impact of life 3) Dysfunctional grief – a failure to
changing. Ang nawawala sa tao. (Ex. follow the predictable course of
Self-esteem, security, & confident, normal grieving to resolution.
malaki ang impact and changes sa ➢ According to Elizabeth Kubler-Ross,
buhay kapag ito nawala) grief has 5 stages. (kapag nag stock up sa
2) Perceived loss – person experience isang grief it is called “Dysfunctional
the loss. (ex. Rejecting by his/her Grief”
family it may lead to loss of security Bereavement
to an individual or big changes to ➢ subjective response to by loved one.
his/her social status) ➢ It is a period of mourning or state of
3) Maturational loss – during the life intense grieving.
cycle. (ex. The person unable to cope ➢ Nag luluksa, ayaw lumabas ng kwarto
the natural process of development) Mourning
4) Situational loss – unexpected or ➢ behavioral response
traumatic event. (ex. Sudden loss of a ➢ expressions of grief or intervention of
partner or a pet) grief
5) Actual loss – recognize and verify ➢ kadalasan yung mga taong malapit sayo
with others. (ex. Dati kang mayaman or kakilala mo sila ang makaka pag
tapos bigla kang nag hirap, and provide ng help sayo to move on na
tendency magiging dependent doon nararanasan mo
sa mga nakapaligid sayo, they will
Dying
recognize that something lost about
➢ On the point of death.
you)
➢ Irreversible cessation of the circulatory,
Grief
respiratory and brain function.
➢ total response to emotional experience
➢ This is the process of approaching death.
related to loss. (kalungkutan/intense
➢ Autonomy – it is keeping the right of the
sorrow)
patient to choose what kind of treatment,
1) Abbreviated grief – when a person
what kind of medication, what kind of
finds it necessary to move on (short
process what kind of death he/she wants,
lived grief)
either with CPR or DNR
(ex. Si lola nawalan ng partner, pero
dahil sa mga suportado nyang apo

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 Death ➢ Naiintindihan na nila pero
➢ The cessation or permanent termination kailangan sabihin ng totoo
of all the biological functions that sustain kung ano yung dahilan
a living organism. about death
➢ End of life ➢ They believe that death is
➢ The phenomenal which commonly bring “brutal” na kapag winish
about death includes: mon a mamatay ang isang
o Aging tao is mangyayari sya.
o Poisoning ➢ Understands death as
o Malnutrition the inevitable end of life.
o Disease ➢ Begins to understand
o Suicide own mortality, expressed as
o Homicide interest in afterlife or as fear
o Drug intoxication 9-12
of death.
years
o Starvation ➢ Expected na
o Dehydration malulungkot at may
o Accident or major trauma resulting in dalamhati silang
fatal injury. mararamdaman kapag may
namatay.
Development of the concept of Death
➢ Fears a lingering death.
Age Beliefs and attitudes
May fantasize that death
➢ Does not understand
can be defied, acting out
concept of death. (hindi pa
defiance through reckless
nila naiintindihan)
behaviors (e.g., dangerous
➢ Infant’s sense of
driving, substance abuse).
separation forms basis for
➢ Seldom thinks about death
later understanding of loss
Infancy but views it in religious
and death.
– 5 years 12-18 and philosophic terms.
➢ Believes death is
years ➢ May seem to reach “adult”
reversible, a temporary
perception of death but be
departure, or sleep.
emotionally unable to
➢ Emphasizes
accept it.
immobility and inactivity as
➢ May still hold concepts
attributes of death.
from previous
➢ Understands that
developmental stages.
death is final.
➢ Almost similar concept to
➢ Believes own death
adult
can be avoided.
5-9 ➢ Has attitude toward death
➢ Associates’ death with 18-45
years influenced by religious
aggression or violence. years
and cultural beliefs.
➢ Believes wishes or
➢ Accepts own mortality.
unrelated actions can be 45-65
➢ Encounter’s death of
responsible for death. years
parents and some peers.

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 ➢ Experiences peaks of ➢ Nagkukulong sa kwarto, ayaw
death anxiety. makipag usap, nagmumukmok.
➢ Death anxiety diminishes ➢ Kapag na stock up ka it is called
with emotional well- “dysfunctional grief”
being. 5. Acceptance
➢ Tanggap na lahat ng tao ➢ Acceptance of the inevitability of
doon pupunta death with peace and detachment.
➢ Fears prolonged illness. ➢ Letting go
➢ Encounter’s death of ➢ Embracing the present, it could be
family members and good or bad response
peers.
Indications of death
➢ Sees death as having
▪ Total lack of response to external stimuli
multiple meanings (e.g.,
65+ ▪ No muscular movement, especially
freedom from pain,
years breathing
reunion with already
▪ No reflexes
deceased family
▪ Flat encephalogram (brain waves)
members).
- In hospital, we base in ECG, flat line it
➢ Di natatakot sa death but
means no electrical activity in the heart
scared of prolong illness
of the pt.
before death
Physiological Needs of Dying Persons
Kubler-Ross 5 Stages of Grief ▪ They also needs care
1. Denial o Five areas:
➢ Shock and disbelief. - Physical comfort
➢ Pretending that the loss is not exist. - Mental
(hindi nangyari) - Emotional
➢ Ayaw tanggapin or pag usapan - Spiritual
2. Anger - Practical task
➢ Hostility and resentment Problem Nursing care
➢ Blaming others ➢ Fowler’s position:
- Ex. Sinisisi mo yung mga doctor, nurses conscious clients
na nag-alaga o nagbigay ng care to your ➢ Throat
loved once suctioning: conscious
3. Bargaining clients
➢ Looking for a way out ➢ Lateral position:
➢ What if? You may feel guilt Airway
unconscious clients
➢ The responsibility for that person (ex. clearance
➢ Nasal oxygen for
Kung umuwi lang ako ng maaga edi hypoxic clients
sana buhay pa sya) ➢ Anticholinergic
4. Depression medications may be
➢ No longer able to deny, patients indicated to help dry
experience sadness and loss. secretions
➢ Isolation and loneliness

ELI
 ➢ Open windows or ➢ Skin care in response
use a fan to circulate air to incontinence of
Air hunger ➢ Morphine may be urine or feces
indicated in an acute ➢ Bedpan, urinal, or
episode commode chair
➢ Frequent baths within easy reach
and linen changes if ➢ Call light within
diaphoretic reach for assistance
➢ Mouth care as onto bedpan or
needed for dry mouth Urinary commode
Bathing/ ➢ Absorbent
➢ Liberal use of elimination pads
hygiene
moisturizing creams placed under
and lotions for dry skin incontinent client;
➢ Moisture-barrier linen changed as
skin preparations for often as needed
incontinent clients ➢ Catheterization, if
➢ Assist client out of necessary
bed periodically, if ➢ Keep room as clean
able and odor free as
➢ Regularly change possible
client’s position ➢ Check preference for
➢ Support client’s light or dark room
position with pillows, ➢ Hearing is not
Physical blanket rolls, or diminished; speak
mobility towels as needed clearly and do not
Sensory/
➢ Elevate client’s legs whisper
perceptual
when sitting up ➢ Touch is diminished,
changes
➢ Implement pressure but client will feel
ulcer prevention pressure of touch
program and use ➢ Implement pain
pressure-relieving management protocol
surfaces as indicated if indicated
➢ Antiemetics or a
small amount of an Signs of impending Clinical Death
alcoholic beverage to ➢ This is the upcoming death of the patient
Nutrition
stimulate appetite Loss of Muscle Tone
➢ Encourage liquid ➢ Relaxation of the facial muscles (e.g., the
foods as tolerated jaw may sag)
➢ Dietary fiber as ➢ Difficulty speaking
tolerated ➢ Difficulty swallowing and gradual loss of
Constipation
➢ Stool softeners or the gag reflex.
laxatives as needed ➢ Decreased activity of the gastrointestinal
tract, with subsequent nausea,

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 accumulation of flatus, abdominal ➢ Impaired senses of taste and smell.
distention, and retention of feces, ➢ Visual and auditory hallucination –
especially if narcotics or tranquilizers are nagsasalita nalang bigla na yung kapatid
being administered. (through tranquilizer or yung family member nasa tabi nya
it may lead the relaxation of the organ) w/ch is patay na yung binabanggit na
➢ Possible urinary and rectal incontinence pangalan
due to decreased sphincter control. ➢ Hearing sensation – pinaka last
➢ Diminished body movement.
Pronouncement of Death
➢ The body function of the pt decreases
▪ Absence of the carotid pulses
also, due to loss of activity
▪ Pupils are fixed and dilated
➢ Myoclonic – involuntary or muscle
▪ Absent heart sounds
spasm and after magkakaroon na ng
▪ Absent breath sounds
muscle reflexes
▪ Asystole or Flat line – there is no
Slowing of the Circulation
electrical activity in the heart.
➢ Diminishes sensation
▪ Doctor yung nagpo pronounce ng death
➢ Mottling and cyanosis of the extremities
➢ Cold skin, first in the feet and later in the Religious Beliefs
hands, ears and nose. (The client, ➢ Spiritual support is of great importance in
however, may feel warm if there is a dealing with death.
fever) ➢ way for them to cope up on death of their
➢ Slower and weaker pulse family member – madali silang maka
➢ Decreased blood pressure. move on
➢ The dying person has slow heartbeat, so
kapag bumagal ito babagal din ang blood Sociocultural Definitions of Death
circulation, kapag mabagal ang blood ➢ Different cultures view death in diverse
circulation ang blood na mapupunta kay ways.
brain hindi na sapat yung blood, so mag ➢ Customs and expectation also differ in
la-lack din ang energy na masusupply ng ritual of bereavement and mourning.
brain sa ibang organs. ➢ Even within a culture there is diversity in
the view of death.
Changes in Respirations ➢ Kanya-kanyang paniniwala.
➢ Rapid, shallow, irregular, or abnormally
slow respirations. Postmortem Changes
➢ Noisy breathing, referred to as the death - Signs of deaths
rattle, due to collecting of mucus in the Pallor mortis
throat ➢ Paleness of death
➢ Mouth breathing dry oral mucous ➢ Almost immediately after death a body of
membranes. a person with light skin will begin to grow
➢ Dying person: 50-60 breaths per min or as very pale. This is caused by a lack of
few as 6 per min. (progressively blood in the capillary region of the blood
decreasing) vessel.
➢ Apnea – absence of breathing Algor Mortis
Sensory impairment ➢ Cool of death
➢ Blurred vision

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➢ After death a human body will no longer ▪ Chart any special directions
be working to keep warm, and as a result ▪ Notify family members
will start cooling. ▪ Allow time with loved one
➢ About an hour postmortem (after death) a ▪ Gather eyeglasses and other belongings
human body will have decreased around ▪ Prepare necessary paperwork for body
2 degrees Celsius and will continue to removal
decrease one degree Celsius until it ▪ Call funeral home (or other appropriate
reaches the temperature of the personnel) for body transport
environment around it. ▪ Note on chart
➢ Mabilis ang pag lamig ng katawan, kapag ➢ What personal artifacts were released
nag stop na yung circulation, cue na yun with the body?
para mag start lumamig yung katawan ng ➢ What belonging were released?
pt. (yung namatay na pt.) ➢ Who received the belongingness?
Rigor Mortis ▪ Tag or provide body identification as per
➢ Death stiffness policy.
➢ About three hours after death a chemical
Nursing responsibilities
change in the muscles of a human corpse
To the patient
causes the limbs of the corpse to become
▪ Nurses need to take time to analyze their
stiff and difficult to move.
own feelings about.
➢ Kailangan i-ayos ang extremities agad
▪ Understand that you may experience
para hindi mag stock yung katawan sa
grief.
ganung position, the stiffness is due to
▪ Nurses must be strong to control their
chemical changes of the body.
feelings to be able to tolerate pain, illness,
➢ Calcium is one of the chemical changes
and death, and to keep their distance.
that affect the body
▪ Provide relief from illness, fear, and
Postmortem Care depression.
▪ Needs to be done promptly, quietly ▪ Help clients maintain sense of security.
efficiently and with dignity. ▪ Help accept losses.
▪ Straighten limbs before death, if possible, ▪ Provide physical comfort.
place head on pillow To the family
▪ Remove tubes ▪ Explain procedures and equipment
▪ Replace soiled dressings ▪ Prepare them about the dying process.
▪ Pad anal area ▪ Involve family and arrange for visitors
▪ Gently wash body to remove discharge ▪ Encourage communication
▪ Place body on back with head and ▪ Provide daily updates
shoulders elevated. ▪ Resources
▪ Grasp eyelashes and gently pull lids ▪ Do not deliver bad news when only one
down. family member is present.
▪ Insert dentures
▪ Place clean gown on body and cover with
clean sheet.
▪ Note time of death and chart
▪ Notify attending physician

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