FUNDAMENTALS OF NURSING

NURSING THEORIES

Theories that focus on the environment

 Florence Nightingale –
to facilitate the body’s reparative process by manipulating the environment

Theories that focus on the Client as an Individual/ Holistic Approach

 Holistic Delivery of Health care to meet the social , physical, intellectual , creative,
emotional and spiritual needs of the client and family( 21 problems)
Faye Abdellah

 to work interdependently with other health caregivers. Focus is on the independent

satisfaction of 14 human needs( Complementary – supplementary)
Virginia Henderson

 Client is an individuaql with a need that when met diminishes distress, increases
adequacy and enhances well-being. Three elements comprises a nursing situation ; 1.) Client
behavior , 2) Nurse Raection and 3) Nurse actions
Ida Orlando

Focuses on how the client adapts to illness and how actual or potential stress can affect ability to
adapt. The goal of nursing is to reduce stress. Clients basic needs are categorized according to
behavioral subsystems
Dorothy Johnson

 Nursing care is necessary only if the client is unstable to fulfill biological, psychological,
developmental or social needs
Dorothea Orem

 The client is an adaptive system, thus the goal of nursing is to help the person adapt to
this changes in physiological needs, self-concept, role function and interdependent relations
during health and illness.
Sis. Callista Roy

 The client is composed of overlapping parts; person(core), pathologic state and

treatment() cure) and body ( care)
Lydia Hall – first introduced the Nursing process

Focus is interaction between Client and environment

 Health is viewed in terms of conservation of client’s energy, structural, personal and

social integrity
Myra Levine

 Believes that nursing incorporates knowledge of basic sciences, physiology and nursing
practice. Views nursing primarily as a science and is committed to research. The humanistic
science of nursing”,man is changing and coexisting with the environment
Martha Rogers

Focuses on the interrelationship between Client and Nurse

 To develop interaction between the client and the nurse( Psychodynamic Nursing)
Hildegard Peplau

 To identify problems and to identify goals- focuses on the dynamic interpersonal

relationship between the client and the nurse. Communication is used to help client rte-establish
positive adaptation to the environment
Imogene King

DEFINITIONS OF NURSING

 DIAGNOSIS AND TREATMENT OF HUMAN RESPONSES TO ACTUAL OR

POTENTIAL HEALTH PROBLEMS
 NURSING SCIENCE-COGNITIVE BRAIN OF NURSING
 NURSING ESTHETICS- ART AND HEART OF NURSING
 NURSING ETHICS- KNOWLEDGE OF PROFESSIONAL STANDARDS OF CONDUCT
 PERSONAL KNOWLEDGE-CONSCIOUS AWARENESS OF ONE’S OWN VALUES.

HEALTH CARE DELIVERY SYSTEM

LEVELS OF PREVENTION

 PRIMARY PREVENTION-IDENTIFIES RISK FACTORS, ATTEMPTS TO ELIMINATE STRESSOR

AND FOCUSSES ON PROTECTING THE DEFENSE, REACTION HAS NOT YET OCCURRED. To
encourage optimal health and to increase the persons resistance to illness.
- health promotion
-specific protection
 SECONDARY PREVENTION- INTERVENTION OR ACTIVE TREATMENT AFTER SYMPTOMS
HAVE OCCURRED.STRENGTHEN RESISTANCE. Also known as health maintenance- early diagnosis/
detection/screening; prompt treatment
 TERTIARY PREVENTION- INTERVENTION, READAPTATION AND STABILITY- establishment of
high level wellness.

HEALTH AND ILLNESS

 BASIC HUMAN NEEDS MODEL

 HEALTH ILLNESS CONTINUUM MODEL( health seeking and illness behavior)

 HOLISTIC HEALTH MODEL

 HEALTH BELIEF MODEL

 HEALTH PROMOTION MODEL

THE NURSING PROCESS

ASSESSMENT-
ASSESSMENT- SYSTEMATIC COLLECTION OF DATA TO DETERMINE PATIENTS STATUS
AND TO IDENTIFY ANY ACTUAL OR POTENTIAL HEALTH PROBLEMS

 INITIAL ASSESSMENT-SPECIFIED TIME AFTER ADMISSION

 FOCUS OR ONGOING ASSESSMENT-ONGOING PROCESS INTEGRATED WITH
NURSING CARE
 EMERGENCY ASSESSMENT-DURING ANY PHYSIOLOGIC OR PSYCHOLOGIC
CRISIS OF THE CLIENT
 TIME-LAPSED- SEVERAL MONTHS AFTER INITIAL ASSESSMENT
ANALYSIS/NURSING DIAGNOSIS- IDENTIFICATION OF ACTUAL OR POTENTIAL HEALTH
PROBLEMS AMENABLE TO RESOLUTIONS BY NURSING ACTIONS

DIAGNOSIS FORMAT(p>e>s>)
 PROBLEM STATEMENT(ALTERED,IMPAIRED,INEFFECTIVE,ACUTE AND
CHRONIC
 ETIOLOGY(RELATED TO / SECONDARY TO)
 DEFINING CHARACTERISTICS (SIGNS AND SYMPTOMS)

DIAGNOSTIC PROCESS
 ANALYSIS- SEPARATION INTO COMPONENTS
 SYNTHESIS – PUTTING TOGETHER OF PARTS INTO WHOLE
 Critical thinking-cognitive process-person reviews data and considers explanations
before forming an opinion.
REMEMBER THE 3 C’S

 PLANNING- DEVELOPMENT OF GOALS AND A PLAN OF CARE DESIGNED TO

ASSIST THE PATIENT IN RESOLVING THE NURSING DIAGNOSIS
( ORGANIZE,ANALYSE,SYNTHESIZE AND PRIORITIZE)
(IDENTIFY PROBLEM,PNT.CHARAC. AND ETIOLOGIES)

PLANNING-
PLANNING- DESIRED OUTCOME
GOALS SHOULD BE:
SYSTEMATIC
MEASURABLE
ATTAINABLE
REASONABLE
TIME-FRAMED

 IMPLEMENTATION- ACTUALIZATION OF THE PLAN OF CARE THROUGH NURSING

INTERVENTIONS ( COORDINATION,DELEGATION-CAPABILITIES ,LIMITATIONS AND
SUPERVISION

 PROTOCOLS- STANDARDS OF CARE

 POLICIES AND PROCEDURES- GOVERN THE HANDLING OF FREQUENT
OCCURING SITUATIONS
 STANDING ORDER- POLICIES,RULES, REGULATIONS AND ORDERS OF CLIENT
CARE( authority to carry out specific actions under certain circumstances)

 EVALUATION-DETERMINATION OF PATIENT’S RESPONSES TO THE

INTERVENTIONS AND EXTENT TO WHICH GOALS HAVE BEEN ACHIEVED(FEEDBACK)

 ONGOING
 INTERMITTENT
 TERMINAL

NURSING DOCUMENTATION FORMATS

1)NURSING CARE PLANS-TRADITONAL OR STANDARDIZED

2)CRITICAL PATHWAYS-MANAGED CARE SYSTEMS(INTERVENTIONS FOR SPECIFIC
DISEASES
3)KARDEX-CONCISE METHOD OF ORGANAZING AND RECORDING DATA ABOUT A
CLIENT,MAKING INFORMATION READILY ACCESIBLE TO ALL HEALTH
RPOFESSIONALS
4) PROGRESS NOTES
 NARRATIVE CHARTING IS A DESCRIPTION(NARRATION) OF INFORMATION
AND CHRONOLOGIC CHARTING.
 SOAP FORMAT / SOAPIER
 PIE CHARTING
 FLOWSHEETS (GRAPHIC OR TABULAR)MED.,MIO,DAILY NURSING CARE
RECORD
 CLINICAL RECORDS( GCS, CVP)
 FOCUS CHARTING- OUTLINES OCCASIONS FOR AND ACTIVITIES OF
NURSING CARE(DATA , ACTION AND RESPONSE)

ETHICS AND VALUES

 MORALITY OF HUMAN BEHAVIOR
 BIO-ETHICS – APPLIED TO LIFE
 CODE OF ETHICS- STANDARD OF GROUP’S IDEALS AND VALUES
 VALUES- BOTH INTRINSIC AND EXTRINSIC
 ENDURING BELIEFS AND ATTITUDES WORTH OF A PERSONS OBJECTIVES , IDEA
OR ACTION

 MORALS – PRINCIPLES AND RULES OF RIGHT CONDUCT. PRIVATE AND

PERSONAL COMMITMENT DEFENDED IN DAILY LIFE
 ETHICS – PROFESSIONALLY AND PUBLICLY STATED. INQUIRY OR STUDY OF
PRINCIPLES AND VALUES
VALUE STANDARDS
 MORALS – STANDARDS OF RIGHT AND WRONG
 INTUITIONISM – NOTION
 AUTONOMY – INDEPENDENCE
 NON-MALEFICENCE – DO NO HARM
 BENEFICENCE – DOING GOOD
 JUSTICE – FAIRNESS
 FIDELITY – FAITHFULLNESS AND COMMITMENT
 VERACITY – TRUTHFULNESS
 ADVOCACY- INFORMED SUPPORT / ENHANCE AUTOMOMY

JURISPRUDENCE
 LAW- RULES THAT REGULATE SOCIAL CONDUCT IN A FORMALLY PRESCRIBED
AND LEGALLY BINDING MANNER
 RIGHTS-PRIVILEDGES
 RESPONSIBILITIES-OBLIGATIONS
 GRIEVIANCE-DISPUTE/CONTROVERSY

 STARE DECICIS-”TO STAND BY THINGS DECIDED”

Classified into:
 PUBLIC OR CRIMINAL LAWS-ACTIONS AGAINST SAFETY AND WELFARE OF THE
PUBLIC
 FELONY(SERIOUS)
 MISDEMEANOR(LESS SERIOUS)
 CIVIL/PRIVATE LAWS
 CONTRACTS
 TORTS – WRONG AGINST PERSON OR PROPERTY
  UNINTENTIONAL-NEGLIGENCE
 INTENTIONAL

 INTENTIONAL TORTS
 ASSAULT AND BATTERY
 INVASION OF PRIVACY
 DEFAMATION
 MALPRACTICE AND NEGLIGENCE
 FALSE IMPRISONMENT
 FRAUD

JURISPRUDENCE

 LIVING WILL – DECLARATION OF A COMPETENT INDIVIDUAL

 DNR – COMPETENT CLIENTS AND VALUES – PRIORITY
 ADVANCE DIRECTIVES- CLEARLY DOCUMENTED , RECIEWED AND UPDATED
 PROVIDE COMFORT MEASURES
 IF NURSE IS NOT COMFORTABLE – CONSULT NURSE MANAGER
 MEET STANDARDS OF CARE
 CRITERIA- TERMINAL/BRAIN DEATH – TO PREVENT SUFFERING
 RESTRAINTS-NOT INSTITUTED FOR THE PURPOSE OF CONVENIENCE AND AS A
TREATMENT OF MEDICAL SYMPTOMS(FALSE IMPRISONMENT)
 BOTH PHYSICAL AND CHEMICAL
 INFORMED CONSENT-DURATION REQUIRED NOT PRN
 ALTERNATIVE MEASURES FIRST
 REMOVE Q2h for skin care and ROM
 DONE TO PREVENT HARM OR INJURY OR COMPLICATION IF PNT. DISORIENTED
(SAFETY)
INCIDENT REPORTS
 INCIDENT REPORTS-STATEMENT OF FACTS AND PATIENT’S PHYSICAL
RESPONSE FROM UNEXPECTED OCCURRENCE THAT (COULD/) AFFECT THE CLIENT----
SEQUENCE, W/IN 24 HOURS---RISK MANAGER—COMPR. SITUATIONS
 NO-REFERENCE , INAPPROPRIATE TERMS OR WORDS, JUDEGMENTAL
STATEMENTS, ----- -MONITORING AND DOCUMENTATION

 TELEPHONE ORDERS- REPEAT ORDER TO THE AP AND LET HIM SIGN WITHIN 24
HOURS

INFORMED CONSENT
 AGGREED UPON
 FACTS KNOWN
 TREATMENT
 EXPLANATION
 RISK UNDERSTOOD
CONSENT CONSIDERATIONS
 OB , STD,REHAB ,BLOOD DON.
( MINOR CAN GIVE)
 ER, LIFE THREATENING(IMPLIED)
 MENTALLY ILL(INCAPABLE)

MODELS FOR DELIVERY OF NURSING

 CASE METHOD-TOTAL CARE-CONSISTENCY
 FUNCTIONAL METHOD-TASK ORIENTED- CENTRALIZED DIRECTION AND CONTROL
 TEAM NURSING-TEAM COORDINATED CARE-INDIV. ROLES –EFFICIENCY
 PRIMARY NURSING-COMPREHENSIVE,INDVIDUALISTIC, CONSISTENT – TECHNICAL
KNOWLEDGE AND MNGT.SKILLS
 CASE MNGT. COMPREHENSIVE CONTINOUS CARE
 MANAGED CARE- COST CONTAINMENT
 DIFFERENTIATED-COMPETENCY-DELINEATION

TEACHING AND LEARNING

 ANDRAGOGY VS PEDAGOGY
 DEPENDENCE TO INDEP.
 PREVIOUS EXPERIENCE
 READINESS TO LEARN(DEV. TASK)
 PERSONAL USEFULNESS and VALUE
 DOMAINS-COGNITIVE, AFFECTIVE AND PSYCHOMOTOR
 A KEY ELEMENT IN THE CHANGE PROCESS IS TRUST
DESIRE + ACTING - COMPLIANCE

STRESS
 GAS – ALARM-RESISTANCE-EXHAUSTION
 COPING AND STRESS MANAGEMENT
 ANXIETY-
 MILD – SLIGHT AROUSAL AND INCREASED PERCEPTION
 MODERATE-INC. TENSION AND SELECTIVE INATT.
 SEVERE – DEC. PERCEPTION AND FOCUSSED ENERGY
 PANIC – OVERPOWERING AND LOSS OF CONTROL

LOSS ,GRIEVING AND DEATH

 DEATH CONCEPTS
 1-5Y.O – IMMOBILITY AND INACTIVITY Wishes and unrelated action responsible for
action
 5-10 – final but can be avoided
 9-12 – understands own mortality and fears death
 12 – 18 – fears and fantasizes avoidance
 18-45 – increased attitude awareness
 45-65 – accepts mortality
 Above 65 – multiple meanings, encounters and fears

SENSORY PERCEPTION AND COGNITION

 SENSORY DEPRIVATION
 SENSORY OVERLOAD
 SENSORY DEFICITS

PROTECTING HEALTH

Universal Precautions

 Strict Isolation-highly transmissible diseases by direct contact and airborne routes of

transmission
Private room,gowns, mask , gloves, handwashing,double bagged techniques for soiled articles
Diptheria(pharyngeal),Herpes Zoster, Varicella , Pneumonia( S.Aureus , Strep,group A)
 Respiratory Isolation-droplet transmission(3 feet)
Private rom,patient w/ same organism,mask,handwashing,labelled plastic bags for soiled articles
H. influenza, measles, mumps, N. Meningitidis
 Tuberculosis/ AFB isolation-suspected / active TB
 Private room with negative pressureventilation so that air room is vented outside, mask,
handwashing, bronchoscopy and dental examination postponed until 2 weeks of antibiotic
therapy
 Contact Isolation – infectious disseases or multiple resistant microorganisms that are spread by
direct contact or close contact
Private room , mask gown , gloves
diptheria( cutaneous), Herpes simplex, MRSA , Pediculosis , Scabies , Syphilis
 Enteric Precautions – infectious diseases transmitted through direct or indirect contact with
infected feces.
Handwashing , gloves , gowns worn only when handling contaminated objects with feces
Aseptic meningitis, AGE , Hepa A , Typhoid fever, diarrhea (CDT )
 Drainage / Secretions precautions – patients with wound drainage or infected wounds
Gloves, gowns indicated if clothing is likely to be contaminated
Burns
 Universal Blood and Body fluids precautions – blood borne , body fluids pathogens ( blood ,
semen , vaginal secretions , CSF , synovial fluid , pleural fluid , peritoneal fluid , pericardial fluid ,
amniotic fluid and tissues.
Gloves , mask, protective eyegears, gown , contaminated needles not recapped and sharps in
puncture resistant containers
Aids , Hepatitis B and C , STD’s
 Reversed Isolation - Patient is protected from pathogens and nosocomial infections by instituting
reversed transmission precautions
Burns and open wounds, patients with artificial airway , immunocompromised patients – leukemia
, AIDS , steroid therapy , radiation or cancer chemotherapy , medication effect of leukopenia or
agranulocytosis

REST AND SLEEP

 Stages of Sleep:
 Non-Rapid Eye Movement (NREM)- for body restoration
 Very Light Sleep- drowsy, and readily awakened
 Light Sleep- Heart and respiratory rate decreases and the body temperature gradually
falls.
 PNS domination- Difficult to arouse
 Deep Sleep- Decrease metabolism and very difficult to arouse
 Rapid Eye movement (REM)- increase synthetic processes of the brain
 Paradoxical Sleep
 Dream state of the sleep
 Close to wakefulness but difficult to arouse

ACTIVITY AND EXERCISE

 ERGONOMICS

 TYPES AND PRINCIPLES

 ROM AND ISOMETRICS
 PROBLEMS OF IMMOBILITY AND NURSING INTERVENTIONS

 ACTIVITY ORDERS

POSITIONING FOR SPECIAL CONDITIONS

 ABDOMINAL ANEURYSM SURGERY-FOWLERS
 ASTHMA – ORTHOPNEIC POSITION
 AUTNOMIC DYSREFLEXIA-HIGH FOWLERS
 POST BRONCHOSCOPY-SEMI FOWLERS
 CARDIAC CATHETERIZATION-KEEP INSETION SITE EXTENDED FOR 4-6 HOURS TO
PREVENT ARTERIAL OCCLUSION
 CAST – ELEVATE EXTREMITY
 CATARACT – SEMI FOWLERS
 CEREBRAL ANEURYSM – SEMI - FOWLERS
 CLEFT LIP – SUPINE
 CLEFT PALATE – PRONE
 CHF – HIGH FOWLERS
 CRANIOTOMY – SUPRATENTORIAL – SEMI FOWLERS
 ;INFRATENTORIAL – FLAT
 ICP – LEVATE HEAD
 DUMPING SYNDROME – SUPINE AFTER MEALS
 EPISTAXIS – LEAN FORWARD
 FLAIL CHEST – AFFECTED SIDE
 FEMORO-POPLITEAL BYPASS GRAFT – AFFECTED EXTREMITY EXTENDED
 GLAUCOMA(POST OP) – AFFECTED SIDE
 HEMORROIDECTOMY – SIDE LYING
 HIATAL HERNIA- UPRIGHT
 HIP SURGERY – LEGS IN ABDUCTION
 LAMINECTOMY – BACK AS STRAIGHT AS POSSIBLE
 LIVER BIOPSY – RIGHT SIDE LYING
 LOBECTOMY – SEMI FOWLERS
 POST LP – FLAT
 MASTECTOMY – ELEVATE EXTREMITY ON PILLOW
 MYELOGRAM – WATER BASED DYE – ELEVATE THE HEAD --- OIL BASED DYE - FLAT
 POSTURAL DRAINAGE – LUNG SEGMENT – UPPERMOST POSITION
 PROLAPSED CORD – KNEE-CHEST
 PULMONARY EDEMA – FOWLERS
 PYLORIC STENOSIS – RIGHT SIDE LYING
 RADIUM IMPLANT – FLAT ON BED
 RETINAL DETACHMENT – AFFECTED SIDE TOWARDS THE BED
 SEIZURE – SIDE-LYING
 SHOCK – MODIFIED TRENDELENBURG
 SCI – IMMOBILIZE
 TONSILLECTOMY – SIDELYING / PRONE
 THYROIDECTOME – SEMI – FOWLERS
 THROMBOPHLEBITIS – ELEVATE LEG
 TPN – TRENDELENBURG – DURING INSERTION
 THORACENTESIS – FOWLER’S(DURING)
 AFTER – POSITION OF COMFORT

BEDSIDE SAFETY/EMERGENCY MATERIALS / EQUIPMENTS

 AMPUTATION – TOURNIQUET
 AUTONOMIS HYPERREFLEXIA – CATHETER
 CHEST TUBE DRAINAGE- EXTRA BOTTLE- FORCEPS – VASELINIZED GAUZE
 CHOLINERGIC AND MYASTHENIC CRISIS – ENDOTRACHEAL TUBE /
TRACHEOSTOMY SET
 EPIGLOTITIS - ENDOTRACHEAL TUBE / TRACHEOSTOMY SET
 PIH – PADDED MOUTH GAG
 PARKINSONS – SUCTION APPARATUS
 RADIUM IMPLANT – LEAD CONTAINER , FORCEPS
 SENGSTAKEN BLAKEMORE TUBE – SCISSORS
 SCI AND THYROIDECTOMY – TRACHEOSTOMY
 TONSILLECTOMY – FLASHLIGHT
 TRACHEOSTOMY TUBE – OBTURATOR , HEMOSTAT

HYGIENE AND COMFORT

 INFANT BATHING
 COMPLETE ADULT BED BATH
  TUB BATH
 THERAPEUTIC
 SALINE
 OATMEAL
 CORNSTARCH
 NACHO3
 KMnO4

 PERINEAL / GENITAL CARE

 FOOT AND NAIL CARE
 HAIR CARE
 ORAL CARE
 BEDMAKING

 PRESSURE ULCER
 GRADING
 PREVENTION
 TREATMENT

THERAPEUTIC DIET FOR SPECIFIC CONDITIONS

 AGE – CLEAR LIQUID
 AGN – LOW NA , LOW CHON
 ADDISON’S – HIGH NA , LOW K
 ANEMIA , PERNICIOUS – HIGH CHON , VIT. B.
 ANEMIA SICKLE CELL – HIGH FLUID
 GOUT – PURINE RESTRICTED
 ADHD AND BIPOLAR – FINGER FOODS
 BURN – HIGH CAL. HIGH CHON
 CELIAC – GLUTEIN FREE
 CHOLECYSTITIS – HIGH CHON, HIGH CARB, LOW FAT
 CHF – LOW NA , LOW CHOL.
 CROHNS – HIGH CHON AND CHO, LOW FAT
 CYSTIC FIBROSIS – HIGH CAL., HIGH NA
 LITHIASIS----ACID ASH FOR ALK. STONES------ALK. ASH FOR ACID STONES
 DECUBITUS ULCERS – HIGH CHON , HIGH VIT C
 DIARRHEA – HIGH K AND NA
 DUMPING SYNDROME – HIGH FAT, HIGH CHON,DRY
 HEPATIC ENCEPHALOPATHY-LOW CHON
 HEPATITIS – HIGH CHON,HIGH CAL.
 HIRSPRUNGS – LOW RESIDUE, HIGH CHON AND CHO
 CIRRHOSIS – LOW CHON
 MENIERE’S LOW NA
 MI AND HPN – LOW CHOL.,FATS,NA
 HYPERTHYROIDISM- HIGH CAL. AND CHON
 HYPOTHYROIDISM – LOW CAL. , LOW CHOL, LOW SAT. FAT
 NEPHROTIC SYNDROME – LOW NA, HIGH CHON , HIGH CAL.
 HYPERPARATHYROIDISM – LOW CALCIUM
 HYPOPARATHYROIDISM – HIGH CA, LOW PHOSPHORUS
 OSTEOPOROSIS – HIGH CALCIUM AND HIGH VIT. D
 PANCREATITIS – LOW FAT
 PUD – HIGH FAT, HIGH CARB. LOW CHON
 PKU – LOW CHON / PHENYLALANINE
 PIH – HIGH CHON
 RENAL FAILURE (ACUTE) – LOW CHON,HIGH CARB
 LOW NA (OLIGURIC PHASE)
 HIGH CHON , HIGH CAL AND RESTRICTED FLUID (DIURETIC PHASE
 RENAL FAILURE (Chronic) – LOW CHON , LOW NA , LOW K

OXYGENATION
 PULMONARY FUNCTION TESTS
 DIAGNOSTIC LABORATORIES(ABG, SPUTUM CS AND THROAT CULTURE)
 VISUALIZATION
 AUSCULTATION

 OXYGEN DELIVERY EQUIPMENT

 CHEST PHYSIOTHERAPY
 ARTIFICIAL AIRWAYS
 THORACOCENTESIS,THORACOSTOMY.TRACHEOSTOMY AND ET INTUBATION
 SUCTIONING
 CHEST TUBES AND DRAINAGE SYSTEMS

BOWEL ELIMINATION
 TOILET TRAINING
 FACTORS AFFECTING
 PROBLEMS
 MANAGEMENT-CATHARTICS , ENEMA , SURGERY

 DIAGNOSTIC AND THERAPEUTIC PROCEDURES

 ENEMA

 COLOSTOMY/ILEOSTOMY,OTHER SURGERIES

 BARIUM STUDIES

 SCOPIC EXAMS

 ROENTOLOGIC EXAMS

URINARY ELIMATION
 BLADDER TRAINING
 LABS AND DIAGNOSTIC TESTS
 CONDITIONS
 CATHETERIZATION AND IRRIGATIONS

WOUND CARE

 WOUND TYPES
 HEALING
 DRESSING
 DRAINS
THERAPEUTICS
 MEDICATION ADMINISTRATION
 IVF INFUSIONS(INCLUDING MIO)
 BLOOD TRANSFUSION
 PHYSICAL AND OCCUPATIONAL THERAPY

SUPPLEMENTS
 NORMAL VALUES
 DIAGNOSTIC TESTS

DIAGNOSTIC STUDIES AND INTERPRETATION

 DETERMINATION REFERENCE RANGE CLINICAL SIGNIFICANCE
Hematology

Bleeding Time 1.5 – 9.5 min. Prolonged in thrombocytopenia,

defective platelet function and aspirin
therapy
Factor VIII assay 60 % - 140 % Deficient in classical hemophilia
PTT ( activated ) 25-45 secs. Prolonged in deficiency of fibrinogen,
( normal 2.5 x control ) factors II,V,VIII,IX,X,XI And XII
PTT 60 – 70 secs. and in Heparin therapy
PT 9 – 14 secs. Prolonged by deficiency of factors I,
II, V, VII and X , fat malabsorption,
severe liver disease, counarin
anticoagulant therapy
INR 1.0 Used to standardize the prothrombin
time and anticoagulation therapy
Erythrocyte count M 4.6 – 6.2 x 1012/ L Increased in severe diarrhea and
F 4.2 – 5.4 x1012/ L dehydration, polycythemia,acute
poisoning, pulmonary fibrosis

Decreased in all anemias, in

leukemia, and after hemorrhage,
when blood volume has been restored
ESR Westergren meth. < 15-20 mm / H Increased in tissue destruction,
ESR Zeta Centrifuge < 0.40-0.60 whether inflammatory or
degenerative, during menstruation
and pregnancy and in acute febrile
illness
Hematocrit M; 42- 52 % Decreased in svere anemias, anemia
F; 35 – 47 % of preganancy, acute massive blood
loss

Increased in erythrocytosis of any

cause and in dehydration or
hemoconcentration associated with
shock
Hemoglobin M; 13 – 18 gm / dl Decreased in various anemias,
F; 12 – 16 gm / dl pregnancy, severe or prolonged
hemorrhage, with excessive fluid
intake
Increased in polycythemia, chronic
obstructive pulmonary disease,
gfailure of oxygenation because of
CHF and normally in people living at
high altitudes
WBC / leukocytes 5,000 – 10,000 /cu.mm Increased in various infections
Neutrophils 45 %– 73 % Neutrophils increased with acute
Eosinophils 0%-4% infections, trauma or surgery,
Basophils 0% - 1% leukemia, malignant disease, necrosis,
Lymphocytes 20 %– 40 % decreaqsed with viral infections, bone
Monocytes 2% - 8 % marrow suppression, primary bone
marrow disease

Eosinophils increased in allergies,

parasitic disease, collagen disease,
subacute infections, decreased with
stress, use of some medications
( ACTH, epinephrine, thyroxine)

Basophils increased with acute

leukemia and following surgery or
trauma, decreased with allergic
reactions, stress, parasitic disease, use
of corticosteroids

Lymphocytes increased with

infectious mononucleosis, viral and
some bacterial infections, hepatitis;
decreased in aplastic anemia, SLE,
immunodeficiency including AIDS

Monocytes increased with viral

infections, parasitic disease, collagen
and hemolytic disorders, decreased
with use of corticosteroids, RA, HIV
infection
Platelet count 150,000- Increased in malignancy,
450,000/cu.mm myeloproliferative disease,
rheumatoid arthritis and post
operatively
Decreased in thrombocytopenic
purpura, acute leukemia, aplastic
anemia and during cancer
chemotherapy

Serum, Plasma, and Whole Blood Chemistries

Normal Adult Reference Clinical Significance
Range
Determination Conventiona SI Units Increased Decreased
l Units
Acid, total Males: 2-12UL Males: 2- Carcinoma of
phosphatase Females: 0.3- 12UL prostate
9.2UL Females: 0.3- Advance Paget’s
9.2UL disease
Hyperparathyroidis
m
Gaucher’s disease
Carcinoma of
prostrate
Acid, 2.5-3.37 ng/mL 2.5-3.37 ug/L Carcinoma of
phosphatase, prostate
prostatic—RIA

Alkaline Adults:50-120 50-120 UL Conditions

phosphatase UL reflecting increased
osteoblastic activity
of bone
Rickets
Hyperparathyroidis
m
Hepatic disease
Bone disease

Ammonia 15-45 ug/dL 11-32/umol/L Severe liver disease

(plasma) (varies with Hepatic
method) decompensation

Amylase 60-10 Somogyi 111-296U/L Acute pancreatitis Chronic pancreatitis

U/dl Mumps Pancreatic fibrosis and
Duodenal ulcer atrophy
Carcinoma of head Cirrhosis of liver
of pancreas Pregnancy (2nd and 3rd
Prolonged elevation trimesters)
with pseudocyst of
pancreas
Increased by
medications that
constrict pancreatic
duct sphincters:
morphine, codeine,
cohlinergics
ALT (alanine Males: 10-40 Males: 0.17- Same conditions as
aminotransferase) U/mL 0.68ukat/L AST (SGOT),
, formerly SGPT Females: butincrease is more
Females: 8-35 0.14- marked in liver
U/mL 0.60ukat/L disease that AST
(SGOT)
AST (aspartate Males: 10-40 Males: ).34- Myocardial
aminotransferase) U/L 0.68 ukat/L infarction
, formerly SGOT Females0.25- Skeletal muscle
Females: 15-30 0.51 ukat/L disease
U/L Liver disease
Biluribin Total: 0.3-1.0 5-17umol/L Hemolytic anemia
mg/dL 1.7-3.7 (indirect)
Direct: 0.1-0.4 umol/L Biliary obstruction
mg/dL 3.4-11.2 and disease
Indirect: 0.1- umol/L Hepatocellular
0.4 mg/dL damage (hepatitis)
Pernicious anemia
Hemolytic disease
of newborn
Blood gases
Oxygen, 85-95 mm Hg 10.64-12.64 Polycythemia Anemia
arterial kPa Cardiac or pulmonary
(whole blood): disease
Partial pressure
(PaO2)
Saturation 95%-99% Volume Cardiac decompensation
(SaO2) fraction: 0.95- Chronic obstructive lung
0.99 disease

Carbon 35-45 mm Hg 4.66-5.99 kPa Respiratory acidosis Respiratory alkalosis

dioxide, arterial Metabolic alkalosis Metabolic acidosis
(whole blood)
partial pressure
(PaCO2)
pH (whole 7.35-7.45 7.35-7.45 Vomiting Uremia
blood, arterial) Hyperventilation Diabetic acidosis
Fever Hemorrhage
Intestinal Nephritis
Obstruction
Calcium 8.6-10.2 mg/dL 2.15-2.55 Tumor or Hypoparathyroidism
mmol/L hyperplasia of Diarrhea
parathyroid Celiac disease
Hypervitaminosis D Vitamin D deficiency
Multiple myeloma Acute pancreatitis
Nepritis with Nephrosis
Uremia After parathyroidectomy
Malignant tumors
Sarcoidosis
Hyperthyroidism
Skeletal
immobilization
Excess calcium
intake: milk alkali
syndrome
CO2 venous Adults: 24-32 24-32 mmol/L Tetany Acidosis
mEq/L 18-24 mmol/L Respiratory disease Nephritis
Infants: 18-24 Intestinal Eclampsia
mEq/L obstruction Diarrhea
Vomiting Anesthesia
Chloride 97-107 mEq/L 97/107mmol/ Nephrosis Diabetes mellitus
L Nephritis Diarrhea
Urinary obstruction Vomiting
Cardiac Pneumonia
decompensation Heavy metal poisoning
Anemia Cushing’s syndrome
 Intestinal obstruction
Febrile conditions
Cholesterol 150-200mg/dL 3.9-5.2 Lipemia Pernicious anemia
mmol/L Obstructive jaundice Hemolytic anemia
Diabetes Hyperthyroidism
Hypothyroidism Severe infection
Terminal states of
debilitating disease
Creatine Males: 50-325 50-325 U/L Myocardial
phospokinase mU/mL infarction
(CPK) Females: 50- 50-250 U/L Skeletal muscle
250 mU/mL diseases
Intramuscular
injections
Crush syndrome
Hypothyroidism
Alcoholic myopathy
Cerebrovascular
disease
Creatine MM band MB band increased
phosphokinase present in myocardial
isoenzymes (skeletal infarction, ischemia
muscle)-MB
band absent
(heart muscle)
Creatinine 0.7-1.4 mg/dL 62-124 Nephritis
umol/L Chronic renal
disease
Creatinine Males: 85- 1.42-2.08 Kidney diseases
clearance 125mL/min mL/s
Females: 75-
115mL/min 1.25-1.92
mL/s
Glucose Fasting: 60-110 3.3-6.05 Diabetes mellitus Hyperinsulinism
mg/dL mmol/L Nephritis Hypothyroidism
Hyperthyroidism Late hyperpituitarism
Postprandial Early Pernicious vomiting
(2h): 65-140 3.58-7.7 hyperpituitarism Addison’s disease
mg/dL mmol/L Cerebral lesions Extensive hepatic damage
Infections
Pregnancy
Uremia
Glucose tolerance Features of a Two-hour value > Decreased 2 and 3 hour
(oral) normal 200 mg/dL (11.1 values may occur with
response: mmol/L) is hypoglycemia mellitus
1. Norma diagnostic for
l 3.3-6.05 diabetes mellitus
fasting mmol/L
betwee
n 60/-
110mg
/dL
2. No
sugar
in
 urine
3. Upper
limits
of
normal
: 6.88 mmol/L
Fasting =
125 10.45 mmol/L
1 hour =
190 7.70 mmol/L
2 hours =
140 6.88 mmol/L
3 hours =
125

Glycohemoglobi Nondiabetics Suboptimal glucose

n and diabetics control
(GHB, with good
hemoglobin A1c, control: 4.4 % -
hemoglobin A1) 6.4%
High-density Males: 35-70 0.91-1.81 HDL cholesterol is lower
lipoprotein mg/dL mmol/L in patient with increased
cholesterol(HDL Females: 35- 0.91-2.20 risk for coronary heart
cholesterol) 85mg/dL mmol/L disease
Immunoglobulin Adults: 85-385 0.85-3.85g/L Gamma A Ataxia tenagiectasis
A mg/dL (in myeloma Agammaglobulinemia
children the Wiskott-Aldrich Hypogammaglobulinemia
normals are syndrome , transient
lower and vary Autoimmune Dysgammaglobulinemia
with age) disease Protein-losing
Hepatic cirrhosis enteropathies
Immunoglobulin 0-14 mg/dL 0.140mg/L IgD multiple
D myeloma
Some patients with
chronic infectious
diseases
Immunoglobulin 100-700 ng/mL 100-700ug/L Allergic patients
E and those with
parasitic infections
Immunoglobulin Adults: 565- 6.35-14 g/L IgG myeloma Congenital and acquired
G 1765 mg/dL Following hypogammaglobulinemia
hyperimmunization Some malabsorption
Autoimmune syndromes
disease states Extensive protein loss
Chronic infections
Immunoglobulin Adults: 55- 0.4-2.8 g/L Waldenström’s Agammaglobulinemia
M 375mg/dL macroglobulinemia Some IgG and IgA
Parasitic infections myeloma
Hepatitis Chronic lymphatic
leukemia
Lactic 90-176 mU/mL 90-176 U/L Untreated
dehydrogenase pernicious anemia
(LDH) Myocardial
infarction
Pulmonary
 infarction
Liver disease
Lead (whole Up to 40 ug/dL Up to umol/L Lead poisoning
blood)
Lipase <200 U/mL <200 U/L Acute and chronic
pancreatitis
Biliary obstruction
Cirrhosis
Hepatitis
Peptic ulcer
Low-density mg/dL LDL cholesterol is
lipoprotein desirable highe in patients
cholesterol (LDL levels: with increased risk
cholesterol) <160 if no for coronary heart
coronary artery disease
disease (CAD)
and <2 risk
factors
<100 if CAD
present
Magnesium 1.3-2.3 mg/dL 0.62-0.95 Excess ingestin of Chronic alcoholism
mmol/L magnesium- Severe renal disease
containing antacids Diarrhea
Defective growth
Phenylalanine 1.2-3.5 mg/dL 0.07- Phenylketonuria Chronic renal failure
1st week 0.21mmol/L
0.7-3.5 mg/dL 0.04-0.21
thereafter mmol/L
20-90IU/L
Phosphorus, 2.5-4.5 mg/dL 0.8-1.45 Chronic nephritis
inorganic mmol/L Hypoparathyroidism
Potassium 3.5-5mEq/L 3.5-5mmol/L Renal Failure Hyperparathyroidism
Acidosis Vitamin D deficiency
Cell lysis GI losses
Tissue breakdown Diuretic administration
or hemolysis
Prostrate-specific <4 ng/mL Prostatic cancer,
antigen benign prostatic
hyperplasia,
prostatitis
Protein, total 6-8 gm/dL 60-80 g/L Hemoconcentration Malnutrition
Protein, Albumin 4-5.5 g/dL 40-55 g/L Shock Hemorrhage
Protein, Globulin 1.7-3.3 g/dL 17-33 g/L Globulin fraction Loss of plasma from
increased in burns
multiple myeloma, Proteinuria
chronic infection,
liver disease
Sodium 135-145 mEq/L 135-145 Hemoconcentration Alkali deficit
mmol/L Nephritis Addison’s disease
Pyloric obstruction Myxedema
T3 24%-34% Relative Hyperhyroidism Hypothyroidism
(triodothyronine) uptake Thyroxine-binding Pregnancy
uptake fraction: 0.24- globulin (TBG) TBG excess
0.34 deficiency Estrogens and anti-
 Androgens and ovulatory drugs
anabolic steroids
T4 (thyroxine) – 5-11 ug/dL 65-138nmol/L Hyperthyroidism Primary and pituitary
RIA Thyroiditis hypothyroidism
Elevated thyroxine- Idiopathic involvement
binding proteins Cases of diminished
caused by oral thyroxine-binding
contraceptives proteins caused by
Pregnancy androgenic and anabolic
steroids
Hypoproteinemia
Nephritic syndrome
Triglycerides 100-200 mg/dL 1.13- Trytophan-specific
3.8mmol/L malabsorption syndrome
Urea nitrogen 10-20 mg/dL 3.6-7.2 Acute Severe hepatic failure
(BUN) mmol/L gomerulonephritis Pregnancy
Obstructive
uropathy
Mercury poisoning
Nephritic syndrome
Uric acid 2.5-8mg/dL 0.15-0mmol/L Gouty arthritis Defective tubular
Acute leukemia reabsorption
Lymphomas treated
by chemotherapy
Toxemia of
pregnancy

PREVENTION AND EARLY DETECTION OF DISEASE

GROWTH AND DEVELOPMENT
 DEVELOPMENTAL TASKS---MILESTONES ----DELAYS(FIXATIONS/LAG)

 IQ = MA / CA X 100
 JUDGEMENT , COMPREHENSION AND LISTENING
 DDST – BIRTH TO 6 YEARS
 PERSONAL SOCIAL, FINE , GROSS MOTOR AND LANGUAGE SKILL

HEALTH SCREENING

 OB – GYNE / REPRODUCTIVE TESTS

 UTZ-5 WKS CONFIRM PREGNANCY AND AOG
 AMNIOCENTESIS – 16 WKS-DETECT GENETIC DISORDERS – 30 WEEKS – L/S
RATIO ( 2-4 WKS RESULT)(EMPTY Bladder)
 OCT – (28 WKS)FHR DECELERATIONS – IV OXYTOCIN 15-20 MIN----3
CONTRACTIONS OBTAINED WITHIN 10 MINUTES- REACTIVE
 NST – FHR ACCELERATIONS (32-34 WKS) – 2-MORE FHR ACCELERATION OF
15BPM/MORE LASTING 15 SECS -20 MINS. AND RETURN OF FHR TO NORMAL/BASELINE
– REACTIVE
 DOPTONE- 12 WEEKS (18 – 20 WKS-AUSCULTATION)
 AFPT-FETAL SERUM CHON , -DETECT NEURAL TUBE DEFECTS – 16-18 WKS
 CHORIONIC VILLI SAMPLING –FETAL ABNORMALITIES- 10-12 WKS

NEWBORN/INFANT HEALTH SCREENING

 PKU – GUTHRINE BLOOD TEST-EAT CHON FOR 2 DAYS MIN.(PHEONISTICS –
DIAPER)
 SICKLE CELL DISEASE –ABNORMALLY SHAPED Hg ,
 ELISA AND WESTERN BLOT
 CARRIER SCREENING FOR CYSTIC FIBROSIS AND SWEAT CHLORIDE TEST

SCHOOL AGE
 HEARING AND VISION TESTS
 ALLEN PICTURE CARDS
 SNELLEN CHART-20/40 AT TODDLER AND 20/20 AT SCHOOL AGE
 WEBER’S-SENSORINEURAL AND CONDUCTIVE
 RINNE’S- CONDUCTIVE
 DENTAL EXAM – STARTS AT 2 YEARS

ADOLESCENT
 PPD – INDURATION – 72 HOURS
 BSE – (18-20 YRS.) POST MENSTRATION/MONTHLY
 TSE – MONTHLY (18-20 YRS)
 PELVIC EXAM WITH PAP SMEAR – IF SEXUALLY ACTIVE OR 18 Y.O. ANNUALLY

ADULT/ELDERLY
 HPN , DM, HEARING AND VISION
 PROSTATE –ANNUALLY@40
 Ca CHECK-UPS-Q3Y-20YO ; QY – 40 YO
 SIGMOIDOSCOPY- > 50 Y.O. =Q3-5 YRS
 FECAL OCCULT BLOOD TEST- > 50 = ANNUALLY
 DIGITAL RECTAL EXAM - > 40 Y.O. = YEARLY
 PELVIC EXAM – 18-40 Y.O. =PERFORMED Q 1 – 3 YEARS WITH PAP TEST
 MAMMOGRAM – 35 – 39 y.o. = once BASELINE
40 – 49 y.o. = Q2Y
50 – older = every year

NORMAL VITAL SIGNS

NEWBORN= 30 – 50 / MIN; 120 – 140 / MIN; 60/40 – 80/50 mmHg

1 – 4 YEARS= 20 – 40 / MIN; 80 – 140 /MIN; 90/60 – 99/65 mmHg

5 – 12 YEARS= 15 – 25 / MIN; 70 – 115 / MIN; 100/56 – 110/60 mmHg

ADULT= 12 – 20 / MIN; 60 – 100 / MIN ; 90 / 60 –140 / 90 mmHg

“ NOTHING Here on earth can harm you except yourself……..nothing here cannot be done
unless you choose to give up……failure cannot overcome you unless you permit it………AIM
HIGH AND HIT THE MARK”