Study Guide 2021

Laws Affecting the Nursing Practice
Board of Nursing Resolutions

No. 663 Series of 1984 – ICN Code of Ethics
No. 1955 Series of 1989 – PNA Code of Ethics
No. 425 Series of 2003 – Implementing Rules and Regulations of RA 9173
No. 220 Series of 2004 – Code of Ethics for Nurses
No. 27 Series of 2004 – Integrated Comprehensive Philippine Nurse Licensure Examination
No. 31 Series of 2016 – Promulgating the Guidelines on the Regulation and Monitoring of the Conduct of
In-Service Training Programs for Nurses in Government and Private hospitals and Healthcare
institutions in the Philippines
No. 38 Series of 2016 –Prescribing new rules on the Implementation of the Special Training Requirement
in Intravenous Therapy for Nurses, Repealing for the purpose Board of Nursing Resolution No. 08, s. of
1994
No. 11 Series of 2017– Re-classification of the subjects Nursing Practice I and Nursing Practice II in the
Philippine Nurse Licensure Examination (PNLE)
No. 21 Seriesof 2017 – Philippine Professional Nursing Practice Standard
- Which provides the operational guidelines for the implementation of Republic Act 10912 (CPD Act
of 2016) for nursing. Based on the operational guidelines, nurses need 15 CPD units for PIC
renewal from January to December 31, 2018. Starting January 2019 and onwards, 45 units of CPD
(15 CU per year) is required for renewal which is regularly done in a three-year period
No. 1146 Series of 2019 –Amending RA 10912, known as the Continuing Professional Development
(CPD) Act of 2016 re 15 CPD credit units for renewal of PIC
Proclamations/Pronouncements and Letters of Instruction (LOI)
Proc # 6 – United Nations Goal in Universal Child Immunization by 1990
Proc # 539 – Nurses Week everylast week of October
LOI #949 – Legal Basis of Primary Health Care
- Instructs DOH and all officials and personnel of the department to design, develop and implement
programs which will focus on health development at the community level particularly in rural areas
LOI # 1000 – Members of accredited professional organizations given preference in hiring or attendance to
seminars
ILO Convention #149 – Improvement of Life and Work Condition of Nursing Personnel (ILO
Recommendation #157)
Executive Orders
EO 203 – List of regular holidays and special holidays
EO 209 – Family Code of the Philippines (amended by RA 6809 & RA 9255)
EO 503 – Transfer of personnel, assets, liabilities, and records of national government agencies whose
functions are to be devolved to LGU
EO 2009 – The Family Code of the Philippines
Presidential Decrees
PD 48 – Four children with paid maternity leave privilege
PD 69 – Four children for personal tax exemption
PD 148 amending RA 679 – States that the employee’s age shall be 16 years
PD 603 – Child and Youth Welfare Code
PD 651 – Birth registration following delivery
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PD 851 – 13-month Pay
PD 965 – Family Planning and Responsible Parenthood Instructions prior to issuance of marriage license
PD 996 – Compulsory immunization of children below eight years old against communicable diseases
PD 1083 – Code of Muslim Personal Laws of the Philippine
Republic Acts
RA 1054 – Free emergency medical and dental attendance to employees/laborers of any commercial,
industrial or agricultural establishments
RA 1080 – Automatic Civil Service Eligibility for the Regulated Professions
RA 1082 – The Rural Health Act
RA 1891 amended RA 1082– It strengthened health and dental services in the rural areas
RA 2382 – Philippine Medical Act
RA 3753 – Civil Registration Law, Philippine Legislature
RA 4073 – Treatment of leprosy in a government skin clinic, rural health unit or/by a duly-licensed
physician
RA 4226 – Hospital Licensure
- Requires healthcare facility to maintain health records from 10 to 25 years as per Department of
Health’s record retention regulation
RA 5181 – Permanent residence and reciprocity qualifications for examination/registration
RA 5901 – Working hours and compensation in agencies with 100-bed capacity
RA 6675 – Generics Drug Act of 1988
RA 6713 – Code of Conduct and Ethical Standards for Public Officials and Government Employees
RA 6725 – Prohibition on Discrimination Against Women
RA 6758 – Salary Standardizations of Government Employees
RA 7170 – Legacy of Donations of All Parts of a Human Body After Death
RA 7192 – Women in Development and Nation-Building
RA 7432 – Senior Citizens Benefits and Privileges (amended by RA 9257)
RA 7610 – Special Protection of Children Against Child Abuse, Exploitation and Discrimination
RA 7719 – National Blood Service
RA 7875 – National Health Insurance Act of 1995
RA 7876 – Senior citizen center for every Barangay
RA 7877 – Anti-sexual Harassment Act of 1995
RA 7883 – Barangay Health Workers Benefits and Incentives Act of 1995
RA 7885 – Advance Corneal Transplantation in the Philippines
RA 8042 – Migrants Workers and Overseas Filipino Act of 1995 (amended by RA 9922)
RA 8187 – Paternity Leave Act of 1995
RA 8344 – An act penalizing the refusal of hospitals & medical clinics to administer appropriate initial
treatment &
support in emergency cases
RA 8423 – Traditional and Alternative Medicine Act of 1997
RA 9255 – Provides illegitimate children to use the surname of their fathers
RA 9262 – Anti-violence Against Women and Children Act of 2004
RA 9439 – Prohibiting detention of patients on grounds of non-payment of hospital or medical expenses
RA 5901 – An act prescribing 40 hours/week for government & private hospitals or clinic personnel
RA 8981 – PRC Modernization Act of 2000
RA 10931 – Universal Access to Quality Tertiary Education Act
- A law for students to pursue quality college education without paying tuition and other school fees.
It also allows students to enrol in technical-vocational education and training programs in public
training institutions for free. It also provides financial aid to students from the poorest of the poor
households as well as loan programs for students who need additional finances to support their
tertiary education.
RA 11223 – Universal Healthcare Act

- The act will automatically enroll Filipino citizens into the National Health Insurance Program and
expand PhilHealth coverage to include free medical consultations and laboratory tests.
- 8 Salient Points: ALL Filipinos are covered – direct contributors (e.g., employee-employer
relationship);
indirect contributor (e.g., dependents)
It is not completely free – basic services accommodations will be covered by
PhilHealth (e.g., regular meal, bed in a shared room with fan ventilation, shared
toilet and bath); essential health benefit package (e.g., primary care, medicines,
diagnostic & laboratory test); no longer free when one wants private
accommodation, air condition, television, and meal choices)
PhilHealth will become the “national purchaser” of health goods and services
Health systems will become city-wide & province-wide – the DOH will need to work with
DILG
Return service in the public health sector – graduates of health & health-related courses
who received government-funded scholarships will be required to work in the public health
sector for at least 3 full years; to address the need for health workers across the country
A “Health Technology and Assessment Council” (HTAC) will be created – HTAC will be responsible
for assessing the safety and effectiveness of health technology, devices, machine, vaccines,
health procedures and other health- related advances
Health information will be collected - having access to health care networks province-wide can
address the problem of inadequate access to health services due to lack of funds in
barangays/municipalities
RA 11230 – Tulong-Trabaho Act

- An act instituting a Philippine Labor Force Competencies Competitiveness Program and free
access to Technical-Vocational Education and Training (TVET), and appropriate funds therefor
Under Maternal, Newborn and Child Health and Nutrition Strategy (MNCHN)
RA 11148 – Kalusugan at Nutrisyon ng Mag-Nanay Act
- The country’s key health bodies are mandated to ensure access to adequate food, care & nutrition
during the different pregnancy and life stages for both mother and child, starting from conception to
the first 24 months of life
RA 9710 – Magna Carta of Women
RA 7277 – Magna Carta for Disabled Persons
RA 10354 – Responsible Parenthood & Reproductive Health Act of 2012
RA 9288 – Newborn Screening Act of 2004
RA 9709 – Universal Newborn Hearing Screening & Intervention Act of 2009
RA 10152 – Mandatory Infants & Children Health Immunization Act of 2011
RA 7846 – Compulsory Immunization against Hep B for Infants & Children below 8 Years Old
RA 7600 – Rooming-In and Breastfeeding Act of 1992
RA 8172 – ASIN (Act for Salt Iodization Nationwide) Law
RA 8976 – Philippine Food Fortification Act
- Promotes fortification of food products through Sangkap Pinoy Seal Program
RA 10028 – Expanded Breastfeeding Promotion Act
Pres. Proc. No. 4 s. 1998 – Phil. Measles Elimination Campaign
Pres. Proc. No. 1066 s. 1997 – National Neonatal Tetanus Elimination Campaign
EO No. 51 – Milk Code
EO No. 382 – National Food Fortification Day every November 7
AO 2005-0014 – National Policies on Infant and Young Child Feeding
AO 36, s. 2010 – Expanded Garantisadong Pambata (GP)
RA 11210 – 105-day Expanded Maternity Leave Law
- An act increasing the maternity leave period to one hundred five days (105) days for female
workers with an option to extend for an additional thirty (30) days without pay, and granting an
additional fifteen (15) days for solo mothers, and for other purposes
Health Care Delivery System
RA 9173 – The Philippine Nursing Act of 2002
RA 7875 – National Health Insurance Act of 1995
RA 7305 – Magna Carta of Public Health Workers
RA 7883 – Barangay Health Workers’ Benefit and Incentives Act
Entitles them to hazard & subsistence allowances & other benefits
RA 7160 – Local Government Code
EO 352 – Field Health Service Information System (FHSIS) is the official recording & reporting system of
the
DOH and used to generate health statistics
AO 2010-0036 – Outlined the policy directions of Universal Health Care
Laws Affecting Noncommunicable Disease

RA 9211 – Tobacco Regulation Act of 2003
- Prohibits smoking in public places and sale of tobacco products to minors. The law requires a
printed warning on cigarette packages & it prohibits all forms of tobacco advertising in mass media
& regulates other forms of tobacco promotion
RA 6425 – Penalties for Violations of the Dangerous Drug Act of 1972
RA 9165 – Comprehensive Dangerous Drug Act of 2002
RA 8423 – Traditional & Alternative Medicine Act of 1997
- Signed into law through efforts of then secretory of health Juan Flavier
RA 10352 – Excise Tax on Alcohol & Tobacco
Laws Affecting Communicable Disease

RA 3573 – Reporting of Communicable Disease
- To report notifiable diseases to local and national health authorities
RA 4073 – An Act Liberalizing the Treatment of Leprosy
RA 8504 – Philippines AIDS Prevention and Control Act of 1998
Ministry Circular No. 2’s 1986 – Includes Acquired Immune Deficiency Syndrome (AIDS) as a notifiable
disease
RA 9482 – Rabies Act of 2007
RA 1136 – Tuberculosis Law of 1954
Memorandum Circular No. 98-155 – Pronounced the National Tuberculosis Control Program as the
highest priority public health program of the LGUs
Pres. Proc. No. 46 of 1992 – Reaffirming the commitment to the Universal Child and Mother Immunization
goal by launching the Polio Eradication Project
Pres. Proc. No. 1204 of 1998 – Declaring National Dengue Awareness Month every June, and formulation
of the National Dengue Prevention and Control Program
AO 24, s. 1996 – The National Tuberculosis Control Program adopted DOTS in the management of TB
PD 996 – Compulsory immunization of children below eight years old against communicable diseases
Environmental Health & Disaster Management

PD 856 – Sanitation Code
PD 825 – Anti-improper garbage disposal
EO 489 – Institutionalizing the Inter-Agency Committee on Environmental Health (IACEH)
AO 2007-0012 – Philippine National Standards for Drinking Water of 2007
RA 9275 – Philippine Clean Water Act of 2004
AO 2000-81 – Implementing Rules and Regulations for RA 8749
RA 8749 – Clean Air Act of 1999
RA 9003 – Ecological Solid Waste Management
RA 9711 – Food and Drug Administration Act
PD 1096 – National Building Code of the Philippines, revising RA 6541
RA 10072 – Philippine Red Cross Act
RA 10121 – Philippine Disaster Risk Reduction and Management Act
Impact of Legislation on Occupational Health

PD 442 – Philippine Labor Code on Prevention & Compensation
EO 307 – Creating the Occupational Safety & Health Center (OSHC) under the Employees Compensation
Commission
PD 626 – Employees Compensation & State Insurance Fund
PD 1144 – Fertilizer & Pesticide Act
RA 6969 – Toxic Substance Act
RA 6541 – National Building Code of the Philippines
RA 9231 – Special Protection of Children against Child Abuse, Exploitation & Discrimination
RA 10912 – Continuing Professional Development Act of 2016
- Requires CPD as the mandatory requirement for the renewal of Professional Identification Card
RA 10173 – Data Privacy Act of 2012
AO 24, s. 2001 – National Mental Health Policy
AO 114 s. 1991 – Revised/updated the roles and functions of the Municipal Health Officers, Public Health
Nurses
And Rural Health Midwives
RA 10968 – An act institutionalizing the Philippine Qualifications Framework (PQF), establishing the
PQF-National Coordinating Council and appropriate funds thereof
- Pursuant to the constitutional guarantee for the State to promote the night of all citizens to quality
and accessible education at all levels, the state shall establish, maintain and support a complete,
adequate and integrated systems of education relevant to the need of the people and society
RA 11058 – An act strengthening compliance with Occupational Safety and Health Standards and
providing
penalties thereof
- The state shall ensure a safe and healthful workplace for all working people by affording them full
protection against all hazards in their work environment
RA 11369 – National Students’ Day
- Declaring November 17 of every year National Students’ Day. The law is envisioned as an
opportunity to recognize the “invaluable contribution of student activism to Philippine democracy”
and for “initiating efforts to foster leadership among Filipino students,” according to reports
announcing the measure
Nursing Theorists
Theorist Theory & Description

Florence - Environmental Theory
- “the act of utilizing the environment of the patient to assist him in his
Nightingale recovery” (Nightingale, 1860/1969)
“First Nurse - 5 environmental factors: fresh air, pure water, efficient drainage,
Theorist” cleanliness & light (Berman, Snyder, Frandsen, 2016, p. 66)
Hildegard - Interpersonal Relations Model
- the use of a therapeutic relationship between the nurse & client
Peplau - 4 phases: orientation, identification, exploitation & resolution (Berman,
“Mother of Snyder, Frandsen, 2016, p. 66)
Psychiatric
Nursing”
- 14 Fundamental/Basic Needs
Virginia - concerned with both healthy and ill individuals to gain independence
Henderson (Berman, Snyder, Frandsen, 2016, p. 66)
- Science of Unitary Human Being
- viewed the person, an irreducible whole, the whole being greater than
Martha
the sum of its parts (Berman, Snyder, Frandsen, 2016, p. 67)
Rogers - the art of nursing is the creative use of the science of nursing for human
betterment (Rogers, 1994b)
- General Theory of Nursing
Dorothea
- 3 related concepts: self-care, self-care deficit & nursing systems
Orem (Berman, Snyder, Frandsen, 2016, p. 67)
- Goal Attainment Theory
- transaction process model describes the nurse-patient interactions
that lead to goal attainment (outcomes)(Berman, Snyder, Frandsen,
Imogene King 2016, p. 67-68)
- goal of nursing “is to help individuals maintain their health so they can
function in their roles” (King, 1981, pp. 3-4)
- Systems Model
Betty Neuman - viewed the client as an open system; relationship & reaction to
stressors; preventive levels: primary, secondary, & tertiary(Berman,
Snyder, Frandsen, 2016, p. 68)
- Adaptation Model
Sister Callista
individual as a biopsychosocial adaptive system; to enhance life
Roy processes through adaptation(Berman, Snyder, Frandsen, 2016, p. 68)
- Human Caring Theory
Jean Watson - caring is central to nursing(Berman, Snyder, Frandsen, 2016, p. 70)
- Cultural Care Diversity and Universality Theory
Madeleine
- Sunrise Model; human caring varies among cultures (Berman, Snyder,
Leininger Frandsen, 2016, p. 69)
- Twenty-One Nursing Problems
- viewed nursing as both art & science
Faye Glenn
- Abdellah’s problems are formulated in terms of nursing-centered
Abdellah services and her work reflects problem-centered approach (Alligood,
Tomey, 2010, p. 57)
- From Novice to Expert
Patricia - adapted the Dreyfus model to clinical nursing practice
Benner - 5 levels of skills acquisition & development: novice, advanced
beginner, competent, proficient & expert (Alligood, Tomey, 2010, p. 140)
Theorist Theory & Description

- Conservation Model
- stressed nursing interactions & interventions intended to promote
Myra Estrin adaptation and maintain wholeness
Levine - 4 principles: conservation of energy, conservation of structural integrity,
conservation of personal integrity, & conservation of social integrity
(Alligood, Tomey, 2010, p. 229)
- Behavorial System Model
- to maintain and restore the person’s behavioral system balance and
Dorothy stability
Johnson - 7 subsystems: attachment-affiliative, dependency, ingestive, eliminative,
sexual, achievement & aggressive-protective (Alligood, Tomey, 2010, p.
368)
- Health Promotion Model
- an attempt to depict the multifaceted natures of persons interacting with
Nola Pender the environment as they pursue health
- the desire to enhance well-being and to actualize human potential
(Alligood, Tomey, 2010, pp. 441)
- Health as Expanding Consciousness
- nurse facilitates pattern recognition in client, concentrating on what is
meaningful in their own stories and patterns of relating, by forming
Margaret relationships (focus of nursing)
Newman - utilized nursing process & NANDA health assessment framework be used
to facilitate clients’ pattern recognition (Alligood, Tomey, 2010, pp.
481-482)
- Core, Care and Cure Model
Lydia Hall - 3 interlocking circles: care (patient’s body), cure (disease), & core
(management)
- stressed the autonomous function of nursing and shared circles with
other providers (Alligood, Tomey, 2010, pp. 60-61)
- Human-to-Human Relationship Model
Joyce - to assist a client to prevent or cope withillness and suffering
Travelbee - 5 phases:original encounter, emerging identities, empathy, sympathy, &
rapport (Alligood, Tomey, 2010, p. 61)
- Child Health Assessment
- founder of the Nursing Child Assessment Satellite Training Project
Kathryn
(NCAST)
Barnard - focused on mother-infant interaction with the environment (Alligood,
Tomey, 2010, pp. 61-62)
- Transition Theory
- development of nursing therapeutics that is congruent with the unique
Afaf Meleis experience of client and their families in transition (e.g., recovery process
& diagnosis of chronic disease), thus promoting healthy responses to
transition(Alligood, Tomey, 2010, pp. 424-425)
- The Helping Art of Clinical Nursing
- “People may differ in their concept of nursing, but few would disagree that
Ernestine nursing is nurturing or caring for someone in a motherly fashion”
Wiedenbach (Weidenbach, 1964, p. 1)
- postulated that clinical nursing is directed towards meeting the
patient’sperceived need for help (Alligood, Tomey, 2010, p. 58)
Nursing Leaders
Leader Contribution
- referred to as the “Lady with the Lamp” & first nurse researcher
Florence - nursing’s first scientist-theorist for her work Notes on Nursing: What It
Nightingale Is, and What It Is Not (1860/1969) (Berman, Snyder, Frandsen, 2016, p.
32)
- established the American Red Cross, which linked with the International
Red Cross when the U.S. Congress ratified the Geneva Convention in
Clara Barton 1882, so it could perform humanitarian efforts (Berman, Snyder,
Frandsen, 2016, p. 32)
- America’s first trained nurse
- known for introducing nurse’s notes & doctor’s orders
Linda Richards - credited for her pioneering work in psychiatric and industrial nursing
(Berman, Snyder, Frandsen, 2016, p. 32)
- first African American professional nurse
- the ANA gives a Mary Mahoney Award biennially in recognition of
Mary Mahoney significant contributions in interracial relationships (Berman, Snyder,
Frandsen, 2016, p. 33)
- founder of public health nursing
Lillian Wald - founded the Henry Street Settlement and Visiting Nurse Service (circa
1893) (Berman, Snyder, Frandsen, 2016, p. 33)
Lavinia Dock - nursing leader and suffragist
- campaigned to allow nurses rather physicians to control their
profession
- founded the American Society of Superintendents of Training Schools
for Nurses of the United States (Berman, Snyder, Frandsen, 2016, p.
33)
- public health nurse and has impact on women’s health care
Margaret Higgins
- founder of Planned Parenthood (Berman, Snyder, Frandsen, 2016, p.
Sanger 33)
- a nurse who practiced midwifery
- founded the Frontier Nursing Service to provide family-centered
Mary Breckinridge primary health care to rural populations (Berman, Snyder, Frandsen,
2016, p. 34)
Frameworks for Care / Nursing Delivery Care System
Type Description
- Def: concentrates on duties/tasks
- Ex: An RN is assigned to pass medications and another nurse
takes the vital signs in a shift
Functional - Adv: cost-effective
Nursing - Disadv: RN seldom cares directly for the client; rely on others’
assessment; highly dependent on other members (Black, Hawks,
2008, p. 77)
- Def: delivery of nursing care to individual clients by a group of
providers led by a professional nurse
- Adv: an RN is usually the head & generally knows the client; team
Team Nursing leader can provide guidance to new/inexperienced staff
- Disadv: fairly expensive; lack of delegation skills by RNs may
reduce efficacy (Black, Hawks, 2008, p. 78)
- Def: also referred to as total care; considered the precursor of
primary nursing; a client has consistent contact with one nurse
Case Method during an 8- to 12-hour shift but may have different nurses on other
shifts (Berman, Snyder, Frandsen, 2016, p. 125)
- Goal: comprehensive & coordinated client care, from admission to
discharge
- Def: each client is assigned a primary nurse
Primary Nursing - Adv: client has the same nurse; psychosocial needs are met;
communication within the team is improved; RN feels autonomous
- Disadv: increased cost in hiring large RN staff (Black, Hawks,
2008, p. 78)
- Goal: promote self-care; upgrade quality of life; efficient use of
resources
- Def: involves multidisciplinary teams that assume collaborative
Case responsibility for planning, assessing needs, and coordinating,
Management implementing and evaluating care for groups of clients from
preadmission to discharge or transfer and recuperation (Berman,
- Ex: RN (case manager) follows the client through the entire stay in
the facility and back into the community (Black, Hawks, 2008, p.
78)
- Def: best possible use of nursing personnel is based on their
educational preparation and resultant skill sets (e.g., LVN, BSN RN)
Differentiated - Adv: enables nurses to progress and assume roles and
Practice responsibilities appropriate to their level of experience, capability
and education (Berman, Snyder, Frandsen, 2016, p. 125)
Universal Moral Values& Principles Basic to Clinical Nursing
Practice
Value Description
- right toself-determination or right to make one’s own decisions(Berman, Snyder,
Autonomy Frandsen, 2016, pp. 100-102)
- e.g., the RN respects the client’s right to refuse a treatment
Nonmaleficen - duty to “do no harm” (Berman, Snyder, Frandsen, 2016, p. 102)
- e.g., the RN stays on the affected side of a client during ambulation
ce
- duty to actively do good for patients (Zerwekh, Garneau, 2018, p. 421)
Beneficence - the benefits outweigh the discomfort of the procedure
- e.g., the RN advises a client about an exercise program to improve health
- the duty to treat all patients fairly, without regard to age, socioeconomic
status or other variables
Justice (Zerwekh, Garneau, 2018, p. 421)
- e.g., an RN making home visits stays few minutes more to talk to a depressed
client and stays with a DM client to give health teaching and observation
- faithful to agreement or promises (Berman, Snyder, Frandsen, 2016, p. 103)
Fidelity - e.g., the RN returns to the patient’s room after promising of coming back to
chat
- refers to telling the truth (Berman, Snyder, Frandsen, 2016, p. 103)
Veracity - e.g., nurse informs the patient about the discomfort of IV insertion
- answerable to oneself & other for one’s own actions (Berman, Snyder,
Accountability Frandsen, 2016, p. 103)
- specific accountability or liability associated with the performance of duties of a
Responsibility particular role
- an advocate is one who expresses & defends the cause of another (Berman,
Advocacy - e.g., RN’s responsibility to ensure the client has access to health care services
that meet health needs
- “the nurse safeguards the clients’ right to privacy by judiciously protecting
Confidentiality information of a confidential nature” (ANA 1985b, p. 1)
- used by taking or treating some acts as exceptions to the rule; hence, they are
allowed to bedone or their performance is justified under this principle
Epikia - e.g., a nurse is confronted with a dangerous client and the doctor cannot be
contacted, then he/she might use restraints in the emergency pursuant to the
principle of epikia. Restraining a patient is unethical/illegal. However, under
emergency circumstances, it can be justified (De Belen, De Belen, 2007, p.
248)
- allows one to make decisions for another; limits freedom of choice
Paternalism (RNpedia.com)
- “Father knows best”
- a concern for the welfare and well-being of others; in practice, it is reflected by
Altruism the nurse’s concern for the welfare of patients, other nurses , and other health
care providers (Berman, Snyder, Frandsen, 2016, p. 100)
- judges as right the action that does the most good and least amount of harm for
Utilitarianism the greatest number of individuals (Berman, Snyder, Frandsen, 2016, p. 1454)
Figure 1.Benner’s Clinical Nursing Skills Trajectory Framework by DZM, Power Dev
Drug & IVF Calculation
Formula Example
D= desired dose (i.e., ordered by primary Order: Cefuroxime 750 mg
care provider) On hand: 250 mg in 5 mL
H= dose on hand (i.e., dose on label of
bottle, vial, ampule) 750 mg
V= vehicle (i.e., from the drug comes, X = --------------- x 5 mL = 3 x 5 mL = 15 mL
such tablet or liquid) 250 mg
D
Formula = ---- x V = amount to administer
H
Determine the FLOW RATE (drops/min) Volume: 500 mL of PLR
*Drop factors: microdrip (60 drops/mL) Time: 5 hours
macrodrip (10, 15, Drop Factor: 60 drops/mL
25drops/mL)
500 mL 30000 drops
volume (mL) X = ------------- x 60 drops/mL = --------------=100
drops/min = ----------------- x drop factor drops/minutes
time (min) 5 hrs 300 mins
Determine the AMOUNT OF SOLUTION Volume: 300 mL of PNSS

TO BE INFUSED (mL/hr) Time: 6 hours
total volume to be infused 300 mL

(mL) X = ------------ = 50 mL/hour
mL/hour = --------------------------------------- 6 hours
time ordered (hr)
Determine the TIME TO COMPLETE THE Volume: 400 mL
INFUSION Drip Rate: 20 gtts/min
Drop Factor: 15 gtts/mL
amount of solution
----------------------- x drop factor 400 mL
drops per minute X = ----------------- x 15 gtts/mL = 300 minutes or 5 hours
20 gtts/min
Pediatric Dosages
Formula
Fried’s Rule Infant’s age (in months)
child’s dose (age < 1 year) = ---------------------------- X average adult
dose
150 months
Young’s Rule child’s age (in years)
child’s dose (age 1-12 years) = --------------------------X average adult
dose
child’s age (in years) + 12
Clark’s Rule weight of child (in pounds)
child’s dose = ----------------------------------- X average adult dose
150 pounds
Surface Area Calculation surface area in square meters
child’s dose = ------------------------------------- X average adult dose
1.73
(Karch, 2008, p. 59)
Written Orders
Type Description
One-time-only - an order for a medication or procedure to be carried out only one time
order
- an order to be carried out when the patient needs it, not on a scheduled
PRN order basis
- e.g., PRN pain medication order
- a physician’s routine set of orders for a specific procedure or condition
Standing order - e.g., standing preoperative and/or postoperative orders for an
abdominal surgery patient
- an order that is to be implemented immediately; one-time order
STAT order - derived from the Latin word statim, which means “immediately”
(Zerwekh, Garneau, 2018, p. 238)
Selected Intravenous Solutions
Type Example Nursing Implication
- 0.9% NaCl normal - used to restore vascular volume
saline - carefully assess signs of hypervolemia
- Lactated Ringer’s (a (e.g., bounding pulse, shortness of
Isotonic balanced electrolyte breath)
solution) - D5W is avoided in clients at risk for
- 5% dextrose in water increased ICP because it can increase
(D5W) cerebral edema
- 0.45% NaCl (half - used to provide free water and treat
normal saline) cellular dehydration; lesser
- 0.33% NaCl (one-third concentration of solutes
Hypotonic normal saline) - promote waste elimination by the
kidneys
- do not administer for clients at risk for
IICP or third-space fluid shift
- 5% dextrose in normal - draw fluid out of the intracellular and
saline (D5NS) interstitial compartments into the
- 5% dextrose in 0.45% vascular compartment, expanding
NaCl (D5 1/2NS) vascular volume
Hypertonic - 5% dextrose in lactated - do not administer to clients with
Ringer’s (D5LR) kidney/heart disease or clients who are
dehydrated
- watch for signs of hypervolemia
- Dextran - used to increase the blood volume
- Plasma following severe loss of blood (e.g.,
Volume - Albumin hemorrhage) or loss pf plasma (e.g.,
Expanders - Hespan (a synthetic severe burns, which draw large amount
plasma expander) of plasma from the bloodstream to the
burn site)
Documentation Systems
Type Description
- Def: each person/department makes notation in a separate
section/sections of the chart (e.g., admission sheet, nursing assessment,
physician’s progress notes, diagnostic reports)
Source-Orie
- Adv:care providers from each discipline can easily locate forms to record
nted Record data; easily trace the information specific to one’s discipline
- Disadv:client information is scattered throughout the chart; difficult to find
chronological information on client’s progress; decreased communication
among health team; lack of coordination of care (Berman, Snyder,
Frandsen, 2016, p. 249)
- Def: data are arranged according to the problem rather than the source of
information
- Adv:encourages collaboration; easier to track status of problem
Problem-Ori - Disadv: caregivers differ in using the required charting format; takes
ented constant vigilance to maintain up-to-date problem list; assessments &
Medical interventions that apply to more than one problem must be repeated
Record - 4 basic components: database
problem list
(POMR) plan of care
progress notes (e.g., SOAP/SOAPIE/SOAPIER)
(Berman, Snyder, Frandsen, 2016, p. 250-251)
- Def: intended to make the client and client concerns and strengths the
focus of care
Focus
- 3 columns:date & time
Charting focus (e.g., condition, diagnosis, S/S, client’s strength)
progress notes (e.g., Data, Action, Response)
- Def: only abnormal or significant findings or exceptions to norms are
recorded
- 3 elements: flow sheets (e.g., graphic VS record, graphic fluid record)
Charting by standards of nursing care (e.g., documentation of care according to
Exception specified standards)
(CBE) bedside access to the chart forms (e.g., allow immediate recording)
- Adv:elimination of lengthy, repetitive notes; presumption that the nurse did
assess and determine client’s normal and abnormal responses(Berman,
- Def: developed to manage the huge volume of information required in
contemporary health care
Computerize - Adv: allow RNs to use time efficiently; client information, requests, &
d results are sent and received quickly; links to monitors improve accuracy of
Documentati documentation
- Disadv:client’s privacy may be infringed if security measures are not used;
on breakdowns make information temporarily unavailable; system is
expensive (Berman, Snyder, Frandsen, 2016, p. 256)
- Def: uses a multidisciplinary approach to planning and documenting client
care, using critical pathways and incorporates graphics and flow sheets
Case - Adv: promotes collaboration & teamwork; decrease length of stay, efficient
Managemen use of time
t - Disadv: clients with multiple diagnoses or those with unpredictable course
of symptoms are difficult to document on a critical path (Berman, Snyder,
Frandsen, 2016, p. 254-255)
Overview of the Nursing Process
Phase Purpose Critical Thinking Activities
- to establish a database about the client’ - establish a database
response to health concerns or illness - update data as needed
Assessing and the ability to manage health care - organize data
needs - validate data
- communicate/document data
- to identify client strengths and health - analyze data
problems that can be prevented or - identify health problem, risks,
resolved by collaborative and and strengths
Diagnosing independent nursing interventions; to - formulate diagnostic statements
develop a list of nursing and
collaborative problems
- to develop an individualized care plan - prioritize problems/diagnoses
that specifies client goals/desired - formulate goals/desired
Planning outcomes, and related nursing outcomes
interventions - select nursing interventions
- write nursing interventions
- to assist the client to meet desired - reassessing the client
goals/outcomes; promote wellness; - determining the nurse’s need for
prevent illness and disease; restore assistance
Implementin
health; and facilitate coping with altered - implementing the nursing
g functioning interventions
- supervising the delegated care
- documenting nursing activities
- to determine whether to continue, modify - collecting data related to
or terminate the plan of care desired outcomes
- comparing data with desired
outcomes
- related nursing activities to
Evaluating outcomes
- drawing conclusions about
problem status
- continuing, modifying, or
terminating the NCP
(Berman, Snyder, Frandsen, 2016, p.183, 202, 216, 235, 237)
Commonly Used Abbreviations
Abbreviati Meaning Abbreviati Meaning
on on
Abd - abdomen ECG (EKG) - electrocardiogram
ABO - the main blood group CBC - complete blood count
system
ADL - activities of daily living GI - gastrointestinal
ad lib - as desired PE (PX) - physical examination
BRP - bathroom privileges MSE - mental status examination
ac - before meals ID - intradermal
(antecibum)
pc (post - after meals IM - intramuscular
cibum)
BT/hs - at bedtime IV - intravenous
amb - ambulatory SC/SQ - subcutaneous
amt - amount SASH - saline-administer
drug-saline-heparin
approx. - Approximately LR - lactated Ringer
bid - twice daily NS (N/S) - normal saline
tid - three times a day Gtt - drop
qid - four times a day ml (ml) - millilitre
STAT - at once, immediately h (hr) - hour
prn (pro re - when necessary meds - medications
nata)
VS - vital signs MAR - medication administration
record
BP - blood pressure Po - by mouth
O2 - oxygen NPO (NBM) - nothing by mouth
TPR - temp, pulse, DAT - diet as tolerated
respirations
C - Celsius (centigrade) TPN - total parenteral nutrition
F - Fahrenheit NG - Nasogastric
I&O - intake & output (L) - left
BM (bm) - bowel movement (R) - right
LMP - last menstrual period Per - by or through
wt - weight Prep - preparation
fld - fluid preop - preoperatively
OOB - out of bed postop - postoperatively
CVAD - central venous access OD - right eye/overdose/once
devices daily
CVP -
central venous OS - left eye
pressure
AND - allow natural death OU - each eye
AM
OTC - over-the-counter - morning
PM
TO - telephone order - afternoon
VO - verbal order C - with
D/C - discharge or S - without
discontinue
(Berman, Snyder, Frandsen, 2016)
Commonly Used Abbreviations in Maternal & Child Nursing

Abbreviati Abbreviati
Meaning Meaning
on on
IUGR - intrauterine growth TENS - transcutaneous electrical
restriction/retardation nerve stimulation
EVLBW - extremely-very-low-birth-weig CVS - chorionic villi sampling
ht
SGA - small for gestational age UTZ - ultrasonography
AGA - appropriate for gestational CST - contraction stress testing
age
LGA - large-for-gestational age NST - nonstress testing
DVT - deep vein thrombosis D&E - dilatation & vacuum extraction
NEC - necrotizing enterocolitis D&C - dilatation & curettage
HELLP - hemolysis, elevated liver AMTSL - active management of the
enzymes, and low third stage of labor
platelets
PID - pelvic inflammatory OGT - oral glucose test
disease
PDD - premenstrual dysphoric FHR - fetal heart rate
disorder
TORCH - toxoplasmosis, rubella, GTPALM - gravida, term, preterm,
cytomegalovirus, herpes abortion, living children,
simplex virus multiple pregnancy
STI - sexually transmitted IUD - intrauterine device
infection
PIH - pregnancy-induced BBT - basal body temperature
hypertension
DIC - disseminated intravascular BTL - bilateral tubal ligation
coagulation
TSS - toxic shock syndrome COC - combination oral
contraceptives
hCG - human chorionic LMP - last menstrual period
gonadotropin
FSH - follicle-stimulating EDC - expected date of
hormone confinement
LH - luteinizing hormone VBAC - vaginal birth after cesarean
birth
GnRH - gonadotropin-releasing NSVD/NSD - normal spontaneous
hormone vaginal delivery
RAA/LAA - right/left scapuloanterior PROM - preterm rupture of
membranes
RAP/LAP - right/left scapuloposterior SBA - skilled birth attendant
ROA/LOA - right/left occipitoanterior HCF - health care facility
ROP/LOP - right/left occipitoposterior EINC - essential intrapartum and
newborn care
ROT/LOT - right/left occipitotransverse AFP - alpha-fetoprotein
RSaA/ LSaA - right/left sacroanterior BEmONC - basic emergency obstetric
and newborn care
RSaP/LSaP - right/left sacroposterior CEmONC - comprehensive emergency
obstetric and newborn care
RSaT/LSaT - right/left sacrotransverse MNCHN - maternal, newborn, and
childe health and nutrition
strategy
RMA/LMA - right/left mentoanterior PMI - point of maximum impulse
RMP/LMP - right/left mentoposterior HSV - herpes simplex virus
RMT/LMT - right/left mentotransverse HPV - human papillomavirus
(Pillitteri, 2010) (Famorca, Nies, McEwen, 2013)
INDICATIONS OF PREGNANCY
PRESUMPTIVE PROBABLE POSITIVE
Breast changes Maternal serum test (presence of Sonographic evidence of fetal
HCG) outline (can be seen and
measured by sonogram)
Nausea and vomiting Chadwick’s sign (color change of Fetal heart audible ( Doppler
the vagina from pink to violet) ultrasound reveals heartbeat)
Amenorrhea Goodell’s sign (softening of the Fetal movement felt by the
cervix) examiner
Frequent urination Hegar’s sign (softening of the
lower uterine segment)
Fatigue Sonographic evidence of
gestational sac
Uterine enlargement (uterus can Ballottement
be palpated over the symphysis
pubis)
Quickening (fetal movement felt Braxton Hicks contractions
by woman)
Linea nigra (line of dark pigment Fetal outline felt by the examiner
forms on the abdomen)
Melasma (dark pigment forms on
face)
Striae gravidarum (stretch marks
form on abdomen
(Maternal & Child Health Nursing by Pillitteri, 8th Ed.)
COMPONENTS OF LABOR
FOUR P’s DESCRIPTION
The Passage (a woman’s The route a fetus must travel from the uterus through the cervix and vaginal
pelvis) to the external perineum.
The Passenger The passenger is the fetus. The body part of the fetus that has the widest
diameter is the head, so this is the part least likely to be able to pass
through the pelvic ring.
The Powers of Labor This is the force supplied by the fundus of the uterus and implemented by
uterine contractions, which causes cervical dilatation and then expulsion of
the fetus from the uterus.
The Pysche A woman’s psychological state which may either encourage or inhibit labor.
CARDINAL MOVEMENTS OF LABOR
1. DESCENT – Downward movement of the biparietal diameter of the fetal head within the pelvic
inlet.
2. FLEXION – As decent is completed and the fetal head touches the pelvic floor, the head bends
forward onto the chest, causing the smallest anteroposterior diameter to present to the birth canal.
3. INTERNAL ROTATION – This movement brings the shoulder, coming next, into the optimal
position to enter the inlet or puts the widest diameter of the shoulders in line with the wide
transverse diameter of the inlet.
4. EXTENSION – As the occiput of the fetal head is born, the back of the neck stops beneath the
pubic arch, and acts as a pivot for the rest of the head. The heads extends, and the foremost parts
of the head, the face and chin, are born.
5. EXTERNAL ROTATION – The head rotates a final time back to the diagonal or transverse position
of the early part of labor. This brings the after coming shoulders into an anteroposterior position,
which is best for entering the outlet.
6. EXPULSION – Once the shoulders are born, the rest of the baby is born easily and smoothly
because of its smaller size. This is the end of the pelvic division of labor.
STAGES OF LABOR
STAGE DESCRIPTION
FIRST STAGE The first stage of dilatation, which begins with the initiation of true labor
contractions and ends when the cervix is fully dilated. It is divided into
three segments: a latent, an active, and a transition phase.
1. The Latent Phase – or early phase begins at the onset of regularly
received uterine contractions and ends when rapid cervical dilatation
begins. Contractions during this phase are mild and short, lasting 20 to
40 seconds.
2. The Active Phase – cervical dilatations occurs more rapidly. Contractions
grow more stronger, lasting 40 to 60 seconds, and occur approximately
every 3 to 5 minutes. Show (increased vaginal secretions) and perhaps
spontaneous rupture of the membranes may occur during this time.
3. The Transition Phase – during this phase, contractions reach their peak
of intensity, occurring every 2 to 3 minutes with a duration of 60 to 70
seconds, and a maximum cervical dilatation of 8 to 10 cm.
SECOND STAGE Extending from the time of full dilatation until the infant is born.
THIRD STAGE Placental Stage, lasting from the time the infant is born until after the
delivery of the placenta. Two separate phases are involved: placental
separation and placental expulsion.
1. Placental separation – as separation is completed, the placenta
sinks to the lower uterine segment or the upper vagina. The
placenta has loosened and is ready to deliver when:
a. There is lengthening of the umbilical cord.
b. A sudden gush of vaginal blood occurs.
c. The placenta is visible at the vaginal opening.
d. The uterus contracts and feels firm again.
● Schultze – placenta appears shiny and glistening from the fetal
membranes
● Duncan – placenta looks “dirty” (the irregular maternal surface
shows)
2. Placental expulsion – once separation has occurred, the placenta
delivers either by the natural bearing-down effort of the mother or
by gentle pressure on the contracted uterine fundus by the
primary healthcare provider (a Crede maneuver)
FOURTH STAGE The first 1 to 4 hours after birth of the placenta is sometimes termed the
“fourth stage” to emphasize the importance of close maternal observation
needed at this time.
PHASES OF PUERPERIUM
1. Taking-in phase – is largely a time of reflection. During this 1- to 3-day period, a woman is largely
passive. She prefers having a nurse attend to her needs and make decisions for her rather than do
these things herself.
2. Taking-hold phase – after a time of passive dependence, a woman begins to initiate action. She
prefers to get her own washcloth or to make her own decisions.
3. Letting-go phase – in this third phase, a woman finally redefines her new role. She gives up her
old role of being childless or the mother of only one to two. This process requires some grief work
and readjustment of relationships, similar to what occurred during pregnancy.
CHARACTERISTICS OF LOCHIA
Type of Lochia Color Postpartal Day Composition
Lochia rubra Red 1-3 Blood, fragments of deciduas, and
mucus
Lochia serosa Pink 3-10 Blood, mucus, and invading leukocytes
Lochia alba White 10-14 (may last 6 Largely mucus; leukocyte count high
weeks)
(Maternal and Child Nursing by Pillitteri, 8th Ed.)
APGAR SCORING
# of Heart Rate Respiratory Muscle Tone Reflex Color
Points Effort Irritability
2 Heart rate >100 Strong, Maintains a Cries or Body and
beats per minute vigorous cry position of flexion sneezes extremities pink
(bpm) with brisk when
movements stimulated
1 Heart rate present, Weak cry, slow Minimal flexion of Grimaces Body pink,
but <100bpm or difficult extremities when extremities blue
respirations stimulated
0 No heart rate No respiratory Limp and flaccid No response Body and
effort to stimulation extremities blue
(cyanosis) or
completely pale
(pallor)
*APGAR Scoring is done at one and five minutes after birth.
BASIC DIVISIONS OF CHILDHOOD

STAGE AGE PERIOD
Neonate First 28 days of life
Infant 1 month-1 year
Toddler 1-3 years
Preschooler 3-5 years
School-age child 6-12 years
Adolescent 13-17 years
Late adolescent 18-21 years
FREUD’S PSYCHOANALYTIC THEORY

STAGE PSYCHOSEXUAL STAGE NURSING IMPLICATIONS
Infant Oral stage: Child explores the world by Provide oral stimulation by giving
using the mouth. pacifiers; do not discourage thumb
sucking.
Toddler Anal stage: Child learns to control Help children achieve bowel and
urination and defecation. bladder control without undue
emphasis on its importance.
Pre-schooler Phallic stage: Child learns sexual Accept children’s sexual interest,
identity through awareness of genital such as fondling his or her own
area. genitals, as a normal area of
exploration.
School-age child Latent stage: Child’s personality Help children have positive
development appears to be non-active experiences with learning so their
or dormant. self-esteem continues to grow.
Adolescent Genital stage: Adolescent develops Provide appropriate opportunities for
sexual maturity and learns to establish the child to relate with opposite and
satisfactory relationship with others. own sex relationships.
(MCN by Pillitteri 8th Ed.)
ERIKSON’S PSYCHOSOCIAL DEVELOPMENT

STAGE DEVELOPMENTAL TASK NURSING IMPLICATIONS
Infant Developmental task is to form a sense Provide a primary caregiver. Provide
of trust versus mistrust. Child learns experiences that add to security.
to love and be loved.
Toddler Developmental task is to form a sense Provide opportunities for independent
of autonomy versus shame. Child decision making such as choosing
learns to be independent and make own clothes.
decisions for self.
Pre-schooler Developmental task is to form a sense Provide opportunities for exploring
of initiative versus guilt. Child learns new places or activities. Allow
how to do things (basic problem free-form play.
solving) and that doing things is
desirable.
School-age child Developmental task is to form a sense Provide opportunities such as
of industry versus inferiority. Child allowing the child assemble and
learns how to do things well. complete a short project.
Adolescent Developmental task is to form a sense Provide opportunities for an
of identity versus role confusion. adolescent to discuss feelings about
Adolescents learn who they are and events important to him or her. Offer
what kind of person they will be. support and praise for decision
making.
PIAGET’S THEORY OF COGNITIVE DEVELOPMENT
STAGE OF
AGE SPAN NURSING IMPLICATIONS
DEVELOPMENT
Sensorimotor
Neonatal Reflex 1 month Stimuli are assimilated into beginning mental images.
Behavior entirely reflexive.
Primary circular 1-4 months Hand-mouth and ear-eye coordination develop. Enjoyable
reaction activity for this period: a rattle or tape of parent’s voice.
Secondary circular 4-8 months Infant learns to initiate, recognize and repeat pleasurable
Reaction experiences from environment. Good toy for this period:
mirror; good game: peck-a-boo.
Coordination of 8-12 months Infant can plan activities to attain specific goals. Good toy
Secondary reactions for this period: nesting toys (i.e. colored boxes).
Tertiary circular 12-18 months Child is able to experiment to discover new properties of
reaction objects and events. Good game for this period: throw and
retrieve.
Invention of new 18-24 months Transitional phase to the preoperational thought period.
means Good toys for this period: those with several uses, such as
through mental blocks or colored plastic rings.
combinations
Preoperational thought 2-7 years Thought becomes more symbolic. Comprehends simple
abstractions but thinking is basically concrete and literal.
Child is egocentric (unable to see the viewpoint of another).
Display static thinking (inability to remember what they
started to talk about so at the end of a sentence children
are talking about another topic). Concept of time is now,
and concept of distance is only as far as they can see.
Centering or focusing on a single aspect of an object
causes distorted reasoning. Unable to state cause-effect
relationship. Good toy for this period: items that require
imagination such as modeling clay.
Concrete operational 7-12 years Concretes operations include systematic reasoning. Uses
thought memory to learn broad concepts (fruit) and subgroups of
concepts (apples, oranges). Classifications involve sorting
objects according to attributes. Child is aware of
reversibility, an opposite, an opposite operation or
continuation of reasoning back to a starting point. Good
activity for this period: collecting and classifying natural
objects such as native plants or sea shell.
Formal operational 12 years Can solve hypothetical problems with scientific reasoning.
thought Good activity for this period: “talk time” to sort through
attitudes and opinions.
KOHLBERG’S STAGES OF MORAL DEVELOPMENT

Age (in Stag
Description Nursing Implications
Years) e
Preconventional (Level I)
2-3 1 Punishment/obedience orientation Child needs help to determine what right
(“heteronymous morality”). Child does actions are. Give clear instructions to
right because a parent tells him or her avoid confusion.
to and to avoid punishment.
4-7 2 Individualism. Instrumental purpose Child is unable to recognize that like

and exchange. Carries out actions to situations require like actions. Unable to
satisfy own needs rather than take responsibility for self-care because
society’s. Will do something for meeting own needs interferes with this.
another if that person does something
for him or her.
Conventional (Level II)
7-10 3 Orientation to interpersonal relations Child enjoys helping others because this
of mutuality. Child follows rules is nice behavior. Allow child to help with
because of a need to be a good bed making and other such activities.
person in own eyes and eyes of Praise for desired behavior such as
others. sharing.
10-12 4
Maintenance of social order, fixed Child often asks what the rules are and if
rules, and authority. Child finds something is right. May have difficulty
following rules satisfying. Follows modifying a procedure because one
rules of authority figures as well as method may not be right. Follows
parents in an effort to keep the self-care measures only if someone is
system working. there to enforce them.
Postconventional (Level III)
Older than 5 Social contract, utilitarian law-making Adolescents can be responsible for
12 perspectives. Follows standards of self-care because they view this as
society for the good of all people. standard of adult behavior.
6 Universal ethical principle orientation. Many adults do not reach this level of
Older than Follows internalized standards of moral development.
12 conduct.
th
(MCN by Pillitteri 8 Ed.)
GROWTH AND DEVELOPMENTAL MILESTONES

Time
Fine Motor Socialization
Month Motor Development Reflexes Play
Development and Language
Fade
0-1 Largely flex actions Keeps hands Enjoys watching
fisted; able to face of primary
follow object to caregiver, needs
midline with eyes play time in prone
position
2 Holds head up when Demonstrates Makes cooing Grasp reflex Enjoys
prone social smile sounds; fading bright-colored
differentiates mobiles
cry
3 Holds head and Follows object Laughs out Landau Spends time
chest up when prone past midline with loud reflex is looking at hands
eyes strong (hand regard);
“time time
important during
the day
Month Motor Development Fine Motor Socialization Times Play

Development and Language Reflexes
Fade
4 Turns back to front, Stepping Needs space to
no longer has head tonic neck, practice turning
lag, bears partial extrusion
weight on feet
reflexes are
fading,
5 Should turn readily Tonic neck Handles rattles
front to back and reflex fading well
back to front
6 Beginning to show Uses palmar May say vowel Moro and Enjoys bathtub
ability to sit grasp sounds (oh-oh) tonic neck toys, rubber ring
reflex have for teething
faded
7 Reaches out to be Transfers objects Shows Likes objects that
picked up; first tooth hand to hand beginning fear are good size for
(central incisor) of strangers transferring
erupts
8 Sits securely without Fear of Enjoys
support strangers manipulation,
peaks rattles, and toys
of different
textures
9 Creeps or crawls Says first word Needs safe space
(abdomen off floor) (da-da) for creeping
10 Pulls self to standing Uses pincer grasp Plays games like
(thumb and finger) patty-cake and
to pick up small peek-a-boo
objects
11 Cruises (walks with Cruising can be
support) main activity
12 Stands alone; some Holds cup and Says two Landau Likes toys that fit
infants take first step spoon well; helps words plus reflex fades inside each other
to dress (pushes ma-ma and (pots and pans),
arm into sleeve) da-da nursery rhymes;
will like pull toys
as soon as
walking
REFLEXES
Reflex Description Disappears
Blink reflex It may be elicited by shining a strong light such as
flashlight into an eye.
Rooting reflex Newborn’s cheek is brushed or stroked near the 6-week of life
corner of the mouth, the infant will turn the head in
that direction
Sucking Reflex When newborn’s lips are touched, the baby makes a 6 months of age
sucking motion.
Swallowing reflex Food that reaches the posterior portion of the tongue
is automatically swallowed. Gag, cough, and sneeze
reflexes also are present in newborns to maintain a
clear airway
Extrusion reflex In order to prevent swallowing of inedible substances, 4 months of age
a newborn extrudes any substance that is placed on
the anterior portion of the tongue.
Palmar Grasp Newborn’s grasp an object placed in their palm by 6 weeks-3 months of age
reflex quickly closing their fingers on it. Mature newborns
grasp so strongly they can be raised from a supine
position and suspended momentarily from an
examiner’s fingers.
Step Newborns who are held in a vertical position with their 3 months of age
(Walk)-in-Phase feet touching a hard surface will take a few quick,
reflex alternating steps.
Placing reflex Elicited by touching the anterior lower leg against a
surface such as the edge of a table. The newborn
makes a few quick lifting leg motions, as if to step
onto the table.
Plantar Grasp When an object touches the sole of a newborn’s foot 8 to 9 months of age
reflex at the base of the toes, the toes grasp in the same
manner as the fingers.
Tonic neck reflex It is also called a “boxer” or “fencing” reflex. When the 2-3 months of age
arm and leg on the side toward which the head is
turned extend, and the opposite arm and leg contract.
Moro reflex Can be elicited with a loud noise or by jarring the 4-5 months
bassinet. Hold the newborn in a supine position and
then allow the head to drop backward about 1 inch,
then the newborn first extend arms and legs, then
swings the arms into an embrace position and pulls
up the legs against the abdomen.
Babinski reflex When the sole of a newborn’s foot is stroked in an 3 months of age
inverted “J” curve from the heel upward, a newborn
fans the toes (positive Babinski sign)
Magnet reflex If pressure is applied to the soles of the feet of a
newborn lying in a supine position, he or she pushes
back against the pressure.
Crossed extension When a newborn is lying supine, if one leg is
reflex extended and the sole of that foot is irritated by being
rubbed with a sharp object, the infant raises the other
leg and extends it as if trying to push away the hand
irritating the first leg.
Trunk incurvation When a newborn lies in a prone position and is
reflex touched along the paravertebral area on the back by
a probing finger, the newborn flexes the trunk and
swings the pelvis toward the touch.
Landau reflex When a newborn is supported in a prone position by
a hand, the newborn should demonstrate some
muscle tone.
The 2017 Joint Commission Hospital National Patient Safety Goals
Goal 1: Identify Patients Correctly
- Use at least two ways to identify patients, such as using patients’ names and dates of
birth. Make sure that the correct patient receives the correct blood during a blood
transfusion
Goal 2: Improve Effective Communication

- Improve the effectiveness of communication among caregivers. Get important test results
to the right staff person on time.
Goal 3: Use Medicines Safely

- Use medications safely. Before a procedure, label medicines that are not labelled, for
example, medicines in syringes, cups, and basins. Do this n the area where medicines and
supplies are set up. Take extra care with patients who take medicines to thin their blood.
Record and pass along correct information about a patient’s medicines. Find out what
medicines the patient is taking. Compare those medicines to new medicines given to the
patient. Make sure the patient knows which medicines to take when he or she is at home.
Tell the patient it is important to bring an updated list of medicines every time he or she
visits a provider.
Goal 4: Use Alarms Safely

- Make improvements to ensure that alarms on medical equipment are heard and
responded to on time
Goal 5: Prevent Infection

- Use the Centers for Disease Control and Prevention (CDC) hand hygiene guidelines or the
current World Health Organization (WHO) hand hygiene guidelines. Set and use the goals
for improving hand cleaning. Implement evidence-based practices to prevent health
care-associated infections (HAIs) and infections caused by multidrug-resistant organisms
that are difficult to treat.
Goal 6: Identify Patient Safety Risks

- Find out which patients are most likely to try to commit suicide
Goal 7: Prevent Mistakes in Surgery
- Make sure that the correct surgery is done on the correct patient and at the correct place
on the patient’s body. Mark the correct place on the patient’s body where the surgery is to
be done. Pause before the surgery to make sure that a mistake is not being made.
3 Major Elements of Informed Consent:
- Must be given voluntarily
- Must be given by a client/individual with the capacity and competence to understand
- Must be given enough information to be the ultimate decision-maker
(Berman, Snyder, Frandsen, 2016, p.80)
Nurse’s Signature Confirms 3 Things (Informed Consent):

- the client gave consent voluntarily
- the signature is authentic
- the client appears competent to give consent
Responsibilities of the Nurse in Delegation:

- Appropriate delegation of duties (that is, giving people duties within their scope of practice
and abilities and under the right circumstances)
- Adequate direction, communication and supervision of personnel to whom work is
delegated or assigned
5 Rights of Delegation by NCSBN (2005):

- The right task
- Under the right circumstances
- To the right person
- With the right direction & communication; and
- Under the right supervision and evaluation
10 Rights of Medication Administration:

- Right Medication - Right Client Education
- Right Dose - Right Documentation
- Right Time - Right to Refuse
- Right Route - Right Assessment
- Right Client - Right Evaluation
Clinical Pathways
- also known as care maps, are multidisciplinary plans of “best” clinical practice for groups of
patients with a specific medical diagnosis; these support the coordination and delivery of
high-quality care
- 4 essential elements: a timeline outlining when specific care will be given
the categories of care or activities and their interventions
intermediate- and long-term outcomes to be achieved
a variance record (allows caregivers to document when and why the
progress of individual patients varies from that outlined the pathway)
Evaluating the Quality of Nursing Care
Definition
Quality - Def:an ongoing, systematic process designed to evaluate and promote
excellence in the health care provided to clients
Assurance - 3 components of care: structure evaluation –setting in which care is given
(QA) (e.g., equipment, staffing)
process evaluation –how the care was given& the use of nursing process
(e.g., checks
client’s ID band before giving medications)
outcome evaluation –demonstrable changes in the client’shealth status as a
result
of nursing care(e.g., How many clients who have a colostomy experience an
infection that delays discharge?)
Quality - Def: follows client care rather than organizational structure; focuses on
process rather than individuals; uses a systematic approach of improving the
Improvem quality of care rather than ensuring the quality of care; assessment involves
ent root cause analysis
(QI) - Aka: continuous quality improvement (CQI), total quality management,
performance improvement (PI), or persistent quality improvement
(PQI)(Berman, Snyder, Frandsen, 2016, p.240-241)
- Tools: PDCA Cycle – best used as a management tool to improve processes
in the work area; plan-do-check-act
Fishbone Diagram/Ishikawa Diagram – a technique used to generate,
organize & display the factor that might contribute to a problem; also called
cause-and-effect diagram; a problem-solving tool which indicates causes &
effects and how they interrelate
Pareto Chart – a graphic tool which presents sources of problems in order
from most to the leastsignificant; based on the principle of “the vitalfew &
trivial many”or the “80-20 rule” which means that 80% of the problems result
from the 20% of the causes; if you can fix the 20%, you can fix the system
DMAIC – used primarily for improving existing processes that do not meet
institutional goals or national norms; DEFINE the issue, possible causes, and
goals, MEASURE the existing system with metrics, ANALYZE the gap
between the existing system and goal, IMPROVE the system with creative
strategies, CONTROL and sustain the improvement
Gantt Chart – highly developed schedules that allow one to visualize multiple
tasks that have to be done; a grid with rows for tasks/assigned responsibility
and columns for time frame (e.g., minutes, hours, days, weeks); a line drawn
through the time frame while the task is in progress; an X is put where the
task is completed
(Hospital Nursing Service Administration Manual, 2008, pp. 157-162)
(Tomey, 2009, p. 88)
Nursing - audit– refers to the examination or review of records
–types: retrospective audit – evaluation of a client’s record after discharge from
Audit an agency
concurrent audit – evaluation of a client’s health care while the client is still
receiving care from the agency (e.g., interviewing, direct observation of
nursing care)
- peer review – nurses appraise the quality of care or practice performed by
other equally qualified nurses
– types: individual – focuses on the performance of an individual
nurse
nursing audit – focuses on evaluating nursing care through the review of
records(Berman, Snyder, Frandsen, 2016, p.241-242)
Fishbone Diagram or Ishikawa Diagram or Cause & Effect Diagram

Possible Causes Effect
drugorder was not sent to the pharmacy
away from floor for tests
nurse busy with an emergency

medication not available
Figure 2.CQI Cause and Effect Diagram: Delayed Medication

(Moore, 2018, p. 5)
Leadership Styles
Type Description
- Degree of control: makes decision alone
- Leader activity level: high
Autocratic - Responsibility: primarily the leader
(authoritarian) - Output: high quantity, good quality
- Efficiency: very efficient
- Degree of control:collaborative
- Leader activity level:high
Democratic - Responsibility:shared
Classic (participative, - Output:creative, high quality
Leadership consultative) - Efficiency:less efficient than authoritarian
Theory
- Degree of control:no control
- Leader activity level:minimal
Laissez-faire - Responsibility:relinquished
(nondirective, - Output:variable, may be of poor quality
permissive) - Efficiency:inefficient
- Degree of control:strict reliance on policy
- Leader activity level:high
Bureaucratic - Responsibility:leader
- Output:good quality through following standard
procedures
- Efficiency:efficient
- characterized by having an emotional
relationship with the group members; the
Charismatic followers of a charismatic leader often
overcome extreme hardship to achieve the
group’s goal because of faith in the leader
Contemporar - focused on the day-to-day tasks of achieving
y Leadership Transactional organizational goals, and understanding and
Theory meeting the needs of the group(Berman,
Snyder, Frandsen, 2016, p.490)
- the leaders inspire others with a clear,
attractive, and attainable goal and enlists the
Transformation group to participate in attaining the goal; the
group is empowered because members and
leaders share values, honesty, trust and
continual learning (Berman, Snyder, Frandsen,
2016, p.490)
- recognizes that a professional workforce is
made up of many leaders; no one person is
Shared considered to have knowledge or ability beyond
Leadership that of other members of the work group
Torts
Tort Description
- misconduct or practice that is below the standard expected
of an ordinary, reasonable & prudent person (Berman,
Negligence - e.g., making an assignment beyond a worker’s capabilities
without giving adequate direction in carrying out delegated
Unintention function; administers incorrect medication (Tomey, 2009, p.
491)
al - Doctrines:res ipsa loquitor; respondeat superior; force
majuere
- “professional negligence”
- 6 elements must be present in malpractice: duty,
Malpractice breach of duty, foreseeability, causation, harm or injury, &
damages
- e.g., failure to check equipment for safety prior to use;
failure to notify a physician in a timely manner when
conditions warrant it (Berman, Snyder, Frandsen, 2016,
p.88)
- attempt or threat to touch another person unjustifiably
- e.g., a nurse threatens a client with an injection after the
Assault client refuses to take the medication (Berman, Snyder,
Frandsen, 2016, p.90)
- the willful touching of a person that may or may not cause
harm
Battery
- e.g., the nurse followed through on the threat and gave the
injection without the client’s consent (Berman, Snyder,
Intentional - “unjustifiable detention of a person without legal warrant to
confine the person” (Guido, 2014, p. 88)
False - e.g.,the nurse suggests under certain circumstances that a
Imprisonmen client remain in the hospital room or in bed against the
t client’s will (Berman, Snyder, Frandsen, 2016, p.90)
- injures the feelings of a person and does not take into
account the effect of revealed information on the reputation
Invasion of of the person in the community
Privacy - e.g., unnecessary discussions and gossips about the
client’s diagnosis and treatment (Berman, Snyder,
- defamation by means of print, writing or pictures
- e.g., writing in the nurse’s notes that a physician is
Libel incompetent for not responding to calls (Berman, Snyder,
- defamation by the spoken word, stating unprivileged or
false words by which a reputation is damaged
Slander - e.g.,the nurse to tell a client that another nurse is
incompetent (Berman, Snyder, Frandsen, 2016, p.91-92)
Commonly Used Inferential Statistics
Inferential Statistics Description

- used to compare the mean performance of
two independent groups (such as men &
Independent t-test women) (Berman, Snyder, Frandsen, 2016,
p.57)
two dependent or related groups (such as a
Dependent (or paired) t-test before and after test given to the same
individuals) (Berman, Snyder, Frandsen,
2016, p.57)
Analysis of variance (ANOVA) three or more groups (Berman, Snyder,
Pearson’s product-moment - used to describe and test the relationship
between two continuous variables (such as
correlation coefficient age & weight)(Berman, Snyder, Frandsen,
(Pearson’s r) 2016, p.57)
- used to compare the distribution of a
Chi-squared condition across two or more groups
Steps in the Research Process:

- Stating a research question or problem
- Defining the purpose of a study
- Reviewing related literature
- Formulating hypotheses and defining variables
- Selecting the research design
- Selecting the population, sample, and setting
- Conducting a pilot study
- Collecting the data
- Analyzing the data
- Communicating conclusions and implications
- Utilizing the research
(Kozier, Erb, Olivieri, 1991, p.45 )
Protecting the Rights of the Study Participant:

- Right Not to Be Harmed
- Right to Full Disclosure
- Right to Self-Determination
- Right to Privacy and Confidentiality
Theoretical Foundations of Community Health Nursing Practice
Theory Description
General - applicable to CHN clienteles: individual, family, group/aggregate &
community
Systems - viewed as open system, client is considered as a set of interacting
Theory elements that exchange energy, matter or information with the external
environment to exist (Katz and Kahn, 1966; von Bertalanffy, 1968)
- Application: The family gets inputs of matter (e.g., food, water), energy
(e.g., electricity) & information (e.g., news, health teaching) which are
resources from its environment. Outputs refer to the result from family’s
processing (throughput) of inputs. (Famorca, Nies, McEwen, 2013, pp.
36-37)
Social - based on the belief that learning takes place in a social context, that is,
people learn from one another and that learning is promoted by modelling
Learning or observing other people
Theory - Application: serving as a live model (e.g., demonstrating infant care
procedure); giving detailed verbal instructions (e.g., teaching how to collect
a sputum specimen); using print or multimedia strategies for health
education(Famorca, Nies, McEwen, 2013, p. 37)
Health Belief - individuals must know what to do and how to do it before they can take
action
Model - has been used to explain behavior change and maintenance of behavior
change and to guide health promotion interventions (Janz et al., 2002);
based on the assumption that the major determinant of preventive health
behaviour is disease avoidance
- Constructs: perceived severity, perceived susceptibility, perceived benefits
of treatment, perceived barriers to treatments, cues to action, self-efficacy
(Famorca, Nies, McEwen, 2013, pp. 37-39)
Milio’s - outlined 6 propositions that relate an individual’s ability to improve healthful
behavior to a society’s ability to provide accessible and socially affirming
Framework options for healthy choices; health-promoting choices must be readily
for available and less costly than health-damaging options for individuals to
Prevention gain health & for society to improve health status; this encourages the
nurse to understand health behaviors in the context of their societal milieu
(Famorca, Nies, McEwen, 2013, pp. 39-42)
Pender’s - depicts the complex multidimensional factors, health-related variables, with
which people interact as they work to achieve optimum health (Famorca,
Health Nies, McEwen, 2013, pp.42-43)
Promotion
Model
Transtheoreti - based on the assumption that behavior change takes place over time
through sequence of stages; each stage is stable & open to change – one
cal may stop in one stage, progress to the next or return to the previous stage
Model - Stages of Change: precontemplation; contemplation; preparation; action;
maintenance (Prochaska et al., 2008)(Famorca, Nies, McEwen, 2013, pp.
43-44)
PRECEDE-P - developed by Dr. Lawrence W. Green & colleagues; provides a model for
community assessment, health education planning and evaluation
ROCEED - PRECEDE (Predisposing, Reinforcing, and Enabling Constructs in
Model Educational Diagnosis and Evaluation) is used for community diagnosis
- PROCEED (Policy, Regulatory, and Organizational Constructs in
Educational and Environmental Development) is a model for implementing
and evaluating health programs based on PRECEDE
- Factors:predisposing refers to people’s characteristics that motivate health
behaviors (e.g., attitudes, beliefs); enabling refers to condition &
environment that facilitate/impede health behaviors (e.g., skills, availability,
accessibility); reinforcing refers to support persons & groups (e.g., support
from family, health care providers) (Famorca, Nies, McEwen, 2013, pp. 44)
Vital Health Statistics
Description Formula
Crude Birth Rate (CBR) Total no. of live births registered in a given calendar year
- measure of one characteristic of CBR = ------------------------------------------------------------------- x
the natural growth or increase of 1,000
a population Estimated population as of July 1 of the same year
Crude Death Rate (CDR) Total no. of deaths registered in a given calendar year
- measure of one mortality from all CDR = ------------------------------------------------------------------ x
causes which may result in a 1,000
decrease of population Estimated population as of July 1 of the same year
Infant Mortality Rate (IMR)
- measures the risk of dying during
the 1st year of life; a good index Total no. of deaths under 1 year of age
of the general health condition of registered in a given calendar year
a community since it reflects the IMR = ------------------------------------------------------------------ x 1,000
changes in the environment and Total no. of registered live births of same calendar year
medical condition of a community
Maternal Mortality Rate (MMR)
- measures the risk of dying from Total no. of deaths from maternal causes
causes related to pregnancy, registered in a given calendar year
childbirth and puerperium; an MMR = ----------------------------------------------------------------- x 1,
index of the obstetrical care 000
needed and received by women Total no. of registered live births of same calendar year
in a community
Fetal Death Rate (FDR)
- measures pregnancy wastage; Total no. of fetal deaths registered in a given calendar year
death of the product of FDR = ------------------------------------------------------------------- x
conception occurs prior to its 1,000
complete expulsion, irrespective Total no. of registered live births of same calendar year
of duration of pregnancy
Neonatal Death Rate (NDR)
- measures the risk of dying the 1st No. of deaths under 28 days registered in a given calendar year
month of life; an index of the NDR = ------------------------------------------------------------------ x
effects of prenatal care and 1,000
obstetrical management of the No. of registered live births of same calendar year
newborn
Specific Death Rate (SDR) Deaths in specific class/group registered in a
given calendar year
- describes more accurately the SDR = ---------------------------------------------------------------- x
risk of exposure of certain
100,000
classes or groups to particular
Estimated population as of July 1 in the same specified
diseases; understand the forces
class/group of said year
of mortality, the rates should be
made specific provided the data No. of death from specific cause registered in a given year
are available for both the CSDR = ---------------------------------------------------------------x
population and the event in their 100,000
specifications Estimated population as of July 1st of same year
- examples include: cause
specific death rate; age specific No. of death in a particular age group registered in a given year
death rate; sex specific death ASDR = --------------------------------------------------------------x 100,
rate 000
Estimated population as of July 1st of same year in the
same age group of same year
Description Formula
Incidence Rate (IR) No. of new cases of a particular disease registered
during a specified period of time
- measures the frequency of IR = ---------------------------------------------------------------- x 100, 000
occurrence of the phenomenon
Population at risk
during a given period of time
Prevalance Rate (PR) No. of new and old cases of a certain disease
registered at a given time
- measures the proportion of the PR = ---------------------------------------------------------------- x 100
population which exhibits a
Total no. of persons examined at same given time
particular disease at a particular
time; deals with total (new & old)
number of cases
Attack Rate (AR) No. of persons acquiring a disease
registered at a given year
- a more accurate measure of the AR = --------------------------------------------------------------- x 100
risk of exposure
No. of exposed to same disease in the same year
Proportionate Mortality Rate
No. of registered deaths from specific cause or age
(Death Ratio) for a given calendar year
- shows the numerical relationship PM = ---------------------------------------------------------------- x 100
between deaths from all causes No. of registration deaths from all causes, all ages
(or group of causes), age (or in same year
group of age, etc., and total no.
of deaths from all causes in all
ages taken together
Case Fatality Ratio (CFR) No. of registered deaths from specific disease
for a given year
- index of a killing power of a CFR = ---------------------------------------------------------------- x 100
disease and is influenced by
No. of registered cases from same specific disease
incomplete reporting and poor
in same year
morbidity data
(Cuevas, 2007, pp. 76-79)
Types of Immunity
Type Antigen or Antibody Source Duration & Example
Natural - antibodies are formed in the - lifelong
(human) presence of active infection - e.g., chicken pox
Active in the body
Artificial - antigens are administered to - many years; the
(laboratory) stimulate antibody immunity must be
production reinforced by booster
- e.g., vaccines, toxoids
Natural - antibodies are transferred - 6 months to 1 year
(human) naturally from an immune - e.g., measles
Passive mother to her baby through immunity from the
(Acquired) the placenta or in colostrum mother
Artificial - immune serum (antibody) - 2-3 weeks
(laboratory) from an animal or another - e.g., antitoxin,
human is injected antiserum, IGs
Expanded Program on Immunization, Philippines

Antigen Age Dose Route Site
right deltoid region
BCG vaccine at birth 0.05 ml intradermal
(arm)
Hepatitis B anterolateral thigh
at birth 0.5 ml intramuscular
vaccine muscle
DPT – Hep B
6 weeks, 10 anterolateral thigh
–Hib weeks, 14 weeks
0.5 ml intramuscular
muscle
(Pentavalent)
Oral Polio 6 weeks, 10
2 drops oral mouth
Vaccine weeks, 14 weeks
Anti-measles outer part of the upper
9 – 11 months 0.5 ml subcutaneous
vaccine (AMV 1) arm
Measles-Mumps- outer part of the upper
12 – 15 months 0.5 ml subcutaneous
Rubella (AMV 2) arm
Rotavirus 6 weeks, 10
1.5 ml oral mouth
vaccine weeks
(Famorca, Nies, McEwen, 2013, p. 225)
Tetanus Toxoid (TT) Immunization Schedule
TT %
Interval Duration of Protection
dose Protected
as early as possible
TT 1 during first pregnancy
- infants born to the mother are
TT 2 at least 4 weeks later 80 protected against neonatal tetanus
- 3-year protection to the mother
TT 3 at least 6 months later 95 protected against neonatal tetanus
TT 4 at least 1 year later 99 protected against neonatal tetanus
- all infants born to the mother are
TT 5 at least 1 year later 99 protected against neonatal tetanus
- lifetime protection to the mother
10 Medicinal Plants Endorsed by DOH
Medicinal Plant Use/Indication Preparation

(S) Sambong antiedema or antiurolithiasis decoction
diabetes mellitus (mild non-insulin decoction
(A) Ampalaya dependent) steamed
(N)Niyog-niyoga
antihelminthic seeds are used
n
(T) Tsaang
diarrhea, stomachache decoction
gubat
(A) Akapulko antifungal poultice
asthma, cough & colds, fever, decoction
(L) Lagundi dysentery, pain, skin disease wash affected site
(scabies, ulcer, eczema), wounds with decoction
(U) Ulasimang
lowers blood uric acid (rheumatism & decoction
bato or gout) eaten raw
Pansit-pansitan
washing wounds, diarrhea, gargle,
(B) Bayabas toothache
decoction
hypertension, lowers blood eaten raw/fried
(B) Bawang cholesterol, toothache apply on part
headache, stomachache, cough & decoction, infusion,
(Y) Yerba buena colds, rheumatism, arthritis massage sap
Vital Signs
Newborn
Adult
1st Period of Reactivity
Temperature 36℃ and 37.5℃
100.6 ℉ or 38.1 ℃
(96.8℉ to 99.5℉)
Pulse (PR) 80 (60 – 100) bpm Rapid, as much as 180 bpm while crying
160 – 180 then 100 – 120 bpm
Respiration 16 (12 – 20) breaths Irregular; 30-90 breaths/min while
(RR) crying; some nasal flaring, occasional
retraction may be present
Blood pressure <120 (SBP) / <80 (DBP) 74/47
(BP) 60 – 80 (SBP) / 40 – 60 (DBP)
O₂ Saturation 95 to 100%
95%
(SaO2)
Pulse Pressure 40 mmHg
- difference 100 mmHg (during exercise)
between the
diastolic &
systolic
(Pillitteri, 2010, p457) (Berman, Snyder, Frandsen, 2016, pp.504-535)
Arterial Blood Gas (ABG)
Mixed Venous
Arterial Blood Implication
Blood
- ↑ alkalosis
pH 7.35 – 7.45 7.32 – 7.42
- ↓ acidosis
- ↑ respiratory acidosis
paCO₂ 35 – 45 mmHg 38 – 52 mmHg
- ↓ respiratory alkalosis
- ↑ metabolic alkalosis
HCO₃ 22 – 26 mEq/L 19 – 25 mEq/L
- ↓ metabolic acidosis
>80 mmHg - an indirect measure of blood
paO₂ 80 – 100 mmHg
24 – 48 mmHg
oxygen content
Oxygen
>94% - <90% indicates hypoxia
Saturati 95% to 98%
65% to 75%
- <70% life threatening
on
(Hinkle, Cheever,2018, pp. 288)
Immunoglobulin Electrophoresis
% of Total
Type Significance
Immunoglobulin
IgM 10%
first immunoglobulin produced in response to bacterial and
“Military” viral infections
appears in body fluids (blood, saliva, sweat, tears, breast
IgA 15% milk, as well as pulmonary, GI, prostatic & vaginal
secretions)
the only antibody to cross the placental barrier
IgG 75% assumes major role in blood borne and tissue
“Go” infections
takes part in allergic & some hypersensitivity
IgE 0.004% reactions
- combats parasitic infection
possibly influences B-lymphocyte differentiation, but
IgD 0.2%
role is unclear
(Hinkle, Cheever,2018, pp. 1010)&(Kozier, Erb, Olivieri, 1991, p.457 )
Coagulation Studies
Normal
Significance
Value/Range
used to monitor the level of
Prothrombin time
9.5 – 12 seconds anticoagulation with warfarin
(PT) (Coumadin)
Partial thromboplastin 60 – 70 seconds
used to assess the effects of
time Therapeutic range: 1.5
unfractionated heparin
(PTT) – 2.5
Activated partial 20 – 39 seconds
used to assess the effects of
thromboplastin time Therapeutic range: 1.5
unfractionated heparin
(aPTT) – 2.5
International normalized 1
used to monitor the effectiveness of
ratio Therapeutic range: 2 –
warfarin
(INR) 3.5
(Hinkle, Cheever,2018, pp. 694)
Hematologic Studies
Male Female Possible Cause
Red Blood 4.6 – 6.0 4.2 – 5.0 - Excess: dehydration, polycythemia vera, high
million/mm3 million/mm3 altitude, cardiovascular disease
Cell (RBC)
- Deficit: blood loss, anemias overhydration,
Count leukemias, chronic renal failure, pregnancy
Hematocrit 42% to 52% 35% to 47% - Excess: hypovolemia, dehydration, burns
- Deficit: blood loss, pregnancy, dietary
deficiencies, anemias
Hemoglobi 13-18 g/dL 12-16 g/dL - Excess: polycythemia, dehydration, COPD, HF
- Deficit: blood loss, anemias, kidney diseases,
n cancer
Platelet 150, 000 – 450, 000/mm³ - Excess: malignant tumors, polycythemia vera
- Deficit: idiopathic, thrombocytopenic purpura,
viral infections, AIDS, SLE, chemotherapy
drugs, some types of anemia
White 4, 500 – 11, 000/mm³ - Excess: acute infections, tissue necrosis (e.g.,
myocardial infarction), collagen diseases
Blood Cell - Deficit: viral infections, hematopoietic diseases,
(WBC) rheumatoid arthritis
Count
Neutrophil 50 – 70 % - Excess:acute infections
- Deficit: viral diseases, leukemias, aplastic and
s IDA
Lymphocyt 25 – 35 % - Excess: viral infection, chronic infections,
lymphocytic leukemia
es - Deficit: cancers, leukemia, multiple sclerosis,
renal failure
Monocytes 4–6% - Excess: viral diseases, parasitic diseases,
collagen diseases, cancer
- Deficit: lymphocytic leukemia, aplastic anemia
Eosinophil 1–3% - Excess: allergic reactions, phlebitis,
thrombophlebitis, parasitic infestations
s - Deficit: stress (burns, shock), adrenocortical
hyperfunction
Basophils 0.4 – 1.0 % - Excess: infections, polycythemia vera, acute
blood loss, splenectomy
- Deficit: idiopathic, thrombocytopenic purpura,
cancer, SLE, some types of anemias
(Hinkle, Cheever,2018, p. 694)
(Berman, Snyder, Frandsen, 2016, pp. 750-751)
Cardiac Biomarkers & Other Tests for CVD
Normal Significance &Cause
Value/Range
Myoglobin 5-70 ng/mL - an increase is not very specific in indicating an acute
cardiac event, however negative results can rule out
an acute MI; starts to increase within 1 to 3 hours and
peaks within 12 hours after the onset of
symptoms(Hinkle, Cheever,2018, p. 764)
- Excess: MI, angina, renal failure, rhabdomyolysis
- Deficit: rheumatoid arthritis, myasthenia gravis
CK (creatine - ↑ CK-MB is an indicator of acute MI; the level begins
kinase) MM: 96% to 100% to increase within a few hours and peaks within 24
MB: 0% to 6% hours of an infarct(Hinkle, Cheever,2018, p. 764)
3 Isoenzymes:
MM, MB, BB BB: 0% - 3 isoenzzymes: MM (skeletal muscle);MB (heart
muscle); BB (brain tissue)
- Excess: acute MI, myocardial ischemia & infarct,
angina pectoris
Troponin Trop I: <0.35 - troponins I & T are specific for cardiac muscle,
3 Isomers: ng/mL and these biomarkers are currently recognized as
C, I, T Trop T: <0.2 ng/mL reliable and critical markers of myocardial injury
(Amsterdam et al., 2014)
- remains elevated for a long period, often as long as 3
weeks, and it therefore can be used to detect recent
myocardial damage(Hinkle, Cheever,2018, p. 764)
- Excess: Trop I (small infarct, myocardial injury); Trop
T (acute MI, unstable angina, myocarditis
C-Reactive 3 mg/L or greater - protein produced by the liver in response to systemic
1 to 3 mg/L inflammation; predicts CVD risk(Hinkle,
Protein Cheever,2018, p. 695)
(moderate)
<1 mg/L (low) - positive reading indicates active inflammation
- Excess: rheumatoid arthritis & SLE
Brain <100 pg/mL or - Excess: heart failure, symptomatic cardiac volume
<100 ng/L overload, paroxysmal atrial tachycardia(Berman,
(B-type) Snyder, Frandsen, 2016, pp. 750-751)
Natriuretic
Peptide
(BNP)
Lipid Profile
Normal
Possible Cause
Value/Range
Cholesterol <200 mg/dL Excess: familial hypercholesterolemia, chronic
renal failure, alcoholism, high cholesterol & fat
diet
Deficit: severe hepatocellular disease,
hyperthyroidism, malnutrition, chronic anemias,
severe burns
Triglycerides 100 to 200 mg/dL Excess: hyperlipoproteinemia, liver disease,
renal disease, hypothyroidism, pancreatitis, MI
Deficit: malnutrition, brain infarction, chronic
obstructive lung disease
High – Density M: 35 – 70 mg/dL Excess: chronic liver disease, long-term
F: 35 – 80 mg/dL aerobic or vigorous exercise
Lipoprotein (HDL) Deficit: familial hypoproteinemia, poorly
“good cholesterol” *higher levels are
better controlled DM, chronic renal failure
Low – Density <160 mg/dL Excess: nephritic syndrome, multiple myeloma,
*lower levels are DM, chronic renal failure
Lipoprotein (LDL) Deficit: hypolipoproteinemia, hyperthyroidism,
“bad cholesterol” better
chronic anemias, severe hepatocellular
disease
Blood Chemistries
Normal
Significance
Value/Range
BUN 10 – 20 mg/dL ↑ BUN reflects reduced renal perfusion from decreased
cardiac output or intravascular fluid volume deficit as a
result of diuretic therapy or dehydration(Hinkle,
Cheever,2018, p. 694)
Creatinine 0.7 – 1.4 mg/dL best indicator for GFR & renal function because crea is a
(62 – 124 mcmol/L) product of muscle metabolism and not influenced by protein
intake unlike BUN; increase may indicate kidney damage in
SLE, scleroderma and polyarteritis(Hinkle, Cheever,2018, p.
694)
Uric Acid 2.5 – 8 mg/dL measures level of uric acid in serum; increase is seen in
(0.15 – 0.5 mmol/L) gout(Hinkle, Cheever,2018, p. 1058)
Amylase 111-296 U/L an enzyme that aids in the digestion of starch (Hinkle,
Cheever, 2018, p. 1224)
Excess: acute pancreatitis; mumps; duodenal ulcer;
pancreatic CA
Deficit: liver cirrhosis; chronic pancreatitis
Lipase <200 U/L an enzyme that aids in the digestion of fats (Hinkle,
Cheever, 2018, p. 1224)
Excess: acute & chronic pancreatitis; biliary obstruction;
cirrhosis; hepatitis
Trypsin 115-350 ng/ml an enzyme that aids in the digestion of protein (Hinkle,
Cheever, 2018, p. 1224)
Liver Function Tests

Normal
Significance &Cause
Value/Range
ALT(alanine M: 10 – 55 unit/L - marker of hepatic injury; more specific of
aminotransferase), F: 7 – 30 unit/L liver damage than AST
- Excess: hepatitis, infectious mononucleosis,
formerly known as
acute pancreatitis, acute MI, heart failure
serum pyretic
transaminase
(SGPT)
AST(aspartate M: 10 – 40 unit/L - found in heart, liver, and skeletal muscle; can
aminotransferase), F: 9 – 25 unit/L also indicate liver injury
formerly known as - Excess: liver diseases (e.g., hepatitis,
serum alcoholism), acute MI, anemias, skeletal muscle
glutamic-oxaloaceti diseases
c transaminase - Deficit: chronic renal dialysis, vitamin B6
deficiency
(SGOT)
Albumin 3.5 – 4.8 g/dL or - a protein produced by the liver
35 – 48 g/L - Excess: reflects dehydration
Panic value: <1.5 - Deficit: chronic liver dysfunction, AIDS, severe
g/dL burns, malnutrition, renal disease, acute &
chronic infections
Alkaline 25 – 100 unit/L - used as an index of liver and bone disease
when correlated with other clinical findings
phosphatase - Excess: liver disease, bone disease,
hyperparathyroidism, MI, chronic renal failure,
HF
- Deficit: malnutrition, pernicious anemia & severe
anemias, hypothyroidism, magnesium & zinc
deficiency
Ammonia 15 – 45 mcg/dL - liver converts ammonia, a by-product of protein
metabolism, into urea, which is excreted by the
kidneys
- Excess: liver disease, cirrhosis, Reye’s
syndrome, GI hemorrhage
- Deficit: renal failure
Bilirubin Total: 0.3 – 1.0 - results from the breakdown of hemoglobin in the
mg/dL RBCs
Direct: 0.0 – 0.2 - Excess: total (hepatitis, obstruction of the
mg/dL common bile or hepatic ducts, pernicious
anemia, sickle cell disease); direct (cancer of
Indirect: 0.1 – 1.0
the head of the pancreas, choledocholithiasis);
mg/dL
indirect (hemolytic anemias, drug toxicity,
Panic value: >10 transfusion reaction)
mg/dL
GGT (gamma – M: 1 – 94 unit/L - is more specific for the hepatobiliary system
glutamyl F: 1 – 70 unit/L - Excess: liver disease, alcohol abuse
transferase)
Prothrombin 11 – 13 seconds - a protein produced by the liver for clotting of
Critical value: >20 blood
secs for - Excess: liver disease/damage, vitamin K
non-anticoagulated deficiency, obstruction of common bile duct,
deficiency of factors II, V, VII or X
individuals
- Deficit: thrombophlebitis, malignant tumor
Electrolytes
Electrolyt
Normal Value/Range Sign/Symptom
e
Sodium 135-145 mEq/L or - hyponatremia: headache, lethargy, confusion,
135-145 mmol/L weight gain, edema
(Na+) - hypernatremia: thirst, elevated body
temperature, swollen dry tongue
Potassiu 3.5 to 5 mEq/L or - hypokalemia: fatigue, nausea & vomiting,
3.5 to 5 mmol/L paresthesia, leg cramps, flattened T waves,
m prominent U waves
(K+) - hyperkalemia: tachycardia, dysrhythmias,
irritability, tall T waves, prolonged QRS
duration
Calcium 8.6 to 10.2 mg/dL or - hypocalcemia: numbness, tingling of fingers,
2.2 to 2.6 mmol/L (+) Trousseau’s & Chvostek’s sign,
(Ca2+) hyperactive DTR
Ionized serum calcium: 4.5 to
5.1 mg/dL or 1.1 to 1.3 mmol/L - hypercalcemia: constipation, dehydration,
hypoactive DTR, calcium stones
Magnesiu 1.3 to 2.3 mg/dL or - hypomagnesemia: neuromuscular irritability,
0.62 to 0.95 mmol/L mood changes, ↑ BP
m - hypermagnesemia: flushing, hypotension,
(Mg2+) drowsiness, diaphoresis
Phospho 2.5 to 4.5 mg/dL or - hypophosphatemia: paresthesia, bone pain,
0.8 to 1.45 mmol/L chest pain, confusion
rus - hyperphosphatemia: tetany, tachycardia,
(PO4¯) anorexia, s/s of hypocalcemia
Chloride 97 to 107 mEq/L or - hypochloremia: agitation, irritability, tremors,
97 to 107 mmol/L muscle cramps
(Cl¯) - hyperchloremia: tachypnea, lethargy,
weakness,
↓ cardiac output
*Other Values
Normal
Significance
Value/Range
Intracranial 10 – 15 mm Hg - pressure exerted by the volume of the
5 – 10 cm H₂O intracranial contents within the cranial
Pressure (ICP) vault(Hinkle, Cheever,2014, p. 1979)
Cerebral 70 – 100 mm Hg - closely linked with ICP; must be maintained to
70 to 80 mm Hg to ensure adequate blood flow
Perfusion to the brain(Hinkle, Cheever,2018, p. 1980)
Pressure (CPP)
Central Venous 4 – 12 mm Hg or cm - used to measure right atrial pressure(Hinkle,
H₂O Cheever,2018, p. 305)
Pressure (CVP)
Intraocular 10 to 21 mm Hg or - production of aqueous humor is related to the
<21 mm Hg intraocular pressure; when aqueous fluid
Pressure production & drainage are in balance, the IOP
(IOP) is between 10 and 21 mm Hg(Hinkle,
Cheever,2018, p. 1878)
Erythrocyte 0 – 15 mm/hr (men); - increases significantly in widespread
0 – 20 mm/hr inflammatory or degenerative disorders; aid in
Sedimentation the detection of occult disease (e.g., TB, tissue
(women)
Rate (ESR) necrosis or connective tissue disorder)
(Deciphering Diagnostic Test, 2008, p. 2)
Nutrient Content of the Therapeutic Lifestyle Changes (TLC) Diet
Normal Value/Range
25% to 35% of total calories
Saturated: <7%
Total Fat Polyunsaturated: Up to 10%
Monounsaturated: Up to 20%
Carbohydrate 50% to 60% of total calories
20 to 30 gm/d
Dietary fiber Or at least 25 grams
Protein Approximately 15% of total calories
Cholesterol <200 mg/d

(Hinkle, Cheever,2018, p. 755)
Defense Mechanisms
Definition & Patient Example
Denial - unconscious refusal to admit an unacceptable idea or behavior
- e.g.,Mr. Juan was diagnosed as diabetic patient but still continue to eat
sweet foods
Repression - unconscious and involuntary forgetting of painful ideas; accdg to Freud,
most common defense mechanism
- e.g.,Ms. Ann, a victim of incest, no longer remembers the reason she
always hated the uncle who molested her
Suppression - consciously keeping unacceptable feelings and thoughts out of awareness
- e.g.,A student taking a test is upset about an argument with her boyfriend,
but deliberately puts it out of her mind so she can finish the test
Rationalization - conscious/unconscious attempts to make/prove that one’s feelings or
behaviors are justifiable (publicly acceptable)
- e.g.,Mr. Miguel, diagnosed with schizophrenia, states that he cannot go to
work because his co-workers are mean, instead of admitting that his
illness interferes with working
Intellectualizat - separating an emotion from an idea or thought because the emotional
reaction is too painful to be acknowledged
ion - e.g.,A man learns from his doctor that he has cancer. He studies the
physiology and treatment of cancer without experiencing any emotion
Dissociation - unconscious separation of painful feelings and emotions from an
unacceptable idea, situation, or object
- e.g., Ms. Nena recalls that when she was sexually molested as a child,
she felt as if she were outside of her body watching what was happening
without feeling anything
Identification - conscious or unconscious attempt to model oneself after a respected
person
- e.g., Mr. Galang states to the clinical instructor, “When I finished my
college, I wanted to be a clinical instructor just like you.”
Definition & Patient Example

Introjection - acceptance of another’s values and opinions as one’s own
- e.g., A woman who prefers a simple lifestyle assumes the materialistic,
prestige-oriented values of her husband
Compensat - consciously covering up for a weakness by making up a desirable trait
- e.g., Mr. Rizal, who is depressed and unable to share his feelings with other
ion patients, writes and becomes known for his expressive poetry
Sublimatio - consciously or unconsciously channeling instinctual drives into acceptable
activities/outlets
n - e.g., Mr. Smith, a former perpetrator of incest who fears relapse, forms a local
chapter of Sex Addicts Anonymous
Reaction - unacceptable feelings disguised by repression of the real feeling and by
reinforcement of the opposite feeling
formation - e.g., A woman dislikes her mother-in-law is always very nice to her
Undoing - consciously doing something to counteract for a transgression or wrongdoing
- e.g., After accidentally eating another patient’s cookies, Ms. Dacayan
apologizes to the patients, cleans the refrigerator, and labels everyone’s snack
with their names
Displaceme - unconsciously discharging pent-up feelings to a less threatening object
- e.g., Students fail in their final examination and blame their professors for not
nt teaching properly
Projection - unconsciously (or consciously) blaming someone else for one’s difficulties or
placing one’s unethical desires on someone else
- e.g., An adolescent comes home late from a dance and states that her van
was busted
Conversion - unconscious expression of intrapsychic conflict symbolically through physical
symptoms
- e.g.,A student awakens with a migraine headache the morning of a final
examination and feels too ill to take the test. She does not realize that 2 hours
of cramming left her unprepared
Regression - reverting to an earlier stage of development
- e.g., A man exposes his genitalia to women he sees in public places
(Davadilla, 2012, p. 23)
Cycle of Abuse & Violence

Cycle Definition
Tension - after honeymoon period, tension-building phase begins
- there may be arguments, stony silence, or complaints from husband
Building
Violent - tension ends in another violent
- the peak of violence; the perpetrator experiences a release of tension and
Behavior this behaviour may become habitual
Honeymoon - period of contrition or remorse
- period of the abuser expressing regret, apologizing and promising it will
Period never happen again
- professes his love for his wife and may even engage in romantic behavior
(e.g. buying gifts & flowers)
- last weeks or even months, causing the woman to believe that the
relationship has improved & her husband’s behavior has changed
(Videbeck, 2017, p. 199)
FOUR TONES OF PERSONAL SPACES:
1. Intimate distance (6 – 8 inches) – allows interpersonal sensory stimulations

2. Personal Distance (1 ½ - 4 ft) – also known as “comfort zone”; used for close relationships; the
nearest distance for a client with schizophrenia-paranoid is 4 ft.
3. Social Distance (4-12 ft) – also known as consultative distance or business distance ; speech must
be louder
4. Public Distance (12ft and more) – used in speech giving during gatherings
LEVELS OF ANXIETY
Anxiety Level Psychological Responses Physiological Responses
Mild Wide perceptual field Restlessness
Sharpened senses Fidgeting
Increased motivation GI “butterflies”
Effective problem solving Difficulty sleeping
Increased learning ability Hypersensitivity to noise
Irritability
Moderate Perceptual field narrowed to immediate Muscle tension ; Diaphoresis
task Pounding pulse ; Headache
Selectively attentive Dry mouth ; High voice pitch
Cannot connect thoughts or events Faster rate of speech
independently GI upset
Increased use of automatisms Frequent urination
Severe Perceptual field reduced to one detail or Severe headache
scattered details Nausea, vomiting, diarrhea
Cannot solve problems or learn effectively Trembling ; Rigid stance
Behavior geared toward anxiety relief and Vertigo ; Pale
is usually ineffective Tachycardia
Doesn’t respond to redirection Chest pain
Feels awe, dread or horror
Cries
Ritualistic behavior
Panic Perceptual field reduced to focus on self May bolt and run or Totally
Cannot process any environmental stimuli immobile and mute
Distorted perceptions Dilated pupils
Loss of rational thought Increased blood pressure and
Doesn’t recognize potential danger pulse
Can’t communicate verbally Flight, fight, or freeze
Possible delusions and hallucination
May be suicidal
(Psychiatric – Mental Health Nursing 7th Ed by Sheila Videbeck)
ANXIOLYTIC DRUGS
Generic/Trade Speed of Half-life
Side Effects Nursing Implications
Name onset (Hours)
Bendodiazepines Dizziness, clumsiness, Avoid other CNS
sedation, headache, fatigue, depressants such as
Diazepam (Valium) Fast 20-100 sexual dysfunction, blurred antihistamines and
Alprazolam Intermedia 6-12 vision, dry throat and mouth, alcohol.
(Xanax) te 5-30 constipation, high potential for Avoid caffeine.
Chlordiazeperoxid Intermedia 10-20 abuse and dependence Take care with potentially
e te 18-50 hazardous activities such
(Librium) 4-15 as driving.
Lorazepam Slow Rise slowly from lying or
(Ativan) Slow sitting position.
Clonazepam Use sugar-free
(Klonopin) beverages or hard candy.
Oxazepam (Serax) Drink adequate fluids.
Do not stop taking the
drug abruptly.
Nonbenzodiazepi Dizziness, restlessness, Rise slowly from sitting
nes agitation, drowsiness, position.
Very slow headache, weakness, nausea,
Rapid
Buspirone vomiting, paradoxical Take care with potentially
(Buspar) excitement or euphoria hazardous activities such
Meprobamate as driving.
(Miltown, Take with food.
Equanil) Report persistent
restlessness, agitation,
excitement, or euphoria
to physician.
SCHIZOPHRENIA
POSITIVE OR HARD SYMPTOMS NEGATIVE OR SOFT SYMPTOMS
Ambivalence Alogia
Associative looseness Anhedonia
Delusions Apathy
Echopraxia Asociality
Flight of ideas Blunted affect
Hallucinations Catatonia
Ideas of reference Flat affect
Perseveration Avolition of lack of volition
Bizarre behavior Inattention
SIDE EFFECTS OF ANTIPSYCHOTIC MEDICATIONS

SIDE EFFECT NURSING INTERVENTION
Dystonic reactions Administer medications as ordered; assess for effectiveness; reassure client if
he or she is frightened.
Tardive dyskinesia Assess using tool such as Abnormal Involuntary Movement Scale (AIMS);
report occurrence or score increase to physician.
Neuroleptic malignant Stop all antipsychotic medications; notify physician immediately
syndrome
Akathesia Administer medications as ordered; assess for effectiveness
EPS or neuroleptic Administer medications as ordered; assess for effectiveness
induced parkinsonism
Seizures Stop medication; notify physician; protect client from injury during seizure
Sedation Caution about activities requiring client to be fully alert such as driving a car.
Photosensitivity Avoid sun exposure; wear protective clothing and sun-blocking lotion
Weight gain Encouraged balanced diet; regular exercise; focus on minimizing gain
Anticholenergic
symptoms Use ice chips or hard candy for relief
Dry mouth
Blurred vision Assess side effect, which should improve with time
Constipation Increase fluid and dietary fiber intake; client may need stool softener if
unrelieved
Urinary retention Report any frequency or burning with urination
Orthostatic hypotension Instruct client to rise slowly from sitting or lying position; wait to ambulate until
no longer dizzy or light-headed
SYMPTOMS AND INTERVENTIONS OF LITHIUM TOXICITY
Serum Symptoms of Lithium Toxicity Interventions
Lithium
Level
1.5 – 2 mEq/L Nausea and vomiting, diarrhea, reduced Withhold next dose.
coordination, drowsiness, slurred speech, Serum lithium levels are ordered.
and muscle weakness Doses of lithium are suspended for a few
days or the dose is reduced.
2 – 3 mEq/L Ataxia, agitation, blurred vision, tinnitus, Withhold future doses.
giddiness, choreoathetoid movements, Stat serum lithium level.
confusion, muscle fasciculation, Gastric lavage may be used to remove oral
hyperreflexia, hypertonic muscles, lithium.
myoclonic twitches, pruritus, maculopapular IV containing saline and electrolytes used
rash, movement of limbs, slurred speech, to ensure fluid and electrolyte function and
large output of dilute urine, incontinence of maintain renal function.
bladder or bowel and vertigo
3.0 mEq/L Cardiac arrhythmia, hypotension, All preceding interventions plus lithium ion
and above peripheral vascular collapse, focal or excretion is augmented with use of
generalized seizures, reduced levels of aminophylline, mannitol or urea.
consciousness from stupor to coma, Hemodialysis may also be used to remove
myoclonic jerks of muscle groups, and lithium from the body.
spasticity of muscles Respiratory, circulatory, thyroid, and
immune systems are monitored and
assisted as needed.
PERSONALITY DISORDER
PERSONALITY DISORDER
Characteristics/
CLUSTER A – odd or eccentric Nursing Intervention
Symptoms
behaviors
Paranoid Personality Disorder Mistrust and suspicions of others; Serious, straightforward approach
guarded, restricted affect Teach client to validate ideas
before taking action.
Involve client in treatment planning
Schizoid Personality Disorder Detached from social Improve client’s functioning in the
relationships; restricted affect; community; assist client to find
involved with things more than case manager
people
Schizotypal Personality Disorder Acute discomfort in relationships; Develop skin-care skills
cognitive or perceptual Improve community functioning
distortions; eccentric behavior Social skills training
CLUSTER B – erratic or
dramatic behaviors
Antisocial Personality Disorder Disregard for rights of others, Limit setting; confrontation
rules, and laws Teach client to solve problems
effectively and manage emotions of
anger or frustration.
Borderline Personality Disorder Unstable relationships, Promote safety
self-image, and affect; Help client to cope and control
impulsitivity; self-mutilation emotions
Cognitive restructuring techniques
Structure time; teach social skills
Histrionic Personality Disorder Excessive emotionality and Teach social skills
attention seeking Provide factual feedback about
behavior
Narcissistic Personality Disorder Grandiose; lack of empathy; Matter-of-fact approach
need for admiration Gain cooperation with needed
treatment
Teach client any needed self-care
skills
CLUSTER C – anxious or fearful
behaviors
Avoidant Personality Disorder Social inhibitions; feelings of Support and reassurance
inadequacy; hypersensitive to Cognitive restructuring techniques
negative evaluation Promote self-esteem
Dependent Personality Disorder Submissive and clinging behavior Foster client’s self-reliance and
Excessive need to be taken care autonomy
of Teach problem-solving and decision
making skills
Cognitive restructuring techniques
Obsessive-Compulsive Preoccupation with orderliness, Encourage negotiation with others
Personality Disorder perfectionism, and control Assist client to make timely
decisions and complete work
(Psychiatric – Mental Health Nursing 7th Ed. by Sheila Videbeck)
Common Drugs (Toxicity) and Antidotes
Common Drug (Toxicity) Antidote
Acetaminophen N-acetylcysteine (Mucomyst) – this drug protects the liver
(Tylenol/Paracetamol) from toxic metabolites; replenishes essential liver enzymes
and requires a total of 18 doses every 4 hours (Adams,
Holland, Jr., Bostwick, 2007, p.479)
Anticholinesterase Atropine sulfate – initial dose of 1 to 2 mg IV (Adams,
Holland, Jr., Bostwick, 2007, p.479)
Antimuscarinic/Anticholine Physostigmine salicylate – 1 to 2 mg SQ or IV; a 2nd
rgic injection may be given 2 hours after, if required (Adams,
Holland, Jr., Bostwick, 2007, p. 268)
Benzodiazepines Flumazenil (Romazicon) – to reverse CNS depressant
effects; (Adams, Holland, Jr., Bostwick, 2007, p.177); dose to
be determine
Beta Blockers Atropine or Isoproterenol – to reverse bradycardia;
(Adams, Holland, Jr., Bostwick, 2007, p.353); dose to be
determine
Ca Channel Blockers Calcium infusions;(Adams, Holland, Jr., Bostwick, 2007,
p.314); dose to be determine
Coumadin (Warfarin) Vitamin K – oral or IV (reverse effects within 6 hours);
determine
Cyanide Oxygen & Amyl nitrate;do not induce vomiting (Adams,
Holland, Jr., Bostwick, 2007, p. 24)
Digoxin Digoxin immune fab (Digibind) via IV; (Adams, Holland, Jr.,
Bostwick, 2007, p. 417); dose to be determine
Dopamine Phentolamine – a short-acting alpha-adrenergic blocker;
determine
Heparin Protamine sulfate – 1 mg per 100 units of heparin via IV
(Adams, Holland, Jr., Bostwick, 2007, p. 383)
Insulin Oral glucose (mild); parenteral glucagon or IV glucose
(severe); (Adams, Holland, Jr., Bostwick, 2007, p.686); dose
to be determine
Iron Deferoxamine (Desferal);(Adams, Holland, Jr., Bostwick,
2007, p.404); dose to be determine
Methotrexate Leucovorin (folinic acid) – to rescue normal cells or protect
against severe bone marrow damage; (Adams, Holland, Jr.,
Bostwick, 2007, p. 562); dose to be determine
Opioid Naloxonehydrochloride– via IV or IM administration as
prescribed to reverse severe respiratory depression and
coma; (Adams, Holland, Jr., Bostwick, 2007, p. 228); dose to
be determine
Tricyclic Antidepressants Physostigmine (Antilirium) – given only to patients with
life-threatening symptoms (e.g., coma, convulsions);
Diazepam (to manage seizure activity)
- use cathartics or gastric lavage with activated charcoal
to prevent further drug absorption (for up to 24 hours)
(Keltner, Bostrom McGuiness, 2012, p. 199); dosage
to be determine
Phencyclidine HCl Diazepam(for seizure & agitation); Haloperidol (for psychotic
behavior); (Keltner, Bostrom McGuiness, 2012, p. 387); dose
to be determine
Organs in the Nine Abdominal Regions
Right Hypochondriac Epigastric Left Hypochondriac
- right lobe of liver - aorta - stomach
- gallbladder - pyloric end of stomach - spleen
- part of duodenum - part of duodenum - tail of pancreas
- hepatic flexure of colon - pancreas - splenic flexure of colon
- upper half of right kidney - part of liver - upper half of left kidney
- suprarenal gland - suprarenal gland
Right Lumbar Umbilical Left Lumbar
- ascending colon - omentum - descending colon
- lower half of right kidney - mesentery - lower half of left kidney
- part of duodenum and - lower part of duodenum - part of jejunum and
jejunum - part of jejunum and ileum
ileum
Right Inguinal Hypogastric (Pubic) Left Inguinal
- cecum - ileum - sigmoid colon
- appendix - bladder - left ureter
- McBurney’s point - uterus - left spermatic cord
- lower end of ileum - left ovary
- right ureter
- right spermatic cord
- right ovary
Infant Reflexes
Reflex Description
Sucking - occurs when the infant’s lips are touched; persists throughout infancy
Rooting - elicited by touching the baby’s cheek, causing the baby’s head to turn to the
side that was touched; disappears after 4 months
Moro - often assessed to estimate the maturity of the CNS; a loud noise, a sudden
change in position or an abrupt jarring of the crib elicits this reflex; the infant
reacts by extending both arms and legs outward with the fingers spread, then
suddenly retracting the limbs & cries at the same time; disappears after 4
months
Palmar grasp - occurs when a small object is placed against the palm of the hand, causing
the fingers to curl around it; disappears after 3 to 6 months
Plantar - similar to palmar; an object is placed just beneath the toes causes them to curl
around it; disappears after 8 to 10 months
Tonic neck - a postural reflex; when a baby who is lying on its back turns its head to, for
example, the right side, the left side of the body shows a flexing of the left arm
(fencing) and the left leg; disappears after 4 to 6 months
Stepping - elicited by holding the baby upright so that the feet touch a flat surface; legs
(walking/dancin then move up and down as if the baby were walking; disappears at about 2
months
g)
Babinski - when the sole of the foot is stroked, the big toe rises and the other toes fan
out; a newborn baby has a positive Babinski; after age 1, the infant exhibits a
negative Babinski that is, the toes curl downward; a positive Babinski after age
1 can indicate possible upper motor neuron damage
Figure 3.Cardiac Arrest Algorithm (ACLS Training Center)
Surgical Safety Checklist (WHO)
Before induction of Before patient leaves
Before skin incision
anaesthesia operating room
SIGN IN TIME OUT SIGN OUT
o Patient has confirmed o Confirm all team Nurse verbally confirms
members have with the team:
- Identify (Name, introduced
DOB) themselves by name o The name of the procedure
- Site and role recorded
- Procedure o That instrument, sponge and
- Consent needle counts are correct (or
o Surgeon, anaesthesia not applicable)
o Site marked/Not professional and o How the specimen is labelled
applicable nurse verbally (including patient name)
confirm o Whether there are any
- Patient equipment problems to be
- Site addressed
- Procedure
Anticipated critical
o Anaesthesia safety events o Surgeon, anaesthesia
check completed professional and nurse
o Surgeon Reviews: review the key concerns
What are the critical or for recovery and
unexpected steps, management of this patient
operative duration,
anticipated blood loss?
o Anaesthesia Team
Reviews: Are there any
patient-specific
concerns?
o Nursing Team
Reviews: Has sterility
(including indicator
results) been
confirmed? Are there
equipment issues or
any concerns?
o Pulse oximeter on Has antibiotic
patient and functioning prophylaxis been
Does patient have a: given within the last
60 minutes?
Known allergy? o Yes
o No o Not applicable
o Yes
Is essential imaging
Difficult displayed?
airway/Aspiration risk? o Yes
o No o Not applicable
o Yes, and
equipment/assitance
available
Risk of >500ml blood
loss (7ml/kg in
children)?
o No
o Yes, and adequate
intravenous access and
fluids planned
Figure 4. Surgical safety checklist. Used with permission from World Health Organization. (2008)
Levels of Consciousness: Glasgow Coma Scale
Faculty Response Score
Measured
Eye Opening - Spontaneous 4
- to verbal command 3
- to pain 2
- no response 1
Motor - to verbal command 6
Response - to localized pain 5
- flexes and withdraws 4
- flexes abnormally 3
- extends abnormally 2
- no response 1
Verbal - oriented, converses 5
Response - disoriented, converses 4
- uses inappropriate words 3
- makes incomprehensible 2
sounds 1
- no response
The lowest score is 3 (least responsive); the highest is 15 (most responsive). A GCS score
between 3 and 8 is generally accepted as indicating a severe head injury. The GCS is considered
the most sensitive indicator of a lapse in neurologic functioning in patients with TBI and is often
the earliest sign of acute change in ICP.
Risk Assessment (Pressure Ulcer) Tool
Tool Definition
Braden Scale for - consists of 6 subscales: sensory perception
moisture
Predicting Pressure activity
Sore Risk mobility
nutrition
level of consciousness
- total of 23 points (adult); below 18 points is
considered at risk
Norton’s Pressure Area - categories: general physical condition
mental state
Risk Assessment activity
Scoring System mobility
incontinence
*medication – added by some users
- possible score of 24; scores of 15 or 16 are
indicators, not predictors, of risk
Recommended Isolation Precautions in Hospitals

Precautions Description & Guidelines
- designed for all hospitalized individuals regardless of their
diagnosis or possible infection status; primary strategy of
preventing health care-associated infections (HAIs); used in
any situations involving blood, all body fluids, excretions &
secretions except sweat, nonintact skin & mucous membranes
- include: hand hygiene
use of PPEs (gloves, gowns, eyewear, masks)
Standard Precaution safe injection practices (puncture-resistant containers,
or Universal Precaution one-handed approach
(for ALL clients in the for recapping, needleless devices to prevent injury
hospital) according to OSHA)
safe handling of potentially contaminated
equipment/surfaces in client
environment (do not shake soiled linens; clean
side out, dirty side in; away from
side othe uniform)
respiratory hygiene/cough etiquette(separating potentially
infected
individuals from others by at least
1m/3 ft; proper waste disposal)
- place client in an airborne infection isolation room (AIIR) with
negative air pressure, 6 to 12 air changes/hour, and air either
highly filtered or exhausted directly outside
- if private room is not available, place with another infected
Airbor client who has the same microorganism (cohort)
Transmission- ne - health care providers should always wear N95 respirator mask
while the client’s room
Based - limit movement of client outside the room to essential
Precaution purposes; place a surgical mask on the client during transport
(in addition to - place client in a private room
standard - if private room is not available, cohort clients
precaution; when Droplet - wear mask within 1 m or 3 to 6 feet of the client
organisms have - limit movement of client outside the room to essential
been identified) purposes; place a surgical mask on the client during transport
- place client in a private room
- if private room is not available, cohort clients
Contac - wear gloves & gown (both remove in the client’s room)
t - limit movement of client outside the room
- hand hygiene
Trajectory Model of Chronic Illness
Phase Description Focus of Nursing Care

Pretrajectory - genetic factors or lifestyle behaviors that - genetic testing; counselling;
place a person/community at risk for education about prevention
chronic condition
Trajectory - onset of noticeable symptoms - explanation of diagnostic
associated with chronic disorder; tests & procedure; emotional
Onset announcement of diagnosis support
Stable - illness course & symptoms are under - positive reinforcement;
control; disability managed ongoing monitoring; health
screening
Unstable - exacerbation of illness symptoms; - guidance & support;
development of complications; reinforce education
reactivation of an illness; period of
inability to keep symptoms under control;
difficulty in carrying out ADLs
Acute - development of illness complications - direct care & emotional
necessitating hospitalization& bed rest support
Crisis - critical or life-threatening situation - direct care; collaboration with
requiring emergency treatment other healthcare team to
stabilize condition
Comeback - gradual recovery after an acute period - coordination of care;
and learning to live with/overcome rehabilitation; positive
disabilities & return to an acceptable way reinforcement
of life within the limitation imposed by the
chronic disability; physical healing
Downward - rapid or gradual worsening of a - home care &
condition; physical decline with community-based care;
increasing disability or difficulty end-of-life preferences &
controlling symptoms; alterations in planning
everyday life
Dying - final days or weeks before death; - palliative care or hospice
gradual or rapid shutting down of body program
processes; biographical disengagement
& closure; relinquishment of everyday
life interests & activities
(Hinkle, Cheever, 2018, p. 146)
Communicable Diseases
Disease or
Condition
Chicken Pox - CA:Varicella zoster virus ; IP: 10 to 21 days
“Varicella” - MOT:airborne or spread by aerosolized droplets; direct contact from vesicles;
indirectcontact through linen/fomites
- DT: determination of varicella-zoster virus through complement fixation test &
electronmicroscopic examination of vesicular fluid
- S/S:(pre-eruptive): mild fever & malaise
(eruptive): centrifugal rash (unexposed area); pruritic vesicular lesions
(stages: macule-papule-vesicle-pustule-crust/scab); loss of appetite;
headache
- Complication: shingles (reactivation); secondary infection in children (e.g.,
furuncles, cellulitis, skin abscess, erysipelas); pneumonia in adults; Reye’s
Syndrome
- Prevention: 2 doses of chicken pox vaccine: 1st dose at 12-15 months of
age, 2nd dose at 4 to 6 years old
- MGT: airborne precaution/respiratory isolation; calamine lotion and a cool
bath with added baking soda, uncooked oatmeal, or colloidal oatmeal may
help relieve some of the itching; trim fingernails short; avoid aspirin or
aspirin-containing products, use acetaminophen instead; oral acyclovir 800
mg 3x/day for 5 days; antihistamine; antipyretic; disinfect soiled linens
(boiling & under the sunlight)
Herpes Zoster - CA: Varicella zoster virus; IP: 13 to 17 days
“Shingles” or - MOT: direct contact through droplet & airborne
- DT: culture of vesicle/tissue culture technique; smear of vesicle fluid;
“Acute Posterior
microscopy
Ganglionitis”
- S/S: vesicular rash (clustered, unilateral, belt-like, stripe-like) with nerve pain;
fever; headache; chills; upset stomach; anorexia; regional lymph nodes; 5th
cranial nerve is affected (Gasserian Ganglionitits); 7th cranial nerve is
affected (Ramsay-Hunt Syndrome)
- Complication: encephalitis; paralytic ileus; ophthalmic herpes which leads to
blindness
- Prevention: handwashing, avoid exposure to infected patient; immunization
against chickenpox; increase immune resistance
- MGT: contact precaution; acyclovir; analgesics for pain; anti-inflammatory
wet compresses, calamine lotion, and colloidal oatmeal baths may help
relieve some of the itching; apply cool, wet dressings with NSS to pruritic
lesions; bed rest
Tuberculosis - Robert Koch discovered the anthrax diseasecycle (1876) and
“Phthisis” or the bacteria responsible for tuberculosis (1882) and cholera (1883)
- CA:Mycobacterium tuberculosis; M. africanum (human); M. bovis (cattle)
“Koch’s Disease” or
- IP: 2 to 10 weeks
“Consumption
- MOT:airborne droplet through inhalation & indirect contact by means of
Disease” coughing, singing or sneezing
- DT: direct sputum smear microscopy (contraindicated if there’s hemoptysis)
as confirmatory; chest X-Ray; tuberculin testing (mantaux test/PPD; tine test;
heaf test)
- S/S: afternoon rise in temperature; night sweating; body malaise & weight
loss; dry to productive cough; dyspnea & hoarseness of voice; hemoptysis
(pathognomonic); occasional chest pain; sputum positive for AFB
- Prevention: BCG; avoid overcrowding; health teaching & prompt diagnosis;
respiratory isolation; environmental sanitation
- MGT: directly observed treatment, short-course (DOTS) or Tutok Gamutan;
isoniazid (H), rifampicin (R), pyrazinamide (Z), ethambutol (E) & streptomycin
(S); airborne precaution; health education;
coughing etiquette; proper disposal of discharges; be alert for drug reactions;
stop smoking; rest; follow-up check up
Disease or
Condition
Measles - 7-day fever with desquamation
“Rubeola” or - CA:Paramyxoviridae; IP: 10 to12 days
- MOT:droplet or direct contact; articles soiled with nose & throat secretions;
“Morbilli” or
fomites
“Hard Measles”
- DT: nose & throat swab; urinalysis; blood exams (CBC, leukopenia,
leukocytosis); complement fixation or hemogglutinin test
- S/S:(pre-eruptive): fever; catarrhal symptoms (rhinitis, conjunctivitis,
photophobia, coryza); common colds to persistent cough;Koplik’s spot
(pathognomonic & enanthem sign) ; (eruptive): maculo-papular rash on face
(cephalocaudal& centripetal); on & off high-grade fever; anorexia; irritability;
abdominal pruritus, tympanism &lethargy; red & sore throat ;
(convalescence): rashes fade in the same manner as they erupted, then
desquamation begins, fever subsides
- Complication: bronchopneumonia; otitis media; pneumonia/bronchitis;
nephritis; encephalitis; blindness (seldom)
- Prevention: AMV at 9 months of age; 1st dose of MMR at 15 months old, 2nd
dose at 11 to 12 years; avoid overcrowding
- MGT: protect eyes from glare of light; sponge bath; proper disposal of nose &
throatdischarges; airborne precaution (quiet, well-ventilated, subdued light);
eye & skin care; Penicillin for complication; anti-viral; TSB; mineral oil for
pruritus
German - 3-day fever without desquamation
- CA: Rubella virus; genus – rubivirus; IP: 14 to 21 days
Measles - MOT: direct contact with nasopharyngeal secretions; air droplets;
“Rubella” transplacental; pharyngeal secretions & urine in congenital rubella (infants)
- S/S: (prodromal): low-grade fever; headache; malaise; mild coryza;
conjunctivitis; lymphadenopathy (post-auricular/sub-occipital/posterior
cervical)
(eruptive): Forchheimer’s spot on soft palate/uvula (enanthem);
maculo-papular rash on face to trunk & legs (exanthem; cephalocaudal &
centripetal); testicular pain (adults); transient polyarthralgia & polyarthritis
- Complication: encephalitis; neuritis; arthritis; arthralgias; rubella,
syndrome/teratogenic effects
(microcephaly; mental retardation; cataract; deaf-mutism; PDA)
- Prevention: MMR; pregnant avoid exposure to rubella; immune serum
globulin 1 week after exposure
- MGT: isolation; rest until fever subsides; darkened room; mild liquid diet &
increase fluid intake; eye irrigation with NSS; proper ventilation
Mumps - CA: Mumps virus, from paramyxomviridae
“Infectious Parotitis” - Source: saliva (man) ; IP: 14 to 25 days
- MOT: direct contact or contact soiled articles; secretions of the mouth and
or
nose
“Epidemic Parotitis”
- DT: complement fixation; hemoagglutination inhibition test; viral culture;
serum amylasedetermination
- S/S: painful swelling in front of ear, angle of jaws and down the neck; fever;
malaise; loss of appetite; swelling of one/both testicles in boys
- Complication: orchitis; oophoritis (female); nuchal rigidity; pancreatitis;
deafness
- Prevention: MMR; isolation; reporting of cases
- MGT: soft bland diet; proper disposal of nose and throat discharges; support
scrotumwith pillow or suspensory (orchitis); TSB or aspirin for fever &
discomfort; ice collar on parotid glands for pain; isolation; anti-viral
Disease or
Condition
Erythema - CA: Parvovirus B19
- MOT: droplet
Infectiosum - DT: blood test for IgM antibody
“5th Disease” - S/S: fever; malaise; myalgia; vomiting; diarrhea; headache; arthralgia;
“slapped-cheek rash”;
maculopapular rash on the trunk & limbs
- MGT: (self-limiting) symptom control and supportive management;
acetaminophen/NSAIDs for headache,
fever & arthralgia
Roseola - CA: Human herpes virus 6 (HHV-6)
- MOT: saliva; not highly contagious & rarely transmitted
Infantum - DT: clinically based diagnosis
“6th Disease” - S/S: fever (3 to 5 days) with raised, red rashes; malaise; conjunctivitis; after
defervescene of fever,
- nonpruritic maculopapular rash appears from trunk to neck, face &extremities
(centrifugal) ; Prevention: adequate handwashing
- MGT: (self-limiting) rest; maintenance fluid intake; antipyretic
Schistosomiasi - CA: Schistosoma japonicum (Katayama disease; oriental schistosomiasis;
schistosoma mansoni; schistosoma haematobium
s - Vector: oncomelania quadrasi (snail)
“Snail Fever” or - Source: feces of infected person; dogs, pigs carabaos, cows, monkey & wild
“Bilharziasis” rats
- IP: 2 months ; MOT: vehicle (water); indirect (skin pores)
- DT: direct stool examination; Kato Katz technique; cercum ova precipetin test
(COPT); liver & rectal biopsy; ELISA
- S/S: rash at site of inoculation; enlargement of abdomen; diarrhea; body
weakness
- Complication: liver cirrhosis & portal hypertension; cor pulmonale &
pulmonary hypertension; heart failure; ascites; hematemesis; renal failure;
cerebral schistosomiasis ; Prevention: proper disposal of feces & urine;
proper irrigation of all stagnant bodies of water; prevent exposure of
contaminated water (wear rubber boots); eradication of breeding places of
snails; use of molluscicides; footbridges; health education; have a stool
exam;
- MGT: praziquantel (Biltricide) tab for 6 months; oxamniquine for S. Mansoni
&S. haematobium; fuandin via IM or IV
Leptospirosis - CA: Leptospirosis interrogans
“Canicola” or - Source: urine & excreta of rodents/rats (main host), including pigs,
cattles,rabbits, hare & skunk; dogs ; IP: 6 to 15 days
“Weils Disease” or
- MOT: inoculation into broken skin, mucous membrane, ingestion
“Mud Fever” or
- DT: blood culture; leptospira agglutination test (LAT);BUN & creatinine; liver
“Trench Fever” or function test
“Spiroketal - S/S: (septicemic): high remittent fever 4-7 days; myalgia/myosites
Jaundice” or particularly calf pain
“Japanese Seven (immune/toxic):with or without jaundice; iritis; headache; disorientation;
Days Fever” or convulsion; oliguria; anuria; shock; coma; CHF
“Swine Herd (convalescence): relapse may occur during the 4th to 5th week
Disease” - Complication: meningitis; respiratory distress; Weil’s disease;
cardiovascular problems
- Prevention: source eradication; sanitation; vaccinate animals; information
dissemination
- MGT: symptomatic management; skin care; darken room; isolation; eradicate
rats &rodents; Penicillin or Tetracycline
Disease or
Condition
Leprosy - CA: Mycobacterium leprae ; IP: 5 months to 8 years
“Hansen’s Disease” - MOT: respiratory droplets; inoculation into skin breaks & mucous membrane
- DT: identification of signs & symptoms; tissue biopsy; blood tests show ↑RBC
or
& ESR; ↓ serum calcium, albumin & cholesterol; skin slit smear or SSS
“Hansenosis”
- S/S: (early): skin patches/lesion; anhidrosis; skin loss; nerve pain; paresis;
paralysis; nasal obstruction & bleeding; skin ulcers
(late): madorosis; lagophthalmus; loss of digits; sinking of nose bridge;
contractures; gynecomastia; elongation of ears; chronic skin ulcer
- Prevention: BCG; separate newborn from leprous mothers; health education
- MGT: RA 4073; sulfone therapy; rehabilitation; isolation; full diet; personal
hygiene; terminal disinfection; multidrug therapy (MDT) after 1 week no
longer infectious;multibacillary (cured after 12 months); paucibacillary (cured
after 6 mos)
Paucibacillary
Schedule Adult Children (10-14 years)
Day 1 rifampicin 600 mg
rifampicin 450 mg
once/month
dapsone 50 mg
dapsone 100 mg once/daily
Day 2-28 dapsone 100 mg dapsone 50 mg
Full course 6 blister packs for 6
6 blister packs for 6 months
duration months
Multibacillary
Schedule Adult Children (10-14 years)
Day 1 rifampicin 600 mg
rifampicin 600 mg
once/month
dapsone 50 mg
dapsone 100 mg once daily
clofazimine 150 mg
clofazimine 300 mg
Day 2-28 dapsone 50 mg
dapsone 100 mg
clofazimine 50 mg q
clofazimine 50 mg
other day
Full course 12 blister packs for 12 12 blister packs for 12
duration months months
Rabies - CA: Rhabdovirus

“Hydrophobia” or - IP: 20 to 90 days for humans, 1 week to 7.5 months for dogs
- MOT: bite of a rabid animal (saliva of infected animal or human)
“Lyssa”
- DT: post mortem direct fluorescent antibody staining test; presence of Negri
bodies in brain tissue in rabid animal (variable)
- S/S:(dog): change in mood; nervousness & apprehension; unusual
salivation; changes in barking; paralysis on hind legs spreading towards
entire body, death
(man): headache; fever; pain & numbness sensation at the site of bite;
depression; anxiety; confusion; insomnia; intense excitement, difficulty of
breathing; swallowing; drooling; hydrophobia; flaccid ascending paralysis, coma,
death
- MGT: isolation; darken room & observe silence; give food if hungry; keep
water out of sight; universal precaution; wash hands; remove oral & nasal
secretions; dispose contaminated materials
(post exposure): wash wound with soap & water; anti-tetanus & anti-toxin;
observe dog for 10 days; active vaccine infiltration in & around the wound for
the 1st dose (purified vero cell vaccine & purified duck embryo vaccine);
passive vaccine (IGs) equine rabies & human rabies
Disease or
Condition
Influenza - CA: RNA-containing myxoviruses types A, A-prime, B & C ; IP: 24 to 48
“La Grippe” hours
- MOT: airborne spread; direct contact with droplet
- DT: blood exam (leukopenia); oropharyngeal culture/swabs; viral serology
(e.g., completion fixation test, hemo-agglutination test, neutralization)
- S/S: chilly sensation; hyperpyrexia; malaise; sore throat; coryza; rhinorrhea;
myalgia; headache; severe aches & pain with sweating; GI symptoms &
vomiting
- Complication: hemorrhagic pneumonia; encephalitis; Reye’s syndrome
(acute encephalopathy & fatty degeneration of liver with epidemic influenza B
infection); myocarditis; SIDS; myoglobinuria; bacterial infections (e.g., otitis
media, sinusitis, pneumonia) ; Prevention: immunization; avoid crowded
places; health education
- MGT: plenty of fluids; stay at home; paracetamol, aspirin, unless
contraindicated,Ibuprofen; TSB; isolation; limit strenuous activity
Pneunomia - CA: Streptococcus pneumoniae; Staphylococcus aureus; hemophilus
influenzae; Klebsiella pneumoniae (Friedlander’s bacilli) ; IP: 1 to 3 days
- MOT: droplet via nasopharynx cavity; contact with carriers
- Types: (accdg to where & how the client was exposed):
community-acquired – acquired in the course of daily life nosocomial –
hospital setting; reflects the kind of nursing care given aspiration – gastric
contents enter the lungs after vomiting
pneumocystis carinii – impaired immune system
actinomycosis – Actinomyces israeli; associated with poor dental hygiene
(accdg to anatomy): bronchopneumonia (lobural or catarrhal pneumonia);
lobar pneumonia (croupous pneumonia); primary atypical pneumonia (viral
pneumonia)
(accdg to general classification): primary – direct result of
inhalation/aspiration of
pathogens/noxious substances
secondary – develops a complication of the disease
- DT: chest x-ray; sputum analysis, smear & culture; blood/serologic exam
- S/S: sudden onset of chills with rising fever; stabbing chest pain aggravated
by respirations& coughing; paroxysmal or choking cough; pain in the
abdomen; herpes on the lips;body malaise; rusty
sputum/prune-juice in color (pathognomonic); respiratory grunting with
tachypnea & nasal flaring; labored respiration; rapid & bounding pulse;
diaphoresis; convulsion & vomiting in children
- Prevention: prevent common colds, influenza, other URTIs, immunization;
addressing environmental factors (e.g., cold, pollution, fatigue or alcoholism)
- MGT: (antimicrobial therapy): streptococcus – macrolides 7 to 10 days;
nafcillin oroxacillin for 14 days klebsiella – aminoglycosides & cephalosporins
pneumocystis carinii – cotrimoxazole/pentamidine
*Pen G Na (DOC)
(supportive measures): oxygen therapy for hypoxia; mech vent for
respiratory failure; high-calorie, adequate fluid; absolute bedrest;
bronchodilators (aminophylline); expectorants; pain reliever pleuritic pain;
cough exercises & DBE to remove secretions; calm environment; regulate
temperature; monitor VS
Disease or
Condition
Malaria - CA: protozoa genus Plasmodium:falciparum; vivax; ovale; malariae; knowlesi
“Marsh Fever” or - DT: history of having been in a malaria-endemic area (Palawan & Mindoro);
blood smear; rapid diagnostic test
“Periodic Fever” or
- MOT: vector (female Anopheles)
“King of Tropical
- S/S: recurrent fever preceded by chills & profuse sweating (triad signs);
Disease” malaise; anemiahepatomegaly; spleenomegaly
- Prevention: mosquito control; chemical methods (insecticides); biological
methods(stream seeding); zoophylaxis (larvae-eating fish, farm animals kept
near thehouse); environmental methods (cleaning & irrigating canals);
screening of houses; educational methods; mechanical methods (fly
swats/traps); universal precaution; screening of blood donors
- MGT: (IMCI-pink): quinine
(IMCI-yellow): 1st line antibiotic: artemether-lumefantrine (days 1 to 3) &
primaquine (day 4) for falciparum; chloroquine (days 1 to 3) &primaquine
(days 4 to 17) for vivax & ovale
2nd-line anitbiotic: quinine sulfate& doxycycline or tetracycline or clindamycin
Dengue - CA: Dengue virus (DEN) 1, 2, 3, 4 that belong to genus Flavivirus, family
Flaviviridae
Hemorrhagic - Vector: female Aedes aegypti (aka yellow fever mosquito or tiger
Fever mosquito);Aedes albopictus (aka asian tiger mosquito); Aedes
“Break Bone” or polynesiensis;Aedes scutellaris
“Dandy Fever” or - DT: tourniquet test (Rumpel-Leads Test); capillary refill test or nail blanch
“Dengue Shock test; platelet count & hematocrit count; hemagglutination-inhibition test
Syndrome” - IP: 3-14 days, commonly 5-7 days
- MOT: bite of an infected Aedes mosquito
- S/S: (febrile phase): high-grade fever; facial flushing; skin erythema;
generalized body generalized body ache; myalgia; arthralgia; headache;
anorexia; nausea; vomiting; nose & gum bleeding
(critical phase): ↓temperature;↑ capillary permeability with ↑ hematocrit;↓
platelet; pleural
effusion; ascites; shock preceded by warning signs (abdominal
pain/tenderness;
persistent vomiting; mucosal bleeding; lethargy; restlessness; liver
enlargement
>2cm; ↑ HCT, ↓platelet; metabolic acidosis; DIC
- Prevention: 4 S: search & destroy breeding places; seek immediate
treatment; say no to indiscriminate fogging; self-protection
- MGT: paracetamol q 6; avoid ibuprofen, ASA (Reye’s syndrome), NSAIDs →
bleeding; TSB; ORS; avoid dark-colored foods; low-fat, low-fiber,
nonirritating &noncarbonated diet; strict bed rest; avoid IM injections; referral;
ice compress for epistaxis; ice chips for gum bleeding & soft-bristled
toothbrush; blood transfusion; dorsal recumbent for circulation during shock;
monitor lab test
Disease or
Condition
Filariasis - CA: Wuchereria bancrofti; Burgia malayi; Brugia timori (affects genitals); Loa
“Elephantiasis” or loa (transmitted by the deer fly)
- Vector: aedes poecilus, culex quinquefasciatus
“Filarioidea
- MOT: bite of mosquito
Infection”
- DT: circulating filarial antigen (CFA) – finger prick; nocturnal blood exam
taken from8pm to 4am; Knott’s technique & nucleopore filtration to increase
the chance offinding microfilariae; immunochromatographic test
- S/S: on-and-off chills; fever; myalgia; lymphangitis with gradual thickening of
the skin (limbs, scrotum resulting in elephantiasis & hydrocele)
- Prevention: eradication of vectors; insecticides; screening of houses; long
sleeves & long pants; health education; repellants; mosquito net
- MGT: albendazole; ivermectin; diethylcarbamazine citrate (Hetrazan);
surgery to drain fluid; elevate legs & elastic bandages for elephantiasis;
health education; destruction of breeding places; personal hygiene
Diphtheria - CA: Corynebacterium diphtheriae; Klebs-Leoffler bacillus
- IP: 2 to 5 days
- Source: nose, pharynx & eyes or lesions on the body parts of infected
persons
- MOT: contact with patient or soiled articles, enters bloodstream then
releasing toxins (toxemia)
- DT: swab from nose & throat or suspected lesions; virulence test; schick test;
molony test; loeffler slant
- Type & S/S:(skin/cutaneous): localized punched out ulcer
(respiratory/nasal): pseudomembranes as pathognomonic; fever; exudates;
serousanguinous nasal discharges
(tonsillar/pharyngeal): bull’s neck; cough; breathing diffuclty; sorethroat
(laryngeal): brassy metallic cough; husky voice/hoarseness until diminished
- Complication: myocarditis – caused by toxin on the heart muscles; heart
failure; paralyzeddiaphragm;
respiratory failure; liver & kidney failure; cervical adenitis; otitis media; airway
obstruction leads to death
- Prevention: isolation (min. 14 days from onset of dx until 3 negative
cultures); DPT vaccine for babies; booster doses for children under 5; avoid
food handling
- MGT: diphtheria antitoxin (DAT) to neutralize circulating toxins (made from
horse serum); perform skin test first, if (+), still administer but give
antihistamine; penicillin; erythromycin 40 mg/kg in 4
doses for 10-14 days; respiratory isolation; bed rest for 2 weeks; avoid
swabbing of
pseudomembranes – causes bleeding; soft diet; small, frequent feeding, ice
collar to the neck; fruit juice with Vit. C to maintain the alkalinity of blood &
increase resistance
Disease or
Condition
Pertussis - CA: Bordetalla pertussis
“Whooping Cough” - IP: 7 to 14 days
- Source: nose & throat secretions
- MOT: direct contact & droplet; indirect through soiled linens and articles
- DT: nasopharyngeal swabs; sputum culture; CBC (leukocytosis) & blood
culture
- S/S:(catarrhal): most contagious for 2 weeks; mucoid rhinoria; sneezing;
lacrimation; dry bronchial cough that becomes irritating, hacking & nocturnal
(paroxysmal): spasmodic & recurrent with excessive, explosive outburst in
rapid series of 5 to 10 coughs/whoops in loud, high-pitched, crowing
inspiratory & choking on mucus that causes vomiting; paroxysmal coughing
induces nosebleeding, ↑ venous pressure, periorbital edema, conjunctival
hemorrhage; distended facial & neck veins, eyes pop, tongue protrudes;
profuse sweating; involuntary urination; lethargy, exhaustion; convulsion as
result of intracranial hemorrhage
- Complications: interstitial pneumonia; atelectasis; convulsions; umbilical
hernia; otitis media; bronchopneumonia (most dangerous); severe
malnutrition
- Prevention: isolation (4 to 6 wks); active immunization
- MGT: adequate nutrition; F & E replacement; O2; isolation; suctioning
equipment at bedside; sunshine & fresh air are impt but protect from drafts;
keep still & quiet because activity & excitement cause paroxysms; warm
baths; dry bed; I & O; pertussis IG IM for one dose; erythromycin for 10-14
days;
boosters 4 to 6 yrs oldafter 3rd dose (never give beyond 7 yrs, causes
neuroparalysis)
Tetanus - CA: Tetanus bacillus (Clostridium tetani) – anaerobic, spore-forming
“Lock Jaw” - Source: soil; street dust; animal (manure) & human feces; rust; unhealed
stump of the umbilical cord; Plaster of Paris
- IP: 3 days to 3 weeks (adult); 3 days to 30 days (newborn)
- MOT: skin entry through punctured wounds
- S/S: (neonate): feeding & sucking difficulties; short, excessive & voiceless
crying; attemptto suck causes spasm & cyanosis; fever; stiff jaw; tonic/rigid
muscular contraction; exhaustion; death
(children & adult): hypertonicity; hyperactive deep tendon reflexes;
tachycardia; profuse sweating; low-grade fever; painful involuntary muscle
contractions; neck & facial muscle rigidity (trismus); grinning expression
(risus sardonicus) as pathognomonic sign; board-like abdomen/rigidity;
opisthotonos; tonic convulsions which may result in cyanosis & sudden death
due to asphyxiation; laryngospasm; fractured vertebrae during severe
spasm; death in severe cases in 10 days
- Complication: hypostatic pneumonia; hypoxia; atelectasis & pneumothorax;
traumatic glossitis & microglassia; transitory hallucinosis;
hypersalivation;diaphoresis; unusual tachycardia; cardiac standstill &
bradycardia (high mortality); laceration of tongue & buccal mucosa;
intramuscular hematoma; fracture of spine & ribs; septicemia
- Prevention: tetanus toxoid for adults & pregnant women; DPT for babies &
children
- MGT: ATS, TAT or TIG if doesn’t have any previous immunization within 72
hours; TT 0.5 cc IM; Pen G Na to control infection;muscle relaxant; employ
measures todecrease convulsions; keep client away from noise & bright
lights; O2; NGT feeding; tracheostomy; adequate fluid, electrolyte & caloric
intake; maintain adequate airway; cardiac monitoring; IV line; wound care;
avoid stimulation (e.g.,
visitors); prevent contractures & pressure sores; watch out for urinary
retention
Disease or
Condition
Meningitis - CA: Streptococcus pneumoniae & Neisseria meningitidis (septic);
“Cerebrospinal Enterovirus (aseptic)
- IP: 1 to 10 days
Fever”
- MOT: droplet through nasopharyngeal mucosa
- DT: CT scan; bacterial culture and gram-staining of CSF and blood; lumbar
puncture; smear from petechia; urine culture
- S/S & Types:(acute meningococcemia): nasopharyngitis followed by
sudden high-gradefever, chills, nausea, vomiting, malaise, malaise,
petechial, purpuric/ecchymotic hemorrhagesover the body & mucous
membranes; Waterhouse-Friderichsen syndrome (petechial, purpuric &
ecchymotic spots with shock)
(aseptic meningitis): headache; feve; LOC changes; blurring of vision;
meningeal irritation (e.g., stiff neck/nuchal rigidity; opisthotonos; +
Brudzinski’s; + Kernig’s; exaggerated & symmetrical DTR; sinus arrythmia;
irritability; photophobia; diplopia; delirium; deep stupor & coma; ↑ ICP (e.g.,
bulging fontanels, projectile vomiting)
- Prevention: meningococcal conjugated vaccine at 11-12 years of age, with
booster 16 years; rifampicin as prophylaxis
- Complication: subdural effusion; hydrocephalus; deaf-mutism; blindness of
either one or both eyes; otitis media & mastoiditis; pneumonia or bronchitis
- MGT: penicillin G in combination with one cephalosporins (e.g., ceftriaxone
sodium,cefotaxime sodium) via IV within 30 minutes of arrival;
dexamethasonevia IV (decrease risk of gastrointestinal bleeding & prevents
deafness); respiratory isolation; infection control precautions until 24 hours
after initiation ofantibiotic; pain mgt; rest in a quiet, darkened room;
hydration; safety; digitalis glycoside (Digoxin) for arrythmias; mannitol to
decrease cerebral edema; anticonvulsant/sedative; acetaminophen; neuro
VS; fluid balance; position; provide comfort; strict aseptic technique; isolation
Typhoid Fever - CA: Salmonella typhosa/typhi
- IP: 5 to 40 days; mean of 10 to 20 days
- Source: person who just recovered (carrier); ingestion of shellfish (e.g.,
oysters) fromcontaminated water; stool & vomitus of infected individual
- MOT: fecal-oral route; 5Fs:
- DT: typhidot – confirmatory test; ELISA; widal test; rectal swab
- S/S:(onset): headache, chilly sensation & aching; nausea, vomiting,
diarrhea; higher temperature in morning than in the afternoon; breathing is
accelerated; tongue furred; hot & dry skin; tender & distended abdomen;
rose spots on abdomen
(typhoid): tongue protrudes, dry & brown; dirty-brown collection of dried
mucus &bacteria in teeth & lips (sordes); coma vigil; subsultus tendinum;
carphologia; slips down to the foot part of the bed
- Complication: hemorrhage/perforation; peritonitis; bronchitis & pneumonia;
tympanites; thrombosis & embolism; early HF; typhoid spine or neuritis;
septicemia; reiter’s syndrome (joint pain, eye irritation & painful urinationthat
can lead to chronic arthritis)
- Prevention: proper disposal of excreta; proper food handling; enteric
isolation; provisionof adequate safe drinking water supply; health education
- MGT: chloramphenicol (DOC); ampicillin; cotrimoxazole;
ciprofloxacin/ceftriaxone;isolation; maintain/restore F&E at frequent intervals;
safety; disinfection
Disease or
Condition
Mononucleosis, - CA: Epstein-Barr virus
- IP: 30 to 50 days, averaging in 6 weeks
Infectious - MOT: close personal contact (kissing disease); saliva; blood & genital
“Glandular Fever” secretions
- DT: lymphocytosis; + for cephalin-cholesterol flocculation test; ↑
transaminase 4 levels(e.g., SGOT, SGPT, LDH); ↑ total IgM levels
- S/S: fatigue; anorexia; inability to concentrate; chilly sensation; headache;
fever with enlarged lymph nodes & sore throat; exudative tonsillitis often with
ulceration; severe dysphagia & gum bleeding; palatine petechiae;
retro-orbital headache; photophobia& puffy eyelids; splenomegaly,
hepatomegaly & jaundice
- Complication: pneumonia; neurologic manifestations (e.g., meningitis,
encephalitis, GBS); hematologic manifestations
- MGT: disposal of oral secretions; avoid straining or refrain any strenuous
activity; coolingmeasures for febrile; soft diet & increase fluid intake
Herpes Simplex - CA: Herpes simplex virus (HSV); type 1 & 2
- MOT:(type 1): close personal contact (e.g., kissing, sharing kitchen utensils,
towels); sores appear 2 to 20 days after contact & last from 7 to 10 days;
affects the lips,mouth, nose, chin/cheek & open wounds shortly after
exposure
(type 2): sexual contact with an infected person; touching lesions; itchy &
painful sores; fever; muscular pain; burning sensation during urination;
affects thebuttocks, penis, vagina or cervix and lasts 2 to 20 days
- S/S & Types: (mild-moderate):
oral herpes: gingivostomatitis (common in children); vesicular & ulcerative
lesions in buccal mucosa & tongue; inflammation of gums; cervical
adenopathy; fever; excessive salivation from pain on swallowing
labile herpes: cold sores/fever blisters
ocular herpes: herpetic keratitis that leads to vision loss; primary keratitis
accompanied
by conjunctivitis & preauricular lymphadenopathy
cutaneous herpes: deep burning pain, fever, skin edema, ascending lymphangitis
&
regional lymphadenopathy
erythema multiforme: zosteriform distribution of lesions that mimic herpes zoster
genital herpes: one of the most common STI
(severe-fatal):
newborns: neonatal herpetic infection from maternal infection during delivery
eczema varicelliform eruption: common in atopic dermatitis; occasionally occurs
in seborrheic dermatitis & diaper rash
encephalitis: most common non-epidemic form
- MGT: oral antiviral drugs (e.g., acyclovir, famciclovir, valacyclovir); personal
hygiene; F &E balance
restoration; isolation especially with eczema herpeticum/neonatal herpes;
universal precaution & handwashing
Chlamydia - CA: Chlamydia trachomatis
- MOT: vaginal/rectal intercourse; oro-genital contact
- DT: swab from the infection site; culture of aspirated materials; ELISA; direct
fluorescent antibody test
- S/S: mucopurulent discharges; pelvic pain; dyspareunia; tenderness of the
abdomen; urinary frequency & discharge; diarrhea; tenesmus
- MGT: doxycycline PO for 7 days; azithromycin single dose; universal
precaution; HIV testing
Disease or
Condition
Gonorrhea - CA: Neisseria gonorrheae or gonococcus
“Clap” or - IP: 3 to 21 days (average 3 to 5 days)
- MOT: direct sexual contact (orogenital, anogenital); utero transmission;
“Flores Blancas” or
fomites
“Gleet” or
- DT: culture from cervix & anal canal (inoculation of specimen on
“Tulo” Thayer-Martinmedium) in females; gram stain in males
- S/S: (in females): burning sensation & frequent urination; yellowish purulent
vaginal discharge;redness &swelling of genitals; burning & itchiness;
urethritis/cervicitis; endometritis salpingitis/pelvic peritonitis (e.g. fever, N&V,
abdominal pain/tenderness)
(in males): dysuria with purulent discharge (gleet); rectal infection; urethral
inflammation; prostatitis; urethritis; pelvic pain & fever
(accdg to site involved): urethra (dysuria; urinary frequency, incontinence,
purulent discharge, itching, red & edematous meatus); vulva (occasional
itching, burning & pain); vagina (engorgement, redness, swelling, profuse
purulent discharge); pelvis
(severe abdominal pain, muscle rigidity, tenderness, abdominal distention,
tachycardia); liver (RUQ pain)
- Complication: sterility; PID; epididymitis; arthritis; endocarditis;
conjunctivitis; meningitis; ophthalmia neonatorum
- Prevention: sex education; case finding/contact tracing
- MGT: (uncomplicated, adult): ceftriaxone 125-250 mg IM single dose;
doxycycline 100 mg BID for 7 days
(pregnant): ceftriaxone 125-250 mg IM single dose, erythromycin 500 mg
PO for 7 days
(disseminated gonococcal): 1 g ceftriaxone IM/IV q 24 hours, for allergy 2
g spectinomycin IM q 12 hours
continuation antimicrobial: 400 mg ceftriaxone PO twice daily or 500 mg
ciprofloxacin PO twice daily (ciprofloxacin iscontraindicated with children,
adolescents, pregnant & lactating women); gonococcal conjunctivitis – 1 g
ceftriaxone IM single dose, irrigation of infected eye with NSS
nursing mgt: ask for drug sensitivities; standard precaution; information
should be confidential; isolation; apply moist heat to relieve pain for
gonococcal arthritis; 1% silver nitrate or any ophthalmic prophylaxis
(Crede’s); inform sexual contacts to seek treatment
Candidiasis - CA: Candida albicans; Candida tropicalis
“Moniliasis” or - IP: variable
- DT: microscopic demonstration of pseudohype or yeast cells in infected
“Candidosis”
tissue or body fluids (vaginal discharge)
- S/S: severe vulvar pruritus; vaginal discharge; sore vulva; oropharyngeal
mucosa (thrush); flank pain; dysuria; fever; headaches; periorbital pain
- Prevention: case treatment; treatment of underlying medical
conditions/predisposing factors
- MGT: nystatin for oral thrush; clitrimazole, fluconazole, ketoconazole; avoid
sharing utensils; mouth care; proper disposal
Disease or
Condition
Syphilis - CA: Treponema pallidum
“Lues Venereal” or - Source: discharges from lesions of the skin/mucous membrane; semen;
blood; tears; urine
“Morbus Gallicus”
- IP: 10 to 90 days
- MOT: direct transmission; sexual contact; indirect contact; placental
transmission
- DT: dark field illumination; venereal disease research laboratory (VDRL) test;
fluorescent treponemal antibody absorption test
- S/S: (primary): painless chancres (genitalia, anus, nipples)
(secondary): pinkish/grayish-white lesions (condylomata); alopecia; sore
throat; weight loss; N&V; anorexia
(tertiary): gumma formation; cardiovascular & nervous system involvement
- Prevention: practice monogamy; sex education
- MGT: penicillin; tetracyline; universal precaution; symptomatic
HIV/AIDS - CA: HIV 1 & 2
- IP: varies (3-6 months) to many years (8-10)
- MOT: sexual contact; blood transfusion; contaminated syringes, needles,
nipper, blades; direct contact of open wounds/mucous membranes with
contaminated blood,body fluids, semen, vaginal discharges
- DT: EIA or ELISA; western blot (confirmatory); HIV antibody test;
- S/S: (minor): persistent cough for 1 month; generalized pruritic dermatitis;
recurrent herpes zoster; oropharyngeal candidiasis; lymphadenopathy
(major): weight loss of 10% body wt; chronic diarrhea; prolonged fever for 1
month
- Opportunistic Infection:bacterial (mycobacterium avium complex;
tuberculosis; salmonillosis)
viral (herpes; hepatitis; genital warts; cytomegalovirus; molluscum
contagiosum)
fungal (candidiasis; cryptococcal meningitis; histoplasmosis)
pneumonias (bacterial, pneumocystis carinii)
cancer (Kaposi’s sarcoma; cervical dysplasia & cancer; non-Hodgkin’s
lymphoma)
parasitic (toxoplasmosis; cryptosporidiosis)
- Prevention: screen blood donors; universal precaution; refrain from using
contaminated syringes & needles; abstain from promiscuous sexual contact;
be faithful; use condoms; health education
- MGT:4Cs: compliance; counseling/education; contact tracing; condoms
reverse transcriptase inhibitors(e.g., zidovudine); protease inhibitors
(e.g.,saquinavir)
Disease or
Condition
Hepatitis A, - CA: Hepatitis A virus
foodborne - IP: 30 days as average
- MOT: fecal-oral transmission or GIT
“Infectious
- DT: HAV or HBV complement fixation rate; liver function test; bile exam of
Hepatitis” or
stool &urine; IgM level; SGOT; SGPT; ALT
“Catarrhal - Complication: encephalopathy; GIT bleeding to stupor; hyperreflexia to loss
Jaundice” or of DTR; edema; ascites; aplastic anemia
“Short Incubation - Prevention: hand hygiene; safe food handling/preparation
Hep” - MGT: isolation; bed rest; observe for presence of blood in the stool; skin &
oral care; IVF;vitamin B
supplement; ↑ carbohydrates, ↓ fat and protein
Hepatitis E, - CA: Hepatitis E virus
foodborne - IP: 15 to 60 days
- MOT: fecal-oral & waterborne route or GIT
“Traveller’s
- DT: detection of hepatitis E antigen
Hepatitis”
- MGT: large meal in the morning because nausea tends to intensify as the
day progresses;monitor weight daily; I&O
Hepatitis B, - CA: Hepatitis B virus
bloodborne - IP: 50 to 180 days or 2 to 5 months
- MOT: direct exchange of contaminated blood; infected body fluids,
“Serum Hepatitis”
contaminated needles & syringes; sexual contact
- DT: compliment fixation test; radio-immunoassay-hemaglutinin test; liver
function test; bile exam in blood & urine; blood count; serum transaminase;
HBsAg
- Prevention: screen blood donors; hand hygiene; dispose needles, syringes
& sharp objects accordingly;
avoid sharing of toothbrush/utensils; safe sex; Hepatitis B vaccine 0.5 cc IM
ALT (made from Baker’s yeast)
Hepatitis C, - CA: Calici virus; Hepatitis C virus
bloodborne - IP: 30 to 150 days
- MOT: blood (most common entry); post-BT; GIT
- DT: diagnosis depends on serologic testing for the specific antibody one or
moremonths after the onset of acute hepatitis
Hepatitis D, - CA: Hepatitis D virus (Delta virus)
bloodborne
- MOT: transmitted by blood & blood products;this occurs only in the presence
of hepatitis B infection (co-infection)
- DT: detection of intrahepatic delta or immunoglobulin M (IgM)
Hepatitis A, E, - Stages: (Pre-Icteric): RUQ pain; highly infectious necrosis; low moderate
fever; anorexia; body malaise
B, C, & D (Icteric): jaundice; tea-colored urine; ash/light/grey stool; pruritus
(Signs/Symptoms) (Post-Icteric): ↓ s/s; body malaise
Disease or
Condition
Bacillary - CA: Shigella group: Shigella flexeri (Group B) common in the PH
Shigella boydii
Dysentery Shigella connei
“Shigellosis” or Shigella dysenteriae (most infectious & GIT)
“Bloody Flux” - IP: 7 hours to 7 days
- MOT: fecal-oral transmission; ingestion of contaminated food/water/milk
- DT: fecalysis/microscopic examination of stools; rectal swab/culture;
peripheralblood exam; blood culture; sheet of polymophonuclear
leukocytes in stainingwith methylene blue
- S/S: fever; tenesmus; N&V; headache; colicky or cramping abdominal
pain; diarrhea with bloody-mucoid stools; dehydration
- Prevention: sanitary disposal of human feces; safe washing facilities; fly
control; isolation; proper food handling
- Complication: rectal prolapse; cough; pneumonia; peripheral neuropathy
- MGT: low-residue diet; IV with electrolytes; antibiotics; disposal of excreta
Amoebic - CA: Entamoeba histolytica (protozoa)
- IP: 3 days (severe); 2 to 4 weeks
Dysentery - MOT: fecal-oral; oro-genital; oro-anal
“Amoebiasis” - DT: stool exam; blood exam
- S/S: bloody & mucoid diarrhea; flatulence; abdominal distention &
tenderness; tenesmus; proastration; enlarged liver; weight loss; fatigue;
fever; jaundice
- Prevention: health education; sanitary disposal of feces; proper food
handling; fly control (vector)
- MGT: metronidazole (avoid aloohol while taking meds); F&E replacement;
isolation; hand hygiene; skin care; force fluids; bland diet & bulk-forming
foods
Cholera - CA: Vibrio cholerae or Vibrio coma
“El Tor” - IP: few hours to 5 days
- MOT: stool & vomitus
- DT: rectal swab; darkfield or phase microscopy; stool exam
- S/S: rice-water stools or white flecks (pathognomonic); profuse watery
diarrhea (yellowish green); vomiting; poor skin turgor; washerwoman’s
hand;↓ peripheral circulation; mental deterioration (↓ Na); limb weakness (
↓ K)
- Complication: severe dehydration; metabolic acidosis; hypokalemia;
renal failure; tetany &convulsion; hypoglycemia; corneal scarring; acute
pulmonary edema
- Prevention: proper food handling & storage; sanitary disposal of human
excreta
- MGT: IVF; F&E replacement; combat infection; hand hygiene; VS & weight
monitoring
Giardiasis/Lambli - CA: Giardia lamblia
- IP: 1 to 4 weeks (average of 9 days)
asis - MOT: ingestion of mature cysts from feces of humans or animals (e.g.,
“Giardia Duodenalis” dogs, rats, horses)
or - DT: stool specimen; duodenal aspiration; biopsy
“Lamblia Duodenalis” - S/S: moderate & protracted diarrhea; cramping; abdominal bloating;
or nausea; anorexia; flatus with an odor of rotten eggs
“Lamblia Intestinal” - Prevention: health education; proper hygiene; environmental sanitation;
proper food handling; regular exam of food handlers
- MGT: avoid overcrowding; hand hygiene; symptomatic
Disease or
Condition
Taeniasis - CA: eggs of Taenia solium ingested by pig/swine develop to Cysticercus
cellulosae
eggs of Taenia saginita ingested by cow/cattle develop to Cysticercus bovis
- DT: stool/perianal swab
- S/S: nervousness; insomnia; poor appetite; abdominal pain
- Prevention: health education of thorough cooking of meat; freezing meat at
<5℃; properdisposal of human feces
Paragonimiasis - CA: Paragonimus westermani; Paragonimus siamenses
“Lung Fluke” - Reservoir: rats; cats; dogs; pigs
- MOT: GIT of fresh crabs/cray fish; GIT cercariae (infective utensils)
- DT: sputum specimen; stool exam; serologic test (extra-intestinal organs)
- S/S: same with PTB (e.g., cough, hemoptysis, fever); easy fatiguability;
generalized myalgia; chest pain; dyspnea; may co-exist with TB
- Prevention: thorough cooking of crabs; safe food preparation; sanitary
toilets
- MGT: Praziquantel (e.g., Biltricide, Distocide)
Hookworm - CA: Ancylostoma duedenale; Necator americanus
- IP: 40 to 100 days or 2 to 8 weeks
Disease - MOT: directly through skin of the foot (ground itch); ingestion of
“Ancylostomiasis” contaminated water or food
or - DT: microscopic examination of feces for the eggs; blood exam reveals
“Miner’s Disease” or eosinophilia
“Egyptian - S/S: small lesions in the intestinal mucosa; IDA (gradual blood loss);
Chlorosis” abdominal pain; diarrhea; urticaria; protruding abdomen; lethargic;
malnourished; pedal edema
- Prevention: health education on proper excreta disposal; avoid walking
barefoot; good hygiene; proper food handling
- MGT: Pyrantel embonate (Quantrel); isolation; diet high in calories, vitamins
& minerals; good hygiene
Enterobiasis - CA: Enterobius (Oxyuris) vermicularis
“Oxyuriasis” or - MOT: ingestion or inhalation of the eggs
- DT: scotch tape in swabbing the perianal region (best done in the morning
“Pinworm”
before shower)
- S/S: perianal itching
- Complication: secondary bacterial infection
- Prevention: personal hygiene; hand hygiene; properly sterilized
contaminated linens &clothing using boiling
Scabies - CA: Sarcoptes scabiei
- IP: 24 hours of the original contact from itch mite
- MOT: direct transmission from infested bed or wearing infested clothing
- DT: a drop of mineral oil over the burrow, followed by superficial scraping &
exam
- S/S: itching at night (warmth of the skin stimulates the parasite); sleep
disturbance; secondary lesions
(e.g., vesicles, excoriations, crusts); bacterial superinfection
- Prevention: good personal hygiene; avoid contact with infected persons;
proper laundry of bedding & clothing
- MGT: application of pediculicide; neosporin ointment; Kwell lotion;
antihistamines; skincare; hand hygiene; disinfection
Disease or
Condition
Poliomyelitis - CA: Legio debilitans (Entero virus); Wild virus (Polio 1, 2 & 3)
“Infantile Paralysis” - IP: 7 to 21 days
- MOT: direct contact w/ oropharyngeal secretions & feces; through flies &
or
contaminated water, food, utensils & other articles
“Heine-Medin
- DT: throat swab; stool culture; culture of CSF
Disease” - S/S & Types: (abortive): headache; sore throat; fever; low lumbar pain;
vomiting
(non-paralytic): muscles spasms; changes in deep & superficial reflexes;
positive Pandy’s test; pain in the neck, back, arms, legs, abdomen
(paralytic): positive Hoyne’s sign; paralysis; less tendon reflexes; positive
Kernig &
Brudzinski; muscle weakness
- Complication: respiratory failure; circulatory collapse; electrolyte imbalance;
bacterial infection; urinary problem r/t bladder paralysis; abdominal distention
- Prevention: OPV or IPV; proper disposal of GIT secretions; isolation;
standard precaution; proper food handling & storage
- MGT: monitor signs of paralysis & neurologic damage; skin care; hot packs
to relieve pain; hand hygiene; dispose excreta & vomitus properly
Zika Virus - 1st discovered in monkeys in the Zika Forest of Uganda on 1940s; cause
human disease in1950s
- CA: Aedes genus mosquito; Flavivirus
- IP: few days
- MOT: bite of infected mosquitos from Aedes genus; sexual transmission
- S/S: microcephaly (pregnancy); mild fever; rash; headache; conjunctivitis;
joint & musclepain
- Prevention: avoid travel to endemic areas (pregnancy); safer sex method;
contraceptive option
Ebola - 1st human outbreak occurred in 1976 at Ebola river; in 2014, virus broke
“Ebola Hemorrhagic through the West African countries (e.g., Liberia, Guinea, Sierra Leone)
- CA: Ebola virus (host: fruit bats, monkeys, chimpanzee, gorilla, porcupine)
Fever”
- IP: 2 to 21 days
- MOT: direct contact with blood or body fluids (e.g., urine, vomit, saliva,
sweat, semen, breast milk) yet not airborne
- DT: blood test
- S/S: high-grade fever; severe body weakness; bleeding/hemorrhage (poor
prognosis); fatigue; abdominal pain; vomiting; dehydration; confusion,
agitation; delirium; muscle aches
- MGT: IVF therapy; no treatment & immunization; may resume sexual activity
after 2 negative results from semen; isolation; PPE
Bird Flu - CA: human H5N1 Influenza A; H 5N9
“Avian Flu” - IP: 2 to 4 days
- MOT: direct contact (chicken, birds, etc.); respiratory/inhalation of fecal dust;
bird to man (flu-like symptoms)
- S/S: fever; sore throat; cough; pneumonia (severe cases)
- MGT: antiviral: Tamiflu (Oseltamivir) & Zanamivir (Relenza); yearly
vaccine/seasonal; limit poultry handling; proper cooking & food handling
Disease or
Condition
H1N1 Influenza A - CA: H1N1 Influenza A virus
“Novel H1N1” or - IP: 1 to 7 days
- MOT: droplet contact (e.g., birds, chicken, pigs, human)
“Swine Flu”
- MGT: wear N95 mask (PPE & dispose after); antiviral (e.g., Tamiflu,
Zanamivir);
Influenza vaccine (↓ 6 mos. – give 0.25 cc IM; ↑6 mos. – give 0.5 cc IM)
given during outbreaks
SARS - 1st reported in China in November 2002
“Severe Acute - CA: SARS coronavirus (SARS-CoV) – crown-like in form
- IP: 2 to 10 days or up to 13 days; 2 to 3 days outside the body
Respiratory
- MOT: respiratory droplet or airborne
Syndrome”
- S/S: (prodromal): sudden onset of high-grade fever; headache; body
malaise
(respiratory phase): pneumonia; respiratory failure; dry cough
- Prevention: early treatment; build good body immunity; personal hygiene;
wear mask in public; hand hygiene
- MGT: antiviral with antibiotic; bronchodilator with steroids; Ig when exposed
MERS - 1st reported in Saudi Arabia 2012
“MERS-CoV” or - CA: Corona virus different from Corona virus of SARS → BETA CORONA
VIRUS
“Middle East - Host: Camel
Respiratory - MOT: direct contact/indirect contact with infected dromedary camel
Syndrome” - IP: 2 to 21 days
- S/S: same with SARS; diarrhea; cough; shortness of breath
- Prevention: wear PPE; hand hygiene; avoid contact with infected animals;
proper food handling
- MGT: same with SARS
3 Levels of Public Health Prevention
Level Definition Activity

Primary - emphasize the components and - assessing community to determine
principles of preparedness in potential disaster hazards
both the non disaster stage - developing disaster plans at local, state &
(before disaster occurs) and in federal levels
the pre-disaster stage (disaster - conducting drills to test the plan
is pending) - training volunteers and health care
- aimed at preventing the providers
occurrence of a disaster or limit - providing educational programs of all
in consequences when the kinds
event itself cannot be prevented - educating about awareness and
implementation of disaster kits and family
emergency plans
Secondary - disaster has occurred; nurse - search & rescue
emphasize the components and - triage of victims
principles of response on - assessment of destruction & devastation
preventing further injury or of the area involved
destruction
Tertiary - focuses on recovery after the - preventing the recurrence
disaster has occurred to restore - minimizing effects of future disasters
the community to its previous
level of functioning and its
residents to their maximum
functioning
Disaster Management
Stage Definition Activity
Prevention - the first stage in disaster - identify potential disaster risks
management occurs - create risk maps (e.g., geohazard
before a disaster is maps are used in identifying areas
imminent and is known as prone to natural dangers like
the non disaster landslides, flooding & ground
sinking
Preparedness & - elements: authority; - training in first aid
communication; control;
Planning
logistical coordination of - assembling a disaster emergency
personnel, supplies and kit
equipment, evacuation, - establishing a predetermined
rescue, and care of the meeting place away from home
dead - making a family communication
plan
Response - begins immediately after - remain calm and exert patience
the disaster incident - follow advice of local government
occurs officials
- community preparedness - listen to radio/television for
plans that have been instructions
developed are initiated - evacuation
- staging
- disaster triage
Recovery - begins when the danger - cleanup of damage
from the disaster has - repair homes
passed; local and national - businesses begin
agencies are present to - research
help victims rebuild their
lives and help community
restore public services
Triage
- a system of sorting patients according to medical need when resources are unavailable for
all persons to be treated
- remember ABCs when triaging
- disaster triage – START( Simple Triage and Rapid Treatment); nondisaster –ESU
(Emergency Severity Index)
START System of Triage
Group Definition
Deceased - injured persons who are beyond the scope of medical assistance
- persons are tagged “deceased” only if they are not breathing and attempts to
(Black) resuscitate have been unsuccessful
Immediate - injured persons who can be assisted or their health aided by advanced
medical care immediately or within 1 hour of onset
(Red)
Delayed - medically stable but require medical assistance
(Yellow)
Minor (Green) -will not need medical care for at least several hours and can usually walk
with assistance (usually consisting of bandages and first aid)
Priority Management in Patients With Multiple Injuries
- Establish airway and ventilation
- Control hemorrhage
- Prevent and treat hypovolemic shock
- Assess for head and neck injuries
- Evaluate for other injuries (e.g., expose and reassess head & neck, chest; assess
abdomen, back and extremities)
- Splint fractures and then reassess pulses and neurovascular status
- Perform a more thorough and ongoing examination and assessment; diagnostic studies
(Adapted from American College of Surgeons. 2013)
Healthcare Waste Management

Color-Coding Waste
Black or Colorless - nonhazardous and nonbiodegrable wastes;
dry
Green - nonhazardous biodegradable wastes; wet
Yellow with Biohazard - pathological/anatomical wastes
Symbol
Yellow with Black Hand - pharmaceutical, cytotoxic, or chemical
wastes (labeled separately)
Yellow Bag that can be - infectious wastes
Autoclaved
Orange with Radioactive - radioactive wastes
Symbol
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Study Guide 2021

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Laws Affecting the Nursing Practice

Board of Nursing Resolutions

RA 11223 – Universal Healthcare Act

RA 11230 – Tulong-Trabaho Act

Laws Affecting Noncommunicable Disease

Laws Affecting Communicable Disease

Environmental Health & Disaster Management

Impact of Legislation on Occupational Health

Theorist Theory & Description

Theorist Theory & Description

Determine the AMOUNT OF SOLUTION Volume: 300 mL of PNSS

total volume to be infused 300 mL

Selected Intravenous Solutions

Overview of the Nursing Process

Phase Purpose Critical Thinking Activities

Commonly Used Abbreviations in Maternal & Child Nursing

(Maternal & Child Health Nursing by Pillitteri, 8th Ed.)

(Maternal and Child Nursing by Pillitteri, 8th Ed.)

BASIC DIVISIONS OF CHILDHOOD

FREUD’S PSYCHOANALYTIC THEORY

ERIKSON’S PSYCHOSOCIAL DEVELOPMENT

PIAGET’S THEORY OF COGNITIVE DEVELOPMENT

KOHLBERG’S STAGES OF MORAL DEVELOPMENT

4-7 2 Individualism. Instrumental purpose Child is unable to recognize that like

GROWTH AND DEVELOPMENTAL MILESTONES

Month Motor Development Fine Motor Socialization Times Play

(MCN by Pillitteri 8th Ed.)

Goal 2: Improve Effective Communication

Goal 3: Use Medicines Safely

Goal 4: Use Alarms Safely

Goal 5: Prevent Infection

Goal 6: Identify Patient Safety Risks

3 Major Elements of Informed Consent:

Nurse’s Signature Confirms 3 Things (Informed Consent):

Responsibilities of the Nurse in Delegation:

5 Rights of Delegation by NCSBN (2005):

10 Rights of Medication Administration:

Evaluating the Quality of Nursing Care

Fishbone Diagram or Ishikawa Diagram or Cause & Effect Diagram

drugorder was not sent to the pharmacy

away from floor for tests

nurse busy with an emergency

Figure 2.CQI Cause and Effect Diagram: Delayed Medication

Commonly Used Inferential Statistics

Inferential Statistics Description

Steps in the Research Process:

Protecting the Rights of the Study Participant:

Theoretical Foundations of Community Health Nursing Practice

Expanded Program on Immunization, Philippines

Tetanus Toxoid (TT) Immunization Schedule

10 Medicinal Plants Endorsed by DOH

Medicinal Plant Use/Indication Preparation

Liver Function Tests

Protein Approximately 15% of total calories

Cholesterol <200 mg/d

Definition & Patient Example

Cycle of Abuse & Violence

FOUR TONES OF PERSONAL SPACES:

1. Intimate distance (6 – 8 inches) – allows interpersonal sensory stimulations

(Psychiatric – Mental Health Nursing 7th Ed by Sheila Videbeck)

POSITIVE OR HARD SYMPTOMS NEGATIVE OR SOFT SYMPTOMS

(Psychiatric – Mental Health Nursing 7th Ed by Sheila Videbeck)

SIDE EFFECTS OF ANTIPSYCHOTIC MEDICATIONS