OSCE REVIEW - BSN II

Oxygen administration
NGT insertion/care/gavage/lavage
Essential Intrapartum and Newborn Care (EINC)
Nebulization therapy
Skin preparation for CS, Post OP Wound Care
Drug Administration
IMCI - assessment, color coded triage system
Drug Computation and IVF computation (no of
drops per minute/hr required)
Measuring intake and output
Specimen collections (urine,feces,blood,CSF)

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OSCE REVIEW - BSN II  Benefits of IMCI
▪ Addresses major child health problems
THE IMCI STRATEGY ▪ Responds to demand
▪ Promotes preventive as well as curative care
 Integrated Management of Childhood Illness ▪ Cost-effective
▪ An integrated approach to child health that focuses ▪ Promotes cost saving
on the well-being of the whole child. ▪ Improves equity
▪ Aims to reduce death, illness & disability, and to
promote growth and development among under  The IMCI Case Management Process
under 5 children. 1. Assess
▪ It combines improved management of childhood 2.Classify
illness with aspects of Nutrition, VAC 3.Identify Treatment
supplementation, deworming, immunization, and 4.Treat
other factors influencing child and maternal health. 5.Counsel the Mother
6.Follow-Up
▪ A strategy for reducing mortality and morbidity
associated with major causes of childhood illness. COLOR CODED TRIAGE SYSTEM:
▪ A joint WHO/UNICEF initiative since 1992  PINK
▪ Currently focused on first level health facilities give pre-referral treatment
▪ Comes as a generic guidelines for management which
have been adapted to each country - advice the parents
- refer the child URGENTLY
 Diseases comprising 70% of deaths among under 5
children
▪ Pneumonia
▪ Diarrhea
▪ Dengue hemorrhagic fever
▪ Malaria
▪ Measles
▪ Malnutrition

 Objectives of IMCI
▪ To reduce significantly global mortality and
SI
morbidity associated with the major causes of
disease in children.
▪ To contribute to healthy growth and development of
children.
▪ Assess for “General Danger Signs”
▪ Routinely assess for major symptoms.
▪ Use limited number of carefully selected clinical
signs.
▪ Address most, if not all of the major reasons a child
is brought to the clinic.
▪ Use a limited number of essential drugs and
encourage participation of caretakers in the
treatment.
▪ Counseling of caretakers.
 GREEN
SIMPLE ADVICE ON HOME MANAGEMENT
- teach the mother or caregiver how to give oral
drugs and treat local infections at home
- counseling the mother or other caregiver about
food (feeding problems), fluids, when to return to the
health facility, and her own health
 Age groups
▪ Sick Child Aged 2 months up to 5 years
▪ Young Infants Aged Up to 2 months
 The IMCI Case Management Process
ASSESS AND CLASSIFY

Components of IMCI  Check for GENERAL DANGER SIGNS

▪ Improving case management skills of health
workers.
o Standard guidelines
o Training (pre-service and in-service)
o Follow-up after training
▪ Improving the health system to deliver IMCI:
o Essential drug supply and management
o Organization of work in health facilities
o Management and supervision
▪ Improving family and community practices
▪ not able to drink or breastfeed
▪ vomits everything
▪ convulsions
▪ abnormally sleepy or difficult to awaken
 Not able to drink or breastfeed
▪ Not able to suck or swallow when offered a drink or
breast milk because he/she is too weak or cannot
swallow
▪ Ask: Is the child able to take fluid into his/her
mouth and swallow it?

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OSCE REVIEW - BSN II Chest Indrawing – the lower chest wall goes IN as the
child breaths IN
IMCI Stridor – a harsh noise as the child breaths IN
Wheeze – soft musical noise made when the child
 Check for GENERAL DANGER SIGNS breaths OUT

 Vomits everything Classify the illness

▪ Not able to hold anything down Urgent pre-referral treatment and referral
▪ What goes down comes back up Specific medical treatment and advice
▪ Check: offer the child fluid – water or expressed Simple advice on home management
breast milk
Classify cough or difficult breathing
 Convulsion Any general danger sign Severe pneumonia
▪ Arms and legs stiffen because the muscles are Chest indrawing or Very Severe
contracting Stridor in calm child Disease
▪ The child may lose consciousness or not able to Fast breathing Pneumonia
respond to spoken directions or handling, even if the (If wheezing go directly to
eyes are open treat wheezing)
▪ May be due to fever or associated with meningitis, No signs of pneumonia or No Pneumonia:
cerebral malaria or other life threatening very severe disease Cough or Cold
conditions (If wheezing go directly to
treat wheezing)
 Abnormally sleepy or difficult to awaken
▪ Drowsy and does not take notice of his/her Assess diarrhea
surroundings ▪ For how long?
▪ Does not respond normally to sounds or movement ▪ Is there blood in the stool?
▪ Stares blankly and appear not to notice what is ▪ Look at the child’s gen. condition.
going on ▪ Look for sunken eyes.
▪ Cannot be wakened. Does not respond when touched, ▪ Offer the child fluid – drinking
shaken, or spoken to normally/poorly/eagerly? Not able to drink?
▪ Pinch the skin of the abdomen.
 Assess & Classify THE 4 MAIN SYMPTOMS o Look for sunken eyes
▪ Cough or difficult breathing o Skin Pinch that goes back Very Slowly
▪ Diarrhea
▪ Fever Classify diarrhea for dehydration
▪ Ear problem Two of the following signs: Severe
Abnormally sleepy or Dehydration
 Assess and classify cough or difficult breathing difficult to awaken
▪ How long? Sunken eyes
▪ Count the breaths in one minute. Decide if fast Not able to drink or
breathing is present drinking poorly
▪ Look for chest indrawing Skin pinch goes back very
▪ Look and listen for stridor slowly
▪ Look and listen for wheeze Two of the following signs: Some Dehydration
o If wheezing and either fast breathing or chest Restless, irritable
indrawing: Sunken eyes
- Give a trial rapid acting inhaled Drinks eagerly, thirsty
bronchodilator for up to three times 15-20 Skin pinch goes back slowly
minutes apart. Count the breaths and look Not enough signs to classify No Dehydration
for chest indrawing again, then classify. as some or severe
- 0.5 ml salbutamol diluted in 2.0 ml of dehydration
sterile water per dose nebulization should
be used.
If diarrhea is 14 days or more
▪ Assess and Classify Cough or Difficult breathing
Dehydration present. Severe persistent
If child is: Fast Breathing is:
diarrhea
2 months up to 12 50 breaths per minute or
No Dehydration. Persistent Diarrhea
months more
12 months up to 5 40 breaths per minute or
If there is blood in stool
years more
Blood in the stool Dysentery

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OSCE REVIEW - BSN II ▪ Cold and clammy extremities
▪ Capillary refill more than 3 seconds
IMCI ▪ Persistent abdominal pain
▪ Persistent vomiting
Assess Fever ▪ Tourniquet test positive
▪ Decide malaria risk
▪ If malaria risk, obtain a blood smear Assess DHF
▪ For how long? ▪ Skin petechiae – dark red spots or patches in the
▪ If more than 7 days, has fever been present every skin. When skin is streached, they do not disappear
day? ▪ Persistent abdominal pain – continuous, without
▪ Has the child had measles within the last 3 months relief
▪ Look or feel for stiff neck. ▪ Persistent vomiting – not associated with food
▪ Look for runny nose. intake
▪ Look for signs of measles. ▪ Positive tourniquet test – 20 or more petechiae in
▪ If child has measles now or within the last 3 one square inch
months:
o Look for mouth ulcers Assess/Classify Dengue Hemorrhagic Fever
o Look for pus draining from the eyes. ▪ Any one sign present: Severe Dengue Hemorrhagic
o Look for clouding of the cornea Fever
▪ No sign present - Fever: Dengue Hemorrhagic Fever
Generalized Rash of Measles Unlikely

Measles Complications: Assess Ear Problem

▪ Mouth Ulcer ▪ Is there ear pain?
▪ Pus Draining from Eye ▪ Is there ear discharge? For how long?
▪ Clouding of the Cornea ▪ Look for pus draining from the ear.
Classify fever (Malaria Risk) ▪ Feel for tender swelling behind the ear.
Any general danger sign Very Severe
Stiff neck Febrile Classify ear problem
Disease/Malaria Tender swelling behind the Mastoiditis
Blood smear (+) Malaria ear
If no blood smear: no runny Ear Pain Acute Ear
nose and no measles and no Pus is seen draining from Infection
other causes of fever the ear and discharge is
Blood smear (-) or runny Fever: Malaria reported for less than 14
nose or measles or other Unlikely days
causes of fever Pus is seen draining from Chronic Ear
the ear and discharge is Infaction
Classify fever (No Malaria Risk) reported for 14 days or
Any general danger sign Very Severe more
Stiff neck Febrile Disease No ear pain No Ear Infection
No signs of very severe Fever: No Malaria No pus seen draining from
febrile disease the ear

Classify Measles Check for malnutrition and anemia

Clouding of the cornea
Deep or extensive mouth
ulcers
Any general danger sign
Pus draining from the eye,
or Mouth ulcers
Measles now or within the
last 3 months
Assess/Classify Dengue Hemorrhagic Fever
▪ Bleeding from nose or gums
▪ Bleeding in stools/vomitus
▪ Black stools/vomitus
▪ Skin petechiae
Severe For all Children:
Complicated ▪ Determine weight for age.
Measles ▪ Look for edema of both feet.
▪ Look for visible severe wasting.
Measles with Eye For children aged 6 months or more, determine if MUAC
or Mouth is less than 115 mm
Complications
Measles Signs of Severe Malnutrition
▪ Edema of Both Feet
▪ Visible Severe Wasting

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OSCE REVIEW - BSN II Duration of antibiotic treatment from 5 days to 3 days
Frequency of administration of antibiotics from 3x to
IMCI 2x a day

Classify Nutritional Status: Management for non-severe pneumonia therefore:

If age up to 6 months SEVERE First line - Oral amoxicillin to be given in 25mg/kg dose
- and visible severe MALNUTRITIO twice daily in children 2-59 months of age for 3 days
wasting N Second line - Oral Cotrimoxazole to be given 2x daily
- and edema of both feet for 3 days

If age 6 months and above Technical basis:

and: ▪ 3 days treatment is equally effective as the 5 day
- MUAC less than 115mm treatment
or edema of both feet ▪ Reduces cost of treatment
or visible severe ▪ Improves compliance
wasting ▪ Reduces antimicrobial resistance in the community
Very low weight for age VERY ▪ Use of oral Amoxicillin vs injectable penicillin in
LOWWEIGHT children with severe pneumonia
Not very low weight for age NOT VERY LOW o Where referral is difficult and injection is not
and no other signs of WEIGHT available, oral Amoxicillin in 45 mg/kg/dose 2x
malnutrition daily should be given to children with severe
pneumonia for 5 days
Check for Anemia Technical basis: Clinical outcome with
LOOK AND FEEL: oral amoxicillin was comparable to injectable
▪ Look for palmar pallor. Is it penicillin in hospitalized children with severe
▪ Severe palmar pallor? pneumonia
▪ Some palmar pallor ▪ Gentamicin plus ampicillin vs chloramphenicol for
very severe pneumonia
Check for Signs of Anemia o Injectable ampicillin plus injectable gentamicin
▪ No palmar pallor is a better choice than injectable
▪ Some palmar pallor o chloramphenicol for very severe pneumonia in
▪ Severe palmar pallor children 2-59 months of age.
o A pre-referral dose of 7.5mg/kg intramuscular
Classify for Anemia: injection gentamicin and 50 mg/kg injection
Severe palmar pallor SEVERE ANEMIA ampicillin can be used
Some palmar pallor ANEMIA ▪ Use of oral Amoxicillin vs injectable penicillin in
No palmar pallor NO ANEMIA children with severe pneumonia
o Where referral is difficult and injection is not
Check for: available, oral Amoxicillin in 45 mg/kg/dose 2x
▪ Immunization Status daily should be given to children with severe
▪ Vitamin A Supplementation Status pneumonia for 5 days
▪ Deworming Status Technical basis: Clinical outcome with
▪ Assess for Other Problems oral amoxicillin was comparable to injectable
penicillin in hospitalized children with severe
Identify Treatment pneumonia
▪ Determine if urgent referral is needed.
▪ Identify treatment for patient who do not need Give Extra Fluid for Diarrhea and Continue Feeding
urgent referral. Treatment Plan A for No Dehydration
▪ For patients who need urgent referral, identify 1. Give Extra Fluid:
urgent pre-referral treatment. a. Up to 2 yrs. : 50-100 ml after each loose stool
▪ Give pre-referral treatment. b.2 yrs. Or more: 100-200 ml after each loose
▪ Refer the child with a referral note. stool
2.Give Zinc Supplements (for 10-14 days):
Acute respiratory infection a. < 6 mos. : 10 mg/day
First-line/second line antibiotic for non-severe b.6 mos. – 5 yrs: 20 mg/day
pneumonia 3.Continue feeding
4.When to Return
PREVIOUS UPDATED
First line Cotrimaxazole Amoxicillin
Second Amoxicillin Cotrimaxazole
line

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OSCE REVIEW - BSN II ▪ Continue breastfeeding whenever the child wants
▪ After 4 hours: Reassess, classify, select
IMCI appropriate treatment plan; begin feeding the child
in the clinic.
Diarrheal diseases
Use or oral osmolarity oral rehydration salt Treatment Plan C for Severe Dehydration
Technical basis: ▪ Can you give IV fluid? If yes, give IV fluid
▪ Efficacy of ORS solution for tx of acute immediately.
non-cholera in children is improved by reducing ▪ If No: Is IV treatment available nearby (within 30
its sodium concentration to 75 mEq/l, its minutes)? If yes, refer immediately to hospital for
glucose concentration to 75 mmol/l, and its total IV treatment.
osmolarity to 245mOsm/l. ▪ If No: Are you trained to use NG tube for
▪ The need for unscheduled supplemental IV is rehydration? If yes, start rehydration by NG
reduced by 33%, stool output is reduced by ▪ If No: Can the child drink? If yes, give ORS by
about 20% and the incidence of vomiting by mouth
about 30%. ▪ If No, refer URGENTLY to hospital for IV or NG
treatment.
Composition
mmol/liter Diarrheal Diseases
New Old Use of antibiotics in the management of bloody diarrhea
Sodium 75 90 (shigella dysentery)
Chloride 65 80 ▪ Ciprofloxacin is the most appropriate drug in place
Glucose, 75 111 of nalidixic acid which leads to rapid development of
anhydrous resistance
Potassium 20 20 ▪ Dose: 15 mg/kg body weight 2x a day for 3 days
Citrate 10 10 ▪ Treat the Child: Oral Antibiotics/Antimalarial
Total 245 311
Osmolarity For Cholera:
▪ First Line: Tetracycline
▪ Second Line: Erythromycin
Benefits of Zinc Supplementation
▪ Reduces the severity of diarrhea
Oral Antimalarial:
▪ Shortens the duration of diarrhea
▪ First Line: Artemether-Lumefantrine
▪ Lowers the number of diarrhea episodes – protects
▪ Second Line: Chloroquine, Primaquine, Sulfadoxine
the child from diarrhea for the next 2 – 3 months.
and Pyrimethamine
Treatment Plan B for Some Dehydration
Fever
Give recommended amount of Reformulated ORS:
Treatment of drug-resistant malaria
AGE Up to 4 months 12 2
▪ In case of parasitological or clinical failure to a
4 up to 12 months years
given drug, refer patient to the next level with
month months up to 2 up to 5
proper documentation (blood smear result incl.
s years years
parasite count on day7, 14, 21, & 28
WEIG Less 6 6 to less 10 to 12 to
o Quinine sulfate(300 or 600 mg/tab)
HT kg than 10 kg less less
o 10 mg/kg/dose every 8 hours for 7 days +
than 12 than
Clindamycin 10 mg/kg 2x a day for 3 days
kg 20 kg
Pre-referral treatment:
Amoun 200-4 450-800 800-96 960-16
▪ Artesunate suppository for uncomplicated P.
t of 50 0 00
falciparum malaria in infants or young children who
fluid
cannot swallow.
(ml)
over 4
EAR INFECTIONS
hours
Chronic ear infection
▪ Chronic ear infection should be treated with otical
▪ The approximate amount of ORS required can also
quinolone ear drops for at least 2 weeks in addition
be calculated by multiplying child’s weight by 75
to dry ear by wicking
▪ If the child wants more ORS, give more
▪ For infants below 6 months who are not breastfed,
also give 100-200 ml clean water during this period.
▪ Give frequent small sips from a cup.
▪ If child vomits, wait 10 minutes then continue –
more slowly

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OSCE REVIEW - BSN II Routinely Check for Deworming Status
Give Mebendazole/Albendazole
IMCI - Give 500 mg. Mebndazole/400mg Albendazole as a
single dose in the health center if the child is 12
Acute ear infection months up to 59 months and has not received a dose
▪ Oral amoxicillin is a better choice for the in the previous 6 months
management of suppurative otitis media in countries
where antimicrobial resistance to cotrimoxazole is Mebendazole/Albendazole Dose:
high AGE OR Albendaz Mebendaz
▪ Dry the Ear by Wicking and Instill Quinolone WEIGHT ole 400 ole 500 mg
Eardrops mg tab. tab.
▪ Dry the ear using wick of clean absorbent cloth or 12 months up to ½ tablet 1 tablet
soft, strong tissue paper. 23 months
▪ Instill quinolone eardrops after wicking 3 times 24 months up to 1 tablet 1 tablet
daily for 2 weeks 59 months
▪ Quinolone eardrops may include: ciprofloxacin,
norfloxacin, or ofloxacin Vitamin A Treatment/Supplementation
▪ Follow the “Rule of Three” : 3 drops, tilt head for 3 AGE Vitamin A Capsules
minutes, instill 3 times a day 100,000 200,000
IU IU
Other Treatments 6 months up to 12 1 capsule ½ capsule
▪ Vitamin A for sick children months
▪ Iron for anemia 12 months up to 5 1 capsule
▪ Paracetamol for high fever (38.5 C or more) and for yrs
ear pain.
▪ Mebendazole/Albendazole for deworming. ▪ Counsel the Mother on Infant Feeding
▪ Multivitamins and minerals for Persistent Diarrhea 1. Exclusive breastfeeding up to 6 mos.
(with at least 2 of Recommended Energy and ▪ Breastfeed as often as the child wants, day and
Nutrient Intake: folate, Vitamin A, zinc, magnesium, night at least 8 times in 24 hours
copper) ▪ Breastfeed when the child shows signs of hunger,
▪ Tetracycline Eye Ointment for eye infection (TID) beginning to fuss, sucking fingers, or moving the lips
▪ Quinolone Eardrops & Ear Wicking for ear discharge ▪ Do not give other foods or fluids
(TID).
▪ Half-strength Gentian Violet for mouth ulcers 2.Complementary feeding 6 mos. up to 23 mos.
( BID). ▪ Breastfeed as often as the child wants
▪ Cough Remedies: breastmilk ▪ Give adequate serving of complementary foods: 3
▪ tamarind, calamansi, ginger (SKL) times per day if breastfed, with 1-2 nutritious
▪ Given at Health Center Only: snacks as desired from 9-23 mos.
o IM Antibiotic for children being referred who ▪ Give foods 5 times per day if not breastfed with 1
cannot take oral antibiotic : or 2 cups of milk
- Give Gentamicin (7.5 mg/kg) AND Ampicillin 50 ▪ Give small chewable items to eat with fingers. Let
mg/kg the child try to feed itself, but provide help

Treat to Prevent Low Blood Sugar 3.Management of severe malnutrition where referral is
▪ Breastfeed more frequently not possible
▪ Give sugar 30-50 ml of milk or sugar water before ▪ Where a child is classified as having severe
departure (for referral) malnutrition and referral is not possible, the IMCI
▪ To make sugar water: Dissolve 4 level teaspoon (20 guidelines should be adapted to include management
grams) of sugar in 200 ml cup of clean water at first-level facilities
▪ If unconscious, give D10 5ml/kg over a few minutes ▪ modified milk diet is given
or give D50 1ml/kg by slow push.
Revised Immunization Schedule
Age Vaccine
Birth BCG, HepB1
6 weeks DPT1, OPV1, HepB2
10 weeks DPT2, OPV2
14 weeks DPT3, OPV3, HepB3
9 months Anti – measles
12 – 15 MMR
months

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OSCE REVIEW - BSN II Signs to look for in assessment:
Previous: 12 signs
IMCI Updated: 7 signs
Classify: Aged Up to 2 months (Updated)
4.HIV and Infant Feeding ▪ Not feeding well, or
▪ In areas where HIV is a public health problem all ▪ Convulsions, or
women should be encouraged to receive HIV testing ▪ Fast breathing (60 bpm or more), or
and counseling ▪ Severe chest indrawing, or
▪ If a mother is HIV-infected and replacement ▪ Fever (37.5 C or above), or
feeding is acceptable, feasible, affordable, ▪ Low body temp. (less than 35.5 C), or
sustainable and safe for her and her infant, ▪ Movement only when stimulated or no movement at
avoidance of all breastfeeding is recommended. all
Otherwise, exclusive breastfeeding is
recommended during the first months of life Classify, Identify Treatment
▪ The child of HIV-infected mother who is not Red Local • Give an appropriate
breastfed should receive complementary foods umbilic Bacteri oral antibiotic.
▪ Care for Development – communication and play us al • Teach the mother to
▪ Increase fluids during illness Skin Infecti treat local infections
▪ When to Return: pustule on at home.
o for follow-up s • Advise mother how
o immediately to give home care for
o for immunization the young infant.
• Follow-up in 2 days.
When to Return Immediately
Any sick child Not able to drink or Checking for jaundice is added in the protocol
breastfeed
Becomes sicker Classification: Severe jaundice (pink), Jaundice (yellow),
Develops fever No jaundice (green)
No Pneumonia: Cough Fast breathing ▪ Any jaundice if age SEVERE
or cold Difficult breathing less than 24 hrs, or JAUNDICE
Diarrhea Blood in stool ▪ Yellow palms and
Drinking poorly soles at any age
Fever: DHF Unlikely Any sign of bleeding ▪ Jaundice appearing JAUNDICE
Persistent abdominal after 24 hrs of age,
pain and
Persistent vomiting ▪ Palms and soles not
Skin petechiae/ Skin yellow
rash ▪ No Jaundice NO
JAUNDICE
Give Follow-Up Care: Persistent Diarrhea
▪ After 5 days: Assess and Classify diarrhea
▪ Ask: Has the diarrhea stopped? ▪ For dehydration ( severe, some or no dehydration)
▪ How many loose stools is the child having per day? ▪ If diarrhea is 14 days or more: Severe Persistent
Diarrhea
Treatment ▪ If blood in stool: Dysentery
▪ If diarrhea has not stopped (3 or more/day), do a
full reassessment. Give any treatment needed. Check for feeding Problem or Low Weight
Refer to hospital. Not well attached to Feeding
▪ If diarrhea has stopped, tell the mother to follow breast Problem or Low
the feeding recommendation for child’s age. Not suckling Weight
effectively
Assess: Age up to 2 months Less than 8 feeds in 24
Previous Updated hrs.
Age: 1 week up to 2 Birth up to 2 Receives other foods or
months months drinks
Low weight for age
Main symptom: Thrush
Previous: Possible serious bacterial infection Not low weight for age No feeding
Updated: Very severe disease and local bacterial and no other signs of Problem
infection inadequate feeding

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OSCE REVIEW - BSN II o For Immunization
▪ Make sure the young infant stays warm at all times.
IMCI
When to Return Immediately
Assess: Age up to 2 months ▪ Breastfeeding or drinking poorly.
▪ Check for the young infant’s immunization status ▪ Becomes sicker.
▪ Assess other problems ▪ Develops fever.
▪ Fast breathing.
Treat the Young Infant ▪ Difficult breathing.
▪ Give an appropriate oral antibiotic: ▪ Blood in stool.
▪ First Line: Amoxycillin
▪ Second Line: Cotrimoxazole ( Not given in infants
less than 1month of age who are premature or Follow-Up Care: Oral Thrush
jaundiced). ▪ After 2 days:
▪ Injectable Antibiotic (for referred patients unable ▪ Look for ulcers or white patches in the mouth.
to take oral antibiotic or for cases where referral is ▪ Reassess feeding
not possible): Ampicillin and Gentamicin ▪ If thrush is worse, or if the infant has problems
with attachment or suckling, refer to hospital.
Treat Skin Pustules ▪ If thrush is the same or better, and the infant is
▪ Wash hands. feeding well, continue half-strength Gentian Violet
▪ Gently wash off pus and crusts with soap and water. for a total of 5 days.
▪ Dry the area.
▪ Paint with full-strength Gentian Violet. Technical updates adapted in Philippine IMCI
▪ Wash hands. ▪ Antibiotic treatment of non-severe and severe
Treat Umbilical Infection pneumonia
▪ Wash hands. ▪ Low osmolarity ORS and antibiotic treatment for
▪ Paint with full-strength Gentian Violet. bloody diarrhea
▪ Wash hands. ▪ Treatment of fever/malaria
▪ Treatment of ear infections
Treat Oral Thrush ▪ Infant feeding
▪ Wash hands. ▪ Treatment of helminthiasis
▪ Wash mouth with clean soft cloth wrapped around ▪ Management of sick young infant aged up to 2
the finger and wet with salt water. months
▪ Paint the mouth with half-strength Gentian Violet.
▪ Wash hands.

Teach Correct Positioning and Attachment for

Breastfeeding
▪ Show her how to help the infant to attach. She
should:
▪ Touch her infant’s lips with her nipple.
▪ Wait until her infant’s mouth opening wide,
▪ Move her infant quickly onto breast, aiming the
infant’s lower lip well below the nipple.
▪ Look for signs of good attachment and effective
suckling. If the attachment or suckling is not good,
try again.

Signs of Good Attachment

▪ Chin touching the breast
▪ Mouth wide open.
▪ Lower lip turned outward.
▪ More areola visible above the top lip than below the
lower lip.

Advise Mother to Give Home Care for the Young Infant

▪ Food and Fluid: Breastfeed frequently, as often and
for as long as the infant wants.
▪ When to Return:
o For Follow-up Visit
o Immediately
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OSCE REVIEW - BSN II

Nebulization

A nebulizer is a small machine that turns liquid into

the mist.
Take a deep breath for 10-15 min.
 It is usually prescribed for severe cases of nasal
and chest congestion.
 Administered in pt. with asthma, COPD, unable to
take inhalers.

PROCEDURE
1. Place the compressor into the sturdy surface.
Plug the cord into the outlet.
2. Hand wash
3. Become familiar with the nebulizer parts.
4. Place the meds. In the nebulizer cup.
5. Attach the top portion of the nebulizer cup, and
connect the mouthpiece or face mask to the cup.
6. Connect the tubing to nebulizer and compressor
7. Turn on compressor, and see for a light mist.
8. Sit up straight and put the mouthpiece/face mask
9. Breath normally through mouth. Slow deep breath
for 2 to 3 sec. before breathing out. This allows the
meds to settle into the airways.
10. Continue the treatment till the meds is gone (5-10
min)
IF YOU BECOME DIZZY, SLOW BREATHING OR
REST BRIEFLY. SOME MEDS MAY MAKE YOU FEEL
“JITTERY” OR SHAKY.”

SIDE EFFECTS (rare)

 Vomiting
 Tremors
 Headache
 Tachycardia
 Bronco-spasms
TURN OFF THE COMPRESSOR, HAND WASH, DRY
THEM WITH A CLEAN TOWEL.

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OSCE REVIEW - BSN II  HYPERVENTILATION/ OVERBREATHING
Increase air in the lungs above the normal. Usually
O2 ADMINISTRATION associated with acute anxiety or emotional tension. It
 RESPIRATION MOVEMENT can cause dizziness and may even lead to
1. Oxygen rich air from environment unconsciousness.
2. Nasal cavities
3. Pharynx  IMMEDIATE TREATMENT
4. Trachea Breathing in paper bag is not recommended instead
5. Bronchi breath with only one nostril while the other is closed
6. Bronchioles thru finger then focus breathing to reduce the amount
7. Alveoli of air that enters the lungs.
8. 02 an carbon dioxide exchange in alveoli
9. Bronchioles  METHODS OF OXYGEN ADMINISTRATION FOR
10. Bronchi ADULTS
11. Trachea
12. Pharynx 1) Nasal Cannula (FOR ADULT)
13. Nasal cavities ✔ Is a tube that has two prongs to go in the nose
14. Carbon dioxide rich air in the environment. passages (nostrils)
✔ Nasal prongs delivers low flow of oxygen
 Oxygen concentration of 25% to 33% at 1-3 L/min.
Odorless, tasteless, colorless, transparent gas that
is slightly heavier than air. EQUIPMENTS
✔ Oxygen source
It is essential for cell metabolism, and in return, tissue ✔ Plastic nasal cannula with connecting
oxygenation is essential for all normal physiologic tubing (disposable)
functions. ✔ Humidifier filled with sterile water
✔ Flowmeter
Used to treat or prevent symptoms of hypoxia and ✔ No smoking sign
hypoxemia

 INDICATIONS
 CARDIOPULMONARY EMERGENCIES
 SOB
 CHEST PAIN PROCEDURE:
 CARDIAC OR RESPI ARREST 1. Show the nasal prong to the patient and explain the
 SEVERE TRAUMA procedure.
 USED BY HOSPITALS AND FIRST AIDERS
2. Make sure the humidifier is filled to the appropriate
mark.
 CONTRAINDICATIONS
 All patients with unfavorable ventilation to oxygen 3. Attach the connecting tube from the nasal prong to
treatment the humidifier outlet.
 Mechanical ventilation must be turned on in all cases 4. Set the flow rate at the prescribed liters per minute.
with patients in respi coma.
5. Place the tip of nasal prong in the patient’s nose
and adjust the strap.
 PT. TO RECEIVE TREATMENT
 ASTHMA-it could result in a pneumothorax
Nasal cannula- is low flow system, oxygen
 HIGH FEVER-to lower seizures; and lowering temp.
concentration will vary, depending on the patient’s
 OPTIC NEUTRITIS- rare cases of worsening vision
respiratory rate and tidal volume. Approximate
and blindness
concentrations delivered are:
 PREGNANCY- if any stress is caused to the fetus.
COMPLICATIONS 1L= 24%-25% 3L= 30%-33%
2L= 27%-29%
 EMPHYSEMA
Room Air = 21% + 4 % in each L/min of O2
Type of COPD involving damage of the air sacs
concentration
(alveoli) with carbon dioxide retention. Therefore If
you give a high concentration of O2, you are removing Example: 21% + 4% (1L) = 25%
the trigger to breath that leads to respi depression or 21% + 8% (2L) = 29%
even arrest.
21% + 12% (3L)= 33%
Effect of O2 on COPD is to cause increased CO2
retention, which may cause drowsiness, headaches, and
in severe cases lack of respi which may lead to death.
SN RMPB 11
OSCE REVIEW - BSN II
O2 ADMINISTRATION
2) FACE MASK (FOR ADULT)
⮚ mask that delivers moderate oxygen flow to
nose and mouth.
⮚ Delivers oxygen concentrations of 40%-60% at
4L-6L/min.
EQUIPMENTS:
✔ Oxygen source
✔ Humidifier bottle with distilled water
✔ Simple face mask with tubing(disposable)
✔ Flowmeter
PROCEDURE
1. Show the mask to the patient and explain the
procedure.
2. Make sure that the humidifier is filled to the
appropriate mark
3 Attach the tubing from the mask to the
humidifier outlet
4 Set the desired oxygen concentration as
prescribed.
5 Apply the mask to the patient’s face and adjust
the straps so the mask fits securely
3) Non Rebreathing Mask (FOR ADULT)
Has an inflatable bag to store 100% oxygen and
one way valve between the bag and mask to
prevent exhaled air from entering the bag.
- one way valves covering one or both the
exhalation ports to prevent entry of room air on
inspiration
Delivers oxygen concentrations of 60%-100% at
6L-10L/min.
4) PARTIAL REBREATHER MASK (FOR ADULT)
✔ has an inflatable bag that stores 100
% oxygen
a) On inspiration, the patient inhales
from the mask and bag; on
expiration, the bag refills with
oxygen and expired gases exit
through perforations on both side
of the mask and some enters the
bag
b) High concentrations of oxygen
50% to 75% can be delivered.
SN RMPB
PROCEDURE: For Non Rebreathing Mask
And Partial Rebreathing Mask
1. Show the mask to the patient and explain the
procedure
2. Attach the tubing to the flowmeter
3. Set and adjust the flowmeter to 6- 10 L/min
4. Place mask on patients face and adjust the straps
5. Stay with the patient to make the patients
comfortable
and observe reactions
6. Remove mask periodically
5) Venturi Mask (FOR ADULT)
Mask with device that mixes air
and oxygen to deliver constant
oxygen concentration.
Mask that delivers oxygen
concentration of 24% - 40% at
4 – 8 L/min.
PROCEDURE: For Venturi mask
1. Show the venturi mask to the patient
and explain the procedure.
2. Connect the mask to the oxygen
flowmeter
3. Set the prescribed rate (usually
indicated on the mask
4. Place the mask over the patient’s nose
and mouth then under the chin. Adjust
the elastic strap
5. Determine the patient’s comfort with
oxygen use
6) Bag-Valve Mask (Ambubag) (FOR ADULT)
Delivers high concentration of
oxygen to patient with insufficient
inspiratory effort.
Delivers O2 concentration
of 15L/min at 100% with reservoir.
PROCEDURE: For Manual
Resuscitation Bag
1. Wash hands. Refer to the Hand Washing procedure.
2. Explain procedure to client.
3. Connect to oxygen by attaching one end of tubing to
flow
meter adapter and one end to the Ambu bag. Turn the
flowmeter to “ flush” position.
4. Place mask over nose and mouth - use dominant hand
to
ventilate by compressing the bag oxygenation until able
to
breathe independently.
5. Observe chest rise and fall to determine
effectiveness of
compressions.
6. Observe client color, comfort level.
12
OSCE REVIEW - BSN II Pediatric Assessment Triangle

O2 ADMINISTRATION ⚫ Appearance
⚫ Awake
7) T - PIECE ( BRIGGS) adapter (FOR ADULT) ⚫ Aware
⚫ Upright
Is used to administer oxygen to patient
⚫ Work of breathing
with ET or tracheostomy tube who is ⚫ Retractions
breathing spontaneously. ⚫ Noises
A device for connecting two inputs to ⚫ Skin circulation
one output or vice versa

PROCEDURE: For T-piece (Briggs) adapter

1. Show the T-tube to patient and explain the
procedure
2. Make sure the humidifier is filled to the appropriate
mark TYPES OF DELIVERY OF O2
3. Attach the large bore tubing from the T-tube to the  NASAL CANNULA
humidifier outlet. ✔ A thin, soft, plastic tube and has soft
4. Adjust the flow rate as ordered prongs that gently fit into your baby’s nose.
5. Drain the tubing frequently by emptying condensate ✔ Oxygen flows through the tube. The baby
into a separate receptacle, not into the humidifier must be able to breathe without assistance in
order to use this type of oxygen therapy.
8) CONTINOUS POSITIVE AIRWAY PRESSURE
(CPAP) (FOR ADULT)  OXYGEN HOOD
Is a method of respiratory ventilation used primarily
in the treatment of sleep apnea - is used for babies who can breathe on their own but
Commonly used for critically ill patient with still need extra oxygen.
Respiratory Failure, CHF and COPD who are admitted
- A hood is a plastic dome or box with warm, moist
in ICU, CCU or other specialized respiratory unit
oxygen inside. The hood is placed over the baby's
head.
PROCEDURE: For CPAP
1. Show the mask to the patient and explain the
procedure.
2. Insert NG tube if ordered
3. Attach NG tube adapter
4. Set the desired oxygen concentration.
5. Place the mask on the patient’s face and adjust the
✔ Continously monitor the oxygen concentration,
strap.
temperature, and humidity inside the hood.
6. Organize care to remove the mask as infrequently as
possible Rationale: Oxygen should be warmed to prevent a
neonatal response to cold stress, including oxygen
9) Transtracheal Catheter (FOR ADULT) deprivation and reduction of blood glucose levels.
Accomplished by way of a small (8 French)  FACE TENT
catheter inserted between the second and third ✔ are available in adult size only
tracheal cartilage Oxygen delivery is more efficient ✔ a flow of 8- 10 L/min should be used
because all to flush the system and provide a stable
oxygen enters the lungs. Delivers oxygen oxygen concentration
concentrations of 60% - 100%
at 4L-6L/min.

Oxygen Concentration in Infants

⚫ It can replace oxygen masks when masks are
✔ High levels of oxygen given to infants causes
poorly tolerated by clients.
blindness by promoting overgrowth of new blood
⚫ Soft and lightweight face tent designed for
vessels in the eye obstructing sight. This is called
patients with facial skin burn or trauma.
retinopathy of prematurity (ROP).
Latex-free elastic head strap for better fit and less
skin irritation.

SN RMPB 13
OSCE REVIEW - BSN II

O2 ADMINISTRATION

 CLOSED INCUBATOR OR
ISOLETTES

✔ The incubator is used to provide a

controlled environment for the neonate.
✔ When a baby is relatively stable but
still premature or requiring intravenous fluids
or other special attention, he or she is cared
for in an "incubator."
✔ The incubator keeps the baby warm
with moistened air in a clean environment, and
helps to protect the baby from noise, drafts,
infection
✔ Keep sleeves of incubator closed -
to prevent loss of oxygen

PROCEDURE
Explain the procedure to the child and allow
the child to feel the equipment and the
oxygen flowing through the tube and mask
2. Maintain a clear airway by suctioning, if
necessary.
3. Provide source of humidification
4. Observe the child’s response to oxygen
5. Terminate oxygen therapy gradually
6. Continually monitor the child’s response during
weaning.
7. Observe for restlessness, increased pulse rate,
respiratory distress, and cyanosis.

POTENTIAL COMPLICATIONS
⚫ Impairment of respiratory drive in people with
COPD(those who retain carbon dioxide)
⚫ Discomfort secondary to drying of mucous
membranes
⚫ Eye irritation
⚫ Mask can act as barrier against feeding and
communication
⚫ Creation of a fire hazard (smoking in same room
must be banned)
⚫ Restriction of activities.

NURSING CARE
⚫ Before commencing oxygen therapy ensure
that it is prescribed and that the patient
understands why he/she requires it. Reassurance
and information can relieve the distress
significantly.
⚫ Reassure the patient and sit him/her up
comfortably supported by pillows before
explaining how to use the equipment.

SN RMPB 14
OSCE REVIEW - BSN II Perform a physical assessment .
6. Inspect all tubings and drains .
MONITORING INPUT AND OUTPUT
7. Notice if all suction containers or drainage containers
- The measurement and recording of all fluid intake and
were emptied
output during a 24hrs period which provides important
8. Determine how much the client understands.
data about the client’s fluids and electrolyte balance.
9. Look for a calibrated container and bedside I&O
- One of the most basic methods of monitoring a client’s
record.
health, commonly called I/O.
10. Obtain a collection device for inside the toilet
11. Measure the amount of water in the client’s
PURPOSE
bedside.
 For comparison from normal intake and output
 Helps evaluate client’s fluid and electrolyte balance
IMPLEMENTATIONS
 Suggest various diagnosis
12. Explain the purpose and procedures for measuring
 Influence the choice of fluid therapy
I&O to the client.
 Document the client’s ability to tolerate oral fluids
 Recognize significant fluid loss 13. Record the volume for all fluids consumed.
 To ensure effective hydration and elimination 14. Make sure that all IV fluids or tube feedings are
❖ being administered at the prescribed rate.
NURSING INTERVENTION . Ensure that the nurse who adds additional IV fluid
 To obtain accurate record containers also records the volume .
 In critical situation I/O should be monitored hourly
urine output less than 500ml/24hrs or less than 16. Keep track of fluid volumes used to irrigate
30ml/hour indicate renal failure drainage tubes or flush feeding tubes.
 Daily weights are often done indicate fluid 17. Wear gloves.
retention
18. Measure and record the volume of voided urine,
 Identify if patient undergone surgery or with
urine collected in a catheter drainage bag, liquid stool or
medical problem
other.
 Make sure you know the total amount and fluid
sources once you delegate this task to get an 19. Wash hands .
accurate measurement
20. Check the volume remaining in currently infusing IV
 Record the type and amount of all fluid and
fluids.
describe the route at least every 8hrs
Review the plan of care and if the goals have not been
 Subtract the total amount of irrigating solution,
met.
NGT or tube on bladder to get exact amount of
output 25. Report the I&O volumes IV fluid credit amount, and
 Keep toilet paper out of your patient urine and or other data.
measure drainage in a calibrated container. Read
the meniscus on eye level Documentation
1. Date and time.
THE PURPOSE OF I NO CALCULATION Intake and output volumes for the next shift.
1. Ensure accurate record keeping.
2. Prevent circulatory overloud.
3. Prevent dehydration.
4. Aids in analyzing trends in fluid status.
Contributes to accurate assessment record

ASSESSMENTS
 Check the kardex or listen in report to determine
if an assigned client is on I&O.

 Verify during report how much IV fluid has been

accounted for from any currently infusing solution.

Review the nursing care plan.

5) Review the client’s medical record and analyze
trends in I&O, vital signs measurements, laboratory
findings, and weight records

SN RMPB 15
OSCE REVIEW - BSN II
Surgical Skin Preparation
⚫Many surgeons prefer to have their bathe with
antimicrobial soap the morning of the surgical
procedure.
* The perioperative nurse should assess the
patient’s skin before, during and after the
prepping process.
⚫* Abnormal skin irritation, infection, or abrasion
on or near the surgical site might be a
contraindication to the surgical procedure and
is reported to the surgeon.
⚫ HAIR REMOVAL –carried out per surgeon’s
order, whether on the preoperative unit or in the
OR as close to the scheduled time for surgical
procedure as possible.
⚫ CLIPPERS –electric clippers with fine teeth cut
hair close to the skin. Clipping can be done
immediately before the surgical procedure or up to
24 hours preoperatively.
⚫ DEPILATORY CREAM –hair can be removed by
chemical depilation before the patient comes to the
OR suite. This should not be used around the eyes
or genitalia. After the cream has remained on the
skin for the required time, usually about 20 min, it
is washed off. The hair comes off in the cream.
⚫ RAZOR –shaving should be performed as near
the time of incision as possible if this method is
used.
⚫ SKIN DEGREASING –it is used to enhance
adhesion of ECG or other electrodes.
PREPPING AREAS CONSIDERED CONTAMINATED
⚫ UMBILICUS : some surgeons prefer the
umbilicus to be cleaned with cotton-tipped swabs
before the main incision.
`STOMA :should be isolated with a sterile clear
plastic adhesive dressing to prevent fecal material
from entering the wound..
`OTHER CONTAMINATED AREAS: the general
rules of scrubbing the most contaminated area last
with separate sponges applies.
`FOREIGN SUBSTANCES –a none-irritating
solvent should be used to cleanse the skin.
`TRAUMATIC WOUNDS –the wound may be
packed or covered with the sterile gauze while the
area around it is thoroughly scrubbed and shaved if
necessary.
`AREAS PREPARED FOR GRAFTS –the donor site
for a skin graft should be scrubbed with a colorless
antiseptic agent so that surgeon can properly
evaluate the vascularity of the graft
postoperatively.
SN RMPB
Common antiseptic solutions
⚫ CHLORHEXIDINE CLUCONATE –used as
antiseptic skin cleansing soap preoperatively.
IODINE AND IODOPHORS –it is used for wound
care
ALCOHOL –a 70% concentration with continuous
contact for several minutes is satisfactory for skin
antisepsis if the surgeon prefers a colorless
solution that permits observation of true skin color.
TRICLOSAN –is a broad spectrum antimicrobial
agent.
PARACHLOROMETAXYLENOL –has a bactericidal
properties useful for skin antisespsis.
Standard of Practice I
The patient and surgical team members should follow
the surgeon’s preoperative orders. Additionally,
preoperative preparations by the surgical team should
be completed.
⚫ The surgeon’s orders may include the patient
taking a bath or showering with an antiseptic agent
the night before surgery and/or the morning of
surgery
⚫ The preoperative patient interview should
include asking the patient if she/he has any known
allergies, as well as a review of the patient’s history
and physical.
⚫ The surgical team should refer to the surgeon’s
orders pertaining to hair removal (also referred to
as “shave prep” in this document) should or should
not be performed prior to skin prep. However, it is
recommended that hair removal not be performed.
Standard of Practice I
⚫ The patient’s body jewelry should be removed
from the area of the skin prep.
⚫ Patient education should include informing the
patient to not wear any cosmetics the day of
surgery.
⚫ For surgery that involves the fingers, hand or
wrist, the patient should beinstructed to cut the
nails short, thoroughly clean the subungual areas
during the preoperative bath or shower, remove
artificial nails and nail polish.
16
OSCE REVIEW - BSN II ⚫ Gross soil, grease, skin oil, blood and other
debris should be removed from the skin prior to
Surgical Skin Preparation performing the skin prep
⚫ Just as with the surgical scrub, the ideal
Standard of Practice II duration of the skin prep has not been established.
The health care facility should use FDA-approved However, it is recommended that the skin prep last
agents that have immediate, a minimum of five, and until all sponges have been
cumulative, and persistent antimicrobial action. used
⚫ The skin prep agents should have the following
properties: fast-acting, persistent and cumulative
actions, and non-irritating.
⚫ The surgical team members and infection
control officer should be involved in the process of
evaluating and selecting the skin prep agents.
Standard of Practice III

⚫ The paint solution should be applied with prep

stick sponges, using the no-touch technique in
order to avoid contamination from the gloves
that came into contact with the prep-solution
soaked sponges.
⚫ Alcohol and alcohol-based agents should not
be used on mucous membranes.
Alcohol is an accepted antiseptic agent; however, it
⚫ Gentle pressure should be used when applying
should not be used as the single
the prep agents on patients with friable skin
agent but as part of the skin prep regimen.
⚫ The antimicrobial action of alcohols is the
denaturing of proteins. 60%-95% alcohol is the
most effective. Additionally, antiseptic solutions
that contain alcohol, such as chlorohexidine with
70% alcohol, are less effective at higher alcohol
concentrations since the denaturing of proteins
does not easily occur in the absence of water.
⚫Alcohol has broad-spectrum antimicrobial
properties, including the ability to destroy Contaminated areas require special attention and
Gram-positive and Gram-negative bacteria as generally should be prepped last.
well as multidrug-resistant pathogens including
MRSA and VRE, Mycobacterium tuberculosis ⚫ Areas of high microbial counts, including the
and fungi axilla, groin, perineal region, anus and vagina are
prepped last. Each sponge is used and discarded; it
should not be reused.
⮚ Umbilicus.
⮚ Stomas, skin ulcers, sinuses and open wounds
are considered contaminated and should be
prepped last (stoma be isolated with a sterile
clear plastic adhesive drape, irrigation with
warm sterile normal saline open wounds)
Standard of Practice IV
Surgical team members should perform a standardized
patient skin prep procedure
based upon manufacturer’s written instructions that
are specific to the
antimicrobial agent to be used and according to health
care facility policy and
procedures.

⚫ The surgical team member(s) who will be

performing the skin prep should first perform a
hand wash.
SN RMPB 17
OSCE REVIEW - BSN II Standard of Practice IX
The Material Safety Data Sheets (MSDS) for the
Surgical Skin Preparation antiseptic agents that are stored
and used in the surgery department must be readily
Standard of Practice VI available and accessible to all
Surgical procedures, such as grafts, surgical personnel.
abdominal-perineal and abdominal-vaginal ⚫ If unsure about the handling, storage, use, etc.
require two separate skin preps to be performed. of an agent or chemical, surgical personnel should
⚫ Separate skin prep set-ups are required for review the MSDS and follow the instructions
prepping the donor and recipient sites for skin, bone Standard of Practice X
or vascular graft procedures. ( donor. Use less The patient skin prep should be well
colourless. Contaminate wound ) documented in the patient chart.
⚫ Abdominal-perineal and abdominal-vaginal
procedures require separate skin preps since the ⚫ Documentation should include, but not be
perineal and vaginal areas are considered limited to, the following:
contaminated. A. Patient education and preoperative
instructions
B. Removal and handling of jewelry
C. Condition of the skin prior to the shave
prep
D. Shave prep
Standard of Practice VII (1) Prep parameters
Eye and facial preps may require the use of alternative (2) Time of prep
prep solutions or diluted (3) Method used
regular solutions in order to avoid injury to the patient. (4) Name of person who performed the shave prep
E. Skin prep
• Iodophors are contraindicated for use in eye (1) Prep parameters
and facial preps. Both agents can severely injure (2) Time of prep
the cornea if they accidentally enter the eye. (3) Condition of skin
Additionally both agents are ototoxic and can cause (4) Fat solvents or degreasers used
sensorineural deafness if they enter the inner ear. (5) Antiseptic agent(s) used
⚫ Triclosan are considered non-toxic and should (6) Name(s) of person(s) performing prep
be considered for use in facial preps. However, it F. Condition of skin postoperatively
is still advised to ensure that the agents do not
enter the eyes. Warm sterile water should be used
as the rinse.
⚫ If the patient is awake during the prep, he/she
should be advised to keep eyes closed. If the
patient is under anesthesia, the eyes should be
protected by placing a small sterile plastic adhesive
drape.
⚫ Cotton balls should be placed in the ears to
prevent the prep agent from entering.

Standard of Practice VIII

Manufacturer’s instructions should be followed for the
storage and warming of
antiseptic agents.
⚫ The antiseptic agents should always be stored in
the manufacturer’s original container.
⚫ The manufacturer’s instructions should be
consulted to determine the safety of warming an
antiseptic solution.

SN RMPB 18
OSCE REVIEW - BSN II
EINC
THE EINC practices evidenced based standards for
safe and quality care of birthing mothers and their
newborns, within 48 hrs of intrapartum period and
a week of life for the newborn.
 Series of timebound, chronologically-ordered,
standard procedures that a baby receives at birth.
 Can prevent at least half of newborn death without
additional cost to both families an hospitals.
4 time bound interventions are:
1. Immediate and thorough drying of the newborn
30 sec to 1 min. warms the NB to stimulate
breathing. Use clean dry cloth to dry the baby
by wiping the eyes,face,head,front, back, arms
and legs.
2. Early skin to skin contact between mother and the
newborn
Place the NB prone to mothers abdomen or
chest.
Cover NB back with blanket an head with bonnet.
Place ID. This
prevents-hypothermia,infection,hypoglycemia.
3. Properly timed cord clamping and cutting
Clamp and cut the cordd after pulsations have
stopped. Typically 1-3 min.
Put ties at the cord @ 2cm and 5cm from NB
abdomen.
Cut between ties with sterile instrument.
This prevents:
Anemia, protects against hemorrhage in
preterm NB.
4. Non separation of baby from the mother.
Time bound within 90 min. of age
Continuous non separation for early
breastfeeding which protects the infants from
infection.
 EINC FROM 90 MIN TO 6 HRS OF LIFE
INTERVENTION:
Give Vit K prophylaxis
ACTION: Wash hands. Inject a single dose of Vit K 1mg
IM.
INTERVENTION:
Inject Hepa B and BCG vaccinations at birth
ACTION:
Inject Hepa B vaccine IM and BCG intradermally.
Record.
SN RMPB
INTERVENTION:
Examine the baby
ACTION:
Thoroughly examine the baby. Weigh the bb and record.
INTERVENTION
Check for birth injuries,malformations or defects.
ACTION:
Look for possible injury (bumps on one or both sides of
head, bruises,swelling on buttocks,abnormal position of
legs (after breech presentation) or assymetrical arm
movement, or arm that does not move.
Look for malformations; cleft palate or lip-club
foot-odd looking, unusual appearance- open tissue on
head, abdomen or back.
INTERVENTION
Cord care
ACTION:
Wash hands. Put nothing on stump. Fold diaper below
stamp. Keep cord stump loosely covered with clean
water and soap. Dry it thougrouly with clean cloth.
Explain to the mother that she should seek care if the
umbilicus is red or drainingpus.
Teach the mother to treat local umbilical infection
three times a day.
Wash hands with clean water and soap.
Gently wash off pus and crusts wth boiled and cooled
water and soap. Dry the area with clean cloth.
 CARE PRIOR TO DISCHARGE
TIME BAND: after 90 min of age, but prior to
discharge
INTERVENTION:
Support unrestricted per demand breastfeeding, day
and night.
ACTION:keep the NB in the room with the mother.
(rooming in). support exclusive breastfeeding on demand
day and night.
INTERVENTION
Ensure warmth of the baby
ACTION: keep the room warm (>25 C and draft-free) it
is for the baby to be healthy.
INTERVENTION
Keep skin to skin contact as much as possible.
ACTION:
Dress the baby or wrap in a soft dry clean cloth. Cover
the head with a cap for the first few days, especially if
the baby is small.
19
OSCE REVIEW - BSN II

EINC

INTERVENTION:
Washing and bathing
ACTION:
wash hands. Wipe the face,neck and underarms
with a amp cloth daily,. Bathe when necessary, ensuring
that the room is warm and draft free. Using warm water
for bathing and thoroughly drying the baby is small,
ensure that the room is warmer when changing, wiping
an bathing.

SN RMPB 20
OSCE REVIEW - BSN II

DRUG ADMINISTRATION
COLOR CODING AND FREQUENCY

WHITE YELLOW
OD/ONCE A DAY BID/TWICE A DAY
10AM 6AM – 6PM
PINK BLUE
TID/THRICE A DAY QID/FOUR TIMES A DAY
6AM – 10AM – 2PM – 6PM
8AM – 1PM – 6PM
GREEN
WHITE W/ RED PRN/ AS NEEDED
(OR SOMETIMES RED) q4/every 4 hours
q8/every 8 hours
6am – 2pm – 10pm

ORANGE
q6/every 6 hours
6AM – 12PM – 6PM – 12AM

DRUG AND IV FLUID COMPUTATION

I. BASIC FORMULA
D/S x V = A (ml) or D/H x V = A (ml)
where: D = desired dose/doctor’s order
S/H = stock/on hand dose
V= volume/vehicle/dilution
A = amount to be given
Example: The expectorant guaifenesin (Robitussin)300
mg p.o. has been ordered. The bottle is labeled 100
mg/5ml. How many mls. should be given?
Answer: 300 mg / 100 mg x 5mls = 15 mls

PRINCIPLES OF DRUG ADMINISTRATION

1. Right drug. Read the label three times.
2. Right dose. Know the usual dose of the drug.
Calculate the correct amount.
3. Right time. Standard time may be followed in
the institution.
4. Right route. Check the route of administration.
5. Right patient. Identify patient by: Checking the
ID band, asking him to stte his name.
6. Right recording. Sign medication sheet
immediately after administration of the drug.
7. Right approach and right to refuse.
8. Right history and assessment.
9. Right drug-drug integration on evaluation.
10. Right education and information.

SN RMPB 21
OSCE REVIEW - BSN II
PURPOSE
 OXYGEN ADMINISTRATION
The goal of this therapy is maintaining normal
hemoglobin saturation so as to facilitate normal oxygen
delivery to peripheral tissues.
 NGT INSERTION
By inserting a nasogastric tube, you are gaining access
to the stomach and its contents. This enables you to
drain gastric contents, decompress the stomach,
obtain a specimen of the gastric contents, or introduce
a passage into the GI tract. This will allow you to treat
gastric immobility, and bowel obstruction.
 NEBULIZATION THERAPHY
The medicines and moisture help control breathing
problems like wheezing and help loosen lung secretions. 
 SKIN PREP FOR CS
SKIN-PREP is a liquid film-forming dressing that, upon 
application to intact skin, forms a protective film
to help reduce friction during removal of tapes and
films. SKIN-PREP can also be used to prepare skin
attachment sites for drainage tubes, external
catheters, surrounding ostomy sites and adhesive
dressings.
ensuring the safety of our nation's food supply,
cosmetics, and products that emit radiation.
 EQUIPMENT NEEDED OXYGEN
ADMINISTRATION
 Pulse Oximeter. A pulse oximeter is a commonly
used portable device used to obtain a patient's oxygen
saturation level at the bedside or in a clinic. ...
 Oxygen Flow Meter. ...
 Portable Oxygen Supply Devices. ...
 Nasal Cannula. ...
 Simple Mask. ...
 Non-Rebreather Mask. ...
 Continuous Positive Airway Pressure (CPAP) ...
 BiPAP.
 EQUIPMENT NEEDED NGT INSERTATION.
Gloves.
 Fine bore nasogastric tube (feeding only) or
nasogastric “Ryles” tube 16Fr (all other indications).
Water based lubricant.
 Syringe.
 Bile bag.
 Securing device or tape.
 Cup of water.
 pH indicator paper

 POST OP WOUND CARE

Regardless of the mechanism of wound healing, the aims  EQUIPMENT NEEDED POST OP WOUND CARE
of post-operative wound care remain the same: to allow 1. Gauze.
the wound to heal rapidly without complications, 2. Medical gloves.
And with the best functional and aesthetic results. 3. Alcohol Wipes and Disinfectants.
4. Bandages.
 IMCI
5. Pain Relieving Medications.
IMCI aims to reduce preventable mortality, minimize
illness and disability, and promote healthy growth and
development of children under five years of age. IMCI
includes both preventive and curative elements that can
be implemented by families, in communities and in
health facilities.

 MEASURING INTAKE AND OUTPUT

Intake and output (I&O) indicate the fluid balance for
a patient. The goal is to have equal input and output. Too
much input can lead to fluid overload.

 SPECIMEN COLLECTION
Specimen collection is the process of obtaining tissue
or fluids for laboratory analysis or near-patient
testing. It is often a first step in determining diagnosis
and treatment.

 Drug administration
The Food and Drug Administration is responsible for
protecting the public health by ensuring the safety,
efficacy, and security of human and veterinary drugs,
biological products, and medical devices; and by

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The measurement and recording of all fluid intake
and output during 24hrs period which provides
important data about the client’s fluids and
electrolyte balance.
One of the most basic methods of monitoring a
client’s health, commonly called I/O
For comparison from Normal Intake and Output
Helps evaluate client’s fluid and electrolyte balance
Suggest various diagnosis
Influence the choice of fluid therapy
Document the client’s ability to tolerate oral fluids
Recognize significant fluid loss
To ensure effective hydration and elimination
Burns
Electrolyte Imbalance
Recent Surgical Procedure
Severe vomiting and diarrhea
Taking diuretics or corticosteroids
Renal failure
CHF
NGT, drainage collection device and IV therapy
To obtain accurate record
In critical situation I/O should be monitored hourly
urine output less than 500ml/24hrs or less than
30ml/hour indicate renal failure
Daily weights are often done indicate fluid
retention
Identify if patient undergone surgery or with
medical problem
Make sure you know the total amount and fluid
sources once you delegate this task to get an
accurate measurement
Record the type and amount of all fluid and
describe the route at least every 8hrs
Subtract the total amount of irrigating solution,
NGT or tube on bladder to get exact amount of
output
Keep toilet paper out of your patient urine and
measure drainage in a calibrated container. Read
the meniscus on eye level.
Check the kardex or listen in report to determine
if an assigned client is on I/O
Verify during report how much IV fluid has been
accounted for from any currently infusing solution.
Review the nursing care plan
Review the client’s medical record and analyze
trends in I&O, V/S measurements, Laboratory
findings, and Weight records.
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Perform a physical assessment.
Inspect all tubing’s and drains
Notice if all suction containers or drainage
containers were emptied.
Determine how the client understands.
Look for a calibrated container and bedside I&O
record.
Obtain a collection device for inside the toilet.
Measure the amount of water in the client’s
bedside.
Explain the purpose and procedures for measuring
I&O to the client.
Record the volume for all fluids consumed.
Make sure that all IV fluids or tube feedings are
being administered at the prescribed rate.
Ensure that the nurse who adds additional IV fluid
containers also records the volume.
Keep track of fluid volumes used to irrigate
drainage tubes or flush feeding tubes.
Wear gloves.
Measure and record the volume of voided urine,
urine collected in a catheter drainage bag, liquid
stool or other.
Wash hands.
Check the volume remaining in currently infusing IV
fluids.
Record the total amount of all fluid intake and
output volumes.
Compare the data to determine if the intake and
output are approximately the same.
Report major differences in I&O to the client’s
physician.
Review the plan of care and if the goals have not
been met.
Report the Intake & Output volumes IV fluid credit
amount, and or other data.
Documentation.
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IMCI - assessment, color coded triage system IMCI - assessment

 1 million Children under 5 (<5) y/o die each year in
less developed countries.
 Just 5 diseases (pneumonia, diarrhea, malaria,
measles and dengue hemorrhagic fever) account
for nearly half of these deaths and malnutrition is
often the underlying condition.
 Effective and affordable interventions to address
these common conditions exist but they do not yet
reach the populations most in need, the young and
impoverish.
 The Integrated Management of Childhood Illness
strategy has been introduced in an increasing
number of countries in the region since 1995. IMCI
is a major strategy for child survival, healthy
growth and development and is based on the
combined delivery of essential interventions at
community, health facility and health systems
levels.
 IMCI includes elements of prevention as well as
curative and addresses the most common
conditions that affect young children.
 The strategy was developed by the World Health
Organization (WHO) and United Nations Children’s
Fund (UNICEF).
 In the Philippines, IMCI was started on a pilot
basis in 1996.
 Reduce death and frequency and severity of illness
and disability, and
 Contribute to improved growth and development.
1. ASSESS the child or young infant
1.1 Ask the mother or caretaker about the child’s
problem
 Use words the mother understands
 Give the mother time to answer the questions
 Ask additional questions when the mother is not
sure about her answer
 Determine if this is an initial visit or follow-up visit
for the problem.
1.2 Ask the mother or the caretaker about the FOUR
MAIN SYMPTOMS
 Cough/Difficulty of Breathing
 Diarrhea
 Fever
 Ear infection
 PLUS check for MALNUTRITION, ANEMIA, &
HIV INFECTION
1.3 Check for GENERAL DANGER SIGNS
 ASK:
 Convulsion
 UNCONSCIOUS/Unable to drink or
Breastfeed
 Vomits everything taken in
 LOOK:
 Abnormally sleepy or lethargy
 Exception: A child with any general danger sign
needs URGENT attention; complete the assessment
and any pre-referral treatment immediately so
referral is not delayed.

IMCI - color coded triage system

 Improving case management skills of health  CLASSIFY the illness using the “Color-coded triage
workers. system”
 Improving over-all health systems.  PINK - SEVERE
 Improving family and community health practices.  YELLOW - MODERATE
 GREEN - MILD

 Sick young infant (0-2 months)

 Sick child (2 months - 5 years old)  REASONS FOR REFERRAL:
 ETAT (Emergency Triage, Assessment and
Treatment)
 Diagnosis
 Majority of these deaths are caused by  Treatment
5 preventable and treatable conditions namely:  Monitoring/Further Evaluation
 Pneumonia  Follow-up care
 Diarrhea  EXCEPTION: Rehydration according to PLAN C
 Malaria may resolve the danger signs so that referral is no
 Measles longer needed.
 Malnutrition
 Three (3) out of four (4) (3/4) episodes of
childhood illness are caused by these 5 conditions.  Specific Medical Treatment and Advice (YELLOW
ROW)
1) Treat local infection, 2) Give Oral Drugs, 3) Advise
and teach the Mother, 4) Follow up care

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IMCI - color coded triage system

 Simple Advice on Home Management (GREEN

ROW)
1) How to give oral drugs and treat local infections at
home center.
2) Counsel the mother and other care giver about foods,
fluids, and her own health and when to return to the
health center.

 THE SICK CHILD AGE 2 MONTHS UP TO 5

YEARS
1. CHECK FOR GENERAL DANGER SIGNS (CUVA)
 Convulsion
 Unable to drink/drinks poorly
 Vomits everything taken in
 Abnormally sleepy or Lethargic

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B. IDENTIFY SPECIFIC TREATMENTS FOR THE
INTEGRATED MANAGEMENT OF CHILDHOOD CHILD
ILLNESS  If the child requires urgent referral  GIVE
I. Integrated Management of Childhood Illness ESSENTIAL TREATMENT BEFORE
(IMCI) Objectives TRANSFER
 To reduce significantly global mortality  If the child will be sent home  DEVELOP
and morbidity associated with the major INTEGRATED PLAN AND GIVE FIRST
causes of disease in children. DOSE OF THE DRUG IN THE HEALTH
 To contribute to healthy growth and FACILITY
development of children.
II. Integrated Management of Childhood Illness C. TREAT THE CHILD
(IMCI) as a key strategy for improving  Teach the mother to give oral drugs at home
child health  Treat local infections at home
Managemen Nutrition Immunization Other disease  Give treatments in the health center
t of sick Prevention
Promotion of  Give extra fluid for Diarrhea
children
Growth and
Development
 Immunization

D. COUNSEL THE MOTHER

 Food
Integrated Management of
Childhood illness (IMCI)  Fluid
 When to return
 About her own health

E. GIVE FOLLOW-UP CARE

THE CASE MANAGEMENT PROCESS  Reassess the child for new problems
1. Assess the child or young infant.  vitamin and immunization
2. Classify the illness.  Teaching the mother specific treatments at
3. Identify treatment. home
4. Treat the child.  Counseling the mother
5. Counsel the mother.
6. Give follow-up care. What is the importance of IMCI Integrated
Management of Childhood Illness?
6 PROCESSES OF THE CASE MANAGEMENT SYSTEM In health facilities,
OF THE IMCI  the IMCI strategy promotes the accurate
identification of childhood illnesses in
A. ASSESS THE CHILD OR INFANT outpatient settings,
 History, PE  ensures appropriate combined treatment of
 Checking for the DANGER SIGNS all major illnesses,
 Examining the child  strengthens the counselling of caretakers,
 Checking the nutrition and immunization status  and speeds up the referral of severely
o ill children.
COLOR CODED TRIAGE SYSTEM: PINK
 give pre-referral treatment WHAT ARE THE BENEFITS OF THE IMCI
 advice the parents STRATEGY?
 refer the child URGENTLY  Addresses major child health problems
because it systematically addresses the
COLOR CODED TRIAGE SYSTEM: YELLOW most important causes of children illness
SPECIFIC MEDICAL TREATMENT AND ADVICE and death.
 treat the local infection  Responds to demands.
 give an appropriate antibiotic Promotes prevention as well as cure
 advice and teach the caregiver because IMCI emphasizes important preventive
 follow up interventions

COLOR CODED TRIAGE SYSTEM: GREEN

SIMPLE ADVICE ON HOME MANAGEMENT
 teach the mother or caregiver how to give oral
drugs and treat local infections at home
 counseling the mother or other caregiver about
food (feeding problems), fluids, when to return
to the health facility, and her own health
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Essential Intrapartum and Newborn Care (EINC)
6.
To rapidly reduce maternal and newborn morbidity
and mortality.
To promote ways to take care of newborn children
and their mother and ensure the health of both the
mother and the baby.
To give appropriate and immediate support on the
health and nutrition of a newborn.
Non-separation of baby from mother: Parents,
especially the mother, are encourage to hold their
newborn.
Breastfeeding initiation: Once the newborn shows
feeding cues, suggest to the mother to encourage
her baby to move toward her breast; Make sure to
counsel on positioning and attachment, especially
first time mothers.

The EINC practices are evidenced-based

standards for safe and quality care of birthing
mothers and their newborns, within the 48 hours of
Intrapartum period (labor and delivery) and a week
of life for the newborn.
A series of time bound, chronologically-ordered,
standard procedures that a baby receives at birth.
Is described as a “simple cost-effective newborn
care intervention” intended to enable improved
neonatal and maternal care.

To ensure survival of the newborn from birth up to

the first 28 days of life.
Provides appropriate and timely emergency
newborn care to newborns in need of resuscitation
by early and accurate assessment of the infant’s
adjustment of the outside world.
It ensures access of newborns to affordable
life-saving medicines to reduce deaths and
morbidity.
It also ensures inclusion of newborn care in overall
approach to the Maternal, Newborn, Child
Healthcare Nutrition Strategy.

 The EINC practices for newborn care constitute a

series of time-bound, chronologically-ordered,
standard procedures that a baby receives at birth:
1. Cleaning after delivery: With the use of a suction
bulb, clear any mucus and other material from the
In conclusions the expected essential newborn care
newborn’s mouth, nose, and throat so the baby able
practices are not getting to a greater proportion of the
to take a breath.
newborns. Early bathing, non-immediate drying and
2. Immediate dyring: Using a clean, dry cloth to dry
application of substances to cord stump were commonly
the baby’s face eyes, head, front and back, arms
practiced. This may be depriving newborns of basic
and legs.
protections against infection and death. And provider,
3. Skin-to-skin contact: Placing the newborn prone
also the preventative interventions in order to save
on the mother’s abdomen or chest with skin-to-skin
newborns include breastfeeding and antibiotic
contact, cover newborn’s back with a blanket and
prophylaxis for premature rupture of membranes,
head with a bonnet for warmth.
among all others. In addition, the multi-stakeholder and
4. Proper cord clamping and cutting: 2 clamps are
cross-sectoral approach taken by the DOH, supported
placed on the newborn’s umbilical cord, side by side,
changes both within and outside of the health sector
and the umbilical cord is then cut between the
which drove improved care facilities. A detailed
clamps.
documentation of strategies that led to practice change
is now needed, alongside a cost-effectiveness analysis.

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