NCM 116 COMMENTS & NOTES: FOR FINALS

NOTES:

2/22/2021
Traumatic Lesion’s
• Acute head injury results from a trauma to the head, leading to brain injury or bleeding within the
brain. Effects of injury may include edema and hypoxia.
Manifestations of the injury can vary greatly from a mild cognitive defect to severe functional deficits. A
head injury is classified by brain injury type: fracture, hemorrhage, or trauma.
Fractures can be depressed, comminuted, or linear.
Hemorrhages are classified as epidural, subdural, intracerebral, or subarachnoid.

CAUSES
• Assault
• Automobile accident
• Blunt trauma
• Fall
• Penetrating trauma

ASSESSMENT FINDINGS
• Decreased level of consciousness (LOC)
• Disorientation to time, place, or person
• Otorrhea, rhinorrhea, frequent swallowing (if a CSF leak occurs)
• Paresthesia
• Unequal pupil size, loss of pupillary reaction (if edema is present)
• Pain at site of impact
• Wound at site of impact

DIAGNOSTIC TEST RESULTS

• CT scan shows hemorrhage, cerebral edema, or shift of midline structures.
• EEG may reveal seizure activity.
• ICP monitoring shows increased ICP.
• MRI shows hemorrhage, cerebral edema, or shift of midline structures.
• Skull X-ray may show skull fracture.

NURSING DIAGNOSES
• Ineffective tissue perfusion: Cerebral
• Decreased intracranial adaptive capacity
• Risk for injury
• Acute pain

TREATMENT
• Cervical collar (until neck injury is ruled out)
• Craniotomy: surgical incision into the cranium (may be necessary to evacuate a hematoma or evacuate
contents to make room for swelling to prevent herniation)
• Oxygen therapy: intubation and mechanical ventilation, if necessary (to provide controlled
hyperventilation to decrease elevated ICP)
• Restricted oral intake for 24 to 48 hours
• Ventriculostomy: insertion of a drain into the ventricles (to drain CSF in the presence of
hydrocephalus, which may occur as a result of head injury; can also be used to monitor ICP)

Drug therapy
• Analgesic: codeine phosphate
• Anticonvulsant: phenytoin (Dilantin)
• Barbiturate: pentobarbital, if unable to control ICP with dieresis
• Diuretics: mannitol, furosemide (Lasix) to combat cerebral edema
• Dopamine to maintain cerebral perfusion pressure above 50 mm Hg (if blood pressure is low and ICP is
elevated)
• Glucocorticoid: dexamethasone to reduce cerebral edema
• Histamine2 (H2)-receptor antagonists: cimetidine (Tagamet), ranitidine (Zantac), famotidine (Pepcid),
nizatidine (Axid)
• Mucosal barrier fortifier: sucralfate (Carafate)
• Posterior pituitary hormone: vasopressin if client develops diabetes insipidus

INTERVENTIONS AND RATIONALES

• Assess neurologic and respiratory status to monitor for signs of increased ICP and respiratory distress.
• Observe for signs of increasing ICP (including ICP measurements greater than 20 mm Hg for more than
10 minutes) to avoid treatment delay and prevent neurologic com promise.
• Assess neurologic and respiratory status to monitor for signs of increased ICP and respiratory distress.
• Observe for signs of increasing ICP (including ICP measurements greater than 20 mm Hg for more than
10 minutes) to avoid treatment delay and prevent neurologic compromise. • Minimize stimuli if ICP is
unstable to avoid increases in ICP. • Monitor and record vital signs and intake and output, hemodynamic
variables, ICP measurements, cerebral perfusion pressure, specific gravity, laboratory studies, and pulse
oximetry to detect early signs of compromise. • Assess for CSF leak as evidenced by otorrhea or
rhinorrhea. CSF leak increases the risk of infection. • Assess and treat pain. Pain may cause anxiety and
increase ICP.
• Assess cough and gag reflex to prevent aspiration.
• Monitor for signs of diabetes insipidus (low urine specific gravity, high urine output) to maintain
hydration.
• Administer I.V. fluids to maintain hydration.
• Administer oxygen and maintain position and patency of endotracheal tube, if present, to maintain
airway and hyperventilate the client to lower ICP.
• Assist with turning, coughing, and deep breathing to prevent pooling of secretions.
• Provide suctioning only as necessary to prevent increase in ICP.
• Maintain position, patency, and low suction of nasogastric (NG) tube to prevent vomiting.
• Maintain seizure precautions to maintain client safety.
• Administer medications as prescribed to decrease ICP and pain.
• Provide rest periods between nursing activities to avoid increase in ICP.
• Encourage verbalization of feelings about changes in body image to allay anxiety.
• Provide appropriate sensory input and stimuli with frequent reorientation to foster awareness of the
environment.
• Provide a means of communication, such as a communication board, to prevent anxiety.
• Provide eye, skin, and mouth care to prevent tissue damage.
• Reposition every 2 hours or maintain in a rotating bed if condition allows to prevent skin breakdown.

Teaching topics
• Explanation of the head injury and its implications
• Recognizing the signs and symptoms of decreased LOC
• Treatment measures • Medication use and possible adverse effects
• Recognizing the signs of seizures and safety precautions to take during a seizure
• Adhering to fluid restrictions
• Contacting the National Head Injury Foundation

• A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in
its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the
parts of the body served by the spinal cord below the level of the injury.
• Spinal cord injuries usually result from traumatic force on the vertebral column. Necrosis and scar
tissue form in the area of the traumatized cord. Damage to the spinal cord results in sensory and motor
deficits.
• The client may experience partial or full loss of function of any or all extremities and bodily functions.

CAUSES
• Congenital anomalies
• Penetrating wounds
• Infections
• Trauma resulting from situations, such as an automobile accident, diving into shallow water, or fall
• Tumors

ASSESSMENT FINDINGS
• Absence of reflexes below the level of the injury
• Flaccid muscle
• Loss of bowel and bladder control
• Neck pain
• Numbness and tingling
• Paralysis below the level of the injury
• Paresthesia below the level of the injury
• Respiratory distress

DIAGNOSTIC TEST RESULTS

• CT scan shows spinal cord edema, vertebral fracture, and spinal cord compression.
• MRI shows spinal cord edema, vertebral fracture, and spinal cord compression.
• Spinal X-rays reveal vertebral fracture.

NURSING DIAGNOSES
• Impaired physical mobility
• Posttrauma syndrome
• Powerlessness
• Anxiety
• Fear
• Disturbed body image

TREATMENT
• Flat position, with neck immobilized in a cervical collar
• Maintenance of vertebral alignment through skull tongs, Halo vest
• Specialized rotation bed

Surgery for stabilization of the upper spine such as insertion of Harrington rods.

Drug therapy
• Antianxiety agent: lorazepam (Ativan)
• Glucocorticoid: methylprednisolone infusion immediately following injury
• H2-receptor antagonists: cimetidine
• (Tagamet), ranitidine (Zantac), famotidine
• (Pepcid)
• Laxative: bisacodyl (Dulcolax)
• Mucosal barrier fortifier: sucralfate (Carafate)
• Muscle relaxant: dantrolene (Dantrium)

INTERVENTIONS AND RATIONALES

• Monitor neurologic and respiratory status to determine baseline and detect early complications.
• Assess for spinal shock to detect early changes in the client’s condition and initiate prompt treatment.
• Monitor and record vital signs and intake and output, laboratory studies, and pulse oximetry to detect
early changes in the client’s condition.
• Monitor for autonomic dysreflexia (sudden extreme rise in blood pressure) in clients with spinal injury
at level T6 or higher to prevent life-threatening complications.
• Administer fluids to maintain hydration.
• Administer oxygen, as needed, to maintain oxygenation to cells.
• Provide suctioning, if necessary, and encourage coughing and deep breathing to maintain patent
airway.
• Administer medications, as prescribed, to maintain or improve the client’s condition.
• Encourage verbalization of feelings about changes in body image, changes in sexual expression and
function, and altered mobility to reduce anxiety and depression.
• Reposition the client every 2 hours using the logrolling technique (only if the client is stabilized and not
in a specialty bed) to prevent pressure ulcers.
• Provide skin care to maintain skin integrity.
• Keep the tool available to open Halo vest in the case of cardiac arrest to maintain client safety.
• Maintain body alignment to maintain joint function and prevent musculoskeletal degeneration.
• Initiate bowel and bladder retraining to avoid stimuli that could trigger dysreflexia.
• Provide passive ROM exercises to maintain joint mobility and muscle tone.
• Provide sexual counseling to encourage questions and avoid misunderstandings.
• Provide emotional support to decrease anxiety and fear.

Apply antiembolism stockings to maintain venous circulation and prevent thromboembolism

Teaching topics
• Explanation of the disorder and treatment plan
• Medication use and possible adverse effects
• Nutritional therapy
• Exercising regularly to strengthen muscles
• Recognizing the signs and symptoms of autonomic dysreflexia, urinary tract infection, and upper
respiratory infection
• Continuing a bowel and bladder program ((as well as pseudomonas infection)
• Maintaining acidic urine with cranberry juice to prevent urinary tract infection
• Consuming adequate fluids: 3 qt (3 L)/day
• Using assistive devices with proper body mechanics for ADLs
• Maintaining skin integrity
• Using a wheelchair and proper transfer techniques such as moving the strong part of the client’s body
to the chair first
• Maintaining a sense of independence
• Contacting the National Spinal Cord Injury Association

Neuropathies
• Neuropathy is damage or dysfunction of one or more nerves that typically results in numbness,
tingling, muscle weakness and pain in the affected area. Neuropathies frequently start in your hands and
feet, but other parts of your body can be affected too.

Neuropathic pain is caused by damage to peripheral nerves or structures in the CNS.14 Typically
described as numbing, hot, burning, shooting, stabbing, sharp, or electric shock–like, neuropathic pain
can be sudden, intense, short lived, or lingering.
• Paroxysmal firing of injured nerves is responsible for shooting and electric shock–like sensations.
Common causes of neuropathic pain include trauma, inflammation.

Diabetic neuropathy is caused by high blood sugar levels sustained over a long period of time. Other
factors can lead to nerve damage, such as: damage to the blood vessels caused by high cholesterol
levels. mechanical injury, such as injuries caused by carpal tunnel syndrome.
• Nerve damage from diabetes can't be reversed. This is because the body can't naturally repair nerve
tissues that have been damaged.

Best vitamin for neuropathy

• B vitamins for neuropathy
• B vitamins are useful in treating neuropathy since they support healthy nervous system function. ...
• Supplementation should include vitamin B-1 (thiamine and benfotiamine), B-6, and B-12. ...
• A deficiency in vitamin B-12 is one cause of peripheral neuropathy.
• Foods rich in vitamin B :
• milk.
• cheese.
• eggs.
• liver and kidney.
• meat, such as chicken and red meat.
• fish, such as tuna, mackerel, and salmon.
• shellfish, such as oysters and clams.
• dark green vegetables, such as spinach and kale.

Disturbance in Visual and Auditory Function

CATARACT-is the clouding of the lens of the eye which leads to a decrease in vision. Cataracts often
develop slowly and can affect one or both eyes. Symptoms may include faded colors, blurry or double
vision, halos around light, trouble with bright lights, and trouble seeing at night.

Key signs and symptoms:

• Dimmed or blurred vision
• Better vision in dim light with pupil dilated
• Yellow, gray, or white pupil
Key test results:
• Ophthalmoscopy or slit-lamp examination confirms the diagnosis by revealing a dark area in the
normally homogeneous red reflex.
Key treatments:
• Extracapsular cataract extraction or intracapsular lens implant

Key interventions
• Provide a safe environment for the client.
• Modify the environment to help the client meet his self-care needs (for example, by placing items on
the unaffected side).

Glaucoma
Glaucoma is a group of eye conditions that damage the optic nerve, the health of which is vital for good
vision. This damage is often caused by an abnormally high pressure in your eye. Glaucoma is one of the
leading causes of blindness for people over the age of 60.

Loss of peripheral or side vision: This is usually the first sign of glaucoma. Seeing halos around lights: If
you see rainbow-colored circles around lights or are unusually sensitive to light, it could be a sign of
glaucoma. Vision loss: Especially if it happens suddenly.

Key signs and symptoms

• Acute angle-closure glaucoma
• Acute ocular pain
• Blurred vision
• Dilated pupil
• Halo vision
• Chronic open-angle glaucoma
• Initially asymptomatic

Key test results

• Ophthalmoscopy shows atrophy and cupping of optic nerve head.
• Tonometry shows increased intraocular pressure.

Key treatments
• Acute angle-closure glaucoma
• Cholinergic agent: pilocarpine
• Laser iridectomy or surgical iridectomy if pressure doesn’t decrease with drug therapy
• Chronic open-angle glaucoma
• Alpha-adrenergic agonist: brimonidine (Alphagan-P)
• Beta-adrenergic antagonist: timolol (Timoptic)
Key interventions
• Assess eye pain and administer medication as prescribed.
• Modify the environment for safety.

Retinal detachment

Retinal detachment describes an emergency situation in which a thin layer of tissue (the retina) at the
back of the eye pulls away from the layer of blood vessels that provides it with oxygen and nutrients.
Retinal detachment is often accompanied by flashes and floaters in your vision.

Key signs and symptoms

• Painless change in vision (floaters and flashes of light)
• With progression of detachment, painless vision loss may be described as a “veil curtain” or “cobweb”
that eliminates part of visual field

Key test results

• Indirect ophthalmoscope shows retinal tear or detachment.
• Slit-lamp examination shows retinal tear or detachment.

Key treatments
• Cryopexyhttps://www.youtube.com/watch?v=ueVYp4Rhl8s
• Scleral buckling – https://www.youtube.com/watch?v=v30ct9tQJtI&has_verifi ed=1
• or diathermy to reattach the retina

Key interventions
• Postoperatively instruct the client to lie on his back or on his unoperated side.
• Discourage straining during defecation, bending down, and hard coughing, sneezing, or vomiting

Ménière’s disease
• Meniere's disease is a dysfunction in the labyrinth (the part of the ear that produces balance) that
produces severe vertigo, sensorineural hearing loss, and tinnitus. It usually affects adults, men slightly
more often than women, between ages 30 and 60. After multiple attacks over several years, this
disorder leads to residual tinnitus and hearing loss.
• This disorder may also be called endolymphatic hydrops
• https://www.youtube.com/watch?v=qrk7OyAB_ss

CAUSES
• Autonomic nervous system dysfunction that produces a temporary constriction of blood vessels
supplying the inner ear
• Overproduction or decreased absorption of endolymph, which causes endolymphatic hydrops or
endolymphatic hypertension, with consequent degeneration of the vestibular and cochlear hair cells

ASSESSMENT FINDINGS
• Sensorineural hearing loss
• Severe vertigo
• Tinnitus

Key test results

• Audiometric studies indicate a sensorineural hearing loss and loss of discrimination and recruitment.
• Key treatments
• Restriction of sodium intake to less than 2 g/day
• Anticholinergic: atropine (may stop an attack in 20 to 30 minutes)
• Antihistamine: diphenhydramine (Benadryl) for severe attack
• Audiometric studieshttps://www.youtube.com/watch?v=A6uIZmrTCQA

Key interventions
• Advise the client against reading and exposure to glaring lights.
• Provide assistance when getting out of bed or walking.
• Instruct the client to avoid sudden position changes and any tasks that vertigo makes hazardous.

Before surgery
• Monitor fluid intake and output.
• Administer antiemetics as necessary, and give small amounts of fluid frequently.

After surgery
• Tell the client to expect dizziness and nausea for 1 to 2 days after surgery

Hearing Impairment

• Hearing loss results from a mechanical or nervous impediment to the transmission of sound waves.
Hearing loss may be partial or total.

There are three major forms of hearing loss:

• conductive loss—interrupted passage of sound from the external ear to the junction of the stapes and
oval window
• sensorineural loss—impaired cochlea or eighth cranial nerve dysfunction, causing failure of
transmission of sound impulses within the inner ear or brain
• mixed loss—combined dysfunction of conduction and sensorineural transmission.
Sudden deafness refers to sudden hearing loss in a person with no prior hearing impairment. This
condition is considered a medical emergency because prompt treatment may restore full hearing.

Noise-induced hearing loss, which may be transient or permanent, usually follows prolonged exposure
to loud noises (85 to 90 dB) or brief exposure to extremely loud noises (greater than 90 dB).

Presbycusis, an otologic effect of aging, results from a loss of hair cells in the organ of Corti. This
disorder causes progressive, symmetrical, bilateral sensorineural hearing loss, usually of high-frequency
tones.
• Minor decreases in hearing are common after age 20. Some deafness due to nerve damage occurs in
one of every five people by age 55.

CAUSES
• Acute infections
• Blood dyscrasias, such as leukemia and hypercoagulation
• Brain tumor
• Head trauma
• Loud noises
• Metabolic disorders (diabetes mellitus, hypothyroidism)
• Multiple sclerosis
• Ototoxic drugs (loop diuretics, aminoglycosides)

ASSESSMENT FINDINGS
• Gradual loss of perception of certain frequencies (around 4,000 Hz)
• Inability to understand spoken words
• Sudden deafness (in sudden hearing loss)
• Tinnitus DIAGNOSTIC TEST RESULTS
• Audiologic examination provides evidence of hearing loss.
• Weber, Rinne, and specialized audiologic tests https://www.youtube.com/watch?v=FgF91K7dU8Y
differentiate between conductive and sensorineural hearing loss.

NURSING DIAGNOSES
• Anxiety
• Ineffective health maintenance
• Disturbed sensory perception
• Disturbed body image

TREATMENT
• Hearing aids
• Overnight rest, for noise-induced hearing loss
• Reduce exposure to loud noises
• Speech and hearing rehabilitation
INTERVENTIONS AND RATIONALES
• Speak slowly and clearly and avoid shouting to help the client understand your voice.
• Make sure all staff members are aware of the disability and the client’s preferred communication
method to help communicate with the client.
• Provide emotional support.
• Determine cause of hearing loss, if possible to help minimize further hearing loss.
• Stand directly in front of the client with the light on your face so that the client can read your lips.
• Approach the client within his vision range and use visual cues to get his attention because the client
will depend more on visual cues.
• Monitor drug levels in the client receiving ototoxic drugs to minimize the risk of hearing loss.

OTC products causing Ototoxicity:

 Analgesics
 Antibiotics
 Tetanus antitoxin
 Antiseptics
 Antimalarials
 Caffeine
 Tobacco
 Eardrops containing propylene glycol

Teaching topics
• Explanation of the disorder and treatment plan
• Using protective devices to minimize exposure to loud noises
• Using and caring for a hearing aid

Responses to Altered Coordination

Injuries

FRACTURES
ARM AND LEG FRACTURES
• Loss of limb function
• Acute pain
•Deformity

Key test results

• Anteroposterior and lateral X-rays of the suspected fracture as well as X-rays of the joints above and
below it confirm the diagnosis.
Key treatments
• Closed reduction (restoring displaced bone segments to their normal position)
https://www.youtube.com/watch?v=cy6f7he2e4w
• Immobilization with a splint, a cast, or traction
• Open reduction during surgery to reduce and immobilize the fracture with rods, plates, and screws
when closed reduction is impossible, usually followed by application of a plaster cast
• Analgesics: morphine, acetaminophen, oxycodone (Percocet)

Key interventions
• Monitor vital signs and be especially alert for a rapid pulse, decreased blood pressure, pallor, and cool,
clammy skin.
• Administer I.V. fluids as needed.
• Assess for and treat pain with analgesics, as needed.
• If the fracture requires long-term immobilization with traction, reposition the client often. Assist with
active rangeof-motion (ROM) exercises to the unaffected extremities.
• Encourage deep breathing and coughing.
• Make sure that the immobilized client receives adequate fluid intake. Watch for signs of renal calculi,
such as flank pain, nausea, and vomiting.
• Provide cast care.
• Encourage and assist with ambulation as soon as possible. Demonstrate how to use crutches properly.
• Refer the client for physical therapy.

Motor Vehicles Collision- A traffic collision, also called a motor vehicle collision, car accident, or car
crash, occurs when a vehicle collides with another vehicle, pedestrian, animal, road debris, or other
stationary obstruction, such as a tree, pole or building.

Sports injuries are injuries that occur when engaging in sports or exercise. Sports injuries can occur due
to overtraining, lack of conditioning, and improper form or technique. Failing to warm up increases the
risk of sports injuries. Bruises, strains, sprains, tears, and broken bones can result from sports injuries.

Common bone Fracture

A transverse fracture occurs when a bone breaks at a 90- degree angle to the long axis of the bone. ...
• Oblique fracture. ...
• Comminuted fracture. ...
• Greenstick fracture. ...
• Stress fracture. ...
• Pathologic fracture.

How to Apply a Below Knee Conventional Cast

https://www.youtube.com/watch?v=rPajAfGgyTU

Synthetic Lower Leg Cast Removal

https://www.youtube.com/watch?v=y1n623RB1CY

A pathologic fracture is a broken bone that's caused by a disease, rather than an injury. Some conditions
weaken your bones, which makes them more likely to break.

Commonly responsible for pathological fractures:

Osteoporosis
Osteomalacia
Paget's disease
Osteitis
osteogenesis imperfect
benign bone tumours
and cysts
secondary malignant bone tumours
primary malignant bone tumours

Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone,
or both. As a result, bones become weak and may break from a fall or, in serious cases, from sneezing or
minor bumps. Osteoporosis means “porous bone.”

Osteomalacia refers to a marked softening of your bones, most often caused by severe vitamin D
deficiency. The softened bones of children and young adults with osteomalacia can lead to bowing
during growth, especially in weight-bearing bones of the legs. Osteomalacia in older adults can lead to
fractures.

Paget's disease of bone interferes with your body's normal recycling process, in which new bone tissue
gradually replaces old bone tissue. Over time, the disease can cause affected bones to become fragile
and misshapen.

Osteitis is inflammation of bone. More specifically, it can refer to one of the following conditions:
Osteomyelitis, or infectious osteitis, mainly bacterial osteitis. Alveolar osteitis or "dry socket“.

Osteogenesis imperfecta (OI) is a group of genetic disorders that mainly affect the bones. The term
"osteogenesis imperfecta" means imperfect bone formation.

Benign bone tumours The most common ones are endochondromas, osteochondromas, nonossifying
fibromas, chondroblastomas, osteoid osteomas, osteoblastomas, periosteal chondromas, giant cell
tumors and chondromyxoid fibromas. These tumors are often strongly affected by the hormones that
cause growth.

Malignant bone tumours • Osteosarcoma and Ewing's sarcoma, two of the most common malignant
bone tumors, are usually found in people age 30 or younger.
Malignant bone tumors include:
• Chondrosarcoma.
• Chordoma.
• Ewing's sarcoma.
• Neuroblastoma.
• Osteosarcoma.

Taking Care of Your Splint or Cast

• Keep your splint or cast dry. Moisture weakens plaster and damp padding next to the skin can cause
irritation. ...
• Walking casts. Do not walk on a "walking cast" until it is completely dry and hard. ...
• Avoid dirt. ...
• Padding. ...
• Itching. ...
• Trimming. ...
• Skin. ...
• Inspect the cast regularly.

Joints Disorders

• Osteoarthritis (OA) is a long-term chronic disease characterized by the deterioration of. cartilage in
joints which results in bones rubbing together and creating stiffness, pain, and impaired movement.

Key signs and symptoms

• Crepitation
• Joint stiffness
• Pain that’s relieved by resting the joints

Key test results

• Arthroscopy reveals bone spurs and narrowing of joint space.
• X-rays show joint deformity, narrowing of joint space, and bone spurs.

Key treatments
• Cold therapy
• Heat therapy
• NSAIDs: indomethacin (Indocin), ibuprofen (Motrin), sulindac
• (Clinoril), piroxicam (Feldene), flurbiprofen (Ansaid), diclofenac
• (Voltaren), naproxen (Naprosyn), diflunisal

Key interventions
• Assess musculoskeletal status.
• Assess for adverse reactions to aspirin and NSAIDs, especially signs of increased bleeding or bruising
tendency.

Gout
Gout is a metabolic disease marked by urate deposits in the joints, which cause painfully arthritic joints.
It can strike any joint butfavors those in the feet and legs. Primary gout (originating from a metabolic
cause that’s genetic or inborn) usually occurs in men older than age 30 and in postmenopausal women.

• Secondary gout (originating from drug therapy or from a metabolic cause that isn’t genetic or inborn)
occurs in elderly clients. Gout follows an intermittent course and • may leave clients free from
symptoms for years between attacks. Gout can lead to chronic disability or incapacitation and, rarely,
severe hypertension and progressive renal disease. The prognosis is good with treatment.

CAUSES
• Genetic predisposition
• Increased uric acid

ASSESSMENT FINDINGS
• Hypertension
• Back pain
• Inflamed, painful joints

DIAGNOSTIC TEST RESULTS

• Arthrocentesis reveals the presence of monosodium urate monohydrate crystals or needlelike
intracellular crystals of sodium urate in synovial fluid taken from an inflamed joint or a tophus.
• Blood studies show serum uric acid level above normal. The urine uric acid level is usually higher in
secondary gout than in primary gout.
• X-ray examination results are normal initially. X-rays show damage of the articular cartilage and
subchondral bone in chronic gout and outward displacement of the overhanging margin from the bone
contour

NURSING DIAGNOSES
• Chronic pain
• Impaired physical mobility
• Risk for injury
• Fear

TREATMENT
• Bed rest
• Immobilization and protection of the inflamed joints
• Local application of heat and cold
• Diet changes (avoiding purines and alcohol, achieving and maintaining optimum weight, increasing
fluid intake)

Drug therapy
• Antigout drug: allopurinol (Zyloprim)
• Uricosuric drug: probenecid (Probalan)
• Alkalinizing drug: sodium bicarbonate
• Corticosteroids: betamethasone
• (Celestone), hydrocortisone, prednisone
• NSAIDs: indomethacin (Indocin),
• naproxen (Naprosyn)
• Antilipemic: fenofibrate (Tricor)

INTERVENTIONS AND RATIONALES

• Encourage bed rest but use a bed cradle to keep bedcovers off extremely sensitive, inflamed joints.
• Assess for and treat pain, as needed, especially during acute attacks, to promote comfort.
• Apply hot or cold packs to inflamed joints to promote comfort.
• Administer anti-inflammatory medication and other drugs to decrease inflammation and increase
excretion of uric acid.
• Monitor for GI disturbances with colchicine administration to prevent complications.
• Encourage increased oral fluids (up to 2 qt [2 L]/day) to prevent renal calculi formation.
• Monitor serum uric acid levels regularly to evaluate the effectiveness of the treatment plan.
• Stress the importance of having serum uric acid levels checked periodically to help ensure compliance.
• Advise the client receiving allopurinol, probenecid, and other drugs to immediately report adverse
effects, such as drowsiness, dizziness, nausea, vomiting, urinary frequency, and dermatitis, to prevent
complications.
• Warn the client taking probenecid to avoid aspirin and other salicylates because their combined effect
causes urate retention.

Teaching topics
• Explanation of the disorder and treatment plan
• Medication use and possible adverse effects
• Adequate fluid intake
• Avoiding alcohol, especially beer and wine
• Sparing use of purine-rich foods, such as anchovies, liver, sardines, kidneys, sweetbreads, and lentils
• Losing weight, if obese

CARPAL TUNNEL SYNDROME

Carpal tunnel syndrome, also called median nerve compression, is a condition that causes numbness,
tingling, or weakness in your hand. It happens because of pressure on your median nerve, which runs
the length of your arm, goes through a passage in your wrist called the carpal tunnel, and ends in your
hand.

Key signs and symptoms

• Numbness, burning, or tingling in affected arm • Pain in affected arm and hand
• Weakness
• Pain in affected arm and hand

Key test results

• A blood pressure cuff inflated above systolic pressure on the forearm for 1 to 2 minutes provokes pain
and paresthesia along the distribution of the median nerve.
• Electromyography detects a median nerve motor conduction delay of more than 5 msec.

Key treatments
• Resting the hands by splinting the wrist in neutral extension for 1 to 2 weeks (if a definite link has been
established between the client’s occupation and the development of carpal tunnel syndrome, he may
have to seek other work)
• Corticosteroid injections: betamethasone (Celestone), hydrocortisone
• Nonsteroidal anti-inflammatory drugs (NSAIDs):
• indomethacin (Indocin), ibuprofen (Motrin), naproxen (Naprosyn)
• Surgical decompression of the nerve by resecting the entire transverse carpal tunnel ligament or by
using endoscopic surgical techniques

Key interventions
• Administer NSAIDs as needed.
• Encourage the client to perform hand exercises as much as possible.
• Assist with eating and bathing.
• After surgery, monitor vital signs and regularly check the color, sensation, pulse, and motion of the
affected hand.

LOW BACK PAIN

• HERNIATED NUCLEUS PULPOSUS- Herniated nucleus pulposus is a condition in which part or all of the
soft, gelatinous central portion of an intervertebral disk is forced through a weakened part of the disk,
resulting in back pain and nerve root irritation.

Key signs and symptoms

• Lumbosacral disk herniation
• Acute pain in the lower back that radiates across the buttock and down the leg
• Pain on ambulation
•Weakness, numbness, and tingling of the foot and leg
• Cervical disk herniation
• Neck pain that radiates down the arm to the hand
• Neck stiffness
• Weakness of the affected upper extremities
• Weakness, numbness, and tingling of the hand

Key test results

• Myelogram shows spinal cord compression.
• X-ray shows narrowing of disk space.
• Magnetic resonance imaging identifies spinal canal compression by the herniated disk and damage to
the intervertebral disk.

Key treatments
• Corticosteroid: cortisone
• NSAIDs: indomethacin (Indocin), ibuprofen (Motrin), sulindac (Clinoril), piroxicam (Feldene),
flurbiprofen (Ansaid), diclofenac sodium (Voltaren), naproxen (Naprosyn), diflunisal
• Surgery: laminectomy or discectomy https://www.youtube.com/watch?v=hcMT3a96XYw

Key interventions
• Monitor neurovascular status.
• Reposition the client every 2 hours using the logrolling technique.

Degenerative Osteoporosis

Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone,
or both. As a result, bones become weak and may break from a fall or, in serious cases, from sneezing or
minor bumps. Osteoporosis means “porous bone.”

Key signs and symptoms

• Deformity
• Kyphosis
• Pain
• Pathologic fracture

Key test results

• X-rays show typical degeneration in the lower thoracic and lumbar vertebrae. The vertebral bodies
may appear flattened and may look denser than normal. Loss of bone mineral becomes evident in later
stages.
• Bone mineral density is 2.5 standard deviations or more below the normal reference range (–2.5 or
less). https://www.youtube.com/watch?v=OkjndlCsqBQ

Key treatments
• Physical therapy
• Hormonal agents: conjugated estrogen (Premarin), parathyroid hormone
• Antiresorption drugs: calcium, vitamin D, calcitonin (Calcimar)
• Antihypercalcemic: etidronate (Didronel)
• Biphosphonates: alendronate (Fosomax), ibandronate (Boniva)

Key interventions
• Provide a safe environment and institute fall prevention measures.
• Encourage the client to perform weight-bearing or resistance exercises as able.
• Provide a balanced diet high in such nutrients as vitamin D, calcium, and protein.
• Administer analgesics and heat.
• Treat fractures.

Good sources of calcium include:

• milk, cheese and other dairy foods
• green leafy vegetables, such as broccoli, cabbage and okra, but not spinach
• soya beans
• tofu
• soya drinks with added calcium
• nuts
• bread and anything made with fortified flour
• fish where you eat the bones, such as sardines and pilchards

MODULE 3
• Relevant Legal, Moral and Ethical Standard of Care.

Learning Outcome: • Adapt to Ethico-legal considerations when providing safe, quality and professional
care.
• Recollect Graduate Attributes: Dynamism in Prayer Life
It is the mastery of the Knowledge, Skills and Attitudes (KSA) and the ability to apply the KSA effectively
in dealing with real life challenges in the social and professional world.

A. Patient’s Bill of Rights

1. Receive care that is respectful of your personal beliefs, cultural and spiritual values.
2. An explanation in terms that you can understand and to have any question answered concerning your
symptoms, diagnosis, prognosis, and treatment.
3. Appropriate assessment and management of your symptoms, including pain.
4. Know your: diagnosis; prognosis; testing and treatment to be used; risks of treatment and common
side effects of medications; financial considerations associated with medical care
5. Know the contents of your medical records through interpretation by the provider.
6. Know your health care team.
7. Develop a collaborative plan to prevent your medical problem from recurring.
As a Patient You Have The Responsibility to:
1. Provide Health Services with information about your current symptoms, including pain and
medications.
2. Provide Health Services with information about your medical and mental health history.
3. Ask questions if you do not understand the directions or treatment being given by a provider.
4. Keep appointments or notify Health Services within a reasonable time frame if you need to cancel.
5. Be respectful of others and others' property while at Health Services.
6. Limit the use of mobile devices while at Health Services.
7. Choose or change your provider.
8. Refuse to be examined or treated and to be informed of the consequence of such decisions.
9. Be assured of the confidential treatment of disclosures and records and to approve or refuse the
release of such information, except when release of specific information is required by law or is
necessary to safeguard you or the university community.
10. Be informed and provide consent to participate in research conducted at Health Services.
11.Participate in the consideration of ethical issues that may arise in the provision of your care.
12. Provide feedback on the services you receive.

B. Advance Directives Advance directive — A written document (form) that tells what a person wants or
doesn't want if he/she in the future can't make his/her wishes known about medical treatment.

Types of Advance Directives:

The living will.- An advance directive includes a living will and a durable power of attorney for health
care.Durable power of attorney for health care/Medical power of attorney.
A living will specifies a client’s wishes about medical care, including treatment options, in the event that
he becomes incompetent or no longer able to express his wishes.
POLST (Physician Orders for Life-Sustaining Treatment) ...
• Do not resuscitate (DNR) orders. ...
• Organ and tissue donation

C. Ethical Principles on Beneficence

• Beneficence in Nursing
• Beneficence is defined as “mercy, kindness, and charity.”
• Means two things: refraining from maltreatment and maximizing potential benefits to patients while
minimizing potential harm.

In practice, nursing beneficence takes on many different forms. Examples might include:
• Resuscitating a drowning victim
• Providing pain medication as soon as possible to an injured patient in the emergency room
• Lifting side rails on a patient’s hospital bed to prevent falls
• Providing vaccinations
• Performing daily tasks for patients who are unable to carry them out alone

Autonomy: The recognition that people have the right to make their own choices, hold their own views
and take actions based on their own personal values and belief systems.
Justice: Treating others equitably and with fairness.
Nonmaleficence: Doing no harm, whether intentionally or unintentionally.

D. R.A. 9442: Magna Carta for Persons with Disability

• In cases where the person with disability is also a senior citizen entitled to a 20% discount under
his/her valid senior citizen identification card (ID), the person with disability shall use either his/her PWD
ID Card or Senior Citizen ID card to avail of the 20% discount.

Section 13. • R.A. 9442: Magna Carta for Persons with Disability
Here are just a few of the types of discounts listed:
• Assistive technology discounts.
• Banking services special offers.
• Education discounts.
• Health care supplies at reduced rates.
• Prescription plans for discounted medicine.
• Tax breaks for disabled people.
• Transportation help and rides for those with disabilities.

E. RA 10054 Motorcycle Helmet Law

• Republic Act 10054 (RA 10054), known as the Motorcycle Helmet Act of 2009, is the primary law that
mandates all motorcycle riders to wear standard protective motorcycle helmets and provides for the
specific penalties for its violation.
• (a) Any person caught not wearing the standard protective motorcycle helmet in violation of this Act
shall be punished with a fine of One thousand five hundred pesos (Php1,500.00) for the first offense;
Three thousand pesos (Php3,000.00) for the second offense; Five thousand pesos (Php5,000.00) for the
third offense.

Different types of cast, molds, and tractions:

AN ORTHOPEDIC CAST, OR SIMPLY CAST

- is a shell, frequently made from plaster or fiberglass, that encases a limb (or, in some cases, large
portions of the body) to stabilize and hold anatomical structures—most often a broken bone (or
bones), in place until healing is confirmed.
 COLLAR CAST – FOR CERVICAL AFFECTATION &
 CERVICAL COLLAR-THE PURPOSE OF A CERVICAL COLLAR IS TO SUPPORT YOUR NECK AND
SPINAL CORD, AND TO LIMIT THE MOVEMENT OF YOUR NECK AND HEAD. THEY’RE TYPICALLY
MEANT FOR SHORT-TERM USE WHILE YOU RECOVER FROM AN INJURY, SURGERY, OR PAIN.
 AERO PLANE CAST AND SPLINT– FOR HUMERUS AND SHOULDER JOINT WITH COMPOUND
FRACTURE.
 BODY CAST – FOR LOWER DORSO-LUMBAR SPINE AFFECTATION.
 CYLINDRICAL LEG CAST – FOR FRACTURED PATELLA.
 CAST BRACE – FOR FRACTURE OF FEMUR (DISTAL CURVE) WITH FLEXION AND EXTENSION.&
 FUNCTIONAL CAST – FOR FRACTURED HUMERUS WITH ABDUCTION AND ADDUCTION
 BOOT LEG CAST – FOR HIP AND FEMORAL FRACTURE.
 BODY CAST – FOR LOWER DORSO-LUMBAR SPINE AFFECTATION.
 BASKET CAST – FOR SEVERE LEG TRAUMA WITH OPEN WOUND OR INFLAMMATION.
 DELBIT CAST – FOR FRACTURE OF TIBIA OR FIBULA.
 DOUBLE HIP SPICA CAST – FOR FRACTURE OF HIP AND FEMUR & DOUBLE HIP SPICA MOLD
 DOUBLE HIP SPICA MOLD – CERVICAL AFFECTATION WITH CALLUS FORMATION.
 FROG CAST – FOR CONGENITAL HIP DISLOCATION.
 HANGING CAST – FOR FRACTURED SHAFT OF THE HUMERUS.
 INTERNAL ROTATOR SPLINT – FOR POST HIP OPERATION.
 LONG ARM CIRCULAR CAST – FOR FRACTURED RADIUS OR ULNA.&
 LONG ARM POSTERIOR MOLD – FOR FRACTURED RADIUS OR ULNA WITH COMPOUND
AFFECTATION
 LONG LEG CIRCULAR CAST – FOR FRACTURED TIBIAFIBULA.&
 LONG LEG POSTERIOR MOLD – FOR FRACTURE TIBIAFIBULA WITH COMPOUND AFFECTATION.
 MINERVA CAST – FOR UPPER DORSAL OR CERVICAL AFFECTATION.
 NIGHT SPLINT – FOR POST POLIO.
 PANTALON CAST – FOR PELVIC BONE FRACTURE
 PATELLA TENDON BEARING CAST – FOR FRACTURED TIBIA-FIBULA WITH CALLUS FORMATION.
 QUADRILATERAL (ISCHIAL WEIGHT BEARING) CAST – FOR SHAFT OF FEMUR WITH CALLUS
FORMATION.
 QUADRILATERAL (ISCHIAL WEIGHT BEARING) CAST – FOR SHAFT OF FEMUR WITH CALLUS
FORMATION.
 SHORT ARM CIRCULAR CAST – FOR WRIST AND FINGERS.&
 SHORT ARM POSTERIOR MOLD – FOR WRIST AND FINGERS WITH COMPOUND AFFECTATION.
 SHORT LEG CIRCULAR CAST – FOR ANKLE AND FOOT FRACTURE.
 SHOULDER SPICA – FOR HUMERUS AND SHOULDER JOINT
  90-90 TRACTION-FOR FEMURAL FRACTURED . FOR FEMUR FRACTURE REDUCTION WHEN SKIN
TRACTION IS INADEQUATE. SKELETAL TRACTION WITH FORCE APPLIED THROUGH PIN IN DISTAL
FEMUR.
 BRYANTSTRACTION-BRYANT'S TRACTION IS USED FOR DEVELOPMENTAL DISLOCATED HIP(S)
(DDH). IN BRYANT'S TRACTION, THE CHILD'S BODY AND THE WEIGHTS ARE USED AS TENSION TO
KEEP THE END OF THE FEMUR (THE LARGE BONE THAT GOES FROM THE KNEE TO THE HIP) IN
THE HIP SOCKET.
 BUCK'S SKIN TRACTION IS WIDELY USED IN THE LOWER LIMB FOR FEMORAL FRACTURES,
LOWER BACKACHE, ACETABULAR AND HIP FRACTURES. SKIN TRACTION RARELY REDUCES A
FRACTURE, BUT REDUCES PAIN AND MAINTAINS LENGTH IN FRACTURES
 COTREL SKIN TRACTION - FOR SCOLIOSIS
 DUNLOP SUSPENSION-SKIN TRACTION IS PLACED ON THE FOREARM AND A SPECIAL FRAME
USED ON THE SIDE OF THE BED. ... IF A SUPRACONDYAR FRACTURE CANNOT BE REDUCED TO
OVER 90 DEGREES ELBOW FLEXION, THIS METHOD OF TRACTION IS AN ALTERNATIVE TO
INVASIVE METHODS SUCH AS A PERCUTANEOUS K-WIRES. IT ALLOWS SWELLING TO SUBSIDE.
 HALO PELVIC-HALO TRACTION HAS BEEN USED AS AN ADJUNCTIVE METHOD IN THE
TREATMENT OF SEVERE SPINAL DEFORMITIES.
 HAMMOCK SUSPENSION-FOR HNP -CONTINUOUS OR INTERMITTENT TRACTION HAS BEEN
REGARDED AS AN EFFECTIVE TREATMENT FOR HERNIATED CERVICAL DISCS BECAUSE IT
FACILITATES WIDENING OF THE DISC SPACES. THE TRACTION INDUCES PAIN RELIEF AND
REGRESSION OF THE HERNIATED DISCS.
 OVER HEAD TRACTION- FOR SUPRACHONDILAR OF THE HUMERUS AFFECTION
 ZERO DEGREE TRACTION- A MECHANICAL POSITION BETWEEN inad AND HUMERUS, AND THE
"SCAPULAR PLANE" IS WIDELY ACCEPTED AS A MECHANICAL PLANE AT THE SHOULDER JOINT

(ORTHO HARDWARE DISCUSSION)

LEGAL ASPECTS OF NURSING

The Philippine Nursing Law

The word "law" may be defined as a rule of conduct pronounced by controlling authority, which may be
enforced.

There are three essential characteristics of every law:

-The first one is the authority or the right to declare the rule exists.
-The second is that such rule is pronounced or expressed and that its source can be identified.
-Lastly, a right to apply the same must be provided.

Nursing Jurisprudence
- department of law which comprises all legal rules and principles effecting the practice of nursing
- includes the study and interpretation of rules and principles and their application in the regulation
of the practice of nursing
Functions of Law in Nursing:
- provides a outline for establishing what nursing actions in the care of patients are legal
- explains the nurse’s responsibilities from those of other professionals
- helps to establish the boundaries of independent nursing actions
- assists in maintaining a standard of nursing practice by making nurses accountable to the law

Brief History of the Philippine Nursing Law

The first law that had to do with the practice of nursing was contained in Act No.2493in 1915, which
regulated the practice of medicine. This act provided for the examination and registration of nurses in
the Philippine Islands. During that time, the applicants need to be only twenty years old, of good
physical health and good moral character. Graduates of intermediate courses of the public school could
enter the school of nursing, which was then giving only two years, and a half of instruction. These
graduates were called first class nurses. Those who desired to be second-class nurses filed an application
with the district health officer in the district where they resided. In 1919 Act 2808was passed-this is
known as the First True Nursing Law. It created among others a board of examiners for nurses. However,
it was in 1920 that the first board examination in the Philippines was given. On June 19, 1953, the
Philippine Nursing Law or R.A. 877 was passed. This act regulated the practice of nursing in the
Philippines. One of the landmarks in the history of the nursing profession in the Philippines is the
Presidential Proclamation of a Nurses' Week. Under Proclamation No. 539dated October 17, 1958 the
President of the Philippines designated the last week of October every year beginning in 1958 as Nurses'
Week. On June 18, 1966, Republic Act 4704amended certain portions of R.A. 877. The following were
included among the salient changes:
a. The scope of nursing practice was broadened to circumscribe the whole management of the
care of patients and the acts constituting professional practice of nursing were spelled out to include
such services as reporting, recording and evaluation of a patient’s case, execution of nursing procedures
and techniques, direction and education to secure physical and mental care and the application and
execution of physician’s orders concerning treatment and medication.
b. The minimum age required of applicants for admission to the nurse’s examination was
lowered from 21 to 18 years of age, but no candidate who passed the examination was permitted to
practice the profession until he or she reached the age of 21.

Republic Act 7164, introduced by Senator Heherson Alvarez, codified and revised all the laws regulating
the practice of nursing in the Philippines. It was known as the Philippine Nursing Act of 1991.

In October 21, 2002,Republic Act No. 9173otherwise known as “The Philippine Nursing Act of 2002”
replaced R.A. 7164 .
There are laws governing the practice of Nursing, one of which is House Bill No. 4955, AN ACT
PUNISHING THE MALPRACTICE OF ANY MEDICALPRACTITIONER IN THE PHILIPPINES AND FOR OTHER
PURPOSES

Legal Liabilities in Nursing

As nurses begin their professional obligations, their legal responsibilities begin as well. Their license to
practice attests that they are qualified under the law to practice their profession. The Philippine Nursing
Act of 1992 is the best guide the nursecan utilize as it defines the scope of nursing practice. There are
also standards of care that may be used as criteria in evaluating their work. The nurses are enjoined to
be familiar with the Philippine Nursing Law, and the standards of nursing care, other laws which affect
nursing practice and their code of ethics.

Responsibility and Accountability for the Practice of Professional Nursing

When nurses undertake to practice their profession, they are held responsible and accountable for the
quality-of performance of their duties. Nurses employed in an agency, institution, or hospitals are
responsible directly to their immediate supervisors. Private duty nurses, being independent
practitioners, are held to a standard of conduct that is expected of reasonably prudent nurses. The
standard is clearly defined, legal expectation to which nurses are held accountable.

A nurse assumes responsibility and accountability for all nursing care delivered.

Responsibility
- refers to the execution of duties associated with a nurse’s particular role. That is, the nurse is
responsible for providing care within established standards of the profession. The responsible nurse
demonstrates characteristics of reliability and dependability.
Accountability
- refers to the ability to answer for one’s own actions. The nurse is accountable to herself most of all.
He/she also balances accountability to the patient, the profession, the employing institution, and
society.
Liability
- an obligation one has incurred or might incur through any act or failure to act.-When the nurse fails
to meet the legal expectations of care, the client can initiate action if harm or injury is incurred by
the client.
Professional Negligence
The term negligence refers to the commission or omission of an act, pursuant to a duty, that a
reasonably prudent person in the same or similar circumstances would or would not do, and acting or
the non-acting is the proximate cause of injury to another person or his property.

The elements of professional negligence are:

(1) existence of a duty on the part of the person charged to use due care under circumstances,
(2) failure to meet the standard of due care,
(3) the foreseeability of harm resulting from failure to meet the standard, and
(4) the fact that the breach of this standard resulted in an injury to the plaintiff.

Malpractice
Malpractice in the usual sense implies the idea of improper or unskillful care of a patient by a nurse. It
would also see that malpractice also denotes stepping beyond one's authority withserious
consequences.

Medical Orders, Drugs, and Medications

R.A. 6675 states that only validly registered medical, dental and veterinary practitioners, whether in
private institution/ corporation or in the government, are authorized to prescribe drugs. Prescriptions
made by unauthorized persons constitute illegal practice of medicine, dentistry or veterinary medicine
and is punishable under R.A. 2832 of the Medical Act of 1959, R.A. 4419 of the Dental Act, and R.A. 382
or the Veterinary Act.

In accordance with R.A. 5921, or the Pharmacy Act as amended, all prescriptions must contain the
following information: name of the prescriber, office address, professional registration number,
professional tax receipt number, patient’s/client’s name, age and sex, and date of prescription. R.A.
6675 requires that the drugs be written in their generic names.

The dependent and coordinated function of the nurse pertains to the application and execution of
written legal orders of physicians concerning treatment and medications. Only when these orders are
legal in writingand bear the doctor’s signature does the nurse have the legal right to follow them.
Written orders are better understood and chances of error are minimized if they are clear, specific,
complete and legible.Verbal orders can be minimized if the nurse seeks a clear understanding from the
physicians in establishing a policy concerning the importance of written orders.

The general rule requiring a nurse to execute all lawful orders of a physician is tempered by common
sense. The nurse must not execute an order if she is reasonably certain it will result in harm to the
patient. In such case she must speak out and risk incurring the physician’s resentment or ire rather than
a lawsuit.

It is preferable to raise the matter of carrying out the procedure as a point of clarification in a tactful,
acceptable manner .A nurse must see to it that she understands the action of a drug, its minimum and
maximum dosages, route of administration, and untoward effects so that she may skillfully, safely, and
effectively carry them out. She should be able to report and record the effects on the patient so that the
doctor can judge its therapeutic value and know when to discontinue its use.

Tests and treatments should be explained to the patient in accordance with the general plan of his care
so that the patient can give full consent and cooperate in its implementation. Any unfavorable
psychologic or physical reaction should be likewise reported so that the proper action maybe taken.
Sometimes, however, refusal may be due to inaccurate presentation of facts. Patients must receive
special sympathetic attention from the nurses. Every effort should be made to correct inaccurate views
and modify superficially-held beliefs.

Intravenous Therapy and Legal Implications

Nurses now participate in complex intravenous therapy procedures that were once performed only by
doctors. Because of this change, nurses must remember that Tapacion2021 their legal right to give
intravenous injections is based on the Philippine Nursing Act of 1991 Section 28which state that "in the
administration of intravenous injections, special training shall be required according to protocol
established. "Therefore, nurses have to undertake a certified training course on intravenous therapy.

In giving intravenous injections, nurses should also follow the policies of their agencies. Even if nurses
have formal training on IV therapy, if the hospital does not allow them to do so, then they may not do
the procedure.

Board of Nursing Resolution no. 8 states that any registered nurse without such training and who
administers IV injections to patients, shall be held liable, either criminally under Sec. 30 ( c) Art. VII of
said law or administratively under Sec. 21 Art. III or both (whether causing or not injury or death to the
patient).

Telephone Orders
There are legal risks by telephone orders. These may be misunderstood or misinterpreted by the
receiving nurse. Sometimes too, messages from telephones may sound unclear or garbled because of
some trouble in the telephone lines. Most importantly, the signature of the ordering physician is not
present and this order may later be denied incase errors exist or court litigations arise.

Consent to Medical and Surgical Procedures

Consent is defined as a “free and rational act that presupposes knowledge of the thing to which consent
is being given by a person who is legally capable to give consent.” The consent signed by the patient or
his authorized representative/legal guardian upon admission is for the initial diagnosis and treatment.
Subsequent treatments/operations require individual, informed consent.

Before any medical or surgical procedure can be performed on a patient, consent must be obtained
from the patient or his authorized representative who may be his parent or guardian. It is only in case of
emergency where the consent requirement does not apply. The physician should give as much
information about a contemplated procedure and the patient should receive enough information to
allow him to give an informed consent for such procedure or treatment. The intentional touching or
unlawful beating of another person without authorization to do so is a legal wrong called battery.

Nature of Consent
Consent is an authorization, by a patient or a person authorized by law to give the consent on the
patient's behalf that changes a touching from non-consensual to consensual.

It is the nurse who actually secures the consent of the patient upon admission. This consent is usually
for diagnostic procedures and initial treatment deemed necessary by the medical staff. To substantiate
the patient’s consent, a written authorization is needed as proof against any liability that may arise due
to an alleged unlawful touching of a patient.

Informed consent. “It is established principle of law that every human being of adult years and sound
mind has the right to determine what shall be done with his own body. He may choose whether to be
treated or not and to what extent, no matter how necessary the medical care, or how imminent the
danger to his life or health if he fails to submit to treatment

The essential elements of informed consent include

(1) the diagnosis and explanation of the condition;
(2) a fair explanation of the procedures to be done and used and the consequences;
(3) a description of alternative treatments or procedures;
(4) a description of the benefits to be expected;
(5) material rights if any; and
(6) the prognosis, if the recommended care, procedure, is refused.

Proof of Consent. A written consent should be signed to show that the procedure was the one
consented to and that the person understood the nature of the procedure, the risks involved and the
possible consequences.

A signed special consent is necessary before any medical or surgical treatment is done such as x-rays,
special laboratory tests, blood transfusions, operations, cobalt therapy, or chemotherapy and the like.

Who Must Consent. Ordinarily, the patient is the one who gives the consent in his own behalf.
However, if he is incompetent (such as in the case of minors or the mentally ill) or physically unable and
is not an emergency case, consent must be taken from another who is authorized to give itin his behalf.

Consent of Minors. Parents, or someone standing in their behalf, give the consent to medical or surgical
treatment of a minor. Parental consent is not needed however, if the minor is married or otherwise
emancipated.

Consent of Mentally ill . A mentally incompetent person cannot legally consent to medical or surgical
treatment. The consent must be taken from the parents or legal guardian.

Emergency Situation. When an emergency exists, no consent is necessary because inaction at such time
may cause greater injury. A mother who is on the advanced stage of labor or a patient who goes to the
emergency room gives an implied consent to an immediate treatment or attendance. However, if time
is available and an informed consent is possible, it is best that this be taken for the protection of all
parties concerned.

Refusal to Consent. A patient who is mentally and legally competent (sane mind and of legal age) has
the right to refuse to permit touching of his body or to submit to a medical or surgical procedureno
matter how necessary, nor how imminent the danger to his life or health if he fails to submit to
treatment. Examples are patients who, because of their religious beliefs, may refuse blood transfusion.

A patient may refuse to consent due to inadequate information regarding the procedure to be done. If
after the explanation, he still refuses to sign the consent form, he should be made to fill out the release
form to protect the hospital and/or agency and its personnel from any liability that may result from his
refusal. If he refuses to sign the release form, this should be noted in his chart. The competent person
has a legal and ethical right to refuse treatment, and this right is formally established.

Consent for Sterilization. Sterilization is the termination of the ability to produce offsprings. The
husband and the wife must consent to the procedure if the operation is primarily to accomplish
sterilization.
When the sterilization is medically necessary, the sterilization is an incidental result such as in cases of
abruptio placenta, ectopic pregnancies or ruptured uterus, the patient's consent alone is sufficient.

Medical Records The value of medical records is both scientific and legal. As a record of illness and
treatment, it saves duplication in future cases and aids in prompt treatment. The record supplies rich
material for medical and nursing research. It serves as a legal protection for the hospital, doctor and
nurse by reflecting the disease or condition of the patient and his management. Nurses must remember
the rule. "If it was not charted, itwas not observed or done.

”In the performance of their duties, nurses are expected to record fully, accurately, legibly, and
promptly their observations from admission to the time of the Tapacion2021 patient’s discharge. Daily
notes should include not only medications and treatments given or rendered but also the physical and
emotional symptoms exhibited by the patient. The nurses’ notes are aids to medical diagnosis and in
understanding the patient’s behavior.

Since patients have the right to confidentiality of these records, nurses are legally and ethically bound to
protect the patient’s chart from unauthorized persons. Permission has to be taken from the hospital
authorities for authorization to secure any information from the patient’s chart. Nurses are responsible
for safeguarding the patient’s record from loss or destruction or from access by persons who are not
legally authorized to read such.

Legal Responsibilities of Students

Nursing students are responsible for acquiring the knowledge and skills necessary to become a safe
practitioner. Included in this knowledge and skill development is the awareness of ethical principles and
the process of ethical decision making.
Nursing students must act as reasonably prudent persons, equivalently with education and experience,
when performing nursing duties. They must perform only those tasks that they are competent to
perform.

Liability for the Work of Nursing Students Under the Philippine Nursing Act of 2002 R.A. 9173,

nursing students do not perform professional nursing. They are to be supervised by their Clinical
Instructors.
In order that the errors committed by nursing students will be avoided/minimized, the following
measures should be taken:
1. Nursing students should always be under the supervision of their Clinical Instructors.
2.They should be given assignments that are in level of their training, experience and competency.
3.They should be advised to seek guidance specially if they are performing a procedure for the first
time.
4.They should be oriented to the policies of the nursing unit where they are assigned.
5.Their performance should be assessed frequently to determine their strengths and their weaknesses .
6.Frequent conferences with the students will reveal their problems, which they may want to bring to
the attention of their instructors or vice-versa.
Discussions of these problems will iron out doubts and possible solutions may be provided

Charting Done by Nursing Students

When a nurse or a clinical instructor countersigns the charting of a nursing student, she attests that she
has personal knowledge of information and that such is accurate and authentic. Anyone who
countersigns without verification commits herself to possible legal risk.

Source: Venzon, L. & Venzon, R. (2010). Professional Nursing in the Philippines 11thedition

***Incident Reports The primary purpose of an incident report is to document and prevent possible
consequent injuries. Classifying an event, as an incident does not imply that someone made a mistake, it
only means that something unusual happened.

Cited: https://studylib.net/doc/7070653/legal-aspects-of-nursing-the-philippinenursing-law
 Module 4
Continuing Professional Development Programs

A. In-service Training programs

• An in-service program is a professional training or staff development effort, where professionals
are trained and discuss their work with others in their peer group. It is a key component of
continuing medical education for physicians, pharmacists, and other medical professionals.
• Training is teaching, or developing in oneself or others, any skills and knowledge or fitness that
relate to specific useful competencies. Training has specific goals of improving one's capability,
capacity, productivity and performance.

Purpose of inservice training

In-service education is designed for the manpower development of the school system and the
educational enterprise as a whole. If teachers are to perform their functions effectively and efficiently, it
becomes imperative for them to require training in new skills and modern methodology.
There are a number of different types of training we can use to engage an employee. These types are
usually used in all steps in a training process (orientation, in-house, mentorship, and external training).

B. Continuing Education
• Continuing education generally refers to any postsecondary learning or programs that adults
pursue after formal education. This can vary from seminars or one-time classes to online courses
and entire degree programs. Some professions require continuing education in a variety of ways.
• Continuing education is required for workers to stay current with the latest developments, skills,
and new technologies required for their fields. Certain professions also require continuing
education to comply with laws, remain licensed or certified, or maintain membership in an
association or licensing body.

What are examples of professional development?

Professional Development Examples
• Continuing Education. (Masters,PHd)
• Participation in professional organizations.(PNA)
• Research.
• Improve job performance.
• Increased duties and responsibilities.
• Approaches to professional development:
• Skill Based Training.
• Job Assignments.

C. Formal Education
• Formal education encompasses primary, lower and upper secondary education, higher and
university education that culminate in the achievement of a degree or a professional qualification or
diploma or a recognised certification as well as adult education programmes.
• Formal learning refers to a type of learning program in which the goals and objectives are defined
by the training department, instructional designer, and/or instructor. ... Examples of formal learning
include classroom instruction, web-based training, remote labs, e-learning courses, workshops,
seminars, webinars, etc.

Characteristics of formal education

• Formal education is hierarchically structured.
• It is planned and intentional.
• Planned fees are paid regularly.
• It has a chronological grading system.
• It has a curriculum and is subject-oriented. ...
• The child is taught by the teachers.

D. Self-Directed Learning Initiatives

• Self-directed learning is a process in which individuals take the initiative, with or without the help
of others, in diagnosing their learning needs, formulating learning goals, identifying human and
material resources for learning, choosing and implementing appropriate learning strategies, and
evaluating learning ...

Module 5
Filipino Culture, Values and Practices in Relation to of At -Risk and Sick adult
Clients with Acute and Chronic alterations/ problems in Nutrition, and Gastro
intestinal, Metabolism and Endocrine, Perception and Coordination

Filipino Culture
What are health care beliefs and practices unique to the Filipino culture?
• Filipinos, especially older adults, tend to cope with illness by relying on advice from family and friends,
and by faith in God. In fact, experiencing a complete recovery from an illness is often regarded as
personally witnessing a miracle—greatly influencing how Filipinos view healthcare.
What are the values of Filipino culture?
• Key values such fellowship, respect and acceptance are found throughout the culture, with many
Filipinos displaying a warming and hospitable demeanour. The Philippines is made up of over 7,000
islands, of which approximately 2,000 are inhabited.

How do you show respect in Filipino culture?

• Pagmamano, or simply mano is an honoring gesture used to greet elders in the Philippines. To show
respect, a younger person asks mano po which means “your hand, please” and then proceeds to place
the back of the elder's hand lightly on their forehead.

Language, literacy and cultural barriers

• differences in language or ethnicity between care providers and patients,
• a care provider not knowing how to use an interpreter appropriately,
• a lack of reliable professional interpreter services,
• a lack of printed information in the patient's first language.
• What do Filipinos value?
• The family. The family is at the center of the Filipino community. ...
• Humor and positivity. Optimism, humor, and positivity are valued traits in the Philippines. ...
• Flexibility and adaptability. ...
• Faith and religion. ...
• Filipino hospitality. ...
• Brief Philippine history. ...
• Languages of the Philippines. ...
• Religion.
• Filipino cultural beliefs
• Seven common Filipino cultural beliefs—namamana, lihi, sumpa, gaba, pasma, namaligno, and kaloob
ng Diyos
• Filipino word depicting cultural beliefs English translation
• Namamana Inheritance • Lihi Conception or maternal cravings
• Pasma Hot and cold syndrome
• Sumpa and gaba Curse
• Namaligno Mystical and supernatural causes
• Kaloob ng Diyos God’s will

• Namamana
BA, a 6-year-old girl, was first brought to clinic due to the prompting of her school teacher. She
was observed to be of significant short stature when compared to her peers. However, no pediatric
genetics consults were previously pursued because short stature was said to be “namamana” in their
family. During her evaluation with a medical geneticist, she was diagnosed to have achondroplasia. The
family was shocked upon hearing this information.

• Lihi
 LC is a 25-year-old female who was seen at the local health clinic due to flu-like symptoms.
During examination, she was noted to have crab-like arms and legs and her family history revealed that
both her parents and a maternal aunt also have the same condition. No prior consultations were
pursued due to their family’s belief that her maternal grandmother had taken a “lihi” for crabs while
pregnant, hence giving birth to children with crab-like limbs. On consult, she was diagnosed to have
ectrodactyly, or split hand and foot malformation.

• Pasma
MP is a 30-year-old female who had just delivered her first child via a caesarian section. The
delivery was complicated by severe blood loss and late post-partum hemorrhage, requiring several
blood transfusions and prolonged hospital stay. Fourteen days postpartum, the patient complained of
uncontrollable emotions. She was admitted with the impression of post-partum psychosis. Assessment
revealed a family history of depression disorder. During admission, a family member asks, “Kaya po ba
siya nagkaganyan ay dahil po ba sa pagligo niya pagkatapos manganak?” (Free translation: Is the reason
for her condition a result of her taking a bath after giving birth?). And, a family member answers, “Siguro
napasok siya ng lamig?” (Free translation: Probably, a cold air entered her body?).

• Sumpa and gaba

AS, a 12-year-old girl, is noted to have baldness and senile appearance, and her mother shared
that these features started when she was 5 years old. At her genetics consult, she was diagnosed to
have Progeria and was featured in the local media. Her father referred to her as “sumpa” of the family.
Her mother narrated that her husband would always beat AS and blamed her for their life struggles. This
became habitual and her mother decided to take AS and her younger sisters away. • GV is a 33-year-old
married woman who sought consult at the cancer genetics clinic due to changes in bowel movement
and sudden weight loss. She was diagnosed with colon cancer, and her family history is significant for
multiple members with previous diagnosis of cancer (e.g., kidney, endometrial, renal, and liver cancers).
With resignation, the patient shared during the clinic visit that the cancers in the family are due to
“gaba.”

• Namaligno
JH, a 28-year-old female, was admitted in the emergency room for severe abdominal pain and
increased abdominal girth. Physical examination and series of diagnostic tests revealed that she has
ovarian cancer. She had several prior consultations with a traditional healer who told her that the
increase in abdominal girth was due to a “maligno” or a supernatural being who took fancy at her. Her
family history showed that her mother and two maternal aunts died of early-onset breast and ovarian
cancers.

• Kaloob ng Diyos
CA is a 33-year-old who came for genetic counseling because of recurrent pregnancy loss. She is
a gravida 7 para 0 wherein all pregnancies terminated before 12-week age of gestation as early
embryonic demise or blighted pregnancy. When her psychosocial status was assessed, her acceptance of
the situation was embodied with the belief in God’s will. She was asked how she was coping with the
losses and she responds “Siguro, kaloob ng Diyos ito.” (Free translation: Perhaps it is God’s will that all
these happened).

Filipino Culture, Values and Practices in Relation to of At -Risk and Sick adult
Clients with Acute and Chronic alterations

• An Albularyo is a "witch doctor" commonly found in the more rural areas of the Philippines who heals
people using herbs and traditional practices such as hilot or massage. Their patients are usually common
folk who have trouble affording legitimate medical services, or those who are very traditional and/or
superstitious.
• Fresh or dried gumamela flowers and leaves that are mashed, crushed or pounded – softened in boiled
water, can be applied directly to the skin with the help of gauze or a clean cloth to keep it in place. This
is used to treat headaches, boils, swelling, abscesses and mumps when applied to the affected area.
• Do you know Tuba-tuba leaf are useful for our health as well as for curing dangerous diseases.(should
be used Cautiously. It has yet to be approved by the FDA.)

These are 18 benefits of Tuba-Tuba leaves:

1. Mild Cough Medicine • -For curing mild cough, just simply prepare around 7 pieces of young tuba-
tuba leaves. Squeeze them and hold the water in a glass. Consume it in the morning before consuming
anything.
2. Lowering High Blood Level • -Hypertension is a dangerous condition that can actually invite another
disease to the body just like stroke. For lowering the high blood pressure, consuming the boiling water
of tuba-tuba leaves is a great idea.
3. Healing Eczema and Rheumatic • -Prepare around 5 pieces of either young or old tuba-tuba leaves.
Squeeze them with the use of your hands until they are smooth. Apply the concoction in those painful
areas for some time. After doing so, clean the affected area.
4. Treating Ulcer • -Take about 8 pieces of old and medium tuba-tuba leaves. Rinse them with the help
of warm water. Squeeze them until they are half smooth. Apply the mixture on ulcers area. Leave it for a
couple of minutes to dry and after doing so, clean the area.
5. Asthma and Hard Breathing Medicine • -Prepare at least 7 pieces of tuba-tuba leaves that are
commonly used as a nest for red ants. Squeeze those leaves and hold the water until it reaches more or
less of a half glass. Consume it every morning until you feel a lot better.
6. Healing Acnes • -Crush some pieces of tuba-tuba leaves. After doing so, add water and apply the
mixture on the acnes. Wait until the skin pores absorbs the mixture then rinse it with warm water. This
mixture is usually used by those people from the ancient times in order to maintain their beautiful faces.
7. Treating Back Pain • -Tuba-tuba leaves can also be used for treating back pain. Just take at least 20
pieces of tuba-tuba leaves and boil them with 5 glasses of water and leave it until it becomes only 3
glasses of water. Consume ¾ glass of it on a daily basis.
8. Skin Face Regeneration • -Tuba-tuba leaves can also be used for skin face regeneration. Prepare
around 8 pieces of its leaves and boil them with 3 glasses of water and wait until it turn to one. Consume
this concoction for at least twice a week until you notice its best result.
9. Healing Uric Acid • -Uric acid frequently attacks older men. Nevertheless, both of young men and
women have the tendency to suffer from this illness, too. Tuba-tuba leaves can actually help you with it.
Just simply boil 10 pieces of its leaves which are already old but the color are still in green and fresh, not
brown of dry, with a glass of water. After doing so, once it becomes warm, you can now consume it for
at least twice a day.
10. Treating Diabetes • -Another benefit that people can actually get from tubatuba leaves is its ability
to treat diabetes. The level of high blood sugar in the body can be reduced by consuming boiling water
of tuba-tuba leaves because it can lower down the blood sugar into its normal level. The normal level of
sugar level is from 70 to 120mg.
11. Curing Cancer • -Tuba-tuba leaves are known to be potent in curing cancer that is a hundred times
stronger than chemotherapy. Just take 10 pieces of it leaves and then boil them with 3 glasses of water
until it becomes only a glass. Consume it for at least twice a day for about 2 consecutive weeks. They are
said to be stronger than chemotherapy due to its powerful ability in diminishing the growth of abnormal
cells and assist the normal cells to growl well.
12. Medicine for Hemorrhoids • -People who are suffering from hemorrhoids should avoid consuming
spicy and acid foods because they have to ability to trigger it. However, the inner medication should also
be done. One of the traditional medications for hemorrhoids is tuba-tuba leaves. Just boil at least 10
pieces of its leaves with 3 glasses of water until it becomes one. Consume the concoction on a daily
basis.
13. Lessening Lice • -Tub-tuba leaves can also be used on lessening the lice. Its power is just the same as
potent chemical medication that is made by factories. Simply boil old tuba-tuba leaves and utilize the
water for washing your hair. Do this regularly
14. Treating Liver • -The liver is not healthy if there is an inflammation in it. It happens due to the
patient’s poor living habit just like consuming drugs or excessive amounts of alcohol. In order to treat
this issue, boil about 7 pieces of tuba-tuba leaves with 3 glasses of water until it turns to one. Consume
it for twice a day before sleeping.
15. Getting Rid of Blackheads • -Blackheads are known to be a type of acne that is produced by too
much oil in the skin pores. They are commonly found on the face, back, arms as well as chest and
shoulders. Tuba-tuba leaves are really effective in getting rid of them. Just take about 5 pieces of its
leaves and then rinse them. Afterwards, crush them until they are smooth and apply on the affected
area every night before sleeping.
16. Preventing Infection • -Tuba-tuba leaves are powerful for preventing infections. Infection is a health
issue due to germs that are coming into the body. The usual symptom of it is fever because it is the sign
that the body is being attacked by the germs. Due to its high content of antioxidant, they are known to
be potent in treating infection. Simply prepare at least 5 pieces of tuba-tuba leaves and boil them with 5
glasses of water until it becomes 1. Consume it on a regular basis.
17. Eliminating Tumor • -Tumor is an illness due to the inflammation that it brought to the body. Every
inflammation whether it is dangerous or not can be called as tumor because it is the place where
abnormal cells will grow. Tuba-tuba leaves are loaded with Acetogenis and this substance has the ability
to eliminate the abnormal cells that causes tumor without even affecting the other cells. Prepare at least
11 pieces of tuba-tuba leaves and boil them in 2 glasses of water until it turns to only half glass.
Consume this liquid on a daily basis before going to sleep for a month.
18. Reducing Cholesterol Level • -Some researches have shown that tuba-tuba leaves have the ability to
strongly lower the level of bad cholesterol in the blood. It also contains a substance that can actually
eliminate the bad cholesterol in the blood. Bad cholesterol commonly goes together with poor choices
of food consumption just like fried duck, fried chicken, fritters and other oily foods. In addition, the oil
that has been used for numerous times until it becomes black is the main source of bad cholesterol in
the body.
• (You may use it at your own risk)

Faith healing is the practice of prayer and gestures that are believed by some to elicit divine ... The first
is post hoc ergo propter hoc, meaning that a genuine improvement or spontaneous remission may have
been experienced coincidental ...

Hilot (/HEE-lot/) is an ancient Filipino art of healing. It uses manipulation and massage to achieve the
treatment outcome, although techniques differ from one practitioner to another.[1] It emerged from
the shamanic tradition of the ancient Filipinos with healers considering their practice as derived from
their calling from visions or from having been born by breech.
• (But should not be use on dislocation and fracture)

Magpapaanak
The magpapaanak, the other "hilot", is the folk "midwife" who does prenatal visits and check-ups to
pregnant mothers. Normally a woman, she delivers babies during childbirth and often performs the
ritual called the suob (a form of "aroma therapy" performed while placed under a cloak).

Pagtatawas is a divination ritual in pseudomedicine in Filipino Psychology (but considered superstition in

Western psychology), carried out by the mangtatawas (literally "user of tawas").[1] It attempts to
diagnose an affliction or psychological disorder by interpreting shapes produced in water by heated
alum or molten wax droppings from a burning candle. It is thus a form of both carromancy and
oryctomancy.

Mambabarang
• In the Philippine Mythology, The Mambabarang.
• "Barang is a type of magic, much closer to shamanism than Kulam, and is quite diverse and High“
The Mambabarang is the Filipino version of a sorcerer; the witch is a Mamalarang. The the name
is derived from the word barang. Other synonymous terms include the Hiligaynon word manog hiwit,
which is also synonymous to kulam. The verb barangon or hiwitan means "to place a hex"; a curse in
Filipino is a sumpa. The mambabarang keeps his beetles in a bottle or a section of bamboo, carefully
feeding them ginger root. When the practitioner decides to employ his dark art, he performs a prayer
ritual wherein he whispers instructions and identifies the victim to the beetles. The insects are then set
free and to seek out the victim and gain entry into the body via any bodily orifice: the nose, mouth, ears,
anus or dermal breaks such as open wounds.
• The victim will then feel the effects of the invasion through manifestations depending on the area of
entry; hemorrhoids if through the anus, ear ache if through the ears and other similar cases. The
resulting illness is resistant to conventional medical treatment and only reveals its true nature when the
victim succumbs and flying insects issue forth from bodily cavities. Superstitious folks still attribute
certain illnesses or diseases to barang. This most often happens in the provinces, where an herbal
doctor, albularyo or a faith healer, a mananambal or sorhuana (female) / sorhuano (male) treats such
diseases. In some rural provincial areas, people completely rely on the albularyo and mananambal for
treatment.

SUOB
is a ritual of postpartum care performed two to three weeks after childbirth. Prior to the "suob," whole
body massages are performed by the midwife "hilot" for 18-21 days after a first-born and for 14 days for
subsequent births. The massages last 20 to 30 minutes, twice daily for four days, every afternoon for 4
days, every morning for another four days, then alternate mornings and afternoons for a total of 18 to
21 days. The massages are believed to hasten the mother's return to health and healing of her
obstetrical wounds. During these 2 to 3 weeks, bathing, other than sponge baths, is prohibited. On the
18th day, preparations are started for the ritual of "suob." Nine to ten indigenous herbal ingredients
(palad ng buli, payang-payang, sambong, salay, balingway, pakpaklawin, galamay-amo, balat ng sahi,
balat ng buboy, bayabas) are collected and placed in a big wok-like ware, at the center of which is placed
an indigenous rock (batong-buhay) of sufficient size for the mother to sit on.

• The mother, wrapped in a loose blanket or duster wear, straddles the wok and catches the smoke into
her lower extremities and bare perineal area. After 5 to 10 minutes, the wok with the residuum of the
still smoking insenso-kamangyan is taken once around the outside of the house and finally placed in the
crawl space of the bedroom (if there is one) or the head of the bed. The ritual is believed to drive away
the evil spirits that might impede the mother's full recovery.

• When a paella of cultures, magic, religion, and the medical needs of a people merge, alternative
therapies will likely offer a motley bag of of options, from near-mainstream to new-age to way-out
fringe.

• There is the new-age fringe, heralded by countless gurus mongering through the cybermarts and
profusion of health magazines, flooding the information grapevine with newest in 'naturalceuticals' and
life-extenders, catering to the urban and burgis markets. For the hapless user trying to get an edge on
health and longevity, it can be a bewildering challenge maneuvering through a cyber-supermarket of
noni-juices, snake oils, crystals, magnets and countless supplements.

• Most of Philippine alternative medicine will qualify for a "Fringe" classification.

• Many of the folkloric therapies (tawas, tapal, lunas, kudlit) with its varied prayer-form ingredients
(bulong, orasyon) common to the alternative armamentarium of healing modalities and often first-line
therapies in rural health care, would easily qualify as "fringe" to the urban-suburbanites and burgis,
attuned to the traditional western modalities of healthcare
 Module6
Online Database/Journal Articles Related Assessment and Provision of Care of
At-Risk Sick Adult Clients with Acute and Chronic alterations/ problems in
Nutrition, and Gastro intestinal, Metabolism and Endocrine, Perception and
Coordination

• Online Database- An online database is a database accessible from a local network or the Internet, as
opposed to one that is stored locally on an individual computer or its attached storage (such as a CD).
Online databases are hosted on websites, made available as software as a service products accessible
via a web browser.

Introduction to OR

Surgery
- a branch of medicine concerned with diseases and conditions requiring or amenable to operative or
manual procedures. It involves making an opening into the body by REMOVE, REPAIR or REPLACE a part.
- discipline branch of learning in w/c total care of illness with an extra modality of treatment to correct
deformities, detect, repair of injuries, diagnose and cure of the disease process, relief of sufferings and
prolong life.

SURGICAL ABBREVIATIONS:
AKA – ABOVE THE KNEE AMPUTATION
AEA – ABOVE THE ELBOW AMPUTATION
AP – APPENDICITIS; APPENDECTOMY; ANTERO-POSTERIOR
AROD – ANESTHESIA RESIDENT-ON-DUTY
BEA – BELOW ELBOW AMPUTATION
BG – BONE GRAFTING
BKA – BELOW KNEE AMPUTATION
BM – BREAST MASS
BPH – BENIGN PROSTATIC HYPERTROPHY
BTL – BILATERAL TUBAL LIGATION
Bx – BIOPSY
CBD – COMMON BILE DUCT
D – DORMICUM
EB – ELASTIC BANDAGE
EBL – ESTIMATED BLOOD LOSS
ECCE – EXTRA CAPSULAR CATARACT EXTRACTION
EENT – EYE, EAR, NOSE, THROAT
ET – ENDOTRACHEAL TUBE
Ex Lap – EXPLORATORY LAPAROTOMY
GA – GENERAL ANESTHESIA
K – KETAMINE/POTASSIUM
KUB - KIDNEY, URETER, BLADDER
LA – LOCAL ANESTHESIA
Lap – LAPAROTOMY
Lap Chole – LAPAROSCOPIC CHOLECYSTECTOMY
GSW – GUNSHOT WOUND
I & D – INCISION AND DRAINAGE
IMN – INTRA MEDULLARY NAILING
IOP – INTRAOCCULAR PRESSURE
IVP - INTRAVENOUS PYELOGRAM
LBB – LIVE BABY BOY
LBG – LIVE BABY GIRL
LLD – LEFT LATERAL DECUBITUS
LT – LUMBAR TAP
LSCS – LOW SEGMENTAL CESAREAN SECTION
LTCS – LOW TRANSVERSE CESAREAN SECTION
LUS – LOWER UTERINE SEGMENTS
MRI – MAGNETIC RESONANCE IMAGING
MRM – MODIFIED RADICAL MASTECTOMY
NSS – NORMAL SALINE SOLUTION
OB – OBSTETRICS
OD – OCCULUS DEXTER (RIGHT EYE)
OPD – OUT PATIENT DEPARTMENT
OR – OPERATING ROOM/OPEN REDUCTION
ORIF – OPEN REDUCTION INTERNAL FIXATION
ORSF – OPEN REDUCION SCREW FIXATION
Ortho – ORTHOPEDICS
OS – OCCULUS SINISTER (LEFT EYE); OPERATIVE SPONGE
OU – OCUCULI UTERQUE (BOTH EYE/ EACH EYE)
PACU – POST ANESTHESIA CARE UNIT (A.K.A. RR)
PoP – PLASTER OF PARIS
Post Op – POST OPERATIVE / AFTER OPERATION
Pre Op – PRE OPERATIVE/ BEFORE OPERATION
Premed – PREMEDICATION
PRHP – PARTIAL REPLACEMENT HIP PROSTHESIS
T&A – TONSILLECTOMY AND ADENOIDECTOMY
TAH – TOTAL ABDOMINAL HYSERECTOMY
RA-SB – REGIONAL ANESTHESIA-SUBARACHNOID BLOCK
RP – RETROGRADE PYELOGRAM/phy
RLD – RIGHT LATERAL DECUBITUS
ROI – REMOVAL OF IMPLANT
RR – RECOVERY ROOM (see PACU)
S&O – SALPHINGECTOMY AND OOPHORECTOMY
SA – SPINAL ANESTHESIA
SAB – SUBARACHNOID BLOCK
SMR – SUBMANDIBULAR RESECTION
SN – SPINAL NEEDLE
S/P – STAUS POST
SW – STAB WOUND
TAHBSO – TOTAL ABDOMINAL HYSTERECTOMY WITH BILATERAL SALPHINGO-OOPHORECTOMY
THA – TOTAL HIP SRTHROPLASTY
THRP – TOTAL HIP REPLACEMENT ARTHOPLASTY
TRHP – TOTAL REPLACEMENT HIP PROSTHESIS
TURP – TRANSURETHRAL RESECTION OF PROSTATE
UGIB – UPPER GASTROINTESTINAL BLEEDING
V-pack – VISCERAL PACK
WD – WADDING SHEET

SURGICAL TERMINOLOGIES:
 PREOPERATVE - FROM DECISION TO TRANSFER
 INTRAOPERATIVE – FROM OR TO RECOVERY ROOM
 POSTOPERATIVE - FROM RR TO FOLLOW UP EVAL
 PERIOPERATIVE – INCORPORATE THE THREE PHASES
 EXCISION – REMOVAL BY CUTTING
 INCISION - CUTTING
 RESECTION – REMOVAL OF PORTION OF AN ORGAN
 DISSECTION – SEPARATION OF TISSUE
 STERILIZATION – PROCESS WITH ALL PATHOGENIC AND NON PATHOGENIC INCLUDING SPORES
ARE KILLED
 DISINFECTION – EXCEPT SPORES
 SEPTIC/SEPSIS – RESULT OF THE ACTION OF BACTERIA
 CONTAMINATION – SOILING… CONTAMINATION
 INFECTION- INVASION BY PATHOGENS
 SUTURES
 LIGATURE
 ANALGESIA
  ANESTHESIA
 ANTISEPTIC
 BACTERICIDE/GERMICIDE
 MICROORGANISM
 PATHOGENIC MICRORGANISM
 SPORES
 BACTEROSTATIC
 ADHESION
 AMPUTATION
 ANASTOMOSIS B
 IOPSY
 BRONCHOSCOPY
 CALCULUS
 CATARACT
 CIRCUMCISION
 CULDOSCOPY
 DEHISCENCE
 EVISCERATION
 INCISION and DRAINAGE
 ENUCLEATION
 FISSURE
 FISTULA
 HEMOSTASIS
 INFARCT
 LACERATION
 LAMINECTOMY
 LOBECTOMY
 MAMMOPLASTY
 OCCLUSION
 SHUNT
 SKIN GRAFTING
 STENOSIS
 SYNOVECTOMY
 TUMOR
 VAGOTOMY
 VENIPUNCTURE

PHYSICAL LAYOUT OF THE OPERATING ROOM

……………….
COMMON INDICATION for SURGICAL PROCEDURES:
Diagnostic – biopsy tissue samples
Repairs – closing of hernia
Removal – foreign body
Reconstruction – creation of new breast
Palliation – relief of obstruction
Aesthetics – facelift
Harvest – autologous skin graft
Procurement – donor organ
Transplant – placement of a donor organ
Bypass/shunt – vascular re-routing
Drainage/evacuation – incision of abscess / thoracentesis
Stabilization – repair of fracture
Parturition – cesarean section
Termination – abortion of pregnancy
Staging – check of cancer progression
Extraction – removal of tooth
Exploration – invasive examination
Diversion – creation of stoma for urine

EFFECT OF SURGERY ON THE PERSON:

1. Initiation 0f stress response
2. Penetration of bacterial barrier
3. Vascular system is disrupted
4. Removal of tissue and organs
5. Precipitation of anxiety and depression

PRE-OPERATIVE NURSING

- Pre operative means before surgery. The pre operative period may be many
days or few minutes. If time permits, the person is prepared mentally and
physically for the effects of anesthesia and surgery. The goal is to prevent
complications before, during and after surgery.