NCMA113 LECTURE – SUMMER MIDTERM 2021

- This may have been a cure for headache. The remains of

Coverage for Lecture: skulls where the hole has healed that some patients even
 Nursing as a Profession survived the operation.
 Nursing Process - To remove the evil spirit from the body of person.
 Fluids and Electrolytes
 IV Therapy
 Blood transfusion
 Dosage and Computations
 Concept of Administering Medications
 Concept of Pain

NURSING AS A PROFESSION
Discussed by Prof. Francis A. Vasquez, MAN, RN Important events during intuitive nursing
Definition of Nursing 1.
Growth of religion
As an Art… 2.
Growth of civilization
- Is the art of caring for the sick and well individual. a) Near east
- It refers to the dynamic skills and methods in assisting sick and b) Far east
well individual in their recovery and in the promotion and c) Ancient Greece
maintenance of health. d) Ancient Rome
- Remember: our client is not always a sick client, our client can Near east
also be well individual, we want that person to maintain his - Mode of nomadic life  agrarian society  gradual
normal state of health. development of urban community life.
- A nurse must develop manual dexterity – the ability to use your- Nomadic life – they move from one place to the other after they
hands in a skillful. (Kagaanan ng kamay) consume the resources in that area.
- Different nurses have different style. - Agrarian society - knows how to cultivate soil and plant trees
As a Science... that’s why they stay in one area.
- - Urban community life - A leader was born, nag karoon ng
Is the scientific knowledge and skills in assisting individual to
achieve optimal health. structure.
- It is the diagnosis and treatment of human responses to actual - Nursing as a duty of slaves and wives.
or potential problem. - Birth of 3 religious’ ideologist:
- Nursing diagnosis – disease or illness itself; based on the  Judaism
response of client.  Christianity
- Medical diagnosis – given by a doctor based on his assessment  Mohammedism or Islam
or based on the interpretation of results of the laboratory and Contributions to Medicine and Nursing
diagnostic procedures. 1. Babylonia – Code of Hammurabi
- Actual problem – already existing - 1st recording on the medical practice.
- Potential problem – the capacity in developing. - Established the medical fees.
- Example: UTI - Discouraged experimentation.
 Patient A: Fever and painful urination - Specific doctor for each disease.
 Patient B: painful urination - Right of patient to choose treatment between the use of
 We are focusing on the client’s response. As a nurse, we charms, medicine, or surgical procedure.
are going to help relieve the pain. 2. Egypt – Art of Embalming
- We are using the nursing process or ADPIE (Assessment, - Mummification, removing the internal organs of the dead
Diagnosis, Planning, Intervention and Evaluation) body, instillation of herbs and salt to the dead.
- Salt attracts water. The salt is extracting or pulling the fluid
Era in Nursing
from the body tissues.
Period of Intuitive Nursing
- Practiced since pre-historic among primitive tribes and lasted - Used to enhance their knowledge of the human anatomy.
through the early Christian era. - Documentation about 250 diseases and treatments
- Slaves and patients’ families nursed sick.
- Nursing was untaught and instinctive. (Instinctive – common
sense) 3. Israel – Teaching of Moses
- “The Father of Sanitation”
Trephining (6500BC)
- The first known surgery was trephining or drilling the skull. - Discovered Artesian Well
- Wrote five books in the Old Testament.
 Practice of Hospitality and charity
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 FUNDAMENTALS OF NURSING PRACTICE LECTURE: 1ST YEAR SUMMER MIDTERM

 Laws of control of spread of communicable disease and the - Established the Alexian Brothers School of Nursing,
ritual of circumcision of male child. the largest school under religious auspices exclusively
 Referred to nurses as midwives, wet nurse, or child’s course. in US and it closed in 1969.
Far East The Rise of Secular Orders
1. China – Materia Medica - Queens, princesses and other ladies of royalty founded many
- Book that indicates the pharmacologic drug used for religious orders.
treatment. 1. Order of St. Francis of Assisi (1200 – present)
- No knowledge on anatomy - Believed in devoting lives to poverty and service to the
- Use of wax to preserve the body of the dead. poor.
- Use of pharmacologic drugs. 2. The Beguines
2. India – Shushurutu - Composed of lay nurses who devoted their lives in the
- 1st recording on the nursing practice. service of suffering humanity.
- Hampered by Taboos due to social structures and practices - Founded in 1170 by priest Lambert Le Begue.
of animal worship. 3. The Oblates
- Medicine men-built hospitals. 4. Benedectines
 They use intuitive form of asepsis. 5. Ursulines
 There was proficient practice of medicine and surgery. 6. Augustinians
Ancient Greece Important Nursing Personages
- Nursing was a task of untrained slave. St. Clare
- Caduceus - Took vows of poverty, obedience to service and chastity.
- Insignia of medicine - Founded the 2nd order of St. Francis of Assisi
- 3 parts: Staff, Wings and Serpent. St. Elizabeth of Hungary
- The patroness of nursing
 Staff – medicine is the leader in the health profession.
- A princess, daughter of a Hungarian king
 Wings – doctor will always be there where help is
- Sees her calling to give care for the sick fed thousands of
needed.
hungry people.
 Serpent – represents as cure.
St. Catherine of Siena
- Hippocrates
- 25th child of a humble Italian parents
- Father of scientific/ Modern Medicine
- “Little saint” – took care of the sick as early as 7 years old.
- 1st to reject the idea that diseases are caused by evil spirits.
St. Vincent De Paul
- 1st to apply assessment.
- He organized the charity group called the “La Charite” and
- Practice medical ethics.
the “Community of Sisters of Charity.”
Ancient Rome
- He founded the “Sisters of Charity School of Nursing” in
- Paganism  Christian Philosophy
Paris, France where Florence Nightingale had her 2nd
- Romans’ Motto: “If you’re strong, you’re healthy”
formal education in nursing.
- Care of the ill was left to the slaves or Greek physicians.
The Dark Period of Nursing
- Fabiola
- Also called the period of reformation until the American Civil
 Converted to Christianity by Marcella and Paula War
 Made her home the first hospital in the Christian World. - The American Civil War was led by Martin Luther, the war was
Period of Apprentice Nursing a religious upheaval that resulted to the destruction in the unity
- 11TH century – 1836 of Christians.
- “On the Job” training period - The conflicts swept everything connected to Roman
The Crusades Catholicism in schools, orphanages, and hospitals.
- Religious war - Nurses were lowest people of the society.
- Military religious orders and their works
1. Knight of St. John of Jerusalem (Italian) Period of Educated Nursing
- Also called as “Knights of the Hospitalers” - Began on June 15, 1860 when the Florence Nightingale School
- Established give care. of Nursing opened at St. Thomas Hospital in London.
2. Teutonic Knights (German) Florence Nightingale
- Took subsequent wars in the Holy Land. - Mother of modern nursing
- Cared for the injured and established ten hospitals in - Lady with the lamp
the military camps. - Born on May 12, 1820 in Florence, Italy.
3. Knights of St. Lazarus - Her self-appointed goal – to change the profile of Nursing.
- Care for those who suffered Leprosy, syphilis, and - She compiled notes of her visits to hospitals, her observations
chronic skin diseases. of sanitation practices and entered Deaconesses School of
4. Alexian Brothers Nursing at Kaiserwerth, Germany for 3 months.
- Founded in 1348 - Contributions:
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 her book “Notes on nursing: What it is and What it is not” - Brotherhood of Miserecordia
 We need to correlate theory to practice. What is thought in - For poor people Located at Roxas Boulevard
the school is what must be practice in the area. Prominent Personages during the Philippine Revolution
 Paid instructors. 1. Josephine Bracken
 The nurses must receive decent quarters. - Wife of Jose Rizal installed a field hospital in an estate in
 Environmental theory Tejeros that provided nursing care to the wounded night
and day.
Period Contemporary Nursing 2. Rosa Sevilla de Alvaro
- World War II – present - Converted their house into quarters for Filipino soldiers
- This refers to the period after World War I and the changes and during the Phi-American War in 1899.
development in the trends and practice of Nursing occurring 3. Maria Agoncilla de Aguinaldo
since 1945 after World War II. - 1st president of Philippine Red Cross (Batangas chapter)
Development and Trends 4. Hilaria de Aguinaldo
- W.H.O. established by UN to fight diseases by providing health - Wife of Emilio Aguinaldo organized the Filipino Red
information, proper nutrition, living standard, environmental Cross
conditions. 5. Melchora Aquino
- The use of atomic energy for diagnosis and treatment. - Nursed the wounded Filipino soldiers, gave them shelter
- Space medicine and Aerospace Nursing. and food.
- Medical equipment and machines for diagnosis and treatment - Tandang sora
- Health related laws Hospital and School of nursing
- Primary health care – nurses’ involvement in CHN 1. Iloilo Mission Hospital Training School of Nursing (1906)
- Utilization of computers - Ran by the Baptist Foreign Mission Society of America
- Technology advances such as development of disposable - Miss Rose Nicolet  1st superintendent
equipment and supplies that relieved the tedious task of nurses. - March 1944 – 22 nurses graduated.
- Development of the expanded role of nurses. - April 1944 – a board exam was held outside of Manila.
The Nursing Leaders - It was held in the Iloilo Mission Hospital thru the request
 Florence Nightingale (1820-1910) – mother of modern nursing of Ms. Loreto Tupas, principal of the school.
 Clara Barton (1821--1912) – established American Red Cross 2. St. Paul’s Hospital School of Nursing (1907)
 Lillian Wald (1867--1940) – Founder of Public Health Nursing - Most reverend Jeremiah Harty under the supervision of St.
 Lavinia Dock (1858--1956) – women’s rights to vote. Paul de Chartres.
 Margaret Higgins Sanger (1879--1966) - 1st birth control - Rev. Mother Melaine – superintendent
information clinic - Miss E. Chambers – Principal
 Mary Breckinridge (1881--1965) – nurse who practice 3. Philippine General Hospital (1907)
midwifery. - 1906 – Mary Coleman Masters  trained Filipino girls for
nursing
History of Nursing in the Philippines - Elsie McCloskey-Gaches became the chief nurse.
Early beliefs, practices, and care for the sick - Anastacia Giron-Tupas, the 1st Filipino chief nurse and
Shaman/ Albularyo superintendent.
- a person regarded as having access to, and influence in, the 4. St. Luke’s Hospital School of Nursing (1907)
world of good and evil spirits. - Opened after 4 years as a dispensary clinic.
Health care during the Spanish Regime - Miss Helen Hicks – first principal
1. Hospital Real de Manila – 1577 - Vitaliana Beltran – first Filipino superintendent of nurses
- 1st hospital established. - Jose Fores – first Filipino Medical Director
- Founded by Gov. Francisco de Sande. 5. Mary Johnston Hospital School of Nursing (1907)
- To give service to king’s Spaniard soldiers - Was called as Bethany Dispensary founded by the
2. San Lazaro Hospital – 1578 Methodist Mission.
- Fray Juan Clemente - It became an emergency hospital during Japanese
- Named after the Knights of St. Lazarus occupation.
- Hospital for the lepers. - Burned down in 1945.
3. Hospital de Indios – 1586 6. Philippine Christian Mission Institute School of Nursing
- Franciscan Orders 7. San Juan de Dios Hospital School of Nursing (1913)
- Hospitals for the poor Filipino people 8. Emmanuel Hospital School of Nursing (1913)
4. Hospital de Aguas Santas – 1590 9. Southern Islands Hospitals School of Nursing (1918)
- Fray Juan Bautista College of Nursing
- Named after its location (near spring) because people 1. UST College of Nursing – 1946
believed that spring has a healing power. - 1947 – 21 graduate nurses
5. San juan de Dios Hospital – 1596 - 1st college of nursing in the Philippines
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2. MCU College of Nursing – 1947
- 1st college who offered BSN – 4-year program
3. UP College of Nursing - 1948
- Miss Sotejo – 1st dean
4. FEU Institute of Nursing – June 1955
5. Fatima College of Nursing – 1973
Nursing Leader in the Philippines
1. Anastacia Giron Tupas
- Founder of Filipino Nurses Association – established on
Oct 15, 1922.
- 1st Filipino chief nurse of PGH
- 1st Filipino superintendent of nurses in the Philippines
2. Francisca Delgado
- 1st president of Filipino Nurses Association
3. Cesaria Tan
- 1st Filipino to receive master’s degree in nursing abroad.
FROM COURSE UNIT
Contemporary Nursing Practice
Recipients of Nursing
1. Patient – A Latin word meaning “to suffer” or “to bear”;
person who is waiting for or undergoing medical treatment
and care. Usually, people become patients when they seek
assistance because of illness or for surgery.
2. Client – a person who engages the advice or services of
another who is qualified to provide this service. The term
client presents the receivers of health care as collaborators
in the care, that is, as people who are also responsible for
their own health.
3. Settings for Nursing – In the past, the acute care hospital
was the main practice setting open to most nurses. Today
many nurses work in hospitals, but increasingly they work
in clients’ homes, community agencies, ambulatory clinics,
long--term care facilities, health maintenance,
organizations (HMOs), and nursing practice centers.
4. Nurse Practice Acts – or legal acts for professional
nursing practice, differ in various jurisdictions, they all
have a common purpose: to protect the public. Nurses are
responsible for knowing their state’s nurse practice act as
it governs their practice.
5. Standards of Nursing Practice – the purpose is to
describe the responsibilities for which nurses are
accountable. Establishing and implementing standards of
practice are major functions of a professional organization.
6. Standards of Professional Performance describe behaviors
expected in the professional nursing role.
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Factors Influencing Contemporary Nursing Practice
Roles and Functions of the Nurse
 Client Advocate – promote decision making to patient and
family.
 Teacher
 Caregiver – hands on patient
 Communicator – communicate to patient, family, and other
health care provider.
 Manager – manage all the time.
 Leader – if we go to community, we implement, we give
directions.
 Counselor – to give advise.
 Research consumer – there is upgrade to improve.
 Change agent
NURSING PROCESS
Discussed by Prof. Francis A. Vasquez, MAN, RN
- Systematic, chronological, step by step procedure of ADPIE.
- It is a systematic, rational method of providing care to patients.
- It is a five-step critical thinking and decision -making process
the nurse may utilize to provide individualized patient care.
- If you want to take care your patient, you need to move forward
from assessment to evaluation. But if you’re going to evaluate
that nursing care you rendered to the client, you move backward.
You’re going to evaluate the nursing care that you have
performed. So that you will know if the plans or goal of care
have been met. If the goals of care have been met, then the
problem should not exist anymore.
- Specific to the nursing profession
- A framework for critical thinking
- Purpose: Diagnose and treat human responses to actual or
potential health problems
- Characteristics:
 Organized framework to guide practice.
 Problem solving method.
 Systematic
 Goal oriented – under the planning
 Dynamic – always changing, flexible. (Medical problem
stays for a longer period but nursing problem is dynamic)
 Utilizes critical thinking process.
 Client-centered
 Universally applicable
 Interpersonal and collaborative
Critical Thinking
- You are trying to analyze the problem of the patient.
- A discipline specific, reflective reasoning process that guides a
nurse in generating, implementing, and evaluating approaches
 FUNDAMENTALS OF NURSING PRACTICE LECTURE: 1ST YEAR SUMMER MIDTERM

for dealing with client care and professional concerns (National
League of Nurses).
- This is important in ensuring that the nurse delivers safe,
competent and skillful practice. In doing so, an excellent quality
of care is received by the client.
Problem solving
- Identify what are the different nursing care that are needed to
solve the problem of the patient.
- A process that involves clarifying the nature of the problem and
suggesting possible solutions. In nursing, client’s condition is
observed over time to ensure its initial and continual
effectiveness.
- Commonly used approaches to problem solving include trial
and error, intuition, the research process, and the
scientific/modified scientific method.
Decision making
- A critical thinking process for choosing the best actions to meet
a desired goal.
- The decision-making process and the nursing process share
similarities, and the nurse uses decision-making in all phases of
the nursing process.
- It is essential that the nurse use critical thinking in each step or
phase of these processes so that decisions and care are well
considered and delivered with the highest possible quality.
- This is important in helping you formulate nursing diagnosis,
expected outcomes and interventions. It is a vital
communication tool to other health care team members.
4 types of Assessment
Initial Assessment
- First time to see the patient.
- Provides an in-depth, comprehensive database, which is critical
for evaluation changes in the client’s health status.
- This is performed within the specify time after admission to
establish complete database for problem identification.
- Example: Nursing admission assessment, nursing health history.
Problem-Focused Assessment
- Period of confinement
- The nurse determines whether the problem still exists and
whether the status of the problem has changed (i.e., improved,
worsened, or resolved)
- Example: Hourly assessment of clients intake and output and
checking of vital signs of client.
Emergency Assessment
- Takes place in life-threatening situations in which preservation
of life is the top priority.
- Example: Rapid assessment of an individual’s airway breathing
and circulation during a cardiac arrest; Assessment of suicidal
tendencies.

Advantages of Nursing Process Time-Lapsed or Ongoing Assessment

 Provides individualized care. - Follow-up check up
 Client/family is an active participant. - Takes place after the initial assessment to evaluate any changes
 Promotes continuity of care. in the client’s functional health.
 Provides more effective communication among nurses and - Example: Reassessment of a clients’ functional health patterns
healthcare professionals. in a home care or outpatient settings.
 Develops a clear and efficient plan of care. Type Time Purpose
 Provides personal satisfaction as you see client achieve goals. First time to see the
 Professional growth as you evaluate effective of your Initial
patient. And
Completing database
interventions. Under go to seminars and trainings performed after
admission
Ongoing process
To determine status of
integrated with
Problem- a specific problem
nursing care.
focused identified in an earlier
Period of
assessment.
confinement
During any To identify life-
physiological or threatening problems
Emergency
psychological crisis To identify new or
NOTES:
of the client overlooked problems
 Nursing care plan- product of nursing process. Compare current
 Goals of care- planning Several months after
Time-lapsed status to baseline date
 Intervention- laging may rationale initial assessment
previously obtained

ASSESSMENT Steps of Assessment

- To establish database
- This is the deliberate and systematic collection of information
about a patient to determine the patient's current and past health
and functional status and his/her present and past coping
patterns.
- This is the systematic and continuous collection, organization,
validation and documentation of data.
Collecting Data
- Gathering information about a client's health status in order to
form database.
- Database – all information about the client.
- Health assessment – review to systems
- Physical exam – inspection, palpation, percussion, and
auscultation.
 Make sure information is complete and accurate.

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 Validate prn (if necessary) - Recreation/ hobbies

 Interpret and analyze data. 7. Social data
 Compare to standard norms. - Family relationship, ethnic affiliation, education history,
 Organize and cluster data. occupational history, economic status, home and
Source of Data neighborhood conditions.
8. Psychologic data
Primary Secondary 9. Patterns of health care
 Physical exam 10. Review of systems
 Nursing history
 Client or family
 Team members, Data Collection Methods
 Laboratory reports 1. Observation
 Diagnostic tests - A method that makes use of the senses in gathering data.
- It is a conscious, deliberate skill that is developed through
Types of Data effort and with an organized approach.
Subjective Objective - It involves two important aspects: (a) noticing the data, and
 Symptoms  Signs (b) selecting, organizing, and interpreting the data. Nursing
 Covert  Overt observations must be organized so that nothing significant
 Verified only by the  Can be observed and is missed.
patient. measured. - Examples: overall appearance, facial expression, body
 Examples: itchiness, severe  Example: discoloration of gestures, skin color, smell, etc. (4 senses)
pain, or feelings of worry. the skin, BP 130/80 2. Interview
- A planned communication or a conversation with a purpose.
Components of Nursing health history: - Example: history taking
1. Biographic data - Approach of an interview:
- Demographic profile a.) Directive
- Client’s name, age, sex, marital status, occupation, - A highly structured interview that elicits specific
religious affiliation, income, address etc. information.
2. Chief complaint/ reason for visit - Close type of questions is asked.
- “What brought you to the hospital? What seems to be the - When time is limited. Example is emergency
problem?” situation.
- Chief complaint should be recorded in the clients’ own b.) Non-directive
words. - Rapport-building interview
3. History of present illness - Unstructured interview that provides flexibility on
- Use chronologic story. (sunod sunod) how the nurse directs the focus of the conversation.
- When the symptoms started - Client controls the purposes and the subject matter.
- Whether the onset of symptom was sudden or gradual - Stages of an interview:
- How often the problem occurs exact location of distress. a) Opening or Introduction
- Exact location of distress - The most important part of the interview.
- Character of complaint (e.g., intensity of pain, quality of - Purpose of this is to establish trust.
sputum) - “Good morning sir! I will be your nurse for
- Activity in which the client was involved when the problem today...” Accompanied by nonverbal gestures like
occurred. smile, handshake, and a friendly manner.
- Aggravating factors b) Body or Development
4. Past History/illness - Which clients communicates what he or she think,
- Childhood illness (common colds, chicken pox, mumps, feels, know in response to question from the nurse.
measles), immunization (BCG, vaccine), allergies, - Example: What have you brought you to the
accidents, and injuries, hospitalization, medication. hospital today?
5. Family history of illness c) Closing
- Mother: (+) HPN, (-) DM, (-) PTB - When the nurse has gathered all information, she
- Father: (-) HPN, (-) DM, (+) PTB requires for the objective part of the assessment.
- Shows only the diseases run in the family - This is important to maintain the trust and in
6. Lifestyle facilitating future interaction,
- Personal habits – e.g., amount, frequency, and duration of - “Do you have any questions?”
substance use. Ex. Smoking and alcohol.
- Diet – description of typical daily diet.
- Sleep / rest patterns
- Activities of daily living (ADL)

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- Types of interview questions:
a) Closed questions
- Are questions that is restrictive that requires
specific answers such as a “yes”, a “no” or any
information.
- A person has difficulty communicating will find
closed question easier to answer.
- Ex. Does it hurt? Did you take your medicine?
b) Open-ended questions
- Not answerable by yes or no.
- If you need more information
- They allow client the freedom to talk about what
they wish.
- Are questions that encourage discovery,
exploration, elaboration, clarification or
illustration of the client’s experiences, thoughts,
or feelings.
- Ex. Tell me how you feel today.
c) Neutral questions
- Client can answer without direction or pressure
from the nurse.
- They allow client to think for themselves.
- Example: Why do you think you had operation?
d) Leading questions
- Directs the client’s answer.
- The phrasing of the questions suggest what
answer is expected.
- Example: you’re stress about the surgery
tomorrow? Aren’t you?
- This type of questions can create problems if the
client in an effort to please the nurse keeps
inaccurate response. This can result inaccurate
data.
3. Examination
- Objective part of data collection
- The process by which the nurse makes use of his/her senses
to gather relevant information from the client.
- Unlike, interview, by which information is taken from the
responses of the client, examination is a more accurate way
of gathering relevant data from the patient.
- Examination techniques:
a) Inspection is the deliberate, purposeful, observations
in a systematic manner. Nurses use the physical
senses: visualizing, hearing, and smelling.
b) Palpation is the technique that uses the sense of touch.
The hands and the fingers are the most sensitive tool
that a nurse has.
c) Percussion is the act of striking one object against
another to produce a sound. The tones produced during
percussion are used to assess location, shape, size, and
density of a tissue.
d) Auscultation is the act of listening with a stethoscope
to sound produce within the body. Pitch, loudness,
quality, and duration of the sound are being assessed
during auscultation.
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- Ways of examination:
a) Cephalocaudal – “head to toe approach” This is an
examination of the client that follows the head-neck-
thorax-abdomen-extremities-toes sequence of
assessment.
b) Body System – This type of examination focuses on the
structures and functions of a specific body system:
respiratory system, circulatory system, nervous system,
etc.
c) Screening examination – “review of systems” This
manner of examination gives emphasis on the client’s
chief complaint and its associated signs. This is also a
brief review of essential functioning (nursing
admission assessment form)
Collecting Data
 Make sure information is complete and accurate.
 Validate prn (if necessary)
 Interpret and analyze data “compare to standard norms”
 Organize and cluster data. According to subjective and
objective.
Example
 Obtain info from nursing assessment, history and physical
(H&P) etc.
 Client diagnosed with hypertension (objective)
 B/P= 160/90 (objective)
 2Gm Na diet and antihypertensive medications were
prescribed (objective, and secondary type of data)
 Client statement “I really don’t watch my salt” “it’s hard to do
and I just don’t get it” (subjective)
Organizing Data
- The nurse uses an organized assessment framework.
- Nurses used written or computerized format called nursing
assessment, nursing history, or nursing database form.
- 11 Typology of Functional Health Pattern (Gordon)
1. Health perception/ Health Management – describes the
clients perceived pattern of health and well-being and how
health is managed.
2. Nutritional/ Metabolic Pattern – describes client’s pattern
of food and fluid consumption.
3. Elimination Pattern – describes pattern of excretory
function (bowel, bladder, and skin).
4. Activity- Exercise Pattern – describes pattern of exercise,
activity, leisure, and recreation.
5. Sleep-Rest Pattern – describes pattern of sleep, rest, and
relaxation.
6. Cognitive-Perceptual Pattern – describes sensory-
perceptual and cognitive patterns.
7. Self-Perception/ Self Concept Pattern – describes client’s
self-concept and perception of self-pattern (self-worth,
comfort, body image, feeling state).
8. Role-relationship Pattern – describes pattern of
participation and relationship.
9. Sexuality reproductive Pattern – describes client’s pattern
of satisfaction and dissatisfaction with sexuality patterns;
describes reproductive patterns.
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10. Coping/ Stress tolerance Pattern – describes client’s - Example: Acute pain is a response to an injury such as surgical
general coping pattern and effectiveness of pattern in terms procedure or chemical burn.
of stress tolerance. Medical Diagnosis Nursing Diagnosis
11. Values-beliefs Pattern – describes patterns of values, Focuses on the
beliefs and goal that guide the client’s choices or decisions. Focuses on illness, responses to actual or
Validating Data injury or disease potential health
- Double checking or verifying data to ensure that it is accurate process problems or life
and factual. Focus processes
- This ensures that assessment information is complete. Ineffective Airway
- You may also obtain additional information that may have been Pneumonia
Clearance
overlooked. Comparing subjective and objective data. Diabetes mellitus
Decreased Mobility
- Cues – are subjective or objective data that can be directly
observed by the nurse. Remains constant Changes as the client’s
- Inferences – are the nurse’s interpretation or conclusion based until a cure is response and/or health
on the cues. effected problem changes
- We are checking this one with:
 Compare Day 1 at the ward –
Duration Hyperthermia
 Clarify
Day 1 - COVID-19 Day 2 at the ward –
 Double check Day 2 – COVID 19 Ineffective Airway
 Determine factors that may interfere accurate measurement. Day 10 – COVID Clearance
 References 19, discharged After 6 hours –
Documenting Data Ineffective breathing
- Accurate documentation is essential and should include all data pattern
collected about the client’s health status. Identifies condition
- Data are recorded in a factual manner and not interpreted by the the health care
nurse. practitioner is
 F-actual licensed and licensed and qualified to
 A-ctual qualified to treat intervene.
 T-imely Management Identifies situations
- For example, the nurse must record the client’s intake as “coffee in which the nurse
240 ml, juice 120 ml, 1 egg and 1 slice of toast” rather than as is
“appetite good” or “normal appetite” a judgment. Cerebrovascular Self-Care Deficit:
Accident (Stroke) Dressing & Grooming
DIAGNOSIS Collaborative problem
- Second step of nursing process - An actual or potential physiological complication that nurses
- Interpret and analyze clustered data. monitor to detect the onset of changes in patients’ health status.
- Identify clients’ problems and strengths. - A partnership between a team of health care providers.
- This is a clinical judgment concerning human response to health - A patient in a participatory collaborative and coordinative
condition/s, life processes or vulnerability for that response by approach for share decision making around health issues, nurses
an individual, family, or community that a nurse is licensed and manage collaborative problems such as hemorrhage, infections
competent to treat. and paralysis using medical nursing.
- Formulate nursing diagnosis (NANDA: North American - For example, a patient with a surgical wound is at risk
Nursing Diagnosis Association) – statement of how the client is developing an infection, thus the physician describes the
responding to an actual or potential problem that requires antibiotics. The nurse then monitors patient for fever and other
nursing intervention. signs of infection and implements appropriate wound care
Medical Diagnosis measures. A dietitian recommends a therapeutic diet, high in
- Within the scope of medical practice protein and nutrients to promote wound healing.
- Focuses on curing pathology.
- Stays the same as long as the disease is present. Types of Nursing Diagnosis (WRAP)
- Based on the result of laboratory and examination. Wellness nursing diagnoses/
Nursing Diagnosis Health Promotion Nursing diagnosis
- Within the scope of nursing practice. - Describes human responses to levels of wellness in an
- Identify responses to health and illness. individual, family or community that have readiness for
- Can change from day to day. enhancement.
- Focuses on care aspect - This is a clinical judgment concerning a patient’s motivation
- Actual problem – already existing and desire to increase wellbeing and actualize human health
- Potential problem – there is a chance that the problem will potential.
develop.
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- Used clients in any health state that express readiness to - Risk factors are the environmental, physiological,
enhance specific health behaviors. psychological, genetic, or chemical elements that place a person
 Readiness for enhanced family coping at risk for a health problem.
 Readiness for enhanced spiritual well Signs and Symptoms (Defining Characteristics)
Risk nursing Diagnosis - What’s the evidence of the problem?
- Can be based on actual problem - Proves the problem is present.
- Problem does not exist, but the presence of risk factors indicates Example:
that a problem is less likely to develop.  Problem: activity intolerance.
- This is a clinical judgment concerning the vulnerability of an  Etiology: imbalance between oxygen supply/demand
individual, family, group, or community for developing an  S/S: (a.m.b.) as manifested by abnormal HR and BP in response
undesirable human response to health conditions/life processes. to light activity.
- This type of diagnosis DO NOT have defining characteristics or
related factors because they have not yet occurred. Nursing Diagnosis: P –e –s
 Risk for infection
 Risk for activity intolerance
 Risk for aspiration
- Risk Factors:
- They are the environmental, physiological, psychological,
genetic, or chemical elements that place a person at risk for
a health problem.
- These are the diagnostic-related factors that help in
planning preventive health care measures.
Actual Nursing Diagnosis
- Client problems that are present at the time of the nursing
assessment.
- Examples:
 Ineffective breathing pattern
 Ineffective tissue perfusion
 Activity intolerance
Possible Nursing Diagnosis
- Evidence about the health problem is incomplete or unclear.
- This may be compared to a physician who list several rule out
medical diagnoses in a patient admission assessment. The
physician made an order diagnostic test to gather more data to
Actual Problem High Risk Etiology and S/S
make a decision. With an increased database, the nurse may be
NANDA: domain 4: NANDA: domain related to aging
able to establish possible nursing diagnosis as valid or eliminate 11:
activity/rest, class 2: process as
it as invalid for a particular patient. safety/protection,
activity/exercise, manifested by
- “Possible” class 2: physical
impaired physical inability to sit and
 Possible social isolation mobility
injury, risk for
stand by himself
impaired skin
 Related to unknown etiology.
integrity
Syndrome Diagnosis ND: impaired physical
- Two or more problem mobility ND: high risk for
impaired skin
Formulating Nursing Diagnosis integrity, bed sore
Actual nursing diagnoses (PED/PES format) Main prob: infected related to bike
Problem (Diagnostic Label) wound. accident as
manifested by open
- Nsg. Dx - This is the diagnostic label that describes client’s
NANDA: domain 11: wounds on the
health problem or response for nursing therapy given.
safety/protection, class right elbow,
- The purpose of this is to direct the formation of client’s goals 2: physical injury, risk presence of
and desired outcomes. for impaired skin inflammation and
Etiology (Related Factors/Risk Factors) integrity purulent discharge
- r/t - Identifies one or more probable causes of health problem,
gives direction to the required nursing therapy and enables the ND: impaired skin
nurse to individualized nursing care. integrity
- What’s causing or contributing to the client’s problem. Main prob: chest pain related to physical
- Related factors are the etiological or causative factors for the activity
diagnosis.
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NANDA: domain 12: Actual Nursing diagnosis

comfort, class 1:
physical comfort, acute
pain

ND: acute pain

Main prob: manas related to impaired
renal function
NANDA: domain 2:
nutrition, class 4:
metabolism, excess
fluid volume

ND: fluid volume

excess
 High risk problem- is based on actual problem
 ND- nursing diagnosis
 Possible- hindi malinaw contributing factor Risk Nursing diagnosis
 Risk- malinaw contributing factor
 Purulent- may nana
 Acc. To maslows prioritize physical

Two-part Diagnostic statement

Three-part diagnostic statement

Do’s and Dont’s when writing nursing diagnosis

Example 1:
 Imbalanced nutrition: less than body requirements related
to improper feeding of the nurse.
- Make sure that your nursing diagnosis will avoid
court mitigation.
 Imbalanced nutrition: less than body requirements related
to impaired swallowing.

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Example 2:
 Impaired skin integrity related to bedsores.
- Make sure that the problem is different from the
etiology.
 Impaired skin integrity related to immobility.
Example 3:
 Risk for ineffective airway clearance related to
Emphysema.
- Avoid medical terms.
 Risk for Ineffective airway clearance related to retained
bronchial secretions.
Example 4:
 Ineffective Sexuality pattern related to Homosexuality.
- Avoid a nursing diagnosis that is judgmental.
 Ineffective Sexuality pattern related to conflicts with
sexual orientation.
Example 5:
 Impaired oral mucous membrane related to irritating agents.
- Avoid vague nursing diagnosis.
 Impaired oral mucous membrane related to excessive
intake of Anti-cholinergic (Atropine sulfate)
Guidelines For Writing A Nursing Diagnostic Statement
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PLANNING
- Third step of the nursing process
- This is when the nurse organizes a nursing care plan based on
the nursing diagnoses.
- Enumerate interventions we need to perform.
- Nurse and client formulate goals to help the client with their
problems. (we always involve the patient)
- Expected outcomes are identified.
- Interventions (nursing orders) are selected to aid the client reach
these goals.
- The nurse collaborates with the patient and the family and the
rest of the health care team to determine the urgency of
identifies problems and prioritizes patient needs.
- A deliberative, systematic phase of nursing process that
involves decision making and problem solving.
- SMART- Specific, Measurable, Attainable, Realistic and Time
bound.
- When we start conceptualizing the plan of care to be rendered
to a specific client, we us nurses should prioritize the actualize,
emanate or life threating conditions first this is called
prioritizing.
Types of Planning
1. Initial Planning
- Admission assessment (short and quick)
- It answers initial assessment.
- Initial comprehensive plan of care
2. Ongoing Planning
- Confinement (day to day/shift planning)
- done by all nurses who work with the client, occurs at the
beginning of the shift as the nurse plans the care to be given
that day.
- PURPOSES:
 To determine whether the client’s health status has
changed.
 To set priorities for the client’s care during the shift.
 To decide which problems to focus on during the shift.
 To coordinate the nurse’s activities so that more than
one problem can be addressed at each client contact.
3. Discharge Planning
- The process of anticipating and planning for the needs
before discharge.
- Before patient go home
- We should have discharge plan that will guide pt. on things
he must perform himself at home to sustain recovery like
take home medications, diet and activities to do and when
should go back to hosp. like follow up check up.
 FUNDAMENTALS OF NURSING PRACTICE LECTURE: 1ST YEAR SUMMER MIDTERM
Types of Goals
1. Short term goal
- Less 6 months
- Usually used
2. Long term goal
- More than 6 months
Ex. Combination of long and short term:
 Overweight of 100 pounds, after 10 mos. of weight
reduction program the pt. will lose 100 pounds or the pt.
will be able to loose 10 pounds per mos or pt. will lose 2.5
pounds per week.
Planning Process
Setting Priorities
- Begin by prioritizing client problems.
- Prioritize list of clients nursing diagnoses using Maslow.
- Rank as high, intermediate, or low
- Client specific
- Priorities can change.
- Priority setting is the ordering of nursing diagnoses or patient
problems using notions of urgency and importance to establish
a preferential order for nursing interventions.
- This may use models such as: Maslow’s Hierarchy of Human
Needs and the ABC’s of emergency care (Airway- Breathing-
Circulation and definitive management)
 Airway comes first before breathing. (there must be
Airway Patency) patency means walang bara.
- Factors to consider:
 Client’s Values and Beliefs – values concerning health may
be more important to the nurse than to the client.
 Client’s Priorities – involving client in prioritizing and care
planning enhances cooperation.
 Resources Available
 Urgency of Health problem
o High - If untreated, result in harm to patient or others.
o Intermediate - Non-emergent, non-life-threatening
needs of the patients.
o Low - May not always related to a specific illness but
affect the patient’s future well-being.
 Medical treatment plan
Prioritize the following nursing diagnosis:
 Anxiety related to difficulty in breathing
 Deficient fluid volume r/t high grade fever
 Sleep pattern disturbance r/t persistent cough
 Ineffective airway clearance r/t tenacious secretions
 If client have this all problem una iprioritize ineffective airway
clearance, fluid volume, anxiety, last is sleep pattern.
Developing a Goal and Outcome statement
- Goal and outcome statements are client focused.
- Worded positively.
- Measurable, specific observable, time-limited and realistic.
- Goal – broad statement. Ex: Client will achieve therapeutic
management of disease process.
- Expected Outcomes – objective criterion for measurement of
goal. Ex: AEB B/P readings of 110-120/70-80 and client
statement of understanding importance of dietary sodium
restrictions by day of discharge.
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Patient-Centered and SMART
- reflects a patient’s highest possible level of wellness and
independence in function.
- It is realistic and based on patient needs, abilities, and resources.
It is focused on PATIENT’s specific behavior NOT the nurse’s
goal or interventions.
 Pt will walk 50 ft on his 2nd week of rehabilitation program.
(not smart)
 Pt will eat 75% of his meal. (smart)
 Pt will be OOB 2-4hrs with minimal assistance. (smart)
 Pt will maintain HR<100 (not smart)
 Pt will state pain level is acceptable at 5/10 PS 2-3 hrs. after
medication. (not smart)
Nursing-sensitive patient outcome
- a measurable patient, family, or community state, behavior, or
perception largely influenced by and sensitive to nursing
interventions, such as: Reduction in pain frequency and severity.
Goal statement- should have condition and smart
Selecting Intervention
- interventions are nursing care we need to perform to the pt.
- Interventions are selected and written.
- The nurse uses clinical judgment and professional knowledge
to select appropriate interventions that will aid the client in
reaching their goal.
- Interventions should be examined for feasibility and
acceptability to the client.
- Interventions should be written clearly and specifically.
- Nursing Intervention is any treatment based on clinical
judgment and knowledge that a nurse performs to enhance
patient outcomes. Must be evidenced-based.
- This includes direct and indirect care measures aimed at
individuals, families and/or community.
Categories of nursing interventions
1. Independent (Nurse-initiated)
- Actions that a nurse can perform without supervision
or direction from others.
- Si nurse mag dedecide.
 Vital signs monitoring
 Client having difficulty of breathing with position
the client on high back rest.
2. Dependent (physician-initiated)
- Nursing actions requiring MD orders.
 During emergency, the patient is having difficulty
of breathing, you administered go to therapy.
 Administering insulin subcutaneously
3. Collaborative
- nursing actions performed jointly with other health
care team members.
- Whatever you do to the patient, you are accountable.
 FUNDAMENTALS OF NURSING PRACTICE LECTURE: 1ST YEAR SUMMER MIDTERM

 Medication administration
 Catheterization
 Counselling
 Discharge instruction
2. Indirect Care
- These are treatments performed away from a patient but on
behalf of the patient or group of patients.
- Examples:
 Managing patient’s environment
 Documentation
 Verb- in interventions we use action words
Skills needed during Implementation Phase
1. Cognitive skills - include intellectual skills like problem solving,
decision-making, critical thinking, and creativity. Crucial to
safe, intelligent nursing care
2. Interpersonal skills- nurse ability to communicate with others.
caring, comforting, advocacy, referring, counseling/ supporting
3. Technical skills- hands on skills, tasks, procedures, and
psychomotor skills, manipulating equipment, giving injections,
bandaging, moving, lifting.
4. Therapeutic use of self – is being willing and being able to care.

EVALUATION
IMPLEMENTATION
- This is the ''Doing'' step  Done to determine the effectiveness of the nursing care plan
- carrying out nursing interventions (orders) selected during the  final step of the nursing process but also done concurrently
planning step. throughout client care
- This includes monitoring, teaching, further assessing,  A comparison of client behavior and/or response to the
reviewing NCP, incorporating physicians’ orders and established outcome criteria.
monitoring cost effectiveness of interventions.  Continuous review of the nursing care plan
- Utilize NIC as standard.  Examines if nursing interventions are working
- Putting the plan into action  Determines changes needed to help client reach stated goals.
- Types: Independent (nurse initiated), Interdependent/  An appraisal whether expected outcomes are met
Collaborative and Dependent (need doc. order).  An appraisal of the effectiveness of nursing care plan
- Key components: should have action word  Possible results:
 Monitor GOAL is: Met, Partially met, Not met
 Teach  Outcome critieria met? Problem resolved! Then u stop
 Administer performing intervention but continue taking care of the patient
 Perform  Outcome criteria not fully met? Then continue plan of care- on
- Monitor VS q4h (every 4 hours) going
- Position Client on HBR. High back rest.  Outcome criteria unobtainable- then review each previous step
- Teach client amount of sodium restriction, foods high of the NCP and determine if modification of the NCP is
in sodium, use of nutrition labels, food preparation and needed. Reevaluate the patient
sodium substitutes.  Were the nursing interventions appropriate/effective?
- Teach potential complications of hypertension to
instill importance of maintaining Na restrictions. Factors that Impede Goal Attainment
- Assess for cultural factors affecting dietary regimen.  Incomplete database
- Perform passive range for motion exercise for 30 mins  Unrealistic client outcomes
every morning.  Nonspecific nursing interventions
- Perform wound dressing aseptically twice a day.  Inadequate time for clients to achieve outcomes
- Perform art therapy when needed.
- Instruct the importance of ongoing follow-up patient
feels well.
Types of Care
1. Direct Care
- These are interventions performed through interactions
with patients.
- Examples:

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Nursing Care Plan
Example 1
Clients name: Clara Cruz
Age: 23 y/o
 1 day PTA, client attend a wedding ceremony. SHe ate
baked mussels and carbonara. 8 hrs PTC, client
experienced abdominal pain and 2 bouts of watery stools.
Client self-medicated with diatabs but offered no relief. 2
hrs PTC client exp. 3 bouts of water stools and abdominal
apin. Client stated “grabe ang pagtatae ko hinang hina na
ako at mainit din ang pakiramdam ko.” Examination
revealed a sunken eyeballs, poor skin turgor, body
weakness, BP of 90/80, HR of 110 bpm and T of 38.5C
hence client was admitted. Buscopan 10mg 1 tab prn for
abdominal pain and hydrite 1 tab dissolve in 1 glass of
water per LBM were ordered by AP.
 PTA- prior to admission
 PTC- prior to consultation
 AP- attending physician
 COC- color orange
Assessment: Cues
First problem: Diarrhea
 Subjective:
“grabe ang pagtatae ko hinang hina na ako at mainit din
ang pakiramdam ko.” As verbalized by the client.
 Objective:
Vital signs: BP of 90/80, HR of 110 bpm and T of 38.5C
Sunken eyeballs, poor skin turgor, loose watery stools
Second problem: Fever
 Subjective:
“mainit ang pakiramdam ko” as verbalized by the client.
 Objective:
Vital signs: BP of 90/80, HR of 110 bpm and T of 38.5C
Sunken eyeballs, poor skin turgor, loose watery stools,
warm to touch skin
Third problem: Dehydration
 Subjective:
“grabe ang pagtatae ko hinang hina na ako at mainit din
ang pakiramdam ko.” As verbalized by the client.
 Objective:
Vital signs: BP of 90/80, HR of 110 bpm and T of 38.5C
Sunken eyeballs, poor skin turgor, loose watery stools
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Nursing Diagnosis
First problem: Diarrhea
 NANDA: Domain 3: elimination and exchange, Class 2:
Gastrointestinal Function (may diarrhea under nito so un
ung gagamitin nating nursing diagnosis)
 Nursing diagnosis: (problem) diarrhea related to
(etiology) ingestion of contaminated food (S/S) as
manifested by elimination of watery stools
 There can be also a pt present more than one problem.
Tingnana ang cues kung meron pa problem at nakita natin
na may lagnat sya so gagawa kapa ulit ng isang NCP. Sa
mga beginners like us 1 nursing problem and 1 NCP
although u only have one pt.
 First problem diarrhea, second is fever, third dehydration.
Second problem: Fever
 NANDA: Domain 11: safety and protection, Class 6:
thermoregulation (may hyperthermia under nito so un ung
gagamitin nating nursing diagnosis)
 Nursing diagnosis: (problem) hyperthermia is related to
(etiology) infection (S/S) as evidenced by body temp. of
38.5c and warm to touch skin.
 Kung marunong ka gumawa ng 3 part nursing diagnosis
kaya mo rin gumawa ng 2 part nursing diagnosis (problem
and etiology).
Third problem: Dehydration
 NANDA: Domain 2: nutrition, Class 4: metabolism (may
dehydration under nito so un ung gagamitin nating
nursing diagnosis)
 Nursing diagnosis: dehydration related to diarrhea as
evidence by body weakness, sunken eyeballs, poor skin
turgor.
Background knowledge
First problem: Diarrhea
 Ingestion of contaminated food  m.o. release toxins
increased GI irritation/peristalsis increased cell
permeability LBM
Goals of Care
First problem: Diarrhea
 After 12-24 hrs of nursing care, client will establish
normal bowel movement as manifested by elimination of
formed stools
Intervention
First problem: Diarrhea
1. increased oral fluid intake of the client.
2. Restrict foods that irritate the GI tract.
3. Collaborative: administer antidiarrheal drug as ordered by the
doctor.
Rationale
First problem: Diarrhea
1. Fluid replacement prevents dehydration.
2. To prevent abdominal pain.
3. None
 FUNDAMENTALS OF NURSING PRACTICE LECTURE: 1ST YEAR SUMMER MIDTERM

Example 2 3. Dependent: oxygen therapy helps achieving normal o2

saturation in the blood
Evaluation
 TIP: Aralin sakit as whole then check sa nanda kung tama
 Parang binalikan lang ung goal of care pinast tense lang
 After 2-4hrs of nursing care the patient was able to exhibit or
improve gas exchange as evidenced by CRT of less than 2 and
absence of cyanosis.

FLUIDS AND ELECTROLYTES

Discussed by Prof. Donato A. Mirador
Fluids
- 60% of an adult’s body weight
- Infants = more water (80%)
- Elderly = less water
- More fat = less water
- More muscle = high water
- Infants and elderly - prone to fluid imbalance
- younger people have a higher percentage of body fluid than
older and fat people.

 This is called pathophysiology used to learn the disease of the

patient and is included in background knowledge in the table
 Trigger factor- allergies
 Airway inflammation- because of histamine release
Cues
 Subjective:
He begins complaining of breathing difficulty and chest pain
as verbalized by the patient.
 Objective:
Vital signs: RR of 60/min, HR 120bmp, expiratory wheezes,
CRT of 3-4secs, perioral cyanosis, pallor.
Nursing Diagnosis
 Impaired gas exchange related to bronchial constriction as
evidenced by wheezes, perioral cyanosis, capillary refill, etc. Fluid compartment
Background knowledge Intracellular Fluid
 How impaired gas exchange developed - 25 liters of the total fluids in the body.
Extracellular Fluid
 Narrowed down ang pag susulat dito
- 15 liters of the total fluids in the body.
 Tigger factor  airway inflammation bronchial a) Intravascular
constriction narrowed airway wheezes, cough, shortness - Plasma 3 liters
of breath, tightness in chest. - Red cell 2 liters
Goals of care b) Interstitial
 State goal of care by setting time frame - 12 liters
 After 2-4hrs of nursing care, patient will exhibit optimal gas
Formula:
exchange as evidenced by a capillary refill test of less than 2
seconds, absences of cyanosis and normal RR. ECF – Plasma volume = ITF
Intervention
1. Place the client in Fowler’s position Fluid Environment (Normal values)
Extracellular Fluid Intracellular Fluid
2. Instruct patient to perform pursed-lip breathing.
3. Dependent: administer oxygen therapy via face mask at 5-6 Na 142 mEq/L Na 15 mEq/L
K 5 mEq/L K 141 mEq/L
liters per minute as ordered by the doctor.
Ca 5 mEq/L Ca <1mEq/L
Rationale
Mg 3 mEq/L Mg 58 mEq/L
1. Upright position promotes greater lung expansion. Cl 103 mEq/L Cl 4 mEq/L
2. Pursed-lip breathing allows slower and intentional breathing HCO3 28 mEq/L HCO3 10 mEq/L
allowing: blood to absorb more oxygen. P 4 mEq/L P 75 mEq/L
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SO4 1 mEq/L SO4 2 mEq/L  GC in ECF and LC in ICF permits diffusion to become faster
Glucose 90 mg Glucose 0-20 mg and it increases rate of diffusion. The difference bet. The
Amino Acid 30 mg Amino Acid 200 mg concentration of substances in both sides affects the rate of
Cholesterole 0.5 gm Cholesterole 2- 95 gm diffusion.
Phospholipids 0.5 gm Phospholipids 2- 95 gm Osmotic Pressure
Neutral Fats 0.5 gm Neutral Fats 2- 95 gm - The minimum pressure, which needs to be applied to a solution
PO2 35 mm Hg PO2 20 mmHg to prevent the inward flow of its pure solvent across a
PCO2 46 mmHg PCO2 50 mmHg semipermeable. (When we look at ECF and ICF there are non-
pH 7.4 pH 7.0 diffusible solutes that can be found)
- ECF side – cannot pass this semipermeable, there are the one
Fluid Transport who attracts the water.
- How does fluid is being transported from one compartment to
another.
- It can be from intracellular to extracellular or vice versa.
Diffusion
- The movement of a substance from an area of high
concentration to an area of low concentration.
- Diffusion happens in liquids and gases because their particles
move randomly from place to place.  In this illustration this vertical line signifies the semi-permeable
- ex. Perfume, coffee mix in water membrane and on the ECF side there are non-diffusible solutes
Kinetics of Diffusion meaning these solutes cannot pass or cross the semi-permeable
1. The greater the concentration difference between the area membrane so what they do is to attract water because they have
the greater the rate of diffusion. the capacity to hold the water therefore water is being attracted
2. The less the molecular weight the greater the rate of from ICF to ECF.
diffusion.  Ex. Of these is hyponatremia in the ECF it attracts water from
3. The shorter the distance the greater the rate inside the cell going to the ECF.
4. The greater the cross section of diffusion pathway the Active Transport
greater the rate of diffusion - The movement of ions or molecules across a cell membrane into
5. The greater the temperature the greater is the molecular a region of higher concentration, assisted by enzymes and
motion the greater is the diffusion. (Means temp. increases requiring energy.
the rate of diffusion) - Substances from one side of the ECF going to the ICF. There is
Diffusion through the cell membrane a substance form ECF which needs to be transported to the ICF
a) Effect of lipid solubility in diffusion utilizing enzymes and energy. It can be adenosine triphosphate
- ex. O2, CO2, alcohol, fatty acids = very soluble in lipid or ATP adenylate cyclase w/c utilizes adenosine
(passes easily in the cell membrane) monophosphate and when these subs. Is transported to ICF
b) Carrier mediated facilitated diffusion = (insoluble, insulin these adenosine recovers its phosphate compound restoring to
carries glucose across cell membrane) its original form.

c) Diffusion through membrane pores = 8 A (Armstrong) (0.8

nanometer)
- ex. Water molecule, urea molecule, chloride smaller than
the pore
d) Effect of electrical charge
- Electrical charges affects diffusion greatly.
- ex. Na cannot easily pass because of the positive charge.
e) Effect of concentration difference on net diffusion rate.
Problems that Cause Altered Fluid Volume
 Vomiting, diarrhea, fever, and infection.
 Excessive sweating.
 Heat-related illness.
 Excessive urination— known as polyuria, which can be caused
by renal disease, renal failure, adrenal insufficiency, and
overuse of diuretics.
 Blood loss from wounds, injuries, and bleeding disorders.

Types of fluid for replacement

Hypotonic
- Solutions that have a lower osmolality than body fluids.
- Use: cellular dehydration for fluid replacement
- Fluid going inside the cell and it will swell.

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Hypertonic factor is 60 micro drops per ml while in macro drop it has 15 to

- Solutions that have a higher osmolality than body fluids. 2 drops per ml.
- Use: (most commonly used in edema) to reabsorb fluids to
୚୭୪ ୧୬ ୡୡ
lessen edema Cc per hour =
- > traumatic brain injury, intracranial hypertension, intracranial ୦୭୳୰ୱ ୲୭ ୰୳୬
pressure reduction, hypovolemic shock, hyponatremia, ୚୭୪ ୧୬ ୡୡ ୶ ୥୲୲ ୤ୟୡ୲୭୰
hypertonic saline for sepsis. Hours to run =
୤୪୭୵ ୰ୟ୲ୣ ୶ ଺଴ ୫୧୬
Isotonic
- Solutions that have the same osmolality as body fluids. IV THERAPY
- Use: balance the fluid in both ECF and ICF Discussed by Prof. Donato A. Mirador
Definition of terms
 Hypotonic - solutions that have a lower osmolality than body
fluids. Given to the client, the fluid moves from vessels to
interstitial fluids until it reach cell.
 Hypertonic - solutions that have a higher osmolality than body
fluids.
 Isotonic - solutions that have the same osmolality as body fluids.
Fluid stays inside of the blood vessels/ interstitial spaces.
 Phlebitis – an inflammation of the vein that can result
 Hypertonic- water or plasma gets out of the cell. It makes the
mechanical or chemical trauma or local infection.
cell shrink
 Infiltration – seepage of IVF out of the vein and into the
 Isotonic- water coming out is being replaced by another vol. of
surrounding interstitial space.
water. The cell becomes flaccid.
 Air embolism – obstruction caused by a bolus of air that enters
 Hypotonic- fluid is going inside the cell making the cell swell
the vein through an inadequately primed IV line, from a loose
so the cell becomes turgid meaning the cell is swelling.
connection, or during tubing change or removal of IV line.
Tonicity of IV Fluids  Catheter embolism – obstruction that results from breakage of
the tip of the catheter during IV-line insertion.
 0.3%NaCl Hypotonic
Intravenous (IV) therapy
 0.45% SALINE (1/2 NS) Hypotonic
- The insertion of a needle or catheter/cannula into a vein, based
 0.9% NS Isotonic on the physician’s written prescription.
 5% dextrose in water D5W Isotonic - The needle or catheter/ cannula is attached to a sterile tubing
 D5 ¼ NS Isotonic and a fluid container to provide medication and fluids.
 Lactated Ringer’s solution Isotonic - Is used to sustain clients who are unable to take substance orally.
 D5LR Hypertonic - Replaces water, electrolytes, and nutrients more rapidly than
 D5 ½ NS Hypertonic oral administration.
 D5 NSS Hypertonic - Provides immediate access to the vascular system for the rapid
 D10W Hypertonic delivery of specific solutions.
- Provides a vascular route.
Formula for IV computation 10 golden rules for administering drug safely.
Macro Drops 1. Administer the right drugs. (We cannot administer a solution
୴୭୪୳୫ୣ ୧୬ ୡୡ ୶ ୢ୰୭୮ ୤ୟୡ୲୭୰ ሺଵହ ୭୰ ଶ଴୫୪ሻ when it is not needed)
Flow Rate =
୬୭.୭୤ ୦୭୳୰ୱ ୲୭ ୰୳୬ ୶ ଺଴ ୫୧୬. 2. Administer the right drug to the right patient. (IV line serve as
 We can determine drop factor in drip chamber of fluid set where parenteral medications)
in the spike when it is connected to the IV bottle. In the drip 3. Administer the right dose. (We should have the ability of
chamber we can notice whether there is needle or it will form a computing the right dose, we have to validate and make sure
big drop or macro drop. When there is no needle in the drip that the dose is correct)
chamber the drop factor is considered to be 15 or 20 per ml but 4. Administer the right drug to the right route. (There are some
regular is 15 drop per ml. drug administered intramuscular, subcutaneous or intradermal)
 Used in computing drop per minute or per flow rate. 5. Administer the right drug to the right time. (Drugs ordered by
 No. of hours (sol. Is intended to be run or consume) the doctor have frequencies that is why there is q6 for every 6
Micro Drops hours, q8 for every 8 hours and PRN means when needed)
୴୭୪୳୫ୣ ୧୬ ୡୡ ୶ ଺଴ ୳୥୲୲ୱ/௠௟ 6. Document each drug you administer. (Put your signature)
Flow Rate =
୬୭.୭୤ ୦୭୳୰ୱ ୲୭ ୰୳୬ ୶ ଺଴ ୫୧୬. 7. Teach patient about the drugs he is receiving. (To educate the
client regarding the drugs that the patient is receiving)
 1 liter= 1,000 cc
8. Proper documentation provides:
 500 ml= 500 cc
- An accurate description of care that can serve as legal
 ml and cc is the same protection.
 If flow rate is in micro drops or if we see needle in drip chamber - A mechanism for recording and retrieving information.
these tubings are intended to be used by pediatrics patients so
they have a larger no. but it is in a form of macro drops. So drop

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 FUNDAMENTALS OF NURSING PRACTICE LECTURE: 1ST YEAR SUMMER MIDTERM
Label the IV solution specifying:
 Type of IV fluids
 Medication additives and flow rate.
 Use of any electronic infusion device.
 Duration of therapy and the nurse’s name and
signature.
Tonicity of IV Fluids
- IV fluids are classified based on
their types and classification of
fluids are based on tonicity.
- Tonicity – is an action word because
it defines the possible movement of
fluids inside the body.
- 3 types of tonicity:
 Hypotonic- are solutions when given to the clients the
fluid moves from the intravascular wherein the fluid is
introduced or loaded and the water/solution moves
from the vessel to the interstitial fluids spaces until it
reaches the cell
 Isotonic- the fluids are introduced to the IV line and
the fluids stays inside the blood vessels or in the
interstitial fluid spaces because the concentration of
these fluids is the same as the concentration of the
solutes in the extracellular fluid compartment.
 Hypertonic- when we compare this sol. To the body
fluids of the patient, it has a higher mol. Content of
solutes it can be through the glucose or dextrose or
through electrolytes and major electrolytes are sodium
and potassium so they form to have higher
concentration in the content when it comes to
hypertonic solution.
 0.45% SALINE (1/2 NS) Hypotonic
 0.9% NS Isotonic
 5% dextrose in water D5W Isotonic
 D5 ¼ NS Isotonic
 Lactated Ringer’s solution Isotonic
 D5LR Hypertonic
 D5 ½ NS Hypertonic
 D5 NSS Hypertonic
 D10W Hypertonic
Local IVF Color
Aki & Kaye 18 of 34
Types of Solutions
 Hypotonic - solutions that have a lower osmolality than body
fluids.
 Hypertonic - solutions that have a higher osmolality than body
fluids.
 Isotonic - solutions that have the same osmolality as body fluids.
 Crystalloids – solutions that contain electrolytes (for fluid
volume replacement, this is where hypo, iso and hyper are
patterned).
 Colloids/ plasma expanders – pull fluid from the interstitial
compartment into the vascular compartment (given for pt. who
have hge or hypervolemia in order for them torecover from
decrease in blood volume).
IV Cannulas
Steel needle of butterfly sets
- Wing tip needle with a metal cannula.
- Needle is 0.5 – 1.5 inches in length (G16 -26)
- Use in small and fragile bones.
- Infiltration is more common.
- Inserted while avoiding the joints.
Plastic needle
- Use in short term therapy.
- Use for rapid infusion and more comfortable for the client.
- In-needle catheter can cause catheter embolism. (because the
catheter, the needle inserted inside that is the one who will
penetrate the skin of the client)
Types of an IV Cannula and purposes
 Gauge 14- 25 – the smaller gauge the larger the outside
diameter.
 G14 -19 – for rapid fluid administration (blood products or
anesthetics)
 G20 - 21 – for peripheral fat infusion
 G22 - 24 – STD IV fluid and clear liquid medication
 G24 - 25 – for very small veins (for infants)
 The lower the size the larger is the gauge, the higher is the size
the lower is the gauge or diameter.
 FUNDAMENTALS OF NURSING PRACTICE LECTURE: 1ST YEAR SUMMER MIDTERM

IV Tubing
- Contains the spike end, drop chamber, roller clamp, Y – site and
adapter end.
- Use of vented or non – vented tubing.
- Shorter secondary tubing – use for piggyback solutions,
connecting them to the injection site.

Selection of Peripheral IV Site

 Veins in the hand, forearm, antecubital fossa, scalp and feet.
 Assess the veins of both arms closely before selecting a site.
 Start IV site selection distally. (We should start peripheral,
away from the body. We must start first the farthest before
going to the vein near the body)
 Determine the client’s dominant side. (We must avoid the
dominant side. Because the patient’s will use his hands for daily
activity)
 Bending the elbow on the arm with IV may obstruct the flow
Drip chamber causing thrombophlebitis and infiltration.
Microdrip  Use an arm board as needed in the area of flexion.
- Are used if fluid will be infused at 50cc/ hr
- Used if solution contains potent medication that needs to be
titrated.
- Delivers 60drops/ ml.
- Being use when computing micro drops per minute because the
chamber contains needle.
- Commonly used tubing for infants and babies
Macrodrip
- Use if solution is thick or need to infuse rapidly.
- Delivers 10 – 20drops/ ml.

Filters
- Filters provide protection by preventing particles from entering
the client’s veins.
- Filters are used in IV lines to trap small particles such as
undissolved antibiotics or salt or medications that have
precipitated in solution.
- Usually used when nurses will hook a blood for transfusion of
the client because it prevents blood clot and other particles.

Intermittent infusion sets

- Used when intravascular accessibility is desired for intermittent
administration of medications by IV push or IV piggyback.
- (Sometimes there are drugs that are made or prepared in small
amount and even drug illustration, in children if they will
receive medications that are very reactive. The drug
concentration is very high. The nurse is putting the drugs inside
the soluset mixing it with IV solutions and starting to drip as
piggyback. This is a type of intermittent infusion set where in
there is a time when this drug should be given to the client.)
- An IV lock is attached for intermittent infusion devices. (That
is why there is regulator that you can control whenever the
infusion is too fast or slow)
- Patency is maintained by periodic flushing with normal saline
solution (sodium chloride and normal saline are
interchangeable names).
Administration of IV Solution
 Check the IV solution for the type of amount, percent of
solution and rate of flow.
 Assess the health status and medical disorders.
 Wash hands thoroughly and use sterile technique.
 Prime the tubing to remove air from the system.
 Check the IV solution for the type of amount, percent of
solution and rate of flow.
 Assess the health status and medical disorders.
 Wash hands thoroughly and use sterile technique.
 Prime the tubing to remove air from the system.

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 FUNDAMENTALS OF NURSING PRACTICE LECTURE: 1ST YEAR SUMMER MIDTERM

Complications in IV Insertion BLOOD TRANSFUSION

 Infection – redness, swelling and drainage at site; chills, fever, Discussed by Prof. Donato A. Mirador
malaise, headache. Blood
 Tissue damage – skin color change, sloughing of skin, - Comes from Erythropoiesis – RBC production has to get
discomfort at site. Can be brought about by infiltration or erythropoietin from the kidney.
 Phlebitis – heat, redness, tenderness, not hard and swollen. - Erythropoietin – hormone produced by the kidney. It is a
 Thrombophlebitis – heat, redness, tenderness, hard and hormone that enhances the maturity of the RBC.
cordlike vein. - Normal RBC production also requires:
 Infiltration – Edema, pain, and coolness at the site. When 1. Iron
needle of IV line penetrates to the veins and the IV sol. Is 2. Vit. B12
pouring outside the vein the sol. Is accumulated causing edema 3. Folic Acid
 Catheter embolism – decrease BP, pain along vein, weak, 4. Vit. B6
rapid pulse, cyanosis of nail beds, loss of consciousness. When 5. Protein
tip of the catheter was accidentally punctured or detached by the Iron Stores and Metabolism
needle. - Total body iron content is 3g present in hemoglobin.
 Circulatory overload – increased BP, distended jugular veins, - Stored in small intestine, transported within the marrow where
rapid breathing, dyspnea, moist cough, and crackles. (common it is incorporated in the hemoglobin to produce another RBC.
in children) - With Iron Deficiency
 Electrolyte overload – signs depend on the specific electrolyte  Bone marrow iron stores are depleted.
imbalance. If it is potassium it is hard, rapid pumping action of  Hemoglobin synthesis is depressed.
the heart but if it is sodium it is increased in perspiration etc.  RBC produced are small and low in hemoglobin.
 Hematoma – ecchymosis (purplish discoloration), immediate - If there is iron deficiency, it is a sign of bleeding in the
swelling, and leakage of blood at the site, and hard painful gastrointestinal tract.
lumps at the site. Vit. B12 and Folic Acid Metabolism
 Air embolism – tachycardia, dyspnea, hypotension, cyanosis, - To utilize folic acid/ Vit B12, our body must use intrinsic factor.
decreased level of consciousness. – this enhances the Vit B12 Absorption.
- Without intrinsic factor, Vit B12 will only be eliminated by the
Computation colon.
୴୭୪୳୫ୣ ୧୬ ୡୡ ୶ ୈ୰୭୮ ୤ୟୡ୲୭୰ - In order to utilize Vit B12 within the stomach and up to the
 Gtts/ min = distal ileum intrinsic factor is being released and therefore Vit
୬୭.୭୤ ୦୭୳୰ୱ ୶ ଺଴ ୫୧୬.
B12 will be absorbed.
 Vol. in cc (volume of IV fluids) - Deficiency in folic acid metabolism: Production of abnormally
 Used for drops per minute large RBC –megaloblast (type of rbc that are large but immature,
trapped in the marrow)
 drop factor can be 15 if it is a macrodrop 15 drops per ml.
if it is in microdrop it has to be 60 drops per ml Blood
- Composed of:
 no. of hours (where solution is intended to finish) 1. Plasma – fluid portion (55%)
୚୭୪ ୧୬ ୡୡ ୶ ୈ୊ 2. Cellular Component (45%)
 Nos. of hours =  RBC – Erythrocytes
୥୲୲ୱ /୫୧୬ ୶ ଺଴୫୧୬
 WBC – Leukocytes
୚୭୪ ୧୬ ୡୡ  Platelets – Thrombocytes
 Cc/ hr =
୬୭. ୭୤ ୦୭୳୰ୱ - Blood is 7% to 10% of body weight 5-6 L.
୲୭୲ୟ୪ ୴୭୪୳୫ୣ ୲୭ ୧୬୤୳ୱୣ - Functions:
 Infusion time = 1. Carries O2 absorbed from lungs.
୫୪/୦୰ ୠୣ୧୬୥ ୧୬୤୳ୱୣୢ
2. Carries nutrients absorbed from GI tract.
Calculation of infusion of unit dosage per hour - These two important functions of the blood, helps the
Order: continuous heparin Na by IV at 1000 units per hour body to perform metabolism.
Available: IV bag 500 ml D5W with 20,000 unit of heparin Na. 3. Carries waste products that are eliminated in the body.
Question: How Many ml/hr are required to administer the correct 4. Carries hormones and antibodies. (That helps the body to
dose? perform bios functions and helps the body bacterial
Answer: infections and other infection.)
ଶ଴,଴଴଴ ୳୬୧୲ୱ Red blood cells
 Conc/ml= = 40 units/ml
ହ଴଴୫୪ - Hemoglobin (95%) contains iron, can transport O2 because iron
has the capacity to bind with oxygen.
ଵ଴଴଴ ୳୬୧୲ୱ
 ml/hr.= = 25ml/hr - Reticulocytes – immature RBC, starts the formation of RBC.
ସ଴ ୳୬୧୲ୱ
After reticulocytes they form immature RBC until it becomes
matured/ erythrocytes.
- Hemoglobin binds with O2 – arterial blood (this oxygen comes
from diffusion of oxygen in the alveoli, it is caught up by the
blood then it will be delivered by the heart through the arterial
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 FUNDAMENTALS OF NURSING PRACTICE LECTURE: 1ST YEAR SUMMER MIDTERM
to the cells, and then this hemoglobin after delivering oxygen to
the cells, before they leave the cell they absorb hydrogen as a
product of metabolism/ bi-product of metabolism)
- Hemoglobin binds with H – venous blood (decrease pH level)
which means acidity is rising.
- 15 g of hemoglobin per 100 ml of blood
Blood groups and their constituent agglutinogens and
agglutinins
Blood groups Agglutinogens Agglutinins
O - Anti A & Anti B
A A Anti B
B B Anti A
AB A&B - Platelets
Agglutinogens
- blood group antigens are A & B inherited by a person and
may have neither of them.
- Are antigen A & B these are inherited of persons from their
parents or maybe none of them will be inherited from the
parents meaning there can be absence of these
agglutinogens in the blood and in that case, it falls under
the blood type of O, while if agglutinogen A appears in the
blood it is blood type A, if agglutinogen B appears in the
blood it is blood type B and if both appears in the blood it
is blood type AB.
Agglutinins
- Strong antibodies react specifically with either type of
antigen.
- In the blood type group O, since there is no agglutinogen
they can form agglutinin anti-A and anti-B, which means
in blood type group O if we will transfuse blood, whether
it is A or B, the formation of agglutinins Anti A and Anti
B will surely destroy the blood that is being transfuse.
- In the blood type A, which has agglutinogen A can only
form agglutinin anti B. therefore, blood type A cannot
receive blood type B because there is an agglutinin Anti B
to destroy blood type B.
- In blood type B which is agglutinogen B it forms agglutinin
anti A if blood type A will be transfused to blood B
agglutinin anti A will be formed to destroy blood type A
that is being transfused to the patient.
- The opposite of blood type O is AB because AB has two
types of agglutinogen therefore, it will not form agglutinin
on both agglutinogen or antigen.
Blood Typing
Blood groups Anti A serum Anti B serum
O - - form of autoimmune problem and fibrinogen is also replaced
A REACTION NO REACTION
B NO REACTION REACTION
AB REACTION REACTION
- Anti-serum A has the ability to have reactions with antigen A
which is in the blood type A.
- When we get a sample of blood type A, and we expose to Anti
A serum there will be a reaction. It means that Antigen A is
present in the blood type A but if we will expose type A blood
to anti serum B there will be no reaction means that there is no
antigen B present and this process is the same with blood type
B.
Aki & Kaye 21 of 34
Blood components (that can be transfuse)
Red Blood Cells
- Used to replace erythrocytes.
- Preparation: 250ml
- When we transfuse RBC, it increases the hemoglobin by 1g/dl
and hematocrit by 2 - 3 %
- Commonly used for Acute and chronic anemia
Fresh Whole Blood
- Use to resolve hypovolemic shock resulting to hemorrhage.
- Preparation: 500ml
- Rarely use. (because instead giving fresh whole blood, doctors
tend to a fragmentalize this whole blood in to different
components.)
- Use to treat thrombocytopenia and platelet disfunctions.
- X – matching is not required.
- Preparation: 50 – 70ml /unit or 200 – 400ml/ unit
- Administer immediately and given for 5 – 30min. (after that
platelet will no longer be used. Because it will form a thick
rubbery like substance.)
- Evaluated after client 1 hr and 24 hrs after transfusion of
platelets.
Fresh frozen plasma
- Use to provide clotting factors or volume expansion.
- Infused within 6 hours of thawing.
- Infused as rapidly as possible. (Or else, it will get thick rubbery
consistency and it will no longer be transfused to the client if
more than 6 hours.)
- X- matching is needed.
- There will be elevations of prothrombin time and arterial
plasma thromboplastin time.
Albumin
- Use to treat hypovolemic shock or hypoalbuminemia.
- Prepared from plasma and can be stored for 5 years.
- 25g/100ml of albumin = 500ml of plasma
- Albumin can be able to increase the volume of the blood. That
is why it is a potent drug or transfusion to treat hypovolemic
shock or hypoalbuminemia.
Cryoprecipitate
- Use to replace factor VIII and fibrinogen.
- (From 12 it cascades to 1 until it forms blood clot. If one of
these factors is missing, the cascades will not continue, and
blood clot will not be formed. Just like in the case of dengue
hemorrhagic fever, the virus stays in factor VIII, but it does not
do anything to the clotting factor. Our body antibodies, they are
the one destroys the virus in the factor VIII and then after
destruction of the virus, the factor VIII is also destroyed. It is a
when we transfused cryoprecipitates to the patient)
- Prepared from FFP.
- Can be stored for 1 year but once thawed, the product must be
used.
Types of Blood Donation
Autologous
- Donation of the client’s own blood before the scheduled
procedure.
- Reduces the risk of disease transmission and potential
transmission complications.
- Can be made every 3 days as long as hemoglobin remains with
in a safe range.
 FUNDAMENTALS OF NURSING PRACTICE LECTURE: 1ST YEAR SUMMER MIDTERM
- Donation should be made within 5 weeks of the transfusion date
and end at least 3 days before the date of transfusion. (so that is
how a person who wishes to have this own blood for transfusion
should follow this transfusion)
Blood Salvage
- An autologous donation.
- Involves suctioning of blood from body cavities, joint spaces.
- Blood may need to be washed by a special process that removes
tissue debris before reinfusion.
Designated Donor
- When recipients select their own compatible donors.
- It is the client who bring the donor and the donor will donate
blood for the client and that blood that is compatible is being
used. It will also undergo examinations.
- Does not reduce the risk of contracting infection but they feel
comfortable.
- Compatibility:
 Rh type and ABO type are identified.
 Use to prevent transfusion reaction.
 Crossmatching – the testing of donor’s blood and the
recipients for compatibility.
Complications
 Transfusion reaction. Informed of the allergic reaction. (there is
some blood, even though there are crossmatch. There is some
protein part of the blood that causes transfuses reaction.) Doctor
might order to antihistamine.
 Circulatory overload (when transfusion of blood exceeds the
expected blood that can be received by the client)
 Septicemia (that bacteria may be present in the blood that is
being transfused. To prevent this development, the desired
number of hours is 4-6hours, and it should not exceed.)
 Iron overload (iron comes from hemoglobin, if blood is
undergoing hemolysis and nurse is pushing through to complete
transfusion it is better to set aside transfusion bcs nurse is
infusing too much iron and potassium and too much iron in the
body can cause liver damage)
 Disease transmission (most common hepatitis B and human
immune virus)
 Hypocalcemia and citrate intoxication
 Hyperkalemia (heart rate is becoming faster and harder so it is
detrimental to the condition of the patient)
Nursing Intervention
 A large volume of blood transfused rapidly through a central
catheter into the ventricle of the heart will cause cardiac
dysrhythmias. (The nurse should be aware that the volume must
be transfuse slowly)
 No solutions other than NS should be added on blood
components. (or else, IV and blood reactions will develop, it
will cause blood clot)
 Infusion should not exceed more than 4 hrs.
 Medication is never added to blood components. (stop blood
transfusion when medication is needed run plain NSS to clear
the tubings so that blood cells will be pushed with IV fluids and
then medications can now be given)
 Blood administration set should be changed every 4 - 6 hrs.
(change blood set if there is another blood to be transfused.
There are filters in the blood set for transfusion and this might
clogged and therefore blood transfusion might not be possible
Aki & Kaye 22 of 34
if same blood set is to be used so we have to change it every
after transfusion)
 Check the date of expiration. (two nurses are required to check
the data)
 Inspect the blood for abnormal color, leaks, clots, bubbles.
 Blood must be administered 20-30 minutes from its being
received from the blood bank. (blood is sometimes frozen, and
should be left at room temp. but not to extend too warm)
 Never refrigerate blood in refrigerator other than blood bank. (if
blood is not utilize by the patient nurse should tell the lab. To
fetch the blood to manage it)
 Monitor vs and assess lung sounds. (before blood transfusion
initial VS is taken and after blood is hooked to the client vital
signs should be taken every after 15min for 1 hour and after 1
hour it will be taken every 30 minutes and after that it will be
taken hourly until the blood is consumed)
 2 RN need to check the physicians order, client’s identity,
client’s identification band.
 Check the blood bag tag, label, and blood requisition form.
 Written in the label: expiration date, serial no., blood type,
name of the client. So if this matches with the patient data
it will then be administered.
Client Assessment
 Assess for any cultural or religious beliefs. (as nurses we have
to be knowledgeable with the background of the patient)
 Informed consent has been obtained. (should be signed by the
patient or significant others)
 Check the clients vital sign and medical status.
DOSAGE AND COMPUTATION
Discussed by Prof. Francis Vincent Acena, MAN, RN, RM
- Nurses are often intimidated by the math that occurs in every
practice in most clinical and academic settings nurses must
demonstrate a 100% accuracy with medication dosage because
patient safety depends on practitioners ability to calculate
medications correctly in timely manner.
- Patient safety is a key concern for nurses; ability to calculate
drug doses correctly is an essential skill to prevent and reduce
medication errors.
Common Medical Abbreviations Related to Medication
Routes
Routes – kung saan natin pinapadaan yung mga gamot papunta sa
katawan ng pasyente.
 IM– Intramuscular (Intra – within/ inside, w/in the
muscles)
 IO– Intraosseous (directly into the bone marrow)
 IV– Intravenous (vein)
 IVP– Intravenous Push (blood stream/ vein)
 ID – Intradermal (under the skin)
 IN – Intranasal (nose)
 IP – Intraperitoneal (within peritoneum or the walls of
abdominal cavity.)
 IT – Intrathecal (spinal canal, subarachnoid space so it
reaches the CSF, useful in anesthesia, chemotherapy, pain
management)
 IVPB – Intravenous piggyback ( sometimes called
secondary IV infusion)
 p.o – By mouth
 SC / SubQ – Subcutaneous
 FUNDAMENTALS OF NURSING PRACTICE LECTURE: 1ST YEAR SUMMER MIDTERM

 SL – Sublingual (under the tongue)  gm or G- gram

 top. – Topical (on the skin)  gr- grain
 Supp – suppository (rectal) by insertion to a body  ml-milliliter
 pess – pessary, Vaginal suppository  cc-cubic centimeters
Measurement  L -liter
 Kg– kilogram  Neb -nebule
 gm– gram  Amp -ampule
 mg– milligram  Tsp -teaspoon
 mcg– microgram  tbsp. -table spoon
 mEq- milliequivalent  ODBB- once a day before breakfast
 L– liter  R – refused
 mL– milliliter  NA - not available
 μg– microgram  Syr – syrup
 gtt – drop  Susp – suspension
 μgtt – micro drop  Elix -elixir
 tbsp – tablespoon  Supp - suppository (rectal)
 tsp – teaspoon  Pess - vaginal suppository
 mg/dL – milligrams per deciliter  Gtt - drop; gtts- drops
Medical abbreviations  a – before
 OD- once a day - the drug is given at 8 am or 9 am unless  ac –before meal
specified by the doctor.  cap. -capsule
 BID- twice a day- the drug is given at 8 am and 6 pm  hs or HS –at bedtime: Hours of sleep
 TID- thrice a day- the drug is given at 8 am, 12 nn or 1pm and  MDI –metered dosage inhaler
6 pm.  P –after
 QID- four times a day- the drug is given at 8am, 12nn, 4pm and  Rx –prescription
8 pm  stat –immediately
 prn- whenever necessary/needed, no specific time unless time  Tab –Tablet
interval is specified by the doctor.  Tx –Treatment
 FR –Fast Release
Example (prn):
 TR –Timed-Release
 You have patient that always complain of abdominal pain now
 XR –Extended Release
you reffered him/her to the doc. and the doctor ordered:
Conversion
- Buscopan 10 mg 1 tab prn for abdominal pain
- Buscopan 10 mg 1 tab prn q 4 hrs. for abdominal pain
- In the first example, you can give Buscopan when
necessary, but the 2nd example you can give Buscopan
whenever necessary, but the nurse must observe a 4-hour
interval between doses. If the client is still in pain and the
4-hour interval is not yet done, the nurse can re-assess the
client and can refer the client’s severity of pain to the doctor.
 q- every
 q4 hrs.- every 4 hours. The drug is given at (4am-8am-12nn-
4pm-8pm-12mn). The drug is given 6x a day (24 hrs. divided
by 4 hrs.) or RTC (Round-the-clock)
 q6 hrs.- every 6 hours. The drug is given at (6 am-12nn -6pm-
12 mn). The drug is given 4x a day (24 hrs. divided by 6 hours)
or RTC.
 q8 hrs - every 8 hours. The drug is given at (8am-4pm-12mn).
The drug is given 3x a day (24hrs divided by 8) or RTC.
 p.o.- per orem or by mouth
 SL- sublingual- the medication is placed under the tongue.
 o.d. - occulus dexter or right eye
 o.s. - occulus sinister or left eye
 o.u. - occulus uterque or both eyes or each eye
 a.d. –right ear
 a.s. - left ear
 a.u. both ears
 HS - hours of sleep, at bedtime or half strength
 mg- milligrams

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 FUNDAMENTALS OF NURSING PRACTICE LECTURE: 1ST YEAR SUMMER MIDTERM

Used in identifying how many tablets you will give to the patient
Desired dosage is the ordered dosage of the physician.
Stock dose is the amount of drug present in each tablet.
Example:
The physician orders 500 mg of Amoxicillin tablet TID for the
patient. The drug is available in 250 mg tablets. How many tablets
should be given to the patient?

500 mg
ൌ 2 tablets
250 mg
Example 2:
The physician orders 1g of Paracetamol tablet prn for the patient.
The drug is available in 500 mg tablets. How many tablets should
be given to the patient?
 1g x 1000= 1000mg

Mass
 Kg  g  mg  mcg ( x by 1,000 ) big to smallest
Example:
1 Kg to g? [ 1 kg x 1000 = 1000g]
3 g to mg? [ 3 g x 1000 = 3000 mg]
5 mg to mcg? [ 5 mg x 1000 = 5000 mcg]
 mcg  mg  g  kg ( ÷ by 1,000 ) small to biggest
500 mcg to mg? [ 500mcg ÷ 1000 = 0.5 mg ]
1000 mg to g? [ 1000 mg ÷ 1000 = 1 g ]
250 g to kg? [ 250 g ÷ 1000 = 0.25 kg ]

 lb ←kg ( x by 2.2 ) Calculating Mixtures and Solutions

 lb  kg ( ÷ by 2.2 )
desired dosage
x stock volume ൌ amount of soltion to be given
stock dose

Stock volume
- the amount of the solution where the drug is diluted.
- is the amount of the solution where the drug is diluted or
the amount of sterile water to dissolve powder-based meds.

Volume
 Liter to mL L → mL (multiply by 1,000) big to small
Example: How many mL in 5 Liters?
Computation: 5 liters x 1000 = 5000 mL
 mL to Liter mL → L (divide by 1,000) small to big
Example: How many liters in 3000 mL?
Computation: 3000 mL ÷ 1000 = 3 L
Time
 Hour to minutes hr → min (multiply by 60)
Example: How many minutes in 3 hours?
Computation: 3 hours x 60 = 180 minutes
 minutes to hour min → hr (divide by 60)
Example: How many hours in 120 minutes?
Computation: 120 minutes ÷ 60 = 2 hours
Example 1:
The physician orders 500 mg of Ceftriaxone q8 for the patient. The
drug is available in 1 g vial. You plan to dilute it in 10 mL of sterile
water. How much should you give to your patient?
500 mg
x 10 mL ൌ 5mL
1000 mg
 10ml- diluted medication
 5ml= 500ml, ito lang kukunin para i-inject sa pt.
 Kung gaano karami ung kukunin liquid/medication ganun din
karami air na ilalagay sa syringe

Calculating Tablet Dosages

desired dosage
ൌ number of tablets
stock dose

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 FUNDAMENTALS OF NURSING PRACTICE LECTURE: 1ST YEAR SUMMER MIDTERM
Example 2:
The physician orders 5 mg of Metoclopramide prn for the patient.
The drug is available in 10 mg per 2 mL preparation. How much
should you give to your patient?
5 mg
x 2 mL ൌ 1mL
10 mg
CONCEPTS OF ADMINISTERING MEDICATIONS
Discussed by Prof. Francis A. Vasquez, MAN, RN
MEDICATION 1 – CONVERSION
Administration of medication
- One of the most common tasks performed by a nurse that
requires systematic, organized, and accurate drug preparation,
administration and documentation that are needed to ensure
client’s safety and possible resolution of his health problems.
- Three phases:
1. Drug preparation – read and analyze the doctor’s order. Try
to compute whether the dosage is correct.
2. Drug administration – you must know how to administer
the drug particularly the route like oral, topical, parenteral
and in parenteral u have intradermal, subcutaneous,
intramuscular and intravenous.
3. Drug documentation – you must document the drug that
you administered. Task not documented is task not done.
- You need to know each drug that you going to administered to
your client. Know indication of the drug kung para saan ba siya,
action of the drug to the body, adverse reaction of the drug and
dosage of the drug or route.
- Drugs have different therapeutic action such as the
following:
 Palliative – it relieves the symptoms of the disease but does
not treat the disease itself. Examples are the pain relievers
such as mefenamic acid, Morphine, and aspirin.
 Curative- it cures the disease process itself. Example of this
are the antibiotics or antiviral drugs such as penicillin,
ampicillin.
 Supportive- it maintains body function until treatment
takes over. Example is paracetamol for fever.
 Substitutive- it replaces body fluid or substances. Example
is Insulin for diabetes
 Chemotherapeutic- it destroys malignant cells. Example is
Vincristine for Leukemia
 Restorative- it restores client’s health. Example of this are
the vitamins and mineral supplements.
Medication/ Drug Orders
1. Client’s Full Name
- for accurate identification of the client
2. Date and time the order is written.
- for documentation and monitoring purposes.
- In some agencies, a drug order for narcotics is only valid for 48
hours, hence, if the doctor did not make any order to cancel or
continue that narcotic drug, his order is automatically cancelled
after 48 hrs.
- The nurse should not carry out that order anymore.
- To monitor how long the patient take the drugs
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3. Name of the drug to be administered.
- this must be clearly written.
- The name of the drug could be in generic name or with brand
name beside it.
4. Dosage of the drug
- the doctor is one who determines the dosage or strength of the
drug to be given to the client, for example 500 mg of Ampicillin.
- The nurse calculates the amount to be given to the client based
on the dosage ordered by the doctor.
5. Frequency of administration
- This indicates the number of times the client will take the drug
in a day or the number of times the nurse will administer the
drug to the client in a 24-hour basis.
- Remember: the frequency of administration can affect the total
dosage that the patient receive 1day.
- Example is “Ampicillin 500 mg 1 cap p.o. QID”. The dosage or
strength of the drug is 500 mg to be given QID which means 4
times a day therefore the client will receive a total of 2,000 mg
of Ampicilin within 24 hours or 1 day.
6. Route of administration
- this implies how the drug is to be given to the client.
- Example is “p.o.” which literally means “per orem” or by
mouth; SC or subcutaneously via injection.
7. Signature of the person writing the order.
- Once the order is signed by the doctor, the order becomes legal.
Types of Drug or Medication Orders
1. Standing Order
- a drug order that must be carried out as specified by the
doctor until it is cancelled or changed by the doctor.
- Ex. Doc change the drug, dosage of the drug per dose,
frequency, route, hold or stop the drug
2. Single Order
- a drug order that must be carried ONLY ONCE. This is a
one-time order only.
- Example: Penstrep ¼ IM (intramuscularly) before
discharge. Here, the nurse will only administer the drug
before the client goes home or upon discharge from the
hospital.
3. Stat order
- a drug order that must be carried out AT ONCE or
Immediately.
- Example is “Morphine sulfate 10 mg IV stat”.
4. prn order
- a drug order that must be carried when needed or when
necessary. It allows the nurse to administer the drug if
based on his knowledge and assessment, the client needs
the drug.
- Example is “Buscopan 10 mg 1 tablet prn for abdominal
pain.”
- Combine prn and standing order: buscopan 10 mg 1 tab
every 4 hrs prn for abdominal pain so if sumakit sa umaga
ng 8 am kailangan ibigay agad at kapag sumakit ulit ng 10
am hindi na pwede ibigay kase may interval na 4 hrs so
next na bigayan 12 pa and if masakit talaga siya sabi ng
pasyente pain scale of 10/10 u have to notify the doc.
 FUNDAMENTALS OF NURSING PRACTICE LECTURE: 1ST YEAR SUMMER MIDTERM
Interpreting Drug orders
 “Tetracyline 250 mg 1 tab p.o. TID.
Interpretation: Administer 1 tablet of 250 milligrams of
Tetracycline orally three times a day.
 “Lanoxin 0.25 mg 1 tab OD”
Interpretation: Give 1 tablet of 0.25 milligrams of Lanoxin
orally once a day.
 “Solucortef 80 mg IV q 8 hrs”
Interpretation: Administer intravenously 80 milligrams of
Solucortef every eight hours.
 “Nifedipine 10 mg SL stat”
Interpretation: Immediately administer sublingually 10
milligrams of Nifedipine.
 “Ventolin inhal 1 neb q 4hrs prn for DOB”
Interpretation: “If necessary for difficulty of breathing, perform
inhalation with 1 nebule of ventolin
every four hours.
10 Rights the Nurse Must Observe in Administering
Medications
Right Client or Patient
- Administer the drug to the right client.
- Ask the client to state his full name if applicable. (Do not state
the patients name)
- Counter check the stated name to his identification band.
Right Medication or Drug
- Give the medication ordered by the doctor. You may also
counter check if the medication card is up to date by checking
the Doctor’s order found in the client’s chart.
- Nurses: based on pt. chart or doc order we make medication
card
- Doctor: writes drug order on the patients chart
Right Dose
- Administer the drug with the dose ordered by the doctor. (Most
of the time doc. will just give the strength of the drug 500 mg,
200 mg, 1g and its up to the nurses the amount of drug to be
given: volume or no. of tablets)
- Carefully and accurately compute the dosage of the drug.
- Be familiar with usual range of dose of the drug that you are
preparing and administering.
- Question the dose if it is beyond the usual range of dose. (we
can verify the dosage to the doc. that he is asking to administer)
Right Time or frequency
- Administer the drug according to the frequency indicated by the
doctor and following the hospital’s or agency’s policy of drug
administration. For example OD- 8 am, BID 8 am and 6 pm.
- Since the nurse cannot administer all the drugs of all his patients
at the same time, some agencies allow the nurse to administer
the drug 30 minutes early or 30 minutes late. Follow agency
policy.
Right Route
- Administer the drug based on the order of the doctor and check
if the route is safe for the client.
Right Client Education
- Explain to the client why he is receiving the drug, how will the
drug help her condition, what to expect and possible side effects.
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Right Documentation
- Document or record each drug you administered. In case if a
drug is not administered, be sure to record the reason why the
drug was not administered. Possible reasons are: R, NA, or P.
- Notify the doctor for any drug not administered.
Right to Refuse
- A client of legal has the right to refuse any medication.
- Your responsibility is to make the client informed of the
possible consequences of his action. In some agencies, the client
needs to sign a Refusal Form. Be sure to inform the client’s
doctor.
Right Assessment
- Some medications like prn medications require assessment
form the nurse.
- Vital signs
Right Evaluation
- Evaluating the client after drug administration allows the nurse
to monitor the client’s response to the drug or if there are any
side effects or adverse reactions the client is experiencing.
Routes of Drug Administration:
Oral Route
- Form: Solid – Tablet, capsule, caplet, lozenge (strepsils)
- Liquid- Syrup- sugar based, drops- for infants, elixir-
alcohol based, suspension- dissolve in water, emulsion-
oil based, extract
Sublingual
- the drug is placed under the tongue.
Buccal – the drug is placed near the cheek.
Topical
- the medication is applied on the skin or mucus membrane.
- Forms: Cream, soap, powder, liniment, patch, ointment,
lotion, shampoo, paste, tincture, suppository, pessary, gel,
inhalation
Parenteral
a) Intradermal
b) Subcutaneous
c) Intramuscular
d) Intravenous
MEDICATION 2 – DRUG COMPUTATION
Medication error
- One of the most common sources of errors and legal problems
of nurses. Errors can originate from any part of the drug order.
- Example, the nurse administers a wrong medication, or the
nurse administers the right medication to a wrong patient.
- Most often than not, the nurse administers the right medication
to the right patient but with wrong dosage.
- The dosage given to the client maybe overdose or underdose.
Therefore, knowledge and skills in computing accurately drug
dosages across lifespan is of utmost important on the part of the
nurse.
Drug dosage
- The doctor is the one who orders what drug to be given to the
client.
- Included in his order are the dosage of the drug, the route of
administration and the duration and frequency the nurse must
administer the drug.
- Remember the different types of drug orders: standing, single,
stat and prn orders.
 FUNDAMENTALS OF NURSING PRACTICE LECTURE: 1ST YEAR SUMMER MIDTERM

Example In other countries like USA, the pharmacist dispenses the drug per
Given: patient based on the drug order of the doctor and the pharmacist
 Norvir 100 mg 2 tabs BID. places a prescription label on the container of the drug that includes
Questions: the client’s name, address and the instruction on how to take the drug.
a. What type of drug order the doctor used? It’s like a personalized drug container. Other information are the
b. How many times per day are you going to administer following:
Norvir?
c. What is the dosage/strength of the drug are you going to
administer per dose?
d. What is the total dosage of the drug the patient is receiving
per day?
Answers:
a. Standing order
b. The frequency stated in the order is BID which means twice
a day (Example: Give the first dose of the drug at 8am and
the 2nd dose at 6 pm/day)
c. Norvir 100 mg 2 tabs BID means that each tablet contains
100 mg. Since you will administer 2 tablets, you will
administer 200 mg of Norvir per dose.
d. Since the frequency indicated in the order is BID, the total
dosage of the drug the client is receiving per day is 400 mg.
( 200 mg/dose x twice/day is 400mg/day)

Understanding drug labels

Name of drug: Amoxicilin
Form: Oral Suspension
Supply dosage: 125 mg/5 ml
Total Volume per bottle: 100 ml
- kapag isa lang pangalan generic
name ito

- Brand Name or Trade name of the drug: KEFLEX . The small

R besides Kelfex means “registered” trade name by DISTA
Products Co. (pharmaceutical company)
- Generic Name: Cephalexin MEDICATION:
- Form of the drug: Capsule ADMINISTRATION AND DOCUMENTATION
- Strength/capsule: 250 mg - Administration of medication is one of the most common
- Number of capsules/bottle: 100 procedures a nurse performs in the hospital.
- Active ingredient: Cephalexin Monohydrate - The efficient, organized and timely administration of prescribed
- Expiration date. medications may alleviate pain, promote comfort and well-
being, cure and support the rehabilitation process of the patient.
- Knowledge and skills in administering medications while
adhering to the 10 Rights in medication are a must on the part
of the nurse.
- Likewise, correct and proper documentation of the drugs
administered and were not administered are equally important.

General Safety Guidelines in Administering Medications

1. Verify doctor’s order. If you think that the medication order is
in error or if you are having a hard time reading the doctor’s
order, verify it with the doctor who made the order.
2. Always assess the client’s condition before and after you
administer the medication. This will tell you if the client still
needs the medication specially the prn meds or if the client’s
condition is improving or not.
3. The nurse is accountable to every medication he administers to
his client. Be sure you adhere with the 10 rights of medication
and be knowledgeable about the medications you administer.
4. Use only clearly labeled medication and check for expiration
date.
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5. The nurse who prepared the drug must administer the drug and - Never allow the tip of the dropper to touch any part of the
don’t let yourself administer a drug you didn’t prepared. eyes of the client. (horizontal position pag hawak sa
6. Calculate drug doses accurately. dropper)
7. Identify the client correctly. Ask the client to state his name and - Instruct patient gently close his eyes to prevent drug from
check his identification bracelet or tag. coming out and roll his eye balls to spread the drug.
8. Do not leave the medication at the bedside except for some b) Opthalmic Ointment (application)
medications. - Position of the client: supine, head on a pillow, patient
9. Know your hospital policy in receiving verbal or telephone looks up or sitting, head is tilted back, patient is looking up.
orders. - Pull lower lid down.
10. Update your medication sheet and medication card for non- - Apply the medication from the inner canthus to outer
EMR wards or hospitals. (If any change is done, update the canthus. Avoid applying the medication on the lacrimal sac
medication card) because of the presence of blood vessels.
11. If the client refuses to take the medication, verify why he - Never allow the tip of the tube to touch any part of the
doesn’t want to take the drug and discuss the possible effect of patient’s eyes. It will contaminate the medication.
his action. Notify your head and client’s doctor. - Instruct patient gently close his eyes.
12. If an error in medication is made, report immediately to your Otic Drugs
charge-nurse and client’s doctor. - Place the client in a sidelying position on his unaffected side.
- Pull pinna backward and upward for adults (above 2 years old)
Steps of Administering Medications: and backward and downward for children (below 2 years old)
1. Identifying the client. to straighten auditory canal. (horizontal hawak sa dropper)
2. Informing the client. - Instill the drug and never allow the tip of the tube to touch any
3. Administering the medication. part of the patient’s ear to avoid contaminating the drug.
4. Provide necessary interventions when needed. - Instruct the patient to remain on sidelying position for 15-20
5. Record the drug administered. minutes to allow the drug to enter the auditory canal.
Preparing and administering Oral medications: - If both ears need treatment, allow a 30-minute interval between
1. Verify doctor’s order and check medication card. instillations.
2. Compute accurately for the drug dosage. Rectal Suppository
3. Perform hand washing. - Provide Privacy and place client on Sim’s position.
4. Get the right drug. Read the label of the drug upon getting it - Wear clean gloves.
from the cabinet, before pouring the drug into the medicine - Separate the buttocks and insert the suppository then hold the
glass and before returning the drug inside the cabinet. buttocks together to allow the drug to go further inside the
5. If you are using a liquid drug like suspension or elixir, place the rectum.
label of the drug against your palm so that drippings will not - Could be laxative drug (commonly used drug para lumambot
flow onto the drug label making it hard for you to read the label ang poop)
the next time you use it. Vaginal Suppository or Pessary
6. Use appropriate vehicle for oral drug administration. Medicine - Provide privacy and place the patient in dorsal recumbent
dropper, oral syringe, teaspoon, tablespoon and medicine glass. position. Put on drapes.
In using medicine glass, be sure to read at lower meniscus. - Prepare the pessary and wear clean gloves.
7. Greet the client, identify yourself and identify the client. - Separate the labia minora with your non-dominat hand and
8. Explain the procedure to the client. using the applicator, insert the pessary into the vaginal canal by
9. Place client on Fowler’s position when administering an oral pushing the plunger.
drug. - Remove and dispose the applicator and gloves properly.
10. Again, check client’s identity. - Make the patient comfortable.
11. Administer the drug. For children with stranger anxiety, it’s best
to allow the child to sit on the lap of the mother to decrease
anxiety. If you are using a dropper or oral syringe, be sure to
place the dropper or oral syringe on the side of the mouth.
12. Provide water.
13. Make the client comfortable.
14. Document the drug given.

Administering Topical Medications

- Topical drugs applied, instilled or sprayed and intended to be
absorbed on the skin or mucous membrane.
Opthalmic Medication
a) Opthalmic drops (installation)
- Position of the client: supine, head on a pillow, patient
looks up or sitting, head is tilted back, patient is looking up.
- Pull lower lid down and the drug is instilled in the
conjunctival sac.

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CONCEPTS OF PAIN
Discussed by Dr. PA Maroma Nociceptive Pain
Pain - Subdivided into: Somatic and Visceral pain
- An unpleasant sensory and emotional “suffering” experience
usually associated with disease or injury.
- Universal-experienced by everybody, complex- influenced with
emotional, behavioral changes etc., subjective experience- it is
felt only by the patient.
- Most common reason why a person seek medical care.
- Fifth vital signs. (While monitoring the vital signs we should
ask the patient if he/she is in pain)

Example:
 Exposed to extreme heat nabanglian ng mainit na tubig so there
will be damage to the cell and these damage cells release
chemical like histamine, bradykinin, prostaglandin, that is
noxious stimuli and there will be injury and stimulation of
peripheral sensory nerves and there will be propagation of nerve
impulse and this impulse pass through the spinal cord (serves as
sensory pathway) via spinal thalamic tract going to thalamus
(serves as relay center for all sensory impulses) and proceding
to the cerebral cortex where it is interpreted as pain.
 Superficial cutaneous pain- affects the skin and subcutaneous.
 Deep somatic pain/ muscle pain- affects muscles and bones. Somatic pain
 Visceral pain- affects the internal organs. - Caused by: mechanical (distention of an organ), chemical
 Neuropathic pain- affects the nerves, brain and spinal cord. (release of chemical mediators), thermal, electrical injuries
(nakuryente), D/O affecting bones, joints, muscle, skin,
Acute pain connective tissue.
- Short duration (less than 6 months) - Superficial ''Cutaneous'' somatic pain
- Results from acute injury, disease or surgery usually temporary,  Ex; Insect bite, paper cut
sudden onset and easily localized (postoperative, trauma-  "sharp'' or "burning'' discomfort.
stabbed by a knife, burns, procedural- like simple blood - Deep somatic pain
extraction or endoscopy, obstetric-labor pain)
 Ex: trauma (fractures)
- Acts as a warning signal (activates "fight or flight" reaction).
 Localized sharp, throbbing & intense sensations.
There is stimulation of sympathetic nervous system therefore
there is: Higher HR, BP, RR, mydriasis- causes pupillary
Neuropathic Pain
dilatation, sweating- increased in perspiration.
- Results from damage to the (brain, spinal cord) pain pathways
- Endoscopy- direct visualization of cavity or organ.
or pain processing centers in the brain.
- Example: laryngoscopy, hepatitis a, appendicitis, labor pains,
- Example: Phantom limb pain (pt. have an amputation), spinal
burn injury
cord injuries (nabaril, nasak-sak), strokes, diabetes, and herpes
zoster (shingles)
Chronic Pain
- Long duration (more than 6 months)
- Chronic cancer pain
- Chronic noncancer pain
- Cancer occupies space therefore pag malaki na yung tumor, it
occupies space and compress the nerve and veins. It also
spreads through blood stream or to nearby structures. It can also
be secondary to chemotherapy or radio therapy
- Chronic non cancer is a prolong duration more than 6 mos and
most common type is secondary to arthritis they experienced
low back pain.
- It can also cause obstruction.
- Example: hepatitis c and b, osteoarthritis

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center for sensory impulses  limbic system brain  cerebral

Cancer Pain cortex/ sensory cortex where it is interpreted as pain.
- May be either nociceptive or neuropathic pain.
- Tumor creating a pressure in the organ – nociceptive pain
(visceral pain)
- Effects of chemotherapy or radiation – neuropathic pain
- Note: regardless of its nature, pattern, or cause, pain that is
inadequately treated has harmful effects beyond the suffering it
causes.

Impact of Unrelieved Pain

1. Physiologic impact
- Prolongs stress response,  HR, BP & oxygen demand, 
GI motility (mabagal peristalsis), causes immobility
(difficult to gain cooperation of client because it is hard for
them to turn, after surgery the most common complication
because of pain exp. is that of atelectasis it is the no. 1 lung
complication after surgery. After anesthesia wears off
narcotics and analgesic will be given a round the clock), 
immune response, delays healing,  risk for chronic pain.
- Example: we give morphine to the patient every 4hrs 8am,
12pm, 4pm, 8pm, 12am, 4am with 6 doses within 24hrs and
after that the patient is prn as necessary
- Unrelieved pain become chronic
2. Quality of Life impact
- Interferes with ADL, causes anxiety, depression, fear,
anger & sleeplessness, impairs family, work & social
relationships.
3. Financial impact
- Increases hospital lengths of stay, leads to lost income &
productivity.
Pain Transmission
Transduction
- Conversion of chemical information to electrical impulses
- Chem’I mediators (PG, bradykinin, S, histamine, subs P) ➔
stimulate free nerve endings "nociceptors.”
- Impulses are carried by nerve fibers (peripheral sensory nerve);
A-delta fibers & C- fibers.
 A delta fibers- are small myelinated fibers w/c carries fast
traveling impulses
 C fibers- are unmyelinated so they carry slow travelling
impulses
 Synapse- at the opposite side of the spinal cord 
spinothalamic tract
A delta fiber
- myelinated fibers aka "mechanical nociceptors (respond
predominantly to mechanical rather than chemical or thermal
stimuli)
- carries rapid (3-30m/sec) sharp, acute pain. Ex: touching a hot
iron.
- Produces intermittent.
C fibers
- Unmyelinated/ poorly myelinated fibers.
- Conduct thermal, chemical, and strong mechanical impulses.
- Throbbing, aching, or burning sensation (0.5-2m/ sec)
- Produces persistent pain.
Transmission Phase
- Peripheral nerve fibers form synapses with neurons in the SC.
- It will ascend to reticular activating system, limbic system
(center of behavior), thalamus (sensory pulses), cerebral cortex.

 Point of cellular injury  injured cell release chemical

mediators like histamine, prostaglandin, bradykinin,
leukotrienes  stimulation of nociceptors/ peripheral nerves
like A delta and C fibers  propagation of nerve impulse 
pass through the dorsal horn of spinal cord  synapse of the
opposite side  spinothalamic tract   thalamus has relay

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Perception
- Brain experiences pain at the conscious level (conscious
experience of discomfort)
- Nalaman mo ng masakit
 Sign of painful stimulus  spinal cord  message conveyed
to the brain  cries as respond to the pain  pull legs toward
the body or withdrawal from painful stimuli.
Pain Threshold
- The point at which the pain-transmitting neurochemicals reach
the brain, causing conscious awareness (same among healthy
persons).
- Lowest pain stimulus
Pain Tolerance
- amount of pain a person endures once the threshold has been
reached.
- “Plain Tolerance is influenced by gender, age and culture.”
- Maximum of pain na kaya niyang tiisin
Modulation Phase
- Last phase of pain impulses transmission, during which the
brain interacts with the spinal nerves.
- At the point, pain is reduced due to endogenous opioids release.
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Red- transduction
Yellow- transmission
Violet- perception
Impulse can be block both in ascending and
descending in order to reduce or modulate
the pain
Example:
Patient A have burn injury in the upper
extremity with 4th degree burn which means
up to the bone the nociceptors in here are
destroyed so wala ng stimulation at hindi na madadala impulse to
the brain. Patient B have only superficial burn affects only epidermis
and portion of dermis kaya mas masakit. Another is nadulas nag ka
hyper extension of the head so mawawalan ng transmission hindi
ulit makakarating impulse sa brain. Another is nag karron ng
accident na apektuhan ang brain although may transduction at
transmission hindi naman siya ma pa-process ng brain kaya there
will be no pain perception.
Theoretical bases for Pain
Gate Control Theory
- Explains the relationship between pain & emotion.
- Results to a conclusion that pain is not just a physiologic
response ... that psychological variables (behavior & emotion)
also influence the perception of pain.
- In this theory: “Gating mechanism” occurs in the SC.
 FUNDAMENTALS OF NURSING PRACTICE LECTURE: 1ST YEAR SUMMER MIDTERM

- Portion of the SC that serves as the gating mechanism is the  Ex. Masakit sikmura ni pt. so maiisip mon a ito ay
substancia gelatinosa. peptic ulcer disease where in there are two types of
- Small diameter fibers are the a delta these gastric ulcer and duodenal ulcer. kapag mas
- Large diameter fibers are the a beta fibers masakit ang tiyan nya kapag kumakain ito ay gastric
- Gate closed the impulse will not reach the brain and there will ulcer kapag namn nagigin hawahan kapag kumaian
be decreased pain perception or pain modulation. that’s duodenal ulcer.
- Stimulation of large diameter fiber will close the gate and there 2. Aggravating factors
will be no pain or decreased pain.  What factors make the pain worse?
- Stimulation of the small diameter fibers will open the gate and  Ex. Kapag nag tatrabaho si pt. mas sumasakit ang
there will be pain. katawan niya.
- What stimulates the a data or large diameter fibers? It is by 3. Localization of pain
touch, massage therefore this is the focus of touch and massage  Can the client localize the pain or describe where it
therapy and other physical measures in order to relieve the pain travels or radiates?
- Similar gating mechanisms exist in the nerve fibers descending  Ex. Saan masakit? Examine it by using quadrants.
from the thalamus and cerebral cortex (areas that regulates 4. Character and quality of pain
thoughts & emotions, beliefs & values).  What words does the client use to describe the pain and
- When pain occurs, a person's thoughts and emotions can modify its character, quality or intensity? (have to quote and
perceptual phenomena as they reach the level of conscious unquote)
awareness.
 Duration of pain
- Significance of gate control theory:
 Assess pain through PQRST or COLDSPA
 Recognition of holistic nature of pain.
Note: if the client is in pain when the nurse is obtaining the history,
 Development of many cognitive-behavioral therapies the session should be kept reasonably short or continued at a later
(imagery & distraction) to relieve pain. (kapag ang pt. ay time.
nalilibang na da-divert ang focus nya sa pain experience) Clinical manifestations
Acute pain
CNS Processing - Warning signal; stimulation of sympathetic NS (BP
1. Thalamus – relay station for sensory input from spinothalamic changes, tachycardia, etc)
tract of SC. Chronic pain
2. Midbrain – signals the cortex to increase awareness of the - Adaptation and coping occurs.
stimuli.
3. Cortex – discrimination of well-localized pain & interpretation Assessment Tools
of pain experience.

Terms used in the context of Pain:

1. Radiating pain – perceived at the source of the pain and
extends to the nearby tissues.
2. Referred pain – pain is perceived in an area distant from the
site of painful stimuli.
3. Intractable pain – pain that is highly resistant to relief. (severe
pain na hindi ma-relieve ng drug therapy or other measure)
4. Phantom pain – painful perception perceived in a missing body
part or in a body part paralyzed from a spinal cord injury.
(pakiramdam ng pt. masakit pa rin ung missing leg nya)
5. Phantom sensation – feeling that the missing body part is still
present. (pakiramdam na nandito pa ung leg na wala na)
6. Hyperalgesia – excessive sensitivity to pain.
7. Pain threshold ''Pain Sensation'' – the amount of pain
stimulation a person requires in order to feel pain.
8. Pain tolerance – maximum amount and duration of pain that
an individual is willing to endure.
9. Nociceptors – pain receptors.
10. Pain perception – the point which the person becomes aware
of the pain.
Nursing process
Assessment
 Data gathering through physical exam or through interview and
sources is the patient or the significant others
History:
1. Precipitating factors
 Does the client associate any activities, food, or other
environmental factors with the onset of pain?

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 Opioids/ Narcotics
 Adjuvants - potentiators or enhancers
WHO Analgesic Ladder
1. Mild to moderate pain
- Lasting 3-4 hours
- Start with low doses of nonopioid drugs.
2. Intermediate pain
- Or pain not well controlled with nonopioid.
- Combine nonopioid with a low dose opioid.
3. Severe pain
- Add a higher dose opioid to the nonopioid or use a drug
that potentiates its analgesic effect like antihistamine.
Non-opioids/ non-narcotic analgesics
- Mild to moderate pain.
- Relieve pain by altering neurotransmission at the peripheral
level (site of injury).
- ASA acetyl salicylic acid, acetaminophen, NSAIDs non
esteroydal inflammatory drugs- like ketorolac, parecoxib. (side
effects lahat ng NSAIDs are gastric irritants so dapat ibigay ang
gamot after meal)
Opioids/ Narcotics
- Mainstay in the management of all types of pain
- Work centrally by blocking the release of neurotransmitter in
the SC.
 Morphine, Codeine, Hydrococlone, Oxycodone,
Hydromorphone, Metnadone, Tramadol, Meperidine
(Demerol)
 Withdrawal symptoms, antidote/ narcotics antagonist:
Naloxone (Narcan)
 If you give narcotics u should also give narcotic antagonist
Adjuvants
- Potentiators or enhancers
- Promethazine (Phenergan) antihistamine, antiemetic, sedative
agent + Morphine = enhanced opioids effects.
- Pag sinama sa opiods mas maganda ang effect niya.
Patient-controlled Analgesia
- Allows client to self-administer their own narcotic analgesic by
means of an intravenous pump system.
- Dose & time intervals between doses are programmed into the
device to prevent accidental over dosage.
- Can be given parenteral, orally or tinatapal sa katawan.
Intraspinal Analgesia
- Infused into the subarachnoid or epidural space of the SC
through a catheter inserted by a physician.
- Nurses DO NOT administer INTRASPINAL ANALGESIA!!!
Nursing Management Related to Side Effect of Medications
- Monitor for and implements measures for managing side-
effects of the drugs used
 Risk for impaired gas exchange r/t resp. depression (pos.
Pain Management patient, check VS especially oxygen saturation)
 Drug therapy  Constipation (provide high fiber diet if pwede na sya
kumain)
 Physical measures
 Risk for injury r/t drowsiness & unsteady gait (put side rails
 Cognitive-behavioral measures
up, provide support, pabantayan)
 Invasive techniques
 Risk for imbalance nutrition r/t anorexia & nausea (serve
Drug therapy
attractively and warm food)
- Gold standard form of pain control
- 3 groups of medications  Risk for deficient fluid volume r/t reduced oral intake.
(needs IV fluid therapy, hypertonic sol. with electrolytes,
 Non-opioids/ non-narcotic analgesics
hyper alimentation)
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 FUNDAMENTALS OF NURSING PRACTICE LECTURE: 1ST YEAR SUMMER MIDTERM

 Disturbed sleep pattern r/t depression of the CNS (provide

env. w/c is properly ventilated)
Note: if artificial airway is obstructed by secretion it is useless
therefore maintain this by suction apparatus.

Physical Measures/ Nondrug interventions

Cutaneous stimulation
- Transcutaneous electrical nerve stimulation (TENS)
- Percutaneous electrical nerve stimulation (PENS)
 a combination of acupuncture needles w/ TENS
 30mins 3x a week for 3 weeks
 Using needles
- Thermal therapy (heat- causes vasodilation inc. blood
supply, muscle relaxation and promotes wound healing &
cold- causes vasoconstriction, reduces edema formation,
numbs the nerve endings)
- Therapeutic touch  Cervical Chordotomy- destruction of the spinal tracts in the
- Massage spinal canal in cervical canal
- Vibration
 Thoracic Chordotomy- destruction of the spinal tracts in the
thoracic cord
 Pain pathway can be blocked in any way para lang hindi
mapunta ang impulse sa brain.
 Rhizotomy- destruction of sensory route
 Chordotomy- destruction of the ascending tract
 If patient undergo spinal surgery he/she is positioned flat, good
body alignment, whole body is turned to side.

 The illustration above is the TENS it applies low voltage of

electrical current to the skin.
 Used by physical therapist
Cognitive-behavioral measures
- Effectiveness of these measures reflect the premises of the gate
control therapy.
 Distraction - divert the attention.
 Imagery- use one imagination to give pleasant substation
of pain.
 Relaxation
 Hypnosis
 Music therapy
 Aromatherapy
 Prayer & meditation
Invasive Techniques
- For intractable pain (cannot be cured by medications), severely
debilitating.
- Used when chronic or persistent pain can no longer be
adequately controlled with drugs or other pain-reducing
methods.
 Nerve block (temporary, ablation)
 Spinal cord stimulation
 Surgical procedures Hiwalay po ung reviewer ng Lecture and Laboratory. Masyado
kasing mahaba kaya pinaghiwalay ko HAHAHA at thank you kay
kaye, dahil may katulong na rin ako dito sa paggawa ng reviewer
kaya mabilis namin to natapos hohoho. Good luck sa exam natin!!
– Aki

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