Man, and the Basic Human Needs Health

Man – Biopsychosocial and Spiritual being (Roy)

a) Biological ✔ is a state of complete physical, mental and social
✔ Man is like all other men well-being, and not just merely the absence of
b) Psychological disease of infirmity (WHO, 1948)
✔ Man is like no other men ✔ A state of wellbeing and using every power the
c) Social individual possesses to the fullest extent
✔ Man is like some other men (Nightingale)
✔ this is why we have groups or friends but
not with everyone Illness
d) Spiritually
✔ Unhealthy
✔ Man is like other men in terms of
✔ An abnormal process
believing, worshiping, having faith
✔ The persons level of functioning is changes when
Open System
compared with a previous level
⮚ Receives input and output
✔ Acute Illness – Rapid onset, short period
⮚ A unified whole (Rogers)
✔ Chronic Illness – Slow onset, long period of time
✔ Composed of parts
[Usually related to remissions and exacerbations]
⮚ Greater and different from the sum of all his parts
⮚ Composed of subsystems
Suchmann’s Stages of Illness Behavior
a) Cells
b) Tissues a. Symptom experience
c) organ system ❒ Person comes to recognize that
⮚ Suprasystems something is wrong
a) The world outside 1) Physical (e.g. cough)
b) the extension 2) Cognitive (e.g. interpretation of
c) family symptoms)
d) community 3) Emotional (e.g. fear, anxiety)
e) society 4) May try home remedies
b. Assumption of sick role
Characteristics of Human Needs
❒ The individual now accepts the sick
a. Universal
b. Modified by culture role and seeks confirmation from
c. Met in different ways family and friends.
d. Aroused by stimuli (external/internal) ❒ Person may be excused from normal
e. Altered by own priorities duties and role expectations
f. May be deferred. The length of defer depends on ❒ When symptoms persist, the person
the need seeks professional help or validation.
g. May be interrelated c. Medical Care contact
h. Unmet human need = disruption of normal body ❒ Person seeks confirmation from
activities – leads to eventual illness experts through diagnosis
❒ Types of information asked by the sick
MASLOW’s Hierarchy of Needs
(IN ORDER!!!!!!!!!!!!!!!!!!) “PSLSS” person:
A. Physiologic needs (BASIC needs) 1) Validation of real illness
“OWFSCSPS” 2) Explanation of the symptoms
a. Oxygen in understandable terms
b. Water 3) Reassurance that they will be
c. food all right or prediction of what
d. shelter the outcome will be.
e. clothing ❒ The client may:
f. sleep and rest 1) Accept the diagnosis
g. freedom of pain
2) Deny the diagnosis (then seek
h. sex
B. Safety and Security (Freedom from second opinion)
harm and injury) d. Dependent client role
C. Love/belongingness (social decision ❒ Person accepts care, sympathy and
and companionship) protection
D. Self-Esteem (belief on oneself) e. Convalescence/Rehabilitation
E. Self-actualization (SATISFACTION) ❒ Resumption of former roles and
responsibilities
Disease ✔ Halt the disease or injury process
✔ Obtain optimal health status
✔ A pathologic change in the structure or ✔ ACTIVITIES:
function of the body a) Self-monitoring of CBG among
✔ there is an alteration of body functions diabetics
✔ Resulting in reduction of capacities or b) PT after CVA
shortening of normal lifespan 🡪 death c) Cardiac rehab
✔ Cause: d) Attending self-management
a) Biological education
b) Genetic/Inherited e) Speech therapy after
c) Developmental laryngectomy
d) Physical agents (radiation, etc)
e) Chemical agents (lead, pollution) 4. QUATERNARY PREVENTION
f) Injury ✔ Actions taken to identify a patient at
g) Metabolic process risk of over-medicalization
h) Emotional response ✔ Protect patients from new medical
THREE LEVELS OF PREVENTION invasiion
1. PRIMARY PREVENTION
✔ Encourage optimal health & increase Wellness: well-being
person’s resistance to illness
✔ Prevent disease or condition at a ⮚ Optimum health and fitness
pre-pathologic state ⮚ Enhance quality of life
✔ HEALTH PROMOTION & SPECIFIC
PROTECTION Dimensions of Wellness
✔ ACTIVITES:
a) Physical
a) Smoking cessation
✔ Able to function and to ADL’s, fit,
b) Avoid alcohol
nutrition, no drugs, smoking, alcohol
c) Regular exercise
drinks.
d) Well-balanced diet
b) Social
e) Reduce fat
✔ Able to interact successfully, sense of
f) Increase fiber
intimacy, respect, and tolerance.
g) Adequate fluids
c) Emotional
h) Maintain ideal body weight
✔ Ability to manage stress, to express
i) Complete immunization
emotions, ability to accept limitations.
program
d) Intellectual
✔ Able to learn, use knowledge
2. SECONDARY PREVENTION
effectively
✔ HEALTH MAINTENANCE
✔ Able to continue to develop oneself.
✔ Identify specific illness/condition at
e) Spiritual
an early stage with prompt
✔ Faith, developing morals, values,
intervention to prevent or limit
ethics
disability
✔ Understanding the purpose of life.
✔ Early Diagnosis, Detection, Screening,
Prompt Treatment
✔ ACTIVITIES:
a) Annual physical exam
b) Regular PAP smear
c) Monthly BSE Fundamentals of Nursing
d) Sputum exam for TB
Nursing Process (Popularized by Lydia Hall, 1955)
Mentioned 3 steps:
3. TERTIARY PREVENTION
✔ Support’s client achievement of
successful adaptation Note Observation
✔ Occurs after a disease or disability
✔ Recovery process has begun Ministration of Care
 a) Actions Ida Jean Orlando (C-N-N)
b) What the things the nurse needs to do based
on his/her observation Client’s Behavior
✔ Manifestations of the patient, signs and
Validation symptoms.
a) Based on the actions
✔ Is there anything that has helped the Nurse’s Reaction
patient? ✔ How the nurse received the manifestation;
✔ Evaluation his/her analysis
b) Nursing Process
✔ A systematic method that directs the Nurse’s Action
nurse and the client as they together
determine the need of nursing care, ✔ What the nurse did; his/her interventions
plan, and implement the care, and
Lois Knowles 5 D’s
evaluate the result.

GOSH Approach
Discover
✔ Observe
Goal-oriented ✔ assessment
✔ problem-solving Delve
Organized ✔ Go deeper
✔ to go further
✔ Steps, since it is called a process there are
different steps to be done.
✔ Do the assessment, analyze and identify the
Decide
✔ What needs to be done?
problem, proceed to the plan of care.
✔ What do you have to do?
✔ You cannot have an intervention if you do
not have a Nursing Diagnosis Do
Systematic ✔ Perform functions and actions/interventions
✔ Done at an orderly function.
✔ Organization 🡪 Plan 🡪 Evidenced-based
Discriminate
✔ Critique
Humanistic Care ✔ Evaluation on the interventions.
✔ Was it able to help the patient?
✔ Involve patients
✔ Address the concerns of your patient.
STEPS: ADPIE
✔ Nurse + Patient
Assessment
Dorothy Johnson (A-D-N) ✔ A systematic and continuous collection,
Assessment validation and communication of client’s data
● C-V-O-D-R
Decision – Decision will involve Plan a. Collection of Data
b. Validate the Data
Nursing Action c. Organization of Data
d. Data Analysis
e. Recording / Documentation
Purpose: Establish a Database

Types of Data
Subjective
● Symptoms – pain, dizziness, vertigo
Objective
● Signs – measured/observed; the patient
BP 120/80, pallor, redness
Sources of Data
⮚ Primary – Client/Patient
⮚ Secondary – Significant others, medical
records, chart, other members of the health
care team, related health care literature
✔ Shows transition from a specific level
of wellness to a higher level of
wellness
✔ The patient has coped or adjusted to
his/her problem

Methods of Collecting Data PLANNING

Interview – Use open-ended questions (to elicit more ⮚ Identify beforehand specific actions to be
information). done before implementation of nursing
Observation – Make use of senses interventions
Physical Assessment ⮚ PURPOSE:
a) Identify the client’s goals
TYPES OF ASSESSMENT ✔ SMART goals
1. INITIAL ✔ Goal is BROAD
✔ Establish complete database ✔ Objective is SPECIFIC
2. FOCUSED ✔ 1 GOAL ONLY with specific
✔ About a specific problem objectives
✔ SHORT TERM = days/weeks
✔ LONG TERM= weeks/months
3. EMERGENCY b) Identify appropriate interventions
✔ Identify life-threatening problems or
physiologic or psychological crisis IMPLEMENTATION
4. TIME-LAPSED ⮚ Put into NCP into action
✔ Compare current status from baseline ⮚ PURPOSE
a) Carry out NCP and meet client’s
Diagnosis: health needs
⮚ Statement the client’s potential or actual ⮚ TYPES OF INTERVENTIONS:
health problems, resulting from analysis of a) INDEPENDENT
data ✔ Nursing actions without
⮚ Identify healthcare needs of the patient Physician’s orders
⮚ Prepare diagnostic statements b) INTERDEPENDENT
⮚ Consists of: ✔ Collaborative functions
a) Problem (NANDA based), ✔ Referring to other healthcare
b) Etiology, professionals (e.g. dietician)
c) Signs and Symptoms or Secondary c) DEPENDENT:
factors ✔ Based on physician’s orders

TYPES OF NURSING DX: EVALUATION

1. ACTUAL ⮚ Assess your nursing interventions
✔ Actual or Presenting problem of the ⮚ Comparing previous statements to current
patient statements
2. POTENTIAL ⮚ PURPOSE:
✔ May arise if nursing interventions are a) Determine the extent of which goals
not provided have been achieved
✔ RISK problems ✔ Determine goals is MET,
3. POSSIBLE PARTIALLY MET, or UNMET
✔ Needs more assessment to say it can ⮚ ACTIVITIES:
be a problem a) Data collection of the client’s
✔ Could be a problem but needs more responses
observation b) Analyze results
✔ Assess other areas to validate the ✔ Analyze if there is needed
problem interventions
4. WELLNESS c) Modify NCP as necessary
✔ WHEN TO MODIFY:
− PARTIALLY MET
 ❖ Modify OBJECTIVES ✔ High Age (Decreased PR)
− UNMET 2) GENDER
❖ Modify NCP ✔ Females have higher PR during
❖ Must be specific! puberty compared to men
3) EXERCISE
CONVERSIONS ✔ Increase in the BMR = Increased PR
⮚ FOMRULA 4) FEVER
a) F 🡪 C ✔ Increase in the BMR = Increased PR
C= (F-32) x 5/9 5) HEMORRHAGE
b) C 🡪 F ✔ Compensatory mechanism of blood
F= (C x 9/5) + 32 loss
✔ Increase PR
NURSING INTERVENTIONS FOR FEVER 6) MEDICATIONS
1) Monitor VS ✔ Digoxin = decrease PR
2) Assess skin color and temperature ✔ Atropine sulfate = Increase PR
3) Monitor WBC 7) STRESS
4) Remove excess blankets ✔ Sympathetic response
5) Provide adequate food and fluid replacement 8) POSITION CHANGES
6) Measure I&O ✔ Sudden change of positions
7) Promote Rest ✔ Decrease venous return
8) Provide TSB PRN ✔ Decreased BP
9) Administer antipyretics ✔ increased PR

PULSE
✔ Wave of blood created by the contraction of RESPIRATION
the LV ✔ act of breathing
✔ Regulate by the ANS ✔ inhalation and exhalation
✔ 60-100 bpm = NORMAL for Adults ✔ NORMAL = 16-20 cpm
✔ 120-160 bpm = NORMAL for pedia ✔ Medulla oblongata = primary responsible for
✔ Sites: respiration
a) Temporal ✔ Pons
b) Carotid a) Pneumotaxic center (rhythmic quality
c) Apical of breathing
d) Brachial b) Apneustic center (for deep and
e) Radial prolonged respiration)
f) Femoral ✔ Types of breathing
g) Popliteal a) Thoracic
h) Posterior Tibial ▪ Chest
i) Pedal (Dorsalis Pedis) b) Diaphragmatic
✔ AMPLITUDE (Volume) ▪ Abdomen
o Strength of the pulse ✔ NORMAL ADULT for stimulating of
o +4 (bounding/full/strong) respiration
o +3 (increased) o INCREASE CO2
o +2 (NORMAL)
o +1 (weak, thread. Feeble)
o 0 (absent) FACTORS AFFECTING RESPIRATION
✔ RATE 1) Increased altitude
✔ RHYTHM 2) Stress
o Pattern and intervals of beats 3) Environment
✔ PULSE DEFICIT a) Increase temp = decreased RR
b) Decreased temp = increased RR
c) Mountain climbers bring portable
FACTOR AFFECTING PULSE oxygen for high altitudes to facilitate
1) AGE breathing
✔ Low Age (Increased PR) 4) Exercise
5) Medications
 a) Narcotics = decrease RR 6) Eliminate/reduce use of chemicals
7) Support a pollution-free environment
ALTERATIONS IN RESPIRATIONS
A. RATE PULSE OXIMETRY
1) Apnea ✔ Measures O2 saturation
✔ Cessation of breathing ✔ Percentage of Oxygenated Hgb in arterial
✔ In newborns, periods of apnea in blood
newborns is considered NORMAL ✔ NORMAL = 95-100%
2) Bradypnea (low RR) ✔ 91-94% = MILD hypoxia
3) Tachypnea (high RR) ✔ 86-90% = MODERATE hypoxia
✔ <85% = SEVERE hypoxia
B. VOLUME ✔ <70% = LIFE-THREATENING
1) Hyperventilation ✔ SITES:
✔ Deep rapid respirations a) FINGERTIPS
✔ CO2 excessively inhaled b) TOES
2) Hypoventilation c) EARLOBE
✔ Decreased RR and decreased depth d) NOSE BRIDGE
✔ CO2 excessively retained e) FOREHEAD

C. EASE OF EFFORT ✔ Factors Affecting the Accuracy of Pulse

1) Dyspnea Oximeter:
✔ DOB 1) Nail Polish
2) Orthopnea ✔ Advise to remove nail polish
✔ Use other sites if patient does not
D. RHYTHM want to remove nail polish
1) BIOT’S RESPIRATIONS 2) Direct Sunlight
✔ Regular, deep followed by apnea ✔ Cover the site with cloth
✔ Cluster respiration ✔ Avoid sunlit areas
✔ Very shallow breathing 3) Carbon monoxide poisoning
✔ E.g. meningitis, severe brain damage ✔ Do not use pulse oximeter!
2) CHEYNE STOKES 4) Arterial Disorders (Raynaud’s &
✔ Shallow, fast then labored, deep then Buerger’s Disease)
episodes of apnea ✔ Avoid using fingertips and toes
✔ Rapid waxing and waning with periods ✔ Use other sites
of apnea
✔ E.g. in ICP patients, Drug toxicity INCENTIVE SPIROMETRY
patients ✔ Measures the flow of air inhaled through
3) KAUSSMAUL’S mouthpiece
✔ Hyperventilation ⮚ Also called SUSTAINED MAXIMAL
✔ Labored breathing INSPIRATION (SMI) devices
✔ Very deep breathing ⮚ LIFE:
✔ E.g. DKA, severe metabolic acidosis, ✔ Loosens secretions
kidney failure ✔ Improve ventilation
4) APNEUSTIC ✔ Facilitates gas exchange
✔ Prolonged gasping (inspiration) ✔ Expands the collapsed alveoli
followed by very short expiration ⮚ Ball goes up in INHALATION, Ball goes down
in EXHALATION
PROMOTE OXYGENATION ⮚ STEPS:
1) Sit straight and Erect 1. Place UPRIGHT
2) Exercise 2. EXHALE comfortably.
3) Breathe through the nose 3. OPTION 1: HOLD MDI 1-2 INCHES from
4) Breathe in to expand chest fully open mouth
5) Avoid smoking
 OPTION 2: LIPS TIGHTLY around 2) PERCUSSION: mechanically dislodge
MOUTHPIECE tenacious secretions from the
4. INHALE SLOWLY and DEEPLY through bronchial walls
the MOUTHPIECE (2-6 seconds) a. COVER THE AREA WITH A
5. HOLD FOR 2 SECONDS (gradually TOWEL OR GOWN
increase on every repetition until you b. BREATHE SLOWLY AND DEEPLY
reach maximum of 6 seconds) c. ALTERNATE FLEX AND EXTEND
6. REMOVE mouthpiece THE WRISTS RAPIDLY TO SLAP
7. EXHALE SLOWLY THE CHEST
8. COUGH 2 times d. PERCUSS 1-2 MIN/SEGMENT
9. REPEAT 5-10 times if ordered. ✔ HAND IS IN C-SHAPE FORM
10. Perform q hour. ✔ When done correctly produce a
⮚ Do THIS BEFORE MEALS hollow popping sound
✔ Avoid:
❒ Breast
❒ Sternum
❒ spinal column
❒ kidneys
3) VIBRATION:
✔ VIBRATE ON EXHALATION
✔ 5x in each lung segment
CHEST PHYSIOTHERAPY A. PLACE HANDS, PALMS DOWN,
⮚ DEPENDENT NURSING INTERVENTION ON THE CHEST AREA TO BE
(needs DOCTOR’s ORDERS) DRAINED, ONE HAND OVER
⮚ CONSIDERATIONS FOR PERFORMING CPT THE OTHER
(STEPS): B. INHALE DEEPLY AND EXHALE
1) POSTURAL DRAINAGE: DRAINAGE SLOWLY THROUGH THE NOSE
BY GRAVITY OF SECRETIONS FROM OR PURSED LIPS
VARIOUS LUNG SEGMENTS. C. EXHALATION: VIBRATE THE
✔ ONLY USE SPECIFIC POSITIONS HANDS
ON SPECIFIC AFFECTED AREAS 4) DEEP BREATHING + COUGHING
TO BE DRAINED IN THE 5) AUSCULTATE LUNG SOUNDS
PROCEDURE
✔ IF PATIENT FELTS PAIN, STOP
THE PROCEDURE OXYGEN THERAPY
✔ EACH POSITION: 5-20 MINUTES
✔ FLOWER LOBES REQUIRE ⮚ DEPENDENT NURSING INTERVENTION
DRAINAGE MOST FREQUENTLY ⮚ Primary care provider specifies:
BECAUSE THE UPPER LOBES concentration, method of delivery, and liter of
DRAIN BY GRAVITY. flow rate.
✔ BEFORE PD: ⮚ EMERGENCY: RN MAY INITATE therapy,
❒ GIVE BRONCHODILATOR CONTACT physician after.
OR NEBULIZATION ⮚ OXYGEN DELIVERY SYSTEMS:
THERAPY 1) NASAL CANNULA
✔ SCHEDULE: ✔ 24-45%
❒ 2-3 TIMES DAILY ✔ 2-6 L/min
❒ BEFORE BREAKFAST, ✔ COMFORTABLE
BEFORE LUNCH, LATE ✔ Does not interfere with
AFTERNOON, BEFORE eating/talking
BEDTIME 2) SIMPLE FACE MASK
✔ AVOID: ✔ FOR EMERGENCIES
❒ HOURS SHORTLY AFTER ✔ 40-60%
MEALS ✔ 5-8 L/min
❒ TIRING AND CAN 3) PARTIAL REBREATHER
INDUCE VOMITING ✔ 40-60%
✔ 6-10 L/min
 ✔ Oxygen reservoir bag allows ⮚ Once RESISTANCE is felt, PULL BACK for
the client to rebreathe exhaled 10mm to 1cm
air ⮚ Intermittent, rotating motion of suction
✔ When inhalation/exhalation, catheter
the bag must not be fully ⮚ Total suction time = must not exceed 5
deflated and fully inflated. minutes
4) NON REBREATHER ⮚ Interval between each suction 20-30 seconds
✔ 90-100% ⮚ Assess effectiveness after.
✔ 10-15 L/min
✔ HIGHEST CONCENTRATION 4 D’s TO WARRANT OF SUCTIONING:
✔ One-way valve prevents the
1) DYSPNEA
room air and exhaled air from
2) DROOLING
re-entering.
3) DECREASED O2 SATURATION
5) Venturi Mask
4) DECREASED BREATH SOUNDS
✔ APPROPRIATE for COPD pts
✔ 24-40% or 50%
✔ 4-10 L/min
✔ MOST ACCURATE
CONCENTRATION
✔ Blue: 24% on 4 L/min
✔ Green: 35% on 8 L/min
ORO NASO TRACHEO
6) FACE TENT PHARYNGEAL PHARYNGEAL STOMY
✔ For BURN patients
✔ 30-50%
✔ 4-8 L/min POSITION SEMI-FOWLER SEMI-FOWLER SEMI-FOWL
S S ERS
OXYGEN THERAPY PRECAUTIONS: NECK SLIGHLT
HYPER
1) POST NO SMOKING SIGNS EXTENDED
2) STAY AT LEAST 6 FT AWAY FROM AN LENGTH 3-5 IN 3-5 IN 2-3 IN
OPENFLAME LUBRICANT TAP WATER KY JELLY NSS
3) DO NOT EXPOSE TO ELECTRICAL DURATION 5-10/15 20-30 10 SECONDS
APPLIANCES SECONDS SECONDS
4) BE SURE TO HAVE A FUNCTIONING INTERVAL 20-30 20-30 30 SECONDS
SMOKE DETECTOR AND FIRE SECONDS SECONDS
EXTINGUISHER O2 SIMPLE FACE SIMPLE FACE HYPER
5) OXYGEN CYLINDER MUST BE MASK MASK OXYGENATE
SECURED AT ALL TIMES WITH 100%
6) AVOID MATERIALS THAT GENERATE O2
STATIC ELECTRICITY (WOOLEN,
BLANKETS AND SYNTHETIC FIBERS). BLOOD PRESSURE
7) COTTON BLANKETS SHOULD BE ⮚ Measure of the pressure as it flows to the
USED artery
8) BE SURE THAT ELETRIC DEVICES ⮚ Systolic = contraction
ARE ALL GROUNDED ⮚ Diastole = ventricles at rest
9) AVOID USE OF VOLATILE, ⮚ Starling’s Law
FLAMMABLE MATERIALS (OILS, ✔ Pumping action of the heart (venous
GREASES, ALCOHOL AND ACETONE) return = force of contraction)
⮚ PULSE PRESSURE
Guidelines in ET Suctioning: ✔ Systolic Blood Pressure subtracts to
Diastolic Blood Pressure
⮚ Purpose: Removal of secretions ❒ NORMAL
⮚ HYPEROXYGENATE before and after. SYSTOLIC-DIASTOLIC:
⮚ INSERT CATHETER into trachea WITHOUT 30-40 mmHg difference
SUCTION. ⮚ STROKE VOLUME
 ✔ Amount of blood ejected per Cuff too small or Falsely high
heartbeat narrow
✔ NORMAL: 55-100 mL/heartbeat Cuff too loose Falsely High
Arm unsupported False high
Blood Pressure Systolic Diastolic Arm below the level of False high
Classification BP BP the heart
NORMAL <120 <80 Deflating cuff too Low systolic
and quickly High diastolic
Prehypertension 120-139 80-89 Deflating cuff too slow High diastolic
or
Arm above the heart False low
Stage 1 HTN 140-159 90-99 level
or
Insufficient rest, False high
Stage 2 HTN ≥ 160 ≥ 100 activity, drinking,
HYPERTENSIVE >180 >100 eating, pain
CRISIS Cuff over a joint Less likely to
Examples 140/70 HTN 1 compress artery
mmHg Hole in cuff Pressure leaks too
119/100 HTN 2 fast to reliably record
mmHg Cardiac arrhythmias Erratic readings
⮚ CONSIDERATIONS IN TAKING BP:
✔ The arm must be at heart level. PAIN
✔ Duration-Deflation (15 minutes rest ⮚ Subjective
before taking another BP) (2-3 ⮚ Best way to know the pain of the patient:
mmHg) ✔ INTERVIEW
✔ Distance – antecubital fossa (2
finger breadths) ⮚ <6 months (Acute) = Fast Pain
✔ Proper wrapping of the BP cuff is ⮚ >6 months (Chronic)
advised to avoid false high BP reading. ✔ Slow Pain
✔ REPEATING BP IS ONLY ONCE! ✔ Exceeded expected time of healing
✔ Wait for 1-2 minutes upon inflation of ⮚ Pain is protective and preventive mechanism
cuff ⮚ ALGOLOGY = study of pain management
⮚ FACTORS THAT AFFECT BP: ⮚ Pain Threshold
1) AGE ✔ Amount of pain stimulation
✔ Increased age = increased BP required to feel pain.
2) DIURNAL VARIATIONS ✔ Awareness of pain stimulus
✔ AM = decreased BP ⮚ Pain Tolerance
✔ PM = Increased BP ✔ Amount of duration of pain
3) EXERCISE ✔ Person no longer accepts pain
4) GENDER ⮚ Types of Pain
✔ Females reach in menopause = a) Radiating Pain
increased BP - Pain that travels from the nearby
5) MEDICATIONS tissues
6) OBESITY b) Referred Pain
7) RACE - The pain you feel in one remote part
✔ WHITES = INCREASED BP of your body is actually caused
8) STRESS by pain or injury in another part of
✔ INCREASED CO = vasoconstriction your body.
✔ INCREASED BP c) Intractable Pain
⮚ CONSEQUENCES OF COMMON ERRORS and - Pain is constant and excruciating
ARTIFACTS - Type of pain that can't be controlled
with standard medical care.
ERROR or ARTIFACT CONSEQUENCE
d) Cutaneous pain
Cuff too wide Falsely low
− Superficial areas of the body
Cuff too tight False low
(skin)
e) Deep somatic pain
 − Bones, muscles Pretended Pain = phantom pain
− E.g. bone cancer
f) Malignant pain
− Cancer-related pain
g) Visceral pain PAIN MANAGEMENT
− Body cavity A. NON-INVASIVE
h) Phantom Pain 1) RELAXATION/DBE
-  Pain that feels like it's coming from 2) REFRAINING EXERCISES
a body part that's no longer there. 3) DISTRACTION
4) GUIDED IMAGERY
⮚ PQRST Pain Assessment: 5) HUMOR
a) Precipitating/Predisposing –WHY? 6) CUTANEOUS STIMULATION
✔ What triggers the pain or what 7) HOT & COLD APPLICATION
makes it worse?
b) Quality – WHAT? B. PHARMACOLOGIC
✔ Tell me what the pain feels like
✔ Stabbing (e.g. Angina)
✔ Crushing (e.g. Myocardial
Infarction)
✔ Pounding (e.g. Hypertension)
✔ Gnawing (e.g. Peptic Ulcer
Disease)
✔ Knife-like (e.g. AAA, ruptured
appendix, ectopic pregnancy)
c) Region/Radiation – WHERE?
✔ Where else do you feel pain?
d) Severity – HOW PAINFUL?
✔ Does it interfere with ADLs?
✔ How does it rate on a severity
scale of 1 to 10?
✔ Use of Pain Scale (MOST
IMPORTANT) ASEPSIS AND INFECTION CONTROL
1) 1-3 = Mild pain INFECTION
2) 4-7 = Moderate pain
3) 8-10 = Severe pain ⮚ Disease resulting from an infective agent in or
e) Time – WHEN? on a suitable host
✔ Onset; Frequency
✔ When did it begin? Chain of Infection
✔ How often does it occur? 1) Infectious Agent
❒ 6 components:
a) Viruses
b) Bacteria
c) Fungi
d) Parasites
❒ How to break the CHAIN?
a) Rapid organism identification
b) Prompt treatment
c) Decontamination

2) Reservoir
❒ Natural habitat of microorganisms
❒ Other humans, animals, soil, other
reservoir
❒ How to break the CHAIN?
a) Environmental sanitation
 b) Good health & hygiene ✔ Mostly, the reason is the break of
c) Decontamination/ Sterilization sterility
Stages of infection
1) Incubation period
3) Portal of Exit ✔ Exposed to potential carrier that
❒ Through sneezing, coughing, waste, started to show signs and symptoms
secretions 2) Prodromal stage
❒ How to break the CHAIN? ✔ Show characteristics symptoms
a) Control of secretions ✔ Viral infections must be
b) Hand hygiene pharmacologically managed in this
c) Proper waste disposal stage
3) FULL stage illness
4) Mode of Transmission ✔ Actual stage
a) Contact ✔ Signs and symptoms worsens
b) Droplet (larger prticles) ✔ Very infectious during this stage
c) Airborne (smaller particles) ✔ Signs and symptoms is specific to the
d) Vector-borne (mosquitoes) infection itself
e) Vehicle-borne ✔ Pathognomonic signs occur
❒ How to break the CHAIN? ✔ Bacterial infections must be
a) Hand hygiene pharmacologically managed in this
b) Isolation precautions stage
c) Disinfection/sterilization 4) Convalescent period
✔ Signs and symptoms abate
5) Portal of Entry ✔ Recovery period
❒ Food ingested, inhaled
❒ Skin, respiratory system, GI tract MEDICAL ASEPSIS SURGICAL ASEPSIS
❒ How to break the CHAIN? REDUCES number of ELIMINATES/FREE OF
a) Hand hygiene pathogens ALL pathogens
b) Aseptic technique CLEAN TECHNIQUE STERILE TECHNIQUE
c) Wound care USES FOR:
Administration of DRESSING CHANGES
6) Susceptible Host MEDICATIONS
❒ At risk: immune-compromised patients ENEMAS CATHETERIZATIONS
❒ Considered as CARRIER TUBE FEEDING SURGICAL PROCEDURES
❒ How to break the CHAIN?
DAILY HYGIENE
a) Recognize high-risk patients
b) Prompt treatment
HAND WASHING
● MOST IMPORTANT PART IN THE CHAIN OF 1. MEDICAL:
INFECTION NEEDS TO BE BROKEN TO ⮚ Uses SOAP
PREVENT INFECTION
⮚ Not less than 10 seconds
✔ BETWEEN RESERVOIR AND PORTAL
⮚ Recommendation: 20 seconds or
OF EXIT
more
2. SURGICAL
NOSOCOMIAL INFECTIONS
⮚ Hospital acquired infections ⮚ Uses STERILIUM and BETADINE
⮚ Most common HAI: UTI ⮚ Not less than 5 minutes
⮚ Most common causative agent: S. aureus
QUESTION: WHY DOES SURGICAL HANDWASHING
1) EXOGENOUS
MAKES YOUR HANDS DRY?
✔ Through environment or the people
2) ENDOGENOUS − Microorganisms die out on DRY surroundings.
✔ Patient harbors the microorganisms − This is to dehydrate the microorganisms’
3) IATROGENIC nuclear envelope (nucleus) which makes the
✔ Through medical treatments or
RNA & DNA of the microorganisms be
procedures done by the patient
destroyed.
CDC and Prevention Isolation Guidelines
A. Tier One
1) Standard Precautions
✔ Designated for the care of ALL
hospital patients.
✔ Hand hygiene
✔ PPE (depending on the care
rendered to a patient)
✔ Respiratory hygiene
✔ Puncture-resistant containers
❖ PROTECTION FROM NEEDLE PRICKS
a) NEVER RECAP needles
b) Puncture-resistant containers
❖ ENVIRONMENTAL CONTROL
a) Routine cleaning
b) Waste disposal
❖ ROOM ASSIGMENTS
✔ Prevent contamination
❖ ASCEPTIC PRINCIPLES
a) CLEANING
o Physical removal of dirt or
debris
b) DISINFECTION
o Chemical or physical
processes used to reduce
MAINTAINING A STERILE FIELD: STERILE
the number of pathogens
c) ISOLATION
❖ In PPE:
✔ Upon WEARING in SEQUENCE:
GoMEGlo
1. Gown
2. Mask
3. Eyewear
4. Gloves
✔ Upon REMOVING in SEQUENCE
(GlEGoMa)
1. Gloves
2. Eyewear
3. Gown
4. Mask
B. Tier Two
1) Transmission-based Precautions
✔ Airborne-precautions
− Fine particles (<5 microns)
1. Isolate (private room)
1. Maintain 3 ft distance
2. Negative air pressure room
3. N95 mask/Hepa-filter
mask
4. E.g. Measles, TB, Varicella
✔ Droplet precautions
− larger particles (>5 microns)
2. Isolate (private room)
1. Ordinary Mask (not
necessarily N95)
2. Maintain 3 ft distance
3. E.g. Diphtheria, Rubella,
Pneumonia
✔ Contact Precaution
− Secretions, excretions,
skin-skin, blood and body
fluids
3. Isolate (private room)
4. Avoid close intimate
contact
5. Wear PPE: gloves, gown,
goggles
6. E.g. scabies
✔ Protective environment
1. People underground gene
therapy, organ transplant
2. Administered drugs that
cause immunosuppression
1) STERILE TO STERILE ONLY
2) TUYO DAPAT (MUST BE DRY)
3) EDGE = 1 INCH OF THE TABLE: UNSTERILE
4) REACHING ACROSS OR OVER IS AVOIDED
5) IF IN DOUBT, DISCARD
6) LEVEL UP IS STERILE, LEVEL DOWN IS
UNSTERILE
7) EXPOSED MATERIALS = UNSTERILE