RLE Notes Compilation

Cebu Doctors’ University
College of Nursing
1 Dr. P. V. Larrazabal Jr. Avenue, North Reclamation, 6014 Mandaue City, Cebu, Philippines
Tel. No. +63 (32) 2388746 local 8191-8192 Web: www.cebudoctorsuniversity.edu E-mail: cdu-cn@cebudoctorsuniversity.edu
NCM 103
Fundamentals in Nursing Practice RLE
Heat and Cold Application
Statement of Purpose: Cold treatment reduces inflammation by decreasing blood flow, heat
treatment promotes blood flow and helps muscles relax. This module teaches the learners proper
application of heat or cold to the body in dry, moist or wet form.
CLO#1: define the following terms related to heal and cold application with counter irritant.
1. Aquathermia Pads - also called as Water-Flow Pads

- consists of a waterproof plastic
Dry Heat
or rubber pad connected by two
hoses to an electrical control unit
that has a heating element and
motor.
2. Cold Application - generally an application of cold

to the body to reduce pain and
body temperature, anaesthetize
an area and prevent edema.
3. Cold Chemical Pads - it has a strong outer plastic layer

that holds a bag of water and a
chemical, or mixture of chemicals
that result in an endothermic
reaction when dissolved in water.
4. Compress - this can be either warm or cold.

It is a moist gauze dressing
applied to a wound or injury.
aseptic technique - use gloves

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5. Counterirritant - something used to cause

surface irritation of the skin, such
as heat or ointment, in order to
pau liniment, vicks vaporub, tiger bomb relieve underlying pain or
suffering.
6. Rebound Effect - it is a phenomenon that is

developed by exceeding the
effect is vasodilation instead of maximum time of therapeutic
vasoconstriction effect in heat and cold
application, and in which an
opposite effect of the practice
other than the desired effect
occurs
7. Heat Application - generally an application of heat

to the body to reduce pain by
opening blood vessels, which
increases the blood flow.
Hot Water Bag
8. Vasoconstriction -the narrowing of blood vessels

Therapeutic Effect: cold by small muscles in their walls.
Blood flow is delayed or halted as
blood arteries constrict.
9. Vasodilation -widening of blood vessels as a
result of the relaxation of the
blood vessel's muscular walls. It
Therapeutic Effect: heat is a physiological process that
increases blood flow to parts of
the body that are deficient in
oxygen or nutrients.
10. Electric Heating - a pain-relieving electric mat that
Pad heats up and is pressed against
Dry Heat the body.
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11. Heat Lamp -an electrical device with a bulb

that emits mainly heat rather
Dry Heat than light
12. Hyperthermia - an elevated body temperature

due to a break in
thermoregulation that arises
when a body produces or absorbs
more heat than it dissipates.
13. Ice Collar - it is made of plastic or rubber,

and its mouth is wide enough to
contain ice. Designed to be places
around the neck, covering the
throat as a collar.
14. Ice Bag - bags designed to be filled with

ice to provide cold therapy for a
limited external area of the body.
15. Ice Glove - is used in the same principle as

other dry cold application but
specially designed for alleviating
pain in hands such as
inflammation, arthritis, sprains
and strains.
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16. Heat Cradle - a tunnel or hood shaped cradle

equipped with light bulbs for
application of heat to the
patient’s body.
CLO#2: give the importance of cold application, counterirritant and heat application.
Heat Application - relieves muscle spasm and joint stiffness

- reduces pain sensation
- softens exudates
- hastens the suppuration process
- hastens healing
- warms a part of the body
- reduces congestion of underlying organ
- reduces pressure of accumulated fluid
- promotes vasodilation
- relieves swelling and hematoma
Cold Application - decreases and terminates bleeding

vasoconstriction - alters tissue sensitivity (producing numbness)
- slows pain sensation
- reduces inflammation
- controls fluid accumulation
Counterirritant - to relieve pain

- to divert patient’s attention
applying too much may cause burns
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CLO#3: state the indication and contraindication of cold application, counterirritant and heat
application.
Indication Contraindication
Heat Application muscle spasm, inflammation, present malignancies,

contracture, joint stiffness patients with impaired
and pain kidney, heart and lung
function, cutaneous injuries,
patients who have
paralysis/paresthesia and
areas where diffusion of heat
is limited, haemorrhage,
localized malignant tumor,
abdomen of a pregnant
woman
Cold Application traumatic injury, presence of open wound,

inflammation, muscle spasm impaired circulation and
and pain allergy and hypersensitivity
to cold
Counterirritant painful muscles and joints, open wounds, impaired

patients with arthritis, sensation, altered skin
abdominal distention integrity
CLO#4: describe the different methods of applying: dry heat, dry cold, moist heat, moist cold.
Heat Application
A. Moist Heat
1. Warm Soak - immersion of a body part in a warmed solution called soak
- promotes circulation, lessens edema, increase muscle
relaxation and provides a means to debride wounds and apply
medicated solution.
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2. Hot Moist Compress - a piece of gauze dressing moistened in a prescribed warmed

solution applied on the area affected.
3. Sitz Bath - a bath in which only the pelvic area is immersed in warm
water. The client sits in a special tub or chair in a basin that fits
on the toilet seat so that the legs and feet remain out of the
water.
- This is useful to patients who had rectal surgery, episiotomy
during childbirth, painful haemorrhoids, or vaginal
inflammation.
4. Paraffin Bath - used to completely coat the hand or feet with paraffin
- Its warm temperature is intended to relieve arthritis pain, stiff
Moist Heat
joints, and aching muscles.
5. Whirlpool Bath - a therapeutic bath in which all or part of the body is

moist heat submerged in a whirlpool of hot water.
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6. Hubbard Tank - a tank designed for full immersion of the body, used for
hydrotherapy. A narrow section at the middle of the tank allows
the therapist to reach the patient, and wider sections at each
end permit full abduction of the patient's legs and arms. It is
commonly used to treat one or both of the upper or lower
extremities, plus the trunk, to achieve a superficial change in
temperature.
B. Dry Heat
1. Aquathermia Pads - distilled water circulates through hollowed channels within the
pad to the control unit where water is heated. This is used for
treating muscle sprains and areas of mild inflammation or
edema.
Guidelines in using Aquathermia Pads
- If the distilled water in the reservoir runs low, add more
at the top of the control unit. Fill 2/3 of the control unit.
Do not use tap water.
- Place the unit above the patient so that gravity will
make the water flow.
- Plug in the unit and let it warm for 2 minutes before
applying to the patient.
- Allow the application to remain in place for only 20 to
30 minutes.
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2. Heat Lamp - provides fast, radiant heat and are fairly economical when
used for short periods.
- They are placed 18 to 30 inches from the area to be treated
If the patient complains for it being
too hot, the procedure should be stopped and applied for 15 to 20 minutes.
- This is usually used to mothers who had episiotomy during
delivery.
Guidelines in using Heat Lamps
- clean and dry area before the treatment to prevent
burning
- do not cover the lamp or place it under the bedclothes
- assess the skin exposed to heat every 5 minutes
- is a metal half-circle frame that encloses the body part to be

3. Heat Cradle treated with heat
- placed 16 to 18 inches from the patient
- provides heat over a larger area of the body
used for new borns or neonates
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4. Commercial Hot Pack - commercially prepared, disposable hot packs provide specified
amount of dry heat to an injured area for a specific period.
- The chemicals mix and release heat when tha pack is stroke,
kneaded or squeezed.
5. Hot Water Bottle - hot water placed inside a water bottle. Wrap the bottle with
towel before applying on the area affected. This is usually
used to relieve menstrual pain.
1. make sure this is wrapped in - relatively easy and inexpensive
cloth
2. before application, make sure to
secure the cover tightly
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6. Electrical Pad - an electric mat that heats up and is held against the body to
reduce pain.
difference from aquathermia pad: - advantage: easy to apply, safe to use, provides constant and
even heat
- no control unit - Guidelines in using Electrical Pads
- no need for water - avoid using pins to secure the heating pads
- place a covering over the pad
- avoid wet and moist conditions around the pad
- place heating pad anteriorly or laterally to, not under, the
body part
Cold Application
A. Moist Cold
1. Cold Soak -immersion of a body part in a cold soak. The desired

temperature for a 20-minute cols soak is 15 degree Celsius.
2. Sterile / Cold - apply cold compress for 20minutes at a temperature of 15

Compress degree Celsius to relieve inflammation and swelling.
- the same as cold pack but is sterile
sterile cold compress uses sterile

gauze compress and employs
aseptic technique upon application
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B. Dry Cold
1. Commercial Cold Pack - similar to commercial hot packs; comes in various shapes
and sizes to fit different body parts.
- depending on the type, the pack is frozen in the freezer and
is squeezed to activate
- advantage: pliable and easy to fit a body part
2. Ice Bag / Collar -for a client who has muscle sprain, localized haemorrhage, or
hematoma or who has undergone dental surgery
- ice bag/collar is ideal to prevent edema formation, control
bleeding and anesthetize the body part.
- relatively easy and inexpensive
Guidelines in using Ice Bag
- Fill the bag with small pieces of ice about 2/3 full.
- Apply for 30 minutes and then remove it for about an
hour before reapplying it.
- Bag of frozen vegetables may be used as a substitute
in home setting.
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CLO#5: discuss the processes of heat transfer.
Conduction -the transfer of heat from one object to another with direct contact. When
the warm skin touches a cooler object, heat is lost. The body gains heat
by conduction when it makes contact with materials warmer than skin
temperature.
Convection -the transfer of heat away by air movement. Convective heat loss increases
when moistened skin comes in contact with slightly moving air.
Evaporation -the transfer of heat energy when a liquid is changed to gas.
Radiation -the transfer of heat from the surface of one object to the surface of
another without direct contact between the two.
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CLO#6: explain the following: scientific principles involved in heat and cold application, effects
of cold and heat application, effects of a counterirritant, factors that affect heat and cold
application
Scientific principles in heat and cold application

parts of our body • Anatomy and Physiology nurse should know what will happen to the vessels or body when heat or cold is applied
that are more
sensitive to • Microbiology medical handwashing, gloving, observe sterility from preparation to application
temperature • Chemistry commercially prepared packs that has chemicals inside
• Physics different mechanism of heat transfer placement of control unit
• Psychology explain the procedure to the patient to lessen anxiety and make them cooperate
• Time and Energy preparation of necessary materials, observe proper duration of application for the procedure
Effects of heat and cold application

A. Heat
- vasodilation
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- increase capillary permeability

- increase local metabolism
- increase oxygen requirement
- increase blood flow
- increase lymph flow
- increase motility of leukocytes
- decrease muscle tension
- decrease blood viscosity
- decrease venous congestion
B. Cold
- vasoconstriction
- decrease capillary permeability
- decrease local metabolism
- decrease oxygen requirement
- decrease blood flow
- decrease lymph flow
- decrease motility of leukocytes
- increase muscle tension
- increase blood viscosity
- increase venous congestion
C. Rebound Phenomenon
- it is a phenomenon that is developed by exceeding the maximum time of
therapeutic effect in heat and cold application, and in which an opposite effect of
the practice other than the desired effect occurs
- if heat application is beyond its ideal duration, the client is at risk of burns
since constriction of blood vessels disallow the dissipation of heat adequately via
the blood circulation
- if cold application is beyond the ideal conditions, alternating vasodilation
and vasoconstriction occurs
Factors that affect heat and cold application

• Temperature tolerance
• Patient’s response to stimuli
• Level of Consciousness
• Condition of equipment
• General Health
CLO#7: enumerate the following evidence-based guidelines on the safety measures in applying
heat and cold application
Guidelines in performing heat and cold application

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- Determine client’s ability to tolerate the therapy. varied heat tolerance

- Identify conditions that might contraindicate treatment.
- Explain the application to the client.
- Assess the skin area to which the heat and cold will be applied.
- Ask the client to report any discomfort.
- Return to the client 15 minutes after starting heat or cold therapy and observe
the local skin area for any untoward signs.
- Remove the equipment at the designated time and dispose appropriately.
- Examine the area to which the heat or cold was applied, and record the client’s
response.
- The prior skin temperature affects the degree of physiologic response.
- The rapidity of the temperature change determines the degree of receptor organ
stimulation.
- The duration of the application has a direct effect on the response of the body.
- The environmental temperature influences the effect of the heat or cold
applications.
- There are differences in temperature toleration levels between individuals and
within the same individuals in different parts of his body.
- Where there has been traumatic damage to a body surface, there exists a greater
potential for further damage with the application of heat or cold. - The amount of
body surface area involved affects the body’s response.
- If the body surface area affected is large enough, the physiologic effects of local
heat or cold becomes a generalized systemic response
- The physiologic condition of the patient is important to assess.
- Special consideration must be made for patients with neurological impairments.
- The fatigued patient will be less sensitive to cutaneous stimulation.
- Metabolic disorders (e.g. diabetes, shock) increase the hazards of tissue damage,
therefore, heat or cold applications must be applied to such patients with caution
and frequent assessments are necessary.
CLO#8: list down the materials used in heat and cold application.
Refer to the procedure guide.
CLO#9: demonstrate beginning skills in heat and cold application.
Refer to the Video Demonstration posted.

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CLO#10: document relevant information to after performing heat and cold application bath.
Documentation in heat and cold application

- type of compress applied
- solution used
- appearance of wound/skin surface
- presence of any exudates
- any statement of discomfort from the patient
- duration and frequency of the procedure
- signs of relief from swelling or hematoma
Parenteral Medication
Learners’ Names: Year and Section: BSN 1-A

CHAN, Althea Zen
CHUA, Sophia Maxine
CORNEJO, Kiara Elana
DELOS REYES, Quianne Kisha
DESPACIO, Jenix
DIAZ, Angel Chrizianne
ESTERIOSO, Bianca Lianne
GAMALLO, Khiarra Francheska
GENOVE, Rhys Aizel
LEGARDE, Amira Francheska
LIM, Guyll Gilbert
Materials Needed: A lined tray containing:

Note: The following materials shall be provided by the Central Supply:
stock tray
sterile syringes and needles sterile file (if needed)
bottle of denatured alcohol container for waste
match receptacle for used syringes and needles
desired drug solution small injection tray
sterile gauze alcohol swabs
jar of sterile dry cotton ball
sterile forceps (Kelly straight and curved) in disinfectant solution
jar of cotton ball soaked with alcohol (70% isopropyl alcohol)
Note: The following materials shall be prepared by every student-demonstrator:

Patient’s chart waste receptacle
3 pairs of gloves big bath towel
bandage scissors pens (blue, black, red, green)
Procedure Guide: Parenteral Medication
PROCEDURE RATIONALE
A. Before
De Los Reyes. A medication review
1. Read physician’s order in the patient’s chart. ensures that a patient is getting the most
Review for discontinued, suspended or new out of all of their medications. Reviews
medication orders. are used to update and adapt drugs
based on the patient's condition. The
evaluation also assures that the patient
is taking the most up-to-date
medications.
2. Check medicine ticket with doctor’s order. For De Los Reyes. Transcribing new
new medication orders, transcribe it on the prescription orders ensures that patients'
appropriate medicine ticket. medical records are up to date. This can
help to avoid pharmaceutical errors and
keep clients safe during medication
administration.
3. Introduce self and explain procedure to the
patient as to nature of the drug, effects to De Los Reyes. Introducing Self to
expect and untoward symptoms to watch. patient build rapport. Explaining the
nature and objective of the procedure to
the patient would minimize patient
anxiety and improve patient compliance.
4. Do medical hand washing.
De Los Reyes. This helps prevent
spread of infection.
5. Prepare cotton balls on jars and wet 1 jar with
70% isopropyl alcohol. Dispense syringes and Chua. In the preparation for parenteral
needles to the stock tray. medication, a jar of cotton balls and
another jar of cotton balls with 70%
isopropyl alcohol is prepared
beforehand. The jar containing cotton
balls with 70% isopropyl alcohol serves
as a disinfectant that contains more
water. The presence of water is a vital
factor in destroying or inhibiting the
growth of pathogenic microorganisms
with isopropyl alcohol. Water serves as a
catalyst, which plays a key role in
penetrating the cell wall more completely.
Therefore, killing the bacteria.
6. Clamp one dry cotton ball and place it on the
injection tray. Pour denatured alcohol over it. GAMALLO
while placing palm against the label of Alcohol is frequently used in order to
container. Ignite the soaked cotton ball. quickly eradicate or disinfect areas that
are believed to contain microorganisms
(such as the hypotray). In order not to
waste alcohol, the nurse must soak the
cotton ball with the alcohol and then
proceed to ignite the cotton ball for the
next procedure.
7. Pass flaming cotton ball over the hypotray in
one direction, top-to-bottom using forceps. GAMALLO
Passing a flaming cotton ball over the
hypotray promotes the principle of
microbiology. This method helps in
eradicating microorganisms that may be
present in the hypotray through dry heat,
which is one of the methods used during
sterilization.
8. Spread sterile medicine towel over the tray. Fan
fold sterile towel to one direction. Do the first LIM Spreading the medicine towel will
reading by comparing the ticket with drug. Align make it more efficien when fan folding it.
vial/ampule with the ticket. Fan folding the medicine towel will make
it look neat and presentable prior to
creating sterile field. First reading must
be done to validate and confirm drug to
be adminestered as ordered.
9. Using sterile forceps, place the following items

on the sterile towel: LIM Sterile forceps are used to place
a. dry cotton ball for each needle to be used. appropriate items that will be used in the
procedure. The forceps are necessary so
b. sharp needles of desired sizes (for
there wont be any direct contact from the
aspiration and injection)
items and the hand, minimizing spread of
c. syringe(s) depending on number and the
any existing microbes.
amount of drugs to be given.
d. Gauze
e. file if necessary
f. five wet cotton balls
B. Preparation of drug from:

Genove
To transfer fluid from the ampule's neck
❖ An Ampule to the bottom. This ensures that the
solution is withdrawn from the head
1. Tap tip of ampule lightly to collect solution at space and transported to the ampule's
bottom body for simple extraction.
2. Disinfect neck of the ampule with cotton ball in
one circular motion and disinfect hands. Legarde
Disinfecting the ampule in one circular
motion with a cotton ball reduces the
microorganisms that can affect the
patients during the procedure. After
disinfecting the ampule, disinfect hands
by handwashing to remove excess
germs and bacteria.
3. Wrap sterile gauze around neck of ampule
evenly in 3 areas. Break tip away from you. CORNEJO The sterile gauze protects
the fingers from the broken glass, and
any glass fragments will spray away from
the nurse.
4. With syringe in locked position, introduce
needle into ampule without touching sides and CORNEJO The needle will remain
invert ampule to upright position. Hold hub of sterile if it is not in contact with the rim of
needle between thumb and ring finger of left the ampule at its tip or shaft. When the
hand while holding the ampule in cigarette-like ampule is inverted, the solution flows out
position. of the needle tip or shaft and makes
contact with the ampule's rim, thus,
making it susceptible to being
contaminated.
5. Withdraw desired dose. Never inject air into

ampule. Legarde
Withdraw the desired dose that will be
administered to the patient, ensure that it
is the right medication and right dose in
order to prevent removing extra air out of
the syringe. Do not inject air into the
ampule since it will be difficult to
withdraw the medicine that will cause it
to flow out.
6. Replace aspirating needle with hypodermic
needle of desired gauge using sterile pick-up CORNEJO This is to prevent the
forceps. medication's sterility (i.e., microbial
contamination or proliferation) or
physical and chemical stability (e.g., loss
of potency, adsorption to the container)
from being compromised when it is taken
out of its original container and stored for
a period of time before being
administered.
7. Place on sterile towel. Identify filled syringe by
inserting medicine ticket under sterile medicine CORNEJO The sterile towels are
towel in line with syringe-containing drug. presumed to diminish the chances of
contamination. Identifying the filled
syringe ensures the proper medication to
be given by the nurse. This prevents
confusion and possible errors in
administering the parenteral medication
later on.
❖ A Vial De Los Reyes. The antiseptic in the wet
cotton ball cleans the cap and reduces the
number of microorganisms which prevents
1. Disinfect rubber cap of vial and hands with wet
spread of infections.
cotton ball.
2. Attach sterile aspirating needle to sterile
Legarde
syringe.
Properly attach sterile aspirating needle
to sterile syringe to avoid breakage and
detachment of the needle to the syringe.
Ensure that the aspirating needle and
syringe are sterile to prevent any
microorganism that will risk the patient.
3. Introduce air to the vial equal to the amount of
Legarde
solution and withdraw the solution from the vial.
It is important to introduce air to the vial
equal to the amount of the solution to
create a pressure that will be needed to
withdraw the medication without
aspirating, After this, withdraw the
solution from the vial to be administered
to the patient.
4. Replace aspirating needle with injection needle
CORNEJO This is to avoid compromising the
of desired gauge. medication's sterility when it is removed from
its original container and stored for a period
of time before being administered.
5. Place syringe on injection tray.

Genove
To be able to transport the ready-to-use
injections to the patient.
C. Administration of Drug
GAMALLO
Following the principle of microbiology,
❖ Intradermal disinfecting the hands is one of the most
basic ways to avoid bacteria from spreading.
Reading the medication ticket a second time
1. Disinfect hands. Do second reading of as well will help the nurse in confirming if the
medication ticket and prescribed drug. Pick medication prepared will be received by the
syringe up. Attach aspirating needle and secure correct patient. This procedure, along with
it in place. attaching and preparing the needle
beforehand will help the nurse save both
their time and energy so as to avoid going
back and forth from the nurse’s station to the
patient’s room.
2. Introduce air equal to the amount of distilled

Esterioso. The nurse must introduce air
water to be withdrawn from the vial. Invert vial equal to the required amount of water into
and hold at eye level while withdrawing 0.9 cc the vial before actually withdrawing the
of diluent into the syringe. distilled water into the syringe. This is to
equalize the pressure within the vial and
prevent forming a vacuum. Aspirating air
before drawing out the diluent ensures that
the contents of the vial can easily be drawn
and contained within the syringe.
3. Withdraw 0.1 cc of drug to be tested from

CORNEJO In a solution it is required that all
ampule or vial. Shake well to mix the ingredients are properly dispersed.
solution inside the syringe.
4. Pull plunger down and change aspirating
LIM Pulling the plunger after the needle is
needle to gauge 25-26 for injection. inserted can help check if there are any
blood that enter or return to the syringe.
Aspiring the needle is crucial to ensure the
tip is going to the designated area.
5. Place syringe back on injection tray to prevent

Genove
spillage of drug. Keeps the equipment sterile and fosters
organization.
6. Do third reading and return medication back to

Genove
the cubicle. The third and final reading assures that the
medication is right. Medication is returned to
preserve organization and accurate
medication recording.
7. Insert medicine ticket under sterile medicine

Legarde
towel in level with syringe and prepare alcohol
The medicine tickets are the indication of
swab.
the frequency of doses and the method
of administration to the patient. Thus, it is
important to insert a medicine ticket
under sterile medicine for the nurse to be
guided. Alcohol swabs will be used to
clean injection sites.
8. Identify patient. Place in a comfortable position
and drape accordingly. Expose site for testing. Chua. Beforehand, the nurse should
Palpate skin for induration or tenderness. identify the patient. The nurse asks the
Disinfect injection site using alcohol swab. patient to identify himself or herself by
using at least two patient identifiers such
as the patient’s name and date of birth.
Patient identification is vital as it is the
process of correctly matching a patient to
the relevant interventions and
consistently and reliably communicating
information about the patient's identity.
The patient must be positioned
comfortably and draped accordingly. The
sleeves of the drape must be rolled up
for the injection site to be exposed. The
skin must be palpated for induration or
tenderness to determine whether it is
normal or abnormal findings occur. Using
the cotton ball soaked in 70% isopropyl
alcohol, disinfect the injection site in an
inner to outer circular motion.
9. Disinfect hands with wet cotton ball. Wear
Chua. Using the same cotton ball,
gloves. Place a cotton ball between left small
disinfect the hands. Then, don clean
finger and ring finger.
gloves. The technique of placing a dry
cotton ball in between the left small
finger and ring finger will be used as this
is the most convenient method once the
parenteral medication has been given to
the patient later on.
10. Support and grasp forearm from the
underside, stretching skin. Hold syringe LIM Stretching the skin will make the site
between thumb and four fingers and place more clearer, it also prevents excess skin
needle with bevel side up at 150 angle against from getting in the way when injecting.
the skin. While injecting, it is best to have the
bevel side up at a fifteen-degree angle
for smoother piercing and easier drug
administration.
11. Insert needle point into the skin until lumen is
under the skin. Introduce medication slowly DESPACIO
and gently to create a bleb or wheal about ½ The occurrence of a weal or bleb in the
cm in diameter. dermis shows that the medication is
present.
12. Withdraw needle and pat site with cotton ball.
Do not press or massage GAMALLO
As the needle is withdrawn from the
patient’s skin, lightly patting the injected
site with a cotton ball will help in
minimizing bleeding, as well as to avoid
blood from staining the patient’s clothing.
Furthermore, the nurse must also avoid
pressing or massaging the injection site
so as not to cause the product in
breaking down and spreading too quickly
in the bloodstream.
13. Encircle the margin of bleb or wheal with black
or blue pen. Mark and note time given, time Esterioso. The bleb or wheal’s margin
due and site of injection at the back of must be encircled with a black or blue
medicine ticket for reading of result. pen right after intradermal injection. This
is an indicator of the patient’s
hypersensitivity to a certain medication.
If a patient is allergic to the medication
administered, the bleb or wheal will
expand beyond the margins of the
originally drawn circle because of
inflammation.
14. Make patient comfortable. Inform client that
bleb will be evaluated after 30 minutes. DIAZ
The patient must relax for 30 minutes
before being evaluated to see if the drug
has any adverse effects or causes
allergic responses.
15. Do after care at client’s bedside. Call a
physician to read result after 30 minutes. DIAZ
This is done to maintain cleanliness and
ensure that any changes are noticed
after the procedure has been completed
for a period of 30 minutes for constant
monitoring.
16. Inform patient of result and subsequent activity
DIAZ
to expect.
Giving patients the summary information
at the end of the procedure improves
their comprehension of their care,
strengthens their connections with
clinicians, boosts their happiness with
care, and encourages them to stick to
treatment regimens. Patients will be able
to participate more successfully in their
own care if their information needs are
addressed.
17. Record on Medication Administration Record
as to: date, time, kind, amount of drug, site DIAZ
and result as read by the physician. Medication administration documentation
is essential for client safety since it
decreases the chances of repeat
administration. Documentation can also
inform healthcare providers to results
that require extra precautions to ensure
patient safety.
❖ Subcutaneous LIM Placing and preparing necessary

materials for injection in a orderly
1. Prepare injection tray in prescribed manner. manner helps avoid forgetting the
Disinfectant hands. Do second reading. needed apparatus. Second reading
Pick up syringe and attach aspirating further confirm the drug to be
needle. administered and means of
administering as ordered. After
confirming, attach needed aspiring
needle.
2. Introduce air to vial equal to the amount of
medication to be withdrawn. Withdraw desired CORNEJO The volume of air instilled in
amount of medication. the vial must be equal to the volume of
medication extracted from the vial prior
to medication removal. It will aid in
pressure regulation and prevent a
vacuum from forming inside the vial. As a
result, the air injected into the vial
prevents the formation of negative
pressure in the vial and allows the
medicine to be withdrawn more easily.
needle to gauge 24. DIAZ
To make sure the drug isn't mistakenly
injected into a vein.
4. Place prepared drug on injection tray. Do third
reading and return medication back to the Esterioso. The nurse must perform a
cubicle. Identify filled syringe by inserting third and final reading of the medicine
medicine ticket under medicine towel in line ticket to ensure that the right medication
with the syringe and prepare alcohol swab. was prepared for the patient. The
medicine ticket must be placed near the
filled syringe to identify it. Alcohol swabs
should be prepared for disinfection of the
nurse's hands and injection site to
maintain the sterility of the procedure.
5. Identify patient and place in comfortable
position. Drape accordingly. GAMALLO
Identifying the patient will help the nurse
indicate if he/she is the person who will
be receiving the medication that is to be
administered by the nurse. Furthermore,
placing the patient in a comfortable
position will help the patient relax, which
is very important when administering
parenteral medication.
6. Disinfect injection site. Disinfect hands with
GAMALLO
wet cotton ball. Wear gloves. Place a cotton
Following the principle of microbiology,
ball between left small finger and ring finger.
disinfecting ones hands and wearing
gloves is one of the most basic ways to
avoid cross contamination. Placing a
cotton ball between the left small finger
and ring finger will help the nurse in
immediately putting on the cotton right
after pulling out the injection from the
site, in order to avoid bleeding.
7. Grasp a substantial portion of skin and
subcutaneous tissue between thumb and DESPACIO
fingers of non-dominant hand. Raise if patient This is to create a skin fold if there is little
is emaciated. adipose tissue. The decision to create a
skin fold is based on the nurse’s
assessment of the patient and the
needle length used.
8. With right hand, hold syringe in 1-3-1 fashion
and inject in the base on the deltoid observing GAMALLO
450 angle. Keeping the syringe in a 450 angle will
provide better piercing on the patient’s
skin, and can help in the smooth
induction of medication onto the patient.
9. When the needle is in place, support the hub
of the needle with the thumb and index DESPACIO
finger of your left hand. To avoid harm and error, this maintains
the needle steady and in position.
10. Aspirate, by pulling back the plunger, to check
if needle is not inside a blood vessel. If blood Esterioso. It is important for the nurse to
appears in the syringe, withdraw the needle, aspirate the needle before injecting the
discard the syringe and prepare a new medication in the syringe. This is to
injection. If blood does not appear, administer ensure that the needle is not directed at
the medication by pushing the plunger slowly a blood vessel when the medication is
using the cigarette position. administered. Otherwise, it may damage
the blood vessels and lead to other
complications.
Follow the cigarette position to steadily

and smoothly administer the prescribed
medication to prevent any more pain or
discomfort to the patient.
11. Place cotton ball over injection site. Press and
withdraw needle quickly. DESPACIO
Tissue injury and excessive discomfort at
the injection site can be avoided by
immediately withdrawing the needle at
the same angle. When the safety
mechanism is engaged, the chance of
needle stick injury is minimized
immediately.
12. Apply gentle pressure. Check for bleeding and
possible reactions or complications. Do after DESPACIO
care in patient’s bed side. Apply Band-Aid as needed after covering
the injection site with sterile gauze and
applying gentle pressure. Do not rub the
area.
13. Chart kind of drug, amount, time administered,
route, site and reaction. DIAZ
Documenting the type of medications,
the dose, the time given or delivered, the
route, the site, and the patient's reaction
allows nurses and physicians to ensure
that the patient has received or is
receiving the correct medication for the
correct cause.
14. Clean all articles used. Return to place.
Genove
Lowers the likelihood of infection and the
spread of germs
❖ Intramuscular Genove
Preparing an injection tray will assist
1. Prepare injection tray in prescribed manner. organize the supplies that will be utilized,
and it will be easier to transport all of the
prepared materials to the patient's room.
2. Disinfect hands. Do second reading. Pick up
syringe and attach aspirating needle. Chan. Hand hygiene prevents the
spread of microorganisms. Reading the
medication for the second time prevents
medication errors by providing an
additional check. Attaching the aspirating
needle to the syringe facilitates in getting
the medication from the vial.
3. Introduce air to vial equal to the amount of
medication to be withdrawn. Withdraw desired Chan. This prevents the formation of a
amount of medication. vacuum. If you put in too little air, it will
be difficult to extract the medicine. If you
inflate the syringe too much, the
medicine may be forced out.
needle to gauge 23. Chan. Aspirating needle should be
change before injection. Because the
outside of the new needle (gauge 23) is
free of medication, it does not irritate
subcutaneous tissue as it passes into the
muscle.
5. Place prepared drug on injection tray. Do third
reading and return medication back to cubicle. Chan. The prepared drug should be
Identify filled syringe by inserting medicine placed on the injection tray since this will
ticket under medicine towel. Prepare alcohol be brought to the patient’s room.
swab. Reading the medication for the third time
prevents medication errors by providing
an additional check. The nurse should
prepare all the materials needed for the
procedure to save time and energy. For
example, the alcohol swab must be
prepared since it is needed for the
client’s skin disinfection before injection.
6. Identify patient and place in comfortable
position. Drape accordingly. LEGARDE
Before proceeding to the procedure, the
nurse must identify the patient through
two identifiers which are the patient’s
name and date of birth. This is to ensure
that a correct match is made between
the procedure and the individual. It is
important to place the patient in a
comfortable position to prevent anxiety
and reduce muscle tension. Drape the
patient accordingly to maintain
sterilization during the procedure.
7. Disinfect injection site using alcohol swab.
Disinfect hands with wet cotton ball. Wear Esterioso. Following the principle of
gloves. Place a cotton ball between left small Microbiology, the nurse must disinfect
finger and ring finger. the injection site and his or her hands
with a wet cotton ball and wear gloves to
minimize the risks for infections and
cross contamination throughout the
procedure.
A cotton ball should be prepared

between the left small and ring fingers so
that it can easily be used to cover the
injection site after the administration of
the medication.
8. Place ulnar side of left hand and grasp buttocks
or deltoid tissue with thumb and index finger. Chan. Pulling the skin and subcutaneous
tissue or pinching the muscle makes it
firmer and facilitates needle insertion.
9. With right hand, hold the syringe between
thumb and forefinger; hold as a dart, palm Esterioso. Insert needle with a dart-like
down. Inject needle quickly into the deltoid positioning at a 90 degree angle to
muscle or upper outer corner of the upper outer ensure that the intramuscular
quadrant of the buttock at 900 angle. administration of the parenteral
medication can steadily and smoothly be
done. This method assures both the
efficiency of the procedure and
minimizes the pain or discomfort the
patient might feel when injected.
10. Pull needle slightly to form space for drug in
tissue. LIM As the needle is pushed, tissue is
pushed sideways to make room for the
needle to move. Pulling it back a bit will
create a small pocket for the
adminestered drug to occupy.
11. Release hold on flesh. Steady hub of needle.
Chan. Once the needle is in, let go of the
skin. This prevents seepage of the
medication into the subcutaneous
tissues and subsequent discomfort.
Holding the syringe steady minimizes
discomfort.
12. Aspirate to check if needle is not on a blood
vessel. DESPACIO
To make sure the needle tip is at the
right place and hasn't punctured a blood
vessel by accident.
13. After injecting the medicine, slowly press site
with cotton ball. Withdraw needle quickly. Chua. The site must be pressed with a
cotton ball after injecting the medicine. In
intramuscular injections, pressing the
site has an advantage for the muscles as
it ensures that the body will quickly
absorb the medication. As with any
injection, withdraw the needle smoothly
and quickly, following the angle of
insertion. Afterwards, immediately place
the needle and syringe directly into its
designated waste container.
14. Apply gentle pressure. Do after care at
patient’s bed side. Chua. In intramuscular injections,
applying gentle pressure to the injection
site is a simple and cost-effective method
to reduce the pain associated with
injection. After care services include:
frequently checking up on the patient,
monitoring vital signs, and observing the
proper disposal of materials. These
services keep the patient on track after
they have been treated for a particular
illness or injury.
15. Chart kind of drug, amount, time
administered, route, site and reaction. Chua. The data from the documentation
provides information about the patient
characteristics and care outcomes.
Thorough documentation promotes
patient safety and quality of care;
furthermore, it is essential for good
clinical communication among health
care professionals.
16. Clean all articles used. Return to place.
De Los Reyes. To keep the caregiver
safe and to avoid infection. Cleaning
used articles helps to keep them in good
condition and extends their lifespan.
Updated: November 2018
Sources:
Drawing medicine out of a vial: MedlinePlus Medical Encyclopedia. (n.d.). Retrieved April 12, 2022, from
https://medlineplus.gov/ency/patientinstructions/000530.htm
College of Nursing
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NCM 103
Fundamentals in Nursing Practice RLE
Bed Making
Statement of Purpose: Skillful bed making promotes comfort for the patient. Nurses
need to be able to prepare hospital beds in different ways for specific purposes.
CLO#1: define the following terms related to bed making.

1.1 Bed making -preparing and arranging
different types of bed for the
client’s comfort in the hospital
1.2 Fanfold -a continuous sheet of paper

folded in an alternating,
regular pattern.
1.3 Mitered -a method of making a crisp,

Corner smooth corner on the bed
where non-fitted sheets
would typically leave
wrinkles.
1.4 Toe Pleat -pleats in the sheets that

allow a patient in bed to move
their feet to avoid developing
pressure sores on their heels
and toes.
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1.5 Foot Drop -attributable to a lack of
strength in the foot's
dorsiflexors, the inability to
lift the forefoot.
1.6 Bed Cradle - a bed frame that is placed at

the foot of the bed to keep
sheets and blankets off the
legs and feet.
1.7 Magic Corner -corners of a folded linen

upon opening it automatically
positions the sheets the way
it is placed on the bed.
CLO#2: discuss the following:
Purpose of Bed Making

 promotes a clean, wrinkle-free bed that remains intact when
patient moves in order to provide the patient with physical and
psychological comfort
 provides a safe and comfortable bed to the clients or patients.
 organizes a specific ward.
 prepares for any critical condition.
 prevents bedsores.
 promotes neat appearance and cleanliness.
Importance of Bed Making

 provides physical and psychological comfort to patient
Principles in Bed Making

 Microbiology
 Body Mechanics
 Safety and Security
 Time and Energy
 Physics
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CLO#3: enumerate the following:
Common and Special Types of Bed
Common
Type Open Bed -the lines folded
down, making it
easier for the client
to get into bed.
-open a bed for a
new client or leave it
open when the client
is out of bed for a
short time.
Closed Bed -used to

designate the
hospital bed which
remains empty until
the admission of
another patient.
-the top covers are
so arranged the all
linen beneath the
spread is fully
protected from dust
and dirt.
Cradle Bed -is a frame that is
installed at the foot
of the bed to keep
sheets/blankets off
legs/feet. This helps
with air circulation,
sensitive skin and
keeping skin dry,
especially if the
patient is lying in bed
for long periods of
time.
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Surgical/Post- -is a bed designed to
Operative receive a patient
Bed after any surgical
procedure.
-is a special type of
bed designed for a
patient who is
coming from an
operation theater or
from any other
procedure that
requires anesthesia.
Special
Type Balkan Frame -a frame that offers
Bed overhead weights
and pulleys for
suspension, traction,
and continuous
extension of the
splinted fractured
limb in the treatment
of fractured bones of
the leg or arm.
Bradform - a rectangular
Frame Bed structure of gas pipe
across which are
stretched two strips
of canvas, once used
as a bed frame for
patients with
fractures or disease
of the hip or spine.
Stryker -a device that allows
Wedge Frame patients with spinal
Bed (Turning cord injuries to turn
Frames) while maintaining
spinal traction
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Circoelectric -it was created for
Bed patients with spinal
cord injuries to keep
them immobile
following surgeries
while allowing for
moderate position
changes to let the
body acclimatize
with less stress on
the nervous system.
-it also made moving
patients during this
type of recuperation
easier for doctors
and nurses.
Water Bed -a bed whose
mattress is a
watertight bag filled
with water.
Rotation Bed - A turning mattress,

also known as a
lateral rotation
treatment mattress,
allows the user to
rotate their body to
the side on a regular
basis by using air
pressure to produce
an angled plane that
forces the body to
turn.
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Clinton -Air-fluidized bed
Therapy Bed that is simple to
operate and allows
for easy care and
feeding of bedridden
individuals.
-provides advanced
pressure
redistribution,
climate
management, and
pain relief for
patients with
pressure ulcers,
burns, surgical flaps
and grafts, and other
skin wounds.
Air Therapy -an alternating
Bed pressure mattress
system developed
for the comfort of
the patients under-
recovery, confined to
the bed for more
than 15 hours in a
day. Such patients
are likely to develop
bedsores which later
develop into
pressure ulcers.
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Kinds of Linen
Bottom Sheet - is laid above the mattress and

bed occupants lie on it. A
bottom sheet may be either a
flat sheet, or a fitted sheet,
which has been sewn to form a
large pocket around the top,
sides and bottom edge of a
mattress, with elastic or a
drawstring in the hem to stop
it slipping off the bottom of the
mattress.
Top Sheet -is the same flat sheet but
placed over the bed occupant.
Contrary to the bottom sheet,
which protects the mattress, a
top sheet protects the bed
covers laid over it
Cotton Draw - also known as a lift sheet, is a

Sheet sheet used in the medical
industry to lift immobile
patients from their beds.
Pillow Sheet -a removable washable cover

of cotton, linen, nylon, etc, for
a pillow.
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Rubber Sheet - used in hospital beds for
protection of mattresses. Light
and easily portable,
pliable/supple and soft for skin
contact. Rubber sheets have
been used for many years to
protect mattresses from bed
wetting, other moisture and
dust.
CLO#4: state evidence based practice guidelines in bed making.
 Wash hands thoroughly before and after handling client’s bed linen.
 Hold soiled linens away from the body.
 Linen for one client is never placed on another client’s bed. Soiled linens is
placed directly in a portable linen hamper or tucked in to a pillow case at
the end of the bed before it is gathered up for disposal in the linen
hamper or in linen chute; pillow case is then tied and labeled with: name,
room number, communicable/non-communicable
CLO#5: enumerate the different materials in bed making.
 Stripping the Bed: disposable clean gloves, yellow plastic for soiled linens with
body fluids, hamper
 Closed Bed: A lined tray containing: mattress cover, bottom sheet, rubber sheet,
cotton draw sheet, top sheet, pillow case & blanket
 Post-Operative Bed: A lined tray containing: mattress cover, bottom sheet,
rubber sheet, cotton draw sheet, wipes, tongue blade, disposable gloves, top
sheet, pillowcase, blanket/thermal blanket, emesis basin, sphygmomanometer
and stethoscope, and wash cloth
 Occupied Bed: A lined tray containing: mattress cover, bottom sheet, rubber
sheet, cotton draw sheet, yellow plastic for soiled linens with body fluids, top
sheet, pillowcase, blanket/top sheet and disposable gloves
CLO#6: demonstrate the beginning skills in bed making
Refer to video demonstration.

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CLO#7: Document relevant information to after performing bed making.
 Does the client assume a more relaxed position?

 Is the client able to fall asleep?
 Assess client’s level of consciousness when asked to move out of bed or in
changing positions (e.g. dizziness, orthostatic hypotension)
 Although linen changes aren’t usually documented, record their dates and times
in your notes for patients with incontinence, excessive wound drainage, pressure
ulcers, or diaphoresis
College of Nursing
Mandaue City, Cebu
NCM 103 – FUNDAMENTALS IN NURSING

PRACTICE:
RLE MODULE 4b:

Hair Shampoo & Cleansing Bed bath
LEARNING OUTCOMES:
After 3 hours of various online class activities, the level I nursing students will be
able to:
Hair Shampoo
CLO#1: Define the following terms:

1.1 hair shampoo
1.2 alopecia
1.3 dandruff
1.4 infestation
1.5 nits
1.6 pediculosis
1.7 pediculicide
1.8 lice
1.9 delousing
1.10 seborrheic dermatitis
1.11 sebum
1.12 ticks
1.13 emulsification
CLO#2: Explain the importance of hair shampooing

CLO#3: Discuss the following:
3.1 indications and contraindications of hair shampoo
3.2 factors that influence hair shampoo
3.3 evidence-based guidelines before, during, and after a hair shampoo
3.4 common hair and scalp problems as to its:
3.4.1 characteristics and causes
3.4.2 treatment and nursing interventions
CLO#4: Relate the scientific principles involved in hair shampoo
CLO#5: Identify materials and equipment used in hair shampoo
CLO#6: Demonstrate beginning skills in hair shampoo
2
CLO#1: Define the following terms:
1.1 hair shampoo

- a type of liquid or cream preparation
of soap or detergent that is used to
wash the hair and scalp.
1.2 alopecia
- another term for hair loss which refers to a
loss of hair from the head (baldness) or other
parts of the body. It normally occurs with
aging but other factors such as
chemotherapeutic agents and radiation may
also cause such.
1.3 dandruff
- appears as a diffuse scaling of the scalp

which is often accompanied by itching. In
some severe cases, it involves the auditory
canals and the eyebrows. Dandruff may
usually be treated effectively with shampoo.
However, the client may need to seek advice
from a primary care provider during severe
cases.
1.4 infestation
- the state of being invaded or overrun in

numbers or quantities large enough to be
harmful, threatening, or obnoxious.
3
1.5 nits
- are lice eggs that are generally whitish and
oval-shaped. They are firmly attached to the
side of hair shafts. They usually hatch within
1 to 2 weeks after they’re laid.
1.6 pediculosis
- another term used for infestation of lice.

Infestation may be in other hairy areas of
the body.
1.7 pediculicide
- a chemical agent used to treat or kill

lice.
4
1.8 lice
- are parasitic insects that infect on

mammals. Three common kinds are
Pediculosis capitis (head louse) which is
often found in the scalp and tends to stay
hidden in the hairs; Pediculosis corporis
(body louse) which suck blood from the
person and lay their eggs on the clothing
and Pediculus pubis (crab or pubic
louse) which stays in the pubic hair.
1.9 delousing
- the ridding of lice from the body.

Usually done by other person/s to a
person with lice.
1.10 seborrheic dermatitis
- a common inflammatory disease of the

skin that is characterized by scaly lesions
usually on the scalp, hairline, and face. It
is particularly common among patients
with Parkinson’s disease or HIV/AIDS.
5
1.11 sebum
- an oily substance secreted by the

sebaceous glands in the skin which softens
and lubricates the hair and skin.
1.12 ticks
- are small gray-brown parasites that bite

into tissue and such blood. They transmit
several diseases to people, particularly
1.13 emulsification
- a process in which an emulsion is formed,

being a liquid containing fine droplets of
another liquid without forming a solution.
6
CLO#2: Explain the importance of hair shampooing
Hair should be washed as often as needed to keep it clean, a dirty scalp and hair
are itchy, uncomfortable, and can have an odor. Shampooing an infant’s hair daily to
prevent seborrhea and If the person is being given a shampoo to destroy lice, a
medicated shampoo is being used. Hair Shampooing also improves appearance, well-
being and promotes blood circulation in the head and can mainly treat unsightly
infestations on the hair. How often a person needs a shampoo is highly individual,
depending largely on the person’s activities and the amount of sebum secreted by
the scalp.
1. To the comfort of the patient.

2. To remove tangles from the hair.
3. To preserve or keep the hair in good condition during illness.
4. To observe the presence of lice without the patient’s being aware of it.
5. To prevent infection.
6. In preparation for diagnostic procedures involving the head.
7. Shampoo cleans the hair with chemicals called surfactants.
Advantage Disadvantage
• Relieves itch and irritation • shampoo can damage your hair.

Shampoo strips the important oils the
• Keep your hair beautiful and scalp produces and can leave the hair
blossomed: One of the major and scalp too dry.
advantages of using hairs
shampoos on a regular basis is • Sodium laureth sulfate is commonly
that they make them look used in shampoos which may harm
beautiful. eyes and skin and may even be
carcinogenic.
• Hair shampoos fight dryness
and oiliness • Daily shampooing decreases the
• Removes the redness: In this natural production of oils of the
case, people with sensitive skin skin, thus causing various skin
can easily get inflamed skin irritations. Frequent exposure to
which eventually leads to many shampoo can cause rashes, skin
other hair related problems. inflammation, itching, redness and
The regular use of mild and eczema because of the various
high -quality products can give harsh chemicals present in all the
you better results in every beauty products.
way.
7
CLO#3: Discuss the following:
3.1 indications and contraindications of hair shampoo

3.2 factors that influence hair shampoo
• Indications
1. Immobilized Patients – those who are incapable of giving themselves a hair

shampoo. Despite their condition, they should still receive this hair care
procedure in order to keep their hair clean and maintain good hygiene.
2. Head lice - With the proper use and application of medical hair shampoo. This
can help treat and remove the presence of head lice.
3. Patients at risk for infection related to scalp laceration and insect bites – a
laceration is a pattern injury in which blunt forces result in a tear in the skin
and underlying tissues. This procedure can help prevent the risk for the said
infections by removing foreign bodies, thereby achieving homeostasis in the
scalp.
4. Patients with excess perspiration - Excess amounts of sweat can weaken the
hair strand and shorten the lifespan of the hair. This can also clog the hair
follicles, as it can be mixed with bacteria and irritate or damage the scalp.
Although it is not advisable to shampoo everyday, applying hair shampoo can
still help keep the moisture of the hair and makeit clean and smell good.
5. Ticks- With the proper use and application of medical hair shampoos. It can
help in exterminating ticks that are present on our heads.
6. Dandruff- Many hair shampoo products promote hair dandruff removal. The
proper use and application can help in exterminating dandruff on our hair.
7. Dull Hair- Dull hair tends to lack moisture, shine, and body. It can be caused
by many factors, like using the wrong products, not getting enough nutrients
in your diet, or overusing harsh chemicals or techniques. With the use of
medical hair shampoo/moisturizing shampoo it will make the hair smoother
and shinier.
8. Oily/Greasy hair- Oily hair is caused when the scalp produces too much of a
natural oil called sebum. The proper and consistent use of hair shampoo can
8
help treat this problem.
• Contraindications
1. Patients who have undergone surgery (especially in the areas near the head)
– Patients who have undergone surgery, especially in the areas near the head,
may still feel discomfort from such a procedure.
2. Patients with brittle and broken hair - Brittle and broken hair may be caused by
washing the hair too often or using harsh shampoos. Patients with brittle and
broken hair may need to be contraindicated for hair shampooing as this can
cause more damage to their hair.
3. Patients with neck injury - Hair shampooing given to patients with neck injury
should be handled and heldcarefully. The healthcare provider should see to it
that the patient is in the rightposition as their neck could feel sore and they
may feel discomfort throughout the procedure. Keeping the neck of the patient
relaxed is important during hairshampooing.
4. Use of inappropriate shampoo - Using inappropriate shampoo may cause more

trouble than help to the patient receiving the procedure. The healthcare
provider should see to it that the shampoo that will be used for the procedure
is appropriate to the hair type andhair needs of the patient.
5. Use of shampoo that is not recommended - Using unrecommended shampoo

may be harmful to the patient. Some patients may be allergic to certain
ingredients in the shampoo so it is best to verify this first for safety purposes.
3.2 Factors that influence hair shampoo:
1. Social Practices- Social practices in society like in the school setting can be influential in
one’s hair shampoo choice. Something that would be trendy and have a good quality hair
shampoo product is something that many teenagers would want and this would be a
deciding factor on one’s choices.
2. Personal Preferences - Our personal preferences are one of the many factors that
influence hair shampoo. We may be comfortable using a product which is cheaper or
maybe we are more on the expensive but good quality type of product. It all depends on
9
many different individuals.
3. Body Image - A person’s subjective view about their physical appearance. Being conscious
and aware of what products work best on us is what influence what hair shampoo we
use and love.
4. Socioeconomic Status - Our socioeconomic status is also a factor that influences hair
shampoo. We want to buy something expensive and have a good quality product but do
we have the financial capability to actually buy and use it? We choose to use something
achievable given by our financial capabilities.
5. Health Beliefs and Motivation - Our health beliefs and motivation will help us decide and
ultimately influence us not only in hair shampooing but in many other activities as well.
We may believe in a product that promotes shiny and fragrant hair shampoo. Our
motivations can also be a factor, if the more attainable product can be bought and used
then depending on our motivation to buy and use it depends solely on that specific
individual.
3.3 Evidence-Based Guidelines Before, During and After a Hair Shampoo:
BEFORE
• Prepare the necessary equipment/materials to be used and check their
functionality.
• Gather the equipment on the patient’s bedside stand.
• Before shampooing the patient’s hair, adjust the room temperature and eliminate
drafts to prevent chilling the patient. Next, obtain a shampoo tray or devise a trough
if necessary.
• Perform hand hygiene and put on gloves, as necessary
• Confirm the patient’s identity using two patient identifiers according to your facility’s
policy
• Explain the procedure to the patient
DURING
• Place cotton in the patient’s ears to prevent moisture from collecting in
them.
• Hand the patient a washcloth to place over his eyes.
• Carefully pour water over the patient’s hair. Don't overfill the shampoo
tray.
• Using your fingertips, rub shampoo into the patient’s hair. Massage the
scalp well to emulsify hair oils.
• Pour water over the patient’s hair until it's free from shampoo. Then reapply shampoo
10
and rinse again. Apply conditioner or a rinse, if desired.
• Remove the shampoo tray, and wrap the patient’s hair in a towel. Remove the linen-
saver pad from the bed, and return the bed to its original position.
• Dry the patient’s hair by gently rubbing it with a towel. Then comb,
brush, and style it.
AFTER
• Remake the bed or change the linens, if needed, and remove the bath blanket.
• Reposition the patient comfortably.
• Remove and discard your glove, if worn and perform hand hygiene.
• Remove and empty the pail. Clean and disinfect the shampoo tray, and return it to
storage. Remove the pitchers from the bedside and return the shampoo to the bedside
stand.
• Perform hand hygiene.
• Do not forget to document the procedure.
3.4 Common Hair and Scalp Problems as to its:
Head Lice – characterized by extreme scalp itchiness, lice on scalp, lice eggs(nits) on hair shafts, and
sores on the scalp, neck and shoulders. This is usually caused by becoming infected when the insects
crawl onto your head,which means that head lice are contagious.
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Pediculosis – characterized by an infestation of the hairy parts of the body or clotting with the
eggs, larvae or adults of lice. The crawling stages of thisinsect feed on human blood, which can
result in severe itching. This can easily be caused by active infestation from another person with
pediculosiscapitis or head lice.
Dandruff – characterized by an excessive flaking of the scalp accompaniedby intense itching and
patches of flaky skin. Causes of dandruff include changes in weather, cradle cap, certain hair
care products, and infrequent shampooing.
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Ticks – are small parasitic organisms that live in wooded areas and fields that can attach
themselves in the hair. Tick infestations can occur when justone tick is brought into the home.
Seborrheic Dermatitis – characterized by itching, scaly patches, red skin andstubborn dandruff.
The exact cause of this condition is not known yet butit said to be related to a yeast (fungus)
called malassezia that is in the oil secretion on the skin and an irregular response of the immune
system.
Alopecia – characterized by an excessive loss of hair from the scalp which also includes thinning
and breaking. Hereditary thinning or balding is the most common cause of thinning hair. Other
possible causes include damageto the hair from hair care products, heavy metal poisoning, poor
nutrition, or damage to the hair shafts from burns or other injuries.
A. Treatment
1. Head Lice
❖ Considering an alternative home treatment can be done to treat head lice

which includes:
a. Wet Combing
- Combing wet hair with a fine-toothed nit comb may remove lice and some
nits.
- The hair should be wet, and you should add something to lubricate the
hair, such as a hair conditioner or olive oil. Comb the entire head from the
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scalp to the end of the hair at least twice during a session. The process
should be repeated every three to four days for several weeks — at least
two weeks after no more lice are found.
b. Smothering Agents
- A number of household products are used to treat head-lice infestations.

These products are thought to deprive the lice of air when generous amounts
14
are applied to the hair, covered with a shower cap and left on overnight.
Products used for this purpose include:
o Mayonnaise
o Olive oil
o Margarine or butter
o Petroleum jelly
c. Household Cleaning
- As a precaution, you may clean items that the affected person has used in
the previous two days. Cleaning recommendations include the following:
o Wash items in hot water. Wash bedding, stuffed animals and clothing
in hot, soapy water — at least 130 F (54.4 C) — and dry at high heat.
o Clean hair care items. Clean combs, brushes and hair accessories by
soaking them in hot, soapy water for five to 10 minutes.
o Seal items in plastic bags. Seal items that can’t be washed in plastic
bags for two weeks.
o Vacuum. Give the floor and upholstered furniture a good vacuuming.
2. Pediculosis
- Medicated shampoos or cream rinses containing pyrethrins or permethrin

are preferred for treating people with pediculosis.
3. Dandruff
- Doing daily cleansing with a gentle shampoo to reduce oil and skin cell buildup
can treat dandruff.
- Home interventions include:
a. Shampoo more often. This can help reduce the oils on your scalp.
b. Use green tea. Combine green tea, peppermint essential oil and white
vinegar and massage it on your scalp for five minutes. Then, rinse it off with
a sulfate-free shampoo and conditioner. Green tea and peppermint essential
15
oil have antioxidants and anti-microbial properties which can promote a
healthy scalp and also condition your hair so it is not as dry or irritated.
c. Use apple cider vinegar. Dilute the vinegar with equal parts of water. Use
this mixture as a substitute for your shampoo. Apple cider vinegar can kill
the fungus that may cause dandruff. It provides relief from itchiness and can
help subside the dandruff.
d. Use lemon juice. Massage 2 tablespoons of lemon juice onto your scalp and
let it sit for a minute. Then, mix 1 teaspoon of lemon juice and 1 cup of
water. Rinse your hair with the mixture. Repeat this right before your daily
shower for the best results. Fresh lemon juice contains acids that help break
down the fungus that can cause dandruff. It also does not have harsh
chemicals in it, which could harm your scalp.
e. Use baking soda. Wet your hair and sprinkle 1 tablespoon of baking soda
along your scalp. Leave it on for a minute and wash it off. You can also
shampoo after to thoroughly rinse it off. Baking soda fights against
overactive fungi and can help exfoliate the skin on your scalp without
irritating it. Baking soda also soaks up excess oil.
4. Ticks
- The easiest way to get rid of individual ticks is to vacuum pet bedding,
floor cracks and under furniture.
- If you find a tick, remove it as soon as possible. Using fine-tipped

tweezers, grasp the tick as close to the skin as possible and pull the tick
upward in a steady motion. Do not use twisting or jerking movements.
- Clean the area with rubbing alcohol or soap and water.
5. Seborrheic Dermatitis
- Seborrheic Dermatitis may be controlled through lifestyle changes and by

using home remedies such as:
o Aloe Vera. Apply to the affected area aloe vera gel, either in a
product or directly from a cut leaf of the plant.
o Apply mineral oil or olive oil. Soften and remove scales from your
hair by applying mineral oil or olive oil. Leave it in for an hour or so.
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Then comb or brush your hair and wash it. Mineral oil and olive oil
help to loosen the flakes.
o Washing scalp regularly. If regular shampoo doesn't help with

dandruff, try over-the-counter dandruff shampoos. Use a product
daily until your signs and symptoms begin to subside, and then use
it one to three times a week as needed.
o Avoid styling products. Stop using hair sprays, gels and other styling
products while you're treating the condition.
o Avoid skin and hair products that contain alcohol. These products
can cause the disease to flare up.
6. Alopecia
- The most common form of alopecia treatment is the use of

corticosteroids, powerful anti-inflammatory drugs that can suppress the
immune system.
- Home interventions include:
o Eating more protein. The body needs protein to grow new hair. Hair
loss can arise due to a protein deficiency.
o Drinking green tea. An extract made from its compounds may help
a range of health issues, including hair loss.
o Trying aromatherapy. According to the authors of 2011 study paper,

aromatherapy can help stimulate hair growth. When using essential
oils on the scalp, be sure to mix only a few drops into a carrier oil,
such as coconut oil or walnut oil. The researchers also state that
inhaling the scent of these oils may affect hair growth.
o Massaging the scalp. Massaging the scalp helps stimulate blood flow
to the scalp, which could help encourage hair growth.
o Stress management. Stress may play an important role in triggering

episodes of alopecia. With alopecia, the body's immune system
attacks the hair follicles — causing hair loss. If your hair loss has
been triggered by stress, managing your stress could be the key to
returning to a healthy rate of hair growth. Try techniques like
meditation, deep breathing, guided imagery, relaxation exercises, or
talking to a counselor.
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B. Nursing Interventions
1. Head Lice
- Nursing interventions include providing clean clothing and bedding to the

patient. When giving hair care to the patient, a nurse should:
• Massage the scalp after wetting the hair and then the hair with finger tips
working from the hairline towards the back and then the front of the head
symmetrically. Add water as necessary to work up the lather. Leave the hair
in lather for five minutes and rinse.
2. Pediculosis
• Provide health education on the life history of lice, proper treatment and the
importance of laundering clothing and bedding in hot water or dry cleaning
to destroy lice and egg
• Educate the patient about vacuuming infested areas of the home
• Check entire scalp
• Use medicated shampoo for eliminating lice
• Be cautious against the use of products containing lindane because the

ingredient is toxic and known to cause adverse reactions
• Manual removal of head lice is the best option when treatment has failed
3. Dandruff
• Use hot water when taking a bath for it strips out natural oil that prevents
skin dryness and therefore relieves the flaking problem
• Apply medicated shampoo regularly
• In severe cases, a nurse should obtain health care provider’s advice
4. Ticks
• Provide education about the prevention of Lyme disease, the best way to
remove ticks, and how to spot early symptoms
• A nurse should not pull ticks from skin because sacking apparatus remains
and the head will possibly become infected
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• Place a drop of oil or ether on the tick or cover it with petrolatum in order to
ease removal
5. Seborrheic Dermatitis
• Advising clients to take a shower at least once a day for 15-20 minutes
because the bath water will seep into the skin saturation
• Encourage the patient to keep fingernails trimmed short. Long fingernails

used for scratching are more likely to cause skin trauma and aggravate
itching.
6. Alopecia
• Advising the patient to stop doing hair care practices that damage the hair
• Educate the patient about the use of hair curlers, hair picks, tight braiding
and use of hot comb which can all contribute to hair loss condition
4. Relate Scientific Principles Involved in Hair Shampoo
4.1 Physics
- Humidity, temperature, sun, central heating and the different products we used
are all factors that determine elasticity of hair and how much force a strand of
hair can withstand without breaking. The room in which the hair shampoo is
being given should be warm and free from drafts in order to prevent the patient
from being cold by rapid evaporation of the moisture from the hair.
- The patient should be drawn close to the edge of the bed to eliminate reaching
and straining on the part of the nurse.
4.2 Psychology
- Hair Care improves the morale of the client since they are aware of their
appearances. Maintaining a good hair routine can provide clients a positive self-
image. On the other hand, not taking care of their hair can raise more health
concerns such as lice infection, hair loss and dandruff which makes them more
conscious of it.
- When giving hair shampoo to patients, the nurse should avoid anxiety and fear
of unfamiliar procedure.
4.3 Microbiology
- Neglected hair and scalp contain dirt and microorganisms and also produce
infection of the scalp.
o Shampoos can rid the scalp and hair of fungi and bacteria that disrupts
the homeopathy of the skin and hair. The process of lathering and rinsing
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helps dilute and rinse microbes off your hair. Some detergents inshampoo
can dissolve membranes on certain bacteria and viruses which inactivates
them.
- Unbroken skin acts as a barrier to infection.
o Antibacterial shampoo is often medicated to kill invading agents of
bacterial and fungal groups. The way that happens is either by denying
bacteria and fungus access to nourishment for their own propagation or
by presenting an agent that is toxic to their survival but does not harm
the human skin and hair.
4.4 Anatomy and Physiology
- The structure of the hair, head, and the integumentary system is that hairs are
cylindrical, horny structures of the epidermis developed in the hair follicles that
extend downward into the subcutaneous tissue.
- Various endocrine and immune abnormalities and imbalances greatly influence
the growth and distribution of hair.
- Hair shampoo aids in getting rid of the buildup that forms on the scalp, which
can obstruct blood flow below the skin, at times. This can be prevented by
exercising a proper hair care routine which involves gentle lathering and
massaging around the scalp area, in order to improve blood circulation.
4.5 Chemistry
Detergent is found in shampoo, it acts as a surfactant since it lowers the surfacetension of
water, making it less likely to stick to itself and more able to bind withoils. A detergent
molecule has two portions; hydrophobic and hydrophilic. The hydrophobic portion binds
to the sebum coating hair, as well as to any oily styling products. The hydrophilic
portion helps carry sebum away with the detergent when you rinse your hair.
Protectants are also found in shampoo. It helps protect the hair from heat and chemical
damage.
5. Identify the materials and equipment used in Hair Shampoo:
1. Basin with water – used to hold the water that will be used to wash the client’s hair.
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2. Pitcher with hot water - used to pour water to wet the patient’s hair and scalp with the
right temperature. The use of the hot water is to open the hair's cuticle, which helps
the shampoo and conditioner do a better job on the hair.
3. Pitcher with cold water - used to pour water to wet the patient’s hair and scalp with
the right temperature. The purpose for the cold water is to seal the cuticle back up and
lock in the moisture from the conditioner.
4. Bucket for used water - used to catch the drained water used from washing the client’s
hair.
5. Bath Thermometer - used to determine the desired temperature for hair washing.
Water should not be higher than 115 degrees F (46 degrees C) in order to prevent
burns to the client’s scalp.
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6. Kelly Pad - a funnel rubber used to collect the water into a collection container.
7. Foot Stool – placed at the side of the patient’s bedside that is used to rest the feet
comfortably when the client is sitting down.
8. Cotton balls in a container - The use of the cotton balls is to plug it in the client’s ears
to protect it when performing hair washing.
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9. Rubber Sheet - is placed under the patient’s head and shoulder to prevent the bed
from getting wet.
10. Bath Blanket - used to wrap around the patient’s shoulder before performing the
procedure to also cover the upper body and keep the patient warm.
11. Big Bath Towels – are used to dry the hair by patting the hair to remove the excess
water. This is also used to wrap around the patient’s head to dry the hair and ensure
they do not feel cold.
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12. Washcloths - used to cover the patient’s eyes to protect them from water and shampoo.
13. Shampoo and Conditioner - Shampoo is a liquid preparation containing detergent or

sap for washing the hair. Conditioner’s main purpose is to reduce friction between
strands of hair to allow smoother brushing or combing, which might otherwise cause
damage to the scalp.
14. Comb/Brush - used to prevent tangling the hair of the patient
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15. Used newspaper - used to prevent surfaces from being wet when washing the client’s
hair. It is generally preferred because it is easily recyclable and is much cheaper.
6. Demonstrate Beginning Skills in Hair Shampoo:
Step 1: Secure doctor’s order for hair shampoo. Explain procedure. Bring preparation
to bedside.
Step 2: Replace top sheet with bath blanket.
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Step 3: Adjust head of patient to edge of bed.
Step 4. Place rubber sheet and clean towel under patient’s head over the pillow.
Step 5. Put Kelly pad under the patient’s head.
Step 6. Make the necessary adjustments to facilitate flow of water.
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Step 7. Protect chest with clean towel. Cover eyes with damp cloth.
Step 8. Plug the ears with cotton balls.
Step 9. Remove clips/pins from hair. Massage scalp briskly. Mix hot and cold water to
get desired temperature in the basin. Check temperature of water. Wet hair after warning the
patient.
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Step 10. Dilute shampoo with water. Apply to hair and scalp. Rub well into scalp with
fingertips.
Step 11. Rinse with warm water. Repeat several times until hair is thoroughly clean.
Step 12. Apply hair conditioner to soften hair. Rinse thoroughly with warm water.
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Step 13. Squeeze water from hair. Remove Kelly pad and place in the wastebasket.
Step 14. Dry hair with bath towel.
Step 15. Comb, brush and arrange hair.
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Step 16. Make patient comfortable. Tidy place.
Step 17. Clean and return things used.
Step 18. Chart time, patient’s reaction, any unusual conditions of patient’s hair and
scalp.
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TOPIC: Cleansing Bed Bath
CLO#7: define the following terms:
7.1 Cleansing bed bath

- A process of cleaning with soap and water given to a bed-restricted patient.
7.2 Personal hygiene

- Refers to how one takes care of his body. This consists of practices such as
washing our hands, brushing our teeth, and bathing.
7.3 Sebaceous gland

- Small oil-producing gland attached to hair follicles and release a fatty substance,
sebum, into the follicular duct and thence to the surface of the skin.
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7.4 Epidermis
- The upper/outer layer of the two main layers of cells that make up the skin.
7.5 Dermis
- The inner layer of the skin that makes up blood, vessels, hair follicles, and
glands.
7.6 Massage
- A therapeutic practice of manipulating muscles and limbs with the intent to ease
and/or reduce pain.
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7.7 Therapeutic bath
- Also known as “balneotherapy”, the therapeutic bath consists of water and
additives for relaxing and soothing patient.
7.8 Tepid sponge bath

- A procedure done to increase the control of body temperature through
evaporation and conduction which is usually conducted to the high fever client.
7.9 Medical bath

- A type of bath recommended in home setting. This relieves skin irritation and
creates an antibacterial and drying effects.
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7.10 Whirlpool bath
- A type of bath in which the water is kept in constant motion by mechanical
means and has a massaging action that can improve circulation and promote
relaxation
7.11 Friction stroke

- A specific massage technique that help relieves tight tissues after an injury.
Deep, circular, or transverse movements made are made with the thumbs,
fingertips, knuckles or elbows that aim to manipulate the muscles beneath the
skin.
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7.12 Apocrine glands
- Exocrine glands that are found in the skin, breast, eyelid, and ear. They secrete
fatty sweat into the gland tubule.
7.13 Effleurage
- A massage technique that encourages relaxation, blood circulation, and lymph
flow. It is performed onto many parts of the body using fingers and flat hands,
with long and circular strokes.
7.14 Tapotement
35
- It is a rhythmic percussion, most frequently administered with the edge of the
hand, a cupped hand or the tips of the fingers used to wake up nervous system
and also as a stimulating stroke which can release lymphatic build up in the
back.
7.15 Three handed effleurage

- A type of massage that includes three classical movements to energize and
stimulate blood flow. One hand is used to squeeze the tissue as it rolls out of
the hand, while the other hand is prepared to lift additional tissue.
CLO#8: explain the importance of cleansing bed bath.

Relevance of Cleansing Bed Bath to an Individual’s health
As a general term, bathing promotes circulation through the body while also making it
more oxygenated. Cleansing bed bath provides range of motion exercises through the
procedure which can help relax the patient’s muscles. Cleansing bed bath is very important
especially to patients who cannot leave their beds. Hygiene is always a top priority no matter
what the situation is. Giving bed bath to patients will let them feel refreshed and relaxed in
which it can improve the patient’s morale, appearance, and self-respect.
Effects of Cleansing Bed Bath

• Improved circulation
- Bathing helps to increase blood circulation in the body that can considerably
ease pain, stimulate healing and reduce inflammation.
• Relief of fatigue
- Bathing can reduce pain and inflammation while also calming the nervous
system, reducing the levels of stress and anxiety in the body and improving
overall mood.
• A sense of well-being
- Bathing promotes relaxation and a feeling of being refreshed and comfortable.
It helps the person to maintain a standard of cleanliness, both in appearance
and olfactory.
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• Regulated body temperature
- Since bathing increases blood circulation from the body’s core to its hands and
feet, this also removes body heat and lowering body temperature. Moreover,
the core body temperature will be optimal through bathing
Advantages of Cleansing Bed Bath
• Provides bath to bedridden patients
- Some patients cannot safely leave their beds to bathe. For these people, daily
bed baths can help keep their skin healthy, control odor, and increase comfort.
• Bed baths will make a person feel better
- People who are unable to bathe themselves will benefit psychologically if they
know they are clean and free of body odor. Patients who are enduring the pain
and depression brought about by a serious health condition will have a much
better outlook on things if they are clean.
• Treat skin breakdowns
- Bedridden patients in the hospital or other nursing facilities are prone to skin
breakdowns. The bed bath is the perfect opportunity for the caregiver to check
the person’s skin for reddened areas.
Disadvantages of Cleansing Bed Bath

• Presence of risk factors
- It was observed that the physical effort is a risk factor for the professionals'
safety, due to the exhaustion, and it is intimately related with the team's
workload. Therefore, an appropriate dimensioning of the nursing staff becomes
relevant for the procedure to be accomplished preferably in pairs or by a larger
number of professionals, according to the demand of the patient attended,
making the bed bath safer.
• Unhealthy work environment
- The relevance of work environments that promote complex and discontinued
organizational processes was also observed, which favor the professionals'
stress and lack of concentration and adaptations to the safety standards with a
view to facilitating the work. Hence, all of this involves potential risks each day.
The risks related to infection, falls from the bed and dislocation of devices during
the bed bath were observed and described as the main potential patient safety
risks.
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CLO#9: discuss the scientific principles involved in cleansing bed
bath.
9.1 Human Anatomy and Physiology
- Cleansing bed bath involves all the body parts so it is necessary to know
how to be able to do it effectively and efficiently.
- Bed bath is said to leave the patient's skin cleaner and better moisturized,
thus minimizing the risk of the skin impairment.
- Studies show that soap and water washing can have a direct impact on
the epidermis by posing a number of threats to skin integrity and skin
barrier function. Soap can remove the resident flora and the natural lipids,
increase skin acidity, interfere with the water-holding capacity of the skin,
thin the layers of the stratum corneum and decrease natural skin
lubricants.
9.2 Microbiology
- In terms of equipment being used, plastic wash bowls were routinely used
in hospitals for bed bathing but they can easily become contaminated with
micro-organisms responsible for healthcare-acquired infections which is
why single-use disposable bowls are now commonly used. All patient
should have their own toiletries or be supplied with single-patient use
items until their own toiletries can be brought into hospital.
- Reusable washcloths should be avoided as they can harbor bacteria. This

is particularly important in patients who are immunocompromised or
critically ill, or those whose skin integrity is compromised, for example,
patients with burns.
- In a study designed to compare soap and water with no-rinse cleanser in

terms of their ability to remove transient microbial flora from the skin, the
investigators concluded that no-rinse cleansers could achieve a sufficiently
low level of pathogenic microbes on the skin and provide an acceptable
alternative to washing with soap and water.
9.3 Chemistry
- A relatively new development is pre-packaged cloths for bed bathing

(commonly known as the bag bath), which do not require water. A
systematic review comparing bag baths with traditional bed baths
38
concluded that washing without water may be an alternative to the
traditional bed bath, although more research is required.
- We use cleaning materials that contain substances that clean the patients.
Examples of these materials are shampoo and soap which play a huge role
in cleansing because they interact with the hair and skin, causing cleaning
reactions to it.
9.4 Psychology and Sociology
- Psychology: Patients who have not cleaned themselves after a few days
of their admission, they would feel embarrassed and ashamed to interact
with the people around them, but once the patient receives the cleansing
bed bath, they would feel more refreshed and comfortable due to the fact
that they are already clean.
- Sociology: In doing cleansing bed bath, rapport with the client should
always be maintained; thus, talking with the client while doing the
procedure is important.
9.5 Body Mechanics
- The patient’s position during the bath is determined by his physical

conditions and his movement abilities. Unless prohibited, the bed is level
and movement and position change is encouraged.
- While washing individual areas, the skin should be checked thoroughly for
breakdown. During washing, range of motion should be done.
- In performing the procedure, making sure that doing the process with
correct posture and locomotive movements would make the cleansing
more efficient
9.6 Time and Energy
- Practice of good techniques saves time and energy which adds to the
comfort of the patient.
9.7 Safety and Security
- Skillful doing of a procedure adds more comfort and safety to the patient
receiving the cleansing bed bath.
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CLO#10: enumerate the different kinds of bath.
In the health care setting, there are four different types of baths. These are the following:
1. Complete Bed Bath

- A bath that is given in the bed to a totally dependent patient by a nurse
or another member of the health care team.
2. Partial Bed Bath

- Bed bath that consists of bathing only body parts that would cause
discomfort if left unbathed such as the hands, face, axillae, and perineal.
3. Tub/Shower Bath
- A type of bath that the clients are usually able to take themselves, done
in a tub or the shower, but they may still need assistance, such as getting
in or out of the tub or shower, so it is important for the nursing staff
member to be available and present to help the client as needed.
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4. Tepid Sponge Bath
- A therapeutic bath by washing all around the body with warm water to
decrease body temperature. This can be done by the patient
himself/herself with minimal help from the nurse.
- In this type of bath, the patient is not completely immersed but is wiped
with a wet cloth or sponge. He/she also does not necessarily have to be
in bed.
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CLO#11: differentiate cleansing bed bath and tepid sponge bath.
Cleansing Bed Bath Tepid Sponge Bath
Purpose ➢ It is usually applied to ➢ It can reduce fever and

dependent clients that are stress when performed
unable to clean themselves. correctly. It is used to lower
➢ To observe objective the body temperature of a
symptoms and look for any patient that reaches 102 F
signs of skin infections, or over.
lesions ➢ To stimulate blood
➢ To rid the patient of circulation and respiratory
microorganisms, bacteria, movement
body secretions and ➢ To stimulate excretion
excretion, and dead skincells. through kidney and skin
➢ To remove foul body odor ➢ To decrease toxicity in case
➢ To promote healthy skin of toxemia due to some
circulation cause
Advantages ➢ It gives a nurse the ➢ Tepid water is gentle on the

opportunity for health body and skin
teaching ➢ Reduces fever
➢ It establishes an effective
nurse-client relationship.
➢ Improves hygiene and skin
condition
➢ It prevents bedsores
Disadvantages ➢ Bath basins have been cited ➢ Eye issue
as a reservoir for bacteria ➢ Hair loss
➢ The sponge and wash clothes ➢ Prolonged use is unadvised
may harbor bacteria
Effects to ➢ It boosts the self-esteem ➢ Mood elevation
Patients ➢ Induces sleep ➢ Improved sleeping
➢ Gives a sense of well-being ➢ Boost brain power
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➢ Provides comfort ➢ Muscle pain relief
➢ Soothing relief for irritated
skin
CLO#12: identify the types of massage as to its:

11.1 indications and
contraindications
A. Petrissage/Kneading
➢ Indications:
• Local edema
- This is supposed to force blood out of an area by the application of
pressure, then releasing the pressure and repeating the technique distally
to force fresh blood and nutrients into the area.
- Alternate squeezing and relaxation of the tissues stimulates the local
circulation and may have a pain-relieving effect with some muscular
disorders.
• Improves reduced range of motion
- Petrissage is used to increase range of movement. When muscle fibers are
stretched, the fibers are able to move apart slightly releasing and
improving flexibility.
• Adhesions, contracture, fibrosis
- This massage technique reduces the potential of adhesions, contracture
and fibrosis.
• Constipation
- In treating with chronic constipation, petrissage is a good technique. This
stimulates muscles in the abdomen.
• During pregnancy
- This massage technique is useful during pregnancy, because it improves
mood, better sleep and less back pain among expectant mothers.
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➢ Contraindications:
• Nerve dysfunction, restricted circulation, unresponsive muscle, acute
inflammation, newly formed scar tissue, bruising, varicosity, irritated or broken
skin
- These are contraindicated using this technique because it involves skin
rolling that is forceful and patients could be prone to bleeding, especially
if the skin is broken.
• Acute illness, cardiovascular conditions, fever, contagious disease
- Massage increases blood flow. If you have high blood pressure that is not
under control, the increased blood flow that is a result of massage therapy
may cause problems
B. Effleurage
➢ Indications:
• Conditions of overstimulation (e.g. muscular tension, anxiety, excitability,
insomnia) where overall relaxation or sedation is desired.
- Using a wide surface area of the palmar surface of the hand and fingers,
either with both hands simultaneously or alternating hands would
encourage venous return to the heart, thus increases perception of
relaxation and reduce perception of anxiety.
• Pain
- The sustained pressure throughout the stroke would decrease pain.
• Reduced swelling (by increasing lymph return) and increase circulation in
conditions in which circulation is temporarily compromised (e.g. in case of
musculoskeletal injuries such as: spring, strain, bursitis, contusions, dislocations,
separations and fractures)
- This effleurage is a massage technique that encourages relaxation, blood
circulation and lymph flow. If the lymphatic system does not function then
excess fluid can build up. This should build up to deeper pressure with
slower movements for increased circulation and stretching of the tissues
at a later stage in the session.
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• Need for oxygen and nutrients delivery to a body area
- Delivering oxygen and nutrients assists with the repair of any damaged
tissues.
• Post-surgery
- Effleurage can be performed for post-surgery patients as this can help
maintain the function of the lymphatic system.
• Pain (use caution)
- Effleurage may be used with varying tempo and pressure according to the
stage of the condition and whatever the desired effect of the massage is.
• Conditions in which venous returns compromised (e.g. varicose veins, severe
edema, over areas of possible infection)
- The hands are passed rhythmically and continuously over a client's skin,
in one direction only, with the aim of increasing blood flow in that direction,
stretching tissues, relaxing the client and aiding the dispersal of waste
products.
• Conditions in which organic function is compromised (e.g. serious kidney
pathology, serious nutritional deficiency)
- Massage can put increased strain on both the liver and kidney if they are
not functioning normally. This occurs because massage increases blood
flow, increasing the movement of waste through the body
C. Friction Stroke
➢ Indications:
• Pain
- The analgesic effect of the massage can last up to 24 hours, thus relieving
pain.
• Stimulation of fiber orientation in regenerating connective tissue
- Transverse friction when applied in early repair cycle enhances remodeling
and hence reorientation of the collagen fibers in a longitudinal manner.
45
• Situations showing adhesion formation
- As friction massage causes a transverse movement of the collagen fibers,
it helps in preventing adhesion formation. In situations where adhesion is
already formed, a more intense friction can help to break them as well. In
such cases friction is used to mobilize the scar tissue and break the cross
linkages between the connective tissues and the surrounding structures
• Conditions of traumatic hyperemia
- As it is a forceful and deep movement it effectively causes increased blood
flow to the local area of application through vasodilatation. This assists in
removal of chemical irritants and allows the transportation of endogenous
opiates, thus causing pain relief.
• Clients with rheumatoid tendinous lesion, ossification and calcification of soft
tissues, ulcers, blisters or psoriasis, bacterial infections, large hematomas in the
area, bursitis, local sepsis, and any local skin diseases
D. Vibration
➢ Indications:
• Improves muscle strength and mass; activates circulation within the body
- Improved circulation and maintenance of healthy muscles are the benefits
commonly gained through vibration massage. When muscles are
unhealthy, they can become weak, fatigued and more likely to become
damaged. A massage will help to stimulate an increase in blood flow.
Nutrients such as calcium and iron are carried within the blood which are
essential to keep muscles healthy and strong. Oxygen is also carried within
the blood. Oxygen provides muscles with energy within the working
muscles.
• Body pains
46
- Vibrations can reduce tightness by increasing blood circulation and
temperature of the muscles. Increased blood flow causes the temperature
of the muscle to increase therefore inducing relaxation.
• For losing weight
- Research shows that as little as 15 minutes a day of whole-body vibration
may aid weight loss. A vibration massage helps to improve digestion and
when the digestion health is optimal, the body is able to make the most
of the nutrients that it gets and thus helps to lose weight.
• Osteoporosis
- There is always concern with any type of exercise program as to whether
it will be putting you at an increased risk of breaking bones. Any vibration
may be detrimental to the spinal bones if they are very fragile.
• Rheumatism
- Vibration massage should be used with caution on patients with
rheumatism because this may bring pain to their part. Moderate pressure
can be applied because it can stimulate pressure receptors under the skin
that convey signals to the brain that alleviate pain and stress-reducing
neurochemicals.
• Lymph drainage
- Patients that have extreme amounts of edema should work with a group
of healthcare practitioner trained in lymph drainage, bandaging and other
modalities. With Vibration massage, we can stimulate the opening of the
initial lymphatic and increase the volume of lymph flow by as much as 20
times. But if we push too hard, we collapse the initial lymphatic,
diminishing the lymph flow.
E. Tapotement
➢ Indications:
• Should only be used on the fleshy portions of the body
47
- Tapotement should only be used on the fleshy portions, never on body
areas. For example, it may be used on the posterior portion of the leg,
such as on the gastrocnemius and soleus muscles, but never along the
anterior tibia.
• Patients suffering from cystic fibrosis
- Cupping, specifically, can be used over the upper and middle back to
loosen mucus in the lungs, and has been helpful with those suffering from
cystic fibrosis. Any client appearing to have respiratory problems should
be cleared first by his or her physician to make sure the massage is
appropriate for his or her condition.
- Should not be used on:
• The spine, the head, the neck or back of the knee
• Inflamed, strained or abnormally contracted tissue
• Any area of hypersensitivity
• Varicose veins
• Directly over kidney
• Paralyzed, flaccid or otherwise compromised muscle tissue
• Suspected or diagnosed fractures
*Tapotement is a stroke that should be used only for short periods of time, as
prolonged use will result in muscle fatigue and become counterproductive.
11.2 factors
A. Petrissage/Kneading
• Improved blood circulation, relieved knots and muscle spasm
- Petrissage allows muscle fibers to move freely and tension to be released.
Increases fresh blood to the muscles reducing pain and stiffness.
• Improved muscular function
- With some muscular disorders, alternating squeezing and relaxation of the
tissues stimulates the local circulation and have a pain-relieving effect.
• Influence circulation as well as interstitial drainage of both superficial and deep
tissues
- This technique force blood out of an area and improves interstitial drainage
by the application of pressure.
B. Effleurage
• Reduced blood pressure
- Effleurage is a massage technique that encourages relaxation, blood
circulation and lymphatic flow. It can actually lower blood pressure more
long term. Your blood vessels are made up of smooth muscle fibers that
48
move together at one time to create a contraction or “pumping” action
and then relax or dilate to allow the blood to flow.
• Lowered anxiety levels, improved mood scores, and lowered cortisol levels
- A 2010 meta-analysis of 17 clinical trials concluded that massage therapy
may help to reduce depression and a 2010 review concluded that massage
may help older people relax.
C. Friction Stroke
• Faster healing process
- When friction is performed over ligaments and around joints, the
circulation to the area is increased. Increased circulation improves
nourishment of ligaments and joint structures, and improves their
function.
• Increased space movement
- Friction stroke releases areas that are tight – particularly around joints and
where the adhesions within the muscles or tendons
• Fibroblastic proliferation
- Friction stroke can minimize the scarring that develops perpendicular to
the actin and myosin filaments, to facilitate the proliferation of the
fibroblasts in the scar and to develop a strong, mobile scar that won’t be
a source of recidivate pain when returning to normal activities.
D. Tapotement
• Increases local blood circulation
- Tapotement has a hyperemic effect of increasing local blood circulation,
which in turn, helps to warm and soften the underlying tissue. The skin
will feel warm to the touch and appear flushed. It is also often used to
warm up an athlete prior to an event.
• Relaxes muscles
- Applied across large muscles, tapotement stimulates the muscle spindles
and causes minute muscle contractions which is a great help to release
tension and cramping from muscles in spasm.
• Excites nerve endings
- Tapotement is a repetitive staccato, striking movement of the hands,
simultaneously or alternately. If performed well, it has a stimulating but
relaxing effect. With this technique, nerve endings are stimulated, which
produce tiny muscular contractions, resulting in an overall increase in
muscle tone.
E. Vibration
• Relaxation of the body and mind
49
- Vibration is a repeated staccato, a striking rhythm of the fingertips, either
concurrently or alternately. If well done, it has a motivating yet relaxing
effect.
• Increased blood circulation
- Vibration has a hyperemic effect, which ensures that it stimulates the local
supply of blood, and this in turn tends to warm and soften the underlying
tissue.
• Relieved pain
- This massage therapy can stimulate the secretion of pain-fighting
endorphins, which can relieve pain and discomfort.
• Improved muscle strength and mass
- This technique stimulates nerve endings that create tiny muscle
contractions, resulting in an overall improvement in muscle tone.
CLO#13: discuss the responsibilities and evidence-based guidelines

of a nurse before, during, and after bed bath
Before:
• Introduce self to the client and verify the client’s identity using agency protocol. Explain
to the client what procedure you are going to perform and the reason for it.
• Perform hand hygiene and observe other appropriate infection prevention procedures.
• Provide for client privacy by drawing the curtains around the bed or closing the door
to the room.
• Prepare the client and the environment. Keep room temperature at normal level as the
client may get cold.
• Draw patient to the side nearer you.
During:
• Start with the cleanest areas of the body and finish with the areas that are less clean.
• Only expose the area of the body being washed.
• Always assist the patient when changing positions. See to it that the patient will not
fall.
• Change water if necessary, just like if it becomes dirty or cold, and always after washing
the genitalia and sacrum.
• Ask if the patient prefers powder or alcohol. Never use alcohol for the aged.
• In doing the procedure, follow the sequence wet, soap, and rinse and for the last part,
it would be wet, soap, rinse, and dry.
After:
• Dump the dirty water and clean the water basins.
• Remove gloves and dispose of supplies properly.
• Help the person as needed to finish dressing or changing wash clothes.
50
• Finish making the bed and ensure the patient is warm and comfortable.
• Record the care that has been undertaken, along with any abnormal finding(s), and
ensure you update the patient’s care plan.
CLO#14: list down the materials and equipment used in cleansing bed
bath.
1. Big and small basins - The big basin is used for holding the water that will be used for
bathing while the small basin is used to keep the sponge cloth separately that is used for
putting the soap.
2. Receptacle for used water - This is where used water will be placed when the need to
change it arises. Having a receptacle for used water is efficient so as to have a container
nearby while bathing the patient.
51
3. Two pitchers of cold and hot water – These two pitchers of cold and hot water are
necessary in order to make sure that the temperature of the water is of the client’s
preference. Moreover, hot water relieves muscle spasm and muscle tension while cold
water is for relaxation and for reducing muscle tension as well.
4. Bath thermometer - used to measure the temperature of the water and also the
temperature of the room.
52
5. Wash cloths - used for washing the face and the body. They also work well to cleanse
and exfoliate the body during the bathing process.
6. Used newspaper - used for lining/covering the surface where the basin will be placed so
as to prevent it from getting wet
7. Bath blanket - A flannel covering used to prevent chilling when administering a bed bath.
This also provides privacy for the patient.
53
8. Patient’s clothes - A patient’s gown serves practical purposes from a hospital standpoint.
Bathing is a procedure that anticipates access to body parts so a patient’s gown/clothes
is important in order for the healthcare provider to easily clean certain body parts of the
patient, while still maintaining modesty and privacy.
9. Alcohol - Applied to the back of the patient after bathing in order to cool the body and
lower body temperature by removing heat from the skin surface by rapid evaporation
10. Clean gloves - used when bathing patients with open wounds and when coming into
contact with bodily fluids or feces
54
11. Bath towel – a piece of absorbent cloth used for drying off the patient after the bathing
process
CLO#15: demonstrate beginning skills in cleansing bed bath.
Step 1: Provide a screen for privacy in the ward.
55
Step 2: Explain procedure to patient. Bring preparation to bedside.
Step 3. Close door and windows. Assemble equipment. Turn off electric fans and/or
air-conditioning unit.
Step 4. Replace top sheet with bath blanket.
Step 5. Draw patient to side nearer you.
56
Step 6. Remove patient’s gown or pajama.
Step 7. Remove pillows. Leave one under the patient’s head if he feels
uncomfortable.
Step 8. Place one bath towel under the patient’s head and the other one over his
chest.
57
Step 9. Don clean gloves.
Step 10. Ask patient if he likes to use soap for his face.
58
Step 11. Wet wash cloth (#1). Wrap it around your palm to make a mitten. With circular
strokes, wash around the eyes, nose, mouth, cheeks, forehead and the back of the ears.
Using the same technique, get the other wash cloth (#2) for soap. Soap area (if patient
prefers) and rinse 3x using wash cloth (#1).
Step 12. Expose arm further. Place bath towel lengthwise under it. With wash cloth #1
sponge from wrist to shoulder to axilla in long circular strokes. Apply soap on those areas
59
using wash cloth #2 while supporting the elbow joints. Rinse well with wash cloth #1 at least
3x. Dry thoroughly. Wet soap and rinse hand using small basin. Dry thoroughly.
Step 13. Expose the other arm. Follow step #12.
Step 14. Lay a bath towel on the chest & abdomen. Fanfold bath blanket down to the
pubis. Wet, soap and rinse thoroughly at least 3x starting from neck to chest, abdomen, sides
and pubis using respective washcloths. Change water if necessary.
Step 15. Assist patients in turning toward the nurse. See to it that the patient will not
fall. Place the towel lengthwise under the patient’s back down to the buttocks and remove
60
the bath blanket covering the areas. Wet, soap and wash back and buttocks thoroughly. Then
dry with a towel. Ask the patient if he prefers powder or alcohol. (Never use alcohol for aged).
Help a patient turn on his/her back and then change the water.
Step 16. Expose leg further. Place the towel under it. Wet soap, wet leg and thigh
thoroughly. Pay particular attention to the groin knee joints.
Step 17. Spread towel under the patient’s foot. Soak out foot in basin. Wet soap, rinse,
and dry. Repeat number 14 and 15 with the other leg.
Step 18. Clean the basin very well and fill it with water. Ask the patient to “finish the
bath”. Wrap clean wash cloth #3 around his palm to clean genitalia. Assist patient in changing
wash cloth as needed. Dry with clean towel or tissue. If patient is weak or unable to carry out
61
his step, do it. Give an external douche instead of this activity if the patient prefers. Wash
hands of the patient and dry.
Step 19. Remove gloves. Dispose it properly.
Step 20. Apply deodorant. Powder parts preferred by patient. Put on client’s
camisa/gown. Remake bed. Comb hair, clean and cut fingernails.
62
Step 21. Tidy the ward. Adjust the windows and blinds.
Step 22. Do recording.

College of Nursing
Mandaue City, Cebu
NCM 103 - FUNDAMENTALS IN NURSING PRACTICE
ASSISTING INTRAVENOUS FLUID INSERTION (IVF) and

DISCONTINUATION of IVF with COMPUTATION
Group A4:
Rodriguez, Raven Kaye
Reroma, Luke Shannen
Saycon, Jelyka
Silva, Isabela
Tabo, Marie Kyla
Tamano, Ilyanna Angelina
Te, Carol Claire
Tejero, Stella Maris
Tiu, Maxenne Nicole
Torino, Joley May
Yuson, Darah Angelie
Facilitator: Mr. Dwight Benedict G. Lepiten, MSN, RN

Date Submitted: April 26, 2022
TABLE OF CONTENTS
TITLE PAGE
Learning Outcome for Assisting of Intravenous Fluid (IVF) Insertion 3
CLO#1: Define the following terms related to assisting Intravenous Fluid Insertion 4
CLO#2: Give the importance of intravenous infusion 10
CLO#3: Enumerate the purpose of intravenous infusion 12
CLO#4: Explain the different scientific principles involved during

14
intravenous infusion.
CLO#5: Discuss the types of solutions according to tonicity and purpose 15
CLO#6: Cite the factors affecting IVF insertion as to its selection of site 17
CLO#7: Discuss the different types of IVF infusion system 18
CLO#8: Explain the different complications of intravenous fluid therapy with regards
to insertion and administration of fluids, the nursing interventions to prevent or
19
manage these complications and the techniques in checking intravenous site
patency
CLO#9: Identify the different venipuncture sites 29
CLO#10: Discuss the nursing responsibilities before, during and after IVF infusion 45
CLO#11: Calculate the drop factor, flow rate, number of hours to consume, volume
infused (number of milliliter/hour), conversion of milliliter/hour to drops/minute, and 50
conversion of drops/minute to milliliter/hour
CLO#12: List down the materials used in assisting IVF insertion 53
References 59
LEARNING OUTCOMES:
After 3 hours of various classroom and laboratory activities, the level I nursing students
will be able to:
CLO#1: Define the following terms related to assisting Intravenous Fluid insertion
1.1 angiocatheter 1.8 hypertonic solution 1.15 intracatheter

1.2 antecubital spaces 1.9 hypotonic solution 1.16 recipient
1.3 colloid solution 1.10 isotonic solution 1.17 venipuncture
1.4 donor 1.11 ischemia 1.18 blood transfusion
1.5 edema 1.12 infiltration 1.19 intravenous infusion
1.6 embolus 1.13 patency
1.7 hemolysis 1.14 phlebitis
CLO#2: Give the importance of intravenous infusion
CLO#3: Enumerate the purpose of intravenous infusion
CLO#4: Explain the different scientific principles involved during intravenous infusion.
CLO#5: Discuss the types of solutions according to tonicity and purpose
CLO#6: Cite the factors affecting IVF insertion as to its selection of site
CLO#7: Discuss the different types of IVF infusion system
CLO#8: Explain the different complications of intravenous fluid therapy with regards to insertion
and administration of fluids, the nursing interventions to prevent or manage these complications
and the techniques in checking intravenous site patency
CLO#9: Identify the different venipuncture sites
CLO#10: Discuss the nursing responsibilities before, during and after IVF infusion
CLO#11: Calculate the drop factor, flow rate, number of hours to consume, volume infused
(number of milliliter/hour), conversion of milliliter/hour to drops/minute, and conversion of
drops/minute to milliliter/hour
CLO#12: List down the materials used in assisting IVF insertion
CLO#13: Demonstrate beginning skills in assisting IVF infusion
CLO #14: Document relevant information after assisting IVF insertion and discontinuing IVF
3
CLO #1: Define the following terms:
1.1 Angiocatheter - also referred to as angiocaths, are essential for medical practitioners in
diagnostic and therapeutic applications. Angiocaths are thin hollow tubes that allow the
introduction of contrast dyes into various body areas for diagnostic purposes.
1.2 Antecubital spaces - is an inverted triangular space that forms the transition between the
arm and the forearm. It is located anterior to the elbow joint. It is the region where blood is
drawn from since superficial veins cross. It is the site where blood pressure is measured. It is
also an area used to palpate for the brachial pulse.
4
1.3 Colloid solution - are mixtures in which microscopically dispersed insoluble particles of
one substance are suspended in another substance. For a mixture to be classified as a colloid,
its suspended particles must not settle.
1.4 Donor - a living or deceased human being who is a source of cells, tissues, or organs
intended for transplantation.
1.5 Edema - is a swelling caused by fluid trapped in your body's tissues. Edema happens most
often in the feet, ankles, and legs but can affect other body parts, such as the face, hands, and
abdomen. It can also involve the entire body.
5
1.6 Embolus - a particle or mass (most typically, a blood clot) that travels through the
bloodstream. An embolus may subsequently lodge in a blood vessel, causing blockage and
organ damage.
1.7 Hemolysis - the destruction of red blood cells. It is also when the erythrocyte membranes
are disrupted, thus, hemolysis is released. It can also be defined as erythrocyte necrosis and
this happens at the end of every erythrocyte's life.
1.8 Hypertonic solution - a solution containing more dissolved particles (such as salt and
other electrolytes) than normal cells and blood.
6
1.9 Hypotonic solution - a solution that contains fewer dissolved particles than is found in
normal cells and blood. Hypotonic solutions are commonly used to give fluids intravenously to
hospitalized patients to treat or avoid dehydration.
1.10 Isotonic solution - contains equal concentrations of impermeable solutes on either side
of the membrane, so the cell neither swells or shrinks. Isotonic solutions are commonly used as
intravenously infused fluids in hospitalized patients.
1.11 Ischemia - is the medical term for what happens when your heart muscle doesn't get
enough oxygen. Ischemia usually occurs because of a shortage of blood and oxygen to the
heart muscle. It is generally caused by a narrowing or blockage of one or more coronary
arteries (which supply blood to the heart muscle).
7
1.12 Infiltration - a medical complication that emerges when I.V. fluid leaks into the
surrounding tissue. An incorrect catheter insertion might result in infiltration. The catheter may
also slip out or through the blood vessel lumen if the patient moves.
1.13 Patency - a state of not being blocked. It is also defined as the degree of openness of a
tube (such as a blood vessel).
1.14 Phlebitis - also known as inflammation of a vein, or inflammation of a vein, is a condition

where a leg vein and surrounding tissues have become irritated, red, warm, and tender.
8
1.15 Intracatheter - a plastic tube that is attached to a puncturing needle that is inserted into
a blood vessel usually for the purpose of infusion, injection or pressure monitoring.
1.16 Recipient - the human being into whom allogeneic human cells, tissues or organs were
transplanted.
1.17 Venipuncture - when a vein is pierced by a needle for either intravenous injection or
the removal of blood.
9
1.18 Blood transfusion - a common and safe medical procedure that transfers healthy blood
through an intravenous (IV) line that has been inserted to the blood vessels of the recipient.
1.19 Intravenous infusion - a procedure that refers to administering medication directly into
a vein. This technique allows an efficient treatment to patients since it delivers medicine,
antibiotics or hydration directly into the bloodstream which results in a higher absorption rate,
thus the patient can acquire relief faster.
CLO #2: Give the importance of intravenous infusion
Intravenous infusion is the most effective and safest method for health care practitioners to
administer medications. The importance of Intravenous infusion helps keep a patient's hydration,
electrolyte, and blood sugar levels stable. Clinicians can also inject warmed IV fluids straight into
a patient's bloodstream, as it is normal for a patient's body temperature to gradually drop while
sedated.
10
Importance of Intravenous infusion:
1. Rehydration after getting dehydrated as a result of illness or strenuous exercise

- The fastest and most efficient way to replace fluids in the body is to have an IV for
dehydration.
2. Antibiotic therapy of an infection

- When administered intravenously, antibiotics reach tissues faster and in higher
concentrations than when administered orally.
3. Chemotherapeutic medicines for cancer treatment

- IV chemotherapy can be given as a single shot, through a catheter and pump, or by
a drip bag that dilutes the medication, providing variety and flexibility in treatment
dosage.
4. Pain relief by the use of specific drugs

- Patients with a variety of chronic painful illnesses have been reported to benefit
from intravenous infusions of particular pharmacologic medications. Because
enzymes in your stomach or liver would break down certain medications if taken
orally, they may be administered by IV. When the medications are ultimately
delivered to your bloodstream, this will make them ineffective.
5. Supply nutrients needed by the body.

- Patients who cannot obtain adequate nutrition via oral or other routes can benefit
from IV therapy in some or all of their nutritional requirements.
6. To maintain one’s health and function in all body systems.

- Intravenous (IV) therapy detoxifies your body naturally, removing damaging free
radicals that contribute to toxin build-up and weakened immunity. IV immune
system therapy can not only help you avoid getting sick, but it can also help you
avoid the long-term damage caused by free radicals by cleansing them out of your
system.
7. To restore electrolyte balance and fluid loss.

- A catheter and a saline-based electrolyte solution containing your chosen vitamins
and nutrients are used in an IV fluid drip. Bypassing your digestive tract, an IV drip
directly delivers vital nutrients and fluids to the bloodstream. Different intravenous
11
fluids are available to treat dehydration. Normal saline contains sodium and chlorine,
it replenishes lost fluid and helps to prevent or rectify electrolyte imbalances.
Advantages of Intravenous Infusion

● Intravenous drugs have the ability to provide a rapid, fast-acting therapeutic effect, which
is critical in cases like cardiac arrest or narcotic overdose.
● Short-acting medicine doses can be adjusted based on patient reactions to treatment.
Medication can be prepared and administered over a short period of time.
● Some drugs only require a little dilution, which is preferable due to the patient's own fluid
limits.
● An IV infusion can be used as an alternative to oral administration of medications that
cannot be absorbed by the gastrointestinal tract. This procedure is ideal for clients who are
experiencing GI dysfunction or malabsorption, as well as those who are NPO (nothing by
mouth) or unconscious.
● This route delivers a more exact medication dose since there is none left in the intravenous
tubing.
Disadvantages of Intravenous Infusion

● Intravenous medications cannot be withdrawn once they have been administered. If an
adverse reaction or error happens while administering IV drugs, there is insufficient time to
stop the infusion. If IV drugs are administered too quickly or inappropriately, they might
cause serious injury or death.
● Extravasation of drugs into the adjacent tissues may result in sloughing, nerve damage,
and scarring.
● The direct IV route is not suitable for all drugs.
● Most IV drugs reach their peak quickly since their onset of effect is rapid. As a
consequence, there is a substantial risk of mild to severe infusion reactions. Supportive
measures are needed since hypersensitive reactions can happen suddenly or gradually.
● This procedure can cause tissue damage in the adjacent areas. Highly concentrated
medications can cause phlebitis, especially if the patient has small peripheral veins or a
venous access device that is too short.
CLO #3: Enumerate the purpose of intravenous infusion
The purpose of intravenous infusion serves as a:

1. Management of pain
- A treatment option for variety of different pain syndromes
12
- Includes fibromyalgia, neuropathic pain, phantom limb pain, post-herpetic neuralgia,
complex regional pain syndrome(CRPS), diabetic neuropathy, and central pain
related to stroke or spinal cord injuries
2. Treatment of an Infection
- Antibiotics can enter the bloodstream immediately and bypass the absorption in the
gut
- Used for bacterial infections in the lungs, hearts, bones, soft tissue, and brain
- Infection that are resistant to traditional oral medications
- Infections that require high dose of antibiotics that cannot be taken orally
3. Fluid supply when clients are unable to take fluid orally

- Coma or an respirator, or a sick infant who cannot suck on a bottle are common
examples
4. Provide glucose (dextrose)

- Glucose is a sugar which provides energy for the body
- Glucose Intravenous Infusion is given to patients who have low levels of sugar in
their blood or are dehydrated
5. Establish a lifeline for rapidly needed medications

- Giving of concentrated medications (diluted or undiluted) directly into the vein t
treat emergent concerns
- This eliminates the process of drug absorption and breakdown by directly
dispositioning it into the blood:
● Immediate elevation of serum levels
● High concentration in vital organs, such as the heart, brain, and kidneys
6. Rehydration from Illness / Excessive Activity

- Severe dehydration can cause seizures and shock
- Administering fluids full of electrolytes is recommended to moderates to severe
cases of dehydration
- Includes magnesium, potassium, B vitamins, sulfate, or calcium
13
CLO #4: Explain the different scientific principles involved during intravenous
infusion.
➔ Principles involved in intravenous insertion

● Anatomy and Physiology - administering fluids into a patient’s body necessitates a
thorough understanding of where the fluid should enter and be absorbed. The nurse
should also keep in mind how the body functions in taking those fluids into the
required places in the body.
● Microbiology - Many substance infusions can be absorbed and disregarded by the

body's cells. These cells and other microorganisms react differently to various fluids,
thus it's important to evaluate what these microorganisms benefit from.
● Chemistry - Chemicals and other materials are required for the fluids infused into
the patient to work. It must interact with the patient's other substances. During this
process, several components decompose and reassemble.
● Pharmacology - A nurse should be aware of what fluids are administered to a

patient, especially if they are fluids such as medicine or other vital needs. These
fluids are extremely beneficial to the patient, but it is critical to understand the
potential adverse effects of the fluids they ingest.
● Physics - Fluids flow differently than solids, making them easier to manage when
placed in containers and tubes. Due to their flexible nature, fluids can easily spill
when the equipment has small holes. It's also important to consider how the fluid
reacts in the body.
● Psychology - Having fluids delivered through the body can be stressful for some
patients, it is the nurses' responsibility to provide comfort and support to ensure
that they will be well cared for.
● Mathematics - It is essential to monitor the amount of fluid supplied to the patient,

as administering a random amount can have serious consequences. The nurse
should be able to calculate the exact amount of fluid measures and how long they
must take it on a daily basis.
● Safety - When transferring fluids, it's essential to follow safety procedures, as failing
to do so might result in serious consequences. Acknowledge that these actions can
14
cause harm to both the nurse and the patient. Infection in the location where
infusion was given is a common risk due to contaminated equipment.
● Sociology - Fear of sharp objects is quite frequent in today's life. Infusion needles
are included in this category. With this in mind, a nurse should know how to deal
with a patient who is afraid of needles and reassure them that everything will be
fine.
CLO#5: Discuss the types of solutions according to tonicity and purpose
HOW DOES THE

TYPE OF SOLUTIONS’
PURPOSE EXAMPLES USES
SOLUTION TONICITY AFFECT
THE INFUSION
Fluid
- use to resuscitation for
0.9% Normal
replace or hemorrhaging,
Saline (0.9% NaCl)
maintain severe
blood vomiting,
Isotonic volume If a cell is placed in diarrhea, GI
solution an isotonic solution, suctioning
- to maintain
there will be no net losses, wound
balanced drainage, mild
- has the same flow of water into or
osmotic out of the cell, and hyponatremia,
osmolality as
plasma and pressure the cell’s volume will or blood
interstitial fluid. with equal remain stable. If the transfusions.
It can be added amounts of solute concentration
Lactated Ringer’s Fluid
to intravascular floods, both outside the cell is the
Solution (LR) resuscitation,
fluid without inside and same as inside the
cell, and the solutes GI tract fluid
affecting its outside of
cannot cross the losses, burns,
osmolality and
the cells. membrane, then that traumas, or
without fluid to
- prevents solution is isotonic to metabolic
shift into the
sudden acidosis. Often
cells. the cell. used during
shifts of
surgery.
fluid and
electrolytes 5% Dextrose in Provides free
in the body Water (D5W) water to help
*starts as isotonic renal excretion
15
and then changes of solutes,
to hypotonic when hypernatremia,
dextrose is and some
metabolized dextrose
supplementatio
n.
Hypotonic 0.45% Sodium

solution Chloride
- has an Used to treat

osmolality lower extracellular
than that of dehydration or
extracellular If a cell is placed in a hypovolaemia.
- used to
fluid. An hypotonic solution,
intravenous provide free
there will be a net
infusion of a water and
flow of water into the
hypotonic treat cellular
cell, and the cell will
solution dehydration.
decreases the gain volume. If the
These
osmolality of the solute concentration
solutions
extracellular outside the cell is 2.5% Dextrose in
fluid, which then promote
lower than inside the water
moves toward waste
cell, and the solutes
the cells to dilute elimination Used to treat
cannot cross the
the more by the dehydration and
concentrated membrane, then that
kidneys. decreased
intracellular fluid. solution is hypotonic levels of sodium
The cells absorb to the cell. and potassium.
fluid and swell,
thereby replacing
any fluid lost
through
dehydration.
- used to If a cell is placed in a Used to treat

3% Sodium
Hypertonic severe
restore hypertonic solution, Chloride (3% NaCl)
Solution hyponatremia
16
osmotic there will be a net and cerebral
- has an equilibrium flow of water out of edema.
osmolality - Increases the cell, and the cell
greater than that
solute will lose volume. A
of extracellular
fluid. An concentratio solution will be
intravenous n of plasma, hypertonic to a cell if
increase the drawing its solute
osmolality of 5% Dextrose and
water out of concentration is
extracellular and 0.45% Sodium
the cells into higher than that Chloride (D50.45%
causes the inside the cell, and
intracellular fluid NaCl) Used to treat
to shift out of extracellular the solutes cannot severe
cells in an compartmen cross the membrane. hyponatremia
attempt to dilute t to restore and cerebral
the more edema.
osmotic
concentrated equilibrium
extracellular. It cells; cells
causes the cells
will shrink.
to shrink. 5% Dextrose and
- help
Lactated Ringer’s
increase
(D5LR) D10
intravascular Used to treat
fluid volume. severe
hyponatremia
and cerebral
edema.
CLO#6: Cite the factors affecting IVF insertion as to its selection of site
Factors that affect IVF insertion according to its selection of site are:
1. Catheter-related bloodstream infection

- Catheter-related bloodstream infection (CR-BSI) is caused by microorganisms that
are introduced into the blood through the puncture site, the hub, or contaminated
IV tubing or IV solution, leading to bacteremia or sepsis
17
2. Infection at insertion site
- Insertion sites may become red, tender, swollen, or have purulent drainage. So it is
best to monitor blood work and temperature
3. Impairments
- Unstable patients who have signs and symptoms of complications would be
assessed more frequently
4. Condition of Vein
- Use of soft, straight, bouncy veins; Avoid veins near previously infected areas.
5. Presence of Shunts or Graft

- Do not use the arm or hand that has a patient graft or shunt for dialysis
6. Duration of Therapy
- Therapy is to be stopped after every 72 to 96 hours p.r.n., as soon as the patient is
stable and no longer requires IV fluid therapy, as soon as the patient is stable
following insertion of a cannula in an area of flexion and immediately if tenderness,
swelling, redness, or purulent drainage occurs at the insertion site
7. Skin Condition
- Infection and phlebitis are of primary concern.
8. Patient with allergies

- Question regarding allergies to medications, foods, animals and environmental
substances
CLO #7: Discuss the different types of IVF infusion system:
Electrolyte Solution Contains varying amounts of cations and

anions that are used to replace fluid and
electrolytes for clients with continuing losses.
Nutrient Solution May contain dextrose, glucose, and levulose to

make up the carbohydrate component – and
water. Water is supplied for fluid requirements
and carbohydrates for calories and energy.
Nutrient solutions are useful in preventing
dehydration and ketosis.
18
Alkalizing Solution Are administered to treat metabolic acidosis.
Acidifying Solutions Are used to counteract metabolic alkalosis.
Blood Volume Expanders Are solutions used to increase the blood

volume after a severe blood loss, or loss of
plasma.
CLO #8: Explain the different complications of intravenous fluid therapy with regards
to insertion and administration of fluids, the nursing interventions to prevent or
manage these complications and the techniques in checking intravenous site patency
Local Complications
Definition:
IV infiltrations and extravasations occur when
fluid leaks out of the vein into surrounding soft
tissue. Common signs include inflammation,
tightness of the skin, and pain around the IV
site. While immediate action using appropriate
measures (ie, dilution, extraction, antidotes,
and supportive treatments) can decrease the
need for surgical intervention, many injuries
may be prevented by following established
Extravasation and infiltration policy and procedures.
Specific nursing intervention for

extravasation:
Immediate stop of administration of IV
fluids, disconnecting the IV tube from
the cannula, and aspirating any residual
drug from the cannula. If
recommended, administer a specific
drug antidote.
19
infiltration:
Discontinue the site and relocate the IV
if possible. Elevate the site to reduce
swelling and apply warm compress.
Definition:
A hematoma occurs when there is leakage of
blood from the vessel into the surrounding soft
tissue. This can occur when an IV
angiocatheter passes through more than one
wall of a vessel or if pressure is not applied to
the IV site when the catheter is removed. A
hematoma can be controlled with direct
Hematoma and Phlebitis pressure and will resolve over the course of 2
weeks. Phlebitis is inflammation of the vein
which occurs due to the pH of the agent being
administered during the administration of the
I.V. Applying heat to the painful area, elevating
the affected leg, using an over-the-counter
nonsteroidal anti-inflammatory drug (NSAID)
and possibly wearing compression stockings.
20
hematoma:
Apply an ice or a cold pack wrapped in
a cloth on the site for about 10 to 20
minutes.

phlebitis:
- Elevate the area and apply warm, moist
compress over the area for about 10
minutes.
Thrombophlebitis is an inflammatory process

that causes a blood clot to form and block one
or more veins, usually in the legs. The affected
vein might be near the surface of the skin
Thrombophlebitis (superficial thrombophlebitis) or deep within a
muscle (deep vein thrombosis, or DVT).
Anticoagulant is the medicine that prevents
blood clots. It is taken by mouth, by injection,
or through an IV. Commonly used
anticoagulants include warfarin and heparin.
21
Specific nursing intervention:
Elevate the affected leg and apply heat
to the area. If recommended, use an
over-the-counter nonsteroidal
anti-inflammatory drug. When
consistent, apply compression stockings
to the patient.
Phlebothrombosis is the obstruction of a vein

by a blood clot, without preceding
inflammation of its wall. It is most common
within the deep veins of the calf of the leg
(deep vein thrombosis, DVT). Anticoagulant
drugs (such as heparin and warfarin) are used
in prevention and treatment.

Elevate the leg and apply heat to the
area. Wear compression stockings. If it
worsens and develops into
Phlebothrombosis thrombophlebitis, use an
over-the-counter nonsteroidal
anti-inflammatory drug.
Sclerosis Multiple sclerosis, or MS, is a long-lasting
22
disease that can affect your brain, spinal cord,
and the optic nerves in your eyes. It can cause
problems with vision, balance, muscle control,
and other basic body functions. The medicine
is administered by an infusion pump that drips
the medication through a catheter into a
syringe.

Physical therapy to help the patient
mobilize until they are able to manage
themselves. If severe, muscle relaxants
can be used.
Systemic Complications
A pyrogenic reaction is a febrile phenomenon

that occurs when a contaminated solution is
infused into the body. The reaction is often
manifested by cold, chill and fever which can
be fatal in humans and animals due to the
varying body temperature the pyrogen
substance causes. This complication can be
Pyrogenic Complication managed by improving sterilization and
generalized application of single-use infusion
sets. When it is already infused, the nurse
must immediately discontinue the infusion.

Immediate stop of infusion. Drugs that
are antipyretics, antihistamines and
23
steroids can be given to the patient to
treat the symptoms.
A pulmonary embolism refers to a blood clot

that develops in a blood vessel. Clots can
develop on the end of an indwelling
intravenous catheter, break off and travel to
the pulmonary cavity. The blood clot is then
now referred to as an embolus. This embolus
can block the blood supply to the lung artery,
causing a pulmonary embolism. To manage
these complications, sequential compression
devices can be used to relax leg muscles.
Anticoagulant therapy may also be prescribed
to prevent blood clots to high-risk patients.
Pulmonary Embolism Specific nursing intervention:

Seek for the physician to recommend
medications which would often be blood
thinners (anticoagulants) and clot
dissolvers (thrombolytics).
An air embolism is when one or more air

bubbles enter a vein which causes a blockage.
Air Embolism
This can occur when air is present in the
intravenous line while injected into the patient.
24
With 50 mL of air, it can cause significant risk
to the life of the patient. To prevent this, it is
crucial to clear the central line of air before
insertion. Nurses may also use iv pumps with
in-line air detectors to monitor any air passing.

Start hyperbaric oxygen therapy. If
severe, surgery might be required to
remove the air embolism.
A catheter embolism happens when a catheter

ruptures from using too much pressure when
flushing the line. This may also occur with
power-injecting a non-power injectable central
line. Thus, if a catheter doesn’t flush easily, it
should never be forced and instead be
assessed for mechanical or fibrin occlusions.

Start catheter embolization treatment
where embolic agents are sent through
the catheter into the blood vessel to
Catheter Embolism prevent blood flow to the area.
25
Pulmonary edema occurs when there is excess
fluid in the lungs which causes difficulty in
breathing. This can be caused when
administering large amounts of intravenous
fluid as fluid shifts into the lungs. This can be
prevented by decreasing the amount of
intravenous fluid given or replacing the
intravenous fluid.

Introduce supplemental oxygen through
a face mask or nasal cannula to deliver
oxygen to the nostrils. Treatment can
Pulmonary Edema include drugs such as diuretics,
morphine or blood pressure drugs, as
prescribed by the physician.
Speed shock and nerve damage can happen

when an intravenous catheter penetrates a
nerve. Extra precautions should be taken such
as being conscious of the proximity of the
superficial peripheral nerves. If a nerve has
been hit, the catheter must be withdrawn
quickly.
Speed Shock and Nerve Damage
Specific nursing intervention for speed
shock:
Start fluid resuscitation. The first fluid
of choice is crystalloid. Administer 2 L of
isotonic sodium chloride solution or
lactated Ringer’s solution to stabilize the
patient.
26
Specific nursing intervention for nerve
damage:
Physiotherapy or use of assistive
devices for the area of the nerve
damage. Drugs may be prescribed and
surgical exploration might take place
when severe.
A pneumothorax is a collapsed lung caused

when air leaks into the space between the
lung and chest wall. When air is present in an
intravenous fluid, it can bring fluid between
the lining of the lungs and the chest wall.
Pneumothorax Similar to the nursing interventions to prevent
air embolism, it is necessary to clear the
central line of air and use IV pumps with
in-line air detectors.

Reexpansion. The patient is instructed
to inhale and strain against a closed
27
glottis to reexpand the lung and eject
the air from the thorax.
Hydrothorax is the collection of serous fluid in

the pleural cavities. This can be caused by
intravenous fluid therapy when there is too
much fluid administered to the patient. In this
case, the dose of fluid should be decreased by
the attending nurse. A treatment known as
pleurodesis which is a procedure that seals up
the pleural space may also prevent
hydrothorax.
Hydrothorax Specific nursing intervention:

Assist the patient in creating a low-salt
diet. Treatment is assisted with diuretics
which will be prescribed by the
physician.
Hemothorax is the accumulation of blood in

the area between the chest wall and the lung.
It is usually caused by a chest trauma or blood
Hemothorax clotting. Intravenous fluid therapy can induce
this when air bubbles in an intravenous line
cause blood clots that lead to hemothorax.
When this occurs, a crucial procedure is
28
draining the blood out of the chest cavity.

In severe hemothorax, treatment
includes thoracentesis to remove blood
and other fluids from the pleural cavity
and then insertion of a chest tube into
the sixth intercostal space in the
posterior axillary line.
CLO #9: Identify the different venipuncture sites
Scalp
Frontal auricular vein: This vein drains the anterior portion of the
external ear.
Advantages:
- Reduced likelihood of catheter
dislodgement due to reduced
movement and lack of a flexible joint
Disadvantages:
- May look scary to parents and thus
decrease likelihood to give consent
Indications:
- Needed peripheral intravascular access
for infants and children
Contraindications:
29
- Overlying skin infection
- Thrombophlebitis
Posterior auricular vein: This vein is located on the side of the head in
a plexus that communicates with branches of
the occipital and superficial temporal vein.
Advantages:
- Regional proximity to areas being
reconstructed
Disadvantages:
- Greater tendency of needle to roll due
to increased range of motion than
frontal auricular vein and superficial
temporal vein
Indications:
- For peripheral intravascular access for
infants and children
Contraindications:
- Overlying skin or soft-tissue infection
- Older infant due to risk of easy
dislodgement
- Thrombophlebitis
Superficial temporal vein: This vein begins on the side of the skull and
communicates with the frontal vein and
supraorbital vein.
Advantages:
- Generally easy to find
Disadvantages:
- Greater tendency of needle to roll due
to increased range of motion and
possible slanting direction of the vein
- Precaution in avoid entering beneath
the vein as the vein is superficial
Indications:
- Dermal fillers
30
- Needed peripheral intravascular access
for infants and children
Contraindications:
- Overlying skin infection
- Thrombophlebitis
Upper arm
Cephalic vein This vein runs along the superficial fascia on

the biceps and communicates with the basilic
vein through the media cubital vein at the
elbow.
Advantages:
- It can generally accept large-gauge
needles.
- A safe site due to its distance from the
median nerve and brachial artery
Disadvantages:
- The valves located at the junction with
the cephalic vein may inhibit the
advancing of the cannula.
- Vein is too short or difficult to locate
among children
Indications:
- Ideal vein to try when cannulating
“blind” a baby
31
- Used for insertion of percutaneous
central venous catheters
Contraindications:
- Burns, trauma, skin infection
- History of venous thrombosis at the site
- Active bacteremia
Basilic vein The basilic vein can be found from the palm of
the hand on the side of the ulna and the pinky
finger. It is visible in the inner arm. This is
usually the third choice for a site of
venipuncture.
Advantages:
- This large vein is easily palpated.
- Generally easy to find
Disadvantages:
- Patient might be positioned awkwardly
during venipuncture.
- Caution since the medial antebrachial
cutaneous nerve is draped over the
basilic vein
Indications:
- Blood sampling
Contraindications:
- Active bacteremia
Axillary vein The axillary vein is a deep vein of the upper

limb that is formed by the union of the
brachial and basilic veins. It starts at the lower
border of the teres major muscle and ascends
medially through the axilla towards the 1st rib,
where it is continued by the subclavian vein.
Advantages:
- Has a good margin of safety since its
distance between artery and vein and
from vein to rib cage.
32
Disadvantages:
- Risk for opposing muscle contractile
forces since it courses through the
pectoralis major and pectoralis minor.
Indications:
- Placement of pacing or defibrillation
leads
- Placement of dialysis catheters
- Placement of temporary pacing wire or
pulmonary artery catheters
Contraindications:
- Chronic or ongoing ipsilateral cellulitis
- Ipsilateral lymphedema
- Ipsilateral radical lymph node resection
- Occlusion of the ipsilateral venous
system
Median cubital vein The median cubital vein is located in the

cubital fossa superficial to the bicipital
aponeurosis. It is the most commonly used
site.
Advantages:
- Has a lower tendency to move or roll
when the needle is inserted
- Vein is easy to palpate or visualize due
to its cross-sectional area
Disadvantages:
- Precaution since the median nerve and
brachial artery are located closeby.
Indications:
- Blood sampling
- Intravenous cannula
Contraindications:
- Cellulitis or abscess is present
- Hematoma
- Vascular shunt or graft
- Venous fibrosis on palpation
33
Inner arm
Basilic vein The basilic vein can be found from the palm of
the hand on the side of the ulna and the pinky
finger. It is visible in the inner arm. This is
usually the third choice for a site of
venipuncture.
Advantages:
- Large vein is easily palpated
- Generally visible
Disadvantages:
- Has a greater tendency to roll than the
cephalic and median cubital veins
- Position may be awkward depending on
the exact location of the vein
Indications:
- Blood sampling
Contraindications:
- Active bacteremia
Cephalic vein The cephalic vein is a superficial vein running

through the superficial fascia in the inner arm.
It can be seen through the radial side of the
forearm. It is considered a safe secondary
option for a site of venipuncture.
Advantages:
- A large vein, the cephalic is excellent for
venipuncture and readily accepts
large-gauge needles.
Disadvantages:
- Because of joint motion, venipuncture
sites in the wrist or antecubital fossa
are at increased risk for complications.
Indications:
34
“blind” a baby
Contraindications:
- Active bacteremia
Median Cubital vein The median cubital vein is located in the

cubital fossa superficial to the bicipital
aponeurosis. It is the most commonly used
site.
Advantages:
- Has a lower tendency to move or roll
when the needle is inserted
- Vein is easy to palpate or visualize due
to its cross-sectional area
Disadvantages:
- Precaution since the median nerve and
brachial artery are located closeby.
Indications:
- Blood sampling
- Intravenous cannula
Contraindications:
- Cellulitis or abscess is present
- Hematoma
- Vascular shunt or graft
- Venous fibrosis on palpation
35
Dorsal venous arch The dorsal venous can be found within the
superficial fascia on the backside of the hand,
giving rise to veins such as the cephalic and
basilic vein.
Advantages:
- Veins here are easily splinted
- Infiltration can be easily spotted
Disadvantages:
- Arch position is not straight and may be
hard to penetrate properly
- Can be painful since the hand has many
nerve endings
Indications:
- Joint pain around the area
- Anesthetic purposes
Contraindications:
- Local skin infection, trauma or burns
- Lymphedema
- Need for long-term IV access
Superficial dorsal veins The superficial dorsal veins travel distally then
laterally across the metacarpals.
Advantages:
- Options for choosing an accessible vein
- Veins are easily splinted here
- Infiltration can immediately be spotted
Disadvantages:
- Smaller veins compared to other
venipuncture sites
- May not easily be palpated or visible for
each person
- May be painful due to the many nerve
endings in the area
Indications:
36
- Inflammation that can be reduced by
cortisone shots in the hand
- Joint pain
- Anesthetic purposes
Contraindications:
- Lymphedema
Forearm
Basilic vein This vein runs up to the posterior surface of

the forearm.
Advantages:
- Large vein is generally palpable.
Disadvantages:
- Patient might be positioned awkwardly
during venipuncture.
Indications:
- Blood sampling
Contraindications:
- Active bacteremia
- Hematoma
Cephalic vein The cephalic vein is found in the superficial

fascia and communicates with the basilic vein
through the median cubital vein.
Advantages:
- A large vein, the cephalic is excellent for
venipuncture and readily accepts
large-gauge needles.
37
Disadvantages:
- Because of joint motion, venipuncture
sites in the wrist or antecubital fossa
are at increased risk for complications.
Indications:
“blind” a baby
Contraindications:
- Active bacteremia
Hand
Superficial palmar venous arch The superficial palmar arch is associated with
venae comitantes which plays a role in
draining oxygen-depleted blood.
Advantages:
- Sign of infiltration is easily spotted
Disadvantages:
- May not easily be palpated or visible for
each person
endings in the area
Indications:
- Joint pain
Contraindications:
- Lymphedema
38
Median antebrachial vein The median antebrachial vein (median vein of
the forearm) is a large superficial forearm vein
that drains the structures of the anterior
forearm, palmar (volar) surface of the hand
and antecubital region of the forearm.
Advantages:
- Accessible and visible
- Can be palpated
Disadvantages:
- Small and fibrosed if frequently used for
venipuncture
- Difficult to stabilize
- Limits mobility
Indications:
- Blood sampling
- IV cannulation
Contraindications:
- Coagulopathy
- Trauma or burns
Dorsal surface of the hands
Basilic vein The basilic vein is located in the deep

subcutaneous tissue running down the ulnar
side of the arm.
Advantages:
- This large vein is easily palpated.
Disadvantages:
- trouble accessing this vein because of
its location, and the patient must be
positioned awkwardly during
venipuncture.
Indications:
39
- Blood sampling
Contraindications:
- Active bacteremia
- Hematoma
Dorsal metacarpal vein Dorsal metacarpal veins are the three veins
that are located on the back of the hand.
These veins are made up of the dorsal digital
veins, which are the veins that are located on
adjacent sides of the second, third, and fourth
fingers along the dorsal interossei.
Advantages:
- Accessible, distal location of the veins
Disadvantages:
- Small size veins and tendency to be
mobile
endings in the area
Indications:
- Joint pain
Contraindications:
- Trauma or burns
- Lymphedema
- Hematoma
Median antebrachial vein The median antebrachial vein (median vein of

the forearm) is a large superficial forearm vein
that drains the structures of the anterior
forearm, palmar (volar) surface of the hand
and antecubital region of the forearm.
Advantages:
- Accessible and visible
- Can be palpated
40
Disadvantages:
- Small and fibrosed if frequently used for
venipuncture
- Hard to stabilize and limits mobility
Indications:
- Blood sampling
- IV cannulation
Contraindications:
- Coagulopathy
- Trauma or burns
Dorsal surface of the foot
Dorsal plexus The dorsal plexus are superficial and

continuous with the superficial veins of the leg
and ankle.
Advantages:
- Generally large and accessible
Disadvantages:
- High infection rate
- Potentially increased venous pressures
Indications:
- Circumstances where the veins in upper
extremities are inaccessible
- Anesthesia for reconstructive forefoot
surgery
Contraindications:
- Coagulopathy
41
- Trauma or burns
Dorsal arch The dorsal arch is a superficial vein that is

connected with veins draining the sole.
Advantages:
- Easily visible on their foot's upper side
Disadvantages:
Indications:
surgery
Contraindications:
- Trauma or burns
- Coagulopathy
Great saphenous vein This is the largest vein in the human body
starting from the vein of the foot running
superficially along the lower limb.
Advantages:
- On transverse scan this compartment
appears as an ‘eye’
- This ‘eye’ is readily visible in the thigh
Disadvantages:
- It may be difficult to recognize in very
thin subjects, and in some areas such
as the knee and ankle
Indications:
- to drain deoxygenated blood from the
foot, as well as superficial parts of the
leg and knee
42
Contraindications:
- A blood clot in the GSV can often be
identified by a warm, tender, or aching
feeling in the leg area. In some cases, it
can also cause swelling.
Feet and ankle
Dorsal venous arch The dorsal venous arch is connected to the

small saphenous vein and the great saphenous
vein.
Advantages:
- Easily visible on the foot's upper side
Disadvantages:
Indications:
surgery
Contraindications:
- infection, failed cannulation,
hemorrhage, nerve injury, and air
embolism
Dorsal plexus vein The dorsal plexus are superficial and

continuous with the superficial veins of the leg
and ankle.
Advantages:
- Generally large and accessible
Disadvantages:
- Veins in the foot are farther from the
central circulation than an IV in the
upper extremity
43
Indications:
Contraindications:
- Coagulopathy
- Trauma or burns
Great saphenous vein This is the largest vein in the human body
starting from the vein of the foot running
superficially along the lower limb.
Advantages:
- On transverse scan this compartment
appears as an ‘eye’
- This ‘eye’ is readily visible in the thigh
Disadvantages:
- It may be difficult to recognize in very
thin subjects, and in some areas such
as the knee and ankle
Indications:
- Draining deoxygenated blood from the
foot and superficial parts of the leg and
knee
Contraindications:
- Blood clot in the GSV can often be
identified by a warm, tender, or aching
feeling in the leg area. In some cases, it
can also cause swelling.
44
CLO #10: Discuss the evidence-based nursing responsibilities before, during and after
IVF infusion:
Rationale
10.1 Before
1. Preparation is necessary when it comes
1. Preparation of equipment to be used. to patient care as it allows the nurse to
determine the necessary materials and
2. Washing or disinfecting hands. equipment the patient needs for their
care.
3. Wearing gloves to prevent transmission
or spreading of microorganisms and 2. Cleaning the hands is one of the
taking appropriate care of equipment. important steps to avoid spreading
germs to the patient. This protects both
4. Setting the IV fluid or the IV lock in the the patient and the nurse from getting
medication preparation area. an infection that can greatly affect the
caring process.
5. Explaining the procedure to the
patient/client 3. Wearing gloves creates a barrier
between the nurse and the material or
6. Ensure that the patient’s ID includes equipment. Gloves also help prevent the
two identifiers: patient’s name and spread of germs and other hazardous
birthdate which will be similar to their materials.
record and their wristband.
4. This allows easy access to the
7. Check and examine the physician’s peripheral vein for intermittent IV fluids
order. or medications. The IV lock is “flushed”
or filled with normal saline to prevent
8. Determine the type and sequence of clotting when not in use.
solution to be infused in the procedure.
Examine the patient’s chart to 5. This allows the patient to know what is
determine the insertion date and the expected to happen to them and what
type of solution ordered. is expected of them to do. This also
allows the patient to be ready of what
9. Double checking the expiration date of will happen during the process.
the IVF.
6. Verifying the patient’s identity and
10. Determine the flow rate and infusion comparing it to the patient chart makes
schedule. sure that it is the correct patient for the
treatment.
11. Adjust the bed of the patient to an
appropriate level or in a working 7. The physician’s order is the most
position based on the nurse's height. common way of delegating authority to
45
write an order for the nurse to treat the
12. Open and prepare the infusion set using patient under the physician.
the aseptic technique.
8. In the physician’s order, it is written
13. Prime the IV tubing before attaching there what is to be infused in the IV
the IV tube to the patient. solution. Patients are prescribed an IV
solution or fluids based on their
electrolyte and fluid volume status
based on the assessment and
physician’s order. The nurse also must
take note on the insertion date as this
may determine the reason the patient is
admitted.
9. Expiration dates are important as it

reflects the time period the product is
known to remain stable as it retains its
quality, strength, and purity. If expired
IV fluid is used, this may have effects
on the patient’s body; IV fluids are
stored for extended periods of time
without knowing the effects of that
extended cooling or heating have effect
on its stability or sterility. It is
recommended that these fluids are to
be discarded after 28 days.
10. Flow rate and flow rates are performed

to make sure that there is an accurate
delivery of medications administered
through the IV route. There are
numerous medications that are
delivered via IV infusion that have
potent effects and narrow margin to
safety, so accuracy in the calculations
and administration is vital.
11. The adjustment of the patient’s bed

allows the nurse to work comfortably
and it also allows the patient to
comfortably work with the nurse.
According to Freitag and company
(2013), raising the bed to hip height
46
and using a bathroom stool can greatly
benefit the nurse as they can spend a
great proportion of their time in an
ergonomic posture.
12. The aseptic technique is an important

competency for many nursing personnel
and it is necessarily required to be
practiced in everyday procedures such
as wound dressing and IV fluid
administration.
13. Priming the IV tubing is done to remove

all air before attaching the IV tubing to
the patient. If air is not removed, the
patient will develop air embolism as this
is a potential complication when it
comes to IV insertion. Air embolism can
enter the patient’s blood system
through cut tubing, unprimed IV tubing,
access ports, and drip chambers with
too little fluid.
10.2 During
1. Observe aseptic technique to avoid or 1. Aseptic technique makes sure that the
prevent contamination to the equipment material to be used on the patient is
used in the procedure which is the most clean and not contaminated. If the
important action for every procedure for material is contaminated and is used on
an IVF infusion. the patient, it will dangerously affect
the patient’s health and change the
2. Check if it is infused with the correct care plan of the patient.
infusion.
2. Ensuring that the infused medicine is
3. As the infusion begins, leave the ends the correct one as it is necessary to
of the tubing covered with plastic cups always double check for it is a risk
to avoid contamination. Sterility is mitigation technique to prevent the
important and present in this step. reporting of near misses.
4. Ensure the intravenous is labeled 3. Sterility is very important to ensure the

correctly with the time and date. safety of the patient.
4. Labeling allows the nurse to make sure
47
5. Preparing and keeping aside strips of that they have the correct materials and
adhesive tapes for use when ready. medicine on hand.
Assess the IV insertion site.
5. Adhesive tapes are used to stabilize the
6. Locate a vein in which to start the IV IV once it is inserted into the patient’s
insertion. IV site to avoid accidental
dislodgement.
7. Place a tourniquet above the area
where it is going to be inserted. Make 6. This is to avoid injuring the vein, as this
sure that there are no complications on can help the nurse determine if the vein
the patient’s arms or hands. is not frail enough to blow up during
the insertion. It is also better to feel
8. Inspect for any patency of the rather than look as it can help the nurse
intravenous tubing and of the needle. make sure that they are not aiming for
something else other than the vein.
9. Inspect the insertion site for any
bleeding, fluid infiltration and phlebitis. 7. The tourniquet must be placed tightly
Assess the tubing for bends that can enough to hinder the venous flow, but
decrease the flow of the IV fluid. not too tight to impede arterial flow.
The tourniquet must be applied snugly
about 20 to 25 cm above the needle
insertion site. Feel for the radial pulse
with the tourniquet on, if it can’t be
palpated, the tourniquet is too tight.
8. The nurse will check the patency by

inserting a syringe filled with saline
solution into the cannula, then gently
injects a small amount of the saline
solution while checking for the
appropriate flow. During this process,
the nurse will then check for resistance
that can indicate blockage, pain or
swelling of the skin at the site of IV
line.
9. The IV site should be free from

swelling, redness, and pain. Dressing on
the site should be dry and intact.
10.3 After
1. Removing and properly disposing of
48
1. Removing and disposing of used gloves. used gloves, and washing or
Washing or disinfecting hands. disinfecting hands is necessary to avoid
the spread of diseases. Even after the
2. Any catheter or needle should be IV insertion procedure, there may be
disposed properly in sharps container potential pathogens on the nurses
hands from the patient’s hands, so this
3. Teaching and guiding the patient ways is a way of protection for all of the
to maintain infusion system. Check on people in the facility.
the patient if they are comfortable in
bed. 2. Used catheter or needle should be
disposed immediately in a sharps
4. The nurse must instruct the patient to disposal. Used needles and other sharp
not move or tamper with the materials used during the procedure are
venipuncture site if the patient is dangerous to everyone around if not
conscious disposed of properly for they can
spread infections that can cause serious
5. Record the procedure, interpret, and health conditions.
report the observations accordingly (the
date and time). Document the relevant 3. Instruct the patient on how to manage
dates, especially during assessments. and maintain the infusion system by
themselves. The nurse will also ensure
6. Assess the rate of flow hourly. that the patient is comfortable in bed
after the procedure.
4. It is also necessary to instruct the

patient not to touch the roller clamp
and to not bump the clamp for this can
change the flow rate. The patient is also
to be instructed to keep their hand or
arm below heart level.
5. Recording and documenting what has

happened during the procedure, such
as the findings and aftermath if there
are any side effects, is necessary so
that the health care team is able to take
note of that and communicate with one
another.
6. This is to ensure that there is a

constant, even flow of the fluid to
prevent further complications from too
much or too little fluid. The nurse may
49
also use this time to administer the
necessary medications ordered by the
physician.
CLO #11: Calculate the following
11.1 Drop factor
The number of drops it takes to make up on 1 mL of fluid
Macro drip (gtt) 10 gtts/mL

15 gtts/mL
20 gtts/mL
Micro drip (ugtt) 60 ugtts/mL
11.2 Flow rate
Formula:
𝑉𝑜𝑙𝑢𝑚𝑒 (𝑚𝑙) 𝑥 𝐷𝑟𝑜𝑝 𝐹𝑎𝑐𝑡𝑜𝑟 ( 𝑔𝑡𝑡𝑠/𝑚𝐿)

𝑇𝑖𝑚𝑒 (𝑚𝑖𝑛𝑠)
= 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛
Example:
A physician orders 500 mL. of normal saline (NS) to infuse over 5 hours. The drop
factor is 10 drops per 1 mL. A nurse sets the flow rate at how many drops per minute?
Calculation:
𝑉𝑜𝑙𝑢𝑚𝑒 (500 𝑚𝑙) 𝑥 𝐷𝑟𝑜𝑝 𝐹𝑎𝑐𝑡𝑜𝑟 (10 𝑔𝑡𝑡𝑠/𝑚𝐿)

𝑇𝑖𝑚𝑒 (300 𝑚𝑖𝑛𝑠)
= 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛
5000
300
= 16. 66 𝑜𝑟 17 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛
Answer:
A nurse should set the flow rate to 17 gtts/min
50
11.3 Number of hours
Formula:
𝑉𝑜𝑙𝑢𝑚𝑒 (𝑚𝑙) 𝑥 𝐷𝑟𝑜𝑝 𝐹𝑎𝑐𝑡𝑜𝑟 (𝑔𝑡𝑡𝑠/𝑚𝐿)
𝐹𝑙𝑜𝑤 𝑅𝑎𝑡𝑒 (𝑔𝑡𝑡𝑠/𝑚𝑖𝑛) 𝑥 𝑇𝑖𝑚𝑒 (𝑚𝑖𝑛𝑠/ℎ𝑟)
= ℎ𝑟𝑠
Example:
A physician orders 1000 mL of normal saline (NS) for infusion at a rate of 21 drops per
min. The drop factor is 15 drops per mL. At how many hours will the IVF infuse?
Calculation:
𝑉𝑜𝑙𝑢𝑚𝑒 (1000𝑚𝑙) 𝑥 𝐷𝑟𝑜𝑝 𝐹𝑎𝑐𝑡𝑜𝑟 (15 𝑔𝑡𝑡𝑠/𝑚𝐿)
𝐹𝑙𝑜𝑤 𝑅𝑎𝑡𝑒 (21 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛) 𝑥 𝑇𝑖𝑚𝑒 (60 𝑚𝑖𝑛𝑠/ℎ𝑟)
= ℎ𝑟𝑠
15,000
1260
= 11. 9 𝑜𝑟 11 ℎ𝑟𝑠 54 𝑚𝑖𝑛𝑠 𝑜𝑟 12 ℎ𝑟𝑠
Answer:
It takes 12 hrs. to infuse the IVF
11.4 Volume infused
Formula:
𝑇𝑜𝑡𝑎𝑙 𝐼𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑉𝑜𝑙𝑢𝑚𝑒 (𝑚𝐿)

𝑇𝑜𝑡𝑎𝑙 𝐼𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑇𝑖𝑚𝑒 (ℎ𝑟)
= 𝑚𝐿/ℎ𝑟
Example:
A physician orders 1000 mL of normal saline (NS) to be administered over an 8 hour
period. A nurse determines that how milliliters per hour will be administered to the
client?
Calculation:
51
𝑇𝑜𝑡𝑎𝑙 𝐼𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑉𝑜𝑙𝑢𝑚𝑒 (1000 𝑚𝐿)
𝑇𝑜𝑡𝑎𝑙 𝐼𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑇𝑖𝑚𝑒 (8 ℎ𝑟)
= 𝑚𝐿/ℎ𝑟
1000 𝑚𝐿
8 ℎ𝑟
= 125 𝑚𝐿/ℎ𝑟
Answer:
125 mL/hr will be administered to the client
11.5 Conversion of milliliter/hour to drops/minute
Formula:
Flow rate (mL/hr) x Time (hr/min) x Drop Factor (gtts/mL)
Example:
A physician orders 1000 mL of IVF to be infused at a flow rate of 120 mL/hr in a
macroset using 10 gtts/mL. How many drops per minute should the nurse regulate to it?
Calculation:
120 𝑚𝐿 1 ℎ𝑟 10 𝑔𝑡𝑡𝑠 1200 𝑔𝑡𝑡𝑠

1 ℎ𝑟
𝑥 60 𝑚𝑖𝑛𝑠
𝑥 1 𝑚𝐿
= 60 𝑚𝑖𝑛𝑠
= 20 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛
Answer:
20 gtts/min should the nurse regulate it
11.6 Conversion of drops/minute to milliliter/hour
Formula:
52
Example:
A physician orders 1000 ml of IVF to be infused at 20 gtts/min using macroset at
10 gtts/ml. How many ml will be infused every hour?
Calculation:
20 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛 𝑥 60 𝑚𝑖𝑛𝑠/ℎ𝑟 1200

10 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛
= 10
= 120 𝑚𝐿/ℎ𝑟
Answer:
120 mL/hr will be infused every hour.
CLO #12: List down the materials used in assisting IVF insertion
Saline Flush - mixture of salt and water ideal for body tissues and fluids, used to push residual
medication or fluids through the IV line. Keeps the PIV clean and reduces infection.
Gloves - essential layer of barrier protection to prevent and fight against direct contact with
infectious agents
53
IV Needle - most commonly used needle for infusions of large amounts is the 18 gauge
needle (green). The 20 gauge needle (pink) is ideal for IV infusions and blood infusions.
Infusion Set
IV Tubing - is used to infuse continuous or intermittent fluids or medication.
Luer Connector - used to make secure leak proof unions in devices.
Drip Chamber - device used to allow gasses to rise out from the fluid so that the air does not
pass downstream.
54
V-track controller - controls the flow rate
Spike - punctured/fitted into a sterile bag/bottle containing prefilled IV solution
55
Start Kit
Tegaderm IV Dressing - Used to cover and protect catheter sites and wounds, maintain a
moist environment for wound healing. Provides advanced catheter securement as well as
flexibility and comfortability.
Surgical Tape (transparent) - plastic medical tape is ideal in IV insertion to allow nurses to
closely monitor the IV site. It is easy to tear and offers solid grip.
Alcohol prep pads - gauze pads soaked in alcohol to prepare the skin prior to injection, to
prevent and decrease infections from bacteria.
56
Povidone-Iodine Prep Pads - gauze pads soaked in 10% povidone-Iodine solution used as
an antiseptic for skin preparation
Gauze Sponge - highly absorbent material used to quickly absorb fluids, used for cleaning up
and administering medicine
Tourniquet - Used to enhance venous filling, increase vein distention and aid vein location;
partially hinder venous blood stream back to the heart and prompt the blood to briefly pool in
the vein for easy obtainment.
57
Sticker Label - labels used to appropriately assign data such medication name, current
measurements, and any precautions.
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Cebu Doctors’ University

Heat and Cold Application

1. Aquathermia Pads - also called as Water-Flow Pads

2. Cold Application - generally an application of cold

3. Cold Chemical Pads - it has a strong outer plastic layer

4. Compress - this can be either warm or cold.

aseptic technique - use gloves

5. Counterirritant - something used to cause

6. Rebound Effect - it is a phenomenon that is

7. Heat Application - generally an application of heat

8. Vasoconstriction -the narrowing of blood vessels

11. Heat Lamp -an electrical device with a bulb

12. Hyperthermia - an elevated body temperature

13. Ice Collar - it is made of plastic or rubber,

14. Ice Bag - bags designed to be filled with

15. Ice Glove - is used in the same principle as

16. Heat Cradle - a tunnel or hood shaped cradle

Heat Application - relieves muscle spasm and joint stiffness

Cold Application - decreases and terminates bleeding

Counterirritant - to relieve pain

Heat Application muscle spasm, inflammation, present malignancies,

Cold Application traumatic injury, presence of open wound,

Counterirritant painful muscles and joints, open wounds, impaired

2. Hot Moist Compress - a piece of gauze dressing moistened in a prescribed warmed

5. Whirlpool Bath - a therapeutic bath in which all or part of the body is

- is a metal half-circle frame that encloses the body part to be

1. Cold Soak -immersion of a body part in a cold soak. The desired

2. Sterile / Cold - apply cold compress for 20minutes at a temperature of 15

sterile cold compress uses sterile

CLO#5: discuss the processes of heat transfer.

Evaporation -the transfer of heat energy when a liquid is changed to gas.

Scientific principles in heat and cold application

Effects of heat and cold application

- increase capillary permeability

Factors that affect heat and cold application

Guidelines in performing heat and cold application

- Determine client’s ability to tolerate the therapy. varied heat tolerance

Refer to the procedure guide.

CLO#9: demonstrate beginning skills in heat and cold application.

Refer to the Video Demonstration posted.

Documentation in heat and cold application

Learners’ Names: Year and Section: BSN 1-A

Materials Needed: A lined tray containing:

Note: The following materials shall be prepared by every student-demonstrator:

Procedure Guide: Parenteral Medication

9. Using sterile forceps, place the following items

B. Preparation of drug from:

5. Withdraw desired dose. Never inject air into

5. Place syringe on injection tray.

2. Introduce air equal to the amount of distilled

3. Withdraw 0.1 cc of drug to be tested from

5. Place syringe back on injection tray to prevent

6. Do third reading and return medication back to

7. Insert medicine ticket under sterile medicine

❖ Subcutaneous LIM Placing and preparing necessary

Follow the cigarette position to steadily

A cotton ball should be prepared

CLO#1: define the following terms related to bed making.

1.2 Fanfold -a continuous sheet of paper

1.3 Mitered -a method of making a crisp,

1.4 Toe Pleat -pleats in the sheets that

1.6 Bed Cradle - a bed frame that is placed at

1.7 Magic Corner -corners of a folded linen