4 MDW 204 Part 2 Fundamentals of Health Care

Republic of the
Philippines City of
Olongapo
GORDON COLLEGE
Olongapo City Sports Complex, East Tapinac, Olongapo
City Tel. No. (047) 224-2089 loc. 314
College of Allied Health Studies
Detailed Learning Module(Case-Based Learning Module)
Program: Graduate in Midwifery
Course Code: MDW 204(Seminar in Midwifery)
Title: Preparation in Board Exam

Part 2 Fundamentals of Health Care
Module No. 4
I. Introduction: Midwifery means "with woman". Midwives form partnerships with women as they experience
the life process of childbearing and early parenting. Midwives share knowledge, experience and wisdom with
women reciprocally, which was acknowledging the uniqueness of each woman’s culture, beliefs, expectations,
values and previous experiences. To qualified in midwifery profession the health professional should acquired
the appropriate qualifications to practice midwifery, works in partnership with women to give the necessary
support, care and advice during pregnancy, labour, birth and the postnatal period, provides care for the new
born infant. She/ He are trained in the birthing process and deals capably with any adverse situation including
seeking medical assistance when required. They will commence emergency procedures in the absence of
medical help and educates and provides health counseling for the woman, family and community.
This module focuses on how a health professional to become a registered midwife, the preparation,
documents needed before applying the licensure exam at the Professional Regulation Commission. It also
focused on the review of all professional subjects, mastery of clinical procedures in the preparation of
midwifery licensure examinations.
II. Learning Objectives: After studying the complete module, the student should be able to:
o Understand the midwifery law which focuses on how to become qualified in the midwifery
licensure exam.
o Understand the trends and development in science and technology, medicine and other health
fields that influence maternal and child health services.
o Identify these trends and developments that may have direct relationship with midwifery services
in the hospital/community setting.
o Develop the student midwives and have interest in midwives conventions, conferences, promotes
interchange of knowledge and meeting of the minds regarding the problems affecting the
standards of midwifery training.
o Develop the analytical and intellectual skills in answering the midwives licensure examination.
o Develop the student midwives to participate in research activities or in any effort.
o Develop the student midwives in analization and presentation of any obstetrical cases.
o Confidently perform the midwifery procedures in clinical and non- clinical settings.
III. Topics and Key Concepts:
TOPIC 9: HEAT AND COLD APPLICATIONS

Republic of the
Philippines City of
Olongapo
GORDON COLLEGE
City Tel. No. (047) 224-2089 loc. 314
BODY’S RESPONSES TO HEAT AND COLD
HEAT COLD
Vasodilation Vasoconstriction
Blood viscosity decrease Blood viscosity increase
Lymph flow increase Lymph flow decrease
Stroke volume decrease Stroke volume increase
Blood pressure falls Blood pressure rises
Pulse rate increase Pulse rate decrease
Perspiration is present Perspiration is present, shivering and
gooseflesh is present
Increases inflammation-increases blood Slows bacterial growth
flow to an area bringing phagocytes
Decreases pain by relaxing area Decreases pain by numbing the muscles
showing the flow of pain impulses and by
increasing the painthreshold.
Increases cellular metabolism Decreases cellular metabolism
Muscles become atonic Muscles become tense
Sedative effect Local anesthetic effect
Reduces joint stiffiness Decreases bleeding
HEAT APPLICATION
Purpose:
• To promote wound healing,- Ex. Perilight
• To relieve discomfort – Ex. Hot packs
• To relieve muscle tension. – Ex. Warm bath
• To relive congestion in remote tissue – Ex. HWB
• To warm a part of the body . Ex. Hot compress
• To reduce edema . _ Ex. Hot compress
Guidelines in Heat Application

1. Determine the client’s ability to tolerate the pain
– Back of hands and feet – are not very sensitive to heat, while
– Inner aspect of wrist & forearm, neck & perineal areas – are temperature sensitive
– The larger the area exposed to heat & cold – the lower the tolerance
– Very young & very old – have lower tolerance
– Injured skin areas – are more sensitive to temperature variations
2. People feel hot & cold application most while the skin temperature is changing. After a period of time,
tolerance increases
3. Identify conditions that might contraindicate treatment.
– Ex. Bleeding
4. Explain the application to the client. Ask client to report any discomfort.
5. Return to the client 15 minutes after starting the heat and observe the local skin area for
any untoward signs (redness).
- Stop application if untoward reaction occurs.
6. Apply only at the designated time, no more- no less.
DIFFERENT METHODS OF HEAT APPLICATION

A. DRY HEAT
1. HOT WATER BAG
Temperature:- infant and debilitated – 40.5 to 46 ‘C
Children & healthy adults – 46 to 52
‘C
Republic of the
Philippines City of
Olongapo
GORDON COLLEGE
City Tel. No. (047) 224-2089 loc. 314
• Procedure:
– Fill the bag 2/3 full
– Expel air from bag & check for leaks by holding it upside-down
– Dry the bag and wrap it with a towel or cover before placing on body site to prevent burning.
– Maximum effect – after 20-30 mins
– Observe the treated area after 30 mins.
– If redness occurs – discontinue
2. Aquathermia or Aquamatic bag
• Temperature: Adults 40-5 ‘C
• Procedure:
– Do not crease the pad
– Do not apply pins to secure the pad in place.
– Fill 2/3 of distilled water
– Set at desired temperature, cover and plug the unit
– Procedure is usually – only for 10-15 minutes
3. Hot Packs
• Commercially prepared packs provide heat at a designated time.
• Instructions tell how to initiate the heating process. It could be by striking. Squeezing or kneading
the pack
4. Electric Pads
• Provide constant even heat and can be molded in a body part
• Temperature – can be controlled according to desired setting
• Procedure:
– Do not insert sharp objects
– Ensure that the body surface is dry to prevent electric shock
– Do not place under the client because heat cannot dissipate which can cause burning.
5. Heat Cradle
• A metal frame with a row of 25 watt light bulbs. It is placed over the client and covered with bath
or blanket sheet. Heat is provided by radiation. Assess client every 10 minutes.
6. Heat lamp or Infrared Lamp
• Is goose neck lamp with a 60 watt bulb. Heat is provided by radiation
• Procedure:
– Place 18-24 inches from the patient
– Skin must be clean and dry.
– Drape patient properly to provide privacy.
– Note skin color change every 5 minutes.
– Carry out procedure for 20 to 40 minutes 2x a day.
– After treatment, cover the area to protect from cold and drafts until skin has adjusted to
normal temperature.
B. MOIST HEAT
1. Hot Compress
• A compress is a several layer of moist gauze folded together to cover a body part, frequently to an
open wound( sterile technique must observed.)
• Procedure:
– Its purpose is to hasten the suppurative process
– If solution is gauze is irritating. Cover surrounding skin with sterile petroleum jelly.
– Soak gauze in solution, then wring it out so that it does not drip.
– Apply and pack snugly over wound.
– Cover gauze with dressing and piece of plastic and secure with tapes.
2. Hot Packs
Republic of the
Philippines City of
Olongapo
GORDON COLLEGE
City Tel. No. (047) 224-2089 loc. 314
• A moist cloth applied to the body area, usually unsterile
• Are applied to prevent muscle spasm or painful congestion to underlying organs.
• Procedure:
– After application of Hot pack, cover with moisture resistant plastic to contain moisture and
prevent transfer of airborne mo
3. Hot Soaks
• Is the direct immersion of a body surface or part into warm water or medicated solution
• Procedure:
– Temperature – 41- 43 “C
– Maintain T by discarding fluid and replacing it with every 5 minutes
– Usually applied for 15-20 minutes.
– If area has open wound, observe sterile technique.
4. Sitz/Hips Bath
• Is used to soak a patient’s pelvic area. The patient sits on a special tub or chair and is soaked up to the
umbilicus or midthights.
• Procedure:
– T – 40-43, lasts for 15 – 20 minutes
– Provide blanket over shoulder
– Observe for dizziness, fainting, accelerated PR and weakness.
COLD APPLICATION
Purpose:
1. To relieve discomfort as vasoconstriction prevents edema thus decreasing pressure and pain
2. To limit inflammation and suppuration
3. To control bleeding
Contraindications:
1. When there are poor circulation and nourishment to the area as manifested by
pallor, cyanosis, feeling of cold and numbness.
2. When there is fluid accumulation for it further retards flow
3. When body temperature is below normal
4. When there are muscle spasm.
METHODS OF COLD APPLICATION

1. ICE BAGS
• Procedure:
– Fill 2/3 full with ice chips
– Remove air from the bag and test for leaks
– Place cover to absorb moisture before application
– Apply for ½ to 1 hour only.
2. Cooling Blankets or Hypothermic Blankets
• Cooling blankets have coils where fluid circulates
• Procedure
– Clean skin & apply lotion or lanolin to protect the skin
– Place a thin cotton sheet between the cooling blanket and patient for comfort.
– Administer medication to suppress shivering
– Observe every 5-10 minutes, check vital signs, papillary response and level of
consciousness.
– Change position and massage skin every hour.
– Turn off blanket when patient’s temperature is 1’C to 2’C higher than desired
temperature
Republic of the
Philippines City of
Olongapo
GORDON COLLEGE
City Tel. No. (047) 224-2089 loc. 314
– Allow patient’s temp to warm naturally, use warm blanket if necessary to rewarm
patient gradually
– Monitor V/S until temp is normal
– Rewarming the patient too rapidly can cause shock
3. COLD COMPRESS
• The compress, usually a piece of cloth folded in several layers, is soaked in water containing ice cubes
to provide moist, cold and local applications. Used for injured eye, headache, toothache and
sometimes hemorrhoids
• Compress should be changes frequently and wrung to avoid dripping. Application lasts for 15-20
minutes and repeated every 2 to 3 hours.
4. ALCOHOL COLD SPONGE BATH
• Used most frequently to reduce body temperature. Plain water or water with alcohol may be used.
• Procedure:
– Prepare water with alcohol at 29.5 to 32 “C
– Add ice chips to water to bring temperature down to 18 ‘C
– Place ice bags on patient’s head and comfort and hot bags on feet to prevent shivering.
– Expose only the parts to be bathed
– Sponge face and forehead, neck and arms and legs for – 3-5 minutes and the back for – 10
minutes.
• Usually the anterior chest and abdomen are not sponge. Although they may be
bathed.
– Cover but do not dry each part being sponged
– Move from one part of the body to another and continue for 25-30 minutes.
– Pat the patient dry after bathing.
TOPIC 10: Massage of Back & Buttocks

Purpose:
To manipulate the soft tissues of back in order to improve the circulation & so:
a. Relieve discomfort due to congestion in the muscles
b. Promote relaxation of the muscles
Provide a soothing comfortable sensation – a feeling of a well being
Stroking (Effleurage)
Principles;
A. The HAND of the midwife:
1. Should be relaxed so that it fits the part of the body being treated.
2. Should move slowly, smoothly & rhythmically over the surface.
o if the skin is dry, a small amount of cold cream or mineral should be used.
o if moist & sticky – TALCUM POWDER may be used.
3. Pressure should be firm & gentle pressure and never cause pain.
o Heaviest pressure should be in the upward direction toward the heart or in the direction of
the venous stream (it is downward of the neck ).
o Light pressure should be downward.
4. Should be in contact with the skin at all times and return to the starting point of the stroke.
5. B. POSTURE
1. The patient should be in comfortable position and relax.
● There should not tight clothing to bind.
2. The midwife should be relaxed standing w/ one foot in front of the other.
● Motion should be at ankle and shoulder joints to obtain rhythm in movement of hands.
Republic of the
Philippines City of
Olongapo
GORDON COLLEGE
City Tel. No. (047) 224-2089 loc. 314
C. Massage is NOT applied to the part w/c are edematous and painful unless ordered by physician.
D. Heat if applied before the massage will exchange its action.
MOVEMENT USED:
1. STROKING (Effleurage)
● A long sweeping movement w/ palm of the
head conforming to the contour of the surface
treated.
● Over small surface (on the neck) the thumb and
fingers are used.
● The pressure may vary from superficial to deep.
● Strokes should be slow, rhythmical and gentle w/
pressure constant and in the direction of the venous
stream.
● Superficial stroking produces a reflex effect of
cutaneous stimulation resulting in increased circulation.
● Deep stroking produces a mechanical effect on the
circulation.
2. KNEADING
Is performed w/ the ulnar side of the palm resting on the
surface and the fingers and thumbs grasping the skin &
subcutaneous tissues.
Which move w/ the hand of the operator & thus the
underlying structures are massaged by the pressure of the
fingers.
A variation of pressure maybe used; superficial deep.
kneading
friction
3. FRICTION
Is performed w/ the whole PALMAR surface of the hand or the fingers & thumbs over limited areas.
This movement is a CIRCULAR form of kneading w/ pressure against the underlying part of a tissue w/c
cannot be grasp.
4. HACKING
KARATE
Edge of the tissue 2-3 motion.
Republic of the
Philippines City of
Olongapo
GORDON COLLEGE
City Tel. No. (047) 224-2089 loc. 314
5. PINCHING
● Elevation of the tissues 2-3 inches.
6. PETRISSAGE
● Pinching of the skin, subcutaneous tissues & muscle as you move up &
down the patient’s back.
PREPARATION OF THE PATIENT (Massage of the back & Buttocks)
1. Pan fold top sheet & place with bath blanket.

2. Remove gown & abdominal binder.
3. Bring patient to the near side of bed & place in proper position. For relaxation
a. place small pillow or folded towel under abdomen.
b. feet over edge of mattress and
c. remove pillows
●If prone position is not possible, place in lateral position w/ a pillow supporting the upper moist
flexed lower extremity.
4. Wash back with warm water.
PROCEDURES (PREPARATION OF THE PATIENT)

A.OVER THE BACK
1. Apply to back & buttocks cold cream or talcum to reduce friction.
2. Superficial stroking to distribute the lubricant or powder. Begin w/ the neck & shoulders then proceed
over the entire back. Return to neck w/ alternate stroking.
3. Superficial palmar stroking downward the length of the spine. Return the neck w/ alternate stroking.
4. Superficial kneading to the FAR SIDE of the back and then to NEAR SIDE of back. Return to neck w/
alternate stroke.
5. Deep thumbs kneading to both sides of spine, pushing muscles away from spine w/ movement &
pressure upward. Return to neck w/ alternate stroking.
6. Straight deep kneading to both sides of the spine using fist & second fingers of one hand on each side
of spine & reinforcing w/ the other hand. Return to neck w/ alternate stroking.
7. Deep stroking is the same type of movement as no.2 superficial stroking w/ increased pressure in
the direction of the venous system.
8. Friction w/ tips of fingers over neck & upper borders of shoulders changing to the palm for the back.
9. Deep kneading is the type of movement as no.4 superficial kneading w/ the deeper grasp of the skin
and subcutaneous tissues.
10. Deep transverse kneading a wringing action from neck to buttocks. Return to neck w/ alternate stroking.
11. Superficial stroking (no.2)
B. OVER BUTTOCKS
1. Superficial stroking
Republic of the
Philippines City of
Olongapo
GORDON COLLEGE
City Tel. No. (047) 224-2089 loc. 314
2. Superficial kneading
3. Deep stroking
4. Friction
5. Superficial stroking of back and buttocks
6. Superficial palmar stroking downward over beginning w/ a heavy stroke and gradually changes to feather-
like stroke.
TOPIC 11: COMFORT MEASURES

 COMFORT MEASURES – measure to relieve discomfort such as changing position of patients,
providing a comfortable bed, avoiding glaring light/noise.
PURPOSES OF BATHING:
CLEANSING THE SKIN – cleansing removes perspiration, some bacteria, sebum, and dead skin cells, which
minimizes skin irritation & reduces the chance of infection.
STIMULATION OF CIRCULATION – Good circulation is promoted through the use of warm water & gentle
stroking of the extremities.
IMPROVED SELF-IMAGE – Bathing promotes relaxation & a feeling of being refreshed & comfortable.
REDUCTION OF BODY ODORS – Excessive secretion of sweat from apocrine glands located in the axilla &
pubic area causes unpleasant body odors. Bathing & use of antiperspirants minimize odors.
PROMOTION OF RANGE OF MOTION (ROM)- Movement of the extremities during bathing maintains joint
function.
TYPES OF THERAPEUTIC BATHS:

1. HOT WATER TUB BATH – Immersion in hot water relieves muscle soreness & spasm.
o The danger of causing burns exists.
o Water Temp: 45’-46’C(113’-114’F)
2. WARM WATER TUB BATH
o Bathing in warm water relieves muscle tension.
o Temp of water: 43’C(109”F)
3. COLD WATER BATH
o Bathing in cool water can relieve tension & lower body temperature
o Temp of Water – 37’C or 98”F) – tepid rather than cooling- to avoid chilling & to promote slow
cooling
o TYPES OF THERAPEUTIC BATHS
4. SOAK
o Local application of water or a medicated solution can remove dead tissue or soften encrusted
secretions.
o An antiseptic technique is necessary
o It is useful in reducing pain & swelling of inflamed or irritated surfaces
5. SITZ BATH
o A sitz bath cleanses & reduces inflammation of the perineal & anal areas of a client who has
undergone rectal or vaginal surgery or childbirth or who has local rectal irritation from
hemnorrhoids or fissures
o Water Temp – 43-45’C(100’F)
o The bath – may be given before breakfast or an hour before breakfast
o offer bedpan or urinal before bath –
Republic of the
Philippines City of
Olongapo
GORDON COLLEGE
City Tel. No. (047) 224-2089 loc. 314
ELIMINATION
BOWEL ELIMINATION
o NORMAL DIGESTION AND ELIMINATION
The GI tract is the series of hollow mm lined-muscular organs.
 The purposes of these organs:
- are to absorb fluid and nutrients,
- prepare food for absorption & use by the body’s cells, &
- to provide for temporary storage of feces.
o FACTORS AFFECTING ELIMINATION
1. AGE
o Infant – has a small stomach capacity & less secretion of digestive enzymes
- unable to control defecation because of lack or neuromuscular development.
o Adolescent – there is a rapid growth of the large intestine, the secretion of HCL increase.
o OLDER ADULTS – often experiences changes in the GI system that impair digestion & elimination.
o The amount of digestive enzymes in saliva & the volume of gastric acid decrease with aging.
2. DIET –
3. FLUID INTAKE
4. PHYSICAL ACTIVITY
5. Psychological factors
6. Personal habits – A busy work schedule may disrupt habits & results in alterations such as constipation.
7. Position during defecation – Squatting is the normal position during defecation
8. Pain
9. Pregnancy
10. Medications
DEFECATION
o is the expulsion of feces from the rectum. It has an involuntary phase.
 When the feces enters the rectum, the local distension & the pressure gives rise to sensory
impulses that initiate reflex impulses to the internal anal sphincter and to the muscle tissue
of the sigmoid colon and the rectum.
 The sphincter relaxes & the muscle tissue contracts, moving he feces into the anal canal.
 The external anal canal sphincter in under voluntary control and must also relax for
evacuation of the rectum.
NORMAL CHARACTERISTIC OF STOOL
o COLOR: yellow or golden brown -(due to bile pigment derivative known as stercobilin)
Substance giving color.
o ODOR: aromatic upon defecation
( due to indole & skatole, which are products of fermentation & putrefraction in the large intestine).
Indole/Skatole – amino acid excreted in the urine.
o AMOUNT: depends on the bulk of food intake, between 150-300 g of feces/d; 75 % water & 25% solid
o CONSISTENCY: SOFT, FORMED
o SHAPE: CYLINDER
o FREQUENCY: variable, usual range 1-2/d to 1 to 2-3 days
ALTERATION IN CHARACTERISTICS OF STOOL

1. ALCOHOLIC STOOL-gray, pale or clay-colored stool due to biliary obstruction.
2. HEMATOCHEZIA – passage of stool with bright red blood. It is due to lower gastrointestinal bleeding.
Republic of the
Philippines City of
Olongapo
GORDON COLLEGE
City Tel. No. (047) 224-2089 loc. 314
3. MELENA – Passage of black, tarry stool. It is due to upper g.i. bleeding.
4. STEATORRHEA – Greasy, bulky, foul smelling stool.

o It is due to hepatobiliary-pancreatic obstruction/disorders.
 Hepato- liver
 Biliary – bile duct, secrete fluid thick alkaline by liver
 Pancreatic- deudenum, secrete pancreatic juice
COMMON FECAL ELIMINATION PROBLEMS

1. CONSTIPATION
- Refers to the passage of small, dry hard stools or the passage of “no stool” for a period of time.
MEASURES TO RELIEVE CONSTIPATION
1. Adequate fluid intake.(1,500-2,000ml/d)
2. High-fiber diet.To provide bulk to the stool. High fiber foods include fresh or cooked fruits & veg with
their skin, whole grain breads and cereals.
3. Establish regular pattern of defecation.
4. Respond immediately to the urge to defecate.
- The defecation reflex & the urge to defecate subside after a few minutes if the initial urge is
ignored.
- The feces remain in the rectum until another mass colonic movement propels more stools
into the rectum, which may not be for several hours or longer.
5. Minimize stress. Stress triggers the sympathetic nervous system, causing decrease peristalsis.
6. Assuming sitting or semi-sqautting position. This position allows gravity to assist the elimination of feces and
also makes it easier for the client to contract the abdominal and pelvic muscle.
7. Administered laxatives as ordered. Laxative stimulate peristalsis & promote defecation. Avoid overuse
of laxative because natural defecation reflexes are inhabited, rebound CONSTIPATION occurs.
8. More fruits, nuts, veg & whole grains in meal prep.
- Ex:
• rice, mongo, beans, corn
• Papaya, pineapple, prunes, oranges, watermelon
• NO FIBERS: Fish, milk, meat & eggs
TYPES OF LAXATIVES
a. CHEMICAL IRRITANTS
- They provide chemical stimulation to intestinal wall, thereby increasing peristalsis.
Ex: dulcolax (bisocodyl)
castor oil
senokot (senna)
b. STOOL LUBRICANTS
- They lubricate feces & facilitates its expulsion.
Ex; mineral oil
c. STOOL SOFTENERS
- They soften the stool & facilitate its expulsion.
Ex: colace
d. BULK-FORMERS
- They increase the bulk of feces, increasing mechanical pressure & distention of intestine, thereby
increasing peristalsis.
Ex: Metamucil
e. OSMOTIC AGENTS
- They attack fluids from the intestinal capillaries to the stool.
Ex: milk of magnesia
Republic of the
Philippines City of
Olongapo
GORDON COLLEGE
City Tel. No. (047) 224-2089 loc. 314
2. FECAL IMPACTIONS
- Is a mass or collection of hardened, putty like-feces in the folds of the rectum.
- Results from unrelieved constipation
Obvious signs: inability to pass a stool for several days despite a repeated urge to defecate.
ASSESSMENT (Fecal Impaction)
- Passage of liquid fecal seepage.
- Hardened fecal mass is palpated during digital examination of the rectum.
- Nonproductive desire to defecate & rectal pain.
- Anorexia (loss of appetite)
- Abdominal distension.
- Nausea & vomiting.
MEASURES TO RELIEVE FECAL IMPACTION:
- Manual extraction of fecal impaction.
- Increase fluid intake.
- Sufficient bulk in diet.
- Adequate activity & exercise
3. DIARRHEA
- Refers to the passage of liquid feces & increased frequency of defecation.
MEASURES TO RELIEVE DIARRHEA
- Replace fluid-electrolyte loss.
- Provide good perineal care.
- Promote rest.
- Diet: Small amount of bland foods:Low fiber diet
BAR diet (banana, apple & rice am)
Avoid excessively hot or cold fluid.
Potassium-rich foods & fluids (banana,Gatorade).
ANTIDIARRHEAL medications as ordered:
o DEMULCENTS – mechanically coat the irritated bowel & act as protectives.
o ADSORBENTS – absorb gas or toxic substances from the bowel.
o ASTRINGENT – shrink swollen or inflamed tissues.
CAUTION:
“Do not administer antidiarrheal at the start of diarrhea. Diarrhea is a body’s protective mechanism
to rid itself to bacteria & toxins.
4. FLATULENCE
o Is the presence of excessive gas in the intestines (also, tympanites)
o Due to the swallowed air, bacterial action in the large intestine and diffusion from blood.
COMMON CAUSES OF FLATULENCE:

1. Constipation
2. Codeine (analgesic, oral injection-to relieve pain/cough)
* Barbiturates (meds that depress the function of CNS
3. Anxiety
4. Eating gas-forming foods.( cabbage, onions, rootcrops, legumes)
5. Abdominal Surgery. (opening of the abdomen).
MEASURES TO RELIEVE FLATULENCE

a. Avoid gas-forming foods.
Republic of the
Philippines City of
Olongapo
GORDON COLLEGE
City Tel. No. (047) 224-2089 loc. 314
Ex: carbonated, chewing gums
b. Provide warm fluids to drink.
c. Early ambulation. (activity)
d. Adequate activity & exercise.
e. Limit carbonated beverages, use of drinking straws & chewing gum.
f. Rectal tube insertion as ordered. (Enema)
- Place client in left lateral position
- Insert 3-4 inches of the lubricated rectal tube, gently in rotating motion
- Use rectal tube Fr 22-30
- retain rectal tube for maximum of 30 minutes
g. Carminative Enema as ordered.
(to expel flatus 60-80 mls fluid introduced.
h. Administer cholinergics as
ordered. Ex: prostigmin
5. FECAL INCONTINENCE
– is the ability to control passage of feces and gas from the anus.
- Physical conditions that impair & sphincter function or control can cause
incontinence.
- Condition that create frequent loose large volume watery stools also predispose to
incontinence.
NURSING MEASURES TO HELP THE PATIENT WITH FECAL INCONTINENCE:
1. Take into account that the patient suffers from embarrassment. The patient requires emotional
support and understanding.
2. Note when incontinence is most likely to occur, & place the patient on a bedpan at those times.
If there is NO pattern, offer a bedpan at regular intervals.
3. Keep the skin clean & dryby using proper hygieneic measures.
Change bed linens and clothing as necessary to avoid odor, skin irritation, & embarrassment.
CATHARTIC – drug that acts to promote bowel evacuation
LAXATIVE – drug that acts to promote bowel evacuation
Topic 12: ENEMA

o Is installation of a solution into the rectum & sigmoid colon.
o Is a procedure of emptying the colon of fecal matter.
o It is not routine procedure in preparation of woman in labor, it is only done to:
 Prevent infection
 Facilitate descent of fetus.
 Stimulate uterine contractions
PURPOSES OF ENEMA
- To relieve constipation.
- To relieve flatulence (excessive gas).
- To administer medications.
- To lower body temperature.
- To evacuate feces in preparation for diagnostic procedure or surgery.
COMMONLY USED ENEMA

TAP water.
FLEET enema.
PREPACKED disposable enema (private pt).
CONTRAINDICATIONS TO ENEMA
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GORDON COLLEGE
City Tel. No. (047) 224-2089 loc. 314
1. Not given during active phase (old)
- May cause precipitate delivery 4-7cm cervix dilatation.
2. Vaginal bleeding
3. Ruptured bag of water
- Tendency to deliver delivery anytime.
4. Abnormal fetal presentation & position
- May cause complications
5. Fetus not yet engaged. (premature labor)
6. Premature labor because of the danger of cord prolapse.
7. Abnormal FHR pattern.
THE MOST COMMON USE OF AN ENEMA

- Temporary relief of constipation.
- Removing impacted feces.
- Emptying the bowel before diagnostic tests, surgery or childbirth & beginning a program of
bowel training.
REMEMBER
- Discourage those client’s to rely on enemas to maintain bowel regularity.
- Enemas do not treat the cause of constipation.
TYPES OF ENEMA
1. CLEANSING ENEMA- Stimulate peristalsis by irritating the colon & rectum &/or by distensing the intestine
with the volume of fluid introduced.
o Non-retention
a. High Enema – to clean as much as of the entire colon as possible.

> 1000 mls of solution is introduced to an adult.
High enema – fluid is delivered at a high pressure by raising the enema container to a high level.
(1,000mls of solution is introduced to an adult)
Infant - 150 - 250 ml
Toddler- 250 – 350 ml
School Age - 300 – 500 ml
Adolescence -500 – 750 ml
Adult 750 – 1000 ml
b. LOW-ENEMA- to clean the rectum & the sigmoid colon only.

- 500 mls of the solution is introduced to an adult
4 TYPES OF CLEANSING ENEMA

1. TAP WATER
2. NORMAL SALINE
3. HYPERTONIC SOLUTION
4. SOAP SUDS
Remember: Each solution exerts a different osmotic pressure, influencing the movement of fluids
between the colon & interstitial spaces beyond the intestinal wall.
1. TAP WATER (500-1000 ml)

- Is hypotonic & exerts a lower osmotic pressure.
- It should not be repeated because water toxicity or circulatory overload can develop if large amount
of water are absorbed.
2. NORMAL SALINE
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- The safest solution to use because it exerts the same osmotic pressure.
- 9 ml of NaCl to 1000ml of water
- Home preparation of SALINE:
- 500 ml (1 pint) of Tap water mixed w/ 1 teaspoon of table salt can be substituted
3. HYPERTONIC SOLUTIONS
- Infused into the bowel exert osmotic pressure that pulls fluids out of interstitial spaces.
- 120-180 mls (4-6 oz) usually effective.
- Fleet enema is the most commonly used.
4. SOAP SUDS
- Maybe added to Tap water or saline to create the effect of intestinal irritation.
o Only pure “castile soap” is safe.
o Harsh soaps or detergents can cause serious bowel inflammation.
o 20 ml of castile soap in 500-1000 ml of water
o The recommended ratio of “soap” to solution is: 5 ml (1 teaspoon) of castile soap to 1000ml
of warm water or saline
2. CARMINATIVE ENEMA
- To improve expel flatus
- Provide relief from gaseous distention (flatulence)
- 60-180 mls of fluid is introduced
3. RETENTION ENEMA
- Introduces oil into the rectum & sigmoid colon.
- Oil retained in 1 to 3 hours.
- Acts to soften the feces & to lubricate the rectum & anal canal, facilitating passage of feces.
4. RETURN-FLOW ENEMA/HARRIS FLUSH/COLONIC IRRIGATION
- Used to expel flatus
- 100-200 mls of fluid is introduced into & out of the large intestines to stimulate peristalsis
& expulsion of flatus.
- The solution container is lowered so that the fluid backs out through the rectal tube into
the container.
STEPS OF RETURN-FLOW ENEMA

1. Wash hands.
2. Assess if client understand procedure.
3. Apply gloves.
4. Place absorbent pad on bed under client & assist into left lateral position.
5. Heat solution to desired temperature.
6. Pour solution into the bag or bucket, open clamp & prime tubing.
7. Clamp tubing when primed.
8. Lubricate 5 cm of the rectal tube unless the tube is prelubricated.
9. Hold the enema container level w/ the rectum. Have the client take a deep breath.
10. Simultaneously insert rectal tube into rectum.
10. Raise the solution container to the appropriate height & open clamp.
11. Slowly administer approximately 200cc of solution.
12. Clamp the tubing & lower the enema container 12-18 inches below the client’s rectum. Open clamp.
13. Observe the solution container for air bubbles & fecal particles as the solution returns.
14. When no further solution is returned, clamp the tubing & raise the enema container as before.
15. Open the clamp & instil approximately 200cc of fluid.
16. Repeat until no further flatus is seen or the institutional guidelines have been met.
17. After the final return, clamp the tubing & remove the tubing. Clean the anus w/ tissue.
18. If the client needs to empty his rectum, assist him to the bedpan, bathroom, or commode.
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19. Instruct client not to flush the toilet.
20. When the client is finished, assist him to clean the perineal area.
21. Return the client to a comfortable position on a protective pad.
22. Observe any expelled solution.
23. Remove gloves & wash hands.
24. Document the results of the enema.
- The inflow-outflow process is repeated 5-6 times.
- Replace the solution several times during the procedure as it becomes thick with feces.
5. OIL RETENTION ENEMA

- Lubricate the rectum & colon
- The feces absorb the oil & become softer & easier to pass.
- To enhance of the oil, the client retains the enema for several hours if possible.
6. SEDATIVE ENEMA
- Induced sleep, calming effect, relieving anxiety & tension.
7. MEDICATED ENEMAS
- Contains drug, treatment to reduce m.o.,bacteria
o Ex: sodium Polystyrene Sulfonate (Kayexalate)
- Used to treat client’s w/ dangerous high serum potassium level.
o Appropriate size of rectal tube:
o Adult #22-#30Fr
o Child #12-#18Fr
o Correct volume of solution:
o 40.5’-43’C(105-109F)-Adult
o 37”(98’F) - Child
NON-RETENTION ENEMA
a. Solutions:
- Tap water (500-1,000 mls)
- Soap Suds (20 ml of castle soap in 500-1,000 ml of water)
- NSS (9 ml of Nacl to 1000 ml of water)
- Hypertonic Solution/Fleet Enema (90-120 ml)
b. Height of Solution:
 18 inches above the rectum
c. Temperature of Solution:
 115 degree to 125 degree F on preparation
d. Time of retention:
 5 to 10 mins
RETENTION ENEMA
a. Solutions:
- Carminative Enema (60-180 mls)
- Oil Retention (90-120 ml of mineral, olive, cottonseed oil)
b. Height of Solution:
- 12 inches above the rectum
c. Temperature of Solution:
- 105 degree to 110 degree F on preparation
d. Time of retention:
- 1 to 3 hours
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NURSING INTERVENTION IN ENEMA ADMINISTRATION

1. Check the doctor’s order.
2. Provide privacy. To prevent the feeling of embarrassment.
3. Promote relaxation. To relax anal sphincter and facilitate insertion of rectal tube.
4. Position the client
- Adult: left lateral position
- Children: /Infant: dorsal recumbent
5. Sizes of rectal tube to be used :
- Adult: Fr 22-32
- Children: Fr 14-18
- Infant: Fr 12
6. Lubricate 5 cm (2 In) of the rectal tube
- Allow solution to flow through the connecting tubing and rectal tube to expel air before
insertion of rectal tube.This prevents introduction of air into the colon.
7. Insert 7-10 cm(3-4 in) of rectal tube gently in rotating motion. To prevent irritation of anal and rectal tissues.
8. Introduce solution slowly. To prevent sudden stimulation of peristalsis, and the client can better tolerate
introduction of solution.
9. Change the position to distribute solution well in the colon(high enema); if low enema, remain in left
lateral position
10. If the order is cleansing enema:
 Give the enema 3 x
 Alternate hypotonic solution with isotonic solution to prevent water intoxication or
hypoosmolar fluid imbalance.
11. If abdominal cramps occur during introduction of solution, temporarily stop the flow of solution
by clamping the tube until peristalsis relaxes.
12. After introduction of the solution, press buttocks together to inhibit the urge to defecate.
13. Ask the client who is using the toilet not to flush it. The midwife must observe the return flow.
14. Do perineal care.
15. Make relevant documentation.
Topic 13: URINARY ELIMINATION- The major role of the urinary system – is to maintain homeostasis or
maintaining body fluid composition and volume.
COMPONENTS OF URINARY SYSTEM

1. Kidney –
- two bean-shaped organs located retroperitoneally at the level of the twelfth thoracic & third
lumbar vertebra.
- the organs that forms urine.
- The right kidney is slightly LOWER than the left kidney:- due to the presence of liver on the right side
of abdomen.
o The kidney is divided into renal cortex, medulla(composed of series of pyramids) & pelvis
- NEPHRONS- the functional units of the kidney which composed of glumerous & renal tubules.
o The primary function of nephrons is formation of urine.
o About 1,200 ml of blood flows to the kidneys/min, which is 20-25% of cardiac output.
o Through the formation of urine;
 the kidneys: remove waste products from the body,
 regulate fluid volume, &
 maintain electrolyte concentration, BP & pH within the body.
o The glomerular filtration rate(GFR) - 125ML/min.
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o From this, the kidneys form 0.5 to 1 ml/min, 60 mls/hr, & approximately 1,500 mls/day of
urine
2. URETERS –
- two small tubes about 25 cm long.
- transport urine from the renal pelvis to the urinary bladder.
- The ureters enter the urinary bladder obliquely & is guarded by ureterovesicular sphincter.
- These 2 factors prevent reflux of urine as bladder contracts.
3. URINARY BLADDER
- It serves as reservoir for urine, storage of urine
- It is composed of 3 layers of destrusor muscles. Contraction of these muscles expels urine
from the bladder
- The bladder is guarded by internal urethral sphincter in the junction of its opening into the
urethra.
- The trigone is a triangular region in the floor of the bladder that is marked by the openings
for the 2 ureters and internal urethral orifice.
- The approximate maximum capacity of the bladder is 1,000 mls. of urine.
-
4. URETHRA
- The urethra is the passageway of the urine into the external environment.
- The internal urethra sphincter is a voluntary muscle.
- FEMALE urethra: 1 ½ to 2 ½ inches,
- MALE urethra : 5 ½ to 6 ½ inches up to 8 inches in length
URINE FORMATION(3 STEPS IN FORMATION OF URINE BY THE KIDNEY:

1. GLOMERULAR FILTRATION
- Water & solutes move from the blood to the glomerular capsule.
- The fluid that enters the capsule is called glomerular filtration.
2. TUBULAR REABSORPTION
- It is the movement of the substance from the filtrate in the kidney tubules into the blood in
the peritubular capillaries.
- Water & other substances that are useful to the body are reabsorbed. Water is reabsorbed by
osmosis, while most solutes are reabsorbed by active transport.
3. TUBULAR SECRETION
- It is the transport of substances from the blood into the renal tubules. Potassium and hydrogen
are preliminary eliminated from the body. Ammonia, uric acid, some drug metabolites are likewise
eliminated.
MICTURITION
o Is the act of expelling urine from the bladder(urination, voiding)
- Normal characteristics of URINE:
o COLOR: Amber/straw
o ODOR: aromatic-upon voiding
o TRANSPARENCY: Clear
o pH: slightly acidic(4.6-8, AVERAGE 6)
o Specific gravity: 1.010-1.025(This measured by URINOMETER OR URINOMETER)
A. ALTERED URINE PRODUCTION

POLYURIA/DIURESIS – the production of excessive amount of urine(100ml/hr or 2500/d)
OLIGURIA – the production of decreased amount of urine such as less than 30ml/hr or less 500ml/24
hours.
ANURIA/urinary suppression – The absence of production of urine by the kidneys such as 0-10ml/hr
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B. ALTERED URINARY FREQUENCY

1. FREQUENCY. Voiding at frequent intervals
2. NOCTURIA – Increased frequency at night
3. URGENCY – The strong feeling that the person wants to void. They may or may not be a great amount of
urine in the bladder.
4. DYSURIA – Voiding that is either painful or difficult.
5. HESITANCY- Difficulty in initiating voiding.
6. ENURESIS – Repeated involuntary voiding beyond 4-5 years of age.
7. POLLAKURIA – Frequent, scanty urination
8. URINARY INCONTINENCE
A. TOTAL INCONTINENCE – A continuous & unpredictable loss of urine.
B. STRESS INCONTINENCE – The leakage of less than 50 ml of urine as a result of a sudden increased in
the intra-abdominal pressure, (e.g. when one coughs, sneezes, laughs or exerts physically.)
C. URGE INCONTINENCE- Follows a sudden strong desire to urinate and leads to involuntary detrusor
contraction
D. FUNCTIONAL INCONTINENCE. – The involuntary unpredictable passage of urine.
E. REFLEX INCONTINENCE – is an involuntary of urine in the bladder with associated inability of the
bladder to empty itself.
9. RETENTION – The accumulation f urine in the bladder with associated inability of the bladder to empty itself.
- 250-450 ml of urine in the bladder triggers micturition reflex.
C. ALTERED URINE COMPOSITION

1. URINARY TRACT INFECTION
- RBC, WBC, pus (Pyuria), Bacteria(bacteriuria), Albumin(albuminuria), Protein(Rroteinuria)
2. DIABETIC KETA ACIDOSIS
- Casts(Cylinduria), Glucose(Glycosuria), Ketones(Ketonuria),
CLINICAL SIGNS OF URINARY RETENTION

- Discomfort in the pubic area.
- Bladder distention(palpation & percussion)
o Smooth, firm, ovoid mass at the suprapubic area.
o Mass arising out of the pelvis.
o Dullness on percussion
- Inability to void of frequent voiding of small volumes(25-50ml at a time)
- A disproportionately small amount of output in relation to fluid intake.
- Increasing restlessness and feeling of need to void.
NURSING INTERVENTION TO INDUCE VOIDING:

o Provide privacy. This is the most nursing measure to induce voiding.
o Provide fluids to drink,
o Assist the patient in the anatomical position of voiding.
o Serve clean, warm and dry bedpan or urinal
o Allow the patient to listen to the sound of running water
o Dangle fingers in warm water.
o Pour warm water over the perineum
o Promote relaxation
o Provide adequate time of voiding
o Perform Crede’s maneuver as ordered - by applying pressure on the suprapubic area.
o Administer cholinergics(Urecholine(Bethanecol) as ordered.
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o Last resort: Urinary catheterization.
URINARY CATHETERIZATION
- Single Catheterization: Straight/Nelaton catheter
- Retention: 2-way foley catheter
PURPOSE:
- To relieve bladder distention
- To instill medications into the bladder
- To irrigate the bladder
- To measure hourly urine output accurately.
- To collect urine specimen
- To measure residual urine(the amount of urine retained in the bladder after forceful voiding)
- To maintain continence among incontinent clients.
- To promote healing of the genitor-urinary structures postoperatively.
- To empty the bladder in preparation for diagnostic procedure and surgery.
NURSING INTERVENTIONS IN URINARY CATHETERIZATION

1. Verify doctor’s order and identify client.
2. Explain the procedure and purpose to client
3. Provide privacy
4. Promote relaxation to relax urethral sphincter.
5. Practice strict asepsis to prevent ascending UTL.
6. Do perineal care before the procedure. To minimize mo at the external genitalia
7. Use appropriate size of catheter:
 Male: Fr 16-18
 Female: 12-14
8. Have adequate lighting
 NURSING INTERVENTIONS IN URINARY CATHETERIZATION
9. Position the patient during urinary catheterization
- Male: Supine, legs abducted and extended
- Female: Dorsal recumbent position
10. Use sterile gloves
11. Locate the urinary meatus:
- Male: at the tip of the glands penis
- Female: between the clitoris and vaginal orifice
12. Cleanse urinary meatus with antiseptic solution using downward stroke.
13. Lubricate catheter with water soluble lubricant before insertion to reduce friction and prevent trauma.
14. Insert catheter gently in rotating motion. Instruct the client to slow deep breaths to relax sphincter,
or strain as if sttempting to void to open urinary meatus.
15. Length of catheter insertion:
- Male: 6-9 inches
- Female: 3-4 inches
16. During insertion of the catheter in male, hold the penis at 90 degree angle or penpendicular to the
body. To straighten the urethra and facilitate catheter insertion
17. DO not remove more than 1,000 ml of urine at a time.
18. For retention catheterization, inflate the balloon 5 ml of NSS.
19. Gently pull the catheter. If resistance is felt, the catheter balloon is properly inflated in the bladder
20. Anchor catheter properly.
- Male: laterally to upward over the lower abdomen to prevent penoscrotal pressure.
- Female: inner aspect of the thigh, providing enough :”give” so it will not pull when the legs
move.
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21. Attach the drainage bag to the bed frame, ensuring that tubing does not fall into dependent loops
TOPIC 14: BASIC NUTRITION
Nutrition – the science of foods & their nutrients, their action, interaction, & balance in relation to health &
disease, & the processes when any human being ingest, digest, absorbs, transport, utilizes or store, & excrete
food’s waste products.
FOOD – any substance, organic or inorganic, when ingested or eaten nourishes our body by building and
repairing cells & tissues, supplying heat & energy, & regulating bodily processes.
NUTRIENT – a chemical component of food needed by the body for one or more of these functions, to provide
energy, to build & repair cells and tissues of the body, & to regulate bodily processes.
NUTRITIONAL STATUS OR NUTRITURE – the condition of the body resulting from utilization of essential
nutrients.
CLASSIFICATIONS:
1. GOOD NUTRITION – the body has adequate supply of essential nutrients that are efficiently utilized such
as that growth & good health are maintained at the highest possible level.
MALNUTRITION – the opposite of good nutrition. The condition of the body resulting from lack of one or more
essential nutrients or it may be due to an excessive nutrient supply to the point of creating toxic or harmful
effects(overnutrition or hypervitaminosis)
FACTORS CAUSING MALNUTRITION

A. PRIMARY FACTOR – refers to faulty diet. Nutrient intake Is lacking in quantity, quality, proper
combination of food in a given individual.
1. poverty
2. ignorance or lack of education
3. poor food habit
4. limited food supply
5. low food supply
6. poor distribution of food
7. cultural taboos
8. poor environmental sanitation
B. SECONDARY FACTORS – are multiple & include all factors within the body that reduce the ultimate
supply of nutrient to the cells after the food goes beyond the mouth.
DIETETICS – the combination of art & science of feeding of an individual or groups according to the principles
of nutrition & management which includes consideration of the planning of meals for the healthy & the sick
with the selection, storage, preparation, and serving of food with due consideration of economic, social, &
psychological factors.
NUTRITIONIST – one who investigate and gives information on nutrition
DIETETIAN – one who prepares diet & supervise or administers food services
INGESTION – the act of taking in food

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DIGESTION – the preparation of food from the alimentary tract to the blood & lymphatic circulation. It is
conversion of food into absorbable substance in the gastrointestinal tract, mechanical breakdown, chemical
breakdown
ABSORPTION – the passage of food (digested foods, the nutrient) from the alimentary tract to the blood and
lymphatic circulation
ASSIMILATION – the taking up of nutrients, form the blood by cells.
METABOLISM – the word used to indicate the chemical changes which takes place in the cells & tissues which
are necessary for the fulfillment of vital function
ANABOLISM – the building up or compress which include digestion to the storage of nutrients.
CATABOLISM – the breaking down of complex & the utilization stored substances
EXCRETION – the throwing out or elimination of waste products of the body
HORMONES – are organic substances produced by special cells of the body which are discharge into the blood
to be circulated and brought to specific organ or tissues that are remote from the source or point of
manufacture.
ENZYMES – organic catalyst that are protein in nature and are produced by living cells,
ALIMENTOLOGY – the science of nutrition
CLASSIFICATION OF NUTRIENTS ACCORDING TO:

A. FUNCTION:
1. Nutrients that build and repair body cells and tissues
2. Nutrient that gives heat and energy
3. Nutrients that regulates bodily processes
B. CHEMICAL NATURE
1. Organic substances are those carbon containing with the exception of carbonated
cyanide Ex. Protein, fat, carbohydrate, vitamin
2. Inorganic are those without carbon
Ex. Water, minerals
C. ESSENTIALITY
1. Physiologic
2. Dietary
D. CONCENTRATION
1. MACRONUTRIENTS – present in large amount in the body
Ex. Water, protein, fat, carbohydrate
2. MICRONUTRIENTS- present in small amount in the body
Ex. Vitamins, & minerals
E. SOURCES
1. PLANT – vegetable & fruits, sugar
2. ANIMALS – meat sources, milk, egg fats
3. SEAFOODS – fishes, crabs, shrimp, squid
PASSAGES OF FOOD in ALIMENTARY TRACT

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Mouth (salivary gland-pharynx-esophagus-stomach-phylorus-duodenum), liver, gallbladder, spleen) jejunum,
ileum, cecum, ascending colon-transverse colon-descending colon-sigmoid- rectum-anus
PROCESSES OF FOOD
Ingestion-digestion-absorption-transportation-assimilation-utilization or the storage-utilization-excretion from

the digestion- the indigestible parts of food will go to the colon form into feces
ANTOINE LAURENT LAVOISER – father of nutrition
DR. FLORENTINO O. SANTOS – father of nutrition in the Philippines
LUNIN – father of vitamins
JULY – nutrition month of the Philipppines
PROTEIN – are large complex organic compound composed of amino acids are the building unit
CHON
The only nutrient that contain NITROGEN
Functions:
1. Of primary importance: builds & repair body cells & tissues
( Note: all cells and body fluids contain protein, except bile, urine ,sweat)
2. Regulates some bodily processes.
a. HEMOGLOBIN AND IRON – being protein which is the chief constituent of RBC nourshes the
body by carrying oxygen to the tissue
b. SERUM PROTEIN – regulates osmotic pressure thus maintaing the water balance of the body.
c. Protein enter into the formation of enzymed as trypsin
3. Maintaining acid-base balance by acting as acids or as alkalies and are value in regulating the acid-
base balance.
4. Antibodies contain protein (as gamma globulin) thus aiding in bodily resistance to infection
5. Source of energy when is shortage of fats & carbohydrates.
SOURCE:
Milk, meat, glandular organ, cheese, poultry, eggs, fish, legumes, soya products
TYPES OF MEAT
1. beef – BULL OR COW
2. veal – MEAT OF YOUNG CALF (NOT LESS THAN 3 WEEKS, 6-8 WKS)
3. LAMB – meat of young sheep
4. MUTTON – meat of a matured sheep
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5. PORK – pig or dog
DIGESTION AND ABSORPTION OF PROTEIN

The digestion starts in the STOMACH. First it contact with hydrochloric acid & then with enzymes-
pepsin. Pepsin breaks down protein into proteosis and peptones. IN the intestines, the proteoses and
peptones are split up further by the action of (pancreatic juice) the trypsin – an enzyme secreted by the
pancreas.The final breakdown is effeced bt erepsin (an intestinal juice) – a powerful protein in splitting enzyme
in the intestinal juice. The final breakdown is AMINO ACIDS then pass through the intestinal wall by way of the
capillaries into the blood stream.
PROTEIN MALNUTRITION DEFICIENCY:

1. KWASHIORKOR – occurs shortly after weaning, usually between 1 and 4 months. The diet consists
mainly of starchy foods of sugar-water.
PEM – Protein Energy Malnutrition
Dietary defect: lack of protein
SIGNS: Falbby, moon like face, nutritional edema (particularly involving the limbs) pot belly
NUTRITIONAL EDEMA – one clinical sign of hypoproteinemia (low protein level in blood)
2. MARASMUS –
SIGNS – skin and bone appearance, whitering, old man’s face
Dietary effect: LACK OF PROTEIN AND CALORIES
PCM – Protein – Calorie Malnutrition
Other signs of Protein Malnutrition:
1. Hair – lack of luster, thinness, sparseness, dipegmentation – means lightening of its normal color
2. Skin – dry, scaly, usually with lesion
3. GI – enlarge liver (hepatomegaly)
CARBOHYDRATE
Carbohydrates – are substances which can be reduced to a simple sugar ( the simplest unit is saccharide) by
hydrolysis
FOOD SOURCES:
Plants are the main source of carbohydrates
A. STARCHES
1. CEREALS – wheat, oats, rioce, corn, seeds, grains
2. FLOURS – wheat, oats, rice corn, sago, flour products
3. Edible paste – macaroni, spaghetti, noodles
4. Root vegetable/rootcrops
B. SUGAR
1. sugar cane
2. preserved in sugar – jellies, jam, candies, syrup, dried stewed with sugar
3. fresh fruits
GULAMAN (SUGAR) source: seaweed
PROTEIN SPARER
1. If carbohydrates foods are not adequate supplied, protein will be catabolized to provide heat and
energy instead of being used for building and repairing tissues
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2. Storage form of energy as glycogestored in the liver and muscle tissue (especially important for the
heart muscle where glycogen is an immediate source of contractile energy.
CLASSIFICATIONS:
1. MONASACCHARIDE – or simple sugar, easily digestible, easily absorbed
a. GLUCOSE or physiologic sugar – is the principal product of hydrolysis from starch and cane
sugar. It is form of carbohydrates circulating in the blood.
b. FRUCTOSE – or fruit sugar – is the sweetest of all sugars
c. Galactose – result from hydrolysis of lactose ( the digestive and product of milk sugar)
2. DISSACHARIDE or DOUBLE SUGAR – crystallized and can be acted upon by an acid or enzymes to
form disaccharides
a. SUCROSE – the table sugar
b. MALTOSE – result from the digestion of starch found in sprouting grains
c. LACTOSE OR MILK SUGAR – found in milk products
3. POLYSACCHARIDE OR COMPLEX COMPOUND YIELDING SUGAR

a. STARCH – most abundant and cheap form of carbohydrates grains, seeds, tubers, roots and
unripe fruits, cereals
b. DEXTRIN – formed from partial breakdown of starches as toasting bread, browning of
cake crust in the oven.
c. GLYCOGEN OR ANIMAL STARCH - - the storage form of carbohydrates in the body
d. CELLULOSE – indigestible and cannot be absorbed by the body
Mostly found in skin of fruits and vegetables and fibers of fruits and vegetable.
VITAMINS
Vitamins – are potent organic compounds which occur in minute amounts in food and are not needed for a
specific regulatory functions
PREFORMED VITAMINS – are naturally occurring vitamins
AVITAMINOSIS – a conditions resulting from lack of vitamin in its later stage when more defined signs and
symptoms occur such that a nutritional deficiency disease is recognizable.
HYPERVITAMINOSIS – or vitamin toxicity – A CONDITION RESULTING FROM EXCESSIVE ACCUMULATION OF

VITAMIN IN THE BODY
SYNTHETIC VITAMIN – are man made or synthesized in the laboratory, it does not substitute for normal intake
of vitamin from food sources
PROVITAMIN OR POTENTIAL VITAMINS – are compound that can be changed to the active vitamins
FAT SOLUBLE VITAMINS
VITAMIN A (Retinol of Retinoic Acid)

Functions:
1. A constituent of the visual purple in the retina, it is needed for normal night vision. (The rods and
cones of the retina cannot adjust to light changes resulting in NIGHT BLINDNESS or POOR DARK
ADAPTATION – early sign when there is Vitamin A deficiency)
2. Maintains the integrity of epithelial tissues especially mucous linings
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KERATINIZATION – means hardening and sloughing of the mucous membranes lining the respiratory tract
digestive tract, urinary system, skin and eyes, keratinization of the eye in the stigma of xeropthalmia
3. For normal growth of bone and skeletal

4. Deficinecy: lower resistance against infection
5. BITOT’S SPOT – (in mild form of vitamin deficiency), it is dry, grayish, silvery or chalky white
plagues often confined to the cornea.
6. XEROPTHALMIA – (in extreme deficiency) – abnormal dryness of the surface of the conjunctiva
7. SKIN LESION OR PHRYNODERMA – the skin is dry and rough with popular eruptions occurring around
the hair follicles.
8. KERATOMALACIA – softening of cornea
FOOD SOURCES
Fish oils are the richest source , skim milk fortified with Vitamin A, fortified margarine, foods fortified with
Vitamin A, eggyolk, cheese, dark green leafy vegetables and deep yellow fruits and yellow vegetables
VITAMIN D (ENGOCALCIFEROL OR D2, CHOLECALCIFEROL OR D3

“SUNSHINE VITAMIN” ANTI-RACHITIC OR RICKET PREVENTIVE
FUNCTIONS
1. Promotes normal bone and teeth development because it facilitates the absorption of calcium and
phosphorous.
2. Synthesized in the skin by activity of ultraviolet rays or sunlight
SOURCES:
Primary: Ordinary exposure to sunlight
Secondary: Salmons, sardines, food fortified with Vitamin D (milk, margarine, butter)
MALNUTRITION:
INFANTS:
TETANY – a syndrome characterized by abnormal muscle twitching, cramps, and a sharp bilateral spasm of
joints in the wrist and ankles.
DENTITION – delayed and persistent opening of anterior fontanelle
CRANIOTABES – softening of the skull usually involving the occipital and parietal bones of the skull
OLDER CHILDREN:
Rickets – defective bones and retarded growth
ADULTS:
OSTEOMALACIA- softening of bones – skeletal deformities, easy fragility and rheumatioc like pains of the
joints
VITAMIN E (TOCOPHEROL)
Functions:
1. Related to cellular respiration when energy is released from glucose and fatty acids and is anti-
oxidabts, thereby protecting other nutrients like Vitamin A, essential fatty acids and carotene (vitamin
A, from being destroyed by oxidabts
2. Prevention of hemolysis (hemolytic anemia) of RBC
SOURCES
Republic of the
Philippines City of
Olongapo
GORDON COLLEGE
City Tel. No. (047) 224-2089 loc. 314
Eating the recommended serving of basic food groups and a variety of foods daily assure one of
adequate Vitamin E intake.
Wheat germ oil, sunflower seeds, nuts oil, corn soybeans, peanuts
VITAMIN K (QUINONES)
MENADIONE-commercial form/Synkavit, Hykinone
AMNTIHEMMORHAGIC FACTOR
Functions: Maintenance of prothrombin level in blood plasma for normal clotting time
SOURCES: liver, dark green leaves, soybean oil, & wheat germ oil
MALNUTRITION:
Hemorrhagic Disease in Newborn (from birth to 1 month)
Delayed Clotting Time in Adults Clotting time: 3-5 mins
Bleeding time: 1 to 3 mins
WATER SOLUBLE VITAMINS
(C AND B Complex)
Vitamin c or ascorbic acid

FUNCTIONS:
1. Essential to the normal functioning of all cellular units (especially collogenous connective tissues bone
marrow, capillary walls, teeth, gums and skin)
2. Necessary for the following reactions:
a. make iron more available for hemoglobin and RBC maturation so it improves iron absorption.
Vitamin C + iron+ ANEMIA PREVENTION
- Building of bodily resistance against infection, and healing of wounds and bone
fractures (orthopedic cases)
- Prevention of megaloblastic anemia and pinpoint (or petechial) hemorrhages
SOURCES: Raw, fresh fruits, half cooked vegetables (raw-means not cooked)
MALNUTRITION: At the early stage: irritability, general weakness, lack of appetite, lowered resistance to
infections and pallor.
SCURVY + SPONGY BLEEDING GUMS
NOTE: Vitamin C rich food is easily destroyed by heat, alkali, light, & oxygen
VITAMIN B1 (THIAMIN OR ANTIBERI-BERI)

FUNCTIONS:
1. Needed in carbohydrate metabolism (glucose oxidation and conversion of glucose to fat)
2. Helps maintain good appetite, good muscle tones, especially gastrointestinal and normal functioning
of nerves.
SOURCES: Liver and glandular organs, lean meat of pork, pork products (hotdog, bologna, sausage)
Legumes (monggo, patani, nuts, peas)
MALNUTRITION: Early deficiency signs: loss of appetite, weakness, and easy fatigability, indigestion, severe
constipation, gastric atony, poor reflexes amd irritability and numbness and extremities
LATER STAGE: Beri-beri, Nutritional polneuritis (manifested by changes in GI tract, nervous system and
cardiovascular system)
Republic of the
Philippines City of
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GORDON COLLEGE
City Tel. No. (047) 224-2089 loc. 314
3 TYPES
1. INFANTILE BERI-BERI – refers infants usually 2-5 months old who are breastfed by mothers suffering
from beri-beri
SIGNS: a. APHONIA – whinning cry, loss of voice
b. CYANOSIS – bluish discoloration of skin
c. DYSPNEA – difficulty in breathing
d. DEATH
2. DRY BERI-BERI – progressive paralysis

Sign: PARESTHESIA – pain and needle sensation
3. WET BERI-BERI – characterized by pitting edema particularly in lower extremities to the abdomen
then chest causing enlargement of the heart
VITAMIN B2 (RIBOFLAVIN)
Function: 1. Helps maintain healthy skin, tongue, & mouth, normal vision , proper growth and
development
2. Essential for protein, fat and carbohydrate metabolism
MALNUTRITION:
1. Advanced deficiency disease B2- ARIBOFLAVINOSIS – characterized by scaly, greasy eruption
especially of skinfolds – SEBORRHEIC DERMATITIS
2. Extra blood vessels over the cornea – eyes become itchy with burning sensation and
corneal vascularization
3. Swollen tongue and becomes magenta red (purple red) GLOSSITIS
4. Inflammation of the soft tissue of the mouth – STOMATITIS
5. Lips swollen, corners of the mouth cracked – CHEILLOSIS
NIACIN OR NICOTINIC ACID

FUNCTION: Important in energy metabolism
SOURCES: same for protein sources

MALNUTRITION:
PELLAGRA : dermatitis, dementia, diarrhea, & death

Common in group on high-corn diet alone
EARLY SIGNS OF DEFICIENCY: ANOREXIA – loss of appetite, weakness, indigestion, skin changes
GLOSSITIS – beefy red tongue, swollen, very painful

ANGULAR STOMATITIS – cracked at the corners of the mouth
FATS AND OTHER LIPIDS

True fats belong to a larger group of organic compounds chemically called lipids
SOURCES:
1. VISIBLE – butter, margarine, cooking oil, pork fat, beef fat, salad dressing
2. INVISIBLE – eggyol, chocolate, coconut, avocado
FUNCTIONS:
1. Concentrated sources of energy :
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2. As storage form of energy
3. Serves as a cushion or padding around the vital organs holding them in places
4. Prevents rapid heat loss from the body
5. Sparer of protein
6. Carrier of fat soluble vitamins
7. Depresses the hunger sensation
INFANT NUTRITION
⚫ FLUIDS & WATER:
⚫ Water is essential component of body structure & a solvent for minerals & other physiologically
important compounds.
⚫ It transports nutrients to & waste products from d cells & helps to regulate body temperature.
⚫ The water requirements of an infants is determined by d amount lost from d skin,lungs feces & urine.
⚫ What is d daily fluid consumption of infants fluid? 10-15% of his body weight
Absorbed in:
a. large intestines
b. blood stream
c. lymph stream
Water retained:
 Depend on d rate of growth
Losses water via:
a. Urine – 40-50% of water intake
b. Lungs – 40-50%
c. Fecal – 3-10%
Kidney – organ that maintains d fluid & electrolyte balance in d body by varying d osmolar content & volume
of urine.
⚫ WHY do infants need more water than adults:
1. Metabolism requires water.
 Infants have higher metabolic rate than adults so they need more water.
2. Amount of insensible water loss thru: -perspiration -lungs -saliva
3. Inability of kidney to concentrate urine bcos of immaturity & increased metabolic rate result in
increased “urinary output”.
4. Infants have more extracellular fluid than adult. Their body is 70% fluid.
But extracellular fluid is easily depleted especially in conditions like diarrhea, fever & other stressful
conditions.
FLUID REQUIREMENT OF INFANTS:

⚫ FLUID DEFICIENCY
DEHYDRATION- when water loss is over 10% of d total body water.
Manifestations:
1. Thirst
2. Dryness of skin
Hemoconcentration – an increase in d proportion of RBC relative to plasma, brought about by a decrease in d
volume of plasma.
Tendency may occur:
> Severe loss of water from d body.
4. Decreased in urine output- Oliguria
5. Impaired kidney function
6. High specific gravity of urine
7. Acidosis-abnormally high acidity of body fluids.
Republic of the
Philippines City of
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GORDON COLLEGE
City Tel. No. (047) 224-2089 loc. 314
⚫ EXCESS EFFECTS- OVERHYDRATION

 Occurs when water intake is greatly increased or too much fluid is given thru IV.
⚫ Manifestations:
⚫ Cramps
⚫ Water intoxication
⚫ Headache
⚫ Convulsions
⚫ Edema
⚫ Circulatory failure
⚫ CALORIE
Good Sources: PRO/CARBO/FAT
Caloric Requirements of Infant-100 to 120 kcal/kg Body Weight
3 y/o below
> This requirement decreases by about 10kcal on each succeeding 3 yrs bcos of d slowing of growth rate.
Human milk PRO content: 1.2 gm/100ml

Cow’s milk PRO content : 3x more Pro than human milk
>This high PRO content of cow’s milk may not be tolerated well by d infant’s immature kidney.
⚫ DEFICIENCY:
⚫ PEM (Protein Energy Malnutrition)
⚫ Affects immune function
⚫ Increase their risk of infections
ESSENTIAL AMINO ACIDS FOR INFANTS & CHILDREN

a. Theonine- requirements is .087 gm/kg body weight.
b. Leucine – requirements is .150gm/kg body weight
c. Isoleucine – requirements is .126gm/kg body weight
d. Valine- requirements is .105gm/kg body weight
e. Methionine – important component of heme portion of d hemoglobin of d
blood. Requirement: .045gm/kg body weight
f. Phenylalanine – for the production of hormones thyroxine & epinephrine is d precursor of tyrosine
Req: .090gm/kg body weight
g. Tryptophan – is d precursor of niacin,B Vit & serotonin.
Req: is .022gm/kg body weight
h. Lysine – Req: is .103gm/kg body weight
i. i.Histidine – Req: is .034/body weight
j. Other important amino acids:
1. Taurine- impt for d devt of d eyes
2. Glycine-simplest amino acids w/c renders toxic substances harmless.
TOPIC 15: EMERGENCY ACTION PRINCIPLES

EMERGENCY ACTION PRINCIPLES
o Survey the scene
o Do a primary survey of the victim
o Phone the emergency medical services(EMS)system for help.
o Do a secondary survey of the victim
Republic of the
Philippines City of
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GORDON COLLEGE
City Tel. No. (047) 224-2089 loc. 314
HOW TO SURVEY THE SCENE:
- Make a quick decision-making survey of the entire scene.
- Don’t look only at a victim, look at the area around the victim(few seconds)
- Decide what needs to be done immediately & the order in which you will take other steps.
BURNS
- Injuries resulting from exposure to heat, chemicals, electricity or radiation.
- The severity depends on the depth, size and locations
- Burns are most serious when they are located on the: Face, neck, hands, feet and genitalia.
o Common causes:
- Careless with matches and cigarettes
- Scalds from hot and water and other liquids
- Defective heating, cooking and electrical equipment
- Unsafe use of flammable liquids to start fires and clean floors
- Unsafe use of strong alkalis such as acids and fires.
DEGREE OF BURNS:
1. Superficial Burn (First Degree)
- A first degree burn involves only the top layer of skin.
- The skin is red and dry and usually painful.
- The burned area may also swell.
- Most sun burns are superficial burns.
- Characterized by redness of discoloration, mild swelling and pain.
- This type of burn usually heals in 5-6 days without any permanent scarring.
2. Partial-Thickness Burn(Second Degree)
- A second degree burn involves the top layers of skin.
- The skin is red with blisters that may open and weep clear fluid, giving the skin a wet appearance.
- The area may also appear mottled.
- The burn is usually painful and often swells.
- This type of burn usually heals in 3-4 weeks, and scarring may occur.
- The MOST PAINFUL – because the most of the nerve endings are still intact, even though the tissue
damage is severe.
3. Full-Thickness Burn(Third Degree)

- A third degree burn destroys all layers of skin and any or all of the underlying structures(fat,
muscles, bones and nerves).
- The burn appears brown or black(charred) with the tissues underneath sometimes appearing white.
- This type of burn can be extremely painful or relatively painless if the burn destroys the
nerve endings.
- This burn is critical and requires immediate medical attention.
Care for Burns

General Care / Thermal Burns
1. Stop the burning. Put out flames or remove the victim from the source of the burn.
2. Cool the burn.
o Use large amounts of cool water to cool the burn.
o Never use ice except on small superficial burns, because it causes body heat loss.
o If the area cannot be immersed, like the face, you can soak a clean cloth and apply it to the
burn, being sure to continue adding water to keep the cloth cool.
3. Cover the burn.
o Use dry, sterile dressings or a clean cloth to help prevent infection and reduce pain.
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4. Bandage loosely.
5. Do not put any ointment on a burn unless it is very minor.
6. Do not use any other home remedies,
7. Do not break any blisters.
o For minor burns or burns with broken blisters that are not severe enough to require
medical attention,
o wash the burned area with soap and water,
o keep it clean and apply an antibiotic ointment.
Remember, some people can be allergic to topical ointments, so if you have any doubts, call your
doctor for advice.
For a victim of severe burns,

Lay him or her down unless he or she is having trouble breathing.
Try to raise the burned areas above the level of the victim's heart if possible,
Protect the victim from drafts.
Chemical Burn
- Call EMS(Emergency Medical Services) in any case of a chemical burn.
- Remove the chemical from the skin or eyes immediately by flushing the area with large amounts
of cool running water until EMS arrives.
- Remove any clothes with chemicals on them, and be careful not to spread the chemical to other body
parts or to yourself.
- Chemical burns can be caused by chemicals used in manufacturing or in a lab, or by household
items such as bleach, garden sprays or paint removers.
Electrical Burns
- Call EMS in any case of an electrical burn.
- Do not go near the victim unless you are sure the power source has been turned off.
- The burn itself will not be the major problem.
- First aid-electric burn
- If the victim is unconscious,
o Check breathing and pulse.
o Check for other injuries, and do not move the victim because he or she may have spinal
injuries.
o Cover an electrical burn with a dry, sterile dressing.
o Do not cool the burn.
o Prevent the victim from getting chilled.
o Electrical burns can be caused by power lines, lightening, defective electrical equipment,and
unprotected electrical outlets.
Solar Radiation Burn
- Burns caused by solar radiation may be painful and may also blister.
- Cool the burn.
- You may want to put a product designed specifically for sunburn on the area; these products usually
contain aloe vera and help cool the area and reduce the pain.
- Protect the burn by staying out of the sun.
- Be sure to cover up any existing sunburn if you are going to be outside again.
NOSE BLEED
The nose - a part of the body rich in blood vessels (vascular) and is situated in a vulnerable position as
it protrudes on the face.
 As a result, trauma to the face can cause nasal injury and bleeding
Republic of the
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City Tel. No. (047) 224-2089 loc. 314
Common:
 in dry climates, or
 during the winter months when the air is dry and
 warm from household heaters.
The following factors predispose people to nosebleeds:
o Infection
o Trauma, including self-induced by nose picking, especially in children
o Allergic and non-allergic rhinitis
o Hypertension (high blood pressure)
o Use of blood thinning medications
o Nosebleeds...(Epistaxis)
o Have the victim sit with his or her head tilted a little bit forward
o while pinching his or her nostrils together.
o Apply cold compresses to the victim’s nose and face
o Apply pressure beneath nostril above lip
o Instruct not to blow his nose several hours after the bleeding has stopped.
CHOKING
o If a person is clutching his or her throat with both hands, he or she is making the universal sign
for choking.
o Choking Adult-Conscious Adult
o If the person can cough or talk, encourage him or her to continue coughing.
o Once the victim can no longer talk or cough, you must clear the obstructed airway.
 To clear the obstructed airway that causes choking, you must perform the Heimlich
maneuver, also known as abdominal thrusts.
 Stand behind the conscious choking adult, wrapping your arms around his or her
waist. With one hand, make a fist. Place the thumb side of the fist against the
victim's abdomen just above the bellybutton.
 Be sure your hand is far below the tip of the breastbone.
 Put your other hand over the fist and give quick upward thrusts into the
victim's abdomen.
 Continue giving thrusts until the object blocking the airway is dislodged and the
victim begins to breathe, or until the victim becomes unconscious.
o Choking Child-Conscious Child
- If the child can cough or talk, encourage him or her to continue coughing.
- If the child cannot cough or talk,
o Ask if he or she is choking.
o Perform abdominal thrusts.
 Stand behind the victim, wrap your arms around his or her waist, and make a
fist with one hand.
 Place the thumb side of the fist against the child's abdomen, above the bellybutton
yet far below the tip of the breastbone. Put your other hand over the fist and give
quick upward thrusts into the victim's abdomen.
 Continue giving thrusts until the airway is cleared and the child begins to breathe, or
until the child becomes unconscious
Types of Wounds
1. Lacerations – Injury where tissue is cut or torn.
- For treatment, tissue is first cleansed of any blood clots and foreign material, débribed and irrigated.
- Local anesthetic is administered and atraumatic technique of wound closure is employed, where
wound margins are realigned with careful regard to prevention of any further crush injury to tissues.
- Sterile dressings are applied and immobilization is recommended for complex extremity wounds.
Republic of the
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GORDON COLLEGE
City Tel. No. (047) 224-2089 loc. 314
2. Abrasions – Injury where a superficial layer of tissue is removed, as seen with 1st degree burns.
- The wound is cleansed of any foreign material, sometimes employing a scrub brush to prevent
traumatic tattooing by dirt and gravel, and should be performed within the first day of injury.
- Local anesthetic can be used for pain, however treatment of the wound is non-surgical, using moist
dressings and a topical antibiotic to protect the wound and aid healing.
3. Contusions – Injuries resulting from a forceful blow to the skin and soft tissue, however leaving the
outer layer of skin intact.
- These injuries generally require minimal care as there is no open wound.
- However, contusions should be evaluated for possible hematoma deep to the surface or other
tissue injuries that may indicate more severe morbidity.
- An expanding hematoma can damage overlying skin and demands evacuation.
4. Avulsions – Injuries where a section of tissue is torn off, either partially or in total.
A. In partial avulsions,- the tissue is elevated but remains attached to the body.
- In the case of a partial avulsion where the torn tissue is still well-vascularized and viable, the tissue is
gently cleansed and irrigated and the flap is reattached to its anatomical position with a few sutures.
B. A total avulsion - the tissue is completely torn from the body with no point of attachment.
- In the case of a total avulsion, the tissue is often very thick and demands debulking and defattening
methods before it can be regrafted.
- Major avulsions describe amputation of extremities, fingers, ears, nose, scalp or eyelids and require
treatment by a replant team.
METHODS OF CONTROLLING BLEEDING

1. DIRECT PRESSURE WITH STERILE BANDAGE-Apply pressure directly to the wound.
2. ELEVATION-Elevating the bleeding part of the body above the level of the heart will sloiw the flow of
blood and speed clotting.
3. PRESSURE POINT
- Arterial bleeding can be controlled by digital pressure applied at pressure points
- Pressure points – are places over a bone where arteries are close to the skin
- TEMPORAL PRESSURE – points is used to control arterial bleeding from the scalp or head
wound
o Used for brief periods only
o Cause brain damage if more than 30 sec.
4. TOURNIQUETS
 A device used to control severe bleeding
 Used as an absolute last resort
 Dangerous
 Improper use may cause death , tissue injury
o A standard tourniquet:
o A piece of web belting about 36 inches long, with a buckle or small device to hold it tightly in
place when applied.
o Improvised:
o Belt, suspender, handkerchief, towel, necktie cloth
o 2 inches wide to distribute pressure over tissue
o DO NOT USE:
o WIRE,
o cord
o FACIAL PRESSURE –
o Help slow the flow of blood from the cut on the face
o Used only for 1-2 min
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o Located in the “notch” along the lower edge of the bony structure of the jaw.
o AXILLARY PRESSURE
o Under the upper arm is pressed against the bone from underneath
o BRACHIAL POINT
o Cuts on the lower arm
o POISONING
POISONS – is any substance which act to produce harmful effects on the normal body processes.
4 MAIN WAYS A PERSON CAN BE POISONED:
1. By ingestion (eating or drinking)
2. By inhaling (nose and mouth)
3. By absorption ( through the skin)
4. By injection ( body tissue or blood stream
FOOD POISONING – sudden unexplained severe illness, accompanying by explosive episode of nausea and
vomiting, abdominal cramping or diarrhea.
BACTERIAL FOOD POISONING – is often caused by bacteria in food that has been poorly prepared.
Salmonella – one of the most common culprits and is found in many farm products such as eggs and chickens.
Toxic (potentially lethal) food poisoning such as botulism can be due to poisons caused by bacteria in
certain type of food, including honey and fish
SIGNS AND SYMPTOMS:
Nausea and vomiting
Stomach cramps
Diarrhea
Fever
Aches and pains
Signs of shock
Symptoms of toxic poisoning_ dizziness, slurred speech, and difficult breathing and swallowing
POISONING BY INHALATION
Certain toxic or noxious gases may stop respiration
Gases are encountered:
 In mining
 Oil drilling
 Other industries
SIGN AND SYMPTOMS:
 Shortness of breath
 Coughing
 Cyanosis
 Cherry red color if dealing with carbon monoxide poisoning
FIRST AID FOR POISONING BY INHALATION

- Remove the victim to fresh air as quickly as possible
- Maintain an open airway
- In appropriate cases. Initiate CPR
- Treat the victim for shock
POISONING BY INJECTION
- Bites of animals
- Poisonous snakes and insects
FIRST AID – minimizing the travel of the poison to the heart:
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 1. Keep the person calm, quiet and rest
 2. All jewelry should be removed from the bitten extremity – in case of swelling
 3. Apply a constricting bandage above & below the bite at the edge of the swelling.
 4. Transport the victim to a medical facility
PETROLEUM PRODUCTS –
- Kerosene, gasoline & related petroleum products usually cause severe chemical pneumonia.
- Products may be identified by their characteristic odors.
- If petroleum has been swallowed:
- Do not induce vomiting!
- Give 4 ounces of mineral oil or give him milk or water 2 glasses (adult), 1 glass (child)
Corrosive agents – rapidly produced deep chemical burns of the victim’s lips, mouth and digestive passages
when swallowed.
 These are strong acids and compounds with acid like actions
 Ex. Sulfuric acids, some toilet bowl cleaners, washing soda, ammonia, bleaches and strong
detergents.
DURING TRANSPORTATION OF ALL POISONED VICTIM – treat the victim for shock!....
FIRST AID POISONING:
OBJECTIVES: Poisoning by mouth is to dilute or neutralize the poison ASAP!
If the victim id UNCONSCIOUS – keep his airway open
If the victim in CONVULSIONS – do not give him any medications and do not induce vomiting.
TRANSFER ASAP.
 Do not give anything to drink.
 Turn the victims head to one side so that mucus will drain from his mouth.
NON CORROSIVE POISON

- Dilute the poison by giving milk or water 3-4 glasses (adult), 2 glasses (child)
CORROSIVE POISON
- Do not induce vomiting
- CONSCIOUS:
 Give milk or water, 2 glasses (adult) , 1 glass (child)
 If swallowed strong alkali (drain cleaner, washing soda, ammonia, bleach , laundry
detergent) water & vinegar or lemon juice may be given after the initial fluids.
- CPR
CPR (or cardiopulmonary resuscitation)
- a combination of:
- (1)rescue breathing (mouth-to-mouth resuscitation) and
- (2)chest compressions.
- If someone isn't breathing or circulating blood adequately,
- CPR can restore circulation of oxygen-rich blood to the brain.
- Without oxygen, permanent brain damage or death can occur in less than 8
minutes.
 Incorrect application of external heart compressions:
o Damage to internal organs
o Fracture of ribs or sternum
o Separation of cartilage from ribs.
 CPR may be necessary during many different emergencies,
o accidents,
o near-drowning,
o suffocation,
o poisoning,
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o smoke inhalation,
o electrocution injuries, and
o suspected sudden infant death syndrome (SIDS).
Three Parts of CPR

The three basic parts of CPR are easily remembered as
"ABC":
 A for airway,
 B for breathing, and
 C for circulation.
Chest compressions can sometimes restore circulation.
CARDIOPULMONARY RESUSCITATION (CPR) PROCEDURE

1. Establish unresponsiveness
 Gently shake the victim’s shoulder and shout
 “Are you OK”
2. Call for HELP
3. Position the victim
- Be sure to watch the neck and keep it in line with the rest of the body.
- The victim should now be flat on his/her back
4. A – Airway. Open the airway.
- The most common cause of airway obstruction – TONGUE (unconscious)
- Use the head-tilt-lift maneuver to open airway
o This maneuver is not recommended for a victim with possible neck or spinal injuries.
5. BREATHING. Establish breathlessness.
o Turn your head toward the victim’s feet with your cheek close over the victim’s mouth (3-5
sec)
o Look for a rise and fall in the victim’s chest.
o Listen for air exchange at the mouth and nose.
o Feel for the flow of air.
6. PROVIDE ARTIFICIAL VENTILATION
 If the victim is not breathing – give two full breaths
- by mouth-to-mouth
- Mouth-to-nose
- Mouth-to-stoma ventilation
C- CIRCULATION. Check for pulse.

o Check the victim’s pulse to determine whether external cardiac compressions are necessary
o Maintain an open airway position by holding the forehead of the victim
o Place your fingertips on the victim’s windpipe and then slide them towards you until you
reach the groove of the neck. Press gently on this area (carotid artery)
o Check the victim’s carotid pulse for at least 5 sec. but not more than 10 sec.
o If a pulse is present, continue administering artificial ventilation:
- Once every 5 sec or
- 12 times a minute
- If NOT – make arrangement to send – for trained medical assistance & begin CPR
7. PERFORM CARDIAC COMPRESSIONS
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IV. Teaching and Learning Materials and Resources

o Reference book
o Have your copy of the previous board exam test paper, compile, answer and rationalize.
o Midwifery Skills Procedure Checklist
o White paper and pen/computer
V. Learning Task
The student is expected to comply with the following:
1. Participate in online class activities, online return demonstration of midwifery procedures.
2. Obtain satisfactory rating for quizzes, programming exercises, and major examinations given for the
course and return demonstration
3. Finish and submit all requirements, all mandated midwifery skills procedures at the end of
the semester.
4. Students are expected to perform in the form of revalida the following midwifery skills procedures in
a mastery level or higher level of understanding
o Internal Examination
o Handwashing
o Gloving
o Leopold’s Maneuver
o Insertion of intravenous Fluid
o Intramuscular injection of Tetanus Toxoid
o Intramuscular Injection in newborns
o Intradermal injection of newborn
o Repair of First & Second Degree Laceration
o Referring & transporting patients
o EINC including AMSTL
5. The students are expected to comply with the requirements of MDW 204 as follows:
o Read all prescribed readings especially the “required readings” such as previous board
exams, articles, etc.
o Submit all required midwifery board exams with analytical explanation and answers
o Submit one (1) obstetrical cases and present it at the end of the term
o Complete 20 required hospitals, DOS, 5 suturing of perineal lacerations, 5 intravenous
insertion, 20 assisted deliveries and 20 cord dressing.
o Present the group community diagnosis in chosen barangay
o Have their own IMCI Activity Book
o Prepared for online class presentations and discussion on assigned topics
o Take all major exams
o All candidates must obtain a rating of 75% seventy five percent in the written revalida
with no grade lower than fifty percent (50%) in any subject (OB, PHC, ICF, PGD, FHC).
6. Queries relevant to the topic will be entertained thru online discussion via facebook messenger or any
online platforms or via SMS.
References:
WHO Global Health Observatory(http://www.who.int/who/child health/en/index.html)
Obstetrics for Student Midwives, 3rd Edition, William Heinemann Medical Books Limited, 1976
A Handbook for Practicing Midwives By: Alejandro R. San Pedro, MD FPOGS 1992
Myles Margaret: Textbook for Midwives, 8th Edition. J.P. Lippincott Company, Phil Copyright 1976
Republic of the
Philippines City of
Olongapo
GORDON COLLEGE
City Tel. No. (047) 224-2089 loc. 314
Essential Procedures for Safe Maternity Care First Edition By: Rosalinda ParadoSalustiano
Maternal and Child Health Nursing by Adele Pilliteri
Outline in Obstetrics by Sia
The Essentials of Contraceptive Technology, March 2005
Maternity and Women Health care by Lowdermilk, Perry Eight Edition
Family Planning competency Based Training: Basic Course Handbook 2010, DOH, UNFPA
Sanchez, P. LoarcaJ. The Midwife, The Law and Ethics
Venzon, Lydia M. Nursing Practice in the Philippines
Edge, Raymond S. John Randall Grooves, Ethics of Health Care – Guide for Clinical Practice, 2nd Edition,
1999
Ciabal, Laura Evelyn, Health Ethics Allied Professionals, 1 st Edition, 2001
Paunil-Ciabal, Laura Evelyn, Ethics for Health Professionals
Timberza, FlorentinoT.,Bioethics and Moral Decisions, 1993
Magna Carta of Public Health Worker
Ethics and Logic, Bas. De Villa
Professional Growth and Development for Midwives 2008 Edition by: Maria Loreto J. Evangelista-Sia
The Ethics and the Midwives by Alice SanzdelaGente
Prepared by:
Maria Sandra C. Rivera, RM MCHS

4 MDW 204 Part 2 Fundamentals of Health Care

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4 MDW 204 Part 2 Fundamentals of Health Care

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Republic of the

College of Allied Health Studies

Detailed Learning Module(Case-Based Learning Module)

Program: Graduate in Midwifery

Course Code: MDW 204(Seminar in Midwifery)

Title: Preparation in Board Exam

III. Topics and Key Concepts:

TOPIC 9: HEAT AND COLD APPLICATIONS

Guidelines in Heat Application

DIFFERENT METHODS OF HEAT APPLICATION

METHODS OF COLD APPLICATION

TOPIC 10: Massage of Back & Buttocks

D. Heat if applied before the massage will exchange its action.

PREPARATION OF THE PATIENT (Massage of the back & Buttocks)

1. Pan fold top sheet & place with bath blanket.

PROCEDURES (PREPARATION OF THE PATIENT)

TOPIC 11: COMFORT MEASURES

TYPES OF THERAPEUTIC BATHS:

ALTERATION IN CHARACTERISTICS OF STOOL

4. STEATORRHEA – Greasy, bulky, foul smelling stool.

COMMON FECAL ELIMINATION PROBLEMS

COMMON CAUSES OF FLATULENCE:

MEASURES TO RELIEVE FLATULENCE

Topic 12: ENEMA

COMMONLY USED ENEMA

THE MOST COMMON USE OF AN ENEMA

a. High Enema – to clean as much as of the entire colon as possible.

b. LOW-ENEMA- to clean the rectum & the sigmoid colon only.

4 TYPES OF CLEANSING ENEMA

1. TAP WATER (500-1000 ml)

STEPS OF RETURN-FLOW ENEMA

5. OIL RETENTION ENEMA

NURSING INTERVENTION IN ENEMA ADMINISTRATION

COMPONENTS OF URINARY SYSTEM

URINE FORMATION(3 STEPS IN FORMATION OF URINE BY THE KIDNEY:

A. ALTERED URINE PRODUCTION

B. ALTERED URINARY FREQUENCY

C. ALTERED URINE COMPOSITION

CLINICAL SIGNS OF URINARY RETENTION

NURSING INTERVENTION TO INDUCE VOIDING:

NURSING INTERVENTIONS IN URINARY CATHETERIZATION

TOPIC 14: BASIC NUTRITION

FACTORS CAUSING MALNUTRITION

NUTRITIONIST – one who investigate and gives information on nutrition

INGESTION – the act of taking in food

ASSIMILATION – the taking up of nutrients, form the blood by cells.

EXCRETION – the throwing out or elimination of waste products of the body

ALIMENTOLOGY – the science of nutrition

CLASSIFICATION OF NUTRIENTS ACCORDING TO:

PASSAGES OF FOOD in ALIMENTARY TRACT

Ingestion-digestion-absorption-transportation-assimilation-utilization or the storage-utilization-excretion from

ANTOINE LAURENT LAVOISER – father of nutrition

DR. FLORENTINO O. SANTOS – father of nutrition in the Philippines

LUNIN – father of vitamins

JULY – nutrition month of the Philipppines

DIGESTION AND ABSORPTION OF PROTEIN

PROTEIN MALNUTRITION DEFICIENCY:

GULAMAN (SUGAR) source: seaweed

3. POLYSACCHARIDE OR COMPLEX COMPOUND YIELDING SUGAR

PREFORMED VITAMINS – are naturally occurring vitamins

HYPERVITAMINOSIS – or vitamin toxicity – A CONDITION RESULTING FROM EXCESSIVE ACCUMULATION OF

FAT SOLUBLE VITAMINS

VITAMIN A (Retinol of Retinoic Acid)