Abnormal Pedia Hallmark: pulling their feet up under their body and clenching their

fists
Complications of Breast Feeding
1. Sore nipples Rule of 3 in Colic:
2. Engorgement
3. Mastitis > 3 hours/day
> 3 days/week
A. SORE/ CRACKED NIPPLES > 3 weeks/month in an otherwise healthy, well-fed baby
C orrect latching on and positioning Management: Always BURP the baby
R ecommend to continue breastfeeding
A dvise to use the least sore breast first JAUNDICE/HYPERBILIRUBINEMIA
C ream: lanolin ointment
K eep the breast air dried after feeding
E xpress milk or colostrum and apply to nipples -YELLOWISH discoloration of skin
D o not use SOAP, silk bra, bra with plastic straps.
CAUSE: Build up of bilirubin
B. Engorgement Bilirubin – product of HEME CATABOLISM
2 types of bilirubin
H eavy and tight 1. Direct/Conjugated bilirubin – excretable type. DOES NOT
E rythema (redness) CAUSES JAUNDICE
A warm to touch breast
V ery firm or hard, painful and tender(CBQ) 2. Indirect/unconjugated bilirubin – free floating, non excretable,
Y es! It is shiny and swollen CAUSES JAUNDICE

ONSET: FIRST 3-5 days postpartum LIVER – site of conjugation

Management: Glucuronyl transferase – enzyme for conjugation of bilirubin.

F requent breastfeeding
U se engorged breast FIRST(CBQ) Two types of JAUNDICE
L atch baby properly
L et mother massage, express and air dry breast 1. PHYSIOLOGIC – NORMAL
TAKE NOTE: onset: after 24 hours (2nd or 3rd day of life.)
1. Apply warm packs 15-20 minutes BEFORE feeding Peak at 3th day to 4th day(4-7 days resolves)
2. Warm compress during feeding-cold compress between feeding-
pump milk 2. PATHOLOGIC – ABNORMAL
3. use cabbage leaves. – seen within FIRST 24 hours after birth
4. Try a warm shower before breastfeeding. (CBQ) CAUSE: ABO or RH incompatibility.
5. Use the last use breast First in your next feeding. (CBQ)
6. NEVER STOP BREASTFEEDING(CBQ)
7. MASSAGE AND MANUALLY EXPRESS MILK IN A CUP(CBQ) PHOTOTHERAPY:
1. Cover the eyes, place eye shield, patch breast, cover the genitals
C. Mastitis of the newborn to prevent priapism(CBQ)
– Inflammation of the breast, can be infective or non-infective 2. Feeding is okay, remove from light for feeding
Most common: at 2-3weeks postpartum 3. Breastfeed every 2 – 4 hours(CBQ)
4. Turning every 2 hours(CBQ)
Non infectious type – MILK STASIS 5. Hydrate the baby, assess skin turgor and temperature
INFECTIOUS type – Staphylococcus aureus bacteria(CBQ) 6. A yellowish green or bright stool is a normal response to
Signs and symptoms: phototherapy(CBQ)
I nflamed 7. Transient discoloration of skin is known as “BRONZE BABY
N ursing discomforts ( painful) SYNDROME”(CBQ)
F lu like ( chills) (CBQ) 8. Kernicterus is fatal, deposition of bilirubin in the brain
E levated temperature ( fever) (CBQ) CLEFT
C ontinuous burning sensation
T ender and swollen 1. CLEFT LIP – splits in the upper lip

◾male predominance
E rythema or redness
D ischarge ( pus)
Management:
2. CLEFT PALATE – split in the roof of mouth

◾female predominance
A lternating warm & cold compress(CBQ)
B reastfeed on demand basis(CBQ)
C orrect position and latching on(CBQ)
D o not use soap in breast (CBQ) Causes:
E xpress milk and massage
F ree the breast to Air. C orticosteroid in pregnancy
L ack of folic acid in pregnancy
D. COLIC ETOH or alcohol drinking
Crying loudly, often for two to three hours. F amilial (genetic)
Cause: Swallowing of excessive air/gas T obacco smoking

1
Problems can include:

1. Feeding problem – inability to maintain good seal with their mouth 4. Pyloric Stenosis
2. hearing problems–more vulnerable to ear infections and a build-up – muscle hypertrophy & constriction at the pylorus.
of fluid in their ears (glue ear)
3. dental problems – teeth do not develop correctly and they may be Mean age onset: 2 -3 weeks
at a higher risk of tooth decay Hallmark: NON BILIOUS forceful, projectile vomiting
4. speech problems –if not repaired, it can lead to speech problems. Clinical features
1. Cheiloplasty:
P ersistent hunger
done at 3 to 6 months Y es! Abdominal distension is present
L eft to right peristaltic movement
Milard “Rule of 10s” O live shaped mass RUQ of abdomen

◾10 weeks old

R efeeding after vomiting is common
I nfant appears malnourished

◾10 lbs weight

C an be dehydrated

◾10 grams of hemoglobin

Management: Surgery - pyloromyotomy
– incision into the pyloric muscle

◾10,000 WBC
Surgical Management:

 Ramstedt’s Pyloromytomy
Pre-operative (cheiloplasty – repair of cleft lip) - Through a short transverse skin incision
1. Proper positioning and feeding - Underlying pyloric mass is cut longitudinally to
2. Burp frequently the layer of submucosa
3. Use a large bore needle or rubber tipped syringe - Incision is closed
4. Gavage feeding and provide Small frequent feedings
5. Finish feeding with water E. LACTOSE INTOLERANCE
CAUSE: lactase enzyme deficiency
Post operative
1. Anticipate child needs (CBQ) Clinical features
2. USE ELBOW RESTRAINTS • chronic, watery diarrhea
3. KEEP SUTURE LINE CLEAN • abdominal pain, bloating, borborygmi
4. skin sutures are removed at 4th day
5. PROVIDE PAIN CONTROL RELIEF Diagnosis: clinical trial of milk or lactose free milk
NOTE. Feed in bulb syringe/rubber tipped up to 10 to 14 days Management: lactose-free diet, soy formula
F. CELIAC DISEASE
2. Palatoplasty – “gluten-sensitive enteropathy”, Celiac sprue
– repair of cleft palate
◾toxic or immunologic reaction to gluten in “BROW” (Barley, Rye,

◾done between 6 to 12 months prior speech development.

Oats, Wheat)
Treatment: Gluten Free diet

Preoperative PALATOPLASTY presents at any age, usually 6-18 months

1. INFANT SHOULD BE WEANED TO CUP before surgery Clinical features:
• FTT with poor appetite, irritability, apathy
Post operative • anorexia, nausea, vomiting, edema
◾Position on Side or Abdomen(prone)
• wasted muscles, distended abdomen and flat buttocks
• anemia, bleeding

◾Have suction available

• rickets
• clubbing of fingers

◾Prevent Injury or trauma to suture line Allowed to eat: Potato, Rice, Corn
(USE CUP, no bottles , no straw and utensils)
AVOID:
3. Tracheoesophageal Fistula (TEF) malted milk shake
- abnormal communication or opening between trachea and fistula. hot dog with catsup
graham crackers and peanut butter
Hallmark: drooling, frothy secretions Soy sauces.

Clinical features:
• history of maternal polyhydramnios
• vomiting, coughing and gagging
• cyanosis with feeds, respiratory distress
• frothy bubbles of mucus in mouth and nose that return after
suctioning

Management: Surgery – fistulectomy

2
G. Hirschsprung’s Disease
ASTHMA PROBLEM: Getting air out is the problem due to chronic

◾“congenital aganglionic megacolon”

inflammation WITH mucous production.

◾rectosigmoid in 75% of cases

Wheeze common: Expiratory
WOF: Diminishing breath sound

◾associated with Down Syndrome (DS)

Action: Give bronchodilators before oxygen.

Asthma cough: usually attacks at night.

CLINICAL FEATURES Treatment: Bronchodilators – to relieve wheezing
Example: Albuterol via MDI – 1/2 a puff per kg. Or 5 mg Nebulizer
• no meconium within first 24 hours Taken up to 2 hours; if longer may need to be admitted.
• palpable stool on abdominal exam with empty rectum on digital Albuterol is a short acting B2 agonist that causes bronchodilation.
rectal exam (DRE) peak effect: 15 to 30 mins
• intermittent diarrhea, BM only with rectal stimulation Lasting Duration: 4-6 hours
• constipation, abdomin adistention, vomiting 2 adverse affects: Tachycardia (beta 1) and Hypokalemia
• failure to thrive (FTT)
Theophylline – can be helpful for nighttime asthma symptoms

◾relaxing the smooth tissue of the bronchial airways (CBQ)

HALLMARK: “RIBBON LIKE STOOL”
TREATMENT: SURGERY-Reanastomosis

◾reducing inflammation of the airways of the lungs (CBQ)

H. Intussusception

◾telescoping or invagination of segment of bowel into distal segment ◾Long-acting beta agonists (LABAs)

◾effects last at least 12 hours

––> ischemia and necrosis
• usual site: ileocecal junction
Adverse effect: Irregular heart beat (Tachycardia) (CBQ)
TRIAD S/Sx:
Leukotriene modifiers medications
Red currant jelly” stools and bloody mucus in rectum • Montelukast (Singulair)
Abdominal pain • Zafirlukast (Accolate)
Palpable sausage-shaped mass at RUQ (Dance’s sign) • Zileuton (Zyflo)

Diagnostic Test 1. block the effects of leukotrienes, immune system chemicals that
Abdominal ultrasound helps to diagnose intussusception. cause asthma symptoms.
Barium enema confirms colonic intussusception 2. prevent symptoms for up to 24 hours (long term)
common side effects: HEADACHE
TREATMENT:
1. barium saline or pneumatic pressure enema Flovent (fluticasone) Pulmicort (budesonide) and Azmacort
2. resection and anastomosis. (triamcinolone) are ICS for long term control of asthma

Nursing care Atrovent (Ipratropium Bromide)

◾An anticholinergic; antagonizes AcH producing bronchdilation; Used

1. Stabilize the patient.
2. IVF, NGT to decrompress.
3. Pain control. in conjunction with albuterol

◾USE ONLY IN EMERGENT CASES NO MORE THAN 3 TIMES

4. Monitor for stools.
5. Monitor for signs of perforation or peritonitis

1. ASTHMA ◾NOT TO BE USE AT HOME OR OUTPATIENT OR IN REGULAR

– an INFLAMMATORY airway disease characterized by
Hyperresponsiveness and airway OBSTRUCTION
Gold standard for the diagnosis: Spirometry
HOSPITAL
2. RESPIRATORY DISTRESS SYNDROME (RDS)
◾also known as “hyaline membrane disease”

◾ most common cause of respiratory distress in the pre-term infant

Risk factors:

◾Allergies – pollen, dust mites, animal fur/feathers. CAUSE: Lack of surfactants

◾Genetics (first generation) PATHOPHYSIOLOGY: surfactant deficiency ––> poor lung

compliance due to high alveolar surface tension and atelectasis ––>
◾Pollution, diet, obesity, inner city living/poverty, ◾tobacco smoke and
respiratory distress ––> hypoxia + acidosis

viral respiratory infections Surfactant decreases alveolar surface tension, improves lung
◾Stress and strong emotions
compliance and maintains functional residual capacity

◾Exercise
MANIFESTATIONS:

◾Tachypnea
◾Weather
◾Tachycardia
◾Occupational hazards – inhalants (CBQ)
3
◾chest wall retractions (recession)
Slim extremities, Wt loss, steatorrhea

◾expiratory grunting
Intestines – meconium ileus
Respiratory System – thick tenacious secretions

◾nasal flaring and cyanosis during breathing efforts.

Risk for Respiratory infections

Reproductive system
PREVENTION: Steroid therapy (e.g. Celestone/bethamethasone) for Male – aspermia- sterility
mothers prior to delivery of premature infants Female- increase in cervical mucus- infertility

Monitor lecithin:sphingomyelin (L/S) ratio Salty Skin by “SWEAT –CHLORIDE TEST”

2:1 ratio is matured lungs -administer pilocarpine to induce sweat
Normal- <40mEq/L
TREATMENT: (+) - >60 mEq/L
1. supportive Treatment: Pancreas enzyme- do not mix with hot foods and fluids.
• O2, assist ventilation, nutrition
• administer fluids cautiously to avoid pulmonary edema TREATMENT: includes physiotherapy to help clear the mucus from
the lungs and antibiotic medication to fight chest infections.
2. Surfactant administration – Endotracheal route
Life expectancy : age of 30-35.
Spina bifida ("split spine")

◾a developmental congenital disorder caused by the incomplete

closing of the embryonic neural tube.

◾most common location of the malformations is

the lumbar and sacral areas

Risk factor: LACK OF FOLIC ACID intake during pregnancy

Myelomeningocele
is a herniation of the spinal cord, meninges, and CSF into a sac

Meningocele, a sac formation containing meninges and

cerebrospinal fluid (CSF).
PRIORITY item at bedside: Bottle of sterile normal saline
PRIORITY nursing diagnosis before surgery: RISK FOR INFECTION
PRIMARY reason for surgical repair: Decrease risk of infection

MOST important for the care: Inspecting the anterior fontanel for
bulging
MOST often associated with myelomeningocele: Hydrocephalus
MOST common problem of children born with a myelomeningocele:
Neurogenic Bladder
Prevention: Folic acid should be taken before and after conception
– 400mcg or 0.4mg daily

Cystic Fibrosis
autosomal recessive genetic disorder.
Dysfunction of exocrine glands -mucus secreting glands
PROBLEM: VISCOUS SECRETIONS

***BOTH PARENTS ARE CARRIERS

REFER TO: GENETICIST

Signs and symptoms:

Absence of pancreatic enzymes in the duodenum (malabsorption of

nutrients)
4
 DOC: indomethacin – prostaglandin inhibitor that facilitates the
closure of DA
• Last resort : Surgery or ligation of PDA @ ages 3-4 years
old

COA – narrowing of aorta

• Prominent sign – absence of femoral pulse

Nsg. Intervention: Monitor BP of four extremities
Reveals:
• Upper extremities hypertension with bounding pulse
• Unequal peripheral BP – low bp @ lower extremities with
weak thread pulse
• Surgery : Balloon angioplasty
• - Left to right
Congenital heart defects that don't normally interfere with the amount Cyanotic heart defect – R-L
of oxygen or blood that reaches the tissues of the body.
• If a bluish tint occurs, it often is during activities when the cyanotic heart defects, less oxygen-rich blood reaches the tissues of
baby needs more oxygen, such as when crying and the body.
feeding. This results in the development of a bluish tint—cyanosis—to the
skin, lips, and nail beds.
Acyanotic congenital heart defects include:

Patent ductus arteriosus (PDA) .

Atrioventricular septal defect .
Pulmonary valve stenosis .
Aortic valve stenosis .

Coarctation of the aorta

Atrial septal defect (ASD) .
VEntricular septal defect (VSD).

Ventricular septal defect (VSD)

S/sx :
1. systolic murmur @ the lower sternum
2. increase O2 saturation @ the right side of heart
3. will undergo cardiac cath. – femoral
• brachial
• carotid/jugular
Nsg management:
• NPO- 6-8 hours before
• CBR without bathroom privileges
• 3 hypertrophy of the right side of heart
MGT:
• Long term antibiotics to prevent sub acute endocarditis
• Open heart surgery
• Administer digoxin as per doctors order to strengthen heart
contractions
Tetralogy of Fallot
ASD – failure of foramen ovale
Right ventricular hypertrophy
• Closes within 3 mos – 1 year Overriding of aorta
• **position baby RSL – to increase pressure @ the left side Ventricular septal defect,
S/Sx: Stenosis of pulmonary artery,
• Systolic murmur @ the upper border of sternum
• Increase O2 saturation @ the right side of the heart Causes
• Hypertrophy of the right side of heart
• Mgt. same as ASD • Tetralogy of Fallot causes low oxygen levels in the blood.
This leads to cyanosis (a bluish-purple color to the skin).

PDA- Patent ductus arteriousus-

- failure of DA to close

• It should close to 24 hours up to 1 week

• Abnormal connection between aorta and pulmonary artery

S/Sx:
• “ continous machinery like murmurs”
• Prominent radial pulse at birth
• Hypertrophy at the left ventricle

5
 • Echocardiogram
• Electrocardiogram (EKG)
• MRI of the heart (generally after surgery)

TOGA – TRANSPOSITION OF THE GREAT ARTERIES Signs and symptoms

• Aorta arises from R.V 1. Cyanotic

• P.A arises from L. V 2. Polycythemia vera
Signs and symptoms – 1st cry will make the baby cyanotic 3. Severe dyspnea
• Knee chest or SQUATTING POSITION
• Polycythemia vera – increase RBC in the blood due to • TO INHIBIT VENOUS RETURN
decrease oxygen level • Promotes lung expansion
• Plethora- ruddy complexion • Relieve of DOB
• Cardiomegaly • 4. Tet spels or blue spells – due to short periods of hypoxia

Ventricular septal defect • 5. Paroxysmal dyspnea

• 6. Mild mental retardation – due to decrease oxygen in the
• hole between the right and left ventricles brain
• Narrowing of the pulmonary outflow tract (the valve and
artery that connect the heart with the lungs) • 7. Syncope
• Overriding aorta (the artery that carries oxygen-rich blood
to the body) that is shifted over the right ventricle and • 8. Growth retardation
ventricular septal defect, instead of coming out only from
• 9. Clubbing of fingers
the left ventricle
• Thickened wall of the right ventricle (right ventricular • 10. X-ray will show BOOT SHAPED HEART
hypertrophy)
Mgt:
Factors :
1. Position the child to squatting
• Alcoholism in the mother 2. Oxygen as ordered not to high concentration
• Diabetes 3. Avoid valsalva maneuver
• Mother who is over 40 years old 4. Propanolol to decrease heart spasm
• Poor nutrition during pregnancy 5. Surgey:
• Rubella or other viral illnesses during pregnancy • Blalock- Taussig procedure (BLT)
• Anastaomosis of subclavian artery and pulmonary artery
Symptoms thus increasing peripheral blood flow
• Post care- evaluate infants color – absent cyanosis
• Blue color to the skin (cyanosis), which gets worse when
the baby is upset
• Clubbing of fingers (skin or bone enlargement around the Possible Complications
fingernails) • Delayed growth and development
• Difficulty feeding (poor feeding habits) • Irregular heart rhythms (arrhythmias)
• Failure to gain weight • Seizures during periods when there is not enough oxygen
• Passing out • Death
• Poor development
• Squatting during episodes of cyanosis Acquired heart disease

Exams and Tests RHF – Rheumatic heart fever – 3-5x of tonsillitis per year
• -sysytemic inflammation that affects the brain – heart ,
joints SQ tissues
Jones criteria
C.A: GABHs
Major S/Sx: Minor S/SX: • Complication RHD due to destruction of mitral valve
• Polyarthritis • Athralgia/arthritis
• Chorea- dyskinesias • Low grade fever
– jerking • Increase ASO titer
movements of • normal of ASO in
shoulders, hips, and 200 normal children of 5-15
face. years of age
• Carditis • increase ESR
• Erythema
marginatum
• Subcutaneous
nodules

• A physical examination with a stethoscope almost always

reveals a heart murmur
• Presence of 2 major = RHF
Tests may include: • 1 major + 2 minor + sorethroath = RHF

• Chest x-ray Mngt :

• Complete blood count (CBC)
• Increase fluid intake
6
 • CBR • Bleeding in the mouth from a cut or bite or from losing a
tooth
• Throat swab exam • Hemarthosis (tightness, swelling, warmth and/or pain in the
• Antibiotic therapy Azithromycin & erythromycin joints)
• Bleeding into soft tissues
• ASA therapy • Heavy bleeding from a minor cut
• Cuts that bleed again after they have already stopped for a
A – Genetic Defects short time
• Gastrointestinal, genitourinary, or intracranial bleeding
1 – Hemophilia
-cause by a genetic deficiency or lack of certain clotting factors
Type A hemophilia:

 Most common form (80% or more).

 X-linked recessive disorder Results from a
deficiency of clotting factor VIII(8)
Type B hemophilia(Christmas Disease):

 Second most common form of hemophilia (10-15%)

 X-linked autosomal recessive disorder.
 Results from deficiency of clotting factor IX(9)
Type C hemophilia (Rosenthal’s Disease):

 Least common of all hemophilia cases(<5%).

• People born with hemophilia A are usually males, because
 Results from a deficiency of clotting factor XI(11).
the
 Autosomal recessive disorder
gene
DIAGNOSTIC PROCEDURES is

• PLATELET COUNT- NORMAL

• PT (PROTHROMBIN TIME)
• PTT – PARTIAL THROMBOPLASTIN TIME – INCREASE
BLEEDING TIME
• NORMAL PTT of infants – is < 90 secs

located on the X-chromosome.

• Females have two X-chromosomes, one of which is usually
a healthy X-chromosome, which compensates for a
potentially defective Factor VIII (FVIII) gene on the other
(however, this makes them carriers of hemophilia A).
• This compensation does not work in males, who have only
one X-chromosome and a Y-chromosome

hemophilia A treatment options

• Humate
• Haemate
• Biostate
Hemophilia B
• also known as Christmas disease, is the second most
common type of hemophilia, affecting about 20% of people
with hemophilia.
• It is typically an inherited bleeding disorder that results from
a deficiency of Factor IX.
• Like hemophilia A, people born with hemophilia B are
usually male, because the gene is located on the X-
chromosome.
Hemophilia A
• Females have two X-chromosomes, one of which is
• Most common usually a healthy X-chromosome, which compensates for a
• CLASSIC TYPE potentially defective Factor IX gene on the other (however,
• CLOTTING FACTOR 8 this makes them carriers of hemophilia B).

The most common hemophilia A symptoms are: • This compensation does not work in males, who have an
• Hematomas (for example, an infant born with hemophilia A only X-chromosome and a Y-chromosome.
may bruise simply from being lifted)
7
 • The symptoms of hemophilia B may vary from almost none
to frequent spontaneous bleedings.
The most common symptoms of hemophilia B are:
• Hematomas (for example, an infant born with hemophilia B
may bruise simply from being lifted)
• Bleeding in the mouth from a cut or bite or from losing a
tooth
• Hemarthosis (tightness, swelling, warmth and/or pain in the
joints
• Bleeding into soft tissues
• Heavy bleeding from a minor cut
• Cuts that bleed again after they have already stopped for a
short time
• Gastrointestinal, genitourinary, or intracranial bleeding

Treatment option for hemophilia B:

• Mononine-Coagulation Factor IX
• Berinin®

8
Essential lntrapartum and Newborn care (EINC) is a package of
evidence-based practices recommended by the Department of
Health (DOH), Philippine Health Insurance Corporation (PhilHealth),
and the World Health Organization (WHO)
– as the standard of care in all births by skilled attendants in
all government and private settings.
It is a basic component of DOH’s Maternal, Newborn and Child
Health and Nutrition (MNCHN) strategy. The EINC practices for
newborn care constitute a series of time- bound, chronologically-
ordered, standard procedures that a baby receives at birth. At the
heart of the protocol are four time-bound interventions:
1. immediate drying
2. skin-to-skin contact
3. clamping of the cord after 1-3 minutes
4. non-separation of baby from mother; and breastfeeding
initiation.
TAKE NOTE: If baby is gasping or has a difficulty of breathing or
cyanotic at birth start ventilation using valve-mask-bag
If NOT — perform immediate and thorough drying using a dry warm
towel for 30 seconds
1. Immediate drying (FIRST ACTION in the FIRST 30
seconds)
– To prevent hypothermia and stimulate newborns
respiration
Using a clean, dry cloth, thoroughly dry the baby, wiping the face,
eyes, head, front and back, arms and legs.
2. Skin-to-skin contact (AFTER 30seconds of drying)
— To prevent hypothermia, allows colonization of good bacteria,
increases overall success of exclusive breastfeeding, facilitates
bonding and prevents hypoglycemia and infection.
• If a baby is crying and breathing normally, avoid any manipulation,
such as routine suctioning, that may cause trauma or introduce
infection. Place the newborn prone on the mother’s abdomen or
chest skin-to- skin.
• Cover newborn’s back with a blanket and head with a bonnet. Place
identification band on ankle.
3. Proper cord clamping and cutting (within 1 to 3 mins or
after cord pulsations stops)
– Prevent anemia in the newborn and intraventricular
hemorrhage
– Waiting pulsation to stop, ALLOWS transfusion of
remaining 80 to 100ml of blood from the placenta to
newborn, essential to prevent ANEMIA of newborn
• Clamp and cut the cord after cord pulsations have stopped (typically
at 1-3 minutes).
• Put ties tightly around the cord at 2 centimeters and Second
clampis 5 centimeters from the newborn’s abdomen.
• Cut between ties with sterile instrument.
• Observe for oozing blood. (Apply firm pressure)
• Do not milk the cord towards the newborn.
• After cord clamping, ensure oxytocin 10 IU IM is given to the mother
4. Non-separation of baby from mother & breastfeeding
initiation (within 90 mins)
— NO SEPARATION FOR 24 HOURS
• Observe the newborn. Only when the newborn shows feeding cues
(e.g., opening of mouth, tonguing, licking, rooting), make verbal
suggestions to the mother to encourage her newborn to move toward
the breast (e.g., nudging).
 DROOLING is the EARLIEST feeding cue.
• Counsel on positioning & attachment.
• When the baby is ready, advise the mother to:
a. Make sure the newborn’s neck is neither flexed nor twisted.
b. Make sure the newborn is facing
the breast, with the newborn’s nose opposite her nipple and chin
touching the breast.
c. Hold the newborn’s body close to her body.
d. Support the newborn’s whole body, not just the neck and
shoulders.
e. Wait until her newborn’s mouth is opened wide.
f. Move her newborn onto her breast, aiming the infant’s lower lip well
below the nipple.
g. Look for signs of good attachment and suckling:
− Mouth wide open
− Lower lip turned outward
− Baby’s chin touching breast
− Suckling is slow, deep with some pauses
− If the attachment or suckling is not good, try again and reassess.
Notes
• Health workers should not touch the newborn unless there is a
medical indication.
• Do not give sugar water, formula or other prelacteals.(EO 51)
• Do not give bottles or pacifiers. (EO 51 – MILK CODE)
• Do not throw away colostrum.
FIRST AID
F irst Aid is the immediate care given to victim until qualified medical
personnel arrives.
I mplied consent involves an unresponsive victim in a life-threatening
condition(CBQ)
R ender First Aid assistance for which you have been trained.
S urvey the scene for NOT more than 10 seconds. (CBQ)
T hrust maneuver ( jaw thrust) for safety approach for the airways
A BC is the priority
I nitiate Cardiopulmonary resuscitation
D o the greatest good to the greatest number (CBQ)
Scene Safety Assessment
Before providing aid, take a moment to remember the mnemonic S-A-F-
E.
S top.
A ssess the scene : Assess NOT more than 10 seconds(CBQ)
F ind the first aid kit, oxygen unit and AED
E xposure protection: Use PPE such as gloves
 Determine if victim is conscious - by tap and shout “are you okay”.
Check for ABC as indicated:
A irway Open
▪ NO suspected spinal cord injury - Head tilt chin lift maneuver(CBQ)
▪WITH suspected spinal cord injury- Jaw thrust maneuver(CBQ)
B reathing
▪ look, listen, and feel.
C irculation
▪CAROTID – adult and children
9
▪BRACHIAL – infants spontaneously words pain (decorticate)
CONSCIOUS VICTIM UNCONSCIOUS VICTIM 4- Confused 4- Withdrawal from
Ask them what injuries or  Observe for obvious signs of 5- Orientated pain
difficulties they are injury or illness, CHECK FROM 5- Localizing pain
experiencing. HEAD TO TOE. 6- Obeys commands
 PROVIDE FIRST AID/CPR for
injuries or illness observed Take note: A GCS score of 8 or less defines a severe head
injury or coma ; GCS score of 3 or less than 4 is in deep
TAKE NOTE: The preferred sequence of
coma.
CPR NOW is change to the C-A-B
sequence (Compressions-Airway- ASSESSMENT GUIDE FOR STOKE AND HEART ATTACK
Breathing). COMPRESSION FIRST!!! STROKE HEART ATTACK
CARDIOPULMONARY RESCUSITATION F: Face. Ask the person to S: Shortness of breath
"FIVE-link chain of survival." smile. Does the face look T: Tightchest, or pressure(like elephant in
uneven? chest)
1. Early recognition of an ongoing emergency, A: Arms. Ask the person to O: Other symptoms such as cold sweats,
2. Early initiation of CPR by a bystander raise both arms. Does one weakness or fatigue, heart palpitations,
3. Early/rapid use of a defibrillator arm drift down or is it unable dizziness or even loss of consciousness
4. Basic and advanced emergency medical services to move? P: Pain in chest, throat, neck, jaw,
5. Advanced life support and post-cardiac arrest care S: Speech. Ask the person to arms/back
repeat a simple phrase. Does
TAKE NOTE: Qualified bystanders with training in BLS are encouraged to their speech sound strange?
perform the first three steps of the five-link chain of survival. Strange speech could be
slurred, the wrong words may
INFANT CPR CHILDREN AND ADULT CPR come out, or the person is
unable to speak.
Compression CPR ratio Compressi CPR ratio T: Time to call 9-1-1
on rate
Rate: 100-120/min Compressio 100-120/ Compressio
n: 30 min n: 30 SEVEN (7) LEVELS OF CONSCIOUSNESS
Compression depth: 1.5 Ventilation: Ventilation:
inches (4 cm) 2 Compressi 2 Conscious normal, attentive; oriented to self, place, and mind,
on depth: WIDELY AWAKE(CBQ)
Two-finger Single Children: CPR ratio –
chest compression techniq rescuer Two (2) 30:2 Confused impaired or slowed thinking; disoriented
ue in infant (1 rescuer) 30:2(CBQ) inches or
(5 cm) Disorientation happens FIRST IN TIME then in place and
Two finally in person.
rescuer Adult: least
15:2 (CBQ) 2 inches (5 Delirious RESTLESS and IRRITABLE(CBQ)
cm) but no possible incidence of hallucinations and delusions
greater Somnolent excessive drowsiness; little response to external stimuli
than 2.4 Obtunded decreased alertness, slowed motor responses; sleepiness
inches (6 Stupor only responsiveness is in reaction to PAIN
cm) STIMULI(CBQ)
Comatose PROFOUND UNCONSCIOUSNESS in which the person
The Glasgow Coma Scale divides into three parameters: best eye is alive but unable to react or respond to stimuli. (CBQ)
response (E), best verbal response (V) and best motor response (M).
The levels of response in the components of the Glasgow Coma no response to stimuli, cannot be aroused; no gag reflex
Scale are ‘scored’ from 1, for no response, up to normal values of 4 or pupil response to light
(Eye-opening response and spontaneity) 5 ( Verbal response) and 6 deep state of unconsciousness
(Motor response). The total Coma Score thus has values between three
and 15, three being the worst and 15 being the highest. CHOKING / Foreign body airway obstruction (FBAO)
S/s: Coughing , Cannot talk, Cyanosis, Clutching neck
Best eye Best Best motor General Precaution: (CBQ)
response verbal response (6) C oughing and clutching of neck ▪If someone is coughing,
(4) response H eimlich maneuver leave the person alone,
(5) O bese and pregnant do Abdominal thrust allow him to cough.
Scores Scores Scores (CBQ) ▪Do not perform the
1- No eye opening 1- No verbal 1-No motor K eep repeating thrust if necessary Heimlich
2- Eye opening to response response. E xamine inside mouth ▪Keep eyes on that person.
pain 2- 2-Abnormal D O NOT perform finger sweeping(CBQ)
3- Eye opening to Incomprehensible extension to ▪Hands wrapped around
sound sounds pain (decerebrate) neck is universal sign for
4- Eyes open 3- Inappropriate 3-Abnormal flexion to choking.
10
 Do: Heimlich Maneuver Lead poisoning High risk: Toddlers ( and less than 6 years old)
(CBQ) (CBQ)
Organ damage: Irreversible brain
damage(CBQ)
CHOKING INFANT: Place the baby face down on your forearm. Your arm Common sources of lead: OLD houses built
should be resting on your thigh. With the heel of your other hand, give the before 1978 ( chipping paints and soil)
child 5 quick, forceful blows between the shoulder blades ( 5 BACK Diagnostic test: ONLY by blood test
THRUST, and if object is not expelled perform 5 CHEST THRUST) (CBQ) Signs/Symptoms: Difficult to detect, signs and
symptoms appear in long period of time.
Initially no signs. (CBQ)
POISONING
KINDS FIRST AID
BITES
Swallowed poison. FIRST ACTION: Call for help ( poison center)
NON CORROSIVE: Remove anything TICK BITES ANIMAL BITE SNAKE BITE
remaining in the person's mouth. Allow to Tick bite can cause: Animal bites can cause Remove person in
vomit. (CBQ) lyme disease, rocky Rabies infection. snake vicinity and call
mountain spotted for help
CORROSIVE: If the suspected poison is a fever W ash
household cleaner or other chemicals, DO immediately(CBQ) S tay still, do not panic
NOT INDUCE VOMITING T weezer A void suction/tandok, N ever elevate bite area
removal(CBQ) garlic A void tourniquet, ice,
If patient has ingested a corrosive poison, I nstruct to pull NOT S hot of tetanus for coffee
which can be a strong acid or alkaline Squeeze wound K eep in neutral
substance, GIVE WATER OR MILK TO C leanse area with H ave an anti-rabies position(CBQ)
DRINK FOR DILLUTION. (CBQ) water injection E mergency transport
K eep watching for victim
TAKE NOTE: Do not attempt dilution-if patient any signs of severe TAKE NOTE: Wash S uctioning venom by
has acute airway edema or obstruction or allergic reactions immediately with mouth should be
esophageal, gastric, or intestinal burn or detergent soap and AVOIDED. (CBQ)
perforation. running water for 15
minutes. (CBQ) TAKE NOTE: REMOVE
POINTS TO REMEMBER: JEWELRIES or any
 If you suspect poisoning, be alert for clues such as empty pill constrictive material or
bottles or packages, scattered pills, and burns, stains and odors clothing before swelling
on the person or nearby objects. begin.
 If the person vomits, turn his or her head to the side to prevent
choking. Do not extend head up
 Begin CPR if the person shows no signs of life /UNCONSCIOUS BURN INJURY
 Don't give syrup of ipecac or do anything to induce vomiting.
 For corrosive poisoning substance – NEVER INDUCE DEGREES BURNED SKIN PAIN FIRST AID
VOMITING!! (CBQ) AREA
 Maintain airways, check ABCDs, (CBQ) First Epidermis of Red, dry Painful Cool
 GIVE COLD WATER OR MILK TO DILUTE if poison was degree skin NO running
corrosive (acid) or caustic (alkali) (Superficial Ex. Sunburn blister water(CBQ)
 Place victim on left side (gravity delay poison entering )
bloodstream) (CBQ)
Second Dermis/ BLISTE MOST Cool
degree Coreum R PAINFUL running
Poison on the skin Remove any contaminated clothing using (Partial Moist (CBQ) water.
gloves. Rinse the skin for 15 to 20 with running thickness) with
water. (CBQ) seepage Cool
of fluid. compresses
Poison in the eye. Gently flush the eye with running water for 20 if running
minutes or until help arrive(CBQ) Note: water isn't
Inhaled poison. Get the person into fresh air as soon as Never available.
possible. (CBQ) break
Blisters
Red tide poison Give FRESH COCONUT MILK; and NEVER (CBQ)
COOK THE SHELLFISH WITH RED TIDE
WITH VINEGAR. (CBQ) Third Fatty tissue White or PAINLESS Cover
degree Subcutaneous Charred ▪damaged of loosely with
Firecracker poison If ingested, DO NOT induce vomiting. Children (FULL fat(CBQ) nerve sterile,
(Watusi/Piccolo) may be given 6-8 raw egg whites and adults, thickness) endings(CBQ nonstick
8-12 raw egg whites ) bandage.

11
Fourth Deeper tissue Charred NO PAIN Cover •Hot, dry skin or ASHEN cooling
degree Muscles, bone and stiff. loosely with SKIN •Place cold, wet cloths or ice on head,
(FULL sterile, •Seizures neck, armpits, and groin
thickness) nonstick •Fatal if treatment delayed •Stay with client until emergency medical
bandage services arrive
NOTES: Seizure S afety! Protect from injury ( clear
 Immediate priority is AIRWAY ( FOR ANY CHEST, FACE, NECK surrounding) (CBQ)
or INHALATION BURN INJURY) (CBQ) A irway patency ( loosen constrictive
 In emergent phase: FLUID RESUSCITATION IS ALSO A clothing)
PRIORITY. (CBQ) F olded cloth, spoon, tongue depressor is
 DO NOT APPLY TOOTHPASTE, TOMATO. ALOE VERA can NOT ALLOWED
be in minor burns. E nsure safety at all times
 Intravenous is the BEST route of drug administration in 3rd T ransferring and holding patient should be
degree burn ( AVOID SQ and IM) (CBQ) AVOIDED.
 hyperkalemia and hyponatremia F & E shifts in Y ou must AVOID restraints
Emergent phase(CBQ)
CLOSED WOUNDS

FIRST AID STINGS CONTUSION CONCUSSION

SOFT TISSUE INJURY An HEAD INJURY that may cause
BEE STINGS JELLY FISH STING SEA URCHIN produced by blunt force, causing instant loss of awareness or alertness
STINGS small blood vessels to rupture for a few minutes up to a few hours
and bleed into soft tissues after the traumatic event
S crape to remove D o not remove U se sea water to
sting(CBQ) tentacles with bare wash site Contusion is the medical term for Injury resulting specifically from brain
T weezers are NOT hands( use gloves) R emove spikes with BRUISES or hematoma ( blood trauma
allowed I nstruct wash with sea tweezer accumulation in soft tissue) MOST COMMON TYPE OF BRAIN
I nstruct cold packs water. C old/ice pack is not INJURY
after K eep area rinse with allowed
N ote for any acetic acid H OT WATER for pain
OPEN WOUNDS
anaphylaxis Y es! ONLY ACETIC relief
G ive epinephrine shot ACID NOT all types of I mmerse but avoid Abrasion Skin wound caused by rubbing or scraping the skin
for anaphylactic vinegar. scalding against a hard, rough surface(CBQ)
reaction(CBQ) A pply calamine lotion N EVER pee on the Puncture Piercing wound that causes a small hole in the tissues.
hydrocortisone cream sting Such objects as nails, needles, ice picks and other
Takenote: Anaphylaxis or cold packs pointed object
is a severe form of
allergic reaction. High risk for tetanus bacteria (lockjaw)
Laceration TEARING OF SOFT TISSUE
jagged, irregular or blunt breaking or tearing of soft
FIRST AID TO CERTAIN CONDITIONS tissue(CBQ)

Hypoglycemic attack Give sugar candy, soda or fruit juice(CBQ) Avulsion FORCEFUL SEPARATION or PARTIAL TEARING
Electrocution Turn of the main switch immediately AWAY of tissues. Due to EXPLOSIONS, ANIMAL
Near drowning Provide warmth ( clothing, blankets, BITESmishandlingtools or other body-crushing injuries
thermal blankets) that may cause SKIN TO FLAP in body. (CBQ)
Heat exhaustion •Remove from hot area, and place in shady
Temp: 101°F (38.3°C) cool place If a body part (a finger, tooth or toe, for example) has
to 104°F (40°C). •Remove unnecessary clothing, including been torn away in an accident, it should always be sent
shoes and socks along with the victim to the hospital (placed on moistened
S/s: •Cool with water, cold compresses, an ice gauze and cooled or soak in normal saline) (CBQ)
▪ Headache bath, or fans Incision A cut caused by a knife, the rough edge of metal, broken
•Nausea •Encourage frequent sips of cool water glass, a razor blade or some other sharp object.
•Dizziness, weakness
• Irritability If the cut is deep, muscles, tendons and nerves may be
•Thirst, heavy sweating damaged.
•Decreased urine output
Regular, smooth and defined edge of wound.
Heat stroke •This is an emergency! Call for emergency EPISIOTOMY is a type of INCISED WOUND. (CBQ)
( above 104°F or 40°C) care immediately!
•Move client to a cool area and remove Missile wound Also called VELOCITY WOUND, they are caused by an
S/s: outer clothing object entering the body at a high speed, typically a bullet
•Confusion, altered mental •Cool client with water, cold compresses,
state, slurred speech, loss of an ice bath, or fans
consciousness •Circulate air around worker to speed WOUND CARE MATERIALS

12
Dressing A with band cloth or other material placed above a wound
to stop all flow of blood(CBQ)
The purpose of a dressing is to:
 Absorb drainage or discharges(CBQ)
 Control bleeding
 Prevent infection and contamination
 Protect the wound from further injury
Bandage Material used to wrap or cover a part of the body;
commonly used to hold a dressing or a splint in place.
Strips of cloth, gauze, or elasticized material used to wrap
a body part.
TAKE NOTE:PERFORM NEUROVASCULAR assessment, check pulses
DISTAL OF THE FRACTURED SITE. (CBQ)
TYPES OF ROLLER BANDAGING
Simple spiral bandage UNIFORM THICKNESS body part (ex. wrist)
each turn of bandage overlaps previous turn by ½
to 1/3 width
Reverse spiral used for body part that DOES NOT have uniform
bandage thickness (ex. thigh); similar to spiral but each turn
is reversed on itself to prevent gaping
Applied to parts of body that VARIES in length
( cylindrical or cone parts)

Bandage can be used to: Figure of eight This bandage is used for elbow, knee joints and
 Hold a dressing in place over an open wound ankle. This bandage is made by forming two loops
 Apply direct pressure over a dressing to control or oblique turns over a joint. The turns alternately
bleeding ascend & descend to cover the part.
 Prevent or reduce swelling The bandage is carried above the joint, around it,
 Provide support and stability for an extremity or and below the joint, making figure-of-eight turns.
joint
 Bandage should be clean but need not be Spica A form of the figure of eight bandage. The turn is
sterile. larger than the other. It is used for joints at right
angles to the body, e.g. the shoulder, groin,
Tourniquet Any elastic band material applied by stretching, wrapping, thumb.
and tucking around the limb to stop bleedings. (CBQ)
CRAVAT BANDAGE / A triangular bandage, folded lengthwise. It may be
NOTE: Tourniquet must be always at the bed side of a triangular bandaging used as a circular, figure
patient who undergoneamputation. eight, or spiral bandage to control bleeding or
to tie splints in place.
Useful to control bleeding from wounds of the
WOUND CARE scalp or forehead , eye , temple, cheek, or ear
W ear sterile gloves and clean wound MONITOR FOR SHOCK
O pen wounds: APPLY FIRM DIRECT
pressure. Hemorrhagic shock: STRAIN VERSUS SPRAIN
U se TORNIQUET if severe bleedings. Hypotensive STRAIN SPRAIN
N O THICK DRESSINGS (CBQ) Tachycardia S prain injury is to joints and
D O HAVE a anti-tetanus injection Tachypnea S tretched or pulled MUSCLES LIGAMENTS
within 72 hours(CBQ) T earing of MUSCLES and tendons P ainful, tender, swollen injured
Management: R isk factor: accident and overuse ligaments
C loth/dressing is placed in top of Monitor ABC's muscles R est/ immobilize
wounds Position: Trendelenburg A pply ice to reduce swelling. A nkle sprain is the most
A pply bandage to hold the dressing IVF: Lactated Ringers I mmobilize ( do not move the injured common
R eport any signs of wound infection part) I ce application
E xamine for the signs and symptoms Normal saline for BLOOD N EVER apply ice for more than 20 N o straightening of the sprained
of infection. TRANSFUSION. (CBQ) minutes part.
Fever /chills
A sensation of warmth and foul
REMEMBER: P.R.I.C.E is the management for both strain and sprain
discharge
(Protection, Rest, Ice, Compress, Elevate) (CBQ)
Swelling, and redness around the
wound Protection – Stop activity immediately and protect the injured
Throbbing pain and Swollen lymph part from further damage
nodes Rest – to allow the tissues to heal
Ice – Apply cold therapy to an acute injury
Compress – Quickly wrap the injured body part with elastic
BANDAGING
B andage is just CLEAN and NOT sterile. bandage not too tight but have it snug
A pply bandage direction will from DISTAL to PROXIMAL and from MEDIAL Elevation – Elevate the injured part above the heart to reduce
to LATERAL(CBQ) the blood flow and swelling to the area
N ote: Overlap each bandage turn by two-thirds the width of the bandage
D o not begin bandaging over a wound or in an area where pressure is
contraindicated
A lways Hold the roller bandage with the roll facing upward HYDROTHERAPY : refers to the therapeutic use of water, including hot tubs,
G et bony prominences padded. cold water treatments, ice packs, vapors, saunas, mineral springs, hot
E xpose the distal aspect of limb to check adequacy of blood circulation

13
springs, sitz baths, wet towel applications, water exercises, and water of the drug(CBQ) maleate
massage. (CBQ) ( molecular structure)
CRYOTHERAPY / COLD THERMOTHERAPY/HEAT
COMMON DRUG PREPARATIONS
COLD HOT Tablet a powdered drug compressed into a hard small
disc; some are readily broken along a scored line;
Cold Application Hot Application others are enteric coated to prevent them from
C ontrols bleeding by dissolving in the stomach
VASOCONSTRICTION H ealing of wounds ( promotes Capsule a gelatinous container to hold a drug in powder,
O ffers ANESTHETIC EFFECT circulation) liquid, or oil form
( relieve pain) O pen blood vessels Caplet a solid form, shaped like a capsule, coated and
L owers body temperature ( VASODILATION) easily swallowed
D ecreases EDEMA T o promote MUSCLE Pills one or more drugs mixed with a cohesive
RELAXATION(CBQ) material, in oval, round, or flattened shapes
REMEMBER: S edative ( induces sleep) Syrup an aqueous solution of sugar often used to
Cold constricts vessels and retains disguise unpleasant-tasting drugs
heat REMEMBER: Elixir a sweetened and aromatic solution of alcohol
Cold is usually best for a fresh injury, Dilates vessels and releases used as a vehicle for medicinal agents(CBQ)
like a bruise or a sprain. heat(CBQ) Extract A concentrated form of a drug made from
Cold should only be used for the first Heat relax muscles, joints, and vegetables or animals
48 hours or so after an injury. blood vessels Lozenge A flat, round, or oval preparation that dissolves
Watch for burns or if your skin (troche) and releases a drug when held in the
becomes numb, blistered, or red. mouth(CBQ)
Suppository One or several drugs mixed with a firm base such
COLD CONTRAINDICATION: as gelatin and shaped for insertion into the body
1. Open wounds. HEAT CONTRAINDICATIONS (e.g., the rectum); the base dissolves gradually at
2. Impaired Circulation. 1. Fresh injury body temperature, releasing the drug. (CBQ)
3. Allergy or Hypersensitivity to cold 2. Active hemorrhage.
3. Non-inflammatory Edema.
4. Localized malignant tumor.
CLASSES OF DRUG
5. Skin disorder that causes
redness or blisters. Therapeutic effect: the desired or intended effect of a particular
medication.
GENERAL PRECAUTION:
 Keep a towel between your skin and the heat/cold source.
 Don’t apply heat/cold for more than 15-20 minutes at a time. Curative able to heal or Antibiotics
cure
Chemotherapeutic destroys Chemotherapeutic
malignant cells drugs
Palliative receives Analgesic for pain
symptoms of a relief(CBQ)
Pharmacology
disease but does
Pharmacology the science that deals with the study of drugs
not affect the
Pharmacotherap study of the use of drugs in the treatment of the
disease itself
eutics sick
Restorative returns the body Vitamins and minerals
Pharmacokinetic study of the movement of drugs in the body, incl
to health
s uding the processes of ADME (Absorption-
Supportive supports body Acetaminophen to
Distribution-Metabolism-Excretion) (CBQ)
function until adjust fever
other treatments
of the body
*Liver – site of drug metabolism
response can
Kidneys – for excretion
take over
Pharmacodyna Study of the effect of drugs in the body ( how
Substitutive replaced bodily Insulin
mics drug works in body) (CBQ)
fluids or
Study of the impact of medication on living
substances
tissue

THREE (3) DRUG NAMES

NON THERAPEUTIC DRUG EFFECTS
NAMES DESCRIPTION EXAMPLE
Generic/Official Used in official Paracetamol
NONTHERAPEUTIC : an undesired response to a drug
name publications(CBQ)
Side effect an unintended, but usually predictable,
Brand/Trade Given by the Biogesic
response to a drug which can be harmless or
name manufacturer
injurious(CBQ)
Propriety name (CBQ)
Drug toxicity deleterious effects of a drug(CBQ)
Chemical name Chemical composition acetaminophen, dex
Adverse effects more severe side effects that may justify the
or the active ingredients brompheniramine
14
 discontinuation of a drug D.An order written by the physician that has to be carried out
Cumulative effect the build up of a drug when the body cannot immediately.
bio transform (metabolize) and/or excrete
one dose of the medication before the next
is administered
Drug tolerance decreased physiologic response ; DRUG DOSAGE CALCULATION
necessitates an increased dosage of the drug
to maintain a therapeutic effect(CBQ)
Anaphylactic reaction severe allergic reaction that occurs rapidly
and causes a life-threatening response
involving the whole body. (CBQ)
Drug dependence reliance on or need to take a drug or
substance
Physiologic biochemical changes occurring in the body
dependence as a result of excessive use of a drug

Psychologic a state of emotional reliance on a drug to

dependence maintain one's well-being; a feeling of need
or craving for a drug
Drug Addiction term applied to a condition in which these is
a dependence and craving for a narcotic or
other habit-forming drug. (CBQ)

TYPES OF MEDICATION ORDERS

TYPES DESCRIPTION KEYWORDS

Example: Metoprolol 50 mg PO, is ordered. Metoprolol is
Single order an order that is to be one time order; available as 100 mg per
carried out one time GIVENONCE at a tablets. How many tablets would the nurse administer?
only at a specified time SPECIFIEDTIME.
(CBQ)
Drug dose computation in ml
Standing an order that may be may or may not have a Formula: D/H x Q = x
order carried out indefinitely termination date.
until another order is may be CARRIED OUT D is the Desired dose (amount) = ordered
written to cancel it; or INDEFINITELY until Dose amount
that may be carried out an order is written to H is the amount on Hand (available)
for a specified number cancel it. (CBQ) Q is the Quantity.
of days
Example: The Dr. ordered lorazepam 4 Mg IV Push for a patient.
Stat order indicates an order that IMMEDIATELY and The clinician has 2 mg/mL vials on hand. How many milliliters
is to be carried out only once(CBQ) should he or she draw up in a syringe to deliver the desired dose?
immediately and only Dose ordered (4 mg) x Quantity (1 mL)/Have (2 mg) = Amount to
once give (2 mL)
▪as soon as
possible/NOW
TELEPHONE ORDERS
Prn order "as needed order"; Use/requires GOOD O rder taken must be entered immediately ( date & time entry) –
permits the nurse to JUDGEMENT about (CBQ)
give a medication when the medication is R epeat order back to Doctor ( VERIFICATION) – (CBQ)
when, in the nurse's needed and when it can D on't understand: Ask another nurse to listen in, have her read it
judgment, the client be safely administered. back.
requires it (CBQ) E nsure that the other nurse must sign the order too. – (CBQ)
▪when, as R equire that the order must be signed by the Dr. WITHIN 24
necessary(CBQ) hours. – (CBQ)
▪as required

The physician orders a PRN pain medication to patient Alma. When

will Nurse Norma administer a PRN drug? TEN “RIGHTS” OF MEDICATION
A.A standing order is carried out as specifies until discontinued for ADMINISTRATION(CBQ)
another order.
B. When the physician writes the drug as needed in the order
sheet.
C.A single dose of the drug, carried out by the nurse at a time
specified by the physician.
15
RIGHT Drug. (right drug name and form.) GENERAL PRESCRIPTIONS BODY
RIGHT Patient. ( Ask the name and check his/her ID band) TERMS DESCRIPTIONS
RIGHT Dose. (Check doctor’s order) AMA - against Ad lib - at will, as AD - right ear
RIGHT Route. ( Check doctor's order) medical advice desired(CBQ) AL - left ear
RIGHT Time and Frequency. (Check doctor's order) ALS - BID - twice a AU - both ears
RIGHT Documentation. ( chart it correctly) advanced life day(CBQ) BMI - body mass
RIGHT History and Assessment. support SOS – as necessary index
RIGHT Drug approach and Right to Refuse. ( Autonomy) ADL – /prn(CBQ) HC - head
RIGHT Evaluation. activities of GTT(s) – drop(s) circumference
RIGHT Education and Information. daily living ugtt(s) – microdrop(s) IBW - ideal body
CBR – NPO - nothing per weight
complete bed orem ( nothing by LLQ - left lower
DRUG CLASSIFICATIONS AND ACTIONS rest mouth) (CB quadrant
DNR - do not a.c. – before LUQ - left upper
Analgesic - Antidiarrheal – Antipyretic – drug resuscitate meals(CBQ) quadrant
relieves inhibits peristalsis to treat or reduce DO - disorder p.c.- after OD - right eye(CBQ)
pain (tylenol) and reduces fecal fever (CBQ) DOA - dead on meals(CBQ) OS - left eye
volume (Lomotil, arrival or date PO – per orem/by OU - both eyes
loperamide) of admission mouth RUQ - right upper
Anesthetic – to Antihistamine – Antitussive – DOB - date of PRN - as ne quadrant
numb/lack of acts to prevent the prevents or relieves birth OD - once a day
feeling ( lidocaine) action of histamine cough (codeine, DOTS- directly BID – twice a
(allergies) dextrometorphan) observed day(every 12 hrs.)
(Benadryl) treatment short TID – 3x a day ( every
Antacid – Antihypertensive – Diuretic – increases course 8 hrs.)
neutralize acid prevents or controls the excretion of HS - hour of QID – 4x a day
(Milk of Magnesia) high blood pressure urine (Diuril, Lasix, sleep (bedtime) (CBQ)
(Catapres, Osmitrol)
Aldomet,
Lopressor)
Antidepressant – Anti-inflammatory Laxative – COMMON ROUTES OF DRUG ADMINISTRATION
relieves symptoms – prevents promotes defecation ENTERAL ROUTES
of depression inflammation (CBQ) Oral most common route(CBQ) Oral polio vaccine,
(tofranil) Vit. A
safest route Paracetamol tablet,
Antidote – Antibiotic – Corticosteroid – least expensive Oral contraceptive
counteracts poisons destroys or inhibits suppresses pill.
and their effects growth of bacteria inflammation and Buccal Mucous membrane into the Buccal nicotine
(Narcan) microorganisms modifies normal CHEECK (CBQ)
immune response Let drug dissolve
DO NOT CHEW
Antiemetic – Anticoagulant – Anticholinergic – DO NOT SWALLOW
prevents or relieves prevents or delays blocks Sublingual Under the Nitroglycerine ,
nausea and blood clotting parasympathetic tongue/frenulum Nifedipine
vomiting (heparin, warfarin, nerve impulses; (CBQ)
(Dramamine, Coumadin) decreases oral and Efficient absorption
Reglan) (CBQ) Aspirin – anti respiratory achieved 10-15minutes.
platelet aggregation secretions (atropine) LET DRUG DISSOLVE
(CBQ) DO NOT CRUSH
Anthelmintic - used Antispasmodic – Thrombolytic – DO NOT CHEW
to treat worm controls dissolves thrombus DO NOT SWALOW
infections/expels hypermotility of (clot) (CBQ) Rectal Inserted to rectum(CBQ) Suppository drugs
worms bowels Use water based lubricants
to ease insertion

COMMON MEDICAL ABBREVIATIONS

16
 PARENTERAL ROUTES Hallucinogens - increase a Examples of
Intradermal Drug into coreum/dermis 0.05 ml BCG person’s hallucinogens are:
Used for sensitivity test. 0.1 ml Rabies awareness of sight, Marijuana (Cannabis
Longest absorption. vaccine touch, taste, or Weed)
Purified protein feeling and Ecstasy
10 degree angle insertion derivatives hearing. LSD (lysergic acid
( 10-15) Antibiotic skin - Hallucinogens diethylamide) (CBQ)
testing can also alter a
person’s mood.

Subcutaneou Drug into fatty tissue/ measles

s subcutaneous tissue vaccine(CBQ) TYPES OF IV FLUID
40-50 degree angle (45°) Insulin (CBQ) HYPOTONIC ISOTONIC HYPERTONI
C
Intramuscula Drug into the muscles Vitamin K, Have lesser have the same have greater
r 90 degree angle insertion. Hepatitis B, concentration of concentration of concentration of
DPT, Tetanus solutes than plasma solutes as blood solutes than
toxoid vaccine, plasma plasma
pentaHIB vaccine, CAN CAUSE cells
pneumococcal to swell. DO NOT cause red CAUSES CELL
vaccine. (CBQ) blood cells to shrink or to shrink
Intravenous Drug into the vein IV cheotherapy  0.45% swell.
Fastest route (CBQ) drugs, IV Sodium  3%
antibiotics, IV Chloride  0.9% NaCl sodiu
morphine, dextrose (0.45% (Normal m
solutions NaCl) Saline chlori
Intrathecal Drug into the spinal theca Intrathecal Solution, de
morphine, baclofen  0.33% NSS) (3%
Intraosseous Drug into the bone Resuscitation drugs Sodium -for blood NaCl)
Chloride transfusion  5%
(0.33%  Dextrose 5% sodiu
REMEMBER: NaCl) in Water m
 Before administering a drug, the nurse should identify (D5W) chlori
the patient by checking the identification band and  2.5%  Lactated de
asking the patient to state his name(CBQ) Dextrose Ringer’s-TO (5%
 To clean the skin before an injection, the nurse uses a in Water PREVENT NaCl)
sterile alcohol swab to wipe from the center of the site (D2.5W) HYPOVOL  D5NS
outward in a circular motion. EMIC S,
 If bleeding occurs after an injection, the nurse should SHOCK D5LR
apply pressure until the bleeding stops(CBQ) (LRS/D5LR S
S)/Hartman  Dextr
OTHER TYPES OF DRUGS n solution ose
- correct 10%
TYPES DESCRIPTION EXAMPLES
dehydration in
Depressant drugs relieve tension, Examples of
and replace Water
(Tranquilizers) anxiety and depressants are:
G.I fluid (D10
irritability. “BARBITURATES”
losses W)
(CBQ) Alcohol, Heroin ,
 Dextr
-decreases cell Inhalants , Sleeping
ose
activity Pills
20%
in
Stimulants speed up the Examples: Tobacco ,
Water
central nervous Cocaine , Crack ,
(D20
system. Amphetamines ,
W)
-increases cell Methamphetamine
 Dextr
activity
ose
- help people feel
50%
more alert and
in
they increase the
Water
user’s physical
(D50
energy.
W)
- taken to make
people feel happy
Calculation of drips rates in drops per minute (dpm)
and to decrease
There are two standard giving sets of drip rates:
appetite.
1. Macro Drop Factor — drop size is normally 20 drops in 1 mL.
17
2. Micro Drop Factor — drop size is normally 60 drops in 1 mL.

The formula to calculate drip rates in drops per minute (dpm):

Example:
A pregnant patient is to receive 1 L of lactated ringers solution
over the next 12 hours. What is the rate of infusion in drops per
minute (dpm), if the drop factor is 60 drops per mL ..

Solution:
Volume = 1 000 mL, since 1 L = 1 000 mL.
Time = 12 hours.
Drop Factor = 60 drops per mL.

Substituting these values into the drip rate formula gives:

18