NCM 109-SL NOTES

-mouth or oropharynx and hypopharynx should

NEWBORN INFANT SUCTIONING be thoroughly suction using flexible suction
 Removing mucus and fluids from the nose, catheter or syringe bulb. Attach catheter end to
mouth or back of the throat with a bulb syringe connect on tubing from the suction apparatus
or a catheter (thin flexible tube). -wall suction: NICU/ DR/OR
 Used to clear secretions from the airway which -Pressure:
inhibit normal respiratory functions.  Pediatrics: < 80 – 120 mmHg
 The procedure involves inserting a catheter into  Neonates: < 80 - 100 mmHg
an infant's nose and advancing it to the back of 2.Nasopharyngeal Suctioning
the throat (pharynx) approximately 4-8 cm. -Suctioning in the nose
 According to WHO (Word Health Organization) -remove mucus from your child's airway
now advises against routine bulb suctioning of -artificial airway such as a tracheostomy tube
neonates in the minutes following birth. -removes mucus between the end of the tube and
 If the baby is born through clear amniotic fluid the carina (trachea splits into the bronchi, the
and begins breathing on their own shortly after tubes go into the lungs)
birth, do not suction. Indication of Oropharyngeal & Nasopharyngeal
 However, if the baby struggles with signs of Suctioning:
respiratory distress, do not delay suctioning.  head and neck surgery
 Aspirated meconium can be especially lethal to  Signs of respiratory distress
newborns, and the faster you are able to suction  Unable to cough and expectorate secretions
them, the greater their likelihood of survival.  Sample for diagnostic test purposes
 Prevent infection
Breathing in a healthy newborn: breath o Bluish color of the skin and mucus
spontaneously immediately after delivery and membranes (cyanosis)
sustained by the baby without assistance o Brief stop in breathing (apnea)
 fetus was not asphyxiated while in the uterus o Decreased urine output.
 Res. system function well o Nasal flaring.
 Cardio. system (heart & blood vessels) function o Rapid breathing.
well o Shallow breathing.
 coordination by the brain of the movements o Shortness of breath and grunting sounds
required for sustained rhythmical breathing
while breathing.
(brain is functioning well)
 check or observe the baby (>4 to 5 months) for
Suctioning
poor sucking or feeding/ food pattern
-Oronasopharyngeal (mouth nose)
-removing mucus and fluids from the nose, mouth or  ICU: specimen tracheostomy, sputum exam
back of the throat with bulb syringe or a catheter  Sputum/ phlegm to get specimen: deep breath,
(thin flexible tube). hold breath for 10 secs.  force cough
-clear secretions from the airway  normal Saliva Sputum/ phlegm
respiratory functions clean white dirty white
-inserting a catheter into an infant's nose and Thin Thick
advancing it to the back of the throat (pharynx) 3.Nasal Suctioning (nose)
approximately 4-8 cm 4.Oral Suctioning (mouth)
-clearing of lung fluid and expansion of the lungs Indication of oral suctioning:
with air  Audible secretions from the mouth with inability to
-WHO: against routine bulb suctioning of neonates cough independently
in the minutes following birth  Aspiration
 ! NOT SUCTION! clear amniotic fluid and  Reduced oxygen saturation (blockage airway
begins breathing on their own shortly after birth passage)
 ! SUCTION! Signs of Respiratory distress  Increased airway pressure when ventilated could be
(cyanosis & difficulty breathing), aspirated due to airway occlusion by secretions
meconium (postdated/ overdue) o aspiration-Weak sucking. Choking or
-Normal Spontaneous delivery: cerebral palsy coughing while feeding.
(problem on brain development  problem on o Other signs of feeding trouble: red face,
movement & maintain balance & posture) watery eyes, or facial grimaces.
5 Types of Newborn Suctioning: Contraindicated:
1.Oropharyngeal Suctioning  paralysis
 head and neck surgery
 NCM 109-SL NOTES
Nursing Diagnosis: Ineffective Airway Clearance  Adult: < 15 secs.
5.Deep Suctioning  Neonate: < 5-10 secs.
-remove mucus from your child's airway with an  Rest Time
artificial airway such as a tracheostomy tube  Adult: 30-60 secs.
-removes mucus between the end of the tube and the  Neonate: 15-20 secs.
carina (trachea splits into the bronchi, the tubes go into  withdrawn re-oxygenatesuction
the lungs) Avoid Forcing Catheter
Bulb Syringe  difficult airway can be stressful and upsetting
- remove mucus from your baby’s mouth or nose. (emergency suctioning) trauma
-stuffy nose: hard to breathe  baby fussy (tries to eat  feel resistance=may Nakabara/ prob. positioning
or sleep) Monitor for Complications
***Suctioning: easier for baby to breathe and eat. ***Monitor v/s, physical assessment, oxygen sat.
-suction your baby’s nose (30 mins to 1 hr) before  Hypoxia
feeding or bedtime  Bradycardia and arrhythmias
-avoid suctioning after feeding to prevent vomiting  Airway trauma  risk of infection
Indication of Suctioning  Higher blood flow in the cerebrum and
***Only suction a neonate: clear signs are appropriate increased intracranial pressure
 increase in CO2  Pneumothorax or lung perforation
 increased oxygen needs  Atelectasis (lung collapse)
 Bradycardia and apnea Choose the Right Equipment
 Audible breathing, gasping or wheezing  right catheter size is key
 Visible secretions or obvious difficulty clearing the  Suction catheter: external diameter < half internal
airway diameter of endotracheal tube
 A "gurgle" sound of secretions
 Geriatric: more difficult airways due to loss
 hard time breathing
muscle tone  smaller suction catheter
 blue or gray color around eyes, mouth, fingernails,
 Pediatric: smaller airways smaller suction
or toenails (Black American: palms, soles,
catheter
conjunctiva, mouth)
 you feel "rattling" on the child's chest or the back
 child seems anxious or restless, or cries and cannot
be comforted
 breathing rate or heart rate increases
 nostrils flare (open wider when breathing in)
 retracting (chest or neck skin pulls in with each
breath)
***rattle or wheezing which is visible also when
there is asthma
Suction
*** Monitor v/s before and after suctioning Descriptio Weight ETT Size
Catheter
Dangerous to neonates: airway trauma, hypoxia, n (kg) (mm)
Size (Fr)
infection, increased intracranial pressure NB (0-
 weigh risks and benefits 3.5 -7 2.5-3.5 6-8
6mons.)
 know health hx 6-12 mons. 7-10 3.5-4.0 8
Precautions Suctioning Newborn Infant 1-2 yrs. 10-12 4.0-4.5 8
Contraindication: 2-4 yrs. 12-16 4.5-5.0 10
 head or neck injury 4-6 yrs. 16-21 4.5-5.5 10
 Geriatric & pediatric pt.: more fragile airways
5-8 yrs. 21-27 6.0-6.5 10
 w/ cognitive or mental health conditions (difficult
>8 yrs. Varies 6.0-8.0 10-12
to understand the procedure & cooperate)
Age Size
 w/lose dental hardware
Adult #12-#18
 w/ difficult airway or a hx of suctioning
complications Children #8-#10
 w/ bradycardia (low heart rate) & hypoxia (low Infant #5-#8
oxygen level in tissues) Minimize the risk of the Newborn:
Not Suction Too Long:  hyperoxygenatete the neonate before and after
 Prolonged suction risk hypoxia suctioning
 Suction time  length of suctioning to 10 seconds or less
NCM 109-SL NOTES
 first pass does not fully clear the airway:
withdraw reoxygenate try again
 Choosing smaller equipment. Neonates have
fragile airways that are easily damaged.
 Being mindful of differences in the neonate’s
airway.
 Babies: smaller, more narrow airways,
larger tongue and epiglottis, and shorter
trachea
 Adapt technique and equipment accordingly
 Supporting the infant’s head.
 newborn cannot support the weight of their
own head risk of injury
 Reducing the risk of infection. Pathogens (adult
can be lethal to neonates, especially with
compromised immune systems)
 wash hands in warm water
 wear gloves and a mask
 change gloves before changing equipment or
after touching anything contaminated
Reducing the risk of Suctioning
 Minimizing suctioning time
 Monitoring the baby’s vital signs and oxygen
saturation levels before and after suctioning
 Treating suctioning as a two-person procedure.
(performs the suctioning & physically supports
and monitors the baby’s condition)
 Delaying suctioning until at least 8 hrs. after the
administration of a surfactant
 Preoxygenating the baby prior to suctioning and
reoxygenating the baby again after suctioning
Methods in suctioning:
Suctioning with bulb syringe: clean nose or remove
mucus that has been coughed up
1. Wash your hands
2. Squeeze the bulb until it is collapsed
3. Place the tip in the nose or mouth and release the
bulb. This will create suction and bring the
mucus into the bulb
4. Remove the bulb syringe from the nose or
mouth and squeeze it into a tissue to get the
mucus out
 paggagamitin pa: cloth/ tissue not wash
5. After use, wash the bulb syringe in warm soapy
water, squeezing the bulb several times. Squeeze
in clear warm water to rinse
6. Wash hands again
Suctioning with a catheter
1. Wash your hands.
2. Gather equipment:
• water-soluble lubricant
• suction catheter kit
• suction machine (working)
• normal saline for lavage (flush)
• sterile water
3. Turn on the suction machine.
4. Open the suction catheter kit, keeping
everything inside the kit sterile as you open it.
Put some sterile water in the cup.
5. Using sterile technique, put on the glove(s).
Avoid touching anything that is not sterile.
6. Pick up the suction catheter with your
"suctioning hand" and the suction tubing with
your other hand. Connect the two ends.
7. Apply a water-soluble lubricant to the end of the
suction catheter.
8. Keep your thumb off the thumbport while you
gently pass the catheter into the nostril to the
back of the throat. This may or may not
stimulate a cough.
• If more than gentle pressure is needed to put
the catheter in, stop and take it out
9. To suction, block the thumbport with the thumb
of your non-sterile hand and withdraw the
catheter. Do not suction longer than 5 to 10
seconds.
10. Let your child rest for 15 to 20 seconds before
suctioning again.
• If the mucus is thick, lavage with 3 to 5
drops of normal saline into the nostril before
suctioning
11. Rinse the catheter by suctioning some water
through it.
12. After suctioning the nose, you can use the
catheter to suction the back of the mouth if
needed.
• If you do this, do not use the catheter to
suction the nose again.
13. Throw away the used catheter kit.
14. Suctioning some water through the suction
tubing.
15. Turn off the suction machine.
16. Wash hands again.
Call the doctor:
 child coughs up fresh blood
 fresh blood is in the mucus you suctioned
 hard time breathing even after suctioning
 increased mucus
 mucus changes color (trauma, blood)
 mucus becomes thicker and does not thin after
putting a few drops of sterile salt water in the
nose
 fever
 lip or nail color becomes darker
NCM 109-SL NOTES
Note:
BASIC LIFE SUPPORT  Don’t leave person if unresponsive.
 Check for response by stimulating child or
 It is the life support method used when there is
call for attention: “Hey hey hey, are you
limited access to advanced interventions such okay?”
as medications and monitoring devices. If you witness a cardiac arrest in an infant or
o Advanced interventions are usually child, call EMS and get an AED before starting
done in hospital or nearest clinics for CPR.
more sophisticated managements.
o BLS is the method to give people a Note:
high chance for survival.  Call for help right away.
o BLS utilizes CPR and cardiac
defibrillation when an Automated Note: AED stands for Automated External
External Defibrillator (AED) Defibrillator and there is a big difference between
 According to the 2020 CPR guidelines, for all CPR and AED training even though both are
ages of children, the new ratio of usually covered in the same class. Unlike CPR
compressions to ventilations should be 15:2. which only pumps blood to vital organs, the AED
o 15 compressions; 2 breath blows is the machine that can restart the heart.
INFANTS (BIRTH- CHILDREN (AGE 1-
AGE 1) PUBERTY)
Check for the infant’s Check for the child’s Basic Life Support for Infant
pulse using the pulse using the carotid
 BLS for both children and infants are almost
brachial artery on the artery on the side of
inside of the upper the neck of the identical. For example, if two rescuers are
arm between the femoral pulse on the available to perform CPR, the breath
infant’s elbow and inner thigh in the compression is 15:2.
shoulder. crease between the leg  Check for the infant’s pulse using the brachial
and groin. artery on the inside of the upper arm between
Perform compression Perform compressions the infant’s elbow and shoulder.
on the infant using two on a child using one or  During CPR, compressions can be performed
fingers (if you are by two-handed chest on an infant using two fingers (with one
yourself) or two compressions rescuer) or with two-thumb encircling hands
thumbs with hands depending on the size (if there are two rescuers and rescuer’s hands
encircling the infant’s of the child.
are big enough to go around the infant’s chest)
check (with two
rescuers) One Rescuer BLS for Infants
Note: If thin and small,
Note: Only use two use one hand, if not can If you are alone with an infant, do the following:
fingers and not the use two hands.
whole palm to avoid 1. Tap the bottom of their foot and talk loudly to
fracture on the rib cage. the infant to determine if they are responsive.
This could affect the  We have to speak loudly to fully
heart and lungs. stimulate the infant.
Compression depth Compression depth 2. If the infant does not respond, and they are not
should be one-third of should be one-third of breathing (or if they are only gasping), yell for
the chest depth; for the chest depth; for
help. If someone responds, send the second
most infants, this is most children, this is
person to call EMS and to get an AED.
about 1.5 inches (4 about 2 inches (5 cm)
cm)  To alert EMS to know what they will
If you are the only person at the scene and find bring for the emergency.
an unresponsive infant or child, perform CPR 3. Assess if they are breathing while feeling for
for 2 minutes BEFORE you call EMS or go for the infant’s femoral or brachial pulse for no
an AED. more than 10 seconds.
NCM 109-SL NOTES
 You can assess breathing to infant by
observing the rising and falling of
chest
 Place finger at nose and feel breathing
 Observing the flaring of nostrils
 Place palm on chest and feel the rise
and fall.
 Listen the sounds of breathing and feel
the breathing, and observe rise and fall
of the chest.
 Note: if infant is unresponsive and no
pulse and breathing, do the CPR.
4. If you cannot feel a pulse (or if you are
unsure), begin CPR by doing 15 compressions
followed by two breaths. If you can feel a
pulse but the rate is less than 60 beats per
minute, begin CPR. This rate is too slow for
an infant. To perform CPR on an infant, do the
following:
 Be sure the infant is face-up on a hard
surface.
o Supine position.
o Infants should be placed in
a flat and hard surface
 Soft surface- soft
compression,
ineffective because
compression bounces.
 Hard surface- quality of
compression is steady,
can easily measure the
depth of compression
o Emergency Cart- used for
emergency cases only.
o Chest compression helps
heart to pump blood for the
distribution of blood in the
organs where it also distributes
oxygenated blood in all parts of
the body to prevent the brain
from lacking in oxygen
 Using two fingers, perform
compressions in the center of the
infant’s chest; do not press on the end
of the sternum as this can cause injury
to the infant.
o Note to press on center, and
not on sternum.
 Compression depth should be about
1.5 inches (4 cm) and a rate of 100 to
120 per minute.
Note: To check for sternum, check middle line
between nipples.
5. After performing CPR for about two minutes
(usually about ten cycles of 15 compressions
and two breaths) if help has not arrived, call
EMS while staying with the infant. Get an
AED if you know where one is.
 Do not stop CPR if help has not yet
arrived.
6. Use and follow AED prompts when available
while continuing CPR until EMS arrives or
until the infant’s condition normalizes.
 Only stop CPR if help arrived, or when
infant has normalized.
Two-Rescuer BLS for Infants
If you are not alone with the infant, do the
following:
1. Tap the bottom of their foot and talk loudly at
the infant to determine if they are responsive.
 Stimulate patient.
2. If the infant does not respond and is not
breathing (or is only gasping), send the second
rescuer to call for help and get an AED.
 One person performs CPR, one person
calls for help.
3. Assess if they are breathing while
simultaneously feeling for the infant’s brachial
pulse for 5 but no more than 10 seconds.
4. If you cannot feel a pulse (or if you are
unsure), begin CPR by doing 15 compressions
followed by two breaths. If you can feel a
pulse but the rate is less than 60 beats per
minute, begin CPR. This rate is too slow for
an infant.
5. When the second rescuer returns, begin CPR
by performing 15 compressions by one rescuer
and two breaths by the second rescuer. If the
second rescuer can fit their hands around the
infant’s chest, perform CPR using the two
thumb-encircling hands method. Do not press
NCM 109-SL NOTES
on the bottom end of the sternum as this can
cause injury to the infant.
 One performs compression, one
performs blow
6. Compressions should be approximately 1.5
inches (4 cm) deep and at a rate of 100 to 120
per minute.
7. Use and follow AED prompts when available
while continuing CPR until EMS arrives or
until the infant’s condition normalizes.
 Are you ready?
 Don’t touch the patients.
 All hands up.
 Activate AED.
Basic Life Support for Children
 BLS for both children and infants is almost
identical. For example, if two rescuers are
available to perform CPR, the compression to
breath ratio is 15:2 for both children and
infants.
One-Rescuer BLS for Children
If you are alone with a child, do the following:
1. Tap their shoulder and talk loudly to the child
to determine if they are responsive.
2. If the child does not respond and is not
breathing (or is only gasping for breath), yell
for help. If someone responds, send the second
person to call for help and to get an AED.
 Specify condition, what emergency do
you have. So emergency or ambulance
will know what to bring that are
necessary for the emergency.
3. Assess if they are breathing while feeling for
the child’s carotid pulse (on the side of the
neck) or femoral pulse (on the inner thigh in
the crease between their leg and groin) for no
more than 10 seconds.
4. If you cannot feel a pulse (or if you are
unsure), begin CPR by doing 15 compressions
followed by two breaths. If you can feel a
pulse but the pulse rate is less than 60 beats
I.
per minute, you should begin CPR. This rate is
too slow for a child.
5. After doing CPR for about two minutes
(usually about ten cycles of 15 compressions
and two breaths) and if help has not arrived,
call EMS while staying with the child. Get an
AED if you know where one is located.
6. Use and follow AED prompts when available
while continuing CPR until EMS arrives or
until the child’s condition normalizes.
Two-Rescuer BLS for Children
If you are not alone with a child, do the following:
1. Tap their shoulder and talk loudly to the child
to determine if they are responsive.
2. If the child does not respond and is not
breathing (or is only gasping for breath), send
the second rescuer to call for help and get an
AED.
 State emergency, and state, “Bring
AED.”
3. Assess if they are breathing while feeling for
the child’s carotid pulse (on the side of the
neck) or femoral pulse (on the inner thigh in
the crease between their leg and groin) for no
more than 10 seconds.
4. If you cannot feel a pulse (or if you are
unsure), begin CPR by doing 15 compressions
followed by two breaths. If you can feel a
pulse but the rate is less than 60 beats per
minute, begin CPR. This rate is too slow for a
child.
5. When the second rescuer returns, begin CPR
by performing 15 compressions by one rescuer
and two breaths by the second rescuer.
 Always call for help. BLS is not an
individual work, you need help.
6. Use and follow AED prompts when available
while continuing CPR until EMS arrives or
until the child’s condition normalizes.
Note: If patient is already normal after CPR
without aid of AED, breathing and pulse is
already present, position him/her in a side-lying
position. Side-lying position encourages better
circulation and pumping of the heart. This
position is to avoid na maipit yung largest aorta
for circulation.
Allow complete chest recoil after each
compression
 NCM 109-SL NOTES
 Heart should be pumping.
Compressions should introduce
circulation.
 Compressions manually helps heart to
pump where it distributes oxygenated
blood to the body especially in the
brain.
II. Minimize interruptions in compressions (try
to limit interruptions to less than 10 seconds)
 Avoid interrupting a person during
chest compression
III. Give effective breaths that make the chest
rise.
 Observe the chest for rising while
blowing.
 If you saw that chest does not rise,
blow is not effective and enough.
IV. Avoid excessive ventilation
 Chest compression is more important
than giving breath. Blows only assist.

Maintenance of tissue oxygen supply is

vital for life, and establishing and keeping an open
airway is a critical first step when caring for an
unconscious or nonbreathing person. Airway
obstruction impedes or prevents oxygen delivery
to our lungs, which then prevents delivery to our
blood and subsequently to tissues.
When oxygen supplies are interrupted, the
organs will suffer and eventually die. Without
oxygen, especially vulnerable tissues such as the
brain may start dying after 4-6 minutes. The need
for immediate action is therefore crucial.
During BLS, rescuers provide and
maintain oxygen supplies to ill persons by using
chest compressions to maintain blood circulation
and ventilations to maintain oxygen levels. Key
steps in BLS include:
1. Check for responsiveness, and activate
emergency medical services (EMS).
2. Quickly check for normal breathing.
3. If the person is not breathing normally, provide
chest compressions to temporarily take
over the function of the heart and circulate
blood.
4. Open the airway, and provide ventilations to
deliver air to the lungs
 The goal of CPR is not to restart the heart but
to provide critical blood flow to the heart and
brain and to keep oxygenated blood
circulating. CPR delays damage to vital organs
such as the brain and improves the chances of
successful defibrillation.
Duty of Care
 As a potential first responder, you have no
legal obligation to provide medical care. In
some areas, however, you may have an
obligation to notify authorities that someone is
in need of medical assistance. If you engage in
basic life support, be sure to provide care
within your scope of training.
 Ask an individual for permission before you
provide care. This can be done by saying: “My
name is _______, and I am a first-aid
provider. May I help you?”
 If responsive, the individual should give
permission before care is provided. Not asking
for permission or forcing care against a
person’s will exposes you to potential legal
action for involuntary assistance or battery. If
NCM 109-SL NOTES
a person is unresponsive, permission to
provide medical assistance is implied.
Immediate Recognition and Activation of EMS
Recognition of a medical problem should be
followed by prompt action. Once
unresponsiveness is established, call EMS. By
activating local EMS, the chance of survival
increases. Either call EMS yourself, or ask a
bystander or other rescuer to call EMS.
If you are alone, EMS can be activated utilizing
your cell phone on speaker setting as you initiate
CPR. This practice minimizes lost time and can
reduce any delays that otherwise may occur in
starting CPR. If you are not alone, have someone
else activate EMS while you begin CPR.
There are two scenarios when the solo rescuer
may consider initiating CPR prior to activating
EMS:
1. child or infant victim
2. drowning victim
The use of a cell phone as just noted above to
activate EMS while initiating CPR is still
recommended to expedite the arrival of advanced
medical care.
If a cell phone is unavailable, the lone rescuer
should perform two minutes of CPR before calling
for help. Since cardiac arrest is typically
secondary to respiratory arrest in these two
groups, this slight alteration in procedural order is
recommended. Children and drowning victims
may spontaneously recover if CPR is initiated
immediately. Additional information on drowning
victims is covered later in this course. For
information on conducting CPR for children and
infants, please consider taking the CPR Health-
Care Provider with First Aid course
In contrast, acute coronary syndromes (heart
attacks) often cause unstable heart rhythms that
respond best to rapid defibrillation. Activating
EMS and getting a defibrillator on scene as soon
as possible provide the best chance of
reestablishing a life-sustaining heart rhythm. CPR
should not be delayed, however, if an AED is not
immediately available.
Regardless of who calls EMS, the person
relaying information to them should state:
1. caller's name
2. number of injured persons
3. exact location
4. call-back phone number
5. condition of the injured persons
6. what happened
7. care provided
Do not hang up until the operator releases you.
It is important to answer all dispatcher questions
to assure an appropriate response team and
resources are sent to the site.
The operator may repeat critical information
before ending the call, which ensures that the
message was received and key facts were
conveyed. If someone else calls EMS, be sure to
have that person return to the scene after making
the call to verify that help is on the way.
Remember, the sooner you make the call, the
sooner advanced life support will arrive.
Early CPR
Early CPR significantly improves the chance of
survival. Chest compressions temporarily take
over the function of the heart, manually
circulating blood in the body. Ventilations deliver
air to the lungs and ensure a supply of oxygen for
the body, especially for critical areas such as the
heart and brain.
Rapid Defibrillation
Rapid defibrillation is the single most
important intervention in the case of an unstable
cardiac rhythm and provides the greatest chance
of survival. CPR will not restart the heart but may
NCM 109-SL NOTES
delay tissue damage associated with inadequate
oxygen supplies.
Most cases of adult respiratory arrest are due to
cardiac arrest. Cardiac arrest often results from a
non-life-sustaining rhythm known as ventricular
fibrillation (VF). This rhythm disturbance results
in inadequate blood flow to vital organs and is
therefore life threatening.
It is crucial to defibrillate a person with
suspected sudden cardiac arrest as soon as
possible. Delays of as little as 7-10 minutes
greatly reduce the chance of survival.
Scene Safety Assessment
Rescuer safety comes first. The ability to
provide first aid is impaired if the rescuer is
injured when approaching the individual or Initial Assessment
rendering care. Taking the time to assess the scene
The assessment sequence consists of three
and circumstances surrounding the person may
primary steps:
prevent compromising the rescuer and causing
further injury to the individual. Before providing  Assess for responsiveness, and activate
BLS, assess the scene, and take steps to avoid or EMS.
remove any sources of potential injury.  Determine if the person is breathing
Scene Safety Assessment Before providing aid, normally.
take a moment to remember the mnemonic S-A-F-  Adjust the individual's position for
E. ongoing care, if necessary.

S-A-F-E is a reminder to: Assessing Responsiveness

 Stop: Take a moment to think and then act.
 Assess the scene: Before assisting another
person, determine if the scene is safe. Dangers
may include: — fire — chemicals —
electricity or gas — traffic — animals
(tentacles from a jellyfish or a pet that feels
threatened)
 Find your first aid kit, oxygen unit and
AED.
 Exposure protection: Avoid contact with
blood and other body fluids. — Locate and
don barriers such as gloves, eye shields and
resuscitation masks
Once a rescuer ensures the scene is safe,
assess the individual's level of responsiveness.
Tap the person’s collarbone and shout, “Are you
OK?” Remember to introduce yourself, state you
are trained in first aid, and express your desire to
help. Reassure the individual by showing a caring
attitude, and talk to him about what is happening.
The rescuer should also try to keep bystanders at a
distance to avoid added stress.
If the person can answer, initially he should be
left in the position in which he was found. Call
EMS, and then conduct a secondary assessment
(discussed later in this course) to determine if any
injuries are present. If no evidence of injury is
present, then the rescuer can place the individual
in the recovery position or a position of comfort.
The rescuer should reassure the person and try to
find out what happened.
If the person does not respond, call EMS, turn
him on his back, and assess for normal breathing.
NCM 109-SL NOTES
To turn an individual from a face-down position
onto his back, use the log roll.
Recovery Position
If normal breathing is present or resumes, place
the unresponsive, injured person in the recovery
position to ensure an open airway. This helps to
prevent blood and vomit from obstructing the
airway or flowing into the lungs. Should vomiting
occur or if blood or other fluids are present in the
mouth, gravity will aid in their removal and
minimize the chance of aspiration.
Remember to call local EMS. Until help
arrives, continually check that the individual is
still breathing. The recovery position is
accomplished from a supine position.
 Kneel beside the person, and make sure that
both of his legs are straight.
 Place the individual’s arm nearest to you at
right angles to his body, with elbow bent and
palm facing upward.
 Bring the far arm across the individual’s chest,
and hold the back of his hand against the
cheek nearest to you.
 Place your other hand under the leg farthest
from you, just above the knee, or grab the pant
leg of the person’s clothing, and pull the knee
up, keeping the foot on the ground.
 Keeping the individual’s hand pressed against
his cheek, pull the far leg to roll him toward
you and onto his side.
 Adjust the top leg to form 90-degree angles at
both the hip and knee.
 Tilt back the individual’s head to ensure the
airway remains open.
 Adjust his hand under his cheek, if necessary,
to keep the head tilted.
 Check breathing regularly.
Cardiopulmonary Resuscitation
1. Starting CPR
2. Support Circulation When normal breathing is
not present, activate EMS immediately.
Inform them that the person under care is
not breathing normally. After notifying
EMS, begin CPR, starting with 30
compressions followed by two breaths.
3. Begin chest compressions by stacking your
hands with the fingers of both hands
interlocked and the heel of the bottom
hand on the center of the chest between the
nipples. Keep the fingers raised off the
chest wall, and compress the chest 30
times at a rate of 100-120 per minute.
4. The depth of the compression should be 2-2.5
inches (5-6 cm). Excessive depth during
chest compressions can reduce
survivability due to internal damage.
Regardless of the size of the individual,
limit compression depth to 2-2.5 inches (5-
6 cm). It is important to release the
pressure on the chest between the
compressions but without losing contact
with the chest. Avoid leaning on the chest
between compressions because it will
inhibit full recoil of the chest wall. Full
recoil is required for adequate circulation.
The skills section covers the exact hand
position and compression technique in
detail.
5. During compression, blood is pushed out of the
left side of the heart and then throughout
the body. At the same time, deoxygenated
blood is squeezed from the right side of
the heart to the lungs, where it will take
oxygen from the lungs. When releasing the
pressure on the chest, blood flows from the
body into the right side of the heart, and
oxygenated blood returns from the lungs to
the left side of the heart.
6. When compressions are too fast, the heart does
not have time to refill with blood, and thus
the resulting volume that flows out of the
heart is decreased. When compressions are
too slow, the amount of circulating oxygen
available to tissues decreases. When
compressions are not deep enough, the
amount of blood pushed out of the heart
may be inadequate to support tissue
oxygen demands.
7. Ventilations, described on the next page, follow
chest compressions. Together they are
delivered at a ratio of 30 compressions to 2
ventilations.
8. If more than one rescuer is present, alternate
the role of performing chest compressions
about every one to two minutes to
minimize rescuer fatigue.
Drowning
NCM 109-SL NOTES
Drowning is the third-leading cause of
accidental death worldwide.7 Responding to these
incidents promptly and effectively can help reduce
the mortality of drowning.
It has already been noted that for victims of
drowning a lone rescuer should conduct CPR for
two minutes before activating EMS.
Another shift in protocol for drowning victims
is for rescuers to initiate CPR with ventilations
(not compressions) after determining
unresponsiveness. This change is due to the
hypoxic condition of drowning. It also is possible
that prompt oxygenation of tissues with the use of
a ventilations-first protocol can prevent cardiac
arrest (if it has not already occurred). The rescuer
can also consider using supplemental oxygen if
available.
Begin CPR for drowning victims by
establishing an open airway, delivering two
ventilations and then performing 30 compressions
— a protocol acronym of A-B-C. Continue with
two ventilations after every 30 chest
compressions. Hands-only CPR is not appropriate
in this situation.
INTEGRATED MANAGEMENT OF
CHILDHOOD ILLNESS (IMCI)
 One million children under five years old die
each year in less developed countries.
 Just five diseases (pneumonia, diarrhea,
malaria, measles and dengue hemorrhagic
fever) account for nearly half of these deaths
and malnutrition is often the underlying
condition.
 Effective and affordable interventions to
address these common conditions exist but they
do not yet reach the populations most in need,
the young and impoverish.
 The Integrated Management of Childhood
Illness strategy has been introduced in an
increasing number of countries in the region
since 1995.
 IMCI is a major strategy for child survival,
healthy growth and development and is based
on the combined delivery of essential
interventions at community, health facility and
health systems levels.
 IMCI includes elements of prevention as well
as curative and addresses the most common
conditions that affect young children.
 In the Philippines, IMCI was started on a pilot
basis in 1996, thereafter more health workers
and hospital staff were capacitated to
implement the strategy at the frontline level.
Strategy of World Health Organization (WHO)
and United Nations Children's Fund (UNICEF)
 Goal: improve child survival in resource poor
settings via integrated approach
o reduce death, illness and disability, and
promote growth and development
o preventive and curative elements
o implemented by families, communities and
health facilities
WHO’s Integrated Management of Childhood
Illness
 Preventive interventions
o Immunizations
o Breastfeeding support
o Nutrition counseling (e.g. weaning foods)
 Curative interventions
o Malaria
o Pneumonia
o Diarrheal illnesses
o Undernutrition (co-factor in 1/3)
o Also…serious infections (meningitis),
other illnesses (vitamin A def. with
measles)
 Cause 70% of childhood deaths worldwide
THREE COMPONENTS OF IMCI
 Improving case management skills of health
workers
o 11-day Basic Course for RHMs, PHNs and
MOHs
o 5 - day Facilitators course
o 5 – day Follow-up course for IMCI
Supervisors
 Improving over-all health systems
 Improving family and community health
practices
IMCI Component 1: Improving case
management skills of health workers
 Targets first level health facilities
o Training
o Case management guidelines for the causes
of at least 70% of deaths
o Supervision
o Monitoring
IMCI Component 2: Improving over-all health
systems
 Planning and Management
NCM 109-SL NOTES
 Availability of drugs and supplies symptoms include: cough or difficulty
 Organization of work breathing, diarrhea, fever and ear infection. For
 Monitoring and supervision sick young infants, local bacterial infection,
 Referral pathways and systems diarrhea and jaundice. All sick children are
 Health information systems routinely assessed for nutritional, immunization
and deworming status and for other problems
IMCI Component 3: Improving family and  Only a limited number of clinical signs are
community health practices used
 Community participation  A combination of individual signs leads to a
 Preventive care child’s classification within one or more
o Immunization symptom groups rather than a diagnosis.
o Breast-feeding and other nutritional  IMCI management procedures use limited
counseling number of essential drugs and encourage active
 Home care of sick children participation of caretakers in the treatment of
 Recognition of severe illness children
 Care-seeking behavior  Counseling of caretakers on home care, correct
feeding and giving of fluids, and when to return
OBJECTIVES OF IMCI to clinic is an essential component of IMCI
 Reduce death and frequency and severity of
illness and disability, and THE INTEGRATED CASE MANAGEMENT
 Contribute to improved growth and PROCESS
development Outpatient health facility
 Check for danger signs
RATIONALE FOR AN INTEGRATED  Assess main symptoms
APPROACH IN THE MANAGEMENT OF  assess nutrition and immunization status and
SICK CHILDREN potential feeding problems
 Check for other problems
Majority of these deaths are caused by:  Classify conditions
 Identify treatment actions
 5 preventable and treatable conditions namely: Outpatient Outpatient HOME
o pneumonia, diarrhea, malaria, measles and health facility health  Caretaker is
malnutrition. Three (3) out of four (4) episodes  Urgent facility counseled
of childhood illness are caused by these five referral  Treatme on home
conditions  pre- nt treatment
referral  treat  Feeding &
 Most children have more than one illness at one treatment local fluids
time. This overlap means that a single diagnosis  Advise infection  When to
may not be possible or appropriate. parents  give oral return
 Refer drugs immediatel
WHO ARE THE CHILDREN COVERED BY child  advise y
THE IMCI PROTOCOL? and  Follow up
 Sick children birth up to 2 months (Sick Young  Referral teach
Infant) facility caretaker
 Sick children 2 months up to 5 years old (Sick  Emergenc  Follow
child) y triage up
and
STRATEGIES/PRINCIPLES OF IMCI treatment
 All sick children aged 2 months up to 5 years  Diagnosis
are examined for GENERAL DANGER signs and
and all Sick Young Infants Birth up to 2 months treatment
are examined for VERY SEVERE DISEASE  Monitorin
AND LOCAL BACTERIAL INFECTION. g and
These signs indicate immediate referral or follow up
admission to hospital
 The children and infants are then assessed for BASIS FOR CLASSIFYING THE CHILD’S
main symptoms. For sick children, the main ILLNESS
NCM 109-SL NOTES
 The child’s illness is classified based on a
color-coded triage system:
PINK
 indicates urgent hospital referral or admission
YELLOW
 indicates initiation of specific Outpatient
Treatment
GREEN
 indicates supportive home care

Basic Resuscitation Equipment

 Warm room
 Two pieces of cloth
o Dry
o Wrap up
 Suction bulb or DeLee
 Positive Pressure Bag (“Ambu”) and mask
NCM 109-SL NOTES
NCM 109-SL NOTES
NCM 109-SL NOTES
NCM 109-SL NOTES

Give an Appropriate Antibiotic:

A. For Pneumonia, Acute ear infection or Very
Severe disease

COMPLEMENTARY, ALTERNATIVE AND

INTEGRATED HEALTH PRACTICES

Complementary and Alternative Medicine

B. For Dysentery (CAM)
 Is used to describe group of diverse medical
and health care systems, practices and
products that have historic origins outside
mainstream medicine.
Alternative Medicine
 Is any practice that is perceived by its users to
have healing effects of medicine but does not
originate from evidence based scientific
C. For Cholera method and is not a part of biomedicine.

Alternative Medicine
 Differs in that it is not used as a complement
but as a “substitute” for conventional
therapy.

Complementary Medicine
 Is an alternative medicine used together with
Give an Oral Antimalarial conventional medicine i.e. it “complements”
the treatment.

Integrative Medicine
 Integrative medicine combines treatments
from conventional medicine and CAM for
which there is evidence of safety and
effectiveness;
 It is also called integrated medicine
Examples:
o Hospitals that offer chiropractic,
GIVE VITAMIN A acupuncture, herbal therapy, etc. as part of
the regular care plan
o Chiropractic office that offers trigger
point injections or pain meds to assist
with pain relief

ADVANTAGES
 CAM offer optimism or greater personal
attention and provide 3T’s: Time, Talk, and
GIVE PARACETAMOL FOR HIGH FEVER
Touch
(38.5oC OR MORE) OR EAR PAIN
 CAM is less expensive, have fewer side
effects and is more easily accessible
 Patient has “self-help” approach to health and
wellness
NCM 109-SL NOTES
 It satisfies a search for “NATURAL” or less MIND BODY PRACTICES
invasive alternatives ACCUPRESSURE
 Promise of “MIRACLE CURES” and quick  Stimulation of defined anatomic points
results. ACCUPUNCTURE
 Insertion of and manipulation of thin metallic
Why Patients choose CAM? needles
 Symptoms often poorly controlled by
conventional care, particularly back pain and
other painful muscuskeletal complaints,
anxiety, and insomnia.
 Failure or dissatisfaction with conventional
heath provider
 High health costs
 To treat side effects of drugs and treatment
 Focus on spirituality and emotional well
being
 Ignorance and inadequate knowledge
regarding disease.

TERMINOLOGY OF CAM PRACTICES

 MIND BODY PRACTICES
 TRADITINAL MEDICAL SYSTEMS
 MODERN MEDICAL SYSTEMS

MIND BODY PRACTICES

 Acupuncture And Acupressure
 Alexander Technique
 Guided Imagery
 Hypnosis
 Massage
 Meditation
 Reflexology
 Rofling / Structural Integration
 Pinal Manipulation
 Tai Chi
 Therapeutic Touch
 Yoga

TRADITINAL MEDICAL SYSTEMS

 Ayurvedic Medicine
 Curanderismo
 Native American Medicine
 Siddha Medicine
 Tibetian Medicine
 Traditional Chinese Medicine ALEXANDER TECHNIQUE
 Unani Medicine  A movement therapy that uses guidance and
education to improve posture, movement and
MODERN MEDICAL SYSTEMS efficient use of muscles for improvement of
 Anthroposophic Medicine body functioning.
 Chiropractic
 Homeopathy
 Naturopathy
 Osteopathy
NCM 109-SL NOTES
GUIDED IMAGERY
 The use of relaxation techniques followed by
the visualization of images, usually calm and
peaceful in nature, to invoke specific images
to alter neurologic function or physiologic
states.
HYPNOSIS
 The induction of an altered state of
consciousness characterized by increased
responsiveness to suggestion
MASSAGE
 Manual therapies that manipulate muscle and
connective tissues to promote muscle
relaxation, healing, and sense of well being
MEDITATION
 A group of practices, largely based in eastern
spiritual traditions, intended to focus or
control attention and obtain greater awareness
of the present moment, or mindfulness
REFLEXOLOGY
 Manual stimulation of points on hands or feet
that are believed to affect organ function
SPINAL MANIPULATION
 A range of manual techniques, employed by
chiropractors and osteopaths for adjustments
of the spin to affect neuromuscular function
and other health outcomes.
TAI-CHI
 A mind-body practice originating in China
that involves slow, gentle movements and
sometimes is described as “moving
meditation”
THERAPEUTIC TOUCH
 Secular version of the laying on of hands,
described as “healing meditation”
YOGA
 An exercise practice originally East Indian,
that combines breathing exercises, physical
postures, and meditation
TRADITINAL MEDICAL SYSTEMS
AYURVEDIC MEDICINE
 The major East Indian traditional medicine
system
 Treatment includes meditation, diet, exercise,
herbs, and elimination regimens using
emetics and diarrheal.
CURANDERISMO
 A spiritual healing tradition common in Latin
America communities that uses ritual
cleansing, herbs, and incantations
NATIVE AMERICAN MEDICINE
 Diverse traditional systems that incorporate
chanting, shaman healing ceremonies, herbs,
laying on of hands, and smudging (ritual
cleansing with smoke from sacred plants)
SIDDHA MEDICINE
 An East Indian medical system (prevalent
among Tamil-speaking people)
TIBETIAN MEDICINE
 A medical system that uses diagnosis by pulse
and urine examination
 Therapies include herbs, diet, and massage
TRADITIONAL CHINESE MEDICINE
 A medical system that uses acupuncture,
herbal mixtures, massage, exercise, and diet
UNANI MEDICINE
 An East Indian medial system
 derives from Persian medicine practiced
primarily in the Muslim community also
called ‘hikmat’
MODERN MEDICAL SYSTEMS
ANTHROOSOHIC MEDICINE
 a spiritually based system of medicine that
incorporates herbs, homeopathy, diet, and a
movement therapy called “eurythmy”
CHIROPRACTIC
 involves the adjustment of the spine and
joints to alleviate pain and improve general
health
 primarily used to treat back problems,
musculoskeletal complaints, and headaches
HOMEOPATHY
 a medical system which origins in Germany
that is based on core belief in the theory of
“like cures like” - compounds that produce
certain syndromes if administered in very
diluted solutions, will be curative.
NATUROPATHY
 a clinical discipline that emphasizes a holistic
approach to the patient, herbal medications,
diet, and exercise
 practitioners have degrees as doctors of
naturopathy
OSTEOPATHY
 a clinical discipline, now incorporated into
mainstream medicine, that historically
NCM 109-SL NOTES
emphasized spinal manipulative techniques to
relieve pain, restore function, and promote
overall health.
NUTRITION AND DIET THERAPIES
PRE – SURGERY DIET
 Are typically high in protein and low in
carbohydrates
 This type of diet reduces bleeding, promotes
healing and helps reduce the amount of fat in
and around your liver and abdomen (an
enlarged liver can make a surgery more
difficult because it can obstruct the surgeon’s
view).
 Losing weight before surgery not only keeps
safer during the procedure, but it also helps
train for a new way of eating
 Pre – op diet consists largely of protein
shakes and other high-protein, low calorie
foods that are easy to digest
GOALS OF PERIOPERATIVE NUTRITION
SUPPORT
 Decrease surgical mortality
 Decrease surgical complications and infection
 Reduce the catabolic state and restore
anabolism
 Support the depleted patient throughout the
catabolic phase of recovery
 Decrease hospital length of stay
 Speed the healing/ recovery process
 Ensure the prompt return of GI function to
resume standard oral intake as soon as
possible
PERIOPERATIVE NUTRITION SUPPORT
GUIDELINES
o The American Society for Parenteral and
Enteral Nutrition evidence-based practice
guidelines
 Preoperative specialized nutrition support
should be administered for 7 -14days to
moderately or severely malnourished
patients undergoing major surgery.
 PN should not be routinely given in the
immediate post-op period to patients
undergoing major GI procedures
 Postoperative nutrition support should be
administered to patients who are expected
to be unable to meet their nutrient needs
orally for 7 – 10 days
POST – SURGERY DIET
 NPO
o Length of time a patient can remain NPO
after surgery without complications is
unknown, however depends on:
 Severity of operative stress
 Patient’s pre-existing nutritional status
 Nature and severity of illness
 in uncomplicated cases, well-nourished
patients tolerate up to 10days of starvation
with no medical complications. Moderately or
severely malnourished patients usually
require nutritional support earlier.
NUTRITION SUPPORT
 Parenteral Nutrition (PN)
o Also termed hyperalimentation
o Supplies nutrients via the veins
o Consists of both PARTIAL
PARENTERAL NUTRITION (PPN) and
TOTAL PARENTERAL NUTRITION
(TPN); the indication of the type used
depends on the client’s nutritional needs
o It supplies carbohydrates in the form of
dextrose, fats in an emulsified form,
proteins in the form of amino acids,
vitamins, minerals, electrolytes, and water.
o It prevents subcutaneous fat and muscle
protein from being catabolized by the body
for energy
o PN solutions are hypertonic
 due to the higher concentrations of glucose
and addition of amino acids
Indications
 Clients with severely dysfunctional or non-
functional gastrointestinal tracts who are
unable to process nutrients may benefit from
PN.
 Clients who can take some oral nutrition, but
not enough to meet their nutrient
requirements may benefit from PN.
NCM 109-SL NOTES
 Clients with multiple gastrointestinal
surgeries, gastrointestinal trauma, severe
intolerance to enteral feedings, or intestinal
obstruction, or who need to rest the bowel for
healing, may benefit from PN.
 Clients with severe nutritionally deficient
conditions such as acquired
immunodeficiency syndrome, cancer, burn
injuries or malnutrition or clients receiving
chemotherapy, may benefit from PN.
COMPONENTS OF PARENTERAL
NUTRITION
• Carbohydrates
• Amino acids (protein)
• Fat Emulsion (lipids)
• Vitamins
• Minerals and trace elements
• Electrolytes
• Water
• Regular insulin
• Heparin
ENTERAL TUBE FEEDING/ ENTERAL
NUTRITION
 Also called “tube feeding”, is a liquid
mixture of all the needed nutrients
 Consistency is sometimes similar to a
milkshake
 It is given through a tube in the stomach or
small intestine
 If oral feeding is not possible, or an extended
NPO period is anticipated, an access devise
for enteral feeding should be inserted at the
time of surgery
 Feeds can meet 100% of patient’s needs or
can be used to supplement poor po intake
 Provides nutrients into the GI tract
 It is preferred method of meeting nutritional
needs if a patient is unable to swallow or take
in nutrients orally yet has a functioning GI
tract
 Provides physiological, safe, and economical
nutritional support
 Patients with enteral feedings receive formula
via: nasogastric, jejunal or gastric tubes
 Patients with a low risk of gastric reflux
receive gastric feeding; however, if there is a
risk of gastric reflux, which leads to
aspiration, jejunal feeding is preferred.
Indications for enteral nutrition
 When the GI tract is functional or partially
functional and….
 Patient has inability to consume or absorb
adequate nutrition
 Patient is not meeting > 75% of needs with po
intake
 Malnourished patient expected to be unable to
eat adequately for >5-7days
 Adequately nourished patient expected to be
unable to eat >10 days
Enteral Access Devices
Nasogastric Tube
 Determine length of tube to be inserted and
mark with tape
 Measure distance from tip of nose to earlobe
to xiphoid process of sternum
 Measure distance from tip of nose to earlobe
to mid- umbilicus for pediatric patients
 Add additional 20 to 30 cm (8to 12 inches)
for nasointestinal (NI) tubes
 Checking of placement prior feeding
 Auscultation of insufflated air
 Gastric residual volume (GRV)
 ph
o nasogastric tube: attach syringe and
aspirate 5ml of gastric contents. Observe
appearance of aspirate and note pH.
o Gastrostomy tube: attach syringe and
aspirate 5 ml of gastric contents. Observe
appearance of aspirate and note pH.
 Gastric fluid of patient who has fasted for at
least 4 hours usually has a pH of 5 or less,
especially when patient is not receiving
gastric- acid inhibitor. Continuous
administration of tube feedings elevates pH.
A pH greater than 6 indicates intestinal or
pulmonary placement
Choosing appropriate formulas
 Categories of enteral formulas:
o Polymeric
• Whole protein nitrogen source, for use
in patients with normal or near normal
GI function. Examples: ensure and
jevity
o Monomeric or elemental
• Pre-digested nutrients; most have a
low-fat content or high % of MCT; for
use in patients with severely impaired
GI function. Examples: include
Peptamen and Opti mental
o Disease specific
NCM 109-SL NOTES
• Formulas designed for feeding
patients with specific disease states
• Formulas are available for respiratory
disease, diabetes, renal failure, hepatic
failure, and immune compromise.
examples: Glucerna and Nepro
 Complications of Enteral Nutrition
Support
o Issues with access, administrations, GI
complications, metabolic complications.
These include:
• Nausea, vomiting, diarrhea, constipation,
delayed gastric emptying, malabsorption,
refeeding syndrome, hyponatremia,
microbial contamination, tube
obstruction, leakage from ostomy/stoma
site, micronutrient deficiencies.
 Introduction of solid food depends on the
condition of the GI tract.
 Oral feeding delayed for24-48 hours after
surgery
 Wait for return of bowel sounds or passage of
flatus
CLEAR LIQUID DIET
 Start clear liquids when signs of bowel
function returns
 Clear liquid diets supply fluid and electrolytes
that require minimal digestion and little
stimulation of the GI tract
 Clear liquids are intended for short- term use
due to inadequacy
 Things to consider:
o For liquid diets, patients must have
adequate swallowing function
• Even patients with mild dysphagia often
require thickened liquids
• Must be specific in writing liquid diet
orders for patients with dysphagia
o There is no physiological reason for solid
foods not to be introduced as soon as the
GI tract is functioning and a few liquids
are being tolerated. multiple studies show
patients can be fed a regular solid- food
diet after surgery without initiation of
liquid diets.
 Consists of clear liquids – such as water,
broth and plain gelatin – that are easily
digested and leave no undigested residue in
the intestinal tract
FULL LIQUIDS
 It means that a person eats no solid foods and
only consumes liquids, such as soups, juices,
and smoothies
 It is a temporary measure and not a long- term
nutritional strategy
 Recommended:
o Preparing for a test or medical procedure
o Recovering from a surgery such as
bariatric surgery
o Having difficulty swallowing or chewing
 Short periods of time: 5 days to 2weeks
 May eat foods that are liquid or turn liquid at
room temperature on a full liquid diet
 It contains no fiber or protein, so they give
digestive system a break
 May need to eat more than the three standard
meals a day to get in all calories and nutrients
on a full liquid diet. Try eating six to eight
times throughout the day with a variety of
liquids and strained or blended foods
 To increase caloric intake, incorporate full –
fat diary, such as butter or whole milk, or
high –calorie supplement shakes.
 After clear liquid diet it will graduate to
additional types of liquid that may include:
o Decaffeinated coffee and tea
o Skim milk
o Thin soup and broth
o Unsweetened juice
PUREED DIET
 if there is trouble chewing, swallowing, fully
breaking down/ digesting solid food
 “pureed” means that all food has been
ground, pressed, and/or strained to a soft,
smooth consistency, like a pudding
 It is a thick, pudding – like consistency
 Foods can be pureed though food processor or
blender
 V – 8 juice and first- stage baby foods that
don’t contain solids are also convenient
options
SOFT DIET
 it is one of the only diets that will encourage
to eat low-fiber foods and refined, processed
carbohydrates
 should also focus on processed canned
vegetables and fruit as opposed to fresh
produce and try to get protein from softer
sources such as eggs and well- cooked fish
 Most patients won’t move into this stage until
between six and eight weeks after surgery
 Soft, easy – to – chew foods are:
o Soft – boiled eggs
NCM 109-SL NOTES
o Ground meat
o Cooked white fish
o Canned fruits

STABILIZATION
 Food will still need to be chopped into small
bites, since the stomach will be smaller and
large pieces of food can cause issues
 Foods will need to be reintroduced slowly in
order to figure out which ones the stomach
can handle and which ones it can’t.
 Foods that are hard to digest should still be
avoided at this point, this includes fibrous or
stringy vegetables, popcorn, bread, bread
products and fried food.