THEORETICAL FOUNDATION, GOOD LUCK! BREAK A LEG!
Nursing Foundation  Theory (Foundation for
the art (our doing/diskarte/skills) and science
(our knowledge on something) of nursing) 
Research (Testing theories)  Practice
(Application)
 Theory research and practice are bound
together in continuous interactive
relationship, interrelation of theory,
research, and practice.
E.g. Florence Nightingale’s (Environmental
theory) It’s based on five points (clean water,
pure air, efficient drainage, sanitation or
cleanliness, sunlight or light)
THEORY
 It’s important because it
 Helps us to decide what we know and
what we need to know
 Helps explain an event
 Defining ideas/concept
 Explaining relationship among the
concepts
 Predicting outcomes
NURSING THEORY
 Describes, explains, predicts and/or
prescribes nursing care
 Help to generate further knowledge
 Indicate in which direction nursing
should develop in the future
COMPONENTS OF A THEORY
 Phenomenon- an observable event
 Concepts- abstract description of
phenomena, building blocks of theories
 Definitions- meaning of the concept
 .1 Theoretical/Conceptual
meaning/definition/basis
 .2 Operational- measurable
 Assumption- statements that describe
concepts
THE DOMAIN OF NURSING
Paradigm- Conceptual framework
NURSING METAPARADIGM CONCEPT – 4
1. Person- recipient of nursing care, can
involve family community
2. Health- degree of wellness or well-being
that the px experience
3. Environmental/Situation- Positive or
negative internal/external surrounding
that affects the px
4. Nursing- nurse’s attributes,
characteristics, and actions provide care
on behalf of or in conjunction with the
px
E.g. Dorothea orem- Orem’s Self care theory or
self care deficit theory
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 Self care agency-
Kakayahang alagaan
Ang sarili
 Self care demands-
tataaspag bumaba ang self care agency
 Nursing agency- nurses will provide care
on a px with deficit care
OREM’S METAPARADIGM CONCEPT
 Person: an individual with physical and
emotional requirments for
development of self and maintenance
of their well-being
 Environment: px surroundings which
may affect their ability to perform their
self care activities
 Health: “Structural and functional
soundness and wholeness of the
individual”-(orem 1991)
 Nursing: The acts of a specially trained
and able individual to help a person or
multiple people deal with their actual or
potential self-care deficits
EVOLUTION OF NURSING THEORY
 Florence Nightingale- 1900(Dark era)
 First nursing theorist
 Curriculum era- 1900-1940(Standardize)
 Research era- 1950-1970’s (Research
started)
 Graduate (Masteral degree) education
era- 1950-1970’s (Research started)
 Theory era- 1980-1990’s
 Theory utilization era- 2000 up to the
present
 Theories are dynamic and responsive to
the changing environvent in which we
live
CLASSIFICATION OF THEORY by abstract -3
 Grand- broad in scope, complex
 Middle ranged- limited in scope and less
abstract
 Practice- narrow in scope and focus
 E.g. Leininger’s Culture care theory
(Grand) purpose of this is to generate
knowledge related to caring for persons
considering their cultural heritage and
values
 Orem’s self care deficit (Grand) suggest
px are better able to recover when they
maintain some independence over their
own self-care
 Pender’s health promotion (Middle
ranged) is to “assist nurses in
understanding the major determinants
of health behavior as a basis for
behavioral counseling to promote
healthy lifestyle
 Antonia nelson’s breastfeeding theory,
which recommends that when
educating a mother about
breastfeeding, the nurse should be
respectful of the mothers right to
decide, and carefully consider how
promote breastfeeding without causing
conflict
 The outcome is a more positive
breastfeeding experience for the
mother and infant
CLASSIFICATION OF THEORY by goal orientation
-2
1. Descriptive- (Describe) enlightenment
and understanding
2. Prescriptive- Control and manipulation
application
CLASSIFICATION OF THEORY by afaf meleis -3
1. Needs-based- provide care, needed by
the px
2. Interaction- emphasize nursing-px
relationship
3. Outcome- describe the nurse
controlling to heve improvement on the
px
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CLASSIFICATION OF THEORY by alligood -4
1. Nursing philosophie
2. Nursing conceptual models
3. Grand theories
4. Middle-range theories
NURSING PHILOSOPHY- it is the most abstract
type and sets forth the meaning of nursing
phenomena through analysis, reasoning, and
logical presentation
FUNDAMENTAL PATTERNS OF KNOWING
 Emperical (Science of nursing)- your
strategy to get the data- based on the
assumption that what is known
accessible through the physical senses,
seeing, touching, and hearing
 Ethics (Moral knowledge)- matters of
obligation, what ought to be done
 It requires consideration of all patterns
of knowing
 Aesthetic (Through knowledge and
experience)- The art of nursing
encompasses knowledge of the
experience of nursing
 Ability to skillfully perform nursing
activities it is constantly changing as we
build on knowledge with experience
 Personal (Awareness on the situation)
knowing what you do and doing what
you know, self-knowing that is
conscious to know fully who you are
and understand your actions and
relationships being made on the job
through care.
 Experiential knowing- understanding
 Interpersonal knowing- awareness
FLORENCE NIGHTINGALE- Founder of modern
nursing (environmental theory) patient care
theory
 Defined Nursing: “The act of utilizing
the environment of the patient to assist
him in his recovery.”
 Caring for the patient is of more
importance than the nursing process,
the relationship between patient and
nurse, or the individual nurse
Identified five (5) environmental factors: Could
affect or could heal the px (The nurse could
control tats why he is outside)
1.fresh air
2.pure water
3.efficient drainage
4.cleanliness or sanitation
5.light or direct sunlight
 Her work during the Crimean war has
the greatest impact on the
professionalism of nursing
 Nurses can manipulate and mediate the
environment to put the patient in best
condition for nature to act upon.
 The most important aspect for a nurse
to learn is to know the client by
establishing a relationship.
JEAN WATSON- TRANSPERSONAL CARING
(beyond the limit of personal identity)
 Nursing is concerned with promoting
health, preventing illness, caring for the
sick, and restoring health
 Mainly concerns with how nurses care
for their patients and how that caring
progresses into better plans to promote
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health and wellness, prevent illness and
restore health.
 Focuses on health promotion, as well as
the treatment of diseases
 Caring is central to nursing practice and
promotes health better than a simple
medical cure.
WHAT ARE THE C’s OF CARING?
1. Compassion
2. Competence
3. Confidence
4. Conscience
5. Commitment
BETTY NEUMAN- SYSTEM MODEL
 Nursing interventions occur through
three prevention modalities. Primary
prevention occurs before the stressor
invades the system; secondary
prevention occurs after the system has
reacted to an invading stressor; tertiary
prevention occurs after secondary
prevention as reconstitution is being
established.
HILDEGARD PEPLAU-INTERPERSONAL RELATION
THEORY
 Defined Nursing: “An interpersonal
process of therapeutic interactions
between an Individual who is sick or in
need of health services and a nurse
especially educated to recognize,
respond to the need for help. Nursing is
a “maturing force and an educative
instrument”
 conceptualized the framework for
psychiatric nursing, wherein a nurse
must established a therapeutic
relationship with the client.
IDENTIFIED 4 PHASES OF THE NURSE-PX
RELATIONSHIP
Orientation - individual/family has a “felt need”
and seeks professional assistance from a nurse
(who is a stranger). This is the problem
identification phase. Identification - where the
patient begins to have feelings of belongingness
and a capacity for dealing with the problem,
creating an optimistic attitude from which inner
strength ensues. Here happens the selection of
appropriate professional assistance.
Exploitation - the nurse uses communication
tools to offer services to the patient, who is
expected to take advantage of all services.
Resolution - where patient’s needs have already
been met by the collaborative efforts between
the patient and the nurse. Therapeutic
relationship is terminated and the links are
dissolved, as patient drifts away from
identifying with the nurse as the helping person
JOYCE TRAVELBEE- INTERPERSONAL ASPECTS
OF NURSING
 She postulated the Interpersonal
Aspects of Nursing Model.
 She advocated that the goal of nursing
individual or family in preventing or
coping with illness, regaining health
finding meaning in illness, or
maintaining maximal degree of health.
 She further viewed that interpersonal
process is a human-to-human
relationship formed during illness and
“experience of suffering” She believed
that a person is a unique, irreplaceable
individual who is in a continuous
process of becoming, evolving and
changing
LYDIA HALL- CORE-CARE-CURE MODEL
THE CLIENT IS COMPOSE OF THE FOLLOWING
OVERLAPPING PARTS
 person (core), pathologic state and
treatment (cure) and body (care).
 Introduced the model of Nursing: What
Is It?
 Focusing on the notion that centers
around three components of Care, Core
and Cure. Care represents nurturance
and is exclusive to nursing.
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 Core involves the therapeutic use of self
and emphasizes the use of reflection.
 Cure focuses on nursing related to the
physician’s orders.
 Core and cure are shared with the other
health care providers.
 The major purpose of care is to achieve
an interpersonal relationship with the
individual that will facilitate the
development of the core.
MADELEINE LEININGER-TRANSCULTURAL
NURSING CARE MODEL THEORY AND
ETHNONURSING
 Transcultural Care Theory and
Ethnonursing Developed the
Transcultural Nursing Model.
 She advocated that nursing is a
humanistic and scientific mode of
helping a client through specific cultural
caring processes (cultural values, beliefs
and practices) to improve or maintain a
health condition.
 Nursing is a learned humanistic and
scientific profession and discipline
which is focused on human care
phenomena and activities in order to
assist, support, facilitate, or enable
individuals or groups to maintain or
regain their well being (or health) in
culturally meaningful and beneficial
ways, or to help people face handicaps
or death.
 Transcultural nursing as a learned
subfield or branch of nursing which
focuses upon the comparative study
and analysis of cultures with respect to
nursing and health-illness caring
practices, beliefs and values with the
goal to provide meaningful and
efficacious nursing care services to
people according to their cultural values
and health-illness context.
 Focuses on the fact that different
cultures have different caring behaviors
and different health and illness values,
beliefs, and patterns of behaviors.
 Awareness of the differences allows the
nurse to design culture-specific nursing
interventions.
MARILYN ANNE RAY- BUREAUCRATIC CARING
THEORY
 Challenges participants in nursing to
think beyond their usual frame of
reference and envision the world
holistically while considering the
universe as a hologram.
 Presents a different view of how health
care organizations and nursing
phenomena interrelate as wholes and
parts in the system.
 Nurses bring caring into being that
makes a human community on an
organization identifying to our spiritual
well-being and intellectual lives
 Bureaucratic Caring: is spiritual-ethical
caring—complex, dynamic patterns of
meaning of caring emerging in and
related to the context or institution.
 What issues (ethical, spiritual, legal,
socio-cultural, economic, and physical)
from the structure of Theory of
Bureaucratic Caring can influence end
of life issues?
PATRICIA BENNER- FROM NOVICE TO EXPERT
THEORY
 States that caring practices are instilled
with knowledge and skill regarding
everyday human needs.
Novice  beginner  competent  proficient
 Expert
 This concepts explains that nurses
develop skills and understanding of px
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care over time from a combination of a
strong educational foundation and
personal experience
IDA JEAN ORLANDO- DELIBERATIVE NURSING
PROCESS THEORY (THE DYNAMIC NURSE-PX
RELATIONSHIP)
 She proposed that “patients have their
own meanings and interpretations of
situations and therefore nurses must
validate their inferences and analyses
with patients before concluding.”
 Orlando’s nursing theory stresses the
reciprocal relationship between patient
and nurse.
 Communication is central to the nurse-
patient relationship. It allows the nurse
to know their patient including their
strength and weakness.
NURSING CONCEPTUAL MODEL- These are
comprehensive nursing theories that are
regarded by some as pioneers in nursing, these
theories address the nursing metaparadigm and
explain the relationship between them
e.g Levine-Rogers-Roy-King-Orem
MYRA ESTRINE LEVINE- CONSERVATION MODEL
“Nursing is human interaction.”
FOUR CONSERVATION PRINCIPLE – 4
1. Conservation of energy- The human
body functions by utilizing energy. The
human body needs energy producing
input (food, oxygen, fluids) to allow
energy utilization output.
2. Conservation of Structural Integrity- The
human body has physical boundaries
(skin and mucous membrane) that must
be maintained to facilitate health and
prevent harmful agents from entering
the body.
3. Conservation of Personal Integrity- The
nursing interventions are based on the
conservation of the individual client’s
personality. Every individual has sense
of identity, self worth and self esteem,
which must be preserved and enhanced
by nurses.
4. Conservation of Social integrity- The
social integrity of the client reflects the
family and the community in which the
client functions. Health care institutions
may separate individuals from their
family. It is important for nurses to
consider the individual in the context of
the family
 When a person is in a state of
conservation, it means that individual
has been able to effectively adapt to
the health challenges, with the least
amount of effort.
 The main goal of conservation is to
maintain the integrity of the system
according to their respective functions
and achieve a balance (equilibrium)
throught the provision of nursing
intervention so that individuals can
achieve wholeness
MARTHA ROGERS- THEORY OF HUMAN BEINGS
5 BASIC ASSUMPTIONS:
1. The human being is a unified whole,
possessing individual integrity and
manifesting characteristics that are
more than and different from the sum
of parts.
2. The individual and the environment are
continuously exchanging matter and
energy with each other
3. The life processes of human beings
evolve irreversibly and unidirectionally
along a space-time continuum
4. Patterns identify human being and
reflect their innovative wholeness
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5. The individual is characterized by the
capacity for abstraction and imagery,
language and thought, sensation and
emotion
 defined Nursing as an art and science
that is humanistic and humanitarian.
 The Science of Unitary Human Beings
contains two dimensions: the science of
nursing, which is the knowledge specific
to the field of nursing that comes from
scientific research; and the art of
nursing, which involves using nursing
creatively to help better the lives of the
patient
 A px can’t be separated from him or her
environment when addressing health
and tx it provides a way to view the
unitary (open system) human being,
who is integral with the universe.
Human and his environment are a
single unit and therefore, must be
studied together
 developed a theory that can be defined
as the development of a science of
humankind, incorporating the concepts
of energy fields, openness, pattern and
organization.
SISTER CALLISTA ROY- ADAPTATION MODEL
 Adaptation Model Viewed humans as
IMOGENE KING- GOAL ATTAINMENT THEORY
Biopsychosocial beings constantly
interacting with a changing
environment and who cope with their
environment through Biopsychosocial
adaptation mechanisms.
 Presented the Adaptation Model.
 She viewed each person as a unified
biopsychosocial system in constant
interaction with a changing
environment.
 She contented that the person as an
adaptive system, functions as a whole
through interdependence of its part.
 The system consists of input, control
processes, output feedback.
 Focuses on the ability of Individuals,
families, groups, communities, or
societies to adapt to change.
 The degree of internal or external
environmental change and the person’s
ability to cope with that change is likely
to determine the person’s health status.
 Nursing interventions are aimed at
promoting physiologic, psychologic, and
social functioning or adaptation.
 To identify the types and demands
placed on a client and client’s
adaptation to the demands
 defined nursing as a health care
profession that focuses on human life
processes and patterns and emphasizes
the promotion of health for individuals,
families, groups, and society as a whole.
 Views the individual as a set of
interrelated systems that strives to
maintain a balance between various
stimuli
 It states that the goal of nursing care is
to promote patient adaptation, her
model asks questions about the person
who is the focus of nursing care, the
target of that care and when that care is
indicated
 Adaptation theory (physiological, self
concept, interdependence, role
function)
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 “Nursing is a process of action, reaction
and interaction by which nurse and
client share information about their
perception in a nursing situation” and
“a process of human interactions
between nurse and client whereby each
perceives the other and the situation,
and through communication, they set
goals, explore means, and agree on
means to achieve goals”
 Focuses on this process to guide and
direct nurses in the nurse-px
relationship, going hand-in-hand with
their px to meet good health goals
explains that the nurse and px go hand-
in-hand in communicating information,
set goals together and then take actions
to achieve those goals
DOROTHEA OREM- SELF-CARE/DEFICIT THEORY
 “The act of assisting others in the
provision and management of self-care
to maintain or improve human
functioning at the home level of
effectiveness.”
 Focuses on each individual’s ability to
perform self-care.
COMPOSE OF 3 INTERRELATED THEORIES
1. theory of self-care
2. self-care deficit
3. Nursing system, wholly compensatory
(hindi talaga kaya), partially
compensatory (medyo kaya), and
supportive educative (kaya need lang ng
assistance)
 Orem's self-care deficit theory suggests
patients are better able to recover
when they maintain some
independence over their own self-care
NURSING GRAND THEORIES- are works derived
from nursing philosophies, conceptual models,
and other grand theories that are generally not
as specific as middle-ranged theories
e.g. Henderson, Abdellah, Johnson, Neuman
VIRGINIA HENDERSON- NURSING NEED THEORY
(14 components) (centered around
patient/patient needs)
1. Breathing normally
2. Eating and drinking adequately
3. Eliminating body wastes
4. Moving and maintaining desirable
position
5. Sleeping and resting
6. Selecting suitable clothes
7. Maintaining body temperature within
normal range
8. Keeping the body clean and well-
groomed
9. Avoiding dangers in the environment
10. Communicating with others
11. Worshipping according to one’s faith
12. Working in such a way that one feels a
sense of accomplishment
13. Playing/participating in various forms of
recreation
14. Learning, discovering or satisfying the
curiosity that leads to normal
development and health and using
available health facilities
 Focuses on the importance of
increasing the patient’s independence
to hasten their progress in the hospital.
 Emphasizes the basic human needs and
how nurses can assist in meeting those
needs.
 The Need Theory emphasizes the
importance of increasing the patient's
independence and focus
 on the basic human needs so that
progress after hospitalization would not
be delayed
 The unique function of the nurse is to
assist the individual, sick or well, in the
performance of those activities
contributing to health that he would
perform unaided if he has the necessary
strength, will and knowledge, and do
this in such a way as to help him gain
independence as rapidly as possible.
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FAYE GLENN ABDELLAH- 21 NURSING PROBLEM
THEORY
1. To maintain good hygiene.
2. To promote optimal activity exercise,
rest and sleep.
3. To promote safety.
4. To maintain good body mechanics
5. To facilitate the maintenance of a
supply of oxygen
6. To facilitate maintenance of nutrition
7. To facilitate maintenance of elimination
8. To facilitate the maintenance of fluid
and electrolyte balance
9. To recognize the physiologic response
of the body to disease conditions
10. To facilitate the maintenance of
regulatory mechanisms and functions
11. To facilitate the maintenance of sensory
functions
12. To identify and accept positive and
negative expressions, feelings and
reactions
13. To identify and accept the
interrelatedness of emotions and
illness.
14. To facilitate the maintenance of
effective verbal and non-verbal
communication
15. To promote the development of
productive interpersonal relationship
16. To facilitate progress toward
achievement of personal spiritual goals
17. To create and maintain a therapeutic
environment
18. To facilitate awareness of self as an
individual with varying needs.
19. To accept the optimum possible goals
20. To use community resources as an aid
in resolving problems arising from
illness.
21. To understand the role of social
problems as influencing factors
 Changed the focus of nursing from
disease-centered to patient-centered
and began to include families and the
elderly in nursing care.
 Nurses use the problem analysis
approach in identifying and meeting the
patient's needs.
 The nursing model is intended to guide
care in hospital institutions but can also
be applied to community health
nursing, as well.
 The patient-centered approach to
nursing was developed from Abdellah’s
practice,and the theory is considered a
human needs theory.
 The model has interrelated concepts of
health and nursing problems, as well as
problemsolving,which is an activity
inherently logical in nature.
 The problem-solving approach
introduced by Abdellah has the
advantage of increasing the nurse’s
critical and analytical thinking skills
since the care to be provided would be
based on sound assessment and
validation of findings.
DOROTHY JOHNSON- BEHAVIORAL SYSTEM
MODEL
 Advocates to foster efficient and
effective behavioral functioning in the
patient to prevent illness and stresses
the importance of research-based
knowledge about the effect of nursing
care on patients.
 Describes the person as a behavioral
system with seven subsystems.
 Johnson's Behavioral system model is a
model of nursing care that advocates
the fostering of efficient and effective
behavioral functioning in the patient to
prevent illness.
 Behavioral Assessment
 Example of illness behaviour-
Assumption of sick role + Recovery or
Rehabilitation stage – patient is
expected to relinquish the dependence
role and resume former roles and
responsibilities
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JOHNSON’S 7 SUBSYSTEM- describes the person
as a behavioural system
1. Aggressive- Self-protective behavior
2. Attachment-
3. Ingestion- Taking in nourishment in
socially and culturally acceptable ways
4. Elimination- Riddling the body of waste
in socially and culturally acceptable
ways
5. Dependency- Nurturance- seeking
behavior
6. Achievement- master of oneself and
one’s environment according to
internalized standard of excellence
7. sexual
ERNESTINE WIEDENBACH-HELPING ART OF
CLINICAL NURSING
 Developed the Clinical Nursing – A
Helping Art Model. She advocated that
the nurse’s individual philosophy or
central purpose lends credence to
nursing care. She believed that nurses
meet the individual’s need for help
through the identification of the needs,
administration of help, and validation
that actions were helpful. Components
of clinical practice: Philosophy, purpose,
practice and an art
ROSEMARIE RIZZO PARSE- HUMAN BECOMING
THEORY
 “Nursing is a science, and the
performing art of nursing is practiced in
relationships with persons (individuals,
groups, and communities) in their
processes of becoming.:
 Explains that a person is more than the
sum of the parts, the environment, and
the person is inseparable and that
nursing is a human science and art that
uses an abstract body of knowledge to
help people.
IT CENTERED AROUND THREE THEMES:
1. Meaning - persons structure, or choose,
the meaning of their realities, and this
choosing happens with explicit-tacit
knowing.
2. rhythmicity - human beings create
patterns in day-to-day life, and these
patterns tell about personal meanings
and values.
3. transcendence - persons continuously
change and unfold in life as they engage
with and choose from infinite
possibilities about how to be, what
attitude or approach to have, whom to
relate with, and what interests or
concerns to explore.
 The primary purpose of nursing theory
is to improve practice by positively
influencing the health and quality of life
of patients. Nursing theories are also
developed to define and describe
nursing care, guide nursing practice,
and provide a basis for clinical decision-
making
 Guide nursing practice, and provide a
basis for clinical decision-making
LOCAL NURSING THEORIES
 Filipino nurses philosophical outlook
roots to Florence Nightingale and as
descendants of Anastacia Giron Tupaz
as the Mother of Philippine Nursing
Profession. Filipino nurses have its way
of delivering the paradigms and
theoretical perspectives in terms of
their core of professional
understanding, deepening nursing
principles as applied as science, arts and
philosophy, and their nature of
acquiring new knowledge as based to
their inherited characteristics from our
culture and traditions.
ROZZANO LOCSIN- TECHNOLOGICAL
COMPETENCY AS CARING IN NURSING is the
harmonious coexistence between technologies
and caring in nursing. concepts can co-exist
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 This practice theory is focused on
“knowing persons.” With key elements
of technological knowing, designing,
and participative engaging
 Technology brings the patient closer to
the nurse. Conversely, technology can
also increase the gap between the
nurse and nursed.
 Technological Competency as Caring in
Nursing: A Model for Practice Dr.
Locsin’s middle range nursing theory is
a correlation between hands-on patient
care and the use of technology.
Technology is defined as anything that
makes things efficient from basic
diagnostic technologies to therapeutic
practices familiar to all nurses.
Specifically, he discusses the
importance of understanding the need
for knowing “high-tech” instruments
e.g. monitors, implants, and devices
that are a part of patient care as these
will provide opportunities for the nurse
to know the patient fully as person.
Nurses use and encounter technology in
nearly every aspect of their profession.
 As a nursing practice process,
technological knowing (Locsin, 2009)
involves knowing persons through
technologies of health and nursing
which are significantly used to know
persons more fully as whole and
complete in the moment
 Technological knowing is the shaping of
deliberate understanding of persons
guided by the revelations of technology
 Designing is a multidimensional process
of knowing persons in which both the
nurse and the one nursed cocreate a
mutually fulfilling care process from
which the nurse can design responses
to the patient’s desire for quality
human care
 Participative engaging promotes the
opportunity for simultaneous practice
of shared activities that are crucial to
knowing persons
CAROLINA AGRAVANTE- TRANSFORMATIONAL
LEADERSHIP THEORY is focused primarily on the
educational and psycho-spiritual aspect of
nursing
 Sr. Agravante's theory of
Transformational Leadership Theory is
focused primarily on the educational
and psycho-spiritual aspect of nursing.
We believe that Sr. Agravante
emphasized the need for nursing faculty
specially trained to develop holistic
nurses who will become leaders in
health service. There were no citations
about its use in research but her
approach to the development of the
theory can be modified to include
nurses with different religion and
peremploy nursing educators from a
wider variety of schools to attain
practicability. Sister Carolina
Agravante’s CASAGRA Transformative
Leadership Theory focuses on the
Three-Fold Transformative Leadership
Concept namely,
1. Servant-Leader Spirituality,
wherein a leader, through
spiritual exercise, realizes that
his model in caring for
individual is Jesus;
demonstrated passion for
serving her staff rather than
being served
2. Self-Mastery, which involves
individual’s self-awareness
through formal education in
nursing, a continuous
education, seminars attended
 THEORETICAL FOUNDATION, GOOD LUCK! BREAK A LEG!
and his involvement in
organizations; and lastly,
3. Special Expertise, which draws
emphasis in the nurse faculty’s
involvement in the formation of
his students.
 Indeed, Sr. Carolina’s CASAGRA
Transformative Leadership Theory is
timely in this ever fastpaced world.
Nursing as a profession is inevitably
changing and the demand to be at par
with technology made it more
competitive. Nursing students need
nursing teachers to look up to.
Embodied with these three concepts, it
is timely to put this theory into practice.
 Transformational teaching as the
expressed or unexpressed goal to
increase students' mastery of key
course concepts while transforming
their learning-related attitudes, values,
beliefs, and skills.
CARMELITA DIVINAGRACIA- COMPOSURE
BEHAVIOR THEORY- increase the quality of life
among patients with cancer. sets of behaviour
of nursing measure that the nurse
demonstrates to selected patients
 COMpetence
 P-presence and prayer
 O-open mindedness
 S-stimulation
 U-understand
 R-respect & Relaxation
 E-empathy
 a condition of being in a state of well-
being, a coordinated and integrated
living pattern that involves the
dimension of wellness
 Each individual needs humane, caring,
spirituality-oriented intervention that
can facilitate wellness regardless of
creed, social class, gender, age and
nationality
 Assumption- the wellness outcome of a
px will depend on the intervention the
nurse has when administering the care
 Physiologcai outcome
 Behavioral outcome
SISTER LETTY KUAN- RETIREMENT AND ROLE
DISCONTINUITY THEORY- old age- INEVITABLE
CHANGE IN ONES LIFE
 she values the effect of retirement as a
phase of one's life and its accompanying
adjustments. She identified the
determinants of positive perceptions in
retirement and positive reactions
toward role discontinuities.
 Retiree – is an individual who has left
the position occupied for the past years
of productive life because he/she has
reached the prescribed retirement age
or has completed the required years of
service
 Role Discontinuity - is the interruption
in the line of status enjoyed or
performed.
Example: can no longer return to work due to
accidents
DETERMINANTS OF FRUITFUL AGING
1. Health status dictates the capacities
and the type of role one takes both for
the present and for the future. It fits for
everyone to maintain and promote
health at all ages because only proper
care of the mind and body is needed to
maintain health and old age.
2. Family constellation is a positive index
regarding retirement positively and also
in reacting to role discontinuities. When
one retires, the shock of the role
discontinuities is softened because the
family not only cushions the impact, but
 THEORETICAL FOUNDATION, GOOD LUCK! BREAK A LEG!
also offers gainful substitutes, as in
providing monetary support.
3. Income has a high correlation with both
perceptions of retirement and reactions
toward role discontinuities; since
income is one of the factors that secure
the outlook of individual.
4. Work status goes hand in hand with
economic security that generates
decent compensation. For the retired, it
implies that retirement should (not) be
conceptualized as a period of no work
because capabilities to function get
sharpened and refined as they practice
it on a regular basis.
5. Self-preparation which are said to be
both therapeutic and recreational in
essence pays its worth in old age. This
does not only account professionalism
or expertise but also benevolent work
as in charitable actions with the
colleagues. Self-preparation is investing
not in monetary benefits but in
something that gives them and dignity,
enhances their feelings of self-worth
and happiness.
CARMENCITA ABAQUIN- PREPARE ME
“INTERVENTIONS”
 Basic Assumptions and Concepts:
PREPARE ME (Holistic Nursing
Interventions) are the nursing
interventions provided to address the
multi-dimensional problems of cancer
patients that can be given in any setting
where patients choose to be confined.
This program emphasizes a holistic
approach to nursing care. The goal of
nursing care is to provide holistic care
to improve the quality of life in patients
with advanced stages of cancer despite
their terminal cases.
PREPARE ME HAS THE FOLLOWING
COMPONENTS
 Presence – being with another person
during the times of need. This includes
therapeutic communication, active
listening, and touch.
 Reminisce Therapy- recall of past
experiences, feelings and thoughts to
facilitate adaptation to present
circumstances.
 Prayer-Relaxation-Breathing-
techniques to encourage and elicit
relaxation for the purpose of decreasing
undesirable signs and symptoms such
as pain, muscle tension, and anxiety.
 Meditation- encourages an elicit form
of relaxation for the purpose of altering
patient’s level of awareness by focusing
on an image or thought to facilitate
inner sight which helps establish
connection and relationship with God. It
may be done through the use of music
and other relaxation techniques.
 Values Clarification- assisting another
individual to clarify his own values
about health and illness in order to
facilitate effective decision-making
skills. Through this, the patient develops
an open mind that will facilitate
acceptance of disease state or may help
deepen or enhance values. The process
of values clarification helps one become
internally consistent by achieving closer
between what we do and what we feel.
 Holistic Nursing Interventions are the
nursing interventions provided to
address the multi-dimensional
problems of cancer patients that can be
given in any setting where patients
choose to be confined. This program
emphasizes a holistic approach to
nursing care.
 Carmencita Abaquin’s Prepare Me
theory implies a type of Nursing Care
 THEORETICAL FOUNDATION, GOOD LUCK! BREAK A LEG!
that deals on how to improve the
quality of life a patient with Cancer and
other Chronic diseases already has.
 A person diagnosed with cancer or
other chronic diseases has the same
reactions: fear, anxiety, curiousness,
sadness and sometimes they feel lost.
 This theory emphasizes the holistic
nursing approach to care of patients
having terminal illnesses specifically
those having cancer.
CECILIA LAURENTE- THEORY OF NURSING
PRACTICE AND CAREER
 Cecilia Laurente is a Filipino Nursing
theorist whose works focused primarily
on helping a patient through support
systems, specifically the family.
 The primary purpose of theory in
nursing is to improve practice by
positively influencing the health and
quality of life of patients. Nursing
theories are also developed to define
and describe nursing care, guide nursing
practice, and provide a basis for clinical
decision-making
 She emphasized effective
communication and using the family as
an entry point to help a px
 The nurse can help strengthen the
family’s term of knowledge, skills, and
attitude through effective
communication, employed informative,
psychotherapeutic, modelling,
behavioural, cognitive, and/or hypnotic
techniques
FRESLYN LIM SACRO-CLIFORD MASAYON KILAT-
ROZZANO LOCSIN- SYNCHRONICITY IN HUMAN
SPACE TIME- a theory of nursing engagement in
a global community
 Synchronicity in the human-space-time
theory of nursing is about innovative
process of nursing engagement
expressed as interpersonal relating,
technological knowing, rhythmical
connecting and transformational
engaging.
 The Philosophical and theoretical
perspectives declare the evolutionary
design in affirming the meaningful
human caring experiences within
nursing practice, Moreover, theory-
based practice sustain the human
science view of wholeness of persons
while focusing on the inclusion of the
co-existence between technology and
caring in nursing. The practice of
nursing approaches human caring
beyond the customony fragmented and
routinary healthcare commitment
FOUR PROCESS OF NURSING ENGAGEMENT
(NEP)
1. Interpersonal relating- Therapeutic
communication- nurse interaction
2. Technological knowing- use of
equipment and interpretation of data-
nurse interaction
3. Rhythmical connecting- engaging the px
and family in the implementation of
care- px interaction
4. Transformational engaging- all the
persons involved had experienced
change- px interaction
 THEORETICAL FOUNDATION, GOOD LUCK! BREAK A LEG!
 FLORENCE NIGHTINGALE-
ENVIRONMENTAL THEORY
 JEAN WATSON- TRANSPERSONAL
CARING
 BETTY NEUMAN- SYSTEM MODEL
 HILDEGARD PEPLAU- INTERPERSONAL
RELATION THEORY
 JOYCE TRAVELBEE- INTERPERSONAL
ASPECTS OF NURSING
 LYDIA HALL- CORE, CARE, CURE MODEL
 MADELEINE LEININGER-
TRANSCULTURAL NURSING CARE
MODEL
 MARILYN ANNE RAY- BUREAUCRATIC
CARING THEORY
 PATRICIA BENNER- NOVICE TO EXPERT
THEORY
 IDA JEAN ORLANDO- DYNAMIC NURSE-
PX RELATIONSHIP
 MYRA ESTRINE LEVINE- CONSERVATION
MODEL
 MARTHA ROGERS- THEORY OF HUMAN
BEINGS
 SISTER CALLISTA ROY- ADAPTATION
MODEL
 IMOGENE KING- GOAL ATTAINMENT
THEORY
 DOROTHEA OREM- SELF CARE/DEFICIT
THEORY
 VIRGINIA HENDERSON- NURSING NEED
THEORY
 FAYE GLENN ABDELLAH- 21 NURSING
PROBLEM THEORY
 DOROTHY JOHNSON- BEHAVIORAL
SYSTEM MODEL
 ERNESTINE WIEDENBACH- HELPING ART
OF CLINICAL NURSING
 ROSEMARIE RIZZO PARSE- HUMAN
BECOMING THEORY
 ROZZANO LOCSIN- TECHNOLOGICAL
COMPETENCY AS CARING IN NURSING
 CAROLINE AGRAVANTE-
TRANSFORMATIONAL LEADERSHIP
THEORY
 CARMELITA DIVINAGRACIA-
COMPOSURE BEHAVIOR THEORY
 SISTER LETTY KUAN- RETIREMENT AND
ROLE DISCONTINUITY THEORY
 CARMENCITA ABAQUIN- PREPARE ME
THEORY
 CECILIA LAURENTE- PRACTICE AND
CAREER THEORY OF NURSING
 SACRO-KILAT-LOCSIN- SYNCHRONICITY
IN HUMAN SPACE TIME THEORY
NURSING CONCEPTUAL THEORY MODEL
e.g. MYRA ESTRINE LEVINE- MARTHA ROGERS-
SISTER CALLISTA ROY- IMOGENE KING-
DOROTHY OREM
 THEORETICAL FOUNDATION, GOOD LUCK! BREAK A LEG!

NURSING GRAND THEORIES MODEL

e.g. VIRGINIA HENDERSON- FAYE GLENN

ABDELLAH- DOROTHY JOHNSON- BETTY
NEUMAN

LOCAL NURSING THEORIES MODEL

e.g. ROZZANO LOCSIN- CAROLINA AGRAVANTE-

CARMELITA DIVINAGRACIA- SISTER LETTY
KUAN- CARMENCITA ABAQUIN- CECIIA
LAURENTE- SACRO-KILAT-LOCSIN
COMPETENCY APPRAISAL 1 (CMPA411): PRELIM EXAMINATION – Q.C CAMPUS
FUNDAMENTALS OF THE NURSING PRACTICE  It is a G.O.S.H approach
NURSING PROCESS o G – oal oriented
- Systematic, rational method of planning and o O – rganize
providing individualized nursing care; it provides a o S – ystematic
framework for accountability and responsibility in o H – umanistic Care
nursing and it maximizes responsibility for standards  Benefits for the Client
of care. o Quality of care
- Gained legitimacy in 1973 when ANA published o Continuity of care
standards of nursing practice, describing the 5 steps o Client participation in their health care
of the nursing process  Benefits for the Nurse
- Critical Thinking o Consistent and systematic nursing education
 It is “the intellectually disciplined process of o Job satisfaction
actively and skillfully conceptualizing, applying, o Professional growth
analyzing, and/or evaluating information o Avoidance of legal action
gathered from observation, experience,
reasoning, or communication, as a guide to belief
and action.”
- Decision Making
 Decisions that nurses must make about client
care and about the distribution of limited
resources force them to think and act in areas
where there are neither clear answers nor
standard procedure and where conflicting forces
turn decision making into complex process.

- Characteristics of Nursing Practice

 Cyclic and dynamic rather than static
 Client centered
 Interpersonal and collaborative
 Universally applicable - Assessment
 Adaptation of problem solving techniques and
system theory based on the scientific method
 It was popularized by Lydia Hall in 1955
 It is both a problem solving process and a
framework in which nurses can apply their
knowledge and skills.
PHASES OR STEPS IN NURSING PROCESS
 Get the facts.
 Collect, organize, validate, and record client data.
 Types of Data:
o Subjective (symptoms) – apparent only to the
client
o Objective (signs) – can be observed (by the
use of senses) and measured

1|CELINE
COMPETENCY APPRAISAL 1 (CMPA411): PRELIM EXAMINATION – Q.C CAMPUS
 Sources of Data:
• Symptoms
o Primary Data
P E S
• Problem
• Etiology • as
• NANDA
• related to… evidenced
label
o Secondary Data by…

 Methods of Collecting Data:

o Interview Readiness for Enhanced Knowledge
o Observation - Planning
o Physical Assessment  Determine goals and outcomes. Identifying the
- Diagnosis specific actions to be done.
 Identify the client’s status and health care needs.  Formulation of NCP which is used mainly as a
 Uses the PES format: guide to individualize care.
o P- roblem  Characteristics of a well stated goal:
o E- tiology o S- pecific
o S- igns and symptoms o M- easurable
 Prioritizing nursing diagnosis is based on what o A- ttainable
endangers life. o R- ealistic
 Types of Nursing Diagnosis: o T- ime framed
o Actual – problem is present •SPECIFIC
o Potential – problems may arise S •Address only one behavior perception or
physiological response.
1. Problem-Focused Nursing Diagnosis
•MEASURABLE
o This is a client problem that is present at the M •Quantify the expected change in physiologic findings,
time of the nursing assessment patient’s knowledge perceptions and behavior.

•ATTAINABLE
• Symptoms
A •Consider the patient’s desire to recover and their
P E S
• Problem
• Etiology • as
• NANDA physical and psychological conditions.
• related to… evidenced
label
by…

•REALISTIC
R •Set goals and outcomes within the patient’s
Acute Pain related to Inflammation AEB Guarding behavior limitations and abilities

of the pancreas Pain scale of 9/10 •TIMED

Increased HR&RR T •Provide time frame (short term goal and long term
goal)
2. Risk Nursing Diagnosis
 First Priority – is any threat to the vital functions
o This is a clinical judgment that a problem
of breathing, heartbeat, blood pressure.
does not exist, but the presence of risk
 Medium Priority – health-threatening problems
factors indicates that a problem is likely to
that may result in delayed development or cause
develop unless nurses intervene.
destructive physical or emotional changes.
• Symptoms  Low Priority – problems that arise from normal
P E S
• Problem
• Etiology • as
• NANDA
label
• related to… evidenced
by…
development needs or those that require
minimal nursing support.
 Priority Setting
Risk for FVD Risk factors include Excessive gastric
Losses (Vomiting)
3. Possible Nursing Diagnosis
o Evidence about a certain problem is unclear
HIGH •If untreated, result in harm to patient or others
•Consider Maslow’s Hierarchy of Needs

and need to gather more data to support it INTERM •Non-emergent, non-life threatening needs of
4. Wellness Nursing Diagnosis the patients.
o Clinical judgment about an individual, family EDIATE
and community in transition from a specific
level of wellness to a higher level of wellness LOW •May not always related to a specific illness but
affect the patient’s future well-being.

2|CELINE
COMPETENCY APPRAISAL 1 (CMPA411): PRELIM EXAMINATION – Q.C CAMPUS
- Implementing oCore Temperature- deep tissue temperature
 Putting the NCP into action of the body. Normal ranges from 36.7◦C -37◦C
 Requirement for implementation: o Surface Temperature - temperature of the
o Therapeutic Use of Self (TUOS) skin, subcutaneous tissue, and fats.
o Technical skills  Heat is lost from the body through:
o Knowledge o Radiation
o Communication skills  The transfer of heat from the surface of
 Direct Care one object to the surface of another
o These are interventions performed through without contact between the two
interactions with patients. objects.
o Examples: o Conduction
 Medication administration  The transfer of heat from one molecule
 Catheterization to a molecule of lower temperature
 Counselling o Convection
 Discharge instruction  The dispersion of heat by air currents
 Indirect Care o Vaporization
o These are treatments performed away from a  Continuous evaporation of moisture
patient but on behalf of the patient or group  Factors Affecting Body Temperature:
of patients. o Age
o Examples: o Diurnal variables
 Managing patient’s environment o Exercise
 Documentation o Hormones – progesterone
 Interdisciplinary collaboration o Stress
 Categories of Nursing Interventions o Environment – elderly client is susceptible to
o Independent (Nurse-Initiated) heat stroke
 Actions that a nurse can perform  4 Common types of Fever:
without supervision or direction from o Intermittent – alternates between periods of
others fever and periods of normal temp
o Dependent (Health care provider-initiated) o Remittent – wide range of temp fluctuation
 Actions that require an order from the occurring over the 24-hour period, all of
health care provider (doctor), such as: which are above normal
 Administering medication o Relapsing Fever – temp is elevated for a few
 Implementing an invasive days alternated with 1 or 2 days of normal
procedure temperature
 Preparing for diagnostic tests o Constant Fever – body temp is consistently
o Interdependent (Collaborative) high
 These are therapies that require the Route No. of Normal Description
combined knowledge, skill and expertise mins value
Oral 2-3 mins 37o C– Most convenient and
of multiple health care providers. 98.6o F accessible
- Evaluation Rectal 2 mins 37.7o C– Most accurate and
 Determination of improvement of patient’s 99.6o F invasive
condition or well-being after the application of
Axilla 7-10 mins 36.4o C– Least invasive and
the first four steps of the nursing process 97.5o F least accurate
VITAL SIGNS
1. Temperature Tympanic Automatic 37.7o C– Directly reflects core
membrane results 99.9o F temperature
 The balance between heat produce by the body
and heat loss from the body. (normal- 36◦C  Conversion:
37.5◦C) o Fahrenheit to Celsius = (o F-32) x 5/9
 Types of Body Temperature: o Celsius to Fahrenheit = (o C x 9/5) + 32

3|CELINE
COMPETENCY APPRAISAL 1 (CMPA411): PRELIM EXAMINATION – Q.C CAMPUS
2. Pulse  Stress
 It is the wave of blood created by the contraction  Increased environmental temperature
of the left ventricle.  Lowered O2 concentration
 Pulse reflects the heartbeat o Decrease
 It is regulated by the autonomic nervous sys.  Medication (narcotics)
 Normal PR for adult – 60-100 bpm  Increased ICP
 Peripheral Pulse – a pulse located away from the  Decreased environmental temperature
heart.
 Apical Pulse – a central pulse
 Pulse Scale:
o Scale for measuring pulse strength
 0 Absent
 1+ Pulse is diminished, barely palpable
 2+ Normal
 3+ Full Pulse
 4+ Strong, Bounding Pulse
 Factors Affecting Pulse:
o Age
o Gender
o Exercise  Abnormal Lung Sounds:
o Medications o Crackles (Rales) – heard on inspiration,
 Digitalis – ↓ HR common in px with pneumonia, emphysema,
 Epinephrine – ↑ HR atelectasis, bronchitis
o Hypovolemia – loss of blood from the o Wheezes – high-pitched squeaky sound heard
vascular system ↑ PR on expiration (common in asthmatic px)
o Position changes – sitting or standing o Stridor – harsh, high-pitched sound heard on
Pulse Site Purposes both expiration and inspiration
Temporal Used when radial pulse is not accessible o Absent Breath Sounds – pneumothorax,
Carotid Used for infants and in cardiac arrest
Apical Used for infants and children up to 3 y/o. To
pleural effusion, tumor
determine discrepancies 4. Blood Pressure
with radial pulse  It is the pressure exerted by the blood in the
Brachial Used to measure blood pressure
arteries.
Radial Readily accessible and routinely use
Femoral Determine the circulation of the legs  Normal Adult’s BP is 120/80
3. Respiration  Systolic Pressure – pressure resulting from the
 It is the act of breathing. contraction of ventricles.
 Medulla Oblongata is the primary respiratory  Diastolic Pressure – pressure when the ventricles
center of the body. are at rest.
 Normal Adult breathes 16-20 times per min.  Pulse Pressure – the difference between the
 Characteristics: systolic and diastolic pressure
o Normal Breathing – quiet, regular, rhythmic  Widened Pulse Pressure – with increased ICP BP is
o Cheyne-Stoke – alternate waxing and waning 130/60
with temporary period of apnea.  Narrowed Pulse Pressure – hypovolemic shock BP
o Biot’s – irregular respiration with period of is 70/60
apnea.  The series of sounds during BP reading is called
o Kussmaul’s – increased RR, depth (seen in Korotkoff sounds.
metabolic acidosis, renal failure) o Phases:
 Factors affecting respiration:  Characterized by a thud, thump and
o Increase tapping sound
 Exercise  Swooshing, whooshing sound

4|CELINE
COMPETENCY APPRAISAL 1 (CMPA411): PRELIM EXAMINATION – Q.C CAMPUS
Sound decrease in intensity when INSERTION OF NASOGASTRIC TUBE (NGT)
compared to Korotkoff one - NGT is inserted through the nose and into the
 Muffling sound stomach
 Disappearance of sound - Purposes:
 Factors affecting BP:  Gavage – gastric feeding
o Age, exercise, stress  Lavage – stomach irrigation
o Race  For decompression
o Gender  Medication and supplemental fluid
o Diurnal variations administration
ERROR EFFECT - Principles:
Cuff too narrow High  Position: High Fowler’s Position
Cuff too wide Low  Length of tube to inserted: (NEX) from the tip of
Unsupported arm High
Repeating assessment too quickly High systolic or low diastolic
the nose to the earlobe down to the xiphoid
Cuff wrapped too loosely high process.
Deflating cuff too quickly Low systolic, high diastolic  Remember to stop and remove if the client
Deflating cuff too slowly High diastolic cannot talk, is coughing, or becomes cyanotic
Arm above level of the heart Low
- Fr 12 (36 inches)
- Checking for tube placement:
 Injecting a small amount of air through the tube
and listen for gurgling sound
 Aspirating 20-30ml of gastric secretion and test it
using litmus paper
 X-ray is the most accurate method of determining
the tube placement
- Complications:
Dumping Syndrome Diarrhea
Obstructed Tubing Aspiration Pneumonia
Nausea and Vomiting Skin Infection
Tubing inadvertently Hyperglycemia
pulled-out
PROCEDURES ENEMA
BLOOD GLUCOSE SCREENING - Act by distending the intestine, and sometimes by
- The glucose value measures the effectiveness of the irritating the intestinal mucosa; increases peristalsis
treatment of the client with diabetes. and expulsion of the feces and flatus.
- Capillary blood glucose is monitored by using - Purpose:
commercial glucose meter such as Glucometer.  Bowel training program to establish bowel fxn
Protect test tips from exposure to light.  Eliminate feces and flatus
- Measurement is done 30 minutes before meal.  Avoid contamination of the sterile field
- Normal Blood Glucose is 60-120 mg/dl  Treat constipation and impaction
- Signs and Symptoms of Abnormal Blood Glucose  Support visualization of intestine
Level: - Principles:
Hypoglycemia- Blood Hyperglycemia – Blood  Lubricate tube 3-4 inches
glucose < 60 mg/dL glucose > 120 mg/dL  Position: left lateral position or sims position
Shakiness Weakness  Administration: deliver slowly to minimize
Hunger Polyphagia discomfort
Rapid Pulse Dry Skin and Mouth  Height of container: 12” above the rectum
Irritability Nausea and Vomiting
 Temperature: not more than 42◦C
Loss of Concentration Glucosuria
Seizure Thirst
Kussmaul Breathing (Late)

5|CELINE
COMPETENCY APPRAISAL 1 (CMPA411): PRELIM EXAMINATION – Q.C CAMPUS
- Solutions Commonly Used: MALE FEMALE
1. Hypertonic Solution – increased osmotic pressure Position Supine / flaccid Dorsal Recumbent
penis at 90◦ angle
will draw fluid from the interstitial space into the
Length 40 cm catheter 22 cm catheter
colon (e.g. Saline) Length To Be 6 – 9 inches 2-3 inches
2. Hypotonic Solution – lower osmotic pressure will Inserted
cause water to move from the colon to the SUCTIONING
interstitial space (e.g. Tap water) *watch out for - Is aspirating secretions through a catheter connected
circulatory overload to a suction machine or wall suction outlet.
3. Isotonic Solution - no movement of fluid in or out - Principles: (sterile technique is a must)
of the colon. The volume of solution stimulates  Performed to clear the airways
peristalsis (e.g. Normal saline)  Irritates mucosa and removes oxygen from the
- Types of Enemas: respiratory tract
1. Cleansing – used to cleanse the bowel instruct  It is normal for suctioning to cause coughing,
the client to hold the fluid for 10-15 mins. *If sneezing and gagging
client complains of cramping, clamp the tube for - Manifestations of the need for suctioning: 4D
30 sec.  Dyspnea, pallor and cyanosis
2. Carminative – release gas; it distends the rectum  Drooling; bubbling breath sound
and colon and stimulates peristalsis.  Decreased oxygen saturation
3. Oil Retention – given to soften feces and lubricate  Decreased breath sound
the rectum and anal canal. Route Oro Naso Tracheostomy
- The force of the solution is controlled by R.E.S.T pharyngeal pharyngeal endotracheal
Position Conscious- Semi fowler’s Semi fowlers
 Resistance of the rectum semi-fowler’s with neck unless contra-
 Elevation of the solution container hyper- Indicated
 Size of the tubing Unconscious extended
– side lying
 Thickness of the fluid
Pressure 110 mmHg Depends 90 – 110 mmHg
URINARY CATHETERIZATION upon the age
- Introduction of a catheter into the urethra towards and type of
suction
the urinary bladder.
apparatus
- Principles: (sterile technique is a must) Length of 3 – 5 inches 3 – 5 inches 2 – 3 inches
 Do not allow the catheter bag to lie on the floor. tube to be
 Do not allow the drainage spout to touch the inserted
Lubricant Water Water-soluble Saline solution
collection receptacle. Duration 5 – 15 sec. 5 – 15 sec. 5 – 10 secs.
 Client should void within 4 – 6 hrs after an Resting 20 – 30 sec. 20 – 30 sec. 2 – 3 minutes
indwelling catheter is removed period bet.
suctioning
 Acidify the urine – offer food such as cranberries,
OXYGENATION
plums and prunes
- Oxygen is a clear, odorless gas that constitutes
 Increase fluid intake to 3L/day to prevent urinary
approximately 21% of the air we breathe, is
stasis
necessary for all living cells.
- Types of Catheter:
- 3 - 5 mins. absence of oxygen in the brain may cause
 Indwelling Catheter (Foley, Retention) – for long
permanent damage.
period catheterization, usually with 2 lumens
- Therapeutic Nursing Intervention for Oxygenation:
 Straight Catheter – for short-period
 Facilitate ventilation
catheterization, single lumen
o Position in semi or high fowler’s
 Suprapubic Catheter – small insertion is made
o Incentive spirometer provides an “incentive”
above the pubic area and the tube is directly
to breathe deeply.
inserted into the bladder.
 Ensure adequate hydration
 External Urine Drainage Device (condom
 Promote patent airway
catheter)
 Administer oxygen

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COMPETENCY APPRAISAL 1 (CMPA411): PRELIM EXAMINATION – Q.C CAMPUS
- Measures the highest volume of airflow during forced
expiration.
- Volume is measured in colored-coded zones.
 Green= 80-100%
 Yellow= 60-80%
 Red= <60%
- Postural Drainage:
- Oxygen Delivery Devices:
 Cannula
o Tubes with two prongs for insertion into the
nostrils.
o Oxygen flow rate- 1-6L/min, Oxygen
Concentration = 24-45%
 Face Masks
o The mask covers the client’s nose and mouth
1. Simple Face Mask – delivers oxygen
concentration 60 – 90%. Flows- 5-8L/min.
2. Partial Rebreather – delivers oxygen
concentration; flows: 6-10 L/min, Oxygen
Concentration = 60-90%
3. Non-Rebreather – 95 -100 %, flow 10-15
L/min.
4. Venturi Mask - 25-50%, flow 4-10L/min.
Preferably used for patient with COPD
- Safety Precaution
 No smoking sign on the door
 No objects that cause static electricity
 No volatile subs. near the patient
MEDICATION ADMINISTRATION
- Medication
 A substance administration for the diagnosis,
treatment, relief or prevention of disease.
- Effects:
1. Desired Effect – “therapeutic effect”
2. Adverse Effect – a harmful reaction; unexpected
3. Toxic Effect – plasma concentration of the drug
reaches threatening level
4. Side Effect – a response that is unrelated to the
desired action of the drug; expected
5. Drug Dependence – the physical or psychological
reliance on a chemical agent resulting from
addiction.
6. Hypersensitivity – abnormal, excessive response
7. Paradoxical Reaction - opposite reaction
8. Drug Allergy – a hypersensitive response to an
allergen which the individual has been exposed
and developed antibodies.
- Therapeutic Action of Drugs:
1. Palliative – relieves the symptoms of a disease
but does not affect the disease itself.
2. Curative- cures a disease or condition
3. Substitutive- replaces body fluids or substances
4. Restorative – returns the body to health
5. Supportive – supports body function until other
treatments or the body’s response can take over
- Drug-Drug Interactions:
 Duplication:
o When two drugs with the same effect are
taken, their side effects may be intensified.
Duplication may occur when people
inadvertently take two drugs (often at least
one is an over-the-counter drug) that have
the same active ingredient.
 Opposition (Antagonism):
o Two drugs with opposing actions can interact,
thereby reducing the effectiveness of one or
both
 Alteration:
o One drug may alter how the body absorbs,
distributes, metabolizes, or excretes another
drug.
- Drug-Nutrient Interactions:
 Food:
o Like food, drugs taken by mouth must be
absorbed through the lining of the stomach
or the small intestine.
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COMPETENCY APPRAISAL 1 (CMPA411): PRELIM EXAMINATION – Q.C CAMPUS
o Consequently, the presence of food in the - Part of Legal Doctor’s Order:
digestive tract may reduce absorption of a  Name of patient
drug.  Data and time
o Often, such interactions can be avoided by  Name of drug
taking the drug 1 hour before or 2 hours after  Dose of drug
eating.  Route of administration
 Alcohol:  Time or frequency
o Although many people do not consider  Signature of the physician
alcohol a nutrient, it affects body processes - Principles in Administering Medications:
and interacts with many drugs.  Observe the “10 Rights” of drug administration
o Taking alcohol with the antibiotic 1. Right drug
metronidazole FLAGYL can cause flushing, 2. Right dose
headache, palpitations, and nausea and 3. Right client
vomiting. Doctors or pharmacists can answer 4. Right route
questions about possible alcohol and drug 5. Right time
interactions 6. Right documentation
- Drug-Disease Interactions: 7. Right advice
 People should tell their doctor all of the diseases 8. Complete drug history
they have before the doctor prescribes a new 9. Drug allergies
drug. Diabetes, high or low blood pressure, an 10. Drug-drug interaction
ulcer, glaucoma, an enlarged prostate, poor  14 R’s of Drug Administration
bladder control, and insomnia are particularly 1. Right Drug/Medication
important, because people with such diseases are 2. Right Client/Patient
more likely to have a drug-disease interaction 3. Right Route
- Some of the Common Latin Prescription 4. Right Dose
Abbreviations Include: 5. Right Frequency/Time
 ac (ante cibum) means "before meals" 6. Right Assessment
 bid (bis in die) means "twice a day" 7. Right Approach
 gt (gutta) means "drop" 8. Right Education
 hs (hora somni) means "at bedtime" 9. Right Evaluation
 od (oculus dexter) means "right eye" 10. Right Documentation
 os (oculus sinister) means "left eye" 11. Right to Refuse
 po (per os) means "by mouth" 12. Right Principle Care
 pc (post cibum) means "after meals" 13. Right Prescription
 prn (pro re nata) means "as needed" 14. Right Nurse Clinician
 q 3 h (quaque 3 hora) means "every 3 hours"  Practice asepsis.
 qd (quaque die) means "every day"  Nurses who administer medications are
 qid (quater in die) means "4 times a day" responsible for their own actions. Question any
 Sig (signa) means "write" order you consider incorrect.
 tid (ter in die) means "3 times a day  Be knowledgeable about medications that you
- Types of Doctor’s Order: administer.
 Standing order – it is carried out until the  Keep narcotics and barbiturates in locked place.
specified period of time, or until it is discontinued  Use only medications that are in clearly labeled
by another order. containers.
 Single order – it is carried out for one time only  Return liquid that are cloudy or have changed in
 STAT order - it is carried out at once or color to the pharmacy.
immediately  Before administering a medication, identify the
 PRN order – it is carried out as the patient client correctly.
requires.  Do not leave the medication at the bedside.

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COMPETENCY APPRAISAL 1 (CMPA411): PRELIM EXAMINATION – Q.C CAMPUS
 If the client vomits after taking an oral
medication, report this to the nurse in charge and
or physician.
 Preoperative medications are usually
discontinued during the postoperative period
unless ordered to be continued.
 When a medication is omitted for any reason,
record the fact together with the reason.
 When a medication error is made, report it
immediately to the nurse in charge/ physician.
ROUTES OF DRUG ADMINISTRATION
ORAL
- Advantages
 Most convenient
 Usually less expensive
 Safe, does not break skin barrier
 Administration usually does not cause stress
- Disadvantages
 Inappropriate for client with nausea and vomiting
 Drugs may have unpleasant taste or odor
 Inappropriate if client cannot swallow or is
unconscious.
 Cannot be used before certain diagnostic test or
surgical procedures.
 Drug may discolor teeth, harm tooth enamel.
 Drug may irritate gastric mucosa.
o Drug can be aspirated by seriously ill clients
- Types of Oral Medications:
o Solid preparations are: tablets, capsules and
pills and powder.
o Liquid preparations are: syrup, suspension,
emulsion, milk or other alkaline substances.
o Enteric coated tablets should not be crushed
before administration.
o Do not administer enteric coated with
antacids, milk or other alkaline substance
o If the patient vomits within 20-30 minutes of
taking the drugs, notify physician. Do not
readminister the drug without a physician’s
order
 Therapeutic Nursing Interventions for oral
preparations:
o Assess to be sure that the client has adequate
swallowing and gag reflex.
o Pour liquid medication into medicine cup eye
level.
o For medications with objectionable taste,
offer oral hygiene immediately after
administering.
o Never put any of your clean items which are
used in administering medications directly on
the surface of the counter or medication
cart/tray.
- Sublingual
 A drug is placed under the tongue, where it
dissolves.
 Advantages:
o Same as oral
o Drug can be administered for local effect.
o Drug is rapidly absorbed into the blood
stream.
o Ensures greater potency because drug
directly enters the blood and bypass the liver.
 Disadvantages:
o If swallowed, drug may be inactivated by
gastric juice.
o Drug must remain under the tongue until
dissolved and absorbed
- Buccal
 A medication is held in the mouth against the
mucous membranes of the cheek until drug
dissolves.
 Advantages:
o Same as oral
o Drug can be administered for local effect
o Drug is rapidly absorbed into the
bloodstream
o Ensures greater potency because drug
directly enters the blood and bypass the liver
 Disadvantage:
o If swallowed, drug may be inactivated by
gastric juice
o Drug must remain in the mouth against the
mucous membranes until it is dissolved and
absorbed
TOPICAL
- Application of medications to a circumscribed area of
the body. Includes dermatological medications,
irrigations and instillations.
- Dermatologic – includes lotions, liniments, ointments,
pastes and powders
 Wash and pat dry area well before application to
facilitate absorption of the drug
 Use surgical asepsis when open wound is present
 If the skin has lesions, wear gloves or use tongue
depressor to apply medications
 Remove previous application before the next
application of medication.
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COMPETENCY APPRAISAL 1 (CMPA411): PRELIM EXAMINATION – Q.C CAMPUS
 Apply only a thin layer of medication.
OPHTHALMIC
- Includes instillations and irrigations
- Instillations: to provide eye medication the client
requires.
- Irrigation: to clear the eye of noxious or other foreign
material or excessive secretions or in preparation for
surgery
- Position client either sitting or lying
- For irrigations, tilt the client’s head toward the
affected site.
- Use sterile technique
- Clean the eyelid and eyelashes with sterile cotton ball
moistened with sterile normal saline solutions, wipe
from the inner canthus to outer canthus
- Instill eye ointment into the lower conjunctival sac
from the inner canthus outward. (2cm of ointment)
- Instruct the patient to close the eyes gently
- For liquid eye medications, press firmly on the
nasolacrimal duct for at least 30 seconds.
OTIC
- Includes instillations and irrigations
- Instillations:
 To soften earwax, to relieve pain
 To reduce inflammation and to treat infection
- Irrigation:
 To remove cerumen or pus, to apply heat
 To remove a foreign object
- Warm solution at body temperature
- Side-lying position with the ear being treated
uppermost.
- Clean the pinna of the ear and the meatus of the
canal with cotton tipped applicators.
- Straighten the ear canal (0-3-year-old pull the pinna
downward and backward, and older than 3 years pull
the pinna upward and backward)
- Press gently but firmly a few times on the tragus of
the ear to assist the flow of medication into the ear
canal.
- Ask the client to remain in side-lying position for
about 5 minutes.
- Insert a small piece of cotton fluff loosely at the
meatus of the auditory canal for 15-20 minutes
NASAL
- Nasal instillations (nose drops) usually are instilled for
their astringent effect (to shrink the swollen mucous
membranes) to loosen secretions and facilitate
drainage or treat infections of the nasal cavity or
sinuses
- Have the client blow the nose prior to instillation
- Assume back-lying position
- Elevate the nares slightly by pressing the thumb
against the client’s tip of the nose.
- Keep head tilted backward for 5 minutes after
instillations of nasal drops
- Inhalation
 Use of nebulizers, metered-dose inhalers
 Semi or high fowler’s position
 If bronchodilator a maximum of 2 puffs, for at
least 30 seconds interval
VAGINAL
- Advantage: provides local therapeutic effect
- Disadvantage: has limited use
- Drug forms: tablet, cream, jelly, foam, suppository
- Vaginal Irrigation (Douche): is the washing of the
vagina by a liquid at low pressure.
- Empty bladder before the procedure
- Position and drape the client:
 Instillation: back-lying position with knees flexed
and hips rotated laterally
 Irrigation: back-lying position with hips higher
than the shoulders (use bedpan)
- Irrigating container should be 30 cm. (12 inches)
above.
- Ask client to remain in bed for 5-10minutes following
administration of vagina suppository, cream, foam,
jelly or irrigation
RECTAL
- Advantages: Can be used when the drug has
objectionable taste or odor
- Disadvantages: Dose absorbed is unpredictable
- Suppositories tend to soften at room temperature,
need to be refrigerated
- Use glove for insertion of suppositories
- Lie on left side and breath through the mouth to relax
the anal sphincter
- Have the pt remain on side for 20 minutes after
insertion
PARENTERAL
- Administration of medication by needle.
- Intradermal – under the epidermis (into the dermis)
- Subcutaneous – into the subcutaneous tissue (also
hypodermic)
- Intramuscular – into the muscle
- Intravenous – into a vein
- Intraarterial – into an artery
- Intraosseous – into the bone
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COMPETENCY APPRAISAL 1 (CMPA411): PRELIM EXAMINATION – Q.C CAMPUS
GENERAL PRINCIPLE IN PARENTERAL ADMINISTRATION
OF MEDICATIONS
- Check doctor’s order
- Identify the client properly
- Practice ASEPSIS
- Use appropriate needle size
- Plot the injection properly.
- Use separate needles for aspiration and injection of
medications.
- Introduce air into the vial before aspiration.
- Allow a small air bubble in the syringe to push the
medication that may remain in the hub and lumen of
the needle.
- Introduce the needle in a quick thrust.
- Either spread or pinch when introducing the needle.
- Minimize discomfort by applying cold compress over
the injection site before the introduction of
medication to numb the nerve ending; apply warm
compress to improve blood supply
- Aspirate before introduction.
- Support the tissues with cotton swabs before
withdrawal of needle
- Massage the site of injection to hasten absorption.
- Apply pressure at the site for few minutes.
- Evaluate effectiveness of the procedure and make
relevant documentation
FACTORS THAT DETERMINE THE SIZE OR SYRINGE TO BE
USED
- Type of medication
- Amount of medicine to be injected
- Method of dispensing the medication
- Factors that determine the size of needle to be used:
 Route of administration
 Medication to be administered
 Size of the patient.
- Most commonly used size of needles:
 ID – G27, G26, G25
 SC – G25, G23
 IM – G23, G22, G21
REMOVING MEDICATION FROM AN AMPULE
- Tap the stem of the ampule to remove medication
- Wrap the stem of the ampule with cotton
- Break the neck along the pre-scored line.
- Insert the needle into the ampule and remove the
medication.
- Remove the needle from the ampule
REMOVING MEDICATION FROM A VIAL
- Load the syringe with air at equal amount of solution
to be removed
- Cleanse the rubber stopper of the vial. Insert the
needle into vial and inject the air.
- Remove the prescribed amount of the solution
- Remove the needle from the vial and store the vial
properly.
INTRADERMAL INJECTION
- Administration of a drug into the dermal layer of the
skin just beneath the epidermis.
- Indicated for allergy and tuberculin testing and for
vaccinations.
- Sites: Epidermis
- Needle length: 3/8” 5/8” ½, ¼
- Angle: 10° - 15°
- Administration of Intradermal Injection:
 Re-check the patients name, the drug, dose,
route, against doctor’s order, and medication
card.
 Check patient’s readiness/explains procedure to
patient.
 Arrange your equipment conveniently at
patient’s bedside
 Provides privacy and washes hands
 Position the patient
 Identify injection site
 Clean the injection site with an antiseptic
(alcohol) using circular motion working from the
site outward.
 Remove the protective needle cup.
 Holding the client’s forearm in one hand, stretch
the skin.
 Position the syringe with the bevel of the needle
pointing upward, so that the needle is almost flat
against the client’s skin.
 Insert the needle through the epidermis so that
the point of the needle is visible through the skin.
 The needle should be advanced until it is
approximately 1/8 inch (3mm) below the skin
surface
 Gradually inject a small amount of drug to form a
wheal or bleb.
 When the wheal appears, withdraw the needle.
Never massage the area or apply pressure to the
site as this may interfere with the test result.
 Encircle the side of the wheal using black or blue
ink and label site.
 Dispose needles and syringe according to your
facility’s policy.
 Remove and discard your gloves and wash your
hands.
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 Observe the area for signs of reaction after 30
minutes.
SUBCUTANEOUS INJECTION
- Drug administered subcutaneously are:
 Vaccines, preoperative medication, narcotics,
insulin, heparin.
- Needle length: 45o - 5/8”, 90o - ½”
- Sites
 Outer aspect of the upper arm
 Abdomen
 Thigh
- Only small doses (0.5-1.5 ml) of medication should be
injected via SC route
- Rotate sites of SC injections to minimize tissue
damage, aid absorption and avoid discomfort
- Needle length and gauge are the same as for
intradermal injections
- Use 5/8 needle for adults when the injection is
administered at 45o degree angle of needle.
- For obese patients: 90o degree angle (also use for
administering heparin and insulin)
- For heparin: do not aspirate - to prevent hematoma
formation
- For insulin injection: do not massage the site to
prevent rapid absorption which may result to
hypoglycemic reaction.
- If blood appears on pulling back the plunger of the
syringe, remove the needle and discard the
medication and equipment.
- Administration of Subcutaneous Injection:
 Follow steps #1-8 of ID injection
 Grasp the firmly between the thumb and fore
finger to elevate the subcutaneous tissue.
 Holding the syringe firmly at 45o degree angle to
the skin thrust the needle into the tissue.
 Holding the syringe aspirate by pulling back on
the plunger, if blood appears in the syringe,
remove the needle and discard the medication
and equipment, Begin the procedure from step 1
 If no blood appears, inject the solution slowly
 Remove the needle at the same angle it was
inserted.
 Remove the needle and apply gentle pressure
against injection site.
 Follow step #15 and 16 of ID
INTRAMUSCULAR INJECTION
- Purpose:
 Rapid absorption because of rich blood supply
 Muscles can take a greater volume of fluid
without discomfort. For adult, they can tolerate
up to 3mL
 Medications that are irritating may safely be
given by IM injection
- Danger: Damaging nerves and blood vessels
- Common Complications: Abscess, necrosis, nerve
injuries.
- Needle length: 1”, ½”, 2” (3” needle may be used if
the patient is obese)
- Use the needle G 20,21,22,23 (depending on the
viscosity of the drug)
- Clean site with alcoholized cotton ball.
- Inject the medication slowly (20 seconds) to allow the
tissues to accommodate volume.
- Sites of IM Route:
 Ventrogluteal Site
o Uses gluteus minimus muscles
o Area contains no large nerves or blood
vessels and less fat
o Farther from the rectal area: less
contaminated
o Position: back or side-lying with the knee and
hip flexed to relax muscle
 Dorsogluteal Site
o Uses gluteus medius muscle
o Not to be used for children under 3 years
unless child has been walking for 1 year
o Avoid hitting the sciatic nerve, major blood
vessel
 Vastus Lateralis Site
o Recommended site of injection for infants •
o Assume back lying or sitting position.
 Rectus Femoris Site
o Located at the anterior aspect of the thigh
 Deltoid Site
o Not used for often for IM injection because it
is relatively small muscle and is very close to
the radial nerve and radial artery.
o Rapid absorption
- Administration of Intramuscular Injection:
 Follow steps #1-8 of ID injection
 Holding the syringe firmly and perpendicularly to
the skin, thrust the needle into the muscle.
 Do not insert the needle up to the hub, but leave
1/8-1/4 inch to allow identification in case the
needle should break.
 Holding the syringe with the left hand, aspirate
by pulling back on the plunger with right hand. If
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blood appears in the syringe, remove the needle,  Restore volume of blood components
discard the medication and equipment and begin  Provides avenues for the administration of
the procedure from step 1. medications.
 If no blood appears in the syringe, slowly  Monitor central venous pressure
introduce the medication. IV FLUID SOLUTIONS
 Smoothly and quickly withdraw the needle. - Isotonic Solutions
Immediately place pressure over the puncture  Solutions having the same concentration of
site with a new swab unless contraindicated, solutes with blood plasma
massage the injection site to facilitate the  Ex: 0.9 NSS, D5W, LRS
absorption of medication. IV SOLUTION USES NURSING
CONSIDERATIONS
 Position the client comfortably
0.9% Normal Saline Fluid resuscitation Monitor closely for
 Dispose the needle and syringe properly in (0.9% NaCl) for hemorrhaging, hypervolemia,
container and remove gloves. severe vomiting, especially with
 Chart date, time, route and site of injection and diarrhea, GI heart failure or
suctioning losses, renal failure.
name and the dosage of the medication sheet wound drainage,
and progress notes mild hyponatremia,
Z-TRACT INJECTION or blood
transfusions.
- For parenteral iron preparation (to seal the drug deep
5% Dextrose in Provides free water Should not be used
into the muscle and prevent permanent staining of Water (D5W) to help renal for fluid
the skin.) *starts as isotonic excretion of solutes, resuscitation
and then changes hypernatremia, and because after
- Administration of Z-Tract or Zigzag Injection:
to hypotonic when some dextrose dextrose is
 Follow steps #1-8 of ID injection dextrose is supplementation. metabolized, it
 Pull the skin and underlying tissue of the injection metabolized becomes hypotonic
site to one side and leaves the
intravascular space,
 Insert the needle causing brain
 Aspirate for blood with the thumb and index swelling.
finger and if there is not blood, push the plunger Used to dilute
plasma electrolyte
with thumb to inject the solution concentrations.
 Withdraw the needle Lactated Ringer’s Fluid resuscitation, Should not be used
 Release the skin and underlying tissues to return Solution (LRS) GI tract fluid losses, if serum pH is
burns, traumas, or greater than 7.5
to normal position. metabolic acidosis. because it will
 Use light, steady pressure over the site Often used during worsen alkalosis.
FORMULA FOR DOSAGE COMPUTATION surgery. May elevate
potassium levels if
- Oral (Solid) Medication used with renal
- Oral (Liquid)/Parenteral Medication failure.
- IV Fluid Flow Rate - Hypotonic Solutions (Cell will Swell)
INTRAVENOUS (IV) FLUID THERAPY  Solutions containing lesser concentration number
- The administration of fluids directly into the of solutes as compared with blood plasma.
intravascular compartment thru the veins.  Ex: 0.33 NSS, 0.45 NSS, 2.5 dextrose
- Common practice, an efficient and effective method IV SOLUTION USES NURSING
of supplying fluids directly into the intravascular fluid CONSIDERATIONS
0.45% Sodium Used to treat Monitor closely for
compartment Chloride (0.45% intracellular hypovolemia,
- Usually ordered by the physician NaCl) dehydration and hypotension, or
- Purpose: hypernatremia and confusion due to
to provide fluid for fluid shifting out of
 Maintain or replace body stores of water renal excretion of the intravascular
electrolytes, vitamins, proteins, fats and calories solutes. space, which can be
in the patient who cannot maintain an adequate 5% Dextrose in Provides free water life-threatening.
Water (D5W) to promote renal Avoid use in
intake by mouth. patients with liver
excretion of solutes
 Restore acid-base balance and treat disease, trauma,

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hypernatremia, as and burns to  Port for additives
well as some prevent
 Connection with administration set
dextrose hypovolemia from
supplementation. worsening.  Insertion site
Monitor closely for  Injection port
cerebral edema.  Administration set connection with cannula
- Hypertonic Solutions (Cell will Shrink) SELECTION OF SITE
 Solutions containing greater concentration/
- Use distal veins of the arm first
number of solutes with blood plasma
- Use the client’s non-dominant arm whenever
 Ex: 5% dextrose in 4.5 NSS, 0.9 NSS, in LR possible
IV SOLUTION USES NURSING
CONSIDERATIONS - Select vein that is: easily palpable and feel soft and
3% Sodium Chloride Monitor closely full, naturally splinted by bone and large enough to
(3% NaCl) Used to treat for allow adequate circulation around the catheter.
5% Dextrose and - Avoid using veins that are: in areas of flexion, highly
0.45% Sodium
severe hypervolemia,
Chloride (D50.45% hyponatremia hypernatremia, visible because they tend to roll away from the
NaCl) and cerebral and associated needle, damage by previous use, continually
5% Dextrose and edema. respiratory distended with blood and in surgically compromised
Lactated Ringer’s distress. Do not
(D5LR) or injured extremity.
D10 use it with
patients
experiencing
heart failure,
renal failure, or
conditions
caused by
cellular
dehydration
because it will
worsen these - Micro drip IV set (60 gtts/min)
conditions. - Macro drip IV set (10-20 gtts/min)
NURSING INTERVENTION IN IV INFUSION - Use a tourniquet to produce venous enlargement, to
- Verify the doctor’s order hasten this, the patient may be asked to make a fist,
- Know the type, amount, indication of IV therapy or gently tapped the vein until it become engorged.
- Practice strict asepsis - Cleanse the area with an antiseptic.
- Inform client and explain purpose of IV therapy - If the nurse is right handed, her left hand grasps the
- Prime IV tubing to expel air patient forearm resting her thumb on the skin
- Clean the insertion site if IV needle from center to the approximately 2 inches below the selected site of
periphery insertion. Pressure is exerted downward toward the
- Shave area of needle insertion if hairy patient’s hand, stretching his skin.
- Change IV tubing every 48-72 hours. - With maintained pressure on the selected site, insert
- Change/alter IV needle insertion every 72 hours the catheter, generally the bevel is facing upward
- Regulate IV every 15-20 minutes during insertion. The needle catheter is inserted
- Observe for potential complications. through the skin approximately below the target
PROCEDURES FOR IV THERAPY vein. At insertion, the needle catheter should be held
- Check for doctor’s order. at 15-30o degree angle.
- Assembles all the necessary equipment to start on IV. - Once the needle is entered the skin, the needle is
IV cannula, catheter, IV set, the solution to be carefully pushed into the vein in an upward direction.
infused, tourniquet, alcohol sponge, micropore tape, Once blood appears on the lumen, reduce the angle
IV pole/stand, splint or armboard. of the catheter almost parallel with the skin. Holding
- Sites of Possible Contamination in IV infusion: the needle portion steady, advance the catheter until
 Contamination of infusion fluid the hub is at the venipuncture site.

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- Release the tourniquet o Wide variance between liquid input and
- Attached the end of the infusion tubing to the output
catheter hub maintaining the sterility.  Nursing Considerations
- Check whether the catheter is in the vein by either o Slow the infusion to KVO rate
pinching the IV tubing or lowering the infusion bottle o Raise patient’s head in semi-fowlers
below the site of injection. Backflow indicates that o Keep warm to promote peripheral circulation
the needle is correctly located in the vein and to ease the stress on the central veins
- Anchor the catheter with micropore tape o Monitor vital signs
- Apply a splint or an arm board to splint the joint. o Administer oxygen if permitted
- Regulate the flow rate as indicated and prescribed. o Notify doctor
- Mark on the infusion bottle the time started, time to o Document what you've done
consume, medicine added and flow rate per minute.  Prevention Tips
- Label the dressing with the date and time of o Be aware of the patient’s cardiovascular
insertion, type and gauge of catheter used and your status and history
initials. o Tell the doctor if the fluid volume flow rate
- Dispose the used materials properly may be more than patient can tolerate
- Document o Monitor urine output
COMPLICATIONS OF IV THERAPY - Air Embolism
- Infiltration  Possible Causes
 Possible Causes o Container allowed to run dry
o Needle or Catheter displacement o Air in tubing
o Leakage of blood around needle or catheter o Loose connections
 Signs and Symptoms  Signs and Symptoms
o Coolness of skin around site o Blood pressure drop
o Swelling Around site, which may or may not o Rise in CVP
be painful o Weak, rapid pulse
o Absence of Blood backflow. o Cyanosis
o Sluggish flow rate Discomfort o Loss of consciousness
 Nursing Considerations  Nursing Considerations
o Discontinue the infusion, remove the Needle o Turn patient on his left side, lower the head
catheter of the bed
o If the infiltration’s caught within ½ hr and the o Check system for leaks
swelling small, apply ice o Give O2 if allowed
o Restart IV in another limb o Notify doctor immediately
o Document what you’ve done o Document what you’ve done
 Prevention Tips  Prevention Tips
o Use a splint to stabilize the needle or o Clear all air from the tubing before attaching
catheter when the site’s over a joint or the it to the patient
patient’s active hand palpate occasionally to o Change containers before they’re empty
confirm proper needle position o Make sure all connections are secure
- Circulatory Overload - Catheter Embolism
 Possible Causes  Possible Causes
o Too much fluid o Withdrawing catheter before the needle or
o Fluid delivered too fast attempting to rethread a catheter with a
 Signs and Symptoms needle
o Rise in blood pressure and CVP o Failure to secure the catheter to the skin
o Dilation of veins with neck veins sometimes adequately
visibly engorged
o Rapid breathing, shortness of breath rates

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 Signs and Symptoms  Nursing Considerations
o Discomfort along the vein in which the o Discontinue IV and remove
catheter fragment’s lodge o Apply warm wet compress
o BP drop o Notify doctor
o Rise CVP o Restart IV in another site
o Cyanosis o Document what you’ve done
o Loss of consciousness  Prevention Tips
 Nursing Considerations o If irritating additive find a vein large enough
o Discontinue IV to dilute it.
o Apply tourniquet above site. o Dilute irritating additives if possible
o Have the patient x-rayed to confirm o Make sure drug additives are compatible
embolism o Keep infusion flowing at the prescribed rate
o Document what you’ve done o Stabilize the needle with a splint if necessary.
 Prevention Tips - Nerve Damage
o Remember to withdraw needle and catheter  Possible Causes
together after unsuccessful venipuncture o Tying arm too tightly to the splint
attempt  Signs and Symptoms
o Take special care when taping or withdrawing o Numbness of fingers and hands
- Infection of Venipuncture Site  Nursing Considerations
 Possible Causes o Massage area and move shoulder through its
o Poor aseptic technique ROM
 Signs and Symptoms o Instruct patient to open and close hand
o Swelling and soreness at site several times each hour
o Foul smelling discharge PHYSICAL ASSESSMENT
 Nursing Considerations - Methods of Assessment:
o Discontinue IV infusion, and remove needle 1. Inspection – is the visual examination, that is
and catheter immediately. assessing by using the sense of sight.
o Send IV equipment to lab for bacterial 2. Palpation – examination of the body using the
analysis sense of touch.
o Clean site, apply microbial ointment and o The pads of the fingers are used
cover with sterile gauze pad 3. Percussion – the act of striking a body surface to
o Restart IV in another limb elicit sounds that can be heard or vibrations that
o Document what you’ve done can be felt.
 Prevention Tips o Flatness – produced by very dense tissue
o Improve aseptic technique such as muscle or bone
o Wash your hands o Dullness – produced by dense tissue such as
- Thrombophlebitis liver, heart.
 Possible Causes o Resonance – produced by lung filled with air
o Injury to the vein o Hyperresonance – booming sound that can
o Irritation to the vein caused by: long term be heard over an emphysematous lung.
therapy, irritating/incompatible additives, o Tympany – sound produced from an air-filled
use of vein that’s too small to handle the stomach.
amount 4. Auscultation – is the process of listening to
 Signs and Symptoms sounds produced within the body.
o Sluggish flow rate SKIN
o Edema in limb - Color
o Vein: cord-like, sore warm to touch. It may  Normal Findings
look like a red line above the venipuncture o Varies from light to deep brown
site.

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 Deviation from Normal  Deviation from Normal
o Pallor, cyanosis, jaundice, erythema o Hirsutism in women
- Edema NAILS
 Normal Findings - Curvature and Angle
o No edema  Normal Findings
 Deviation from Normal o Convex; angle of nail plate – 160o
o +1 barely detectable  Deviation from Normal
o +2 indentations of 2-4mm o 180o or greater (clubbing), spoon nail
o +3 indentations of 5-7mm - Nail Bed Color
o +4 indentations >7mm Skin Lesions  Normal Findings
- Skin Lesions o Highly vascular and pink
 Normal Findings  Deviation from Normal
o Freckles, some birthmarks o Bluish (cyanosis)
 Deviation from Normal o Pallor (poor arterial circulation)
o Papule, nodule, vesicle, pustule - Perform Blanche Test
- Moisture  Normal Findings
 Normal Findings o Prompt return of pink or usual color (1-2
o Moisture in skin folds secs.)
 Deviation from Normal  Deviation from Normal
o Excessive moisture (hyperthermia) o Delayed return of color (circulatory
o Excessive dryness (dehydration) impairment)
- Temperature SKULL AND FACE
 Normal Findings - Size, Shape and Symmetry
o Uniform; within normal  Normal Findings
 Deviation from Normal o Normocephalic and symmetrical
o Localized hyperthermia (infection);  Deviation from Normal
generalized hypothermia (shock) o Lack of symmetry: increased skull size
- Skin Turgor o Longer mandible (may indicate excessive
 Normal Findings growth hormone)
o When pinched skin springs back to previous - Facial features and Movement
state  Normal Findings
 Deviation from Normal o Slightly asymmetric facial feature, symmetric
o Skin stays pinched or tented or moves back facial movements
slowly  Deviation from Normal
HAIR o Exophthalmos, myxedema
- Distribution EYES
 Normal Findings - Pupil Size
o Evenly distributed  Normal Findings
 Deviation from Normal o 3 – 7mm in dm
o Alopecia  Deviation from Normal
- Thickness or Thinness o Mydriasis, miosis, anisocoria
 Normal Findings - PERRLA
o Thick  Normal Findings
 Deviation from Normal o Illuminated pupils constrict and when looking
o Very thin hair (hypothyroidism) at near objects
- Amount of Body Hair  Deviation from Normal
 Normal Findings o Absent response
o Variable

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- Extraocular Muscle (6 ocular movement)  Deviation from Normal
 Normal Findings o Purulent discharge, mucosa red, edematous,
o Both eyes coordinated, moves in unison presence of lesions
 Deviation from Normal - Palpate sinuses for tenderness
o Strabismus, nystagmus  Normal Findings
- Visual Acuity o Not tender
 Normal Findings  Deviation from Normal
o 20/20 vision on Snellen chart o Tenderness in one or more sinuses
 Deviation from Normal MOUTH
o Denominator of 40 or more on Snellen chart - Color, Symmetry and Texture of the outer lip
o Myopia, hyperopia, presbyopia  Normal Findings
EARS o Uniform pink in color, symmetry of contour,
- Auricle Alignment soft, moist, smooth texture.
 Normal Findings o Ability to purse lips
o Aligned with the outer canthus of the eye  Deviation from Normal
 Deviation from Normal o Pallor; cyanosis, fissures, crust or scales (may
o Low-set ears (down syndrome) result to nutritional deficiency or fld. Deficit).
- Tympanic Membrane o Inability to purse lip (facial damage)
 Normal Findings periodontal
o Pearly gray color, semi-transparent - Teeth and Gums
 Deviation from Normal  Normal Findings
o Pink to red, yellow-amber, white o 32 adult teeth, smooth, white, shiny tooth
- Weber’s Test enamel.
 Normal Findings o Pink gums
o (-) Weber – sound is heard on both ear  Deviation from Normal
 Deviation from Normal o Excessively red gums, tenderness, bleeding
o (+) Weber – sound is heard better in ear (periodontal disease)
without a problem - Position, Color and Texture of the Tongue
- Rinne Test  Normal Findings
 Normal Findings o Central position; slightly rough; pink color
o (+) Rinne – air conduction is greater than  Deviation from Normal
bone conduction (AC > BC) o Deviated from center (damage to
 Deviation from Normal hypoglossal) smooth red tongue (iron, vit.
o (-) Rinne – bone conduction is greater than B12 deficiency)
air conduction (BC > AC) or BC=AC - Mobility and Position of the Uvula
NOSE AND SINUSES  Normal Findings
- Patency of both nasal cavities o Positioned in midline of soft palate
 Normal Findings  Deviation from Normal
o Air moves freely as the client breathes o Deviation to one side from tumor or trauma;
through the nares immobility (damage to trigeminal or vagus
 Deviation from Normal nerve)
o Air movement is restricted in one or both - Inspect the Tonsils
nares  Normal Findings
- Observe for presence of redness, swelling and o Pink and smooth; no discharge, of normal
discharge size
 Normal Findings  Deviation from Normal
o Clear watery discharge, pink mucosa o Inflamed, presence of discharge
o Grade:
 1 – behind the tonsilar pillar

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COMPETENCY APPRAISAL 1 (CMPA411): PRELIM EXAMINATION – Q.C CAMPUS
 2 – between the pillars and uvula  Deviation from Normal
 3 – touch the uvula o Kyphosis, lordosis, scoliosis; spinal column
 4 – one or both sides extend to the deviates to one side’ shoulders or hips not
midline of oropharynx even
- Elicit Gag Reflex - Respiratory Excursion
 Normal Findings  Normal Findings
o Present o Full and symmetric lung expansion (thumb
 Deviation from Normal separates 3-5cm during deep inspiration)
o Absent (problem with glossopharyngeal or  Deviation from Normal
vagus nerve) o Asymmetric or decreased chest expansion
NECK - Palpate the chest for Vocal (Tactile) Fremitus
- Lymph Nodes  Normal Findings
 Normal Findings o Bilateral symmetry of vocal fremitus.
o Not palpable o Fremitus heard most clearly at the apex of
 Deviation from Normal the lung
o Enlarged, palpable, possibly tender (infection  Deviation from Normal
or tumor) o Decrease or absent (pneumothorax); increase
- Trachea (pneumonia)
 Normal Findings - Percuss the Thorax
o Central placement in midline of neck  Normal Findings
 Deviation from Normal o Resonance except over the scapula; lowest
o Deviation to one side (possible neck tumor; point of resonance is at the diaphragm
thyroid enlargement; enlarge lymph nodes)  Deviation from Normal
- Thyroid Gland o Dullness or flatness over the lung tissue
 Normal Findings (consolidation of lung tissue or mass)
o Not visible, ascends during swallowing; - Auscultate the Chest
absence of bruit  Normal Findings
 Deviation from Normal o Vesicular and bronchovesicular sound
o Visible or enlarged; not movable with  Deviation from Normal
swallowing; presence of bruit o Adventitious breath sounds (crackles,
THORAX rhonchi, wheeze, friction rub)
- Shape and Size (Anterior) o Absence of breath sound (collapsed and
 Normal Findings surgically removed lung lobes)
o Elliptical in shape, AP dm is half its transverse ABDOMEN
dm - Dorsal Recumbent
 Deviation from Normal - Inspect, Auscultate, Percuss and Palpate (IAPePa)
o Pigeon chest (rickets)  Inspect the abdomen for skin integrity, contour,
o Funnel chest- abnormal pressure on the heart and symmetry.
may result in altered function.  Observe any movements associated with
o Barrel chest- ratio of AP to transverse dm is respiration, peristalsis, or aortic pulsations.
1:1 (emphysema, chronic pulmonary  Auscultate the abdomen for bowel sounds,
condition) vascular sounds, and any peritoneal friction rubs.
- Alignment of the Spine  Percuss the abdomen for tympany and dullness.
 Normal Findings  Percuss the abdomen to determine liver and
o Vertically aligned; (R) and (L) shoulders and spleen size.
hips are at the same height  Percuss the abdomen to detect areas of
tenderness over the liver and kidney.
 Percuss the abdomen to define the outline of a
distended bladder

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COMPETENCY APPRAISAL 1 (CMPA411): PRELIM EXAMINATION – Q.C CAMPUS
 Palpate the liver, spleen and kidneys to - CN XI - Spinal Accessory
determine position and size  SCM and Trapezius
- Bowel sounds-high pitched gurgles heard at 5 – 20 PHARMACOLOGY
second intervals (5- 25/min normal) - Pharmacology is the study of drugs, study of
- If not heard in 1-minute stay for 3 -5 mins more. biological effects of chemicals
Sequence is clockwise from RLQ - Drugs are chemicals, they are introduced into the
 Hypoactive < 3 body by:
 Hyperactive  Oral
o Continuous, Loud, Frequent  Intravenous
 Tinkling Sound – Bowel Obstruction  Rectal
NEUROLOGICAL ASSESSMENT - Whatever route we administer, we expect a change
- Mental Status - Pharmacodynamics
 Language-Cerebral Cortex-Aphasia  Dynamo -> change
 Orientation (Time, Place, Person) (Confusion)  Pharmaco -> drugs
 Memory  This is the action of the drug to the body
o Immediate Recall  MoA (Mode of Action)
o Recent Memory and Remote Memory - Pharmacokinetics
 Attention Span and Calculation (Serial 7s/3s tests)  Kinetics -> Movement
- Cerebellar Function  This is the response of the body to the drug
 Coordination  The movement is LADME (Liberation, Absorption,
 Point to Point Touching Metabolism, Distribution and Excretion)
 Alternating Movements - Pharmacognosy
 Gait  Study of drugs derived from the natural sources
- Sensory Function (e.g. Proprioception-Position o Plants and Animals
Sense- Romberg’s Test) - Pharmacotherapeutics
- Cranial Nerve Functions  Therapy means healing or cure
CRANIAL NERVES  Healing of disease using drugs
- CN I – Olfactory - Pharmacovigilance
 Sense of smell  The monitoring of adverse effects of drugs even
- CN II – Optic after a license have been issued
 Visual field testing - Toxicology
- CN III – Oculomotor, CN IV – Trochlear, CN VI –  Toxic means poisons
Abducens  Study of poisons and poisonings
 Visual pathways – pupil size, pupillary reactions, - Receptor
extraocular movements  It is on the cell
- CN V – Trigeminal  It is where the drugs bind
 Muscle of mastication, facial sensation  To receive/the receiver
- CN VIII – Vestibulocochlear/Auditory  “Key and Lock” (Key-Drug, Lock-Receptor)
 Nystagmus, hearing capacity PHARMACODYNAMIC
- CN VII – Facial, CN IX – Glossopharyngeal, CN X – - Actions of the drugs to the body
Vagus, CN XII – Hypoglossal  Replace a missing substance
 Articulation o Insulin (DM1), Cortisol, T3, T4
 Taste  Increase cellular activities
o CN VII – Ant. 2/3 o Epinephrine (to inc the activity of heart)
o CN IX – Post. 1/3  Depress cellular activities
o CN X – Region of epiglottis o “Olols” Beta Blockers
 Swallowing – CN IX, X, XII  Interfere with the growth of a foreign cell
 Facial Expression – CN VII o Antibiotic, anti-cancer/Anti-neoplastic drugs

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COMPETENCY APPRAISAL 1 (CMPA411): PRELIM EXAMINATION – Q.C CAMPUS
- Drug Action maybe through:  If a Neostigmine (Drug for Myasthenia Gravis →
 Receptors muscle problem where there is paralysis), there
 Enzymes will be no breakdown of acetylcholine
 Pumps  Acetylcholine will stay there and there will be
 Chemical Interaction contraction
o Drugs will neutralize the HCl in the stomach INHIBITING PUMPS
 Altering metabolic process - Example is the proton pump inhibitors
DRUG-RECEPTOR INTERACTIONS  For PUD
- Agonist  Inhibits the inc of gastric acid
 Stimulates a receptor site  Blocks the reuptake (SSRI)
 Drugs that binds to the receptor and activates CHEMICAL INTERACTION
(stimulate) a receptor site (Ex: Digoxin, Epi) - Antacids block HCl
- Antagonist INTERRUPTING METABOLIC PROCESS
 Block the effect of cell - Levothyroxine
 Competitive Antagonist PHARMACOKINETICS
o Binds to the same receptor - Response of the body to drugs
o Efficacy of an agonist is blocked - 5 Process (LADME)
o Ex: Morphine and Naloxone 1. Liberation
 Non-Competitive Antagonist o Release of active ingredients
o Binds to a different receptor 2. Absorption
o Not blocked but reduced o The drug already reached the blood
o Potency of an agonist is reduced o Routes of Drug Absorption
o Ex: Diazepam and Flumazenil  Enteral
- Example of the Drug-Receptor Interaction drugs are  Oral
the ANS  Nasogastric
- Adrenergic  Rectal- Fastest absorption (veins
 Alpha (α) line the rectum)
o α1  Parenteral
o α2  IV – Fastest
 Beta (β)  SC
o β1  IM – 2nd fastest
o β2  ID
DRUG-ENZYME INTERACTIONS  Transmucosal
- Example is the Cholinesterase Inhibitor (They will  Sublingual - fastest
block the Cholinesterase)  Inhalation
- Enzyme that breaksdown Ach
 Topical
- Axon Terminal – where storage of chemicals are
o Factors Affecting Absorption
 If there is an electrical impulse, it only reaches
 Formulation- liquid for faster absorption
Axon Terminal
 Particle Size- smaller particles have
 For the impulse to send the message to the
faster absorption
effector cell, it need to bind with the
 Lipid Solubility- faster absorption
acetylcholine
 Area and Vascularity of the Absorbing
 When the acetylcholine binds to the receptor,
Surface- the more vascular, the better
there will be an effect or a change
absorption
 Cholinesterase will break down acetylcholine
 Gastrointestinal Motility- increase side
 If there is no acetylcholine to the receptor, the
effects, more motile, lesser gastric
muscle will relax
irritation
 Presence of Food
 Metabolism

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 Disease - Schedule
3. Distribution  Frequency, how many dose/s per day
o Drug is in the Tissue and cells - Recommended Dose
o Factors Affecting Distribution  The amount of drug administered to reach the
 Blood Flow- more blood flow the better critical concentration
absorption  Right amount + Right schedule
 Protein Binding- the portion of the drug - Critical Concentration
that is Free, actively produce work. The  Level of drug in the blood which produces a
more protein bound, the lesser therapeutic effect
distribution - Therapeutic Effect
 Lipid Solubility- more lipid soluble, faster  Favorable response after a treatment of any kind
distribution  The cure
 Blood Brain Barrier- decreased - Loading Dose
distribution of drug  Initial dose, immediate response
 Placenta and Breastmilk - Half Life
4. Metabolism  Time it takes for a drug to become half of its
o Drug in liver previously peaked level
o Drug changed to a form easily excreted NERVOUS SYSTEM
o Also known as Biotransformation - NERVOUS SYSTEM
o Example: 500 mg (oral)  CNS
 Before this will be distributed, this will o Brain and SC
first pass in the Liver, in the Liver it will  PNS
undergo metabolism o Sensory
 In the liver there is cytochrome p450 (an o Motor
enzyme)  Somatic (voluntary)
 Metabolism will give a new drug (350  ANS (involuntary)
mg) (nabawasan na yung 500 mg na  SNS
drug) (mas active ang 500 mg), the 350  PSNS
is less active, the 350 will go back to the - In pharma, the ANS is the most important part
drug - Neuron
 This is called as the First Pass Effect  Functional unit of the nervous system
(First Pass Effect will only happen if the NEUROTRANSMITTERS
drugs are given via oral) - Chemicals in the body acting as “Messengers”
 But if it is given via IV, hindi na - Acetylcholine (Ach) – Cholinergic
mababawasan yung drug since it did not  Muscle contraction
pass the liver, so there won’t be any  Memory
metabolism activity - Norepinephrine and Epinephrine (NE/E) –
 If there is a pt with liver cirrhosis, and Adrenergic
the recommended dose is 500 mg, the  Released during SNS stimulation
drug given should be less dose, because  Adrenal medulla
if given with 500 mg and it will pass the  Adrenaline rush
liver, it will only be 499 mg and there  Affects behavior
will be an increase risk in toxicity - Dopamine (Dopa) – Dopaminergic
5. Excretion (Elimination  Motor
o Drug changed into inactive form  Cognitive behavior (Thinking, Learning,
o Eliminated by the body Reasoning)
- Dose  Coordination of impulses and responses
 Amount of drug to be administered to the patient  Too much dopa -> Schizo and mania
 Too low dopa -> depression, parkinson and ADHD

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COMPETENCY APPRAISAL 1 (CMPA411): PRELIM EXAMINATION – Q.C CAMPUS
- Serotonin (5HT) – Serotonergic Nerve - DRILL!
 For arousal (Being awake) and sleep  Sympathomimetic to heart – inc HR
 In preventing depression  Sympathomimetic to pupils – mydriasis
 Promotes motivation (Eat chocolate and Banana)  Sympathomimetic to bladder – retention
 Too much -> schizo  Sympathomimetic to BV – vasoconstriction
 Too low -> depression  Sympathomimetic to GIT - constipation
- Gamma Amino Butyric Acid (GABA) – Gabaminergic  Sympathomimetic to Bronchus – bronchodilation
 Inhibits nerve activity  Sympatholytic to heart – dec HR
 Prevents overexcitability or stimulation such as  Sympatholytic to pupils – meiosis
seizure activity  Sympatholytic to bronchus – constrict
 Used to treat seizures/convulsant  Sympatholytic to BF kidney – inc
AUTONOMIC NERVOUS SYSTEM  Sympatholytic to GIT – diarrhea
- Includes 2 neurotransmitters  Parasympatholytic to bronchus – dilate
 Norepinephrine and Acetylcholine  Parasympatholytic to GIT – constipation
- 2 branches  Parasympatholytic to BV – constrict
 Sympathetic – NE  Parasympathomimetic to pupils – meiosis
o Adrenergic nervous system  Parasympathomimetic to bladder – emptying
 Parasympathetic – ACh  Parasympathomimetic to BV – vasodilation
o Cholinergic nervous system  Parasympathomimetic to bronchus – constriction
ANS SYMPATHETIC PARASYMPATHETIC  Adrenergic agonist to heart – inc HR
General Response “Fight or Flight” “Rest and Digest”  Cholinergic antagonist to pupils – mydriasis
Origin Thoracolumbar Craniosacral
Preganglionic Nerve Short Long
AUTONOMIC NERVOUS SYSTEM DRUGS
Neurotransmitter ACh ACh - 3 Important components to know
Postganglionic Long Short  Receptors
Nerve  Agonist or Antagonist
Neurotransmitter NE ACh
Termination of MAO (Mono amine Cholinesterase  Location of the expected response
Impulse Oxidase - Adrenergic Agonist
 Epinephrine
COMT (cathecol-
ortho methyl
 Dobutamine
transferase)  Dopamine
Heart Inc HR, contractility Dec HR, dilate  Norepinephrine
Lungs, Bronchus Inc RR, Bronchoconstriction
- Alpha Adrenergic Agonist
Bronchodilation
Pupils Mydriasis Meiosis  Midodrine
GIT Constipation Diarrhea - Alpha 2 Adrenergic Agonist
(Blood flow,  Clonidine (Catapres)
Motility,
Secretions)  Methyldopa
Kidney (Blood Flow) Dec urine formed Inc, more urine - Beta 1 Adrenergic Agonist
formed  Dobutamine
Urinary Bladder Retention Emptying
(Sphincter) Contract Relax
- Beta 2 Adrenergic Agonists
(Detrusor muscle) Relax Contract  Albuterol/Salbutamol
Blood Vessels Vasoconstriction Vasodilation  Isoproterenol
(Smooth muscle)  Terbutaline
- Sympathetic (SNS) – Adrenergic
 Isoxsuprine
 Agonist – stimulate
- Adrenergic Antagonists
 Mimetic – mimic or copy
 Alpha and Beta Adrenergic Antagonists
- Parasympathetic (PSNS) – Cholinergic
o Carvediol
 Antagonist – block
o Labetalol
 Lytic – block, destroy, dissolve
 Alpha Adrenergic Antagonists
o Phentolamine

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COMPETENCY APPRAISAL 1 (CMPA411): PRELIM EXAMINATION – Q.C CAMPUS
 Alpha 1 Adrenergic Antagonists  The effect will have an SNS effect
o Prazosin - Methyldopa
o Doxazosin  Given also to dec BP
o Terazosin NOREPINEPHRINE
o Alfuzosin - Adrenergic Agonist
o Tamsulosin - Alpha 1
 Beta Adrenergic Antagonists “olol “  Urinary Bladder sphincter
o Propranolol o Retention
o Pindolol  Blood vessels
o Timolol o vasoconstriction
 Beta 1 Specific Adrenergic Antagonists  Iris
o Betaxolol Bisoprolol o Mydriasis
o Esmolol - Alpha 2
o Atenolol Acebutolol  CNS Nerve membrane -> dec NE release ->
o Metoprolol weaken SNS -> PSNS -> Pancreas -> dec insulin
- ANS Drugs: Nursing Consideration release -> hyperglycemia
 Avoid sudden withdrawal of the drug. MIDODRINE (ALPHA 1)
 Monitor vital signs. - Alpha Adrenergic Agonist
 Provide comfort measures. - Alpha 1
 Provide adequate health teaching on the name of  Urinary Bladder sphincter
drug, prescribed dosage, effects and adverse o Retention
effects  Blood vessels
PHENYLEPHRINE o vasoconstriction
- Alpha 1 adrenergic agonist  Iris
SNS SNS stimulate o Mydriasis
 Urinary Bladder sphincter - Alpha 2
o Retention  CNS Nerve membrane -> dec NE release ->
 Blood vessels weaken SNS -> PSNS -> Pancreas -> dec insulin
o vasoconstriction release -> hyperglycemia
 Iris - Used in orthostatic hypotension
o Mydriasis - Side effect: Inc BP
- It is part in Neozep and bioflu DOBUTAMINE
- It is a decongestant (it will cause vasoconstriction -> - Beta 1 (heart) Adrenergic Agonist
dec blood flow -> dec oxygen -> cell will shrink) SNS SNS Stimulate
- This is also used during eye exam  Inc HR, Inc contractility
- Phenylephrine will have an SNS effect  K enters cell
- It will not inc HR because there is no alpha 1 receptor  Kidney -> inc renin release
in the heart - Synthetic Dopamine
- Side Effect: - Used in heart failure
 Inc BP (Hypertension) - (+) inotropic effect (force of contraction)
CLONIDINE AND METHYLDOPA - (+) chronotropic effect (rate of contraction)
- Alpha 2 Adrenergic Agonist - Cardiogenic Shock
SNS SNS Stimulate  Dec HR, RR, and BP
 CNS Nerve membrane -> dec NE release -> - SE: tachycardia and hypertension
weaken SNS -> PSNS -> Pancreas -> dec insulin ALBUTEROL/SALBUTAMOL AND TERBUTALINE
release -> hyperglycemia - Beta 2 (Lungs) Adrenergic Agonists
- Clonidine (Catapres) SNS SNS Stimulate
 Given via sublingual - Lungs
 Given to dec BP  Bronchodilation
 Use to treat hypertension

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- Uterus - Use for hypertensive crisis due to
 Relaxation pheochromocytoma
- Blood vessels - MAOIs
 Vasodilation - PD: Vasodilation
- Liver PRAZOSIN, DOXAZOSIN, TERAZOSIN, ALFUZOSIN,
 Glycogenolysis TAMSULOSIN
 Hyperglycemia - Alpha 1 Adrenergic Antagonist
- Albuterol/Salbutamol (Ventolin) SNS SNS Block

 For asthma and COPD (for bronchodilation)  Urinary Bladder sphincter

 SABA – Duration of action is 6 hrs o Emptying
 For acute attacks of asthma  Blood vessels
 SE: very common o vasodilation
o Palpitation and Tremors (beta 2 > beta 1)  Iris
o Hypertension o Meiosis
- Terbutaline - PSNS effect
 Also used in asthma - Prazosin
 Tocolytics – block the tone of muscle  Binds to blood vessels -> vasodilate = dec TPR ->
 Used for premature labor (relax and prevent used for hypertension
abortion) - Doxazosin and Terazosin
ISOXSUPRINE, FORMETEROL AND SALMETEROL  Blood vessels -> vasodilate = dec TPR -> used for
- Beta 2 adrenergic agonist hypertension
- Lungs  Urinary bladder -> emptying -> used for benign
 Bronchodilation prostatic hyperplasia (BPH) to prevent UTI
- Uterus - Alfuzosin
 Relaxation  Urinary bladder -> emptying -> used for BPH
- Blood vessels - Tamsulosin
 Vasodilation  A new drug
- Liver  Used for BPH
 Glycogenolysis PROPRANOLOL, TIMOLOL, NADOLOL, LABETALOL
 Hyperglycemia (OLOLs)
- Isoxsuprine is a tocolytic - Blocks the beta receptors
- Formeterol and Salmeterol - Uses:
 LABA  Hypertension -> dec HR -> dec BP
 Duration: 12 hrs  Angina -> dec HR -> inc oxygen supply
 Use to prevent future asthma attacks  Myocardial Infarction
PHENTOLAMINE  Prophylaxis for migraine
- Alpha Adrenergic Antagonist  Anxiety attack
SNS SNS Block  Arrhythmia
- Alpha 1 SIDE EFFECT: NURSING INTERVENTION/
CONTRAINDICATIONS
 Urinary Bladder sphincter
Bradycardia Monitor HR and BP
o Retention Hold if HR is less than 60 bpm
 Blood vessels Hypotension Hold if BP is less than 90/60 mmHg
o vasoconstriction Bronchoconstriction Avoid asthma and COPD
Hypoglycemia Caution in pt with DM
 Iris
Impotence
o Mydriasis - Propranolol
- Alpha 2  DOC for tachycardia in hyperthyroidism
 CNS Nerve membrane -> dec NE release ->  Prophylaxis for migraine
weaken SNS -> PSNS -> Pancreas -> dec insulin  Anxiolytics
release -> hyperglycemia
- PSNS effect

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- Timolol - Pharmacotherapeutics:
 DOC for open-angle glaucoma  Cholinergics or Anticholinesterase Agents
 Dec production of aqueous humor o Pyridostigmine (Mestinon)
 Dec IOP  1st in line of MG
 DOC for atropine toxicity
- Nadolol o Neostignine (Prostigmin)
 DOC for pt with angina and hypertension  Long term
- Labetalol (new)  Inc Ach – receptor binding
 Used in PIH  Side effect: PNS effect
BISOPROLOL, BETAXOLOL, ESMOLOL, ACEBUTOLOL,  Corticosteroids
ATENOLOL, METOPROLOL o To suppress immune response
- Beta 1-Selective Adrenergic Blockers - Nursing Management:
- BEAM  Monitor for 2 Types of Crisis
MUSCARINIC AND NICOTINIC 1. Myasthenia Crisis – under dose of cholinergic
- Muscarinic drugs
 Smooth muscle tone  S/Sx: Paralysis and Weakness
o Mucus secretion  Test: Tensilon Test (IV) – Cholinergic
o Vasodilation drug improvement of paralysis
o Inflammation 2. Cholinergic Crisis – overdose of cholinergic
- Nicotinic drugs
 Parasympathetic  S/Sx: Paralysis and Weakness
MYASTHENIA GRAVIS  Tx: Anticholinergic (Atrophy) –
- Description pyridostigmine if too much nabigay
 Women 20-40 years’ old  Slow IV Administration
 Descending muscle weakness o To avoid severe cholinergic effects
- Signs and Symptoms ALZHEIMER’S DISEASE
 Ptosis - Atrophy of brain tissue due to a deficiency of
 Muscle weakness and paralysis cholinergic nerves
 Respiratory muscle paralysis (dangerous) - No neuron
 Dyspnea - No Ach
 Dysphagia - Signs and Symptoms:
- Nursing Priority  4A
 Airway o Amnesia
 Aspiration  Loss of memory
 Immobility o Apraxia
 Goal: strengthen muscle  Unable to determine function and
- Diagnostic Test: purpose of object
 Tensilon Test – most definitive drug test o Agnosia
o This drug is classified as anticholinesterase or  Unable to recognize familiar object
cholinesterase inhibitors – will inhibit the o Aphasia
enzyme for acetylcholine  Problem with language
o Generic name: Edrophonium hydrochloride  Expressive Aphasia – frontal lobe,
o Tensilon will inhibit the enzyme, the Broca’s area (speachless)
acetylcholine is retained in the junction so  Receptive – temporal lobe, Wernicke’s
there will be inc impulse transmission -> inc area
muscle contraction  Global
o A (+) Tensilon test will lead to temporary - Medication
improvement of muscle function, the tensilon  Rivastigmine (Exelon)
is short acting  Donepezil (Aricept)

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 Tacrine expect that there is no balance. (Kulang na ang
 Pharmacodynamics: Anticholinesterase dopamine)
CHOLINERGIC AGONIST - In Parkinson, dopamine lessens because the nerves
- Parasymphatomimetic that produces them are gradually deteriorating and
- Bethanecol dies.
 Selectively activates bladder muscarinic receptor - There is no problem with ACh, but since there is no
 Emptying of the bladder one inhibiting for the ACh, it becomes stronger.
 Use: - That explains why we have s/sx (Ex. Tremors, due to
o Relief of urinary retention strong ACh)
o Post partum - In treating PD, stimulate dopaminergic drug
o Neurogenic atony of bladder (Dopaminergic), if ACH is too strong, we inhibit/block
 Side Effects: the ACH (Anticholinergic)
o Asthma - Question: Is there a cure for PD?
o Cardiac problem  Answer: NO, because they are nerves cell and
o Peptic ulcer nerves do not regenerate
o Intestinal obstruction - BEQ: How would you know that the pt taking
o Constrict airways levodopa for PD is effective?
o Slows HR  Answer: If there will be no tremors, or if the
o Inc GI Tract symptoms are relieved.
o Inc gastric secretion - The goals are always near normal
CHOLINERGIC ANTAGONISTS  Improve motor control
- Parasymphatolytic  Improve quality of life
- Atropine  Inc dopamine or dec ach action
 Antidote to cholinergic crisis - Anticholinergics
 Pre-op  Biperiden (Akineton)
 SE: dryness of the mouth, constipation, retention  Trihexyphenidyl (Artane)
of urine, mydriasis in cataract  Diphenhydramine (Benadryl)
 Sx: bradycardia  Benztropine (Cogentin)
- Dicyclomine - Dopaminergic agent
 Antimuscarinic and Antipasmodic  Dopamine Precursors
 For hyperactive bowel in adult  Dopamine Receptor Agonists
- Scopolamine (Hyoscine butylbromide)  Mao-B Inhibitors
 buscopan  Catechol-O-Methyl Transferase (COMT) Inhibitors
 dec secretion  NMDA-Type Glutamate Antagonist
 Pupil dilation ASTHMA AND MEDS IN A NUTSHELL
 PONV - A chronic disease process
o Post nausea vomiting - Smooth muscle causes bronchoconstriction of
PARKINSON’S DISEASE already narrowed airway
- Degeneration of dopaminergic nerves (nerves that - Inflammatory response causes excess mucus
produces, stores and releases dopamine) - Medicines need to address both;
- Normally, the substancia nigra of Midbrain should  Inflammation
have a balance between two neurotransmitters (ACh  Bronchoconstriction
and Dopamine) - During acute attacks
 ACh function is to contract  Prioritize SABAs
 Dopamine function in the midbrain will have an - For prevention of attacks, use:
inhibitory effect (-), dopamine will say to ACh to  LABAs
relax  Glucocorticoids
- In patients with Parkinson disease, since there is  Leukotriene modifiers
already degeneration of dopaminergic nerves, we  Cromolyn

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ANALGESICS AND ANTI-INFLAMMATORY DRUGS o Allergy
o Immunosuppression
 Organ transplant (They will take
corticosteroids for life because the
organ transplanted is a foreign body,
and the body rejects the transplant part)
 Side Effects:
o Hyperglycemia
o Immunosuppresion
o Gastric irritation
ANALGESICS  Nursing Consideration:
- Non-Opioids/Non-Narcotics o Take with meals (To avoid gastric irritation)
 Anti-Inflammatory Drugs o Do not stop abruptly
o Corticosteroids  Discontinue gradually to prevent crisis ->
o NSAIDS Addisonian Crisis (NO corticosteroids in
o Alicylates the body)
o Para-Aminophenols o Avoid crowded places (Since they are
- Opioids/Narcotics immunocompromised)
 Opioid Agonist o Avoid Raw Foods
 Opioid Agonist-Antagonist o Watch out for side effects
 Opioid Antagonist  Cushing’s Syndrome (Moon fascie,
- A/an – absence, algia/algus – pain truncal obesity, buffalo humps = caused
- Pain reliever by MALDISTRIBUTION OF FATS)
- Gold Compounds  Sodium Retention
 Auric Chloride  Water Retention -> Peripheral Edema
 Chlorauric Acid - Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
- Anti-Migraine Drugs  Any drug that blocks any 1 or more signs of
 Ergots inflammation
 Triptans  Pharmacodynamics: blocks the PG
NON-NARCOTIC ANALGESIC: ANTI-INFLAMMATORY  Indications: inflammatory diseases and pain
DRUGS  Fenamates
- o Mefenamic Acid (Dolfenal, Ponstan)
- Are drugs that blocks any 1 or more of the signs of  Propionic Acid
inflammation; o Ibuprofen (Advil)
 Dolor = Pain o Naproxen (Skelan)
 Rubor = Redness  Indole Acetic Acid
 Calor = Heat o Indomethacin
 Tumor = Swelling  Most Potent Inhibitor of Cox
- Corticosteroids  Used in Patent Ductus Arteriosus/PDA
 Pharmacodynamics:  Cox-2 Inhibitors
o Blocks arachidonic acid o Blocks the COX 2
o Blocks histamine o Celecoxib
o Blocks the immune response (Produces  Arcoxia
Antibodies) -> Destroys antigen (Any foreign - Salicylates
o bodies/Pathogens) -> Immunocompromised  Blocks the Prostagladin
 Inc. risk of Infection  Acetylsalicylic Acid (ASA)
 Indications: o Most commonly used
o Rheumatoid arthritis o Aspirin
o Asthma o Least potent analgesic effect drug

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o Used as a “blood thinner” o NSAIDs
o Don’t give to pts with dengue fever, varicella - Mild to Moderate Pain
-> Reye’s Syndrome  PS: 4-6
o Unwanted SE: o Codeine
 GI o Nalbuphine
 Hemostatic effect o + PAN
 Uricosuric effect - Moderate to Severe Pain
 Antithrombotic effect  PS: 7-10
 Sodium Salicylate o Morphine
 Methyl Salicylate o Meperidine
- Para-Aminophenols o Fentanyl
 Acetaminophen/Paracetamol o + PAN
o A weak anti-inflammatory drug COMMUNITY HEALTH NURSING (COPAR)
o PHD: COMMUNITY
 Binds to the thermoregulatory receptor - Defined by its geographic boundaries
in the hypothalamus - Made up of institutions organized into a social system
o Effects: - Common or shared interests
 Lower body temp (sweating) - Has an area of fluid boundaries
 Analgesic - Has a population aggregate concept
o Adverse Effect: - Group of people sharing common geographic
 Hemolytic anemia boundaries, common values and interest
 Hepatic necrosis COMMUNITY ORGANIZING PARTICIPATORY ACTION
 Acetylcysteine (mucolytic) RESEARCH (COPAR)
o Antidote for acetaminophen overdose - Process of change and empowerment for building the
OPIOIDS/NARCOTIC ANALGESIC capacity of people for future community action.
- Opioid Agonist - Process by which people, health service and agencies
 PHD: of the community are brought together to:
o Binds to opioid receptors in brain and in GIT  Learn about the common problems
o Stimulates the receptors  Identify these problem as their own
 Morphine  Plan the kind of action to solve problems
 Meperidine  Act on this basis
 Codeine - A social development approach that aims to
 Fentanyl transform the apathetic, individualistic and voiceless
- Opioid Agonist-Antagonist poor into dynamic, participatory and politically
 PHD: responsive community.
o Stimulates some opioid receptors and blocks - A collective, participatory, transformative, liberative,
some opioid receptors sustained and systematic process of building people’s
 Nubain (Nubain) organizations by mobilizing and enhancing the
 Pentazocine capabilities and resources of the people for the
- Opioid Antagonist resolution of their issues and concerns towards
 Naloxone effecting change in their existing oppressive and
o Narcan exploitative conditions (1994 National Rural
o Reverses the effect of opioid agonist Conference)
o Antidotes to opioid agonist overdose IMPORTANCE OF COPAR
WHO PAIN LADDER - Important tool for community development and
- Mild Pain people empowerment
 PS: 1-3 - Prepares people to eventually take over the
o Paracetamol/Acetaminophen management of a development programs in the
o ASA future.

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- Maximizes community participation and involvement
PRINCIPLES OF COPAR
- People, especially the most oppressed, exploited and
deprived sectors are
 Open to change
 Have the capacity to change and
 Are able to bring about change.
- Based on the interest of the poorest sectors of
society
- Lead to a self-reliant community and society.
EMPHASIS OF COPAR GUIDELINES
1. Community working to solve its own problem
2. Direction is established internally and externally
3. Development and implementation of a specific
project less important than the development of the
capacity of the community to establish the project
4. Consciousness raising involves perceiving health and
medical care within the total structure of society
5 STAGES OF ORGANIZING “COMMUNITY HEALTH
PROMOTION MODEL”
- ADIC DR
 Analysis (Community Analysis)
 Design and Initiation
 Implementation
 Consolidation
 Dissemination – Reassessment
COMMUNITY ANALYSIS
- Process of assessing and defining needs for
community health action plan.
- Also known as (M.E.N.D)
 Mapping (Spot Mapping)
 Education Planning
 Needs Assessment
 Diagnosis
- This process may be referred to as “community
diagnosis,” “community needs assessment,” “health
education planning,” and “mapping.”
- 5 Components: (P.H.O.S.T)
 Profile: eg. Economic, Demographic, Social
 Health risk
 Outcome Profile (Mortality/ Morbidity Data)
 Survey (health promotion programs)
 Target group studies
- Steps of Community Analysis
 Define community
 Data Collection
 Capacity Assessment
 Barriers assessment
 Change Readiness
 Set Priorities
DESIGN AND INITIATION
- In designing and initiating interventions the
following should be done:
1. Core Group Planning and select a local organizer.
(5-8 members comm. members)
2. Choose an organizational structure
o Leadership board or council – local Leaders
o Coalition- groups with certain concerns
o “Lead” or official agency – HW
o Grass-roots
o Citizen panels
o Networks and consortia
3. Identify, select and recruit organizational
members.
4. Define the organization mission and goals
5. Clarify roles and responsibilities of people
involved in the organization.
6. Provide training and recognition
IMPLEMENTATION
- Implementation put design phase into action.
- To do so, the following must be done:
1. Generate broad citizen participation.
2. Develop a sequential Work Plan
3. Use comprehensive, integrated Strategies that is
unified
4. Values of the community integrated in the
programs, materials and messages
CONSOLIDATION/PROGRAM MAINTENANCE
- To maintain and consolidate gains of the program,
the following are essential:
1. Integrate activities into community networks
2. Establish a positive organizational culture
3. Establish an ongoing recruitment plan
4. Disseminate results
DISSEMINATION – REASSESSMENT
- Before any programs reach its final step, evaluation is
done for future direction.
1. Update the community analysis
2. Assess effectiveness of interventions/programs.
3. Chart future directories and modifications.
4. Summarize and disseminate results.
COPAR PROCESS
- A progressive cycle of action-reflection-action.
- Consciousness through experimental learning
- COPAR is participatory and mass-based
- COPAR is group-centered and not leader-oriented
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PHASES/PROCESS OF COPAR (P.E.O.S.T)
- Pre-entry
 Is the initial phase of the organizing process
where the community/organizer looks for
communities to serve/help.
 It is considered the simplest phase in terms of
actual outputs, activities and strategies and time
spent for it
- Entry
 This phase signals the actual entry of the
community worker/organizer into the community
- Organization Building Phase (Community Organizing)
 Entails the formation of more formal structures
and the inclusion of more formal procedures of
planning, implementation, and evaluating
community-wide activities
- Sustenance and strengthening
 Occurs when the community organization has
already been established and the community
members are already actively participating in
community-wide undertakings
- Turn-over
PRE-ENTRY/PREPARATORY PHASE (C.A.S.E.D)
- Courtesy call with the mayor
- An initial ocular survey
- Site selection
- Encourage dialogues with the people
- Demographic profiling
 Site Selection Criteria: (P.I.E.R.A.A)
o Poor health situation
o Inaccessibility of health services
o Economically depressed
o Relative peace and order
o Absence of similar agencies
o Acceptance of the community
- Activities include:
 Designing a plan for community development
including all its activities and strategies for care
development.
 Designing criteria for the selection of site
 Actually selecting the site for community care
ENTRY PHASE
- Courtesy call with the students
- Ocular survey
- Integration
- Deepening social investigation/community study
- Potential leaders are identified.
- Core group formation
- Recognize the role of local authorities by paying them
visits to inform their presence and activities.
- Avoid raising the consciousness of the community
residents; adopt a low-key profile.
- Integration
 Establishing rapport with the people in
continuing effort to imbibe community life.
o Living with the community
o Seek out to converse with people where they
usually congregate
o Lend a hand in household chores
o Avoid gambling and drinking
- Deepening social investigation/community study
 Verification and enrichment of data collected
from initial survey
 Conduct baseline survey by students, results
relayed through community assembly
- Core Group Formation
 Leader spotting through sociogram.
o Key persons - approached by most people
o Opinion leader - approach by key persons
o Isolates - never or hardly consulted
 Diagnosis with core group
o Criteria for core group formation (B.R.O.W.N)
 Belong to poor sector of the community
 Respect member of the community
 Open and willing to learn
 With good communication skills
 No political position in the barangay
COMMUNITY ORGANIZING AND CAPABILITY-BUILDING
PHASE
- Core group members develop their capabilities in
leading their community.
- Setting up organization committee
- Team buildings
- Rigid Trainings
- Formation of Community Health Organization (CHO)
Nursing Planning
- Four Criteria for Determining Priorities
1. Nature of Condition or Problem
o Categorized into wellness state/ potential,
health threat, health deficit of foreseeable
crisis.
2. Modifiability of the Problem
o Refers to the probability of success in
minimizing, alleviation or totally eradicating
the problem through nursing intervention.
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3. Preventive Potential - At this point, the different communities’ setup in the
o Refers to the nature and magnitude of future organization building phase are already expected to
problems that can be minimized or totally be functioning by way of planning, implementing and
prevented if intervention is done on the evaluating their own programs with the overall
problem under consideration. guidance from the community-wide organization
4. Salience - Strategies used may include: (E.N.C.I)
o Refers to the family’s perception and  Education and training
evaluation of the problem in terms of  Networking and linkaging
seriousness an urgency attention needed  Conduct of mobilization on health and
- Scale for Ranking Health Problems according to development concerns
Priorities  Implementing of livelihood projects
CRITERIA SCORE WEIGHT - Developing secondary leaders
1. Nature of the Problem Presented - Ratification: approval of laws
Scale:
- Key Activities:
- Health Deficit 3
- Health Treat 2 1  Training of CHO for monitoring and implementing
- Foreseeable Crisis 1 of community health program.
2. Modifiability of the Problem  Identification of secondary leaders.
Scale:
 Linkaging and networking.
- Easily Modifiable 2
- Partially Modifiable 1 2  Conduct of mobilization on health and
- Not Modifiable 0 development concerns.
3. Preventive Potential  Implementation of livelihood projects.
Scale:
- High 3
- It is the end portion of COPAR but the most
- Moderate 2 1 important phase. It is during this phase by which the
- Low 1 community and its people are being developed to be
4. Salience self- reliant.
Scale:
- A serious problem, immediate action 2
- Part of our role in the provision of nursing care is to
needed encourage the client’s ability to be independent and
- A problem but not needing immediate 1 1 to resume his functions with less assistance.
attention
TURN-OVER/TERMINATION
- Not a felt need/problem 0
TOTAL/HIGHEST SCORE 5 - Endorsement Phase
- Scoring: - Turn-Over Phase
 Decide on a score for each of the criteria. - Gradual process
 Divide the score by the highest possible score and - Development of self-reliance
multiply by the weight. - People empowerment
SCORE/HIGHEST SCORE X WEIGHT
 Sum up the scores for all the criteria.
 The highest score is 5, is equivalent to the total
weight
SUSTENANCE AND STRENGTHENING
- R.E.M.I.N.D
 Ratification of by-laws
 Evaluation
 Monitoring
 Implementation of Livelihood Programs
 Networking & Linkages
- The community organization has already been
established and the community members are already
actively participating in community-wide
undertakings.

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