1.

Crisis Intervention
Goal: OLOF; pre-crisis state; equilibrium;
homeostasis
Approach: problem-solving
Role: facilitator; active and directive
Experience: DABDA
Duration: 4-6wks
Monitor: 2-3mos (risk for suicide persist)
2. Levels of Health Care:
a. Primary- devolved to cities and municipalities; first
contact between the community and other levels
of health facility; e.g. center MD, PHN,RHU
midwives, BHW, traditional healers
b. Secondary- given by physicians with basic training;
infirmaries, municipal and district hospital, OPD
c. Tertiary- complicated cases and intensive care;
regional and provincial hospitals, specialized
hospital
3. Treatment Modalities:
a. Individual psychotherapy- verbal interactions
between 2 individuals (therapist & pt.)
- Short term: 4-6 sessions
- Intermediate: 6mos
- Long term: 6mos-several years
- Each session lasts for 50mins.
b. Group therapy- working with a large number of pt.; 1
therapist: 5-15pt; 1-2hrs/wk
Benefits of group therapy:
- Opportunity to address issues with input from others
( gain new insight, knowledge and perspective)
- Feeling of acceptance and a sense of belonging
- Accountable to a group of people with similar
struggles
c. Family Therapy- coined by American Psychiatrist
Nathan Ackerman in the 1950s
- A psychotherapeutic approach that focusses on
altering interactions between a couple
To provide initial intensive education program me
followed by continuing education target at needs.
To provide explicit crisis plan and professional
response
To promote clear communication and active
listening.
To provide training in structured problem solving
technique.

To help resolve family conflict and sensitive

response to emotions.
- Goal
- : provide social support and share info relevant to
the mental d/o so that pt can adapt to living with
chronic illness and find was to remain stable.
e. Support therapy- organizations of people who
share a common disorder, like depression or
anxiety, and who meet together to discuss their

within nuclear family or its members in extended

family or between the family and other
interpersonal systems with the goal of alleviating
problems initially presented by individual family.

Purpose of Family Therapy:

a. Deals with Family Pain- When one person in a family
(the patient) has pain which shows up in
symptoms, all familymembers are feelings this
pain in same way.
b. Assists for Family Homeostasis-Family behaves as a unit.
c. Therapist Gives Marital Counseling- marital relationship
is the axis around which all other family
relationships are formed.
GOALS OF FAMILY THERAPY FOR THE INITIAL
SESSIONS:
Establishing Empathic / Supportive Connection
Evaluating the Familys Current Needs
Explore the expectations of relatives
Experiences by all members of the family
Orienting Relatives to the Current Situation:
Developing an Initial Plan for Family Service / Involvement
NURSES ROLE IN FAMILY WORK:
To co-ordinate treatment- everyone is working
towards same goals in a collaborativesupportive
way.
To pay attention to the social and clinical needs of
patient and family.
To provide optimum medication management.
To listen to families and treat them as equal
partners.
To explore family expectations.
To assess familys strengths, problems and goals.
To help family come in-terms with feelings of loss.
To encourage family to expand social support
networks.
To encourage the family to adjust their expectations.
To be flexible in meeting the needs of the family.
To provide follow up contacts for future access to
support if work with family ceases
d. Educational Therapy- educating pt and family
regarding sx recognition mngt.

experiences, share ideas, and provide emotional

support for one another.
- self-help group- usually not led by a professional
therapist
Benefits of Support Groups
a. helping a patient realize that he or she is not alone
b. develop new skills to relate to others

c. facing the same type of situation may help you open

up and discuss your feelings
d. everything that takes place within the support
group should be kept confidential.
f. Psychiatric Rehabilitation- promotes recovery, full
community integration and improved quality of life
for persons who have been diagnosed with any
mental health condition that seriously impairs
functioning
- services are collaborative, person directed, and
individualized, and an essential element of the
human services spectrum and should be
evidencebased
- focus on helping individuals develop skills
- and access resources needed to increase their
capacity to be successful and satisfied in the
living, working, learning and
- social environments of their choice.
Principle 1. Psychiatric rehabilitation
practitioners convey hope and respect, and
believe that all individuals
have the capacity for learning and growth.
Principle 2. Psychiatric rehabilitation
practitioners recognize that culture is central to
recovery, and strive to
ensure that all services are culturally
relevant to individuals receiving services.
Principle 3. Psychiatric rehabilitation
practitioners engage in the processes of informed
and shared decision
making and facilitate partnerships with
other persons identified by the individual receiving
services.
Principle 4: Psychiatric rehabilitation
practices build on the strengths and capabilities of
individuals.
Principle 5. Psychiatric rehabilitation
practices are personcentered; they are designed
to address the unique
needs of individuals, consistent with their
values, hopes and aspirations.
Principle 6. Psychiatric rehabilitation
practices support full integration of people in
recovery into their
communities where they can exercise their
rights of citizenship, as well as to accept the
responsibilities and
explore the opportunities that come with
being a member of a community and a larger
society.
Principle 7. Psychiatric rehabilitation
practices promote selfdetermination and
empowerment. All individuals
have the right to make their own decisions,
including decisions about the types of services
and supports they

receive.
Principle 8. Psychiatric rehabilitation
practices facilitate the development of personal
support networks by
utilizing natural supports within
communities, peer support initiatives, and self
and mutualhelp groups.
Principle 9. Psychiatric rehabilitation
practices strive to help individuals improve the
quality of all aspects of
their lives; including social, occupational,
educational, residential, intellectual, spiritual and
financial.
Principle 10. Psychiatric rehabilitation
practices promote health and wellness,
encouraging individuals to
develop and use individualized wellness
plans.
Principle 11. Psychiatric rehabilitation
services emphasize evidencebased, promising,
and emerging best
practices that produce outcomes
congruent with personal recovery. Programs
include structured program
evaluation and quality improvement
mechanisms that actively involve persons
receiving services.
Principle 12. Psychiatric rehabilitation
services must be readily accessible to all
individuals whenever they
need them. These services also should be
well coordinated and integrated with other
psychiatric, medical, and
holistic treatments and practices.
g. Components of Therapeutic Relationship
a. P-OSITIVE REGARD-unconditional, nonjudgmental attitude, implies respect irregardless of
the patients behavior, background or lifestyle
Patient: I was so mad, I yelled at my
mother for an hour.
Nurse:Well, that didnt help, did it? or I
cant believe you did it.
* Nurse: you must have been really
upset.
A-CCEPTANCE-nurse does not
become upset or respond negatively to a clients
outbursts, anger or acting out
A client puts his arm around the waist of
the nurse:
Nurse: John, stop that! Whats gotten into
you? I am leaving!
* Nurse: John, do not place your hand on
me. We are working on your relationship with your

girlfriend and that does not require you to touch

me. Now. Lets continue.
G-ENUINE INTEREST-nurse is clearly
focused and is comfortable with ity and
reliabilityhimself/herself (client can detect artificial
behavior)
Ex. The nurse asking a question and then
not waiting for an answer, talking over the client
or assuring the client that everything will be all
right.
E-MPATHY-ability of the nurse to perceive
the meanings and feelings of the patient and
communicates that understanding to the patient
Ex. Patient: Im so confused! My son just
visited and wants to know where the safety
deposit box key is.
Nurse: Youre confused because your son
asked for the safety deposit key?
T-RUST-patient is confident of the nurse
and the nurses presence conveys integrity and
reliability
Trusting behaviors: caring, consistency,
approachability, listening, keeping promises,
honesty
Power: The therapeutic nurse-client
relationship is one of unequal power. Although
nurses may not perceive themselves as
having power in the relationship, nurses have
more power than the client. The power of
the nurse comes from the authority of own
position in the health care system,
specialized knowledge, influence with other health
care providers and the clients significant
others, and access to privileged information.
In any professional-client relationship,
there is an imbalance of power in favour of the
professional, and is reinforced in health
care services by the inherent vulnerability of a
client needing care.
Trust: Clients expect the nurse to have the
necessary knowledge and skills and to
demonstrate caring attitudes and
behaviours, and so entrust their care to the nurse.
Trust
is critical, as the client is in a vulnerable
position in the relationship. Part of trust is keeping

promises to clients. If trust is breached,

then it becomes very difficult to re-establish it.
Respect: Respect for the dignity and worth
of the client is fundamental to the relationship.
The nurse needs to know and understand
the culture and other aspects of the clients
individuality and to take these into account
when providing care. Part of respect is being
non-judgmental of the client, and seeking
to discover the meaning behind certain of the
clients behaviours.
Intimacy: This does not refer to sexual
intimacy. Intimacy relates to the kinds of activities
nurses perform for and with the client
which create personal and private closeness on
many levels. This can involve physical,
emotional and spiritual elements.
h. 3 phases of NPR
1. Orientation Stage

Establishing therapeutic environment.

The roles, goals, rules and limitations of

the relationship are defined, nurse gains trust of
the client, and the mode of communication are
acceptable for both nurse and patient is set.

Acceptance is the foundation of

all therapeutic relationship

Acceptance of others requires

acceptance of self first.

Rapport is built by demonstrating

acceptance and non-judgmental attitude.

Acceptance of patient means encouraging

the patient verbally and non-verbally to express
both positive and negative feelings even if these
are divergent from accepted norms and general
viewpoint.

The nurse can encourage the

client to share his/her feelings by making the
client understand that no feeling is wrong.

Trust of patient is gained by being

consistent.

Assessment of the client is made by

obtaining data from primary and secondary
sources.

The patient set the pace of the

relationship.

During this phase, the problems are not

yet been resolved but the clients feelings
especially anxiety is reduced, by using palliative

measures, to enable the client to relax enough to

talk about his distressing feelings and thoughts.
This stage progresses well when the
nurses show empathy provide support to client
and temporary structure until the client can control
his own feelings and behavior.
Reality testing is accepting the
patients perceptions, feelings and thoughts as
neither right nor wrong, but at the same time
offering other options or points of view to the
client in a non-argumentative manner for the
purpose of helping the client arrive at more
realistic conclusions.
To provide structure is to
intervene when the client loses control of his own
feelings and behaviors by medications, offering
self, restrain, seclusion and by assisting client to
observe a consistent daily schedule.
2. Working/ Exploration/ Identification
Stage at this point, the clients problems are
identified and solutions are explored, applied and
evaluated.
The focus of the assessment and of the
relationship is the clients behavior and the focus
of the interaction is the clients feelings.
The nurse should realize that the clients
feelings of security are developed by being
consistent at all times.
Perception of reality, coping mechanisms
and support systems are identified.
The nurse assists the patient to develop
coping skills, positive self concept and
independence in order to change the behavior of
the client to one that is adaptive and appropriate.
The nurse uses the techniques of
communication and assumes different roles to
help the client.
3. Termination/ Resolution stage
the nurse terminates the relationship when
the mutually agreed goals are met, the patient is
discharged or transferred or the rotation is
finished. The focus of this stage is the growth that
has occurred in the client and the nurse helps the
patient to become independent and responsible in
making his own decisions. The relationship and
the growth or change that has occurred in both
the nurse and the patient is summarized.
Client may become anxious and react with
increased dependence, hostility and withdrawal,
these are normal reactions and are signs of
separation anxiety, these feelings and behavior
should be discussed with the client.
The nurse should be firm in maintaining
professionalism until the end of the relationship.
She should not promise the client that the
relationship will be continued.

i.
-

j.

k.

l.

The time parameters should be made

early in the relationship and meetings are set
further and further apart near the end to foster
independence of the patient and prepare the latter
gradually for the separation.
The nurse should not give her address or
telephone numbers to the patient.
Referral for continuing health care and
support after discharge provides additional
resources for the client and the family.
The goal of the therapeutic relationship
have been met when the patient has developed
emotional stability, cope positively, recognized
sources or causes of anxiety, demonstrates ability
to handle anxiety and independence, and is able
to perform self-care.
Preparation of the termination
phase begins at the orientation phase, when the
duration and length of the nurse-client relationship
was established.
It is normal for the client to
experience separation anxiety such as
sleeplessness, anorexia, physical symptoms,
withdrawal and hostility.
Self- awareness- understanding ones own beliefs,
thoughts, motivations, biases, and limitations and
recognizing how the affect others.
process of developing an understanding of ones
own values, beliefs, thoughts, feelings, attitudes,
motivations, prejudices, strengths and limitations
and how these qualities affect others
Therapeutic use of self- the nurse
beginning to use aspects of his or her personality,
experiences, values, feelings, intelligence, needs,
coping skills and perceptions to establish
relationship with clients
Social relationship- Social relationships may be
casual (for example, acquaintance), friendship (for
example, platonic) or romantic (for example,
sexual). Social relationships serve the interests of
both parties and are for the purpose of mutual
interest and pleasure.
Therapeutic Relationship- established and
maintained by the nurse through the use of
professional nursing knowledge, skills and, caring
attitudes and behaviours in order to provide
nursing services that contribute to the
clients health and well-being. The
relationship is based on trust, respect and
intimacy and requires
the appropriate use of the power inherent
in the care providers role.
Abuse and Violence:
POWER AND CONTROL

a. Intimidation- putting in fear by sing looks, action,

gestures, or loud voice; smashing things,
destroying property.
b. Using male privilege- treating her like servant,
making big decisions, master of the caste
c. Threats
d. Using children
e. Sexual abuse
f. Economic abuse
g. Emotional abuse
h. Isolation
CYCLE OF VIOLENCE
a. Tension building
b. serious battering incident
c. honeymoon
m.SUICIDE
Triad of Suicide:
1. Alone
2. Loss of spouse
3. Loss of job
- Ways of Suicide:
1. Gun
2. Hanging
3. Jumping in high places
4. Overdose of drug or poisoning
5. Wrist cutting
Nsg Intervention:
D: direct approach
I: interval- unpredictable
E: endorsement; early morning
commitment of suicide
n. Positive Symptoms of Schizophrenia
Delusions
Hallucinations
Disorganized speech/thinking
Grossly disorganized behavior
Catatonic behaviors
Other symptoms
Negative Symptoms of Schizophrenia
Affective flattening
Alogia,
Avolition
o. Know and understand the ff:
1. Ambivalence- The coexistence of contradictory
emotions, attitudes, ideas, or desires with respect
to a particularperson, object, or situation.
Suggests psychopathology only when present in
an extreme form.
2. Associative looseness- Thinking that is
overgeneralized, diffuse, and vague with only a

tenuous connection between one thought and the

next.
3. Delusions- A firm, fixed idea not amenable to
rational explanation and maintained despite
objective evidence to the contrary. Some types of
common delusions are delusions of being
controlled, delusions of grandeur, delusions or
persecution and somatic delusions.
4. Hallucinations- A sensory impression in the absence
of any external stimuli; can arise in respect to any
sensory modality- visual, auditory, olfactory, tactile
or gustatory.
5. Ideas of Reference- The interpretation of external
events, especially the actions and statements of
other people, as having reference to one's self
when in fact they do not.
6. Perseveration- The emission of the same verbal or
motor response again and again to varied stimuli,
despite the person's effort to move on.
7. Alogia- negative speech/words
8. Anhedonia- negative pressure
9. Blunt affect- lack of emotional reactivity
10. Flat affect- severe reduction in emotional
expressiveness
11. Lack of volition- avolition, no motivation
p. LEVELS OF ANXIETY
a. Mild- normal
- Increase in level of perception, intelligence,
problem-solving
- Reaction: psychological
- n/i: make observation
b. moderate- narrowed perception; selective
inattention; pacing
- reaction: psychophysiological
- n/i: relaxation, assist pt, give PRN drugs
c. severe- perception is greatly reduced
- the do not do what to do and say
- Reaction: neurotic
- n/i: directive approach
d. Panic- 15-30mins SNS
- Risk for suicide
- Dx: Ineffective Coping
- Priority: safety, hyperventilation
q. Grief- encompassing response ( physical,
psychological, cognitive and behavioral) that a
person experiences after the loss of significant
person, object, belief or relationship.
a. Anticipatory- impending loss
b. Chronic- >6mos.
c. Distorted or exaggerated- self- destruction
d. Disenfranchised- cannot be publicly express
Models:
-

a. Engels shock and disbelief to developing

awareness
b. Kubler-Ross- DABDA
c. Parkes- 4stages of Grief
1. Numbness
2. Yearning
3. Disorganization
4. Reorganization- begins 6-9mos.
d. Grief cycle Model
1. Shock
2. Protest
3. Disorganization 3-6mos
4. Reorganization- 6mos-1yr
r. Defense Mechanism
a. Compensation- overachievement
b. Conversion- body s/sx
c. Denial- failure to admit
d. Displacement- anger to others
e. Identification- idol
f. Introjection- blame self
g. Intellectualization- reasoning with basis
h. Projection- blame others
i. Rationalization- reasoning without basis
j. Reaction formation- plastic
k. Regression- moving to childhood
l. Resistance- walk out
m.Repression- unconscious forgetting
n. Suppression- conscious forgetting
o. Substitution- replacement, replacing
p. Sublimation- changing the unacceptable
q. Undoing- patching the unacceptable
Stages of Dementia
1: No Cognitive Decline
In this stage the person functions normally,
has no memory loss, and is mentally healthy.
People with NO dementia would be considered to
be in Stage 1.No Dementia
Stage 2: Very Mild Cognitive Decline
This stage is used to describe normal
forgetfulness associated with aging. Symptoms
are not evident to loved ones or the physician.No
Dementia
Stage 3: Mild Cognitive Decline
This stage includes increased forgetfulness, slight
difficulty concentrating, decreased work
performance. People may get lost more often or
have difficulty finding the right words. At this
stage, a person's loved ones will begin to notice a
cognitive decline. Average duration: 7 years
before onset of dementia Early-stage

Stage 4: Moderate Cognitive Decline

This stage includes difficulty concentrating,
decreased memory of recent events, and
difficulties managing finances or traveling alone to
new locations. People have trouble completing
complex tasks efficiently or accurately and may be
in denial about their symptoms. They may also
start withdrawing from family or friends, because
socialization becomes difficult. At this stage a
physician can detect clear cognitive problems
during a patient interview and exam. Average
duration: 2 yearsMid-Stage
Stage 5: Moderately Severe Cognitive
Decline
People in this stage have major memory
deficiencies and need some assistance to
complete their daily activities (dressing, bathing,
preparing meals). Memory loss is more prominent
and may include major relevant aspects of current
lives; for example, people may not remember their
address or phone number and may not know the
time or day or where they are. Average duration:
1.5 yearsMid-Stage
Stage 6: Severe Cognitive Decline (Middle
Dementia)
People in Stage 6 require extensive assistance to
carry out daily activities. They start to forget
names of close family members and have little
memory of recent events. Many people can
remember only some details of earlier life. They
also have difficulty counting down from 10 and
finishing tasks. Incontinence (loss of bladder or
bowel control) is a problem in this stage. Ability to
speak declines. Personality changes, such as
delusions (believing something to be true that is
not), compulsions (repeating a simple behavior,
such as cleaning), or anxiety and agitation may
occur. Average duration: 2.5 yearsLate-Stage
Stage 7: Very Severe Cognitive Decline
(Late Dementia)
People in this stage have essentially no ability to
speak or communicate. They require assistance
with most activities (e.g., using the toilet, eating).
They often lose psychomotor skills, for example,
the ability to walk. Average duration: 2.5 years
s. Definition of Nsg
1. ANA- Nursing is the protection, promotion, and
optimization of health and abilities, prevention of
illness and injury, alleviation of suffering through
the diagnosis and treatment of human response,
and advocacy in the care of individuals, families,
communities, and populations.
2. Florence Nightingale - the act of utilizing the
environment of the patient to assist him in his
recovery( Nightingale,1860).

COMPETENCIES OF PROFL NSG

STANDARD
1. SAFE AND QUALITY NURSING CARE
2. MANAGEMENT OF RESOURCES AND
ENVIRONMENT
3. HEALTH EDUCATION
4. LEGAL RESPONSIBILITY
5. ETHICO-MORAL RESPONSIBILITY
6. PERSONAL AND PROFESSIONAL
DEVELOPMENT
7. QUALITY IMPROVEMENT
8. RESEARCH
9. RECORD MANAGEMENT
10. COMMUNICATION
11. COLLABORATION AND TEAMWORK
t. Philosophy and goals of Nsg
A philosophy of nursing is an approach to
nursing, usually created by individual nurses in
their own daily practice in the field. A nurse uses
his or her philosophy of nursing to explain what he
or she believes nursing is, the role nursing plays
in the health care field, and how he or she
interacts with patients. A philosophy of nursing
also addresses a nurse's ethics as it relates to the
practice of nursing.
-

Florence Nightingaless

Environmental Theory

Defined Nursing: The act of utilizing the

environment of the patient to assist him in his
recovery.

Focuses on changing and manipulating the

environment in order to put the patient in the best
possible conditions for nature to act.

Identified 5 environmental factors: fresh air,

pure water, efficient drainage,
cleanliness/sanitation and light/direct sunlight.
Dorothea Orems Self-Care Theory

Defined Nursing: The act of assisting

others in the provision and management of
self-care to maintain/improve human
functioning at home level of effectiveness.

Focuses on activities that adult individuals

perform on their own behalf to maintain life, health

and well-being.
-

Virginia Hendersons Definition of the

Unique Function of Nursing

Defined Nursing: Assisting the

individual, sick or well, in the performance of
those activities contributing to health or its
recovery (or to peaceful death) that an
individual would perform unaided if he had the
necessary strength, will or knowledge.

Madeleine Leiningers Transcultural

Care Theory and Ethno

nursing

Individual and redirect human and environmental

patterns or organization to achieve maximum

Nursing is a learned humanistic and

health.

scientific profession and discipline which is

focused on human care phenomena and activities

Hildegard Peplaus Interpersonal

in order to assist, support, facilitate, or enable

Relations Theory

individuals or groups to maintain or regain their

well being (or health) in culturally meaningful and

Defined Nursing: An interpersonal process

of therapeutic interactions between an Individual

beneficial ways, or to help people face handicaps

who is sick or in need of health services and a

or death.

nurse especially educated to recognize, respond

to the need for help.

-

Callista Roys Adaptation Theory

Nursing is a maturing force and an

educative instrument
Viewed humans as Biopsychosocial beings

constantly interacting with a changing

Lydia Halls Key Concepts of Three

environment and who cope with their environment

Interlocking Circles Theory

through Biopsychosocial adaptation mechanisms.

Focuses on the ability of Individuals.,

Nursing is participation in care, core and

cure aspects of patient care, where CARE is the

families, groups, communities, or societies to

sole function of nurses, whereas the CORE and

adapt to change.

CURE are shared with other members of the

-

Martha Rogers Concept of Science of

Unitary Human Beings, and Principles of

health team.
The major purpose of care is to achieve an

Homeodynamics

interpersonal relationship with the individual that

will facilitate the development of the core.

Nursing is an art and science that is

humanistic and humanitarian. It is directed toward

Dorothy Johnsons Key Concepts of

the unitary human and is concerned with the

Behavioral System

nature and direction of human development. The

goal of nurses is to participate in the process of
change..

Nursing interventions seek to promote

harmonious interaction between persons and their
environment, strengthen the wholeness of the

Each individual has patterned, purposeful,

repetitive ways of acting that comprises a
behavioral system specific to that individual.

Faye Glenn Abdellahs Concept of

Twenty OneNursing Problems

Nursing is broadly grouped into 21 problem

areas to guide care and promote the use

of nursing judgement.
Nursing is a comprehensive service that is

based on the art and science and aims to help

people, sick or well, cope with their health needs.
-

Imogene Kings Goal Attainment Theory

Nursing is a process of action, reaction,

and interaction whereby nurse and client share

information about their perception in the nursing
situation
-

Jean Watsons The Philosophy and

Science of Caring
Nursing is concerned with promotion

health, preventing illness, caring for the sick, and

restoring health.
-

Rosemarie Rizzo Parses Theory of

Human Becoming

Nursing is a scientific discipline, the

practice of which is a performing art

u. Profession, Vocation, and occupation
PROFESSION
o An occupation or calling requiring advance
training
o Provides service to society in that special
field
o Characteristics and Attributes of a
Professional
o Concerned with quality

Possesses competence to practice the

profession
o Self-directed, responsible and accountable
for his/her actions.
o Able to make independent and sound
judgment including moral judgment
o Dedicated to the improvement of human
life
o Committed to the spirit of inquiry
Classic Criteria of a Profession ( Flexners)
1. A profession utilizes in its practice a
well-defined and
well-organized body of knowledge that is
intellectual
in nature and describes its phenomena of
concern.
2. A profession constantly enlarges the
body of
knowledge its uses and subsequently
imposes on its
members the lifelong obligation to remain
current in
order to do no harm.
3. A profession entrust the education of its
practitioners
to institutions of higher education.
4. A profession applies its body of
knowledge in
practical services that are vital to human
welfare and
especially suited to the tradition.
5. A profession functions autonomously
(with authority)
in the formulation of professional policy
and in the
monitoring of its practice and practitioners.
6. A profession is guided by a Code of
Ethics that
regulates the relationship between
professional and
client.
7. A profession is distinguished by the
presence of a
specific culture, norms and values that are
common
among its member.
8. A profession has a clear standard of
educational
preparation for entry to practice.
9. A profession attracts individuals of
intellectual and
personal qualities who exalt service above
personal
gain and who recognize their chosen
occupation as a
o

lifes work.
10. A profession strives to compensate its
practitioners by
providing freedom of action, opportunity for
continues
professional growth and economic security.
PROFESSIONAL ADJUSTMENT
The growth of the whole individual and
the
development of his physical, mental,
emotional, social
and spiritual capacities.
NURSING as a PROFESSION
Nursing is a profession. A profession
possesses the
following primary characteristics:
Education, requires an extended
education
of its members, as well as basic liberal
foundation.
Theory, has a theoretical body of
knowledge leading to defined skills,
abilities
and norms.
Service
Autonomy
Code of ethics
Caring
PROFESSIONAL NURSING
Is an art and a science, dominated by
an ideal of
service in which certain principles are
applied in
skillful care of the well and the ill and
through
relationship with the client, significant
others and
other member of health care team.
According to the 1991 Nursing Law, a
person shall be
deemed to be practicing nursing when, for
a fee, salary
or other reward or compensation, singly or
in
collaboration with another.
Initiates and performs nursing services
to individuals,
families and communities in various stages
of
development towards the promotion of
health,
prevention of illness, restoration of health
and
alleviation of suffering through:
Utilization of the nursing process

Establishment of linkages with

community
resources and coordination of the health
team.
Motivation of individuals, families and
communities
Coordination of services with other
member
of health team.
Participation in teaching, guidance and
supervision of students in nursing
education
programs.
Undertaking nursing and health
manpower
development training and research.
PROFESSIONAL NURSE
One who has acquired the art and
science of nursing
through her basic nursing education
program.
One who interprets her role in nursing
in terms of the
social ends for which it exists- the health
and welfare
of society and who continues to add to
his/her KSA
through continuing education and scientific
inquiry.
Licensed in his/her country or state to
practice
professional nursing
Qualifications and Abilities of a
Professional
Nurse:
Has faith in the fundamental values that
underlie
the democratic way of life
-

Profession

College or
University
Prolonged
education
Mental
creativity
Decisions
based on science
or theoretical
constructs
Values,
beliefs & ethics
integral part of
preparation
Strong
commitment
Autonomou
s
Unlikely to
change professions
Commitmen
t > $ reward
Individual
accountability
-

tion

Voca

on

Nursi

On the
job training
Length
varies
Largely
manual work
Guided
decision
making
Values,
beliefs & ethics
not part of
preparation
Commit
ment may vary
Supervis
ed
Often
change jobs
Motivate
d by $ reward
Employe
r is primarily
accountable
-

ng, as a
vocation, is a
response to a
divine call to
help the ailing

calling
long term
commitment
to a
profession

Occupati

v. Functions of nsg
1.
2.
3.
4.
5.
6.
7.

Care Provider
Communicator/Helper
Teacher
Counselor
Client Advocate
Change Agent
Leader

8.
9.
10.
11.
12.

Manager
Researcher
Case Manager
Collaborator

w. Internal and external envt

The internal environment combines the
physiological and pathophysiological aspects of
the individual and is constantly challenged by the
external environment. The internal environment
also is the integration of bodily functions that
resembles homeorrhesis rather
than homeostasis and is subject to challenges of
the external environment, which always are a form
of energy.
The external environment is divided into the
perceptual, operational, and conceptual
environments. The perceptual environment is
that portion of the external environment which
individuals respond to with their sense organs and
includes light, sound, touch, temperature,
chemical change that is smelled or tasted, and
position sense and balance. The operational
environment is that portion of the external
environment which interacts with living tissue even
though the individual does not possess sensory
organs that can record the presence of these
factors and includes all forms of radiation,
microorganisms, and pollutants. In other words,
these elements may physically affect individuals
but are not perceived by the latter. The
conceptual environment is that portion of the
external environment that consists of language,
ideas, symbols, and concepts and inventions and
encompasses the exchange of language, the
ability to think and experience emotion, value
systems, religious beliefs, ethnic and cultural
traditions, and individual psychological patterns
that come from life experiences.
x. Purpose of nsg theory
The purpose of nursing theory is to guide
nurses in their practice of their profession, so to
be able to maximize the outcome of nursing
process. It is very imperative that nurses in clinical
setting should have something to follow to create
an outcome that have a definite result. In the
natural sciences, the main function of theory is to
guide research. In the practice disciplines,
the main function of theory and research is to
provide new possibilities for understanding the
disciplined focus such as music, art,
management specially nursing.
y. NEED theory

o
o

These theories are based around helping

individuals to fulfill their physical and
mental needs.
Needs theories have been criticized for
relying too much on the medical model of
health and placing the patient in an
overtly dependent position.

Nursing Need Theory was developed

by Virginia Henderson; emphasizes the
importance of increasing the patient's
independence so that progress after
hospitalization would not be delayed. Her
emphasis on basic human needs as the central
focus of nursing practice has led to further theory
development regarding the needs of the patient
and how nursing can assist in meeting those
needs. Henderson identifies three major
assumptions in her model of nursing. The first is
that "nurses care for a patient until a patient can
care for him or herself," though it is not stated
explicitly. The second assumption states that
nurses are willing to serve and that "nurses will
devote themselves to the patient day and night."
Finally, the third assumption is that nurses should
be educated at the college level in both sciences
and arts.
INTERACTION FOCUS
These theories revolve around the
relationships nurses form with patients.
Such theories have been criticized for largely
ignoring the medical model of health and not
attending to basic physical needs.

Abdella
h
Hender
son
Orem

OUTCOME THEORY

These portray the nurse as the changing

force, who enables individuals to adapt to or
cope with ill health (Roy 1980).
Outcome theories have been criticized as
too abstract and difficult to implement in
practice (Aggleton and Chalmers 1988).
-

King
Orlando
Peterso
n and
Zderad
Paplau
Travelbe
e
Wiedenb
ach

John
son
Levin
e
Roger
s
Roy

DOC for Appendicitis:

Pre op and Post op: antibiotic (penicillin,
cephalosporin)
Pain: morphine SO4
DOC for SLE: corticosteroid
- Topical: cutaneous
- Low oral doses:
minor dse activity
- High doses: major
dse activity
*antimalarial- cutaneous, MSK
and mild systemic features of SLE

*NSAID-used along with steroids

to minimize steroid requirement
*Immunosuppressive agents- pt
who have not responded to conservative
therapies
TPN (total parenteral nutrition)
- Supplies nutrients
via vein
- CHO: dextrose
- Fats: emulsified
form- lipids
- CHON: amino acid
- Sites:
- Peripheral
- Centraljugular/subclavian
vein
Indications:
- GIT is not functional
- Intestinal obstruction
- Multiple GI surgeries
- AIDS,CA,
malnutrition
- Chemotherapy,
extensive burns
Components:
- Peripheral: 5%
- Central: 40%
- Insulin may be
added to control bld
sugar level
- Heparin may be
added to prevent the
build up of fibrinous
clot at the tip1000ccTPN:0.5mg
heparin
Complication: hyperglycemia
Wt gain: 1-3lbs/wk
Bld glucose: assess 4-6hrs
Change TPN infusion bag every
24hrs
BLOOD TRANSFUSION
1. Verify MDs order
2. Secure informed consent
3. Proper bld typing and cross
matching
4. 2 RNs to check
5. Prepare the equipment
a. Macroset (Y filter set)
b. PNSS- same osmolality
with bld; dextrosehemolysis of RBC

c. G18 green- for BT and

surgery
G26 purpleneonate and preterm
G24 yellowpedia
G22 bluechildren and elderly
G20 pink- adult
G16 gray- bone
marrow aspiration,
hemodialysis
d. Blood product- 30mins
preparation in room temp
FWB: no
special prep
PRBC: 80% of
plasma is removed
1unit=2-3units of hct
Do
hgb and hct count
Platelet:
1unit=
5000platelet/ml
Albumin:
plasma expander
Cryoprecipitate:
clotting factor
FFP: no need
for cross matching and
bld typing
*safest BT:
autologous- donate bld
4-5wks prior to surgery
Transfusion reactions:
1. Febrile non hemolytic- fever and
chills
fever before BT: delay the transfusion
2. allergic reaction
W: wheezing
I: itchiness
F: flushing
U: urticarial
DOC: benadryl
anaphylactic shock- epinephrine
3. Acute hemolytic Reaction
- ABO incompatibility
- Pathognomonic
sign: flank pain,
fever, chills
4. Fluid overload
- Pulmonary
congestion/edema
- Pink frothy sputum
5. Bacteremia/ septicemia

- Prolonged BT
NGT
Insertion:
a. Levine tube-intermittent suctioning
b. Salem sump- continuous suctioning + NGT
feeding
c. Child/infant: fr. 5-10
d. Adult: fr. 14-18
- If Levine and Salem
Sump is plasticsoak in a warm H2O
Insulin
O
nset give
Peak
Duratio
food
n
Rapid
10
acting: lispro
-15mins
-1hr
4-5hrs
(Humalog)
Short

acting:
-1hr
2-4hrs
5-7hr
regular(humulin R,
novolin R)
Clear, can
be given IV
Intermedi
1ate acting: NPH
2hrs
6-8hrs
16( humulin N, Lente)
20hrs
Long
acting: ultralente

8hrs

6-

122016hrs
30hrs
to soften and
become flexible
- If made of rubbersoak in ice to make
it stiff for 5-10mins.
e. Pass the tube 5-10cm (2-4in) with each
swallow
NGT FEEDING
1. High fowlers
2. Introduce 5-10cc of air
3. Hold feeding: 50-100cc
of residue
4. Abnormal: often passing
flatus
5. Quick administration can
cause:
- Flatus
- Cramp pain
- Reflux vomiting
6. Irrigation: q4hrs gentl instill 3050cc of h2o or NSS
7. Removal: deep breath and hold
for 3-6sec
- Remove for 3-6sec
-

1.

DM
Type1 absolutely NO INSULIN
insulin therap
Type2- deficiency- OHA
Insulin Therapy
Nsg responsibility:
Storage- multidose vialroom temp- good for 30days
2. Pre-filled syringe/insulin
pen-ref
- Good for 7days
Upright
crystallization on the
needle
OHA
Sulfonylureas- stimulates beta cells to promote
more insulin
- e.g. tolazamide (tolinase);
glipizide (Glucotrol)
Biguanides- inhibit glycogenolysis and
gluconeogenesis in the liver
e.g. metformin (Glucophage) do
not take with iodine based prep- increase
risk for lactic acidosis
Alpha- Glucosidase inhibitor- inhibits absorption
of excess glucose at small intestine
- e.g. acarbose ( Precose)
Thiazolidinediode- increase insulin sensitivityhepatotoxic- monitor SGPT and SGOT
- e.g rosiglitazone (Avandia)
- pioglitazone (Actos)
- IMCI
- Ask what the childs
problem are
1. Know the general danger sign
- C: convulsions
- U: unable to
feed/drink or
breastfeed
- V: vomits everything
- A: abnormally
sleepy or difficult to
awaken
2. Know the color coding
- Pink
Urgent
referral
Severe
Needs
immediate
attention
give FIRST

d.
e.
f.

dose/ ONE
dose of
antibiotic
Tx to
prevent low
bld sugar
Monitoring
and follow
up
Yellow
Give
antibiotic/m
eds
Give oral
drugs
Tx local
infxn
Soothe the
throat with
safe
remedy
Dry ear by
wicking
Follow up
within
2days or
5days
Green
Follow up
in 2days or
5days
Home
mngt, tx,
care
No Urgent
referral
Feeding/flui
ds will be
recommen
ded
Praise
mother for
feeding the
child

- *DHN:
plan
a=green
Planb=yell
ow
Plan c=
pink
o
o
o
o

PTB

Kochs Dse
Consumption Dse
Poormans Dse
Ptysis= cough
1. Agent: mycobacterium
tuberculosis, bovis: cattle,
africanum
2. MOT: airborne
3. IP: 6-8wks
4. s/sx:
presumptive:
a. tuberc
ulin
test
b. manto
ux test
c. PPD
- Read 48-72hrs
- Induration:
immunocompromise
d- 5mm
- With risk: 10mm
- Without risk:
15mm
- Gold Standard- AFB
test
5. Mngt: DOTS
Domiciliary

a.
g.
h.

I
e.
S
e
ri
o
u
sl
y
ill
f.
D
S
S
M
(
+
)
g.
N
e
w
pt
h.
R
I
P
E
(
2
m
o
s)
i.
R
I
(
4
m
o
s)

b.
I

I
j.
D
e
f
a
u
l
t
k.
F
a
i
l
u
r
e
s
l.
R
e
l
a
p
s
e
s
m.
R
I
P
E
S
(
2
m
o
s
)
n.
R
I
P
E
(
1
m
o
)
o.
R
I
(
5
m
o
s
)

c.

III
p.
Les
s
seri
ous
q.
DS
SM
(-)
r.
Chil
dre
n
s.
RIP
E
(2m
os)
t.
RI
(4m
os)
u.
Eth
am:
not
giv
en
for
chil
dre
n
bel
ow
6yo

d.

IV
v.
Ch
ro
nic
w.
Ho
spi
tal

i.
j.
k.
l.
m.
n.
o.
p.
q.
r.
s.
t.
u.
v.

S/E:
Rifam: nephrotoxic- red orange urine
INH: hepatotoxic: peripheral neuropathy=vit.b6
PZA: hyperuricemia
Etham: optic neuritis= NO to below 6 yo
Strep: ototoxic: deafness, vertigo
w.

x. ENEMA
y.

and
sometim
es to
irritate
the
intestinal
mucosa
thereby
increasi
ng
peristalsi
s and
the
excretio
n of
feces
and
flatus

instillatio
n of a
solution
into the
rectum
and
sigmoid
colon to
promote
defecati
on

z.
aa. action:
distend
the
intestine

ab.

ac. Types
of
enemas
:
ad. 1.
Cleansin
g
Enema
ae. promote
s
complet
e
evacuati
on of
feces
from the
colon by
stimulati
ng
peristalsi
s
through
infusion
of large
volume
of
solution
af. - given
chiefly
to:
ag. 1.
prevent

the
escape
of feces
during
surgery
ah. 2.
prepare
the
intestine
s for
certain
diagnost
ic tests
(colonos
copy)
ai. 3.
Remove
feces in
instance
s of
constipa
tion or
impactio
n
aj.
ak. 2.
Carmina
tive
Enema
al. -given
primarily
to expel
flatus

am.

ar. 4.
Medicat
ed
Enema

an. 3. OilRetentio
n
Enema

as. contains
pharmac
ological
therapeu
tic
agents

ao. lubricate
s the
rectum
and
colon,
soften
the
feces
and
facilitate
s
defecati
on

at. -to
reduce
dangero
usly high
serum
potassiu
m levels
or to
reduce
bacteria
in the
colon
before
bowel
surgery.

ap. - used
alone or
as an
adjunct
to
manual
removal
of fecal
impactio
n

au.
av. 5.
Return
Flow
Enema

aq.
aw. -used
occasion
ally to

expel
flatus

ax. Guideli
nes
ay.
bc.

az.
bd.

bo.

bp.
bs.

bg.

bh.

bk.

bl.

bt. Commo
nly
Used
Enema
Solutio
ns

bu.

bv.

bw.

bx.

by.

bz.
ca.

cb.

cc.

cd.

ce.

cf.

cg.

ch.

ci.

cj.
ck.

cl.

cm.

cn.

co.

cp.

cq.

cr.

ct.

cu.

cv.

cy.

cz.

da.

cs.

cw.

cx.
db.

towel,an
d soap

dc. Articles
dd.
de. Enema
bag/can
df. Waterpr
oof
absorbe
nt pads
dg. Watersoluble
lubricant
dh. toilet
tissue
di. bath
blanket
dj. clean
gloves
dk. IV
stand/po
le
dl. Wash
basin,
wash
cloths,

dm. Bedpan/
Bedside
commod
e/
access
to toilet
dn.
do.
dp.
dq. Purpos
e:
dr. To
achieve
one or
more of
the
following
:
cleansin
g,
carminat
ive,
retention
, or
returnflow

ds.

dt.

PAIN SCALE

du.
Numeric Pain Rating Scale: Ask, If 0 is no pain and 10 is the worst possible pain, please give me a number that
indicates the amount of pain you are having now.

dv.
dw.
Faces Pain Scale: Ask the person to choose the face that best describes how he is feeling. The Wong-Baker Faces Pain
Scale is recommended for persons age 3 years and older
dx.

Wong Baker Faces Pain Scale

dy.
dz.
Faces Pain Scale: Explain to the person that each face is for a person who feels happy because he has no pain (hurt) or
sad because he has some or a lot of pain. Face 0 is very happy because he doesn't hurt at all. Face 2hurts just a little bit. Face
4 hurts a little more. Face 6 hurts even more. Face 8 hurts a whole lot. Face 10 hurts as much as you can imagine, although you
don't have to be crying to feel this bad. Ask the person to choose the face that best describes how he is feeling. The Wong-Baker
Faces Pain Scale is recommended for persons age 3 years and older. From Wong DL, Hockenberry-Eaton M, Wilson D,
Winkelstein ML, Schwartz P, Wong's Essentials of Pediatric Nursing, ed. 6, St. Louis, 2001 Mosby. p. 1301. Copyrighted by MosbyYear Book, Inc.
ea.
eb.

FLACC Scale For Children > 6 Months Old:

ec.
Face
0- No particular expression or smile
1-Occasional grimace or frown, withdrawn, disinterested
2-Frequent to constant quivering chin, clenched jaw
ed.
Legs
0-Normal position or relaxed
1-Uneasy, restless, tense
2-Kicking, or legs drawn up
ee.
Activity
0-Lying quietly, normal position, moves easily
1-Squirming, shifting back and forth, tense
2-Arched, rigid or jerking
ef.
Cry
0-No cry (awake or asleep)
1-Moans or whimpers, occasional complaint
2-Crying steadily, screams or sobs, frequent complaints
eg.

Consolability

0-Content, relaxed
1-Reassured by occasional touching, hugging or being talked to, distractible
2-Difficult to console or comfort
eh.
Merkel & Voepel-Lewis (1997). The FLACC: A Behavioral Scale for Scoring Postoperative Pain in Young Children.
Pediatric Nursing, 23(3). Select a criterion from each area and total the score.
ei.
Modified Infant Pain Scale (MIPS):
a. The MIPS must be started by adding the row on the Vital Signs screen. Choose "Pain <28", "Pain 28-32", or "Pain >32"
depending on the gestational age of the infant. As the infant's gestational age changes, it will be necessary to add the other pain
rows (i.e., when the infant becomes either 28 or 33 weeks adjusted).
b. The computer will add the pain score.
c. Interventions are required to be done and documented for any score of 4 or greater. Interventions include medications, non-drug
interventions (positioning, holding, pacifier, etc.).
d. Reassessment with the MIPS is required 1 hour or sooner after any intervention. If reassessment score is 4 or greater then
another intervention and assessment will be required.
ej.
Scoring:
Babies <28 weeks, items 1-6, possible score 0-12.
Babies 28-32 weeks, items 1-7, possible score 0-14.
Babies >32 weeks, items 1-10, possible score 0-20.
ek.

SCORE

el.

em.

en.

eo.

1. Sleep last hour

ep.

None

eq.

Naps <10 min

er.

Naps >10 min

es.

2. Facial Expression

et.

Marked

eu.

Less Marked

ev.

Calm

ew.

3. Cry

ex.
High pitched,
screaming, silent cry

ey.
Modulated,
distractible

ez.

No cry

fa.

4. Consolability

fb.

fc.

Quiet after 1 min

fd.

Quiet <1 min

fe.

5. Motor activity

ff.
Thrashing, agitated,
unresponsive

fg.

Moderate agitation

fh.

Quiet

fi.

6. Finger/toes flexion

fj.

fk.

Intermittent

fl.

Absent

fp.

Quiet

ft.

Strong/organized

None after 2 min

Pronounced/constant

fm.
7. Excitability/
Responsiveness

fn.
Spontaneous
Moro/tremulous

fo.
stim

Excess reaction to all

fq.

8. Suck

fr.

Absent/disorganized

fs.
crying

3-4 sucks/stops with

fu.

9. Tone

fv.

Strong hypertonicity

fw.

Moderate

fx.

Normal

fy.

10. Sociability

fz.

Absent

ga.

Difficult

gb.

Easy and prolonged

gc.

Items 5, 6, 7, 9, 10 - score 0 if asleep.

gd.
ge.

gf.
gg.
gh.
gi.

gj.
gk.
gl.
gm.
gn.

go. Perioperative nsg- begins with the decision

to proceed with surgical interventions is made and
ends with the transfer of the pt onto the OR table.
gp.
gq. The surgical team
gr. MEMBER
S OF
THE
SURGIC
AL TEAM
gs. Surgeon
gt. The
surgeon
is the
leader of
the
surgical
team
and has
the
ultimate
responsi
bility for
performi
ng the
surgery
in an
effective
and safe
manner.
He is
depende
nt upon
other
member
s of the
team for
thepatie
nt's
emotion
al wellbeing
and
physiolo
gic
monitori
ng.
gu. Anesthe
siologist/
Anesthet
ist
gv. The
anesthe
siologist/

anesthet
ist must
be
constant
ly aware
of the
surgeon'
s
actions.
He must
do
everythi
ng
possible
to
ensure
the
safety of
the
patient
and
reduce
the
stress of
the
operatio
n.
gw. Anesthe
siologist
gx. The
anesthe
siologist
is a
physicia
n who is
trained
in the
administ
ration of
anesthet
ics.
gy. Anesthet
ist
gz. The
anesthet
ist is a
registere
d
professi
onal
nurse
who is
trained
to

administ
er
anesthet
ics. The
responsi
bilities of
the
anesthe
siologist
and the
anesthet
ist
include:
ha. Providin
ga
smooth
inductio
n of the
patient's
anesthe
sia in
order to
prevent
pain.
hb. Maintain
ing
satisfact
ory
degrees
of
relaxatio
n of the
patient
for the
duration
of the
surgical
procedur
e.
hc. Continu
ous
monitori
ng to the
physiolo
gic
status of
the
patient,
to
include
oxygen
exchang
e,
circulato
ry

function
s,
systemic
circulatio
n, and
vital
signs.
hd. Advising
the
surgeon
of
impendi
ng
complica
tions
and
indepen
dently
interveni
ng as
necessa
ry.
he. Scrub
Nurse (or
Scrub
Assistant).
hf. The
scrub
nurse or
scrub
assistant
prepares
the
setup
and
assists
the
surgeon
by
passing
instrume
nts,
sutures,
etc.
hg. In the
Army,
the
operatin
g room
specialis
t (91D)
will often
help to

fill this
role.
hh. Circulating
Nurse.
hi. The
circulatin
g nurse
is a
professi
onal
registere
d nurse
who is
free to
obtain
supplies,
answer
the
anesthe
siologist/
anesthet
ist
requests
, deliver
supplies
to the
sterile
field,
carry out
the
nursing
care
plan,
etc. The
circulatin
g nurse
does not
scrub or
wear
sterile
gloves
or gown.
The
circulatin
g nurse
is the
professi
onal
nurse
liaison
between
scrubbe
d
personn
el and

those
outside
of the
operatin
g room.
Respons
ibilities
of the
circulatin
g nurse
include:
hj. Providin
g for
psycholo
gical
comfort
of the
patient
prior to
and
during
inductio
n of
anesthe
sia.
hk. Making
initial
assessm
ent of
the
patient
and
continue
d
monitori
ng.
hl. Saving
all
discarde
d
sponges
; during
surgery,
participa
tes in
the
sponge
count to
ensure
that no
sponge
is left in
the
patient.

hm. Observi
ng the
surgical
procedur
e and
anticipati
ng the
needs
for
equipme
nt,
instrume
nts
medicati
ons, and
blood
units.
hn. Preparin
g labels
for the
patient
specime
ns for
their
submissi
on to the
laborator
y for
analysis.
ho. Surgical
Hand
Scrub
The
purpose
of the
surgical
hand
scrub is
to
reduce
resident
and
transient
skin
flora
(bacteria
) to a
minimu
m.
Resident
bacteria
are often
the
result of
organis

ms
present
in the
hospital
environ
ment.
Because
these
bacteria
are
firmly
attached
to the
skin,
they are
difficult
to
remove.
However
, their
growth
is
inhibited
by the
antisepti
c action
of the
scrub
detergen
t used.
Transien
t
bacteria
are
usually
acquired
by direct
contact
and are
loosely
attached
to the
skin.
These
are
easily
removed
by the
friction
created
by the
scrubbin
g
procedur
e.

hp. Proper
hand
scrubbin
g and
the
wearing
of sterile
gloves
and a
sterile
gown
provide
the
patient
with the
best
possible
barrier
against
pathoge
nic
bacteria
in the
environ
ment
and
against
bacteria
from the
surgical
team.
The
following
steps
compris
e the
generall
y
accepte
d
method
for the
surgical
hand
scrub.
hq. 1.
Before
beginnin
g the
hand
scrub,
don a
surgical
cap or
hood

that
covers
all hair,
both
head
and
facial,
and a
disposa
ble
mask
covering
your
nose
and
mouth.
hr. 2. Using
approxi
mately 6
ml of
antisepti
c
detergen
t and
running
water,
lather
your
hands
and
arms to
2 inches
above
the
elbow.
Leave
detergen
t on your
arms
and do
not
rinse.
hs. 3. Under
running
water,
clean
your
fingernai
ls and
cuticles,
using a
nail
cleaner.

ht. 4.
Starting
with
your
fingertip
s, rinse
each
hand
and arm
by
passing
them
through
the
running
water.
Always
keep
your
hands
above
the level
of your
elbows.
hu. 5. From
a sterile
containe
r, take a
sterile
brush
and
dispens
e
approxi
mately 6
ml of
antisepti
c
detergen
t onto
the
brush
and
begin
scrubbin
g your
hands
and
arms.
hv. 6. Begin
with the
fingertip
s. Bring
your

thumb
and
fingertip
s
together
and,
using
the
brush,
scrub
across
the
fingertip
s using
30
strokes.
hw. 7. Now
scrub all
four
surface
planes
of the
thumb
and all
surfaces
of each
finger,
including
the
webbed
space
between
the
fingers,
using 20
strokes
for each
surface
area.
hx. 8. Scrub
the palm
and
back of
the hand
in a
circular
motion,
using 20
strokes
each.
hy. 9.
Visually
divide

your
forearm
into two
parts,
lower
and
upper.
Scrub all
surfaces
of each
division
20
strokes
each,
beginnin
g at the
wrist
and
progress
ing to
the
elbow.
hz. 10.
Scrub
the
elbow in
a
circular
motion
using 20
strokes.
ia. 11.
Scrub in
a
circular
motion
all
surfaces
to
approxi
mately 2
inches
above
the
elbow.
ib. 12. Do
not rinse
this arm
when
you
have
finished
scrubbin

g. Rinse
only the
brush.
ic. 13. Pass
the
rinsed
brush to
the
scrubbe
d hand
and
begin
scrubbin
g your
other
hand
and arm,
using
the
same
procedur
e
outlined
above.
id. 14. Drop
the
brush
into the
sink
when
you are
finished.
ie. 15.
Rinse
both
hands
and
arms,
keeping
your
hands
above
the level
of your
elbows,
and
allow
water to
drain off
the
elbows.

if. 16.
When
rinsing,
do not
touch
anything
with
your
scrubbe
d hands
and
arms.
ig. 17. The
total
scrub
procedur
e must
include
all
anatomi
cal
surfaces
from the
fingertip
s to
approxi
mately 2
inches
above
the
elbow.
ih. 18. Dry
your
hands
with a
sterile
towel.
Do not
allow the
towel to
touch
anything
other
than
your
scrubbe
d hands
and
arms.
ii.

19.
Between
operatio
ns,

follow
the
same
handscrub
procedur
e.
ij.
SEQUENCE FOR DONNING PERSONAL
ik.
PROTECTIVE EQUIPMENT (PPE)
il.
im.
The type of PPE used will vary based on
the level of precautions required; e.g., Standard
and Contact, Droplet or Airborne Infection
Isolation.
in.
io.
1. GOWN
ip.
iq.

Fully cover torso from neck to

knees, arms to end of wrists, and wrap around the
back
ir.
is.
Fasten in back of neck and waist
it.
iu.
iv.
iw.
ix.
2. MASK OR RESPIRATOR
iy.
iz.

Secure ties or elastic bands at

middle of head and neck
ja.
jb.
Fit flexible band to nose bridge Fit
snug to face and below chin
jc.
jd.
Fit-check respirator
je.
jf.
3. GOGGLES OR FACE SHIELD
jg.
jh.
Place over face and eyes and adjust to
fit
ji.
jj.
4. GLOVES
jk.
jl.
Extend to cover wrist of isolation gown
jm.
jn.
USE SAFE WORK PRACTICES TO
PROTECT YOURSELF
jo.
AND LIMIT THE SPREAD OF
CONTAMINATION
jp.
Keep hands away from face
jq.
Limit surfaces touched
jr.
Change gloves when torn or heavily
contaminated
js.
Perform hand hygiene
jt.

ju.
REMOVING:
jv.
jw.
1. GLOVES
jx.
jy.

Outside of gloves is
contaminated!
jz.
ka.

Grasp outside of glove with

opposite gloved hand; peel off
kb.
kc.

Hold removed glove in gloved

hand
kd.
ke.

Slide fingers of ungloved hand

under remaining glove at wrist
kf.
kg.

Peel glove off over first glove

kh.
ki.

Discard gloves in waste container

kj.
kk.
2. GOGGLES OR FACE SHIELD
kl.
km.

Outside of goggles or face shield

is contaminated!
kn.
ko.

To remove, handle by head band

or ear pieces
kp.
kq.

Place in designated receptacle for

reprocessing or in waste container
kr.
ks.
kt.
3. GOWN
ku.
kv.

Gown front and sleeves are

contaminated!
kw.
kx.

Unfasten ties
ky.
kz.

Pull away from neck and

shoulders, touching inside of gown only
la.
lb.

Turn gown inside out

lc.
ld.

Fold or roll into a bundle and

discard
le.
lf.
4. MASK OR RESPIRATOR
lg.
lh.

Front of mask/respirator is
contaminated DO NOT TOUCH!
li.
lj.

Grasp bottom, then top ties or

elastics and remove
lk.
ll.

Discard in waste container

lm.
ln. Drugs
that can
cause
bleeding
lp.
lo.
A

lq.
*These
antidepr
essants
have a
mild
inhibiting
effect on
the
platelet
function,
which
may
increase
the
bleeding
tendency
.
However
, since
they are
less
harmful
than
most
other
antidepr
essants
in other

respects
, it is
possible
to try the
medicati
on by
starting
at a low
dose
and
carefully
increase
it. Many
patients
will
tolerate
these
drugs
well.
lr. Herbal
drugs
(phytom
edicines
) that
can
cause
bleeding
ls. While
every
effort
has
been
made to
include
as many
herbal
drugs as
possible,
some
may be
missing.
Some
herbal
medicin
es have
been
reported
in
associati
on with
bleeding
, but in
these
cases
the

patient
also
took
regular
drugs
that
could
have
caused
the
bleeding
or that
the
docume
ntation
in other
respects
was
weak.
These
have not
been
included
in this
list.
lt. People
with
bleeding
disorder
s should
check
with
their
hemophi
lia
centre or
physicia
n, or
consult
the
pharmac
eutical
compan
ys
printed
instructi
ons
before
taking
any new
herbal
drug.
lu. Ginkgo
biloba

Garlic in
large
amounts
Ginger
(not
dried
ginger)
Ginseng
(Asian)
Feverfe
w
Saw
Palmetto
(Sereno
a
repens)
Willow
bark

ly. 2.
Control
Swelling

Ice the area.

If you were stung on your arm or leg, elevate

it.

Remove any tight-fitting jewelry from the

area of the sting. As it swells, rings or bracelets might
be difficult to remove.
lz. 3. Treat
Sympto
ms

For pain, take an over-the-counter painkiller

BEE STING MNGT

like acetaminophen or ibuprofen. Do not give aspirin

Trouble breathing

to anyone under age 18.

Feelings of faintness or dizziness

Hives

also apply a mixture of baking soda and water or

A swollen tongue

calamine lotion.

A history of severe allergy reaction to insect

lv.

For itchiness, take an antihistamine. You can

ma. 4.
FollowUp

stings
lw. If the
person
does
not hav
e
severe

It might take 2-5 days for the area to heal.

Keep it clean to prevent infection.
mb.
mc.

allergy
sympto
ms:
lx. 1.
Remove
the
Stinger
Scrape the area with a fingernail or use

tweezers to remove it.

Don't pinch the stinger -- that can inject more

venom.

md. If the
person
does ha
ve
severe
allergy
sympto
ms
(anaphy
laxis):

me. 1. Call
for help

mh. If the
person
has an

mf. Seek
emergen

anaphyl

cy care

axis

if the

action

person

plan

has any

from a

of these

doctor

sympto

for

ms or a

injecting

history

epinephr

of

ine and

severe

other

allergic

emergen

reaction

cy

measure

(anaphyl

s, follow

axis),

it.

even if

Otherwis

there

e, if the

are no

person

sympto

carries

ms:

an
epinephr

Difficulty breathing or wheezing

ine shot

Tightness in the throat or a feeling that the

(it's a

airways are closing

good

Hoarseness or trouble speaking

idea to

Nausea, abdominal pain, or vomiting

always

Fast heartbeat or pulse

carry

Skin that severely itches, tingles, swells, or

two) or

turns red

one is

Anxiety or dizziness

available

Loss of consciousness

:
mg. 2. Inject
Epineph
rine
Immedia
tely

Inject epinephrine if the person is unable to.

If the person has a history of anaphylaxis,

don't wait for signs of a severe reaction to inject
epinephrine.

Read and follow patient instructions

through

carefully.

routes

Inject epinephrine into outer muscle of the

other

thigh. Avoid injecting into a vein or buttock muscles.

than the

Do not inject medicine into hands or feet,

which can cause tissue damage. If this happens,

alimenta

notify emergency room staff.

ry or

The person may need more than one

respirato

injection if there's no improvement after the first. For

ry tract.

an adult, inject again after 10 to 20 minutes. For a

child, inject again after 5 to 30 minutes.

mp. Indicati

A person should always go to the ER after

ons:

an epinephrine injection, even if the symptoms

subside.

mi. 3. Do
CPR if
the
Person
Stops
Breathin
g

If patient needs fast and immediate drug

therapeutic effect

If oral or respiratory route is contraindicated

If drug effects are optimal and effective in a

parenteral route

mj. 4.
FollowUp
Make sure that someone stays with the

person for 24 hours after anaphylaxis in case of

another attack.
Report the reaction to the person's doctor.

mk.
ml.

mn.

mq. Routes:

Intradermal into the dermis

Subcutaneous into a subcutaneous tissue

Intramuscular into a muscle

Intravenous into a vein

ADVANCE DIRECTIVE- living will

Physical body of the pt
e.g organ donation, DNR status
mm.
PARENTERAL MEDICATIONS

mr. Less
frequen
tly used
sites:

mo. Parente
ral

Intra-atrial

medicat

Intracardiac

ions are

Intraosseous

drugs

Intrathecal/intraspinal

given

Epidural

Intra-articular

Withdraw the medication by initially

injecting air equivalent to the volume of

ms. Adminis

medication to be withdrawn, then invert

tration:
1.

Perform hand washing before anything else

2.

Observe the Rights in Administering

the vial, ensure that the needle tip is below

the fluid level and gradually withdraw the
medication
Ampules (consists of premixed

Medications
3.

Check doctors orders

Prepare the medications (check expiration

medications)

ampule several times

date and physical condition) and equipments

ampule to start a clean break

volume of medication to be administered)

sterile gauze around the ampule

site/route; withdraw medication from a vial or

neck and break off the top bending it

ampule into a sterile syringe (have separate

towards you

needles for withdrawal, aspiration and injection)

Antiseptic/alcohol swab

File

Sterile gauze

Vials

without touching the rim of the

ampule

intended preparation in the medicine

medication to administer (clients knowledge of

drug action and response)

There are single dose and multi

dose vials, for multi-dose vials, inspect for
integrity

Locate site of injection (appearance and

status), disinfect thereafter

package

Administer medication

Intradermal Injection

suggests) by rotating the vial between the

Explain that a small wheal

(bleb) will be produced

Mix the solution (as the package

Prepare the syringe (hold

between thumb and forefinger, hold

palms

Identify the patient properly and explain the

which needs to be reconstituted, read the

Withdraw the medication

Vials have powdered medication

Disinfect and place a

Needles (appropriate size depending on

File the neck of the

Syringe (depends on the injection site and

Flick upper stem of the

Remove protective cap or clean the

rubber cap and disinfect

the needle almost parallel to the skin

surface, bevel up)

Pull the skin at the site

(Common sites: inner lower arm, the

large blood vessels, nerves, and

upper chest, and the back beneath

bone

the scapulae)

2.5 cm to the side

until the bevel is in place through the

thumb and forefinger, pierce the skin

Stabilize the syringe and

smoothly and quickly at a 90-degree

inject the fluid until it creates a bleb

angle and insert the needle into the

Withdraw the needle,

muscle

encircle the injection site with ink for

syringe steady with non-dominant

Subcutaneous Injection

hand and aspirate (if blood appears,

Assess site (Common

withdraw the needle, continue if

sites: outer aspect of the upper arm,

otherwise)

and anterior aspects of the thighs)

smoothly at the angle of the insertion

administration (hold between thumb

for a 90 degree angle insertion)

Apply gentle pressure with

and finger, with palm facing to the

insertion or with the palm downward

Withdraw the needle

Prepare the syringe for

side or upward for a 45 degree angle

Hold the barrel of the

observation

Hold the syringe between

dermis

Pull the skin approximately

Insert the tip of the needle

Select a site away from

gauze
Intravenous injection

IV Container

Pinch the skin at site and

port, remove cover and

insert the needle

May or may not aspirate

disinfect

before injection, if blood appears,

Inject the
medication in the port

withdraw the needle, continue if

Withdraw needle

otherwise)

Mix the

Inject with a firm steady

medication and the solution in

push, withdraw needle afterwards,

wipe the site with gauze

Locate injection

Intramuscular Injection

rotating motion

Label (medication
name, solution, date and
nurses initial)

Spike the bag

with the tubing, hang and

small amount of blood (checks

regulate

for patent flow)

Existing IV Infusion

medication (comply to the

remaining IV solution is

prescribed time of medication

sufficient for adding the

administration)

medication

desired dilution of the

remove the syringe needle

equipments according to institution practice

Close the infusion

clamp

Wash hands

Observe and assess for reactions/response

Disinfect the

Discard the uncapped needle, dispose all

medication

After which,

Confirm the

medication port, insert the

to medication
Document all relevant information (time of

syringe needle and inject the

administration, name of drug, route, clients

medication

reaction)
Gently rotate the

bag or bottle and rehang.

Open clamp and

regulate

Assess effectiveness of the drug at the time

it is expected to act.
mt.
mu.

Label thereafter

IV Push

ENTERAL MEDICATION

Most drug that can be administered orally

can also be given via enteral tube

Check the IV site

Locate the

Liquid meds must be properly diluted;

usually given bolus and then followed with

medicine port, disinfect with

water(to reduce osmolality to

alcohol swab

500mOsm/kgh2o to decrease GI intolerance)

Stop the IV flow

by closing the clamp or by

Inject the

Determine if the

Aspirate a

Stop infusion when administering meds for

30mins fro absorption

simply pinching the tube above

mv.

the port

mw. Signs
Connect the

syringe to the IV system

and
sympto

ms of
BUERG
ERS
DSE:
o

Pain at the foot after exercise specifically at

the arch (in step claudication)

Pain is relieved by rest

Intense redness of the foot and absence of

pedal pulse but with normal femoral and
popliteal pulse
mx.
my. INFUSI
ON
PUMP
mz. An
external
infusion
pump is
a
medical
device
used to
deliver
fluids
into a
patients
body in
a
controlle
d
manner.
There
are
many
different
types of
infusion
pumps,
which
are used
for a
variety
of
purpose
s and in
a variety
of

environ
ments.
na. Infusion
pumps
may be
capable
of
deliverin
g fluids
in large
or small
amounts
, and
may be
used to
deliver
nutrients
or
medicati
ons
such as
insulin
or other
hormone
s,
antibiotic
s,
chemoth
erapy
drugs,
and pain
relievers
.
nb. Some
infusion
pumps
are
designe
d mainly
for
stationar
y use at
a
patients
bedside.
Others,
called
ambulat
ory
infusion
pumps,
are
designe
d to be

portable
or
wearabl
e.
nc. A
number
of
common
ly used
infusion
pumps
are
designe
d for
specializ
ed
purpose
s. These
include:

Enteral pump - A pump used to deliver liquid

nutrients and medications to a patients
digestive tract.

Patient-controlled analgesia (PCA) pump - A

pump used to deliver pain medication, which
is equipped with a feature that allows
patients to self-administer a controlled
amount of medication, as needed.

Insulin pump - A pump typically used to

deliver insulin to patients with diabetes.
Insulin pumps are frequently used in the
home.
nd. Infusion
pumps
may be
powered
electrical
ly or
mechani
cally.
Different
pumps
operate
in
different
ways.
For
example
:

In a syringe pump, fluid is held in the

reservoir of a syringe, and a moveable piston
controls fluid delivery.

In an elastomeric pump, fluid is held in a

stretchable balloon reservoir, and pressure
from the elastic walls of the balloon drives
fluid delivery.

In a peristaltic pump, a set of rollers pinches

down on a length of flexible tubing, pushing
fluid forward.

In a multi-channel pump, fluids can be

delivered from multiple reservoirs at multiple
rates.

A "smart pump" is equipped with safety

features, such as user-alerts that activate
when there is a risk of an adverse drug
interaction, or when the user sets the pump's
parameters outside of specified safety limits.
ne. JUVE
NILE
RHEU
MATOI
D
ARTH
RITIS
nf. Juvenil
e
pertains
to
childhoo
d,
immaturi
ty, or
youth.
ng. Rheuma
toid a
nodule
or other
skin
eruption
that may
accomp
any
rheumati
sm.
nh. Arthritis

inflamm
ation of
a joint,
often

accomp
anied by
pain,
swelling,
stiffness,
and
structura
l
changes
.

ni.
Chronic inflammation of the synovium with
joint effusion.
Primarily involves the joints of the body.
Although it also affects blood vessels and
other connective tissues.
Cause is unknown.
Probably an autoimmune process or the
child has developed circulating antibodies
(immunoglobulins) against his or her own
body cells.

nj.
nk. Occurs two time in childhood:
1 to 3 years
8 to12 years
nl.
nm. To be classified as JRA, symptoms must:
Begin before 16 years of age and last longer
than 3 months.
nn.
no. 3 types
of JRA
np.
Polyarticular Juvenile Rheumatoid Arthritis
Monoarticular or Pauciarticular Juvenile
Rheumatoid Arthritis
Systemic Juvenile Rheumatoid Arthritis.
nq.
nr. PATHO
PHYSIO
LOGY
T cells are activated and cause development
of antigen antibody complexes that release
cytokines into specific organs such as joints
and skin.
JRA is characterized by inflammation of the
synovium with joint effusion and eventual
destruction of the articular cartilage lasting 6
weeks or longer.
ns.
nt. RISK
FACTO
RS
More common in females.

Children as young as 6 months.

nu.
nv. ASSES
SMENT
nw.
The effect their disease is having on self
care such as eating, dressing, ambulating,
toileting etc.
Child and parents understanding of the
illness and planned therapy.
Signs and symptoms of the disease.
nx.
ny. SIGNS
AND
SYMPT
OMS
Persistent fever and rash. (before joint
involvement is present)
Fatigue
Malaise
Anorexia
Weight loss
Lymphadenopathy
localized articular symptoms
- fingers at proximal interphalangeal (PIP)
- metacarpophalengeal joints (MCP)
- metatarsophalangeal joints
- also may extend to wrists, knees,
elbows, and ankles.
nz.
oa. DIAGN
OSTIC
EXAMS
X-ray
Synovial Fluid analysis
WBC count
Serum Protein Electrophoresis
Erythrocyte Sedimentation
CBC
C-reactive Protein Test
ob.
oc. MEDICA
TIONS
Salicylates (particularly aspirin)
Nonsteroidal anti-nfalmmatory
(indomethacin, fenoprofen, and ibuprofen)
Anitmalarials (hydroxychloroquine)
Golds salts
Penisillamine
Corticosteroids (prednisone)
od.
oe. Nursing
Diagnosis

oh.

ok.
oi.

oo.
ol.
om.

on.
oj.

or.
os. TREAT
MENT
Synovectomy
Joint reconstruction
Total joint arthroplasty
ot.
ou. THERA
PEUTIC
MANAG
EMENT
Exercise
Heat application
Splinting
Nutrition
Medication
ov.
ow. NURSIN
G
INTERV
ENTION
S
If the patient requires knee or hip
arthroplasty, provide appropriate teaching
and postoperative care.
Inspect all joints carefully for deformities,
contractures, immobility and inability to
perform everyday activities.
Monitor vital signs and note weight changes,
sensry disturbances and level of pain.
Give maticulous skin care.
Encourage patient to eat a balanced diet.
Explain all diagnostic tests and procedures
to parents.
Monitor the duration not the intensity of
morning stiffness.
Explain the nature of RA to the parents.
Urge the patient to perform activites of daily
living such as dressing and feeding
him/herself etc, resting for 5 to 10mins ou of
each hour and alternating sitting and
standing tasks.
Before discharge, make sure the parent
knows how and when to give the prescribed

medication and how to reorganize its

possible adverse effects.
Teach the patient how to stand, walk and sit
correctly: upright and erect.
ox.
oy. EXPEC
TED
OUTCO
ME
Parents of the patient will verbalize
understanding of the condition.
Patient will be able to perform activities such
as walking, feeding him/herself
independently.
Pain will decrease.
Patients mobility will increase.
Inflammation will decrease.
oz.
pa. EVALUA
TION
Increase in mobility.
Decrease in pain and inflammation.
No longer feel uncomfortable.
Weight returned to normal.
pb.
pc. THROM
BOPHL
EBITIS
RISK
FACTO
RS
Immobility
arms or legs paralyzed
Have a pacemaker or have a thin, flexible
tube (catheter) in a central vein, for
treatment of a medical condition, which may
irritate the blood vessel wall and decrease
blood flow
Are pregnant or have just given birth, which
may mean you have increased pressure in
the veins of your pelvis and legs
Use birth control pills or hormone
replacement therapy, which may make your
blood more likely to clot
Have a family history of a blood-clotting
disorder or a tendency to form blood clots
easily
Are inactive for a long period of time, such
as from sitting in a car or an airplane
Are older than 60
Have varicose veins, which are a common
cause of superficial thrombophlebitis
pd.

pe. ELDERL
Y
PROGR
AM OF
DOH
1999
pf. Cogniza
nt of its
mandate
and
crucial
role, the
Philippin
e
Departm
ent of
Heallth
(DOH)
formulat
ed the
Health
Care
Program
for Older
Persons
(HCPOP
)
in
1998.
The
DOH
HCPOP
(presentl
y
renamed
Health
Develop
ment
Program
for Older
Persons
) sets
the
policies,
standard
s and
guidelin
es for
local
governm
ents to
impleme
nt the
program
in
collabor

ation
with
other
governm
ent
agencie
s, nongovernm
ent
organiza
tions
and the
private
sector.
pg. The
program
intends
to
promote
and
improve
the
quality
of life of
older
persons
through
the
establish
ment
and
provisio
n
of
basic
health
services
for older
persons,
formulati
on
of
policies
and
guidelin
es
pertainin
g
to
older
persons,
provisio
n
of
informati
on and
health
educatio
n to the

public,
provisio
n
of
basic
and
essential
training
of
manpow
er
dedicate
d
to
older
persons
and, the
conduct
of basic
and
applied
research
es.
ph. Target
Populati
on/Clien
ts
pi. 1. Older
persons
(60
years
and
above)
who are:
a. Well
and free
from
sympto
ms
b. Sick
and frail
c.
Chronic
ally ill
and
cognitive
ly
impaired
d. In
need of
rehabilit
ation
services
2.
Health
workers

and
caregive
rs
3. LGU
and
partner
agencie
s
pj. Area of
Covera
ge
pk. Nationwi
de
pl. Mandat
e
pm. Internati
onal:

Vienna International Plan of Action on

Ageing
General Assembly Resolutions
pn. Local:

Philippine Constitution (Article XIII,

Section XI)

Republic Act 7876 - Senior Citizens

Center Act of the Philippines

Republic Act No. 7432 - An Act to

Maximize the Contribution of Senior Citizens
to Nation Building, Grant Benefits and
Special Privileges and for Other Purposes

Proclamation No. 470 - Declaring the

1st week of October every year as "Elderly
Filipino Week"

Philippine Plan of action for Older

Persons (1999-2004)
po. Vision
pp. Healthy
ageing
for all
Filipinos.

pq. Goal

pu.

pr.

pv.

A
healthy
and
producti
ve older
populati
on is
promote
d.

pw.
px.
py.
pz.
qa.

ps.
pt.

qb.

qc.

qd.

qe.

qf.

qg.

qh.
qi.
qj.
qk.
ql.
qm.
qn.
qo.
qp.
qq.
qr.
qs.
qt.
qu.
qv.
qw.
qx.
qy.
qz.
ra.
rb.
rc.
rd.
re.
rf.
rg.
rh.
ri.
rj.
rk.
rl.
rm.
rn.
ro.
rp.
rq.
rr.
rs.
rt.
ru.
rv.
rw.
rx.
ry.
rz.
sa.
sb.
sc.
sd.
se.
sf.
sg.
sh.
si.
sj.
sk.

sl.
sm.
sn.
so.
sp.
sq.
sr.
ss.
st.
su.
sv.
sw.
sx.
sy.
sz.
ta.
tb.
tc.
td.
te.
tf.
tg.
th.
ti.
tj.
tk.
tl.
tm.
tn.
to.
tp.
tq.
tr.
ts.
tt.
tu.
tv.
tw.
tx.
ty.
tz.
ua.
ub.
uc.
ud.
ue.
uf.
ug.
uh.
ui.
uj.
uk.
ul.
um.
un.
uo.

Bradycardia
Bradypnea
Alcohol:
HR
RR
BP
LOC
Coma

Pupil constriction
Cocaine HR
Constipation
RR
HPON
BP
Coma
LOC
Asleep
Seizure
Wt gain

up.
uq.
ur.

COGNITIVE D/O:
us.
De
lirium
uu. acute
uv.
reversible
uw. good
prognosis
ux.
abrupt
memory
loss
uy.
hallucinati
ons

ut.
Dem
entia
uz.
out of
ones mind
va.
- 70
subtypes
vb.
most
common:
Alzheimers
Dse
vc.
can either
be
reversible,
irreversible
vd.
poor
prognosis
ve.
gradual
memory
loss
vf.
misidentific
ation

vg.
Classic s/sx to both:
3. Sundowning- disorientation at late afternoon
4. Empty nest syndrome- depression
vh.
Mngt:
1. Orientation
2. Safety
3. Structured Environment
4. Defense Mech. confabulation
5. Meds: anticholinesterase decrease VS- calm
vi.
C: Cognex
vj.
A: Aricept
vk.
R: Reminyl
vl.
E: Exelon
vm.
2.
Substance Abuse
vn.
DOWNERS ( ABONaMa INE)
vo.
A: alcohol
Morph
vp.
B: barbiturates
Code
vq.
O: opiates
Hero
vr.
Na: narcotics
vs.
Ma: marijuana
vt.
Antidote: NARCAN
vu.
UPPERS ( CHA)
vv.
C: Cocaine
vw.
H: hallucinogens
vx.
A: amphetamines

INE

Euphoria
NARCAN
Tachycardia
Tachypnea
Pupil dilation
Dry mouth
HPN
Seizure
Awake
Wt loss

Detoxificati
on- MD
supervision
Meds:
Methadone

Withdrawalopposite of
overdose

vy.
vz.
wa.
wb.
wc.