FUNDAMENTALS OF NURSING e.

Melchora Aquino (Tandang Sora) –

Nurse the wounded Filipino soldiers and
NURSING- As defined by the INTERNATIONAL gave them shelter and food.
COUNCIL OF NURSES as written by Virginia f. Captain Salome – A revolutionary
Henderson. leader in Nueva Ecija; provided nursing
care to the wounded when not in
“The unique function of the nurse is to assist combat.
the individual, sick or well, in the performance g. Agueda Kahabagan – Revolutionary
of those activities contributing to health, its leader in Laguna, also provided nursing
recovery, or to a peaceful death. The client services to her troop.
will perform these activities unaided if he had h. Trinidad Tecson – “Ina ng Biac na
the necessary strength, will or knowledge. Bato”, stayed in the hospital at Biac na
Nurses help the client gain independence as Bato to care for the wounded soldier.
rapidly as possible. Hospitals and Nursing Schools
1. Iloilo Mission Hospital School of Nursing
The Earliest Hospitals Established were the (Iloilo City, 1906)
following:  It was ran by the Baptist Foreign
a. Hospital Real de Manila (1577). It was Mission Society of America.
established mainly to care for the  Miss Rose Nicolet, a graduate of
Spanish King’s soldiers, but also New England Hospital for woman and
admitted Spanish civilians. Founded by children in Boston, Massachusetts,
Gov. Francisco de Sande was the first superintendent.
b. San Lazaro Hospital (1578) – built  Miss Flora Ernst, an American
exclusively for patients with leprosy. nurse, took charge of the school in
Founded by Brother Juan Clemente 1942.
c. Hospital de Indio (1586) –Established by 2. St. Paul’s Hospital School of Nursing
the Franciscan Order; Service was in (Manila, 1907)
general supported by alms and  The hospital was established by the
contribution from charitable persons. Archbishop of Manila, The Most
d. Hospital de Aguas Santas (1590). Reverend Jeremiah Harty, under the
Established in Laguna, near a medicinal supervision of the Sisters of St. Paul
spring, Founded by Brother J. Bautista of de Chartres.
the Franciscan Order.  It was located in Intramuros and it
e.San Juan de Dios Hospital (1596) provided general hospital services.
Founded by the Brotherhood de 3. Philippine general Hospital School of
Misericordia and support was derived from Nursing (1907)
alms and rents. Rendered general health  In 1907, with the support of the
service to the public. Governor General Forbes and the
Nursing During the Philippine Revolution Director of Health and among others,
The prominent persons involved in the she opened classes in nursing under
nursing works were: the auspices of the Bureau of
a. Josephine Bracken – wife of Jose Education.
Rizal. Installed a field hospital in an  Anastacia Giron-Tupas, was the
estate house in Tejeros. Provided first Filipino to occupy the position of
nursing care to thw wounded night and chief nurse and superintendent in
day. the Philippines, succeded her.
b. Rosa Sevilla De Alvero – converted 4. St. Luke’s Hospital School of Nursing
their house into quarters for the filipino (Quezon City, 1907)
soldier,during the Philippine-American  The Hospital is an Episcopalian
war that broke out in 1899. Institution. It began as a small
c. Dona Hilaria de Aguinaldo – Wife of dispensary in 1903. In 1907, the
Emilio Aguinaldo; Organized the school opened with three Filipino
Filipino Red Cross under the inspiration girls admitted.
of Apolinario Mabini.  Mrs. Vitiliana Beltran was the first
d. Dona Maria de Aguinaldo- second Filipino superintendent of nurses.
wife of Emilio Aguinaldo. Provided 5. Mary Johnston Hospital and School of
nursing care for the Filipino soldier Nursing (Manila, 1907)
during the revolution. President of the  It started as a small dispensary on Calle
Filipino Red Cross branch in Batangas. Cervantes (now Avenida)

1
  It was called Bethany Dispensary and was 3. The need for affection: to associate or to
founded by the Methodist Mission. belong
 Miss Librada Javelera was the first Filipino 4. The need to establish fruitful and
director of the school. meaningful relationships with people,
6. Philippine Christian mission Institute institution, or organization
School of Nursing. Self-Esteem Needs
The United Christian Missionary of Indianapolis, 1. Self-worth
operated Three schools of Nursing: 2. Self-identity
1. Sallie Long Read Memorial Hospital 3. Self-respect
School of Nursing (Laoag, Ilocos Norte,1903) 4. Body image
2. Mary Chiles Hospital school of Nursing Self-Actualization Needs
(Manila, 1911) 1. The need to learn, create and understand or
3. Frank Dunn Memorial hospital comprehend
7. San Juan de Dios hospital School of 2. The need for harmonious relationships
Nursing (Manila, 1913) 3. The need for beauty or aesthetics
8. Emmanuel Hospital School of Nursing 4. The need for spiritual fulfillment
(Capiz,1913) Characteristics of Basic Human Needs
9. Southern Island Hospital School of 1. Needs are universal.
Nursing (Cebu, 1918) 2. Needs may be met in different ways
 The hospital was established under the 3. Needs may be stimulated by external and
Bureau of Health with Anastacia Giron- internal factor
Tupas as the organizer. 4. Priorities may be deferred
5. Needs are interrelated
The First Colleges of Nursing in the Concepts of health and Illness
Philippines HEALTH
 University of Santo Tomas .College of 1. Is the fundamental right of every human
Nursing (1946) being. It is the state of integration of the
 Manila Central University College of body and mind
Nursing (1948) 2. Health and illness are highly individualized
 University of the Philippines College of perception. Meanings and descriptions of
Nursing (1948). Ms. Julita Sotejo was its health and illness vary among people in
first Dean relation to geography and to culture.
The Basic Human Needs 3. Health - is the state of complete physical,
 Each individual has unique characteristics, mental, and social well-being, and not
but certain needs are common to all merely the absence of disease or infirmity.
people. (WHO)
 A need is something that is desirable, 4. Health – is the ability to maintain the
useful or necessary. internal milieu. Illness is the result of failure
 Human needs are physiologic and to maintain the internal environment.
psychologic conditions that an individual (Claude Bernard)
must meet to achieve a state of health or 5. Health – is the ability to maintain
well-being. homeostasis or dynamic equilibrium.
Maslow’s Hierarchy of Basic Human Needs Homeostasis is regulated by the negative
Physiologic feedback mechanism.(Walter Cannon)
1. Oxygen 6. Health – is being well and using one’s
2. Fluids power to the fullest extent. Health is
3. Nutrition maintained through prevention of diseases
4. Body temperature via environmental health factors.(Florence
5. Elimination Nightingale)
6. Rest and sleep 7. Health – is viewed in terms of the
7. Sex individual’s ability to perform 14
Safety and Security components of nursing care unaided.
1. Physical safety (Henderson)
2. Psychological safety 8. Positive Health – symbolizes wellness. It is
3. The need for shelter and freedom from value term defined by the culture or
harm and danger individual. (Rogers)
Love and belonging 9. Health – is a state of a process of being
1. The need to love and be loved becoming an integrated and whole as a
2. The need to care and to be cared for. person.(Roy)

2
 10. Health – is a state the characterized by  The person becomes a client dependent on
soundness or wholeness of developed the health professional for help.
human structures and of bodily and  Accepts/rejects health professional’s
mental functioning.(Orem) suggestions.
11. Health- is a dynamic state in the life  Becomes more passive and accepting.
cycle; illness is interference in the life 5. Recovery/Rehabilitation
cycle. (King) Gives up the sick role and returns to former
12. Wellness – is the condition in which all roles and functions.
parts and subparts of an individual are in Risk Factors of a Disease
harmony with the whole system. 1. Genetic and Physiological Factors
(Neuman)  For example, a person with a family history
13. Health – is an elusive, dynamic state of diabetes mellitus is at risk in developing
influenced by biologic, psychologic, and the disease later in life.
social factors. Health is reflected by the 2. Age
organization, interaction, interdependence  Age increases and decreases susceptibility (
and integration of the subsystems of the risk of heart diseases increases with age for
behavioral system.(Johnson) both sexes
Illness and Disease 3. Environment
Illness  The physical environment in which a person
 Is a personal state in which the person works or lives can increase the likelihood
feels unhealthy. that certain illnesses will occur.
 Illness is a state in which a person’s 4. Lifestyle
physical, emotional, intellectual, social,  Lifestyle practices and behaviors can also
developmental, or spiritual functioning is have positive or negative effects on health.
diminished or impaired compared with Classification of Diseases
previous experience. 1. According to Etiologic Factors
 Illness is not synonymous with disease. a. Hereditary – due to defect in the genes
of one or other parent which is
Disease transmitted to the
 An alteration in body function resulting in i. offspring
reduction of capacities or a shortening of b. Congenital – due to a defect in the
the normal life span. development, hereditary factors, or
Common Causes of Disease prenatal infection
1. Biologic agent – e.g. microorganism c. Metabolic – due to disturbances or
2. Inherited genetic defects – e.g. cleft palate abnormality in the intricate processes of
3. Developmental defects – e.g. imperforate metabolism.
anus d. Deficiency – results from inadequate
4. Physical agents – e.g. radiation, hot and intake or absorption of essential dietary
cold substances, ultraviolet rays factor.
5. Chemical agents – e.g. lead, asbestos, e. Traumatic- due to injury
carbon monoxide f. Allergic – due to abnormal response of
6. Tissue response to irritations/injury – e.g. the body to chemical and protein
inflammation, fever substances or to physical stimuli.
7. Faulty chemical/metabolic process – e.g. g. Neoplastic – due to abnormal or
inadequate insulin in diabetes uncontrolled growth of cell.
8. Emotional/physical reaction to stress – e.g. h. Idiopathic –Cause is unknown; self-
fear, anxiety originated; of spontaneous origin
Stages of Illness i. Degenerative –Results from the
1. Symptoms Experience- experience some degenerative changes that occur in the
symptoms, person believes something is tissue and organs.
wrong j. Iatrogenic – result from the treatment
3 aspects –physical, cognitive, of the disease
emotional 2. According to Duration or Onset
2. Assumption of Sick Role – acceptance of a. a. Acute Illness – An acute illness
illness, seeks advice usually has a short duration and is
3. Medical Care Contact severe. Signs and symptoms appear
Seeks advice to professionals for abruptly, intense and often subside after
validation of real illness, explanation of a relatively short period.
symptoms, reassurance or predict of outcome b. Chronic Illness – chronic illness usually
4. Dependent Patient Role longer than 6 months, and can also

3
 affects functioning in any dimension. -use of environmental sanitation
The client may fluctuate between -protection against occupational
maximal functioning and serious hazards
relapses and may be life threatening. -protection from accidents
Is is characterized by remission and -use of specific nutrients
exacerbation. -protections from carcinogens
 Remission- periods during which -avoidance to allergens
the disease is controlled and b. Secondary Prevention – also known as
symptoms are not obvious. “Health Maintenance”. Seeks to identify
 Exacerbations – The disease specific illnesses or conditions at an early
becomes more active given again stage with prompt intervention to prevent or
at a future time, with recurrence of limit disability; to prevent catastrophic
pronounced symptoms. effects that could occur if proper attention
c. Sub-Acute – Symptoms are and treatment are not
pronounced but more prolonged than provided.
the acute disease.  Early Diagnosis and Prompt
3. Disease may also be Described as: Treatment
a. Organic – results from changes in the -case finding measures
normal structure, from recognizable -individual and mass screening
anatomical changes in an organ or survey
tissue of the body. -prevent spread of
b. Functional – no anatomical changes communicable disease
are observed to account from the -prevent complication and
symptoms present, may result from sequelae
abnormal response to stimuli. -shorten period of disability
c. Occupational – Results from factors  Disability Limitations
associated with the occupation engage - adequate treatment to arrest
in by the patient. disease process and prevent further
d. Venereal – usually acquired through complication and sequelae.
sexual relation -provision of facilities to limit
e. Familial – occurs in several individuals disability and prevent death.
of the same family c. Tertiary Prevention – occurs after a
f. Epidemic – attacks a large number of disease or disability has occurred and the
individuals in the community at the recovery process has begun; Intent is to halt
same time. (e.g. SARS) the disease or injury process and assist the
g. Endemic – Presents more or less person in obtaining an optimal health status. To
continuously or recurs in a community. establish a high-level wellness.
(e.g. malaria, goiter) “To maximize use of remaining capacities’
h. Pandemic –An epidemic which is  Restoration and Rehabilitation
extremely widespread involving an -work therapy in hospital
entire country or continent. - Use of shelter colony
i. Sporadic – a disease in which only
occasional cases occur. (e.g. dengue, CONCEPTUAL AND THEORETICAL
leptospirosis) MODELS OF NURSING PRACTICE
Leavell and Clark’s Three Levels of
Prevention A. NIGHTANGLE’S THEORY ( mid-1800)
a. Primary Prevention – seeks to  Focuses on the patient and his environment.
prevent a disease or condition at a  Developed the described the first theory of
prepathologic state; to stop nursing. Notes on Nursing: What It Is, What
something from ever happening. It Is Not. She focused on changing and
 Health Promotion manipulating the environment in order to
-health education put the patient in the best possible
-marriage counseling conditions for nature to act.
-genetic screening  She believed that in the nurturing
-good standard of nutrition environment, the body could repair itself.
adjusted to developmental phase Client’s environment is manipulated to
of life include appropriate noise, nutrition,
 Specific Protection hygiene, socialization and hope.
-use of specific immunization B. PEPLAU, HILDEGARD (1951)
-attention to personal hygiene

4
Defined nursing as a therapeutic, interpersonal integrity, conservation of personal
process which strives to develop a nurse- patient integrity, conservation of social integrity.
relationship in which the nurse serves as a
resource person, counselor and surrogate.  Described the Four Conversation
Introduced the Interpersonal Principles. She advocated that nursing
Model. She defined nursing as an interpersonal is a human interaction and proposed
process of therapeutic between an individual who four conservation principles of nursing
is sick or in need of health services and a nurse which are concerned with the unity and
especially educated to recognize and respond to integrity of the individual. The four
the need for help. She identified four phases conservation principles are as follows:
of the nurse client relationship namely: 1. Conservation of energy. The human body
1. Orientation: the nurse and the client functions by utilizing energy. The human body
initially do not know each other’s goals needs energy producing input (food,
and testing the role each will assume. oxygen, fluids) to allow energy utilization
The client attempts to identify difficulties and output.
the amount of nursing help that is needed; 2. Conservation of Structural Integrity. The
2. Identification: the client responds to help human body has physical boundaries (skin and
professionals or the significant others who can mucous membrane) that must be maintained
meet the identified needs. Both the client to facilitate health and prevent harmful agents
and the nurse plan together an from entering the body.
appropriate program to foster health; 3. Conservation of Personal Integrity. The
3. Exploitation: the clients utilize all nursing interventions are based on the
available resources to move toward a conservation of the individual client’s
goal of maximum health functionality; personality. Every individual has sense of
4. Resolution: refers to the termination identity, self worth and self esteem, which
phase of the nurse-client relationship. it must be preserved and enhanced by nurses.
occurs when the client’s needs are met 4. Conservation of Social integrity. The social
and he/she can move toward a new goal. integrity of the client reflects the family
Peplau further assumed that nurse-client and the community in which the client
relationship fosters growth in both the client functions. Health care institutions may separate
and the nurse. individuals from their family. It is important for
nurses to consider the individual in the context
C. ABDELLAH, FAYE G. (1960) of the family.
 Defined nursing as having a problem-
solving approach, with key nursing E. JOHNSON, DOROTHY (1960, 1980)
problems related to health needs of  Focuses on how the client adapts to
people; developed list of 21 illness; the goal of nursing is to reduce
nursing-problem areas. stress so that the client can move more
 Introduced Patient – Centered easily through recovery.
Approaches to Nursing Model She  Viewed the patient’s behavior as a
defined nursing as service to individual system, which is a whole with interacting
and families; therefore the society. parts.
Furthermore, she conceptualized  The nursing process is viewed as a
nursing as an art and a science that major tool.
molds the attitudes, intellectual Conceptualized the Behavioral System Model.
competencies and technical skills of According to Johnson, each person as a behavioral
the individual nurse into the desire and system is composed of seven subsystems namely:
ability to help people, sick or well, and 1. Ingestive. Taking in nourishment in socially
cope with their health needs. and culturally acceptable ways.
2. Eliminative. Riddling the body of waste in
socially and culturally acceptable ways.
D. LEVINE, MYRA (1973) 3. Affiliative. Security seeking behavior.
4. Aggressive. Self – protective behavior.
 Believes nursing intervention is a 5. Dependence. Nurturance – seeking behavior.
conservation activity, with 6. Achievement. Master of oneself and one’s
conservation of energy as a primary environment according to internalized
concern, four conservation principles standards of excellence.
of nursing: conservation of client 7. Sexual role identity behavior
energy, conservation of structured
F. ROGERS, MARTHA

5
  Considers man as a unitary human being J. SIS CALLISTA ROY (Adaptation Theory)
co-existing with in the universe, views (1979, 1984)
nursing primarily as a science and is  Views the client as an adaptive
committed to nursing research. system. The goal of nursing is to help
the person adapt to changes in
G. OREM, DOROTHEA (1970, 1985) physiological needs, self-concept,
role function and interdependent
 Emphasizes the client’s self-care needs, relations during health and illness.
nursing care becomes necessary when  Presented the Adaptation Model.
client is unable to fulfill biological, She viewed each person as a
psychological, developmental or social unified biopsychosocial system in
needs. constant interaction with a changing
 Developed the Self-Care Deficit Theory. environment. She contented that the
She defined self-care as “the practice of person as an adaptive system,
activities that individuals initiate to functions as a whole through
perform on their own behalf in maintaining interdependence of its part. The
life, health well-being.” She system consists of input, control
conceptualized three systems as follows: processes, output feedback.
1. Wholly Compensatory: when the
nurse is expected to accomplish all K. LYDIA HALL (1962)
the patient’s therapeutic self-care  The client is composed of the ff.
or to compensate for the patient’s overlapping parts: person (core),
inability to engage in self care or pathologic state and treatment
when the patient needs continuous (cure) and body (care).
guidance in self care;  Introduced the model of Nursing:
What Is It?, focusing on the notion
2. Partially Compensatory: when that centers around three
both nurse patient engage in components of CARE, CORE and
meeting self care needs; CURE. Care represents nurturance
3. Supportive-Educative: the and is exclusive to nursing. Core
system that requires assistance involves the therapeutic use of self
decision making, behavior control and emphasizes the use of reflection.
and acquisition knowledge and Cure focuses on nursing related to
skills. the physician’s orders. Core and cure
are shared with the other health care
H. IMOGENE KING (1971, 1981) providers.
 Nursing process is defined as
dynamic interpersonal process L. Virginia Henderson (1955)
between nurse, client and health  Introduced The Nature of Nursing Model.
care system. She identified fourteen basic needs.
 Postulated the Goal Attainment  She postulated that the unique function of
Theory. She described nursing as the nurse is to assist the clients, sick or well,
a helping profession that assists in the performance of those activities
individuals and groups in society to contributing to health or its recovery, the
attain, maintain, and restore clients would perform unaided if they had
health. If is this not possible, the necessary strength, will or knowledge.
nurses help individuals die with  She further believed that nursing involves
dignity. assisting the client in gaining independence
 In addition, King viewed nursing as as rapidly as possible, or assisting him
an interaction process between achieves peaceful death if recovery is no
client and nurse whereby during longer possible.
perceiving, setting goals, and
acting on them transactions M. Madaleine Leininger (1978, 1984)
occurred and goals are achieved.  Developed the Transcultural Nursing
Model. She advocated that nursing is a
I. BETTY NEUMAN humanistic and scientific mode of helping a
 Stress reduction is a goal of system client through specific cultural caring
model of nursing practice. Nursing processes (cultural values, beliefs and
actions are in primary, secondary practices) to improve or maintain a health
or tertiary level of prevention. condition.

6
  Nursing is viewed as a lived dialogue that
N. Ida Jean Orlando (1961) involves the coming together of the nurse
 Conceptualized The Dynamic Nurse – and the person to be nursed.
Patient Relationship Model.  The essential characteristic of nursing is
 She believed that the nurse helps patients nurturance. Humanistic care cannot take
meet a perceived need that the patient place without the authentic commitment of
cannot meet for themselves. Orlando the nurse to being with and the doing with
observed that the nurse provides direct the client. Humanistic nursing also
assistance to meet an immediate need for presupposes responsible choices.
help in order to avoid or to alleviate
distress or helplessness. S. Helen Erickson, Evelyn Tomlin, and Mary
 She emphasized the importance of Ann Swain (1983)
validating the need and evaluating care  Developed Modeling and Role Modeling
based on observable outcomes. Theory. The focus of this theory is on the
person. The nurse models (assesses), role
O. Ernestine Weidanbach (1964) models (plans), and intervenes in this
 Developed the Clinical Nursing – A interpersonal and interactive theory.
Helping Art Model.  They asserted that each individual unique,
 She advocated that the nurse’s individual has some self-care knowledge, needs
philosophy or central purpose lends simultaneously to be attached to the
credence to nursing care. separate from others, and has adaptive
 She believed that nurses meet the potential. Nurses in this theory, facilitate,
individual’s need for help through the nurture and accept the person
identification of the needs, administration unconditionally.
of help, and validation that actions were T. Margaret Newman
helpful. Components of clinical practice:  Focused on health as expanding
Philosophy, purpose, practice and an art. consciousness. She believed that human
are unitary in whom disease is a
P. Rosemarie Rizzo Parse (1979-1992) manifestation of the pattern of health.
 Introduced the theory of Human  She defined consciousness as the
Becoming. She emphasized free choice of information capability of the system which is
personal meaning in relating value influenced by time, space movement and is
priorities, co – creating the rhythmical ever – expanding.
patterns, in exchange with the U. Patricia Benner and Judith Wrudel (1989)
environment, and co transcending in  Proposed the Primacy and Caring Model.
many dimensions as possibilities unfold. They believed that caring central to the
essence of nursing. Caring creates the
Q. Joyce Travelbee (1966,1971) possibilities for coping and creates the
 She postulated the Interpersonal possibilities for connecting with and concern
Aspects of Nursing Model. She for others.
advocated that the goal of nursing
individual or family in preventing or coping V. Anne Boykin and Savina Schoenhofer
with illness, regaining health finding  Presented the grand theory of Nursing as
meaning in illness, or maintaining Caring. They believed that all person are
maximal degree of health. caring, and nursing is a response to a
 She further viewed that interpersonal unique social call. The focus of nursing is on
process is a human-to-human relationship nurturing person living and growing in
formed during illness and “experience of caring in a manner that is specific to each
suffering” nurse-nursed relationship or nursing
 She believed that a person is a unique, situation. Each nursing situation is original.
irreplaceable individual who is in a  They support that caring is a moral
continuous process of becoming, evolving imperative. Nursing as Caring is not based
and changing. on need or deficit but is egalitarian model
R. Josephine Peterson and Loretta Zderad helping.
(1976) Moral Theories
 Provided the Humanistic Nursing 1. Freud (1961)
Practice Theory. This is based on their  Believed that the mechanism for
belief that nursing is an existential right and wrong within the individual
experience. is the superego, or conscience. He
hypnotized that a child internalizes

7
 and adopts the moral standards aspect or moral development.
and character or character traits of And that virtues or character traits
the model parent through the can be learned from others and
process of identification. encouraged by the example of
 The strength of the superego others.
depends on the intensity of the  Also, Peters believed that some can
child’s feeling of aggression or be described as habits because they
attachment toward the model are in some sense automatic and
parent rather than on the actual therefore are performed habitually,
standards of the parent. such as politeness, chastity, tidiness,
2. Erikson (1964) thrift and honesty.
 Erikson’s theory on the 5. Gilligan (1982)
development of virtues or  Included the concepts of caring and
unifying strengths of the “good responsibility. She described three stages
man” suggest that moral in the process of developing an “Ethic of
development continuous Care” which are as follows.
throughout life. He believed that if 1. Caring for oneself.
the conflicts of each psychosocial 2. Caring for others.
developmental stages favorably 3. Caring for self and others.
resolved, then an ‘ego-strength” or  She believed the human see morality in
virtue emerges. the integrity of relationships and
3. Kohlberg caring. For women, what is right is taking
 Suggested three levels of moral responsibility for others as self-chosen
development. He focused on the decision. On the other hand, men consider
reason for the making of a what is right to be what is just.
decision, not on the morality of the
decision itself. Spiritual Theories
1. At first level called the premolar or 1. Fowler (1979)
the preconventional level, children are  Described the development of faith. He
responsive to cultural rules and labels of believed that faith, or the spiritual
good and bad, right and wrong. However dimension is a force that gives meaning to a
children interpret these in terms of the person’s life.
physical consequences of the actions, i.e.,  He used the term “faith” as a form of
punishment or reward. knowing a way of being in relation “to an
2. At the second level, the conventional ultimate environment.” To Fowler, faith is a
level, the individual is concerned about relational phenomenon: it is “an active
maintaining the expectations of the made-of-being-in-relation to others in which
family, groups or nation and sees this as we invest commitment, belief, love, risk and
right. hope.”
3. At the third level, people make
postconventional, autonomous, or 2. Westerhof
principal level. At this level, people make Proposed that faith is a way of behaving. He
an effort to define valid values and developed a four-stage theory of faith
principles without regard to outside development based largely on his life
authority or to the expectations of others. experiences and the interpretation of those
These involve respect for other human experienced.
and belief that relationships are based
on mutual trust. ROLES AND FUNCTIONS OF THE NURSE
4. Peter (1981)  Care giver
 Proposed a concept of rational  Decision-maker
morality based on principles.  Protector
Moral development is usually  Client Advocate
considered to involve three  Manager
separate components: moral  Rehabilitator
emotion (what one feels), moral  Comforter
judgment (how one reasons), and  Communicator
moral behavior (how one acts).  Teacher
 In addition, Peters believed that  Counselor
the development of character  Coordinator
traits or virtues is an essential  Leader

8
  Role Model  Nurse educator is employed in nursing
 Administrator programs, at educational institutions, and in
hospital staff education.
Selected Expanded Career Roles of  The nurse educator usually ha a
Nurses baccalaureate degree or more advanced
1. Nurse Practitioner preparation and frequently has expertise in
 A nurse who has an advanced a particular area of practice. The nurse
education and is a graduate of a educator is responsible for classroom
nurse practitioner program. and clinical teaching.
 These nurses are in areas as adult 6. Nurse Entrepreneur
 A nurse who usually has an advanced
nurse practitioner, family nurse
practitioner, school nurse degree and manages a health-related
practitioner, pediatric nurse business.
 The nurse may be involved in education,
practitioner, or gerontology nurse
practitioner. consultation, or research, for example.
 They are employed in health care
agencies or community based Nursing Process
settings. They usually deal with A deliberate, problem-solving approach to meeting the
non-emergency acute or chronic health care & nursing needs of patients” -Sandra Nettina
illness and provide primary  The most efficient way to accomplish
personalized care in a time of exploding
ambulatory care.
knowledge and rapid social change. It assists in
2. Clinical Nurse Specialist solving or alleviating both simple and complex
 A nurse who has an advanced degree or nursing problems. Changing, expanding, more
expertise and is considered to be an responsible role demands knowledgeably
expert in a specialized area of practice planned, purposeful, and accountable action by
(e.g., gerontology, oncology). nurses
 The nurse provides direct client care, Steps in the Nursing Process (ADPIE)
educates others, consults, conducts 1. Assessment : Collection of personal, social,
research, and manages care. medical, and general data
 The American Nurses Credentialing Center a. Sources: Primary (client and diagnostic test
provides national certification of clinical results) and secondary (family, colleagues, Kardex,
specialists. literature)
b. Methods
3. Nurse Anesthetist  Interviewing formally (nursing health
 A nurse who has completed advanced history) and informally during various nurse-
education in an accredited program in client interactions
anesthesiology.  Observation
 The nurse anesthetist carries out pre-  Review of records
operative visits and assessments, and  Performing a physical assessment
Administers general anesthetics for 2. Nursing Diagnosis : Definition of client's
surgery under the supervision of a problem: making a nursing diagnosis
physician prepared in anesthesiology.  “A nursing diagnosis is a definitive
 The nurse anesthetist also assesses the statement of the client's actual or potential
postoperative of clients difficulties, concerns, or deficits that are
amenable to nursing interventions .
4. Nurse Midwife  This step is to organize, analyze and
 An RN who has completed a program in summarize the collected data. There are
midwifery. two components to the statement of a
nursing diagnosis joined together by the
 The nurse gives pre-natal and post-natal phrase "related to"”
care and manages deliveries in normal  Part I: a determination of the problem
pregnancies. (unhealthful response of client)
 The midwife practices the association with  Part II: identification of the etiology
a health care agency and can obtain (contributing factors)
medical services if complication occurs. 3. Planning: the nursing care plan, a blueprint for
 The nurse midwife may also conduct action remembering client is the center of the
routine Papanicolaou smears, family health team; client, family, and nurse collaborate
planning, and routine breast examination. with appropriate health team members to
5. Nurse Educator formulate the plan
 The nursing care plan is formulated.
9
  Steps in planning include: 1. SENDER – is the person who encodes and
 Assigning priorities to nursing Dx. delivers the message
 Specifying goals 2. MESSAGES – is the content of the
 Identifying interventions communication. It may contain verbal,
 Specifying expected outcomes nonverbal, and symbolic language.
 Documenting the nursing care plan 3. RECEIVER – is the person who receives the
IDENTIFY GOALS decodes the message.
 GOALS are general statements that direct 4. FEEDBACK – is the message returned by the
nursing interventions, provide broad receiver. It indicates whether the meaning
parameters for measuring results and of the sender’s message was understood.
stimulate motivation. Modes of Communication
 LONG term goal - one that will take time to 1. Verbal Communication – use of spoken or
achieve written words.
 SHORT term goal - can be achieved 2. Nonverbal Communication – use of
relatively quick gestures, facial expressions, posture/gait,
 GOALS should be: (S M A R T) body movements, physical appearance and
 Patient centered, Specific (measurable) body language
 Realistic, Achievable within a time frame Characteristics of Good Communication
4. IMPLEMENTATION 1. Simplicity – includes uses of commonly
Actions that you take in the care of your client. understood, brevity, and completeness.
- Implementation includes: 2. Clarity – involves saying what is meant. The
 Assisting in the performance in ADLs nurse should also need to speak slowly and
 Counseling and educating the patient and enunciate words well.
family 3. Timing and Relevance – requires choice of
 Giving care to patients appropriate time and consideration of the
 Supervising and evaluating the work of client’s interest and concerns. Ask one
other members of the health team question at a time and wait for an answer
5. EVALUATION before making another comment.
 Final step of the nursing process 4. Characteristics of Good Communication
 Measures the patient’s response to 5. Adaptability – Involves adjustments on
nursing intervention what the nurse says and how it is said
 it indicates the patient’s progress depending on the moods and behavior of
 toward achieving the goals established the client.
 in the care plan. 6. Credibility – Means worthiness of belief. To
 It is the comparison of the observed become credible, the nurse requires
 results to expected outcomes. adequate knowledge about the topic being
discussed. The nurse should be able to
provide accurate information, to convey
COMMUNICATION IN NURSING confidence and certainly in what she says.
COMMUNICATION Communicating With Clients Who
 Refers to reciprocal exchange of information, Have Special Needs
ideas, beliefs, feelings and attitudes between 2 1.Clients who cannot speak clearly (aphasia,
persons or among a group.
 The need to communicate is universal. People
dysarthria, muteness)
communicate to satisfy needs. 1. Listen attentively, be patient, and do not
 Clear and accurate communication among interrupt.
members of the health team, including the 2. Ask simple question that require “yes” and
client, is vital to support the client's welfare” “no” answers.
 Is the means to establish a helping-healing 3. Allow time for understanding and response.
relationships 4. Use visual cues (e.g., words, pictures, and
 Communication is essential to the nurse- objects)
patient relationship for the following 5. Allow only one person to speak at a time.
reasons: 6. Do not shout or speak too loudly.
 Is the vehicle for establishing a 7. Use communication aid:
therapeutic relationship -pad and felt-tipped pen, magic slate,
 It the means by which an individual pictures denoting basic needs, call bells or alarm.
influences the behavior of another, 2. Clients who are cognitively impaired
which leads to the successful outcome 1. Reduce environmental distractions while
of nursing intervention. conversing.
Basic Elements of the Communication 2. Get client’s attention prior to speaking
Process
10
 3. Use simple sentences and avoid long 3. accurate
explanation. 4. comprehensive
4. Ask one question at a time 5. flexible enough to retrieve critical data,
5. Allow time for client to respond maintain continuity of care, track client
6. Be an attentive listener outcomes, and reflects current standards of
7. Include family and friends in nursing practice
conversations, especially in subjects 6. Effective documentation ensures continuity
known to client. of care saves time and minimizes the risk of
3. Client who are unresponsive error.
1. Call client by name during interactions 7. As members of the health care team, nurses
2. Communicate both verbally and by touch need to communicate information about
3. Speak to client as though he or she could clients accurately and in timely manner
hear 8. If the care plan is not communicated to all
4. Explain all procedures and sensations members of the health care team, care can
5. Provide orientation to person, place, and become fragmented, repetition of tasks
time occurs, and therapies may be delayed or
6. Avoid talking about client to others in his omitted.
or her presence 9. Data recorded, reported, or c0mmunicated
7. Avoid saying things client should not hear to other health care professionals are
4. Communicating with hearing impaired CONFIDENTIAL and must be protected.
client CONFIDENTIALITY
1. Establish a method of communication 1. Nurses are legally and ethically obligated to
(pen/pencil and paper, sign-language) keep information about clients confidential.
2. Pay attention to client’s non-verbal cues 2. Nurses may not discuss a client’s
3. Decrease background noise such as examination, observation, conversation, or
television treatment with other clients or staff not
4. Always face the client when speaking involved in the client’s care.
5. It is also important to check the family as 3. Only staf directly involved in a specific
to how to communicate with the client client’s care have legitimate access to
6. It may be necessary to contact the the record.
appropriate department resource person 4. Clients frequently request copies of their
for this type of disability medical record, and they have the right to
4. Client who do not speak English read those records.
1. Speak to client in normal tone of voice 5. Nurses are responsible for protecting
(shouting may be interpreted as anger) records from all unauthorized readers.
2. Establish method for client o signal desire 6. When nurses and other health care
to communicate (call light or bell) professionals have a legitimate reason to
3. Provide an interpreter (translator) as use records for data gathering, research, or
needed continuing education, appropriate
4. Avoid using family members, especially authorization must be obtained according to
children, as interpreters. agency policy.
5. Develop communication board, pictures or 7. Maintaining confidentiality is an important
cards. aspect of profession behavior.
6. Have dictionary (English/Spanish) 8. It is essential that the nurse safe-guard the
available if client can read. client’ right to privacy by carefully
Reports protecting information of a sensitive, private
nature.
 Are oral, written, or audiotape exchanges
9. Sharing personal information or gossiping
of information between caregivers.
about others violates nursing ethical codes
Common reports:
and practice standards.
1. Change-in-shift report
10. It sends the message that the nurse cannot
2. Telephone report
be trusted and damages the interpersonal
3. Telephone or verbal order – only RN’s are
relationships.
allowed to accept telephone orders.
Guidelines of Quality Documentation and
4. Transfer report
Reporting
5. Incident report
1.Factual
Documentation
 a record must contain descriptive, objective
1. Is anything written or printed that is relied
information about what a nurse sees, hears,
on as record or proof for authorized
feels, and smells.
person.
2. Nursing documentation must be:
11
 The use of vague terms, such as appears, 7. Chart consecutively, line by line; if space is left,
seems, and apparently, is not acceptable draw line horizontally through it and sign your
because these words suggests that the nurse name at end.
is stating an opinion. 8. Record all entries legibly and in black ink
 Example: “the client seems anxious” (the  Never use pencil, felt pen.
phrase seems anxious is a conclusion  Black ink is more legible when records
without supported facts.) are photocopied or transferred to
2. Accurate microfilm.
 The use of exact measurements 9. If order is questioned, record that clarification
establishes accuracy. (example: “Intake of was sought.
350 ml of water” is more accurate than “  If you perform orders known to be
the client drank an adequate amount of incorrect, you are just as liable for
fluid” prosecution as the physician is.
 Documentation of concise data is clear 10. Chart only for yourself
and easy to understand.  Never chart for someone else.
 It is essential to avoid the use of  You are accountable for information you
unnecessary words and irrelevant details enter into chart.
3. Complete 11. Avoid using generalized, empty phrases such as
1. The information within a recorded entry or “status unchanged” or “had good day”.
a report needs to be complete, containing 12. Begin each entry with time, and end with your
appropriate and essential information. signature and title.
Example: 13. Do not wait until end of shift to record
 The client verbalizes sharp, throbbing important changes that occurred several hours
pain localized along lateral side of right earlier. Be sure to sign each entry.
ankle, beginning approximately 15 14. For computer documentation keep your
minutes ago after twisting his foot on password to yourself.
the stair. Client rates pain as 8 on a  Maintain security and confidentiality.
scale of 0-10.  Once logged into the computer do not leave
4. Current the computer screen unattended.
1. Timely entries are essential in the client’s Vital Signs
ongoing care. To increase accuracy and Vital Signs or Cardinal Signs are:
decrease unnecessary duplication, many  Body temperature
healthcare agencies use records kept near the  Pulse
client’s bedside, which facilitate immediate  Respiration
documentation of information as it is collected  Blood pressure
from a client  Pain
5. Organized  Level of consciousness
1. The nurse communicates information in a
logical order.
 For example, an organized note I. Body Temperature
describes the client’s pain, nurse’s  The balance between the heat
assessment, nurse’s interventions, and produced by the body and the heat loss
the client’s response from the body.
Legal Guidelines for recording Types of Body Temperature
1. Draw single line through error, write word  Core temperature –temperature of
error above it and sign your name or initials. Then the deep tissues of the body.
record note correctly.  Surface body temperature
2. Do not write retaliatory or critical comments Alteration in body Temperature
about the client or care by other health care  Pyrexia – Body temperature above
professionals. normal range ( hyperthermia)
3. Enter only objective descriptions of client’s 1. Hyperpyrexia – Very high fever, 41ºC(105.8 F)
behavior; client’s comments should be and above
quoted. 2. Hypothermia – Subnormal temperature.
4. Correct all errors promptly, errors in recording Factors afecting Heat production
can lead to errors in treatment 1. Basal metabolism
5. Avoid rushing to complete charting, be sure 2. Muscular activity
information is accurate. 3. Thyroxine and Epinephine
6. Do not leave blank spaces in nurse’s notes. 4. Temperature effect on cell
Normal Adult Temperature Ranges
 Oral 36.5 –37.5 ºC
12
  Axillary 35.8 – 37.0 ºC d. Place the activation button, and hold it in place
 Rectal 37.0 – 38.1 ºC for 1 second
 Tympanic 36.8 – 37.9ºC 5. Chemical-dot thermometer
Methods of Temperature-Taking a. Leave the chemical-dot thermometer in place
Oral – most accessible and convenient method. for 45 seconds
1. Put on gloves, and position the tip of the b. Read the temperature as the last dye dot that
thermometer under the patients tongue has change color, or fired.
on either of the frenulum as far back as c. Store chemical-dot thermometer in a cool area
possible. It promotes contact to the because exposure to heat activates the dye
superficial blood vessels and ensures a dots.
more accurate reading. Note:
2. Wash thermometer before use.  Use the same thermometer for repeat
3. Take oral temp 2-3 minutes. temperature taking to ensure more consistent
4. Allow 15 min to elapse between client’s result
food intakes of hot or cold food, smoking. Nursing Interventions in Clients with Fever
5. Instruct the patient to close his lips but not a. Monitor V.S
to bite down with his teeth to avoid b. Assess skin color and temperature
breaking the thermometer in his mouth. c. Monitor WBC, Hct and other pertinent lab
Contraindications records
 Young children an infants d. Provide adequate foods and fluids.
 Patients who are unconscious or e. Promote rest
disoriented f. Monitor I & O
 Who must breath through the mouth g. Provide TSB
 Seizure prone h. Provide dry clothing and linens
 Patient with N/V i. Give antipyretic as ordered by MD
 Patients with oral lesions/surgeries
II. Pulse – It’s the wave of blood created by
2. Rectal- most accurate measurement of contractions of the left ventricles of the
temperature heart.
a. Position- lateral position with his top legs Normal Pulse rate
flexed and drapes him to provide privacy. 1 year 80-140 beats/min
b. Squeeze the lubricant onto a facial tissue to 2 years 80- 130 beats/min
avoid contaminating the lubricant supply. 6 years 75- 120 beats/min
c. Insert thermometer by 0.5 – 1.5 inches 10 years 60-90 beats/min
d. Hold in place in 2minutes Adult 60-100 beats/min
e. Do not force to insert the thermometer Tachycardia – pulse rate of above 100 beats/min
Contraindications Bradycardia- pulse rate below 60 beats/min
 Patient with diarrhea Irregular – uneven time interval between
 Recent rectal or prostatic surgery or injury beats.
because it may injure inflamed tissue What you need:
 Recent myocardial infarction a. Watch with second hand
 Patient post head injury b. Stethoscope (for apical pulse)
c. Doppler ultrasound blood flow detector if
3. Axillary – safest and non-invasive necessary
a. Pat the axilla dry Radial Pulse
b. Ask the patient to reach across his chest and  Wash your hand and tell your client that you
grasp his opposite shoulder. This promote skin are going to take his pulse
contact with the thermometer  Place the client in sitting or supine position
c. Hold it in place for 9 minutes because the  with his arm on his side or across his chest
thermometer isn’t close in a body cavity  Gently press your index, middle, and ring
4. Tympanic thermometer fingers on the radial artery, inside the
a. Make sure the lens under the probe is clean patient’s wrist.
and shiny  Excessive pressure may obstruct blood flow
b. Stabilized the patient’s head; gently pull the distal to the pulse site
ear straight back (for children up to age 1) or  Counting for a full minute provides a more
up and back (for children 1 and older to accurate picture of irregularitie
adults) Apical Pulse
c. Insert the thermometer until the entire ear  Perform hand hygiene.
canal is sealed

13
  Use alcohol swab to clean the diaphragm  Cheyne- stokes breathing- rhythmic
of the stethoscope. Use another swab to breathing; from very deep to very shallow
clean the earpieces if necessary. breathing and temporary apnea.
 Place patient in sitting or reclining position  Biot’s respiration- varying in depth and rate
and expose the chest area. Expose only followed by periods of apnea; irregular.
the apical side. Normal Breath sound
 Palpate the space between then fifth and 1. Bronchial
sixth ribs and move to the left  Loud and high pitched w/ hollow quality.
midclavicular line.  Expiration lasts longer than inspiration.
 Place the diaphragm over the apex of the  Best heard over the trachea
heart.  Created by air moving through the trachea
 Count the rate. close to chest wall.
 Using a watch with a second hand, count 2. Bronchovesicular
the heartbeat for 1 minute.  Blowing sounds that are moderate in pitch
 Cover the patient and help him/her to a and intensity. Inspiration is equal to
position of comfort. expiration.
 Clean the diaphragm of the stethoscope  Best heard posteriorly between scapula &
with alcohol swab for the next use. anteriorly over bronchioles lateral to
Doppler device sternum at first & second intercostal spaces.
a. Apply small amount of transmission gel to  Created by air moving to large airways.
the ultrasound probe Abnormal Breath Sounds
b. Position the probe on the skin directly over 1. Stridor
a  A loud, high-pitched crowing sound that is
c. selected artery heard, usually w/o a stethoscope, during
d. Set the volume to the lowest setting inspiration. Stridor caused by an obstruction in
e. To obtain best signals, put gel between the the upper airway requires immediate attention
skin and the probe and tilt the probe 45 2. Rhonchi (also called gurgles)
degrees from the artery.  Low-pitched, snoring sounds that occur when
f. After you have measure the pulse rate, the patient exhales, although they may also be
clean the probe with soft cloth soaked in heard when the patient inhales.
antiseptic. Do not immerse the probe  Usually changes or disappear w/ coughing
III. Respiration - is the exchange of oxygen and  Sounds occur as a result of air passing through
carbon dioxide between the atmosphere fluid-filled, narrow passages, diseases where
and the body there is increased mucus production such as:
Assessing Respiration  Pneumonia
 Rate – Normal 14-20/ min in adult  Bronchitis
 The best time to assess respiration is  bronchiectasis.
immediately after taking client’s pulse 3. Crackles ( Rales )
 Count respiration for 60 second  Soft, high pitched discontinuous popping
 As you count the respiration, assess and sounds that occur during inspiration
record breath sound as stridor, wheezing, or  Can be produced by rubbing a lock of hair
stertor. between the thumb and finger close to the
 Respiratory rates of less than 10 or more than ear.
40 are usually considered abnormal and  Fluid in the airways
should be reported immediately to the  Obstructive disease in early inspiration
physician.  Bronchitis
 Pneumonia
Reathibg Pattern  CHF
Volume 4. Wheeze
 Hyperventilation- overexpansion of the  deep, low-pitched sounds heard during
lungs characterized by rapid deep breaths. exhalation
 Hypoventilation- underexpansion of the  due to narrowed tracheobronchial passages
lungs characterized by shallow from secretions
respirations.  Continuous, musical, high-pitched, whistle - like
Rate sounds heard during inspiration and exhalation
 Tachypnea quick, shallow breaths  narrow bronchioles, associated with
 Bradypnea- slow respiration bronchospasm, asthma and buildup of
 Apnea- cessation of breathing secretions
Rhythm 5. Friction Rub

14
 Like 2 pieces of rubber rubbed together, a. You must consider both the patient’s
inspiration and exhalation description and your observations on his
 Inflammation and loss of fluid in the pleural behavioral responses.
space b. First, ask the client to rank his pain on a
 Associated with: scale of 0-10, with 0 denoting lack of pain
 Pleurisy and 10 denoting the worst pain imaginable.
 Pneumonia Ask:
 pleural infarct. c. Where is the pain located?
IV. Blood Pressure d. How long does the pain last?
Adult – 90- 132 systolic e. How often does it occur?
60- 85 diastolic f. Can you describe the pain?
Elderly 140-160 systolic g. What makes the pain worse
70-90 diastolic h. Observe the patient’s behave
a. Ensure that the client is rested i. oral response to pain (body language,
b. Use appropriate size of BP cuff. moaning, grimacing, withdrawal, crying,
c. If the b/p cuff is narrow an loosely restlessness muscle twitching and
applied- false high BP immobility)
d. Position the patient on sitting or supine j. Also note physiological response, which may
position be sympathetic or parasympathetic
e. Position the arm at the level of the heart,
if the artery is below the heart level, you Wong’s Pain Scale
may get a false high reading
f. Use the bell of the stethoscope since the
blood pressure is a low frequency sound.
g. If the client is crying or anxious, delay
measuring his blood pressure to avoid
false-high BP Managing Pain
Electronic Vital Sign Monitor 1. Giving medication as per MD’s order
a. An electronic vital signs monitor allows you 2. Giving emotional support
to continually tract a patient’s vital 3. Performing comfort measures
sign without having to reapply a blood 4. Use cognitive therapy
pressure cuff each time.
b. Example: Dinamap VS monitor 8100 Height and weight
c. Lightweight, battery operated and can be a. Height and weight are routinely measured when
attached to an IV pole a patient is admitted to a health care facility.
d. Before using the device, check the client7s b. It is essential in calculating drug dosage,
pulse and BP manually using the same contrast agents, assessing nutritional status
arm you’ll using for the monitor cuff. and determining the height-weight ratio.
e. Compare the result with the initial reading c. Weight is the best overall indicator of fluid
from the monitor. If the results differ call status, daily monitoring is important for clients
the supply department or the receiving a diuretics or a medication that
manufacturer’s representative. causes sodium retention.
V. Pain d. Weight can be measured with a standing scale,
 Is both a protective and an unpleasant chair scale and bed scale.
sensory and emotional experience associated e. Height can be measured with the measuring
with actual and potential tissue damage. bar, standing scale or tape measure if the client
(Porth.2nd ed.) is confine in a supine position.
Classification of Pain Pointers:
Location a. Reassure and steady patient who are at risk
Cutaneous and deep Somatic for losing their balance on a scale.
Visceral b. Weight the patient at the same time each
Referred day. (Usually before breakfast), in similar
Assessment clothing and using the same scale.
 Nature c. If the patient uses crutches, weigh the client
 Location with the crutches or heavy clothing and
 Severity subtract their weight from the total
 Radiation of pain determined patient’ weight.
How to assess Pain Laboratory and Diagnostic
examination
Urine Specimen
15
1.Clean-Catch mid-stream urine specimen for b. Patient is advise on a high residue diet
routine urinalysis, culture and sensitivity test c. avoid dark food and bismuth compound
a. Best time to collect is in the morning, first d. If client is on iron therapy, inform the MD
voided urine e. Make sure the stool in not contaminated with
b. Provide sterile container urine, soap solution or toilet paper
c. Do perineal care before collection of the f. Test sample from several portion of the stool.
urine Venipuncture
d. Discard the first flow of urine  Venipuncture involves piercing a vein with a
e. Label the specimen properly needle and collecting a blood sample in a
f. Send the specimen immediately to the syringe or evacuating tube.
laboratory  Typically using the antecubital fossa
g. Document the time of specimen collection  A plebhotomist from the laboratory usually
and transport to the lab. perform the procedure.
h. Document the appearance, odor, and  Strict asepsis to prevent infection.
usual characteristics of the specimen.  If client has clotting disorder or under
2. 24-hour urine specimen anticoagulant therapy, apply pressure on the
a. Discard the first voided urine. site for 5 minutes to prevent hematoma
b. Collect all specimen thereafter until the formation
following day Pointers
c. Soak the specimen in a container with ice a. Never collect a venous sample from the arm
d. Add preservative as ordered according to or a leg that is already being use d for I.V
hospital policy therapy or blood administration because it
3. Second-Voided urine – required to assess mat affect the result.
glucose level and for the presence of albumen in b. Never collect venous sample from an
the urine. infectious site because it may introduce
a. Discard the first urine pathogens into the vascular system
b. Give the patient a glass of water to drink c. Never collect blood from an edematous
c. After few minutes, ask the patient to void area, AV shunt, site of previous hematoma,
4. Catheterized urine specimen or vascular injury.
a. Clamp the catheter for 30 min to 1 hour to d. Don’t wipe off the povidine-iodine with
allow urine to accumulate in the bladder alcohol because alcohol cancels the effect of
and adequate specimen can be collected. povidine iodine.
b. Clamping the drainage tube and emptying e. If the patient has a clotting disorder or is
the urine into a container are receiving anticoagulant therapy, maintain
contraindicated after a genitourinary pressure on the site for at least 5 min after
surgery. withdrawing the needle.
Arterial puncture for ABG test
a. Before arterial puncture, perform Allen’s
II. Stool Specimen test first.
1. Fecalysis – to assess gross appearance of b. If the patient is receiving oxygen, make sure
stool and presence of ova or parasite that the patient’s therapy has been
a. Secure a sterile specimen container underway for at least 15 min before
b. Ask the pt. to defecate into a clean, dry collecting arterial sample
bed pan or a portable commode. c. Be sure to indicate on the laboratory
c. Instruct client not to contaminate the request slip the amount and type pf oxygen
specimen with urine or toilet paper( urine therapy the patient is having.
inhibits bacterial growth and paper towel d. If the patient has just received a nebulizer
contain bismuth which interfere with the treatment, wait about 20 minutes before
test result. collecting the sample.
2. Stool culture and sensitivity test III. Blood specimen
 To assess specific etiologic agent causing a. No fasting for the following tests:
gastroenteritis and bacterial sensitivity to various - CBC, Hgb, Hct, clotting studies, enzyme
antibiotics. studies, serum electrolytes, HbA1C
3. Fecal Occult blood test b. Fasting is required:
 are valuable test for detecting occult - FBS, BUN, Creatinine, serum lipid
blood (hidden) which may be present in colo- (cholesterol, triglyceride), blood uric acid
rectal cancer, detecting melena stool IV. Sputum Specimen
Instructions: 1. Gross appearance of the sputum
a. Advise client to avoid ingestion of red meat a. Collect early in the morning
for 3 days b. Use sterile container

16
 c. Rinse the mount with plain water before c. Avoid cough during insertion to prevent pleural
collection of the specimen perforation
d. Instruct the patient to hack-up sputum d. Turn to unaffected side after the procedure to
e. Send the specimen immediately prevent leakage of fluid in the thoracic cavity
2. Sputum culture and sensitivity test e. Check for expectoration of blood. This indicate
a. Use sterile container trauma and should be reported to MD
b. Collect specimen before the first dose of immediately.
antibiotic 5. LUNG BIOPSY
3. Acid-Fast Bacilli PRE-PROCEDURE NURSING CARE
a. To assess presence of active pulmonary  Secure consent
tuberculosis  Check coagulation
b. Collect sputum in three consecutive  Have vit K at bedside
morning  Maintain sterile technique
4. Cytologic sputum exam-  Local anesthetic required
 -to assess for presence of abnormal or cancer  Pressure during insertion and aspiration
cells.  Administer analgesics & sedatives as Rx
 Collect sputum in three consecutive morning POST-PROCEDURE NURSING CARE
Diagnostic Test  Pressure dressing to prevent bleeding
1. PPD test  Monitor for bleeding
 read result 48 – 72 hours after injection.  Monitor for respiratory distress
 For HIV positive clients, induration of 5 mm is  Monitor for complications
considered positive  Prepare for CXR
 Induration of more than 10 for non-HIV client 6. PULSE OXIMETRY
is considered positive - NORMAL VALUE: 95%-100%
 A sensor is placed: finger, toe, nose,
2. Bronchography earlobe or forehead
 a radiopaque medium is instilled directly  Don’t select an extremity with an
into the trachea and bronchi through impediment to blood flow
bronchoscope and the entire bronchi tree  Lower than 91% - immediate treatment
or selected areas may be visualized  Lower than 85% - hypo-oxygenation
through X-ray.  Lower than 70% - life-threatening situation
 Secure consent 7.Holter Monitor
 Check for allergies to seafood or iodine or  it is continuous ECG monitoring, over 24
anesthesia hours period
 NPO 6-8 hours before the test  The portable monitoring is called telemetry
 NPO until gag reflex return to prevent unit
aspiration  Avoid magnets, metal detectors, high-
3. BRONCHOSCOPY voltage areas, and electric blankets.
direct visualization of the larynx, trachea and  Stress the importance of logging his usual
bronchi through a flexible fiber-optic activities, emotional upset, fatigue, chest
bronchoscope pain, and ingestion of medication
 Informed consent 
 NPO 6-12 hrs prior to test 8. Echocardiogram –
 Coagulation studies  ultrasound to assess cardiac structure and
 Remove dentures or eyeglasses mobility
 IV Sedatives to relax the client  Client should remain still, in supine position
 Lidocaine spray to suppress the gag reflex slightly turned to the left side, with HOB
 Resuscitation equipment available elevated 15-20 degrees
POST-PROCEDURE NURSING CARE  The conductive gel is applied to the to the
 V/S left of the sternum, third or fourth
 Ý Fowler’s intercostal space
 Check gag reflex  The test takes about 30-45 minutes
 NPO until gag reflex return 9. Electrocardiography-
 Monitor for bloody sputum a. If the patient’s skin is oily, scaly, or
 Monitor respiration diaphoretic, rub the electrode with a dry 4x4
 Monitor for complications gauze to enhance electrode contact.
 Notify the MD if complications occur b. If the area is excessively hairy, clip it
4. Thoracentesis – aspiration of fluid in the c. Remove client’s jewelry, coins, belt or any
pleural space. metal
a. Secure consent, take V/S
b. Position upright leaning on overbed table
17
 d. Tell client to remain still during the  NPO after midnight
procedure  administer suppository in AM
10. Cardiac Catheterization  Enema until clear
 Secure consent  force fluid after the test to prevent
 Assess allergy to iodine, shellfish constipation/barium impaction
 V/S, weight for baseline information 14. Liver Biopsy
 Have client void before the procedure a. Secure consent,
 Monitor PT, PTT, ECG prior to test b. NPO 2-4 hrs before the test
 NPO for 4-6 hours before the test c. Monitor PT, Vit K at bedside
 Shave the groin or brachial area d. Place the client in supine at the right side of
 After the procedure: bed rest to prevent the bed
bleeding on the site, do not flex extremity e. Instruct client to inhale and exhale deeply
 Elevate the affected extremities on for several times and then exhale and hold
extended position to promote blood supply breath while the MD insert the needle
back to the heart and prevent f. Right lateral post procedure for 4 hours to
thromboplebitis apply pressure and prevent bleeding
 Monitor V/S especially peripheral pulses g. Bed rest for 24 hours
 Apply pressure dressing over the puncture h. Observe for S/S of peritonitis
site 15. Paracentesis
 Monitor extremity for color, temperature, a. Secure consent
tingling to assess for impaired circulation. b. check V/S
11. MRI c. Weigh the client before and after the
 secure consent, procedure
 the procedure will last 45-60 minute d. Measure abdominal girth before the
 Assess client for claustrophobia procedure
 Remove all metal items e. Let the patient void before the procedure to
 Client should remain still prevent puncture of the bladder
 Tell client that he will feel nothing but may f. Use gauge 18 trochar or cannula
hear noises g. Check for serum protein. Excessive loss of
 Client with pacemaker, prosthetic valves, plasma protein may lead to hypovolemic
implanted clips, wires are not eligible for shock.
MRI. h. Position:
 Client with cardiac and respiratory  sitting on a chair with feet supported
complication may be excluded with footstool or
 Instruct client on feeling of warmth or  Place in high Fowlers position
shortness of breath if contrast medium is i. Strict aseptic technique to prevent
used during the procedure peritonitis
 Tattoo pigments (body arts), eyeliner, j. Local anesthetic is injected
eyebrow or lip liner may contain metals k. The procedure takes about 45 minutes
which create an electrical current that can l. Monitor urine output for 24 hours as watch
cause redness and swelling to a first out for hematuria which may indicate
degree burn at the site of the tattoo. bladder trauma.
12.UGIS – Barium Swallow 16. Lumbar Puncture
 instruct client on low-residue diet 1-3 days a. obtain consent
before the procedure b. instruct client to empty the bladder and
 administer laxative evening before the bowel
procedure c. position the client in lateral recumbent with
 NPO after midnight back at the edge of the examining table
 instruct client to drink a cup of flavored d. instruct client to remain still
barium e. Spinal needle in inserted in the midline
 x-rays are taken every 30 minutes until between the spinous process between the
barium advances through the small bowel 3rd and 4th lumbar vertebrae
 film can be taken as long as 24 hours later f. Using 18G or 20G in adult, 22G in children
 force fluid after the test to prevent g. obtain specimen per MDs order
constipation/barium impaction Post procedure
13.LGIS – Barium Enema  instruct client to remain still during needle
 instruct client on low-residue diet 1-3 days insertion to prevent trauma on the spinal cord
before the procedure  Instruct the client to remain in flat position for 8
 administer laxative evening before the hours to prevent spinal headache
procedure  obtain specimen per MDs order

18
 Headache is the most common adverse c. Assess residual feeding
effects of a lumbar puncture.. d. Height of feeding is 12 inches above the
Mgt. for spinal headache tube’s point of insertion
 Bed rest e. Ask client to remain upright position for at
 Place patient in dark and quiet room least 30 min.
 Administer analgesics f. Most common problem of tube feeding is
 Fluids Diarrhea due to lactose intolerance
 note: 4. Enema
If the headache continues, epidural patch maybe a. Check MD’s order
required. Blood is withdrawn from the client’s b. Provide privacy
vein and injected into the epidural space, usually c. Position left lateral
at the LP site. d. Size of tube Fr. 22-32
17.Queckenstedt’s Test e. Insert 3-4 inches of rectal tube
 Lumbar manometric test f. If abdominal cramps occur, temporarily stop
 Compressing the jugular vein on each side the flow until cramps are gone.
of the neck during the lumbar puncture. g. Height of enema can – 18 inches
 The increase in pressure caused by the 5. Urinary Catheterization
compression is noted; then pressure is a. Verify MD’s order
released and pressure reading are made b. Practice strict asepsis
at a 10-seconds intervals. c. Perineal care before the procedure
 Normally – CSF pressure rises rapidly in d. Catheter size: male-14-16 , female – 12 – 14
response to compression of the jugular e. Length of catheter insertion
vein and returns quickly to normal when male – 6-9 inches ,female – 3-4 inches
the compression is released. For retention catheter:
 A slow rise and fall in pressure indicates a  Male –anchor laterally or upward over the
partial block due to a lesion compressing lower abdomen to prevent penoscrotal
the spinal subarachnoid pathways. pressure
 If there is no pressure change, a complete  Female- inner aspect of the thigh
bloc is indicated. Types of ostomies
 This test is not performed if an intracranial a. Ileostomy
lesion is suspected.  Liquid to semi-formed stool, dependent
upon amount of bowel removed
NURSING PROCEDURES  May skew fluid & electrolyte balance,
1. Steam Inhalation especially potassium & sodium
a. It is dependent nursing function.  Digestive enzymes in stool irritate skin
b. Heat application requires physician’s  Do NOT give laxatives
order.  Ileostomy lavage may be done if needed to
c. Place the spout 12-18 inches away from clear food blockage
the client’s nose or adjust the distance as  May not require appliance set; if continent
necessary. ileal reservoir or Koch pouch
2. Suctioning b. Colostomy
a. Assess the lungs before the procedure for  Ascending-must wear appliance--semi-liquid
baseline information. stool
b. Position: conscious – semi-Fowler’s  Transverse-wear appliance--semi-formed
c. Unconscious – lateral position stool
d. Size of suction catheter- adult- fr 12-18  Loop stoma
e. Hyper oxygenate before and after  Proximal end-functioning stoma
procedure  Distal end-drains mucous
f. Observe sterile technique  Plastic rod used to keep loop out
g. Apply suction during withdrawal of the  Usually temporary
catheter
h. Maximum time per suctioning –15 sec
 Double barrel
 Two stomas
3. Nasogastric Feeding (gastric gavage)
 Similar to loop but bowel is surgically
Insertion:
severed
a. Fowler’s position
b. Tip of the nose to tip of the earlobe to the  Sigmoid
xyphoid  Formed stool
Tube Feeding  Bowel can be regulated so appliance not
a. Semi-Fowler’s position needed
b. Assess tube placement  May be irrigated

19
 care professional or other caregiver, the bed
Stoma assessment should always be placed in its lowest position to
a. Color-should be same color as mucous reduce the risk of injury from a possible fall.
membranes  At its lowest level, a hospital bed is usually
(Normal stoma color- Red not dusky or pale: sign about 26–28 inches (65–70 cm) above the floor.
of infection) Various safety features are present on
b. Edema-common after surgery. Bleeding-slight hospital beds. These features include:
bleeding common after surgery  Wheel locks: These should be used whenever
6. COLOSTOMY IRRIGATION the bed is stationary.
 Initial colostomy irrigation is done to stimulate  Side rails: They help to protect patients from
peristalsis; subsequent irrigations are done to accidentally falling out of bed, as well as
promote evacuation of feces at a regular and provide support to the upper extremities as the
convenient time patient gets out of bed.
 Recommended with sigmoid colostomy  Removable headboard: This feature is important
 Initiated 5 to 7 days postop during emergency situations, especially during
cardiopulmonary resuscitation.
 Done in semi – Fowler’s position; then sitting Preaparation:
on a toilet bowl once ambulatory.  The nurse normally makes the bed in the
 Use warm normal saline solution morning after a patient's bath, or when the
 Initially, introduce 200 mls. of NSS then 500 to patient is out of the room for tests.
1,000 mls. Subsequently  The nurse should straighten the linens
 Dilate stoma with lubricated gloved finger throughout the day, making certain they are
before insertion of catheter neither loose nor wrinkled.
 Lubricate catheter before insertion.  Any sheets that become wet or soiled should be
 Insert 3 to 4 inches of the catheter into the changed promptly.
stoma  When changing bed linen:
 Height of solution 12 inches above the  the nurse should keep the soiled linen
stoma away from the uniform
 If abdominal cramps occur during  place it in the appropriate linen bag or
introduction of solution, temporarily stop other designated container.
the flow of solution until peristalsis  Never fan or shake linens, which can
relaxes. spread microorganisms
 Allow the catheter to remain in place for 5  if any of the sheets touch the floor, they
to 10 minutes for better cleansing effect; should be replaced.
then remove catheter to drain for 15 to 20 The categories of Unoccupied bed making
minutes. include:
 Clean the stoma, apply new pouch  Open unoccupied: In an open bed, the top
7 . Bed Bath covers are folded back so the patient can easily
a. Provide privacy get back into the bed.
b. Expose, wash and dry one body part a  Closed unoccupied: In a closed bed, the top
time sheet, blanket, and bedspread are pulled up to
c. Use warm water (110-115 F) the head of the mattress and beneath the
d. Wash from cleanest to dirtiest pillows. A closed bed is done in a hospital bed
e. Wash, rinse, and dry the arms and leg prior to the admission of a new patient.
using Long, firm strokes from distal to  Surgical, recovery, or postoperative: These
proximal area – to increase venous return. techniques are similar to the open unoccupied
8. Bed Making bed. The top bed linens are placed so that the
 The ideal hospital bed should be selected for surgical patient can transfer easily from the
its impact on patients' comfort, safety, stretcher to the bed. The top sheets and
medical condition, and ability to change bedspread are folded lengthwise or crosswise at
positions. the foot of the bed.
Purpose  Occupied bed
 The purpose of a well-made hospital bed, as The patient is in the bed while the linens are being
well as an appropriately chosen mattress, is to changed. The nurse should perform the following
provide a safe, comfortable place for the when making the occupied bed:
patient, where repositioning is more easily  Raise the bed to a comfortable working
achieved, and pressure ulcers are prevented. height. Loosen the top linens, and help the
Precautions patient assume a side-lying position.
 Safety factors should also be considered.  Roll the bottom linens toward the patient.
Unless a patient is accompanied by a health

20
  Place the bottom sheet on the mattress,  Ensure that the restraint orders are renewed
seam side down, and cover the mattress. every 24 hours or sooner according to
Miter the corners of any non-fitted sheets. hospital policy.
 Place waterproof pads and/or a draw sheet  Tie the restraints using clove hitch
on the bed.  Secure the tie in a non-movable part of the
 Tuck in the remaining half of the clean bed
sheets as close to the patient as possible.
 Assist the patient to roll over the linen. PRINCIPLES OF MEDICATION ADMINISTRATION
Raise the side rail, and go to the other
side of the bed. Medication- Is a substance administered for the
 Remove the dirty linen and dispose of diagnosis, cure, treatment, or relief of symptom or
appropriately. prevention of disease.
 Slide the clean sheets over and secure. Pharmacology – is the study of the effect of drug
Pull all sheets straight and taut. on living organism.
 Place the clean top sheets over the patient Pharmacy- is the art of preparing, compounding,
and remove the used top sheet and and dispensing drugs.
blanket. Miter the corners of the top linens Medication administration - is a basic nursing
at the foot of the bed. Loosen the linens at function the involves skillful technique and
the foot of the bed for the patient's consideration of patient’s development and safety.
comfort. Ten “Rights” of Medication Administration
 Change the pillowcase. 1. Right Medication
 Return the patient's bed to the appropriate T he medication given was the medication ordered
position, at its lowest level. the nurse compares the label of the medication
container with medication form. The nurse does
9. Foot Care this 3 times.
a. Soaking the feet of diabetic client is no 2. Right Dose
longer recommended The dose appropriate for the client
b. Cut nail straight across Double-check calculations that appears
10. Mouth Care questionable
a. Eat coarse, fibrous foods (cleansing foods) Know the usual dosage range of the medication
such as fresh fruits and raw vegetables 3. Right Time
b. Dental check every 6 mounts Give the medication at the right frequency and at
11. Oral care for unconscious client the right time ordered according to agency policy.
a. Place in side lying position Medications given within 30 minutes before or after
b. Have the suction apparatus readily the scheduled time are considered to meet the
available right time standard.
12. Hair Shampoo Medication that must act at certain times are given
c. Place client diagonally in bed priority ( e.g insulin should be given at a precise
d. Cover the eyes with wash cloth interval before a meal )
e. Plug the ears with cotton balls 4. Right Route
f. Massage the scalp with the fatpads of the Make certain that the route is safe and appropriate
fingers to promote circulation in the scalp. for the client.
13. Restraints 5. Right Client
 Secure MD’s order for each episode of The patient’s full name is used. The middle name
restraints application. or initial should be included to avoid confusion with
 Check circulation every 15 min other patient.
 Remove restraints at least every 2 hours Check the clients identification band with each
for 30 minutes administration of a medication.
Types of Restraints 6.Right Documentation
 Chemical – sedating antipsychotic drugs to Document medication administration after giving it,
manage or control behavior not before.
 Physical – direct application of physical If medication is not given, follow the agency policy
force to a client, with or without the for documenting the reason why.
client’s permission. Sign medication sheet immediately after
 Seclusion – involuntary confinement of a administration of the drug.
client in a locked room 7. Right Education
Explain information about the medication to the
Procedure: client.
 Ensure that face-to face assessment is 8. Right to Refuse
completed on the client Adult client have the right to refuse medication.

21
The nurse’s role is to ensure that the client fully a. The easiest and most desirable way to
informed of the potential consequences of refusal administer medication
and to communicate the client’s refusal to the b. Most convenient
health care provider. c. Safe, does nor break skin barrier
9. Right Assessment d. Usually less expensive
Some medication requires specific assessment Disadvantages
prior to administration. ( vital signs, lab results). a. Inappropriate if client cannot swallow and if
10. Right Evaluation GIT has reduced motility
Conduct appropriate follow-up ( e.g was the b. Inappropriate for client with nausea and
desired effect achieved or not?) vomiting
c. Drug may have unpleasant taste
d. Drug may discolor the teeth
e. Drug may irritate the gastric mucosa
II – Practice Asepsis – wash hand before and f. Drug may be aspirated by seriously ill
after preparing the medication to reduce transfer patient.
of microorganisms. Drug Forms for Oral Administration
III – Nurse who administer the medications are a. Solid: tablet, capsule, pill, powder
responsible for their own action. Question any b. Liquid: syrup, suspension, emulsion, elixir,
order that you considered incorrect (may be milk, or other alkaline substances.
unclear or appropriate) c. Syrup: sugar-based liquid medication
IV – Be knowledgeable about the medication that d. Suspension: water-based liquid medication.
you administer Shake bottle before use of medication to
properly mix it.
“A FUNDAMENTAL RULE OF SAFE DRUG e. Emulsion: oil-based liquid medication
ADMINISTRATION IS: “NEVER ADMINISTER f. Elixir: alcohol-based liquid medication. After
AN UNFAMILIAR MEDICATION” administration of elixir, allow 30 minutes to
elapse before giving water. This allows
V – Keep the Narcotics in locked place. maximum absorption of the medication.
VI– Use only medications that are in clearly
labeled containers. Relabelling of drugs are the “NEVER CRUSH ENTERIC-COATED OR
responsibility of the pharmacist. SUSTAINED RELEASE TABLET”
VII – Return liquid that are cloudy in color to the  Crushing enteric-coated tablets – allows
pharmacy. the irrigating medication to come in contact
VIII – Before administering medication, identify with the oral or gastric mucosa, resulting in
the client correctly mucositis or gastric irritation.
IX – Do not leave the medication at the bedside.  Crushing sustained-released
Stay with the client until he actually takes the medication – allows all the medication to
medications. be absorbed at the same time, resulting in a
X – The nurse who prepares the drug administers higher than expected initial level of
it.. Only the nurse prepares the drug knows what medication and a shorter than expected
the drug is. Do not accept endorsement of duration of action
medication. 2. SUBLINGUAL
a. A drug that is placed under the tongue, where it
XI – If the client vomits after taking the dissolves.
medication, report this to the nurse in-charge or b. When the medication is in capsule and ordered
physician. sublingually, the fluid must be aspirated from
XII – Preoperative medications are usually the capsule and placed under the tongue.
discontinued during the postoperative period c. A medication given by the sublingual route
unless ordered to be continued. should not be swallowed, or desire effects will
XIII- When a medication is omitted for any not be achieved
reason, record the fact together with the reason. Advantages:
XIV – When the medication error is made, report a. Same as oral
it immediately to the nurse in-charge or b. Drug is rapidly absorbed in the bloodstream
physician. To implement necessary measures Disadvantages
immediately. This may prevent any adverse a. If swallowed, drug may be inactivated by
effects of the drug. gastric juices.
b. Drug must remain under the tongue until
Medication Administration dissolved and absorbed
1. Oral administration 3. BUCCAL
Advantages

22
a. A medication is held in the mouth against the 3. Otic
mucous membranes of the cheek until the Instillation – to remove cerumen or pus or to
drug dissolves. remove foreign body
b. The medication should not be chewed, a. Warm the solution at room temperature or
swallowed, or placed under the tongue (e.g body temperature, failure to do so may
sustained release nitroglycerine, cause vertigo, dizziness, nausea and pain.
opiates,antiemetics, tranquilizer, sedatives) b. Have the client assume a side-lying position
c. Client should be taught to alternate the ( if not contraindicated) with ear to be
cheeks with each subsequent dose to avoid treated facing up.
mucosal irritation c. Perform hand hygiene. Apply gloves if
Advantages: drainage is present.
a. Same as oral d. Straighten the ear canal:
b. Drug can be administered for local effect  0-3 years old: pull the pinna downward
c. Ensures greater potency because drug and backward
directly enters the blood and bypass the  Older than 3 years old: pull the pinna
liver upward and backward
Disadvantages: e. Instill eardrops on the side of the auditory
 If swallowed, drug may be inactivated by canal to allow the drops to flow in and
gastric juice continue to adjust to body temperature
4. TOPICAL – Application of medication to a f. Press gently bur firmly a few times on the
circumscribed area of the body. tragus of the ear to assist the flow of
1. Dermatologic – includes lotions, liniment and medication into the ear canal.
ointments, powder. g. Ask the client to remain in side lying
a. Before application, clean the skin thoroughly position for about 5 minutes
by washing the area gently with soap and h. At times the MD will order insertion of cotton
water, soaking an involved site, or locally puff into outermost part of the canal. Do not
debriding tissue. press cotton into the canal. Remove cotton
b. Use surgical asepsis when open wound is after 15 minutes.
present 1. Nasal –
c. Remove previous application before the next  Nasal instillations usually are instilled
application for their astringent effects (to shrink
d. Use gloves when applying the medication swollen mucous membrane),
over a large surface. (e.g large area of burns)  to loosen secretions and facilitate
e. Apply only thin layer of medication to prevent drainage or to treat infections of the
systemic absorption. nasal cavity or sinuses.
2. Opthalmic - includes instillation and irrigation  Decongestants, steroids, calcitonin.
a. Instillation – to provide an eye medication a. Have the client blow the nose prior to nasal
that the client requires. instillation
b. Irrigation – To clear the eye of noxious or b. Assume a back lying position, or sit up and
other foreign materials. lean head back.
c. Position the client either sitting or lying. c. Elevate the nares slightly by pressing the
d. Use sterile technique thumb against the client’s tip of the nose.
e. Clean the eyelid and eyelashes with sterile While the client inhales, squeeze the bottle.
cotton balls moistened with sterile normal d. Keep head tilted backward for 5 minutes
saline from the inner to the outer canthus after instillation of nasal drops.
f. Instill eye drops into lower conjunctival e. When the medication is used on a daily
sac. basis, alternate nares to prevent irritations
g. Instill a maximum of 2 drops at a time. 5. Inhalation – use of nebulizer, metered-dose
Wait for 5 minutes if additional drops need inhaler
to be administered. This is for proper a. Semi or high-fowler’s position or standing
absorption of the medication. position. To enhance full chest expansion
h. Avoid dropping a solution onto the cornea allowing deeper inhalation of the medication
directly, because it causes discomfort. b. Shake the canister several times. To mix the
i. Instruct the client to close the eyes gently. medication and ensure uniform dosage
Shutting the eyes tightly causes spillage of delivery
the medication. c. Position the mouthpiece 1 to 2 inches from
j. For liquid eye medication, press firmly on the client’s open mouth. As the client starts
the nasolacrimal duct (inner cantus) for at inhaling, press the canister down to release
least 30 seconds to prevent systemic one dose of the medication. This allows
absorption of the medication. delivery of the medication more accurately

23
 into the bronchial tree rather than being 8. PARENTERAL- administration of medication by
trapped in the oropharynx then swallowed needle.
d. Instruct the client to hold breath for 10 Intradermal – under the epidermis.
seconds. To enhance complete absorption a. The site are the inner lower arm, upper
of the medication. chest and back, and beneath the scapula.
e. If bronchodilator, administer a maximum b. Indicated for allergy and tuberculin testing
of 2 puffs, for at least 30 second interval. and for vaccinations.
Administer bronchodilator before other c. Use the needle gauge 25, 26, 27: needle
inhaled medication. This opens airway and length 3/8”, 5/8” or ½”
promotes greater absorption of the d. Needle at 10–15 degree angle; bevel up.
medication. e. Inject a small amount of drug slowly over 3
f. Wait at least 1 minute before to 5 seconds to form a wheal or bleb.
administration of the second dose or f. Do not massage the site of injection. To
inhalation of a different medication by MDI prevent irritation of the site, and to prevent
g. Instruct client to rinse mouth, if steroid absorption of the drug into the
had been administered. This is to prevent subcutaneous.
fungal infection. Subcutaneous – vaccines, heparin, preoperative
6. Vaginal – drug forms: tablet liquid (douches). medication, insulin, narcotics.
Jelly, foam and suppository. The site:
a. Close room or curtain to provide privacy.  outer aspect of the upper arms
b. Assist client to lie in dorsal recumbent  anterior aspect of the thighs
position to provide easy access and good  Abdomen
exposure of vaginal canal, also allows  Scapular areas of the upper back
suppository to dissolve without escaping  Ventrogluteal
through orifice.  Dorsogluteal
c. Use applicator or sterile gloves for vaginal a. Only small doses of medication should be
administration of medications. injected via SC route.
Vaginal Irrigation – is the washing of the vagina b. Rotate site of injection to minimize tissue
by a liquid at low pressure. It is also called damage.
douche. c. Needle length and gauge are the same as
a. Empty the bladder before the procedure for ID injections
b. Position the client on her back with the d. Use 5/8 needle for adults when the injection
hips higher than the shoulder (use is to administer at 45 degree angle; ½ is use
bedpan) at a 90 degree angle.
c. Irrigating container should be 30 cm (12 e. For thin patients: 45 degree angle of needle
inches) above f. For obese patient: 90 degree angle of
d. Ask the client to remain in bed for 5-10 needle
minute following administration of vaginal g. For heparin injection:
suppository, cream, foam, jelly or h. do not aspirate.
irrigation. i. Do not massage the injection site to
7. RECTAL – can be use when the drug has prevent hematoma formation
objectionable taste or odor. j. For insulin injection:
a. Need to be refrigerated so as not to k. Do not massage to prevent rapid absorption
soften. which may result to hypoglycemic reaction.
b. Apply disposable gloves. l. Always inject insulin at 90 degrees angle to
c. Have the client lie on left side and ask to administer the medication in the pocket
take slow deep breaths through mouth between the subcutaneous and muscle
and relax anal sphincter. layer. Adjust the length of the needle
d. Retract buttocks gently through the anus, depending on the size of the client.
past internal sphincter and against rectal m. For other medications, aspirate before
wall, 10 cm (4 inches) in adults, 5 cm (2 injection of medication to check if the blood
in) in children and infants. May need to vessel had been hit. If blood appears on
apply gentle pressure to hold buttocks pulling back of the plunger of the syringe,
together momentarily. remove the needle and discard the
e. Discard gloves to proper receptacle and medication and equipment.
perform hand washing. Intramuscular
f. Client must remain on side for 20 minute a. Needle length is 1”, 1 ½”, 2” to reach the
after insertion to promote adequate muscle layer
absorption of the medication.

24
 b. Clean the injection site with alcoholized cm (2 in) or 2 to 3 fingerbreadths below the
cotton ball to reduce microorganisms in acromion process.
the area. IM injection – Z tract injection
c. Inject the medication slowly to allow the a. Used for parenteral iron preparation. To seal
tissue to accommodate volume. the drug deep into the muscles and prevent
Sites: permanent staining of the skin.
Ventrogluteal site b. Retract the skin laterally, inject the
a. The area contains no large nerves, or medication slowly. Hold retraction of skin
blood vessels and less fat. It is farther until the needle is withdrawn
from the rectal area, so it less c. Do not massage the site of injection to
contaminated. prevent leakage into the subcutaneous.
b. Position the client in prone or side-lying. GENERAL PRINCIPLES IN PARENTERAL
c. When in prone position, curl the toes ADMINISTRATION OF MEDICATIONS
inward. 1. Check doctor’s order.
d. When side-lying position, flex the knee 2. Check the expiration for medication – drug
and hip. These ensure relaxation of potency may increase or decrease if outdated.
gluteus muscles and minimize discomfort 3. Observe verbal and non-verbal responses
during injection. toward receiving injection. Injection can be
e. To locate the site, place the heel of the painful. Client may have anxiety, which can
hand over the greater trochanter, point increase the pain.
the index finger toward the anterior 4. Practice asepsis to prevent infection. Apply
superior iliac spine, and then abduct the disposable gloves.
middle (third) finger. The triangle formed 5. Use appropriate needle size. To minimize tissue
by the index finger, the third finger and injury.
the crest of the ilium is the site. 6. Plot the site of injection properly. To prevent
Dorsogluteal site hitting nerves, blood vessels, bones.
a. Position the client similar to the 7. Use separate needles for aspiration and
ventrogluteal site injection of medications to prevent tissue
b. The site should not be use in infant under irritation.
3 years because the gluteal muscles are 8. Introduce air into the vial before aspiration. To
not well developed yet. create a positive pressure within the vial and
c. To locate the site, the nurse draws an allow easy withdrawal of the medication.
imaginary line from the greater trochanter 9. Allow a small air bubble (0.2 ml) in the syringe
to the posterior superior iliac spine. The to push the medication that may remain.
injection site id lateral and superior to this 10. Introduce the needle in quick thrust to lessen
line. discomfort.
d. Another method of locating this site is to 11. Either spread or pinch muscle when introducing
imaginary divide the buttock into four the medication. Depending on the size of the
quadrants. The upper most quadrant is client.
the site of injection. Palpate the crest of 12. Minimized discomfort by applying cold
the ilium to ensure that the site is high compress over the injection site before
enough. introduction of medicati0n to numb nerve
e. Avoid hitting the sciatic nerve, major blood endings.
vessel or bone by locating the site 13. Aspirate before the introduction of medication.
properly. To check if blood vessel had been hit.
Vastus Lateralis 14. Support the tissue with cotton swabs before
a. Recommended site of injection for infant withdrawal of needle. To prevent discomfort of
b. Located at the middle third of the anterior pulling tissues as needle is withdrawn.
lateral aspect of the thigh. 15. Massage the site of injection to haste
c. Assume back-lying or sitting position. absorption.
Rectus femoris site –located at the middle 16. Apply pressure at the site for few minutes. To
third, anterior aspect of thigh. prevent bleeding.
Deltoid site 17. Evaluate effectiveness of the procedure and
a. Not used often for IM injection because it make relevant documentation.
is relatively small muscle and is very close Intravenous
to the radial nerve and radial artery. The nurse administers medication intravenously by
b. To locate the site, palpate the lower edge the following method:
of the acromion process and the midpoint 1. As mixture within large volumes of IV fluids.
on the lateral aspect of the arm that is in 2. By injection of a bolus, or small volume, or
line with the axilla. This is approximately 5 medication through an existing intravenous

25
 infusion line or intermittent venous access c. D5LR
(heparin or saline lock) d. D5NM
3. By “piggyback” infusion of solution Complication of IV Infusion
containing the prescribed medication and 1. Infiltration – the needle is out of nein, and
a small volume of IV fluid through an fluids accumulate in the subcutaneous tissues.
existing IV line. Assessment:
a. Most rapid route of absorption of medications.  Pain, swelling, skin is cold at needle site, pallor
b. Predictable, therapeutic blood levels of of the site, flow rate has decreases or stops.
medication can be obtained. Nursing Intervention:
c. The route can be used for clients with  Change the site of needle
compromised gastrointestinal function or  Apply warm compress. This will absorb edema
peripheral circulation. fluids and reduce swelling.
d. Large dose of medications can be 2. Circulatory Overload -Results from
administered by this route. administration of excessive volume of IV fluids.
e. The nurse must closely observe the client for Assessment:
symptoms of adverse reactions.  Headache
f. The nurse should double-check the six rights  Flushed skin
of safe medication.  Rapid pulse
g. If the medication has an antidote, it must be  Increase BP
available during administration.  Weight gain
h. When administering potent medications, the  Syncope and faintness
nurse assesses vital signs before, during and  Pulmonary edema
after infusion.  Increase volume pressure
 SOB
Nursing Interventions in IV Infusion  Coughing
a. Verify the doctor’s order  Tachypnea
b. Know the type, amount, and indication of  shock
IV therapy.
c. Practice strict asepsis. Nursing Interventions:
d. Inform the client and explain the purpose  Slow infusion to KVO
of IV therapy to alleviate client’s anxiety.  Place patient in high fowler’s position. To
e. Prime IV tubing to expel air. This will enhance breathing
prevent air embolism.  Administer diuretic, bronchodilator as
f. Clean the insertion site of IV needle from ordered
center to the periphery with alcoholized 3. Drug Overload – the patient receives an
cotton ball to prevent infection. excessive amount of fluid containing drugs.
g. Shave the area of needle insertion if hairy. Assessment:
h. Change the IV tubing every 72 hours. To  Dizziness
prevent contamination.  Shock
i. Change IV needle insertion site every 72  Fainting
hours to prevent thrombophlebitis. Nursing Intervention
j. Regulate IV every 15-20 minutes. To  Slow infusion to KVO.
ensure administration of proper volume of IV  Take vital signs
fluid as ordered.  Notify physician
k. Observe for potential complications. 4. Superficial Thrombophlebitis – it is due to
o0veruse of a vein, irritating solution or drugs, clot
Types of IV Fluids formation, large bore catheters.
Isotonic solution – has the same concentration as Assessment:
the body fluid  Pain along the course of vein
a. D5 W  Vein may feel hard and cordlike
b. Na Cl 0.9%  Edema and redness at needle insertion site.
c. plainRinger’s lactate  Arm feels warmer than the other arm
d. Plain Normosol M Nursing Intervention:
Hypotonic – has lower concentration than the  Change IV site every 72 hours
body fluids.  Use large veins for irritating fluids.
a. NaCl 0.3%  Stabilize venipuncture at area of flexion.
Hypertonic – has higher concentration than the  Apply cold compress immediately to relieve
body fluids. pain and inflammation; later with warm
a. D10W compress to stimulate circulation and
b. D50W promotion absorption.

26
  “Do not irrigate the IV because this could  Expiration date
push clot into the systemic circulation’  Screening test (VDRL, HBsAg, malarial
5. Air Embolism – Air manages to get into the smear)- this is to ensure that the blood is free from
circulatory system; 5 ml of air or more causes air blood-carried diseases and therefore, safe from
embolism. transfusion.
Assessment: f. Warm blood at room temperature before
 Chest, shoulder, or backpain transfusion to prevent chills.
 Hypotension g. Identify client properly. Two Nurses check
 Dyspnea the client’s identification.
 Cyanosis h. Use needle gauge 18 to 19. This allows easy
 Tachycardia flow of blood.
 Increase venous pressure i. j. Use BT set with special micron mesh filter.
 Loss of consciousness To prevent administration of blood clots and
Nursing Intervention particles.
 Do not allow IV bottle to “run dry” j. Start infusion slowly at 10 gtts/min. Remain
 “Prime” IV tubing before starting infusion. at bedside for 15 to 30 minutes. Adverse
 Turn patient to left side in the reaction usually occurs during the first 15 to
Trendelenburg position. To allow air to rise 20 minutes.
in the right side of the heart. This prevent k. Monitor vital signs. Altered vital signs
pulmonary embolism. indicate adverse reaction.
6. Nerve Damage – may result from tying the  Do not mixed medications with blood
arm too tightly to the splint. transfusion. To prevent adverse efects
Assessment  Do not incorporate medication into the
 Numbness of fingers and hands blood transfusion
Nursing Interventions  Do not use blood transfusion line for IV
 Massage the are and move shoulder push of medication.
through its ROM l. . Administer 0.9% NaCl before, during or after BT.
 Instruct the patient to open and close Never administer IV fluids with dextrose. Dextrose
hand several times each hour. causes hemolysis.
 Physical therapy may be required m. . Administer BT for 4 hours (whole blood, packed
Note: apply splint with the fingers free to move. rbc). For plasma, platelets, cryoprecipitate,
7. Speed Shock – may result from transfuse quickly (20 minutes) clotting factor can
administration of IV push medication rapidly. easily be destroyed.
 To avoid speed shock, and possible cardiac
arrest, give most IV push medication over Complications of Blood Transfusion
3 to 5 minutes. 1. Allergic Reaction – it is caused by sensitivity to
BLOOD TRANSFUSION THERAPY plasma protein of donor antibody, which reacts with
Objectives: recipient antigen.
1. To increase circulating blood volume after Assessments
surgery, trauma, or hemorrhage  Flushing
2. To increase the number of RBCs and to
maintain hemoglobin levels in clients with
 Rush, hives
severe anemia  Pruritus
3. To provide selected cellular components as  Laryngeal edema, difficulty of breathing
replacements therapy (e.g. clotting 2. Febrile, Non-Hemolytic – it is caused by
factors, platelets, albumin) hypersensitivity to donor white cells, platelets or
Nursing Interventions: plasma proteins. This is the most symptomatic
a. Verify doctor’s order. Inform the client and complication of blood transfusion
explain the purpose of the procedure. Assessments:
b. Check for cross matching and typing. To  Sudden chills and fever
ensure compatibility  Flushing
c. Obtain and record baseline vital signs  Headache
d. Practice strict Asepsis  Anxiety
e. At least 2 licensed nurse check the label of 3. Septic Reaction – it is caused by the
the blood transfusion transfusion of blood or components contaminated
Check the following: with bacteria.
 Serial number Assessment:
 Blood component  Rapid onset of chills
 Blood type  Vomiting
 Rh factor  Marked Hypotension
27
 High fever RBC male 4.5-6.2 million/L
4. Circulatory Overload – it is caused by Female 4.2-5.4 million/L
administration of blood volume at a rate greater Amylase 80-180 IU/L
than the circulatory system can accommodate. Bilirubin(serum)direct 0-0.4 mg/dl
Assessment indirect 0.2-0.8 mg/dl
 Rise in venous pressure total 0.3-1.0 mg/dl
 Dyspnea pH 7.35- 7.45
PaCo2 35-45
 Crackles or rales
HCO3 22-26 mEq/L
 Distended neck vein Pa O2 80-100 mmHg
 Cough SaO2 94-100%
 Elevated BP Sodium 135- 145 mEq/L
5. Hemolytic reaction. It is caused by infusion Potassium 3.5- 5.0 mEq/L
of incompatible blood products. Calcium 4.2- 5.5 mg/dL
Assessment Chloride 98-108 mEq/L
 Low back pain (first sign). This is due to Magnesium 1.5-2.5 mg/dl
inflammatory response of the kidneys to BUN 10-20 mg/dl
incompatible blood. Creatinine 0.4- 1.2
 Chills CPK-MB male 50 –325 mu/ml
 Feeling of fullness female 50-250 mu/ml
Fibrinogen 200-400 mg/dl
 Tachycardia
FBS 80-120 mg/dl
 Flushing Glycosylated Hgb 4.0-7.0%
 Tachypnea (HbA1c)
 Hypotension Uric Acid 2.5 –8 mg/dl
 Bleeding ESR male 15-20 mm/hr
 Vascular collapse Female 20-30 mm/hr
 Acute renal failure
Nursing Interventions when complications Cholesterol 150- 200 mg/dl
occurs in Blood transfusion Triglyceride 140-200 mg/dl
1. If blood transfusion reaction occurs. STOP
THE TRANSFUSION. Lactic Dehydrogenase 100-225 mu/ml
2. Start IV line (0.9% Na Cl) Alkaline phospokinase 32-92 U/L
3. Place the client in Fowler’s position if with Albumin 3.2- 5.5 mg/dl
SOB and administer O2 therapy.
4. The nurse remains with the client, COMMON THERAPEUTIC DIETS
observing signs and symptoms and 1. CLEAR-LIQUID DIET
monitoring vital signs as often as every 5 Purpose:
minutes.  relieve thirst and help maintain fluid
5. Notify the physician immediately. balance.
6. The nurse prepares to administer Use:
emergency drugs such as antihistamines,  post-surgically and following acute vomiting
vasopressor, fluids, and steroids as per or diarrhea.
physician’s order or protocol. Foods Allowed:
7. Obtain a urine specimen and send to the  carbonated beverages; coffee (caffeinated
laboratory to determine presence of and decaff.); tea; fruit-flavored drinks;
hemoglobin as a result of RBC hemolysis. strained fruit juices; clear, flavored gelatins;
8. Blood container, tubing, attached label, broth, consomme; sugar; popsicles;
and transfusion record are saved and commercially prepared clear liquids; and
returned to the laboratory for analysis. hard candy.
Foods Avoided:
 milk and milk products, fruit juices with
Normal Values pulp, and fruit.
Bleeding time 1-9 min 2. FULL-LIQUID DIET
Prothrombin time 10-13 sec Purpose:
Hematocrit Male 42-52%  Provide an adequately nutritious diet for
Female 36-48% patients who cannot chew or who are too ill
Hemoglobin male 13.5-16 g/dl to do so.
female 12-14 g/dl  Use:
Platelet 150,00- 400,000
28
  acute infection with fever, GI upsets, after  table salt; all commercial soups, including
surgery as a progression from clear bouillon; gravy, catsup, mustard, meat
liquids. sauces, and soy sauce;
Foods Allowed:  buttermilk, ice cream, and sherbet; sodas;
 clear liquids, milk drinks, cooked cereals,  beet greens, carrots, celery, chard,
custards, ice cream, sherbets, eggnog, all sauerkraut, and
strained fruit juices, creamed vegetable  spinach; all canned vegetables; frozen peas;
soups, puddings, mashed potatoes, instant  all baked products containing salt, baking
breakfast drinks, yogurt, mild cheese powder, or baking soda; potato chips and
sauce or pureed meat, and seasoning. popcorn; fresh or canned shellfish; all
Foods Avoided: cheeses
 nuts, seeds, coconut, fruit, jam, and  smoked or commercially prepared meats;
marmalade salted butter or margarine;
SOFT DIET  bacon, olives; and commercially prepared
Purpose: salad dressings.
 provide adequate nutrition for those who
have troubled chewing.
 Use: RENAL DIET
 patient with no teeth or ill-fitting dentures; Purpose:
transition from full-liquid to general diet;  control protein, potassium, sodium, and fluid
and for those levels in the body.
 who cannot tolerate highly seasoned, fried Use:
or raw foods following acute infections or  acute and chronic renal failure, hemodialysis.
gastrointestinal Foods Allowed:
 disturbances such as gastric ulcer or  high-biological proteins such as meat, fowl,
cholelithiasis. fish, cheese, and dairy products- range
Foods Allowed: between 20 and 60 mg/day.
 very tender minced, ground, baked  Potassium is usually limited to 1500 mg/day.
broiled, roasted, stewed, or creamed beef,  Vegetables such as cabbage, cucumber, and
lamb, veal, liver, peas are lowest in potassium.
 poultry, or fish; crisp bacon or sweet  Sodium is restricted to 500 mg/day.
bread; cooked vegetables; pasta; all fruit  Fluid intake is restricted to the daily volume
juices; soft raw fruits; plus 500 mL, which represents insensible
 soft bread and cereals; all desserts that water loss.
are soft; and cheeses.  Fluid intake measures water in fruit,
Foods Avoided: vegetables, milk and meat.
 coarse whole-grain cereals and bread; nuts; Foods Avoided:
raisins; coconut;  Cereals, bread, macaroni, noodles, spaghetti,
 fruits with small seeds; fried foods;  avocados, kidney beans, potato chips
 high fat gravies or sauces;  raw fruit, yams
 spicy salad dressings; pickled meat, fish, or  soybeans, nuts, gingerbread
poultry;  apricots, bananas, figs, grapefruit, oranges,
 strong cheeses;  percolated coffee
 brown or wild rice;  Coca-Cola, orange crush, sport drinks, and
 raw vegetables, as well as lima beans and breakfast drinks such as Tang or Awake
corn; spices such as horseradish,
 mustard, and catsup; and popcorn. HIGH-PROTEIN, HIGH CARBOHYDRATE DIET
SODIUM-RESTRICTED DIET Purpose:
Purpose:  To correct large protein losses and raises the
 reduce sodium content in the tissue and level of blood albumin. May be modified to
promote excretion of water. include low-fat, low-sodium, and low-cholesterol
Use: diets.
 heart failure, hypertension, renal disease, Use:
cirrhosis, toxemia of pregnancy, and  Burns
cortisone therapy.  Hepatitis
Modifications:  Cirrhosis
 mildly restrictive 2 g sodium diet to  Pregnancy
extremely restricted 200 mg sodium diet.  Hyperthyroidism
Foods Avoided:  Mononucleosis
 protein deficiency due to poor

29
 eating habits  chocolate
 geriatric patient with poor intake  jams with seeds; nuts
 nephritis, nephrosis,  seasoned dressings
 liver and gall bladder disorder.  caffeinated coffee; strong tea; cocoa;
Foods Allowed: alcoholic and carbonated beverages
 general diet with added protein.  pepper.
Foods Avoided: LOW-FAT, CHOLESTEROL-RESTRICTED DIET
 restrictions depend on modifications added to Purpose:
the diet. The modifications are determined by  reduce hyperlipedimia, provide dietary
the patient’s condition. treatment for malabsorption syndromes and
PURINE-RESTRICTED DIET patients having acute intolerance for fats.
Purpose: Use:
 designed to reduce intake of uric acid-  Hyperlipedimia
producing foods.  Atherosclerosis
Use:  Pancreatitis
 high uric acid retention, uric acid renal  scystic fibrosis
stones, and gout.  sprue (disease of intestinal tract
Foods Allowed:  characterized by malabsorption)
 general diet plus 2-3 quarts of liquid daily.  gastrectomy
Foods Avoided:  massive resection of small intestine
 cheese containing spices or nuts  cholecystitis.
 fried eggs, meat Foods Allowed:
 liver, seafood  nonfat milk
 lentils, dried peas and beans  low-carbohydrate
 broth, bouillon, gravies  low-fat vegetables; most fruits; breads; pastas;
 oatmeal and whole wheat cornmeal
 pasta, noodles  lean meat
 alcoholic beverages  unsaturated fats
 Limited quantities of meat, fish, and seafood Foods Avoided:
allowed.  remember to avoid the five C’s of
BLAND DIET cholesterol- cookies, cream, cake, coconut,
Purpose: chocolate
 Provision of a diet low in fiber, roughage,  whole milk and whole-milk or cream
mechanical irritants, and chemical stimulants. products
Use:  avocados, olives
 Gastritis  commercially prepared baked goods such as
 hyperchlorhydria (excess hydrochloric acid)  donuts and muffins
 functional GI disorders  poultry skin, highly marbled meats
 gastric atony  butter, ordinary margarines, olive oil, lard
 diarrhea  pudding made with whole milk, ice cream,
 spastic constipation candies with chocolate, cream, sauces,
 biliary indigestion gravies and commercially fried foods.
 hiatus hernia. DIABETIC DIET
Foods Allowed: Purpose:
 Varied to meet individual needs and food  maintain blood glucose as near as normal as
tolerances. possible; prevent or delay onset of diabetic
Foods Avoided: complications.
 fried foods, including eggs, meat, fish, Use:
and sea food  diabetes mellitus
 cheese with added nuts or spices Foods Allowed:
 commercially prepared luncheon meats  choose foods with low glycemic index compose
cured meats such as ham of:
 gravies and sauces a. 45-55% carbohydrates
 raw vegetables; b. 30-35% fats
 potato skins c. 10-25% protein
 fruit juices with pulp  coffee, tea, broth, spices and flavoring can be
 figs, raisins used as desired.
 fresh fruits  exchange groups include: milk, vegetable,
 whole wheat; rye bread; bran cereals fruits, starch/bread, meat (divided in lean,
 rich pastries; pies medium fat, and high fat), and fat exchanges.

30
 the number of exchanges allowed from each HIGH-FIBER DIET
group is dependent on the total number of Purpose:
calories allowed.  Soften the stool
 non-nutritive sweeteners (sorbitol) in  exercise digestive tract muscles
moderation with controlled, normal weight
diabetics.
 speed passage of food through digestive
tract to prevent exposure to cancer-causing agents
Foods Avoided:
in food
 concentrated sweets or regular soft drinks.
ACID AND ALKALINE DIET  lower blood lipids
Purpose:  Prevent sharp rise in glucose after eating.
 Furnish a well balance diet in which the total Use: diabetes, hyperlipedemia, constipation,
acid ash is greater than the total alkaline ash diverticulitis, anticarcinogenics (colon)
each day. Foods Allowed:
Use:  recommended intake about 6 g crude fiber
 Retard the formation of renal calculi. The type daily
of diet chosen depends on laboratory analysis  All bran cereal
of the stone.  Watermelon, prunes, dried peaches, apple
Acid and alkaline ash food groups: with skin; parsnip, peas, brussels sprout,
 Acid ash: meat, whole grains, eggs, cheese, sunflower seeds.
cranberries, prunes, plums LOW RESIDUE DIET
 Alkaline ash: milk, vegetables, fruits (except Purpose:
cranberries, prunes and plums.)  Reduce stool bulk and slow transit time
 Neutral: sugar, fats, beverages (coffee, tea) Use:
Foods allowed:  Bowel inflammation during acute diverticulitis,
 Breads: any, preferably whole grain; crackers; or ulcerative colitis, preparation for bowel
rolls surgery, esophageal and intestinal stenosis.
 Cereals: any, preferable whole grains Food Allowed:
 Desserts: angel food or sunshine cake;  eggs; ground or well-cooked tender meat,
cookies made without baking powder or soda; fish, poultry; milk, cheeses; strained fruit juice
cornstarch, (except prune): cooked or canned apples, apricots,
 pudding, cranberry desserts, ice cream, peaches, pears; ripe banana; strained vegetable
sherbet, plum or prune desserts; rice or juice: canned, cooked, or strained asparagus,
tapioca pudding. beets, green beans, pumpkin, squash, spinach;
 Fats: any, such as butter, margarine, salad white bread;
dressings, Crisco, Spry, lard, salad oil, olive refined cereals (Cream of Wheat)
oil, ect.
 fruits: cranberry, plums, prunes
 Meat, eggs, cheese: any meat, fish or fowl,
two serving daily; at least one egg daily
 Potato substitutes: corn, hominy, lentils,
macaroni, noodles, rice, spaghetti, vermicelli.
 Soup: broth as desired; other soups from food
allowed
 Sweets: cranberry and plum jelly; plain sugar
candy
 Miscellaneous: cream sauce, gravy, peanut
butter, peanuts, popcorn, salt, spices, vinegar,
walnuts.
Restricted foods:
 no more than the amount allowed each
day
1. Milk: 1 pint daily (may be used in other ways
than as beverage)
2. Cream: 1/3 cup or less daily
3. Fruits: one serving of fruits daily( in addition to
the prunes, plums and cranberries)
4. Vegetable: including potatoes: two servings
daily
5. Sweets: Chocolate or candies, syrups.
6. Miscellaneous: other nuts, olives, pickles.

31