FUNDAMENTALS OF NURSING GLADYS BAUTISTA JAIME 2010

HISTORY OF NURSING VII. ROME

 Intuitive Period  Roman Catholic
 Apprentice Period  Fabiola – made her home as the first hospital under the
 Educated Nursing Period Christ Era
Page |  Contemporary Period
1 APPRENTICE PERIOD
INTUITIVE PERIOD  11TH century – 1836
 Nursing was untaught and instructive  On the job training period
 Beliefs and practices  From the rise of religious orders from secular orders up to the dark
i. Nomads period of nursing up to the establishment of the 1st training school.
ii. Women
iii. Black magic/ evil spirits (voodoo) RELIGIOUS ORDERS
iv. White magic/ shaman/ witch doctors  Knights of St. John – ranks and superiority
v. Trephining  Teutonic Knights – tent hospitals
 Knights of St. Lazarus – lepers/leprosy
ANCIENT CITIES AND CONTRIBUTIONS
I. BABYLONIA SECULAR ORDERS
 Code of Hammurabi (Law affecting medical practice)  St. Catherine of Siena – “Lady with a lamp”
 RA 9173 – Phil. Nursing Act of 2001  St. Elizabeth of Hungary – “Patroness of Nurses”
 RA 7164 – Old Phil. Nursing Act of 1991  Clara Barton – “Founder of American Red Cross”
II. EGYPT  St. Claire – founded the 2nd order of St. Francis de Asisi
 Art of Embalming (Enhance the knowledge about human
anatomy) Dark Period of Nursing
 Recognize 250 diseases  Religious upheaval led by Martin Luther
III. ISRAEL
 Moses “Father of Sanitation” Theodore Fliedner
 Give laws on communicable disease  Establish the 1st training school in Germany
 Ritual circumcision  Kaiserwerth Institute for the Training of the Deaconesses
IV. CHINA
 “Materia Medica” (pharmacology) EDUCATED NURSING PERIOD
 Used girl clothes for male babies  Florence Nightingale – May 12, 1820 in Florence, Italy
V. INDIA  Crimean War
 Intuitive Asepsis  Lady with a lamp
 SUSHURUTU – record of function and responsibility of  St. Thomas School of Nursing
nurses  Mother of modern nursing
VI. ANCIENT GREECE  Notes: on nursing/ on hospital
 Hippocrates – “Father of Scientific Medicine”  Environmental Theory (first theorist)

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 FUNDAMENTALS OF NURSING GLADYS BAUTISTA JAIME 2010
 Lilian Wald 18 THEORIES AND THEORIST
 Founder of the Public Health Nursing
1) FLORENCE NIGHTINGALE
 Linda Richards  “ENVIRONMENTAL THEORY”
Page |  1st graduate as a nurse in US  Cleanliness, Light, Air, Water, Diet, Warm, Noise Free, Drainage
2  Initiated the use of white uniforms
 Use of Nurse’s Notes and Doctor’s Order 2) LYDIA HALL
 “CORE, CARE and CURE”
 Mary Mahoney  Core – person (therapeutic use of self/communication)
 1st African American Nurse  Care – body (bed bath, oral care, hygiene)
 Cure – disease (medication, IV Therapy)
 Lavinia Dock
 Active in Protest 3) VIRGINIA HENDERSON
 Women has privilege to VOTE  “14 Basic Human Needs”
 Breath normally, Eat and Drink, Eliminate, Move and Maintain
 Margaret Higgins Sanger Posture, Sleep and Rest, Dress and Undress, Maintain Body
 Founder of the Planned Parenthood (Family Planning) Temperature, Keep Clean, Avoid Danger, Communicate, Worship,
Work, Play and Learn
CONTEMPORARY PERIOD
 World War II up to the present 4) HILDEGARD PEPLAU
 Scientific and Technological Advancement  “Psycho dynamic Theory”
 Computer, Sophisticated Equipment, Disposable Supplies  4 Phases of Nurse Patient Relationship
 Own Nursing Law (RA 9173)  Orientation – problem identification
 Identification – feeling of belongingness, trust, Setting
ROLES AND RESPONSIBILITIES OF NURSES GOALS
 CAREGIVER – providing care  Exploitation – use all resources to resolve problem,
 COUNSELOR – supporting emotionally IMPLEMENTATION
 CHANGE AGENT – modification of lifestyle  Resolution – goals met, TERMINATION Phase
 CLIENT’S ADVOCATE – protects client’s right
 CASE MANAGER – collaborates with other member 5) DOROTHEA OREM
 MANAGER – Planning, Organizing, Delegation, Controlling  “Self-care Deficit”
 TEACHER – health promotion and teaching  Whole Compensatory – 100% nurse
 LEADER – attaining goals and objectives  Partially Compensatory – 50-50 nurse-patient
 RESEARCHER – development of profession  Supportive-Educative – discharge planning and health
teaching

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 FUNDAMENTALS OF NURSING GLADYS BAUTISTA JAIME 2010
6) MARTHA ROGERS 12) BETTY NEUMAN
 “Science of Unitary Human Beings”  “Health Care System Model”
 Man is a unified whole – inter-related parts  Origins of Stressors
 INTRA – within the person/inside
Page | 7) IMOGENE KING  INTER – between friends and family
3  “Goal Attainment Model”  EXTRA – outside the person
 Transaction (Communication Skills)
13) SISTER CALLISTA ROY
8) DOROTHY JOHNSON  “Adaptation Model”
 “Behavioral Model”  Process of Adaptation
 7 SUBSYSTEMS  INPUT – stressor
 AGGRESSIVE – self-protective behavior  CONTROL – manage physically and emotionally
 AFFILIATE – security seeking behavior  OUTPUT – outcome and result
 ACHIEVEMENT – master of oneself  FEEDBACK – how it affects the next input
 DEPENDENCY – nurturance seeking
 ELIMINATIVE – moving out of wastes 14) PATRICIA BENNER
 INGESTIVE – taking-in nutrients  “Stages of Expertise”
 SEX – procreation and satisfaction  NOVICE – bounded with rules and standards, no experience
 ADVANCE BEGINNER – demonstrate marginally acceptable
9) FAYE GLENN ABDELLAH procedure, real experiences
 “21 Nursing Problems”  COMPETENT – 2-3yrs. experience, consciously plan the care
 Interrogative = ?  PROFICIENT – 3-5yrs. Experience, perceive situation as a
whole rather than in parts, HOLISTIC VIEW
10) MADELIENE LEININGER  EXPERT – highly fluid and flexible
 “Transcultural Theory”
 Beliefs and Practice = Respect 15) ROSEMARIE RIZZO PARSE
 “Human Becoming Theory”
11) MYRA LEVINE
 “Conservational Model” 16) IDA JEAN ORLANDO
 ENERGY – Input (Food, O2, Water) = Output = Energy  “Dynamic Nurse Patient Relationship”
 PERSONAL INTEGRITY – self-worth/ self-identity
 SOCIAL INTEGRITY – interpersonal needs 17) JEAN WATSON
 STRUCTURAL INTEGRITY – physical boundaries of human should  “Caring Model”
be intact (skin and mucus membrane)
18) ERNESTINE WIEDENBACH
 “Helping Art of Clinical Nursing”

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 FUNDAMENTALS OF NURSING GLADYS BAUTISTA JAIME 2010
SMITH’S MODEL OF HEALTH THERMOMETER
Healthy Illness ROUTE ADVANTAGE NSG.CONSIDERATION N° VALUES
Clinical Model Signs/Symptoms X  RECTAL Most accurate 0.5-1.5 inches 37-38.1
Adaptation Model Adapt  X Most reliable 1-2 minutes
Page | Role Performance Duties  X AXILLARY Safest Pat dry before use 35.8-37
4 Eudemonistic Model Self-actualization  X Non-invasive 5-9 minutes
ORAL Most convenient 30min rest before 36.5-37.5
STAGES OF EXPERTISE Most accessible 2-3 minutes
 SYMPTOM EXPERIENCE – subjective TYMPANIC Very fast Prevent puncture of TM 36.8-37.9
 ASSUMPTION OF SICK ROLE – accept illness and seek advice Within seconds
 MEDICAL CARE CONTACT – seek advice from professionals, validation
and explanation of disease Cleaning – Before Use: bulb to stem
 DEPENDENCY ROLE – healthcare, passive communication After Use: stem to bulb
 REHABILITATION – going back to the pre-illness stage, RECOVERY
Pyrexia – more than normal temperature
NURSING PROCESS: Hyperpyrexia – more than 41°C
 ASSESSMENT
Vital Signs: TEMPERATURE TYPES OF FEVER
 INTERMITTENT – fluctuation of temperature bet. normal and abnormal
HYPOTHALAMUS  REMITTENT – fluctuation of temperature but all above normal
 RELAPSING – fever with 1-2 days of normal temperature
DETERMINED BY METABOLISM  CONSTANT – minimal fluctuation, consistently high

BALANCED BETWEEN HEAT PRODUCTION AND HEAT LOSS PULSE

HEAT PRODUCTION HEAT LOSS Autonomic Nervous System

 Basic Metabolic Rate  Conduction
 Activity  Radiation Pulse Sites:
 Thyroxin Output  Convection Temporal, Carotid, Apical, Brachial, Radial, Femoral, Popliteal, Posterior
 Epinephrine/Nor-Epinephrine  Evaporation Tibia, Dorsalis Pedis
 Fever
PULSE RATE:
1 month – 80-180
1 year – 80-140
2 years – 80-130
6 years – 80-120
Adult – 60-100

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 FUNDAMENTALS OF NURSING GLADYS BAUTISTA JAIME 2010
PULSE FORCE Volumes:
3 – Full Bounding TIDAL VOLUME – inhalation and exhalation
2 – Normal INSPIRATORY RESERVED VOLUME – maximum air that can be inhaled after
1 – Weak Thready Pulse normal breathing
Page | 0 – No Pulse EXPIRATORY RESERVED VOLUME - maximum air that can be exhaled after
5 normal breathing
PULSE Pressure – (Systole-Diastole=PP) N°= 30-40mmHg RESIDUAL VOLUME – remaining in the lungs
PULSE Deficit – (Apical-Peripheral Pulse) TOTAL LUNG CAPACITY – (T I E R)

RESPIRATION CHEST INDRAWING – retraction

 Medulla  Suprasternal – above the clavicle
 PONS – Pneumotaxics Center (rhythmic)  Subcostal – below the breast bone
- Apneustic Center (deep prolonged respiration)  Intercostal – between the ribs
- Aortic and Carotid Bodies
BLOOD PRESSURE
Rate: Normal Value: Systole = 100-140
APNEA – cessation of breathing Diastole = 60-90
ORTHOPNEA – inability to breathe except in upright
EUPNEA – normal breathing Nursing Consideration:
TACHYPNEA – increased respiratory rate  Rested = 30minutes
BRADYPNEA – decreased respiratory rate  Position: at the level of heart and supported
- Above = false low
Rhythm: - Below = false high
CHEYNE’S STOKE – very deep to very shallow then apnea  Palpatory BP (+30mmHg)
KUSSMAUL’S – deep rapid labored breathing  Bell – low pitch sound (Korotkoff)
BIOT’S – very shallow with apnea  BP Cuff – Too narrow = false high
- Too wide = false low
Sounds:  Inflate 2-3mmHg at a time – Too slow = false high
STRIDOR – harsh, shrill sound on inspiration - Too fast = false low
- Laryngeal obstruction  Meniscus – lower, at the level of eye to prevent ERROR OF PARALLAX
STRETOR – snoring sound on expiration  Popliteal Pulse – 10-40mmHg higher than the brachial artery
- Obstructed or narrowed airway
WHEEZE – squeaky musical sound on expiration
- Narrow or constricted bronchus
BUBBLING – gurgling sound, air passing through secretions
- Heard both on inspiration and expiration

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 FUNDAMENTALS OF NURSING GLADYS BAUTISTA JAIME 2010
PHYSICAL EXAMINATION NAILS
 Normal Angle = 160° angle
Skin, Hair, Nails  color and lesion  Flat = 180°angle – indication of early clubbing
- Long term lack of oxygen
Page | Pale – Pallor  Capillary Refill Test – Blanch Test
6 Blue – Cyanosis - Pedia = >2seconds
Yellow – Jaundice - IMCI = more than 3seconds
Red – Erythema - Funda = 4seconds
Virtiligo – Patches or hypopigmented skin
EYES
Lesion:  Darken the room (dilate)
FLAT – non palpable  Pupils – PERRLA
 Macule <1cm  Size – 3-7mm
- Patch >1cm  Miosis – constricted
CIRCUMSIDE – elevated form by solid mass  Mydriasis – dilated
(papule, plaque, nodule, tumor)  Anisocona – unequal
C/E – formed by free fluid  Visual Acuity – Snellen’s Chart
Loose of Skin Surface - Normal = 20/20
- Erosion (epidermis, without scar) - 20/200 = legal blindness
- Ulcer (epidermis, dermis, subcutaneous with scar)
 Myopia – near = concave
- Fissures (linear crack with sharp edges)
 Hyperopia – far = convex
 Papule - <1cm (warts, acne)
 Presbyopia – loss of elasticity of lens caused by aging
Plaque – coalescence of papule (psoriasis)
 Astigmatism – uneven curvature of the cornea
Nodule – 0.5-2cm (squamous and carcinoma)
Tumor - >2cm
EARS
Wheal – irregular shape, insect bite
 4 years old – up and back
 Vesicle - <.5cm (early chicken pox)
 3 years old above – up and back
Bullae - >.5cm (blister, sign of herpes)
Pustule- pus  3 years old below – down and back
 WEBER’S TEST – bone conduction, lateralization of sounds
HAIR - Bad Bone Conduction = conductive hearing loss
 Thickness/Thinness – normal = thick - Good = sensory neural hearing loss
 Infection and Infestation  RINNE’S TEST – conductive hearing loss
 Amount of Hair
THORAX
 Texture of Hair
 Shape – oval, elliptical (adult), equal or cylindrical (infant)
 Growth of Hair
 Spinal Alignment
 Sound – percussion
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 FUNDAMENTALS OF NURSING GLADYS BAUTISTA JAIME 2010
ABDOMEN  BENEDICT’S TEST – glucose
 Palpation – void first  Result – Blue (-)
 Dorsal Recumbent – supine with knees flexed to relaxed abdominal - Green (+)
muscle - Yellow (++)
Page |  Warm hands during palpation – rub - Orange (+++)
7  Slow approach - Red (++++)
 Indusperpal – prevent the distortion of abdominal sounds
STOOL
LABORATORY EXAMS  Routine fecalysis
 URINE – routine urinalysis - 1inch or 2.5cm/tsp
- 24hour urine specimen - 15-30ml liquid stool (diarrhea)
- Catheterization  Guiac Stool Exam
 STOOL – routine fecalysis - Occult blood exam
- Guiac Stool Exam - Don’t give dark color foods (red meat, Iron Supplement)
 SPUTUM – AFB - Avoid turnips and radishes
- Blood specimen  False Positive for 3days
 False Negative – vit.C 250mg/day for 3days
URINE
 Routine urinalysis SPINAL ALIGNMENT
- First thing in the morning  Lordosis – lumbar region is affected
- First voided (collect)  Kyphosis – thoracic region is affected
- First flow is discarded (midstream catch) - Best position when assessing: standing straight
- Perineal Care first  Scoliosis – lateral deviation of spine
- Send to laboratory (ideal: add preservatives as protocol of - Best position: bending forward in 90°angle
agency)
 Collect – 30-50ml SOUNDS
 Culture and Sensitivity – 5-10ml  Bronchial – high pitch sound; hear over the trachea
 24hours urine specimen  Bronchovesicular – moderate pitch sound; hear over main bronchi
- First void discard  Vesicular – low pitch sound; heard over the lung fields
- Collect with same container  Use diaphragm for high pitch sound
 Catheterization
- Do’s: clamp below the cord (30-60mins) PERCUSSION
- Sterile syringe inserted diagonally (self-sealing)  Dull – liver and heart
- Don’ts: do not collect from bag  Flat – bones and muscles
 Acetic Acid Test – protein  Resonance – normal lung sound
- Do not heat could explode  Hyper resonance - hyper inflated lung
- (+) cloudiness of solution  Tympany – stomach
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 FUNDAMENTALS OF NURSING GLADYS BAUTISTA JAIME 2010
 Thorax – Normal Resonance OXYGENATION
- If dull; solidation of lung tissue  Support combustion
- Patient with Pneumonia, Emphysema and Asthma - No smoking
- No faulty electrical devices
Page | ACID FAST BACILLI - No friction
8  Early AM collection - No wool fabrics
 No toothbrush, mouthwash and food  Emergency: nurse can give 2-3liters/min. (independent)
 Plain water only  Carbon dioxide – major stimuli for respiration
TYPES CONCENTRATION LITERS PER MINUTE
BLOOD SPECIMEN Nasal Cannula 24-45 2-6
 FASTING – BUN = triglyceride Simple Face Mask 40-60 5-8
- CREATININE = serum lipid amylase Partial Rebreather 60-90 6-10
- indicative for kidney function Non Rebreather 95-100 10-15
 NON-FASTING – CBC, Hemoglobin, Hematocrit, Serum Electrolytes, Venturi Mask 24-40-50 4-10
Clotting Studies
CATHETERIZATION
BASIC NURSING SKILLS  Straight catheterization – common
SUCTIONING  Indwelling – 5-10ml, inflate balloon, sterile balloon
 POSITION – Conscious: semi-fowlers  SIZES
- Unconscious: Side-lying or lateral to prevent aspiration - Male: 18-16 French
 PRESSURE - Female: 14-12 French
AGE WALT PORTABLE  LENGTH
Adult 120-100mmHg 15-10 - Male: 6-9 inches
Child 110-95mmHg 10-5 - Female: 3-4 inches
Infant 95-50mmHg 5-2  POSITION
 LENGTH – nose to earlobe (13cm or 5inches) - Male: supine with legs slightly abducted
 Lubricant - Female: dorsal recumbent with knees flexed
- Nasopharyngeal – water soluble lubricant (KY Jelly)  LUBRICANT – water soluble lubricant
- Oropharyngeal – sterile water  LOCATION
 TIME – 5-10seconds (15sec. maximum) with 20sec. interval - Male- tip of glands penis
- 30 seconds for hyper oxygenation - Female: urethral meatus between clitoris and vagina
 TECHNIQUE – Never apply suction during the insertion  ANCHOR
- Apply only during withdrawal; intermittent suctioning (on&off) - Male: lower abdomen
 SIZES - Female: inner aspect of thigh
- Adult = 18-12 French
- Children = 10-8 French
- Infant = 8-5 French
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 FUNDAMENTALS OF NURSING GLADYS BAUTISTA JAIME 2010
NASOGASTRIC TUBE (NGT) 60mg = 1gram 1tsp = 5ml/cc
 For feeding - Gavage 1gram = 15 grains 1tbs = 3tsp = 15-30ml
 For irrigation – Lavage 1ml = 15gtts 1 cup = 240ml
 Decompression – preparation for surgery  DRUGS
Page |  POSITION – Feeding: high-fowler’s for 30minutes - 3x check the label:
9  LENGTH – Nose  Earlobe Xiphoid (50cm or 20inches) - Before removing from shelves
 PLACEMENTS – Air: aseptosyringe/stethoscope LUQwhooshing sound - After removing from container
- Aspirate: color = greenish or yellowish - Before returning to the drawer or shelves
- pH: Acid = <6  DOSE – Desired Dose/Stock on Hand X Dilution
- Lithmus Paper: Blue to Red  PATIENT – check for ID band (safest)
- X-Ray: most effective  TIME
 RESIDUAL VOLUME – 50ml withhold the fluid (12inches) - AC = before meals
- PC = after meals
ENEMA - PRN = as needed
RETENTION COMPARISON NON-RETENTION - STAT = immediately
Oil, Carminative SOLUTION Plain NSS, Soap Suds - BID = twice a day
12 inches HEIGHT 18 inches  ROUTE
1-3 hours TIME 5-10 minutes - Oral and Sublingual – easy absorbed thru bloodstream
105-110°F TEMPERATURE 115-125°F - Less expensive, most convenient, safest
 SIZES o Disadvantage – remain under the tongue, if swallowed
- Adult: 32-22 French notify the physician. Dissolved by gastric juice
- Children: 18-14 French o Cause staining of teeth
- Infant: 12 French o Contraindicated with Nausea and Vomiting
 LENGTH - TOPICAL – dermatologic
- Lubricate: 2 inches or 5cm - Only applied at the thin layer
- Insert: 3 inches or 7cm - Patch (Nitroglycerin Patch) – clean, hairless, proximal surface
 POSITION - OPTALMIC – Sitting Position or Lying
- A: left lateral position to follow the contour - OINTMENT – clean, inner to outer canntus
- C: dorsal recumbent - Instill at the lower canntus – 2drops, wait for 5mins to absorb
- Prevent the systemic effect – press nasolacrimal and close eyes
MEDICATIONS - OTIC – side-lying; use cotton tip applicator for cleaning
 Traditional Five Rights: - Instill: allow to flow to side; to change the temp. of meds to
- Right Drug body temp.; absorption for 5minutes
- Right Dose - INHALATION
- Right Time - Position: semi-fowler’s / high fowler’s (for full lung expansion)
- Right Patient - Instill: nebulizer – 1-2inches away from the mouth
- Right Route Metered dose inhaler – hold breath for 10seconds; wait for
another minute before giving another dose
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 FUNDAMENTALS OF NURSING GLADYS BAUTISTA JAIME 2010
Bronchodilator – with multiple medications Rectus Femoris – same with vastus lateralis (NT LATERAL)
Steroid Inhalation – oral hygiene; cause oral fungal infection Deltoid – 0.5-1.5ml
- VAGINAL – vaginal suppository, vaginal duche Position: Sitting
- Position: dorsal recumbent, remain free for 5-10minutes Location: Acromian Process 2-3 finger breaths below
Page | - During irrigation – BL with hips higher than the shoulders Gauge: 20, 21, 22, 23
10 - RECTAL – left lateral position/ Sim’s Position, right leg flexed Length: 1, 1 ½, 2
- Insert until something has grabbed it away – 20mins absorption Degree: 90
- PARENTERAL
o INTRADERMAL - Z-TRACK Technique
Sites: inner lower arm (skin test) - Used for parenteral IRON preparations
Upper chest and back - Retract the skin, inject slowly, hold retraction of the skin until
Beneath the scapula needle is withdrawn, do not massage
Indications: Check for allergy - Principles: Use separate needles for aspiration and injection of
Vaccine (Mantoux test) medication, Introduce air into the vial before aspirating,
Tuberculin Test Introduce needle in quick twist
Gauge: 25, 26, 27
Length: 3/8, 5/8, ½ INTRAVENOUS THERAPHY
Degree: 10-15  TYPES OF SOLUTION
o SUBCUTANEOUS - ISOTONIC – plain NSS(green) , LR(dark blue) , D5W(red)
Sites: outer upper arm - HYPOTONIC – lower concentration; D.45/D.33 (light blue)
Abdominal (insulin) - HYPERTONIC – higher concentration; D5LR(pink), D5NSS(yellow)
Anterior Thigh  GAUGE
Ventro Gluteal - 16 – biggest (gray)
Dorso Gluteal - 18 – blood transfusion (green)
Indications: Insulin, Vaccine, Heparin - 20 (pink)
Gauge: 25, 26, 27 - 22 (blue)
Length: 3/8, 5/8, ½ - 24 – pedia (yellow)
Degree: 0-90 (obese); 45 (thin and average)  Points to remember in IVT
o INTRAMUSCULAR - Place in the non-dominant hand, distal side (metacarpal)
Ventro Gluteal – best site for adult - Select: large vein, easily palpable and naturally splinted by bone
Position: Prone - Avoid highly visible, areas of flexion, damage by previous use
Location: Greater Trochanter and surgically compromised
Dorso Gluteal – contraindicated for 3years below  Nursing Consideration
Position: Prone - Air Embolism (5ml of air) – prime to remove air
Location: Lateral superior, upper outer quadrant - Change IV site and tubing every 72hours, bottle every 24hours
Vastus Lateralis – best site for infant regardless how many cc is remaining
Position: Sitting or Lying - Regulate every 15-30 minutes
Location: middle third anterior lateral aspect of thigh
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