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FUNDAMENTALS OF NURSING

HISTORY OF NURSING

HISTORY OF NURSING 

Early Civilization  Cause of Disease  Medicine Man  Mother Surrogate Cause of Disease  Temples 



Code of Hammurabi: Oldest Sanitation Code - 1760 BC - Law codes - Sanitation

HISTORY OF NURSING 

Early Christian Period  Deaconesses, Crusaders, Hospitals, Good Samaritan Law 

Parabolani Brotherhood



Teutonic Knights





Knights of St. John of Jerusalem Knights of Lazarus

HISTORY OF NURSING



Throughout history, wars have accentuated the need for nurses: 

WWI, WWII, American Civil War, Vietnam War (Recruitment of Nurses) 



Free Education for Nurses

Crimean War Sir Sidney Herbert  Florence Nightingale 

HISTORY OF NURSING 

Florence Nightingale 

1836  Theodor Fliedner, a German pastor in Kaiserwerth, opened a hospital with a training school for nurses  Training



School of Deaconesses

1847  Florence Nightingale went to train as a nurse in Kaiserwerth, Germany  Where

she stayed for 3 months

HISTORY OF NURSING 

1853  Nightingale trained in the Sisters of Charity  Paris  Returning to London, she worked as administrator and director of nurses at the Establishment for Gentlewomen During Illness where she remained  Until she was called into service during the Crimean War

HISTORY OF NURSING 

1860 

Nightingale opened the Nightingale Training School for Nurses



Served as model for other nursing schools



Its graduates traveled to other countries to manage hospitals and nurse training schools

HISTORY OF NURSING

HISTORY OF NURSING 

Nightingales biggest contributions in Nursing: 

Sanitation Practices



Nursing Education



First Nurse Theorist  Notes on Nursing: What It Is And What It Is Not

HISTORY OF NURSING IN THE PHILIPPINES 

Earliest Hospitals 

Hospital de Real de Manila (1577)



San Lazaro Hospital (1578)



San Juan de Dios Hospital (1596)

HISTORY OF NURSING IN THE PHILIPPINES 

Earliest Nursing Schools 

Iloilo Mission Hospital School of Nursing (1906)



St. Luke’s Hospital School of Nursing (1907)



Mary Johnston Hospital and School of Nursing (1907)



Philippine General Hospital School of Nursing (1910)

HISTORY OF NURSING IN THE PHILIPPINES 

Earliest Nursing Universities 

University of Santo Tomas College of Nursing



Manila Central University College of Nursing



University of the Philippines College of Nursing, Manila



FEU Institute of Nursing



UE College of Nursing

HISTORY OF NURSING IN THE PHILIPPINES 

Nursing Leaders 

Anastacia Giron - Tupaz - Nurse Chief Superintendent of PNA - Founder of PNA

HISTORY OF NURSING IN THE PHILIPPINES 

Nursing Organizations 

Philippine Nurse’s Association (PNA) – National



First President 



Rosario Delgado

Current President 

Leah Samaco Pacquiz

NURSE

NURSE 

Came from the Latin word 



“Noutrix”

Meaning of the word 

“To Nourish”

AS A PROFESSION        

Body of specific and unique knowledge Strong service orientation Recognized authority by a professional group Code of ethics and laws Professional organization Ongoing research Autonomy CARE

LEVELS OF NURSES

LEVELS OF NURSES 

5 Levels of Nurses 

Level I  No experience  Novice



Level II  Has acceptable performance and has experienced enough situations  Advanced beginner

LEVELS OF NURSES 

Level III  Has

2 to 3 years of experience  Competent  Employed overseas 

Level IV  Has 3 to 5 years of experience  Proficient

LEVELS OF NURSES 

Level V  Highly proficient  Does not require guidance and rules  Expert  Capable of managing hospital units

FIELDS OF NURSING PRACTICE

FIELDS OF NURSING PRACTICE 

1)Institutional or Hospital Nursing 

Employment in hospitals and health institutions



Biggest field of nursing practice  

Staff Nurse Nurse Managers

FIELDS OF NURSING PRACTICE 

2) Community / Public Health Nursing 

Subdivision: 

School Nursing

FIELDS OF NURSING PRACTICE 

3) Private Duty Nursing 

One to one care



Total nursing care or Case Management



Home or hospital based

FIELDS OF NURSING PRACTICE 

5) Military Nursing

FIELDS OF NURSING PRACTICE 

6) Company / Industrial Nursing

EXPANDED EDUCATIONAL AND CAREER ROLES

EXPANDED EDUCATIONAL AND CAREER ROLES 

Clinical Nurse Specialist 

A nurse with an advanced degree, education, or experience



Considered to be an expert in a specialized area of nursing



Example: Geriatric Nurse, Oncology Nurse, Maternal and Child Nurse

EXPANDED EDUCATIONAL AND CAREER ROLES 

Nurse Practitioner 

A nurse with an advanced degree, certified for a special area or age of patient care



Delivers independent practice to make health assessments and deliver primary care  Diagnose  Prescribe medications

EXPANDED EDUCATIONAL AND CAREER ROLES 

Nurse Anesthetist 

A nurse who completes a course of study in an anesthesia school  Carries

out preoperative visits and assessments  Administers and monitors anesthesia during surgery  Evaluates postoperative status of patients

EXPANDED EDUCATIONAL AND CAREER ROLES 

Nurse midwife 

A nurse who completes a program in midwifery  Provides

 Delivers

prenatal and postnatal care

babies for women with uncomplicated pregnancies

EXPANDED EDUCATIONAL AND CAREER ROLES 

Nurse Educator 

A nurse usually with an advanced degree, who teaches in educational or clinical settings

EXPANDED EDUCATIONAL AND CAREER ROLES 

Nurse Administrator 

A nurse who functions at various levels of management



Responsible for management and administration of resources and personnel involved in giving patient care

EXPANDED EDUCATIONAL AND CAREER ROLES 

Nurse Researcher 

A nurse with an advanced degree who conducts research relevant to the definition and improvement of nursing practice and education

EXPANDED EDUCATIONAL AND CAREER ROLES 

Nurse Entrepreneur 

A nurse, usually with an advance degree who may manage a clinic or health related business

NURSING ROLES

NURSING ROLES 

Caregiver Primary role of the nurse  The provision of care  MOTHER SURROGATE ROLES 

 Complete

Assistance  Partial Assistance  Supportive/Educative

NURSING ROLES 

Communicator 

With Patients  To establish Therapeutic Communication  To identify health problems



With Health Care Professionals  Documentation  Reporting / Endorsements

COMMUNICATION

COMMUNICATION 

It is the interchange of information between two or more people



It is the exchange of ideas or thoughts

ELEMENTS OF COMMUNICATION 











Sender  Originator of the information Message  Information being transmitted Receiver  Recipient of information Channel  Mode of communication Feedback  Return response Context  The setting of the communication

LEVELS OF COMMUNICATION 

Intrapersonal  Occurs when a person communicates within himself



Interpersonal  Takes place within dyads (groups of two persons) and in small groups.



Public  Communication between a person and several other people

MODES OF COMMUNICATION 

Verbal Communication



Non-verbal Communication

NON-VERBAL MESSAGES 

They carry more meaning than verbal messages and involves the following: 

Body movement or kinetics



Voice quality (pitch and range) and nonlanguage sounds (sobbing or laughing)

NON-VERBAL MESSAGES 

Proxemics – use of personal or social space

Intimate Distance – actual contact to 1.5 feet  Personal Distance – 1.5 to 4 feet or 3 to 4 feet for interviews  Social Distance – 4 to 12 feet  Public Distance – 12 feet and beyond 



Cultural Artifacts – items in contact with interacting persons that may act as non-verbal stimuli (i.e., clothes, cosmetics, jewelry, cars)

THERAPEUTIC RESPONSES IN COMMUNICATING WITH PATIENTS

THERAPEUTIC RESPONSES



Identify therapeutic and non-therapeutic phrases



Open-ended or Closed-ended question?



‘Why’ or ‘What’ questions?



Avoid false reassurances

THERAPEUTIC RESPONSES 

Use direct questions for suicidal cases



Avoid the ‘Authoritarian Answer’  Giving advices



In initiating conversation  Use Broad Openings



In ending conversation  Summarizing

COMMUNICATING WITH HEALTH CARE PROFESSIONALS

COMMUNICATING WITH HEALTH CARE PROFESSIONALS 

Documentation



Reporting



Conferring



Referring

COMMUNICATING WITH HEALTH CARE PROFESSIONALS 

Reporting 

Endorsement



Transferring pertinent information regarding a patient to a concerned person



Outgoing nurse to a incoming nurse



Staff nurse to physician

COMMUNICATING WITH HEALTH CARE PROFESSIONALS 

Conferring 

To verify information



Rephrasing  To

validate doctor’s orders

 To

validate a nurse’s endorsement

COMMUNICATING WITH HEALTH CARE PROFESSIONALS 

Referring 

To endorse patient’s special concern to a higher authority or a specialized department or personnel A

community nurse referring a client to a hospital or a doctor

A

staff nurse to a dietitian

NURSING ROLES 

Teacher/Educator 

Providing education about a client’s health and health care procedures they need to perform to restore or maintain their health

NURSING ROLES 

Teaching Strategies 

Assess client’s  Readiness

to learn  Assess the client’s knowledge 

Simple to complex

NURSING ROLES 

Teaching Strategies 

One to One Discussion or Group Discussion  Explanation

and Description  Answering Questions  Visual Assisted Learning Programs  Demonstration  Actual performance of an activity

NURSING ROLES 

What is the best method of teaching? (December 2007 NLE)



What is the best indicator of client learning?

NURSING ROLES 

Counselor 

Facilitates the patient’s problem solving and decision – making skills



By providing information, make appropriate referrals

NURSING ROLES 

Researcher 

The participation in or conduct of research



To increase knowledge in nursing and improve patient care

NURSING ROLES 

Advocate 

Safeguarding the rights of the patients



Patients Bill of Rights

THEORIES OF NURSING

THEORIES OF NURSING 

Theory 

A hypothesis or system of ideas that is proposed to explain a given phenomenon



Purpose:  Directs

and guide nursing practice

THEORIES OF NURSING 

Nightingale's



Environmental Theory 

The act of utilizing the environment of the patient to assist him in his recovery



Linked health with 5 environmental factors

Pure or fresh air  Pure water  Efficient drainage  Cleanliness  Light 

THEORIES OF NURSING 

Nightingale's Environmental Theory 

Addition:  Education  Keeping

of nurses

the client warm

 Maintaining  Attending

a noise free environment

to the client’s diet

THEORIES OF NURSING 

Hildegard Peplau’s



Interpersonal Relations Model 

Peplau is a psychiatric nurse



Focus: Therapeutic process Attained through: Healthy Nurse Patient Relationship



THEORIES OF NURSING 

Hildegard Peplau’s Interpersonal Relations Model 

Four Phases of the Nurse – Patient Interaction  Preorientation  Orientation  Working

/ Exploitation  Termination/Resolution

THEORIES OF NURSING 

Virginia Henderson’s



14 Fundamental Needs of a Person 

Assisting sick or healthy individuals to gain independence in meeting 14 fundamental needs

THEORIES OF NURSING 

Virginia Henderson’s 14 Fundamental Needs of a Person 1) Breathing normally  2) Eating and drinking adequately  3) Eliminating body waste  4) Moving and maintaining a desirable position  5) Sleeping and resting  6) Selecting suitable clothes  7) Maintaining body temperature within normal range by adjusting clothing and modifying the environment 

THEORIES OF NURSING 

Virginia Henderson’s 14 Fundamental Needs of a Person

      

8) Keeping the body clean and well groomed to protect the integument 9) Avoiding dangers in the environment and avoiding injuring others 10) Communicating with others in expressing emotions, needs, fears, or opinions 11) Worshipping according to one’s faith 12) Working in a such way that one feels a sense of accomplishment 13) Playing or participating in various forms of recreation 14) Learning, discovering, or satisfying the curiosity that leads to normal development and health, and using available health facilities

THEORIES OF NURSING 

Dorothy Johnson’s 

Seven Subsystems      



Attachment Affiliative Dependency Ingestive Eliminative Sexual Achievement Aggressive

THEORIES OF NURSING 

Faye Abdellah’s 

21 Nursing Problems     

good hygiene optimal activity safety good body mechanics oxygen

THEORIES OF NURSING 

Faye Abdellah’s 21 Nursing Problems        

nutrition elimination fluid and electrolytes balance physiologic response of the body to disease regulatory mechanisms sensory function. positive and negative expressions, feelings and reactions. accept the interrelatedness of emotions and illness

THEORIES OF NURSING 

Faye Abdellah’s 21 Nursing Problems self awareness  optimum possible goals  use community resources  role of social problems 

THEORIES OF NURSING 

Martha Roger’s



Science of Unitary Human Beings 

Views the person as a irreducible whole, the whole being greater than the sum of its parts

THEORIES OF NURSING 

Martha Roger’s Science of Unitary Human Beings 

Man is composed of energy fields, which are in constant interaction with the environment



Seek to promote harmonic interactions between the two energy fields (Human and Environmental)

THEORIES OF NURSING 

Dorothea Orem’s



Self Care and Self Care Deficit Theory 

Identified three nursing systems

Wholly compensatory systems  Partial compensatory systems  Supportive – Educative systems 

THEORIES OF NURSING 

Imogene King’s



Goal Attainment Theory



Patient has THREE (3) interacting systems 

Individuals / Personal systems



Group systems / Interpersonal systems



Social systems

THEORIES OF NURSING 

Betty Neuman’s



Health Care Systems Model



The concern of nursing is to prevent Stress Invasion  Physiological  Psychological  Developmental  Sociocultural  Spiritual

THEORIES OF NURSING 

Sister Callista Roy’s



Adaptation Model 

Man is a Biopsychosocial Being that requires a feedback cycle

THEORIES OF NURSING 

Sister Callista Roy’s Adaptation Model 

The goal is to enhance life processes through adaptation in four adaptive models  The

Physiologic Mode

 Self

Consent Mode

 Role

Function Mode

 Interdependence

Mode

THEORIES OF NURSING 

Madeline Leininger’s



Transcultural Nursing 

Emphasizes human caring varies among cultures  Culture Care Preservation and Maintenance  Culture Care Accommodation and Negotiation  Culture Care Restructuring and Repatterning

CONCEPT OF MAN

CONCEPT OF MAN 

Nurse’s Clients 

Individuals



Families



Communities

CONCEPT OF MAN 

BIOLOGIC like ALL other men



PSYCHOLOGICAL like NO OTHER man



SOCIAL like SOME OTHER men



SPIRITUAL like SOME OTHER men

ABRAHAM MASLOW’S HIERARCHY OF NEEDS 

5 Human Needs

ABRAHAM MASLOW’S HIERARCHY OF NEEDS 

Physiologic needs Oxygen  Fluids  Nutrition  Body Temperature  Elimination  Rest and Sleep  Sex 

ABRAHAM MASLOW’S HIERARCHY OF NEEDS 

Safety and security (Physical and Psychological) Protection  Security  Order  Law  Limits  Stability 

ABRAHAM MASLOW’S HIERARCHY OF NEEDS 

Love and Belongingness Family  Affection  Relationships  Work group 

ABRAHAM MASLOW’S HIERARCHY OF NEEDS 

Self-esteem  Feeling good about one’s self  Two factors affecting Self-esteem  Yourself  Sense of adequacy  Accomplishment  Self worth & respect  Others  Appreciation  Recognition  Admiration

ABRAHAM MASLOW’S HIERARCHY OF NEEDS 

Self-actualization – essence of mental health Personal growth and fulfillment  Able to fulfill needs and ambitions  Maximizing one’s full potential 

ABRAHAM MASLOW’S HIERARCHY OF NEEDS 

Self Actualization Judges people correctly  Superior perception  Decisive  Capable of making decisions  Clear notion as to what is right and wrong 

ABRAHAM MASLOW’S HIERARCHY OF NEEDS 

Open to new ideas  Not adopts new ideas  Not one track mind



Highly creative and flexible



Does not need fame



Problem-centered rather than selfcentered

ABRAHAM MASLOW’S HIERARCHY OF NEEDS 

Additional needs: 

Need to know and understand



Aesthetic needs



Transcendence

ABRAHAM MASLOW’S HIERARCHY OF NEEDS 

Need to know and understand or Cognitive needs is supported by Richard Kalish who says that Man needs stimulation  Needs to explore  Sex  Activity  New things 

ABRAHAM MASLOW’S HIERARCHY OF NEEDS 

Aesthetic needs: Beauty  Balance  Form 

ABRAHAM MASLOW’S HIERARCHY OF NEEDS 

Transcendence: 

Helping others to self-actualize

ILLNESS, WELLNESS AND HEALTH

DEFINITIONS OF HEALTH Object 5



World Health Organization 

Health is the complete physical, mental, social (totality) well-being and not merely the absence of disease or infirmity

DEFINITIONS OF HEALTH 

Health is individually defined by each person



On a personal level, individuals define health according to  how they feel  absence or presence of symptoms of illness  and ability to carry out activities

DISEASE 

Objective pathologic process



Pathologic change in the structure or function of the mind and body

DISEASE  Acute 

Rapid onset of symptoms



Some are life threatening



Many do not require medical treatment

DISEASE 

Chronic 

Broad term that encompasses many different physical and mental alterations in health 

It is a permanent change



Requires special patient education for rehabilitation



Requires long term of care and support

ILLNESS 

Highly subjective feeling of being sick or ill



How the person feels towards sickness



Concerns the Nurse

ELEVEN STAGES OF ILLNESS AND HEALTH-SEEKING BEHAVIOR BY SUCHMAN 

1. Symptom Experience Client realizes there is a problem  Client responds emotionally 



2. Sick Role Assumption Self-medication / Self-treatment  Communication to others 

ELEVEN STAGES OF ILLNESS AND HEALTHSEEKING BEHAVIOR BY SUCHMAN 

3. Assuming a Dependent Role Accepts the diagnosis  Follows prescribed treatment 



4. Achieving recovery and rehabilitation 

Gives up the dependent role and assumes normal activities and responsibilities

CONCEPTS ON DISEASE AND ILLNESS 

Illness without disease  is possible



Disease without illness  is possible

MODELS OF HEALTH AND ILLNESS

DUNN’S HIGH-LEVEL WELLNESS AND GRID MODEL 

X-axis is HEALTH



Y-axis is ENVIRONMENT

DUNN’S HIGH-LEVEL WELLNESS AND GRID MODEL Quadrant 1 - High Level Wellness in a favorable environment

Quadrant 3 - Poor health in an unfavorable environment environment

Quadrant 2 - Protected Poor Health in a favorable environment

Quadrant 4 - Emergent High Level Wellness in an unfavorable

HEALTH BELIEF MODEL BY ROSENTOCK 

Concerned with what people perceive about themselves in relation to their health



Consider perceptions (influences individuals motivation toward results)  Perceived susceptibility  Perceived seriousness  Perceived benefit out of the action

FOUR LEVELS OF HEALTH BY SMITH 1. Clinical Model 

Man is viewed as a Physiologic Being



If there are no signs and symptoms of a disease, then you are healthy

FOUR LEVELS OF HEALTH BY SMITH 2. Role Performance Model 

As long as you are able to perform SOCIETAL functions and ROLES you are healthy

FOUR LEVELS OF HEALTH BY SMITH 3. Adaptive Model 

Health is viewed in terms of capacity to ADAPT



Failure to adapt is disease

FOUR LEVELS OF HEALTH BY SMITH 4. Eudaemonistic Model 

This is the BROADEST concept of health



Because health is viewed in terms of Actualization

AGENT, HOST, ENVIRONMENT MODEL BY LEAVELL AND CLARK 

Also known as the Ecologic Model



Triad is composed of the agent, host and environment



Based on the interplay of three components of the model

NURSING PROCESS

THE NURSING PROCESS



Definition: 

The Nursing Process is a systematic, organized, rational method of planning and providing individualized, humanistic nursing care

PURPOSES OF THE NURSING PROCESS



To identify health status  Actual health problems  Potential health problems



To establish plans



To deliver specific nursing care



To evaluate nursing care

CHARACTERISTICS OF THE NURSING PROCESS 

Client-centered



Cyclical (sequence), dynamic (moving) rather than static  Data from each phase provide input to the next phase



Interpersonal and collaborative  Work with patients and relatives  Work with colleagues and other members of the health team

CHARACTERISTICS OF THE NURSING PROCESS 

Adaptation of problem-solving techniques and decision making principles in all the phases



Problem-oriented, flexible, open to new information

BENEFITS FROM THE NURSING PROCESS 

Improves quality of care



Ensures continuity and appropriate level of care  Long term plans



Promotes a positive working atmosphere through collaboration



Facilitates client participation through planning with patient

BENEFITS FROM THE NURSING PROCESS



Feedback allows nurse to evaluate care



Serves as a framework for accountability through documentation

PARTS OF THE NURSING PROCESS



Assessment Phase



Diagnosing Phase



Planning Phase



Intervention Phase



Evaluation Phase

ASSESSMENT PHASE

ASSESSMENT PHASE 

Is the systematic and continuous collection, organization, validation, and documentation of data



Carried all throughout the nursing process  Diagnosing  Planning 

Information in assessment is crucial

Implementation  Before performing nursing care  Evaluation  Assessing the current status to compare with previous status 

ASSESSMENT PHASE 

What to assess 

Clients perceived needs



Client’s responses to health problems  Asthma  Difficulty of breathing  Arthritis  Pain



Health practices, values, and lifestyles

FOUR TYPES OF ASSESSMENT

FOUR TYPES OF ASSESSMENT



Initial Assessment



Focus Assessment or On-going Assessment



Emergency Assessment



Time-Lapsed Assessment

FOUR TYPES OF ASSESSMENT



1. Initial Assessment  When performed:  At specified time after admission 

Purpose of Initial Assessment:  To create a data base for problem identification  For reference and future comparison

FOUR TYPES OF ASSESSMENT 

2. Focus Assessment or On-going Assessment 

When performed:  Integrated throughout the nursing process



Purpose of On-going Assessment:  To identify problems overlooked earlier  To determine the status of a health problem  Same from database  Ex before implementation

FOUR TYPES OF ASSESSMENT



3. Emergency Assessment  When done:  During acute physiologic and psychologic crisis  Where done:  Emergency Room  Anywhere  On site  Purpose of Emergency Assessment  To identify life-threatening condition

FOUR TYPES OF ASSESSMENT 

4. Time-Lapsed Assessment 

When done:  Several months after initial assessment



Purpose of Time-Lapsed Assessment  To compare current status of patient with base line data (initial assessment)  Ex  Diabetic

ASSESSMENT PHASE



Nursing Activities in the Assessment Phase 

Data Collection



Data Organization



Data Validation



Data Recording

DATA COLLECTION

DATA COLLECTION 

Is the process of gathering information or data



Data gathering

RECORDED DATA 

Types of Data



Sources of Data



Methods of Data Collection

TYPES OF DATA

TYPES OF DATA



1. Subjective or Covert Data 

Felt by the patient



During the recording of data, this should be stated using the patient’s own words



“Mommy I feel hot”

TYPES OF DATA



2. Objective or Overt Data 

Capable of being observed by use of senses – sight, touch, smell, hearing

SOURCES OF DATA

SOURCES OF DATA 

1. Primary Source 

Patient himself, except when:  Patient

is unconscious  Patient is a baby  Patient is insane  Significant

others become the primary source of data (from a secondary source)  Unconscious brought in the ER?  Whoever brought the patient to the hospital

SOURCES OF DATA



2. Secondary Source Patient’s record  Health care members  Significant others 

METHODS OF DATA COLLECTION

METHODS OF DATA COLLECTION



Observing



Interviewing



Examining

METHODS OF DATA COLLECTION: OBSERVING 

To gather data by using the senses Vision  Overall appearance  Smell  Body or breath odors  Hearing  Lung, heart, and bowel sounds  Touch  Skin temperature, pulse rate 

METHODS OF DATA COLLECTION: OBSERVING 

Two (2) aspects of observation process: 

Noticing the stimuli using the senses



Record the observed stimuli

METHODS OF DATA COLLECTION: INTERVIEWING 

Is a planned conversation with a purpose 

To get or give information



Provide health teachings



Provide support

METHODS OF DATA COLLECTION: INTERVIEWING 

Two types of Interview 

Directive Type of Interview



Non-directive Type of Interview or Rapport-building Interview

DIRECTIVE TYPE OF INTERVIEW



Structured



Uses closed-ended questions calling for specific data   



Yes or No How many When

When used:  When you need to elicit specific data  When there is little time available

NON-DIRECTIVE TYPE OR RAPPORT-BUILDING INTERVIEW 

Uses more open-ended questions



Advantage is that it allows the patient to volunteer information

PLANNING THE INTERVIEW SETTING



Concepts: 

Before the interview, determine what information you already know



An interview is a planned conversation with a purpose



An interview is a two-way process

PLANNING THE INTERVIEW SETTING 

Concepts: 

When is it done?  When patient is available  When patient is comfortable



Recommended distance from the patient is three (3) to four (4) feet



Place



Seating Arrangement



Language

STAGES OF THE INTERVIEW 

1. Opening Stage 

This is the most important part of the interview



Rationale  What was said and done during the opening stage sets the tone all throughout the interview  Establish

rapport

 Orientation

STAGES OF THE INTERVIEW



2. Body of the Interview 

Occurs when patient responds to questioning



The most productive stage

STAGES OF THE INTERVIEW 

3. Closing Stage 

The nurse terminates the interview when

  The

needed information has been obtained and given

 The

client can no longer take in information

 Provided

support

STAGES OF THE INTERVIEW STAGES OF THE INTERVIEW 

3. Closing Stage 

How to close the interview:  Summarizing Technique  To verify accuracy  It reassures the client that the nurse listened  Sense of accomplishment  Offer to answer questions  Thank the client  Plan for the next meeting if there is one

METHODS OF DATA COLLECTION: EXAMINING 

The physical examination or assessment



Use of senses



Use of inspection, palpation, percussion, and auscultation

METHODS OF DATA COLLECTION: EXAMINING 

Cephalocaudal



Proximodistal



IPPA



IAPP

ORGANIZING DATA

ORGANIZING DATA 

Clustering of data Example  Nursing Health History  Current health problem  Past history of illness  Family history of illness  Lifestyle  Body Systems 

VALIDATION OF DATA

VALIDATION OF DATA



Act of double-checking the data



Purposes of Data Validation 

To ensure the:  Correctness  Completeness

DATA RECORDING

DATA RECORDING 

Data Recording COMPLETES the Assessment Phase 

Complete



Factual  Don’t interpret  Man found lying on the floor



Brevity  Short but concise

DOCUMENTATION

DOCUMENTATION 

It is a written, formal document



A record of client’s progress

PURPOSES OF DOCUMENTATION     

Planning Care Communication For legal documentation purposes For research For education

GUIDELINES ON DOCUMENTATION 

Timing  Document patient care as soon as possible



Observe confidentiality



Observe permanence  Use non-erasable ink  Do not use sign pen

GUIDELINES ON DOCUMENTATION 

Signature  Sign full name and append R.N.



Accuracy  Ensure that data is correct  Avoid biases  Avoid ambiguous terms



Appropriateness  Write only appropriate information

GUIDELINES ON DOCUMENTATION 

Completeness



Use standard terminology



Brevity  Make it concise yet meaningful



Legal Awareness  Cross out erroneous entry  Write “Error”  Countersign

TYPES OF RECORDS 

Source-Oriented Clinical Record



Problem-Oriented Clinical Record

PROBLEM-ORIENTED CLINICAL RECORD  

Same as Problem Oriented Medical Record Entry of data is based on CLIENT’S PROBLEM  Example:  Problem No. 1: constipation  Increase fluid intake: doctor  Diatabs: pharmacist  NPO: dietitian

FOUR BASIC COMPONENTS OF PROBLEM-ORIENTED CLINICAL RECORD 

1. Baseline Data 

All information gathered from a patient when he first entered the agency  Assessment

of the physician  Assessment of the nurse

FOUR BASIC COMPONENTS OF PROBLEM-ORIENTED CLINICAL RECORD 

2. Problem List 

Contains only ACTIVE problems (and relevant information about the problem)  Medical

Diagnosis  Nursing Diagnosis

FOUR BASIC COMPONENTS OF PROBLEM-ORIENTED CLINICAL RECORD 

3. Initial list of orders or Care Plans

FOUR BASIC COMPONENTS OF PROBLEM-ORIENTED CLINICAL RECORD 

4. Progress Notes 

Includes:  Nurses’ narrative notes (SOAPIE)  Flow sheets  Discharge Notes and Referral Summaries

SOURCE-ORIENTED CLINICAL RECORD 

Classification of information is based on SOURCE



Each person or department maintains a different section on chart

COMPONENTS OF A SOURCE-ORIENTED CLINICAL RECORD 

Admission Sheet



Nursing Notes



Medical History and Physical Examination Sheet



Diagnostic Findings Sheet



TPR Graphic Sheet



Doctor’s Treatment and Order Sheet



Therapeutic Sheet

DIAGNOSING PHASE

DIAGNOSING PHASE 

Nurses use critical thinking skills to interpret assessment data and identify client strengths and problems



Positive or Negative?

DIAGNOSING PHASE 

Diagnostic Process 

Analyze the data



Identify health problems, risk, and strengths



Formulating diagnostic statements

PARTS OF A NURSING DIAGNOSIS



1. Problem Statement  Example:  Fluid Volume Deficit



2. Presumed Etiology  Example:  …related to frequent loss of bowel movement



3. Signs and Symptoms Example:  …as manifested by decreased skin turgor

TYPES OF DIAGNOSTIC STATEMENTS 

Basic Two Part Statements (PE) 

Problem and Etiology



Altered Nutrition Less than Body Requirements related to difficulty swallowing

TYPES OF DIAGNOSTIC STATEMENTS 

Basic Three Part Statement (PES) Problem  Etiology  Signs and Symptoms 



Altered Nutrition Less than Body Requirements related to difficulty swallowing as manifested by body weakness

TYPES OF DIAGNOSTIC STATEMENTS 

One Part Statements 

Problem



Rape Trauma Syndrome

TYPES OF NURSING DIAGNOSIS

DIFFERENT TYPES OF NURSING DIAGNOSES DIFFERENT TYPES OF NURSING DIAGNOSES 

1. Actual Nursing Diagnosis 

Problem present at the time the statement was made



Example: Ineffective Airway Clearance related to excessive and tenacious secretions

DIFFERENT TYPES OF NURSING DIAGNOSES 

2. High-Risk Nursing Diagnosis 

A diagnosis that a patient is more vulnerable or susceptible compared with others in the same situation



Example: Risk for Impaired Skin Integrity related to immobility secondary to fractured hip.

DIFFERENT TYPES OF NURSING DIAGNOSES 

3. Possible Nursing Diagnosis 

Not enough evidence about a problem



Example: Possible Self Care Deficit related to impaired ability to use left hand secondary to presence of intravenous therapy

DIFFERENT TYPES OF NURSING DIAGNOSES 

4. Wellness Nursing Diagnosis A positive statement  Indicates a healthy response  Examples: 



Potential for increased compliance related to increased level of knowledge



Potential for effective coping related to adequate support systems

PLANNING PHASE

PLANNING PHASE 

Planning is a deliberative, systematic phase that involves decision making and problem solving



Formulating client goals with the patient



Designing nursing interventions

ACTIVITIES DURING THE PLANNING PROCESS 

Set priorities  Client’s problems



Set goals and objectives



Identify alternatives of nursing care



Select nursing measures



Write the nursing care plan

PURPOSES OF GOAL-SETTING



To set direction



To provide a time span



To have a criteria for evaluation



To enable the nurse and the patient to determine whether the problem has been resolved or not



To help motivate the client and the patient by providing a sense of accomplishment

TYPES OF PLANNING

TYPES OF PLANNING



1. Initial Planning 

Done by the nurse



When done:  At specified time upon or after admission/assessment of the patient

TYPES OF PLANNING



2. On-going Planning 

Who are involved:  Done by all nurses who worked with the patient



When done: - Before start of shift

TYPES OF PLANNING



2. On-going Planning 

Purposes of On-going Planning  To determine if the client’s health status has changed  To decide which problems to focus on during the shift  To set priorities for client care during the shift

TYPES OF PLANNING



3. Discharge Planning 

Purpose of Discharge Planning 

To ensure continuity of care



M–E–T–H-O–D-S

CHARACTERISTICS OF THE PLANNING PROCESS 

S 



M 



Attainable

R 



Measurable

A 



Specific

Realistic

T 

Time bound

IMPLEMENTING PHASE

IMPLEMENTING PHASE



Consists of doing and documenting the nursing care given to the patient



Putting the care plan into action

IMPLEMENTING PHASE



Purpose of Implementation 

To carry out planned activities



To help the client

IMPLEMENTING PHASE 

Requirements for Implementation Adequate knowledge  Technical Skills  Communication skills  Therapeutic use of self 

IMPLEMENTING PHASE



Reassess the patient  Rationale  To determine if the procedure is still needed



Determine the need for nursing assistance



Understand orders  Clarify / verify doctors’ orders

NURSING ACTIVITIES DURING THE IMPLEMENTATION PHASE 

Communicate the procedure performed by documenting the procedure



Encourage patient to participate actively

GUIDELINES FOR IMPLEMENTATION OF NURSING STRATEGIES 

It should be based on scientific knowledge, research, professional standards of practice (care)  Rationale:  This is done to ensure safe nursing care



It should be adapted to the individual patient

GUIDELINES FOR IMPLEMENTATION OF NURSING STRATEGIES 

It should always be safe. Do not compromise



It should be holistic



It should be accompanied by support, comfort and teaching

EVALUATION PHASE

EVALUATION PHASE



Purpose of the Evaluation Phase 

To determine client’s progress



To determine the effectiveness of the care plan



To determine as to what extent the nursing goals have been met

EVALUATION PHASE



Importance of doing an Evaluation 

It determines if the care plan will be:  Continued  Modified  Discontinued

EVALUATION PHASE



Activities during the Evaluation Phase Identify the OUTCOME CRITERIA to be used as measurement (Planning)  Gather information (data) relevant to the outcome criteria  Compare outcome (data) with the criteria  Assess the reasons for the outcome  Revise the nursing care plan as needed 

TYPES OF EVALUATION



1. On-going Evaluation 

When done:  During or immediately after the intervention



Importance:  Allows the nurse to decide and make on-the-spot modification/s in an intervention

TYPES OF EVALUATION



2. Intermittent Evaluation 

When done:  At a specified time



Purpose:  It shows the extent of progress of the patient



Importance:  Enables the nurse to correct deficiencies and modify the nursing care plan

TYPES OF EVALUATION



3. Terminal Evaluation 

When done:  At or immediately before discharge



Importance:  States the status of a health problem at the time of discharge  It determines whether the goals are:  Met  Partially  Unmet

met

PROMOTING REST AND SLEEP

PROMOTING REST AND SLEEP 

Sleep is the altered level of consciousness in which the individual’s perception of and reaction to environment are decreased

PROMOTING REST AND SLEEP 

What regulates sleep and wakefulness? 

Reticular formation on the Brain Stem



Ascending nerve fibers  Reticular Activating System (RAS)  Sleep Wake Cycle

PROMOTING REST AND SLEEP 

Types of Sleep 

NREM  Non-Rapid Eye Movement Sleep



REM  Rapid Eye Movement Sleep

PROMOTING REST AND SLEEP 

NREM (Non-Rapid Eye Movement Sleep) 

When the RAS is inhibited  Sleep



BODY RESTORATION



About 75% to 80% of sleep



Has 4 Stages

PROMOTING REST AND SLEEP 

NREM (Non-Rapid Eye Movement Sleep) 

Stage I (Very Light Sleep)  Lasts

only a few minutes  Drowsy and relaxed  Eyes roll from side to side  HR and RR drop slightly  Readily awakened

PROMOTING REST AND SLEEP 

NREM (Non-Rapid Eye Movement Sleep) 

Stage II (Light Sleep)  Lasts

for 10-15 minutes  Body processes continue to slow down  HR and RR decrease furthermore  Body temperature falls  Eyes are still

PROMOTING REST AND SLEEP 

NREM (Non-Rapid Eye Movement Sleep) 

Stage III  The

HR and RR, as well as other body processes, slow further  The sleeper becomes more difficult to arouse  The skeletal muscles are very relaxed  The reflexes are diminished and snoring may occur

PROMOTING REST AND SLEEP 

NREM (Non-Rapid Eye Movement Sleep) 

Stage IV (Delta Sleep or Deep Sleep)  HR

and RR drop 20 – 30% below that exhibited during waking hours  Sleeper is very relaxed, rarely moves and is difficult to arouse  This stage is thought to restore the body physically

PROMOTING REST AND SLEEP 

REM (Rapid Eye Movement Sleep) Occurs about every 90 minutes  Lasts from 5 to 30 minutes  “Paradoxical Sleep”  Resembles wakefulness  Brain is highly active  Dreams are usual  Irregular HR and RR  May be difficult to arouse or wake up spontaneously 

PROMOTING REST AND SLEEP 

For sleep to be normal The person must pass through the NREM and REM  1 Cycle lasts for 90 to 110 minutes (1 ½ to 2 hours)  1st 3 Stages of NREM (20-30 minutes)  Stage IV (30 minutes)  Back to NREM Stages III and II (20 minutes)  REM (10 minutes)  Very brief  Skipped entirely 

PROMOTING REST AND SLEEP 

What is/are the longest type or stage of sleep? 

Stages II and III

PROMOTING REST AND SLEEP 

A sleeper who is awakened at any stage must begin a new cycle



In a 7 to 8 hours of sleep  4 – 6 cycles

PROMOTING REST AND SLEEP 

To restore the body

PROMOTING REST AND SLEEP 

Normal Sleep Requirements 

Newborns  16 to 18 hours a day



Infants  14 to 15 hours



Toddlers  12 to 14 hours

PROMOTING REST AND SLEEP 

Normal Sleep Requirements 

Preschoolers  11 to 13 hours



School Aged  10 to 11 hours



Adolescents  9 to 10 hours

PROMOTING REST AND SLEEP 

Normal Sleep Requirements 

Adults  7 to 9 hours



Elders  7 to 9 hours  Many sleeping problems  Tendency toward earlier bedtime and wake times  Increase in disturbed sleep  Medical conditions

PROMOTING REST AND SLEEP 

Factors Affecting Sleep 

Illness  Pain

or physical distress  Arthritis, back pain and ulcers

 Respiratory

conditions  Nasal congestion

 Need

to urinate

PROMOTING REST AND SLEEP 

Factors Affecting Sleep 

Environment  Noise  Absence of usual stimuli or the presence of unfamiliar stimuli  Namamahay  Discomfort from environmental temperature  Too hot or too cold  Comfort and size of the bed

PROMOTING REST AND SLEEP 

Factors Affecting Sleep 

Emotional Stress  Considered

by sleep experts as the number one cause of short term sleeping difficulties  Preoccupied

with personal problems  May be unable to relax sufficiently to get to sleep

PROMOTING REST AND SLEEP 

Factors Affecting Sleep 

Stimulants and Alcohol  Caffeine

containing beverages  Coffee  Tea  Chocolate Drinks  Alcohol  Speed up the onset of sleep  BUT disrupts REM

PROMOTING REST AND SLEEP 

Factors Affecting Sleep 

Smoking  Nicotine

has a stimulating effect on the body

 Smoker

 Refrain

from smoking after the evening meal

COMMON SLEEP DISORDERS

COMMON SLEEP DISORDERS 

Insomnia 

Inability to fall asleep or remain asleep



Acute Insomnia  Last 1 to several nights  Caused by personal stressors



Chronic  Persists for longer than a month

COMMON SLEEP DISORDERS 

Insomnia 

Chronic Intermittent Insomnia  Difficulty

sleeping for a few nights  Followed by a few nights of adequate sleep  Difficulty sleeping returns

COMMON SLEEP DISORDERS 

Excessive Daytime Sleepiness 

Hypersomnia



Narcolepsy

COMMON SLEEP DISORDERS 

Hypersomnia 

The affected individual obtains sufficient sleep at night



Cannot stay awake during the day



Caused by  CNS Damage

COMMON SLEEP DISORDERS 

Narcolepsy 

Disorder of excessive daytime sleepiness  Sleep

attacks  Cataplexy  Sudden weakness or paralysis 

Fragmented nighttime sleep



Cause  Lack of chemical hypocretin

COMMON SLEEP DISORDERS 

Sleep Apnea 

Frequent short breathing pauses during sleep



10 seconds to 2 minutes  Obstructive

Apnea  Central Apnea  Mixed

COMMON SLEEP DISORDERS 

Sleep Apnea 

Obstructive Apnea  Blockage

of the flow of air



Central  Defect in the respiratory center of the brain  Medulla Oblongata



Mixed

COMMON SLEEP DISORDERS 

Parasomnias 

Arousal Disorder  Sleep

Walking  Somnambulism

COMMON SLEEP DISORDERS 

Parasomnias 

Sleep Wake Transition Disorder  Sleep

talking

 Exhaustion

COMMON SLEEP DISORDERS 

Parasomnias 

Associated with REM Sleep  Nightmares

COMMON SLEEP DISORDERS 

Parasomnias 

Others  Bruxism

NURSING INTERVENTIONS TO PROMOTE REST AND SLEEP

NURSING INTERVENTIONS TO PROMOTE REST AND SLEEP 

Sleep Hygiene 

Referring to interventions to promote sleep

NURSING INTERVENTIONS TO PROMOTE REST AND SLEEP 

Supporting Bedtime Rituals 

Most people are accustomed to bedtime rituals or pre sleep routines 

Adults  Hygienic routines  Washing the face  Brushing teeth  Voiding  Relaxation  Listening to music  Reading  Taking a soothing bath  Praying

NURSING INTERVENTIONS TO PROMOTE REST AND SLEEP 

Supporting Bedtime Rituals 

Children  Need

to be socialized into pre sleep routine  Bedtime story  Holding onto a favorite toy or blanket  Kissing everyone goodnight

NURSING INTERVENTIONS TO PROMOTE REST AND SLEEP 

Supporting Bedtime Rituals 

Massage



Warm drink  Milk  Tryptophan

NURSING INTERVENTIONS TO PROMOTE REST AND SLEEP 

Creating a Restful Environment Minimal noise  Comfortable room temperature  Appropriate lighting 

NURSING INTERVENTIONS TO PROMOTE REST AND SLEEP 

Promoting Comfort and Relaxation Provide loose fitting nightwear  Assist clients with hygienic routines  Assist or encourage the client to void before bedtime  Offer to provide a back massage  Schedule medications  For clients with pain, administer analgesics 30 minutes before bedtime 

NURSING INTERVENTIONS TO PROMOTE REST AND SLEEP 

Promoting Comfort and Relaxation 

Emotional stress interferes with sleep  Relaxation

Techniques  Deep Breathing  Muscle Relaxation  Guided Imagery  Meditation

PROMOTING NUTRITION

PROMOTING NUTRITION 

Nutrition 



Is the sum of all the interactions between an organism and the food it consumes

Nutrients 

Are organic or inorganic substances found in foods that are required for body functioning

PROMOTING NUTRITION 

Essential Nutrients 

The body’s most basic nutrient need is 



Water

Nutrients that provide fuel to body cells 

Macronutrients  Carbohydrates  Proteins  Fats



Micronutrients  Vitamins  Minerals

MACRONUTRIENTS CARBOHYDRATES 

CHO



Two Basic Types 

Simple Sugars



Complex Carbohydrates  Starches  Fibers

MACRONUTRIENTS CARBOHYDRATES 

Simple sugars 

Water soluble



Produced naturally by plants and animals



Monosaccharide  Glucose  Fructose Galactose

MACRONUTRIENTS CARBOHYDRATES 

Simple sugars  Disaccharides

 Two

Monosaccharide

MACRONUTRIENTS CARBOHYDRATES 

Food Sources of Simple Sugars 

Sugarcane  Table sugar



Sugar beets

MACRONUTRIENTS CARBOHYDRATES 

Complex Sugars 

Starches

    

Grains Legumes Potatoes Cereals Breads

MACRONUTRIENTS CARBOHYDRATES 

Complex Sugars 

Fibers 

Supplies roughage or bulk in the diet  Outer layer of grains  Skin, seeds and pulp of many fruits and vegetables

MACRONUTRIENTS CARBOHYDRATES 

Digestion 

In the mouth  Ptyalin (Salivary Amylase)



In the small intestines  Pancreatic amylase

MACRONUTRIENTS CARBOHYDRATES 

Metabolism CHO is Major Source of Body Energy  GO FOODS 

CHON Glucose Bloodstream

Stored

Glycogen

Fats

MACRONUTRIENTS PROTEINS 

CHON



Amino acids 

Essential amino acids  Those that cannot be produced by the body



Nonessential amino acids  Those that can be produced by the body

MACRONUTRIENTS PROTEINS 

May be Complete, Partially Complete and Incomplete

MACRONUTRIENTS PROTEINS 

Complete Proteins 



Contains all essential amino acids plus many non essential amino acids Derived from animals 

Meats, poultry, fish, dairy products, and eggs

MACRONUTRIENTS PROTEINS 

Partially Complete 

Less than the required amount of one or two essential amino acids



Gelatin

MACRONUTRIENTS PROTEINS 

Incomplete 

Lack of one or more essential amino acids



Usually derived from vegetables



Vegetarians?



Solution  Vegetable combinations  Corn and beans  Vegetables with a small amount of animal protein

MACRONUTRIENTS PROTEINS 

Digestion 

In the mouth  Pepsin



In the intestines  Trypsin

MACRONUTRIENTS PROTEINS 

Storage 

Protein is stored in the body as tissue



Growth and Development



GROW FOODS

MACRONUTRIENTS PROTEINS 

Metabolism 

Anabolism  Construction  All body cells manufacture proteins from amino acids



Catabolism  Destruction  A cell can only accommodate a limited amount of protein  Liver

MACRONUTRIENTS LIPIDS 

Organic substances that are greasy and insoluble in water



Fats  Lipids that are solid at room temperature  Butter



Oil  Lipids that are liquid at room temperature  Cooking oil

MACRONUTRIENTS LIPIDS 

Classified as 

Saturated



Unsaturated



Which is healthier?

MACRONUTRIENTS LIPIDS 

Saturated fats 

coconut oil, and palm kernel oil



dairy products (especially butter, , cream, and cheese)



meat (beef)



dark meat of poultry, and poultry skin



chocolate

MACRONUTRIENTS LIPIDS 

Unsaturated 

Avocado



Nuts



Vegetable oils such as soybean, canola, and olive oils

MACRONUTRIENTS LIPIDS 

Digestion 

Starts in the mouth



Mainly in the stomach  Bile  Pancreatic Lipase

MACRONUTRIENTS LIPIDS 

They become 

Glycerol and Fatty acids  Energy



Cholesterol (Lipids plus protein)  Is Cholesterol needed in the body?  Important in producing bile  Excessive  Atherosclerosis



GLOW FOODS

TYPES OF LIPOPROTEINS 

1. High Density Lipoproteins (HDL) 

Good cholesterol



Function of HDLs  Transports

the bad cholesterol from systemic circulation to the liver for metabolism and eventual elimination

TYPES OF LIPOPROTEINS



2. Low Density Lipoproteins (LDL) 

Bad cholesterol



Function of LDLs  They

clog the blood vessels

ENERGY INTAKE

ENERGY INTAKE 

The amount of energy that nutrients or foods supply to the body is their caloric value 

CHO



CHON



FATS



* ALCOHOL  7 Calories/Gram

ENERGY INTAKE 

Recommended Calorie Intake per Day 

Varies



Generally  Men  2000 – 2500 calories  Women  1500 – 2000 calories  Pregnant  Plus 300 calories  Lactating  Plus 500 calories

ENERGY INTAKE 

Compute 800 grams of CHO  600 grams of CHON  400 grams of FATS 

MICRONUTRIENTS

MICRONUTRIENTS 

Required in small amounts 

Vitamins



Minerals

VITAMINS

MICRONUTRIENTS 

Vitamins 

Organic compounds that cannot be produced by the body  Water

 Fat

Soluble

Soluble

WATER SOLUBLE VITAMINS

WATER SOLUBLE VITAMINS 

Vitamins that cannot be stored by the body  Excess? 

Vitamin C



Vitamin B Complex

WATER SOLUBLE VITAMINS  

Vitamin C Ascorbic Acid 



  

synthesis of collagen  an important protein used to make skin, scar tissue, tendons, ligaments, and blood vessels essential for the healing of wounds, and for the repair and maintenance of cartilage, bones, and teeth immune function synthesis of the neurotransmitter, norepinephrine effective antioxidant

WATER SOLUBLE VITAMINS 

Vitamin C



Fruits      



Guava Strawberry Lemon Orange Mangoes Tomato

Vegetables    

Bell Peppers Broccoli Cauliflower Green Cabbage

WATER SOLUBLE VITAMINS 

Vitamin C Deficiency 

Scurvy  Bruising

easily  hair and tooth loss  joint pain and swelling 

Related to the weakening of blood vessels, connective tissue, and bone, which contain collagen

WATER SOLUBLE VITAMINS 

Vitamin B Complex        

Vitamin B1  (thiamine) Vitamin B2  (riboflavin) Vitamin B3  (niacin) Vitamin B5  (pantothenic acid) Vitamin B6  (pyridoxine) Vitamin B7  (biotin) Vitamin B9  (folic acid) Vitamin B12  (cyanocobalamin)

WATER SOLUBLE VITAMINS 

Vitamin B Complex 

Vitamins B1, B2, B3  energy production



Vitamin B6  amino acid metabolism



Vitamin B9  Vital for the function and maintenance of the nervous system and red blood cells  400 mcg or 0.4 mg (Pregnant)

WATER SOLUBLE VITAMINS 

Vitamin B Complex  fish, milk, eggs, liver, meat, brown rice, whole grain cereals, and soybeans, poultry



Folic acid  Green vegetables  Liver  whole grain cereals

WATER SOLUBLE VITAMINS 

Vitamin B Deficiency 

Vitamin B1 (Thiamine)  Beriberi

 Wernicke's

encephalopathy  Impaired sensory perception  Weakening of the limbs  Irregular heart rate  Korsakoff's syndrome  Amnesia and confabulation

WATER SOLUBLE VITAMINS 

Vitamin B Deficiency 

Vitamin B3 (niacin)  Pellagra

 Aggression  Insomnia  Weakness  mental

confusion  diarrhea

WATER SOLUBLE VITAMINS 

Vitamin B Deficiency 

Vitamin B9 (folic acid)



In pregnancy birth defects  Neural

Tube Defects  Spina Bifida  Anencephaly

FAT SOLUBLE VITAMINS

FAT SOLUBLE VITAMINS 

The body can store these vitamins 

A



D



E



K

FAT SOLUBLE VITAMINS 

Vitamin A 

Retinol



Normal Vision



Maintaining normal skin health



Deficiency  Blindness

FAT SOLUBLE VITAMINS 

Vitamin A sources 

     

liver (beef, pork, chicken, turkey, fish) carrots Broccoli leaves sweet potatoes butter spinach pumpkin

FAT SOLUBLE VITAMINS 

Vitamin D 

Calciferol



To maintain normal blood levels of calcium  Vitamin D aids in the absorption of calcium



Deficiency 



In children  Rickets – skeletal deformities  Calcium osteomalacia  muscular weakness in addition to weak bones

FAT SOLUBLE VITAMINS 

Vitamin D Fish  Eggs  fortified milk  cod liver oil 



The sun  as little as 10 minutes of exposure

FAT SOLUBLE VITAMINS 

Vitamin E 

Tocopherol



Antioxidant

FAT SOLUBLE VITAMINS 

Vitamin E sources 

Vegetable oils, nuts, green leafy vegetables, and fortified cereals



Almonds Asparagus Avocado Nuts Olives Seeds Spinach and other green leafy vegetables

     

FAT SOLUBLE VITAMINS 

Vitamin K 

K  Koagulation



Vitamins

Clotting factors  Stops bleeding

FAT SOLUBLE VITAMINS 

Leafy green vegetables, particularly the dark green ones such as Spinach  Broccoli  Malunggay  Avocado 

MINERALS

MINERALS 

Organic or inorganic compounds 

Macrominerals  Over 100 mg



Microminerals  Less than 100 mg

MACROMINERALS

MACROMINERALS

Calcium  Sodium  Potassium  Phosphorous  Magnesium  Chloride  Sulfur 

MACROMINERALS 

Calcium 

Normal growth and maintenance of bones and teeth



Deficiency  Rickets  Osteoporosis

MACROMINERALS 

Calcium Sources 

    

Dairy products, such as milk and cheese beans oranges Okra broccoli fortified products such as orange juice and soy milk

MACROMINERALS 

Sodium Regulation of blood and body fluids  Water Retention  Transmission of nerve impulses  Action Potential (Sodium Potassium Pump) 

2 to 3 grams/day  Table salts and most condiments  Preserved foods 

MACROMINERALS 

Potassium 

muscle contraction and the sending of all nerve impulses in animals through action potentials



All meats, poultry and fish are high in potassium. Apricots (fresh more so than canned) Avocado Banana Cantaloupe Milk Oranges and orange juice Potatoes

      

MICROMINERALS

MICROMINERALS

Iron  Iodine  Flouride  Manganese  Cobalt  Selenium 

MICROMINERALS 

Iron 

Ferrous Sulfate



Hemoglobin  Oxygen carriers



Forms of supplement  Oral  Parenteral

MICROMINERALS 

Iron Sources Dark Green, Leafy Vegetables  Dried Beans and Peas  Dried Fruits  Eggs  Enriched Breads  Iron-Fortified Cereal  Lean Meats  Nuts  Raisins  Spinach  Tofu 

MICROMINERALS 

Iron 

Oral Form  Take

on an empty stomach  If with GI distress, take with food  Use dropper or straw  Drink with  Milk or Orange Juice?  Increase water  Decrease fiber

MICROMINERALS 

Iron 

Parenteral Form



Site  Deep IM  Z Track  Don’t massage  Apply firm pressure for 5 minutes

MICROMINERALS 

Iodine 

As element of the thyroid hormones, thyroxine (T4) and triiodothyronine (T3)



Deficiency  Hypothyroidism  Goiter

MICROMINERALS 

Iodine Sources 

Sea creatures



Seaweeds

NUTRITIONAL ASSESSMENT

NUTRITIONAL ASSESSMENT 

Anthropometric Measurements Height  Weight  (best indicator of nutritional status of an individual)  Skin Fold Test (fat folds)  Mid-upper arm Circumference Measurement  Body Mass Index 

NUTRITIONAL ASSESSMENT 

Weight 

Weighing Technique



Ideal Body Weight  Rule

of 5 for Women  Rule of 6 for Men

NUTRITIONAL ASSESSMENT 

Ideal Body Weight 

Rule of 5 for Women  100

lbs for 5 ft of height  Plus 5 lbs for every inch of height above 5 ft  Example  5 feet 1 inch  Weight = 105 lbs  5 feet 2 inches  Weight – 110 lbs

NUTRITIONAL ASSESSMENT 

Ideal Body Weight  Rule

of 6 for Men

 106

lbs for 5 ft of height  Plus 6 lbs for every inch of height above 5 ft  Height = 5 ft 1 inch  Weight  112 lbs

NUTRITIONAL ASSESSMENT 

Anthropometric Measurements 

Skin Fold Test  Derived

from reserved fat of the body

NUTRITIONAL ASSESSMENT 

Anthropometric Measurements 

Mid-upper arm Circumference Measurement 

Obtains the muscle mass of the body



This reflects the protein reserves of the body

NUTRITIONAL ASSESSMENT 

Body Mass Index 

BMI = weight in kg (height in meter)2

NUTRITIONAL ASSESSMENT 

BMI 

Height in Meter  1 Meter = 3.3 feet or 39.6 inches



1 Kg = 2.2 Lbs

NUTRITIONAL ASSESSMENT 

BMI Results Underweight = Less than 18.5  Normal = 18.5 – 24.9  Overweight = 25.0 – 29.9  Obese Type I = 30.0 – 34.9  Obese Type II = 35.0 – 39.9  Obese Type III = 40.0 plus 

NUTRITIONAL ASSESSMENT 

BMI 

Compute  Weight = 65 kg  Height is = 62 inches



Compute  Weight = 150 pounds  Height = 5 feet 3 inches

NUTRITIONAL ASSESSMENT 

Biochemical Data 

Serum Albumin

NUTRITIONAL ASSESSMENT 

Serum Albumin 

Provide an estimate of protein stores



Albumin  Serum protein

NUTRITIONAL ASSESSMENT 

Dietary Data 

24 hour food recall



Food Diary  Obesity  Eating

Disorders

NUTRITIONAL VARIATIONS THROUGHOUT THE LIFE CYCLE

NUTRITIONAL VARIATIONS THROUGHOUT THE LIFE CYCLE 

Neonate Nutritional requirements are met by breastmilk or formula milk  Total daily requirements of the newborn  80 to 100 ml of milk per kg  Stomach capacity = 90 ml  Feedings are required every 2 to 4 hours  Demand feeding  Burping 

NUTRITIONAL VARIATIONS THROUGHOUT THE LIFE CYCLE 

Infant  Solid foods are added when?  4 to 6 months  Cereals (Rice)  Fruits  Vegetables (Yellows before Greens)  Foods are introduced 1 at a time  Every 5 to 7 days  Honey is not given  May contain small amount of Clostridium botulinum

NUTRITIONAL VARIATIONS THROUGHOUT THE LIFE CYCLE 

Toddlers 

Toddlers can eat most foods 



  

Meals short be short Environmental distractions must be eliminated Rituals Attractive foods Avoid sweet desserts

NUTRITIONAL VARIATIONS THROUGHOUT THE LIFE CYCLE 

Preschooler  



These children eat at school Children at this stage are very active and may rush through meals to return to playing Often require healthy snacks  Fruits  Milk  Yogurt

NUTRITIONAL VARIATIONS THROUGHOUT THE LIFE CYCLE 

School Aged Child 

Watch out for the foods the child are eating at school



High CHO and High CHON  Prolonged physical and mental effort



Breakfast is important

NUTRITIONAL VARIATIONS THROUGHOUT THE LIFE CYCLE 

Adolescents 

Growth spurt



Self Identity and Peer pressure  Eating disorders

NUTRITIONAL VARIATIONS THROUGHOUT THE LIFE CYCLE 

Young Adults and Middle Adults 

Maintain normal diet of healthy food options



Milk

NUTRITIONAL VARIATIONS THROUGHOUT THE LIFE CYCLE 

Elderly 

They have many problems associated with nutrition 









Difficulty chewing  Denture  Chopped and soft foods Loss of appetite  SFF Loss of senses of smell and taste  Favorite foods Limited income  Substitution  Substitute meat with milk or beans Difficulty sleeping at night  Promote sleep

SPECIAL DIETS

SPECIAL DIETS 

Clear Liquid Diets 

Limited to

Water  Tea  Coffee  Clear broths  Strained and clear juices  Plain gelatin  Hard Candy 

SPECIAL DIETS 

Clear Liquid Diets 

This provides water and CHO (in the form of sugar)



After surgery

SPECIAL DIETS 

Full Liquid Diet 

Foods that are liquids or foods that turn to liquid at body temperature 

 





All foods in the Clear Liquid Diet Milk Puddings and custards Ice cream and sherbets Yogurt

SPECIAL DIETS 

Full Liquid Diet 

For clients who have gastrointestinal problems and cannot tolerate semi solid or solid foods

SPECIAL DIETS 

Soft Diet All foods in the Clear and Full Liquid Diet  Meat: Lean, Tender  Fish, grounded meat  Vegetables: Mashed or cooked for a very soft consistency  Fruits: Cooked or canned  Breads and oatmeals  Soft cakes 

SPECIAL DIETS 

Diet As Tolerated (DAT) 

When the client’s appetite, ability to eat and tolerate food  Gag  Bowel

Sounds

SPECIAL DIETS 

Modification for Disease 

Diabetic Diet



Hypertensive Diet

SUPPORTING NUTRITION OF THE PATIENT ENTERAL AND PARENTERAL FEEDING

ENTERAL FEEDING 

An alternative feeding method to ensure adequate nutrition



Feeding through the gastrointestinal system



EN



TEN

ENTERAL FEEDING



Nasogastric Tube



Nasointestinal Tube



Percutaneous Endoscopic Gastrostomy (PEG)



Percutaneous Endoscopic Jejunostomy (PEJ)

NASOGATRIC TUBE

NASOGATRIC TUBE 

Purpose 

For gastric gavage (feeding) and lavage (irrigation)



For administration of medication

NASOGATRIC TUBE 

Indications 

Clients who are unable to ingest foods



The upper gastrointestinal tract is impaired



Transport of food to the small intestines is interrupted

NASOGATRIC TUBE 

Single Lumen Tube 



Levin Tube

Double Lumen 

Salem Sump Tube

NASOGATRIC TUBE 

Procedure Position  High Fowler’s  Hyperextension of head  Explain  Hand Hygiene  Measure Depth of Insertion  NEX 

NASOGATRIC TUBE 

Check Nares  Irritation  Obstruction



Put on Gloves



Lubricate the tip of the tube



Insert  Resistance  Withdraw then lubricate again

NASOGATRIC TUBE 

When the tube reaches the throat  Ask the client to forward head  Swallow  Gag  Stop  Give water and encourage to breath



Continue insertion

NASOGATRIC TUBE 

Ascertain correct placement of the tube 1 – Radiographic Verification 2 – Acidity of pH of aspirate  Lithmus Paper  Blue  Red 3 – Aspiration of gastric content 4 – Ausculate epigastic region

NASOGATRIC TUBE 

Secure the NGT to the clients gown



Document

NASOGATRIC TUBE 

Feeding 

Osterized Food



Average volume of feeding:  300 ml to 400 ml  Warmed at room temperature

NASOGATRIC TUBE 

Feeding 

Procedure  Assist

the patient in high fowler’s position  If tolerated  If not, Slightly elevated right sided lying  Checks the formula's expiration date  Check the patency of the tube

NASOGATRIC TUBE Elevate the tip of the tube to 12 inches above nares  Connect tube to a 60 cc syringe  Flush with 30cc of water  Run the formula through the tubing and reclamp the tube  a rate no greater than 50ml/min is recommended  Flush with 30cc of water 

NASOGATRIC TUBE 

Perform mouth care; brushing teeth, gums and tongue twice daily



Apply lip moisturizer or petroleum jelly unless otherwise ordered



Discourages mouth breathing and uses measures to increase salivation such as chewing gum, sucking on hard candy or ice if permissible



Ask the client to remain sitting for  30 minutes

NASOINTESTINAL TUBE

NASOINTESTINAL TUBE 

Longer than the nasogastric tube



From one nostril to the small intestines



Used for clients at risk for aspiration  Decreased LOC  Poor cough or gag reflex  Restlessness and agitation  Endotracheal intubation

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY PERCUTANEOUS ENDOSCOPIC JEJUNOSTOMY

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY 

PEG 

To the stomach



To provide nutrition to 

Neurologic disorders such as a stroke or a tumor of the head, neck, or esophagus

PERCUTANEOUS ENDOSCOPIC JEJUNOSTOMY 

PEJ 

To the jejunum

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY/ JEJUNOSTOMY 

Stoma



Liquid nutritional formulas are put into the tube and directly into the stomach or intestines



Insert a feeding tube to the stoma  Lubricate tube  Insert into opening (4 to 6 inches)

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY/ JEJUNOSTOMY 

Check patency by getting aspirate



Administer the feeding



Hold the barrel of the syringe 3 to 6 in above opening of the stoma



Slowly pour solution



Flush with 30 cc of water

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY/ JEJUNOSTOMY 

Remove the syringe and clamp or plug the tube



Ensure client comfort and safety  Remain sitting for 30 minutes  Assess the stoma  Washed with soap and water once a day  Rotate the tube to avoid sticking in the stoma  Petrolatum and other skin protectant may be applied



Document

TOTAL PARENTERAL NUTRITION

TOTAL PARENTERAL NUTRITION 

Or Intravenous Hyperalimentation



Used when the gastrointestinal tract is nonfunctional

TOTAL PARENTERAL NUTRITION 

Introduced directly to the bloodstream



Tube is inserted via the:    

Subclavian vein Internal jugular vein of the neck Femoral vein Brachial vein

TOTAL PARENTERAL NUTRITION 

Subclavian Vein



Internal jugular vein of the neck

TOTAL PARENTERAL NUTRITION 

Nursing Responsibilities: 

Maintain aseptic techniques

Watch out for signs and symptoms of embolism  Pain  Swelling  Warmth on the site  Infection 

TOTAL PARENTERAL NUTRITION 

Care of Insertion Site 

Application of sterile dressing with antibacterial ointment as ordered by doctor (PRN)

BLOOD TRANSFUSION

BLOOD TRANSFUSION 

Purposes: 

To administer required blood component by the patient



To restore blood volume  RBC  WBC  Platelets  Plasma Proteins

BLOOD TRANSFUSION 

Human blood is classified into four main groups A B  AB O 

BLOOD TRANSFUSION 

Antigens  Number of proteins in the red blood cell surface  Most important in determining blood type (Blood Type Compatibility) Blood type A, Antigen A  Blood type B, Antigen B  Blood type AB, Antigen A and B  Blood type O, No antigen  Universal Donor 

BLOOD TRANSFUSION 

Antibodies Preformed antibodies are present in the plasma  Blood Incompatibility 

Blood Type A, Antibody B  Blood Type B, Antibody A  Blood Type AB, Antibody None  Universal Recipient  Blood Type O, A and B 

BLOOD TRANSFUSION 

Rh Factor 

The Rh factor antigen is present  Rh+



When the Rh factor antigen is not present  Rh –  Filipinos

BLOOD TRANSFUSION 

Procedure: 1. Verify doctor’s order. Inform client and explain the purpose of the procedure 2. Check for cross matching and blood typing. To ensure compatibility 3. Obtain and record baseline VS

BLOOD TRANSFUSION 4. Practice safe asepsis 5. At least 2 nurses check the label of the blood transfusion > Check the following: - Serial number - Blood component - Blood type - Rh factor - Expiration data - Screening tests (VDRL for sexually transmitted diseases, HBsAg for hepatitis B; malarial smear for malaria)

BLOOD TRANSFUSION 6. Warm blood at room temperature before transfusion. To prevent chills 7. Identify client properly. Two nurses check the client’s identification 8. Use needle gauge 18 or 19. This allows easy flow of blood 9. Use BT (blood transfusion) set with filter. To prevent administration of blood clots and other particulates

BLOOD TRANSFUSION 10. Start infusion slowly at 10 gtts/minute. Remain at bedside for 15 to 30 minutes. Adverse reaction usually occurs during the first 15 to 20 minutes 11. Monitor VS. Altered VS indicates adverse reaction 12. Do not mix medications with blood transfusion. To prevent adverse effects - Do not incorporate medication into the blood transfusion - Do not use the blood transfusion line for IV push of medication 13. Administer 0.9% NaCl before, during or after BT. Never administer IV fluids with dextrose. Dextrose cause hemolysis.

BLOOD TRANSFUSION 

Complications: - Allergic Reaction (flushing, rash, hives, pruritus, laryngeal edema, DOB) - Febrile, Non Hemolytic (sudden chills and fever, flushing, headache, anxiety) - Sepsis (rapid onset of chills, vomiting, marked hypotension, high fever)

BLOOD TRANSFUSION - Circulatory Overload (rise in venous pressure, dyspnea, crackles or rales, distended neck vein, cough, elevated BP) - Hemolytic (low back pain, chills, feeling of fullness, tachycardia, flushing, tachypnea, hypotension, bleeding)

BLOOD TRANSFUSION 

Nursing Interventions When Complication Occurs in Blood Transfusion 1. Stop blood transfusion immediately 2. Start an IV line (0.9% NaCl)

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