Promoting Wellness Through Life Span

PROMOTING WELLNESS THROUGH LIFE SPAN

GROWTH AND DEVELOPMENT CONCEPTS 

Theories of personality development Psychosexual Psychosocial Cognitive Developmental tasks Moral Interpersonal

Freuds psychosexual theory

Libido – inner drive Parts of body –focus of gratification Unsuccesful resolution - fixation Structures of personality 

Id – pleasure principle-instinct

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Ego – controls action and perception –reality principle

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Superego – moral behavior - conscience

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0-18 m0s ;oral – mouth – trust and discriminating 18 mos. – 3 years ; anal – bowels – holding on or letting go 

Negativism and toilet training age

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3 -6 years phallic ; genitals –exploration and discovery ( inc. sexual tension) 

Gender identification and genital awareness Oedipus and Electra complex // Castration anxiety and penis envy 

6-12 years –latency (quiet stage) sexual energy diverted to play. Institution of superego…control of instinctual impulses 12 – young adult – genital ; reawakening of sexual drives – relationships 

Sexual maturation Sexual identity ,ability to love and work 

Psychosocial – Erickson developmental milestones //delay

0-12mos; 1-3y 3-6 6-12 12-18 18-25 25-60 60 and above 

TRUST AUTONOMY INITIATIVE INDUSTRY IDENTITY INTIMACY GENERATIVITY EGO INTEGRITY

INFANCY

CONSISTENT MATERNAL –CHILD INTERACTION – TRUST INNER FEELING OF SELF WORTH 

HOPE



ALLOW EXPLORATION PROVIDE FOR SAFETY 

TODDLER

NO NO – NEGATIVISM OFFER CHOICES / REVERSE PSYCHOLOGY TOILET TRAINING – 18 MOS.-BOWEL 

DAYTIME BLADDER -2 Y NIGHTIME BLADDER 3 Y

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REWARD W/ PRAISE AND AFFECTION

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INDEPENDENCE

PRE-SCHOOL

PROVIDE PLAY MATERIALS SATISFY CURIOSITY TEACH AND REINFORCE(HYGIENE,SOCIAL BEHAVIOR) SIBLING RIVALRY 

WILLPOWER

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SCHOOL AGE

HOW TO DO THINGS WELL-SUPPORT EFFORTS CHUMS AND HOBBIES 

NEEDS TO EXCEL/ACCOMPLISH NEED FOR PRIVACY AND PEER INTERACTION  COMPETENCE 

ADOLESCENCE

MAKE DECISION,EMANCIPATION FROM PARENTS BODY IMAGE CHANGES 

NEED TO CONFORM BUT KEEP INDIVIDUALITY

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SELF - AWARENESS

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YOUNG ADULT COMMITMENT AND FIDELITY

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RESPONSIBILITY

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ACHIEVEMENT OF INDEPENDENCE

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MIDDLE ADULTHOOD

SUPPORT-PERIOD OF ROLE TRANSITIONS MIDLIFE CRISIS 

ADJUSTMENT AND COMPROMISE

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MOST PRODUCTIVE AND CREATIVE

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ALTRUISM

LATE ADULTHOOD

SELF ACCEPTANCE

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SELF WORTH

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WISDOM

PIAGET’S COGNITIVE THEORY 0-2 SENSORIMOTOR

REFLEXES IMITATIVE REPETITIVE BEHAVIOR SENSE OF OBJECT PERMANENCE AND SELF SEPARATE FROM ENVT. TRIAL AND ERROR RESULTS IN PROBLEM SOLVING 

2-7Y PRE-OPERATIONAL

SELF-CENTERED,EGOCENTRIC CANNOT CONCEPTUALIZE OTHER’S VIEW ANIMISTIC THINKING IMAGINARY PLAYMATE – SYMBOLIC MENTAL REPRESENTATION – CREATIVITY 2-4 PRE-CONCEPTUAL (PRE-LOGICAL) 4-7 INTUITIVE (UNDERSTANDING OF ROLES) 

7-12Y CONCRETE OPERATIONAL

LOGICAL CONCRETE THOUGHT INDUCTIVE RESAONING (SPECIFIC TO GENERAL) CAN RELATE ,PROBLEM SOLVING ABILITY REASONING AND SELF-REGULATION 

12-ABOVE FORMAL OPERATIONAL THOUGHT

Abstract thinking Separation of fantasy and fact Reality oriented Deductive reasoning Apply scientific method 

Havighurst Developmental Tasks Baby to early childhood

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Right from wrong and Conscience

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Late childhood

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Physical skills,wholesome attitude,social roles Conscience morality and values 

Fundamental skills in academics Personal independence 

Adolescence

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Sexual social roles Relationships Independence and ideology 

Early adulthood

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Career Selecting a mate Finding Civic or social responsibility 

Middle age

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Achieving Civic or social responsibility Adjusting to changes Satisfactory career performance Adjusting to aging parents Adjusting to parental roles  

Old age

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Adjusting to changes Establishing satisfactory living arrangements and affiliations

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Kohlberg – MORAL DEVELOPMENT/ THINKING/ JUDGEMENT PRE-CONVENTIONAL (0-6)

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PUNISHMENT AND OBEDIENCE OBEDIENCE TO RULES TO AVOID PUNISHMENT 

CONVENTIONAL ( 6-12 )

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MUTUAL INTERPERSONAL EXPECTATIONS,RELATIONSHIPS AND CONFORMITY 

SOCIAL SYSTEM AND CONSCIENCE MAINTENANCE BEING GOOD IS IMPORTANT SELF RESPECT OR CONSCIENCE 

POST –CONVENTIONAL (12 – 18 Y) PRIOR RIGHT OR SOCIAL CONTRACT UNIVERSAL ETHICAL PRINCIPLE ABIDE FOR COMMON GOOD RATIONAL PERSON-VALIDITY OF PRINCIPLES-AND BECOME COMMITTED TO THEM INNER CONTROL OF BEHAVIOR UNDERSTANDING THE EQUALITY OF HUMAN RIGHTS AND DIGNITY OF HUMAN BEINGS AS INDIVIDUALS 

SULLIVANS

INTERPERSONAL THEORY INFANCY

NEED FOR SECURITY-INFANT LEARNS TO RELY ON OTHERS TO GRATIFY NEEDS AND SATISFY WISHES, DEVELOPS A SENSE OF BASIC TRUST, SECURITY AND SELF WORTH WHEN THIS OCCURS 

TODDLERHOOD / EARLY CHILDHOOD

CHILD LEARNS TO COMMUNICATE NEEDS THROUGH USE OF WORDS AND ACCEPTANCE OF DELAYED GRATIFICATION AND INTERFERENCE OF WISH FULFILLMENT 

PRE-SCHOOL

DEVELOPMENT OF BODY IMAGE AND SELF-PERCEPTION ORGANIZES AND USES EXPERIENCES IN TERMS OF APPROVAL AND DISAPPROVAL RECEIVED BEGINS USING SELCTIVE INATTENTION AND DISASSOCIATES THOSE EXPERIENCES THAT CAUSE PHYSICAL OR EMOTIONAL DISCOMFORT AND PAIN 

SCHOOL AGE

THE PERIOD OF LEARNING TO FORM SATISFYING RELATIONSHIPS WITH PEERS-USES COMPETITION,COMPROMISE AND COOPERATION THE PRE-ADOLESCENT LEARNS TO RELATE TO PEERS OF THE SAME SEX 

ADOLESCENCE

LEARNS INDEPENDENCE AND HOW TO ESTABLISH SATISFACTORY RELATIONSHIPS WITH MEMBERS OF THE OPPOSITE SEX 

YOUNG ADULTHOOD

BECOMES ECONOMICALLY, INTELLECTUALLY AND EMOTIONALLY SELF SUFICIENT 

LATER ADULTHOOD

LEARNS TO BE INTERDEPENDENT AND ASSUMES RESPONSIBILITY FOR OTHERS 

SENESCENCE

DEVELOPS AN ACCEPTANCE OF RESPONSIBILITY FOR WHAT LIFE IS AND WAS AND OF ITS PLACE IN THE FLOW OF HISTORY 

FORMATION OF PERSONALITY CERTAIN GOALS MUST BE ACCOMPLISHED, IF THIS GOALS ARE NOT ACCOMPLISHED AT A CERTAIN STAGE,….PERSONALITY WILL BE WEAKENED….

FACTORS IN EACH STAGE PERSISTS AS A PERMANENT PART OF PERSONALITY…. EACH STAGE HAS MAJOR TRAUMAS AND FRUSTRATIONS THAT MUST BE OVERCOME …….SUCCESSFUL RESOLUTION OF CONFLICTS ASSOCIATED WITH EACH STAGE IS ESSENTIAL TO DEVELOPMENT…..UNRESOLVED CONFLICTS REMAIN IN THE UNCONSCIOUS AND MAY, AT TIMES, RESULT IN MALADAPTIVE BEHAVIOR

PREVENTION AND EARLY DETECTION OF DISEASE GROWTH AND DEVELOPMENT

DEVELOPMENTAL TASKS---MILESTONES ---DELAYS(FIXATIONS/LAG) 

IQ = MA / CA X 100

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JUDGEMENT , COMPREHENSION AND LISTENING

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DDST – BIRTH TO 6 YEARS

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PERSONAL SOCIAL, FINE , GROSS MOTOR AND LANGUAGE SKILL AREAS 

HEALTH SCREENING OB – GYNE / REPRODUCTIVE TESTS

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UTZ-5 WKS CONFIRM PREGNANCY AND AOG AMNIOCENTESIS – 16 WKS-DETECT GENETIC DISORDERS – 30 WEEKS – L/S RATIO ( 2-4 WKS RESULT)(EMPTY Bladder) OCT – (28 WKS)FHR DECELERATIONS – IV OXYTOCIN 15-20 MIN----3 CONTRACTIONS OBTAINED WITHIN 10 MINUTES- REACTIVE NST – FHR ACCELERATIONS (32-34 WKS) – 2-MORE FHR ACCELERATION OF 15BPM/MORE LASTING 15 SECS -20 MINS. AND RETURN OF FHR TO NORMAL/BASELINE – REACTIVE DOPTONE- 12 WEEKS (18 – 20 WKS-AUSCULTATION) AFPT-FETAL SERUM CHON , -DETECT NEURAL TUBE DEFECTS – 16-18 WKS CHORIONIC VILLI SAMPLING –FETAL ABNORMALITIES- 10-12 WKS  

NEWBORN/INFANT HEALTH SCREENING

PKU – GUTHRINE BLOOD TEST-EAT CHON FOR 2 DAYS MIN.(PHEONISTICS – DIAPER) SICKLE CELL DISEASE –ABNORMALLY SHAPED Hg , ELISA AND WESTERN BLOT CARRIER SCREENING FOR CYSTIC FIBROSIS AND SWEAT CHLORIDE TEST 

SCHOOL AGE

HEARING AND VISION TESTS

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ALLEN PICTURE CARDS SNELLEN CHART-20/40 AT TODDLER AND 20/20 AT SCHOOL AGE WEBER’S-SENSORINEURAL AND CONDUCTIVE RINNE’S- CONDUCTIVE DENTAL EXAM – STARTS AT 2 YEARS 

ADOLESCENT

PPD – INDURATION – 72 HOURS BSE – (18-20 YRS.) POST MENSTRATION/MONTHLY TSE – MONTHLY (18-20 YRS) PELVIC EXAM WITH PAP SMEAR – IF SEXUALLY ACTIVE OR 18 Y.O. ANNUALLY 

ADULT/ELDERLY

HPN , DM, HEARING AND VISION PROSTATE –ANNUALLY@40 Ca CHECK-UPS-Q3Y-20YO ; QY – 40 YO SIGMOIDOSCOPY- > 50 Y.O. =Q3-5 YRS FECAL OCCULT BLOOD TEST- > 50 = ANNUALLY DIGITAL RECTAL EXAM - > 40 Y.O. = YEARLY PELVIC EXAM – 18-40 Y.O. =PERFORMED Q 1 – 3 YEARS WITH PAP TEST MAMMOGRAM – 35-39 = BASELINE 

40-49 = Q2Y 50 AND OLDER = QYEAR

BP SCREENING(mmHg) IMMUNITY pg 127-130

CONTRAINDICATIONS:



SEVERE FEBRILE ILLNESS LIVE VIRUSES C/I FOR IMMUNOCOMPROMISED ALLERGIES RECENTLY ACQUIRED PASSIVE IMMUNITY(BLOOD TRANSFUSION AND IMMUNOGLOBULINS)  



if child –no evidence of immunization <7 y.o. Give DPT,TOPV,TINE 4-6 WKS LATER MMR 1 MONTH AFTER DPT AND TOPV REPEATED IN ANOTHER MONTH AGAIN IN 10-16 MOS. 

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CAN GIVE DPT,MMR,TOPV, AND TINE SIMULTANEOUSLY

TD- 2 DOSES 4-8 WKS APART;3RD DOSE 6-12 MOS;BOOSTER AT 10 YRS FO LIFE RD OPV/IPV – 2 DOSES AT 4-8 WKS APART ; 3 DOSE 2 -12 MOS ND AFTER 2 (OPV NOT USED IN US) MMR-ONE DOSE – 12 MOS VARICELLA – TWO DOSES 4-8 WEEKS APART STARTS AT 12 MOS. ND HEPA B – 3 DOSES;2 1-2 MOS AFTER;3RD 4-6 MS AFTER PPV- ONE DOSE ;IF 65 AND RECEIVED > 5YEARS – ADMINISTER INFLUENZA –ANNUALLY EACH FALL 

ALLERGY CONTRAINDICATIONS

EGGS – INFLUENZA , MMR NEOMYCIN – VARICELLA,IPV,MMR YEAST – HEPA-B GELATIN – VARICELLA 

PREGNANCY C/I: MMR AND VARICELLA IMMUNOSUPPRESSED; VARICELLA WITH Ig or BT PREVIOUS 3-11 MOS – MMR AND VARICELLA 

CONSIDERATIONS-IMMUNIZATION

DPT - IM – ANTERIOR OR LATERAL THIGH

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FEVER AND SWELLING 24-48 H POTENTIAL SERIOUS-CONVULSIONS,HYPERPYREXIA,LOC AND SCREAMING 

MMR – SC – ANTERIOR OR LATERAL THIGH

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RASH, FEVER ARTHRITIS-10DAYS-2 WKS

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TRIVALENT OPV – PO

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PPD-ID- 4-6/11-16YRS.OLD IN HIGH PREVALENCE AREAS – EVALUATED 48-72 HOURS 

PHYSICAL ASSESSMENT

TEACHING OPPURTUNITY INSPECTION –VISUALLY  PALPATION-WARM HANDS 

DORSUM OF FINGERS FOR TEMP

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PERCUSSION-DIRECT,INDIRECT,BLUNT

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RESONANCE-MODERATE LOW PITCHED CLEAR HOLLOW(LUNG) HYPERRESONANCE-OVERINFLATED(EMPHYSEMA) TYMPANY-HIGH PITCHED,LOUD DRUMLIKE(BOWEL) DULL-SOFT MUFFLED,DENSE FLUID FILLED TISSUE(LIVER) FLAT – SOFT HIGH PITCHED,VERY DENSE TISSUE-(MUSCLE/BONE)  

AUSCULTATIONDIAPHRAGM-HIGH PITCHED(LUNG,BOWEL,HEART); BELL – SOFT LOW PITCHED(HEART MURMURS)  

TEMPERATURE:

VITAL SIGNS

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ORAL – 98.6 ‘F / 37 ‘C RECTAL – 99.6 ‘F / 37.6’C AXILLARY – 97.6’F / 36.5’C 

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NORMAL VITAL SIGNS

NEWBORN=30 – 50 / MIN; 120 – 140 / MIN; 60/40 – 80/50 mmHg 1 – 4 YEARS=20 – 40 / MIN; 80 – 140 /MIN; 90/60 – 99/65 mmHg 

5 – 12 YEARS=15 – 25 / MIN; 70 – 115 / MIN; 100/56 – 110/60 mmHg 

ADULT=12 – 20 / MIN;60 – 100 / MIN ; 90 / 60 –140 / 90 mmHg 

BREATHING PATTERNS

CHEYNE STOKES – PERIODIC BREATHING CHARACTERIZED BY RHYTMIC WAXING AND WANING DYSPNEA - LABORED PAINFUL BREATHING HYPERVENTILATION – ABNORMALLY RAPID DEEP PROLONGED BREATHING KUSSMAULS – AIR HUNGER , MARKED INCREASE IN DEPTH AND RATE TACHYPNEA – FAST SHALLOW BREATHING PARADOXICAL – FLAIL CHEST , DEFLATES DURING INHALATION BIOT’S – SHALLOW BREATHS INTERRUPTED BY APNEA 

NORMAL FINDINGS

PULSE PRESSURE – 30-40 mmHg Intracranial pressure – 10 mmHg PULSE DEFICIT – MINIMAL(3-5 ACCEPTABLE) 

IDEAL BODY WEIGHT –

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MALES -106 LBS FOR 1ST 5FT THEN ADD 6LBS/INCH ST FEMALE – 100LBS FOR 1 5 FT THEN ADD 5LBS/INCH ADD OR SUBTRACT 10% DEPENDING ON BODY FRAME. OBESE AND UNDERWEIGHT IF DEVIATION IS > 20% 

SCARS,BRUISES AND LESIONS CHECK COLOR EDEMA – GRADING

SKIN

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0-NO EDEMA 1-BARELY DETECTABLE 2-INDENTATION<5MM 3-INDENTATION 5-10MM 4-INDENTATION >10MM  

PRESSURE SORE –GRADING

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1-NONBLANCHABLE ERYTHEMA 2-EPIDERMIS,PARTIAL THICKNESS 3-FULL DERMIS AND SQ 4- SUPPORTING TISSUES AND BONES  

TURGOR-PINCH SKIN TENTED 3 SECS NORMAL(ELDERLY-OVER STERNUM)

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HAIR AND NAILS

HIRSUTISM-EXCESS

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ALOPECIA-THINNING

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SHAPE – NORMALANGLE OF NAIL BED-160’; CLUBBING ANGLE > 180 DUE TO PROLONGED DECREASED OXYGENATION BLANCHING =< 3 SECS-NORMAL 

HEAD

SYMMETRY, SIZE AND SHAPE CRANIAL NERVE ASSESSMENTS 

OPTIC-SNELLEN OCULOMOTOR- PERRLA TRIGEMINAL – BITE DOWN AND STROKES WITH COTTON FACIAL – FACIAL MOVEMENT AND TASTE ACCOUSTIC – HEARING AND BALANCE(WATCH TICK TEST,OTOSCOPIC EXAMS AND POSTURE TESTS) GLOSSOPHARYGEAL-GAG AND SWALLOW VAGUS- SWALLOWING AND SPEAKING 

EYES

PTOSIS-DROOPING OF THE UPPER EYELID ASTIGMATISM – UNEVEN CURVATURE OF CORNEA LEADING TO REFRACTION ERRORS NYSTAGMUS- ABNORMAL, INVOLUNTARY EYE MOVEMENTS STRABISMUS-ASSYMETRICAL LIGHT EFLECTION ON EACH CORNEA RED REFLEX FROM RETINA-NORMAL COVER UNCOVER TEST – DET.EYE ALIGNMENT SNELLEN – FAR DISTANCE VISION/VISUAL ACUITY IOP-TONOMETRY TESTS INDENTATION(6-12) 

EARS

PINNA BACK-UP-ADULT;DOWN-BACK-CHILD RINNE TEST – COMPARES AIR CONDUCTION WITH BONE CONDUCTION,VIBRATING FORK PLACED ON THE MASTOID IF SOUND NO LONGER HEARD POSITIONED IN FRONT OF EAR CANNAL. SHOULD HEAR A SOUND= 2:1 ; AIR CONDUCTION > THAN BONE CONDUCTION ;= POSITIVE RINNE 

ASSESS CONDUCTIVE HEARING LOSS

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EARS

WEBER – SENSORINEURAL AND CONDUCTIVE HEARING LOSS

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FORK PLACED MIDDLE OF FORE HEAD,SHOULD BE HEARD EQUALLY=WEBER NEGATIVE  IF NOT EQUAL=SENSORINEURAL HEARING LOSS. SOUND HEARD BETTER IN THE IMPAIRED EAR=BONE CONDUCTIVE HEARING LOSS, IF VICE VERSA = SENSORINEURAL DISTURBANCE 

NECK,MOUTH AND PHARYNX

TEETH-32 TONSILS – NO TPC , + GAG REFLEX CERVICAL LYMPH NODES=<1CM CAROTID – PALPATE THRILL,LISTEN BRUIT JUGULAR VEINS – NOT DISTENDED TRACHEA-MIDLINE 

THORAX AND LUNGS

APL DIAMETER-1:2 – 5:7

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1:1 = BARREL CHEST

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TACTILE FREMITUS NORMAL-BRONCHOPHONY,EGOPHONY AND WHISPERED PECTORILOQUY-CONSOLIDATION OF LUNGS BREATH SOUNDS 

VESICULAR – SOFT-LOW PITCHED BREEZY SOUNDS –PERIPHERAL LUNG SURFACES BRONCHOVESCICULAR-HARSH SOUNDS-MAINSTREAM BRONCHI BRONCHIAL- LOUD COARSE - TRACHEA  

ADVENTITIOUS BREATH SOUNDS

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RALES-FINE SHORT,CRACKLING OR HIGH PITCHED SOUNDS-INSPIRATION RHONCHI-CONTINOUS LOW PITCHED COARSEGURGLING HARSH SNORING BEST HEARD ON EXHALATION WHEEZES- SQUEAKY SOUNDS HEARD – EXHALATION STRIDOR – HARSH , MUSICAL SQUEAK HEARD UPON INHALATION FRICTION RUB-GRATING , CREAKING SOUNDS, FIZZ LIKE VIBRATIONS – BOTH INHALATION AND EXHALATION  

HEART SOUNDS

AORTIC AND PULMONIC VALVE AREAS- 2ND ICS, R AND L RESPECTIVEY RD ERBS POINT 3 ICS TH TRICUSPID AREA-4 / 5TH ICS TH MITRAL AREA – 5 ICS , LEFT MCL TH PMI-5 ICS MCL –(INFANTS-LATERAL TO LEFT NIPPLE-4TH ICS) S1LUBB-CLOSURE OFAV VALVES S2DUBB-CLOSURE OF SEMILUNAR VALVES MURMURS , GALLOP-ABNORMAL HEART SOUNDS 

PERIPHERAL VASCULAR SYSTEM

ASSESS PAIN,PALLOR,PARALYSIS,PARESTHESIASAND PULSES. ASSESS HOMAN’S SIGN PULSE DEFICIT 

BREASTS

START – UPPER OUTER CLOCKWISE ASSESS FOR SIZE,SHAPE,SYMMETRY AND NODES 

ABDOMEN

DORSAL RECUMBENT INSPECT,AUSCULTATE,PERCUSS AND PALPATE BOWEL SOUNDS-HIGH PITCHED GURGLES HEARD AT 5 – 20 SECOND INTERVALS( 5-25/MIN NORMAL) IF NOT HEARD IN 1 MINUTE STAY FOR 3 -5 MINS. MORE. SEQUENCE IS CLOCKWISE FROM RLQ 

HYPOACTIVE < 3 HYPERACTIVE =CONTINOUS,LOUD,FREQUENT TINKLING SOUND – BOWEL OBSTRUCTION  

ABDOMEN

REBOUND TENDERNESS- INFLAMMATION OF PERITONEUM 

KIDNEYS- DORSAL LUMBAR AREA – COSTOVERTEBRAL ANGLE

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KIDNEY PUNCH TEST

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MUSCULOSKELETAL SYSTEM

MUSCLE TONE AND STRENGTH

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0=COMPLETE PARALYSIS 1=10%-NO MOVEMENT CONTRACTION OF MUSCLE PALPABLE/VISIBLE 2=25% - FULL MOVEMENT AGAINST GRAVITY WITH SUPPORT 3=50% - NORMAL MOVEMENT AGAINST GRAVITY 4= 75%- NORMAL MOVEMENT AGAINST GRAVITY WITH MINIMAL RESISTANCE 5=100%-NORMAL FULL MOVEMENT WITH FULL RESISTANCE  

JOINT MOVEMENTS-CREPITUS=GRATING SOUNDS ARE ABNORMAL FASCICULATION ABNORMAL CONTRACTIONS AND SHORTENING OF MUSCLE FIBERS TREMOR-INVOLUNTARY TREMBLING TEST FOR ROM AND ASSESS FOR ATROPHY/HYPERTROPHY/CONTRACTURES  

NEUROLOGIC TESTS

MENTAL STATUS-



LANGUAGE-CEREBRAL CORTEX-APHASIA ORIENTATION(TIME,PLACE,PERSON)(CONFUSION) MEMORY- IMMEDIATE RECALL, RECENT MEMORY AND REMOTE MEMORY ATTENTION SPAN AND CALCULATION JUDGEMENT – EXPLAIN/INTERPRET / PERSONAL VIEWS PERCEPTION – SENSORY ANALYSIS AND INTEGRATION  

CEREBELLAR FUNCTION- COORDINATION , POINT TO POINT TOUCHING,ALTERNATING MOVEMENTS,GAIT  CRANIAL NERVE FUNCTIONS SENSORY FUNCTION(e.g. PROPRIOCEPTION-POSITION SENSERHOMBERG’S TEST) 

NEUROLOGIC TESTS

DEEP TENDON REFLEX



0-NO REFLEX +1 – MINIMAL ACTIVITY(HYPOACTIVE) +2 – NORMAL RESPONSE +3 – MORE ACTIVE THAN NORMAL +4 – MAXIMUM ACTIVITY ( HYPERACTIVE) 

PRESENCE OF INFANTILE REFLEXES(BABINSKI) IN AN ADULT SIGNIFIES CNS PATHOLOGY 

LEVEL OF CONSCIOUSNESS

GLASGOW COMA SCALE=15 POINTS, 7 COMA

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EYE OPENING



SPONTANEOUS=4 TO VERBAL COMMAND=3 TO PAIN=2 NO RESPONSE=1  

MOTOR RESPONSE



TO VERBAL COMMAND=6 TO PAINFUL STIMULI/LOCALIZES PAIN=5 FLEXES AND WITHDRAWS=4 DECORTICATE=3 DECEREBRATE=2 NO RESPONSE=1  

VERBAL RESPONSE

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ORIENTED,CONVERSES=5 DISORIENTED,CONVERSES=4 USES INAPPROPRIATE WORDS=3 USES INCOMPREHENSIBLE SOUNDS=2 NO RESPONSE=1  

ASSESSING MOTOR FUNCTION

WALKING GAITS



ROMBERGS TEST- STAND FEET TOGETHER ARMS RESTING AT THE SIDES,EYES OPEN THEN CLOSED. NEG. ROMBERG – MAY SWAY BUT KEEPS BALANCE. 

SENSORY ATAXIA-CANNOT BALANCE EYES SHUT CEREBELLAR ATAXIA-CANNOT BALANCE EYES SHUT OR EPON 

HEEL-TOE WALKING AND VICE VERSA FINGER TO NOSE TEST AND OTHER SENSORY FUNCTION TEST (ONE AND TWO POINT DISCRIMINATION)  EXTINCTION PHENOMENON-SYMMETRICAL AREAS ARE TOUCHED BUT SENSATION ON ONE SIDE CANNOT BE FELT INDICATES LESIONS OF SENSORY CORTEX 

GENITALIA , ANUS AND RECTUM

ASSESS APPEARANCE AND ORIFICES AND INGUINAL LYMPH NODES INSPECT CERVICAL OS AND VAGINA-SPECULUM DEVIATIONS 

CYSTOCELE, RECTOCELE,ENTEROCELE HYPO AND EPISPADIAS-URETHRAL OPENING DISPLACED HERNIAS-DIRECT,INDIRECT , FEMORAL INSTRUCT PNT TO BEAR DOWN-PALPABLE BULGE  

DIGITAL RECTAL EXAM –INSPECTION AND PALPATION –POSITION BOTH=SIM’S , FEMALES – LITHOTOMY;MALES =STAND AND BEND FORWARD PROSTATE GLAND-4 CM ;CERVIX = 2-3 CM HEMORRHOIDS =DILATED VEINS 

STRESS , ANXIETY AND CRISIS SELF- AWARENESS

SELF CONCEPT – COLLECTION OF FEELING BELIEFS ABOUT ONE’S SELF SELF ESTEEM – CONFIDENCE IN ONE’S ABILITIES AND JUDGEMENT 

ASSERTIVENESS



+ SELF - EVALUATION



STRESS

GAS – ALARM-RESISTANCE-EXHAUSTION COPING AND STRESS MANAGEMENT 

ANXIETY-



MILD – SLIGHT AROUSAL AND INCREASED PERCEPTION MODERATE-INC. TENSION AND SELECTIVE INATT. SEVERE – DEC. PERCEPTION AND FOCUSSED ENERGY PANIC – OVERPOWERING AND LOSS OF CONTROL 

STRESS MANAGEMENT

RELAXATION TECHNIQUES



RELAXATION BREATHING PROGRESSIVE MUSCLE SETTING AUTOGENIC TRAINING(SELF-SUGGESTIONS) IMAGERY(MENTAL VACATION) DISTRACTION 

GRIEF AND LOSS Loss is a universal experience that occurs throughout life span Grief is a form of sorrow involving feelings, thoughts, and behaviors caused by bereavement Responses to loss are strongly influenced by one’s cultural background The grief process involves a sequence of affective, cognitive, and psychological states as a person responds to, and finally accepts a loss. Responses to loss and patterns of coping with loss are developed early in life. 

Stages of Grieving (Kubler-Ross) Denial- refuses to believe that the loss has occurred Anger- the individual resists the loss and may “act out” feelings. Bargaining- the individual attempts to make a deal in an attempt to postpone the reality of loss. Depression- overwhelming feeling of loneliness and withdrawal from others Acceptance- the individual comes to terms with loss, or impending loss, psychological reactions to loss to the loss cease, and the interaction to other people resumed.

LOSS ,GRIEVING AND DEATH

DEATH CONCEPTS



1-5Y.O – IMMOBILITY AND INACTIVITY Wishes and unrelated action responsible for action 5-10 – final but can be avoided 9-12 – understands own mortality and fears death 12 – 18 – fears and fantasizes avoidance 18-45 – increased attitude awareness 45-65 – accepts mortality Above 65 – multiple meanings, encounters and fears 

KUBLER ROSS – STAGES OF GRIEF

D – SUPPORTIVE



A- PROVIDE STRUCTURE AND CONTINUITY



B – LISTEN AND ENCOURAGE



D- ALLOW EXPRESSION AND PROVIDE FOR SAFETY



A- ENCOURAGE PARTICIPATION



CONCEPTS

6 MOS – 2 YEARS PROVISION OF DIGNIFIED PAIN FREE DEATH( QUEST. ANSWERED AND EMT. SUPPORT) DNR- COMFORT AND HYGIENE NEEDS ON-GOING CURE GOALS ----- COMFORT GOALS 

CONCEPTS

HINDU – REINCARNATION , AUTOPSY , ORGAN DONATION, CREMATION ISLAM – NO TO ORGAN DONATION , CREMATION AND AUTOPSY …..CONFESS AND TURN TO MECCA JUDAISM – WASHED NATIVE AMERICAN – NOT TO AUTOPSY BUDDIST – OK – EUTHANASIA AND WITH LAST RITES 

SAFETY AND INFECTION CONTROL

PROTECTING HEALTH

NON – SPECIFIC AND SPECIFIC CHAIN OF INFECTION 

UNIVERSAL PRECAUTION PRINCIPLES OF SURGICAL ASEPSIS INFECTION CONTROL MEASURES 

ISOLATION – CATEGORY SPECIFIC AND DISEASE SPECIFIC MEDICAL AND SURGICAL ASEPSIS 

Universal Precautions

Strict Isolation-highly transmissible diseases by direct contact and airborne routes of transmission 

Private room,gowns, mask , gloves, handwashing,double bagged techniques for soiled articles 

Diptheria(pharyngeal),Herpes Zoster, Varicella , Pneumonia( S.Aureus , Strep,group A) 

Universal Precautions

Respiratory Isolation-droplet transmission(3 feet)



Private rom,patient w/ same organism,mask,handwashing,labelled plastic bags for soiled articles 

H. influenza, measles, mumps, N. Meningitidis



Universal Precautions

Tuberculosis/ AFB isolation-suspected / active TB



Private room with negative pressureventilation so that air room is vented outside, mask, handwashing, bronchoscopy and dental examination postponed until 2 weeks of antibiotic therapy 

Tuberculosis



Universal Precautions

Contact Isolation – infectious disseases or multiple resistant microorganisms that are spread by direct contact or close contact 

Private room , mask gown , gloves



diptheria( cutaneous), Herpes simplex, MRSA , Pediculosis , Scabies , Syphilis



Universal Precautions

Enteric Precautions – infectious diseases transmitted through direct or indirect contact with infected feces. 

Handwashing , gloves , gowns worn only when handling contaminated objects with feces 

Aseptic meningitis, AGE , Hepa A , Typhoid fever, diarrhea (CDT )



Universal Precautions

Drainage / Secretions precautions – patients with wound drainage or infected wounds 

Gloves, gowns indicated if clothing is likely to be contaminated



Burns



Universal Precautions

Universal Blood and Body fluids precautions – blood borne , body fluids pathogens ( blood , semen , vaginal secretions , CSF , synovial fluid , pleural fluid , peritoneal fluid , pericardial fluid , amniotic fluid and tissues. 

Gloves , mask, protective eyegears, gown , contaminated needles not recapped and sharps in puncture resistant containers 

Aids , Hepatitis B and C , STD’s



Reverse Isolation

Patient is protected from pathogens and nosocomial infections by instituting reversed transmission precautions 

Burns and open wounds, patients with artificial airway , immunocompromised patients – leukemia , AIDS , steroid therapy , radiation or cancer chemotherapy , medication effect of leukopenia or agranulocytosis 

Infectious agents- pathogens (bacteria, fungi, virus, protozoa) ReservoirsReservoirs- sources or places for growth of the pathogens Portal of Exit and EntryEntry- provides the way for the pathogen to leave one host and enter another host Modes of transmissiontransmission- vehicles of transmission of the pathogens Susceptible HostHost- a carrier capable of supporting and transmitting microorganism 

Body Defenses Against Infection



Normal Flora



Intact Skin Saliva and Mucus Membrane Cilia of the Upper Respiratory Tract Infection Inflammatory process Immune Response 

Medical Asepsis/ Clean Technique Principles: Pathogens move through spaces or air current Pathogens are transferred from one surface to another whenever objects touch. Hand washing removes microorganism Pathogens are released into the air on droplet nuclei when person speaks, breaths, and sneeze. Pathogens are transferred by virtue of gravity Pathogens move slowly on dry surface but very quickly through moisture. 

Surgical Asepsis/ Sterile Technique Areas of the body considered sterile are: 

Blood stream Spinal Fluid Peritoneal Cavity Urinary Tract Muscles Bones Chamber of the Eyes 

Sterile object remains sterile when touched by another sterile object Sterile objects or fields, which falls out of the range of vision or below one’s waist, are considered contaminated. Sterile items become contaminated when they come in contact with microorganism transported through the air. When sterile object/ field come in contact with another surface, it becomes contaminated. Fluids flows in the direction of gravity. The edges of the sterile field are considered unsterile. 

Isolation Practices Strict Isolation- prevents transmission of highly communicable disease by contact and airborne transmission Respiratory isolation- prevents transmission by droplet Enteric precaution- prevents transmission through ingestion Wound and skin precaution- prevents cross-infection by direct contact with wounds and contaminated articles Discharge precaution- prevent cross-infection by secretions-contaminated articles Blood precaution- prevent transmission by contact with blood or items contaminated with blood

COMFORT AND PAIN *COMFORT AND PAIN

PQRST AND QUEST PHARMACOLOGICAL Tx PAIN GATEWAY CONTROL THEORY PLAN AND PREVENT INJURY/HARM PROVIDE ALTERNATIVE MEASURES PROPHYLACTIC/PREVENTIVE PCA PREFERENCE AND PARTICIPATION 

Pain The noxious stimilation of threatened or actual tissue damage (Geach, 1987) Whatever the experiencing person says it is, existing whenever he or she says it does (McCaferry, 1979) It is highly subjective and individual and that is one of the body’s defense mechanism indicating that there is a problem. It is protective as it gives warning or signal for tissue injury 

Assessment of Pain Precipitating Factors- “ What triggers the pain or makes it worse?” Quality of Pain- “Tell me what the pain feels like” Alleviating Factors- “What measures relieve your pain” Meaning of pain- “ How do you interpret the pain?” 

Pattern Location Pain- “Where is your pain” Periodicity- “How long have you felt the pain sensation?” 

REST AND SLEEP *REST AND SLEEP

REM – DREAM PARADOXICAL SLEEP PRIMARY AND SECONDARY SLEEP DISORDERS 

RESTFUL ENVT. RITUALS RELAXATION RELEVANT MEDS AND RELATED THERAPY & NON PHARMACOLOGIC Tx RECORD ASSESSMENTS AND HISTORY 

Stages of Sleep: Non-Rapid Eye Movement (NREM)- for body restoration 

Very Light Sleep- drowsy, and readily awakened Light Sleep- Heart and respiratory rate decreases and the body temperature gradually falls. PNS domination- Difficult to arouse Deep Sleep- Decrease metabolism and very difficult to arouse  

Rapid Eye movement (REM)- increase synthetic processes of the brain Paradoxical Sleep Dream state of the sleep Close to wakefulness but difficult to arouse 

Common Sleep Disorders Insomia- sleeplessness Hypersomia- Excessive sleep at day time Narcolepsy- Sleep attack Parasomias 

Somnambolism- sleep walking Soliloqy- Sleep talking Bruxism- clenching and grinding of teeth Night Terrors- bad dreams Nocturnal Erections- wet dreams 

Nocturnal Enuresis - BEDWETTING



SAFETY Rest is the diminished state of activity Sleep is a state of decreased perception and reaction to the environment There are theories of sleep: 

Active theory- there are parts of the brain that inhibit other brain parts Passive theory- the reticular activating system of the brain fatigues and becomes depressed, thus sleeps occurs 

*SAFETY

TRIAGE DISASTER MANAGEMENT -=A,B,C 

P REVENT ABSORPTION O FF AND OUT I DENTIFY S UPPORT AND SUPPLY ANTIDOTE O NGOING MONITORING N OTIFY 

POISONING CHILD PROOF REFER - POISON CONTROL CENTER IDENTIFY AND BRING AGENT SECURE SAFETY AND ABC’S INDUCE VOMITING W/ IPECAC STOP/DELAY ABSORPTION W/ WATER/MILK/ACTIVATED CHARCOAL THE NURSE SHOULD INTERVENE IF A MOTHER OF A VICTIM OF POISONING VERBALIZES TO DO THE FOLLOWING: 

PLANS TO INDUCE VOMITING FOR PATIENT WITH ASPIRIN POISONING 

PLANS TO INDUCE VOMITING WHEN SHE IS CERTAIN THAT HER CHILD’S GAG REFLEX AND LOC ARE INTACT WILL NOT GIVE IPECAC IF CHILD IS EXHIBITING NARROWED PULSE PRESSURE WILL WAIT FOR THE SEIZURE TO END BEFORE ADMINISTERING IPECAC 

CONTRAINDICATIONS OF IPECAC / INDUCTION OF VOMITING

SEIZURE SUBNORMAL LOC AND GAG REFLEX SUBSTANCE CORROSIVE/PETROLEUM DISTILATE SHOCK-SEVERE 

DISASTER PLANNING

TRIAGE-GREATEST GOOD FOR THE GREATEST NUMBER OF PEOPLE PRINCIPLES- ABCD , MASLOWS 

RED-UNSTABLE – IMMEDIATE CARE YELLOW- STABLE – CAN WAIT 30-60 MIN GREEN –STABLE- CAN WAIT LONGER BLACK- UNSTABLE – FATAL, LAST SEEN DOA – SUPPORTIVE COMFORT MEASURES 

DURING FIRE WHICH SET OF PATIENTS WILL THE NURSE MOBILIZE FIRST

AMBULATORY BEDRIDDEN CRITICAL TERMINAL 

WHICH STEP IN FIRE MANAGEMENT COMES LAST?

ALARM CONTAIN MOBILIZE EXTINGUISH 

READ ENSURE SUPERVISION LOCK AVOID TRANSFERING TEACH AND EDUCATE MANAGEMENT IPECAC ACTIVATED CHARCOAL H2O OR MILK NA SO4 SPECIFIC ANTIDOTE OR ANTAGONIST 

POISONING CHILD PROOF REFER - POISON CONTROL CENTER IDENTIFY AND BRING AGENT SECURE SAFETY AND ABC’S INDUCE VOMITING W/ IPECAC STOP/DELAY ABSORPTION W/ WATER/MILK/ACTIVATED CHARCOAL 

SAFETY

FALLS(RAT) RISK ASSESSMENT TOOL



ALTERATION IN SENSATION AND PERCEPTION AWARENESS LEVEL ABILITY TO COMMUNICATE ALTERED GAIT AND POSTURE AMBULATION NEEDS ANXIETY AND EMOTIONAL STATE ASSOCIATED INJURY AND DISEASE ACCESS(LIFESTYLE)

BEDSIDE SAFETY/EMERGENCY MATERIALS / EQUIPMENTS

AMPUTATION – TOURNIQUET AUTONOMIS HYPERREFLEXIA – CATHETER 

CHEST TUBE DRAINAGE- EXTRA BOTTLE- FORCEPS – VASELINIZED GAUZE CHOLINERGIC AND MYASTHENIC CRISIS – ENDOTRACHEAL TUBE / TRACHEOSTOMY SET EPIGLOTITIS - ENDOTRACHEAL TUBE / TRACHEOSTOMY SET PIH – PADDED MOUTH GAG PARKINSONS – SUCTION APPARATUS 

BEDSIDE SAFETY/EMERGENCY MATERIALS / EQUIPMENTS

RADIUM IMPLANT – LEAD CONTAINER , FORCEPS SENGSTAKEN BLAKEMORE TUBE – SCISSORS SCI AND THYROIDECTOMY – TRACHEOSTOMY TONSILLECTOMY – FLASHLIGHT TRACHEOSTOMY TUBE – OBTURATOR , HEMOSTAT 

PREVENTION OF FALLS

L IGHTING L OWER BED POSITION L OCATE GRAB BARS AND CALL BELL S UFFICIENT ORIENTATION S IDERAILS S UPERVISE AND ORIENT 

RESTRAINTS

ASSIST FREQUENTLY ASSIGN HEALTH CARE PROCEDURES IN PAIRS AREA SUPERVISION ADIMINISTRATION ADJUSTMENTS ALLOW ROCKER CHAIR AND FREQUENT WALKS APPLY PILLOW,WEDGE , PADS AND PROPER POSITIONING ALLEVIATE AGITATION ASSESS AND MONITOR 

RESTRAINTS-(HALF BOW KNOT/CLOVE HITCH,SQUARE OR REEF KNOT) 

LIMB MUMMY ELBOW MITT OR HAND JACKET BELT OR SAFETY STRAP 

CONFUSED AND COMBATIVE

CONTROL IMMEDIATE SITUATION OUT OF AREA MAINTAIN CALM BE FIRM AND SET LIMITS ALTERNATIVE TO RESTRAINTS,ASSESS AND ASSIST TRY POSITIVE CONSEQUENCES 

HYGIENE *HYGIENE AND COMFORT

INFANT BATHING COMPLETE ADULT BED BATH TUB BATH THERAPEUTIC 

SALINE OATMEAL CORNSTARCH NACHO3 KMnO4 

HYGIENE AND COMFORT

PERINEAL / GENITAL CARE FOOT AND NAIL CARE HAIR CARE ORAL CARE BEDMAKING 

PRESSURE ULCER



GRADING PREVENTION TREATMENT 

ACTIVITY AND EXERCISE *ACTIVITY AND EXERCISE

ERGONOMICS



TYPES AND PRINCIPLES



ROM AND ISOMETRICS



PROBLEMS OF IMMOBILITY AND NURSING INTERVENTIONS 

ACTIVITY ORDERS



*MOBILITY AND IMMOBILTY

POSITIONING MOVING AND LIFTING 

AMBULATION AMBULATION AIDS 

TRANSFERS TRANSFER AIDS 

THERAPEUTIC EXERCISES

PASSIVE ROM-RETENTION OF ROM AND MAINTENANCE OF CIRCULATION ASSISTIVE- INCREASES MOTION , MAINTAINS MUSCLE TONE ACTIVE – MAINTAINS MOBILITY OF THE JOINT AND MAINTAINS MUSCLE STRENGTH RESISTIVE – INCREASES MUSCLE POWER ISOMETRICS- MAINTENANCE OF STRENGTH AND PREVENTS MUSCULAR ATROPHY 

POSITIONING FOR SPECIAL CONDITIONS

ABDOMINAL ANEURYSM SURGERY-FOWLERS



ASTHMA – ORTHOPNEIC POSITION AUTNOMIC DYSREFLEXIA-HIGH FOWLERS POST BRONCHOSCOPY-SEMI FOWLERS 

CARDIAC CATHETERIZATION-KEEP INSETION SITE EXTENDED FOR 4-6 HOURS TO PREVENT ARTERIAL OCCLUSION CAST – ELEVATE EXTREMITY CATARACT – SEMI FOWLERS CEREBRAL ANEURYSM – SEMI - FOWLERS 

POSITIONING FOR SPECIAL CONDITIONS

CLEFT LIP – SUPINE CLEFT PALATE – PRONE CHF – HIGH FOWLERS CRANIOTOMY – SUPRATENTORIAL – SEMI FOWLERS ;INFRATENTORIAL – FLAT ICP – LEVATE HEAD DUMPING SYNDROME – SUPINE AFTER MEALS EPISTAXIS – LEAN FORWARD FLAIL CHEST – AFFECTED SIDE FEMORO-POPLITEAL BYPASS GRAFT – AFFECTED EXTREMITY EXTENDED 

POSITIONING FOR SPECIAL CONDITIONS

GLAUCOMA(POST OP) – AFFECTED SIDE HEMORROIDECTOMY – SIDE LYING HIATAL HERNIA- UPRIGHT HIP SURGERY – LEGS IN ABDUCTION LAMINECTOMY – BACK AS STRAIGHT AS POSSIBLE LIVER BIOPSY – RIGHT SIDE LYING LOBECTOMY – SEMI FOWLERS POST LP – FLAT MASTECTOMY – ELEVATE EXTREMITY ON PILLOW MYELOGRAM – WATER BASED DYE – ELEVATE THE HEAD --- OIL BASED DYE - FLAT 

POSITIONING FOR SPECIAL CONDITIONS

POSTURAL DRAINAGE – LUNG SEGMENT – UPPERMOST POSITION PROLAPSED CORD – KNEE-CHEST PULMONARY EDEMA – FOWLERS PYLORIC STENOSIS – RIGHT SIDE LYING RADIUM IMPLANT – FLAT ON BED RETINAL DETACHMENT – AFFECTED SIDE TOWARDS THE BED 

POSITIONING FOR SPECIAL CONDITIONS

SEIZURE – SIDE-LYING



SHOCK – MODIFIED TRENDELENBURG SCI – IMMOBILIZE TONSILLECTOMY – SIDELYING / PRONE THYROIDECTOME – SEMI – FOWLERS THROMBOPHLEBITIS – ELEVATE LEG TPN – TRENDELENBURG – DURING INSERTION THORACENTESIS – FOWLER’S(DURING) 

AFTER – POSITION OF COMFORT



MOBILITY AND IMMOBILITY

POSTURE AND BODY ALIGNMENT-ERECT JOINT MOVEMENTS=RANGE OF MOTION CONNECTIVE TISSUE 

BONE TO BONE-LIGAMENT BONE TO MUSCLE – TENDON COVERS BONES/JOINTS - CARTILAGE 

TYPES OF JOINT



SYNARTHROSES(CARTILAGENOUS) DIARTHROSES( SYNOVIAL) AMPIARTHROSES(FIBROUS)  

ERGONOMICS-BODY POSITIONING AND MECHANICS

PRIORITY-ASSESS PERSONAL CAPACITY 1ST USE PROTECTIVE DEVICES/ TRANSFER AIDS CHANGE POSITION SLOWLY-ORTHOSTATIC HYPOTENSION(DANGLE LEGS FIRST) PIVOT ON THE STRONGER SIDE,MOVE PNT TOWARDS STRONGER SIDE USE LARGER MUSCLES OF THE BODY AND FACE THE DIRECTION OF THE MOVEMENT PULL SHEETS ARE BETTER METHOD THAN SLIDING ALWAYS MOBILZE MAXIMUM MANPOWER/HAVE AN ASSISTANT STANDING BY. ROCK FROM FRONT TO BACK/VICE VERSA.WIDE BASE OF SUPPORT, WEIGHT NEAR MIDLINE OF THE BODY.USE APPROPRIATE TRANSFER AND AMBULATION AIDS. (TRAPEZE, HOYER LIFT, SLIDE BOARD, DRAW SHEET AND TRANSFER BELT 

DANGERS OF IMMOBILITY

DECUBITUS ULCER-OSTEOMYELITIS OSTEOPOROSIS-PATHOLOGICAL FRACTURES AND RENAL CALCULI INCREASED CARDIAC WORKLOAD- TACHYCARDIA CONTRACTURES- DEFORMITIES THROMBUS FORMATION-PULMONARY EMBOLISM ORTHOSTATIC HYPOTENSION-WEAKNESS,FAINTNESS AND DIZZINESS RESPIRATORY STASIS – HYPOSTATIC PNEUMONIA 

CONSTIPATION – FECAL IMPACTION URINARY STASIS-URINARY RETENTION NEGATIVE NITROGEN BALANCE-WEIGHT LOSS/DEBILITATION 

SPECIFIC THERAPEUTIC POSITION

HIGH FOWLERS-60-90’ FOWLER-45-60’ SEMI-FOWLERS-30-45’ LOW-FOWLERS-15-30’ SUPINE DORSAL RECUMBENT LITHOTOMY TRENDELENBURG SIMS LATERAL MODIFIED TRENDELENBURG PRONE KNEE-CHEST SIDE-LATERAL ORTHOPNEIC 

CRUTCHES

ASSISTIVE DEVICES



CRUTCH HEIGHT-



STANDING ;2 -3 (1-2 INCHES)FINGERS BELOW AXILLA OR SUPINE ;MEASURE FROM THE ANTERIOR FOLD OF THE AXILLA TO THE HEEL OF THE FOOT AND ADD 2.5 CM 

TEACH MUSCLE STRENGTHENING EXERCISES PRIOR TO AMBULATION.WEIGHT ON THE HAND GRIP (TO AVOID CRUTCH PALSY) ELBOWS SHOULD BE FLEXED 20-30’ AND CRUTCHES SHOULD BE KEPT 6 INCHES LATERALLY AND 6 INCHES TO THE FRONT=TRIPOD POSITION(810 INCHES-OK) INSTRUCT CLIENT TO MAINTAIN AN ERECT POSTURE 

CRUTCH WALKING GAITS



FOUR POINT-SLOW SAFE-WEIGHT BEARING ALLOWED FOR BOTH LEGS TWO POINT- FASTER SAFE-WEIGHT BEARING ALLOWED FOR BOTH LEGS THREE-POINT-NON WEIGHT BEARING OF ONE LEG SWINGTO/SWINGTHROUGH-PARTIAL WEIGHT BEARING ALLOWED FOR BOTH LEGS GETTING INTO A CHAIR –BOTH CRUCHES TO THE WEAK SIDE , STRONGER ARM HOLDS THE ARMREST ST GOING UP AND DOWN THE STAIRS- GOOD GOES UP 1 AND BAD GOES ST DOWN 1 .  

WALKERPROVIDES STABILITY AND BALANCE MOVE WALKER AHEAD 15 CM (6INCHES-8-10 INCHES)WHILE WEIGHT IS BORNE BY BOTH LEGS.THEN ALTERNATE WEIGHT BEARING ASSISTED BY THE ARMS ELBOWS SHOULD BE FLEXED-20-30’ IF ONE LEG IS WEAKER MOVE THAT LEG TOGETHER WITH THE WALKER

CANE HOLD CANE ON THE STRONGER SIDE FLEX ELBOW 30’ AND TIP OF CANE 15 CM LATERAL TO THE SIDE OF THE 5TH TOE. ADVANCE CANE AND AFFECTED LEG ,WEIGHT ON CANE WHEN MOVING THE GOOD LEG BUT FOR MAXIMUM SUPPORT ADVANCE CANE 1 FEET ,MOVE AFFECTED LEG THEN THE STRONGER LEG GOING UP AND DOWN THE STAIRS –SAME WITH CRUTCHES 

*NUTRITION *NUTRITION

PREMATURE INFANTS-LESS THAN37WKS/2,500G-100-200 CAL/KG/DAY AND HIGHER Na,Ca AND CHON FULL TERM-120 CAL/KG/DAY PREGNANCY + 300CAL/DAY LACTATION+ 500CAL/DAY 

CONDITIONS

ENTERAL FEEDINGS



PREOPERATIVE NEED FOR NUTRITIONAL SUPPORT GI PROBLEMS ONCOLOGY THERAPY ALCOHOLISM,CHRONIC DEPRESSION AND EATING DISORDERS HEAD,NECK DISORDERS OR SURGERY  

COMPLICATIONS



ASPIRATIONTUBE DISPLACEMENT CRAMPING,VOMITING,DIARRHEA HYPEROSMOLAR NONKETOTIC COMA/GLUCOSE INTOLERANCE  

NUTRITION

SPECIFIC NUTRIENT MODIFICATION CALORIC MODIFICATION CONSISTENCY 

SPECIAL DIETS FOR SPECIFIC DISEASES DIETARY MODIFICATIONS FOR SPECIAL CONDITIONS 

NUTRIENT MODIFICATION

INCREASE,DECREASE,RESTRICTED



CA,K,NA,Fe,FOLIC ACID,VIT C&B COM.,ADEK, CHOLESTEROL,GLUTEIN FIBER, PHENYLALAMINE,TYRAMINE CHO,FATS/LIPIDS,CHON 

THERAPEUTIC DIET FOR SPECIFIC CONDITIONS

AGE – CLEAR LIQUID AGN – LOW NA , LOW CHON ADDISON’S – HIGH NA , LOW K ANEMIA , PERNICIOUS – HIGH CHON , VIT. B. ANEMIA SICKLE CELL – HIGH FLUID GOUT – PURINE RESTRICTED ADHD AND BIPOLAR – FINGER FOODS BURN – HIGH CAL. HIGH CHON CELIAC – GLUTEIN FREE CHOLECYSTITIS – HIGH CHON, HIGH CARB, LOW FAT CHF – LOW NA , LOW CHOL. CROHNS – HIGH CHON AND CHO, LOW FAT 

THERAPEUTIC DIET FOR SPECIFIC CONDITIONS

CYSTIC FIBROSIS – HIGH CAL., HIGH NA LITHIASIS----ACID ASH FOR ALK. STONES------ALK. ASH FOR ACID STONES DECUBITUS ULCERS – HIGH CHON , HIGH VIT C DIARRHEA – HIGH K AND NA DUMPING SYNDROME – HIGH FAT, HIGH CHON,DRY HEPATIC ENCEPHALOPATHY-LOW CHON HEPATITIS – HIGH CHON,HIGH CAL. 

HIRSPRUNGS – LOW RESIDUE, HIGH CHON AND CHO CIRRHOSIS – LOW CHON MENIERE’S LOW NA MI AND HPN – LOW CHOL.,FATS,NA HYPERTHYROIDISM- HIGH CAL. AND CHON HYPOTHYROIDISM – LOW CAL. , LOW CHOL, LOW SAT. FAT 

THERAPEUTIC DIET FOR SPECIFIC CONDITIONS

NEPHROTIC SYNDROME – LOW NA, HIGH CHON , HIGH CAL. HYPERPARATHYROIDISM – LOW CALCIUM HYPOPARATHYROIDISM – HIGH CA, LOW PHOSPHORUS OSTEOPOROSIS – HIGH CALCIUM AND HIGH VIT. D PANCREATITIS – LOW FAT PUD – HIGH FAT, HIGH CARB. LOW CHON PKU – LOW CHON / PHENYLALANINE PIH – HIGH CHON 

THERAPEUTIC DIET FOR SPECIFIC CONDITIONS

RENAL FAILURE (ACUTE) – LOW CHON,HIGH CARB



LOW NA (OLIGURIC PHASE) HIGH CHON , HIGH CAL AND RESTRICTED FLUID (DIURETIC PHASE

 

RENAL FAILURE (Chronic) – LOW CHON , LOW NA , LOW K 

TOTAL PARENTERAL NUTRITION

TYPES OF SOLUTIONS

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TPN-AMINO ACID-DEXTROSE- 2-3 L /24H – FINE BACTERIAL FILTER USED TNA-TOTAL NUTRIENT ADMIXTURE- AMINO ACID, DEXTROSE AND LIPIDS-1 LITER /24 HOURS – NO FILTER  

PERIPHERAL=NO >10% DEXTROSE AND 2 WKS ONLY CENTRAL – INCOMPATIBLE WITH MEDS AND BLOOD IF SINGLE LUMEN USED ATRIAL-HICKMAN/BIOVAC AND GROSHONG- HUBBER NEEDLE USED TO ACCESS PORT THROUGH SKIN  

TPN

INITIAL RATE OF INFUSION 50 ML/HR THEN 100-125/HR. COMPLICATIONS-HYPEROSMOLAR COMA, SEPSIS, PNEUMOTHORAX 

FAST RATE=HYPEROSMOLAR STATE(HEADACHE,NAUSEA,MALAISE,FEVER,CHILLS) SLOWED RATE=REBOUND HYPOGLYCEMIA

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X-RAY CONFIRMS PLACEMENT ATTACH TO PUMP

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IV TUBING AND FILTER CHANGED Q24 HOURS ALLOW SOLUTION TO WARM IMMEDIATELY BEFORE USE IF NO SOLUTION USE DEXTROSE 10% W SOLUTION 

CHECK DAILY CBG,WEIGHT,TEMP. I AND O , CHECK 3X A WEEK BUN, ELECT, ONCE A WEEK – LFT’S, CBC, SERUM ALBUMIN AND PT,PTT  

*ELIMINATION BOWEL ELIMINATION

TOILET TRAINING

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FACTORS AFFECTING

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PROBLEMS MANAGEMENT-CATHARTICS , ENEMA , SURGERY

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DIAGNOSTIC AND THERAPEUTIC PROCEDURES

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ENEMA COLOSTOMY/ILEOSTOMY,OTHER SURGERIES BARIUM STUDIES SCOPIC EXAMS ROENTOLOGIC EXAMS  

ENEMA They act by distending the intestines that increases peristalsis and expulsion of feces and flatus. Enemas serve the following purpose: 

Relief of constipation Relief of flatulence Lowers down body temperature Evacuates feces in preparation for diagnostic procedures Administration of medications 

ENEMA

Take note of the general principles of Enema: Tube: lubricate and insert 3-4 inches Position: adult- left lateral; infants and children- dorsal recumbent 

Administration- administer the enema in a minimum of 15 minutes duration. Conatainer’s Height- 12 inches above the rectum Temperature- 42°C or less 

OSTOMIES

PERMANENT/TEMPORARY STOMA RED AND SLIGHT BLEEDING WHEN TOUCHEDBURNING SENSATION UNDER FACEPLATE INDICATES SKIN BREAKDOWN,REFER ABDL DISTENTION/DISCOMFORT, KARAYA POWDER(DEC.IRRITATION), CHARCOAL/BISMUTH CARBONATEDEODORIZER APPLIANCE CAN LAST 7 DAYS BUT CHANGE Q48-72H AND 24-48H IFPERIOSTOMAL SKIN ERYTHEMATOUS, ERODED ILEOSTOMY-LIQUID,CONSTANT,IRRITATING TO THE SKIN,APPLIANCE CONTINOUS,MINIMAL ODOR COLOSTOMY-FORMED , CAN BE IRRIGATED 300-500ML AND REGULATED,MAY NOT HAVE TO WEAR AN APPLIANCE  

URINARY ELIMATION

BLADDER TRAINING

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LABS AND DIAGNOSTIC TESTS

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CONDITIONS

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CATHETERIZATION AND IRRIGATIONS

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URINARY ELIMINATION

BUN – 10-20 MG/DL CREA – 0.7 – 1.4 MG/DL 24 HOUR URINE PRODUCTION-1000-1500CC 

ANURIA<100ML/24H OLIGURIA< 400 ML/24H POLYURIA > 2000 ML/24H 

KEGELS –STRENGTHEN MUSCLES OF THE PELVIC FLOOR-TIGHTEN FOR 3 SECS THEN RELAX FOR 3 SECS PERFORM LYING DOWN, SITTING AND STANDING FOR TOTAL OF 45 BLADDER RETRAINING 

INTERMITTENT CATHETERIZATION AFTER ATTEMPTING TO VOID Q 2-3H, TIME INCREASES GRADUALLY BUT NO MORE THAN 8 HOURS BLADDER TRAINING – DRINK A MEASURED AMOUNT Q2H THEN ATTEMP TO VOID 30 MINS LATER-TIME GRADUALLY INCREASED TRIGGERING TECHNIQUES-CREDES MANEUVER AND VALSALVA CLAMP INDWELLING CATH BEFORE REMOVAL. THEN DUE TO VOID 3-4 HOURS AFETR REMOVAL 

HEMODIALYSIS

DONE 3-5 HOURS – 2-3 TIMES A WEEK AV FISTULA-NO BP,VENIPUNCTURE OR CONSTRICTIONS PALPATE FOR A THRILL AND LISTEN FOR BRUIT Q8H MONITOR FOR HEMORRHAGE DISEQUILIBRIUM SYNDROME,HEPATITIS,HEMORRHAGE,MUSCLE CRAMPS,AIR EMBOLISM AND SEPSIS-COMPLICATIONS 

PERITONEAL DIALYSIS

TENCKOFF,GORE-TEX CATHETER WEIGH BEFORE AND AFTER, WARM DIALYSATE CHON LOSS, INFECTION, -PERITONITIS(CLOUDY OUTFLOW,BLEEDING) , FEVER , ABDL TENDERNESS AND N & V PREVENT CONSTIPATION BY INCREASING FIBER IN DIET,MAINTAIN STERILE PROCEDURE,FOR PROBLEMS WITH OUT FLOW –REPOSITION TYPES: CAPD(4-6H INDWELLING),AUTOMATED 30MINS EXCHANGES, INTERMITTENT- 4X A WEEK – 10H/DAY, CONTINOUS – 1 DAY INDWELLING 

OXYGENATION OXYGENATION

PULMONARY FUNCTION TESTS DIAGNOSTIC LABORATORIES(ABG, SPUTUM CS AND THROAT CULTURE) VISUALIZATION AUSCULTATION 

OXYGEN DELIVERY EQUIPMENT CHEST PHYSIOTHERAPY ARTIFICIAL AIRWAYS THORACOCENTESIS,THORACOSTOMY.TRACHEOSTOMY AND ET INTUBATION SUCTIONING CHEST TUBES AND DRAINAGE SYSTEMS 

CHEST PHYSIOTHERAPY

TURNING COUGHING DEEP BREATHING POSTURAL DRAINANGE PERCUSSION AND VIBRATION INCENTIVE SPIROMETRY SUCTIONING TRACHEOSTOMY CARE OXYGEN THERAPY VENTILATOR CARE AND MANAGEMENT 

Chest Physiotherapy It is the combination of percussion, vibration, and postural drainage Percussion is done for 1-2 minutes. If the patient has tenacious secretions, this can be performed for 3-5 minutes Vibration is done during 5 exhalations Postural drainage is done for 15-20 minutes usually performed 3-4 times a day. Instruct the client to increase fluid intake to liquefy secretions This procedure should not be performed in clients who are pregnant, with chest injuries, dizzy, with pulmonary embolism and abdominal surgery. This procedure is done before meal or 90 minutes after a meal

Oxygen Therapy Indicated to clients who needs additional oxygen, those clients who have reduced lung diffusion of oxygen through the respiratory membrane, heart failure leading to inadequate transport of oxygen. Humidify the oxygen first before you administer. Check for bubbles in the humidifier to promote adequate flow of oxygen Check for kinks in the tubing Position: semi-fowlers/ high fowlers position Place cautionary readings: “NO smoking: Oxygen is in used” Instruct the client not to use woolen blankets as this may create static electricity 

pulmonary function tests

tidal volume- 500 residual volume- 1200 expiratory reserve volume –1200 inspiratory reserve volume – 3100 

Vital Capacity- tidal volume + IRV + ERV = 4800 Total Lung Capacity – Tidal Volume + IRV +ERV +RV =6000 

Forced Residual Capacity – ERV + RV

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incentive spirometry – hold 2-6 sec; 4-5 times/H (TO MAXIMIZE RESP.&MOBILIZE SECRETIONS endotracheal tube- reposition Q8H; cuff 20 mm Hg, humidification and aerosol, deflate cuff occasionaly visualization – 

X ray Lung Scxan – 20-40mins isotopes in body for 8 H laryngoscopy Bronchoscopy Thoracentesis- consent, VS and baseline X-ray + post Procedural  

Tracheostomy Care

tie new trache tie before removing the old tie to prevent accidental dislodgement.ALLOW 2 FINGERS TO BE INSERTED UNDER TIE use precut gauze and perform care OD at least. soak iiner cannula in antiseptic soak with hydrogen peroxide, rinse well suction prn, oral care prn(PROCEDURE DONE q8h AND PRN) 

Oxygen Delivery Equipment

cannula – 2-6 LPM – 24-45% Mask – 5-8 LPM – 40-60% parial rebreather – 6-10 LPM – 60-90% non rebreather – 10-15 LPM – 95-100% tent – 4-8 LPM – 30-50 % Venturi mask – 

2-3 LPM – 24-28% 4 LPM – 30% 6 LPM – 35% 8 LPM – 45% 14LPM – 55% 

Suctioning PURPOSE: To obtain sputum sample. NURSING ALERT: ASSESS BREATH SOUNDS

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Hyperoxygenate the patient before and after the procedure. Apply intermittent suction on withdrawal of the catheter. Do not suction the patient for more than 15 seconds. IDEAL 10 SECS 

Thoracentesis PURPOSE: Aspiration of fluid and /or air from the pleural space. space. NURSING ALERT: Check the consent. Position: Sitting on the side of the bed with feet on a chair, leaning over a bedside table. If the patient unable to sit, the patient may lie in his/her side with hands on the side resting on opposite shoulder. Instruct the patient not to cough, breath deeply or move during the procedure. After the procedure: Position the patient on the unaffected side/puncture site up. Check for bleeding at the puncture site and monitor the respiratory function. Notify the physician if signs of pneumothorax, air embolism and pulmonary edema occur.  

*PERI-OPERATIVE NURSING PREOP CARE

INFANT-DISTRACT TODDLER-ALLOW REGRESSION AND INVOLVE PARENTS,CONSISTENT CAREGIVER PRE-SCHOOL-LET CHILD HANDLE EQUIPMENT,EXPRESSION OF FEELINGS THROUGH PLAY DEMOFAMILIAR SORROUNDINGS SCHOOL AGE- EXPLAIN SIMPLY AND ALLOW CHOICES ADOLESCENTS- INVOLVE AND POINT OUT STRENGTHS AND BENEFITS,EXPECT RESISTANCE 

PREOP CHECKLIST

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CONSENT HEALTH TEACHING (SPEC. POST OP PROCEDURES) LAB TESTS,ECG,X-RAY SKIN PREP BOWEL PREP IV’S NPO PREOP MEDS,SEDATION AND ANTIBIOTICS REMOVAL OF DENTURES,NAILPOLISH AND JEWELRY NUTRITION-TPN OR ENTERAL FEEDINGS PREOP 

INTRAOP- MAINTAIN SURGICAL ASEPSIS, MONITOR CLIENT STATUS,, APPROPRIATE GROUNDING DEVICES, FLUID BALANCE AND SPONGE/INSTRUMENT COUNT POST OP- MONITOR VS Q15X4;Q30X2;Q1HX2 THEN PRN MONITOR I AND O , K LEVEL , CVP, BOWEL SOUNDS, BREATH SOUNDS AND LOC RESPIRATORY PHYSIOTHERAPY,TCBD INCENTIVE SPIROMETRY-20 SECS INHALATION ENCOURAGE AMBUALTION REFER IF UNABLE TO VOID IN 8 HOURS APPLY TED HOSE AND PNEUMATIC COMPRESSION DEVICE,CHECK FOR HOMAN’S SIGN

WOUNDS NOTE DRESSING AND INCISION FEVER 1-2 DAYS POST OP-ATELECTASIS/ DEHYDRATION 3-7 DAYS – INFECTION UPPER GI TUBES-GASTRIC DECOMPRESSION LOWER GI TUBES – BOWEL DECOMPRESSION ST WOUND HEALING BY 1 INTENTION-SUTURED AND APPROXIMATED ; 3RD INTENTION-NOT CLOSED,W/ PURPOSE EX: DRAINS ND WOUND HEALING BY 2 INTENTION-INCREASED INCIDENCE OF INFECTION , INCREASED SCARRING AND LONGER HEALING TIME  

POST-OP COMPLICATIONS

SHOCK PARALYTIC ILEUS ATELECTASIS AND PNEUMONIA - 2ND DAY EMBOLISM- 2ND DAY WOUND INFECTION-3-5D DEHISCENCE AND EVISCERATION-5-6D PSYCHOSIS CARDIOVASCULAR COMPROMISEURINARY RETENTION-8-12H URINARY INFECTION -5-8 D DVT-6-14 DAYS-1 YEAR  

WOUND CARE WOUND TYPES AND

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HEALING

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DRESSING

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DRAINS

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SENSORY PERCEPTION AND COGNITION

SENSORY DEPRIVATION

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SENSORY OVERLOAD

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SENSORY DEFICITS

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THERAPEUTICS

MEDICATION ADMINISTRATION

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IVF INFUSIONS(INCLUDING MIO)

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BLOOD TRANSFUSION

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PHYSICAL AND OCCUPATIONAL THERAPY

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SUPPLEMENTS

NORMAL VALUES

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DIAGNOSTIC TESTS

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THERAPEUTIC PROCEDURES

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