 Nursing Process Is a systematic, organized method of planning, and providing quality and individualized nursing care.

 It is synonymous with the PROBLEM SOLVING APPROACH

Midwifery Process
1. Assessment Phase - first step of the nursing process
- gathering information or data

2. Planning Phase –formulation of plan of action .  

3. Implementing Phase – working phase

4. Evaluation Phase – goal assessment phase

2 sources of data primary source - (the patient)

Secondary source - (the family, health care professionals, laboratory exams, pt. chart)

Basic Techniques Used in Performing an Assessment

1. Inspection - most frequently used
Observations using visual, auditory, and olfactory senses
2 Types of data
A. Subjective data- “covert data”- ****Not measurable or observable
- Obtained from client (primary source),
Symptoms like Pains, Anorexia,Increase fatiguability, Nauseated, SOB

B. Objective data - “overt data” --- Can be detected by someone other than the client
**Includes measurable and observable client behavior
For example Vital Signs and COLORS:
Cyanosis , Odor, Lethargy , Obtained laboratory results,, Redness or discoloratios

2. Palpation - using the sense of touch

- to gather information about temperature, turgor, texture, moisture, vibrations, and shape

3. Auscultation - The act of listening to sound produced within the body with a stethoscope 
Normal breath Sounds
A. Vesicular sounds are soft, blowing, or rustling sounds normally heard throughout most of the lung fields.
the most commonly auscultated breath sounds,
have an inspiration/expiratory ratio of 3 to 1 or I:E of 3:1.
 
B. Bronchial breath sounds are hollow, tubular sounds that are lower pitched.
auscultated over the trachea where they are considered normal.

C. Bronchovesicular
normal sounds in the mid-chest area or in the posterior chest between the scapula.
bronchial breath sounds heard near the trachea and the alveoli with the vesicular sound. They have an I:E ratio of
1:1.
4. Percussion - act of striking one object against another for the purpose of producing sound by vibrations(tympany,
resonance, hyperresonance, dullness, flatness)

Percussed sounds:
A. Tympany (loud intensity, as heard over a gastric air bubble or puffed out cheek)
B. Hyperresonance- (very loud, as heard over an emphysematous lung)
C. resonance (loud, as heard over a normal lung)
D. dullness (medium intensity, as heard over the liver or other solid organ)
E. flatness (soft, as heard over the thigh).
@VITAL SIGNS
• Also known as Cardinal Signs
• Includes (1) TEMPERATURE, (2) PULSE, (3) RESPIRATION, and (4) BLOOD PRESSURE & recently PAIN as the 5th
V/S in some facilities
• A person’s physiologic status is reflected by these indicators of body function
• Checked to monitor the basic functions of the body
• In taking the vital signs of a child, It should be arranged from the least invasive procedure to the most invasive.

RR-PR-Temp-BP

@I. ASSESSING TEMPERATURE

BODY TEMPERATURE
• heat of the body measured in degrees
• Difference between production of heat and loss of heat from the body

@PROCESS OF HEAT PRODUCTION OCCURS THROUGH:

• Food Metabolism and Activity – basal metabolic rate (BMR) or the rate of energy utilization in the body
• Increased thyroxin production - increased cellular metabolism is d/t inc thyroxine output from the thyroid gland, this effect is
called CHEMICAL THERMOGENESIS
• Chemical thermogenesis
• Epinephrine, norepi, SNS stimulation
• Fever = inc metabolic rate
• Muscle activity = inc metabolic rate

@PROCESS OF HEAT LOSS OCCURS THROUGH:

• Radiation – surface to surface by waves therefore no contact (ex. Nude person standing in room @ normal temperature)
• Conduction – contact between 2 surfaces; heat transfer to a surface of lower temperature (ex. immersion in cold water)
• Convection – mov’t by air currents
• Evaporation – water to steam; continuous & unnoticed evaporation of moisture from the respiratory tract & from mucosa of
mouth & from skin

@TYPES of TEMPERATURE
• Core Temperature - Temperature of the deep tissues of the body such as abdominal cavity & pelvic cavity; relatively constant
 measured thru tympanic and rectal routes
• Surface Temperature- Temperature of the skin, subcutaneous tissue & fats; rises and falls in response to the environment
 measured thru oral and axillary routes

@FACTORS AFFECTING BODY TEMPERATURE

• Age – infant is greatly influenced by the temperature of environment and must be protected from extreme changes; people 75
y.o & up are at risk for hypothermia (T < 36C or 96.8F) for a variety of reasons such as inadequeate diet, loss of subcutaneous tissue,
lack of activity & decreased thermo-regulatory efficiency
• Sex – d/t hormones; women > men hormone fluctuations; progesterone during ovulation rises body temperature
• Exercise – can inc temp to as high as 38.3C to 40C (101-104F) rectally
• Time of day – also “diurnal variations” or “circadian rhythms”; @ 1C between early am and late pm; highest @ 8pm and
midnight; lowest @ sleep between 4-6 am
• Emotions/stress – stimulation of SNS
• Environment – extremes in environmental temp
• Others; food, drugs

BODY TEMPERATURE @4 COMMON SITES FOR ASSESSING

1. Oral – most frequently used, least disruptive, most convenient and accessible, done for 3 – 5 minutes ; wait 30 mins if client
ate or drank cold or hot food/fluids

CONTRAINDICATIONS:
• Infants and very young children (less than 6 y/o)
• Patients with oral surgery
• Unconscious or irrational patients
• Seizure-prone patients
• Mouth breathers and pts. with oxygen
 2. @ Rectal – most accurate route, but invasive and uncomfortable to patient; done for 2-3 mins
CONTRAINDICATIONS:
 Rectal abnormalities – ex. Significant hemorroids
 Diarrhea
 Certain heart conditions – ex. CHF; may result to vagal stimulation = bradycardia
 Immunosuppressed - may inc risk of infection
 Clotting disorder

3. @Axillary – safer than the oral method, non-invasive, least accurate; Done for 5- 10 minutes; for clients with oral
problem( oral inflammation, wired jaws, oral surgery),

4. @Tympanic membrane – fastest, accessible, less invasive; has abundant arterial blood supply; Within two seconds
Up/back for adult
Down/back for pedia

CONTRAINDICATIONS:
• Presence of ear ache
• Significant ear drainage
• Scarred tympanic membrane

ROUTE SPECIAL CONSIDERATIONS

• Done for 3 minutes
ORAL • Upon intake of hot/cold fluids, wait 30 minutes
• Done for 2-3 minutes
• Presence of fecal matter could result to a false reading
RECTAL • Lubricate tip prior to inserting

AXILLARY • Done for 10 minutes

• Within two seconds

TYMPANIC • Up/back for adult
• Down/back for pedia

@ Assessment Findings
Pyrexia Elevated BT
Hyperpyrexia BT above 41˚C
Intermittent fever BT alternates regularly between periods o fever, normal or
subnormal temperature
Remittent fever Fluctuations of several degrees above normal, but not reaching
normal between fluctuations
Constant fever Consistently elevated and fluctuates very little
Relapsing fever Returns to normal for at least a day then the fever occurs
Resolution of Elevated BT returns to normal suddenly
Pyrexia by crisis
Axillary temperature is usually 1° F lower than oral temperature.

Four common types of fever:

A. Intermittent fever- the body temperature alternates at regular intervals between periods of fever and periods of normal or
subnormal temperatures
B. On and off in a matter of hours
C. Relapsing fever- short febrile periods of a few days are interspersed with periods of 1- 2 days of normal temperature **On
and off in a matter of days
D. Constant fever- the body temperature fluctuates minimally but always remains above normal.
E. Remittent fever- a wide range of temperature fluctuations (more than 2°C) occurs over the 24-hour period, all of which
are above normal.
Decline of fever
A. Lysis – gradual decline of fever example from 41 declines gradually to 40 C
B. Crisis- sudden decline of fever  example 42 declines suddenly to 37.8 C less than an hour
*The most effective way to reduce a fever is to administer an antipyretic, which lowers the temperature set point.

BE SURE YOU SHAKE DOWN THE THERMOMETER BEFORE USE up to 35-36 C!  

Care of thermometer
Before use- After use-
#of cotton balls-
Manner:

PULSE
• A wave of blood being pumped into the arterial circulation by the contraction of the left ventricle
• Middle three fingertips are used for palpating all pulse sites except the apex of the heart; a stethoscope is used for assessing
apical pulses & FHT

@ASSESSMENT PARAMETERS / CHARACTERISTICS OF PULSE

AGE GROUP PULSE RANGE
FHT and right after birth 120-160 bpm
Newborn 80-180 bpm
Crying _________bpm
Sleeping _________bpm

Adults 60-100 bpm

Elderly 60-100 bpm

Abnormal Assessment Findings:    = 

A. Bradycardia- **Slow pulse rate less than 60/ minute and must immediately be reported
B.  Tachycardia -   Rapid heart rate over 100/ minute, and must be reported
Normal pulse – can be felt w/ moderate pressure of the fingers & can be obliterated w/ greater pressure
Full or bounding pulse – forceful or full blood volume that is obliterated only with difficulty
Weak, feeble, thready – pulse that is readily obliterated w/ pressure from the fingers

Pulse Deficit – difference between the apical and radial counts taken simultaneously
 To measure pulse deficit you will need (2)two people; one to check apical pulse while the other checks another pulse site.

*Pulse is taken one full minute. The rate of the radial pulse is subtracted from the apical.
*The difference is the pulse deficit.
***The pulse deficit is charted/recorded - A84/R68 ;Pulse Deficit = 16

@LOCATION OF PERIPHERAL PULSES

>temporal – superior and lateral to the eye
>carotid - @ side of cheek; lateral side of trachea or ________________
>brachial – inner aspect of the bicep muscle of the arm or medially in the antecubital space
>radial - @ the thumb side of the inner aspect of the wrist
>femoral - @ inguinal ligament
>politeal – behind the knee
>posterior tibial – medial surface of the ankle
>dorsalis pedis/ pedal – over the bones of the foot
>Apical- Located at the apex of the heart, left side of chest just below the nipple line.
- Only one not palpated but listened for using the stethoscope.
- The most accurate way to take a pulse.

@Reasons for Using Specific Pulse Site

Pulse Site Reasons for Use

Radial Readily accessible

Temporal Used when radial pulse is not accessible
Carotid Used in cases of cardiac arrests
Used to determine circulation to the brain

Apical Routinely used for infants 7 children up to 3 yrs.

Used to determine discrepancies with radial pulse
Used in conjunction with some medications

Brachial Used to measure blood pressure

Used during cardiac arrest for infants

Femoral Used in cases of cardiac arrest

Used for infants and children
Used to determine circulation to the leg

Popliteal Used to determine circulation to the lower leg

Posterior tibial , Pedal Used to determine circulation to the foot

@Factors Affecting Pulse Rate

1. Age – inc age, dec PR
2. Sex/gender – after puberty male’s pulse is slightly lower than femlae’s
3. Exercise – inc exercise, inc PR
4. Emotions/stress – SNS stimulation (fear, anxiety, perception of pain)
5. Prolonged heat application – inc metabolic rate, inc PR
6. Body positions- when sitting or standing, blood usually pools in dependent vessels of venous system  transient dec in
venous return to the heart  inc HR to compensate
7. Pain – d/t SNS stimulation
8. Decreased BP – inc HR as compensatory mechanism
9. Increased temperature – inc metabolic rate
10. Any conditions resulting to poor oxygenation of blood ex. CHF – inc HR to compensate

@ASSESSING RR
@Respiration – act of breathing
 Pulmonary ventilation –(breathing) movement of air in and out of the lungs
 Inspiration –(inhalation) act or breathing in
 Expiration –(exhalation) act of breathing out
 External respiration – exchange of O2 and CO2 between alveoli and blood
 Internal respiration – exchange of O2 and CO2 between blood and tissue cells

Respirations

regulated by the Medulla oblongata – the respiratory center

and the PONS the apneustic and Pneumotaxic center
number of breaths per minute
***represented by
1 Inspiration + 2secs Expiration

@III. ASSESSMENT PARAMETERS / CHARACTERISTICS OF RESPIRATION

1. Rate – number of breaths per minute

AGE GROUP RESPIRATORY RANGE
Newborn 30 – 60 bpm
Adults 12-20 bpm

@2 TYPES OF BREATHING
1. Costal/thoracic breathing – involves external intercostal muscles and other accessory muscles; Observed thru upward and
outward movement of the chest
2. diaphragmatic (abdominal) breathing – involves contraction & relaxation of the diaphragm

@FACTORS AFFECTING RESPIRATION

1. Exercise – inc RR 3. Age 6. Stress – inc RR
2. Certain medications – eg. 4. Emotions – inc RR 7. inc ICP = dec RR
Narcotics 5. Cardiac illness

@ASSESSMENT FINDINGS REGARDING RESPIRATION

Eupnea Normal, effortless quite breathing

Tachypnea RR > 20 to 24 bpm
Bradypnea RR < 10 bpm
Apnea Absence of breathing
Hyperpnea Deeper respiration with normal rate
Cheyne stokes Resp. becomes faster and deeper then slower with
alternate periods of apnea(20-60sec)
- periods of deep breaths, followed by very short or
no breaths (apnea), and repeat in cycles (occurs
shortly before death)
Biot’s Faster and deeper than normal with abrupt pauses
in between each breath

@Abnormal RESPIRATION – known as the “______________, sounds”

• Kussmaul’s Faster and deeper respiration without pauses in between panting
- heavy labored breathing with a fruity odor ( DIABETIC clients)
• Apneustic Prolonged grasping followed by extremely short insufficient exhalation
• Dyspnea difficulty of breathing
• Orthopnea - DOB unless sitting
• Wheezing high-pitched sounds, musical sound in expiration, narrowing of airways, causing whistling or sighing sounds
• Stridor harsh or ______ sounds heard on inspiration
@Rales - sound caused by air passing thru fluid or mucus in the airways usually heard on inhalation
• Rhonchi sound caused by air passing thru airways narrowed by fluids, edema, muscle spasm usually heard during
exhalation
IV. BLOOD PRESSURE or Arterial blood pressure: pressure exerted on the walls of arteries when the blood is pumped out of the
heart
- Force of the blood against the
arterial walls
- Measured in millimeters of mercury
(mmHg)
Since blood moves in waves, there are 2 BP measures:
1. Systole – the highest pressure; pressure of the blood as a result of contraction of ventricles (Heart at________)
2. Diastole – the lowest pressure; pressure of the blood when ventricles are at rest (heart at ______)
Pulse pressure – difference between the systole and diastole

@AF:
• Hypertension – above 140/90 mmHg
• Hypotension – below 90/60 mmHg
• Orthostatic Hypotension – decrease in Bp when changing position
@Korotkoff’s sound –schematic diagram

@Factors that control Blood Pressure

1.Cardiac Output – amount of blood ejected from the heart per contraction
2. Blood Volume – adult has about 5-6 liters of circulating blood
3. Elasticity of arterial walls – yields upon systole and retracts upon diastole

@Factors affecting Blood pressure

– Age – newborns systolic = 75mmHg; BP rises w/ age
– Emotions/stress – SNS stimulation = inc BP
– Exercise – inc cardiac output = inc BP
– Drugs – dopamine, dobutamine, epinephrine
– Obesity – predispose to hypertension
– Disease process – any dse affecting C.O., blood volume, blood viscosity and compliance of the arteries

Assessment Findings:
1. hypertension – dx made when the ave of 2 or more diastolic readings on 2 visits subsequent to initial assessment is 90 mmHg
or higher or ave of multiple systolic BP readings is higher than 140mmHg
2. hypotension = systolic pressure is consistently between 85-110 mmHg

To ensure accuracy in taking the BP, you must:

Let the patient rest for a minimum of 5 minutes for routine assessment
2. Should not have ingested caffeine or nicotine 30 minutes before
3. Delay assessing if patient is: a. in pain b. emotionally upset, or c. have just exercised.

At age 3 start routine BP taking

Sounds of blood pressure - Korotkoff Sounds
Principles related to Blood Pressure:
1. Patient should be resting for 5 minutes prior to taking the reading

2.   You must document the position the patient was in (sitting/lying)

* Do not take the BP standing unless ordered that way

 3. Use the correct size cuff-

 4. Use the brachial artery -
How to take BP.
A. Find brachial pulse.
B. Apply cuff.
C. Close valve and pump up cuff until brachial pulse can no longer be felt or to 170.
D. Position stethoscope over brachial artery, listen.

Some don'ts when taking BP.

A. Do not take on arm with IV in place.
B. Do not take on arm with cast on.
C. Do not take on side with mastectomy or other breast surgery.

Hypotension - low blood pressure   

**only dangerous with symptoms of shock :
 1. Pale, cold clammy skin
2. rapid weak pulse
3. Sudden drop in blood pressure
 4. Thirst/ nausea

Hypertension - sustained elevated blood pressure

**Can cause a stroke ( Cerebral vascular accident / CVA )    
**High blood pressure also damages the kidneys, heart and retina of the
eyes
Tx:

NUTRITION DIET and THERAPHY

1. GO foods - carbohydrate which provides our bodies with energy

- Breakfast cereal, bread, potatoes, pasta, cassava and rice

2. ‘Grow’ foods - protein, - body building foods need to repair a wound or injury. Reduces risk of ________
- build strong bones also contain calcium and vitamin D, whereas other ‘Grow’ foods provide us with iron which is
important to keep our blood healthy.
- Milk, cheese, yogurt, chicken, fish, eggs and baked beans help us grow strong bones and muscles

3. ‘Glow’ foods - Fruit and vegetables contains nutrients such as Vitamin C, Vitamin E and minerals like potassium ‐ important for
fighting off disease.
 Apples, bananas, grapes, pure fruit juice, raisins, broccoli, carrots, peas, sweetcorn and tomatoes

“Water Soluble Vitamins”

1. Thiamine / B1
- prevent beri-beri
sources - Enriched, fortified, or whole-grain products such as bread, pasta, and cereals, flour
- beef, liver, dried milk, nuts, oats, oranges, pork, eggs, seeds, legumes, peas and yeast.

2. Riboflavin /B2
- support skin health,prevent cracks and redness at corners of mouth; inflammation of the tongue and dermatitis.
- Milk, breads, fortified cereals, almonds, asparagus, dark meat chicken, and cooked beef
- Deficiency causes ________________________-

3. Niacin/B3; support skin, nervous  and digestive system, prevents pellagra.

Food sources include: Poultry, fish, meat, whole grains, and fortified cereals
- helps make cholesterol.
 Pellagra - caused by having too little niacin or tryptophan in the diet
characterized by diarrhea, dermatitis, dementia, and death
4. Pantothenic/ vitamin B5-  Help in energy metabolism.
brewer's yeast, corn, cauliflower, kale, broccoli, tomatoes, avocado, legumes, lentils, egg yolks, beef (especially organ meats
such as liver and kidney), turkey, duck, chicken, milk, split peas, peanuts, soybeans, sweet potatoes, sunflower seeds, whole-
grain breads and cereals, lobster, wheat germ

5. Vitamin B6 (Pyridoxine)
What it does: Supports your nervous system.
Prevents Peripheral Neuropathy/neuirtis and Nausea and vomiting in preganancy
Food sources include: Fortified cereals, fortified soy-based meat substitutes, baked potatoes with skin, bananas, light-meat
chicken and turkey, eggs, and spinach
fish, beef liver and other organ meats, potatoes and other starchy vegetables – best sources
 6. vit. B7 – Biotin - Help energy and amino acid metabolism; help in the  synthesis of fat glycogen
organ meats, barley, brewer's yeast, fortified cereals, corn, egg yolks,milk, royal jelly, soy, and wheat bran.
Avocado,bread, broccoli, cauliflower, cheeses, chicken, fish,legumes, mushrooms, nuts, pork, potatoes, and spinach also
provide biotin.

7. Folic acid/B9
 - red blood cells; prevent anemia and some amino acids.
Deficiency: Neural tube defects, spina bifida, meningocele, myelomenigocele,
Best sources: green leafy vegetables, ; lima, lentil, and garbanzo beans;
Citrus fruits and their juices are loaded with vitamin B9.Bananas, oranges, and cantaloupes are good sources. Wheat bran,
fortified cereals, grain products, and barley are good sources of vitamin B9. Non-vegetarian sources include: poultry, pork,
shellfish, salmon, and tuna.

8.  Vitamin B12 - Help in the formation of the new cells; maintain nerve cells, assist in the metabolism of fatty acids and amino
acids.
Deficiency – pernicious anemia
best sources of Vitamin B12 include: eggs, milk,cheese, milk products, meat, fish, shellfish andpoultry.
Some soy and rice beverages as well assoy based meat substitutes are fortified with vitamin B12
Food sources include:  Beef, clams, mussels, crabs, salmon, poultry, soybeans, and fortified foods

9. Vitamin C-  Ascorbic acid - Help in the formation of, Collagen,  Cartilage, skin and sCar tissue;
 facilitate in the absorption of IRON from the gastrointestinal tract;
 increase resistance to infection, prevent sCurvy.
 Essential for GUM HEALTH
Food sources: 
  Citrus fruits, berries,, broccoli, cauliflower, Brussels sprouts, red and green bell peppers, cabbage, and spinach
Guava;pomelo;lemon;orange; calamansi; tomato; cashew
Deficiency: scurvy

Fat Soluble vitamins

1. Vitamin A -retinol 
 promotes good EYESIGHT and normal functioning of the immune system.
 Maintain normal vision, skin health,
 prevents xerophthalmia. 
Deficiency: xerophthalmia 
 
Food sources: squash; tisa; yellow corn; banana; orange; carrot; ripepapaya; mango; guava;
 Vitamin A Deficiency (VAD)
- A condition in which the level of Vitamin A in the body is low.      
 Causes: 
 Not eating enough foods rich in vitamin A. E.g. yellow vegetables and yellow fruits
 Lack of fat or oil in the diet which help the body absorb Vitamin A.
 poor absorption or rapid utilization of Vitamin A during illness
      
 Eye Signs 
 night blindness (early stage);
 bitot’s spot (foamy soapsuds-like spots on white part of the eye)
 keratomalasia and total blindness (later stage)
Prevention 
1. eating foods rich in Vitamin A, such as eggs, carrots, squash, ripe mango, including fats and oils
2. breastfeeding the child
3. immunizing the child
4. taking correct dose of Vitamin A capsules as prescribed

2. Vitamin D/________________- Help in the mineralization of bones by enhancing absorption  of calcium

Best sources :
 milk and other dairy products fortified with  cod liver oil
vitamin D.  DILIS, Dried fruits, Daing/ Dried fish
 oily fish (e.g., herring, salmon and sardines)  Other sources: _____________
Deficiency
 rickets in children
  Osteomalacia and osteoporosis in adults

3.  Vit.E/ Tocopherol - Strong anti-oxidant;

 help prevent arteriosclerosis;
 protect  neuromuscular system;
 important for normal immune     function
 it helps protect cells from damage.
Food sources:
 from vegetable oil (soybean, corn, cottonseed, and safflower).
 (margarine and salad dressing).
 Vitamin E sources also include fruits and vegetables, grains, nuts (almonds and hazelnuts), seeds (sunflower) and
fortified cereals.

4.  Vitamin K /______________naturally produced by the bacteria in the intestines, and plays an essential role in normal
blood clotting
Deficiency: bleeding
Food sources: Green leafy-vegetables such as:
 turnip greens  cabbage and broccoli  olive, canola, and soybean
 Spinach  Parsley oils
 cauliflower  kale;

Others:
I.  Iodine
  As part of the two thyroid hormones,
 Iodine regulates growth, physical and mental development and metabolic rate.
 Aids in the development of the brain and body     especially in unborn babies
Deficiency: FETAL CRETINISM
Adult: GOITER
 Food sources: 
 Iodized salt, some seafood, kelp, and seaweed
 Seaweeds;squids;shrimps;crabs; fermented shrimp;mussels;snails; dried dilis; fish , raw/unpasteurized dairy products,
certain whole-grain products and cage-free eggs.
 FETAL CRETINISM

II. Calcium
What it does: Helps build and maintain strong bones and teeth. Helps muscles work.
Food sources include: Dairy products, broccoli, dark leafy greens like spinach and rhubarb, and fortified products, such as orange
juice, soy milk, and tofu

III. Fluoride
What it does: Prevents dental cavities and stimulates new bone formation.
Food sources include: Fluoridated water, teas, and some fish

IV. Magnesium
What it does: Helps muscles and nerves work, steadies heart rhythm, maintains bone strength, and helps the body create energy.
Food sources include: Whole grains, leafy green vegetables, almonds, Brazil nuts, soybeans, halibut, peanuts,
hazelnuts, lima beans, black-eyed peas, avocados, bananas, kiwi, and shrimp

V. Phosphorus
Food sources include: Dairy products, beef, chicken, halibut, salmon, eggs, and whole wheat breads
What it does: Helps cells work, helps the body make energy, helps red blood cells deliver oxygen, and helps make bone.

VI. Zinc
Supports immune function, as well as the reproductive and nervous systems.
Food sources include: Red meat, fortified cereals, oysters, almonds, peanuts, chickpeas, soy foods, and dairy
products

VII. Potassium
What it does: Helps the nervous system and muscles; helps maintain a healthy balance of water.
Food sources include: Broccoli, potatoes with the skin, prune juice, orange juice, leafy green vegetables, bananas,
raisins, and tomatoes
 VIII.  Iron- Essential in the formation of blood.
It is involved in the     transport and storage of oxygen in the blood
Food sources:  best iron-rich foods include spirulina, liver, grass-fed beef, lentils, dark chocolate, spinach, sardines,
black beans, pistachios and raisins
 Pork liver  shrimp
 Chicken liver  Eggs
 Beef and Fish  CAMOTE, saluyot; alugbati, Monggo
 Legumes like All shellfish is high in iron, but clams,  All shellfish is high in iron, but clams, oysters and
oysters and mussels are particularly good sources.  mussels are particularly good sources. 
 dried dilis

Forms of Malnutrition

1. Iron Deficiency Anemia (IDA)  - not enough hemoglobin produced by the body to meet its requirement.
 According to the Food and Nutrition Research Institute (FNRI) in the Philippines iron deficiency anemia is common among
children 6 months to one year old, pregnant and lactating women.
Women between 15 – 45 years old are the ones being mostly affected.

Pharmacology
Pharmacokinetics the study of the movement of drugs in the body, including the processes of ADME
Pharmacodynamic- ( how drugs work on the body) study of the effect of drugs in the body
3 drug names:
1. Generic name - (ex. Mefenamic Acid) - used in official publications;
2. Trade, or brand name (such as Tylenol, biogesic, solmux), which is selected by the drug company;given by the manufaccturer
3. Chemical name - drug’s chemical composition
- the name which is the precise description of the drug’s chemical composition and molecular structure e.g., N - (4 -
hydroxphenyl)
Common types of drug preparation
Caplet – tablet in a form of capsule
Pill - one or more drugs, mixed with a cohesive material, in oval, round, or flattened shapes
Lozenge (troche) - a flat, round, or oval preparation that dissolves and releases a drug when held in the mouth
Elixir - a sweetened and aromatic solution of alcohol used as a vehicle for medicinal agents
Tablet - a powdered drug compressed into a hard, small disc
Suppository - one or several drugs, mixed with a firm base such as gelatin, and shaped for insertion into the body
Syrup an aqueous solution of sugar often used to disguise unpleasant-tasting drugs
NONTHERAPEUTIC (an undesired response to a drug)

Side effect- an unintended, but usually predictable, response to a drug which can be harmless or injurious
Anaphylactic reaction - a severe allergic reaction that occurs rapidly and causes a life-threatening response involving the whole
body.
Tolerance- decreased physiologic response ; necessitates an increased dosage of the drug to maintain a therapeutic effect
Cummulation- the build up of a drug when the body cannot biotransform (metabolize) and/or excrete one dose of the medication
before the next is administered
Drug dependence - reliance on or need to take a drug or substance
Addiction - term applied to a condition in which these is a dependence and craving for a narcotic or other habit-forming drug is:

Enteral route
-drugs administered along any portion of the gastrointestinal tract
1. oral
2. sublingual (under the tongue)
3. buccal (against the mucous membrane of the cheek)
4. rectal

Parenteral route
-drugs administered other than through the gastrointestinal tract; that is, by a needle

drug absorption in this route is usually rapid

1. subcutaneous (into the subcutaneous tissue, just below the skin) – 40-50 degree (45 degree angle)
2. intramuscular (into a muscle) – (90 degree angle)
3. intradermal (under the epidermis and into the the dermis) – (10-15 degree angle )
4. intravenous (into a vein) - fastest route for absorption
 Before administering a drug, the nurse/midwife should identify the patient by checking the identification band
and asking the patient to state his name
 To clean the skin before an injection, the nurse/midwife uses a sterile alcohol swab to wipe from the center of
the site outward in a circular motion.
 If bleeding occurs after an injection, the nurse/midwife should apply pressure until the bleeding stops

Types of DRUGS
1. Depressant drugs/ tranquilizers are prescribed to relieve tension, anxiety and irritability.
Examples of depressants are: “BARBITURATES” Alcohol, Heroin , Inhalants , Sleeping Pills
2. Stimulants
- speed up the central nervous system.
- help people feel more alert and they increase the user’s physical energy.
- taken to make people feel happy and to decrease appetite.
Examples of stimulants are: Tobacco , Cocaine , Crack , Amphetamines , Methamphetamine 
3. Hallucinogens
- increase a person’s awareness of sight, touch, taste, feeling and hearing.
- Hallucinogens can also alter a person’s mood.
Examples of hallucinogens are:
Marijuana (Cannabis or Weed)
Ecstasy 
LSD (lysergic acid diethylamide) 

POSITIONING
1. dorsal recumbant/ genupectural position - on back, with legs bent and separated, feet flat – NSVD

2. Fowler position –45- 90 DEGREES - on back, head of bed raised about 18 inches and knees elevated (Feeding in bed,
breathing)

3.  Knee-chest position - on knees, head and upper chest on table, arms crossed above head (cord prolapsed)

4. left lateral recumbent position - on left side, right leg drawn up (labor)

5.  lithotomy position -on back, legs flexed on abdomen, thighs apart - recommended during IUD insertion

6. Prone -lying face down (post cleft lip repair)

 7. Sims positon -on left side, right leg drawn up high and forward, left arm along back, and chest forward resting on bed
(Rollm over test, ENEMA, Colonoscopy)

8. Supine -lying face up (post Cs or surgery)

9. Trendelenburg position -on back with head lowered by tilting bed back at 45 degree angle

10. Double up - The right position for patient suffering from severe abdominal pain

11. Sitting position

- to be assumed by the patient in undergoing nasal examination - examining chest

12. Modified trendelenburg position - appropriate to assume for patients in shock (Postpartum bleeding or
hemorrhage)

Sitz bath or hip bath 

- Submerged buttocks, lower back and the upper thigh in the tub
- remain seated for 10-20 minutes
- Temp should be 38-42 C
Note: feet must be out of the tub
Purpose of Sitz Bath:
 To aid healing a wound
 To induce menstruation.
 To induce voiding in urinary retention 
 To relieve pain, congestion and inflammation in cases of: 
Hemorrhoids  Episiotomy Anal fissures Rectal surgery, Tears of Perineum ( lacerations)
Contraindication:  Menstruating or pregnant women

Massage - Therapeutic Massage 

Massage therapy may also improve circulation, which enhances the delivery of oxygen and nutrients to muscle cells and helps remove
waste products or reduce swelling..
Massage therapy induces a relaxation response, which lowers your heart rate, breathing rate, and blood pressure; plus boosts
your immune system; and generally decreases the physical effects of stress.
Therapeutic massage benefits the following conditions:

Low Immunity
Anxiety
Minor injuries
Stress (Anxiety/depression )
Arthritis
Some forms of pains (Headaches, migraine, colic in children, Backpains)

 General Wellbeing
 For High Blood Pressure

 Duration Of Therapeutic Massage?

- ideally be for 60 to 90 minutes
- on a 4 to 6-week basis.
Swedish Massage- four common strokes of Swedish massage
 Effleurage: a smooth, gliding stroke used to relax soft tissue
 Petrissage: the squeezing, rolling, or kneading that follows effleurage
 Friction: deep, circular movements that cause layers of tissue to rub against each other, helping to increase blood flow and break
down scar tissue
 Tapotement: a short, alternating tap done with cupped hands, fingers, or the edge of the hand
-Tapotement should not be used on a particularly bony area or on broken or varicose veins
Pregnancy Massage
Pregnancy massage can help with these changes by reducing stress, decreasing arm and leg swelling, and relieving muscle and joint pain.
Do not massage the abdomen!!!! Only some areas of body part!!
Total Contraindications of Massage:
Cardio-vascular conditions (thrombosis, Deep vein thrombosis, Varicosities, phlebitis, hypertension, heart conditions, eclampsia)
Osteoporosis
Nervous or psychotic conditions
Thickening or Undiagnosed lumps or bumps
Recent operations or acute injuries
Any condition already being treated by a medical practitioner
Skin diseases (contagious diseases – leprosy, scabies)

ENEMAS
Carminative enema is given primarily to expel flatus.
 retention enema introduces oil or medication into the rectum and sigmoid colon.
 acts to soften the feces and to lubricate the rectum and anal canal, thus facilitating passage of the feces.

Cleansing enemas
given chiefly to prevent the escape of feces during surgery, prepare the intestine for certain diagnostic test, or for instances of
impaction or constipation thereby reducing risk of infections.

SLEEP DISORDERS
Most common sleep disorders:
A. Bruxism: Involuntarily grinding or clenching of the teeth while sleeping.
B. Insomnia disorder- Chronic difficulty in falling asleep and/or maintaining sleep when no other cause is found for these
symptoms
C. Narcolepsy:
- Excessive daytime sleepiness (EDS) often culminating in falling asleep spontaneously but unwillingly at inappropriate
times
D. Cataplexy
- a sudden weakness in the motor muscles that can result in collapse to the floor.
E. Night terror:
- an abrupt awakening from sleep with behavior consistent with terror
F. Nocturia
- A frequent need to get up and urinate at night.
G. Enuresis, or bed-wetting, in which the person does not arouse from sleep, but the bladder nevertheless empties.
H. Sleep apnea, obstructive sleep apnea:
Obstruction of the airway during sleep, causing lack of sufficient deep sleep, often accompanied by snoring.
Stops of breathing of at least ten seconds, 30 times within seven hours of sleep, classifies as apnea.
I. Sleepwalking or somnambulism- Engaging in activities that are normally associated with wakefulness (such as eating or
dressing), which may include walking, without the conscious knowledge of the subject.
J. Somniphobia
- is a dread/ fear of falling asleep or going to bed.
K. Sleep talking (somniloquy)

“handwashing”
- single most effective and cheapest way to prevent cross contamination

3 elements of handwashing- Water, Soap, FRICTION- most important

DONE AT LEAST __20_ SECONDS OR AT LEAST SINGING 2 HAPPY BIRTHDAY SON

Each hand requires 15 to 30 seconds of hand washing
minimum time required for watching each hands is 10 seconds and should not be lower than that.

WOUNDS
There are 5 basic types of wound; 

Closed wound: Contusion  -commonly referred to as bruises

-Blood accumulates under the skin causing localised swelling. 
 I. Abrasion------(CBQ)- top layer of skin is removed with little or no blood loss-knees and elbows, are most prone to
abrasions.
o Scrape/rubbing off caused by contact with a rough surface, the skin has been ground away

II. Laceration------(CBQ)- A cut skin with jagged, irregular edges and caused by a forceful tearing away
of skin tissue

III. Incisions------(CBQ) - Smooth edges and resemble a surgical or paper cut

o skin is cut by a sharp object, usually a knife or razor with smooth and defined edges.
o caused by a sharp object such as a knife, broken glass, scissors or surgeon’s scalpel. Incision wounds are ‘neat’
and the edges of the skin are usually smooth.

IV. Punctures------(CBQ)- Deep, narrow wounds such as a stab wound from a nail or a knife in the skin and underlying organs

V. Avulsion------(CBQ) - Flap of skin is torn loose and is either hanging from the body or completely removed
VI. Amputation- Cutting or tearing off of a body part such as a finger, toe, hand, foot, arm, or leg

Basic First Aid for Wounds Cont.

- What to Do:
o Wear gloves (if possible) and expose wound
o Control bleeding apply firm pressure for 10 mins or until bleeding stops
o Clean wounds------(CBQ)
 To prevent infection
 Wash shallow wound gently with soap and water
 Wash from the center out / Irrigate with water
o Severe wound?
 Clean only after bleeding has stopped
- Basic First Aid for Wounds Cont.
- Wounds Care
o Remove small objects that do not flush out by irrigation with sterile tweezers.
o If bleeding restarts, apply direct pressure.
o Use roller bandages (or tape dressing to the body)
o Keep dressings dry and clean
o Change the dressing daily, or more often if it gets wet or dirty.
- Basic First Aid for Wounds Cont.
- Signs of Wound Infection:
o Swelling, and redness around the wound
o A sensation of warmth
o Throbbing pain
o Fever / chills
o Swollen lymph nodes
o Red streaks
 Tetanus (lock jaw), should receive injection in first 72 hours.
• Bleeding Control
• Control Methods For External Bleeding:
– Direct pressure stops most bleeding. ------(CBQ)
• Wear medical exam gloves (if possible)
• Place a sterile gauze pad or a clean cloth over wound
– Elevation injured part to help reduce blood flow.
• Combine with direct pressure over the wound (this will allow you to attend to other injuries or victims).
– If bleeding continues, apply pressure at a pressure point to slow blood flow. ------(CBQ)
• Pressure point locations:
– Brachial (Top of elbow)
– Femoral (Inside upper thigh)
• Bleeding Control Cont.
• Control Methods For Internal Bleeding:
– Signs of internal bleeding:
• Bruises or contusions of the skin
• Painful, tender, rigid, bruised abdomen
• Vomiting or coughing up blood
 • Stools that are black or contain bright red blood
– What to Do:
For severe internal bleeding, follow these steps:
• Monitor ABC’s (Airway Breathing Circulation)
• Keep the victim lying on his/her left side. (This will help prevent expulsion of vomit from stomach, or
allow the vomit to drain and also prevent the victim from inhaling vomit).
• Treat for shock by raising the victim’s legs 8” – 12”
• Seek immediate medical attention
• Shock
• Shock refers to circulatory system failure that happens when insufficient amounts of oxygenated blood is provided for every
body part. This can be as the result of:
– Loss of blood due to uncontrolled bleeding or other circulatory system problem.
– Loss of fluid due to dehydration or excessive sweating.
– Trauma (injury)
– Occurrence of an extreme emotional event.
• Shock Cont.
• What to Look For
– Altered mental status
• Anxiety and restlessness
– Pale, cold, and clammy skin, lips, and nail beds
– Nausea and vomiting
– Rapid breathing and pulse
– Unresponsiveness when shock is severe
• Shock Cont.
• What to Do
– After first treating life-threatening injuries such as breathing or bleeding, the following procedures shall be
performed:
• Lay the victim on his or her back
• Raise the victim’s legs 8” – 12” to allow the blood to drain from the legs back to the heart.
• Prevent body heat loss by putting blankets and coats under and over the victim
• Strain V.S Sprain
• Strain -  is an injury to a muscle in which the muscle fibers tear as a result of overstretching

Sprain - is damage to one or more ligaments in a joint, often caused by trauma or the joint being taken beyond its
functional range of motion
• Care for Sprains and Strains (RICE)
R- Rest
I - Ice
C - Compression
E- Elevation

Hot and Cold Therapy

1. Cold Application 2. Hot Application

-controls bleeding by constricting blood vessels -promote circulation to an injury thereby promoting
-to produce an anesthetic effect; relieve pain healing
-to reduce body temperature -relief of pain or aching particularly in muscles and
- to limit the accumulation of fluid in body tissues; joints by promotingmuscle relaxation
reduce edema -helps overcome feeling of chillness
*****Constricts vessels and retains heat -raises the body temperature
*****Dilates vessels and releases heat

CONTRAINDICATIONS OF HEAT AND COLD

HEAT 
COLDS
1. The first 24 hours after traumatic injury  1. Open wounds.
2.  Active hemorrhage. 2. Impaired Circulation.
3. Noninflammatory Edema. 3. Allergy or Hypersensitivity to cold 
4. Localized malignant tumor.
5. Skin disorder that causes redness or blisters.
  Cold helps minimize inflammation
 Heat relax muscles, joints, and blood vessels
Cold is usually best for a fresh injury, like a bruise or a sprain.
Applying ice or a cold pack immediately reduces swelling by causing blood vessels to constrict.
Cold should only be used for the first 48 hours or so after an injury.
 Keep a towel between your skin and the heat/cold source.
 Don’t apply heat/cold for more than 15-20 minutes at a time.
 Watch for burns or if your skin becomes numb, blistered, or red.
 Cold packs are applied for the first 20 to 48 hours after an injury; then heat is applied

Dressings and Bandages

- The purpose of a dressing is to:
o Control bleeding
o Prevent infection and contamination
o Absorb blood and fluid drainage
o Protect the wound from further injury
- Bandage can be used to:
o Hold a dressing in place over an open wound
o Apply direct pressure over a dressing to control bleeding
o Prevent or reduce swelling
o Provide support and stability for an extremity or joint
o Bandage should be clean but need not be sterile.

BANDAGE
• a strip or roll of gauze or other material for wrapping or binding any part of the body.
• cravat bandage one made by bringing the point of a triangular bandage to the middle of the base and then folding lengthwise
to the desired width.
• figure-of-eight bandage one in which the turns cross each other like the figure 8.
• gauntlet bandage one that covers the hands and fingers like a glove.
• plaster bandage a bandage stiffened with a paste of plaster of Paris.
• pressure bandage one for applying pressure, for the purpose of arresting hemorrhage; pressure is applied directly over thewo
und.
• spiral bandage a roller bandage applied spirally around a limb or fingers
• tailed bandage  for wounds of the nose and chin.

1. Simple Spiral : used for uniform thickness part i.e. wrist or finger. Each turn of the bandage overlaps the previous turn
2. Reverse Spiral: used for the parts where the thickness varies e.g. legs & forearms. It is applied in the same way as the
general spiral bandage, but each turn is reversed as necessary to prevent gaping & to make the bandage smooth.
3. Figure of Eight: ------(CBQ)

This bandage is used for elbow & knee joints. This bandage is made by forming two loops or oblique turns over a joint. The turns
alternately ascend & descend to cover the part.
4. Spica: ------(CBQ)- a form of the figure of eight bandage. The turn is larger than the other. It is used for joints at right angles
to the body, e.g. the shoulder, groin, thumb.

5. CRAVAT BANDAGE / triangular bandaging -a triangular bandage, folded lengthwise. It may be used as a circular, figure

eight, or spiral bandage to control bleeding or to tie splints in place.
- useful to control bleeding from wounds of the scalp or forehead , eye , temple,cheek, or ear

Burns
First-degree burns affect only the outer layer (EPIDERMIS ONLY) of the skin.
 They cause pain, redness, and swelling. There are many causes of first degree burns including hot water from the sink and
sunburn.
 . First, run the burned area under cold water.
 Immerse in cold water 10 to 45 minutes or use cold, wet cloths.
 Cold stops burn progression
 May use other liquids
 Aloe, moisturizer lotion
Second-degree burns affect both the outer and underlying layer of skin (EPIDERMIS & DERMIS).
- MOST PAINFUL, redness, swelling, and blistering
• PRESENCE OF BLISTER FORMATION weeping of fluids, and severe pain.
– They are also called partial thickness burns
– What to Do:
• Immerse in cold water / wet pack
• Aspirin or ibuprofen
• Do not break blisters
• May seek medical attention
-

Third-degree burns affect the deep layers of skin (SQ & MUSCLES).

-They are also called full thickness burns.
-They cause white or blackened (CHARRED MEAT APPEARANCE), burned skin.
-The skin may be numb (INSENSITIVE/ PAINLESS) due to the damage of nerves. 

– What to Do:
• Usually not necessary to apply cold to areas of third degree
• Do not apply ointments
• Apply sterile, non-sticky dressings (do not use plastic)
• Check ABC’s, Treat for shock, Get medical help

Degree of perineal lacerations

1. first-degree lacerations - superficial tears involve the skin of the perineum and the tissue around the opening of the
vagina or the outermost layer of the vagina itself, but no muscles
2. Second-degree lacerations - go deeper, into the muscles underneath.
3. Third-degree laceration is a tear in the vaginal tissue, perineal skin, and perineal muscles that extends into the ANAL
SPHINCTER (the muscle that surrounds your anus).
4. Fourth-degree tear of RECTAL sphincter and the tissue underneath it.

RECTOVAGINAL FISTULA -
- opening between the rectum and vagina is wide it will allow both flatulence and feces to escape through the vagina, leading
to fecal incontinence.
Suturing the Vagina
- The apex of the incision is identified in the posterior wall of the vagina. The first stitch must be inserted posterior wall of the
vagina
- Alternatively the skin layer can be closed using interrupted stitches.

Basic First Aid

What Is First Aid?
– The immediate care given to an injured or suddenly ill person. ------(CBQ)
– DOES NOT take the place of proper medical treatment.
– Legal Considerations
• Implied Consent involves an unresponsive victim in a life-threatening condition.
• It is assumed or “implied” that an unresponsive victim would consent to lifesaving help.
• Only perform First Aid assistance for which you have been trained.
• Scene Survey- only take a few seconds. (10 seconds)
• Initial Assessment
– Determine if victim is conscious - by tap and shout. Check for ABC as indicated:
• A = Airway Open? – Head-tilt/Chin-lift.
• B = Breathing? – Look, listen, and feel.
• C = Circulation? – Check for signs of circulation.
• Victim Assessment Sequence
– If victim is responsive
• Ask them what injuries or difficulties they are experiencing.
• Check and provide first aid for these complaints as well as others that may be involved.
– If victim is not responsive (Unconscious or incoherent).
• Observe for obvious signs of injury or illness:
– Check from head to toe
• Provide first aid/CPR for injuries or illness observed.
 Levels of consciousness
• Conscious: normal, attentive; oriented to self, place, and mind
• Confused: impaired or slowed thinking; disoriented
• Delirious: disoriented, restless, clear deficit in attention; possible incidence of hallucinations and delusions
• Somnolent: excessive drowsiness; little response to external stimuli
• Obtunded: decreased alertness, slowed motor responses; sleepiness
• Stuporous: conscious but sleep-like state associated with little or no activity; only responsiveness is in reaction to
pain------(CBQ)
• Comatose: no response to stimuli, cannot be aroused; no gag reflex or pupil response to light; profound consciousness
 
Choking- Obstruction in the airway.
• General Precaution
– If someone is coughing, leave the person alone.
• Do not perform the Heimlich Maneuver.
– Keep eyes on that person.
– Ask the person if he/she needs help.
• Signs and Symptoms
– Person is not able to breath or talk due to obstruction, choking sign given, distressed, and panic.
– Hands wrapped around the neck is universal sign for choking. ------(CBQ)
• What to Do:
– Perform Heimlich Maneuver if you are properly trained------(CBQ)
• Conscious Victim: Unconscious Victim
– Approach from behind • Ask someone to call 9-911 for help
and wrap arm around the victim’s • Lower victim to floor on back or
waist. left side and perform Heimlich Maneuver
– Place one fist just above • Open airway with tongue-jaw lift
the victim’s navel with the thumb • Look inside mouth – if you cannot
side against the abdomen. see anything, do not do a finger sweep
– Second hand over the fist. • Try to give two full rescue breaths
– Press into the victim’s • If these do not go in, reposition the
abdomen with one upward thrust head and give another breath
– Repeat thrust if necessary. • Perform abdominal thrusts
– Try to pop the obstruction • Continue until successful or help
out with swift thrusts in and up. arrives
– Continue until the
obstruction is relieved or victim
collapses.

Poisoning: First aid

Signs and symptoms of poisoning may include:

 Burns or redness around the mouth and lips (Vomiting)

 Altered mental status (Confusion )

 Difficulty breathing and Drowsiness

 If you suspect poisoning, be alert for clues such as empty pill bottles or packages, scattered pills, and burns, stains and odors
on the person or nearby objects.
Take the following actions until help arrives:

 Swallowed poison. Remove anything remaining in the person's mouth. If the suspected poison is a household cleaner or
other chemical, read the container's label and follow instructions for accidental poisoning.

 Poison on the skin. Remove any contaminated clothing using gloves. Rinse the skin for 15 to 20 minutes in a shower or with
a hose.

 Poison in the eye. Gently flush the eye with cool or lukewarm water for 20 minutes or until help arrives.
  Inhaled poison. Get the person into fresh air as soon as possible.

 If the person vomits, turn his or her head to the side to prevent choking.

 Begin CPR if the person shows no signs of life, such as moving, breathing or coughing. Then Call Poison Help

 Have somebody gather pill bottles, packages or containers with labels, and any other information about the poison to send
along with the ambulance team.
Caution
 Syrup of ipecac. Don't give syrup of ipecac or do anything to induce vomiting.
 Button batteries. The small, flat batteries used in watches and other electronics — particularly the larger, nickel-sized ones
— are especially dangerous to small children. A battery stuck in the esophagus can cause severe burns in as little as 2 hours.

For corrosive poisoning substance – NEVER INDUCE VOMITING!!

LEAD POISONING – Who is at risk: Children under the age of 6 years old

Common sources of lead include:

 house paint made before  bullets, curtain weights, and  jewelry, pottery, and lead
1978 fishing sinkers made of lead figures
 toys and household items  pipes and sink faucets, which  storage batteries
painted before 1976 can contaminate drinking water  kohl or kajal eyeliners
 toys made and painted  soil polluted by car exhaust  some traditional ethnic
outside the United States or chipping house paint medicine
 paint sets and art supplies
Diagnostic test: Lead poisoning is diagnosed with a blood lead test (Finger prick)
Complications- Exposure to even low levels of lead can cause damage over time, especially in children.

Symptoms
Initially, lead poisoning can be hard to detect — even people who seem healthy can have high blood levels of lead. Signs and
symptoms usually don't appear until dangerous amounts have accumulated it appears in a long period of time.
symptoms in children
Learning difficulties Lead poisoning symptoms in adults
Lead poisoning symptoms in  Headache (High blood
Eating things, such as paint newborns
chips, that aren't food (pica) pressure)
 Be born prematurely  Abdominal pain
Abdominal pain
 Abortion  Reduced sperm count and
(Constipation, Vomiting)
Developmental delay  Lower birth weight abnormal sperm
( Irritability)  slowed growth  Miscarriage, stillbirth or
Seizures premature birth in pregnant
wo,en
Treatment of Lead Poisoning :
Chelation therapy ( A chemical called EDTA may also be use)