A PROCEDURAL MANUAL

FOR
HEALTHCARE PROVIDERS

Philippine Copyright 2021 by Daisy Mae R. Bialba, Phd.,RN

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 ACKNOWLEDGEMENT

The author would like to thank and acknowledge the following personalities who made
significant contributions by providing invaluable assistance which lead to the successful
completion of this book:

To the authors friends and relatives for their undying support;

To Dr. Joel M. Durban, Dean College of Education, Arts and Science for the approval of
the intent to publish my work;

To her mother, Emily Brown, who gave love and support to accomplish this research;

To her husband Roel R. Bialba, for the untiring and unconditional love, financial and
moral support for the success of this study;

To her sister Emillie with children Chris and Kirsten and brother Bong, sister- in- law for
their support, love, motivations and encouragement;

And last but definitely not the least my four daughters Alloi, Allec, Allai and Alleyia who
are my inspiration in life.

And most of all, to our Dear Almighty God, for giving her knowledge, wisdom and
guidance.

DAISY MAE R. BIALBA Ph.d., RN

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 DEDICATION

I would like to dedicate this study to my families, friends, readers, Students & Faculty,
Law Enforcement Sector most especially to the allied health students, to my loving and ever
supportive husband Roel and my four beautiful daughters Alloi, Allec, Allai and Alleyia who
always inspires me and to GOD Almighty for the whole blessings I received.

The Author

TABLE OF CONTENTS

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I.INTRODUCTION

Objective of the course

Aims of the procedure course

Methods for self development

Essential for success in health care provider

II. Promoting a Therapeutic/ Safe Environment

Daily Care of the Patient/Client’s room or ward

Fumigation (Preparing for new patient)

Body Mechanics

Bed making

Closed Bed (Unoccupied Bed)

Open Bed

Occupied Bed

Post Operative Bed

III. HYGIENE AND COMFORT NEEDS OF THE PATIENT

Handwashing

Providing for the Hygiene need of the Patient

Providing hygiene and comfort for the patient’s back

Care of the Mouth

Care of the Dentures

Comfort and Safety Measures

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Restraints

Protective Position for Bed Patient

Turning the Mattress with a patient in Bed

IV. POSTURE, ACTIVITY AND REST

Moving and Turning the Patient in Bed

Placing the Patient in various Positions of Rest

Sitting up a Patient and Dangling

Assisting Patient to Walk

Assisting the Patient Out of Bed to Wheelchair

Temperature

Pulses

Respiration

V. OBSERVATIONAL SKILLS

TAKING T P R (Temperature, Pulse rate and Respiratory rate)

Oral Temperature

Taking Pulse

Taking Blood Pressure

Cardiac Rate

Temperature record

Positioning and Draping the Patient

Normal Values for Laboratory Examination

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VI. APPLICATION OF HEAT AND COLD

Hot water bottle/bag

Application of Hot and moist Compress

Preparation and Application of Ice Cap

Cold Pack

VII. COMMUNITY, MEDICAL AND SURGICAL TECHNIQUES

Bag Technique

Thermometer technique

The Surgical Scrub

Scrubbing for Surgical Operations

Putting on sterile gloves

Handling of Sterile Objects

Care of the Wound

VIII. DRUG ADMINISTRATION

Administration of Medicines

The Pluses and minuses of Right drug administration routes

Health Care Providers Responsibilities related to medicines and their administration

Administration of Medication

Rules of Making Medication Cards

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Rules for Recording Drug Administration

Administration of Oral Medication

Preparing for Tablet, pills or Powder

Parenteral Medication

I. INTRODUCTION

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 OBJECTIVE OF THE COURSE

A. General:

At the end of the course, health care providers are expected to have learned the art of
giving effective and comprehensive health care to the individuals, family and community.

B. Contributory:

1. Knowledge an d Understanding of:

a. The physical, social, mental and spiritual needs of the client and the family and to make
provisions for the health care providers’ fulfillment.

b. The role of the health care provider in diagnosis and therapeutic aspects of care.

c. The role of the community agencies with regards to the conservation of health and to
help the patient avail himself of the facilities these can offer.

d. The scientific principles underlying effective health conservation.

2. Attitudes and Appreciation

a. Appreciate health care as a profession with its boundless opportunities and

responsibilities for local and worldwide community service.

b. Appreciate the needs as holistic approach in health care of the client, family, and
society.

c. Gain satisfaction in making a procedure acceptable to the patien/client and an

experience acceptable to him.

d. Develop the attitudes that each patient should be accepted as a unique personality,
possessing his own needs and problems which are different from those of other
patients.

e. Develop willingness to cooperate with other members of the health team in the care of
the patient/client.

f. Establish and maintain sound relationship between the patient/client and his family and
to cultivate the desire to engage in the same to the utmost possible extent.

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 3. Skills and Abilities:

Develop the Ability to:

a. Adapt health care to the needs and peculiarities of the individual client in the health
institution, in the home or in the community.

b. Develop skills in problem solving and decision-making

c. Develop the skills in critical thinking.

d. Develop the ability to administer therapeutic procedures skill fully when such
procedures in permitted of the health care provider.

e. Develop the ability to provide for a safe and comfortable environment of the
patient/client.

f. Develop the ability to skillfully assist the doctor in carrying out diagnostic and
therapeutic procedures.

AIMS OF THE PROCEDURE COURSE:

1. To make the patient economically, physically, system, socially, morally,

psychologically and emotionally comfortable.

2. To develop methods of observation, system, economy and manual dexterity of the

health care providers.

3. To establish uniformity and definite technique

4. To save energy and time in relation to:

a. Patient/Client: Consider the effect of the time taken upon patient’s energy or
comfort. Use available time advantageously for patient.

b. Health Care Provider: Develop the habits of promptness. Use spare moments to
study needs of patient and read chart, history and laboratory reports.
5. To economize on supplies and equipment in relation to:

a. Patient: Torn and stained articles, chipped utensils or dishes, lost articles, etc., and
to the discomfort and poor service.

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 b. Health Care Provider: Improper and inadequate equipment makes good health
care difficult and teaches disregards of appearance.

c. Hospital: Resources are entrusted for improving conditions and welfare of the
patient/client and should not be depleted by lack of economy.

METHODS FOR SELF-DEVELPOMENT

Each student should develop the habit of giving good health care by:

1. Observing therapeutic results, comfort and satisfaction of the patient/client.

2. Recognizing neat finished work.

3. Considering time, effort and material used in obtaining results.

4. Acquiring the ability to analyze the inherent health care principles in each procedure.

5. Correlate each procedure with theory as to:

a. Anatomy and physiology

b. Chemistry
c. Psychology

-principles underlying human conduct

- observing and interpreting human reaction
-development of ability to inspire confidence in patient/client, family and friends
- development of sympathy and understanding in patient/client whether well or
ill.

d. Hygiene

-knowledge of relationship to all health care provider work in prevention of

disease
- recognition of obligation of health care provider as a teacher of personal and
public health

e. Pharmacology

-Accuracy in measuring and administering drugs and in making solution.

f. Nutrition and diet therapy

ESSENTIAL FOR SUCCESS IN HEALTH CARE PROVIDER

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A. Success in health care implies achievements for the benefit of others as well as reward for
the individual.

B. Indispensable Qualification of a HEALTH CARE PROVIDER:

1. Interest in Health Care- the desire to help the less fortunate and dedication to care for
patient/client.

2. Conscientiousness- careful in all her actions so that patient/client’s safety will not be
sacrificed

3. Courtesy- Consideration for other founded on kindness helps to prevent friction. When a
person approaches you for help be careful not to show any unwillingness to do so.

4. Ability to manage people- get them to do with, is required without causing annoyance or
settlement. Know how to read character.

5. Dignity and pleasing personality- this commands respect and is an important aid in
gaining the trust of patients, the confidence of those in authority, and obedience from
subordinates. Although she should be cordial and kindly, she should avoid informally
and intimacy. Jewelry distracts from dignity and is out of keeping with the professional
impression that the uniform should give.

6. Good Memory- There are many things to remember.

7. The Faculty of observing quickly and Accurately- being aware of the physical as well as
social environment. Quick to detect changes in patient’s condition.

8. Orderly Habits- “A place for everything and everything in its place.”

9. Patience, Sympathy and Self-control- there is no place for callous health care providers
in the hospital.

10. Unselfishness- willingness to give all possible help when need arises and thus aid those
in distress in the true spirit of nursing.

11. A lot common sense

12. Observance of the Golden Rule.

II. PROMOTING A THEREPEUTIC/ SAFE ENVIRONMENT

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 DAILY CARE OF THE PATIENT/CLIENTS’ ROOM OR WARD

I. Purpose:

1. To provide a clean, orderly and comfortable environment for the patient/client.

II. Points to Remember.

1. The auxiliary workers usually carry out general measures for cleanliness of the ward as a
whole, however, it is the health care provider’s responsibility to supervise the procedure
and to see to it that the patient’s unit is orderly and clean.

III. Equipment:

Scrubbing basin or pail with tap water

Soap, dusting, cloths, cleanser, newspaper to clean mirrors

IV. Procedure

1. Maintain proper lighting and ventilation

2. Clean articles when not in use should be kept properly.
3. Instruct and supervise auxiliary workers cleaning the rooms.
4. Keep the bedside tables, window grills and chairs free from unnecessary materials.
5. Check all equipment and report those that are missing or out of order.
6. Keep mirrors clean and free from stain.
7. Change the water of the flower vase daily; discard wilted flowers.
8. Have the wastebasket emptied.

FUMIGATION
(Preparing for new patient)
Fumigation is the disinfection of a room or building by the use of gases

Indications:
1. In any case after the discharge of patient with contagious cases.
2. If patient has surgical pus, drainage or foul discharge.

Special Consideration:
1. Close all doors, windows and crevices, etc., keyholes, cracks should be pasted with
paper.
2. All furniture inside the room should be well exposed. Open all cabinets, drawers,
closets.
3. Expose the mattress and pillows
4. Hang the blankets and beddings on the line or spread them on chairs.

Preparation:
1. Drugs commonly used:

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 a. Potassium permanganate crystals – 250grams for every 1,000 cu. ft. of air space.
b. Formaldehyde – 500 grams for every 1,000 cu. ft. of air space.
2. Big basin of water
3. A small basin

Procedure:

1. Move furniture away from the wall, expose all drawers, closets, cabinets, etc.
2. Seal all cracks, crevices, holes, and keyholes
3. Lower the window shades, hang all linens, etc. Close the windows and all openings.
4. Place the big basin of water on the middle of the room. In this, place another small
basin containing KMNO4 crystals in proportion to the air space of the room. Pour the
formalin over the KMNO4.
5. Leave the room immediately closing the door behind. The room should be closed for
12 – 24 hours.
6. Air the room and everything therein. Fix them ready for use.

BODY MECHANICS

Body mechanics is the coordinated use of body parts to produce motion and maintain
equilibrium in relation to skeletal, muscular and visceral system under neurological
association.

Purposes:
1. To maintain good body postures.
2. To help promote good physiologic functions of the body.
3. To use the body correctly and maintain its effectiveness.
4. To help prevent injury to or limitation of the muscular-skeletal system.

General Considerations:

1. Work close to an object to prevent unnecessary reaching and strain on the muscle.
2. Place the feet apart in order to provide a wide base of support when increased
satiability of the body is necessary.
3. Use the longest and strongest muscles of the arms and leg to helps provide the power
needed in strenuous activities.
4. Use the external girdle and long midribs to stabilize the pelvis and to protect the
abdominal viscera when stooping, reaching. Lifting or pulling.
5. Push and pull, slide or roll an object on a surface rather than lift it. Lifting involves
overcoming the pull of gravity.
6. Use the weight of the body’ as force for pulling or pushing by rocking on the feet or
falling forward or backward.
Procedure:

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A. Standing
1. When standing, the curve of the spine should not be exaggerated.
2. The subcostal angle of the ribs should be at least at right angle.
3. The circumference of the chest at xiphoid process should be approximately halfway
between girth at full inspiration and that of full expiration.
4. The abdomen about the umbilicus should be larger and bigger than that below the
umbilicus and each shall show firm resistant structure.
5. The line drawn through the patella and the middle of the ankle shall strike the base of
the second and third toe.

B. Sitting
1. Spinal curve should not be exaggerated but the trunk should be in upright position.
2. Lower abdomen in, back flat, chin in, and most well of the things must be of the
buttocks.
3. Feet pressed on the floor.
4. There should be no lateral curvature from leaning to one side.

C. Lifting and Picking an Object:

1. Flex the knees, put on the internal girdle and come down close to the object which is
to be lifted.

D. Walking

1. Stand erect with chest up, head erect, the lower abdominal muscles retracted and the
body is well balanced.
2. Walk with long stride with feet parallel.

BED MAKING
CLOSED BED (UNOCCUPIED BED)

Definition: A closed bed is a bed prepared for a new patient. It is termed closed bed because the
top covers are arranged with linens beneath are spread out and protected against dust and dirt.

Objectives:

1. To provide a clean and comfortable bed for the patient.

2. To provide a neat and uniforms bed.

Equipment:

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 1. Bed
2. Mattress
3. Mattress pad or mat
4. Mattress covers
5. Two pillow cases
6. Two pillow covers
7. Two Pillows
8. Draw Sheet
9. Bedspread
10. Two sheets
11. Chairs

Procedure:

1. Assess client’s tolerance for activity.

2. Determine the need of a bed linen.
3. Wash hands.
4. Gather linen to be used and arrange according to use.
5. Explain the procedure to the client.
6. Provide privacy.
7. Assist client out of bed.
8. Adjust bed to comfortable level & lower side rails.
9. Remove cases from pillows and place the pillows on chair.
10. Remove cases to be reused, fold & place them on chair.
11. Loosen and roll soiled linens towards the middle of the bed and place them in a
hamper.
12. Place a bottom sheet on the bed beginning at the foot of the bed so that the center fold
is at the center of midline.
13. Tuck the bottom sheet securely under the head of the mattress and miter the top corner
and tuck hanging edge of the sheet.
14. Lay the center folds of the draw sheet along the middle of the bed lengthwise, if using
a rubber sheet, place it under the draw sheet.
15. Tuck the sheet smoothly and snugly on the side of the mattress.
16. From the same side of the bed, apply top sheet with the seam side up and he center
crease on the middle of the middle of the bed and tuck at the bottom and miter the
corner.
17. Fold the top sheet over six inches, from the head of the bead and fan fold.
18. Insert clean pillow case by grasping the closed end, turning the pillow case inside out
and pulling it over the pillow.
19. Place pillow on the head of the bed with the open end of the pillow case facing away
from the door.
20. Return the bed to its lowest position and assist client in mounting on the bed.
21. Wash hands.
22. Evaluate other needs of the patient.
23. Document any unusual circumstances observed such as blood stain, discharge on the
bed sheet.

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Principles of Closed Bed:

1. Linens should never come in contract with uniform or floor.

2. Maintain good body alignment. Health care provider stands facing the direction in which
she is working and works in such a way that she does not twist her body.

3. Use large muscles of the body rather than smaller muscles. Flex the knees rather than
bending the waist.

4. When tucking linens under the mattress, separate feet a lightly and flex knees. Flexing
knees, flexing the knees shifts the work to the longest and strangest muscle and keeps the
back in good alignment.

5. When opening and holding linens, place them on the edge of the bed rather than holding
them above shoulder lever and hyperextending the back.

6. When pulling sheets tight, hold the palms downwards so that pull is produced by the arm
and shoulder muscle.

7. Do not be wasteful of linens. Discourage hoarding linen in the patient’s room.

8. Refrain from using linen for purposes other than that for which it was originally intended.

9. Finish one side of the bed first before going to the other.

OPEN BED

Definition: It is one originally made as a closed bed, the top bed clothes are rearranged for the
patient
Purposes, General Consideration, Equipment and Preparation: as an in closed bed.

Procedure:

1. Grasp and fold back top cover of closed bed about 18 inches from the head of the bed.
2. Fanfold covers towards foot of bed.
3. Place pillow with seam of pillow case underneath and toward the head of the bed, place
softer pillow on top.

OCCUPIED BED

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Definition: It is a bed with a patient on it

Purposes:

1. To make the bed so that it is safe and comfortable.

2. To provide exercise for the patient and thus articulate circulation.
3. To observe the patient’s condition
4. To save the energy of the patient and the health care provider.

General Consideration

1. Before starting the procedure, see to it that all things needed are on hand.

2. In removing bed linens, care is taken not let them come in contract with health care
provider’s uniform or the floor.
3. Control the amount of physical exertion that the procedure will cause by:

a. efficient, rapid workmanship in handling the beddings.

b. cars in lifting and turning the patient.
c. not jarring the bed.
d. lifting the mattress at minimum height to tuck in the sheets.

Equipment:

1. 2 large sheets
2. 1 draw sheet
3. 1 rubber sheet
4. 1 pillow case (or more)

Preparation of Equipment:

1. Arrange the bed linens on a chair near the bed in order of their use.

Preparation of Patient:

1. Explain the procedure to the patient.

2. Provide privacy.

Procedure:

1. Assess client’s activity order.

2. Check linens needed.
3. Wash hands.
4. Gather linen and arrange according to use.
5. Explain procedure to the client.
6. Provide privacy.

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 7. Lower the side rail on the near side of the bed leaving the opposite rail raise up.
8. Position the client on his side facing away from you..
9. Loosen linen on the near side of the bed. Tuck soiled linen under the client.
10. Place bottom sheet at the foot of the bed with the center folded nearest and miter the
corner
11. Moving to the head of the bed, fold the sheet under the mattress and miter the corner.
12. Fold draw sheet in half, identify its center and place close to the client under the soiled
linen.
13. Pull draw sheet over the folded bottom and tuck it under the mattress.
14. Assist client to roll over the soiled and clean linens toward the near side.
15. Raise the side rail on the near side then move to the other side of the be.
16. Loosen soiled linen and roll to the foot of the bed. Place linen in hamper keeping them
away from your uniform.
17. Pull draw sheets towards you and straighten it. Tuck under the mattress.
18. Place clean top sheet on near side of bed and unfold it on top of bath blanket.
19. Request the client (if able) to hold the top upper edge of sheet or secure it by tucking
under the client’s shoulder. While you fold the bath blanket to foot of bed and remove it.
20. Place pillow on the head of the bed with the open end of the pillow case facing away
from the door.
21. Pull clean bottom sheet in place, tuck under mattress, making mitered corner.
22. Evaluate other needs of the client.
23. Document any unusual circumstances observed such as blood stain, discharge on the
sheet and other.

After Care of the Patient:

1. Adjust bed to meet needs of patient.

2. Leave patient in comfortable position.
3. Ventilate room and leave unit in order.

After Care of Equipment:

1. Discard soiled linens.

POST OPERATIVE BED

Definition: A post-operative bed, or anesthetic bed, or either bed or recovery bed is one that is
prepared to receive a patient who has undergoes an operation general or local
anesthesia.

Purposes:
1. To provide a bed in which the patient can be quickly placed after surgery.

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 2. To provide comfort and warmth thus maintaining body heat and lessening the danger of
shock and pneumonia.

General Consideration:
1. See to it that all equipment needed to administer post-operative care is assembled and
ready for use before the patient arrives.

Equipment:

2 large sheets Mouth wipes or tissue paper

1 draws sheet
1 blanket if necessary
4 hot water bags if necessary
1 bath towel or a rubber sheet
And draw sheet for the head
Of bed, prn
paper bags
emesis or kidney basin
1 pillow
1 pillow case
1 liter size bottle for urine from indwelling catheter
if no disposable available.

Preparation of Equipment:

1. Arrange bed linens on a chair according to order of their use.

Procedure:

1. Prepare bottom sheet as in a closed bed.

2. Spread top sheet with the edge in line with the mattress at the head of mattress. Fold
back sheet 18 inches from head of mattress.
3. Fold back lower edge of top sheet so that the folded edge is in line with the edges of the
mattress.
4. Fanfold sheet evenly towards side or towards foot of the bed.
5. Place rubber protector across the head of the bed so that upper edge is in line with the
edge of mattress.

III. HYGIENE AND COMFORT NEEDS OF THE PATIENT

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 A. HANDWASHINNG

PURPOSES:

1. To reduce the number of bacteria present and discourage re-growth of those which
remain in the skin.
2. To protect the health care provider and to safeguard the patient.
3. To act an example for others.

POINTS TO REMEMBER:

1. Wash hands carefully, before each meal, after use of the toilet, after handling
equipment (such as bedpan) in carrying out patient care and when going from one
patient to another.
2. All patients should be regarded as possible sources of infection.
3. From ½ to 1 minute hand washing is sufficient for direct contact. With discharges.
4. From 2-3 minutes hand washing is sufficient for direct contact.
5. Always wash and rinse the soap before returning to the soap dish.
6. Use tissue paper to open and close faucet in communicable diseases.

EQUIPMENT:

1. Liquid soap
2. Nail brush/surgical brush
3. Hand towel/paper towel

PROCEDURE

1. Open the faucet.

2. Pick up the soap and form a later between your two hands under running
water.
3. Use friction to make lather throughout the procedure. Rub tight palm over the
back of left hand and rub between the fingers thoroughly in a rotating motion.
4. Repeat with the left hand over the right.
5. Clean around the nails and under the nails. Use the nail brush and file if
necessary.

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 6. Rub around the waist (and work up until above the elbow)
7. Rinse from above the wrist going down.
8. Rinse the soap and repeat the procedure using friction all the time
9. Rinse, close the faucet, dry hands with the use of tissue paper.

PROVIDING FOR THE HYGIENCE NEEDS OF THE PATIENT

A. Early Morning Care or Partial Bath

Care given to a patient just prior to serving breakfast; include washing of face and hands,
oral hygiene (Brushing teeth, care of dentures, use of mouthwash), offering bedpan or
urinal, combing hair and placing patient, if allowed to sit up, in a comfortable position in
bed as part of preparation for receiving breakfast tray.

Purposes:

1. To refresh patient.
2. To prepare patient for breakfast.

General Considerations:

1) Patients/clients who are well and strong should be encouraged to help themselves provided
they are not overstrained.
2) Patients/clients who are critically ill and debilitated must be given assistance. No over
exertion should be allowed.
3) When a large number of patients/clients are to be given morning care, a systematic procedure
for distributing and collecting the water used for washing should be devised according to
facilities available.

Equipment:

1. Tray with - soap, comb, toothbrush, glass of mouth wash

2. Basin
3. Pitchers of warm water
4. Wash cloth
5. Clean gown
6. Bath towel
7. Kidney basin
8. Bed screen prn.

Procedure:

1. Assess the hands for visible soiling, breaks or cuts in the skin and cuticles.

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 2. Assemble the equipment.
3. Remove jewelry and watch and push long sleeves above the elbow. Uniforms must not
touch the sink.
4. Adjust water to appropriate temperature and flow.
5. Wet elbow down to hands under running water always keeping hands lower than elbow.
6. Lather hands with liquid soap or if bar soap is used, wash soap and lather hands.

Note: If bar soap is accidentally dropped, repeat the procedure.

7. Return bar soap on the soap dish without touching the disk.
8. Wash hands thoroughly using firm circular motion and friction on back of hands, palms
and wrist. Wash each finger individually paying attention to areas between fingers and
knuckles by interlacing fingers and thumb moving hands back and forth. Rather if
necessary.
9. Rinse elbow down to hands, keeping hands lower than elbows.
10. Clean fingernails carefully under running water using an orange stick.
11. Turn off faucets with hand towel or tissue paper.
12. Dry hands thoroughly with towel start by putting at fingertips, hands and then wrist and
forearm.
13. Used hand lotion if desired.
14. Inspect hands and nails for cleanliness.
15. Record time when hand washing is done

After Care of Equipment:

1. Gather and bring all used articles to utility room.

2. Wash and clean equipment and return patient’s belongings to bedside.

Record:

1. Time and type of care given.

2. Condition of patient.

PROVIDING HYGIENE AND COMFORT FOR THE PATIENT

CARE OF THE BACK

Purposes:
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 1. To stimulate circulation
2. To prevent bedsore
3. To give comfort to the patient

Equipment:

1. Alcohol or lotion
2. Powder
3. Bath Towel

General Consideration:

1. Alcohol backrub is never given to patient receiving oxygen therapy.

2. Patient is in prone position with firm circular motion start from sacrum to the soldier
blade.

Procedures:

1. Check chart for information related to client’s ability to participate in the procedure being
planned.
2. Assess vital signs.
3. Determine assistance needed.
4. Determine and obtain articles needed.
5. Identify client.
6. Explain the procedure to the client. Ask preference of rubbing agent.
7. Provide for privacy.
8. Maintain a quiet and relaxing atmosphere.
9. Move the client near to your side and position. If client is able to move, instruct her/him
to assume sitting/ prone position.
10. Wash dry back if necessary.
11. Pour small amount of rubbing agent into hands and rub hands together.
12. Place hands on sacral area while maintaining good posture.
13. Make long firm strokes towards shoulders and back towards buttocks.
14. Move hands towards neck and rub nape, continue rubbing outward across the shoulders.
15. Move hands downward to scapula and massage in circular motion.
16. Rub in figure- 8 pattern over buttocks and sacral area.
17. Complete back rub by moving from shoulders to sacrum and back to shoulders.
18. Remove excess rubbing agent used with towel.
19. Reposition client and replace top linen.
20. Raise side rails and place call light within reach.
21. Return articles used in storage area.
22. Wash hands.
23. Evaluate in terms of the following criteria:
a. fatigue
b. subjective feelings

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 c. objective appearance of comfort
24. Client’s response to back rub.
25. Condition of skin and bony prominences.
26. BP and PR before and after the procedure.
a. Effleurage- upward, downward strokes
b. Petriassage- circular stroke.
c. Friction-using thumb in circulation motion.
d. Tapotement

CARE OF THE MOUTH

1. Brushing the Teeth

It is the special care given to the mouth and teeth.

Purposes:

1. To cleanse the mouth

2. To prevent odors and formation of sores

General Consideration:

1. If patient is able to brush his own teeth he should be permitted to do so.

2. Patients who are unable to perform it should be assisted.
3. Oral Hygiene procedure is carried out as part of the daily routine of each patient/client.

Equipment:

Tooth brush drinking glass tube

Glass of mouth wash toothpaste
Glass of water (lukewarm) towel
Kidney basin protector

Preparation of the Equipment and Patient:

1. Place toothpaste on toothbrush

2. Prepare mouthwash at the desired dilution.
3. Explain procedure to the patient.
4. Turn patient to one side elevate the backrest so that the patient is in semi-sitting position.
5. Protect pillow with small rubber sheet and towel.
6. Place towel across patient’s chest and under the chin.

Procedure:

1. Bring preparation to bedside.

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 2. Hold kidney basin in front under the chin of the patient
3. Assist patient if necessary
4. Have the patient rinse his mouth first with mouth wash followed by water
5. Brush the teeth or allow the patient to clean it
6. Have the patient rinse his mouth wish water followed by mouth wash
7. Dry lips with towel; apply liquid Vaseline to lips prn.

After Care of the Patient:

1. Remove the protector and towel

2. Place patient in comfortable position

After Care of the Equipment:

1. Collect all used articles.

2. Wash and return to proper places.

CARE OF THE DENTURES

Purposes:

1. To cleanse dentures
2. To prevent halitosis and formation of orders

Special Consideration

1. Dentures and breakable and must be kept in safe place.

2. Dentures should not be washed directly over the sink.
3. All health care providers should be aware that artificial dentures are extremely fragile,
very expensive and difficult to replace when lost, extreme caution should be exercised in
their handling and care.

Equipment:

1. Same as in brushing the teeth, plus a reaccept able for dentures, paper wipes or tissues.

25
 Procedure: Underlying Principles

1. Have patient remove dentures if 1. Comfort and safety-it is easier

and possible more comfortable for patient to remove
his own dentures since a certain amount
of pressure is needed to overcome the
auction

2. Place dentures into a container 2. Safety- dentures are fragile

and costlyfilled with water or mouthwash.

3. Hold dentures to patient over 3. Safety- dentures are costly.

Emesis basin; wash thoroughly

4. Return dentures to patient 4. Safety- dentures may break

if not kept or place in labeled container with
moist water

5. Special Care of mouth for very ill patients

Equipment:

1. Same as care of mouth expect toothbrush.

2. Tray with: a. cotton-tipped applicators
1. wooden tongue depressors
2. mineral oil
3. mouthwash ordered or according to hospital routine
3. Paper bag if waste can is not available within reach.

Procedure:

1. Assemble all equipment beside

2. Protect pillows with towel and rubber sheet, Turn patient’s head to one side.
3. Open mouth and remove crusts and debris around the teeth and tongue using applicators
or tongue depressor padded with gauze dipped in the solution.
4. Rinse mouth with mouthwash or water using moistened applicator; apply oil to lips to
prevent dryness

After Care of Equipment:

1. Clean al articles used and return to proper place. Boil if necessary.

26
Record:

1. Time of treatment

COMFORT AND SAFETY MEASURES

Comfort and safety measures are devices and techniques which help to maintain good body
alignment and muscle tonus in bed and to alleviate discomfort or pressure on various parts of
the body.

Materials:

1. Pillow- a means of support and to provide elevation to patients head and other parts
of the body.
2. Mattress- giving comfort and support to the patient at the same time a protective
measure for bedsore
3. Backrest- a device which is used to place in a sitting position.
4. Footrest or footboard- it is used for comfort and to provide protection for any
condition as foot drop, to keep feet in dorsal flexion.
5. Bed board- made of plywood placed under the mattress to keep patient in a better
alignment
6. Cradle- a device placed over a bed to prevent the top shoot from touching there is
affected as in burns, wounds and casts.
7. Sand bags- similar to pillows but filling is sand commonly used to keep part of the
body immobilized and for support.
8. High-low tilted bed- bed whose height and angle can be adjusted; feet in higher than
hand or vice versa
9. Rocking bed- bed rooked rhythmically up and down in seesaw fashion, used for
patients with vascular or respiratory diseases.
10. Cahir bed or cardiac bed- bed that can be made into a chair position. It permits the
patient to be in a sitting position which may aid the patient’s cardiac output.
11. Circular bed- places the patient in a variety of positions. It is useful to the patient who
will be completely helpless for an extended perfect of time.
12. Rubber air rings cushion rings or doughnut- inflated rubber rings for relieving
pressure on hone prominences by lifting the affected area from the mattress surface.
13. Alternating pressure mattress bed- mattress sponge with compartments filled with air
or water to prevent pressure sore on hone prominences.
14. Foot block- a firm objects placed on the mattress at the foot of the bed so that
patient’s feet can rest against it in dorsal flexion.
15. Trochanter roll- sheet folded lengthwise and roll on support
16. Hand roll- used to keep the thumb in correct position for paralyzed patients made of
folded washcloth, a rubber ball or sponge rubber, prevents claw hand deformity.
17. Bed side rail- rails to prevent patients form falling out of bed.
18. Restraints- physical devices used to limit patient’s movements.

27
 RESTRAINTS

Definition: Restrains are devices used to limy patient’s movements

Objectives:

1. To prevent patients from falling out of bed or injuring themselves

2. To prevent patient from injuring others.

Types of Restrains:

A. Side Guard

1. Indication for use-

a. post-operatively
b. disoriented or restless patients
c. children
d. elderly patients
e. comatose patients
f. to assist patients to turn

2. Types of side guards

a. crib- fastened to the bed frame, slides up and down like a crib side
b. wooden bedside guard
c. steel bedside guard

3. Sheet
Method of Application
Method#1

1. Fold 2 sheets diagonally, place one underneath the patient’s waist and the other over the
abdomen
2. Twist the ends of the 2 sheets together close to the body, draw the needs through the
spring and tie.

Method#2

1. Fold 2 sheets diagonally, put one over the abdomen and one over the knees. Knees
should be padded.
2. Twist the ends around the bars over the side of the bed, tuck in extra portion.

Method#3

1. Spread sheet lengthwise across patient

28
 2. Tie sheet and spread corners together around the bedstead at foot portion and at
shoulder level

Method#4
Clove Hitch
Use large triangular bandage, small sheet folded diagonally may also be used.

1. Make the 2 loops form a figure of 8

2. Put the loops together and let the hand or leg pass through
3. Tighten the free ends; be sure circulation is not impaired
4. Make a knot at the ends of about one foot from the limb.
5. Fasten them to the bed; if not properly applied it will not hold or will hinder circulation.

Method#5
Mummy Restraint – used for children

Equipment:
1. Bath blanket
2. Large safety pin

Indication for use:

1. To lavage a child
2. To suture laceration
3. For eye or throat examination

Procedure:

1. Fold the blanket making a triangle

2. Place child in the middle of the blanket; neck should be at the folded areas
3. Bring one end of the blanket over one arm, then over the other
4. Tuck end occultly under patient’s back.
5. Take the other end of the blanket and using across the chest; wound it around the body
down the legs, Expose feet
6. Fasten end with safety pin
7. Hold the patient accurately during the treatment.

C. Posey Restrain:

A jacket like restraint with the front extended in long trails

29
Indication for use:

1. To limit activity of the restless and orderly patients.

Procedures:

1. Put the jacket on patient with the opening in front

2. Cross tails at chest and bring to sides.
3. Tie to bedstead, do not pressure on axillae.

D. Leather Handcuffs and Anklets

Equipment:
1. Cuffs
2. Anklets
3. Straps

Procedure:

1. Explain procedure to patient

2. Place stuff on armor leg to be restrained with padded part on the extremity.
3. Place straps through cuff loop and through bedstead, never fasten hands to the head of the
bed; Attach middle portion of bedstead to facilities comfort and limit activity.
4. Place strap through the buckle, be sure buckles are away from the skin.
5. Drop metal flap down so as to engage hook in strap hole
6. Hold down small metal are protruding on look, push lock in to fasten
7. Check lock by pulling up on leather strap to see if it is secure

E. Chemical Restrains

1. Drugs prescribed by the physicians

General Instructions:

1. Never leave a side guard down or removed unless ordered.

2. Check side guard whether it had been fastened securely.
3. Arms and legs should not be restrained any longer than absolutely necessary, at least
every 4 hours the restraints are loosened and limbs exercised, check for any sign of
cyanosis, pallor, cold or complaints of tingling sensation in the extremities.
4. A limb is best restrained in a slightly flexed position.
5. Before applying a mitten, the patients hand is placed in a naturally flexed position. Hand
roll is grasped by the patient’s it should not be too tight to impede circulation
6. Remember the patient’s dependence upon the health care providers
7. Never restraint a patient unless necessary, or in accordance with the physician’s orders.
8. Make restraints effectual, a careless restraints is worse than none. Do not fasten one side
of the body only, do the same with the other side

30
 9. If violent, care must be taken that there is sufficient help present to manage the patient.
10. Partially screen the patient when in restraint
11. Restraints are not to be kept in patient’s room when patient is through using them
12. Watch for and prevent chafing and pressure sores,
a. pad cuff with cotton
b. use gauze bandage when applying, cuff
c. use stockinet covers with cuffs
13. Restrained patients may have bathroom privilege when ordered by the doctor, with the
health care provider constantly present.
14. Chart every day, chart type of restraint and whether used continuously or at designated
time
EXAMPLE: 7:00 A.M to 7:00 P.M, ONLY

PROTECTIVE POSITION FOR BED PATIENT

A. BACK LYING

Purposes:

1. To maintain good body alignment

2. To give comfort to the patient
3. To prevent formation of decubitus ulcers
4. To prevent development of muscular deformities

General Consideration:
1. The different comfort and safety measured should depend on the patient’s condition and
tolerance.
2. Leave signal light within reach of the patient
3. Any position that may be comfortable for the patient will become exceedingly
uncomfortable if maintained for prolonged period of time, so frequent change of position
is necessary.

Materials:

1. Mattress 4. Sandbag or trochanter roll

2. Pillows 5. Foot board
3. Bed boards 6. Hand roll

Procedure and Underlying Principles

1. To provide a firm supportive mattress, Use bed board if necessary (To prevent
exaggerated curvatures of the spine and flexion of the hips).

31
 2. Place pillows under the upper shoulder, the neck and the head so that the head and neck
are held in correct position (To prevent flexion contractures of the neck).

3. Place pillows or support under the forearm so that the upper arms are alongside the body
and forearms are pronated slightly (To prevent internal rotation of the elbows- hunch
shoulder).

4. Make hand rolls for the hands to grasp, if the patient is paralyzed use thumb guides to
hold it in adducted position (To prevent extension of the finger and adduction of the
thumb claw hand deformity).

5. Place sandbags or trochanter rolls alongside the hips and the upper half of the things
( To prevent external rotation of the femur).

6. Place a small soft roll or sponge rubber under the knees sufficient to fill the popliteal
space but to create pressure.

A. TURNING PATIENT TO SIDE-LYING POSITION

Procedure and Underlying Principles:

1. Have a firm supportive mattress, use bed board if necessary (To prevent sagging of any
part of the body).

2. To move patient to one side the health care providerinserts one arm under the patient’s
head and neck while the other arm is under the shoulder. Move the upper part of the
body towards the health care provider, place your one arm under the shoulders of the
patient, the other arm under the waist and move the patient towards the health care
provider. Place your one arm under the waist and move the patient towards the health
care provider, place you one arm under the patients buttocks, the other under the knee
and move the patients to one side of the bed.

3. To get the patient in position form turning:

a. Let the patient place the arm (of the side of which he is going to turn to) addicted
with elbow flexed upward. (To avoid pressing on the arm when patient is on the
side).
b. Flex the upper leg
c. Supporting patient’s shoulder and hips, gently roll him to the side (with this support,
the health care provider has control of the patient).

4. Place a pillow under the head and the neck (To prevent lateral flexion of the neck)

5. Place the pillow under the upper arm (To prevent inward rotation of the arm and
interferences with respiration)

32
 6. Provide a hand roll for the fingers and the thumbs (To prevent extension of the fingers
and abduction of the thumb)

7. Support the legs from the groin to the floor (To prevent internal rotation and adduction
of the femur).

8. Keep the patient comfortable.

C. FACE-LYING POSITION

Procedure and Underlying Principles;

1. Provide a firm supportive mattress (Sagging mattress do not promote good body
alignment)

2. Turn patient to one side

3. Place patient on his abdomen with arms at side or flexed at the elbow and extended
upward and turned to one side.

4. Move the patient down in bed so that his feet are over the mattress or support his lower
legs on a pillow just high enough to keep the toes from touching the bed (To prevent
plantar flexion).

5. Place the sponge rubber pads under the shoulders if necessary (To prevent forward
hunching)

6. Place a small pillow under the head (To prevent flexion of the cervical spine).

7. Place a small pillow or some other suitable support under the patients between the end of
the rib cage and the upper abdomen if this facilitation breathing and there is a definite
space there. (To prevent hypertension of the spine and to prevent impairment of
respiration).

8. Keep patient comfortable

D. MOVING PATIENT FORM BED TO CHAIR

Procedure:

33
 1. Place the chair facing and against the bed at the point near the patient’s buttocks to
receive the patient and to use as a brace.

2. Place your arms under the patient’s head and shoulders place one foot forward and rock
backward, slide the upper portion of the patient’s body to the edge of the bed.

3. Place your arms well under the patient’s axilla from the rear (The patient’s head and
shoulders will be resting on the health care provider).

4. Move around to the back of the chair. Lean against the back of the chair to keep it from
moving and pull the patient into the chair.

5. Lower the patient’s feet to the floor

MOVING PATIENT FROM CHAIR TO BED

Procedure:

1. Bring the chair to the side of the bed so that the patient is facing the center of the bed.

2. Stand to one side of the chair and behind the patient, Place the arms well under the axilla
and bring patient close to yourself (This enables the health care provider to use the long,
strong muscles of the arms and shoulders).
3. Place the foot that is near the chair, back and the other foot forward, come close to the
patient and using a strong rocking upward motion, quickly lift the patient’s trunk out of
the chair and onto the bed.

4. Support the patient against the bed if necessary, while sliding the chair away with the
foot.
5. Lift the patient’s legs into the bed and place the patient in position.

F. TRANSFER OF PATIENT FROM BED TO STRECHER

Procedure and Underlying Principles:

1. Place the stretcher at right angle to the front of the bed so that it will be in position for the
carrier after they pivot away from the bed, look the wheal of the bed.

2. Arrange the persons lifting the patient according to height; with the tallest at the patient’s
head (The tallest person usually has the longest grasp, making it easier for his to support
the patient’s head and shoulders).

3. Stand facing the patient and prepare to slide the arms under him, the person in the middle
places the arm directly under the patient’s buttocks, the person at the head has one arm
under the patient’s head, neck and shoulder are and the other arm directly against the
34
 middle person’s arms; the person at the patient feet has one arm also against the middle
person’s arm and the other arm under the patient’s ankle(The greatest weight is in the
area of the buttocks having the middle person’s arm spread smaller than that of the other
two persons helps to prevent strain on this person. Having the arm of the first and the
third persons touch the arms of the middle person provides additional support in the
heaviest arm).

4. Slide the arm under the patient as far as possible and get in a position to slide the patient
to the edge of the bed.

5. Place one leg forwards the thigh resting against the bed and knew flexed and put on the
internal girdles.

6. Lean over the patient and on signal, simultaneously rock back and slide the patient to the
edge of the bed(Movement is accomplished by rocking backward and attempting to sit
down; the weight of the health care provider and their arms, hips and knees move the
patient).

7. Place the arms farther underneath the patient place one leg forward, flex knee and put on
the internal griddle. Prepare to “logroll” the patient onto the chest of the three at the same
time lifting the patients from the bed(Logrolling the patient brings center of gravity of all
objects closer, thus increasing stability of the group and reducing strain on carriers).

8. Flex the knee, have one foot forward and bring body with the patient.

PUTTING THE PATIENT IN WHEELCHAIR

Purposes: 1. To assist a patient to get out of bed into a chair.

2. To change patient’s position to provide comfort.

Equipment:
1. Wheelchair
2. 2 pillows
3. One cotton draw sheet
4. Hand bell

Procedures:

1. Have patient wear gown or pajamas

2. Note pulse and respiration
3. Assist patient to sit up on bed for a short time
4. Place the wheelchair parallel with bed, back of the chair toward head of bed
5. Place footstool on side of bed where the patient can reach it
6. Help the patient to get out of bed stepping on the footstool then to the wheelchair
7. Place pillows at patient’s back or side as necessary.
8. Cover knees to feet with draw sheet if patient is in gown

35
 9. Adjust the chair and make patient comfortable
10. Give hand bell to the patient
11. After the desired time, assist patient back to bed
12. Check vital signs

Record:
1. Time patient was placed on the wheelchair
2. Patient’s condition

TURNING THE MATTRESS WITH A PATIENT IN BED

Equipment:
1. 3 large pillows
2. 1 small pillow
3. 2 chairs

Procedure:

1. Move the patient to one side of the bed, loosen bed linens and roll it close to the patient
such that the bottom sheet forms the outside roll.

2. Move the mattress toward one side of the bed so that it extends half of its width over the
bed with the support of chairs.

3. Arrange three pillows on exposed springs and lift or roll the patient onto them.

4. Another health care providerturns the mattress by rolling form head to foot.

5. Put patient back to the mattress and remove pillows, Pull mattress back to original position
on springs. Arrange sheets and make the bed.

IV. POSTURE, ACTIVITY AND REST

MOVING AND TURNING THE PATIENT IN BED

36
1. Moving the Patient Upward in Bed

A. When the Patient is able to help:

1. Explain the procedure to the patient.

2. Adjust the bed to level position and lock the wheels
3. Put the pillow against the headboard.
4. Ask the patient to flex his knees, press his feet firmly against the mattress, and
grasp the head of the bed with both hands.
5. The health care provider places one arm under the patient’s neck and shoulder,
and the other arm under the things while bedding.
6. At a given signal, the patient pulls with his feet while the health care provider
helps him to move toward head of bed.

B. When the Patient is Unable to Move:

1. Ask another staff member to help you and assume the same.
2. Facing head of bed, bend knees and hips and place one arm under patient’s neck
and shoulder and the other arm under the things.
3. Keep forearms on the bed so that the weight of the patient is not lifted.
4. At a given signal, slide the patient towards the head of the bed by shifting body
weight on foot.

2. Moving the Patient Toward You to Near Side of Bed:

1. Explain the procedure.

2. Position yourself ready to slide patient and flexing hips.
3. Place hands as far under patients as possible, lowering your body close over the
patient.
4. Rock backward shifting weight from one foot to the other as the patient slides
towards you.

3. Raising Patient to a Sitting Position:

1. Explain procedure to the patient.

2. Stand facing head of bed and place the foot nearest the bed behind you.
3. Allow patient to look his arms with you by placing his arm under yours and
around your near shoulder.
4. Use your free hand to support his shoulders and neck.
5. Raise patient slowly and gently, shifting your weight to the other foot.

37
4. Lifting the Patient Up with a Draw Sheet:

1. Two health care providers are required for this procedure.

2. Place a draw sheet or a large sheet under the patient so that the head and buttocks
are on it.
3. Roll the sides of the sheet close to the patient so that it can be grasped easily.
4. Lock the wheels of the bed.
5. Flex the patient’s knees.
6. The two health care providers stand at opposite sides near the patient’s shoulders
and chest facing the foot of the bed.
7. Having a wide base of support, hold the sheet securely at a point near the
patient’s neck and lumbar area.
8. Lean forward, then rock backward. By rocking backward, the weight of your
body slides the draw sheet and the patient up.

PLACING THE PATIENT IN VARIOUS POSITIONS OF REST

Points to Remember:

1. The patient’s body must always be in good alignment.

2. His position should be changed every 2 hours or as necessary.
3. The health care provider must bear in mind that contractures as a result of a
prolonged singular position may be a permanent deformity.
4. Learn to use the pillow properly.

1. Placing the Patient in a Back-Lying Position

1. Provide a firm supportive mattress using a bed board if necessary.

2. Place a pillow under the patient’s head and upper shoulder so that the head and
neck are in correct position.
3. Place pillows or arm supports under the lower arms so that the arms are
alongside the body. Use small rolls for the hands to grasp.
4. The feet and legs must be in good alignment by the use of footboard and that will
keep in feet at right angles with the legs.
5. Knees are barely flexed and supported by a small soft roll, sufficient to fill the
popliteal space but not to create pressure and to the exceed flexion.

2. Placing the Patient in Side-Lying Position

1. Assist the patient to flex his near arm and position it across his chest.
2. Assist him to flex knees slightly and cross the far leg over the near one towards
the health care provider.

38
 3. Place one hand under the patient’s far shoulder and the other under his far hips to
draw him towards you.
4. Roll patient gently towards you and place a pillow folded length-wise alongside
the back.
5. Go to the other side of the bed and place your hands under the hips and place the
lower buttocks towards you, doing the same with shoulder.

3. Placing a Patient in Face-Lying Position

1. Move the patient In bed so that his feet are over the mattress, on support his
lower legs on a pillow.
2. Place a small pillow under the shoulder.
3. Place a small pillow under the head.
4. Place a suitable support under the patient between the end of a rib cage and the
upper abdomen as this facilities breathing.

SITTING UP A PATIENT AND DANGLING

I. Definition:

It is a preparation for getting the patient out of bed for the first time after a prolonged
illness or after surgery.

II. Purposes:

1. To prepare the patient for ambulation.

2. To help bring about normal functions of the body.

III. Points to Remember:

1. Dangling the patient should be done in a show and deliberate manner.

2. Avoid raising the patient to a sitting position suddenly to prevent the brain from being
momentarily deprived of its blood supply.
3. Do not tire the patient.

IV. Procedure:

1. Bring the patient to the side of the bed.

2. Elevate the head part of the bed or assist the patient to a sitting position.
3. Ask the patient if he feels dizzy, nauseated or fatigued. Check his pulse rate.
4. If patient feels comfortable, support his shoulder and legs and pivot him around so that
his legs are off the side of the bed.
5. Ask him to dangle his legs 5-15 minutes.
6. Make him comfortable after.

V. Recording:

39
 Time and response of the patient.

ASSISTING PATIENT TO WALK

I. Purpose: To ambulate the patient.

II. Points to Remember:

Walking should be discontinued at the first sign of weakness and fatigue.

III. Procedure:

1. Help him to a standing position by placing one hand (clutoh fashion) under the arm
nearest you and place the other arm securely under the waist.
2. Allow him to stand a moment to be sure of his balance.
3. Move closely to the patient so that your hips are firmly against him.
4. Take steps slowly and in union with the patients.
5. Allow only a few steps at a time and encourage the patient to pause frequently rest.

IV. Recording:

Time and duration of the walk and any reaction of the patient.

ASSISTING THE PATIENT OUT OF BED TO WHEELCHAIR

I. Equipment:

Wheelchair robe, blanket.

II. Points to Remember:

1. Have a patient void before moving to wheel chair.

III. Procedure:

1. Put the patient’s robe on.

2. Place the locked chair facing and against near the patient’s buttocks.
3. Slide the upper portion of the patient’s body to the edge of the bed. This makes the
patient lie diagonally on the bed.

VI. Red Boards:

Purpose: to prevent exaggerated curvatures of the spins and flexion of the hips.

40
 TEMPERATURE

Temperature is defined as the degree of heat maintained by the body. It is the balance maintained
between the heat procedure as this result of the oxidation of food, and the heat lost, through
perspiration, respiration, conduction, conviction, radiation and excretion.

Radiation is the transfer of heat from one object to another without contact between the two and
without a transfer medium.

Conduction is the transfer of heat through air or a liquid.

Evaporation is the process by which a substance is changed from a liquid to gas.

Normal body temperature is 37oC or 98.6oF by mouth or when taken orally; rectal temperature is
0.6oC (1oF) higher and axillary temperature approximately 0.6oC (1OF) lower.

Pyrexia or fever refers to elevated temperature above normal.

Hypothermia refers to temperature below normal.

Clinical thermometer is an elongated glass tube calibrated in degrees centigrade or degrees

Fahrenheit. Within the tube is a column of mercury which expands in response to heat of the
body.

Two types of Clinical Thermometer:

1. Oral- oval shape

2. Rectal- pointed tip

Route of Taking Temperature:

1. Oral- most common and convenient

2. Rectal- most accurate- children and unconscious patient.
3. Axillary- most erratic

Factors influencing temperature variations:

1. Exercise
2. Ingestion of food
3. Emotional state
4. Time of the day
5. Disease condition
6. Drugs

The Fahrenheit and Centigrade Scales Compared:

41
In the F scale, the freezing point is 32% and the boiling point of water is 212 o. In the C scale, the
freezing point is 00 and the boiling point is 100o. Hence, 1 is equivalent to 1.0 (9/5)oF.

1. To convert F to C:
Subtract 32, then multiply by 5/9
Ex. 1000F-32 x 5/9
100-32 68 x 5/9 = 340/9 or 37.80C

2. To convert C to F:
Multiply by 5/9 and then add 32
Ex. 370C x 9/5 + 32
37 x 9/5 = 333/5 or 66.6 + 32 = 98.60F

Comparison of C and F Thermometer Scales (A. Price)

Centigrade Fahrenheit
0
100 2120 (boiling point of water)
0
90 1940
800 1760
0
70 1580
600 1400
0
50 1220
0
40 1040
390 102.20
0
38 104.40
370 98.6 (normal body temperature)
360 96.80
350 950
0
30 860
200 680
0
10 500
0
0 320 (freezing point of water)
100 140
0
20 400
Fever is an abnormal condition characterize by temperature elevated above normal.

The Course of Fever is divided into 3 Steps:

1. Invasion or onset- period during which the temperature rises until it reaches the
maximum.
2. Stationary, fastidious or stadium – period during which the temperature remains more or
less the same.
3. Decline or defervesce- period during which the temperature goes down until it reaches
normal. If this occurs suddenly it is called crises, if gradually it is called lysis.

Identification of Fever:
42
 1. Continues fever is that type diurnal variations is slight pneumonia.
2. Remittent fever is that type in which the diurnal variation marked, but the minimum
temperature is still above normal, (typhoid fever).
3. Intermittent fever is that type in which the diurnal variations is marked and the minimum
temperature is normal or subnormal (malarial fever).Pulse is the rhythmic expansion of
an artery produced by increased volume of blood formed into it by contraction of the left
ventricle at each heartbeat.

PULSES

Average normal pulse rates at different ages: (Alice Price)

Before Birth 140-150

At birth 130-140
Adult 60-100

Factors that may cause variations in pulse rate are:

1. Age
2. Sex
3. Physique- short person more rapid than a tall one
4. Exercise
5. Food- Ingestion of food causes slight increase
6. Posture- more when standing than sitting
7. Mental or emotional disturbances
8. Increased body temperature
9. Disease
10. Drugs
11. Blood pressure- when B.P is low the pulse rate is increased in an attitude.

Common Sites for obtaining pulse:

1. Radial artery- inner aspect of the waist.

2. Temporal artery- anterior to the ear.
3. Facial artery- on the grieve of the mandible.
4. Femoral artery- on the middle of the groin over the pelvic bone.

What to determined record in the taking of pulse:

1. Hour
2. Frequency- number of pulsation in a given time.

43
 3. Force- means the strength of the pulse.
4. Regularity
5. Pressure- the force exerted by the blood against the walls of the artery.

Kinds of Pulse:

1. Intermittent- regular pulse on irregular intervals.

2. Water- hammer or Corrigan’s pulse is an abnormal condition characterized by a quick
powerful act beat which suddenly collapses.
3. Tachycardia- excessive of pulse rate results.
4. Bradycardia- abnormal decrease of pulse rate
5. Dichotic- when pulsations are as if divided, the second part of the beat being weaker
than the first.
6. Arrhythmia- absence of rhythm
7. Thread pulse is one that is fine and scarcely perceptible.
8. Infrequent pulse is one which is abnormally slow.
9. Apical- pulse connected by auscultation of the chest below the nipple where apex of
heart is located.
10. Pulse deficit- the difference between radial pulse beat and apical pulse rate.

Procedure:

Place the second and third fingers over the artery, making slight pressure. Observe the
general character of the pulse them count the number of beats occurring in one minute by
counting for the first half and then the second half of the minute.

Precautions:

1. Do not make too great pressure.

2. Do not use the thumb to feel the pulse.
3. Allow the arm to bind rest when taking the pulse in the radial artery.
4. Be sure that the artery is not constricted.

RESPIRATION

Respiration is the process by means of which the body obtains oxygen and gets rid of the carbon
dioxide produced in the tissues.
V. OBSERVATIONAL SKILLS
TAKING T P R (Temperature, Pulse rate and Respiratory rate)

I. Purpose: To obtain knowledge of patient’s condition and thus aid in diagnose.

II. Points to Remember:

1. The patients must be at rest both physically as well as mentally.

44
 2. The bulb of the thermometer must be under the tongue and the lips must be tightly closed
while the thermometer is in the mouth.
3. The patients must not have taken anything hot or cold or smoked for at least 30 minutes
before the temperature is taken.
4. If there is any doubt as to the accuracy of the temperature, take it again with another
thermometer.
5. Should the thermometer be accidentally broken in the mouth, notify the physician and
observe the patient.

III. Equipment’s:

Thermometer tray with:

1. Clinical thermometer
2. Vaseline or mineral oil
3. Clean dry cotton balls
4. Cotton balls with alcohol
5. Watch with second hand
6. Notebook and pencil

IV. Procedures:

ORAL TEMPERATURE

Contraindications for oral temperature:

1. When there are sores in the mouth.

2. When the patient is unconscious, delirious, hysterical, irrational or unable to cooperate.
3. When the patient cannot breath through his nose for a continues period of time.
4. When the patient is below 10 years old.

Procedures:

1. Bring the thermometer tray to the bedside of the patient.

2. Explain what you are going to do.
3. Remove the thermometer from the alcohol or aq. Zephiran solution and wipe it dry with a
firm rotating motion with a clean dry cotton ball from bulb or thermometer upward.
4. Grasp the thermometer firmly with thumb and forefinger and with a strong movement
shake the thermometer until the mercury reaches 350C.
5. Read the thermometer by holding it at eye level rotating it between the fingers until the
mercury line can be seen clearly.
6. Place the mercury bulb of the thermometer under the patient’s tongue and instruct him to
close his lips tightly.
7. Leave the thermometer in place for 5 minutes.

45
 8. Remove the thermometer and wipe it from the fingers down to the bulb in firm rotating
motion.
9. Read the thermometer.
10. Shake thermometer until mercury reaches 350C.
11. Washthethermometer with soap and water and soak in solution.

TAKING PULSE

1. While the thermometer is in place, count the pulse.

2. Have the patient rest his arm alongside his body with the wrist extended and the palm of
the hand downward (or put the arm of the patient across the chest with the palm of the
hand downward).
3. Place the first, second and third finger along the radial artery and against the ulna; rest the
thumb and the back of the patient’s wrist.
4. Apply a sufficient pressure so that the patient’s pulsating artery can be felt distinctly.
5. Using a watch with a second hand, count the number of the pulsation for a full minute.
Note the volume, rhythm and tension of the pulse.

C. Respiration

1. While the fingertips are still in place, after counting the pulse, observe the patient’s
respiration.
2. Note the rise and fall of the patient’s chest with each respiration.
3. Using a watch with a second hand, count the number of respiration for a full minute.

D. Rectal Temperature

Points to Remember:

1. Rectal temperature is taken in patients who are:

a. very ill
b. infants and young children
c. irrational, uncooperative and unconscious

2. Contraindications

a. when the rectum is operated, inflamed or diseased

b. impacted with fecal material

3. The rectal thermometer should be well lubricated to prevent injury to one’s rectum and to
minimize stimulation of the rectal muscles.

46
 Procedures:

E. Axillary Temperature

Points to Remember:

1. The axillary method of taking temperature should be avoided if it is possible to use

either the oral or rectal method.
2. The axilla should be dry.
3. Of the three methods, this is the least accurate.

Procedure:

1. Assess the client’s skin if it’s warm to touch.

2. Assess for most appropriate site to check the temperature.
3. Wash hands.

4. Gather the equipment needed.

5. Identify the client and explain the procedure.

6. Wipe the thermometer form bulb to stem with a firm twisting motion.

7. Shake the thermometer with strong wrist motion until mercury is down to lowest
marking.

8. Assist the client in a supine or sitting position.

9. Raise the client’s arm away from the torso, insert the bulb into the center of axilla,
lower arm over bulb and place across client’s chest.

10. Leave the thermometer in place for 5 – 10 minutes.

11. Remove thermometer and wipe off any secretion from stem toward the bulb with a
rotating motion.

12. Read the thermometer at aye level.

13. Wash the thermometer with soap and water, dry and shake and return to container.

14. Assist the client in replacing clothing or gown.

15. Wash hands.

16. Evaluate the temperature taken.

V. Charting and Recording

1. Record the TPR in the graphic sheet and use the following:

47
 a. T- blue or black ink
b. P- red ink
c. R- blue or black ink

2. In the health care provider’s notes, record:

a. an abnormal temperature indicating time taken, duration and any nursing

intervention done and its effect.
b. abnormal pulse- time taken, rhythm, rate, and volume
c. abnormal respiration- time taken, rate rhythm and volume

TAKING BLOOD PRESSURE

I. Procedure:

1. Assess the client’s physical condition.

2. Assess for factors that affect blood pressure.
3. Determine the client’s baseline blood pressure.
4. Wash hands.
5. Gather the equipment needed.
6. Identify the client and explain the procedure.
1. Place the client in a comfortable position (lying or sitting)and position the arm at the
level of the heart.
2. Place the cuff at the center observing at leas 1 to 2 inches above the inner aspect of the
brachial artery.
3. Wrap cuff around the arm smoothly and snugly.
4. Feel the pulse beat over the inner aspect of the elbow with the use of the fingertips.
5. Place the stethoscope earpiece and close screw valve on the air pump.
6. Palpate brachial artery, close valve and compress bulb to inflate cuff to 30 mmhg.
7. Release the valve (deflating) on the cuff slowly so that the pressure goes down at the
rate of 2 – 3 mmhg/ sec. listen to the sound (first distinct loud muffling sound is
systolic).
8. Continue to release the air evenly and slowly (last soft muffling sound is diastolic
pressure)
7. Deflate cuff rapidly and complete after the final sound has disappeared.
8. Clean and store the equipment.
9. Wash hands
10. Evaluate the nature of the blood pressure.
11. Evaluate the client condition.
12. Record the result taken.
II. Charting and Recording:

1. Record the blood pressure in the graphic sheet under the TPR or in the Blood
Pressure Sheet.
2. Record the first loud sound heard as the systolic and the last loud sound as the
diastolic.

48
 3. Any abnormal blood pressure should be recorded in the health care provider’s notes
indicating the time taken, any accompanying symptoms, nursing interventions done
and their affect.

CARDIAC RATE

Purpose:
1. To determine the number of heat beat per minute.

Equipment’s:
Stethoscope
Wristwatch with second hand

Procedures:
1. Explain the procedure to the patient.
2. Instruct the patient to assume a sitting or lying position.
3. The four areas for auscultation of heart sounds are:

a. 2nd right intercostal space

b. 2nd left intercostal space
c. midclavicular line in the 5th left intercostal space
d. lower end of the sternum

Place the bell of the stethoscope on any of the above areas.

4. A heart beat is heard as ‘lubb-dubb’ and is counted as one.

5. Count the beats for one whole minute and record.

TEMPERATURE RECORD
(Temperature Record form on the next succeeding page)

ASSISTING WITH PHYSICAL EXAMINATION

49
I. Purpose:

To prepare the patient for a general examination in such a way that complete exposure of the
patient not to made with the least discomfort and exposure of the patient as possible.

II. Points to Remember:

1. Prepare the patient physically and emotionally.

2. Assist the physician or may perform procedure herself.
3. Help the patient assume the desired position during the examination.
4. Screen patient to provide privacy
5. Drape the patient.
6. Explain the procedure to the patient in order to relax and put the patient at ease.
7. Do not leave the patient, especially a female patient, alone with a male doctor.

III. Procedures:

A. Head and Neck (Examination of the eye, ear, nose and throat)

1. Prepare the following:

Ophthalmoscope
Orthoscopic
Tongue depressor
Ear speculum
Flashlight
Nasal speculum
Head mirror or droplight
Cotton applicator (sterile)
Sterile test tube for nose and throat
Cultures

2. Position patient either in a sitting or supine position

3. Turn patient’s head to the side for ear examination.
4. Examine mouth and throat, provide more light
5. If a nose and throat culture is to be done, open the sterile test tube and with the aid of
sterile cotton applicator, swab the throat taking care not to contaminate the mouth of the
test tube and the applicator.
6. Label the specimen (test tube) accurately and send to the laboratory immediately after the
examination.
7. Wash equipment and return to their proper place.

B. Examination of the Chest and Back:

1. Prepare a stethoscope.
2. Position patient either in a lying or sitting position.

50
 3. If the patient is in a lying position, turn back the top sheet exposing the patient from the
waist up.
4. For back examination, turn patient to his side if in a lying position or assist the patient to
sit up.
5. Instruct patient to take a deep breath or to cough as needed.
6. Turn patient’s head away from you when coughing.

C. Examination of the Abdomen:

1. Place patient in a dorsal recumbent position.

2. In a female patient, fold back the gown up to below the diaphragm and turn back the top
sheet to the public area.
3. In a male patient, fold back the pajama top up to below the diaphragm and the pants up to
the public area.
4. Raise both arms over the patient’s head and instruct him to breathe through the mouth
when asked to do so.
5. Palpate the abdomen for tender area, hardness, sizes, and position of the organs and for
new growths.

D. Examination of the Extremities (Neurological Examination):

1. Patient maybe lying down, standing or sitting at the edge of the bed with legs
dangling.
2. In a lying position, untuck the foot part of the top sheet and fold back up to
above the knees. Expose only one extremity at a time.
3. Support the legs when they are being tested for reflex.

POSITIONING AND DRAPING THE PATIENT

Positioning a Patient for Examination

1. Erect position – normal standing position

2. Dorsal, backlying or supine position – the patient lies flat on his back with or
without pillow.
3. Dorsal Recumbent position:
a. The patient lies on her back with legs separated and flexed
b. Rest the soles of the feet flat on the bed or table
4. Lithotomy Position
a. This is done on the examining table
b. Place the patient on a dorsal recumbent position
c. Bring the buttocks to the edge of the table
d. Flex the knees and support the legs

5. Sim’s (lateral) position

a. Put the patient on either side, preferably to the left side
b. Rest his left arm behind his body

51
 c. The right arm is placed forward, flex the elbow and rest it on a
pillow placed under the patient’s head
d. Incline the body slightly forward and flex the knee sharply on the
abdomen.

6. Knee chest (Genupectoral) Position

a. Turn the patient on his stomach
b. Place a pillow under his head and turn it to one side
c. Place the arms above the head and rest alongside the patient’s head
d. Place the lower legs perpendicular to the thighs

Draping a Patient in a Dorsal Recumbent or Lithotomy Position:

1. Untuck the foot part of the sheet.

2. Bring the top sheet diagonally so that one corner of the sheet is over the chest of
the patient.
3. Place the patient in a dorsal recumbent or lithotomy position.
4. Using the corner of the sheet that is farthest from you, drape the other extremity.
5. Using the corner of the sheet (nearest you) drape the other extremity.
6. Turn back the part of the sheet into the middle corner to expose the genitalia.
Adjust draping so as to expose only what is necessary.

NORMAL VALUES FOR LABORATORY EXAMINATION

Drastic Analysis:

Quantity (after Ewalds test) -60-100CC.

Color -Faintly yellow

Reaction -Frank acidic
Order -Sour
Fee HCL -25-50 degrees
Total acidity -50-100 degrees
Combined NCL -10-15 degrees

Duodenal Contents:

Trypsin -0.5 – loc. Of 10th N KOH/ cc

Amylase -1 – 1.7 gm of maltose/cc
Lipase -12-125 cc. of 10th N NaOH/CC

52
  
Blood:
Quantity -6 liters
Reaction -pH 7.4
Sp.Gr. -1.045-1.075
Bleeding time -1-3 minutes
Clot retraction -begins in 1 hr. complete 24 hours
Coagulation time -4-12 minute
ESR (Win Trobe) -0-mm/l hr. (male)
10-20mm/l hr.(female)
Fragility (1% NaCl) -begins at 0.45 – 0.39
Complete in 0.33 -0.30
Prothrombin time - 12-17 sec.
MCH -27-31 mi. mcg.
MCHb conc. – 27-32/100 cc of packed rbc
MCV -82-92 cu. Mic.
Hematocrit - 40-54% male
-37-47% female
Hemoglobin -14-17 gms.%
RBC -4.5-5 billions
Platelets -200-400 thousands
 
WBC:
Lymphocytes -5-10,000
Monocytes -25-35%
Basophils -2-6%
Eosinophils -0.25-0.5%
Enutrophils -60-70%
Myelocytes -0%
Juveniles -0-1%
Stabs -3-5%
Segmenters -51-67%

Blood Chemistry:

Albumin, serum -3.5-5.5 gms.

Ammonia, serum -0.15-3 mg/100 cc
Amylase, serum -less 50 units/100 cc
A/G ratio -1.5: 1-3:1
Bilirubin, total, serum -0.1-0.8 mg/100 cc

53
Calcium, serum -9.11 mg/100 cc
Chlorides, serum (as CI) -600-800 mg/100 cc
(asNaCl) -576-612 mg/100 cc
Cholesterol, total serum -150-250 mg/100 cc
Cholesterol, ester, serum - 50-75% of total cholesterol
Copper, serum -80-160 mg/100 cc
CO2 serum content -50-70 vol.%
CO2 comb. Power -50-65 vol.% or 21-30 mEq/B.
Creatine serum -1-2 mg/100 cc
Fat, neutral, serum -150-300 mg/100 cc
Fatty acid -380-465 mg/100 cc
Fibrinogen, plasma -0.2-0.4 mg/100 cc
Globulin, serum -1.5-3 mg/100 cc
Icterus index, serum -4.7 units
Iron, serum -80-180 mg/100 cc
Iodine, protein, bound -4-8 mg/100 cc
Lipase, serum -less than 0.3 cc of 10th N NaOH/cc
Lipids, total, serum -450-850 mg/100 cc
Magnesium, serum -2-3 mg/100 cc
Oxygen capacity, blood -81-22 vol.%
Phosphatase alkaling (serum) - 5 bondanskyi=unit/.100 cc or
- 14 king and Armstrong units/100 cc

Phosphatase acid (serum) - 2 Bondasky units/100 cc or

5 King and Armstrong units/100 cc
Phospholipids, serum - 230-300 mg/100 cc
Proteins, total, serum -6.5-8 mg/100 cc
Sodium, serum -137-143 mE q/L
Sulfates, inorganic, serum -0.5-1.5 mg/100 cc
Urea nitrogen, serum -10-20 mg/ 100 cc
Uric acid, serum -3-6 mg/100 cc

Bone Marrow: Range in % Ave. in %

Hyeloblasts -0.3-5 2.0

Promyecytes -1.0-8.0 5.0
Myelocytes: Neutrophilic -5.0-19.0 12.0
Eosinophilic -0.5-19.0 1.5
Basophilic -0.0-0.7 0.3
Metamyelocytes (juvenile) -13.0-32.0 22.0
Polymorpho: Neutrophil -70.0-30.0 20.0
Eosinophil -0.5-4.0 2.0
Basophil -0.0-0.7 0.2
Lymphocytes -3.0-17.0 10.0
Plasma cells -0.012-0 0.4
Monocytes -0.5-5.0 2.0

54
Reticulum cells -0.2-2.0 0.2
Megakaryocytes -0.03-3.0 0.4
Propermoblasts -1.0-8.0 4.0
Normablasts 7.0-32.0 18.0

Feces:

Quantity - 100-200 mg/24 hrs.

Dry matter - 23-32 gm.
Water content - 65% approx.
Reaction - Slightly acidic or alkaline
Blood - Negative
Bile - Negative
Total, fat, % of dry matter - 17.5%
Urobilinogen - 100-250/24 hrs.

Urine:

Ave. amount/24 hr. - male - 1.2-1.5 liters

-female - 1-1.1 liters
Color - pale straw to amber
Transparency - clear
Odor - aromatic
Reaction - pH 5-6.5
Specific Gravity - 1.005-1.002
Albumin - negligible traces
Acetone - traces
Ammonia - 0.5-15 gm/24 hrs.
Calcium - 0.1-1.7 gm/24 hrs.
Creatinine - 0.3-0.45 gm/24 hrs.
Chloride - 10-0.15 gm/24 hrs.
Nitrogen , total - 10-0.16 gm/24hrs.
Phosphase - 2.5-3.5 gm/24 hrs.
Sugar -negligible traces
Urea -20-30 gm/24 hrs.
Uric acid -0.6-0.7 gm/24 hrs.
Urobilin -up to 1:20 dilution
Urobilinogen -less than 0.4 mg in 24 hrs.

Cerebrospinal Fluid:

Quantity -60-150cc
Color -colorless clear
Reaction -slightly alkaline
Sp. Gr. -1.002-1.008
Pressure -100-200 mm. of water

55
 Cells -0-8/cu mm all lymphocytes
Calcium -4-6 mg/100 cc
Chloride (NaCl) -720-750 mg/100 cc
Glucose -45-65 mg/100 cc
Phosphatase (inorganic) -1-2 mg/100 cc
Protein -15-45 mg/100 cc

Cerebrospinal Fluid:
Function Tests:

BMR -105 to 10%

Bromsulfalein -less than 5% in serum after 45 min.
Cephalin cholesterol floc. -no ppt.
PSP -45-75% in 2 hrs.
Thymul turbidity -4 units or less
Radioactive iodine uptake -15-4% of adm. dose
SGOT -8-40 units
SGPT -5-35 units
Urea clearance -54 cc of blood cleared by 1 cc of urine in 1 min.
Regurgitation -direct
Van dan Berg -retention-indirect

Cross Agglutination:

Red Cells of Group Serum of Group:

O AB B AB

O ………………. __ __ __ __
A ………………. * __ * __
B ……………….. * * __ __
AB ……………... * * * __
*- Agglutination ___ No agglutination
Radioactive iodine uptake -20-5% of administered dose
Venous pressure, peripheral vein 60-120 mm. water

VI. APPLICATION OF HEAT AND COLD

HOT WATER BOTTLE/BAG

APPLICATION OF HOT AND MOIST COMPRESS

Definition:

56
 A local application of heat with the use of moist gauze or pad.

Purposes:

1. To relieve pain caused by spasm.

2. To produce changes in the blood vessels and underlying tissues.
3. To localize infection.
4. To hasten suppuration.

A. Application to a Sterile Area:

Equipment:

1. Tray with sterile dressing containing:

a. enamel with hot and cold

b. enamel cup with alcohol
c. two pairs of forceps
d. sponge—size depends upon the area to be covered

2. Treatment rubber sheet

3. Hot water bag without cover
4. Table protector

Procedure:

1. Assemble and prepare equipment in the utility room. Open sterile tray and place hot
water in a bowl then place cup with medicine ordered in it. Place forceps and sponge
inside the tray and close. Other unsterile articles are placed outside the tray.
2. Prepare the patient. Expose area for application.
3. Wring from enamel cup the sponge using forceps. Place compress to area.
4. Place rubber sheet on top of sponge. Fasten with bandage if necessary.
5. Place water bag over the compress to maintain the heat.
6. Duration of application usually lasts for 15 minutes.

Record:

1. Time of application.
2. Area applied.
3. Signature.

B. Unsterile Area

57
Equipment:

1. Basin 5. Hot water bag without cover

2. Pitcher 6. Bandage
3. Gauze or wash cloth 7. Enamel tray
4. Treatment rubber sheet 8. Table protector

Procedure:
1. Assemble equipment in the utility room.

a. Place gauze in a basin then pour hot water.

b. Wring till moist.
c. Wrap in a treatment rubber sheet and place in enamel tray.
d. Place hot water bag over it.

2. Take tray to bedside.

3. Expose area to be applied.
4. Place rubber sheet over it and place hot water bag without cover. Fasten with bandage if
necessary.
5. Make patient comfortable.
6. Wash, clean and dry equipment after.

Record:

1. Time of application.
2. Area applied.
3. Signature.

Note:

1. For “cold compress” do not warm solution. Place ice bag without cover over the
compress to maintain temperature of the compress. Ice water may be used for unsterile
area.
2. For other areas of the body, the procedure should be sterile if there is an open lesion.
3. For acute infectious diseases, isolation technique should be carried out.

PREPARATION AND APPLICATION OF ICE CAP

Purposes:

1. To reduce inflammation, temperature and swelling.

2. To slow metabolism.
3. To relieve pain, to reduce congestion.

58
 4. To control bleeding.

Special Considerations:

1. Cold contracts blood vessels and is used to prevent suppuration.

2. Ice bags need to be refilled.
3. Cover ice caps.
4. Observe for bluish or mottling of the skin.
5. Avoid chilling the patient.
6. Be sure ice cap is in good condition.

Equipment:

1. Ice cap and cover

2. Ice chips

Procedure:

1. Fill ice cap with ice chips.

2. Expel the air.
3. Screw cover of cap and test for leakage.
4. Wrap bag with cover.
5. Bring to patient and apply to area.
6. Refill when ice has melted.

Care of the Equipment:

1. Remove water or ice from the bag.

2. If used by a communicable patient, soak in Lysol solution for one hour. Then rinse
with cold water. Dry, inflate and hang to be aired.

Record:

1. Area applied.
2. Reaction and effect to patient.

COLD PACK

It consists of the general application of cold by means of wrapping the patient’s body in
the sheets wrung from the water with a temperature of 40-70° F.

Purposes:

59
 1. To reduce temperature.
2. To aid in elimination.
3. To sedate the patient.
4. To stimulate circulation.

Special Considerations:

1. Avoid exposure to the patient.

2. Do not leave the patient alone during the pack.
3. Take TPR before and after the treatment.
4. Dry patient very well after the procedure.
5. Observe for symptoms like: cyanosis, chilling and increased pulse rate.

Equipment:

2 blankets ice cap

1 large rubber sheet basin
HWB with cover 2 towels (1 bath and 1 treatment)
2 sheets (1 folded lengthwise, face towel or cloth
1 folded crosswise) screen, prn

Procedure:

1. Bring all preparation to bedside.

2. Close the doors. Explain treatment to patient. Take TPR.
3. Soak fan-folded sheets in a basin of ice water.
4. Remove the gown.
5. Replace top sheet with a blanket.
6. Turn patient to one side and slip one bath blanket lined with rubber sheet under the
patient.
7. Wring the sheet (fan-folded lengthwise) from the ice water and spread it under the
patient. Wring the other sheet (fan-folded crosswise) and spread it over the patient’s
body.
8. Place a towel around the neck.
9. Wrap the patient’s body with rubber sheet and blanket.
10. Pull up top covers. Place ice cap on head.
11. While the patient is inside pack, sponge face frequently and check pulse and color.
12. If no untoward reaction is noted, allow patient to stay in the pack for the time
recorded.

How to Remove the Pack?:

1. Remove pack under cover.

2. Turn patient to one side.

60
 3. Roll the pack from each side to the center and fold it over from the top and bottom to
the center to confine the water.
4. Place hot water bag to feet and ice cap on head.

After Care of Patient:

1. Keep the patient between blankets after the treatment.

2. Take TPR 30 minutes after treatment.
3. Dry patient well. Apply alcohol, dry and powder, if desired.
4. Serve hot drinks if patient desires.
5. Leave patient in comfortable position.

After Care of Equipment:

1. Take all linens from room and return to proper places.

2. Clean all other equipment used.

BAG TECHNIQUE

I. Definition – bag technique is the procedure of putting out things for nursing care
and returning them after use.
II. Purpose of Bag Technique:
a. To minimize if not prevent the danger of the spread of any infection.
b. To work efficiently and rapidly using technique as a tool to save time and
effort.
III. Minimum Contents of the Bag:
1. Forms:
a. Child’s Record
b. Clinical record
c. Maternity record
d. Birth Certificate form
2. Dressings:
a. Cord dressing
b. Sterile square gauze
c. Cotton balls
d. Cotton pledgets
3. Instruments:
a. Forceps
b. A pair of scissors (mayo)
4. Bottles of:
a. Aromatic spirit of ammonia

61
 b. Tincture of Merthiolate
c. Alcohol 70%
d. Liquid soap
e. Boiled water
5. Thermometer:
a. Oral
b. Rectal
6. Kidney basic
7. Soap dish with soap
8. Hand towel
9. Cloth lining or plastic lining
10. Apron
11. Paper bag
12. Paper lining

NOTE: Others may be added like test tubes, medicine droppers,

Benedict’s solution, acetic acid, etc., depending upon the needs.

IV. Procedures:
1. Assess the completeness, neatness, cleanliness and availability of bag contents and its
proper arrangement

2. Determine the needs of the client on the basis of findings during the home visit.

3. Prepare all the equipment needed.

4. Upon arrival at the client's home, place bag on a table or any flat surface lined with a
paper lining.
5. Ask for a basin of water. Place thisoutside the work area.
6. Open the bag. Take out the plastic lining and spread over the work field.
7. Take out the hand towel, soap dish and apron. Place them on one corner of the work area.
8. Do hand washing. Wipe dry with hand towel.
9. Put on apron right side out and wrongside touching the body.
10. Take out things that will be mostlyneeded for a particular case and place in one corner of
the of the work field.
11. Place waste paper bag outside work area.
12. Close the bag.
13. Proceed to the specific nursing caretreatment.
14. After completing nursing care ortreatment, clean and sanitize all equipment used.
15. Do hand washing again.
16. Open the bag and put back all articles in their proper places.
17. Remove apron.

62
18. Fold the plastic lining. Clean and place it in the flaps of the bag and close it .
19. Make post visit conference
20. Reassess and evaluate the comfort of the client after the nursing care.
21. Look for other needs of client or family pertaining to their living condition.
22. Record/document all the nursing care and treatment that have been done to the client and
family.
23. Write anecdotal report pertaining to the health status of other members of the family if
there is any.

Thermometer Technique

A. Oral Thermometer Technique:

1. Shake thermometer till mercury registers 35 degree C or 95 degree F. (Case

should be left in bag.)

2. Rinse thermometer with clean water before using. (This moistens the thermometer
and gives a smoothing effect too) and place under patient’s tongue, keep it there
for 2 minutes.

3. Remove and wipe the thermometer with a piece of dry cotton ball, then record
temperature, and record it after giving the nursing care.

4. Cleanse thermometer. The thermometer is held over the paper bag and cleansed
with a downward spiral motion.

First – with a cotton ball moistened with liquid soap.

Second – with a cotton ball moistened with cold water.
Third – With cotton ball moistened with alcohol and wrap the thermometer
around this piece of cotton. Leave it on the kidney basin or soap dish cover.

5. Continue with other nursing technique or treatment.

6. Wash hands.

7. Return thermometer to its case in the bag. Wipe other equipment with alcohol.

Note: Used thermometer may be soaped then rinsed under running water if
available.

8. Record temperature.

63
 B. Rectal Thermometer Technique
Use the same technique as above, but instead of moistened the thermometer with
water before using, lubricate with either oil, Vaseline or soap.

Guide in Planning a Home Visit

1. Definition: A home visit is a contract made by the health care provider to or in behalf of a
case to further a special activity of the agency.
2. Purpose:
1. To give nursing care to the sick, to a postpartum mother and a newborn with a visit of
teaching a responsible number of the family to give subsequent care.
2. To find out living condition of the patient and family in order to fit in health teaching
needs.
3. To teach health practice, prevention of disease and correction of defects for better
living.
4. To supervise home sanitation and health practices.
5. To detect, help prevent and report the presence of communicable diseases.
6. To establish close relationship between the health agency and the public for the
promotion of public health.
3. Outline:
1. Objectives
2. Nursing care to be done or to be given
3. Health teachings
4. Future plan (clinic or home visit appointment)
4. Preparation:
1. Determine cases to be visited and study their records.
2. Write down a plan of the visit in your pocket book.
3. Check contents of the bag and prepare all the necessary articles needed for nursing
care.
4. Provide yourself with pen, watch, and umbrella.
5. Sign out in notebook for whereabouts.
5. Procedure:
1. Greet patient, introduce yourself and companion if any
2. State purpose of visit.
3. Converse with patient and try to establish rapport.
4. Determine the needs of the parents.
5. Give the necessary nursing care or demonstrate any health teaching.
6. Record all important data in small notebook. (Record should be not brought cut to
the field)
7. Make appointment for either a return home visit or a clinic visit as needed. Bid
goodbye.
6. Guide in recording a Home Visit:

64
 1. Observations:
a. Physical condition (general appearance and health condition)
b. Housing condition and environment (may be omitted in succeeding visits if no
change observed)
2. Complains given if any
3. Nursing care given
4. Health teachings
5. Future plan (clinic or home visit appointment, etc.)
6. Signature of visiting health care provider
7. School under name. Ex. SJDH

Factors to Consider in Giving Health Teaching

1. Needs of patient
2. Educational background or level of understanding
3. Financial status
4. Likes and dislikes
5. Religion
6. Availability of supply (ex. Foods in season)
7. Beliefs, customs and habits.
8. Frequency of Home Visits: Depends upon the needs of the patient

I. Pre- Conference Interview

1. Fill up identifying information
2. State condition of patient and history of present illness in brief and clear words. State
also action taken by: Examples: For consultation, a 6 years old child accompanied by
mother looking pale and week. Fever started 3 days ago accompanied by vomiting
anorexia, and dizziness. Mother gave espilets, 2 tabs, every 4 hours but fever did not
subside, for vomiting, ice cubes give. Given fluids most of the time.
3. Chart- TPR for children and adults
BP for adults
Post- Confe Wt. if needed for long term illness.

II. Post- Conference Interview:

1. Interpretation of doctor’s diagnosis and orders’ if not well understood. (Free
medicines may be given if available.)
2. Nursing rendered if any.
3. Health Teachings and motion to be taken.
4. Appointment for follow-up if needed
5. Signature of the health care provider

II. THE SURGICAL SCRUB

65
 Definition:

The Surgical Scrub is the process of removing as many microorganisms as

possible from the hands and arms by mechanical washing and chemical antiseptics before
participating in an operation.

Microorganisms

The skin is inhabited by:

1. Transient organisms- acquired by direct contact usually loosely attached to the
skin surface, they are almost completely removed by through washing with soap
or detergent and water.
2. Resident organisms- below the skin surface in hair follicles, and in sebaceous and
sweat glands. They are more adherent, therefore more resistant to removal. Their
growth is inhibited by the chemical phase of the surgical scrub. Resident skin
flora represents the microorganisms present in the hospital environment. They are
predominantly gram-negative but some are coagulase-positive staphylococci.
Prolonged exposure of skin to contaminants yields a more pathogenic resident
population.

In freeing the skin of as many organisms as possible, two processes are utilized;
1. Mechanical: removes soil and transient organisms with friction.
2. Chemical: reduces resident flora and inactivates microorganisms with a
microbicide or antiseptic agent.

Purpose

The purpose of the surgical scrub is to remove soil, debris, natural skin oils, hand lotions
and microorganisms form the hands and forearms of sterile team members. More
specifically, the purpose is:
1. To decrease the number of microorganisms on skin to an irreducible minimum.
2. To keep the population of microorganisms minimal during the operative
procedure by suppression of growth.
3. To reduce the hazard of microbial contamination of the operative wound by skin
flora.

Agents for Antiseptics

Various antimicrobial (antiseptic) detergents are used for the surgical scrub. The agent
must:
1. A broad- spectrum antimicrobial agent
2. Fast- acting and effective
3. Non-irritating and no sensitizing
4. Prolonged- acting; i.e., leaves an antimicrobial residue on the skin to
temporarily prevent growth of microorganisms.

66
 5. Independent of Cumulative Action

While the action of the agent is important in relation to its efficacy, mechanical friction and
effort while scrubbing are equally influential.

The most frequently used agents are:

1. Chlorgexidinegluconate-A 4% concentration of this agents exerts on antimicrobial

effect against gram-positive and gram-negative microorganisms. Residues tend to
accumulate on the skin with repeated used and produce a prolonged effect. This agent
produces effective of resident and transient flora.
2. Providence-iodine- An iodine-complex detergent, frequently referred to as an
iodophor. This agent fulfills all of the criteria for the surgical scrub, effective
cleansers; iodophors also slowly release iodine for residual effect. They are cidal with
every use and effective against gram-negative as well as gram-positive
microorganisms. The Cidal Action may be sustained for up to eight hours. Persons
allergic to iodine should not scrub with an iodophor.
3. Hexachlorophene- this type of agent is most effective after build-up of cumulative
suppressive action caused by regular use. The residual film is affective in keeping
gram-positive organisms from proliferating, but is not effective against proliferation
of gram-negative bacilli.
4. Trichlosan- a solution of 1 % triclosan is a non-toxic, non-irritating antimicrobial
agent with inhibits growth of a wide range a both gram-positive and gram-negative
organisms. It develops a prolonged cumulative suppressive action when used
routinely. The agent is blended with lanolin cholesterols and petrolatum into a
creamy, mild detergent.

PREPARATION OF SURGICAL SCRUB

General Preparations:
1. Skin and nails should be kept clean and in good condition, and cuticles uncut. If hand
lotion is used to protect skin, a non-oil-base product is recommended.
2. Fingernails should not reach beyond the fingertip to avoid glove puncture.
3. Fingernails polish should not be worn, the lacquer any chip and peel, thereby providing
a harbor for microorganisms in crevices.

PREPARATIONS PRIOR TO SCRUB

1. Inspect hands for cuts and abrasions. Skin integrity of hands and forearms should be
intact, i.e., without open lesions or cracked skin.
2. Remove all finger jewelry. Jewelry harbors microorganisms.
3. Be sure all hair is covered by headgear. Pierced-ear studs must be contained by the
head cover. They are a potential foreign body in the operative wound.
4. Adjust disposable mask snugly and comfortably over nose and mouth.

67
 5. Adjust eyeglasses comfortably in relation to mask.
6. Adjust water to a comfortable temperature.

LENGTH OF SCRUB

The length of the surgical scrub varies from institution to another, as does the scrub
procedures. Results of one study led to estimate that microorganisms are decreased 5Q percent
by each six minute scrub with a reliable agent to be as effective as a ten-minute scrub. Variations
in length may depend on frequency of scrubbing and the agent used. The individual should scrub
according to written policy of the hospital, manufacturer’s recommendations for the agent used,
and documentation of product efficacy in the scientific literature.

SURGICAL SCRUB

The procedure for surgical scrub differs from one hospital to another but the recommended
methods are applications of the principles of aseptic technique. These maybe either the time
method or counter brush-stroke method. If properly executed, they are both effective and each
exposes all surfaces of the hands and forearms to mechanical cleansing and chemical antisepsis.
One should think of the finger, hands and arms as having four sided or surfaces. Both methods
follow an anatomical pattern of scrub: four surfaces of each finger beginning with the thumb and
moving from one finger to the next, down the outer edge of the fifth finger, over the dorsal
(back) surface pf the hand, or the palmar (palm) surface of the hand , or vice versa, from small
finger to thumb, over the wrist and up the arm, in thirds ending 2 in. (5cm.) Above the elbow.
Since the hands are in most direct contact with the sterile field, all steps of the scrub procedure
begin with the hands and with the elbows.
Time Method: fingers, hands, and arms are scrubbed by allotting a prescribed amount of time to
each anatomical area or each step of the procedure.

FIVE MINUTE SCRUB:

1. Wet hands and forearms.

2. Apply six drops of antiseptic agent from dispenser to the hands.
3. Wash hands and arms several times thoroughly to 2 in. (5 cm.) above elbows. Rinse
thoroughly under running water, with hands upward, allowing water or drip from
flexed elbows.
4. Take a sterile brush or sponge (from a package or dispenser) apply antimicrobial agent
if it is not impregnated in the brush. Scrub nails and hands, a half minute for each hand.
5. With brush in hand, clean under fingernails under running water with a metal or
disposable plastic nail cleaner. Discard after use.
6. Again scrub nails and hands with the brush a half minute for each hand, maintaining
lather.
7. Rinse the hands and brush and discard the brush and discard the brush or sponge.
8. Reapply antimicrobial detergent and wash arms with friction to the elbow for three
minutes.

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 9. Rinse hands and arms as before.

BRUSH-STROKE METHOD
1. Wet hands and arms.
2. Wash hands and arms thoroughly 2 in. (5 cm.) above the elbow with antiseptic agent.
3. Clean under fingernails carefully under running water with a metal or disposable
plastic nail cleaner. Discard after used.
4. Rinse hands and arms thoroughly under running water, keeping the hands up and
allowing water to drip from the bows.
5. Take a sterile brush or sponge from a dispenser or package. Apply antiseptic agent to
the brush or sponge if not previously impregnated.
6. Scrub the nails of one hand 30 strokes. All sides of each finger 20 strokes, the back of
the hand 20 strokes for each third of the arm, to 2 in. (5 cm) above the elbow.
7. Repeat step 6 for other hand and arm
8. Rinse hands and arm thoroughly

NOTE:
1. During and after scrubbing, keep the hands higher than the elbows to allow water to
flow from the cleanest area the hands, to the marginal area of the upper arms.
2. If a person scrubs frequently, some hospitals reduce the number of strokes per scrub in
the brush-strokes method.
3. If policy dictates a ten-minute initial scrub, the five minute scrub maybe used for
subsequent operation. Once gloves are removing hands become contaminated from
contact with imamate items.
4. Avoid splashing water on scrub attire because moisture may contaminate sterile gown.

SCRUBBING FOR SURGICAL OPERATIONS

Objective:

To render hands and arms thoroughly clean.

Equipment:

1. 2 sterile brushes

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 2. 2 orange sticks
3. Phished

Procedure:

1. Before starting to scrub is sure the cap and mask are on.
2. Turn and regulate water faucets using knee control.
3. Apply a few drops of liquid soap, wash hands, forearms up to 3 inches above the elbows
thoroughly.
4. Carefully pick up an orange stick form container. Clean under and around nails.
5. Obtain sterile brush from container. Rinse brush under running water removing all
disinfectant.
6. Saturate brush with soap from dispenser.
7. Scrub one hand. Start with finger tips and fingers- scrub all four sides of each finger; the
knuckles, the hands and the wrist for one minute.
8. Repeat no.8 with other hand.
9. Scrub forearm working up to just beyond elbow for one minute. Never go back over
previously scrubbed area.
10. Scrub other hand and forearm in the above manner. Discard brush. Rinse finger tips first,
then hand and elbow.
11. Take another sterile brush, repeat scrub procedure for both hands for 2 minutes. Discard
brush.
12. Rinse hands well- finger tips to elbows. Turn off faucet using knee control. Hold hands
up with arms well away from the body- being sure that water from the elbow will not run
back to hands.

PUTTING ON STERILE GLOVES

Purpose:

To complete a sterile attire in order that the wearer may handle sterile equipment.

Two Methods:

1. Closed Techniques: It provides a means of putting on a sterile gown and gloves without
the outside of the gown or gloves touching the skin.

After scrubbing and drying the hands, the arms are spilled through the sterile gown up
to the stockinet cuff only.

Procedure:

1. With the hands inside the sleeves, grasp the sleeve cuff seams of the gown.

70
 2. With the enclosed right hand, pick up the sterile left glove and place it against the
thumb of the left hand. With the left hand, grasp the lower portion of the turned back
cuff of the glove.
3. With the opposite (right)’ covered finger, grasp the upper portion of the glove cuff and
spread it apart before pulling it down over the stockinet cuff completely enclosing it.
4. Partly pull on the glove over left hand.
5. With the gloved hand, repeat procedure for putting on the other glove.
6. Adjust glove and stockinet cuff.

2. Open technique: when putting on gloves, the health care provider should keep in mind that
the skin is only surgically clean. She should therefore never touch the outside of the glove which
will later come in contact with the operative field. Gloves are prepared with cuff folded back.

Procedure:

1. Apply powder on hands. (Avoid excess powder to fly around).

2. Pick up the right glove at the site of the turned back cuff. With the left hand, grasp the
turned back glove of the hand and pull it onto the hand, leaving the cuff folded back.
3. The gloved fingers of the right hand are inserted under the cuff of the left hand glove
and the left hand is slipped into the glove.
4. Both hands are now gloved. Fold snugly to the wrist cuff of the right sleeves of the
gown.
5. Slip the gloved finger under the cuff of the glove. While the thumb holds the wrists of
the gown, the glove is pulled over.
6. The fingers of the glove are read just and excess powder is removed.

HANDLING OF STERILE OBJECTS

I. Purpose:

1. To use sterile transfer forceps in such a way and neither the prongs of the
forceps nor the sterile equipment becomes contaminated.
2. To manage sterile covered containers in such a way that neither the container
nor the contents to be removed becomes contaminated.

II. Procedures:

A. Use of Sterile Transfer Forceps

Procedures Principles

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1. Keep only one sterile forceps in each
container to prevent accidentally touching of
the prongs of one forceps on the handle of - Liquid flow in the
another while removing from the container. direction of gravity.
- Sterile object that are out
2. When removing forceps from a container, of vision may
keep the prongs of the forceps together and accidentally touch
lift the forceps. unsterile objects and thus
- Sterile object becomes become contaminated.
contaminated when in contact with an
unsterile object

- Sterile object becomes

contaminated when in
contact with an unsterile
object.

3. Hold the forceps with the prongs pointing

downward to prevent the solution from
flowing out the contaminated area.
4. Keep the prongs of the forceps within
visions while using them.

B. Management of sterile covered container

Procedures:
1. Open the sterile pack so that the edges of the wrapper do not come in contact with anything
unsterile.
2. Remove the cover free from the container only if necessary and then open for only a short
period of time.
3. If container is a jar, lift the cover and invert it when it is necessary to place it down.
4. Consider the rim or edge of a sterile to be contaminated.
5. Do not return unused objects to the container once they have been removed.

-Air currents are capable of carrying contamination.

-Contact with unsterile surfaces contamination an object.
-Proximity of the edge of the cover to exposed surfaces makes its sterility doubtful.
-Air currents or capable of carrying contaminated

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 CARE OF THE WOUND

I. Definition: It is the care given to wounds which includes dressing, bandaging,

irrigation and the application of medication.

II. Purpose:
5. To promote wound healing
6. To remove soiled dressings, cleanse the wound and apply a sterilized dressing.

III. Points to remember:

1. The primary aim in caring for wounds is to keep clean ones from
becoming infected and to decrease the infection as rapidly as possible on
infected ones.
2. Only sterile pick up forceps are used to take sterile dressings out of
containers.

IV. Equipment:

Tray containing:

Betadine Solution
Hydrogen Peroxide
Medicine ordered
Sterile pack containing:
1 forcep, Kelly, stitch remover
Bandage and acidosis
Adhesive tape
Bandage
Pick – up forcep in Lysol solution
Kidney Basin
Old newspaper
Aspetic syringe
1 Thumb forcep

V. Procedure

1. Check doctor’s orders.

2. Check client’s dressings.
3. Check client’s unit for supplies.
4. Wash hands.
5. Prepare the environment and gather equipment needed.
6. Identify client and explain procedure.
7. Remove plaster and dressing and drape client if necessary.
8. Observe the wound.
9. Wash hands.
10. Open sterile pack observing aseptic technique.

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 11. Pour solution (if used).
12. Clean wound with antiseptic solution.
13. Apply dressing and plaster.
14. Remove gloves and place it in appropriate receptacle.
15. Assist client to a comfortable position.
16. After care.
17. Evaluate nature of wound.
18. Record unusual observation on the wound.

ADMINISTRATION OF MEDICINES

Common Abbreviation and Symbols Used in Giving Medications

I. Preparation of Drugs

Amp Ampule
Cap Capsule
Elix Elixir
Pwd Powder
Ung Ointment
Liq Liquid
Sp Spirit
Loz lozenges

II. Dosages of Drugs

III. Time of Administration:

Weights and Measure:

Metric System
Apothecaries System
Household Measures:
Commonly Used Equivalents
Dosages for Children:

74
 THE PLUSES AND MINUSES OF FIGHT DRUG ADMINISTRATION ROUTES

INTRAMUSCULAR DRUGS- in aqueous solution injected deep into the muscle are absorbed
rapidly and predictably. Parental administration is especially
useful in emergency therapy or if the patient is unconscious,
uncooperative or unable to retain anything by mouth.
Disadvantages include the need for strict asepsis limited
opportunity for the patient to medicate himself, and expense.

INTRAVENOUS- The desired blood concentration and precise amount are obtained with an
immediacy no other route for certain irritating drugs can make the affected
tissues slough. Like other parenteral routes, it is more expensive and
inconvenient.

INHALATION- Gaseous and volatile drugs may be delivered directly to the sites where
needed in certain pulmonary disease, without the delay and possible adverse
effects of a system route. Absorption by the circulation is almost
instantaneous.

MUCOUS MEMBRANES- absorption is fairly rapid through mucous membrane of the

oropharynx, nose conjunctive, urethra, and vagina. Irritating drugs
cannot be given this way.

THE RIGHT TIME suggested by Lambet:

1. Take on an empty stomach (203 hrs. a.c.) Erythromycin, Tetracycline, Penicillin

2. Take ½ before meals: Belladona and its alkaloids, Librax
3. Take with meals or food: Aminophylline, analgesics, Prednisone, Flagyl, Reserpine
4. Do not take with milk: Dulcolax, Tetracycline except Vibramycin
5. Do not drink alcohol while taking: antihistamines, Librium, Valium

CAUSES OF MEDICATION ERRORS

1. Errors in transcription
2. Giving medication to the wrong patient
3. Misinterpretation of the medication card
4. Not reading the drug label

75
5. Failure to use the medication card
6. Miscalculation and/or wrong measurement
7. Selection and administration of the wrong administration
8. Misunderstanding a verbal order
9. An incomplete or confusing medication order
10. Misreading dosage

SOURCES OF DRUG ADMINISTRATION

1. PDR (Physician’s Drug Reference)

2. PIMS (Philippine Index of Medical Specialist)
3. Pharmacology books
4. Package insert (literature) which comes with the drug or which can be requested from the
pharmacist
5. Nursing or medical periodicals (e.g. RN magazine has a medication tips section with each
issue)
6. Doctor who prescribed the drug

WITHDRAWING MEDICINE FROM A VIAL

1. Remove the safety seal and cleanse the rubber top with antiseptic (e.g. cotton ball with
alcohol).
2. Draw air equal to the prescribed dose into the syringe.
3. Insert the needle into the vial.
4. Introduced the air into the vial.
5. Withdraw the desired volume while holding the vial upside down, taking care of the tip
of the needle is in the solution.
6. Withdraw needle from the vial.

TYPES OF DRUG PREPARATIONS

Aqueous solution: One or more drugs dissolved in water

Aqueous suspension: One or more drugs finely divided liquid each as water

Tablet: A powdered drug compressed into small hard discs

Capsule: Gelatinous container (hard or soft) for powder liquid or oil drug form

Spansule: Beads or tiny particles (variably) coated particles of the active ingredient of a
substance that permit gradual release in the GI tract placed in one capsule; also called
sustained release capsules

Lozenge (troche): Preparation held in the mouth to dissolve and release the drug orally
76
 Powder: Finely ground drug or drug which may be used internally or externally

Syrup: An aqueous solution of sugar often used to disguise unpleasant tasting drugs and
sooth irritated mucus membranes

Elixir: Sweetened and aromatic alcohol solution frequently mixed with another drug

Extract: Concentrated preparation of a drug from vegetables or animals

Tincture: Alcoholic or hydro alcohol solution prepared from plant derivatives

Ointment: Semi-Solid preparation of a drug or drugs in petrolatum

Lotion: Drug in liquid suspension for external use

Plaster: Solid preparation used externally to supply heat to the body

Suppository: A drug or drugs mixed with a firm base (e.g. cocoa butter) and shape for
insertion into the body orifice; it melts at body temperature

THE RIGHT DOSE

FORMULA:

D desired stock/Sor H (Stock dose available) x Q (quantity of solution in grams/amount to be

given)

Example: A patient has been ordered to receive to receive 750,000 units of Penicillin

C Sodium (NA) intramuscular injection every six hours, Penicillin

G Na comes in vials of 1,000,000 units/vial; the patient dose

750,000/1,000,000 x 2 cc = 1.5 cc

DOSAGES FOR CHILDREN

1. Clark’s Rule Weight of child in pounds/150 (average adult weight) x Adult dose

2. Young Rule Age of child (years)/ Age of child (in years) = 12 x Adult dose

3. Fried’s Rule (for infants) Age of child in months/150 x Adult dose

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TO COMPUTE FOR THE INFUSION RATE (drops/minute) the following is utilize

Total volume of infusion x drip factor/ duration of infusion in minutes = flow rate

Example: 1000 cc x 15/ 480 mins. = 1500 = 31 drops/minute

COMMON EQUIVALENTS

1 cc………………..15 drops 240 cc………………..1 glassful

4 cc………………..1 teaspoonful 500 cc………………..1 pint

15-16 cc………………..1 tablespoonful 1000 cc………………..1 quart

200 cc………………..1 cup 4000 cc………………..1 gallon

DRUG ADMINISTRATION ROUTES

ROUTE OF METHOD OF TYPE OF EFFECT

ADMINISTRATION ADMINISTRATION
Oral Patient swallows medication Local (may have effects in GI
(most practical route) mucosa); Systemic (if
absorbed into the
bloodstream)
Non Oral

 Parenteral (via any route

injection of a drug into
other than GI tract;
however tissues when oral
route in practical usage
route is not desirable
refers to the injection of a
drug beneath the skin)
Subcutaneous may modermic Systemic
or hypodermocylysis,
injection of a drug into the
subcutaneous tissues.

Intramuscular: injection of a Systemic

drug deeper between layers of
muscle tissues

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 Intravenous: introduction of a Systemic
drug directly into the
bloodstream, by adding all
barriers to absorption

Intradermal (intracutaneous) Local

injection of a small amount
just below surface of the skin,
reducing a wheel

Intrathecal: injection of drug Local (high concentration of

into the spinal canal anesthetic or other drug in
subarachnoid space)

Intrasynovial or intraarticular Local (high concentration of

Skin or mucous membrane
Mouth, nose, throat, mucosa
injection drug in inflamed joint)
Sublingual: tablet placed Systemic
under the tongue
Buccal: tablet placed between Systemic
the tongue and cheek; local
application of anesthetic
solution in the form of a rays,
lozenges, tam dens, etc.

Snuffling Systemic
Mucosa of deeper respiratory Inhalation Systemic
assess
Rectal Mucosa Irrigation; enema or Harris Local effect, usually intended
flush
Systemic or Local
Suppository or drug in
retention enema
Genitourinary mucosa Irrigation douche, bladder Local effect, usually intended
Irrigation, Instillation,
suppositories

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HEALTH CARE PROVIDERS RESPONSIBILITIES RELATED TO MEDICINES AND
THEIR ADMINISTRATION

Care of Medicine

Regulations are in different hospitals, but regardless of the place, certain principles of
organization should be observed in the care of drugs and associated equipment.

1. All medicines should be kept in a special place, which may be a cupboard closet, or
room. It should not be freely accessible to the public.
2. Narcotic drugs and those dispensed under special legal regulation must be kept in a
locked box or compartment.
3. In some hospitals each patient’s medicines are kept in designated place on a shelf or
compartment of the medicine cupboard or room. such an arrangement means that the
health care provider must be careful to keep the patient medicines in the right area and
to make certain that when he leaves the hospital his medicines are returned to the
pharmacy, unless he is taking them with him. Many hospital require that medicines be
returned to the pharmacy for relabeling if they are to be taken home at the time of
dismissal. It is imperative that the medicine have the patient’s full name on the label of
the container. In some hospitals the medicines are dispensed wholly or in part from a
stock supply kept on the ward. Misplaced medicines and equipment can contribute to
errors in administration.
4. If stock are maintained they should be arrange in an orderly manner. Preparation for
internal use should be kept separate from those used externally.
5. Some preparations, such as serums, vaccines, certain suppositories, certain antibiotics
and insulin, need to be refrigerated.
6. Labels of all medicines should be sent to the pharmacist for relabeling. Health care
providers should not label or re-label medicines.
7. Bottles of medicines should always be stopped.

The Administration of Medicines

Experience has demonstrated that it is wise to abide by established policies and

regulations pertaining to the administration of medicines. Such regulations vary from hospital to
hospital, but principles of safety do not vary appreciably. They have been established usually to
protect patients and also to save health care providers from the traumatizing effects of errors that
other health care providers have had the misfortune to experience. This does not mean that
deviation from the rule or regulation under special circumstances is always bad judgment. The
health care providers must consider the situation carefully before departing from established
policy. It is possible she should consult with a more experienced person, such as her instructor or
the health care provider- in-charge. Policies and regulations are protective guides to live by, not

80
to be followed blindly that thinking and good sense do not enter into the making of decisions.
Safety regulations are effective only when they are understood and readily interpreted by the
nursing staff as being necessary for the patient’s protection. The following staffs are being
necessary for the patient’s protection. The following are policies or regulations that have been
found to be sound relative to the administration of medicines. They are not listed in order to
importance.

1. When preparing or giving medicines concentrate your whole attention on what you’re
doing. Do not permit yourself to be distracted while working with medicines.

2. Make certain that you have a written order for every medication for which you assume
the responsibility of administration. (Verbal orders should become written orders as
soon as possible).

3. Develop the habit of reading the label of the medicine carefully before removing the
dose from the containers.

4. Make certain that the data on your medicine card corresponds exactly with the doctor’s
written order and with the label on the patient’s medicine. A medicine card should
accompany each medicine. Sometimes skipping a dose of medicine may be as
dangerous as an overdose. It is important that for every drug listed in the Kardex there
be a corresponding medicine card.

5. Never give a medicine from unlabeled container or from one on which label is not
legible.

6. Do not administer medicines that have been prepared by some other person unless that
person is a clinical pharmacist.

7. If you must in some way calculate the dosage for a patient from the preparation on
hand and you are uncertain of your calculation, verify your work by checking with
some responsible person, an instructor, health care provider in charge, or pharmacist.

8. Measure quantities as ordered, using the proper apparatus, graduated containers for
milliliters, fluid ounces or fluidrams, minim glasses or calibrated pipets for minims
and droppers for drop. When measuring liquids, hold the container so that line
indicating the desired quantities is on a label with the eye. The quantity is read when
the lowest part of the concave surface of the fluid is on this line.

9. Even though you have cared for a particular patient all morning of for several days,
you should have developed the habit of checking his identification each time you give
a medication. If the patient wears an identification card, the name on it must
correspond with the name on the medication card. The problem of identification
presents an even greater hazard to the health care provider who is responsible for the

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 administration to a group of patients, perhaps an entire unit. For this a 10:00 a.m.
injection may be her initial or only contact with the patient. It is important that each
patient be called by name. If there is the least doubt of his identity, ask him to state his
name. Patients have been known to answer to names other than their own, but they are
not likely to give the wrong name when asked to speak it.

10. Remain with patient until the medicine has been taken. Most patients are very
cooperative about taking medicines at the time that the health care provider brings it,
however, sometimes patients are more ill than they appear and have been known to
hoard medicines until they had accumulated a lethal amount and then have the entire
amount with fatal results.

11. Never return an unused dose of medicine to a stock bottle.

12. Never chart a medicine as having been given until it has been administered.
Sometimes it may be necessary to check the chart before giving the medication. All
medications are recorded. But the manner of recording may vary from hospital to
hospital. The name of the drug, the dosage, the time of administration, and the channel
of administration as well as the patient’s reaction to the medication (if any) should be
recorded.

Additional Suggestions Relative to the Giving of Medicines

The following suggestions contribute habits of thought and behavior developed by

experienced professional health care providers that the nursing student will also be expected to
develop.

1. Dosage forms such as tablets, capsule and pills should be handled in such a way that
the finger will not come in contact with the medicine. Use the cap of the container or a
clean medicine card to guide or lift the medicine into the medicine glass or container
you will be taking to the bedside of the patient.

2. When pouring liquid medicines, hold the bottle so that the liquid does not run over the
side and obscure the label. Wipe the rim of the bottle with a clean piece of paper tissue
before replacing the stopper or cover.

3. Assist weak or helpless patients in taking their medications.

4. Most liquid medicines should be diluted with water or other liquid. This is especially
desirable when medicines have a bad taste. Exceptions to this rule include oils and
cough medicines that are given for local effects in the throat. The patient should be
supplied with an ample amount of fresh water after swallowing solid dosage forms,
such as tablets or capsule, unless for some reason the patient is allowed only limited
amount of liquid.

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 5. Medicine glasses should be thoroughly washed with hot soapy water and scalded with
hot water. Glasses used for oils should be washed separately. Disposable medicine
containers provide as more sanitary means of dispensing medicines than glasses and
are used in most hospitals.

6. The health care provider should avoid waste of medicines. Medicines tend to be
expensive; in some instances a single capsule may cost a patient several pesos.
Dropping medicine on the floor is one way of wasting it.

7. If patient expresses doubt or concern about a medication or the dosage of a medication,

the health care provider should do everything possible to make certain that no mistake
has occurred. Occasionally, the patient may be right. The health care provider should
reassure the patient as well as herself by rechecking to make certain that there is no
error. She may need to recheck the order, the label on the medicine container, or the
patient’s chart.

8. Do not leave a tray of medicine unattended. If you are in a patient’s room and must
leave, take the tray of medicines with you.

9. As a rule, health care providers should not prepare mixture of drugs. They should be
prepared by the pharmacist.

HEALTH CARE PROVIDERS’ APPROACH

The reaction of a patient to medicine may sometimes be an expression of fear, frustration

or hostility. The health care provider who has been caring for a patient can appreciate the many
incidents that may disturb him. A physician calls a patient to discuss the possibility of serious
surgery that will benefit the patient .The proposition leaves the patient rather shaken. He also
knows that sometime during the day he must make financial arrangement for continued
hospitalization. The health care provider who understands this patient is not contented to simply
chart on her noted that the patient refused his 10:00 a.m. medication. She may encourage him to
talk about the thing that are concerning him so deeply and thus make him feel that she is able to
accept his reaction, whatever it may be. The health care provider should realize that a particular
medication is an essential care. Recognition of the patient’s right to express feelings can lead to
greater security for the patient and greater insight for the health care provider.

The medicine containers from which the patient is served with his medicines should be
scrupulously clean, and the water supplied immediately after the medicine should be fresh and
cold. Carelessly prepared medicines and lack of consideration in the way a medicine is handed to
a patient can disgust him in the same way that poor food, wracked dishes and inefficient service
affect him in a restaurant.

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 When giving a medicine with an unpleasant taste it is better to admit that it is a pleasant
and thereby agree with the patient than to make him feel that his reaction is grossly exaggerated
or silly. The health care provider can attempt to improve the taste by diluting the medicine (if
possible) or by offering chewing gum immediately after the medicine.

ADMINISTRATION OF MEDICATION

General Principles:

1. Check the physician’s order. If the order is not legible or complete or if there is
any question, consult the physician. Be sure that the order is signed. Verbal
orders should be accepted only in extreme emergencies, for which orders the
doctor has to sign afterwards.
2. Always have a medicine card or the physician’s order sheet in front of the
health care providers while preparing and administering the drug
3. The health care providers’ hand and equipment should be clean.
4. While preparing the medicine, have only one card exposed at one time.
5. Read the label of the drug three times and check with card or order, making
certain that the two are the same.
6. Measure the drug exactly. Use calibrated devices.

7. When paper cups are used for drugs, the drug is measured in a calibrated device
then transferred to the cups.

8. Place medicine cards and the medicine together in a tray.

9. If there is any change in the color, consistency or odor of the drug, it should not
be administered.

10. Before administering the drug, check the name of the medicine card with the
bedside card and identify the patient by asking the patient his fullness.

11. Remain with the patient until the drug has been taken.

12. Record the patient’s chart, the time, the drug and dosage that must be
administered. If the record was for a single dose, check the physicians order
sheet and indicate when it was administered.

13. Observe the patient for reactions and record it in the chart
14. The health care provider who prepares the drug should be the one to administer
it to the patient.

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 15. If the health care provider is unable to administer it to the patient at the time it
is ordered because of the patients unwillingness to take it, or because the
patient is asleep, or for other similar reasons, the drug should be brought back
to the health care providers’ station and proper notification should be done on
the paper. The health care provider can do much to help the patient see the
need for the drug and to increase willingness to the drug
16. Know the diagnosis, the age of patient as well as his patients condition
17. Observe the five rights in giving medications, the right patient, the right time,
the right medicine, the right dose, and the right method of administration
18. In case of error of administration, notify at once the clinical instructor or
attending physician.
19. The following are the hours of administration:

O.D. . . . . . . . . 8:00
B.I.D. . . . . . . .8:00-6:00p.m
T.I.D. . . . . . . . 8:00-1:00-6:00p.m
Q.I.D. . . .. . . . .8:00-12:00-4:00-8:00p.m
q 4 hours. . . . . 4:00am-8:00-12:00-4:00-8:00-12:00MN
q 3hours . . . . . 3:am-6:00-9:00-12:00-3:00Pm
6:00-9:00-12:00 MN
q 12hours . . . . 8:00am – 8:00p.m

RULES FOR MAKING MEDICINE CARDS

1. Print the words on the face of the card in ink.

2. Cards are signed by the person who made them
3. When a card is lost or is to renewed, the back of the card should contain the date , the
medicine or the treatment is ordered.
4. Indicate the channels of administration for parental drugs as in for intravenous.
5. All medicine cards are kept in designated pockets in the medicine card rack in each rack.
6. Use only standard abbreviations.

RULES FOR RECORDING DRUG ADMINISTRATION

1. Record if an ordered medicine is refused or cannot be administered.

2. Record each dose of medicine soon after it has been administered
3. Use standard abbreviations when recording
4. Record only those medicine which you have administered, no one can record for
someone else.
5. Record the time, kind and dose of drug given, mode of administration.
6. Observe carefully the effect of the drug especially the theunsuall effect and record or
notify the physician immediately

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 ADMINISTRATION OF ORAL MEDICATION

I. DEFINITION: It is the most convenient; simplest most common and most

economical method of drug administration.

II. PURPOSE:

1. To produce systemic following absorption in the digestive tract.

2. To prepare and administer oral medication safely and accurately so that the
patient may derive therapeutic effect from them.

III. POINT TO REMEMBER:

1. Administering medicine orally is a clean procedure. Make certain all equipment

are clean.
2. Medicine given orally are in form of pills, tablets, capsules , powder or solution.
3. When giving pills or tablets, place in proper container directly from bottles. Do
not touch them with your hands.
4. Provide drinking water for irritating drugs and those likely to stain the teeth
5. Always provide drink of fresh water to patient immediately after giving an oral
medication, unless water is contraindicated.
6. Always try to make drug palatable. If taste is unpleasant.
7. If the pleasant has difficulty in swallowing tablets or pills, they can be crushed
and dissolved in water in the same way as provided.
8. Cough syrups (sedative type) are not diluted or followed by water.
The soothing effect on the throat is lost.
When pouring liquid medicines, always use in a calibrated measuring device.

IV. EQUIPMENT

Medicine tray medicine pitcher for drinking water

medicine glass drinking tube or straw

hand towel medicine card

V. PROCEDURE

1. Wash and dry hand thoroughly.

2. Collect the medicine cards from the medicine care compartment and arrange them
to the order of location to the patient’s room or ward.
3. Check the card against the physician’s orders in the kardex or in the patient
together.
4. arrange medicine cards in the medicine tray purposely by location of the patient’s
room or bed. Keep all medications for one patient together.
5. Arrange the medicine card with each medicine glass and start pouring medication.
6. Pouring a liquid medication.

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 a. Take a bottle of medicine from the medicine cabinet. Read the label before
taking it down from the shelf.
b. Hold the bottle in the right hand, read the label for the second time and
compare with medicine card. Shake the bottle if necessary.
c. With the left hand hold the medicine glass at the eye level and place the
thumb at the height on the glass where the medicine is to be poured.
d. Pour the exact amount of medicine on the side opposite the label of medicine
bottle.
e. Place the medicine card with the corresponding medicine glass in the tray.
f. Wipe the mouth of the bottle by a towel replace the towel and read the label
for the third time, then return the bottle in place.

PREPARING TABLETS OR PILLS OR POWDER

a. Take bottle or box from cabinet and read label.

b. Place the pills or tablets directly to the medicine glass. Do not touch with hand. Read the
label for the second time and compare with the corresponding card.
c. If the medicine is in a powder form, pour into medicine glass and dilute it with little
water. Stir with a stirring rod to even consistency.
d. Place each medication in a separate medicine class.

7. Bring the medication to the patient’s bedside carefully keeping the medication in
sight at all times.
8. Identify the patient carefully, using all the precautions, check the medicine card.
Call the patient by name or ask the patient to state his name.
9. If more than one drug is to be administered at one time, administer one separately.
10. Remain with the patient until the medication is swallowed.
11. Offer the patient additional fluid if necessary
12. Check and immediately record the medication given.
13. File the medicine card in the compartment.
14. Wash all medicine glasses with soap and water.

PARENTAL MEDICATION

I. Definition: The administration of a drug by needle injection.

II. Purposes:

1. To obtain a rapid and systemic effect of the drug.

2. To prevent the drug from being destroyed or rendered ineffective by the action of
digestive juices of the stomach.

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 3. To administer the drug when it can be given orally or when the patient is unconscious
or uncooperative.

III. Points to Remember:

1. Prevent contaminating all parts of the needles or syringe with which the drug will
come in contact with.
2. The preparation and administration of an injection must be done under strict aseptic
technique.
3. Breaking the needle in the tissue or striking a bone.
4. Always check that the needle and the syringe are in good condition.
5. The usual size of the needle and syringe for various purposes are:

USE: GAUZE SIZE: SYRINGE:

1. Intradermal 26 Gauze ½ inch long tuberculin

2. Intramuscular 23-24 Gauge 1 inch long 2-5 cc.

3. Subcutaneous 21-23 Gauge 1 inch long

4. Intravenous

IV. Equipments:

Hypodermic tray containing:

Syringe and needle - as necessary medicine card

Sterile towel drug ordered

Cotton balls and alcohol ampule file

V. Procedure

A. Withdrawing drugs from ampoules:

1. Tap with finger the stem

2. Scratch the stem of the ampule with an ampule file. – if the ampule has a bond on the
stem, you don’t need to scratch it.

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 3. With one hand hold the ampule with a cotton ball or gauze and take off the stem.
Discard the cotton ball and the stem.

4. With one hand holding the ampule with an angle, the other hand inserts the needle into
the ampule and withdraws the solution.

5. Place the syringe with solution on a hypo tray and identify the drug with a medicine
card.

B. Withdrawing from a Single Does Vial

1. Remove the metal cup.

2. Sterilize the rubber portion of the cover.
3. Inject distilled water into the vial – if drug is to be dissolved.
4. Withdraw the needle and shake the vial until all dissolves evenly.
5. With one hand hold the vial and with the other hand, inject air into vial comparable to
the amount of drug to be administered.
6. Aspirate the solution by withdrawing the plunger of the syringe.
7. Place the syringe in the hypo tray and identify the drug with the medicine card.

ADMINISTRATION OF INTRAMUSCULAR INJECTION

I. Definition: It is administration of medication into the different layers of the muscles.

II. Purposes:

1. To inject a drug when it is irritating to the subcutaneous tissue.

2. To inject a drug when immediate action rather than prolonged action is preferred.

3. To inject a medication not suitable for intravenous injection.

III. Points to remember:

1. The preferred sites of injections are the gluteus and deltoid muscles.
2. In the gluteus muscles, the inner angle of the upper outer quadrant of either buttock is
a. used, this site will avoid the striking of the sciatic nerve or bone.
3. A maximum of 2-3 cc can be used for intramuscular injection.
IV. Equipment:

See equipment for parenteral injection.

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V. Procedure:

A. Gluteal muscle:

1. Have the patient lie on a sim’s lateral position with the upper leg flexed.
2. Locate the inner angle of the upper outer quadrant by drawing an imaginary line and
dividing the buttocks into four quadrants.
3. Gently tap the selected site of injection with the fingers several times.
4. Cleanse the area thoroughly using friction.
5. Using the thumb and the first two fingers, press the tissue down firmly and in the
direction of the thigh.
6. With the thumb, forefinger and middle finger, hold the syringe in horizontal position
until ready to inject.

STEAM INHALATION

I. Definition: It is the administration of a drug added towater which when heated produces steam
which is 1aden with the drug to be inhaled.

II. Purposes:

1. To soothe irritated, inflamed and congested mucus.

2. To loosen secretions in the respiratory tract.

3. To soothe the mucus membrane.

III. Equipment:

Inhalator set towel

Water salt or prescribed medication

IV. Procedure:

1. Bring inhaler to the utility room

2. Disengage the plug from the cover; hold the top of the vaporizer with the other hand and
the sides of the black plug with the other.

3. Fill the jar with the water to water line mark on the jar.

4. Tilt back the cover and put the prescribed drug. Cover the pug, the inhaler until water
boils and steam comes out of the spout.

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 5. Bring the inhaler to the bedside.

6. Cover the face of the patient leaving only the nose and the mouth with a bath towel.

7. When ready to inject, quickly truth the needle into the tissue at 90º angle.

8. As soon as the needle is in site, slowly pull back the plunger to determine whether the
needle is in a blood vessel. If no blood comes in to the syringe, inject the solution slowly
if blood is noted , pull the needle back slightly and then inject.

9. Remove the needle quickly.

10. Massage the area.

11. Place the dirty needle and syringe in an unsterile container.

12. Wash the syringe and the needle and sterilize.

B. Deltoid Muscle:

1. Have the patient in a sitting position or lying position.

2. Cleanse the area of the skin to be injected by using a firm circular motion while moving
from the center of the area with each stroke.

3. Grasp the area of the deltoid muscle, pinch together and hold the cushion fashion.

4. Inject the needle at the end of an angle of 90º.

5. Once the needle is in site, release the grasp on the tissue.

6. If no blood appears, inject the solution slowly.

7. Withdraw the needle.

8. Direct the steam of the inhaler into the nose and mouth of the patient. If the steam is too
hot, move the inhaler further from the patient.

9. The duration the treatment depends on the order of the doctor, but usually it lasts for
15mins.

10. After the treatment, wipe the patient face if it is wet with steam. Advice the patient to
stay in bed for a few minutes.

11. Allow the inhaler to cool, then wash, clean and dry and return to proper place.

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 AEROSOL THERAPY

I. Definition: It is the administration of a drug by inhalation by the use of nebulizer.

II. Purposes:

1. for treatment in chronic and acute infections of the respiratory track.

2. to aid in the removal of secretions.

III. Equipments:

Oxygen Tank Rubber Tubing

Syringe Drug or Solutions ordered
Nebulizer
IV. Procedure:

1. Put the ordered amount of solution into the nebulizer by means of syringe.

2. Attach the nebulizer to the oxygen tank with the rubber tubing.

3. Bring the oxygen to 4-6 lbs. pressure or until the solution will spray mist from the
spout of the nebulizer.

4. Ask the patient to put the spout of the nebulizer very near his open mouth and take
long deep breathes as he inhales.

5. The procedure lasts until the medicine is consumed.

6. Boil or wash in running water the nebulizer.

ADMINISTRATION OF OXYGEN BY A NASAL CATHETER

I. Purpose:

1. To administer a therapeutic amount of oxygen to a patient by a direct introduction of

oxygen into the nasopharynx to relive dyspnea

II. Points to Remember:

1. The oxygen is passed through a bottle of water to humidify it before entering the
respiratory track to minimize the hydration of the mucous membrane.

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 2. If the catheter is inserted too far, there is the danger of inflating the stomach.

3. If the catheter is not inserted enough, the oxygen will escape before it is inhaled.

III. Procedure:

1. Observe the precautions to prevent fire, and removing electrical appliances and posting
“no smoking” signs.
2. Attach the oxygen bottle to the gauge.
3. Attach a nasal catheter, from 8-10 to the connecting tube of the oxygen bottle.
4. Measure the catheter to be inserted by holding it in a horizontal line from the tip of the
nose to the front of the ear lobe.
5. Moisten the tip of the catheter with water or lubricant.
6. Hold the tip of the patient’s nose up and insert the tip of the nasal catheter into the nares
along the floor of the nose until the marking is reached.
7. Adjust the catheter as necessary so that the tip of the catheter is visible behind the
uvula.
8. Adjust the liter flow to the rate specified or 4-5 liters per minute.
9. Secure the catheter to the side of the patient’s face and drape it over the ear.
10. Secure the catheter to the side of the patient’s face and drape it over the ear.
11. After the treatment, discard catheter
12. Ask the orderly to remove oxygen tank from the patient’s bedside.

COMMON MEDICAL TERMINOLOGIES

1. Anuria – Absence of urine formation

2. Polyuria – Excessive passage of urine
3. Dysuria – Difficulty of urination
4. Oliguria – Decrease urine output, scanty and blurred
5. Uremia – Presence of urine in the blood
6. Hematuria – Presence of blood in urine
7. Apnea – Absence of breathing
8. Dyspnea – Difficulty of breathing
9. Bradypnea –A bnormally slow breathing. A respiratory rate that is too slow. The normal
rate of respirations (breaths per minute) depends on a number of factors
10. Tachypnea – Abnormally fast breathing. A respiratory rate that is too fast.
11. Polydipsia – Excessive thirst
12. Polyphagia – Excessive hunger (excessive eating)
13. Tachycardia – Abnormally fast resting heart rate
14. Bradycardia – Abnormally slow heart rate
15. Hyperemesis Gravidarum – Excessive vomiting during pregnancy

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 16. Emesis – Vomit
17. Dysrrhythmia - Irregular heartbeat
18. Arrythmia – Abnormal heartbeat
19. Asystole – A dire form of cardiac arrest in which the heart stops beating and there is no
electrical activity in the heart. As a result, the heart is at a total standstill.
20. Aphasia – Aphasia is a communication disorder. It's a result of damage or injury to
language parts of the brain. And it's more common in older adults, particularly those who
have had a stroke.
21. Anorexia – Loss of appetite
22. Bulimia – Purposive vomiting to eradicate the food you eat
23. Orthopnea - is the sensation of breathlessness in the recumbent position, relieved by
sitting or standing. Paroxysmal nocturnal dyspnea (PND)
24. Cyanosis - Bluish discoloration of the skin
25. Amenorrhea – Cessation of menses
26. Polymenorrhea – Excessive menstruation
27. Dysmenorrhea – Discomfort/painful menstruation
28. Pyorrhea – Purulent inflammation of the gums and tooth sockets, often leading to
loosening of the teeth.
29. Halitosis – Bad breath
30. Hemoptysis – is the expectoration of blood or of blood-stained sputum from the bronchi,
larynx, trachea, or lungs
31. Ptosis – A drooping eyelid is most often due to: Weakness of the muscle that raises the
eyelid; Damage to the nerves that control that muscle
32. Hypospadia –  is a birth defect of the urethra in the male that involves an abnormally
placed urinary meatus
33. Myopia – Nearsightedness, or myopia, is the most common refractive error of the eye,
and it has become more prevalent in recent years.
34. Hyperopia – farsightedness, is a common vision problem, affecting about a fourth of the
population
35. Hypoxia – reduction of oxygen supply to a tissue below physiological levels despite
adequate perfusion of the tissue by blood
36. Hypoxemia – as decreased partial pressure of oxygen in blood, sometimes specifically as
less than which
37. Cheilosis – a disorder of the lips marked by scaling and fissures at the corners of the
mouth
38. Alopecia – excessive loss and thinning of hair

COMMON MEDICAL ABBREVIATION

ABG - arterial blood gas

Abo -the main blood group
AFB -Acid-fast bacillus
Amp -Ampule
Approx -approximately
AP -appendicitis
AROD -assistance residence on duty

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ARIC -assistance residence in charge
APL -anteropostero lateral
BM -bowel movement
BMR -basal metabolic rate
BE -barium enema
BUN -blood urea nitrogen
BRP -bathroom privilege
BRAT -banana, rice, apple, tea
BT -blood transfusion
cc -chief complainant
CNS -central nervous system
CSF -cerebro spinal fluid
CSR -central supply room
Ca -calcium
CA -cancer; carcinoma
CBR -complete bed rest
C/S -caesarian section
CPR -cardio pulmonary resuscitation
C -centigrade
CB -cotton balls
IOD - intern on duty
IV -intravenous
IM -intramuscular
IVF - intravenous fluid
K - potassium
KVO - keep vein open
KUB -kidney ureter bladder
Lab -laboratory
LMP -last menstrual period
LP - lumbar puncture
LD - last dose
MGH - may go home
Na - sodium
NSS - normal saline solution
NGT - nasogastric tube
NOD - nurse on duty
OT - occupational therapy
OF - osteorized feeding
o.s. - gauze
op - operation
OPD - out patient department
OS - left eye
OU - both eye
ORT - oral rehydration therapy
OGT - oral gastric tube
O2 - oxygen

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OD - right eye
EEG - electro encephalogram
RIC - resident in charge
per - by, through
po - per orem; by mouth; orally
PI - present illness
PE - physical examination
PR - pulse rate
Post-op - post-operative
Pre-op - pre-operative
pt - patient
PNSS - plain normal saline solution
PR - pulse rate
PRBC - packed red blood cell
Prep - preparation
PT - pulmonary therapies
QNS - quality not sufficient
ROD - resident on duty
PH - past history
RR - respiratory rate
RBC - red blood cell
RTC - round the clock
S/S - signs and symptoms
TF - to follow
TO - telephone order
TBS - tepid sponge bath
TLC - tender loving care
TPR - temperature pulse, respiration
Tx - treatment
T/C - to consume
TCB - to come back
TPN - total parenteral nutrition
VO - verbal order
V/S - vital signs
WBC - white blood cell
AM - in the morning: before noon
pc - after meals
ac - before meals
od - once a day
BID - twice a day
TID - three times a day
QID - four times a day
stat - at once; immediately
PRN - as needed
H - hour
qh - every hour

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hs - hours of sleep
@ - at
c - with
s - with out
q - every
i - one
ii - two
iii - three
2 - secondary
Amt - amount
H2O - water
meds - medication
comp - compound
cap - capsule
dist - distilled
dil - dilute; dissolve
elix - mixture
fld - fluid
mist - mixture
pulv - powder
syr - syrup
sol or soln- solution
tinc - tincture
tab - tablet
ung - ointment
susp -suspension
supp - suppository
wt - weight
gr - grain
kg - kilogram
l - liter
mEq - milliequivalent
mcg - micrometer
mg - milligram
gtt or gtts – drop; drops
mcgtts - microdrops
cc - cubic centimeter
ml - millimeter
tsp - teaspoon
tbsp - table spoon
TC - to consider
CPAP -continuous positive airway pressure
CR -cardiac rate
DR -delivery room
D/C -discontinue
D & C -dilation & curettage

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DAT -diet as tolerated
DAMA -discharge against medical advice
DOA -dead on arrival
Dx -diagnosis
DNR -do not resuscitate
EDC -expected date of confinement
“E” -emergency
ER -emergency room
ECG -electro cardiogram
ED -expiration date
FWD -fresh whole blood
F -Fahrenheit
FHT -fatal heart tone
FBS -fasting blood sugar
GIT -gastro intestinal track
Het -hematocrit
Hgb -hemoglobin
Hgt -hemogluco test
HAMA -home against medical advise
IE -internal examination
I & O -intake and output
ICU -intensive care unit
IVP -intravenous pyelogram
IOD -intern on duty

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References:

Philippine Copyright 2021 by Daisy Mae R. Bialba, Phd.,RN

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