FUNDA

Foundations of Midwifery Practice
Philippine Midwifery Licensure Examination
Foundations
of
Midwifery
Practice
HEALTH, WELLNESS, & ILLNESS ❖ Universal

• Health ❖ May be met in different ways.
o According to WHO, health is the state of ❖ May be stimulated by external and
complete physical, mental, and social well-being internal factors.
and not merely the absence of disease. ❖ Relative to the person’s priorities.
❖ Needs may be deferred.
WELLNESS
• Wellness is well-being. ❖ Interrelated
o Engaging in attitudes and behaviors that o Safety and Security

o Love and Belongingness
enhance quality of life.
• Well-being is a subjective perception of balance, o Self-esteem
harmony, and vitality. o Self-actualization
• Wellness is a choice. SEVEN DIMENSIONS OF WELLNESS

• Wellness is a way of life.
Physical
MASLOW’S HIERARCHY OF NEEDS Intellectua

Social
l
• Maslow’s hierarchy of needs is a theory of
motivation developed by Abraham Maslow, which 7
Dimensions
states that five categories of human needs dictate an Occupatio
of Wellness
Emotional
nal
individual’s behavior.
Environme
Spiritual
ntal
• Physical
o Keeping physical body whole and functioning
well.
o The ability to carry out ADL.
o Avoid abuse of drugs, alcohol, and smoking.
• Social
o Ability to connect with others in a healthy and
balanced way.
o To develop and maintain intimacy with
• The five categories under Maslow’s hierarchy are: significant others.
o Physiological or Physical Needs o Placing distance to those people who are
▪ Basic human needs considered unhealthy.
❖ Something that is desirable, useful, or • Emotional
necessary. o The ability to manage stress and to express
❖ Essential to the survival of human. emotions appropriately.
❖ Conditions that an individual must meet o Ability to recognize and accept one’s limitations.
to achieve a state of health or wellness.
• Environmental o Traumatic
o The ability to optimize overall health and ▪ Due to injury.
wellness pertaining to natural resources and o Allergic
environmental preservation. ▪ Due to abnormal response of the body
• Spiritual (hypersensitivity) to chemical and protein
o The belief in some force (e.g., nature, science, substances or to physical stimuli.
religion, or a higher power) that serves to unite o Neoplastic
human beings and provide meaning and purpose ▪ Due to abnormal or uncontrolled growth of
of life. cell.
• Occupational o Idiopathic
o Encourages to seek fulfillment in work or job. ▪ Cause is unknown.
o Ability to achieve a healthy work-life balance. ▪ Self-originated
• Intellectual ▪ Of spontaneous origin.
o Ability to learn and use information effectively o Degenerative
for personal, family, and career development. ▪ Results from the degenerative changes that
occur in the tissues and organs.
DISEASE & ILLNESS
o Iatrogenic
• Illness (subjective)
▪ Results from the tx of disease.
o Can be felt only by the pt. (e.g., feeling sick)
• According to duration or onset:
• Disease (objective)
o Acute Illness
o Can be seen and measured by the HCP.
▪ Has short duration and is usually severe.
CLASSIFICATION OF DISEASE ▪ S/Sx appear abruptly, intense, and often
• According to etiologic factors: subside after a relatively short period.
o Hereditary o Chronic Illness
▪ Defect in genes of one or other parent which ▪ Usually longer than 6 mos. and can also
is transmitted to the offspring. affect function in any dimension.
o Congenital • Disease may also be described as:
▪ Defect in the development, hereditary o Occupational
factors, or prenatal infection. ▪ Disease acquired at the workplace.
o Metabolic o Venereal
▪ Disturbance or abnormality in the intricate ▪ Sexually transmitted diseases.
processes of metabolism. o Sporadic
o Deficiency ▪ Infrequent, irregular.
▪ Results from inadequate intake or absorption o Endemic
of essential dietary factors (e.g., Vitamin B1 ▪ Constant presence.
(Thiamine) deficiency leads to beri-beri, which o Epidemic
can lead to korsakoff syndrome, wernicke’s ▪ Sudden and severe outbreak in a specific
encephalopathy, which is a brain damage location.
caused by B1 deficiency).
o Pandemic HEALTH MODELS

▪ Sudden and severe outbreak that affects a DUNN’S HIGH-LEVEL WELLNESS GRID
large area, usually a country or continent.
• Risk factors of disease:
o Genetic or physiologic
▪ Genetic predisposition.
o Age
▪ Increases or decreases client’s susceptibility
to acquire disease.
o Environment
▪ Surroundings that can affect the person. • Theory that describes the interaction of the
o Lifestyle environment with well-being and illness continuum.
▪ Habits that increase the chances of acquiring • Axis:
a disease. o X-axis
o Sex ▪ Illness-wellness continuum
▪ Gender o Y-Axis
FIVE STAGES OF ILLNESS (Suchman, 1979) ▪ Environment
• Symptom Experience • Quadrants:
o Client realizes there is a problem. o Q1
o Physical experience of symptoms. ▪ Protected poor health wellness in a favorable
o Client responds emotionally. environment.
• Sick Role Assumption o Q2
o Self-medication or self-tx. ▪ High-level wellness in a favorable
o Seeks confirmation from friends and family. environment.
• Medical Care Contact o Q3
o Seeks the advice of health professionals. ▪ Poor health in an unfavorable environment.
o Validation of real illness. o Q4
o Asks for reassurance and possible outcome of ▪ Emergent high-level wellness in an
the condition. unfavorable environment.
• Assuming A Dependent Role TRAVIS’ ILLNESS-WELLNESS CONTINUUM
o Client becomes dependent to health
professionals.
o Accepts the dx.
o Follows prescribed tx.
• Achieving Recovery and Rehabilitation
• Illustrates two arrows pointing in opposite
o Gives up the dependent role and assumes
directions joined with a neutral point in between.
normal activities and responsibilities.
• Moving to the right indicates increase level of health
and wellness.
• Moving to the left indicates decrease level of of o Failure to adapt is disease.

health. o This model believes that the aim or tx is the
ability of the person to cope and adjust with the
ROSENSTOCK’S HEALTH BELIEF MODEL
environment.
AGENT-HOST-ENVIRONMENT MODEL
• Concerned with what people perceive about

themselves in relation to their health.
• Consider perceptions (i.e., influences individuals’ • Also known as “ecologic model”.
motivation toward results). • Triad is composed of agent, host, and environment.
o Perceived susceptibility • Based on the interplay of three components of the
▪ Belief about getting a disease. model.
o Perceived seriousness • Three interactive process that affect health and
▪ Belief about the consequence and illness:
seriousness of the conditions. o Agent
o Perceived threat ▪ Any factor or stressor that can affect health
and illness.
SMITH’S MODELS OF HEALTH
• Clinical Model o Host
o Man is viewed as a physiologic being with ▪ Persons who may or may not be affected by
related function. the disease.
o Health is the absence of s/sx of disease or injury. o Environment
o If there are no s/sx of a disease, then you are ▪ Any factor external to the host that may or
healthy. may not predispose a person to certain
• Role Performance Model diseases.
o Health is defined in terms of the individual’s

ability to fulfill societal roles.
o As long as you are able to perform societal
functions and roles, you are healthy.
• Eudaemonistic Model
o This is the broadest concept of health.
o Because health is viewed in terms of
actualization or realization of one’s potentials.
• Adaptive Model
o Health is viewed in terms of capacity to adapt.
COMMUNICATION MODES OF COMMUNICATION

• It is the interchange of information between two or • Verbal Communication
more people. o The relay of information using words that
• Exchange of ideas and thoughts. consciously chosen before speaking.
• Intent is to elicit response. • Non-verbal Communication
• Two main purposes: o Sometimes called “body language”.
o To influence others. o Reflects more meaning than verbal
o To obtain information. communication.
• Elements of communication: o Proxemics
o Sender ▪ Use of personal space.
▪ Originator of information. ▪ Study of distance spacing.
o Message ▪ Types:
▪ Information being transmitted. ❖ Intimate distance
o Receiver ➢ Actual contact to 1.5 ft.
▪ Recipient of the information. ❖ Personal distance
o Channel ➢ 1.5 – 4 ft. or 3-4 ft. for interviews.
▪ Mode of communication. ❖ Social distance
o Feedback ➢ 4-12 ft.
▪ Return response. ❖ Public distance
o Context ➢ 12 ft. and beyond.
▪ Setting of the communication.
• Active listening:
o Sitting squarely
o Open posture
▪ No to crossing of arms and legs.
o Leaning forward
o Eye to eye contact
▪ No staring
o Relax
LEVELS OF COMMUNICATION
• Intrapersonal
o Occurs when a person communicates within
himself.
• Interpersonal
o Takes place within dyads and in small groups.
• Public
o Communication between a person and several
other people.
HEALTH CARE PROCESS

• Under the health care process, a HCP must follow
the mnemonics ADPIE:
o Assessment
▪ “Baseline data”
▪ The most important step.
▪ Must be gathered and collected.
▪ Fact-finding (PHC)
o Diagnosis
▪ Interpretation and analyzation of data.
o Planning
▪ Formulate plan of care or goals and
outcomes.
▪ When planning, your goal should be SMART:
❖ Specific
❖ Measurable
❖ Attainable
❖ Realistic
❖ Time-bound
o Implementation
▪ Putting in to action the plan of care.
o Evaluation
▪ Reassessment phase our outcome phase.
▪ Determines effectivity of care.
ASSESSMENT o Different type of sounds:

DATA ▪ Tympany
• Sources of data: ❖ Normal sound of the stomach or
o Primary intestines.
▪ The source is the patient. ▪ Resonance
o Secondary ❖ Normal sound of the lungs; has air.
▪ Information that is not from the patient such ▪ Hyperresonance
as SOs, other HCPs, chart, etc. ❖ Abn. lung sound which is common in pt.
• Types of data: with emphysema.
▪ Dull
Objective Subjective
Overt Covert ❖ Sound produced by solid organs (e.g.,
Sign Symptom liver, spleen)
Observable using the Data is coming from ▪ Flat
senses the pt. ❖ Sound produced by bones and muscles.
Measurable Complained by the pt. o During general assessment, the order of
assessment is as follows:
▪ I-Pa-Pe-A
PHYSICAL ASSESSMENT
❖ Inspection, palpation, percussion,
TYPES OF ASSESSMENT
auscultation
• Inspection
o During abdominal assessment, the order of
o Uses the sense of sight.
assessment is as follows:
o Inspects the body movement.
▪ I-A-Pe-Pa
• Palpation
❖ Inspection, auscultation, percussion,
o Uses the sense of touch.
palpation.
o To gather information on skin temperature,
▪ The order is changed due to the fact the
turgor, and texture.
percussion and palpation can alter bowel
o Leopold’s Maneuver is a type of palpation
sounds.
assessment.
• Auscultation
• Percussion
o The act of listening to sound produced within the
o The act of tapping/striking one object against
body with an aid of a stethoscope.
another to produce sounds or vibrations.
o The stethoscope has two important parts which
o This assessment uses the following:
is essential for this type of assessment:
▪ Pleximeter
▪ Diaphragm
❖ Non-dominant hand
❖ For high-pitched sounds (e.g.,
▪ Plexor
borborygmi (bowel), lung, and normal heart
❖ Dominant hand
sounds produced by the S1 and S2).
▪ Bell o Types of heat loss:

❖ For low-pitched sounds (e.g., abnormal ▪ Radiation
heart murmurs or gallops produced by the ❖ Transfer of heat through indirect contact
S3 and S4, FHT). of nearby cold surface/objects.
❖ The Korotkoff sound, which is the sound ▪ Conduction
heard during assessment of BP, also uses ❖ Transfer of heat through direct contact to
the bell. cool surface/objects.
▪ Convection
HEALTH ASSESSMENT
❖ Transfer of heat to air.
VITAL SIGNS
• Body Temperature ▪ Evaporation
o Balance between heart produced and heat lost ❖ Loss of heat when liquid turns to vapor or
gas.
from the body.
o The hypothalamus regulates the body o The normal range of temperature is 36°C-37.5°C
temperature. (96.8°F-99.5°F).
o Progesterone is the hormone responsible for the ▪ Conversion of temperature:

❖ °F = (°C x 1.8) + 32
rise in temperature during ovulation.
❖ °C = (°F – 32) / 1.8
o The body temperature peaks at late afternoon
(4-6PM), while the body temperature is at its o Sites for taking temperature:
lowest during 4-6AM. Site Advantage Results

Tympanic Fastest 1-2 sec.
▪ The circadian rhythm (body clock) also
Most
affects the body temperature as reverse
Rectal accurate, but 2-3 min.
circadian rhythm also leads to reversal of body
invasive
temperature peak.
Most
o Types of temperature: Oral 3-5 min.
accessible
▪ Core temperature Safest, non-
❖ Temperature of the deep tissues in the Axillary invasive, but 5-10 min.
body (e.g., abdominal cavity, tympanic) least accurate
▪ Surface temperature o Considerations in temperature taking:
❖ Temperature of the skin and ▪ Tympanic
subcutaneous tissue. ❖ Contraindicated in pt. with otitis media
o Factors affecting the temperature: (ear infection), tenderness or pain,
▪ Basal Metabolic Rate (BMR) impacted cerumen.
❖ Burned calories at rest. ▪ Oral
▪ Muscle activity ❖ Wait 15-30 min. before taking
▪ Thyroxine output temperature if:
▪ Sympathetic Nervous System (SNS) ➢ Consumed hot or cold food or drinks.
Stimulation ➢ Smoked
▪ Fever ➢ Chewed a gum
▪ Rectal ▪ Constant
❖ Sim’s position is used when using this ❖ Fever above normal that fluctuates in
method. <2°C.
❖ Thermometer must be lubricated. o Declines in temperature:
o Recommended temperature taking for pediatric ▪ Resolution by lysis
patients: ❖ Gradual drop in temperature.
Age Technique ▪ Resolution by crisis
1 : Rectal (Accurate), 2nd :
st
❖ Sudden or abrupt drop in temperature.
Birth – 2 y.o.
Axillary • Pulse
1 : Rectal, 2nd: Tympanic,
st
o Palpable bounding of blood flow created by the
Between 2 & 5 y.o.
3rd: Axillary contraction of the left ventricle.
1st : Oral, 2nd : Tympanic, ▪ Automated by the autonomic nervous
5 y.o. and above
3rd : Axillary
system.
o Technique in cleaning the thermometer:
o Two fingers are used to palpate, the index and
Number of cotton
8 cotton balls middle fingers.
balls
o The pulse should be taken for 1 full min.
Wipe thermometer in
o Do not use the thumb, as it has the princeps
Cleaning before use spiral/rotating motion
pollicis artery.
from bulb to stem
o Types of pulse:
Wipe thermometer in
Cleaning after use spiral/rotating motion ▪ Peripheral Pulse
from stem to bulb ❖ Location is away from the heart.
o Body temperature alterations: ▪ Apical Pulse
▪ Pyrexia/Hyperthermia/Fever ❖ Centrally located at the apex of the heart.
❖ Temperature above normal range but not ❖ Also referred as the Point of Maximal
more than 41°C. Impulse (PMI).
▪ Hyperpyrexia/Very High Fever ❖ Located at left middle clavicular line, 4th
❖ Temperature above 41°C. and 5th intercostal space.
❖ This type of fever can cause brain Pulse Site Specific Use
Superior and Used when
damage, specifically to the hypothalamus.
Temporal lateral to the radial pulse is
▪ Hypothermia eye not accessible.
❖ Temperature below 36°C Used during
o Types of fever: cardiac arrest
and shock for
▪ Intermittent adults; also
Carotid Side of the neck
❖ On and off fever within 24H (e.g., malaria) used to
▪ Relapsing determine
circulation to
❖ On and off fever within weeks. the brain
▪ Remittent Left side of the
Routinely used
❖ Fever above normal that fluctuates in Apical chest, to the left
for infants and
of the sternum
>2°C (e.g., cold, influenza)
at the fifth children up to 3

intercostal y.o.
space.
Inner aspect of
Used to
the biceps
measure BP,
muscle of the
Brachial and cardiac
arm; medially in
arrest for
the antecubital
infants
space
On the thumb
side of the inner Most accessible
Radial
aspect of the pulse
wrist
Used to
Alongside the
determine
Femoral inguinal
circulation to
ligament
the leg
Used to
determine
Popliteal Behind the knee
circulation to
the lower leg
Used to
Behind the
Posterior determine
Tibialis
medial
circulation to
o Normal range of pulse rates:
malleolus
the foot Age Normal Range
Used to Newborn 130 bpm (80-180 bpm)
Dorsal surface determine the
Dorsalis Pedis Infants 120 bpm (80-140 bpm)
of the foot circulation of
the foot Pre-school 100 bpm (75-120 bpm)
Adults 80 bpm (60-100 bpm)
o Rhythm
▪ Corrigan’s Pulse
❖ A pulse that is forceful then suddenly
collapses.
❖ Water hammer pulse
❖ Sign of aortic regurgitation
▪ Thready
❖ Pulsation is not easily felt, and slight
pressure causes it to disappear.
▪ Weak
❖ Stronger than thready pulse.
▪ Pulse Alternans
❖ Has a regular rhythm but with alternate
strong and weak volume.
▪ Bigeminal
❖ It is irregular in which every other beat ❖ Responsible for breathing

comes early. ❖ Respiratory center
▪ Paradoxial ▪ Diaphragm
❖ Pulse volume becomes weak during ❖ Muscle involved by the phrenic nerve.
inspiration. ▪ CO2 levels or Hypercapnia
o Abnormal pulse rates: ❖ The normal stimulus for breathing.
▪ Tachycardia o Normal breath sounds:
❖ Rate above normal for age. ▪ Vesicular
▪ Bradycardia ❖ Soft intensity, low-pitched.
❖ Rate below normal for age. ❖ Heard over peripheral lungs.
• Respiration ▪ Broncho vesicular
o Involves the following: ❖ Moderate intensity, moderate pitched
▪ Ventilation blowing sounds.
❖ Movement of air in and out of the lungs ❖ Heard between scapulae and the lateral
(i.e., inhale, exhale) sternum.
➢ Inspiration or Inhalation ▪ Bronchial
 Movement of air IN ❖ High pitched
➢ Expiration or Exhalation ❖ Loud harsh sounds
 Movement of air OUT ❖ Heard anteriorly over the trachea.
▪ Diffusion o Altered breathing patterns:
❖ Movement of O2 from the alveoli to the ▪ Tachypnea
capillaries, and movement of the CO2 from ❖ Abnormally fast and shallow
blood vessels to the alveoli. ▪ Bradypnea
➢ External Respiration ❖ Abnormally slow breathing
 Gas exchange between the lungs ▪ Apnea
and blood vessels. ❖ Cessation of breathing
➢ Internal Respiration ▪ Dyspnea
 Gas exchange between blood ❖ Difficulty of breathing
vessels and cells. ▪ Orthopnea
o Normal range for respiration: ❖ DOB while flat, supine, recumbent
▪ Adults ▪ Platypnea
❖ 12-20 cpm ❖ DOB while in upright position
❖ Chest or thoracic breathers ▪ Intercostal Retraction
▪ Infants ❖ Indrawing between ribs.
❖ 30-60 cpm ▪ Substernal Retraction
❖ Abdominal breathers ❖ Indrawing beneath the breastbone.
o I:E Ratio – 1:2 ▪ Suprasternal Retraction
o Regulations: ❖ Indrawing above the clavicles.
▪ Pons and Medulla Oblangata
o Volume • Blood Pressure

▪ Hyperventilation o Measure of the pressure exerted by blood as it
❖ Overexpansion of the lungs with rapid flows to the arteries.
and deep breathing. ▪ Systolic Pressure
❖ Mgt.: ❖ BP exerted during ventricular contraction
➢ Cupped hands or brown paper bag. or ejection of blood.
▪ Hypoventilation ▪ Diastolic Pressure
❖ Under expansion of the lungs with ❖ BP exerted during ventricular relaxation
shallow breathing. or filling of blood.
o Abn. breathing sounds: ▪ Pulse Pressure
▪ Stertorous ❖ Difference between systolic and diastolic.
❖ Noisy breathing. o Determinants of BP:
❖ Snaring or sonorous respiration, usually ▪ Cardiac Output
due to a partial obstruction of the upper ❖ High CO = High BP
airway. ❖ Low CO = Low BP
▪ Stridor ▪ Blood Volume
❖ A shrill, harsh sound heard during ❖ High BV = High BP
inspiration with laryngeal obstruction. ❖ Low BV = Low BP
▪ Wheeze ▪ Peripheral Vascular Resistance
❖ Continuous, high-pitched musical squeak ❖ High PVR = High BP
or whistling sound occurring on expiration ❖ Low PVR = Low BP
and sometimes on inspiration when air o Range of BP:
moves through a narrowed or partially
obstructed airway.
▪ Bubbling
❖ Gurgling sounds hear as air passes
through moist secretions in the respiratory
tract.
▪ Cheyne-stoke’s Breathing
❖ Waxing and waning respiration
❖ Death rattle
▪ Biot’s Respiration
❖ Cluster of rapid, shallow respirations then o Classification of BP:
apnea. ▪ Orthostatic Hypotension
▪ Kussmaul’s Respiration ❖ BP that falls when the pt. sits or stands
❖ Labored breathing, rapid, deep. caused by peripheral vasodilation.
❖ Occurs in diabetic ketoacidosis. ▪ White Coat HPN or White Coat Syndrome
❖ Air hunger respiration. ❖ An increase in BP when an HCP takes the
BP of the pt.
❖ Caused by anxiety.
o Steps in taking BP:
▪ The pt should be in a sitting position, with the
arm above the heart level.
▪ Add 30 mmHg to the systolic pressure.
▪ Use the bells to hear Korotkoff sounds.
▪ The cuff should cover 80% circumference,
and 2/3 length of the upper arm.
▪ Let pt. rest for 5 mins. if he/she has done any
activity
▪ Let the pt. rest for 30 mins. if he/she had
recently smoked or has consumed alcohol.
▪ Deflate the cuff at a steady rate of 2-3
mmHg/sec.
DRUG ADMINISTRATION • PRN (Pro re Nata) Order

• Pharmacology o Given as needed, or accordingly to the HCP’s
o The study of drugs or medication judgement (e.g., Acetaminophen 500mg po q4h)
• Pharmacokinetics
PARTS OF DRUG ORDER (PRESCRIPTION)
o The study of the movement of drugs or
• A prescription should have the following details:
medications in the body through ADME:
o Pt’s full name
▪ Absorption (route)
o Date and time
▪ Distribution
o Name of drug
▪ Metabolism
o Dosage of drug
❖ Route for metabolism is oral.
o Frequency of administration
❖ Site for metabolism is the liver.
o Route of administration
▪ Elimination and Excretion
o Signature of person writing the order
❖ Site for excretion is the kidneys.
• Pharmacodynamics EFFECTS OF DRUGS
o The study of the effects of the drugs • Therapeutic or Desired Effect
o Intended effect of the drug.
DRUG NAMES
• Drug Toxicity
• Generic or Official Name
o Deleterious effect of a drug.
o The name used in official publications.
• Drug Tolerance
• Brand or Trade Name
o Decreased physiologic response, which
o The name given by the manufacturer (i.e., brand
necessitates an increase dosage of the drug to
name)
maintain a therapeutic effect.
• Chemical Name
• Drug Dependence
o Chemical composition of the active ingredients
o Reliance on or need to take a drug/substance.
of the drug.
• Anaphylactic Reaction
MEDICATION ORDERS o Severe allergic reaction that causes life-
• STAT Order threatening response.
o Given immediately and only once (e.g., ▪ Desensitization
morphine sulfate 10mg IV STAT). ❖ When the pt. develops an immunity to the
• Standing Order allergen.
o Carried out in advance
COMMON MEDICAL ABBREVIATIONS USED
o Carried out indefinitely
Abbreviation Meaning
o Carried out under specific circumstances (e.g.,
ac Ante cebum (before meals)
multivitamins daily)
pc Post cebum (after meals)
• Single Order
BID Twice a day (q12h)
o Given once at a specified time (e.g., Seconal TID Thrice a day (q8h)
100mg hs pre-op). QID Four times a day (q6h)
gtts Drops
ugtts Microdrops
IM Intramuscular ➢ This site is near to the sciatic nerve,

IV Intravenous which when damage may cause
ID Intradermal paralysis.
SQ or SC Subcutaneous • Subcutaneous (SQ)
q_h Every (number) of hours o Slower absorption.
tab Tablet o Inserted at a 45° angle, or 90° angle if obese.
Hora somni (hours of sleep) or • Intradermal (ID)
hs
before bed time o Used for allergy and TB screening.
SL Sublingual
o Inserted at 0-15° angle, with bevel up to create
Ad lib At will, as desired
wheal or bleb.
NPO Nothing per orem (mouth)
▪ TB is also known as Koch’s Disease
PO Per orem (by mouth)
❖ Screening Test
RUQ Right upper quadrant
➢ Mantoux Test
LUQ Left upper quadrant
➢ Uses purified protein derivatives
RLQ Right lower quadrant
(PPD).
LLQ Left lower quadrant
OU Both eyes ➢ Check results within 48-72 hrs.
OD Right eye  At least 10 mm
OS Left eye  At least 5 mm for pt with AIDS
AU Both ears ❖ Confirmatory Test
AD Right ear ➢ Acid-fast Bacteria (AFB) test also
AL Left ear known as sputum test or Direct
HC Head circumference Sputum Smear Microscopy (DSSM).
IBW Ideal body weight
TYPES OF DRUG PREPARATIONS
BMI Body mass index
• Aerosol Spray or Foam
Recipere, which means to
Rx o A liquid, powder, or foam deposited in a thin
take
layer on the skin by air pressure.
• Capsule
ROUTES OF ADMINISTRATION o A gelatinous container to a hold a drug in
• Intramuscular (IM) powder, liquid, or oil form.
o Faster absorption compared to SQ. • Extract
o Inserted at a 90° angle. o A concentrated form of a drug made from
o Common sites: vegetables or animals.
▪ Deltoid • Liniment
▪ Vastus Lateralis o A medication mixed with alcohol, oil, or soapy
▪ Gluteal Muscles emollient and applied to the skin.
❖ Ventrogluteal (very good) • Lozenge
❖ Dorsogluteal (dangerous) o A flat, round, or oval preparation that dissolves
and releases drug when held in the mouth.
• Suppository
o One or several drugs mixed with a firm base
such as gelatin and shaped for insertion into the
rectum.
o The base dissolves gradually at body
temperature releasing the drug.
• Syrup
o An aqueous solution of sugar often used to
disguise unpleasant-testing drugs.
• Tablet
o A powdered drug compressed into a hard small
disk.
COMMON DRUG CLASSIFICATION

Drug Classification Actions
Analgesics Relieves pain
Lowers body temperature;
Antipyretic
given for fever
Antihistamine Given for allergies
Antitussive Prevents or relieves cough
Prevent or relieves nausea
Anti-emetic
and vomiting
Laxative Promotes defecation
Diuretics Increases secretion of urine
Destroys or inhibits growth
Antibiotics
of bacteria
Prevents or delays blood
clot formation (e.g.,
Anticoagulants Warfarin, Heparin,
Enoxaparin; Aspirin is anti-
platelet coagulant)
Thrombolytics Dissolves thrombus (clots)
Antihypertension Lowers BP
Corticosteroid Suppresses inflammation
Relieves the tension and
anxiety of pt (e.g., Minor –
Tranquilizers
Benzodiazepines, Major -
Antipsychotic drugs)
Illicit drugs (e.g., lysergic
Hallucinogens
acid diethylamide (LSD))
NUTRITION FATS CHARACTERISTICS SOURCES

• PD 491 (Nutrition Act of The Philippines) -Solid at room Vegetable
o Recognizes July as nutrition month. Saturated temperature oil, olive oil,
• Nutrients -Plant-based avocado
o Organic and inorganic substances found in food -Liquid at room
Beef, butter,
for body functions. Unsaturated temperature
fish oils
o The two nutrients that gives fuel to the body are: -Animal-based
• The needed fats during pregnancy are:
▪ Macronutrients
o Linoleic Acid
▪ Micronutrients
▪ Essential fatty acids for cell growth (e.g.,
MACRONUTRIENTS vegetable oil, safflower oil, peanut, olive oil).
CARBOHYDRATES (CHO) o Omega-3 Oils
• Two types of carbohydrates:
▪ Found in fish and fortified eggs.
o Simple Carbohydrates
▪ Simple sugars such as glucose, fructose, PROTEINS (CHON)
galactose; stable sugar, sugar cane. • Made up of amino acids.
▪ Can cause blood glucose spike. • Two main sources:
▪ Digestion is through the following: o Animal (Complete Proteins)
❖ Mouth ▪ Poultry, dairy products, meat, egg, fish meat
➢ Ptyalin o Plant-based (Incomplete Proteins)
 Salivary amylase ▪ Derived from vegetables, beans, lentils,
❖ Small intestines peanuts, soy, tofu.
➢ Pancreatic amylase CALORIE INTAKE DURING PREGNANCY
➢ Where most of the digestion and • Caloric Value (Calories)
absorption happens. o Amount of energy that nutrients or foods supply
o Complex Carbohydrates to the body.
▪ Starch o Calories are comprised of the following:
❖ Grains, legumes, potato, bread, cereals ▪ Carbohydrates 1g = 4 kcal
▪ Fibers (roughage or bulk) ▪ Proteins 1g = 4 kcal
❖ Whole grains, fruits, brown rice, green ▪ Fats 1g = 9 kcal
leafy vegetables ▪ Alcohol 1g = 7 kcal
LIPIDS (FATS) o Normal range of calorie intake

• Organic substances insoluble in water ▪ Male: 2000-2500 kcal
• The two types of fats are: ▪ Female: 1500-2200 kcal
o High-density lipoprotein (HDL) o During pregnancy
▪ Good cholesterol ▪ Add 300 kcal to normal caloric intake.
▪ Olive oil, avocado o During lactation
o Low-density lipoprotein (LDL) ▪ Add 500 kcal to normal caloric intake.
▪ Bad cholesterol
• Normal weight gain during pregnancy B5 – Milk, whole >Rare, but can
Pantothenic grain, breads, result to
o Throughout entire pregnancy
Acid egg yolks depression
▪ 25-35 lbs. (11.25-15.75 kg) >Peripheral
st
▪ 1 Trimester Meat, egg, fish Neuropathy –
meat, green nerve damage
❖ 1lb (0.45kg)/mos. B6 - Pyridoxine
nd
leafy >To treat
▪2 Trimester vegetables nausea and
❖ 1lb (0.45kg)/wk. vomiting
rd >Alopecia – hair
▪ 3 Trimester Organ meat,
loss
❖ 1lb (0.45kg)/wk. B7 - Biotin eggs, nuts,
>Dermatitis –
cheese
o Body Mass Index (BMI) skin irritation
𝑊𝑒𝑖𝑔ℎ𝑡 𝑖𝑛 𝑘𝑔 >Folic Acid
o 𝐻𝑒𝑖𝑔ℎ𝑡 𝑖𝑛 𝑚2
Anemia
Organ meats, >Neural Tube
B9 – Folic Acid/
green leafy Defects – for
Folate
vegetables infants whose
mother lacks B9
intake
Beef, clams,
B12 – milk >Pernicious
Cobalamin production, Anemia
liver
MICRONUTRIENTS ❖ To check for anemia, the CBC must be

VITAMINS tested.
• Organic compounds that can’t be produced by the ➢ Normal range:
body.  Men: 14-18 mg/dL
• Two types of vitamins:  Women: 12-16 mg/dL
o Water soluble ▪ Vitamin C (Ascorbic Acid)
▪ Vitamin B Complex ❖ Functions:
Vitamin Sources Deficiency ➢ Cell protection
>Beri-beri ➢ Iron absorption
Oats, seeds,
B1 - Thiamine (common in
egg, fish ➢ Tendons, collagen, and blood vessel
alcoholics)
>Stomatitis – formation
inflammation of ➢ Repair of tissues (wound healing)
mouth
➢ Used to improve gum health
Bread, milk, >Glossitis –
B2 - Riboflavin meat swollen red ➢ Supports immunity
production tongue ❖ Sources
>Cheilosis –
➢ All citrus food
chapped,
fissured lips ➢ Strawberry
>Pellagra – ➢ Cabbage, cauliflower
B3 – Niacin/ Fish, meat, diarrhea, ➢ Orange
Niacinamide poultry dermatitis,
dementia
➢ Red bell pepper
➢ Bayabas (guava) ➢ Sun exposure (helps synthesize vit. d

➢ Include tomato in the skin)
➢ Cantaloupe ❖ Deficiency leads to rickets (bone
➢ Noni Juice deformities)
❖ Deficiency in Vitamin C leads to scurvy. ▪ Vitamin E (Tocopherol)
o Fat soluble ❖ Act primarily as antioxidants.
▪ Vitamin A (Retinol) ❖ Essential against cell damage.
❖ Maintains normal vision and skin. ❖ Sources:
❖ Essential for cellular health, tooth ➢ Green leafy vegetables (e.g.,
formation, and bone growth spinach)
❖ Sources: ➢ Nuts
➢ Milk ➢ Seeds
➢ Cheese ➢ Eggs
➢ Butter ❖ Deficiency leads to nerve and body
➢ Dark colored vegetables (e.g., damage.
squash, carrot) ▪ Vitamin K (Phytonadione)
➢ Liver products ❖ Promotes clotting and bleeding factors.
➢ Green leafy vegetables ❖ Sources:
➢ Potato ➢ Green leafy vegetables
➢ Dark yellow fruits (e.g., mango, ➢ Avocado
papaya, apricots) ➢ Broccoli
❖ Deficiency leads to xeropthalmia and ❖ Deficiency leads to bleeding tendencies.
nyctalopia (night blindness) (early), and
MINERALS
blindness (late).
➢ Bitot’s spot
 Foamy lesions appearing on the Minerals Sources Deficiency
Seafoods, >Goiter (Adults)
eye which is a late sign of deficiency. oyster, clams, >Cretinism/Congenital
Iodine
❖ During pregnancy, mothers are given anchovies, Hypothyroidism
10,000 IU (colorless) after the first iodized salt (Child)
Organ meat,
trimester. >Iron deficiency
Iron liver, dark green
▪ Vitamin D (Calciferol) anemia
leafy vegetables
❖ Enhances absorption of calcium. Sodium All ready to eat
(normal intake foods, canned >Hyponatremia
❖ Essential for bone health and tooth
amt.: 1.5-2g) goods
formation. Avocado,
❖ Sources: banana,
Potassium cantaloupe, >Hypokalemia
➢ Fish
orange, potato,
➢ Eggs raisins
➢ Fortified milk
➢ Cod liver oil
Dairy products,
Calcium green leafy >Hypocalcemia
vegetables
• To help fight iodine deficiency especially in far-flung
area, form president Fidel V. Ramos enacted R.A.
8172 aka “Asin Law” which mandates food to contain
iodized salt.
NUTRITIONAL ASSESSMENT
ANTHROPOMETRIC MEASUREMENTS
• Height
• Weight
o Best indicator of nutritional statistics
• Skin fold test (fat folds)
• Mid-upper arm circumference measurements
• Body Mass Index
𝑊𝑒𝑖𝑔ℎ𝑡 𝑖𝑛 𝑘𝑔
o 𝐻𝑒𝑖𝑔ℎ𝑡 𝑖𝑛 𝑚2
REST AND SLEEP ▪ Eyes are still.

• Rest o Stage III (Delta sleep)
o Diminished state of activity. ▪ Deep and difficult to arouse.
o Calmness and relaxation w/o emotional stress. ▪ 15-30 mins.
o Free from anxiety. o Stage IV (Delta sleep)
• Sleep ▪ Deepest stage of sleep.
o An altered state of consciousness in which the ▪ Sleepwalking and enuresis occur at this
individual’s perception and reaction to the stage.
environment is gradually decreased. ▪ 15-30 mins.
o What regulates sleep and wakefulness:
RAPID EYE MOVEMENT (REM) SLEEP
▪ Reticular Activating System (RAS)
• Also referred to as “paradoxical sleep”.
❖ Located in the brainstem.
• Exhibit autonomic response of rapidly moving eyes.
▪ Melatonin
• Fluctuating VS.
❖ Secreted during dark, which is why
• Occurs 90 mins. after sleep.
sometimes it is referred to as the “dark
• Dreamstate of sleep.
hormone”.
• Brain is highly active.
❖ Produced by the pineal gland.
• Lasts about 5-30 min.
STAGES OF SLEEP • Difficult to arouse spontaneously.
NON-RAPID EYE MOVEMENT (NREM) SLEEP
FACTORS AFFECTING SLEEP
• Deep restful sleep with some dreaming.
• Illness
• Happens when the RAS is inhibited.
o Pain or physical distress (e.g., arthritis, back
• About 75-80% of the sleep cycle.
pain, ulcers).
• Essential for body restoration.
o Respiratory conditions (e.g., nasal congestion).
• 90 mins. cycle.
o Need to urinate.
• Stages:
• Environment
o Stage I (Very light sleep)
o Noise.
▪ Light sleep that lasts for a few minutes when
o Absence of usual stimuli or the presence of
VS and metabolism slows down.
unfamiliar stimuli.
❖ 20 mins.
o Discomfort from environment temp. (e.g., too
▪ Drowsy and relaxed.
hot or cold).
▪ Eyes roll from side to side.
o Comfort and size of bed.
▪ Easily awaken.
• Emotional stress
o Stage II (Light sleep)
o Considered by sleep experts as the number one
▪ Sound sleep but still can be aroused easily to
cause of short-term sleeping difficulties.
wakefulness.
o Preoccupied with personal problems.
▪ Lasts 10-15 mins.
• Stimulants and alcohol
▪ HR and RR decreases slightly.
o Caffeine containing beverages (e.g., coffee, tea,
▪ Body temp. falls.
chocolate drinks)
o Alcohol o Types:
▪ Speed up the onset of sleep but disrupts REM ▪ Obstructive sleep apnea
sleep. ❖ Structures of the pharynx and oral cavity
blocks airway.
SLEEP DISORDERS
▪ Central sleep apnea
• Insomnia
❖ Defect in the respiratory center of the
o Inability to fall asleep or remain asleep.
brain (i.e., pons and medulla oblongata).
o Types:
▪ Mixed sleep apnea
▪ Acute insomnia
❖ A combination of obstructive and central
❖ Lasts one to several nights.
sleep apnea.
▪ Chronic insomnia
• Parasomnia
❖ Longer than a month.
o Somnambulism
▪ Chronic intermittent insomnia
▪ Sleepwalking
❖ Difficulty sleeping for a few nights
o Somniloquy
followed by a few nights of adequate sleep.
▪ Sleep talking
o Main r/f:
o Nocturnal enuresis
▪ Older age
▪ Bed wetting
❖ Decrease in melatonin.
o Nocturnal erections
❖ Medical conditions.
▪ Nocturnal penile tumescence
▪ Women
o Bruxism
❖ Hormonal changes (i.e., menstruation,
▪ Clenching and grinding of the teeth during
pregnancy, menopause).
sleep.
• Hypersomnia
• Enuresis
o Refers to condition where the affected individual
o Involuntary urination.
obtains sufficient sleep but still can’t stay awake
during day. SLEEP HYGIENE
• Narcolepsy • Refers to interventions used to promote sleep.
o A sudden wave of sleepiness during the day that • Interventions:
cannot be controlled (i.e., excessive daytime o Support bedtime rituals (hygienic, relaxation).
sleeping). o Drinking milk and eating food high in CHON.
o The cause is lack of hypocretin. ▪ This contains tryptophan which is an amino
o Cataplexy acid that aids sleep.
▪ Sudden onset muscle weakness or paralysis o Creating a restful environment.
triggered by a strong emotion. o Providing comfort and relaxation.
• Sleep apnea o Avoiding caffeine and alcohol.
o Characterized by frequent short breathing o Use bed mainly for sleep.
process during sleep. o Exercise two hours before sleep to enhance
o Apneic ep. last 10 sec. to 2 min. REM.
o Ep.: 500-600/night.
MASSAGE ▪ SNS releases norepinephrine and epinephrine

• Effleurage which triggers fight or flight response.
o Long gliding stroke. ❖ S/Sx:
o Used as a transition in between strokes. ➢ Increased HR
• Petrissage ➢ Increased RR
o Kneading, rolling, wringing, and lifting the skin. ➢ Increased BP
o Used on tight muscles to release them. ➢ Increased blood glucose lvl.
• Friction o If stress is intense, death may ensue.
o Used to generate warmth. • Stage of Resistance (SR)
o Used to loosen muscle knots. o Characterized by adaptation.
• Tapotement o Levels of resistance are increased.
o Rhythmic tapping using the fingers, cupped o The person moves back to homeostasis.
hands, or side of the hands. • Stage of Exhaustion (SE)
o To stimulate muscle nerves and promote o Results from prolonged exposure to stress and
circulation. adaptive mechanism can no longer persist.
• Vibration o Unless other adaptive mechanism will be
o The use of fingertips or heel of the palm to mobilized, death may occur.
perform back-and-forth motion.
STRESS
• The modern stress theory is by Hans Selye.
• Stress is a nonspecific response of the body to any
demand made by it.
• Statements on stress:
o Stress is not a nervous energy.
o Man, whenever he encounters stress, he tends
to adapt to it.
o Stress is not always something to be avoided.
o Stress does not always lead to disease.
o A single stress does not cause disease.
o Stress may lead to another stress.
GENERAL ADAPTATION SYNDROME (GAS)

• Stage of Alarm (SA)
o Person becomes aware of the presence of threat
or danger.
o Levels of resistance are decreased.
o Adaptive mechanisms are mobilized.
ASEPSIS AND INFECTION CONTROL o Disinfectant

• Infection ▪ Applied to instruments, equipment, and
o Invasion of microorganisms into the body. facilities.
• Communicable Disease
PRECAUTIONARY MEASURES
o Diseases that can be transmitted to and
• Isolation
individual by direct or indirect contact.
o Measures designed to prevent the spread of
• Nosocomial Infections
infection to health personnel, clients, and visitors.
o Hospital acquired infections.
o Pt. is highly contagious.
• Pathogenicity
• Reverse isolation
o Ability to produce disease.
o For pts. who have weak immune system
• Infectious Agent
(immunosuppressed).
o Microorganisms capable of producing a
• Quarantine
disease.
o Used for healthy people exposed to diseases to
• Opportunistic Infection
limit their movements.
o A pathogen that can cause disease on a
susceptible individual. TYPES OF INFECTION
• Sepsis • Local Infection
o Presence of disease producing microorganism. o Affects certain part of the body only.
• Carrier • Systematic Infection
o An individual who harbors pathogenic o Affects all over the body.
organisms but has no s/sx. STAGES OF INFECTION PROCESS
• Contamination • Incubation
o Presence of pathogenic agents in a surface of o Organisms growing and multiplying.
substances. o Significant threat of transmitting the disease.
TYPES OF ASEPSIS • Prodromal
• Surgical asepsis o Person is most infectious, vague and nonspecific
o Sterile technique to keep an area or object free signs of disease.
from all microorganisms and spores. o Highly infectious stage.
o Also called sterile technique. • Illness
• Medical asepsis o Presence of specific s/sx of disease.
o Technique that reduces the growth and spread • Convalescence
of microorganisms. o Recovery from infection.
o Also called clean technique. DEFENSE
• Agents used for asepsis: • First line of defense
o Antiseptic o Intact skin and mucous membranes.
▪ Refers to agents that destroy and inhibit o Types:
growth of microorganisms. ▪ Mechanical barriers
▪ It can be safely applied on living tissues. ▪ Chemical barriers
• Second line of defense ➢ Used in autoclave.

o Inflammatory response. ▪ Gas
▪ Phagocytic cells and WBC to destroy invading ❖ Use of ethylene oxide gas
microorganism manifesting the cardinal signs. ▪ Boiling water
▪ Cardinal signs of inflammation: ❖ This is the most practical and inexpensive
❖ Pain method for sterilizing in the home.
➢ Dolor ❖ 15-20 mins.
❖ Heat ▪ Radiation
➢ Calor
INFECTION CONTROL
❖ Redness
• Standard Precautions
➢ Rubor
o Used in the care of all hospitalized patients
❖ Tumor
regardless of their diagnosis or possible infection
➢ Swelling
status.
❖ Loss of fx
• Transmission-Based Precautions
➢ Function laesa
o Used in addition to standard precautions for
• Third line of defense
clients with known or suspected infections that are
o Immune response
spread in one or three ways: airborne, droplet, or
▪ Natural or acquired and active or passive.
direct contact.
METHODS OF BREAKING THE CHAIN OF o Types:
INFECTION ▪ Airborne Precautions
• Decontamination ❖ Measles, chicken pox, TB
o Practices that make instruments soft enough to ▪ Droplet Precautions
be handled by persons before cleaning. ❖ Pertussis, influenza, rubella, meningitis
• Cleaning ▪ Enteric Precautions
o The process of physically removing visible blood, ❖ Cholera, amoebiasis, typhoid, shigellosis
fluids, and other foreign substances. ▪ Strict Isolation
• Disinfection ❖ Rabies, infected burns, eczema
o The process of killing disease causing vaccinatum, rubella, diptheria
microorganisms (pathogenic). ▪ Blood Precautions
• Sterilization ❖ Hepa B, C, D; AIDS
o The most complete elimination of all
HANDWASHING
microorganisms including bacterial and spores
• Standard precaution and one of the most effective
from inanimate objects.
methods in preventing the transmission of
o Methods of sterilization:
pathogens, infection, and disease.
▪ Moist heat
• If soap and water is not available, use hand
❖ To sterilize with moist heat, steam under
sanitizer w/ at least 60% alcohol.
pressure is used because it attains temp
• 3 elements:
higher than the boiling point.
o Soap
▪ 1-3 mL of liquid soap • After pt. contact

▪ Antibacterial soap o When:
o Water ▪ Clean hands immediately after doing any
▪ Clean running water. task from the pt.
o Friction o Why:
▪ Most important element. ▪ To protect the midwife and health care
• Duration: environment.
o At least 15 sec. each hand. • After contact with the pt.’s surrounding
o Recommended by WHO is at least 20 sec. o When:
o The best time is 30 sec. as it is more effective in ▪ Clean hands immediately after touching any
removing germs than washing for a shorter object in the pt.’s immediate surroundings.
period. o Why:
▪ To protect the midwife and health care
FIVE MOMENTS OF HANDWASHING
environment.
• Before pt. contact
o When:
▪ Wash hands before touching a pt. or
performing any procedure.
o Why:
▪ To protect the pt. against microorganisms
that can be carried by the HCW.
• Before an aseptic technique
o When:
▪ Clean hands immediately before any aseptic
task.
o Why:
▪ To protect the pt. against harmful
microorganisms including pt.’s own germs that
can enter the body.
• After body fluid exposure
o When:
▪ Clean hands immediately after an exposure
risk to body fluid.
o Why:
▪ To protect the midwife and health care
environment.
COMFORT MEASURES • Hot sitz bath

HEAT APPLICATION o Soak up to the pelvic area.
PHYSIOLOGIC EFFECT OF HEAT o Temp. of water:
• Vasodilation ▪ 105-115°F (40.55-46.1°C)
o Increased blood flow to the area. o Duration: 15-20 min.
• Increased cellular metabolism. o Provide privacy to pt.
• Promotes muscle relaxation. o BP, PR before and after 5 min.
• Relieves pain.
• Provides sedative effect. COLD APPLICATION
PHYSIOLOGIC EFFECT OF COLD
• Promotes suppuration.
• Vasoconstriction
METHODS OF DRY HEAT APPLICATION o Controls bleeding.
• Hot water bag/bottles • Decreased cellular metabolism.
o Temp. of water: • Numbs nerve endings.
▪ Adult: 115-125°F • Slows bacteria growth.
o Fill bag/bottle about ½ to 1/3 full. • Relieves edema.
o Dry the bag/bottle.
METHODS OF DRY COLD APPLICATION
o Hold it upside down to check for leakage.
• Ice collar
o Cover the bag/bottle w/ cloth before application
o Place over the neck.
to an area.
o Fill bag 1/2 to 2/3 full w/ crushed ice or ice chips.
▪ This is to prevent burns.
• Disposable cold packs
• Disposable hot packs
o Strike, shake, or knead package to create a
o Strike, shake, or knead the package w/ hands.
chemical reaction that releases the cold.
o Avoid puncture and damage of the outer
• Ice cap
covering.
o For chest application
METHODS OF MOIST HEAT APPLICATION ▪ Fill the bag 1/3 full.
• Warm moist compress o For abd. and other areas
o Sterile warm moist compress is indicated for eye ▪ Fill the bag 1/2 full.
conditions and open wounds/lesion.
PRINCIPLE OF HEAT & COLD APPLICATION
o Clean warm moist compress is indicated for
• Cold application is safer than heat.
other parts of the body.
• Cold application is done first for the first 72 hrs.
• Warm soak
followed by heat application for the next 72 hrs.
o If wound is present, basin and solution should be
• Heat application requires a doctor’s order.
sterile.
• Application
o Fill the basin half full w/ water, saline, or
o Duration
medicated solution as ordered.
▪ Ave: 15-20 min.
o Temp. of water:
▪ Max: 30 min.
▪ 105-115°F (40.55-46.1°C)
❖ >30 min. leads to rebound effect (e.g.,

heat application causing hypotension due to
its vasodilation effect).
▪ Monitor the area every 15-20 min.
o WOF:
▪ Mottling
▪ Increase in pain
▪ Numbness
▪ Extreme redness
▪ Swelling
▪ If any of these s/sx occur, discontinue tx.
WOUNDS peritoneum. It looks watery and has few

• Injuries that break the skin or other body tissues. cells.
▪ Purulent Exudate
TYPES OF CLOSED WOUND
❖ Presence of pus.
• Contusion
o Soft tissue injury ❖ The process of pus formation is referred
o Caused by a blunt force or trauma. to as suppuration.
o Also called as bruises, hematoma, ecchymosis. ▪ Sanguineous Exudate
• Concussion ❖ Consists of large amts of RBCs.

❖ This type is frequently seen in open
o A type of head injury.
o Can lead to loss of awareness and wounds.
consciousness. TYPES OF BANDAGING

o Brain trauma. • Spiral Turn
o Cylindrical body parts such as wrist, trunk,
TYPES OF OPEN WOUND
• Incision fingers.
o Clean cut caused by a sharp instrument such as • Spiral Reverse

o Cone shaped body parts such as thighs, leg, and
a knife.
• Abrasion forearm.
o Scraping or rubbing off of skin. • Figure of Eight
• Puncture wound or stab wound o Around joints such as elbow, ankle, and wrist.
• Triangular/Cravat
o Caused by a pointed object that penetrates the
tissue. o Head, chest.
• Laceration
o Jagged tears in tissue.
• Avulsion
o When tissues are forcibly separated from the
body.
TYPES OF WOUND EXUDATE

• Exudate
o A material such as fluids and cells, that has
escaped from blood vessels during the
inflammatory process and is deposited in tissue or
on tissue surfaces.
o 3 major types:
▪ Serous Exudate
❖ Consists chiefly of serum (the clear
portion of the blood) derived from blood and
the serous membranes of the body, such as
FIRST AID • Mgt.:

HEMORRHAGE o Put the pt. in Trendelenburg position or lay the
• Also known as “bleeding”, it is an escape of blood pt. in his/her back while elevating the legs
outside the veins, arteries, and capillaries due to (modified Trendelenburg position).
rupture or trauma. o Provide fresh air as much as possible.
• Types of bleeding: o Loosen any tight clothing.
o Arterial o Have the person sniff spirit of ammonia.
▪ Most severe type of bleeding.
STRAIN AND SPRAIN
▪ Urgent
• Strain
o Venous
o Overstretching or injury of the muscle or
▪ Less severe than arterial bleeding.
tendons.
o Capillary
• Sprain
▪ Least severe.
o Twisting or pulling of a joint w/ partial rupture of
▪ Superficial
its ligaments.
• Mgt.:
• Mgt.:
o Apply and maintain direct pressure.
o Rest
o Elevate the affected or injured area above the
o Immobilization
level of the heart.
o Compress (cold)
o If there is an embedded object, do not remove
o Elevate
object. Instead, stabilize the object.
EPISTAXIS
• Also known as “nosebleed”, it refers to any nasal
bleeding for any cause.
• Mgt.:
o Sit the pt. down and lean forward.
o Pinch the soft part of the nose w/ index and
thumb finger.
o Ask the pt. to breathe from the mouth.
o Place cool compress at the bridge of nose or
around the nose.
o Avoid sneezing or coughing, and
hyperextension of the head.
SYNCOPE
• Also known as “fainting”, it is a sudden transient
loss of consciousness due to hypoperfusion of the
brain.
FECAL ELIMINATION ➢ Avoid cold food, caffeine, alcohol,

• Normal characteristics of stool: and smoking.
o Color ❖ Drug of choice: Antidiarrheal agents
▪ Yellow or golden yellow
ENEMA
❖ Due to stercobilin
• An introduction of a solution into the rectum and
o Odor
large intestine.
▪ Aromatic upon defecation
• Purpose:
o Amt.
o Relieve constipation.
▪ Depends on bulk or food intake.
o Relieve flatulence.
• Abn. characteristics of stool
o Evacuate fecal material in preparation for
o Acolic stool
diagnostic procedures or surgery.
▪ Gray or clay-colored stool due to absence of
stercobilin. TYPES OF ENEMA
o Hematochezia • Cleansing Enema
▪ Passage of bright red stools due to lower GI o The most common type of enema.
bleeding. o Purpose:
o Melena ▪ Intended to remove feces.
▪ Passage of black, tarry stools due to upper GI o Mechanism of Action
bleeding. ▪ Stimulates peristalsis via irritation of the
o Steatorrhea colon/rectum and by causing intestinal
▪ Grease, fats in the stool. distention with fluid.
▪ Foul smelling. o Indications:
o Constipation ▪ Remove feces in instances of constipation.
▪ Passage of small dry hard stools, or no ▪ Prepare the intestine for certain diagnostic
passage of stools for a period of time. tests such as x-ray or visualization (e.g.,
▪ Mgt.: colonoscopy).
❖ Increase oral fluid intake. ▪ Prepare the pt for surgery.
❖ Increase fiber diet. o Two classifications:
❖ Adequate activity and exercise. ▪ High cleansing enema
❖ Drug of choice: laxatives ❖ Used to clean most of the colon.
o Diarrhea ❖ Amt.:
▪ Refers to the passage of liquid feces and ➢ 1000 mL
increased frequency of defecation. ❖ Ht. of solution:
▪ Mgt.: ➢ 30-45 cm (12-18 in.)
❖ Replacement of fluid and electrolytes. ▪ Low cleansing enema
❖ Promote rest. ❖ Used to clean the rectum and sigmoid
❖ Diet: colon.
➢ Small frequent feedings. ❖ Amt.:
➢ Bland diet. ➢ 500 mL
❖ Ht. of solution: BODY CHANGES AFTER DEATH

➢ No more than 30 cm. (12 in.) • Rigor Mortis
o Proper position: o Stiffening of the body.
▪ Left lateral or left sim’s position. • Algor Mortis
o Size of rectal tube: o Gradual decrease of body temp after death.
▪ Infant and small child • Livor Mortis
❖ 10-12 F o RBC breaks down and capillaries break,
▪ Toddler releasing hgb discolors surrounding tissues.
❖ 14-16 F • Putrefaction
▪ Adult o Liquefaction and blisters on the skin.
❖ 22-30 F
o Upon insertion, lubricate 5 cm of the rectal tube.
o Insert 7-10 cm (3-4 in.)
• Oil retention
o Lubricate the stool and intestinal mucosa easing
defecation.
o Oil is retained for 1-3 hrs.
o Oils used:
▪ Olive oil
▪ Gingerly or sweet oil
▪ Castor oil
o Purpose:
▪ Softens the fecal material.
▪ Lubricates the rectum and anal canal.
• Carminative
o Help expel flatus from rectum.
• Return Flow Enema
o Also known as “colonic irrigation”.
o Involves alternating flow of 100-200 mL fluid
into and out of the large intestines to stimulate
peristalsis.
o Process if repeated 5-6 times.
• Medicated
o Provide medications absorbed through rectal
mucosa.
• Antihelmintic
o Destroys intestinal parasites.
• Nutritive
o Administer fluids and nutrition rectally.

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Foundations of Midwifery Practice

Philippine Midwifery Licensure Examination

HEALTH, WELLNESS, & ILLNESS ❖ Universal

o Engaging in attitudes and behaviors that o Safety and Security

harmony, and vitality. o Self-actualization

• Wellness is a choice. SEVEN DIMENSIONS OF WELLNESS

MASLOW’S HIERARCHY OF NEEDS Intellectua

o Pandemic HEALTH MODELS

• Moving to the left indicates decrease level of of o Failure to adapt is disease.

• Concerned with what people perceive about

related function. the disease.

o Health is the absence of s/sx of disease or injury. o Environment

healthy. may not predispose a person to certain

• Role Performance Model diseases.

o Health is defined in terms of the individual’s

COMMUNICATION MODES OF COMMUNICATION

HEALTH CARE PROCESS

ASSESSMENT o Different type of sounds:

▪ Bell o Types of heat loss:

o Progesterone is the hormone responsible for the ▪ Conversion of temperature:

lowest during 4-6AM. Site Advantage Results

at the fifth children up to 3

❖ It is irregular in which every other beat ❖ Responsible for breathing

o Volume • Blood Pressure

DRUG ADMINISTRATION • PRN (Pro re Nata) Order

IM Intramuscular ➢ This site is near to the sciatic nerve,

COMMON DRUG CLASSIFICATION

NUTRITION FATS CHARACTERISTICS SOURCES

LIPIDS (FATS) o Normal range of calorie intake

MICRONUTRIENTS ❖ To check for anemia, the CBC must be

➢ Bayabas (guava) ➢ Sun exposure (helps synthesize vit. d

REST AND SLEEP ▪ Eyes are still.

MASSAGE ▪ SNS releases norepinephrine and epinephrine

GENERAL ADAPTATION SYNDROME (GAS)

ASEPSIS AND INFECTION CONTROL o Disinfectant

• Second line of defense ➢ Used in autoclave.

▪ 1-3 mL of liquid soap • After pt. contact

COMFORT MEASURES • Hot sitz bath

❖ >30 min. leads to rebound effect (e.g.,

WOUNDS peritoneum. It looks watery and has few

o Caused by a blunt force or trauma. to as suppuration.

o Also called as bruises, hematoma, ecchymosis. ▪ Sanguineous Exudate

• Concussion ❖ Consists of large amts of RBCs.

consciousness. TYPES OF BANDAGING

o Clean cut caused by a sharp instrument such as • Spiral Reverse

o Scraping or rubbing off of skin. • Figure of Eight

TYPES OF WOUND EXUDATE

FIRST AID • Mgt.:

FECAL ELIMINATION ➢ Avoid cold food, caffeine, alcohol,

❖ Ht. of solution: BODY CHANGES AFTER DEATH

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