RLENCM103-FUNDAMENTALS OF NURSING PRACTICE (MIDTERMS) o DO NOT LEAVE THE MEDICATIONS AT THE BEDSIDE. ➢ intraarterial- into an artery.

MEDICATIONS o IF THE CLIENT VOMITS AFTER TAKING ORAL ➢ intraosseous- into the bone.
A MEDICATION IS A SUBSTANCE ADMINISTERED FOR THE DIAGNOSIS, MEDICATION, REPORT THIS TO THE NURSE IN
CURE, TREATMENT, OR RELIEF OF A SYMPTOM OR FOR PREVENTION OF CHARGE AND/OR PHYSICIAN
DISEASE. ➢ 12 RIGHTS OF DRUG ADMINISTRATIONS
1. RIGHT CLIENT
PRESCRIPTION - WRITTEN DIRECTION FOR THE PREPARATION AND 2. RIGHT DRUG
administration of a drug 3. RIGHT DOSE
4. RIGHT ROUTE
PHARMACOLOGY IS THE STUDY OF THE EFFECT OF DRUGS ON LIVING 5. RIGHT TIME
ORGANISMS. 6. RIGHT ASSESSMENT
7. RIGHT MOTIVATION/ APPROACH
➢ ALL DRUG ORDERS AND PRESCRIPTIONS REQUIRE SPECIFIC 8. RIGHT OF THE CLIENT TO REFUSE
PARTS: 9. RIGHT OF THE CLIENT TO EDUCATE
1. PERSON’S FULL NAME 10. RIGHT EVALUATION
2. DATE 11. RIGHT DOCUMENTATION
3. DRUG NAME (BRAND & GENERIC) 12. RIGHT DRUG PREPARATION
4. ROUTE OF ADMINISTRATION ROUTES OF DRUG ADMINISTRATION
5. DOSE ORAL ROUTE
6. FREQUENCY Oral Route Forms:
7. DURATION OF ORDER a) Solid: tablet, capsule, pill, powder.
8. DOCTOR’S SIGNATURE o Enteric-coated tablets should not be crushed before
➢ TYPES OF DOCTOR’S ORDER: administration.
1. STANDING ORDER- IT IS CARRIED OUT UNTIL THE b) Liquid: syrup, suspension, emulsion
SPECIFIED PERIOD OF TIME OR UNTIL IT IS DISCONTINUED o Suspensions are never administered intravenously. If the
BY ANOTHER ORDER. patient vomits within 20 – 30 minutes of taking the drugs,
2. SINGLE ORDER- IT IS CARRIED OUT FOR ONE TIME ONLY. notify the physician. Do not re-administer the drug without a
3. STAT ORDER- IT IS CARRIED OUT AT ONCE OR physician's order. INTRADERMAL (ID)
IMMEDIATELY. • ARE ADMINISTERED INTO THE DERMIS JUST BELOW THE EPIDERMIS.
4. PRN ORDER- IT IS CARRIED OUT AS THE PATIENT ➢ Sublingual – drug placed under the tongue, where it dissolves. - have the longest absorption time of all parenteral routes
REQUIRES. ➢ Buccal – medication is held in the mouth against the mucous because there are fewer blood vessels and no muscle tissue.
➢ PRINCIPLES IN ADMINISTERING MEDICATIONS membranes of the cheek until the drug dissolves. - used for sensitivity testing because the patient’s reaction is
o OBSERVE THE “12 RIGHTS” OF THE DRUG ➢ Topical easy to visualize, and the degree of reaction can be assessed.
ADMINISTRATION a. Dermatologic - lotions, liniments, ointment, pastes and (EX: tuberculosis (TB) and allergy testing)
o PRACTICE ASEPSIS powders. SITES: THE INNER SURFACE OF THE FOREARM AND THE UPPER BACK
o NURSES WHO ADMINISTER MEDICATIONS ARE b. Ophthalmic- instillations and irrigations. BELOW THE SCAPULA. IT SHOULD BE FREE FROM LESIONS, RASHES,
RESPONSIBLE FOR THEIR ACTIONS. QUESTION ANY c. Otic MOLES, OR SCARS THAT MAY ALTER THE VISUAL INSPECTION OF THE
ORDER THAT YOU CONSIDER INCORRECT. d. Nasal TEST RESULTS.
o BE KNOWLEDGEABLE ABOUT THE MEDICATIONS e. Inhalation
THAT YOU ADMINISTER. f. Vaginal - tablet, cream, jelly, foam, suppository ➢ THE ANGLE OF ADMINISTRATION FOR AN ID INJECTION IS 5 TO
o KEEP NARCOTICS AND BARBITURATES IN A LOCKED g. Rectal – suppository 15 DEGREES. USING YOUR NONDOMINANT HAND, SPREAD THE
PLACE. PARENTERAL ROUTE SKIN TAUT OVER THE INJECTION SITE. TAUT SKIN PROVIDES
o Use only medications that are clearly labeled in - ADMINISTRATION OF MEDICATIONS BY NEEDLE. EASY ENTRANCE FOR THE NEEDLE AND IS ALSO IMPORTANT TO
containers. ➢ Intradermal (ID)- under the epidermis (into the dermis). DO FOR OLDER ADULTS, WHOSE SKIN IS LESS ELASTIC.
o Return liquids that are cloudy or have changed in ➢ subcutaneous (SC)- in the subcutaneous tissue (also, ➢ AFTER THE ID INJECTION IS COMPLETED, A bleb (small blister)
color to the pharmacy. hypodermic) should appear under the skin. The presence of the bleb
o BEFORE ADMINISTERING A MEDICATION, IDENTIFY ➢ intramuscular (IM)- into the muscle. indicates that the medication has been correctly placed in the
THE CLIENT CORRECTLY. ➢ intravenous (IV)- into a vein. dermis.
SUBCUTANEOUS (SQ) SOLID MEASUREMENT CONVERSIONS
• ARE ADMINISTERED INTO THE ADIPOSE TISSUE LAYER CALLED 1000 MICROGRAMS 1 MILLIGRAM
“SUBCUTIS” BELOW THE DERMIS. 1000 MILLIGRAMS 1 GRAM
- Medications injected into the subcutaneous layer are absorbed 1000 GRAMS 1 KG
at a slow and steady rate. 1 KG 2.2 LBS
SITES: OUTER LATERAL ASPECT OF THE UPPER ARM, THE ABDOMEN 1 OZ 28,300 MILLIGRAMS
(FROM BELOW THE COSTAL MARGIN TO THE ILIAC CREST AND MORE 1 OZ 28.3 GRAMS
THAN TWO INCHES FROM THE UMBILICUS), THE ANTERIOR UPPER 1 LBS 16 OZ
THIGHS, THE UPPER BACK, AND THE UPPER VENTRAL GLUTEAL AREA 1 LBS 454 GRAMS
1 LBS 0.45 KG
➢ A 45- OR 90-DEGREE ANGLE IS USED FOR A SUBCUTANEOUS DRUG DOSAGE CALCULATION
INJECTION. A 90-DEGREE ANGLE IS USED FOR NORMAL-SIZED ARE REQUIRED WHEN THE AMOUNT OF MEDICATION ORDERED (OR
ADULT PATIENTS OR OBESE PATIENTS, AND A 45-DEGREE DESIRED) IS DIFFERENT FROM WHAT IS AVAILABLE ON HAND FOR THE
ANGLE IS USED FOR PATIENTS WHO ARE THIN OR HAVE LESS NURSE TO ADMINISTER.
ADIPOSE TISSUE AT THE INJECTION SITE DRUG DOSE CALCULATIONS BASED ON BODY WEIGHT
BODY WEIGHT ARE REQUIRED WHEN THE DOSAGE ORDERED AND
INTRAMUSCULAR (IM) ADMINISTERED IS DEPENDENT ON THE WEIGHT OF THE PATIENT
• USED TO PLACE MEDICATION IN MUSCLE TISSUE.
- MUSCLE HAS AN ABUNDANT BLOOD SUPPLY THAT ALLOWS
MEDICATIONS TO BE ABSORBED FASTER THAN THE
SUBCUTANEOUS ROUTE.
• WHEN ADMINISTERING AN INTRAMUSCULAR INJECTION:
o STABILIZE SKIN WITH NONDOMINANT HAND
o INSERT THE NEEDLE QUICKLY AT A 90-DEGREE ANGLE
o ASPIRATE FOR BLOOD IF NEEDED
o INJECT THE MEDICATION SLOWLY IF NO BLOOD. DISCARD AND
PREPARE AGAIN IF THERE’S A BLOOD
o REMOVE THE NEEDLE AT THE SAME ANGLE
o COVER WITH STERILE GAUZE AND BAND-AID IF NECESSARY

SITES: VENTROGLUTEAL, VASTUS LATERALIS, DELTOID

➢ Z-TRACK METHOD
THIS METHOD PREVENTS THE MEDICATION FROM LEAKING
INTO THE SUBCUTANEOUS TISSUE, ALLOWS THE MEDICATION
TO STAY IN THE MUSCLES, AND CAN MINIMIZE IRRITATION.
DRUG CACLCULATIONS
LIQUID MEASURMENT CONVERTIONS
½ TSP 2.5 ML
1 TSP 5 ML
2 TSP 10 ML
½ TBS 7.5 ML
1 TBS 15 ML
3 TSP 1 TBS
1L 1000 ML
1 FL OZ 30 ML
1 PINT 473 ML
1 GALLON 3785 ML
IV FLUID COMPUTATION ➢ Hygiene is a series of practices performed to preserve health.
➢ Hygiene in a variety of settings plays an important role in
preventing the spread of microorganisms
FACTORS INFLUENCING INDIVIDUAL HYGIENIC PRACTICES:
- Hygiene activities and practices can protect health and prevent
disease
- However, hygiene practices vary widely among groups and
people
- It is important to respect differences in patient hygiene
practices and provide care and information in non-judgemental
manner.
CULTURE
o Cleanliness is highly valued in North American culture. Many
North Americans bathe or shower once or twice a day, whereas
some other cultures bathe only once a week.
o Some cultures believe that bathing requires privacy, whereas
others practice communal bathing. Body odor is considered
offensive in some cultures but normal in others.
SOCIO-ECONOMIC
o A person’s socioeconomic class and financial resources often
define the hygiene options available to that person.
o For example: Some people may have limited finances to buy
soap, shampoo, shaving cream and deodorant.
o Homeless people may have no or limited access to the water
and soap.
SPIRITUAL PRACTICES
o Spiritual practices including religious beliefs may include
ceremonial washings and purifications such as before prayer,
eating
o For e.g. in the Jewish tradition, ritual baths are required for
women after childbirth and menstruation.
o In some religion of Nepal, contact with a deceased person may
make a person unclean.
HEALTH AND ENERGY
HYGIENE AND COMFORT o People may not have the motivation or energy to attend to
HYGIENE hygiene. Some clients who have neuromuscular impairments
➢ According to the World Health Organization (WHO), “Hygiene may be unable to perform hygienic care.
refers to conditions and practices that help to maintain health SKIN CARE
and prevent the spread of diseases.” General Guidelines for Skin Care:
➢ Hygiene is a practice related to lifestyle, cleanliness, health and 1. The body's first line of defense is an intact, healthy skin.
medicine.
2. The amount of subcutaneous tissue and the skin's dryness
determine how well the skin protects the underlying tissues
from injury.
3. Moisture in contact with the skin can promote bacterial growth
and cause irritation.
4. Body odors are caused by skin bacteria that live on the skin and
act on body secretions. Cleanliness is the most effective
deodorant.
5. Individuals' skin sensitivity to irritation and injury varies
according to their health.
6. Skin care agents have specific actions and purposes. Soap,
detergent, bath oil, cream, lotion, powder, deodorant, and
antiperspirant are some examples
COMMON SKIN PROBLEMS:
➢ Acne
- inflammatory condition with papules and pastules.
Nursing Implication:
1. Keep the skin clean to prevent secondary infection.
2. Treatment varies widely
➢ Erythema
- redness associated with a variety of conditions, such as rashes,
exposure to sun, elevated body temperature.
Nursing Implication:
1.Wash area carefully to remove excess microorganisms.
2.Apply antiseptic spray or lotion to prevent itching, promote
healing, and prevent skin breakdown
BATHING
➢ Bathing removes accumulated oil, perspiration, dead skin cells,
and some bacteria.
➢ Excessive bathing, can interfere with the intended lubricating
effect of sebum, causing dryness of the skin.
➢ Bathing stimulates circulation
➢ Bathing offers an excellent opportunity for the nurse to assess
all clients
CLEANING BATHING
Given chiefly for hygiene purposes and include these types:
- Complete bed bath. The nurse washes the entire body of a
dependent client in bed.
- Self-help bed bath. Clients confined to bed are able to bathe
themselves with help from the nurse for washing the back and
perhaps the feet.
- Partial bath (abbreviated bath). Only the parts of the client's
body that might cause discomfort or odor, if neglected, are
washed: the axillae, under the breast, and perineal.
 - Bag bath. This bath is a commercially prepared product that
contains 10 to 12 presoaked disposable washcloths that contain
no rinse cleanser solution
- Tub bath. Tub baths are frequently preferred over bed baths
because they are easier to wash and rinse in.
- Shower. Many ambulatory clients can use shower facilities with
only minor assistance from the nurse.
EAR CARE
Nursing Interventions
➢ Cleanse the pinna with moist wash cloth.
➢ Remove visible cerumen by retracting the ears downward. If
this is ineffective, irrigate the ear as ordered.
➢ Do not use bobby pins or cotton-tipped applicators to remove
cerumen. These can rupture the tympanic membrane or
traumatize the ear canal. Cotton- tipped applicators can push
wax into the ear canal, which can cause blockage
EYE CARE
Nursing Interventions
➢ Cleanse your eyes from the inner to the outer cantus. For each
wipe, use a fresh cotton ball. To avoid nasolacrimal duct
contamination.
➢ If the patient is unconscious, apply sterile moist compresses to
the ayes. To avoid corneal dryness and irritation.
➢ Warm water and soap should be used to clean eyeglasses, and
soft tissue should be used to dry them
➢ Clean contact lenses according to the manufacturer's
instructions. Wear clean gloves and depress the client's lower
eyelid to remove artificial eyes. With your thumb and index
finger, grasp the artificial eye.
➢ Place the artificial eye in a container with water or saline
solution after cleaning it with warm normal saline.
➢ Avoid rubbing the eyes. This may result in infection.
➢ When reading, make sure to have enough light.
➢ Avoid using eye drops on a regular basis.
➢ As an emergency treatment, if dirt or foreign bodies get into
your eyes, rinse them thoroughly with clean tepid water
NOSE CARE
Nursing Interventions
➢ Clean nasal secretions by gently blowing the nose into the soft
tissue.
➢ When blowing the nose, keep both nares open to avoid forcing
debris into the middle ear via the Eustachian tube.
➢ To remove encrusted, dried secretions, use a cotton-tipped
applicator moistened with saline or water. Only insert up to the
cotton tip.
ORAL CAVITY CARE
Measures to Prevent Tooth Decay
➢ Brush the teeth thoroughly after meals and before going to
bed.
➢ Floss your teeth at least once a day.
➢ Ensure adequate calcium, phosphorus, and vitamin D intake.
Fluoride, vitamins A, C, and D. Avoid sweet foods and
beverages between meals. Consume fibrous, coarse foods
(cleansing foods), such as fresh fruits and raw vegetables.
➢ Have the teeth checked every six months
➢ Use topical fluoride applications as directed by the dentist
Brushing and Flossing the Teeth
Purposes
1. To remove food particles from between and around the teeth.
2. To get rid of dental plaque.
3. To improve the client's sense of well-being.
4. To keep mouth sores and infections at bay
Nursing Interventions When Providing Oral Care for Conscious Patient
➢ Inform the client and explain the procedure's purpose.
➢ Provide privacy
➢ Help in a sitting or side-lying position
➢ Place a towel beneath the client's chin.
➢ Dentifrice should be applied to the bristles of the toothbrush.
➢ Hold the kidney basin under the chin. If possible, allow the
client to brush his teeth.
➢ Use downward strokes on the upper front teeth, upward
strokes on the lower front teeth, back and forth strokes on the
biting surfaces of the teeth, and hold the brush against the
teeth at a 45-degree angle to penetrate and clean beneath the
gingival margins. Rinse the mouth thoroughly with water. Floss
the teeth
➢ Perform equipment and article maintenance.
➢ Document any relevant data.
For Unconscious Client
➢ To avoid aspiration, place in a side-lying position.
➢ Suction apparatus should be readily available.
➢ To open the mouth, use a padded tongue blade.
➢ Brush the teeth and gums with a toothbrush or a soft sponge-
ended swab.
➢ Apply a thin layer of petroleum jelly to your lips to prevent
them from drying
➢ Note: Lemon glycerin swabs can be drying to the oral mucosa if
used for extended periods
Care of Artificial Dentures
➢ When handling and cleaning dentures, use gloves.
➢ When brushing dentures, place a washcloth in a basin or bowl
of sink to prevent damage if the dentures are dropped.
➢ Keep the dentures in a watertight container.
COMMON PROBLEMS OF THE MOUTH
1. Plaque - An invisible soft film of bacteria, saliva, epithelial cells
and leukocytes that adhere to the enamel surface of the teeth.
2. Tartar - A visible, hard deposit of plaque and bacteria that
forms at the gum lines.
3. Halitosis - Bad breath.
4. Glossitis -Inflammation of the tongue.
5. Gingivitis -Inflammation of the gums.
6. Stomatitis - Inflammation and dryness of oral mucosa
7. Parotitis - Inflammation of the parotid salivary glands (mumps).
8. Sordes - Accumulation of foul matter (food, microorganisms,
and epithelial elements) on the gums and teeth.
9. Periodontal - disease. Gums appear spongy and bleeding
(pyorrhea). If you’re noticing some issues with your teeth and
gums, you might have to get some dental implants. This is a
painless process however you should do everything you can to
avoid having to have a dental procedure.
10. Cheilosis - Cracking of the lips.
11. Dental Caries - Teeth have darkened area, may be painful
(cavities)
HAIR CARE
➢ The appearance of the hair may reflect a person’s sense of well-
being and health status.
➢ Brushing and combing the hair stimulate circulation of blood in
the scalp; distribute the oil along the hair shaft; help to arrange
the hair.
Hair Shampoo
Purposes
1. Massage is used to increase blood circulation in the scalp.
2. To clean the client's hair and make them feel better.
COMMON HAIR AND SCALP PROBLEMS
1. Dandruff. Is a chronic diffuse scaling of the scalp, with pruritus
(seborrheic dermatitis).
2. Alopecia. Lair loss or baldness.
3. Pediculosis. Infestation with lice. Pediculosis capitis is head
louse Pediculosis corporis is body lice
- The usual treatment for pediculosis is gamma benzene
hexachloride (Kwell), which comes in lotion, cream and
shampoo. Pubic lice are difficult to remove, so the shampoo
may be applied and left on 12 to 24 hours. Linens and clothing
used by clients should be washed in hot water.
4. Scabies. Contagious skin infestation by the itch mite. The
characteristic of the lesion is the burrow produced by the
 female mite as it penetrates the skin. The burrows are short,
wavy, brown, or black threadlike lesions.
5. Hirsutism. Excessive growth of body hair.
FOOT CARE
➢ Wash and dry the feet on a daily basis, paying special attention
to the interdigital spaces.
➢ To soften the nails and loosen debris under them, soak the feet
in warm water. Soaking diabetic clients' feet is no longer
recommended because excessive moisture can contribute to
skin breakdown.
➢ To soften calluses, apply cream or lotion to the skin
➢ To prevent or control unpleasant odors, use deodorant sprays
or foot powder.
➢ Toenails should be filed straight across. To avoid nail splitting
and tissue damage around the nail.
➢ Change socks or stockings on a daily basis.
➢ Wear shoes that are both comfortable and well-fitting
➢ Do not walk barefoot
➢ Exercise feet to increase circulation.
➢ Avoid wearing constrictive clothing or round garters, which can
reduce circulation.
➢ Avoid crossing your legs.
➢ Avoid self-treatment for corns or calluses.
COMMON FOOT PROBLEMS
1. Callus - Painless, flat, thickened epidermis, a mass of keratotic
material. Often caused by pressure from the shoe on bony
prominence.
2. Corn - Keratosis caused by friction and pressure from a shoe. It
commonly affects the fourth and fifth toe. It appears circular
and raised.
3. Unpleasant odors - This result from perspiration and its
interaction with microorganisms.
4. Plantar warts - Caused by virus papovavirus hominins. They
appear on the sole and are moderately contagious. They are
painful and make walking difficult
5. Fissures -Caused by dryness and cracking of the skin.
6. Tinea pedis - Characterized by scaling and cracking of the skin,
particularly between the toes, caused by a fungus. There may
be blisters. (Also, Athlete’s foot, ringworm of the foot.)
7. Ingrown Toenail - Inward growth of the nail, causing trauma
into soft tissues. It is usually due to trimming the lateral edges
of the toenails.
NAIL CARE
➢ Trim nails straight across or in the shape of the fingers.
➢ Smooth the edges of your nails with a file.
➢ To avoid ingrown nails, do not trim them at the lateral corners.
➢ Diabetic clients are advised not to cut their hangnails or
cuticles.
➢ Ingrown is also known as unguis incarnate. ACTIVITY, MOBILITY, AND EXERCISES
➢ Onycholysis is the separation of the nail from the nail bed. BODY MECHANICS
➢ Paronychia is an inflammation of the skin fold at the nail Body mechanics is the utilization of correct muscles to complete a task
margin safely and efficiently without undue strain on any muscle or joint.
PERINEAL-GENITAL CARE
Purposes of Perineal-Genital Care ➢ PRINCIPLES OF GOOF BODY MECHANICS
1. To remove normal perineal secretions and odor. a. Maintain a stable center of gravity.
2. To prevent infection. o Keep your center of gravity low.
3. To promote comfort o Keep your back straight.
o Bend at the knees and hips.
Nursing Intervention during Perineal- Genital Care b. Maintain a Wide Base of Support. This will provide you
➢ Inform the client and explain purpose of the procedure. with maximum stability while lifting.
➢ Provide privacy. To maintain client dignity. o Keep your feet apart.
➢ Position and drape the client as follows: o Keep your back straight.
o Bend at the knees and hips
- Female: dorsal recumbent position; drape the client diagonally. c. Maintain the Line of Gravity. The line should pass vertically
- Male: supine position through the base of support.
- For female clients, use forceps to hold cotton balls for cleansing o Keep your back straight.
the perineum. o Keep the object being lifted close to your body.
- For male clients, wear clean gloves d. Maintain Proper Body Alignment
FOR FEMALE CLIENTS o Tuck in your buttocks.
1. Use anterior to posterior (front to back) stroke to prevent o Pull your abdomen in and up.
contamination of urethral meatus and vagina with o Keep your back flat.
microorganisms from the anus. o Keep your head up.
2. Use one cotton ball for each stroke. o Keep your chin in
3. Cleanse perineum with soap/ antiseptic solution. Include the ➢ TECHNIQUES OF BOFY MECHANICS
inner thigh. a. Lifting
4. Rinse the area with copious amount of water. To remove soap o Use the stronger leg muscles for lifting.
adequately and prevent irritation of the perineal area. o Bend at the knees and hips, keep your back straight.
5. Dry perineum thoroughly. Moisture supports microbial growth o Lift straight upward, in one smooth motion.
b. Reaching
o For post-delivery or menstruating females, apply a perineal pad o Stand directly in front of and close to the object.
as needed from front to back. This prevents contamination of o Avoid twisting or stretching.
urethra and vagina from anal area. o Use a stool or ladder for high objects.
o Keep the client comfortable o Maintain a good balance and firm base of support.
o Do the after-care of equipment and articles c. Pivoting
o Document relevant data o Place one foot slightly ahead of the other.
FOR MALE CLIENTS o Turn both feet at the same time, pivoting on the heel
1. Wash and dry penis using firm strokes, to prevent erection of of one foot and the toe of the other.
the penis. o Maintain a good center of gravity while holding or
2. Use circular motion, from the tip of glans penis towards the carrying the object.
penile shaft. d. Avoid stooping.
3. If the client is uncircumcised, retract the prepuce (foreskin). o Squat (bending at the hips and knees)
This is to remove smegma that collects under the foreskin and o Avoid stooping (bending at the waist)
facilitates bacterial growth. o Use your leg muscles to return to an upright position.
4. Wash and dry the scrotum and buttocks.
➢ REASONS FOR THE USE OF PROPER BODY MECHANICS
- Use proper body mechanics in order to avoid the following:
 o Excessive fatigue.
o Muscles strains or tears.
o Skeletal injuries.
o Injury to the patient.
o Injury to assisting the staff members.
MAINTAINING PROPER BODY ALIGNMENT WITH THE PATIENT ON HIS
BACK
Patients who must lie on their back much of the time should be kept as
comfortable as possible to prevent body deformities. Paraplegics and
quadriplegics may not be able to tell you if their position is
uncomfortable. You must be especially attentive to this case to prevent
possible problems from malalignment
Pillows can be used to support the patient’s head, neck, arms, and hands,
and a footboard used to support the feet.
o Proper alignment gives respiratory and digestive organs room
to function normally.
o The footboard is slanted to support the feet at right angles to
the leg (a normal angle) and prevent foot drop.
If the patient’s trunk must lie flatter than the neck and head:
o The patient should have only one pillow to support the head
and neck.
o The patient may have a pillow placed under the legs to prevent
pressure on the heels.
RANGE OF MOTION EXERCISES (ROM)
- It is the movement of a joint through its full range in all
appropriate planes.
- It is used to measure how much you can move a joint on your
own (active ROM) or with the assistance of someone else
(passive ROM).
Range of motion is measured using a device called a goniometer.
➢ A goniometer is a simple handheld device with two arms that
measures angles. By lining up the arms of the device with a
joint, a physical therapist can get an exact measurement of how
much you can move a joint.
Purpose:
o Maintenance of current joint functions.
o Restoration of joints function that has been lost through
disease, injury, or lack of use.
o To strengthen muscles.
Contraindication:
o Client with heart and respiratory disease for Range of Motion
(ROM) increases the demand for circulation.
o Range of Motion (ROM) exercise should not be performed if
the joints are swollen or inflamed or if there has been injury to
the Musculo-skeletal system in the vicinity of the joints.
TYPES OF JOINT MOVEMENTS
➢ Flexion – Decreasing the angle of the joint (e.g., bending the
elbow)
➢ Extension – Increasing the angle of the joint (e.g., straightening
the arm at the elbow)
➢ Hyperextension – Further extension or straightening of a joint
(e.g., bending the head backward)
➢ Abduction – Movement of the bone away from the midline of
the body
➢ Adduction – Movement of the bone toward the midline of the
body
➢ Rotation – Movement of the bone around its central axis
➢ Circumduction – Movement of the distal part of the bone in a
circle while the proximal end remains fixed
➢ Eversion – Turning the sole of the foot outward by moving the
ankle joint
➢ Inversion – Turning the sole of the foot inward by moving the
ankle joint
➢ Pronation – Moving the bones of the forearm so that the palm
of the hand faces downward when held in front of the body
➢ Supination – Moving the bones of the forearm so that the palm
of the hand faces upward when held in front of the body
 2. To maintain muscle tone and stimulate postural reflexes.

Considerations:
1. It is important to assess the skin and provide skin care before
and after a position change.
2. Clients who can move easily automatically reposition
themselves for comfort, however, people who are weak, frail,
in pain, paralyzed or unconscious rely on nurses to provide or
assist with position changes.
3. Make sure that the mattress is firm and level, has enough give
to fill in and support natural body curvatures.
4. Ensure that the bed is clean and dry.
5. Any position corrects or incorrect can be detrimental if
maintained for a prolonged period.

ERECT (STANDING OR UP-RIGHT)

POSITIONING AND DRAPING
POSITIONING
A client in good body alignment and changing the position regularly
are essential aspects of nursing practice. When the body is
aligned, whether standing, sitting or lying, no excessive strains
placed on these structures
➢ Maintains body alignment in relation to body's normal center
of gravity
➢ Assist the patient to stand with either slipper on or with bare
foot on a piece of paper. Slippers or paper placed under the
feet protects them from dirt.
➢ Erect position facilitates examination
Objective:
o For examination of vagina to determine the presence of
prolapsed uterus.
o For orthopedic condition.
o To determine certain neurological abnormalities.
SITTING POSITION
➢ Sitting upright provides full expansion of lungs and provides
better visualization of symmetry of upper body parts.
Objective:
o For evaluating the head, neck, chest, back, breast, vital signs,
and upper extremities.
HORIZONTAL RECUMBENT (SUPINE POSITION)
➢ Position is used to provide comfort and to facilitate healing
following surgeries or anesthetics.

DRAPING
Objective:
Is the manner of arranging the covering in order to expose the part
o For general physical examination.
being examined, treated or cleaned.
o For various operative procedures.
LITHOTOMY POSITION
Purposes:
➢ Is often used during childbirth and surgery in the pelvic area.
1. To prevent muscle discomfort, undue pressure resulting in
pressure ulcers, damage to superficial nerves and blood vessels,
and contractures.
 Objective:
o Used for patients recovering from general anesthesia.
TRENDELENBURG (SHOCK POSITION)
➢ Promotes venous circulation in certain clients.
➢ Provides postural drainage of basal lung lobes.
Objective:
o For cystoscopic examination
o Operations and examinations on the perineum, vagina, cervix,
bladder, and rectum.
o For normal spontaneous delivery (NSD) and Dilation and Objective:
Curettage (D&C) o Done for certain types of shocks, surgical procedure, and
DORSAL RECUMBENT postural drainage.
➢ Position is used for abdominal assessment because it promotes KNEE-CHEST POSITION (GENUPECTORAL)
relaxation of abdominal muscles. ➢ This position provides maximal exposure of rectal area
Objective:
o Used for vaginal and rectal examination
o Used in first aid treatment in cord prolapse or retroverted
uterus

Objective:
o For abdominal, vaginal, and pelvic examination
o For operative procedure of the vulvar areas
o For catheterization
SIM’S POSITION (SIMS LATERAL POSITION)
➢ Flexion of hips and knee improves exposure of rectal area.

Objective:
o For rectal or colon procedures like giving enema or during
examination as in proctosigmoidoscopy
PRONE POSITION
➢ This position is used to assess posterior thorax and extension of
hip joint.

Objective:
o For examination of the back
FOWLER'S POSITION
➢ Promotes lung expansion for client with respiratory problem.