VISION & MISSION OF FUMC

VISION:
To be recognized as a world standard tertiary provider of Quality Health care in the
country.

MISSION:
To improve MAN as MAN by providing COMPETENT and COMPASSIONATE Healthcare to
those who NEED.

FUMC TRAINING NURSING OFFICE 5TH FLOOR MAIN BLDG

CHIEF NURSE: GABRIEL “GAB” NAIG

ASST CHIEF NURSE: ALICE BOY

NURSE SUPERVISORS:
Ma’am Rolie NoNo
Sir Alex Cura
Ma’am Immelda Maraña
Ma’am Julie Tañala
Ma’am Ronalyn Pascua
Ma’am Maricel Lopez
Ma’am Irish Manzon
Ma’am Geraldin Torres

REMINDER: DO NOT TAKE A PHOTOS OF THE CHARTS!!! CHARTS MUST ONLY BE USED
AT THE NURSE STATION...USE CHARTS ONE AT A TIME...DO NOT BRING THE CHATS
ELSEWHERE...
 "Bubble-She Postpartum Assessment for Nurses"
Bubble-SHE is a postpartum assessment tool that nurses can use to assess the physical and
emotional well-being of postpartum mothers. It stands for:

B - Breasts
U - Uterus
B - Bladder
B - Bowels
L - Lochia
E - Episiotomy/Incision
S - Support
H - Homan's Sign
E - Emotions

Here's a breakdown of each component of the Bubble-SHE assessment:

Breasts: ASSESS for MILK production. Condition of the breast and nipples.
(Assess the breasts for engorgement, tenderness, and signs of infection such as redness,
warmth, and pain.)

Uterus: Assess the size, position, and tone of the uterus. It should be firm, midline, and at or
below the level of the umbilicus.

Bladder: Assess the mother's ability to void and the amount and frequency of urine output.
Monitor for signs of urinary tract infection.

Bowels: Assess for the passage of gas and stool. Monitor for signs of constipation or bowel
obstruction.

Lochia: Assess the amount, color, and odor of vaginal discharge. Monitor for signs of
excessive bleeding.

Episiotomy/Incision: Assess the site of any surgical incisions, such as a cesarean section
incision or episiotomy. Monitor for signs of infection or dehiscence.

Support: Assess the mother's social and emotional support system. Provide resources and
referrals as needed.

Homan's Sign: Assess for PAIN at the 'calf" of the leg. Check for varicosities. ( Assess for the
presence of deep vein thrombosis (DVT) by performing Homan's sign.)

Emotions: Assess the mother's emotional state and screen for postpartum depression or
anxiety. Provide support and referrals as needed.

By using the Bubble-SHE assessment, nurses can ensure that postpartum mothers receive
comprehensive care that addresses both their physical and emotional well-being.
 “Home Care Instructions for PP and NB-”

1) Breastfeeding
a. Bath or sponge daily with soap and water. (mother)
b. Clean nipple area with cool boiled water before each feeding.

2) Expose baby to morning sunlight between 7am to 8am

3) Bath suggested time between 10am to 11am shampoo and sponge bath baby daily with
mild soap

4) Cord care -Allow the cord to be AIR DRIED. It may take 5 days- 10 days for the cord to fall
off spontaneously

5) Bring baby back to the hospital if he/ she develops any of the following:

A- Refusal to suck
B- Deepening yellow color
C- Persistent vomiting
D- Fever
E- Wet watery stools
F- Poor Cry

6) Instruct mother to have follow-up check-up/ well-baby check- up as scheduled

What is Newborn Screening?
Newborn Screening (NBS) is a simple
procedure to find out if your baby has a
congenital metabolic disorder that may
lead to mental retardation and even
death if left untreated.
Why is it important to have Newborn
Screening?
Most babies with metabolic disorders
look normal at birth. One will never
know that the baby has the disorder
until the onset of signs and symptoms
and more often ill effects are already
irreversible.
When is Newborn Screening done?
Newborn screening is ideally done on
the 48th hour or at least 24 hours from
birth. Some disorders are not detected
if the test is done earlier than 24hours.
The baby must be screened again after
2 weeks for more accurate results.
How is Newborn Screening done?
Newborn screening is a simple procedure.
Using the heel prick method, a few drops
are taken from the baby‘s heel and
blotted on a special absorbent filter card.
The blood is dried for 4 hours and sent to
the Newborn screening Laboratory (NBS
Lab).
Who will collect the sample for the
Newborn Screening?
A physician, a nurse, a midwife or medical
technologist can do the newborn
screening.
Where is Newborn Screening available?
Newborn screening is available in practicing
health institutions (hospitals, lying-ins, Rural
Health Units and Health Centers). If babies are
delivered at home, babies may be brought to
the nearest institution offering newborn
screening.
When are Newborn Screening results available?
Newborn screening results are available within
three weeks after the NBS Lab receives and tests
the samples sent by the institutions. Results are
released by NBS Lab to the institutions and are
released to your attending birth attendants or
physicians. Parents may seek the results from the
institutions where samples are collected. are
collected.
A negative screen and that the result of the test is
normal and the baby is not suffering from any of
the disorders being screened.
In case of a positive screen, the NBS nurse
coordinator will immediately inform the
coordinator of the institution where the sample
was collected for recall of patients for
confirmatory testing.
What should be done when a baby has a positive
newborn screening result?
Babies with positive results should be referred at
once to the nearest hospital or specialist for
confirmatory test and further management.
Should there be no specialist in the area, the NBS
secretariat office will assist its attending
physician.
What are the disorders included in the
Newborn Screening package?

1. Congenital Hypothyroidism (CH)

CH results from lack or absence of
thyroid hormone, which is essential to
growth of the brain and the body. If the
disorder is not detected and hormone
replacement is not initiated within (4)
weeks, the baby‘s physical growth will be
stunted and she/he may suffer from
mental retardation.

2. Congenital Adrenal Hyperplasia (CAH)

CAH is an endocrine disorder that causes
severe salt lose, dehydration and
abnormally high level of male sex
hormones in both boys and girls. If not
detected and treated early, babies may
die within 7-14 days.

3. Galactosemia (GAL)
GAL is a condition in which the body is
unable to process galactose, the sugar
present in milk. Accumulation of
excessive galactose in the body can
cause many problems, including liver
damage, brain damage and cataracts.

4.Phenylketonuria (PKU)
PKU is a metabolic disorder in which the
body cannot properly use one of the
building blocks of protein called
phenylalanine. Excessive accumulation
of phenylalaine in the body causes brain
damage.

5. Glucose-6-Phosphate Dehydrogenase
Deficiency (G6PD Def)
G6PD deficiency is a condition where the
body lacks the enzyme called G6PD.
Babies with this deficiency may have
hemolytic anemia resulting from
exposure to certain drugs, foods and
chemicals.
COLOR CODES: for patients
Blue: OB
Yellow: PEDIA
Green: GYNE
Orange: (IM) MEDICINE
White: SURGERY
Pink: EENT
Red: OPHTHALMOLOGY

Home Care Instructions for PP and NB-

1) Breastfeeding a. Bath or sponge
daily with soap and water. (mother)
b. Clean nipple area with cool boiled
water before each feeding.

2) Expose baby to morning sunlight

between 7am to 8am

3) Bath suggested time between 10am

to 11am shampoo and sponge bath
baby daily with mild soap

4) Cord care -Allow the cord to be AIR

DRIED. It may take 5 days- 10 days for
the cord to fall off spontaneously

5) Bring baby back to the hospital if he/

she develops any of the following
A- Refusal to suck
B- Deepening yellow color
C- Persistent vomiting
D- Fever
E- Wet watery stools
F- Poor Cry

6) Instruct mother to have follow-up

check-up/ well-baby check- up as
scheduled
Clindamycin
Classification: lincosamide antibiotic
Action: Clindamycin inhibits bacterial protein synthesis by binding to 23S RNA of the 50S subunit of the bacterial
ribosome, mimicking the structure of tRNA molecules to impair peptide chain initiation and potentially treating
acne vulgaris through its activity against Propionibacterium acnes.
Side effects: Nausea, vomiting, or diarrhea may occur; contact your doctor if you experience serious side effects
like heartburn, joint pain/swelling, yellowing eyes/skin, dark urine, kidney problems, or if prolonged use causes
oral thrush or a new vaginal yeast infection.

Ferrous sulfate (FeSO4)

Classification: oral iron bivalent preparations
Action: Iron is essential for producing red blood cells and maintaining oxygen transport in the body, with iron
deficiency leading to anemia characterized by fatigue and other symptoms, which can be mitigated by iron
supplements that enhance iron absorption and utilization in the body.
Side effects: Temporary digestive issues like constipation, diarrhea, or upset stomach may occur and should be
reported if persistent or worsening, while rare but serious allergic reactions require immediate medical attention.

Tramadol
Classification: opiate (narcotic) analgesics
Action: Tramadol, an analgesic similar to codeine and morphine, has two enantiomers that work together for pain
relief: (+)-tramadol and its metabolite M1 activate mu opioid receptors, while (+)-tramadol also inhibits serotonin
reuptake and (-)-tramadol inhibits norepinephrine reuptake, enhancing pain suppression in the spinal cord. This
combination of actions increases the drug's effectiveness and tolerability.
Side effects: All opioids, including tramadol, can cause serious breathing problems, especially when starting the
medication, increasing the dose, if you are older, or have lung issues. Common side effects include constipation,
headache, dizziness, fatigue, drowsiness, loss of appetite, nausea, vomiting, sweating, and muscle weakness.

Warfarin
Classification: Anticoagulant class
Action: Warfarin inhibits vitamin K production by blocking vitamin K epoxide reductase, disrupting clotting factor
activation and leading to anticoagulation. Initially causing a temporary hypercoagulable state, its main effect
occurs as clotting factors degrade. Reversal requires vitamin K administration or stopping the inhibition, with
new clotting factors produced in about two days. Gut bacteria-produced vitamin K2 can interact with antibiotics,
affecting warfarin's efficacy.
Side effects: The main side effect of warfarin is bleeding, which can range from difficulty stopping bleeding from
minor cuts or nosebleeds to more serious internal bleeding. Seek immediate medical help if you experience
prolonged bleeding, unusual bruising, severe headaches, dizziness, coughing up blood, red or brown urine, black
or bloody stools, or any other severe symptoms. Warfarin can also rarely cause skin necrosis within days of
starting treatment. Contact your healthcare team for any unusual or persistent symptoms, including minor
bleeding or digestive issues.

Mupirocin
Classification: Topical antibiotic
Action: Mupirocin works by attaching to a specific enzyme in bacteria, preventing it from converting isoleucine
and tRNA into isoleucyl-tRNA, which is crucial for making proteins and RNA in bacteria. At lower doses, it slows
bacterial growth, but with longer exposure, it can kill a significant portion of susceptible bacteria.
Side effects: Seek urgent medical attention for signs of allergic reactions like hives or difficulty breathing when
using mupirocin, and contact your doctor immediately if you experience severe stomach pain, bloody diarrhea,
intense itching, rash, blistering, or signs of a new skin infection, while common side effects may include burning,
stinging, itching, or pain.

Ketorolac
Classification: Non-steroidal anti-inflammatory drug (NSAID)
Action: Ketorolac works by blocking certain pathways involved in prostaglandin synthesis, primarily targeting the
COX-2 enzyme which is responsible for inflammation and pain mediation, leading to pain relief and reduced
inflammation, despite also affecting the COX-1 enzyme.
Side effects: Ketorolac might lead to side effects such as headaches, dizziness, or digestive issues like diarrhea or
constipation. Additionally, serious side effects like fever, unexplained weight gain, or difficulty breathing warrant
immediate medical attention, and ketorolac should not be taken further until consulting with your doctor.
Paracetamol
Classification: Analgesics and antipyretics
Action: Paracetamol has a central analgesic effect that is mediated through activation of descending serotonergic
pathways. Debate exists about its primary site of action, which may be inhibition of prostaglandin (PG) synthesis or
through an active metabolite influencing cannabinoid receptors.
Side effects: Paracetamol can cause severe allergic reactions like skin rashes and breathing difficulties, liver
problems such as nausea and yellowing of the skin, and rectal discomfort with suppository use; if these rare effects
occur, stop use and seek medical help, and long-term daily use can lead to liver or kidney damage.

Tranexamic
Classification: Antifibrinolytics
Action: Tranexamic acid works by blocking the activation of plasminogen, which is involved in breaking down blood
clots, thereby stabilizing the clot and preventing excessive bleeding.
Side effects: Possible side effects range from seizures, headaches, and back pain to stomach discomfort, nausea,
and tiredness, as well as more serious issues like blood clotting and allergic reactions, including visual problems.

Sodium ascorbate
Classification: Antioxidants
Action: Ascorbic acid is used to prevent or treat vitamin C deficiency, which can lead to scurvy and various
symptoms, as vitamin C is crucial for overall health, serving as an antioxidant and supporting skin, cartilage, teeth,
bones, and blood vessels.
Side effects: Digestive discomfort like diarrhea or nausea; inform your doctor if these symptoms persist. Serious
side effects are rare but include painful or bloody urine and severe allergic reactions like rash or difficulty
breathing, which require immediate medical attention.

Ranitidine
Classification: Histamine H2-receptor antagonist
Action: Ranitidine works by attaching to histamine (H2) receptors in the stomach cells, which decreases the
production of stomach acid. This helps alleviate symptoms related to excess stomach acid, with relief often
noticeable within an hour of taking a dose. The effects typically last between 4 to 10 hours, offering quick and
effective relief from symptoms.
Side effects: Seek medical attention if you have signs of an allergic reaction like hives, difficulty breathing, or
swelling, or if you experience stomach pain, loss of appetite, dark urine, yellowing of the skin or eyes, fever, chest
pain, irregular heartbeat, easy bruising or bleeding, or any skin or hair issues while taking ranitidine; common side
effects include nausea, vomiting, stomach pain, diarrhea, or constipation.

Metoclopramide
Classification: Antiemetics and prokinetics
Action: Metoclopramide enhances movement in the digestive tract through three methods: blocking certain
dopamine receptors, activating specific serotonin receptors, and counteracting the inhibition of certain
acetylcholine receptors.
Side effects: Metoclopramide may cause side effects like drowsiness, headaches, digestive problems, and mood
changes; some symptoms are serious and need prompt medical attention, including muscle stiffness, speech
issues, mood changes, or skin reactions.

Dexketoprofen Ketesse
Classification: Non-steroidal anti-inflammatory group of drugs (M01AE)
Action: Dexketoprofen trometamol is a medication derived from a compound that provides relief from pain,
inflammation, and fever, falling under the category of non-steroidal anti-inflammatory drugs. Its mechanism of
action involves blocking the production of certain chemicals in the body that contribute to inflammation,
ultimately reducing pain and discomfort.
Side effects: Nausea, vomiting, diarrhoea, flatulence, constipation, dyspepsia, abdominal pain, melaena,
haematemesis, ulcerative stomatitis, exacerbation of colitis and Crohn's disease.
Cefuroxime
Classification: cephalosporin antibiotics.
Action: Cefuroxime, similar to penicillins, is a type of antibiotic called beta-lactam. It works by attaching to
certain proteins within the bacterial cell wall, which stops the final step of building the cell wall. This
interruption eventually leads to the breakdown of the bacterial cell, possibly by affecting a substance that
normally prevents cell breakdown.
Side effects: Possible side effects of cefuroxime oral tablets include diarrhea, nausea, vomiting, and a short-term
reaction called Jarisch/Herxheimer. Mild effects may fade within days or weeks, but if severe or persistent,
consult a doctor or pharmacist. Serious side effects, like allergic reactions with symptoms such as hives or
difficulty breathing, require immediate medical attention.

Celecoxib
Classification: a selective cyclooxygenase-2 (COX-2) inhibitor, is a nonsteroidal anti-inflammatory drug (NSAID)
Action: Celecoxib reduces pain and inflammation while lowering the risk of stomach damage. It shows promise
against cancer by targeting tumor-related proteins and signaling pathways, but may increase the risk of blood
clots.
Side effects: Celecoxib may cause side effects, some of which are severe like gas, bloating, sore throat, cold
symptoms, constipation, dizziness, or unusual taste. Serious symptoms such as unexplained weight gain,
difficulty breathing, swelling, diarrhea, nausea, fatigue, bleeding, yellowing skin/eyes, or flu-like symptoms
require immediate medical attention.

Diclofenac
Classification: Non-steroidal anti-inflammatory drugs (NSAID)
Action: Diclofenac works by blocking the production of prostaglandins through inhibiting both COX-1 and COX-2
enzymes at about the same level of effectiveness.
Side effects: Diclofenac can cause side effects such as diarrhea, constipation, headache, and more. Some
symptoms could be severe, like unexplained weight gain or difficulty breathing, requiring immediate medical
attention.

Omeprazole
Classification: Proton pump inhibitor (PPI)
Action: Omeprazole is a substance that targets and blocks the 'proton pump' found in parietal cells, which is
responsible for producing stomach acid. By doing this, omeprazole prevents the secretion of acid regardless of
what triggers it.
Side effects: If you have allergic reactions such as hives, breathing issues, or facial swelling, get immediate
medical help. Stop omeprazole and call your doctor if you experience severe stomach pain, bloody diarrhea, or
unusual pain in certain areas. Other reasons to discontinue use include seizures, kidney issues, low magnesium
levels, or worsening lupus symptoms. Long-term omeprazole use might cause stomach growths or a vitamin B-12
deficiency, so talk to your doctor about these risks. Common side effects include cold symptoms, fever, stomach
discomfort, nausea, vomiting, diarrhea, and headaches.