FUNDAMENTALS OF NURSING BULLETS The best way to identify the clients identity is looking at the 1. ID band 2.

. Asking the name (do not ask if She is Mr. de la Cruz? Dont place the name NEAR OR INFRONT of the door (according to HIPPA) Hearing aid should be adjusted at the audible level to avoid occlusion effect(may or may not be overcome d by the client In using cane, the patient should lean at the stronger side..the cane should be on the stronger side.. Diuretics should be taken in the morning If the patient refuses to comply with the medical regimen, the best intervention is to educate. From the moment in which the patient signed the consent, the patient can automatically withdraw from the medical regimen (right to refuse) Before administration of the medication, the nurse should check the identity of the patient 3 times..1st on the medication administration record, 2nd while preparing the medication, 3rd recheck the label on the container before administration. Before administration of the medication, read medication administration record and remove the medication from the clients drawer. 2nd while preparing the medication , 3rd recheck the label against the MAR before opening the package at the bedside. In answering questions regarding therapeutic communication..look at the option which is non provocative and non probing(PINAKA CORNY..)Eg..if the patient says hey you stupid nurse, youre here again!..the best response will be Im glad you have express your feelings. Do not give VENTROGLUTEAL INJECTION to children less than 1 years old Do not give DORSOGLUTEAL INJECTION to children less than 3 years old(EXEMPTION: if the child can walk..you can give it if he/she is greater than 1 yr old. In children less than 1 year old, the preferred site for intramuscular injection is vastus lateralis and rectus femoris..the only advantage of rectus femoris injection is its accessibility though the most common disadvantage is too much pain upon insertion Before using any facility within the premise of our working area, see to it that they are functional enough to minimize if not prevent the risk of non anticipatory accidents. If theres an accident due to defective facility, the NURSE AND THE EMPLOYER are responsible and can be charged of by negligence. For cultural indifferences THE FIRST STEP IN APPROACHING IS CONVEYING RESPECT although the practice should not pose a grave threat to the patients health and others. To lower down cholesterol, the patient should be advised to restrict if not limit the intake of unsaturated fats (dairy products, brain, balut, salted egg, fried meat, kidney and lungs) They should eat white meats and protein substitutes such as egg white (protein of high biologic value) fish, lean red meat, pork tofu. CODE OF ETHICS: guide for carrying out nursing responsibility that provide quality nursing care for the ethical obligation of the profession The elements of professional negligence are: (1) existence of a duty on the part of the person charged to use due care under circumstances (2) failure to observe such duty (3) such failure resulted to injury or harm the person who has the highest risk of acquiring infection are those persons who have breaks in the Skin (2nd degree burns, previous board not intact cuticle) THE BEST THERAPEUTIC COMMUNICATION IS ACTIVE LISTENING As much as possible, restraints should be used as the last resort In patients who go out from bed, there should be someone to check the patient at night The best way to facilitate nursing procedure is to demonstrate on subordinates Steps in decision making process..define the problem, testing options(how well the dressings will absorb the drainage), considering effects on the results and making final decision As a RESPONSIBLE NURSE: she adheres or follow the standards of nursing practice As a nurse advocate: the nurse protects the rights of the patient or speak in the patients behalf( in moral principle, the latter is stewardship) In writing nursing diagnosis, the nurse should not used a another nursing diagnosis as a related factor . There should be correlation between the problem and its etiologic agent. The nurse should utilize standard terms provided by NANDA(diagnostic label) Assisting the client towards peaceful death an activity the care of the dying..

Encourage the client to reach optimal health is on health restoration (four fold) Open discussion regarding her funeral service, appearance are all manifestation of acceptance in kubbler ross theory When a person moves, balance depends on the interrelationship of the center of gravity, line of gravity and base of support. The closer line of gravity to the center of the base of support, the greater the stability The closer line of gravity to the edge of the base of support, the more precarious the stability If the line of gravity falls outside the base of support, the person falls The broader the base of support, the greater the stability (12 inches/30 cm) Do not lift an object greater 51 lbs. BODY BALANCE: widen base of support, lower the center of gravity nearer to the base of support Trochanter rolls is the best assistive device to avoid external rotation In the absence of trochanter rolls, you can use sandbags To avoid low back pain, the patient should be provided with firm mattress Footboard is used to avoid foot drop, not for mobilization purpose. The problem associated with high fowlers position, is posterior flexion of the lumbar curvature Suctioning: nasopharyngeal/oropharyngeal/nasotracheal=10 to 15 secs TOTAL DURATION 5 MIN Suctioning: ET/tracheostomy suctioning: 5 to 10 seconds TOTAL DURATION 5 MIN In conflict resolution according to Mintzberg: 1.CONFRONT, 2.THEN DOCUMENT AN IR THEN 3.REPORT TO NURSE SUPERVISOR In managerial questions: you immediately report to nurse supervisor Who will attend to the defibrillator if it wont functioning during emergency situation: BIOMETRICIAN Who will GIVE lethal injection: TRAINED HEALTH WORKER Color of laughing gas: COLORLESS Qualifications : > Graduate of Bachelor of Science in Nursing > A licensed nurse Profession > is a calling that requires special knowledge, skill, and preparation. > requires prolonged, specialized training to acquire a body of knowledge pertinent to the role to be performed > requires an orientation of the individual towards service, either to a community or to an organization. Characteristics of a Profession Specialized Education > education for those preparing to become nurses should take place in institutions of higher education. (ANA) Body of Knowledge > establish a well-defined body of knowledge and expertise as supported by a number of theoretical frameworks that give direction to nursing practice. Ethics > requires integrity of its members who are expected to do what is considered right regardless of the personal cost. Autonomy > regulates itself and sets standards for its members Levels of Health Care Preventive and Primary Care Services Preventive care focuses on reducing and controlling risk factors for disease through activities such as immunization and occupational health programs Illness prevention programs involves providing immunization, identifying risk factors for illness, and helping people take measures to prevent this illness from occurring Primary Care aims to provide integrated accessible health services and majority of personal health services; develop a sustained partnership with clients; and render care to the family and community Service Institutions for Preventive and Primary Care Services > School health services > Occupational health services

> Physicians offices > Clinics > Nursing centers > Volunteer agencies > Primary health care in the community Secondary and Tertiary Care Diagnostic and treatment are generally the most commonly used services of health. Accommodate health problems which are more complicated and require medical specialist Service Institutions for Secondary and Tertiary Care > Hospitals > Intensive Care > Sub acute care > Psychiatric facilities > Rural hospitals Restorative and Continuing Care Assist the individual in regaining maximal functional status, enhancing the individuals quality of life while promoting clients independence and self care Continuing Care > Long term care offers services over a prolonged period of time to people who have lost or never acquired functional capacity > May be provided in institutional settings, communities, or at home Service Institutions for Restorative Care > Home health Care > Rehabilitation > Extended Care facilities > Nursing Facilities > Adult day care centers > Hospice Examples of levels of prevention: Eating nutritious foods Primary level of prevention Performing self-examination for breast or testicular cancer Secondary level of prevention Obtaining tuberculosis skin tests Secondary level of prevention Obtaining treatment for a streptococcal infection Secondary level of prevention Obeying seatbelt laws Primary level of prevention

Work training program after hip dislocation Tertiary level of prevention Active ROM exercises for stroke victim Tertiary level of prevention Obtaining immunization for Hepatitis B Primary level of prevention Quitting smoking and limiting alcohol intake Primary level of prevention Wearing a helmet while working at a construction site Primary level of prevention Taking mefenamic acid for a headache Secondary level of prevention A diabetic patient asking a nurse to teach him how to inject insulin Secondary level of prevention GUIDELINES IN ANSWERING THE BOARDS WHATEVER THE BOOK SAYS..IT SAYS Longest choice could be the answer BECAUSE THEY CANNOT SIMPLIFY THE MOST CORRECT ANSWER All absolute statements with words like ALL and NEVER is considered a negative statement and is therefore incorrect Must answers are letter C.. Eliminate answer which are the highest and the lowest. Answer is most often next to the lowest Eliminate commonalities/similarities in the choices All of the above answer in the choices is 80-90% correct than the none of the above choice which is 40% correct If questions have negative modifiers such as except, least likely, inappropriate, needs further teaching, all but one - choose a negative statement answer/choice with words such as NO and NOT in the statement Questions asking for most important Choose statement showing more exclusivity and more beneficial Statement of nurse with words I am sure - eliminate Statement asking/with word why - eliminate especially if nurse is asking patient. Exemption if nurse is asking the significant others FOR PRIORITY Psyche = priority is SAFETY CHN = priority is CLIENT CENTERED MS ABC, PAIN MASLOWS HEIRARCHY OF NEEDS Statements with not and another negative word in a statement, choose positive statement I.e. not uncommon = common If question is nurse centered, answer is based on nursing process (start with assessment always) Questions with words like INITIAL, PRIMARY and FIRST - choose answers with words like assess, check, determine and ask in the statement For implementation questions, based your answers using NURSING PROCESS showing NURSING ACTIONS Evaluation questions, answers should state expected outcomes, desired effects, and effect. For signs and symptoms question - answer should be based on prevention of complications Read questions carefully, sometimes answers are found in the question Prioritizing intervention questions choose answers following this sequence: o Independent - nursing prescribed intervention o Interdependent - collaborative approach o Dependent - doctor prescribed ACUTE VS CHRONIC, acute is priority STABLE VS UNSTABLE, unstable is priority TRIAGE MASS DISASTER - priority people who can survive Emergency - priority people with life threatening condition Prioritizing intervention questions choose answers following this sequence: Fire situation o RACE 3 levels of prioritizing o LEVEL 1 - EMERGENT o LEVEL 2 - STABLE OR URGENT o LEVEL 3 - CHRONIC INVASIVE VS NON INVASIVE, invasive is priority

TOO OLD AND TOO YOUNG SHOULD ALWAYS BE THE PRIORITY TOO OLD VS TOO YOUNG (neonate or infants), too young is priority EARLY SIGNS VS LATE SIGNS, early signs is priority FOCUS ON Basic procedures Suctioning Postural drainage (CPT) Oral care (unconscious, post - op and special needs Chest tube care/drainage tube Colostomy vs ileostomy Peritoneal vs hemodialysis VS Enema Meds administration LOBECTOMY, laminectomy, pneumonectomy Specific diets TURP Conflict management Bronchoscopy and Thoracentesis Special concerns or needs (death and dying, pain management, periop and post op positions, mobility, ambulation special devices, IMCI, IMAI, elderly care, infection control Core competencies Health teachings Therapeutic communication Collaboration Team work Quality improvement Research Bioethics Jurisprudence Professional and personal growth and development CHN Book, Chapter 6 & 7 Cardio, appendicitis, CPR, ECG, Cardio assessment Respiratory procedures Infectious diseases: TB, Meningitis, HIV, Diarrhea, Malaria Endo - DM, GDM, Insulin, Hypo and hyperthyroidism, Cushings & Addisons Skin - Burns Emergency nursing triage, decontamination Neuro - CVA causes and treatment Head injury and trauma (pedia - hydrocephalus) MS, MG, GBS, ALS, Arnold-Chiari Renal - UTI, Nephritis, Pedia (AGN vs Nephrotic syndrome) Cancer Structure of self Personality development theories Basic psychodynamics Eating disorders (Anorexia, Bulimia) Fears, Phobia Mood Disorders Schizophrenia Dementia PTSD PD Sexual disorder BULLETS Hyper &hypothyroid (hot/ cold intolerance) Side effects& nsg. Consideration: cytoxan, flagyl, refamp (tb) color urine Liver biopsy post: positioning Coronary angiography (other dx. Heart) Osteoarthritis (exercise) Emphysema (barrel chest?)

Nasogastric tube insertion Nasal cannula: most commonly used Intrathecal COPAR IMCI (diarrhea) Hemorrhoids Hgb value consider pt is cyanotic Peritoneal dialysis Other name of abnormal lung sound Maximum range during suctioning: 10 seconds Aids (what is elisa?) determine antibody Who among the ff. Pt will have more adverse effects to a drug? Cancer pt Diet for osteoporosis Where does Furosemide acts - loop of henle What does Furosemide prevent from reabsorbing - potassium Who among the ff. pt. will have a delayed absorption to a drug? Pt is allergic to a drug, but you accidentally give the drug what will you do? NOTIFY TPN - HYPERGLYCEMIA Early sign of CO poisoning? When can be ultrasound be possible? Whats the purpose of ultrasound? To determine AOG The meaning of PSA? Prostate specific antigen What can be seen by a glaucoma patient - exercise for osteoporosis - walking Insulin combined with IV solution - isotonic solution Cystoclysis, whats the purpose of anchoring/ taping in the thigh? to prevent kinks or obstruction Carbonaceous sputum indicates what? Inhalation injury What should you do first in a burning client? put to safe place ELISA determines the presence of antibody Post laryngectomy patient be placed in? NGT When will you start giving post op pain medications? immediately LUMBAR TAP - Normal Composition of CSF Positioning post LT (6 - 8 HRS FLAT) ECG: Hyperkalemia and Hypokalemia EAR Instillation COLOSTOMY (Purpose of neomycin; Diet; Char. of stool diff. Area of intestine) Immediate rise in typhoid patients - EPIDEMIC Cytoxan adverse effect - BLOODY URINE Patient on thorazine, what to instruct - stay out of the sun Diet post hemorroidectomy - high fiber What to restrict to a patient having hypertension - ham sandwich with pickles and tomatoes What is the normal SpO2 that must be maintained to an emphysema patient? Emphysema results into? Hypercapnia; Respiratory acidosis Nursing diagnosis for emphysema? Proper stool collection - transfer using a tongue depressor in a clean container If the lithium levels is at 1.0. what should a nurse do? Give lithium as ordered Operant conditioning - giving of rewards Ventricular fibrillation whats the initial drug you will use? Lidocaine ECG changes for hyperkalemia? Peak t, widened QRS ECG changes for hypokalemia? U wave In emphysema, whats the pathophysiologic problem? Trapping of air in the lungs Most effective way of supporting the baby while walking - HOLDING THE HANDS OF THE BABY OR PULLING THE BABYS HAND Best position for 2 months - SUPINE OR SIDE LYING POSITION, WITH HEAD FLAT Best technique to teach baby to walk - HOLD THE HANDS UP AND LET HIM FOLLOW HIS FACE How to promote good communication in a child - INSTRUCT MOTHER TO TALK TO A CHILD LIKE ANY OTHER ADULT To assess hand development - PROXIMO - DISTAL Child holding bottle - PALMAR GRASP Most Appropriate disinfection - BOILING Pain management which is non-pharmacological - ADMINISTRATION OF MORPHINE SUBJECTIVE MANIFESTATION OF PAIN to consider - Pain is what the patient said it is Insulin management o Stock preparation of insulin brands have the same potency irregardless of volemic constitution this means that 500 units/ml would have different efficacy with client?

o SAME POTENCY HEALTH TEACHINGS (nodding of the client) CULTURE BASED BEHAVIOR TELEPHONE ORDERS - most appropriate nursing actions o Receive the call, repeat to doctor and have doctor signed within 24 hours To confirm if patient did not wear his ID tag - Ask his name Specimen (foreign body specimen like stray bullet, where to go directly) - BRING TO PATHOLOGY THERAPEUTIC BATH FOR PRURITUS - COLLOIDAL SOLUTION CHILD INGESTED LIQUID SOSA, MOTHER PERFORMED HEIMLICH, WHOSE FAULT IS THE DEATH OF CLIENT? MOTHER BEST POSITION FOR PHLEBOTOMY, THORACENTESIS, THORACOTOMY - lying at the back RIGHT WAY OF FOOT WASHING OF NURSE TO PROMOTE VENOUS RETURN - WASHING TOES TOWARDS THE LEGS PRIORITY OF WALKING ENDORSEMENT OR OUTGOING STATEMENT - PRIORITY NEEDS OF CLIENTS INAPPROPRIATE ENDORSEMENT - OPINIONATED ASSESSMENT Client has vehicular accident, arrived unconscious; his uncle who is surgeon - wants to read records? Refuse to read clients record Neighbors son died of meningococcemia -Report to authorities Foot drop - Wear ankle high tennis shoes If C has 5-12 bowels sounds/min every 5 per 1 minute, most appropriate action? Auscultate for 5 minutes Last molar - 13 year old Wisdom tooth - 22 years old Exact pain location - Ask client to use finger where the pain is For 2 years old with pain - Watch guarding behavior Diversionary activity - IMAGERY Health teaching for discharge instruction for the baby - Place baby at back seat facing the dad Age to allow baby to face front (middle seat) at the back - Age 1 year old with weight standard of more than 20 pounds For long travel in car seat weight standard - 40 lbs. weight Passenger seat - When child knows how to read, 9 years old Imaginary playmate - Attainment of autonomy Congenital heart failure - L sided DOB with pain - PULMONARY EDEMA SKIN GRAFT - PAIN? - Donor site Most difficult to deal with - change Client without wrist band o Conscious = ask name o Unconscious = ask relative but verify to ask for ID Miscommunication of drug safe med practice - Only officially approve abbreviations may be used for prescription orders Best way to check identity - Check ID band and compare with bed tag before giving meds Collaboration competencies - Communication, trust, decision making Nurse needs to do nursing procedure which he/she has not tried before - Let another nurse to do the procedure Statement showing global competencies - Following decisions of CGFNS to take test Beginning of nurse according to Benner - Novice Client has HIV during BT, spilled on the floor - BLEACH Blood spilled on the palm - Mild soap and water No no in charting - Recording of action in advance to save time Required before working in ICU - ACLS training Purpose of framework - Organize development study of knowledge to link the findings How to obtain approval for research - Permission from hospital director Insulin firsts o First to inject air from intermediate o First to aspirate solution, regular All signs - objective All symptoms - subjective Most important pillar of PHC - ACTIVE COMMUNITY PARTICIPATION SIGNS AND SYMPTOMS OF INFECTION IN ELDERLY - Change in mental status (confusion) Cholaginase enzymatic chemical - Debridement Hypoglycemia signs and symptoms - Headache Appropriate question to client with arterial disease? - DO YOU EAT HIGH FAT DIET Nursing action during sickle cell crisis OXYGENATION; POSITION - HIGH FOWLERS POSITION ON AND OFF PAIN IN BURNS FOR 3-6 minutes - Chronic pain Aspiration to stop before surgery - 7 to 10 days

AV fistula BP taking - Do not take on affected site Goal in glaucoma - Prevent loss of vision Diet in ulcerative colitis - Low residue diet Lumbar tap - C/I brain tumor Hypokalemia - alkalosis Hyperkalemia - acidosis Hearing aide correct procedure - Ear plugs should be washed with soap and water Prevent resp and vascular complications post op - Ambulate asap S/Sx of left sided heart failure - orthopnea Right sided heart failure - Ascites Nauseated? - Turn to sides and give anti emetic Best way to prevent N/V - Anti emeticNursing diagnosis for spina bifida - Risk for infection Chemotherapy - Temporary alopecia Residual urine volume - 50-100 ml Urinary retention - 100-200 ml Effect of aging - Increase residual lung volume and decrease respiratory flow rate Effect of cataract - Haziness Tension pnuemothorax - immediate or emergent Renal transplant - Risk for infection ESWL - Kidney stones Laryngeal cancer understanding Common radiation side effects - Dry mouth Best position for spina bifida - Prone and side lying Signs of meningeal irritation - Assess LOC Parkinsons diet - Thicken liquid to prevent aspiration Hirschprungs disease - Rectal biopsy Pyloric stenosis positioning - Upright turn to the right (projectile vomiting) T-tube drainage - Metabolic acidosis Inability to blink - Bells palsy Drug for active seizure - Lorazepam Cocaine, vasoconstrictor - Perforated nasal septum Cast to report if Absent pulse Patient with sciatica - Describe to me the pain Pain that occurs when analgesic level is on - Breakthrough pain Liver cirrhosis - Ascites PCA pump - Naloxone/narcan Streptomycin - CN 8 Sensorineural hearing loss Aluminum hydroxide - Neutralizes acid MC complication of PUD - Hemorrhage & Perforation Post craniotomy report - Whitish fluid Huntingtons chorea - Genetic Signs and symptoms of retinal detachment - Cob web Correct way of keeping co trimoxazole - Protect against the sun Patient with stroke - Approach from unaffected site Most common fracture in elderly - FEMUR (long bones) Colostomy stoma normal color - Reddish or pink Epidermis, up to lower portion of dermis - Superficial partial thickness burns Burn priority - Patent airway & Assess extent of injury Carpal tunnel syndrome - Median nerve Kegels exercise - Pubococcygeous muscles Priority after insertion of ET - Auscultate lungs Mg bicarbonate (Dulcolax) - Laxative effect Probanthine - Decrease gastric acid Disaster period with minimal survivor - expectant Spinal cord injury T6-T7 - Bladder retention SCI cervical - priority Respiratory paralysis Crutches - Elbows flexed 30 degrees DM correct understanding - I will drink cola if I have diarrhea Hypoxia to myocardial tissues - Chest pain Total knee replacement - Continuous Passive Motion machine Total hip replacement - Abductor pillow Total laryngectomy except Chest tube HIV - standard precaution

Gentamicin - BUN, ototoxicity Reyes syndrome - VIRAL Contraction - flexion OA Risk factor - Overweight Chest tube - while transporting do not clamp Hysterectomy - thrombophlebitis NO NO for appendicitis- Enema Peripheral arterial disease - Left dependent RA - (+) rheumatoid factor Nursing Aide - checking bowel movement Lobectomy - turning on the unaffected side Critical incidence stress management - Stress debriefing NO induction of vomiting - Kerosene ingestion Oxygen - no smoking sign Promote circulation - CPM Risk factor for Hemorrhagic stroke - AF; HPN Post op abdominal surgery; no bowel sounds - NORMAL FENTANYL - RR SCI WITH NUEROGENIC BLADDER- catheterize Blister - Stage II Anti - convulsive - Phenobarbital Miotic agent - Pilocarpine Infiltration of IV - swelling, coolness Common peptic ulcer - duodenal S/Sx of liver cirrhosis - hematemesis Prostate cancer risk factor except Promiscuous sexual behavior Cervical Cancer risk factor except SMOKING Stage III - surgery and radiation Mode of action of tamoxifen - estrogen receptor antagonist Hypothyroidism - warm room; hypernatrmeia - hypotonic solution Less sodium content - D5W Gonococcal conjunctivitis - Tetracycline Menieres disease - risk for injury Pleural effusion except INCREASE BREATH SOUNDS BMA priority - apply pressure dressing Initial stage of Status asthmaticus - resp acidosis Signs of symptoms of aspirin toxicity - tinnitus Nasal cannula correct usage - use water based lubricant Legal owner of chart - hospital BT Priority - verify MDs order Urine specimen - sterile syringe BA - best way to assess effectiveness of meds - PEAK EXPIRATORY FLOW MOST RELIABLE FOR WOUND INFECTION - culture and sensitivity Pain - no pain (according to patient) After insertion of central catheter - CXR done to verify placement TPN with sudden onset of chest pain, dyspnea, and hypotension - Stop infusion, clamp catheter AGN - restrict fluids and salt UTI - void as soon there is urge every 2-3 hours Urinary retention or incontinence - decrease sugar Assessment findings in thrombophlebitis o Pain in the calf - 90% o Swelling and redness o Homans signs 10-15% Nursing diagnosis in head injury o Impaired tissue perfusion o Increase risk for aspiration Mannitol priority: BP and IO Patient sudden ICP - hyperventilate and decrease CO2 Early sign of Increase ICP - widening pf pulse pressure Cotrimoxazole - increase OFI DKA - fruity odor Burns priority - risk for infection; reverse isolation (room) Post op eye surgery - unaffected side Amputation bedside - tourniquet

Amputation - elevate sump 24-48 hours Correct after AKA - apply circular bandages Uterine atony nursing intervention - empty the bladder BODY POSITIONING Prone o Promote drainage of oral secretions o Prevent aspiration o Promote hip extension to prevent flexion deformity o Oral surgery o Cleft palate o Tonsillectomy o Amputation after 24 hours QID for 30 minutes o Lumbar laminectomy Supine/flat o Dumping syndrome o Lumbar puncture o Post op - spinal anesthesia o Craniotomy o Myelogram, oil based o Pneumonectomy o Radio implant on cervix o Post amputation 1st 24 hours o Male catheterization Fowlers (Low - 15-30; semi - 30-45) o Ruptured AP; peritonitis - spread of infection o Autonomic dysreflexia o Conscious patient for suctioning o NGT insertion o Lobectomy o Craniotomy - supratentorial o Myelogram - water based High fowlers/Fowlers (45-60; 60-90) o Dyspnea o GERD o Hiatal hernia Sims, sidelying, lateral recumbent, semi prone o Tonsillectomy o Pregnancy o Flatulence/enema - L o Body positioning o Dorsal recumbent o Pedia, perineal exam o Bdominal assessment o Female catheterization Lithotomy/jack knife o Max visualization for vagina o Ideal for delivery o Perineal/anal exam o Female catheterization o (orthostatic hypotension) o Body positioning o Knee chest o Max visualization of anus o Ideal for rectal exam o Cord compression o Flatulence o Dysmenorrhea Modified tredelenburg o Shock o TPN catheter Spinal set o 18 pink o 19 cream o 20 yellow o 21 green o 22 black

o 23 blue o 24 purple o 25 orange o 26 brown o 27 gray o 29 red Spaulding classification o Critical sterile cavity sterilized o Semi critical intact mucous membrane disinfected o Non critical intact skin cleaned PRINCIPLES OF STERILE TECHNIQUE Only sterile items are used within the sterile field If in doubt, consider it not sterile Sterile person keeps hand in sight and at or above waist level Gowns considered sterile from waist to shoulder level in front and the sleeves In pouring sterile solution into a sterile basin, only tip of bottle is over the basin The nurse drapes non sterile table first toward self and away Tables are sterile only at table level Persons who are sterile touch only sterile items or areas and persons who are not sterile touch only unsterile items or areas Edges of anything that encloses sterile content are considered unsterile Sterile field is created as close as possible to time of use Sterile areas are continuously kept in view Sterile persons keep well within the sterile area Sterile persons keep contact with sterile areas to a minimum Unsterile persons avoid sterile areas (1 foot distance) Destruction of integrity of microbial barrier results in contamination Microorganisms must be kept to an irreducible minimum Skin cannot be sterilized Some areas cannot be scrubbed Infected areas are grossly contaminates Air is contaminated by dust and droplets Who scrubs patient? - First assistant Contaminated areas within the operative field - Umbilicus, stoma, draining sinuses, skin ulcers, vagina, anus, colostomy Scrub the most contaminated areas last or with a separate sponge Surgical scrub - Removal of as many bacteria as possible o Time method (5-7 minutes) o Brush stroke method Draping - Procedure of covering patient and surrounding areas with a sterile barrier to create and maintain an adequate sterile field during operation Sterile team - Surgeon, Assistant, Scrub nurse Five main layers of abdominal tissue from outermost - Skin, Subcutaneous, Fascia, Muscle, Peritoneum Basic unit of society - Family Tasked to operationalize health programs geared towards the health of the family - Family health office BEMOC - Basic emergency obstetric care Minimum doses of tetanus - 2 doses Booster doses of tetanus - 3 doses Fully immunized mother - 5 doses of TT (2 primary doses and 3 booster doses) Micronutrient supplementation for pregnant mothers - Vitamin A, 10,000 IU BID, 4th month of pregnancy Iron - Daily, 60 mg/400 ug tab DOB - Clear airway Unconscious - ABC - CPR Post partum bleeding - Massage uterine fundus (circular motion) Bimanual uterine compression - Give ergometrine Intestinal parasitism - Mebendazole 500 mg/tab SD 4-9 months of pregnancy Malaria- Sulfadoxin - pyrimethamine Emergency signs (pregnant women) o Unconscious o Vaginal bleeding o Severe abdominal pain o Looks very ill

o Severe headache with visual disturbance o Severe breathing difficulty o Fever o Severe vomiting Newborn screening - Within 48H up to 2 weeks after birth Post partum visit o 1st visit 3-5 days post partum o 2nd visit 6 weeks post partum Misconceptions on FP o Some causes abortion; Will render couple sterile; Result to loss of sexual desire REB strategy - Reaching every barangay Breastfeeding - Initiate within 1 hour after birth Exclusive breastfeeding - 1st 6 months; May last till 2 years Complementary feedings - 6 months Complementary feedings - Timely, Adequate, Safe, Properly fed Low birth weight = < 2,500 grams Fluid needs of young child - Water, pure juices Not good: drinks with lots of sugar, sodas (fizzy drinks), tea and coffee Non breastfed child (6-24 months) o 2-3 cups of water/day in temperate climate o 4-6 cups of water/day in hot climate Milk code of the Philippines: EO 51 RA 7600 - Rooming In and Breastfeeding Act of 1992 RA 8976: Food Fortification Law Not C/I for immunization - Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting (+) convulsions - No DPT 1; No DPT 2 and 3 (+) AIDS - No BCG TT o 1, as early as possible during pregnancy o 2, @ least 4 weeks = 80% o 3, @ least 6 months = 95% o 4, @ least 1 year = 99% o 5, @ least 1 year later = 99% Most sensitive to heat - OPV (live attenuated) and Measles (freeze dried) -15 to -250C Least sensitive to heat - DPT/Hep B, BCG, TT +2 to +80C FEFO - First expiry, first out Common nutritional deficiencies - Vitamin A, Iron, Iodine Araw ng Sangkap Pinoy - Micronutrient supplementation; Sangkap pinoy seal Essential Maternal and child health service package o Breastfeeding o Complementary feeding o Micro nutrient supplementation o Vitamin A universal supplementation Measles, severe pneumonia, persistent diarrhea, malnutrition (infants) = 100,000 IU Measles, severe pneumonia, persistent diarrhea, malnutrition (12 mos 71 mos, Preschool, 6 yrs 12 yrs) = 200,000 IU o Vitamin A high risk supplementation Pregnant women = 10,000 IU Post partum women = 200,000 IU Pregnant women w/ night blindness = 10,000 IU o Iodine supplementation Women 15-45 y.o.; children of school age, adult males = iodized oil capsule with 200 mg iodine Main oral health problems o Dental caries (tooth decay) and periodontal disease (gum disease) o Young people o 10 24 years old Essential health care package for adolescent and youth o Management of illness o Counseling on substance abuse, STD o Nutrition and diet counseling o Mental health o FP o Dental care

Most common cause of death among adult men - Accidents and injuries Male concern - BPH, prostatic cancer Most common cause of death among adult women - Cardiovascular diseases 1st Malignant neoplasms 2nd (MC breast cancer) TB and pneumonia (only CD) - Most common cause of death among elderly Non communicable or degenerative diseases (mortality) - Influenza, TB, pneumonia (morbidity) Most common cause of death among elderly- COPD 1st Reproductive health overall goal - Better quality of life among Filipinos Four (4) Pillars of Population Policy o Responsible Parenthood o Respect for Life o Birth Spacing Informed Choice

DISEASES: THEIR POSITIONS AAA FOWLERS AIR EMBOLISM LEFT SIDE LYING APPENDICITIS ANY POSITION OF COMFORT RUPTURED SEMI FOWLERS ASTHMA SITTING LEANING FORWARD AUTONOMIC DYSREFLEXIA SITTING BRONCHOSCOPY SEMI FOWLERS BRONCHIOLITIS TRIPOD CARDIAC CATHETERIZATION SUPINE CAST LEG ELEVATED CATARACT SURGERY SEMI FOWLERS CEREBRAL ANEURYSM SEMI FOWLERS CLEFT LIP SUPINE CLEFT PALATE PRONE/SIDE LYING CHF HIGH FOWLERS CRANIOTOMY SUPRETENTORIAL SEMI FOWLERS INFRATENTORIAL FLAT CVA SEMI FOWLERS DUMPING SYNDROME FLAT EPISTAXIS LEANING FORWARD FLAIL CHEST SIDE-UNAFFECTED SIDE FEMORO-POPLITEAL BYPASS GRAFT FLAT HEMORRHOIDECTOMY SIDE LYING HIATAL HERNIA UPRIGHT HIP SURGERY ABDUCTION/EXTENDED HYPOPHYSECTOMY SEMI FOWLERS INCREASED ICP SEMI FOWLERS LAMINECTOMY FLAT/ SPINE STRAIGHT LARYNGECTOMY SEMI-FOWLERS LIVER BIOPSY SIDE-AFFECTED SIDE LUMBAR PUNCTURE FLAT MASTECTOMY ELEVATED AFFECTED ARM MYELOGRAM H20 SEMI FOWLERS OIL FLAT AIR TRENDELENBURG POSTURAL DRAINAGE LUNG SEGMENT TO BE DRAIN SHOULD BE IN THE UPPERMOST POSITIO PROLAPSE CORD KNEE CHEST PULMONARY EDEMA UPRIGHT PYLORIC STENOSIS RIGHT SIDE LYING RADIUM IMPLANTS IN THE CERVIX FLAT RETINAL DETACHMENT AFFECTED PART TOWARDS THE BED SEIZURE SIDE LYING SHOCK MODIFIED TRENDELENBURG SPINAL CORD INJURY IMMOBLIZE/SPINE STRAIGHT THORACENTESIS FOWLERS DURING PROCEDURE THROMBOPHLEBITIS LEGS ELEVATED

THYROIDECTOMY SEMI FOWLERS TONSILLECTOMY SIDE LYING/PRONE VARICOSE VEINS LEGS ELEVATED VEIN STRIPPING AND LIGATION LEGS ELEVATED

------------------------------------------------------------DISEASES: THEIR ER EQUIPMENTS AMPUTATION TORNQUET AUTONOMIC DYSREFLEXIA URINARY CATH CHEST TUBE PETROLATU GAUZE/ BOTTLE/ CLAMP CVA SUCTIONING EQUIPMENT CHOLINERGIC CRISIS TRACHEOSTOMY SET DVT TAPE MEASURE EPIGLOTITIS TRACHEOSTOMY SET HYDROCEPHALUS TAPE MEASURE LARYNGOTRACHEOBRONCHITIS TRACHEOSTOMY SET MYASTHENIC CRISIS ENDOTRACHEAL TUBE PARKINSONS DISEASE SUCTIONING EQUIPMENTS PIH PADDED MOUTH GAG RADIUM IMPLANTS LLL SENGSTAKEN BLAKEMORE TUBE SCISSORS SPINAL CORD INJURY TRACHEOSTOMY THYROIDECTOMY TRACHEOSTOMY TONSILLECTOMY PENLIGHT TRACHEOSTOMY TUBE OBTURATOR VARICOSE VEINS TAP MEASURE WIRED JAW WIRE CUTTER ----------------------------------------------------------------DISEASES: THEIR DIETS ACNE LOW FAT ACUTE GLOMERULONEPHRITIS LOW NA/PROTEIN ACUTE GASTROENTERITIS CLEAR LIBERAL FLUID ADDISONS DISEASE HIGH NA, LOW K IRON DEFICIENCY ANEMIA IRON-RICHED PERNICIOUS ANEMIA VITAMIN B SICKLE CELL ANEMIA HIGH FLUID ANGINA PECTORIS LOW CHOLESTEROL GOUTY ARTHRITIS PURINE RESTRICTED ADHD FINGER FOODS BURN HIGH CALORIE/ HIGH PROTEIN CELIAC DISEASE GLUTEN-FREE CHOLECYSTITIS HIGH PROTEIN/CARBO, LOW FAT CONGESTIVE HEART FAILURE LOW NA/FAT CRETINISM HIGH PROTEIN/CALCIUM CROHNS DISEASE HIGH PROTEIN/CARBO, LOW FAT CUSHINGS DISEASE HIGH K, LOW NA CYSTIC FIBROSIS HIGH NA/CALORIE CYSTITIS ACID ASH/ ALKALINE ASH DECUBITUS ULCER HIGH PROTEIN/VIT C DM WELL BALANCED DIVERTICULITIS LOW RESIDUE DIVERTICULOSIS HIGH RESIDUE/NO SEEDS DUMPING SYNDROME DRY/HIGH PROTEIN/FATS HEPATIC ENCEPHALOPATHY LOW PROTEIN HEPATITIS HIGH PROTEIN/CALORIE HIRSCHSPRUNG DISEASE LOW RESIDUE

HYPERPARATHYROIDISM LOW CALCIUM HYPERTENSION SALT RESTRICTED HYPERTHYROIDISM HIGH CALORIE HYPOPARATHYROIDISM HIGH CALCIUM/LOW PHSPHOROUS HYPOTHYROIDISM LOW CALORIE LIVER CIRRHOSIS LOW PROTEIN MENIERES DISEASE LOW SALT MI LOW FAT NEPHROTIC SYNDROME HIGH PROTEIN/LOW SALT OSTEOPOROSIS HIGH CALCIUM/VIT D PANCREATITIS LOW FAT PUD HIGH CARBO/FAT, LOW PROTEIN PHENYLKETONURIA PHENYLALANINE-FREE PIH HIGH PROTEIN RENAL FAILURE (OLIGURIC) LOW NA/PROTEIN, HIGH CARBO (DIURETIC) HIGH PROTEIN/CALORIE (CHRONIC) LOW PROTEIN, NA, K TONSILITIS CLEAR LIQUID ------------------------------------------------------------------------------------(DISEASES: THEIR COMPLICATIONS) ACUTE GASTROENTERITIS DEHYDRATION ACUTE LYMPHOCYTIC LEUKEMIA SHOCK (BLEEDING) ADDISONS DISEASE SHOCK PERNICIOUS ANEMIA PERIPHERAL NEURITIS SICKLE CELL ANEMIA CVA VALVULAR HEART DISEASE CHF CHOLELITHIASIS CHOLECYSTITIS HEART BLOCK CHF GONORRHEA PID HERPES/HPV CERVICAL CA HYPERTENSION CVA INFECTIOUS MONONUCLEOSIS SPLENIC RUPTURE LYMES DISEASE PARALYSIS LEAD POISONING MR MENINGITIS HEARING IMPAIRMENT MYOCARDIAL INFARCTION PVS/ V.FIB PANCREATITIS HYPERGLYCEMIA PHENYLKETONURIA MR POLYCYTHEMIA VERA CVA PRE-ECLAMPSIA ABRUPTIO PLACENTA SEPTICEMIA SHOCK SORE THROAT AGN/RHD HOME VISIT BAG TECHNIQUE BREASTFEEDING FEEDING BABIES OVER 6 MONTHS OLD EO 51 MILK CODE ROOMING IN ACT OF 1992 EPI & IMCI NON - COMMUNICABLE DISEASES (HPN, CAD, STROKE/CVD, CANCER, DM, COPD, BA) OVERWEIGHT/OBESITY BMI WEIGHT IN Kg/Ht in METERS WAIST CIRCUMFERENCE ACCURATE MEASURE OF AMOUNT OF WARNING SIGNS OF CANCER

VISCERAL FAT

MENTAL HEALTH 4 facets as public health burden 1. Defined burden, burden affecting persons with mental disorders; PREVALENCE 2. Undefined burden, impact of mental health problems to persons other than the individual directly affected 3. Hidden burden, stigma and violation of human rights 4. Future burden, burden in the future resulting from aging, increasing social problems and unrest TB REGIMEN and Categories DOTS STRATEGY MENINGOCOCCEMIA Essential nursing values and behaviors: 1. ALTRUISM, welfare and well being of others 2. AUTONOMY, right to self - determination 3. HUMAN DIGNITY, respect for the inherent worth and uniqueness of individuals and populations 4. INTEGRITY, acting in accordance with an appropriate code of ethics 5. SOCIAL JUSTICE, upholding moral, legal and humanistic principles Behaviors that may indicate unclear values 1. Ignoring a health professionals advice 2. Inconsistent communication of behavior 3. Numerous admissions to a health agency for the same problem 4. Confusion or uncertainty about which course of action to take NURSING INFORMATICS Science of using computer information systems in the practice of nursing 1977 First Nursing Information Systems Conference MANAGEMENT INFORMATION SYSTEMS Designed to facilitate the organization and application of data used to manage an organization or department. HOSPITAL INFORMATION SYSTEMS Same with MIS, except that it focuses on the types of data needed to manage client care activities and health care organization HEALTH Presence or absence of disease. State of complete physical, mental, and social well being, and not merely the absence of disease and infirmity (WHO) Ability to maintain normal roles (PARSONS) A dynamic state of being in which the development and behavioral potential of an individual is realized to the fullest extent possible (ANA) QUANTITATIVE RESEARCH QUALITATIVE RESEARCH, investigates the human experience as it is lived through careful collection and analysis of narrative, subjective materials PROTECTING THE RIGHTS OF HUMAN SUBJECTS 1. RIGHT NOT TO BE HARMED a. Risk of harm to a research subject as exposure to the possibility of injury going beyond everyday situations 2. RIGHT TO FULL DISCLOSURE 3. RIGHT TO SELF DETERMINATION a. Feel free from constraints, coercion, or any undue influence to participate in a study 4. RIFHT OF PRIVACY AND CONFIDENTIALITY

Quantitative research process

4 criteria in formulating a research problem: 1. Significance So what? 2. Researchability problem can be adjusted to scientific investigation 3. Feasibility availability of time as well as the material and human resources needed to investigate a research problem or request 4. Interest to the researcher Dependent variable - effect Independent variable cause 1. DEFINE THE STUDYS PURPOSE OR RATIONALE 2. REVIEW THE RELATED LITERATURE 3. FORMULATE HYPOTHESES AND DEFINE VARIABLES a. OPERATIONAL DEFINITION 4. SELECT A REASEARCH DESIGN TO TEST THE HYPOTHESIS a. Quasi experimental design, investigator manipulates the independent variable but without either the randomization or control that characterizes true experiments b. Experimental design, investigator manipulates the independent variable by administering an experimental treatment to some subjects while withholding it from others c. Non experimental design, investigator does no manipulation of the independent variable 5. SELECT THE POULATION, SAMPLE AND SETTING 6. CONDUCT A PILOT STUDY dress rehearsal 7. COLLECT THE DATA empirical data 8. ANALYZE THE DATE 9. COMMUNICATE CONCLUSIONS AND IMPLICATIONS SUCTIONING Aspirating secretions thru a catheter connected to a suction machine or wall suction outlet Sterile technique Open tipped (effective in removing thick mucous plugs) vs whistle tipped (less irritating to respiratory tissues) Indications: dyspnea, bubbling or rattling sounds, poor skin color or decreased SaO2 levels Semi fowlers position Unconscious client lateral position facing nurse Wall unit Adult 100-120 mmHg; Child 95-110 mmHg; Infant 50-95 mmHg Portable unit Adult 10-15 mmHg; Child 5-10 mmHg; Infant 2-5 mmHg Gently rotate upon suctioning prevents trauma 5-15 seconds; average 10 seconds 20-30 seconds interval between each suction and limit suctioning to 5 minutes in total IMMEDIATE CARE OF THE NEWBORN Prof. Leah I. Denila, BSBS, R.N. I. INITIAL CARE OF THE NEWBRON A. Assessment 1. Observe or assist with initiation of respirations 2. Assess APGAR score 3. Note characteristics of cry 4. Monitor for nasal flaring, grunting, retractions, and abnormal respirations 5. Observe vital signs 6. Observe newborn for signs of hypothermia or hyperthermia 7. Assess for gross anomalies B. Interventions 1. Suction mouth, then nares with bulb syringe 2. Dry newborn and stimulate crying or rubbing

3. Maintain temperature stability; wrap newborn in warm blankets and place a stockinette cap on newborns head 4. Keep newborn with mother to facilitate bonding 5. Place newborn at mothers breast if breast-feeding is planned or place on mothers abdomen 6. Place newborn in warmer 7. Position newborn on side or abdomen or in modified Trendelenburgs position 8. Ensure newborns proper identification 9. Footprint newborn and fingerprint mother on identification sheet per agency policies and procedures 10. Place matching identification bracelets on mother and newborn. C. APGAR SCORING SYSTEM

APGAR Score interventions

Silverman and Andersen index To estimate the degrees of respiratory distress in NBs 0 = no distress 4-6 = moderate distress 7-10 = severe distress D. Cord care 1. The cord is clamped approximately 2.5 cm. (1 inch) from the abdominal wall with a plastic or metal cord clamp. 2. Count the number of vessels in the cord-fewer than 3 vessels have been associated with renal and cardiac anomalies E. Eye care 1. 0.5 erythromycin or 1% tetracycline into the conjunctival sac(s). F. Vitamin K PHYSIOLOGIC STATUS OF THE NEWBRON A. CIRCULATORY 1. Umbilical vein and ductus venosus constrict after cord is clamped; these will become ligaments (2-3 months) 2. Foramen ovale closes functionally as respirations are established, but anatomic or permanent closure may take several months. 3. Ductus arteriosus constricts with establishment of respiratory function; later becomes ligament (2-3 months) 4. Heart rate averages 140 beats/min at birth 5. Heart murmurs may be heard; usually have little clinical significance. 6. Blood pressure is 78/42 mm HG 7. Peripheral circulation established slowly; may have mottled ( blue/white) appearance for 24 hours. 8. RBC count high immediately result after birth; then falls after first week; possible physiologic anemia of infancy 9. Absence of normal flora in intestine of newborn results in low levels of vitamin K. B. Respiratory 1. Thoracic squeeze in vaginal delivery helps drain fluids from respiratory tract; remainder of fluid absorbed across alveolar membranes into capillaries. 2. Adequate levels of surfactants (lecithin and sphingomyelin) ensure mature lung function. 3. Normal respiratory rate is 30-60 breaths/min.

4. Newborns are obligate nose breathers. 5. Chest and abdomen rise simultaneously; no seesaw breathing. C. Renal 1. Urine present in bladder at birth, but newborn may not void for first 12-24 hours; later pattern is 6-10 voidings/day, indicative of sufficient fluid intake 2. Urine is pale and straw colored; initial voidings may leave brick-red spots on diaper from passage of uric acid crystals in urine 3. Infant unable to concentrate urine for first three months of life. D. Digestive system 1. Newborn has full cheeks due to well-developed sucking pads. 2. Little saliva is produced. 3. Hard palate should be intact; small raised white areas on palate (Epstein pearls) are normal. 4. Newborn cannot move food from lips to pharynx; nipple needs to be inserted well into the mouth. 5. Circumoral pallor may appear while sucking. 6. Immature cardiac sphincter may allow reflux of food when burped. 7. First stool is meconium (black, tarry residue from lower intestine); usually passed within 12-24 hours after birth. 8. Transitional stools are thin and brownish green in color; after three days, milk stools are usually passed loose and golden yellow for the breast-fed, formed and pale yellow for the formula-fed infant. E. Hepatic 1. Liver responsible for changing hemoglobin (from breakdown of RBC) into unconjugated bilirubin, which is further changed into conjugated bilirubin that can be excreted. 2. Excess unconjugated bilirubin can permeate the sclera and the skin, giving a jaundiced or yellow appearance to these tissues. 3. The liver of a mature infant can maintain the level of unconjugated bilirubin at less than 12 mg/dl. Higher levels indicate a possible dysfunction and the need for intervention. F. Temperature 1. Heat production in newborn accomplished by: 1.1 Metabolism of brown fat a special structure in newborn that is source of heat. 1.2 Increased metabolic rate and activity 2. Newborn cannot shiver as an adult does to release heat. 3. Newborns body temperature drops quickly after birth; cold stress occurs easily. 4. Body stabilizes temperature in 8-10 hours if unstressed. 5. Cold stress increases oxygen consumption; may lead to metabolic acidosis and respiratory distress. G. Immunologic 1. Newborn has passive acquired immunity from IgG from mother during pregnancy and passage of additional antibodies in colostrum and breast milk. 2. Newborn develops own antibodies during first three months, but is at risk for infection during first six weeks. H. Neurologic/Sensory Six states of Consciousness 1. Deep sleep 2. Light sleep: some body movements 3. Quiet alert: few movements, but eyes open and bright 4. Active alert: active, occasionally fussy with much facial movement 5. Crying: much activity, eyes open or closed I. Periods of Reactivity 1. First (birth through first hour) newborn alert with good sucking reflex, irregular R/HR

2. Second (4-8 hours after birth): may regurgitate mucus, pass meconium, and suck well 3. Equilibrium usually achieved by 8 hours of age J. Sleep cycle 1. Newborn usually sleeps 17 hours/day K. Hunger cycle Varies, depending on mode of feeding 1. Breast-fed infant may nurse every 2-3 hours. 2. Bottle-fed infant may be fed every 3-4 hours. L. Special senses 1. Sight: eyes are sensitive to light; newborn will fix and gaze objects, especially those with black and white, regular patterns, but eye movements are uncoordinated. 2. Hearing: can hear before birth (24 weeks); newborn seems best attuned to human speech and its cadences. 3. Taste: sense of taste established; prefers sweet-tasting fluids; derives satisfaction as well as nourishment from sucking. 4. Smell: sense of smell is developed at birth; newborn can identify own mothers breast milk by odor. 5. Touch: newborn is well prepared to receive tactile messages; mother demonstrates touch progression in initial bonding activities. PHYSICAL EXAMINATION A. Body measurements 1. Length: 45-55 cm (18-20 inches) 2. Weight: 2,500-4,300 g (5.5 to 9.5 lb) 3. Head circumference: 33 to 35.5 cm (13-14 inches) 4. Chest circumference: 30-33 cm( 12 to 13 inches) and should be equal to or 2 to 3 cm less than the head circumference B. Head 1. Head should be 25% of the body length (cephalocaudal development). 2. Bones of the skull are not fused. 3. Sutures are palpable (connective tissue between the skull bones). 4. Fontanels are ossified membranous tissue at junction of the sutures. 5. Molding is asymmetry of the head resulting from pressure in the birth canal; molding disappears in about 72 hours. 6. Masses from birth trauma a. Caput succedaneum is edema of the soft tissue over bone (crosses over suture line); it subsides within few days. b. Cephalhematoma is swelling caused by bleeding into an area between the bone and periosteum (does not cross over suture line); is usually is absorbed within 6 weeks with no treatment. 7. Head Lag a. Common when pulling newborn to a sitting position. b. When prone, newborn should be able to lift the head slightly and turn the head from side to side. C. Eyes 1. Slate gray (light skin) or brown-gray (dark skin). 2. Symmetrical and clear. 3. Pupils equal, round, react to light by accommodation. 4. Blink reflex present. 5. Eyes cross because of weak extraocular muscles. 6. Red reflex present. 7. Eyelids often edematous as a result of pressure during the birth process and the effects of eye medication. D. Ears 1. Symmetrical 2. Firm cartilage with recoil 3. Pinna on or above line drawn from canthus of eye 4. Low-set ears are associated with Down syndrome

E. Nose 1. Flat, broad, in center of face 2. Obligatory nose breathing 3. Occasional sneezing to remove obstructions F. Mouth 1. Pink, moist gums 2. Soft and hard palates intact 3. Epsteins pearls (small, white cysts) that may be present on hard palate 4. Uvula in midline 5. Sucking and crying movements symmetrical 6. Able to swallow 7. Gag reflex present G. Neck 1. Short and thick 2. Head held in midline 3. Trachea on midline 4. Good range of motion and ability to flex and extend H. Chest 1. Circular appearance because anteroposterior and lateral diameters are about equal 2. Diaphragmatic respirations 3. Bronchial sounds heard on auscultation 4. Nipples prominent and often edematous 5. Milky secretion (witchs milk) common 6. Breast tissue present 7. Clavicles need to be palpated to assess for fractures I. Skin 1. Pinkish red (light-skinned newborn) to pinkish brown or pinkish yellow (dark-skinned newborn) 2. Vernix caseosa 3. Lanugo 4. Milia 5. Dry, peeling skin 6. Dark red color common in premature newborns 7. Cyanosis common with hypothermia, infection, and hyperglycemia, and with cardiac, respiratory, or neurological abnormalities. 8. Acrocyanosis (peripheral cyanosis) normal in first few hours after birth and if the infant becomes cold. 9. Assessment for ecchymosis and petechiae resulting from trauma of birth. 10. Assessment of skin turgor over the abdomen to determine hydration status. 11. Harlequin sign a. Deep pink or red color develops over one side of the newborns body while the other side remains pale or of normal color b. Harlequin sign may be indicative shunting of blood with a cardiac problem or may indicate sepsis. 12. Birthmarks a. Telangiectatic nevi (stork bites) a.1 Pale pink or red, flat, dilated capillaries a.2 On eyelids, nose, lower occipital bone, and nape of neck a.3 Easily blanch a.4 More noticeable during crying periods a.5 Disappear by age 2 years b. Nevus flammeus (port-wine stain) b.1 Capillary angioma directly below epidermis b.2 Nonelevated, sharply demarcated, red to purple, dense areas of capillaries b.3 Commonly appearing on face b.4 No fading with time b.5 May require surgery in the future

C. Nevus vasculosus (strawberry mark) c.1 Capillary hemangioma c.2 Raised, clearly delineated, dark red, with a rough surface c.3 Common in head region c.4 Disappears by age 7 to 9 years D. Mongolian spots d.1 Bluish black discoloration d.2 On lumbar dorsal area and buttocks d.3 Gradual fading during first and second years of life

J. Genitals Female 1. Labia are edematous; clitoris is enlarged 2. Smegma may be present (thick, white mucus discharge) 3. Pseudomenstruation is possible (blood-tinged mucus) 4. Hymen tag may be visible 5. First voiding should occur within 24 hours Male 1. Prepuce (foreskin) covers glans penis 2. Scrotum is edematous 3. Verify meatus at tip of penis 4. Testes descended but may retract with cold 5. Assess for hernia or hydrocele 6. First voiding should occur within 24 hours K. Spine 1. Straight 2. Posture flexed 3. Supportive of head momentarily when prone 4. Arms and legs flexed 5. Chin flexed on upper chest 6. Well-coordinated sporadic movements 7. A degree of hypotonicity or hypertonicity indicative of central nervous system damage L. Extremities 1. Flexed 2. Full range of motion; symmetrical movements 3. Ten fingers and toes, all separate 4. Legs bowed 5. Major gluteal folds even 6. Creases on soles of feet 7. Assessment of fractures (especially clavicle) or dislocations (hip) 8. Fists clenched 9. Pulses are palpable 10. Slight tremors common but could be a sign of hypoglycemia or drug withdrawal Chills Burning of brown fats Accumulation of fats Burning of glucose Hypoglycemia Destruction of cells retardation

Fatty Acids (end-products) Possibility of brain Acidosi damage & Growth Inhibits function of Medulla APNEA

Pathologic jaundice= 24 H Physiologic jaundice= 2-3 days Gray color in NB = infection Stools: meconium transitional

Vernix caseosa- white cream, cheese like substance Lanugo- fine downy hair that covers NB face, back, shoulders Premature = more lanugo than term infants Postmature = rare lanugo Molding Caput Succedaneum- edema of the scalp; resolves at 3rd day of life Cephalhematoma blood periosteum of the skull bone and bone itself ; resolves weeks after

Reflexes Blink Reflex purpose & procedure Rooting Reflex- brushing or stroking the cheek near the mouth, the child will turn the head in that direction; disappears 6th week. Sucking Reflex- when the NBs lips are touched, the baby makes a sucking motion. Disappears 6th months of age. 4. Swallowing Reflex- food at posterior portion of the tongue is automatically swallowed. 5. Extrusion Reflex the NB will extrude any substance that is placed on the anterior portion of the tongue; disappears 4 months of age. 6. Palmar Grasp Reflex- NB will grasp an object placed in their palm by closing their fingers on it; disappears 6 weeks to 3 months of age. 7. Step (Walk)-in-Place Reflex- NB who are held in a vertical position with their feet touching a hard surface will take a few quick, alternating steps; disappears by 3 months of age. 8. Placing Reflex- similar to the step-in-place, except it is elicited by touching the anterior surface of a newborns leg against the edge of the bassinet or table. 9. Plantar Grasp- when an object touches the sole of the NBs foot at the base of the toes, the toes grasp in the same manner as the fingers do. Disappears about 8 to 9 months in preparation for walking. 10. Tonic Neck Reflex- When the NB lie on back, the arm & leg on the side to which the head turns extend, and the opposite arm & leg contract. Disappears between the 2nd and 3rd months of life. 11. Moro Reflex- (startle) initiated by startling the NB by a loud noise or by jarring the bassinet. They abduct and extend their arms & legs. Their fingers assume a typical C position. 12. Babinski Reflex when the side of the sole of the foot is stroked in an inverted J curve from the heel upward, the NB fans the toes. (+) Babinski Reflex 13. Landau Reflex- A NB who is held in a prone position with a hand underneath supporting the trunk should demonstrate some muscle tone. They are not able to lift their head or arch their back in this position, but neither they should sag into an inverted U position. 14. Deep Tendon Reflex- a patellar reflex can be elicited in a NB by tapping the patellar tendon with the tip of the finger.

WITH God behind you and His arms beneath you, you can face whatever lies ahead of you.
GOD BLESS! QUESTIONS

1. As part of the respiratory assessment the nurse observes the newborns nares for patency and mucus. The information obtained from this assessment is important because: a. infants are obligate nose breathers b. nasal patency is required for adequate feeding c. problems with nasal patency may cause flaring d. a deviated septum will interfere with breathing

QUESTIONS

2. Immediately after a delivery, the nurse-midwife assesses the neonates head for signs of molding. Which factors determine the type of molding? a. Fetal body flexion or extension b. Maternal age, body frame, and weight c. Maternal and paternal ethnic backgrounds d. Maternal parity and gravidity 3. After delivering an 8 lb (3.6 kg) girl, a client asks the nurse what her daughter should receive for the first feeding. For a bottle-fed neonate, the first feeding usually consists of: a. sterile water b. glucose water c. standard infant formula d. enriched infant formula 4. Just after delivery, the nurse measures a neonates axillary temperature at 94.1 0F (34.5 oC). What should the nurse do? a. Rewarm the neonate gradually b. Rewarm the neonate rapidly c. Observe the neonate at least hourly d. Notify the physician when the neonates temperature is normal 5. Which of the following describes the rationale for administering vitamin K to every newborn? a. Infants dont receive the clotting factor in utero b. The infant lacks intestinal flora needed to make vitamin K c. It boost the minimal level of vitamin K found in the infant d. The drug prevents the development of Phenyketonuria (PKU) 6. Which of the following describes how the nurse interprets a newborns Apgar score of 8 at 5 minutes? a. An infant whos in good condition b. An infant whos mildly depressed c. An infant whos moderately depressed d. An infant who needs additional oxygen to improve the Apgar score 7. When assessing a neonate 1 hour after delivery, the nurse measures an axillary temperature of 95.6 oF (35.3 oC), an apical pulse of 110 beats/minute, and a respiratory rate of 64 breaths/minute. Which nursing diagnosis takes highest priority at this time? a. Hypothermia related to heat loss b. Altered parenting related to the addition of a newly family member c. Risk for fluid volume deficit related to insensible fluid losses d. Risk for infection related to transition to the extrauterine environment 8. The nurse is recording an Apgar score for a newborn. The nurse should assess: a. heart rate, respiratory effort, temperature, reflex irritability, and color b. heart rate, respiratory effort, reflex irritability, and color c. a. heart rate, respiratory effort, temperature, and color d. heart rate, respiratory effort, temperature, sucking reflex, and color 9. A neonate begins to gag and turns a dusky color. What should the nurse do first? a. Calm the neonate b. Notify the physician c. Provide oxygen via a face mask as ordered d. Aspirate the neonates nose and mouth with a bulb syringe 10. A client gives birth to a neonate prematurely, at 28 weeks gestation. To obtain the neonates Apgar score, the nurse assesses the neonates: a. temperature b. respiration

c. blood pressure d. weight 11. Its difficult to awaken a neonate 3 hours after birth. The nurse recognizes that this behavior indicates: a. a physiologic abnormality b. probable hypoglycemia c. normal progression into the sleep cycle d. normal progression into a period of neonatal reactivity 12. What is a common adverse effect of phototherapy? a. Kernicterus b. Watery stools c. Positive coombs test d. Polyuria 13. One minute after birth, a neonate has an Apgar score of 7. What should the nurse do? a. Administer oxygen via nasal prongs ordered b. Begin cardiopulmonary resuscitation c. Stimulate breathing by rubbing the neonates back d. Encourage the mother to hold the neonate close 14. The nurse assesses a 1-day-old neonate. Which finding indicates that the neonates oxygen needs are not being met by current treatment? a. respiratory rate of 54 breaths/min b. abdominal breathing c. nasal flaring d. acrocyanosis 15. The nurse is assessing a newborn. When maternal estrogen has been transferred to the fetus, which sign will the nurse see in the newborn? a. weak sucking response b. enlarged breast tissue c. soft skin d. vernix caseosa 16. When caring for a neonate, what is the most important step the nurse can take to prevent and control infection? a. Assessing frequently for signs of infection b. Using sterile technique for all caregiving c. Practicing meticulous hand washing d. Wearing gloves at all times

TOPIC: GROWTH AND DEVELOPMENT PRINCIPLES OF GROWTH Children are individuals not little adults, who must be seen as a part of the family. Children are influenced by genetic factors, home and environment, and parental attitudes Chronologic and development ages of children are most important contributing factors influencing their care Play is a natural medium for expression, communication, and growth in children Growth is complex with all aspects closely related Growth is measured both quantitatively and qualitatively over a period of time

Growth is a continuous orderly process with uneven rates: Infancy: most rapid period growth Preschool to puberty: slow uniform rate of growth Puberty: second most rapid growth period d. After puberty: decline in growth rate until death
Growth is cephalocaudal Different parts of the body grow at different rates Both rate and pattern of growth can be modified by nutrition Each individual proceeds at his/her own rate of growth and development

Primitive reflexes disappear before they are replaced with voluntary activity
CHARACTERISTICS OF GROWTH

Circulatory system Heart rate decreases with increasing age

Infancy: 120 -160 bpm One year: 80 120 bpm Childhood: 70 110bpm

Adolescence: 55 90bpm
Blood pressure increases with age Hemoglobin Highest at birth, 17 g per 100 ml of blood; then decreases during the first year to less than 5% Gradual increase in hemoglobin level to 14.5 g per 100 ml of blood between 1 to 12 years of age

Respiratory system Rate decreases with increase in age

Infancy: 30 40 bpm Childhood: 20 24 BPM Adolescence and adulthood: 16 18 bpm

Urinary system Premature and full-term infants have some inability to concentrate urine
Specific gravity (newborn) 1.001 to 1.02

Glomerular filtration rate greatly increased by 6 months of age

Digestive system Stomach size by birth rapidly increases during infancy and childhood Peristaltic activity decreases with age Blood glucose levels gradually rise from 75 80 mg per 100 ml o blood in infancy to 95 100 during adolescence Enzymes are present at birth to digest proteins and moderate amount of fat but only simple sugars Secretion of hydrochloric acid and salivary enzymes increases with age until adolescence then decreases with
advancing age Nervous system Brain reaches 90% of total size by 2 years of age All brain cells are present by the end of the first year, although their size and complexity will increase Maturation of brain stem and spinal cord follows cephalocaudal and proximodistal laws PLAY Functions of Play

Educational: learn about physical world and associate names with objects Recreational: release surplus energy Sensorimotor: muscle development and tactile, auditory, visual, and kinaesthetic stimulation Social and emotional adjustment: learn moral values, develop ideas of sharing

Therapeutic: release of tension and stress, manipulation of syringe and other equipments allows control over threatening events Types of Play Active, physical: push-and pull toys; riding toys; sports and gym equipment Manipulative, constructive creative, or scientific: blocks; constructions toys; drawing sets; microscope and chemistry sets; books; computer programs Imitative, imaginative and dramatic: dolls; dress up costumes; puppets Competitive and social games: role playing THE FAMILY

Structure of the Family

The basic unit of the society Composition varies Usually share a common goal and belief Roles change within the group and reflect both individuals and groups needs Status of members determined by position in family in conjunction with the views of society
Functions of the Family

Reproduction Maintenance Socialization Growth of individual members towards maturity and independence
THE INFANT Developmental Timetable

1 Month A. Physical 1. Weight: gains about 150 210 g weekly during the first 6 months of life 2. Height: grows about 2.5 cms a month for the first 6 months of life 3. Head circumference: grows about 1.5 cms a month for the first 6 months of life B. Motor 1. Assumes flexed position with pelvis high but knees under abdomen when prone 2. Hold the head parallel with the body when suspended in prone position 3. Can turn head from side to side when prone 4. Primitive reflexes still present C. Sensory 1. Eye movements coordinated most of the time: follows light to midline 2. Visual acuity 20/100 D. Socialization and vocalization 1. Watches face intently while spoken to 2. Utters small throaty sounds
2 to 3 months

A. Physical: posterior fontanel closed B. Motor 1. Hold the head erect for a short time and can raise chest supported on forearms 2. Bears some weight on legs when held in standing position 3. Actively hold rattle but will not reach for it 4. Grasp, tonic neck, and Moro reflexes are fading 5. Plays with fingers and hands C. Sensory 1. Follows a light to the periphery 2. Has binocular coordination 3. Listens to sounds D. Socialization and vocalization 1. Smiles in response to a person or object; cries less 2. Laughs aloud and shows pleasure in making sounds
4 to 5 Months A. Physical

 1. Birth weight doubles 2. Drools because salivary glands are functioning but swallowing reflex is not sufficient, swallow saliva B. Motor 1. Can sit when the back is supported 2. Can sustain a portion of the body weight when held in a standing position 3. Reaches for & grasps an object with the whole hand but misjudges distances 4. Can carry hand or object to the mouth at will 5. Can roll over from abdomen to back 6. Primitive reflexes have disappeared

C. Sensory 1. Recognizes familiar objects and people D. Socialization and vocalization 1. Coos and gurgles when talked to 2. Vocalizes displeasure when object is taken away

6 to 7 Months A. Physical 1. Weight: gains about 90 to 150 g weekly during the second 6 months of life 2. Height: grows about 1.245 cms a month 3. Head circumference: grows about 0.5 cm a month 4. Teething may begin with eruption of two lower central incisors B. Motor 1. Can turn over equally well from stomach or back 2. Sits fairly well unsupported 3. Can approach a toy and grasp it with one hand 4. Plays with feet and puts them in mouth

C. Sensory 1. Has taste preferences 2. Begins to recognize that things are present even though they cannot be seen D. Socialization and vocalization 1. Shows stranger anxiety 2. Vocalizes m-m-m when crying
8 T0 9 Months

Motor 1. Sits steadily alone 2. Has good hand to mouth coordination 3. Crawls B Sensory 1. Displays interest in small objects C.Socialization 1. Definite social attachment is evident 2. Responds to own mane Reacts to adult anger Has imitative and repetitive speech
10 to 12 Months

A. Physical

Weight: birth-weight triples

Height: birth-length increase by 50%

Head and upper chest circumference are equal

Motor Creeps Sands alone for a short time Can sit down from standing position Can et from a spoon and a cup but needs help Can play peek-a-boo Helps in dressing such as putting arm into a sleeve

Sensory Visual acuity is 20/50 Discriminates simple geometric forms Shows jealousy, affection and anger

Socialization and vocalization

Can say two words besides Dada or Mama Play During Infancy (Solitary Play) Safety is the chief determinant in choosing toys Toys need to simple because of a short attention span Visual and auditory stimulation is important

Suggested toys: rattles, soft, stuffed toys, squeeze toys, teething toys, books with textures, activity boxes, nested boxes and fitting forms. HEALTH PROMOTION DURING INFANCY FEEDING MILETONES A. At birth the full-term infant has sucking, rooting and swallowing reflex B. Newborn indicates the need for food by; crying; express satiety by falling asleep C. At 1 month has strong extrusion reflex D. By 5-6 months can use fingers to eat crackers or toast E. By 7-8 months is ready to chew solids F. By 8-9 months can hold a spoon and play with it during feeding G. By 9 months can hold own bottle H. By 12 months usually can drink from a cup GUIDELINES FOR INFANT FEEDING

1. Breast milk is the most complete diet for the first 6 months 2. Iron-fortified commercial formula is an acceptable alternative to breastfeeding 3. Solids can be introduced by about 6 months 4. First solid foods are strained, pured or mashed
5. Finger foods are introduced at 6-7 months 6. Chopped table foods or commercially prepared junior foods can be introduced by 9-12 months 7. Fruit juices should be offered as early as possible from a cup to reduce development of nursing bottle carries 8. Introduce one food at a time to allow for identification of food allergies 9. Never introduce foods by mixing them with the formula in the bottle
IMMUNIZATIONS

1. DPT Tripedia diptheria, tetanus, and attenuated pertussis; given at 2, 4 and 6 months; boosters given at 15
months and 5 years of age age

2.Measles, Mumps and Rubella (MMR) given at 12 months of age, a second dose should be given at 4-6 years of 3. Inactivated Polio Vaccine (IPV) given at 2, 4 and 6 months 4. Hepatitis-B Vaccine given at birth to 1 month, 4 and 9 months

Factors Influencing Administration of Immunizations

1. The benefit from being protected by the immunization is believed to greatly outweigh the risk from the disease 2. Presence of maternal antibodies 3. Administration of blood transfusion or immune serum globulin within 3 months 4. High fever or serious illness 5. Generalized malignancy or leukemia 6. Neurologic problems such as convulsion 7. Allergic reaction to previously administered vaccine
INJURY PREVENTION

A. Accidents 1. Mechanical suffocation occur in children under 1 year of age 2. Aspiration of small objects a nd ingestion of poisonous substances occur during second half of the first year and in early childhood 3. Trauma fro rolling off a bed or falling down stairs can occur at any time

B. Teachings for prevention 1. Place infant to sleep on side or back 2. Use a firm mattress; do not use pillows and loose blankets 3. Keep crib away from other furniture 4. Never leave infant alone in the bath 5. Always raise crib rails

Avoid using a high chair until the child is old enough Keep cigarettes and their ashes away from infants Do not keep the child inside a parked car Transport infant in a specially constructed rear-facing car seat with the appropriate restraint Do not place infant on the seat or in the lap

Avoid sharp, jagged-edged objects 4 to 7 Months

1. Keep buttons, beads and other small objects out of infants reach 2. Do not feed infant with hard candy, nuts, seeds or whole hot dogs 3. Make sure that paint for furniture, toys and equipments do not contain lead 4. Place toxic objects on high shelves 5. Know telephone number of local poison control center
8 to 12 months

1. Keep doors of bathrooms, ovens, dishwasher, and refrigerators closed at all times 2. Fence swimming pools 3. Administer medication as a drug and not as a candy 4. Place guards in front of any heating appliance
DISEASES OF THE INFANT Trisomy 21 (Down Syndrome)

Data Base 1. Frequently associated with advanced parental age (40-44 years) 2. Translocation of chromosome 15 and 21 3. Mosaicism
Clinical Findings 1. Small, round skull and saddle nose 2. Brushfields spots

 3. Small and low set ears 4. Short thick neck 5. Protruding and fissured tongue Broad, short and stubby hands Delayed or incomplete sexual development

Nursing care of children with Trisomy 21 1. Prevent infection 2. Provide activity consistent with abilities and limits 3. Provide physical supervision and rehabilitation

Cleft Lip Database 1. Failure of union of embryonic structure of lace, which occurs between 5 and 8 weeks of fetal life 2. Cause: unknown Clinical Findings 1. Difficulty in feeding because infant cannot form a vacuum with the mouth to suck 2. Mouth breathing develops Therapeutic Intervention 1. Surgical repair performed 6 to 12 weeks after birth Cleft Palate

Database 1. Failure of union of embryonic structure of lace, defect in the fusion of palatal structures between 9 and 12
weeks, may involve the soft or hard palate

2. Cause is unknown 3. More common in females

Clinical Findings 1. Aspiration Pneumonia 2. Altered speech Clinical Findings 1. Aspiration Pneumonia Clinical Findings 1. Aspiration Pneumonia 2. Altered speech 3. Excessive dental carries 4. Hearing problems caused by recurrent otitis media 2. Altered speech 3. Excessive dental carries 4. Hearing problems caused by recurrent otitis media 3. Excessive dental carries 4. Hearing problems caused by recurrent otitis media

Therapeutic Interventions 1. Provide speech appliance to help prevent guttural sounds 2. Surgical repair between 12 to 18 months 3. Speech therapy

Intestinal Obstruction Database 1. Congenital life-threatening obstruction of the intestines a. Mechanical: constricted or occluded lumen b. Muscular: interference with normal muscular contraction Clinical findings 1. Abdominal distension 2. Absence of stools especially meconium 3. Vomiting of bile stained material that may be projectile

Therapeutic Interventions

1. Surgical repair 2. Prevention of pneumonia 3. Supportive nutritional therapy

Imperforate Anus

Data Base 1. Failure of the membrane separating the rectum from the anus to absorb during the 8th week of fetal life Clinical Findings 1. Failure to pass meconium stool and abdominal distension Therapeutic Intervention 1. Immediate surgical repair unless fistula is present 2. Possible colostomy

Defects with Increase Pulmonary Blood Flow Ventricular Septal Defect 1. Abnormal opening between two ventricles 2. Severity of the defect depends on the size of the opening 3. Higher pressure in the right ventricle causes hypertrophy, with development of pulmonary hypertension 4. Low harsh murmur heard throughout systole 5. Specific therapeutic intervention: closure of the opening of the septum 6. Prognosis: a single membranous defect has less than a 5% mortality rate

Atrial Septal Defect 1. Types a. Ostium primum defect: opening at lower end of septum; may be associated with mitral valve abnormalities b. Ostium Secundum Defect: opening is near the center of the septum c. Sinus venosus defect, in which the superior portion of the atrial septum fails to form near the junction of the
atrial wall with the superior vena cava 2. Murmur heard high on the chest with fixed splitting of the second hear sound 3. Specific therapeutic Intervention: closure of the opening at the septum 4. Prognosis: this defect has less than 1% operative mortality

Patent Ductus Arteriosus 1. Failure of the fetal connection between the aorta and pulmonary artery to close 2. Blood shunted from the aorta back to the pulmonary artery; may progress to pulmonary hypertension and
cardiomegaly

3. Machinery type murmur heard throughout the heartbeat in the left second or third interspace 4. Specific therapeutic intervention: closure of the opening between the pulmonary artery

5. Prognosis: this has less than 1% mortality Defects with Decreased Pulmonary Blood Flow Tetralogy of Fallot 1. Four associated defects a. Ventricular Septal Defect b. Pulmonary Valve Stenosis c. Overriding Aorta d. Right Ventricular Hypertrophy 2. Specific therapeutic Interventions: Palliative treatment and complete repair 3. Prognosis: this defect has; less than 5% surgical repair mortality

Transposition of the Great Vessels 1. Aorta exits from the right ventricle and pulmonary leaves the left ventricle 2. Specific therapeutic intervention: a. Specific therapeutic interventions Blalock-Hanlon operation: surgical creation of an atrial septal defect

b. Complete repair: Rastellis procedure: closure of ventricular septal defect 3. Prognosis: this defect has a 5-10% surgical mortality
Neurologic Malformations

Spina Bifida Database 1. Malformation of the spine in which the posterior portion of the laminae of the vertebrae fails to close 2. Associated defects include weakness or paralysis below the defect, bladder and bowel dysfunctions and
hydrocephalus

3. Arnold-Chiari syndrome: defect of the occipitocervical region with swelling and displacement of the medulla
into the spinal cord

4. Classifications: a. Spina Bifida Occulta, spinal cord and meninges are intact : defect only of the vertebrae b. Spina Bifida Cystica: Meningocele meninges but no neural elements, protrude thru the defect, spinal fluid exits thru the defect Meningomyelocele meninges and spinal nerves protrude thru the defect, spinal fluid exits thru the defect, the
most serious type

5. Clinical Findings a. Degree of neurologic dysfunction directly related to level of defect b. Defective nerve supply to bladder affects sphincter and muscle tone c. Frequently poor anal sphincter control 6. Therapeutic management: a. Surgical repair of the sac B Prevent infection Hydrocephalus Data Base 1. Abnormal accumulation of cerebrospinal fluid within the ventricular system 2. Classifications: Noncommunicating: there is obstruction within the ventricles Communicating: there is inadequate absorption of cerebrospinal fluid 3. Clinical Findings: a. Increase head size in the infant because of open sutures and bulging fontanelles b. Sunset eyes c. Head lag d. Increased intracranial pressure e. Brain damage

4. Therapeutic Interventions: a. Relief of hydrocephalus b. Removal of obstruction c. Mechanical shunting of fluid to another area
Inborn Errors in Metabolism Phenylketonuria Database: 1. Lack of enzyme phenylalanine hydroxylase, 2. Clinical findings a. Mental retardation

which changes phenylalanine into tyrosine

b. Strong musty odor of the urine from c. Absence of tyrosine, which results in 3. Therapeutic Interventions: a. Early detection is essential b. Guthrie blood test c. Use of aspartame is prohibited

phenylacetic acid blond hair and blue eyes

Galactosemia Data Base: 1. Missing enzyme that converts galactose to glucose 2. Clinical findings a. Weight loss and vomiting b. Hepatosplenomegaly and jaundice c. Cataracts 3. Therapeutic intervention: a. Early detestation: test for galactosemia at birth b. Dietary reduction of glucose
THE TODDLER From 1 -3 years Characterized by alternating rapid & slow rate of G&D Usually bow-legged (under developed mm of LE) Characterized by marked curiosity, mobility & active)

Development Theories

Freud Anal (ego) (site of satisfaction) 2. Erickson autonomy vs. shame & doubt 3. Piaget preconceptual phase (stage 1 Preoperational Thought Period) : concepts of ideas without logic : characterized by simple classifications : with egocentric thinking (cannot put self in place of another) 4. Kohlberg (Moral)

-Preconventional -Punishment & obedience

Developmental Timetable

15 Months A. Motor 1. Walks well alone by 14 months 2. Builds tower of blocks 3. Drinks from a cup and can use a spoon B. Vocalization and socialization 1. Can use 4-6 words including name 2. Has learned no which may be said while doing requested demand
18 Months A. Physical 1. Growth has decreased and appetite lessened 2. Anterior fontanelle has usually closed 3. Abdomen protrudes

B. Motor 1. Runs clumsily 2. Imitates strokes in drawing 3. Drinks well from a cup 4. Builds tower of 3-4 cubes C. Vocalization and socialization 1. Says 10 or more words 2. Has new awareness of strangers 3. Begins to have temper tantrums 4. Very ritualistic
2 Years

A. Physical 1. Weight: about 11-12 kgs 2. Hight; about 80-82 cms 3. Teeth 16 temporary, begin to visit dentist B. Motor 1. Gross motor skills quite refined 2. Can walk up and down the stairs 3. Builds tower of 6-7 cubes C. Sensory 1. Accommodation well developed 2. Visual acuity 20/40 D. Vocalization and socialization 1. Vocabulary of about 300 words 2. Obeys simple commands 3. Still very ritualistic 4. Can help undress self 5. Does not share possessions, everything is mine
30 Months A. Physical 1. Full set of 20 temporary teeth 2. Decreased need for naps B. Motor 1. Walks on tiptoe 2. Build tower of 8 blocks 3. Copies horizontal o vertical line 4. May attend to own toilet needs C. Vocalization and socialization 1. Begins to see self as a separate individual 2. Still sees other children as objects 3. Increasingly independent, ritualistic, and Major Learning Event

negativistic

Toilet Training: most important task of the toddler 1. Sphincter control is adequate when the child can walk 2. Able to retain urine for at leat 2 hours 3. Usual age for bowel training: 24 to 30 months 4. Daytime bowel and bladder control: during second year 5. Night control: by 3-4 years of age
Common Fears

Separation anxiety (esp. hospitalization) 3 phases

Protest incessant crying, temper tantrums Despair withdrawal, isolates oneself

Denial 2. Fear of big objects & loud sounds 3. Fear of pain Play During Toddlerhood (Parallel Play)

1. The child plays alongside other children but not with them 2. Mostly free and spontaneous, no rules or negotiations 3. Attention span is still short 4. Safety is important 5. Imitation and make believe play begins by the end of the 2nd year 6. Suggested toys: pay furniture an dishes, puzzles with a few large pieces, bicycle, clay, sandbox, push and pull
toys Nutrition

1. Increased variety, types and textures of foods 2. Increase involvement in he feeding process 3. Consider childs appetite, choices and motor skills 4. Anemia: increase foods containing iron 5. Influence of commercialism on selection of foods and emphasis on fast foods, empty calorie snacks and high
carbohydrate convenience food Nutrition

Nutrition - Daily caloric requirement 100 kcal/kg/day Dentition daily caloric requirement Begins dentist visit at 2 years Begins to brush teeth at 2 years

Negativism Ritualistic behaviors

HEALTH PROBLEMS MOST COMMON IN TODDLERS

Poisoning Database 1. Ingestion of a toxic substance or an excessive amount of a substance 2. More than 90% of poisoning occurs in the home 3. Ingestion incidence occur in children under 4 4. Improper storage is the major contributing factor to poisoning
Therapeutic management 1. Empty the mouth of pills, plant parts, or other materials 2. Thoroughly flush eyes with tap water if they were involved 3. Bring the victim to fresh air if an inhalation poisoning occurred 4. Do not induce vomiting if; a. The person is comatose or has lost the gag reflex b. The poison is corrosive 5. Prevent aspiration if the child is vomiting 6. Observe for latent signs and symptoms of poisoning complications
Fractures Fractures Database 1. An interruption in the integrity of the bone 2. In children, bones are easily injured 3. Healing occur rapidly in children 4. Classification; a. Bend: bone is bent no broken

b. Buckle or torus fracture: bone is compressed, appears as a bulge c. Greenstick fractures: incomplete break and bending of a long bone d. Complete fracture: bone fragments are divided

Clinical Findings 1. Generalized swelling 2. Pain or tenderness 3. Diminished function or use of part Therapeutic Intervention 1. Splints and tractions 2. Hard or soft casts to promote bone alignment

Cerebral Palsy Database 1. Non-specific term for a neuromuscular disability or difficulty in controlling voluntary muscles Characteristics 1. Affects young children usually becoming evident before 3 years of age 2. Unprogressively but persists throughout life 3. Mental deficiency may be present Major causes 1. Prenatal brain abnormalities 2. Prematurity 3. Anoxia of the brain 4. Trauma

Clinical Findings 1. Difficulty in feeding 2. Delayed motor development 3. Delayed speech development Therapeutic Interventions 1. Mobility devices 2. Surgery to correct spastic muscles 3. Medications such as skeletal muscle 4. Physiotherapy, occupational and
Cystic Fibrosis

imbalance relaxants speech therapy

Data Base: 1. Autosomal recessive disorders affecting the exocrine glands 2. Most serious pulmonary and genetic disease of children 3. Elevation in sweats electrolytes: Na and Cl are elevated 3 to 5 times higher than normal 4. Increased viscosity of the mucous gland secretions Clinical Findings 1. Presence of cough or wheezing during first 6 months of age 2. Clubbing of fingers, barrel shaped chest, cyanosis and distended neck veins 3. Cardiac enlargement, cor pulmonale Therapeutic Interventions 1. CPT 2. Bronchodilators 3. Pancreatic enzyme supplements
Pinworms

Data Base 1. Children reinfest themselves by fingers to anus to mouth route; can also be infested by breathing airborne ova 2. Crowded conditions such as classrooms and day care centers increase risk of transmission

Clinical Findings 1. Severe pruritus of the anal area 2. Irritability and insomnia 3. Anorexia 4. Eosinophilia Therapeutic interventions 1. Mebendazole is the drug of choice
THE PRESCHOOLER

Begins at 4 years until 6 years Characterized by the following behavior: Creative & curios often asks why
Loves to watch & imitate others Very imaginative Begins to masturbate (exploration)

Developmental Theories Freud Phalic (Superego) - Genital site of satisfaction thru masturbation Oedipal and Electra complexes (resolve?)
Erickson Initiative vs. Guilt - Family most important person - Conscience begins to develop

Piaget

Stage II of PREOPERATIONAL THOUGHT PERIOD = INTUITIVE STAGE = capable of classifying & relating things without awareness of principle = knows what is right but not WHY = unable to understand others point of view = say many words without meaning

KOHLBERG CONVENTIONAL = childs moral standards are those of others

3 Years A. Physical 1. Usual weight gain 1.8 to 2.7 kgs 2. Usual height gain 7.5 cms B. Motor 1. Jumps off bottom steps; walks upstairs alternating feet 2. Rides a tricycle using pedals 3. Constructs 3 block bridge; builds tower of 9-10 cubes 4. Can unbutton front or side button; uses a spoon 5. Usually toilet trained at night

C. Sensory: visual acuity 20/30

D. Vocalization: 1. Vocabulary of about 900 words; uses 3-4 word sentences 2. Begins to understands ideas of sharing and taking turns E. Mental abilities 1. Beginning understanding of the past, present and the future or any aspect of time
4 Years A. Physical 1. Height and weight increases are similar to previous year 2. Length at birth is doubled B. Motor 1. Skips and hops on one foot; walks and down stairs like an adult 2. Can button buttons and lace shoes 3. Throws ball overhand; uses scissors to cut outline

C. Vocalization and socialization 1. Vocabulary of 1500 words or more 2. May have an imaginary companion 3. Tends to be selfish and temperament but takes pride in accomplishments; exaggerates. Boats, and tattles on
others

D. Mental abilities 1. Unable to conserve matter 2. Can repeat four numbers and is learning number concept 3. Knows, which is the longer of two lines
5 Years

A. Physical: height and weight increases are similar to previous year B. Motor 1. Gross motor abilities well developed; can balance on 1 foot for about 10 seconds, can jump rope, skip, and roller
skate

2. Can draw a picture of a person 3. Dresses and washes self; may be able to tie shoelaces C. Sensorimotor 1. Color recognition is well established D. Vocalization and socialization 1. Vocabulary of about 2100 words, talks constantly; asks of meaning of new words 2. Generally cooperative and sympathetic towards others 3. Basic personality structure is well established E. Mental abilities (Piagets phase of intuitive thought) 1. Beginning understanding of time in terms of days as a part of a week 2. Beginning understanding of conversion of numbers

Play during Preschool Years (Cooperative Play) a. Loosely organized group play where membership changes readily, as do rules b. Thorough play, the child deals with reality, learns control of feelings and expresses emotions more through action than through words c. Play is still physically oriented but is also imitative and imaginary d. Increasing sharing and cooperation among pre-school children, especially 5-year old children

E. Suggested toys 1. Dress-up clothes; doll house; small rocks; animals; puppets; etc. 2. Painting sets, coloring books, paste, and cut out sets 3. Illustrated books; puzzles with large pieces and shapes

4. Tricycle; swing; slide; other playground equipment

Imitation Fantasy Night Grinding (Bruxism) a way of letting go

Common Fears

Fear of the Dark Fear of the body mutilation Fear of Separation or Abandonment
Behavior Problems

Telling Tall Tales Imaginary Friends Difficulty Sharing Regression Sibling Rivalry Oedipus complex Electra complex

HEALTH PROBLEMS MOST COMMON IN PRESCHOOLERS

Mucocutaneous Lymph Node Syndrome (Kawasaki Disease) Data Base A. Acute febrile illness of unknown cause; principally involving the cardiovascular system, with extensive
perivasculitis of arterioles, venules, capillaries, including the coronary arteries

B. Clinical Findings 1. Fever for 5 or more days; cervical lymphadenopathy 2. Bilateral congestion of the ocular conjunctiva without exudation 3. Changes of the mucous membranes of the oral cavity, such as erythema, dryness and fissuring of lips and
strawberry tongue 4. Peripheral oedema 5. Extreme irritability 6. Joint stiffness and pain

D. Therapeutic interventions 1. Primarily supportive and directed toward controlling fever, preventing dehydration and minimizing possible
cardiac complications

2. Intravenous gamma globulin 3. Large doses of aspirin initially, then low dose therapy
SCHOOL-AGED CHILDREN

Age: 7 11 years old Characterized by having the slowest period of growth & development

Developmental Theories

Freud : Latency Erickson : industry vs. inferiority Peer and school mate most important person
Cognitive : Concrete Operations

-With principles of observation -Development of mental classifying & ordering activities -With concept of reversibility -Understands others point of view -Accommodation ability to adapt thought processes to fit what is perceived (Ex.)

Moral : conventional -Desires to please others -Wants to be considered good Concerns of girls Concerns of boys

Developmental Timetable A. Physical growth 1. Permanent dentition, beginning with 6 year molars and central incisors at 7 t0 8 years of age 2. Tend to look lanky because bone development precedes muscular development B. Motor 1. Refinement of coordination, balance and control occurs 2. Motor development for necessary for competitive activity becomes important

D. Mental abilities 1. Readiness for learning: names, months of year, knows right from left, can tell time and can follow several
directions at once

2. Acquires use of reason and understanding of rules 3. Trial and error problem solving becomes more conceptual rather than action oriented 4.Concrete operation (Piaget): knows that quality remains the same even though appearance differs
7 years

Known as the quieting stage Psychosomatic illness common Copies diamond Visual acuity 20/20 Teachers find this group easy to handle
8 years

Known as the expansive stage Capable of increase in self-care Sometimes withdrawn Normal homosexuality Loves to play with roller blades Teachers find this group intellectual Tell days of week Oedipal complex resolve
9 years

Neither a youth or a child Teachers find this group most difficult to handle in school Tells months Selects favorite sports Stealing & lying are common Greatly influenced by peers

10 11 years

Pre - adolescence stage Loves dancing & listening to music Enjoys water ( safety with swimming) Posture may be poor Considerate to others Critical of adults Peak period of hero worship
Common Fears

Fear of loss of privacy Fear of death (death means permanent & irreversible) Fear of replacement or displacement in school School phobia

Latchkey children Play during the School-Aged Years (Competitive) Team particular activity increases

A. Play activities vary with age; number of paly activities decreases, whereas the amount of time spent in one B. Likes games with rules because of increased mental abilities C. Likes games of athletic competition because of increased motor ability D. In beginning of school years, boy and girl play together but gradually separate into sex-oriented activities E. Suggested play for 6 9 year olds: 1. More housekeeping toys that work; doll accessories, paper doll sets, simple sewing machine, needlework,
building toys

2. Simple word and numbered games that require increased skills 3. Physically active games such as hopscotch, jump rope and bicycle riding F. Suggested play for 9 12 year olds 1. Handicrafts of all kinds; model kits, pottery clays, collections
2. Archery; dart games, chess, jigsaw puzzles 3. Science toys, magic sets Common Problems

Vehicular accidents Gunshot wounds Obesity Stealing (behavior problem)

HEALTH PROBLEMS MOST COMMON IN SCHOOL-AGED CHILDREN

Rheumatic Fever Data Base A. Inflammatory disease affecting heart, joints, central nervous system, and subcutaneous tissues B. Clinical Findings: 1. Heart: mitral and aortic stenosis may occur 2. Joints: edema, inflammations, and effusions specifically in knees, elbows, hips, shoulder and wrists 3. Skin: erythematous macules with a clear center usually on trunk and proximal extremities 4. Low grade fever, epistaxis, abdominal pain, arthralgia, pallor, and weight loss C. Therapeutic Interventions: 1. Antibiotic therapy to eradicate microorganism and prevent recurrence

2. Prevention of permanent cardiac

damage

3. Prevention of recurrences Pediculosis

Database A. A highly infectious infestation of head, body or pubic hair B. Severe itching may lead to secondary infection C. Therapeutic interventions: 1. Special shampoo and use of fine-toothed comb to remove nits 2. All bed linen and cloth must be washed in hot water and detergent
Scabies

Database A. Produced by itch mite; female burrows under the skin to lay eggs B. Intensely pruritic; scratching can lead to secondary infection Therapeutic Intervention: all members of the family must be treated because it is highly contagious
THE ADOLESCENT

12- 18 years Characterized by growth spurt which begins early in girls about 1-2 years ahead than boys. Increased growth & maturation influenced by hormonal changes. Sebaceous glands become fully functional. Apocrine sweat glands reach secretory capacity during puberty
Developmental Theories

Freud Genital Masturbation & sexual relation with others Body image development & acceptance by opposite sex are important. Erickson Identity vs. role confusion Peer opposite sex Who am I? Piaget Ability of abstract thinking Kohlberg - internal control of conduct Decides between socially accepted standards
Common Fear

Identity Crisis
Common Problems

Vehicular accidents Gunshot wounds Obesity Diseases like:

Pelvic inflammatory disease

Oral monocleosis (kissing disease) Developmental Timetable Physical growth: includes physical changes associated with puberty such as secondary sexual characteristics B. Pubertal Growth Spurt

1. Females between 10 - 14 a. Weight gain 7 to 25 kilograms

b. Approximately 95% of mature height achieved

2. Males between 12 and 16 years a. Weight gain 7 to 30 kgs

by the onset of menarche, height gain 5 to 25 cms

b. Approximately 95% of mature height achieved by skeletal age of 15 years; height gain 10 to 30 cms
C. Mental Abilities
1. Abstract thinking a. Can comprehend satire and double meanings, can say one thing and mean another b. Can conceptualise thoughts, more interested in ideas than facts c. Can appreciate scientific thinking 2. Perception

Can appreciate non representational arts b. Can understand that the whole is more than the sum of its parts 3. Learning

Much longer span of attention Enjoys regressing in terms of language development by using jargon to suit changing moods.

D. Social patterns 1. Peer group identity

a. One of the strongest motivating forces of behavior b. Extremely important to be a part of the group c. Clique formation 2. Interpersonal relationships a. Major goal is learning to form a close intimate relationship with the opposite sex b. May develop crushes and worship idols c. Time of sexual exploration and questioning of ones sexual role

3. Independence

a. By 15 or 16 years old, adolescent feel that they should be treated as adults

b. Ambivalence: adolescent wants freedom but is not happy about corresponding responsibilities and frequently
yearns for more carefree days of childhood

Parental ambivalence and discipline problems are common as parents try to allow for increasing independence
but continue to offer constructive guidance and enforce discipline

Health Problem Common in Adolescents

Scoliosis Database Lateral curvature of the spine usually associated with a rotary deformity that eventually cause cosmetic and
physiologic alterations in the spine, chest and pelvis

Most common spinal deformity, more frequent in adolescent girls during growth spurt
Clinical Findings Curve in the vertebral spinous process alignment Prominence of one scapula Deformity of the rib cage; breast appear unequal in size Clothes do not fir right

Therapeutic interventions Screening for scoliosis Exercise Boston brace Traction Surgery Early/Young Adulthood

Extends from 20 to 40 years old PHYSICAL DEVELOPMENT Persons in their early 20s are at the peak of their physical attributes & intellectual capacities The musculoskeletal system is well-developed & coordinated. The different systems of the body are functioning at their peak efficacy. These are reproductive years for the majority of persons.
Psychosocial Development

INTIMACY vs. ISOLATION (Erickson) Develop intimate, lasting & committed relationship with another person, or a cause, institution, or creative effort. A sense of responsibility, maintenance of appropriate impulse control, ability to plan & implement realistic goals
& development of a career. Cognitive Development

Formal operations -Generating hypothesis -Rational thinking -Deductive & futuristic thinking -Forming new concepts & shifting thinking to solve problems
Moral Development

Principled reasoning. (Based on principles e.g. conservation of the environment justifies protest action) (MEN) Use of ethic of justice & define moral problems in terms of rules & rights.
(WOMEN) define moral problems in terms of obligation to care & to avoid hurt. Spiritual Development

Answer religious queries of their own children according to the teachings on their early childhood.
MIDDLE ADULTHOOD

Extends from 40 to 65 years Years of stability & consolidation

Physical Development

Appearance

-Hair begins to thin, gray hair appears -Wrinkles occur -Fat deposits in the abdominal area
Musculoskeletal system -Decreased bulk of skeletal muscle at 60 y.o. -Decrease in Ht. of about 1 inch due to thinning of the intervertebral disks -Osteoporosis with postmenopausal women

Cardiovascular system -Blood vessels lose elasticity & become thicker Sensory perception -Presbyopia -Presbycusis -Diminished taste sensations Metabolism
- Weight gain due to slowed metabolism

Gastrointestinal system Urinary system

- Constipation due to decreased tone of large intestine.

- Decreased GFR due to actual loss of nephrons.

Sexuality -Menopause, 40 55 years, average 47 years -Andropause 70 90 years

Psychosocial Development

Erickson- Generativity vs. Stagnation -Concern for establishing & guiding the next generation. -Altruism, love & compassion gain prominence -Engaged with civic & social works -Midlife crisis or deadline decade at 35 45 years
: reached the halfway mark of life Cognitive Development

Reaction time, memory, perception, learning, problem solving & creativity. Reflect on the past & current experience & can imagine, anticipate, plan, & hope.
Moral Development

Post conventional level (Kohlberg) -Conventional, action is taken to please another & gain approval. Right behavior is obeying law & following the
rules.

-Post conventional adhering to laws that protect the welfare and rights

of others.

Universal moral principles are internalized. Person respects other humans & believes that relationships are based
on mutual trust. Spiritual Development

Less dogmatic about religious beliefs & religion may offer more comfort than before. Relies on spiritual beliefs to help him deal with illness, death, & tragedy.
Late Adulthood

Extends from above 65 years of age. Ego integrity vs. Despair Gerontology Gerontologic Nursing Geriatrics Geriatric Nursing Senescence Senility

Theories of Adult Development & Aging

Biological Theories Genetic Theory/Mutilation Theory replication of DNA-RNA causes aging Autoimmune Theory/Immunologic Theory changes in autoimmune (e.g. virus)

3. Wear & tear Theory 4. Rate of Living Theory- the faster one lives, the sooner one ages & dies. 5. Waste Theory chemical wastes collect in the body & produce deterioration by interfering with cellular functioning. 6. Collagen Theory collagen stiffens, producing less elasticity in organs, skin, tendons, blood vessels, etc. = AGING 7. Endocrine Theory hypothalamus & pituitary responsible for changes in the hormone production = organisms decline B. Psychosocial Theories

Disengagement Theory human beings are moral & will die. It is their responsibility to look for suitable replacement.

2. Activity Theory - Norms exist for all mature individuals. The degree to which the individual acts like or looks like is a determinant of aging process. - To remain functional, take on new activities to replace lost one. 3. Continuity Theory

-Continuous flow of phases in life cycle & does not limit itself to change. -Persons will remain the same unless factors that stimulate change or necessitate adaptation.
Primary Changes of Aging Skin

-Loss of SC supporting tissues -Sensitive to pressure & trauma -Wrinkled & sagged -Decreased sebaceous secretions -Dry, flabby prone to itching
Primary Changes of Aging Skin

-Thinning & graying hair -Atrophy of tiny arterioles near epidermis -Poor temp regulation (feels cold even in warm temperature)
Musculoskeletal

-Increased fat substitution for muscle -Muscle atrophy -Decreased muscular strength & function -Loss of calcium from bones
Musculoskeletal

-Deterioration of cartilage -Wear, friction, stiffness of joints

Pulmonary

-Reduced breathing capacity -Reduced vital capacity -Increased residual volume -Decreased cough reflex -Decreased ciliary activity
Cardiac

-Endocardial thickening -Thickened heart valves -Decreased CO (?)

Vascular

-Decreased elasticity of blood vessels; increased BP -Atherosclerotic plaques; ischemia -Increased peripheral vascular resistance -Decreased efficiency of baroreceptors
Renal

-Decreased blood flow -Reduced GFR -Reduced nephrons -Decreased creatinine clearance -Increased toxic effects of drugs
Renal - High Risk for Fluid Electrolyte Imbalance (dehydration & dizziness occur even within short time of food & fluid deprivation) Nervous System

-Degeneration & atrophy of neurons -Decreased nerve acuity & sensation; unaware of tissue trauma -Loss of memory (recent) -Reduced concentration ability -Decreased attention span
Nervous System

-Decision making & judgment ability remain intact -Ability to learn is possible up to 200 years of life -Decreased muscle coordination, decreased ability to perform fine motor activities & those requiring coordination

Gastrointestinal

-Minimal loss of digestive enzymes -Decreased absorption -Decreased peristalsis; constipation -Anorexia
Endocrine

-Decreased utilization of insulin -Cessation of progesterone -Decreased then plateau of estrogen -Gradual decline in testosterone -Reduced BMR
Sexual

-Minimal change in amount of sexual response -Increase in time for full sexual response -Reduced vaginal lubrication -Increased refractory periods in males
Sensory Vision

-Presbyopia -Loss of color sensitivity (esp. purple) -Decreased dark adaptation -Decreased peripheral vision -Reduced sensitivity to glare
Sensory Hearing

-Decreased threshold for high frequencies -Loss of hearing of higher pitches -Difficulty of speech discrimination -Degeneration of cochlea & auditory pathways
Sensory Taste & Smell (decreased)

-Lack of appetite -Prefers salty taste

Sensory Touch (decreased) - Safety hazard Dental

Gums become less elastic, less vascular Recede from remaining teeth, exposing areas of teeth not covered with enamel.
Psychosocial Development

Ego integrity vs. Despair -Developmental tasks adjusting to decreasing physical strength & health Adjusting to retirement & reduced income Adjusting to the death of ones spouse

Establishing an explicit affiliation with ones age group

Meeting social & civic obligations Establishing satisfactory living arrangements Establishing satisfactory relationships with adult children Finding meaning in life
Ego Integrity vs. Despair

Ego Integrity -Views life with wholeness & satisfaction from past accomplishments -Death as an acceptable completion of life -Accept ones one & only life cycle -Bringing serenity & wisdom
Ego Integrity vs. Despair

Despair -Believes they have made poor choices during life & wish they live life longer -Inability to accept ones fate -Gives rise to feeling with frustration, discouragement, & a sense that ones life has been worthless
Nursing the Elderly Patient

Communication Considerations

- Call the person by name not grandma or grandpa

-Face the person when speaking -Speak clearly -Do not shout

Independence & Self-esteem - Place equipment conveniently & encourage use of self-help devices

-Let them do activities on their own but provide safety -Assist personal care as necessary -Acknowledge the ability to think, reason, & make decisions
Hygiene & Skin Care

Daily bath is not necessary (dry skin) Use mild, superfatted soap Use bath oils, lanolin, body lotion (no alcohol) Use pressure mattresses, flotation pads/mattresses alteranately
Hygiene & Skin Care

Change position frequently Massage bony prominences & wt. bearing areas Q 2H Sheepskin pads under bony prominences Assist in ambulation Soak feet in warm H20 before cutting nails
Visual Aids & Dental Care

Keep eyeglasses clean & available Keep night lights on to prevent accidents Clean dentures after each meal Prevent loss of dentures
Exercise & Body Alignment

Regular exercises Encourage correct posture Promote proper body alignment Active ROM

Provide leather-soled, well-fitting shoes to prevent

Temperature

Less than 98.6 deg. F or 37 deg. C Temp. of 99 deg. F indicates infection

Sleep Pattern & Mental Status Nutritional Needs

Usually sleep lightly, intermittently with frequent waking Increase in fiber & fluid to prevent constipation. Vitamin & mineral supplements Dry skim milk Decrease in calorie, increase in CHON
Urinary Elimination

Frequency of voiding is common. Increase fluid intake to dilute urine & decrease its irritating effects. Women :Prone to UTI Men : Prone to BPH
Sexuality

Still capable of sexual arousal & orgasm.

Emotional Needs

Needs someone to talk to. Comforted by touch. Maintain family contact. Provide diversional activities. Allow to verbalize about feelings on death.
Common Problems Among Elderly

Confusion / Dementia Osteoporosis Postural Hypotension Hypertension Elder Abuse