NCM 104: CHN RLE
RLE MODULE 1M: Bag Technique
and Urine Testing
BAG TECHNIQUE
CLO# 1: Definition of Terms
1.1. Bag Technique - it pertains to a tool
making use of a community health bag that
will enable a nurse to prepare and perform a
nursing procedure with ease and deftness
during his/her visit, saving time and effort with
the end in view of rendering effective nursing
care.
https://www.allheart.com/b-nursing-bagtechnique.html
1.2. Plan of Visit - it serves as a guide for
healthcare professionals during their home
visits to achieve better results
1.3.
Home Visit - it is defined as a healthcare
service provided by trained professionals who
visit clients at their doorstep to make
assessments of the client’s home, environment
and family condition to provide appropriate
needs and support services.
1.4. Family-Nurse Contact - a nursing care
method wherein it involves communication
between the family and the nurse to develop
a family-nurse relationship and to achieve the
goals set by both parties for a successful
nursing care delivery.
1.5. Community Health Bag - it is a carrier
designed to carry tools, equipment and
materials needed during the nurse’s visit to the
home, school or factory for performing nursing
interventions which include various diagnostic
tests, demonstration of care and patient care
activities. This bag contains basic medications
and articles needed for giving care.
1.6. Case Load - refers to the number and
types of cases handled by the nurse and all
activities involved in supporting people
requiring care in a particular period
NCM 104: CHN RLE
CLO#2: GIVE THE PURPOSE OF BAG
TECHNIQUE AND COMMUNITY
HEALTH BAG AND HOME VISIT
Give the Purpose of:
Purpose of Bag Technique:
-
To prevent or minimize the spread of
infection.
- To work efficiently and rapidly during
techniques.
- To save time and energy.
Purpose of Nursing Bag:
-
It serves as a first aid kit.
To work efficiently and swiftly during
nursing procedures.
- To conserve time and energy.
- To prevent or minimize the spread of
infection.
- To render effective nursing care to
clients and/ or members of the family
during home visit.
Purpose of Home Visiting:
-
To give care to the sick
It provides necessary health care
activities.
- To
provide
appropriate
health
teachings.
- To evaluate the results of the outcomes
of the nursing care given.
- To know the health status of an
individual or a family.
CLO #3: DIFFERENTIATE THE TYPES
OF FAMILY-NURSE CONTACT
Types of Family Nurse Contact
1. Clinic Visit
− Takes place in a private clinic, health
center, barangay health station or in
an ambulatory clinic during a
community outreach activity
2. Group Conference
− Is a small group teaching method.
One example of this type of familynurse contact is a conference of
mothers in the neighborhood. This
also provides an opportunity for
initial contact between nurses and
target families of the community.
3. Telephone (Landline / Cellphone)
− This encourages the family to
communicate with the clinic ro
health center when they feel the
need for it cultivates the family’s
confidence in the health agency.
4. Written Communication
− This is used to give specific
information to families, such as
instructions given to parents
through school children.
5. Home Visit
− This allows a firsthand assessment
of the home situation: family
dynamics, environmental factors
affecting health, and resources
within the home. A professional,
purposeful interaction that takes
place in the family’s residence aimed
at promoting, maintaining or
restoring the health of the family or
its members.
CLO #4: IDENTIFY THE CONTENTS OF
THE CHN BAG
FRONT OF THE BAG (ARRANGE BOTTOM
TO TOP)
CONTENTS:
1. ORAL/ RECTAL THERMOMETER OR
DIGITAL THERMOMETER
2. 3/ 5 CC SYRINGES
RIGHT OF THE BAG (ARRANGE LEFT TO
RIGHT)
CONTENTS:
1. TEST TUBE WITH TEST TUBE HOLDER
2. MEDICINE DROPPER
3. MATCH
4. ALCOHOL LAMP WITH DENATURED
ALCOHOL
NCM 104: CHN RLE
LEFT OF THE BAG (ARRANGE LEFT TO
RIGHT)
CONTENTS:
1. MEDICINE GLASS
CENTER OF THE BAG
CONTENTS:
1. KIDNEY BASIN
2. SUCTION BULB
2. INSTRUMENT POCKET (Kelly Curve, Kelly
Straight and Surgical Scissors)
3. BABY SCALE
3. COTTON BALLS
4. CORD CLAMP
4. COTTON APPLICATORS
5. HAND TOWEL
6. SOAP DISH WITH SOAP
7. APRON
8. STERILE GAUZE
BACK OF THE BAG (ARRANGE LEFT TO
RIGHT)
ARRANGEMENT OF SOLUTION:
1. BETADINE SOLUTION
TOP POCKET
2. 70% ALCOHOL
CONTENTS:
3. HYDROGEN PEROXIDE
1. STERILE GLOVES
4. LYSOL SOLUTION
2. STERILE FRENCH
5. SPIRIT OF AMMONIA
CATHETERS (SIZE 8 AND 12)
6. BENEDICT’S SOLUTION
3. PAPER WASTE BAG (WASTE RECEPTACLE)
4. SMALL PLASTIC BAG (FOLDED PLASTIC
BAG)
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TOP OF THE INNER COVER
ARRANGE BOTTOM TO TOP:
1. 5”-8” soap dish lining paper
2. 14”-20” paper lining
3. 13 ½ “–19 ½ “plastic lining
4. 12 ½ ‘– 18 ½ “paper lining
OUTSIDE AND SEPARATE WITH THE
CHN BAG
4.
1. BLOOD PRESSURE APPARATUS
(SPHYGMOMANOMETER AND
STETHOSCOPE)
5.
2. BLACK FOLDED UMBRELLA
CLO #5: DISCUSS THE DIFFERENT
TYPES OF CASE LOAD
6.
Types of Case Load
1. Ante-partum
− occurring or existing before birth;
"the prenatal period"; "antenatal
care" antenatal, prenatal (Antenatal
-The nurse teaches the patient
proper nutrition, perform Leopold’s
maneuver,
teach
proper
breastfeeding
and
antenatal
exercises); caring of pregnant
women during the time in the
maternity cycle that begins with
conception and ends with the onset
of labor; before delivery.
2. Postpartum
− encompasses management of the
mother, newborn, and infant during
the postpartum period. This period
is usually considered to be the first
few days after delivery, but
technically it includes the six-week
period after childbirth up to the
mother's postpartum check-up;
monitoring and management of the
patient who has recently given birth
(six months after).
3. Health supervision
7.
− a type of case load wherein the
spacing of visit is based on needs
and principles that teaching is more
effective in the learning period are
at frequent intervals. Recipient is
the family and their recognized
needs. Aggregate: children, elderly,
mothers. Patients may be well or
sick.
Morbidity
− a client has an established or
diagnosed illness.
Mortality
− case about death rate due to a
specific illness in a particular
population.
Case finding
− finding out possible illness of the
patient and wherein the nurse will
assess, study the history of, note
signs and symptoms of any of the
patient.
Geriatric
− dealing
with the physiologic
characteristics of aging and the
diagnosis and treatment of diseases
affecting the aged.
CLO#6: PRODUCE A SAMPLE PLAN OF
VISIT
Situation: A student nurse, Sheena
Mabebeng, visited Barangay Sitaw. In the
community, she met with the Quizon family. It
was Mrs. Quizon who had a concern regarding
the health of their family. They are at risk for
developing cardiovascular disease.
Name of family:
Quizon
Date of Visit: August 31, 2021
Address: Barangay Sitaw
Types of Case: Case Finding
Plan of Visit No.: 1
General objectives:
After 1 week of visit, the family will be able to
acquire knowledge and verbalize the
NCM 104: CHN RLE
importance of a healthy lifestyle in the
promotion and prevention of illness or disease.
Specific outcomes:
After 1 hour of interaction, the family will be
able to:
1. Establish rapport with the nurse
2. Define home visit.
3. Explain the purpose and importance of
home visit.
4. Observe
family’s
behavior
and
surroundings.
5. List possible health problems related to
the environment.
6. Verbalize the problems of lifestyle that
can cause cardiovascular disease.
7. Plan appropriate nursing interventions
from identified health problems which
are the risk of having cardiovascular
disease.
Nursing Actions:
1. Establish rapport with the student nurse
● Smile and greet them
● Introduce oneself and ask
names of the family members
2. Define home visit.
● Home visit is a visit done by the
nurse to the family’s home in
order to identify various health
problems through varied tools.
3. Explain the purpose and importance of
home visit.
● To identify health problems and
needs
● Prevent the spread of infection /
illness
● Establish
a
family-nurse
relationship
4. Observe
family’s
behavior
and
surroundings.
● Assess the surroundings
● Ask about health problems that
they commonly experience in
the household.
5. List possible health problems related to
the environment.
● By gathering data and perhaps
the environment they are living,
influences their lifestyle.
6. Plan and formulate appropriate nursing
interventions from identified health
problems which are the risk of having
cardiovascular disease.
7. Set another contact of visit
● Secure the details:
○ Date
○ Place
○ Time
CONTENTS OF A PLAN OF VISIT
1. Demographic Data
→ age, gender, address; socioeconomic
characteristics
of
a
population
expressed statistically, such as age,
sex, education level, income level,
marital status, occupation, religion,
birth rate, death rate, average size of a
family, average age at marriage; allow
for the identification of a patient and his
categorization into categories for a
purpose of statistical analysis.
2. General Objectives
→ outcome / long-term target.
3. Specific Objectives
→ describe the results in terms of
knowledge,
skill,
and
attitude;
participant performance, rather than
trainer performance or instructional
procedure - expected performance
change; short-term.
4. Nursing Actions
→ making
of
plan
and
nursing
interventions to reach the goals being
set.
5. SOAPIE Documentation
→ way to organize information about
patients. SOAP stands for subjective,
objective, assessment and plan. Nurses
NCM 104: CHN RLE
make notes for each of these elements
in order to provide clear information to
other healthcare professionals.
Example:
SOAPIE 1 (SOAPIE DOCUMENTATIONS
OF POV 1)
S: The family introduced themselves including
their name, age, and how long they have been
married. The husband is Mr. Alexander Quizon
and his wife is Mrs. Charlotte Quizon, along
with their 3 children Allan Quizon a 17 yr. Old,
Camille Quizon a 15 yr. Old and Ashley Quizon
a 9 yr. Old.
O: The family had an adequate amount of
space for the 5 of them.
A: Readiness for enhanced family process
P: After 1 week of nursing care, the family will
be able to verbalize the importance of a
healthy lifestyle and know the different ways
in preventing cardiovascular diseases.
I: Assist and guide the family in learning about
having a healthy lifestyle and prevention of
illness and diseases.
E: The family demonstrated individual
involvement in the nursing care to improve the
family process.
CLO#7: RECOGNIZE GUIDELINES IN
USING THE CHN BAG
1. The bag and its contents should be well
protected from contact with any article
in the patient’s home.
2. To be efficient and avoid confusion,
arrangement of the contents of the bag
should be the most convenient to the
users,
3. Proceed
from
“clean”
to
“contaminated”. If the nurse schedules
several home visits within the day, the
sequence should be the newborn first
and postpartum last, then family with a
communicable case.
4. Bring out ONLY the articles needed for
the care of the family
5. Perform hand washing as frequently as
possible before touching the bag to
after physical assessment and physical
care of each family member to minimize
contamination of the bag and its
contents.
6. Remove all jewelry.
7. Line the table / flat surface with a paper
/ washable protector on which the bag
and all the articles to be used are
placed.
8. Avoid shaking or swaying the bag when
carrying it.
9. Do aftercare.
● Whenever possible and as
necessary, wash your articles
before putting them back into
the bag. If not possible, wrap
them properly to prevent
contaminating the bag and its
contents.
● After using an article such as an
apron or washable protector,
confine
the
contaminated
surface
by
folding
the
contaminated side inward.
● Wash the inner cloth lining of the
bag as necessary.
CLO#8: RELATE PRINCIPLES OF BAG
TECHNIQUE
Microbiology
● The CHN bag and its contents should be
kept away from any household items.
● Perform medical handwashing as
frequently as the situation necessitates.
● Sterilization of utensils and other
materials is required.
Time and energy
● Should be wisely planned in order to
achieve an efficient schedule of
procedure.
Body Mechanics
● To prevent the contents from breaking,
avoid swinging the bag.
NCM 104: CHN RLE
● If you are unbalanced, you may fall and
jeopardize the bag's stability.
Pharmacology
● Contains solutions and disinfectants
such as betadine, which is used in
wound cleaning
Sociology
● Interaction between the nurse and the
family should take place at all times
during the procedure.
Psychology
● The bag technique should not
overshadow, but rather demonstrate
the effectiveness of the overall care
provided to an individual or family.
LEFT – marital new born delivery
RIGHT – urine testing
FRONT from pocket =
- baby weighing scale
d. BACK of the bag (left to right)
- betadine
- 70% alcohol
- hydrogen peroxide
- Lysol solution
- spirit of ammonia
- Benedict’s solution
e. on the CENTER OF THE BAG
- kidney basin
- cloth bag:
Kelly curve & Kelly straight
Umbilical scissors
Bandages
BACK – solutions
- cloth bag w/ sterile OS, cotton balls,
cotton applicators
TOP – catheter, sterile gloves, plastic bag=
house keeping or after procedure
- hand towel
CLO#9: DEMONSTRATE THE
BEGINNING SKILLS IN:
9.1 Arranging the contents of the CHN
bag
a. FRONT OF THE BAG (left to right)
- oral thermometer (facing down)
- rectal thermometer
- syringes & needles in a metal
container
b. on the RIGHT SIDE OF THE BAG
- test tube & test tube holder
- soap dish & soap
- apron
f. on the TOP POCKET
- sterile gloves
- French 12 catheter
- French 8 catheter
- cord clamp
- paper waste bags
- plastic bags
g. TOP OF THE INNER COVER
- medicine dropper
- 5’- 8” paper soap dish lining
- match
- 12 ½’ – 18 ½” paper lining
- alcohol lamp & denatured alcohol
- 13 ½’– 19 ½” plastic lining
c. on the LEFT SIDE OF THE BAG (near to the
front)
- medicine glass w/ suction inside
- 14’ – 20” paper lining- for the bottom
NCM 104: CHN RLE
9.2 Performing bag technique
PROCEDURE
A. Health Center
1. Arrange articles needed for the visit
2. Clip plan of visit outside the corner of the
CHN bag
B. Home
1. After greeting the family members and
client, enter the room, look for a clean area
(table, Chest box, if none, on the floor) near
the patient where you can perform the
procedures with ease.
2. While holding the bag, loosen the lock to
partially open it.
3. Take 14” 20” paper lining and hold the
sides to open. Lay outer side flat on the left
side of either table, chest box or floor.
4. Take 13 ½” x 19 ½” plastic lining and
hold the sides to open. Lay inner side flat on
the center on the top of the paper lining.
5. Lastly remove the 12 ½” x 18 ½” paper
lining and hold the side to open. Lay outer
side flat on the center on top of the plastic
lining.
6. Place the bag on the left side on top paper
lining.
7. Tuck in handles under the bag.
8. Open the bag fully and take out the
following: soap dish lining, soap dish with
soap, apron, hand towel, waste paper box,
bottle with Lysol (if necessary).
9. Remove watch or any jewelry. Place it
inside your pocket.
10. Bring soap dish, soap dish lining and
hand towel to the washing area.
11. Spread soap dish lining with the outer
side on the washing area.
12. Place soap dish and hand towel on top.
13. Open soap dish and put down cover
facing upward.
14. Perform medical hand washing.
15. Cover soap dish.
16. Wipe and dry hands with towel.
17. Leave soap dish and towel in the
washing area.
18. Hold the apron on the folded part with
left hand and look for the straps. Hold straps
with the right hand and drop the apron
making sure that it will not touch the things
of the patient and specially the floor.
19. Put on the apron. Slip the head first and
then both hands to the straps.
20. Open the bag and the inner cover.
21. Remove articles needed for the
procedure and care of the patient. Close the
bag.
22. Perform nursing procedure.
23. Wash and clean equipment after the
procedure. If not possible, place it in a
NCM 104: CHN RLE
separate bag to be taken back to the health
center.
24. Perform medical hand washing.
-
Energy source when glucose
is not available.
URINE TESTING
CLO #1: DEFINE THE FOLLOWING
TERMS:
1. Urine Testing - or “Urinalysis” is a
series of tests on your urine, or pee.
This test is used to detect and manage
a wide range of disorders, such as
infections, kidney problems and
diabetes.
2. Enuresis - Is a involuntary urination
and is more commonly known as “bedwetting”. In children ages 3, it’s
normal to not have full bladder control.
/ geriatrics
3. Diuretics - It is called “water pill” and
it is a medication designed to increase
the amount of water and salt expelled
from the body as urine.
4. Ketone Bodies - are substances
produced by the liver during
gluconeogenesis, a process which
creates glucose in times of fasting and
starvation.
- Ketone bodies are water soluble
and energy yielding.
5. Hematuria - Presence of blood in the
urine.
6. Uric Acid - Is a waste product found in
blood. It’s formed when your body
breaks down purines, which are
found in some food. Uric acid dissolves
in blood and travels to the kidneys.
From there, it passes out in urine. If
your body produces too much uric acid
or does not remove enough of it, you
can get sick. A high level of uric acid in
the blood is called “hyperuricemia”.
NCM 104: CHN RLE
CLO #2: DISCUSS THE IMPORTANCE
OF URINE TESTING
1. It helps in detecting and managing a
wide range of disorders, such as
urinary tract infections, kidney disease
and diabetes
2. It determines the hydration status of
a patient.
3. It provides valuable patient information
regarding the patient’s urological
health, and as well as his/her general
health status
4. It helps determine the presence of
glucose,
ketone bodies and
albumin in the urine.
5. It determines the urine acidity and
alkalinity.
6. It helps identify certain illnesses and
warning signs in their earlier stages.
7. It is used to detect bacteria in the urine
which may cause urinary tract
infection.
8. It is used to analyze the content and
chemical makeup of a client’s
urine.
9. It can be used to monitor disease
progression and the client’s response
to treatment for kidney failure, diabetic
nephropathy, lupus nephritis, and
hypertension-related renal impairment,
among others.
10. It
monitors
pregnancy
abnormalities, including bladder or
kidney
infection,
dehydration,
preeclampsia, and gestational diabetes,
among others
Pregnancy in benedicts (glucose in
urine)
Predisposing / reversible / risk factor = weight
Precipitating factor= genetics
CLO #3: IDENTIFY THE FACTORS
INFLUENCING URINATION
Growth and Development
● The aging process affects micturition
(reflex - urination).
● Muscles deteriorate resulting in more
difficult to ambulate and perhaps more
challenging to use the restroom.
- As you age, your kidney and
bladder changes
Psychosocial
● Such as stress, fear, anxiety and
emotional factors.
Fluid and Food intake
● It can either increase or reduce the
amount of urine produced.
Medication
● May cause a change in the color of the
urine.
● Increase
in
urinary
production
(diuretics).
Muscle Tone and Activity
● Exercise on a regular basis improves
muscle tone and metabolic rate.
● Maintaining stretch and contractility of
muscle tone requires good muscle tone.
● Creatinine
Surgical and Diagnostic Procedures or
Examinations
● Surgical operations on any portion of
the urinary system may result in postoperative bleeding.
● A restriction in fluid intake usually
reduces urine output.
NPO – no per orem
Personal Habits
● Certain lifestyle choices can have an
impact on urinary elimination.
● Excess body weight puts pressure on
your abdomen and bladder, which can
lead to leakage and may contribute to
NCM 104: CHN RLE
bladder control problems. Losing
weight might be beneficial.
● Being active on a regular basis
improves bladder control.
CLO #4: EXPLAIN PRINCIPLES
INVOLVED IN URINE TESTING
Anatomy and Physiology
→ Kidney’s filter waste out of the blood
and helps regulate the amount of water
in the body, conserve proteins,
electrolytes and other compounds that
the body can reuse. By knowing the
normal function, you can understand its
mechanism. Through urinary testing,
many disorders may be detected in
their early stages by identifying
substances that are not normally
present. Some include glucose, protein,
bilirubin, RBC, WBC, crystals and
bacteria.
Microbiology
→ In the field of microbiology, this testing
detects
and
measures
several
substances in the urine, such as
byproducts of normal and abnormal
metabolism, cells, cellular fragments,
and
bacteria.
Throughout
the
procedure,
clean technique is
observed to prevent occurrence of
contamination. MIDSTREAM CLEAN
CATCH (ang first mo gawas nay
dghan bacteria).
Time and Energy
→ Preparing the materials in the nursing
bag and keeping it organized saves
time. Thus, creates a clutter-free
environment -- physically and mentally.
Psychology
→ A holistic nurse-patient interaction
builds trust and is likely to cooperate.
Nurses must develop rapport and
create a calm environment to reduce
patient’s anxiety.
Sociology
→ Building therapeutics relationships
towards the client and understanding
them helps address problems in the
management of health and illness.
Chemistry
→ Chemical tests use reagent strips, also
called dipsticks, to identify the
presence and concentration of the
labeled substances. Also, Benedict’s
solution is used to identify the
volume of sugar present in the
urine pH which indicates the acidbased organic waste.
Body Mechanics
→ With the proper body mechanics, it
prevents injury or fatigue towards the
patient and nurse.
CLO #5: COMPARE THE
CHARACTERISTICS OF NORMAL AND
ABNORMAL URINE
Normal Urine
Abnormal Urine
Color
Color ranges from
pale yellow to
deep gold
Has
a
dark
yellow color or
other colors such
as red, orange,
blue, green and
brown
Odor
Odorless or has a
slightly “nutty ”
odor
Ph
Value
Has a ph volume of
4.5-8.0
Sweet
fruity
odor,
“maple
syrup” odor, and
very bad odor.
Has a ph that is
lower than 4.5 and
higher than 8.0
Cloudy or milky
Clarity
Clear
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CLO #6: IDENTIFY THE COMMON
URINARY PROBLEMS AND CAUSES
COMMON
URINARY
CAUSES
PROBLEMS
Dysuria
Painful, burning
urination, usually caused
by a bacterial infection,
inflammation or obstruction
of the urinary tract (UTI)
Glycosuria
Presence of glucose in the
urine, cause by excessive
intake of sugary foods;
diabetes mellitus
Hematuria
Presence of blood in the
urine, caused by bleeding in
the urinary tract due to
trauma, kidney stones,
infection
Oliguria
Abnormally low urinary
output, between 100 and
400 ml/day caused by
dehydration, renal failure
Polyuria
Voiding large amounts of
urine, caused by excessive
water intake, taking diuretics
Retention
Voiding large amounts of
urine, caused by excessive
water intake, taking diuretics
Nocturia
Excessive urination at
night, caused by excessive
fluid intake before bed, renal
disease and prostate
enlargement.
CLO #7: EXPLAIN THE DIFFERENT
WAYS OF SPECIMEN COLLECTION
AND TEST
Specimen Collection
● Urethral catheterization (CATH)
→ Urethral catheterization is a
common medical treatment that
allows for direct urine bladder
drainage. It can be utilized for
both diagnostic and therapeutic
purposes (to help determine the
etiology of certain genitourinary
disorders) (to relieve urinary
retention, instill medication, or
provide irrigation).
● Suprapubic aspiration (SPA)
→ A process to obtain urine
samples is known as suprapubic
aspiration. When a urinary
catheter cannot be inserted, This
procedure is frequently used. It
is most often done on
youngsters, but it can also be
done on adults.
● Midstream Clean-catch (CC)
→ A clean-catch is a technique for
collecting a urine sample for
testing. This method is intended
to prevent pathogens from
entering a urine sample from
the penis or vaginal area.
● Sterile urine technique
→ These are single-use pouches
that are used to collect urine in
the event of incontinence in the
hospital or at home. They are
coupled to an external catheter
or a probe put into the urethra.
Specimen Test Types
● First Morning Specimen
→ This sample is taken when the
patient urinates for the first time
in the morning. The most
concentrated specimen is a first
void specimen, Which is used for
pregnancy tests, bacterial
cultures, and microscopic
inspections.
● Randomly Collected Specimens
→ This is a sample that can be
taken at any moment during the
day. Because the content of
urine fluctuates during the day,
it's usually only utilized for
routine screening. (Drug test)
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● 24 Hour Collection Test
→ This test is performed to see if
proteins,
salt,
metabolic
products, and hormones, among
other things, are present in the
body’s excretion. Urine is
collected every 24 hours and
kept
in
the
refrigerator
throughout that time.
● Pregnancy test
→ This is to determine whether a
lady is pregnant. For accurate
results, the test is performed as
a quick eight to ten days
following
a
late
menstruation period. To
avoid tampering with the
findings, the test should not be
performed too soon if a woman
is on medication or has
consumed a lot of fluid right
before the test.
● Urinalysis
→ A
thorough
urinalysis
is
performed at a laboratory on
people who are going to undergo
surgery, have been admitted to
the hospital, or have abnormal
urine results. It's used to
diagnose or track urinary tract
bleeding, urinary tract infection,
diabetes, kidney illness, bladder
stones, and blood disease.
CLO #8: STATE THE DIFFERENT
METHODS OF URINE TESTING
CHEMICAL APPEARANCE
1. Protein - This is done with a reagent
strip or commonly known as a dipstick
2. Specific Gravity – This is an indicator
of urine concentration, or the
number of solutes present in the urine.
A urinometer or hydrometer in a
cylinder of urine or a spectrometer
or refractometer is used to measure
specific gravity
3. Glucose - This test is used to screen
for clients with diabetes mellitus
and
to
assess
clients
during
pregnancy for abnormal glucose
tolerance.
4. Osmolarity - This test is used to
check the level of water in your
body and to test the ability to produce
urine. This test is also used to assess
the function of the kidney, determine
the electrolyte balance is normal and
if your kidneys are working
properly,
to
monitor
drug
treatment, and to check how effective
treatment is for any conditions that
might affect your osmolality.
5. Urinary pH - This is used to measure
and to determine the relative acidity
or alkalinity of urine and assess the
client’s acid-base status; use of
dipstick or litmus paper
6. Occult blood - Blood in the urine,
also called hematuria, is not a normal
finding, but it is not uncommon. Urine
strips are used in hematuria screening
to test for occult blood. Reported values
of (1+) (hemoglobin 0.06 mg/dL) or
above is considered positive. <1> If
the patient tests positive for urinary
occult blood, additional testing is
required to confirm the erythrocyte
count within the urine.
7. Ketones - Normally, your body burns
glucose (sugar) for energy. If your
cells don't get enough glucose,
your body burns fat for energy
instead. This produces a substance
called ketones, which can show up in
your blood and urine. High ketone
levels in urine may indicate diabetic
ketoacidosis (DKA), a complication of
diabetes that can lead to a coma or
even death. A ketones in urine test
can prompt you to get treatment
before a medical emergency occurs.
NCM 104: CHN RLE
CLO #9: ENUMERATE NURSING
RESPONSIBILITIES BEFORE, DURING
AND AFTER URINE TESTING
Nursing Responsibilities related to Urine
Testing:
Before:
(sociology,
psychology)
MICROSCOPIC EXAM
In performing the Microscopic Exam, a clinical
laboratory technician (CLT) or medical
laboratory technician (MLT) are the ones who
look at the drops of your urine under the
microscope. They look for:
● Infectious bacteria or yeast
● Epithelial cells, which can indicate a
tumor
● abnormalities in your red or white blood
cells, which may be signs of infections,
kidney disease, bladder cancer, or a
blood disorder
● Crystals that may indicate a kidney
stone
VISUAL EXAM
In performing the Visual Exam, a clinical
laboratory technician (CLT) or medical
laboratory technician (MLT) can also examine
the samples for any abnormalities such as:
● Cloudy appearance which can indicate
an infection
● Abnormal odors
● Reddish or brownish appearance which
can indicate blood in the urine
microbiology,
● Prepare all the materials needed in the
procedure and make sure they are all
clean
● Do medical hand washing prior to
procedure
● Provide and check the label of the
sterile container for the urine
specimen
● Explain the test procedure to the
client and its purpose
● Instruct the client to wash their hands
prior to beginning the collection
● Wear gloves when collecting the
specimen to avoid cross contamination
During:
● Give client privacy
● Obtain
urine
specimen
in
accordance with specific requirements
● Tightly cover the specimens and
label the specimen container with
the patient identifying information
After:
● Bring the specimen to the laboratory
● Do medical hand washing
● Dispose all the materials being used
NCM 104: CHN RLE
CLO #10: DEMONSTRATE
BEGINNING SKILLS IN URINE
TESTING
PROCEDURE
Urine Collection
I.
1. Let the client void for urine
collection. (For Urinalysis: Client is
advised to perform perineal care prior
to the collection of urine specimen.
Midstream clean catch is advised.)
2. Collect a small amount of urine
(20cc) in a clean container or
specimen bottle.
II. Test for Sugar
A. Clinitest
1. Proceed with urine
collection.
2. Holding a dropper upright,
put 5 drops of urine into a
clean, dry test tube.
3. Rinse dropper. Using the
same dropper, add 10 drops
of water into the test tubes
with urine.
4. Drop 1 clinitest tablet into
the test tube.
5. Allow reaction to take place
until it stops.
6. Wait for 15 seconds. Shake
gently. Compare color
results in the test tube with
chart.
B.
- Blue indicates negative
results
- Orange indicates highly
positive test
- Dark greenish-brown
proceeded by
rapid change in color
from green to
orange indicates urine
glucose level
above 2%
Acetest (Ketone Test)
1. Place acetest tablet on a
piece of paper towel.
2. Place 1 drop of urine on
acetest tablet with dropper
in upright position.
C.
3. Wait for 1 minute and
compare color of tablet with
chart:
Negative result: tablet color
unchanged or turns cream
colored from wetting.
Positive result: tablet color
will change from lavender to
deep purple depending on
the amount of ketone bodies
present.
Benedict’s Test
1. Follow urine collection.
2. In a clear dry, test tube,
place 5 cc. of benedicts
solution. Add 8-10 gtts of urine
to the solution and place
test tube with mixture over a
direct flame or in a water bath
to boil for 5 min. Compare
color with index card
Results:
Blue – negative
- Green - + - Yellow
- ++ - Yellow orange
- +++ - Red - ++++
III.
Positive Benedict’s Test:
Formation of a reddish
precipitate within three
minutes. Reducing sugars
present.
Negative Benedict’s Test: No
color change (Remains Blue).
Aftercare of the materials
1. Rinse test tube and dropper
immediately. Put them in the
proper places. Chemicals from
reagent tablet should be removed
from test tube quickly. Urine must be
washed out from the dropper.
2. Discard specimen in the receptacle,
rinse and dry immediately.
Specimen bottle must always be clean
and must receive only fresh urine.
3. Store specimen bottle in the
patient’s comfort room labeled
properly with patient’s name.
NCM 104: CHN RLE
4. Keep the Index card in the patient’s
cubicle, if personally owned by the
patient.
5. Discard any waste paper used.
6. Record result of test in the patient’s
chart.
RLE 2M: HERBAL PREPARATION
AND OTHER ALTERNATIVE
HEALTH CARE MODALITIES
CLO#1: Define the terms related to
herbal medication and other
alternative health care modalities.
1.1 Herbal Preparation
− The basis for finished herbal products
which may include tinctures, powdered
or comminuted herbal materials, and/or
fatty oils of herbal materials.
− Obtained by subjecting herbal materials
to treatments or processes such as
distillation, extraction, concentration,
fractionation,
fermentation,
purification, physical or other biological
or chemical methods.
1.2 Traditional and Alternative Health
Care
− Traditional health care refers to health
practices, knowledge, and approaches
unique to a certain country or culture
that incorporate plant, animal, and
mineral based medicines, spiritual
therapies, exercises and manual
techniques that are applied solely or in
combination in order to treat, diagnose,
or prevent illnesses, and to maintain an
individual's wellbeing.
− Alternative health care is often referred
to as “integrative” or “complementary”
medicine.
1.3 Traditional Medicine
− The direct application of plant materials
for the purpose of healing, preventing,
improving, diagnosing, or treating
physiological or psychological illnesses.
1.4 Biomedicine
− It is the theoretical medicine based on
the application of the principles of the
natural sciences namely Biochemistry
and Biology.
1.5 Alternative Health Care Modalities
− This refers to the medical products and
practices that are not considered to be
a part of standard medical care or
conventional medicine.
1.6 Herbal Medicine
− This type of medicine uses roots, stems,
leaves, flowers, or seeds of plants to
treat disease and enhance general
health and wellbeing.
1.7 Natural Products
− It is described as anything that is
derived or produced by nature.
− Natural products have been utilized and
considered to be the backbone or
foundation of the traditional system of
healing on a large scale, as this also
contributed an integral part of history
and culture.
CLO#2: Discuss R.A. #8423 or the
Traditional and Alternative Medicines
Act of 1999.
The R.A. #8423 or also known as the
Traditional and Alternative Medicines Act of
1999 was created in order to promote and
advocate traditional medicine in the
Philippines. When Republic Act 8423 or
Traditional and Alternative Medicine Act
(TAMA) passed in 1997, it cleared the way for
herbal medicines to be produced in the
Philippines. The purpose of this law is to
enhance the PITAHC and give it greater
regulatory powers so that it can provide better
administrative and technical support to the
public. Its primary goal is to improve PITAHC's
administrative and technical capability by
modernizing its equipment, creating its own
testing laboratories and field offices, and
expanding its personnel resources.
NCM 104: CHN RLE
The importance of Republic Act #8423,
also known as the Traditional and Alternative
Medicines Act, raises the possibility of
employing
traditional
and
alternative
medications as a significant means of
delivering health care and administering
medicines to healthcare recipients. Traditional
and alternative medicines may be utilized in
the health care environment to give an
alternative medication to manufactured
medication or as an enhancer to assist in
improving the client's overall health state.
Furthermore, this Act intends to provide
a broader choice of health goods and practices
that are both safe and effective.
CLO#3: List down and discuss
alternative health care modalities as
practice in the Philippines.
3.1 Acupressure
− It is one of the Asian bodywork
therapies (ABT), and can trace its roots
back to traditional Chinese medicine.
− Practitioners used their palms, fingers,
feet or elbow, or a special device to
which pressure is to be applied or
otherwise called “acupoints”. Also,
acupressure
involves
acupressure
massages,
stretching, and other
methods which promotes relaxation,
wellness, and is used to treat diseases.
3.2 Acupuncture
− It is done by penetrating the skin with
thin, solid, metallic needles which are
activated through the practitioner’s
gentle and specific movements or with
electrical stimulation.
− This is done to relieve pain, improve
overall
wellness
and
stress
management, as well as to treat other
conditions.
3.3 Aromatherapy
− This treatment uses oils that stimulate
and activate areas in the nose which
then transmits messages through the
nervous system to the brain. This
sensation induces an impact on the
hypothalamus; to create and release
serotonin that stabilizes feelings, mood,
and happiness.
− Essential oils are the constituent in
aromatherapy, they are typically
extracted from various plant parts and
later distilled. These oils are highlyconcentrated that can be inhaled
directly or indirectly, and applied to the
skin through lotion, massages and or
bath salts.
3.4 Chiropractic
− A system of diagnosis and treatment
based on the concept that the nervous
system coordinates all of the body's
functions, and that disease results from
a lack of normal nerve function.
− It
employs
manipulation
and
adjustment of body structures, such as
the spinal column, so that pressure on
nerves coming from the spinal cord due
to displacement (subluxation) of a
vertebral body may be relieved.
− Chiropractic treatment appears to be
effective for muscle spasms of the back
and neck, tension headaches, and some
sorts of leg pain. It may or may not be
useful for other ailments.
3.5 Herbal Medicine or Phytomedicine
− Herbal medicine involves the use of
natural and biologically based practices,
interventions, and products to treat a
variety of physical or emotional
conditions.
− An herb is a plant or plant part used for
its scent, flavor and therapeutic
properties. Herbal medicines are one
type of dietary supplement. They are
sold as tablets, capsules, powders,
NCM 104: CHN RLE
teas, extracts, and fresh or dried plants.
People use herbal medicines to try to
maintain or improve health.
3.6 Massage
− The
therapeutic
practice
of
manipulating the muscles and limbs to
ease tension and reduce pain. Massage
can be a part of physical therapy or
practiced on its own. It can be effective
for reducing the symptoms of disorders
of or pain in the muscles and nervous
system, and it is often used to reduce
stress.
− The action of rubbing, kneading or
hitting someone's body, to help the
person relax, prepare for muscular
action (as in contact sports) or to
relieve aches.
3.7 Nutritional Therapy
− This therapy prevents or reverses
diseases with the use of food and
nutrients. Benefits of this therapy
includes; healthy immune system,
increased energy levels and balanced
hormones.
− The therapy focuses on natural and
unprocessed foods, most of its diets are
planned to have a balanced and
sustainable nutrition.
− This is important for patients suffering
from obesity, chronic illnesses and
those who are trying to pursue health
promotion and wellness.
3.8 Pranic Healing
− This is an energy treatment that
balances, harmonizes, and transforms
the body’s energy processes with the
use of prana. Prana is a sanskrit word
that means “life-force” that keeps the
body alive and maintains good health.
− A non-touch healing embodies the
principle that the body can heal itself.
The healing process is increased by
increasing the life force of the
individual. The healing takes the
physical and psychological conditions of
a person.
− Benefits of Pranic Healing include;
reduce stress, increase energy levels
and improve immune functions.
3.9 Reflexology
− The application of pressure to areas of
the feet that helps alleviate stress, this
treatment is also known as zone
therapy. Areas of the foot are
connected to the organs and systems of
the body, thus the area in which the
pressure is applied brings relaxation
and healing to a corresponding part of
the body.
− Foot charts are used to guide
reflexologists in applying pressure to
the areas of the foot.
− Reflexology may ease anxiety to people
who have heart surgery, pain during
labor, arthritis pain, and many others.
In addition, this may also help in
relieving back pain, improve sinus
issues and ease constipation.
CLO#4: State the importance of
herbal preparations.
Herbal medicine has been used as
means of healing and treating patients long
before drugs and western medicine has been
discovered and invented. Written evidence of
herbal medicines are found believed to be
present way back over 5000 years ago to the
Sumerians. Herbal preparations or herbal
remedies are used for people that have chronic
illnesses. Herbal medicine is far much cheaper
compared to western medicine. This is why
people opt to use this traditional remedy in
treating hypertension, diabetes and many
more. It is highly important that people should
know that western medicine is not only the
way to provide healing and therapeutic
response to an ill person. People should also
take into account if the method is approved by
the FDA so that it is safe to ingest. Herbal
medicine can be a really good way in dealing
NCM 104: CHN RLE
with chronic illnesses as opposed to lifethreatening conditions. However, herbal
treatment can be used to its maximum
capability when conventional medicine or
western medicine is ineffective in treating the
disease. Herbal medicine might not be the first
choice in treating illnesses but it doesn’t mean
that it is ineffective.
CLO#5: Explain the common methods
of preparing and administering herbal
medicines.
5.1 Decoction
a. Preparation – Decoctions are often used for
tougher plants like as roots, barks, and seeds.
Before making the decoction, ground or crush
the whole root, bark, and seeds. This is made
by boiling the appropriate amount of herbs
with water for around 30 minutes, or until
roughly half of the water is gone. To prevent
vital ingredients from evaporating, the vessel
must be closed while heating. The extract is
then withdrawn from the heat and filtered
through a filter, and the decoction is utilized
whole or after appropriate dilution.
b. Administration – Orally
5.2 Elixir
a. Preparation – Elixirs are made by simply
dissolving two or more liquids with agitation or
by combining two or more liquids. The
ingredients are dissolved in their appropriate
solvents. For
instance,
alcohol-soluble
compounds in alcohol and water-soluble
ingredients in water. The alcoholic solution's
strength is maintained by adding the aqueous
solution to it. The combination is then
increased in volume to the desired level (q.s.).
Because the alcoholic strength has been
decreased, the product may not be clear at
this point due to the separation of some of the
flavoring ingredients. After allowing the elixir
to stand for a while, the oil globules begin to
precipitate. The elixir is then filtered. To
absorb excess oils, talc might be used. A clear
product is then obtained after filtered.
b. Administration – Orally
5.3 Infusion
a. Preparation – Infusions are generally
utilized when the herbs being used include
plant leaves and blossoms. When there are
delicate essential oils that would be lost if
cooked in a decoction, seeds and roots are
sometimes utilized in an infusion. When using
seeds in an infusion, softly smash them so that
the water may reach the components in the
seed. Use filtered, cold water. Use 1-2
teaspoons of dried herb per cup of water OR 3
tablespoons of fresh herb per cup of water.
Bring the water to a boil and pour it over the
herbs. Allow to steep, covered, for 10-20
minutes. Remove the herbs and serve. If you
want a stronger medicinal infusion, add up to
1/2 ounce of dry herbs per cup of water and
steep for 20 minutes or longer, up to several
hours. Infusions do not have a lengthy shelf
life, so make them as required, or keep them
in the fridge for a day or two.
b. Administration – Orally
5.4 Oil
a. Preparation – Ethereal or Essential oils are
extracted from different parts of plants. Steam
distillation and hydrodistillation processes are
two important methods used in extracting
essential oils from plants. Through heating
plant materials with the mixture of water or
other solvent, essential oils are evaporated. In
a condenser, liquefaction of the vapors
happens.
•
•
Biological
activities
such
as
antibacterial, antioxidant, antiviral,
insecticidal, etc. which are shown in
essential oils.
This is used in various methods such as
cancer treatment, food preservations,
aromatherapy, and in the perfumery
industries as well. Several applications
such as processed and fresh food
preservatives,
natural
therapies,
pharmaceuticals,
and
alternative
NCM 104: CHN RLE
•
medicines use the antimicrobial and
antioxidant screening of essential oils.
In aromatherapy, essential oils are used
as an alternative source of wound
healing since aromatic compounds are
also present in essential oils. The
various infectious diseases in the world
are treated with the help of essential
oils.
CLO#6: Enumerate the indications and
preparations of the ten medicinal
plants endorsed by the Department of
Health.
6.1 Lagundi
b. Administration – Applied in skin, inhaled, or
ingested
5.5 Syrup
a. Preparation – The combination of
concentrated decoction and sugar/honey or
sometimes alcohol will result in a herbal syrup.
Decoction is preserved and thickened as it is
mixed with either sugar, honey or alcohol. The
shelf life of the decoction is increased creating
a soothing benefit for sore throat, cough, dry
irritated tissues, and digestive issues. The
palatability of some herbs are increased
because of the sweetener.
b. Administration – Orally
5.6 Tincture
a. Preparation – This is made by concentrating
herbal extracts through soaking the bark,
leaves, or roots from plants in an alcohol or
vinegar. The active parts of the plant are being
pulled by the alcohol or vinegar making them
concentrated as liquid. The health-boosting
chemicals found in plants are easily consumed
because of tincture. This can be easily
prepared at home and inexpensive as well.
a. Indications
− Lagundi was proven to be effective in
preventing the spread of diseasecausing bacteria, lowering fever, mucus
viscosity, improving phlegm color,
reducing shortness of breath and
wheezing,
and
reducing
cough
frequency. In addition, it is traditionally
used to treat insect and snake bites,
ulcers, rheumatism, sore throat, cough,
fever, and clogged sinuses.
b. Preparations
•
•
b. Administration – Orally
•
•
•
For asthma, cough and fever: Boil
chopped raw fruits or leaves in 2
glasses of water left for 15 minutes until
the water left in only 1 glass
(decoction). Strain.
For dysentery, colds and pain: Boil a
handful of leaves and flowers in water
to produce a glass full of decoction 3
times a day.
For skin diseases (dermatitis, scabies,
ulcer, eczema) and wounds: Prepare a
decoction of the leaves. Wash and clean
the skin/wound with the decoction.
For headache: Crushed leaves may be
applied on the forehead
For rheumatism, sprain, contusions and
insect bites: Pound the leaves and apply
on the affected part.
NCM 104: CHN RLE
c. Herbal Preparation Method
•
Decoction
•
•
6.2 Yerba Buena
•
•
a. Indications
− Mentha cordifolia Opiz, also known as
yerba buena, mint, or spearmint, has
long been used as a remedy for
headaches, toothaches, arthritis, and
dysmenorrhea in the Philippines.
Menthalactone, a chemical found in
yerba buena leaves, has been proven to
have analgesic (painrelieving) effects.
Menthalactone is safe and effective in
reducing moderate to severe postoperative pain following circumcision,
dental extractions, and childbirth (postepisiorrhaphy), according to clinical
research.
b. Preparations
•
•
•
•
For pain in different parts of the body:
Boil chopped leaves in 2 glasses of
water for 15 minutes. Cool and strain.
For
rheumatism,
arthritis,
and
headache: Crush the fresh leaves and
squeeze sap. Massage sap on painful
parts with eucalyptus.
For cough and cold: Get about 10 fresh
leaves and soak in a glass of hot water.
Drink as tea. Acts as an expectorant.
For toothache: Cut fresh plant and
squeeze sap. Soak a piece of cotton in
the sap and insert this in aching tooth
cavity. Mouth should be rinsed by
gargling salt solution before inserting
the cotton
To prepare salt solution: Add 5g of
table salt to one glass of water
For menstrual pain and gas pain: Soak
a handful of leaves in glass of boiling
water. Drink infusion. It induces
menstrual flow and sweating.
For nausea and fainting: Crush leaves
and apply at nostrils of patient
For insect bites: Crush leaves and apply
juice on affected part or pound leaves
until paste-like and rub this on the
affected part
c. Herbal Preparation Methods
•
•
Decoction
Infusion
6.3 Sambong
a. Indications
− A very popular Philippine herbal
flowering plant used as medicine to
treat wounds and cuts, rheumatism,
anti-diarrhea, anti-spams, colds and
coughs. It is also used for infected
wounds, respiratory infections and
stomach pains. Sambong is very
popular among people with kidney
problems because of its diuretic
qualities. It can be taken as an early
afternoon tea to maintain a healthy
urinary tract. It also helps flush uric acid
as well. The Philippine National Kidney
and Transplant Institute recommends
taking sambong for patients with renal
problems. Studies noted that it may
help to delay dialysis and other kidney
problems. Sambong also possesses
antibacterial and antifungal properties.
NCM 104: CHN RLE
b. Preparations
•
•
6.5 Niyog-Niyogan
Boil chopped leaves in water for 15
minutes until one glassful remains. Cool
and strain.
Divide decoction into 3 parts. Drink one
part 3 times a day
c. Herbal Preparation Method
•
Decoction
6.4 Tsaang Gubat
a. Indications
− Carmona retusa (Vahl) Masamune, also
known as Tsaang Gubat, is an
affordable, herbal medicine to help
relieve abdominal pain and diarrhea in
adults. It contains alpha-amyrin, betaamyrin, and baurenol which have
shown analgesic activity, anti-diarrheal
and anti-spasmodic activity. Tsaang
Gubat tablet has been clinically proven
to be effective and safe in relieving the
pain from gastrointestinal colic and
biliary colic.
b. Preparations
•
•
For diarrhea, boil the following amount
of chopped leaves in 2 glasses of water
for 15 minutes or until amount of water
goes down to 1 glass. Cool and strain
For stomach ache, wash leaves and
chop. Boil chopped leaves in 1 glass of
water for 15 minutes. Cool and
filter/strain and drink.
c. Herbal Preparation Method
•
Decoction
a. Indications
− Almost all of its parts are used
individually or in combination with other
ingredients to treat a variety of
diseases. These are used to treat
parasitic worms in the Philippines.
Some people use them to treat coughs
and diarrhea. Niyog-niyogan’s leaves
are also used to cure body pains by
placing them on specific problematic
areas of the body.
b. Preparations
•
•
•
Seeds of niyug-niyogan are eaten raw
two hours before the patient’s last meal
of the day.
Adults may take 10 seeds; children 4 to
7 years of age may eat up to four seeds
only; ages 8 to 9 may take six seeds
and seven seeds may be eaten by
children 10 to 12 years old.
Not to be given to children below four
years old
c. Herbal Preparation Method
•
Seeds are used for direct consumption
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6.6 Bayabas
6.7 Akapulko
a. Indications
a. Indications
− Bayabas (guava) with a scientific name
Psidium guajava. As shown by many
research studies, almost all of the parts
of this plant have medicinal qualities
and value. The bayabas fruit bark and
leaves are used as herbal medicine. Its
leaves decoction is recognized for its
effectiveness to cure several ailments
like diarrhea, toothaches. The most
common use of the leaves is for
cleaning and disinfecting wounds by
rinsing the afflicted area with a
decoction of the leaves.
− Akapulko (shrub) with a scientific name
Cassia alata. It is a medicinal herb that
contains chrysophanic acid, a fungicide
used to treat fungal infections, like
ringworms, scabies, and eczema.
Akapulko also contains saponin, a
laxative that is useful in expelling
intestinal parasites.
b. Preparations
•
•
b. Preparations
•
•
•
•
•
Boil one cup of Bayabas leaves in three
cups of water for 8 to 10 minutes. Let
cool.
Use decoction as mouthwash, gargle.
Use as wound disinfectant - wash
affected areas with the decoction of
leaves 2 to 3 times a day. Fresh leaves
may be applied to the wound directly
for faster healing.
For toothaches, chew the leaves in your
mouth.
For diarrhea, boil the chopped leaves
for 15 minutes in water, and strain. Let
cool, and drink a cup every three to four
hours.
c. Herbal Preparation Method
•
Decoction
•
For external use: Pound the leaves of
the Akapulko plant, squeeze the juice
and apply on affected areas.
As laxative: Cut the plant parts (roots,
flowers, and the leaves) into a
manageable size then prepare a
decoction Note: The decoction loses its
potency if not used for a long time.
Dispose leftovers after one day.
The pounded leaves of Akapulko has
purgative functions, specifically against
ringworms
c. Herbal Preparation Method
•
Poultice
NCM 104: CHN RLE
6.8 Ulasimang Bato or Pansit-Pansitan
•
For Toothache: Pound a small piece and
apply to affected area
c. Herbal Preparation Method
•
Eaten raw or fried and applied on a
body part
6.10 Ampalaya
a. Indications
a. Indications
− Ulasimang bato or pansit-pansitan
Folklorically Scientific name Peperomia
pellucida. The leaves have been used as
a decoction to treat gout, arthritis.
b. Preparations
•
For gout and rheumatic pains
(decoction): Boil 1 ½ glasses or 3 cups
of leaves in 2 glasses of water until the
water reduces to half. Boil for 15
minutes. Do not cover the pot. Cool and
strain. Drink 1/3 glass of boiled water
thrice a day.
− Ampalaya (Bitter Melon) with a
scientific name Momordica charantia.
Ampalaya has been a folkloric cure for
generations but has now been proven
to be an effective herbal medicine for
many ailments. Most significant of
which is for Diabetes. Ampalaya
contains a mixture of flavonoids and
alkaloids that make the Pancreas
produce more insulin that controls the
blood sugar in diabetics.
b. Preparations
•
c. Herbal Preparation Method
•
Decoction
6.9 Bawang
a. Indications
− Bawang or Garlic with scientific name
Allium sativum. Garlic is known as
nature's antibiotic. Its juices inhibit the
growth of fungi and viruses thus,
prevent viral, yeast, and infections. It
mainly reduces cholesterol in the blood
and hence, helps control blood
pressure. It is also effective for
toothache.
b. Preparations
•
•
Eaten raw/ fried, applied on a part.
For Hypertension: May be fried,
roasted, soaked in vinegar for 30
minutes, or blanched in boiled water for
15 minutes. Take 2 pieces 3 times a day
after meals.
For diabetes: Chopped leaves then boil
in a glass of water for 15 minutes. Do
not cover. Cool and strain. Take 1/3 cup
3 times a day after meals
c. Herbal Preparation Methods
•
•
Decoction
Steaming
CLO#7. cite other herbal plants
utilized in other countries as approved
by their health agencies.
NIGERIA
Glory Lily
− Glory Lily is a slender, herbaceous vine
grown from a thick tuberous rootstock.
Its tubers has long been used as a
traditional medicine to treat cancer
Spiny amaranth (Amaranthus spinosus)
− Spiny Amaranth is commonly known as
pig weed or spiny amaranth. It is an
annual or perennial herb of which the
whole plants is used for treating
abdominal pain, ulcers, and gonorrhea.
NCM 104: CHN RLE
INDIA
St. John’s wort (Hypericum perforatum)
Ashwagandha (Withania somnifera)
− Ashwagandha is a small woody plant
used to produce a very popular
Ayurvedic remedy. It is believed to help
the body manage stress more
effectively. It also helps reduce
inflammation and boost immune
system.
Cardamom (Elettaria cardamomum)
− Elettaria cardamomum is a herbaceous,
perennial plant in the ginger family,
native to southern India. It may help
lower
blood
pressure,
improve
breathing, and help stomach ulcers
heal.
CHINA
Chinese
ginseng
nodiflorus)
− St. John's wort is a plant that grows in
the wild that has been used for mental
health conditions. Specifically, it is said
to be effective for the treatment of
mild-tomoderate depressions. It also
decreases nervousness and tiredness
related to depression.
EGYPT
(Cumin cyminum)
− Cumin is an umbelliferous herb of which
their seeds are considered to be a
stimulant
and
effective
against
flatulence. Its powder can be mixed
with some wheat flour to relieve pain of
any aching or arthritic joints.
Coriander (C. Sativum)
(Eleutherococcus
− Chinese ginseng is a tonic herb widely
used in Traditional Chinese Medicine to
treat musculoskeletal pain and swelling.
Gotu Kola (Centella asiatica)
− Gotu kola is a type of leafy plant
traditionally used in Asian cuisines that
is also believed by alternative
practitioners to have antimicrobial,
antidiabetic,
antiinflammatory,
antidepressant,
and
memoryenhancing properties.
AMERICA
Chamomile (Matricaria chamomilla)
− Chamomile has been used for
numerous ailments and is also
commonly used in teas (as a mild
sedative) or in herbal products used for
sleep
disorders,
anxiety,
or
gastrointestinal problems.
− Coriander is considered to have cooling,
stimulant, carminative and digestive
properties. Its seed and the plan are
taken as a tea for stomach and all kinds
of urinary complaints.
CLO#8: Discuss the contraindications
in the use of herbal preparation.
8.1. People taking other medications
− People think that herbal medicines are
more effective and cheaper than
doctors' prescription. Some herbal
medicines are considered as dietary
supplements, and sometimes, proper
dose is not mentioned. There is also no
measuring cup or spoon provided with
the medicine as in case of allopathic
syrups. Usually, the same dose is
applied for persons of different age and
weight.
8.2.
People with serious health
conditions, such as liver or kidney
disease
− Herbal medicines are easily available in
the market and can be purchased
without prescription. They are also
advertised in the media as a miracle
NCM 104: CHN RLE
treatment and the people are not aware
of the side effects of the product, which
can put the person at risk for further
complications.
8.3. Breastfeeding women
− It
is
generally
advised
that
breastfeeding mothers avoid herbal
medicines. Some herbal medicines can
be harmful to the mother and baby.
Also, there is a lack of information on
whether or not various herbal
medicines pass into breast milk, and of
scientific safety data.
8.4. The Elderly
− Elderly patients are not aware of the
toxic effects of using herbal medicines.
It is important that they speak to their
doctor or pharmacist about any
medications they are taking in addition
to the herbal medicine they are
considering.
8.5. Children
− As with other medicines,
herbal
medicines should be kept out of sight
and reach of children. Although
medicines are meant to improve health,
they can be harmful if not taken the
right way, most especially to the
children. About 50,000 young children
end up in emergency rooms each year
because of overdose. They should be
stored in a way that means they are
safe and will be effective when
administered.
CLO#9: EXPLAIN THE SCIENTIFIC
PRINCIPLES INVOLVED IN PREPARING
AND ADMINISTERING HERBAL MEDICINES.
Pharmacology:
− Determine the many types of drug
interactions between herbal and
conventional medications.
− Detect plants that are potentially toxic
to the human body and may cause
medication drug interactions.
Safety and Security
− Ascertain that herbal medication has
been scientifically verified to assure its
safety and efficacy.
− There are certain herbal medicines that
might induce allergies and other
unfavorable adverse reactions.
− Follow the 10 rights of medication
administration - right patient, right
medication, right dose, right route,
right time and frequency, right
documentation, right history and
assessment, right to refuse, right
evaluation, and right patient education.
Time and Energy:
− Ensure that all herbal medication
preparation processes are followed in
order to get rid of its toxicity and other
factors that might cause unfavorable
reactions.
− Ensure that all supplies and equipment
have been cleaned and are free of
pathogens to save time by putting
everything in one place.
Microbiology:
− One of the most essential things to
remember
while making
herbal
medicines is to wash or clean the herbs.
This can help avoid the transmission of
microorganisms within our bodies.
− We must obtain information on all
herbal medicines from reputable
sources. to make certain that the herbal
is free of unwanted side effects and
NCM 104: CHN RLE
responses. to ensure the patient's
safety when using herbal medication.
CLO#10. State the Guidelines
in Herbal Preparation
Plant Taxonomy and Botany:
− Knowledge of plants components or
taxa
helps
in
the
systematic
organization of medicinal plants and
effective utilization of the medicinal
properties of such plants
− Correctly identify and ensure that the
plants gathered are safe and do not
contain any toxins that may be harmful
to the patient.
Anatomy and Physiology:
Guidelines
Rationale
Before
giving
herbal medicine to
a patient, check
for allergies (by
consulting
the
patient
and
reviewing
the
patient's record).
•
Take
note
of
expiration dates of
Medications.
•
To prevent toxicity
and to ensure the
patient’s safety and
well-being.
Be knowledgeable
of the herbs' local
and
systemic
effects, as well as
any
potential
adverse effects.
•
To
determine
abnormal and allergic
reactions
to
the
herbs.
Before
administering
herbal medication,
explain
the
procedure to the
patient, including
herbal
use,
dosage,
and
specific concerns.
•
To obtain patient
consent
To
encourage
patient
cooperation
Acknowledge
the
patient’s
right
to
be
knowledgeable
about
his
own
health
regimen.
Position
the
patient
appropriately
before
and
after
administration
•
•
Anatomy:
− Understanding the behavior of each
plant and how it affects our bodies,
How do they attack plant pathogens
Physiology:
− Determine how our bodies behave
physiologically when we take herbal
medications
Psychology:
− Providing information to patients about
the medication before administering it.
− Answers questions
about
dose,
application, and specific concerns.
Sociology:
− Nurses should be able to learn how to
communicate to their patients about
their medications and provide patients
the opportunity to ask questions about
their medicine alongside a family
member if necessary.
Administer the
right amount of
dosage
of medication.
•
•
•
•
To avoid causing an
allergic reaction.
To promote the
safety and well
being of the
patient.
Promote
the
absorption
and
effect
of herbal
medication.
Sitting position
is ideal for oral
administration
to promote easy
passage
of
drugs from the
oral cavity down
the esophagus
and
through the GI
tract.
To avoid the toxic
effect
of
herbal medication.
NCM 104: CHN RLE
Administer
the
right
medication
to
the
right patient
at the right
time.
•
Document
medication
administration
•
Right patient: to
avoid
eliciting
a toxic effect to
other patients.
• Right medication: To
avoid eliciting
a
toxic effect on the
patient
• Right time: To
avoid
overdose
of
medication
which could lead
to
toxicity.
•
•
For accurate recordkeeping
To endorse patient to
next shift
Ensure
continuity of
evidence
based care.
•
•
CLO#11: Cite nursing responsibilities
in administering herbal medications
Herbal Medications are types of
medicine that contain active ingredients
sourced from different parts of the plants such
as its roots, leaves, stems, and petals. Though
the ingredients are said to be all natural does
not mean that it is immediately safe to use and
administer. In this aspect nurses must ensure
that they will administer the correct herbal
medication to their clients as they are
responsible for providing quality care (NHS,
2018).
Before
•
•
•
•
Read the patient's chart.
Identify patients using two unique
identifiers.
Follow the physician's order.
Determine herbs needed.
o Herbal medicine aims to return
the body to a state of natural
balance so that it can heal itself.
Different herbs act on different
systems of the body.
Identify the correct plant, part, and
amount to be used.
o Herbal medicines may produce
negative effects that can range
from mild to severe.
o Take notes of the date you start
a herb and the dose. Then allow
a suitable amount of time.
o Dosage is dependent on the
individual. For example, under
the age of 16 or over 65 require
less of a herb, so be very
cautious with these people
especially.
Identify any potential interaction of
drugs and herbal medicines
o Herbal
medications
and
supplements may interact in
harmful ways with over-thecounter
or
prescription
medicines you are taking.
o Taking herbal supplements may
increase
or decrease
the
effectiveness of other drugs you
are taking or may increase the
risk of negative side effects.
During
•
•
Establish rapport.
Explain procedure to the patient
o Clients and significant others
should be taught about all
aspects of the medications that
they are taking. In this aspect
the nurse must ensure that when
developing a learning plan to
educate and teach the clients it
should minimally include:
 The purpose of the
medication
 The dosage of the
medication
 The side effects of the
medication
 How and where the
medication should be
safely stored
 Special instructions
NCM 104: CHN RLE
•
 Proper disposal
Follow the 10 rights of medication
administration - right patient, right
medication, right dose, right route,
right time and frequency, right
documentation, right history and
assessment, right to refuse, right
evaluation, and right patient education.
o Nurses are responsible for
ensuring safe and quality client
care at all times. As many
nursing tasks involve a degree of
risk, medication administration
arguably carries the greatest
risk. By using the Ten Rights of
Medication
Administration,
nurses can prevent medication
errors during preparation and
administration.
After
•
•
Provide health teaching. Caution them
about fraudulent advertising.
Document medication administration.
o Nurses are legally and ethically
responsible and accountable for
accurate
and
complete
medication
administration,
observation,
and
documentation.
o All medications that are given,
omitted, held or refused by the
patient must be documented in
the patient's medication record
in addition to other data like vital
signs, apical rate, PT and/or PTT
as indicated by the actions of the
medication and/or the doctor's
order.
CLO#12: DEMONSTRATE BEGINNING
SKILLS IN HERBAL PREPARATIONS
12.1 Decoction
− Decoction is a process of boiling the
recommended part of the plant material
in water. This procedure is suitable for
extracting water-soluble, heat-stable
constituents.
Materials Needed:
✓ 3 handfuls of fresh chopped leaves or
one handful of dried chopped leaves
✓ 2 glasses of water
✓ Clean cheesecloth
✓ Cooking utensil (non-aluminum ware)
✓ Sugar, honey or fruit juice (optional)
✓ Clean gloves
Procedure:
1. For mild decoction: in a cooking pot,
put leaves and two glasses of water.
Bring to a boil over a low flame. For
strong decoction: boil leaves in two
glasses of water over a low flame until
one glass of water remains (approx. 15
minutes boiling). Do not cover the pot
to release toxic substances in herbs
while boiling.
2. Strain the decoction using a cheese
cloth.
3. Let the decoction cool before drinking.
If preferred, add sugar, honey, or fresh
fruit juice to improve the flavor.
4. Drink ¼ of the tea every 3 hours during
the next 12 hours.
5. Repeat procedures 1-4 for 3 days.
Remember to discard the leftover
solution after 24 hours.
6. Observe for any improvement and
continue for 2-3 weeks more.
7. If no improvement appears, consult a
physician.
8. Do after care.
NCM 104: CHN RLE
12.2 Hot and cold infusion
− Infusion is the process in which plant
material is soaked in cold or boiling
water much like making tea. These are
dilute solutions of the readily available
constituents of crude drugs.
Hot Infusion Materials:
✓ 1 heaping tsp of dried chopped or
powdered leaves, flowers, seeds, fruits,
bark, or root
✓ 1 cup of boiling water
✓ A clean piece of cardboard or saucer for
cover
✓ Sugar or honey
✓ Clean cheesecloth
Hot Infusion Procedure:
1. Place 1 heaping tsp of dried chopped
herbs in an empty glass.
2. Pour boiling water into the glass until
almost filled.
3. Stir the mixture very well.
4. Cover the glass and let it stand for 15
minutes.
5. Strain
6. Add sugar or honey if preferred.
Cold Infusion Materials:
✓
✓
✓
✓
3 heaping tsp or chopped fresh herbs
1 glass of tsp water
Clean cheese cloth
Sugar or honey (optional)
Cold Infusion Procedure:
1. Wash the herbs.
2. Chop or crush the herbs.
3. Place 3 heaping tsp (or one handful of
chopped herbs in empty glass).
4. Pour tap water until almost filled.
5. Cover the cup for 1-2 hours.
6. Strain the solutions.
7. Add sugar or honey if desired.
12.3 Aromatic bath
− Aromatic bath is an aromatherapy
practice. Aromatic decoctions or
infusions were added to the water in a
bath.
Materials:
✓ 5 handfuls of fresh leaves
✓ 5 liter of water
✓ Cooking utensils
Procedure:
1. Mix the leaves and water in a cooking
pot.
2. Bring to a boil and remove from fire.
3. When the mixture is already lukewarm,
remove the leaves.
4. Take a bath with the remaining
solution.
12.4 Poultice
− Poultice is the process in which the
recommended part of the plant material
is directly applied to the affected part,
usually used on bruises, wounds, or
rashes.
Materials:
✓
✓
✓
✓
✓
✓
✓
Freshly cut leaves of the herb or plant
Sterile gauze
Cassava flour
1 glass of hot water
Porcelain mixing bowl
Mortar and pestle
Lined tray
Procedure:
1. Explain the procedure to the client.
2. Do medical handwashing.
3. Prepare the necessary
materials
needed.
4. Cut the fresh leaves.
5. Softened the leaves by pounding it
using the mortar and pestle.
6. Continue pounding until the juice
comes out and set aside.
NCM 104: CHN RLE
7. Mix the cassava flour with hot water to
form a paste.
8. Spread the cassava flour on sterile
gauze.
9. Incorporate the pounded leaves to the
gauze with cassava flour.
10. Apply the warm and moist preparation
directly to the affected part.
11. Do after care.
RLE 3M: Integrated
Management of Childhood
Illness
CLO#1: define the following terms:
1.1 IMCI
− The Integrated Management
of
Childhood Illness (IMCI) is an
integrated approach to child health that
focuses on the well-being of the whole
child. IMCI includes both preventive
and therapeutic elements that are
implemented
by
families
and
communities as well as by health
workers in facilities.
1.2 Malaria
− Malaria is a serious and sometimes fatal
disease caused by a parasite that
commonly infects a certain type of
mosquito which feeds on humans.
People who get malaria are typically
very sick with high fevers, shaking
chills, and flu-like illnesses. Four kinds
of malaria parasites infect humans:
Plasmodium falciparum, P. vivax, P.
ovale, and P. malariae.
1.3 Measles
− Measles is an acute viral respiratory
illness. It is characterized by a
prodrome of fever (as high as 105°F)
and malaise, cough, coryza, and
conjunctivitis -the three “C”s -,
pathognomonic enanthem
(Koplik
spots) followed by a maculopapular
rash external icon.
1.4 Pneumonia
− Pneumonia is an infection that inflames
the air sacs in one or both lungs. The
air sacs may fill with fluid or pus
(purulent material), causing cough with
phlegm or pus, fever, chills, and
difficulty breathing. A variety of
organisms, including bacteria, viruses,
and fungi, can cause pneumonia.
1.5 Dysentery
− Dysentery is an infection of the
intestines
that
causes
diarrhea
containing blood or mucus. Dysentery is
highly infectious and can be passed on
if you do not take the right precautions,
such as properly and regularly washing
your hands.
1.6 Dengue Fever
− Dengue fever is a disease caused by a
family of viruses transmitted by
infected mosquitoes. It is an acute
illness of sudden onset that usually
follows a benign course with symptoms
such as headache, fever, exhaustion,
severe muscle and joint pain, swollen
lymph nodes (lymphadenopathy), and
rash.
CLO#2: describe Integrated
Management of Childhood Illness
(IMCI) as to its definition and
strategy.
According to the department of health,
the
Integrated
Management
of
Childhood Illness (IMCI) is a major
strategy for child survival, growth and
development. IMCI is based on the combined
delivery of essential interventions at
community, health facility and health system
levels. This strategy was developed by the
World Health Organization and the United
Nations Children’s Fund (UNICEF).IMCI aims
to reduce death, illness and disability, and to
promote improved growth and development
among infants and children aged less than 5
years. IMCI includes both preventive and
therapeutic elements that are implemented by
families and communities as well as by health
workers in facilities. IMCI includes growth
charts for infants aged 0–2 months and 2–59
NCM 104: CHN RLE
months. IMCI consists of numerous clinical
algorithms and training materials that assist
nurses and other primary health-care workers
to manage sick infants and children presenting
to health facilities.
Strategies/Principles of IMCI:
• All sick children aged 2 months up to 5
years are examined for GENERAL
DANGER signs and all Sick Young
Infants Birth up to 2 months are
examined for VERY SEVERE DISEASE
AND LOCAL BACTERIAL INFECTION.
These signs indicate immediate referral
or admission to hospital
• The children and infants are then
assessed for main symptoms. For sick
children, the main symptoms include:
cough or difficulty breathing, diarrhea,
fever and ear infection. For sick young
infants, local bacterial infection,
diarrhea and jaundice. All sick children
are routinely assessed for nutritional,
immunization and deworming status
and for other problems
• Only a limited number of clinical signs
are used
• A combination of individual signs leads
to a child’s classification within one or
more symptom groups rather than a
diagnosis.
• IMCI management procedures use
limited number of essential drugs and
encourage
active
participation
of caretakers in the treatment of
children
• Counseling of caretakers on home care,
correct feeding and giving of fluids, and
when to return to clinic is an essential
component of IMCI
CLO#3: analyze the IMCI protocol
guidelines for health workers using the
integrated approach.
By the end of the classroom and
laboratory activities, students will be able to
analyze the IMCI protocol guidelines for
health workers using the integrated
approach. It is paramount that medical
students can fully distinguish the appropriate
protocols because in essence, it enables
healthcare practitioners to effectively
interact with one another despite variations
in internal operations, structure, or design in
the field of operations in the future.
Protocols help the health workers be aware
of their duties and obligations inside the
company. In the healthcare environment,
policy should lay the groundwork for
providing safe and cost-effective highquality care. IMCI consists of prevention and
treatment elements implemented in facilities
by families, communities, and health care
providers. The IMCI strategy focuses on
infants and young children who are ill in
health institutions, promotes accurate
identification of outpatient illnesses, ensures
adequate joint treatment of all major
illnesses, strengthens consultations with
clinicians, and expedites referral of critically
ill children. IMCI is a set of clinical algorithms
and training materials designed to help
nurses and other primary health care
workers manage sick infants and children
visiting medical institutions. IMCI includes
algorithms for use by health workers in
primary health care centers that reflect WHO
recommendations
on
anthropometric
assessment and feeding of infants and
young children.
There are guidelines pertaining to the
scope of IMCI algorithms for assessment
such as the IMCI flow chart on
anthropometric
assessment
and
classification of nutrition status which
classifies the Nutritional Status of the child,
medical
complications
and
his/her
breastfeeding problem. Relatively, the IMCI
counseling on infant and child feeding
practices
aid
in
the
feeding
recommendations for children during an
NCM 104: CHN RLE
indisposition, HIV exposed children and ARV
prophylaxis.
Three simple-to-follow protocols are
included in the IMCI
protocol
guidelines for healthcare practitioners
to obtain and arrange insights and
improve
home
care
and
communication with mothers:
1. adapting feeding recommendations
2. identifying and validating locally-used
terminology for indications of disease
3. designing and testing an adapted
card for counselling mothers.
CLO#4: classify and distinguish the
case management process as to: age
appropriate case management and
visit.
The case management process is presented on
two different sets of charts: one for children
age 2 months up to five years, and one for
children age 1 week up to 2 months.
This flowchart shows the sequence of
steps and also provides information for
performing them in the IMCI case
management process that is presented. This
series of charts has been transformed into an
IMCI booklet that is designed to help the
nurses carry out the case of the management
process. The IMCI chart contains only three
charts for managing sick children that are aged
2 months up to 5 years, and also a separate
chart for managing a sick young infant that is
aged 1 week up to 2 months. Most of our
health facilities already have a procedure for
registering children and identifying whether
they have come because they are sick or for
some other reasons such as well-child visit or
an immunization or injury. When a parent
brings their child because the shield is sick
maybe because of an illness not from a
trauma, it is very important to know the
client’s age in order to select the appropriate
IMCI charts and to begin the assessment
process
Depending on what kind of procedure when it
comes to registering patients at the clinic, the
name, age and some other information may
have already been recorded. If not, asking for
the child's name can be a great start and just
decide which of the age group the child’s age
range falls to:
-
Aged 1 week up to 2 months
-
Aged 2 months up to 5 years
Note that if the child is 2 months old, the child
does not belong to the range of 1 week up to
2 months old but in the range of 2 months up
to 5 years old based on the chart. Another
example would be this, the age group includes
a child who is 4 years 11 months but not a
child who is 5 years old. Up to 5 years means
that the child has not yet had his/her 5th
birthday. If the child is not yet 2 months of
age, it is considered as a young infant.
Management of the young infant age 1 week
up to 2 months is somewhat different from
older infants and children.
The case management process for sick
children age 2 months up to 5 years is
presented on three charts titled:
■ ASSESS AND CLASSIFY THE SICK CHILD
■ TREAT THE CHILD
■ COUNSEL THE MOTHER
If the child is not yet 2 months of age, the child
is considered a young infant. Management of
the young infant age 1 week up to 2 months
is somewhat different from older infants and
children. It is described on a different chart
titled:
■ ASSESS, CLASSIFY AND TREAT THE SICK
YOUNG INFANT
NCM 104: CHN RLE
FOR SICK CHILDREN 2 MONTHS UP TO 5
YEARS OLD (SICK CHILD)
2. LOOK TO SEE IF THE CHILD’S WEIGHT
AND TEMPERATURE HAVE BEEN
RECORDED
-
The steps on the ASSESS AND CLASSIFY THE
SICK CHILD chart describe what you should do
when a mother brings her child to the clinic
because her child is sick. The chart should not
be used for a well child brought for
immunization or for a child with an injury or
burn. When patients arrive at most clinics,
clinic staff identify the reason for the child’s
visit. Clinic staff obtain the child’s weight and
temperature and record them on a patient
chart, another written record, or on a small
piece of paper. Then the mother and child see
a health worker.
The ASSESS AND CLASSIFY chart summarizes
how to assess the child, classify the child’s
illnesses and identify treatments. The ASSESS
column on the left side of the chart describes
how to take a history and do a physical
examination. The instructions in this column
begin with ASK THE MOTHER WHAT THE
CHILD’S PROBLEMS ARE (see Example 1).
EXAMPLE 1: TOP OF ASSESS AND
CLASSIFY CHART FOR A CHILD AGE 2
MONTHS UP TO 5 YEARS
When you see the mother, or the child’s
caretaker, with the sick child
1. GREET THE MOTHER APPROPRIATELY
AND ASK ABOUT THE CHILD
Look to see if the child’s weight
and temperature have been
measured and recorded. If not,
weigh the child and measure his
or her temperature later when
you assess and classify the
child’s main symptoms. Do not
undress or disturb the child now.
3.
ASK THE MOTHER WHAT THE CHILD’S
PROBLEMS ARE
-
An important reason for asking
this question is to open good
communication with the
-
mother. Using good
communication helps to reassure
the mother that her child will
-
receive good care. When you
treat the child’s illness later in
the visit, you will need to
-
teach and advise the mother
about caring for her sick child at
home. So it is important to
-
have good communication with
the mother from the beginning
of the visit. To use good
-
communication skills:
-
Listen carefully to what
the mother tells you. This
will show her that you are
taking
her
concerns
seriously.
-
Use words the mother
understands. If she does
not
understand
the
questions you ask her,
she cannot give the
information you need to
assess and classify the
child correctly.
NCM 104: CHN RLE
-
-
-
Give the mother time to
answer the questions. For
example, she may need
time to decide if the sign
you asked about is
present.
Ask additional questions
when the mother is not
sure about her answer.
When you ask about a
main symptom or related
sign, the mother may not
be sure if it is present. Ask
her additional questions
to help her give clearer
answers.
4.
DETERMINE IF THIS IS AN INITIAL OR
FOLLOW-UP VISIT FOR THIS PROBLEM
-
If this is the child’s first visit for
this episode of an illness or
problem, then this is an initial
visit.
-
If the child was seen a few days
before for the same illness, this
is a follow-up visit. A follow-up
visit has a different purpose than
an initial visit. During a follow-up
visit, you find out if the
treatment given during the initial
visit has helped the child. If the
child is not improving or is
getting worse after a few days,
refer the child to a hospital or
change the child’s treatment.
-
How you find out if this is an
initial or follow-up visit depends
on how the health facility
registers patients and identifies
the reason for their visit. Some
clinics give mothers follow-up
slips that tell them when to
return. In other clinics a health
worker writes a follow-up note
on the multi-visit card or chart.
Or, when the patient registers,
clinic staff ask the mother
questions to find out why she
has come.
EXAMPLE 2: TOP PART OF A CASE
RECORDING FORM
FOR SICK CHILDREN FROM BIRTH UP TO
2 MONTHS (SICK YOUNG INFANT)
The process is very similar to the one you
learned for the sick child age 2 months up to
5 years. All the steps are described on the
chart titled ASSESS, CLASSIFY AND TREAT
THE SICK YOUNG INFANT. Ask the mother
what the young infant’s problems are.
Determine if this is an initial or follow-up visit
for these problems. If this is a follow-up visit,
you should manage the infant according to the
special instructions for a follow-up visit. These
special instructions are found in the follow-up
boxes at the bottom of the YOUNG INFANT
chart.
Young infants have special characteristics that
must be considered when classifying their
illnesses. They can become sick and die very
quickly from serious bacterial infections. They
frequently have only general signs such as few
movements, fever, or low body temperature.
Mild chest indrawing is normal in young infants
because their chest wall is soft. For these
reasons, you will assess, classify and treat the
young infant somewhat differently than an
older infant or young child. The ASSESS,
CLASSIFY AND TREAT THE SICK YOUNG
INFANT chart lists the special signs to assess,
the classifications, and the treatments for
young infants. The chart is not used for a sick
NCM 104: CHN RLE
newborn, that is a young infant who is less
than 1 week of age. In the first week of life,
newborn infants are often sick from conditions
related to labour and delivery,or have
conditions that require special management.
Newborns may be suffering from asphyxia,
sepsis from premature ruptured membranes
or other intrauterine infection, or birth trauma.
Or they may have trouble breathing due to
immature lungs. Jaundice also requires special
management in the first week of life. For all
these reasons, management of a sick newborn
is somewhat different from caring for a young
infant age 1 week up to 2 months. Some of
what you already learned in managing sick
children age 2 months up to 5 years will be
useful for young infants.
Assess and classify the sick young infant
The steps to assess and classify a sick young
infant during an initial visit are:
■ Check for signs of possible bacterial
infection. Then classify the young infant based
on the clinical signs found.
■ Ask about diarrhoea. If the infant has
diarrhoea, assess for related signs. Classify the
young infant for dehydration. Also, classify for
persistent diarrhoea and dysentery if present.
■ Check for feeding problems or low weight.
This may include assessing breastfeeding.
Then classify feeding.
■ Check the young infant’s immunization
status.
■ Assess any other problems. If you find a
reason that a young infant needs urgent
referral, you should continue the assessment.
However, skip the breastfeeding assessment
because it can take some time.
How to check a young infant for possible
bacterial infection
This assessment step is done for every sick
young infant. In this step you are looking for
signs of bacterial infection, especially a serious
infection. A young infant can become sick and
die very quickly from serious bacterial
infections such as pneumonia, sepsis and
meningitis. It is important to assess the signs
in the order on the chart, and to keep the
young infant calm. The young infant must be
calm and may be asleep while you assess the
first four signs, that is, count breathing and
look for chest indrawing, nasal flaring and
grunting. To assess the next few signs, you will
pick up the infant and then undress him, look
at the skin all over his body and measure his
temperature. By this time he will probably be
awake. Then you can see if he is lethargic or
unconscious and observe his movements.
Check for possible bacterial infection in ALL
young infants.
Ask: Has The Infant Had Convulsions?
Ask the mother this question.
Look: Count The Breaths In One Minute.
Repeat The Count If Elevated
− Count the breathing rate as you would
in an older infant or young child. Young
infants usually breathe faster than older
infants and young children. The
breathing rate of a healthy young infant
is commonly more than 50 breaths per
minute. Therefore, 60 breaths per
minute or more is the cutoff used to
identify fast breathing in a young infant.
If the first count is 60 breaths or more,
repeat the count. This is important
NCM 104: CHN RLE
because the breathing rate of a young
infant is often irregular. The young
infant will occasionally stop breathing
for a few seconds, followed by a period
of faster breathing. If the second count
is also 60 breaths or more, the young
infant has fast breathing.
Look For Severe Chest Indrawing
− Look for chest indrawing as you would
look for chest indrawing in an older
infant or young child. However, mild
chest indrawing is normal in a young
infant because the chest wall is soft.
Severe chest indrawing is very deep
and easy to see. Severe chest
indrawing is a sign of pneumonia and is
serious in a young infant.
Look For Nasal Flaring
− Nasal flaring is widening of the nostrils
when the young infant breathes in.
FOLLOW-UP VISIT
● For Sick Young Infant
Follow-up visits are recommended for
young infants who are classified as
LOCAL
BACTERIAL
INFECTION,
DYSENTERY, FEEDING PROBLEM OR
LOW WEIGHT (including thrush).
Instructions for carrying out follow-up
visits for the sick young infant age 1
week up to 2 months are on the YOUNG
INFANT chart.
If the infant does not have a new
problem, locate the section of the
YOUNG INFANT chart with the heading
“Give Follow-Up Care for the Sick Young
Infant.” Use the box that matches the
infant’s previous classification.
Dysentery
When a young infant classified as
having DYSENTERY returns for followup in 2 days, follow the instructions in
the “Dysentery” box on the follow-up
section of the chart.
Reassess the young infant for diarrhoea
as described in the assessment box,
“Does the young
infant
have
diarrhoea?” Also, ask the mother the
additional questions listed to determine
whether the infant is improving.
➤If the infant is dehydrated, use the
classification table on the YOUNG
INFANT
chart
to
classify
the
dehydration and select a fluid plan.
➤If the signs are the same or worse,
refer the infant to hospital. If the young
infant has developed fever, give
intramuscular
antibiotics
before
referral, as for POSSIBLE SERIOUS
BACTERIAL INFECTION.
➤If the infant’s signs are improving, tell
the mother to continue giving the infant
the antibiotic. Make sure the mother
understands
the
importance
of
completing the 5 days of treatment.
Local bacterial infection
When a young infant classified as
having LOCAL BACTERIAL INFECTION
returns for follow-up in 2 days, follow
the instructions in the “Local Bacterial
Infection” box of the follow-up section
of the chart.
To assess the young infant, look at the
umbilicus or skin pustules. Then select
the appropriate treatment.
➤If pus or redness remains or is worse,
refer the infant to hospital. Also refer if
there are more pustules than before.
NCM 104: CHN RLE
➤If pus and redness are improved, tell
the mother to complete the 5 days of
antibiotic that she was given during the
initial visit. Improved means there is
less pus and it has dried. There is also
less redness. Emphasize that it is
important to continue giving the
antibiotic even when the infant is
improving. She should also continue
treating the local infection at home for
5 days (cleaning and applying gentian
violet to the skin pustules or umbilicus).
Feeding problem
When a young infant who had a feeding
problem returns for follow-up in 2 days,
follow the instructions in the “Feeding
Problem” box on the follow-up section
of the chart. Reassess the feeding by
asking the questions in the young infant
assessment box, “Then Check for
Feeding Problem or Low Weight.”
Assess breastfeeding if the infant is
breastfed.
Refer to the young infant’s chart or
follow-up note for a description of the
feeding problem found at the initial visit
and previous recommendations. Ask
the mother how successful she has
been
carrying
out
these
recommendations and ask about any
problems she encountered in doing so.
➤Counsel the mother about new or
continuing feeding problems. Refer to
the recommendations in the box
“Counsel the Mother About Feeding
Problems” on the COUNSEL chart and
the box “Teach Correct Positioning and
Attachment for Breastfeeding” on the
YOUNG INFANT chart.
For example, you may have asked a
mother to stop giving an infant drinks
of water or juice in a bottle, and to
breastfeed more frequently and for
longer. You will assess how many times
she is now breastfeeding in 24 hours
and whether she has stopped giving the
bottle. Then advise and encourage her
as needed.
➤If the young infant is low weight for
age, ask the mother to return 14 days
after the initial visit. At that time, you
will assess the young infant’s weight
again. Young infants are asked to
return sooner to have their weight
checked than older infants and young
children are. This is because they
should grow faster and are at higher
risk if they do not gain weight.
Low weight
When a young infant who was classified
as LOW WEIGHT returns for follow-up
in 14 days, follow the instructions in the
“Low Weight” box on the follow-up
section of the chart.
Determine if the young infant is still low
weight for age. Also reassess his
feeding by asking the questions in the
assessment box, “Then Check for
Feeding Problem or Low Weight.”
Assess breastfeeding if the young infant
is breastfed.
➤If the young infant is no longer low
weight for age, praise the mother for
feeding the infant well. Encourage her
to continue feeding the infant as she
has been or with any additional
improvements you have suggested.
➤If the young infant is still low weight
for age, but is feeding well, praise the
mother. Ask her to have her infant
weighed again within a month or when
she returns for immunization. You will
want to check that the infant continues
to feed well and continues gaining
weight. Many young infants who were
low birthweight will still be low weight
for age, but will be feeding and gaining
weight well.
➤If the young infant is still low weight
for age and still has a feeding problem,
counsel the mother about the problem.
Ask the mother to return with her infant
NCM 104: CHN RLE
again in 14 days. Continue to see the
young infant every few weeks until you
are sure he is feeding well and gaining
weight regularly or is no longer low
weight for age.
Thrush
When a young infant who had thrush
returns for follow-up in 2 days, follow
the instructions in the “Thrush” box on
the follow-up section of the chart.
Check the thrush and reassess the
infant’s feeding.
➤If the thrush is worse or the infant
has problems with attachment or
suckling, refer to hospital. It is very
important that the infant be treated so
that he can resume good feeding as
soon as possible.
convenient and acceptable for mothers. Some
clinics use a system that makes it easy to find
the records of children scheduled for followup. At a follow-up visit, you should do different
steps than at a child’s initial visit for a problem.
Treatments given at the follow-up visit are
often different than those given at an initial
visit.
Where is follow-up discussed on the case
management charts?
− In the “Identify Treatment” column of
the ASSESS & CLASSIFY chart, some
classifications have instructions to tell
the mother to return for follow-up. The
“When to Return” box on the COUNSEL
chart summarizes the schedules for
follow-up visits.
➤If the thrush is the same or better
and the infant is feeding well, continue
the treatment with half-strength
gentian violet. Stop using gentian violet
after 5 days.
•
Follow-up care for the sick child
Some sick children need to return to the health
worker for follow-up. Their mothers are told
when to come for a follow-up visit (such as in
2 days, or 14 days). At a follow-up visit the
health worker can see if the child is improving
on the drug or other treatment that was
prescribed. Some children may not respond to
a particular antibiotic or antimalarial and may
need to try a second drug. Children with
persistent diarrhoea also need follow-up to be
sure that the diarrhoea has stopped. Children
with fever or eye infection need to be seen if
they are not improving. Follow-up is especially
important for children with a feeding problem;
to be sure they are being fed adequately and
are gaining weight. Because follow-up is
important, you should
make
special
arrangements so that followup visits are
convenient for mothers. If possible, mothers
should not have to wait in the queue for a
follow-up visit. Not charging for follow-up
visits is another way to make follow-up
− Specific instructions for conducting
each follow-up visit are in the “Give
Follow-Up Care” section of the TREAT
THE CHILD chart. The boxes have
headings that correspond to the
classifications on the ASSESS &
CLASSIFY chart. Each box tells how to
reassess
and
treat
the child.
Instructions for giving treatments, such
as drug dosages for a second-line
antibiotic or antimalarial, are on the
TREAT THE CHILD chart.
How to manage a child who comes for
follow-up
− As always, ask the mother about the
child’s problem. You need to know if
this is a follow-up or an initial visit for
this illness. How you find out depends
on how your clinic registers patients
NCM 104: CHN RLE
and how the clinic finds out why they
have come. For example, the mother
may say to you or other clinic staff that
she was told to return for follow-up for
a specific problem.
− If your clinic gives mothers follow-up
slips that tell them when to return, ask
to see the slip.
− If your clinic keeps a chart on each
patient, you may see that the child
came only a few days ago for the same
illness. Once you know that the child
has come to the clinic for follow-up of
an illness, ask the mother if the child
has, in addition, developed any new
problems.
− For example, if the child has come for
follow-up of pneumonia, but now he
has developed diarrhoea, he has a new
problem. This child requires a full
assessment. Check for general danger
signs and assess all the main symptoms
and the child’s nutritional status.
Classify and treat the child for diarrhoea
(the new problem) as you would at an
initial visit. Reassess and treat
pneumonia according to the follow-up
box.
If the child does not have a new problem,
locate the follow-up box that matches the
child’s previous classification. Then follow
the instructions in that box.
■ Assess the child according to the
instructions in the follow-up box. The
instructions may tell you to assess a major
symptom as on the ASSESS & CLASSIFY
chart. They may also tell you to assess
additional signs.
■ Use the information about the child’s signs
to select the appropriate treatment.
■ Give the treatment. Some children will
return repeatedly with chronic problems that
do not respond to the treatment that you can
give. For example, some children with AIDS
may have persistent diarrhoea or repeated
episodes of pneumonia. Children with AIDS
may respond poorly to treatment for
pneumonia and may have opportunistic
infections. These children should be referred
to hospital when they do not improve.
Children with HIV infection who have not
developed AIDS cannot be clinically
distinguished from those without HIV
infection. When they develop pneumonia,
they respond well to standard treatment.
Important: If a child who comes for followup has several problems and is getting
worse, REFER THE CHILD TO HOSPITAL.
Also refer the child to hospital if a secondline drug is not available, or if you are
worried about the child or do not know what
to do for the child. If a child has not
improved with treatment, the child may have
a different illness than suggested by the
chart. He may need other treatment.
CLO#5: Examine the IMCI case
management process.
THE INTEGRATED CASE MANAGEMENT
PROCESS
The complete IMCI case management process
involves the following elements:
Assessment
Assess the child by checking first the danger
signs or possible bacterial infection on an
infant child, asking questions about the
common symptoms, the condition of the child,
examining the child and checking the nutrition
and vaccination status. This also includes
checking the child for possible other health
related problems.
Classifying
Classifying the child’s illnesses using a colorcoded triage system since many children could
have more than one condition and each of this
illness is classified according to whether it
requires:
1. urgent pre-referral treatment and
referral (red)
2. specific medical treatment and advice
(yellow)
NCM 104: CHN RLE
3. simple advice on home management
(green)
Identify
− When all the conditions are classified,
we will then identify a specific
treatment for the child. If the child
requires urgent referral, give the child
an essential treatment before the
patient is transferred. If the child needs
treatment at home then develop an
integrated treatment plan for the child
and give some first dose of drugs that
are available in the clinic but if the
child’s case needs an immunization
then give immunizations.
Treatment
− It is our duty that we must provide
practical treatment instructions, this
includes teaching the caretaker on how
to give oral drugs, how to feed and give
fluids when the child is sick, and also
how to treat local infections at home.
The nurse must ask the caretaker to
return for the next follow-up on a
specific date and should teach the
caretakers to identify or recognize signs
that will indicate that the child must
return immediately to the health
facility.
Counsel
− Must assess feeding which includes
breastfeeding practices, and as well as
counselling to solve any kind of feeding
problems that can be found. Lastly, it is
important that the nurse counsels the
mother about her own health also.
Give follow-up care
− When the child is brought back to the
clinic as requested, follow up care must
be given and if it's necessary, reassess
the child if there are any new health
problems that might have appeared.
− This IMCI Guidelines addresses most
but not all when it comes to finding out
the major reasons why a sick child is
brought to the clinic. If the child returns
with chronic problems or less common
illnesses, that may require special care
which is not in the IMCI handbook. The
case management can only be effective
to the extent that the family or
caretakers has brought their sick child
to a trained health worker for care in a
timely way. In the case of the family
bringing the child to the clinic only
when it is extremely sick or taking the
child to an untrained provider the
chances of the child dying from the
illness is very high. That is why teaching
the families when to seek care for a sick
shield is a very important part of the
case management process.
CLO#6: compare recording forms
used in IMCI
1. Sick young infant
− recording form used for a child younger
than 2 months.
This assessment step is done for every sick
young infant. In this step you are looking for
signs of bacterial infection, especially a serious
infection. A young infant can become sick and
die very quickly from serious bacterial
infections such as pneumonia, sepsis and
meningitis.
This chapter describes the steps to assess and
classify a sick young infant during an initial
visit:
•
Check for signs of possible bacterial
infection. Then classify the young infant
based on the clinical signs found.
•
Ask about diarrhoea. If the infant has
diarrhoea, assess for related signs.
Classify
the
young
infant
for
dehydration.
•
Classify for persistent diarrhoea and
dysentery if present.
•
Check for feeding problem or low
weight. This may include assessing
breastfeeding. Then classify feeding.
•
Check the young infant’s immunization
status.
NCM 104: CHN RLE
•
Assess any other problems.
2. Sick child
− recording form used for a child aged 2
months up to 5 years
− “up to 5 years” means the child has not
yet reached their fifth birthday
A mother or other caretaker brings a sick child
to the clinic for a particular problem or
symptom. If you only assess the child for that
particular problem or symptom, you might
overlook other signs of disease.
This chapter describes the steps to assess and
classify a sick child during an initial visit:
•
Check for general danger sign.
•
Observe if the the child have cough or
difficult breathing
•
Does the child have fever?
•
If the child has measles now or within
the last 3 months.
•
Assess dengue hemorrhagic fever.
•
Check for
anemia.
•
If child has MUAC less than 115 mm or
WFH/L less than -3 Z score.
•
Check for HIV Infection and child’s
immunization status.
•
Assess feeding if the child is less than 2
years old, has moderate acute
malnutrition, anemia or is HIV exposed
or infected.
acute
malnutrition and
3. Weight for age chart
− to determine if the young infant is low
weight for age
− Keep in mind that you should utilize the
Low Weight for Age line for a young
newborn rather than the Very Low
Weight for Age line, which is for older
babies and toddlers. Keep in mind that
a newborn infant's age is generally
expressed in weeks, while the Weight
for Age table uses months and some
young infants who are low weight for
age were born with low birthweight.
Some did not gain weight well after
birth.
NCM 104: CHN RLE
CHILD GROWTH STANDARDS
Weight (kg) for Age of Boys 0-71
months
SIR DIVINA’S DISCUSSION FOR IMCI
IMCI
− WHO and UNICEF developed a strategy
known as Integrated Management of
Childhood Illness (IMCI).
− The strategy combines improved
management of childhood illness with
aspects of:
a. nutrition
b. immunization
c. other important disease prevention in
addition to health promotion elements
IMCI STRATEGY
Health-worker component:
CHILD GROWTH STANDARDS
Weight (kg) for Age of Girls 0-71
months
− Improvements
in
the
casemanagement skills of health staff
through locally adapted guidelines
Health-service component:
− Improvements in the overall health
system
required
for
effective
management
Community component:
− Improvements in family and community
health care practices.
NCM 104: CHN RLE
1 week up to 5 years
Process:
1. Asses – check Danger Signs, asking
questions about common conditions,
examine child, check nutrition &
immunization status
4. Treat
− Give treatment in the facility, prescribe
drugs or other treatment and teach
caregiver how to administer treatment
at home
5. Assess feeding, including assessment
of BF practices, and counsel to solve any
feeding problems, counsel mother on
own health
6. When child is brought back to clinic,
give-follow-up care and re-assess the
child for new problems
2 charts:
 1 week up to 2 months (young infant)
 2 months up to 5 years (young child)
4 Danger Signs
1. Vomiting
2. Lethargy/Consciousness
3. Convulsions
4. Inability to drink or breastfeed
Key Elements of IMCI
1. Assessment
− Assess for general danger signs,
common illnesses and other health
problems.
2. Classification
Color: Classification
Pink:
Severe
classification
needing
admission or pre-referral treatment and
referral
Yellow: A classification needing specific
medical treatment and advice
Green: Not serious and in most cases no
drugs are needed. Simple advice on home
management given.
3. Identify Treatment
− If the child has more than one
classification look at more than one
treatment table.
Ask the problem; then ask if initial visit or
follow-up
For all sick children age 1 week up to
5 years who are brought to a firstlevel health facility
ASSESS the child: Check for danger signs
(or possible bacterial infection). Ask about
main symptoms. If a main symptom is
reported, assess further. Check nutrition
and immunization status. Check for other
problems.
CLASSIFY the child’s illnesses: Use a
colour-coded triage system to classify the
child’s main symptoms and his or her
nutrition or feeding status.
IF URGENT
IF NO URGENT
REFERRAL
REFERRAL
Is needed and
Is needed or
possible
possible
IDENTIFY
IDENTIFY
URGENT
TREATMENT
PRE-REFERRAL
needed for the
TREATMENT(S)
child’s
Needed for the
classifications:
child’s
Identify specific
classifications.
medical treatments
and/or advice.
TREAT THE
TREAT THE
CHILD: Give urgent
CHILD: Give the
pre-referral
first dose of oral
drugs in the clinic
NCM 104: CHN RLE
treatment(s)
needed.
REFER THE
CHILD: Explain to
the child’s caretaker
the need for
referral.
Calm the caretaker’s
fears and help
resolve any
problems. Write a
referral note.
Give instructions and
supplies needed to
care for the child on
the way to the
hospital.
and/or advise the
child’s caretaker
how to give oral
drugs and how to
treat local infections
at home. If needed,
give immunizations.
COUNSEL THE
MOTHER: Assess
the child’s feeding,
including
breastfeeding
practices, and solve
feeding problems, if
present. Advise
about feeding and
fluids during illness
and about when to
return to a health
facility. Counsel the
mother about her
own health
FOLLOW-UP care:
Give follow-up care
when the child
returns to the clinic,
and, if necessary,
reassess the child
for new problems.
FOR ALL SICK CHILDREN ASK THE
MOTHER ABOUT THE CHILD’S PROBLEM,
CHECK FOR GENERAL DANGER SIGNS
AND THEN
ASK: DOES THE CHILD HAVE COUGH OR
DIFFICULT BREATHING?
If NO
⬇️
Then ASK about the next main symptoms:
diarrhoea, fever, ear problems. CHECK for
malnutrition and anaemia, immunization
status and for other problems.
If YES
− ASK for how long?
- LOOK, LISTEN, FEEL:
a. Count the breaths in one
minute
b. Look for chest indrawing
c. Look and listen for stridor
NOTE: CHILD MUST BE CALM
Classify COUGH or DIFFICULT
BREATHING
IF THE CHILD IS:
FAST BREATHING
IS:
2 months up to 12 50
breaths
per
months
minute or more
12 months up to 5 40
breaths
per
years
minute or more
⬇️
CLASSIFY the child’s illness using the colourcoded classification table for cough or difficult
breathing
⬇️
Then ASK about the next main symptoms:
diarrhoea, fever, ear problems. CHECK for
malnutrition and anaemia, immunization
status and for other problems.
SIGNS
CLASSIFY AS
Any
general
danger sign or
Chest indrawing
or
Stridor in calm
child
SEVERE
PNEUMONIA
OR VERY
SEVERE
DISEASE
Fast breathing
PNEUMONIA
IDENTIFY
TREATMENT
(urgent prereferral
treatments are
in bold print.)
► Give first
dose of an
appropriate
antibiotic
►
Refer
URGENTLY to
hospital
► Give an
appropriate
oral antibiotic
for 5 days.
► Soothe the
throat
and
relieve cough
with
a safe
remedy
NCM 104: CHN RLE
No signs of
pneumonia or
very
severe
disease.
NO
PNEUMONIA:
COUGH OR
COLD
►
Advise
mother when to
return
immediately
► Follow-up in
2 days
► If coughing
more than 30
days, refer for
assessment
► Soothe the
throat
and
relieve
the
cough with a
safe remedy
►
Advise
mother when to
return
immediately
► Follow-up in
5 days if not
improving
FOR ALL SICK CHILDREN ASK THE
MOTHER ABOUT THE CHILD’S PROBLEM,
CHECK FOR GENERAL DANGER SIGNS,
ASK ABOUT COUGH OR DIFFICULT
BREATHING AND THEN
ASK: DOES THE CHILD HAVE DIARRHOEA?
If NO
⬇️
Then ASK about the next main symptoms:
fever, ear problem, and CHECK for
malnutrition and anaemia, immunization
status and other health problems
If YES
⬇️
Does the child have diarrhoea?
If YES, ASK:
− For how long?
− Is there blood in the stool?
LOOK, LISTEN, FEEL:
a. Look at the child’s general condition
Is the child:
Lethargic or unconscious?
Restless or irritable?
b. Offer the child fluid, is the child:
Not able to drink or drinking
poorly?
Drinking eagerly, thirsty?
c. Pinch the skin of the abdomen:
Does it go back:
Very slowly (longer than 2 seconds?)
Slowly?
(CLASSIFY DIARRHOEA)
⬇️
CLASSIFY the child’s illness using the colourcoded classification tables for diarrhoea.
⬇️
Then ASK about the next main symptoms:
fever, ear problem, and CHECK for
malnutrition and anaemia, immunization
status and other health problems
NCM 104: CHN RLE
SIGNS
CLASSIFY AS
Two of the
follow signs:
⇔ Lethargic
or
unconscious
⇔
Sunken
eyes
⇔ Not able to
drink
or
drinking
poorly
⇔ Skin pinch
goes
back
very slowly
Two of the
following
signs:
⇔ Restless,
irritable
⇔
Sunken
eyes
⇔
Drinks
eagerly,
thirsty
⇔ Skin pinch
goes
back
slowly
SEVERE
DEHYDRATION
SOME
DEHYDRATION
IDENTIFY
TREATMENT
(urgent prereferral
treatments are
in bold print.)
► If child has
no other severe
classification
= Give fluid for
severe
dehydration
(Plan C)
OR
If child also has
severe
classification:
Refer
URGENTLY to
hospital with
mother giving
frequent sips of
ORS on the
way. Advise the
mother to
continue
breastfeeding.
► If your child
is 2 years or
older, and there
is cholera in
your area, give
antibiotic for
cholera
► Give fluid.
Zinc
supplements
and food for
some
dehydration
(Plan B)
► If child also
has a severe
classification:
Refer
URGENTLY to
hospital with
mother giving
frequent sips
of ORS on the
way. Advise
the mother to
continue
breastfeeding.
►
Advise
mother when to
return
immediately
► Follow-up in
5 days if not
improving
⇔
Not
enough signs
to classify as
some
or
severe
dehydration
NO
DEHYDRATION
► If confirmed/
symptomatic
HIV, follow-up
in 2 days if not
improving
► Give fluid,
Zinc
supplements
and food to treat
diarrhoea
at
home (Plan A)
►
Advise
mother when to
return
immediately
► Follow-up in
5 days if not
improving
► If confirmed/
symptomatic
HIV, follow-up
in 2 days if not
improving
AND IF THERE HAS BEEN DIARRHEA FOR
14 DAYS OR MORE
Dehydration
present
No dehydration
SEVERE
PERSISTENT
DIARRHEA
PERSISTANT
DIARRHEA
→
Treat
dehydration
before referral
to a hospital
unless the child
has
another
severe
classification
→
GIVE
VITAMIN A
→ Refer the
child
to
a
hospital
→ Advise the
mother
regarding the
feeding of a
child who has
PERSISTENT
DIARRHEA
→
GIVE
VITAMIN A
→ Follow up in
5 days
NCM 104: CHN RLE
CLASSIFICATION TABLE FOR PERSISTENT
DIARRHOEA AND DYSENTERY
SIGNS
Dehydration
present
No dehydration
Blood
stool
in
the
If YES
CLASSIFY
AS
IDENTIFY
TREATMENT
⬇️
SEVERE
PERSISTENT
DIARRHEA
→
Treat
dehydration
before referral
severe
classification
→ Refer to
classification
→ Advise the
mother
on
feeding a child
who
has
PERSISTENT
DIARRHOEA
→ Follow-up in
5 days
→ treat for 5
days with an
oral antibiotic
recommended
for Shigella in
your area
→ Follow-up in
2 days
Does the child have fever?
PERSISTENT
DIARRHEA
DYSENTERY
(by history or feels hot or temperature
37.5°C or above)
IF YES:
Decide the Malaria Risk: high or low
THEN ASK:
− For how long?
− If more than 7 days, has fever been
present every day?
− Has the child had measles within the
last 3 months?
LOOK AND FEEL:
− Look or feel for stiff neck
− Look for runny nose
Look for signs of MEASKES
FOR ALL SICK CHILDREN ASK THE
MOTHER ABOUT THE CHILD’S PROBLEM,
CHECK FOR GENERAL DANGER SIGNS,
ASK ABOUT COUGH OR DIFFICULT
BREATHING AND THEN
ASK: DOES THE CHILD HAVE FEVER?
If NO
− Generalized rash and
− One of these: cough, runny nose, or red
eyes
If the child has measles now or within
the last 3 months
− Look for mouth ulcers
Are they deep and extensive?
⬇️
Then ASK about the next main symptoms:
ear problem, and CHECK for malnutrition and
anaemia, immunization status and other
health problems
− Look for pus draining from the eye
− Look for clouding of the cornea
⬇️
CLASSIFY the child’s illness using the colourcoded classification tables for fever.
⬇️
Then ASK about the next main symptom: ear
problem, and CHECK for malnutrition and
anaemia, immunization status and other
health problems
NCM 104: CHN RLE
SIGNS
CLASSIFY
AS
Any
general
danger sign
Stiff neck
NO runny and
NO
measles
and NO other
cause of fever
Runny
nose
PRESENT OR
Measles
PRESENT OR
VERY SEVERE
FEBRILE
DISEASE
MALARIA
FEVERMALARIA
UNLIKELY
IDENTIFY
TREATMENT
(urgent prereferral
treatments are
in bold print.)
►
Give
guideline for
severe
malaria (first
dose)
► Give first
dose of an
appropriate
antibiotic
► Treat the
child
to
prevent
low
blood sugar
► Give one
dose
of
paracetamol
in clinic for
high
fever
(38.5° C or
above)
► If NO cough
with
fast
breathing,
treat with oral
antimalarial
OR
If cough with
fast
breathing,
treat
with
cotrimoxazole
for 5 days
► Give one
dose
of
paracetamol
in clinic for
high
fever
(38.5° C or
above)
►
Advise
mother when to
return
immediately
► Follow-up in
2 days if ever
persists
► If fever is
present
every
day for more
than 7 days,
REFER
for
assessment
► Give one
dose
of
paracetamol
in clinic for
Other cause of
fever PRESENT
high
fever
(38.5° C or
above)
►
Advise
mother when to
return
immediately
► Follow-up in
2 days if ever
persists
► If fever is
present
every
day for more
than 7 days,
REFER
for
assessment
NO MALARIA RISK
Any
general
danger sign or
Stiff neck
VERY SEVERE
FEBRILE
DISEASE
No signs of a
very
severe
febrile disease
FEVER:
NO MALARIA
→ Give the first
dose
of
an
appropriate
antibiotic
→ Treat the
child to prevent
the lowering of
his or her blood
sugar level
→ Give 1 dose
of paracetamol
in the health
center for high
fever
→ Refer the
child
URGENTLY to a
hospital
→ Give 1 dose
of paracetamol
in the health
center for high
fever
→ Advise the
mother
regarding when
to
return
immediately to
the
health
center
→ Follow up in
2 days if the
fever persists
→ If fever has
been
present
every day for
more than 7
days, refer the
child
to
a
hospital
for
assessment
NCM 104: CHN RLE
SIGNS
CLASSIFY AS
Any
general
danger
sign or
Clouding
of cornea
or
Deep or
extensiv
e mouth
ulcers
SEVERE
COMPLICATED
MEASLES***
Pus
draining
from the
eye or
Mouth
ulcers
MEASLES WITH EYE
OR MOUTH
COMPLICATIONS**
*
Measles
now or
within
the last 3
months
MEASLES
IDENTIFY
TREATMEN
T
(urgent prereferral
treatments are
in bold print.)
►
Give
vitamin A
► Give first
dose of an
appropriate
antibiotic
► If clouding
of the cornea
or
pus
draining
from the eye,
apply
tetracycline
eye ointment
►
Refer
URGENTLY
to hospital
►
Give
vitamin A
►
If
pus
draining
from the eye,
treat
eye
infection
with
tetracycline
eye ointment
► If mouth
ulcers,
treat
with
gentian
violet
► Follow-up in
2 days
►
Give
vitamin A
If there is DENGUE risk, classify
⦿
Bleeding
from the nose
or gums
⦿ Bleeding in
the stool or
vomitus
⦿ Black stool
or vomitus
⦿
Skin
petechiae
SEVERE
DENGUE
HEMORRHAGIV
FEVER
⦿ If skin
petechiae,
persistent
abdominal
pain,
persistent
vomiting, or
positive
tourniquet
test are the
only positive
⦿
Cold,
clammy
extremities
⦿
Slow
capillary refill
(more than 3
sec)
⦿ Persistent
abdominal
pain
⦿ Persistent
vomiting
⦿
Positive
Tourniquet
Test
⦿ No signs of
severe dengue
hemorrhagic
fever
FEVER:
DENGUE
HEMORRHAGIC
FEVER
UNLIKELY
signs,
give
ORS
⦿
If
any
other sign of
bleeding
is
positive, give
fluids
rapidly, as in
PLAN C
⦿ Treat the
child
to
prevent the
lowering of
his or her
blood sugar
level
⦿ Refer the
child
URGENTLY
to as hospital
⦿ DO NOT
GIVE
ASPIRIN
⦿ Advise the
mother
regarding
when to return
immediately to
the
health
center
⦿ Follow up in
2 days if the
fever persists
or if the child
shows signs of
bleeding
⦿ DO NOT
GIVE
ASPIRIN
FOR ALL SICK CHILDREN ASK THE
MOTHER ABOUT THE CHILD’S PROBLEM,
CHECK FOR GENERAL DANGER SIGNS,
ASK ABOUT COUGH OR DIFFICULT
BREATHING AND THEN
ASK: DOES THE CHILD HAVE AN EAR
PROBLEM?
If NO
⬇️
Then CHECK for malnutrition and anaemia,
immunization status and other health
problems
NCM 104: CHN RLE
If YES
SIGNS
CLASSIFY
AS
⬇️
Does the child have an ear problem?
IF YES ASK:
Tender swelling
behind the ear
MASTOIDITIS
Pus is seen
draining
from
the ear and
discharge
is
reported
for
less than 14
days,
Or
Ear pain
ACUTE EAR
INFECTION
Pus is seen
draining
from
the ear and
discharge
is
reported for 14
days or more
No ear pain and
No pus seen
draining
from
the ear
CHRONIC
EAR
INFECTION
− Is there ear pain?
− Is the ear discharge?
If yes, for how long?
LOOK AND FEEL:
− Look for pus draining from the ear
− Feel for tender swelling behind the ear
− CLASSIFY the child’s illness using the
colour-coded classification tables for
fever.
⬇️
CLASSIFY the child’s illness using the colourcoded classification tables for ear problem
⬇️
Then CHECK for malnutrition and anaemia,
immunization status and other health
problems
NO EAR
INFECTION
IDENTIFY
TREATMENT
(urgent prereferral
treatments are
in bold print.)
► Give first
dose of an
appropriate
antibiotic
► Give first
dose
of
paracetamol
for pain
►
Refer
URGENTLY to
hospital
► Give an
oral antibiotic
for 5 days
►
Give
paracetamol for
pain
► Dry the ear
by wicking
► Follow-up in
5 days
► Dry the ear
by wicking
► Follow-up in
5 days
No
additional
treatment
NCM 104: CHN RLE
CHN RLE 1M QUIZ:
1M: BAG TECHNIQUE (30/30?)
1.Products for incomplete fat metabolism that
appears in urine - Ketone bodies
2.Agents that increase urine secretion - Diuretics
3.Appearance or presence of blood in the urine Hematuria
4.The uncontrolled or involuntary passage of urine
especially during sleep -Enuresis
5. This is a type of family nurse contact which
provides easy access between the nurse/ health
worker and the family.
Ex. Telehealth apps/MDH customer care service
ANS: Telephone (landline or mobile cellphone)
6.This is a type of a family nurse contact where it
is used to give specific information to families, such
as instructions given to parents through school
children.
Ex. Announcements in the school bulletin board
ANS: Written communication
7.This type of a family nurse contact where in a
professional and purposeful interaction will take
place in the family’s residence aimed at promoting,
maintaining, or restoring the health of the family
or its members
ANS: Home visit
8.This is a type of a family nurse contact that takes
place in a private clinic, health center, barangay
health station, or in an ambulatory clinic during
community outreach activity.
ANS: Clinic visit
9.This is a type of family nurse contact in which it
provides an opportunity for initial contact between
the nurse and target families of the community. It
may take place at a health facility or in the
community.
Ex. conducting preschooler’s class/ Antenatal
classes for young mothers
ANS: Group conference
10. A type of case load when the client has
established or diagnosed illness - Morbidity
11. A type of caseload in which the case is about
death rate due to a specific illness in a particular
population -Mortality
12.It is finding out possible illness of the patient
and wherein the nurse will access, study the
history of, note signs and symptoms of any of the
patient.- Case Finding
13.This is a type of caseload which is considered
to be the first few days after delivery. It includes
the six-week period after childbirth up to the
mother’s postpartum check-up; monitoring and
management of the patient who has recently given
birth (six months after).- Postpartum
14. It is a type of caseload caring of pregnant
woman during the time in the maternity cycle that
begins with conception and ends with the onset of
labor; before delivery - Antepartum
15. A type of caseload wherein the spacing visit is
based on needs and principles that teaching is
more effective in the learning period are at
frequent intervals. Recipient is the family and their
recognized needs. - Health Supervision
16. The average urine output for adults in 1 kidney
is 60 ml/hr - FALSE
17.Health supervision is where the nurse is trying
to find out possible illness of a patient and will
assess and study the history of or note signs and
symptoms if any of the patient. - FALSE
18.In the notes provided, one common factor
influencing urine results is exercise and activity
pattern - FALSE
19.The nurse needs to explain the procedure to the
client at his or own level of understanding - TRUE
20.Bag technique is an indispensable and an
essential equipment of public health nurses in
which they carry during home visit containing basic
medications - FALSE
21. Kidney basin
NCM 104: CHN RLE
22.QUESTION: A professional face to face contact
made by a public health nurse to the patient or to
the family to provide health care activities, it is a
purposeful interaction that takes place in residence
home - Home visit
23.QUESTION: It is the order of preparations or
plans carried out when visiting a patient and an
essential tool in achieving the best results in home
visiting - Plan of visit
24.QUESTION: It is the number of cases handled
usually in a particular period - Caseload
25.It is a technique by which the nurse use, during
her visit and will enable her to perform a nursing
procedure with ease and deftness, to save time
and effort with the end view of rendering effective
nursing care to clients - Bag technique
26.Which of the ff. Statements are TRUE? - In
secretion, solutes are secreted across the wall of
the nephron into the filtrate
27. The Functional unit of the kidneys are
Nephrons
28.A type of specimen collection in which the nurse
collects the specimen when the client wakes up in
the morning - First morning specimen
29.What organs composed the urinary system?
2 kidneys, 2 ureters, a urinary bladder, and a
urethra
30. It is the most common way to obtain a urine
specimen, since it is easiest to obtain and can be
collected anytime - Random specimen
CHN RLE 2M QUIZ:
2M: HERBAL (29/30)
1.
A combination of the use of essential
aromatic oils applied to the body as a form of
treatment -AROMATHERAPY
2.
A person who uses a combination of healing
modalities that includes prayers, incantations,
mysticism and herbalism.-ALBULARYO
3.
It uses the application of pressure on
acupuncture points that promotes healing and
health. -ACUPRESSURE
4.
It is based on the principle that internal
glands and organs can be influenced by properly
applying pressure to the corresponding reflex
areas of the body. -REFLEXOLOGY
5.
A healing that follows the principle of
balancing energy. -PRANIC HEALING
6.
A discipline of the healing arts concerned
with the pathogenesis, diagnosis, therapy and
prophylaxis related to the static and dynamic
locomotor system, especially the spine and pelvis.
-CHIROPRACTIC
7.
A person who acts as a midwife, a
chiropractor or massage therapist to promote
health and healing. -HILOT
8.
A method wherein the body are rubbed,
stroked, kneaded or trapped for remedial,
aesthetic, hygienic or limited therapeutic purposes
-MASSAGE
9.These are labeled medicinal products that
contains active ingredients aerial or underground
parts of the plants -HERBAL MEDICINE
10.The use of food as medicine to improve health
and reduces the risk of a disease -NUTRITIONAL
THERAPY
11. Plant material is being soak for 10-15 minutes
in a hot water, much like making a tea - INFUSION
12. It is indicated for headache, stomachache and
at the same time relieves rheumatism and arthritis
-YERBA BUENA
13.A combination of herbal decoction with sugar or
honey that is taken orally - SYRUP
NCM 104: CHN RLE
14. A method wherein the recommended part of
the plant is boiled with water - DECOCTION
15.The herbal medicine undergone direct
extraction from herbs by compression of oilbearing components or distillation - OIL
16. A herbal plant that is good for asthma, cough,
and colds and is prepared through decoction
method - LAGUNDI
17.A method wherein the herbal plant is mis with
alcohol and is taken using a dropper - TINCTURE
18. A herbal plant that is good for arthritis
(rheumatoid/gout) and lowers the uric acid in the
body - ULASIMANG BATO
19. A medical plant that is use to wash wounds and
helps ease diarrhea - BAYABAS
20. It is indicated as antiedema and antiurolithiasis. It is prepared through decoction SAMBONG
21.One must not do self medication with herbal
plants especially if maintenance medications are
taken - TRUE
22.In the principle of safety and security, one must
check the rights of the patient prior to giving the
any medications -TRUE
23. Administration of herbal medications is allowed
for clients less than 18 but not more than 65 FALSE
24. When doing decoction, it is a must to cover the
pot so that the herbs will boil fast - FALSE
25. Herbal medications that has undergone
through the process of decoction can be use up to
3 days -TRUE
26.A method wherein infused herbs mix with either
rubbing alcohol or grain alcohol that is applied to
the skin and relieves muscle soreness. - LINIMENT
27.A herbal preparation method wherein the herb
is applied to the body to relieve soreness or
inflammation and kept in a place with a cloth for a
period of time - POULTICE
28. It contains highly concentrated extract herb
that is mixed with water and alcohol and is more
potent to use for 2 to 3 years. - TINCTURE
29.It involves boiling a part of the plant for 20 mins
in an uncovered pot when straining with the use of
cheesecloth or muslin cloth. This can be store for
2 ro 3 days - DECOCTION
30. A method of preparation wherein herb from
infused oil is mixed with beeswax and is applied
topically – OINTMENT
CHN RLE 3M QUIZ:
3M : IMCI (30/30 ?)
1. A mosquito-borne tropical disease which
symptoms include high fever, headache, vomiting
and skin rash. – DENGUE FEVER
2. A classification in YELLOW row means the child
needs: - Treatment such as antibiotics and
includes teaching mother how to administer
medications at home.
3. A 2 year-old child is brought to the health center
by his mother for complaints of cough and colds
that have been present for 2 weeks now. The first
thing that the nurse will do is: - CHECK FOR
DANGER SIGNS
4. For a child who needs urgent referral, the
community health care worker needs to:
−
−
−
−
Identify urgent pre-referral treatments
Administer urgent pre-referral treatment
needed
Give instructions and supplies needed to
care for the child on the way to the hospital
ALL OF THE ABOVE
5. IMCI clinical guidelines are meant to be used by
health workers in the management of sick children
aged: - 1 WEEK TO 5 YEARS
6. For children aged 2 months to 1 year, a
respiratory rate of 55 breaths per minute is
considered fast breathing – TRUE
7. In the home setting, IMCI promotes appropriate
care seeking behaviors – TRUE
8. The mother is given health teachings about her
own health. This is part of this element in IMCI
case management process: - COUNSEL
9. “Up to five (5)” means the child is exactly 5
years old. – FALSE
NCM 104: CHN RLE
10. IMCI is a strategy developed by the Philippine
government that provides quality care to sick
children. – FALSE
11. Upon further assessment to the 2 year-old child
with cough and colds and fast breathing, the nurse
hears a harsh noise when the child breathes in.
This is – STRIDOR
21. The health care worker will identify the specific
treatment before classifying condition – FALSE
22. In health facilities, IMCI strengthens the
counseling of caretakers, and speeds up the
referral of severely ill children. – TRUE
12. Using the IMCI case management process, a
classification in PINK row means – URGENT
23. A child with diarrhea and vomiting is observed
to be abnormally sleepy and has sunken eyes. The
nurse knows that the child may have – SEVERE
DEHYDRATION
13. A child with diarrhea is assessed for the
following:
24.
IMCI
promotes
immunization – TRUE
−
−
−
−
Duration of the diarrhea
Presence of blood in the stool
Signs of dehydration
ALL OF THE ABOVE
14. A child is considered “not able to drink and
breastfeed” if: CHILD IS TOO WEAK TO DRINK
AND NOT ABLE TO SUCK OR SWALLOW WHEN
OFFERED FLUIDS OR MILK
15. The following is part of the 3 main components
of IMCI strategy (WHO, 2005)
−
−
−
−
IMPROVEMENTS IN CASE MANAGEMENT
SKILLS OF HEALTH CARE STAFF
To reduce morbidity and mortality in
children below 5 years old
Promote prevention and cure of diseases
IMCI is cost effective
16. Utilizing the IMCI case management process,
severe pneumonia is under this classification: PINK
17. IMCI is focused only on the management of
common childhood illnesses in the hospital setting
– FALSE
18. The nurse assesses the client for chest
indrawing. Chest indrawing is present if: - THE
LOWEST CHEST WALL GOES IN WHEN THE CHILD
BREATHES IN
19. It refers to an intestinal inflammation which is
manifested by severe stomach cramps and
diarrhea with mucus or blood: - DYSENTERY
20. Utilizing the IMCI case management process,
the first step is to assess the child by checking for
danger signs and nutrition and immunization
status – TRUE
breastfeeding
and
25. For a child with diarrhea, restlessness and
irritability are signs of dehydration – TRUE
26. Using an integrated approach, IMCI protocol
guides health workers on assessing signs that may
indicate severe diseases – TRUE
27. A child who manifests cough and colds for an
extended period of time, with fast breathing and
chest indrawing will be classified under – VERY
SEVERE PNEUMONIA
Community Health Nursing RLE Finals
percussion (clapping), vibration, deep breathing,
and huffing or coughing.
RLE 1F: Interventions of Common
Signs and Symptoms
Expectorant – are medications or natural
ingredients that help clear mucus from the airways.
People may take them to help alleviate congestion
due to the common cold or flu.
Definition of Terms
Intervention - A treatment, procedure, or other
action taken to prevent or treat disease, or improve
health in other ways. The nurse uses his or her
knowledge, experience, and critical thinking skills to
decide which intervention is the most beneficial for
the patient.
Sign - Any objective evidence of a disease. It is a
phenomenon that can be detected by someone
other than the individual affected by the disease.
Symptom - Any subjective evidence of disease
which cannot be observed by someone. In contrast,
a sign is objective.
Syndrome – A set of symptoms or conditions that
occur together and suggest the presence of a certain
disease or an increased chance of developing the
disease.
Fever - A temporary increase in your body
temperature, often due to an illness. Having a fever
is a sign that something out of the ordinary is going
on in your body.
Tepid Sponge Bath – a general application of moist
cold liquid to cool skin, by evaporation and by the
absorption of body heat in the cold water. The
temperature of water used for tepid sponge is 80-90
degree F.
Cough - a common reflex action that clears your
throat of mucus or foreign irritants.
Chest tapping - Treatments designed to improve
respiratory efficiency, promote expansion of the
lungs, strengthen respiratory muscles, and eliminate
secretions from the respiratory system.
Chest Vibration – involves placing the hands on the
patient's chest wall and applying an oscillatory action
in the direction of the normal movement of the ribs
during expiration, using the physiotherapist's body
weight.
Chest Physiotherapy (CPT) - Chest physical
therapy (CPT or Chest PT) is an airway clearance
technique (ACT) to drain the lungs, and may include
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Diarrhea – an increase in the frequency of bowel
movements or a decrease in the consistency of
stools that causes the discharge of watery, loose
stools.
Dehydration – a condition caused by the loss of too
much fluid from the body. It happens when you are
losing more fluids than you are taking in, and your
body does not have enough fluids to work properly.
Rehydration - The process of restoring lost water
(dehydration) to the body tissues and fluids.
Oral rehydration solution - (ORS) are used to treat
dehydration caused by diarrhea, a common illness
in travelers.
Oral rehydration therapy - (ORT) is a treatment for
dehydration. It involves drinking a special mixture of
water, glucose and salts to return the amount of
fluids, sugars and electrolytes in the body to normal
levels.
Importance of the following:
Importance of Tepid Sponge Bath
● It helps control body temperature when fever
may be deleterious.
● It produces a more rapid reduction in body
temperature.
● It alleviates pain, promotes cleanliness,
maintains hygiene and provides comfort.
● It reduces congestion, inflammation or swelling.
● It relieves muscle spasm.
● Stimulates the circulation and relaxes the client.
Importance of Chest Physiotherapy
● It prevents pneumonia and keeps the airway
clear.
● It helps patients breathe more freely and to get
more oxygen into the body.
● It helps the patient drain secretions from specific
segments of the bronchi and lungs
into the trachea so he or she is able to cough and
expel them.
● Helps treat such diseases as cystic fibrosis and
COPD (chronic obstructive pulmonary
disease).
period and does not fluctuate
more than 1° Celsius in 24
hours.
Importance of Oral Rehydration Therapy:
● Promotes fluid and electrolyte absorption
● Reduces diarrheal symptoms
● Reduce vomiting
● Minimizes the need for expensive emergency IV
therapy
● Empowers parents with the first line of treatment
for children suffering from diarrhea
Occurs in lobar pneumonia,
typhoid,
urinary
tract
infection, infective
endocarditis, brucellosis and
typhus.
Temperature Conversion:
Types of Fever
Intermittent
Remittent
Relapsing
Constant
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Intermittent fever is a type or
pattern of fever in which there is
an interval where temperature is
elevated for several hours
followed by an interval when
temperature drops back to
normal. This type of fever
usually occurs during an
infectious disease.
In a 24 hour period the
temperature is only present for
some hours of the day and the
rest of the time is normal. The
spike can occur at the same
time each day, every other day
or every few days but is
normally in a repetitive pattern.
Examples of some diseases
which have intermittent fever
are malaria, pyemia and
septicaemia.
May come and go, and
temperature fluctuates, but
though it falls, it never falls all
the way back to normal.
The temperature remains above
normal throughout the day and
fluctuates more than 2° Celsius
in 24 hours. This type is seen in
patients with typhoid fever and
infective endocarditis.
This is a type of intermittent
fever that spikes up again after
days or weeks of normal
temperatures. This type of fever
is common with animal bites
and diseases like malaria.
Also called a “sustained” or
“continuous” fever, this is a
prolonged fever with little or no
change in temperature over the
course of a day. Where the
temperature remains above
normal throughout a 24-hour
Types of Cough
Productive
•
NonProductive
•
Produces phlegm or mucus
(sputum)
Dry and does not produce sputum.
A dry, hacking cough may develop
toward the end of a cold or after
exposure to an irritant, such as
dust or smoke.
Types of Diarrhea
Acute
•
•
•
Chronic
•
•
Abrupt onset of 3 or more loose stools
per day and lasts no longer than 14
days.
Most cases of acute, watery diarrhea
are caused by viruses (viral
gastroenteritis). The most common
ones in children are rotavirus and in
adults are norovirus (this is
sometimes called “cruise ship
diarrhea” due to well publicized
epidemics).
Bacteria are a common cause of
traveler’s diarrhea.
Chronic or persistent diarrhea is
defined as an episode that lasts
longer than 14 days. Chronic diarrhea
is classified as fatty or malabsorption,
inflammatory or most commonly
watery.
Chronic bloody diarrhea may be due
to inflammatory bowel disease (IBD),
which is ulcerative colitis or Crohn's
disease.
Associated Signs and Symptoms
Fever
•
•
Cough
Diarrhea
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Body
aches
and
associated
headaches
Elevated
temperature
(above
37.5°C)
Sweating
Chills and shivering
Loss of appetite
General weakness or Fatigue
Irritability
Dehydration
Flushed complexion or hot skin
Runny or stuffy nose
Postnasal drip
Sore throat
Sinus pressure
Wheezing or shortness of breath
Hoarseness
Bad/sour taste in the mouth
Phlegm
Heartburn
Loose, watery stools
Fever
Abdominal cramps
Dehydration
Nausea
Bloating
Frequent urge to defecate
Body ache
Stomach pain
•
Time
Energy
and •
Psychology
•
•
•
Sociology
•
Scientific Principles in Chest Physiotherapy
Anatomy and • Understand the structure of the
body and its systems in relation
Physiology
•
•
Scientific Principles
Scientific Principles in Tepid Sponge Bath
Anatomy and • Understand the structure of the
body and its systems in relation
Physiology
•
•
Physics
•
•
•
Microbiology
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•
to which locations of the body
the tepid sponge bath can be
applied.
Determine how our bodies
react to fever.
Determine how our bodies
react to the procedures of tepid
sponge bath.
Knowledge of thermodynamics
and how temperature affects
fever in relation to the
application
of
cooling
techniques.
Knowledge of thermodynamics
and how temperature affects
dehydration.
Obtain information on how
friction is applied in the tepid
sponge bath procedure.
Ensure that all tools are
supplies and equipment are
cleaned
prior
and
after
procedure to prevent risk of
contamination
Identify what causes fever such
as
substances
or
microorganisms.
Prepare all supplies and
equipment before performing
procedures to make the
process flow more efficiently.
Provide information
about
procedure and answer any
questions the client may bring
forward.
Ask for permission prior to
establishing physical contact
with the patient.
Establish rapport with patient
prior to procedure to make the
process more efficient.
Explain the significance of the
procedure to patient to further
establish rapport.
Microbiology
•
•
Time
Energy
and •
Psychology
•
•
Sociology
•
to which locations of the body
the oral rehydration therapy
can be applied.
Determine how our bodies
react to dehydration.
Determine how our bodies
react to the procedures of ORT.
Ensure that all tools are
supplies and equipment are
cleaned
prior
and
after
procedure to prevent risk of
contamination
Identify causes of diarrhea in
terms of microbiology such as
infection
by
bacteria,
organisms,
or
pre-formed
toxins.
Prepare all supplies and
equipment before performing
procedures to make the
process flow more efficiently.
Provide information
about
procedure and answer any
questions the client may bring
forward.
Ask for permission prior to
establishing physical contact
with the patient.
Establish rapport with patient
prior to procedure to make the
process more efficient.
•
•
•
•
•
•
Explain the significance of the
procedure to patient to further
establish rapport.
Scientific Principles in Oral Rehydration
Therapy
Anatomy and Physiology
Microbiology
Time and Energy
Psychology
Sociology
Guidelines in:
Tepid Sponge Bath
Guideline
Rationale
1. Observe patient for
elevated
temperature. Review
physician’s
orders.
Recall normal range
of temperature.
2.
Explain
the
procedure to patient.
3.
Prepare
equipment
the
4. Provide privacy;
wash hands. Cover
patient with blanket,
remove gown,
and close windows
and doors.
5. Test the water
temperature. Place
washcloths in water
and then apply
wet cloths to each
axilla and groin.
6. Gently sponge an
extremity for about
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A rise in temperature can be
an indication that TSB is
needed. The nurse can also
gain critical information about
what medical care the nurse is
authorized to perform with the
patient.
Normal body temperature:
Between 97 F (36.1 C) and 99
F (37.2 C) or more.
Fever temperature:
● Rectal, ear or temporal
artery
temperature of 100.4 (38 C) or
higher
● Oral temperature of 100 F
(37.8 C) or higher
● Axillary temperature of 99 F
(37.2 C) or higher
Explaining the procedure
helps establish
rapport with the patient and
ensures.
Preparing
the
needed
equipment makes the process
of TSB more efficient.
Providing
privacy
further
establishes rapport with the
patient and lessens patient’s
anxiety about the procedure.
Performing
handwashing
prevents
contamination
between nurse and patient.
Test the water to make sure it
is not too warm nor too cold for
the patient. The cloths must
then be soaked and applied to
the arterial points to aid in
bringing temperature down.
Apply gentle pressure when
sponging extremities. The
sponge will help in the
5 minutes. If the
patient is in tub,
gently sponge water
over his upper
torso, chest, and
back.
7. Continue sponge
bath to other
extremities,
back,
and buttocks for 3
to 5 minutes each.
Determine
temperature every 15
minutes.
8. Change water;
reapply freshly
moistened
washcloths to axilla
and
groin
as
necessary.
9. Continue with
sponge bath until
body
temperature
falls
slightly above
normal. Discontinue
procedure
according to SOP.
10.Dry
patient
thoroughly, and cover
with light blanket or
sheet.
11. Return equipment
to storage, clean
area, and change bed
linens as necessary.
Wash hands.
12.
Record
time
procedure
was
started, when ended,
vital
signs,
and
patient’s response.
application of water to the
patient's skin surface to
promote dispersal of body heat
Sponging must be continued
towards other body parts to
equally promote cooling. The
patient’s temperature must be
checked to determine if TSB
needs to be reapplied.
New water must be used to
lessen risk of contamination.
The cloths used must be
moistened again and applied
to the arterial points to
promote cooling.
TSB can be continued until the
goal of dropping the patient’s
temperature is achieved.
The patient must be dried with
a towel and covered to avoid
chills.
Performing aftercare will make
the procedure more efficient
the next time it is performed.
Medical handwashing also
lessens risk of contamination.
Record findings in order to
help
support
future
correctness
of
patient’s
treatment.
Chest Physiotherapy
Guideline
Rationale
1. Recall normal lung
sounds and
respiratory rate
Normal Lung Sounds
Low Pitch
● Vesicular: 100-1 kHz;
energy drop at 200 Hz
●
Bronchovesicular:
Intermediate
between
bronchial
and
vesicular
breathing
High Pitch
● Tracheal: 100-5 kHz;
energy drop at 800 Hz
● Bronchial: 00-5 kHz; energy
drop at 800 Hz
2. Assess the chest xray for pulmonary
findings
3. Assess respiratory
rate of patient
4. Assess breathing,
rhythm, skin color,
BP, HR of patient.
Assess patient’s
ability to take deep
breath
5. Perform chest
physiotherapy
6. Monitor the ff.
throughout the
therapy:
a. reaction
b. discomfort and
dyspnea
c. heart rate and
rhythm
d. respiratory rate
e. sputum production,
breathe
sound
f. skin color
g. mental status
h. oxygen saturation
i. blood pressure
8.
Modify
the
techniques of CPT
according to patient
tolerance
Mouth: 200-2kHz
Normal Respiratory Rate:
12-16 bpm
Assessing the chest x-ray is
essential since it can also fluid,
such as mucus, in or around
the lungs.
Assessing the respiratory rate
is essential since it is a
fundamental vital sign that is
sensitive
to
different
pathological conditions and
stressors.
Assessing vital signs and
conducting
a
physical
examination of the chest helps
in finding indications for using
CPT.
Perform the techniques in
chest physiotherapy
● Percussion - rhythmically
clapping on chest wall to force
secretions into larger airways.
● Vibration - gentle pressure
applied to chest wall to force
secretions into larger airways
● Postural drainage –
different
positions
are
assumed to facilitate drainage
of
secretions
from
the
bronchial airways
These indicators can help the
performer determine what
modifications they can do to
the CPT. The new findings that
are recorded after the therapy
should then be compared to
the baseline data to document
the treatment process.
Oral Rehydration Therapy
ORS is administered in frequent, small amounts of fluid
by spoon or syringe. A nasogastric tube can be used in
the child who refuses to drink. Nasogastric (NG)
feeding allows continuous administration of ORS at a
slow, steady rate for patients with p ersistent vomiting.
For those with vomiting, the majority can be rehydrated
successfully with oral fluids if limited volumes of ORS
(5 mL) are administered every 5 minutes, with a
gradual increase in the amount consumed
Mild
to Rehydration phase: The dose is 50100 ml/kg over 3-4 hours.
moderate
dehydration During both phases, ongoing losses
from diarrhea and vomiting are
replaced with ORS. If the losses can
be measured accurately, 1 mL of ORS
should be administered for each gram
of diarrheal stool. Alternatively, 10
mL/kg of body weight of ORS should
be administered for each watery or
loose stool, and 2 mL/kg of body
weight for each episode of emesis.
Severe dehydration is a medical
Severe
dehydration emergency and requires emergent IV
therapy with rapid infusion of 20 mL/kg
of isotonic saline. As the patient's
condition improves, therapy can be
later changed to ORT.
Nursing Interventions
Fever
Interventions
Rationale
Adjust and monitor
environmental
factors like room
temperature
and
bed
linens as indicated.
Eliminate
excess
clothing and covers.
Room temperature may be
accustomed to near normal
body temperature and blankets
and linens may be adjusted as
indicated
to
regulate
temperature of the patient.
Exposing skin to room air
decreases
warmth
and
increases evaporative cooling.
Antipyretic medications lower
body temperature by blocking
the synthesis of prostaglandins
that act in the hypothalamus.
Shivering
increases
the
metabolic rate and body
temperature.
Give
antipyretic
medications as
prescribed.
The techniques must be varied
according to what the patient
can take, such as if there are
contraindications present in
the patient, the force used in
percussion and vibration, or
what positions are used in
postural drainage, or if
postural drainage is to be
performed at all.
Provide
chlorpromazine
(Thorazine)
and
diazepam (Valium)
when
excessive
shivering occurs.
Provide
cooling
mechanisms such
as cooling mattress,
cold packs or a
tepid bath
Providing cooling mechanisms
will help promote cooling and
lower core temperature.
Cough
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Interventions
Rationale
Encourage the patient to
drink lots of water and
other fluids.
Educate
patient
on
effective
coughing
techniques.
Instruct the patient to
assume a sitting position
and bend slightly forward.
Allow the patient to flex the
knees and hips.
This helps thin the mucus
and soothes a dry or sore
throat.
Controlled
coughing
techniques help mobilize
secretions.
Upright position permits a
stronger cough and better
lung expansion.
This is to promote
relaxation and reduce the
strain on the abdominal
muscles while coughing.
Deep breaths expand
lungs fully so air moves
behind
mucus
and
facilitates
effects
of
coughing.
Consecutive coughs help
remove mucus more
effectively and completely
than one forceful cough.
Demonstrate
coughing.
Instruct the patient to take
two slow, deep breaths,
inhaling through nose and
exhaling through mouth.
Instruct and show how to
inhale deeply a third time
and hold breath to count of
three. Cough fully for two
or
three
consecutive
coughs without inhaling
between coughs.
Perform
chest
physiotherapy.
Lined tray containing the following:
- Basin half filled with tepid water (37 C)
- 1 bath towel
- 1 wash cloth
- Camisa or gown
- Bath blanket or top sheet
- Bath thermometer
- Receptacle for used water
- Bath blanket (ready if patients have chills)
Procedure:
1. Assess the condition of the patient (check temperature
if febrile).
2. Explain the procedure to the patient and/or the
significant others.
3. Bring all prepared materials and set them on the
bedside table.
4. Provide screens for privacy (if patient is in the ward).
5. Wash hands thoroughly before starting procedure.
Thick secretions that are
difficult to cough up may
be loosened by chest
tapping and vibration.
6. Adjust the patient’s bed on a certain height that is
accessible for working.
7. Loosen top sheet.
8. Draw patient to side nearer you.
9. Remove patient’s gown or pajama.
Diarrhea
Interventions
Rationale
Encourage the patient to
take at least 1500ml to
2000ml of fluid plus
200ml for each loose
stool.
Discuss the importance
of fluid replacement
during
diarrheal
episodes
Instruct the patient to
avoid stimulant products
like
caffeine
and
carbonated beverages.
Provide perineal care
after
each
bowel
movement
Provide
antidiarrheal
drugs as ordered.
Increasing fluid intake will
replenish the fluid deficit in
the body and prevent
dehydration.
Discussing the importance
of fluid replacement will
promote cooperation from
patient
These products increase
gastric mucosal motility.
Providing gentle cleansing
protects the perianal skin
and prevents injury.
Providing
antidiarrheal
drugs
decreases
gastrointestinal motility.
Tepid Sponge Bath Preparation
•
It is administered by increasing heat loss through
conduction
Materials:
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10.Remove pillows, leave one under patient’s head (if he
feels uncomfortable).
11.Place on bath towel under patient’s head and neck.
12.Wet wash cloth. Wrap it around your palm to make a
mitten. With patting motion, wash around the eyes, nose,
mouth, cheeks, forehead and neck. Rinse wash cloth.
Repeat three times. Dry thoroughly.
13.Expose farther arm. Place bath towel lengthwise under
it. With washcloth, sponge from wrist to shoulder and
axilla using patting motion. Rinse wash cloth. Repeat
three times. Dry thoroughly.
14.Expose other arm. Follow same procedure.
15.Place towel on chest and abdomen. Fanfold top sheet
down to the pubis. Do the same bathing technique from
chest, abdomen, sides and pubis. Rinse washcloth.
Repeat three times. Dry thoroughly. Change water if
necessary.
16.Assist patient in turning towards the nurse. See to it
that the patient will not fall. Place the towel lengthwise
under the patients back down to the buttocks and remove
the top sheet covering these areas. Use patting motion to
wash back and buttocks thoroughly. Rinse wash cloth.
Repeat three times. Dry thoroughly with towel. Turn on his
back. Change water.
10.Explain to the patient to utilize coughing techniques.
Provide and emesis basin and tissue paper.
17. Expose farther leg. Place towel under it. Use patting
motion and dry thoroughly. Pay attention particularly to
the inguinal area. Rinse wash cloth. Repeat three times.
Dry thoroughly.
11.Do auscultation.
12.Document the reaction of the patient and the
characteristics of the secretion.
18.Repeat procedure number 17 with the other leg.
•
19.Check the patient’s temperature (this may be done
every 15 minutes during the procedure or 30 minutes after
the procedure).
Materials needed for Chest Vibration:
20.Apply deodorant. Put on patient’s camisa or gown.
Remake the bed.
Lined tray containing: Tissue paper, Clean gloves,
Stethoscope, Kidney basin/ Emesis basin
21.Tidy the ward. Adjust windows and blinds.
Procedure:
22. Do recording. Document the procedure done, along
with the patient’s vital signs, response to treatment and
complications, if any.
Chest Tapping and Vibration Preparation
•
Chest Vibration a technique of applying manual
compression and tremor on the client’s chest wall to
help loosen respiratory secretions.
1. Secure doctor’s order.
2. Explain the procedure to the client.
3. Do medical hand washing.
4. Do auscultation.
Chest Percussion is the forceful striking of the skin
with cupped hands over congested lung areas to
mechanically loosen tenacious pulmonary secretions
from the bronchial walls facilitating expectoration with
greater ease.
Materials needed for Chest Percussion:
Lined tray containing: Tissue paper, Towel, Kidney basin/
Emesis basin, Clean gloves, Stethoscope
5. After chest percussion, hold the hands flat on patient’s
chest wall (one hand over the other with the fingers
together and extended).
6. Ask the client the patient to inhale deeply and exhale
slowly through the nose/pursed lips.
7. During exhalation, do a vibrating motion with your
hands moving them downward. Stop the vibrating when
the patient inhales.
Procedure:
1. Secure doctor’s order.
2. Explain the procedure to the patient.
3. Do medical hand washing.
4. Auscultate the lung segments.
5. Position patient in lateral, supine or prone position
based on the lung segment to be drained.
6. Cover the area with a towel or gown.
7. Percuss or clap (with the fingers and thumb held
together and flexed slightly to form a cup-as one would
scoop up water) each area of the lung segment for 1-2
minutes. Alternately flex and extend the wrists rapidly
over the chest.
8. Never do percussion on bare skin or perform over
surgical incisions, breasts, lower ribcage, sternum, spinal
column, and kidneys.
9. If the patient has tenacious secretions, percuss area for
up to 3-5 minutes several times per day.
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8. Vibrate during five exhalations over on affected lung
segment. Do this for several minutes, several times each
day.
9. Never do vibrations on patient’s surgical incisions,
breasts, sternum, spinal column and kidneys.
10.Explain to the patient to utilize coughing techniques.
Provide and emesis basin and tissue paper.
11.Do auscultation.
12.Document the reaction of the patient and the
characteristics of the secretion.
Oral Rehydration Therapy Preparation
•
Oral Rehydration Therapy is a simple, cost-effective
treatment given at home using either packets of Oral
Rehydration Salts (ORS) or a simple home-made
solution.
Materials needed for Oral Rehydration Therapy:
- Sugar
- Boiled water
- Salt (ground)
- 1 Liter container
- 1 glass (240 mL container)
Procedure:
1. Do medical hand washing.
2. Measure the correct proportion of boiled water, and salt
and
sugar.
2.1 1 glass mixture:
- 1 teaspoon sugar
- a pinch of salt
- 240 mL of boiled water
2.2 1 Liter mixture:
- 8 teaspoon sugar
- 1 teaspoon salt
- 1000 mL/ 1 liter of boiled water
3. Prepare the solution in a clean container.
4. Stir the mixture until all the solutes dissolve.
5. Do medical handwashing before administering the
solution. Instruct patient to do handwashing as well.
6. Give the client as much solution as needed in small
amounts.
7. If the client vomits, wait for 10 minutes and give ORS
again.
8. If the client needs an Oral Rehydration Solution after
24 hours, make a fresh solution. Discard leftovers.
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RLE 2F: First Aid
Definition of Terms
Accidents - an undesirable or unfortunate
happening that occurs unintentionally and usually
results in harm, injury, damage, or loss; casualty;
mishap
Injuries - It is when there is damage to the body. It
is a general term that refers to harm caused by
accidents, falls, hits, weapons, and more.
Bandaging - Covering a break in the skin helps to
control bleeding and protect against infection.
Dressings are pads of gauze or cloth that can be
placed directly against the wound to absorb blood
and other fluids. Cloth bandages cover dressings
and hold them in place.
Joints - It is also known as an articulation, the part
of the body where two or more bones meet to allow
movement and shape depending on its function.
Every bone in the body except for the hyoid bone in
the throat meets up with at least one other bone at a
joint.
Bites - It is a painful wound caused by the thrust of
an insect's stinger into skin.
Poisoning - a substance that through its chemical
action usually kills, injures, or impairs an organism.
Burns - It is damage to the skin or other body parts
caused by extreme heat, flame, contact with heated
objects, or chemicals.
Seizure - a burst of uncontrolled electrical activity
between brain cells (also called neurons or nerve
cells) that causes temporary abnormalities in muscle
tone or movements (stiffness, twitching or limpness),
behaviors, sensations or states of awareness.
Dislocation - displacement of one or more bones at
a joint.
Splinting - is often used to stabilize a broken bone
while the injured person is taken to the hospital for
more advanced treatment.
Fainting - It is a sudden and temporary loss of
consciousness. This usually occurs due to a lack of
oxygen reaching the brain.
Sprain - a sudden or violent twist or wrench of a joint
with stretching or tearing of ligaments.
First aid - emergency care or treatment given to an
ill or injured person before regular medical aid can
be obtained
Strain - An injury to a tendon or muscle (stretch or
tear) resulting from overuse or trauma.
Frostbite - the superficial or deep freezing of the
tissues of some part of the body (such as the feet or
hands).
Tourniquet - a device (such as a band of rubber)
that checks bleeding or blood flow by compressing
blood vessels.
Hematoma - a mass of usually clotted blood that
forms in a tissue, organ, or body space as a result of
a broken blood vessel.
Trauma - an injury (such as a wound) to living tissue
caused by an extrinsic agent.
Hemorrhage - a copious or heavy discharge of
blood from the blood vessels.
Wound care - involves every stage of wound
management. This includes diagnosing wound type,
considering factors that affect wound healing, and
the proper treatments for wound management.
Infarction - injury or death of tissue (as of the heart
or lungs) resulting from inadequate blood supply
especially as a result of obstruction of the local
circulation by a thrombus or embolus.
Importance of First Aid
Shock - It is a life-threatening condition that occurs
when the body is not getting enough blood flow. Lack
of blood flow means the cells and organs do not get
enough oxygen and nutrients to function properly.
Importance of First Aid
It can help save a person’s life
Emergency care - an essential part of the health
system and serves as the first point of contact for
many around the world.
It encourages healthy and safe living
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•
•
A person cannot just wait long enough for a
professional to help them. If there is someone who
knows first aid, they can help the person in need.
One’s knowledge about first aid helps promote
health and safety for everyone. Having an
awareness and desire to be accident free keeps
you more safe and reduces the number of
casualties and accidents.
It relieves pain
•
Someone who knows first aid could help the person
in need cope up with the pain. That can include
giving the person pain medication from a first aid
kit, preparing an instant-activating cold pack,
pouring cold water over a burn, and so on.
It reduces recovery time
•
As an example, if someone is bleeding from a
wound and no one can stop it before emergency
services show up, the person will have more
substantial blood loss, lowered blood pressure,
and the beginnings of organ failure. Knowing how
to stop the bleeding and dress the wound makes
recovery easier and faster.
Prevent
deterioration
It creates the confidence to care
• By taking first aid training, it helps you to reflect on
yourself and how you and others react in certain
situations. Having this understanding will boost
your confidence in a wide range of non-medical day
to day situations.
Promote
recovery
Aims of First Aid
Preserve Life
➔ Someone who knows first aid should check for vital
life signs, to see if an injury is life-threatening. Signs to
check for include evidence of movement, breathing,
responsiveness, heart rate, and identifying any
particularly bad external injuries.
Prevent Injuries from getting worse
➔ Risk factors are anything that can make an injury
worse for the patient. A first aider should never move
the patient if they are bleeding or are having a fracture.
Relieve Pain
➔ A first aider must always keep the patient
comfortable and so the procedure must also reduce
suffering at all costs.
Aid Recovery
➔ Aiding recovery involves wound bandages and
putting pressure on a bleed. This is the practice of
helping a person heal their wounds, in the short and
long term. In addition, advise the person of what to do
when they go home, like change bandages daily to
avoid infection.
Protect the Unconscious
➔ Unconscious people are known to be more
vulnerable which is why they need extra protection.
Identifying and clearing any hazards away from the
victim or person is a good start. This is done to avoid
more harm to the unconscious person and avoid any
harm to the first aider.
Roles of a First Aider
Main
responsibility
Preserve life
bystander/first
providing first aid
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of
responder
a
by
•
•
•
•
•
treatments. First responders should
start the CAB procedure of first aid.
Circulation: assessing quality of
circulation, Airway: ensure that the
victim has airway, and breathing:
ensure that the person is breathing.
The
performance
of
cardiopulmonary
resuscitation
(SPR) is required to rescue
breathing is done until medical
professionals arrive
Patient must be stable and their
condition must not worsen before
medical
professionals
arrive.
Responsibilities for first responders
are
placing
casualty
in
a
comfortable and safe position,
providing comfort to causality,
preventing further injury and
applying first aid techniques.
Following first aid treatment, first
responders should encourage
confidence in the patient, attempt to
relieve pain, and take steps that
may help in the recovery process.
Characteristics of a First Aider
Communicative
Attentive
Calm
Resourceful
Quick
Principles in First Aid
Anatomy and Physiology
•
•
A first aider should have some understanding of the
underlying anatomy and physiological processes of
the human body so we can best understand how
certain conditions may present and how our
treatment may help victims.
Knowledge on this principle will help emphasize
the need on the part that needs to be prioritized first
and identify the anatomy of the person in need to
be identified
Body Mechanics
•
Applying proper body mechanics prevents
straining on the first aider and prevents adding
injury and harm to patients and healthcare workers.
A broad stance to increase stability
•
Microbiology
•
•
Follow standard precautions to reduce the risk of
transmission of bloodborne and other pathogens
from both recognized and unrecognized sources.
Perform hand hygiene with soap and water, the use
of personal protective equipment, and respiratory
hygiene / cough etiquette
Sociology
•
•
Establish rapport to understand your patient’s
feelings and communicate well with them.
Good Samaritan Law - protect first aiders who act
in the same way another similarly trained,
reasonable and prudent person would in the same
situation. Use your common sense and stay within
what you were trained to do, and you cannot be
held responsible for the injuries suffered by the
injured person.
Psychology
•
•
•
A first aider requires the consent of the client to
provide first aid to them. If the client refuses help
but is seriously unwell or injured, it is best to call
000 and get assistance while continuing to
reassure and monitor the casualty until help
arrives.
Comfort the client who is in distress and help them
feel safe and calm.
Provide emotional support and provide immediate
basic needs, such as food and water, a blanket for
temporary place to stay.
Time and Energy
• Golden Hour - the first 60 minutes following any
•
injury or trauma. Prompt medical attention during
this period can save one’s life. This period is very
critical as the chances of survival depend on this
window period.
Proper techniques of first aid should be observed
and practiced well for more effective procedure;
having the materials ready and organized for a
smooth procedure.
Safety and Security
•
•
•
•
Assessing the situation is needed before doing first
aid. Check whether you or the casualty are in any
danger, and is it safe to approach them.
Always protect yourself first - never put yourself at
risk
Assess the risk to yourself and bystanders. Only
move them if leaving them would cause them more
harm.
If there’s more than one casualty make sure you
help those with life-threatening conditions first.
Pharmacology / Chemistry
•
•
•
A first aider should have a solid understanding of
pharmacology and have more confidence when
dealing with people and avoid potentially fatal drug
interactions.
Betadine Wound Solution - minor wounds, cuts,
abrasions, burns and postoperative wounds.
Hydrogen peroxide - using hydrogen peroxide or
rubbing alcohol to clean an injury can actually harm
the tissue and delay healing. Effervescent
cleansing action helps to lift debris from the wound
surface when used at full strength. If used full
strength, irrigation with normal saline after use is
recommended
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Nursing Interventions for Some Medical
Emergencies
Epistaxis
● Sit upright and lean forward. By remaining upright,
you reduce blood pressure in the veins
of your nose. This discourages further bleeding. Sitting
forward will help you avoid swallowing
blood, which can irritate your stomach.
● Pinch your nose. Use your thumb and index finger
to pinch your nostrils shut. Breathe through your mouth.
Continue to pinch for 10 to 15 minutes. Pinching sends
pressure to the bleeding point on the nasal septum and
often stops the flow of blood.
● Apply ice compress to the nose.
● If the bleeding continues after 10 to 15 minutes,
repeat holding pressure for another 10 to 15 minutes.
Avoid peeking at your nose. If the bleeding still
continues, seek emergency care.
● To prevent re-bleeding, don't pick or blow your nose
and don't bend down for several hours after the
bleeding episode. During this time remember to keep
your head higher than the level of your heart. You can
also gently apply some petroleum jelly to the inside of
your nose using a cotton swab or your finger.
● If bleeding persists, assist in preparing the epistaxis
tray and a headlamp. Make sure lighting
is adequate. Once the bleeding site is identified, the
definitive treatment is cautery (silver nitrate or
electrical). If cautery is unsuccessful, nasal packing will
be used to apply direct pressure to the bleeding site.
During the procedure, reassure the patient, monitor
vital signs, and assess for hypoxia.
● After bleeding is controlled, reassess the patient and
provide oral care. Keep the patient's mouth moist while
the packing is in place.
● If packing is used, especially posterior packing,
monitor for respiratory compromise. Tell the patient to
report signs and symptoms of infection and teach her
about any prescribed antibiotics. If she has posterior
packing, she'll be admitted to the hospital. A patient
with anterior packing will follow up with an ear, nose,
and throat specialist as an outpatient.
● The nasal packing will be left in place for 3 to 5
days. Instruct the patient to avoid exerting herself,
forcefully blowing her nose, or bending over. She
should also avoid NSAIDs, alcoholic beverages, and
smoking for 5 to 7 days. Tell her to apply water-soluble
ointment to her lips and nostrils while packing is in
place and to use a cool-mist room humidifier. Advise
her to take steps to prevent constipation and straining,
which increases the risk of bleeding.
● Nasal packing composition: It is a compressed,
dehydrated sponge composed of hydroxylated
polyvinyl acetate that can increase in size within the
nasal cavity and compress a bleeding vessel through
rehydration with normal saline
● Don't leave the patient unattended during
epistaxis.
Animal Bites (Snakes, dogs, or any rabid
animal)
● To treat a minor bite, first wash your hands thoroughly
with soap to avoid infection. Wash hands afterwards as
well. If the bite is not bleeding severely, wash the
wound thoroughly with mild soap and running water for
3 to 5 minutes. Then cover the bite with antibiotic
ointment and a clean dressing.
● If the bite is actively bleeding, apply direct pressure
with a clean, dry cloth until the bleeding subsides.
Elevate the area of the bite. If the bite is on the neck,
head, face, hand, or fingers, call your doctor right away.
Over the next 24 to 48 hours, observe the bite for signs
of infection (increasing skin redness, swelling, and
pain). If the bite becomes infected, call the doctor or
take the person to an emergency facility.
Wounds
Open Wounds
● Stop the bleeding: Using a clean cloth or bandage,
gently apply pressure to the wound to promote blood
clotting
● Clean the wound: Use clean water and a saline
solution to flush away any debris or bacteria. Once the
wound looks clean, pat it dry with a clean cloth. A doctor
may need to perform a surgical debridement to remove
debris from severe wounds that contain dead tissue,
glass, bullets, or other foreign objects.
Treat the wound with antibiotics: After cleaning the
wound, apply a thin layer of antibiotic ointment to
prevent infection.
● Close and dress the wound: Closing clean wounds
helps promote faster healing. Waterproof bandages
and gauze work well for minor wounds. Deep open
wounds may require stitches or staples. However,
leave an already infected wound open until the infection
clears.
● Routinely change the dressing: The Centers for
Disease Control and Prevention (CDC) recommend
removing the old bandages and checking for signs of
infection every 24 hours. Disinfect and dry the wound
before reapplying a clean adhesive bandage or gauze.
Remember to keep the wound dry while it heals.
Closed Wounds
● Rest. Rest and protect the injured or sore area. Stop,
change, or take a break from any activity that may be
causing your pain or soreness.
● Ice. Cold will reduce pain and swelling. Apply an ice
or cold pack right away to prevent or minimize swelling.
Apply the ice or cold pack for 10 to 20 minutes, 3 or
more times a day. After 48 to 72 hours, if swelling is
gone, apply heat to the area that hurts. Do not apply ice
or heat directly to the skin. Place a towel over the cold
or heat pack before applying it to the skin.
● Compression. Compression, or wrapping the injured
or sore area with an elastic bandage (such as an Ace
wrap), will help decrease swelling. Don't wrap it too
tightly, because this can cause more swelling below the
affected area. Loosen the bandage if it gets too tight.
Signs that the bandage is too tight include numbness,
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tingling, increased pain, coolness, or swelling in the
area below the bandage. Talk to your doctor if you think
you need to use a wrap for longer than 48 to 72 hours;
a more serious problem may be present.
● Elevation. Elevate the injured or sore area on pillows
while applying ice and anytime you are sitting or lying
down. Try to keep the area at or above the level of your
heart to help minimize swelling.
Burns
● Assess skin for location, type, and degree of
burn. Knowing what type of burn and the degree will
provide information on how to treat the burn
First degree burn:
● Apply cool, wet compresses, or immerse in cool,
fresh water. Continue until pain subsides.
● Cover the burn with a sterile, non- adhesive bandage
or clean cloth.
● Do not apply ointments or butter to burn; these may
cause infection.
● Over-the-counter pain medications may be used to
help relieve pain and reduce inflammation.
● First-degree burns usually heal without further
treatment. However, if a first-degree burn covers a
large area of the body, or the victim is an infant or
elderly, seek emergency medical attention.
Second degree burn:
● Immerse in fresh, cool water, or apply cool
compresses. Continue for 10 to 15 minutes.
● Dry with clean cloth and cover with sterile gauze.
● Do not break blisters.
● Do not apply ointments or butter to burns; these may
cause infection.
● Elevate burned arms or legs.
● Take steps to prevent shock: lay the victim flat;
elevate the feet about 12 inches; and cover the victim
with a coat or blanket. Do not place the victim in the
shock position if a head, neck, back, or leg injury is
suspected, or if it makes the victim uncomfortable.
● Further medical treatment is required.
● Do not attempt to treat serious burns unless you are
a trained health professional.
Third degree burn:
● Cover burn lightly with sterile gauze or clean cloth.
(Do not use material that can leave lint on the burn.)
● Do not apply ointments or butter to burns; these may
cause infection.
● Take steps to prevent shock: lay the victim flat;
elevate the feet about 12 inches.
● Have person sit up if face is burned. Watch closely
for possible breathing problems.
● Elevate burned area higher than the victim’s head
when possible. Keep person warm and comfortable,
and watch for signs of shock.
● Do not place a pillow under the victim’s head if the
person is lying down and there is an airway burn. This
can close the airway.
● Immediate medical attention is required. Do not
attempt to treat serious burns unless you are a trained
health professional
Poisoning (Irritant, narcotics, and corrosives)
For Ingested Poison:
● Perform CPR if the person is unconscious and not
breathing, but first check for poisonous material around
the mouth. Wash the area around the person's mouth
and if necessary, use a barrier device.
● Keep a sample of what the person has taken, even if
it is an empty container.
● Never try to induce vomiting as this could cause
further damage. Some poisons, especially corrosive
substances, can cause further damage during
vomiting.
● Do not give anything to eat or drink.
● Common household materials used for ingested
poison:
Household
products
cleaning
products/disinfectants such as bleach, detergents,
carbon monoxide, paint thinners, shampoo, medicines
(especially iron pills and food supplements containing
iron, insect sprays, cosmetics, deodorants and
antiperspirants.
Response
Airway
For Inhaled Poison:
● Get victim to fresh air, evidence is insufficient to
recommend for or against the use of oxygen for first
aid.
● Avoid inhaling fumes.
● Open doors and windows to increase ventilation of
the environment and dissipate fumes.
● If patient is unconscious, assess for initiation of CPR.
For Skin Poison:
● Remove clothing contaminated with toxic
substances.
● Flood skin with large amounts of water for 10
minutes.
● Assess skin for integrity. Seek further medical
treatment, if indicated
For Eye Poison:
● Flood the eye with lukewarm water poured 2 to 3
inches from the eye.
● Repeat irrigation for 15 minutes.
● Instruct the victim to blink frequently while the eye is
being irrigated.
● If the eyelid is shut, do not force the eyelid open.
● Refer victim for medical treatment.
Dislocation
Monitor the patient’s lifeline. Follow DRABC: If the
person has multiple injuries or has been involved in a
serious accident, your first priority is to maintain
breathing and circulation.
DRABC
Danger
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Assess the situation for any danger to
ensure that it is safe for you to
approach the casualty. This means
you need to look around the area for
anything that could be a potential risk
Breathing
to you, the casualty, or anyone else
nearby.
Examples: Moving vehicles, Broken
glass, A live electrical current, Fire
and/or smoke.
Check whether the casualty is
responsive. Do this by asking them
verbally whether they’re ok, to look at
you, or to raise their hand.
● If the casualty responds to you,
either by speaking or moving, then
attend to any injuries or illnesses that
they have before moving on to the
next step.
● If the casualty doesn’t respond, try
tapping them on their arm or gently
shaking their shoulder. Do not shake
them firmly because this could
worsen any potential neck or back
injuries.
Check that the casualty’s airway is
open and clear from obstructions.
If the casualty is unresponsive, you
should:
● Put your hand on their forehead
and gently tilt their head back, lifting
the chin. Do a visual check of their
airway for any obstructions.
● Carefully remove any visible
obstructions. Do not put your fingers
in their mouth if you can’t see
anything, as this risks pushing a
potential blockage further down.
If the casualty is responsive, you
should:
● Check if anything is blocking their
airway that could cause them to
choke.
● Encourage them to remove an
obvious blockage themselves, with
their hands or by coughing.
● If they are unable to dislodge the
blockage themselves and are
severely choking, you need to help
them to remove it. To do so, you must
not put your fingers into their mouth.
Instead, you should give choking
adults and children a combination of
back slaps and abdominal thrusts,
and a combination of back blows and
chest thrust to infants under one year
old.
Check whether the casualty is
breathing normally. To check their
breathing, you should look, listen and
feel for it by tilting their head back,
looking for chest movement and
listening for breathing sounds. Feel
for air from their mouth or nose on
your cheek for 10 seconds. It’s
essential to check for breathing for 10
seconds to confirm that the breathing
is rhythmic and normal.
● If the casualty is breathing
normally, move on to the final step of
the primary survey.
● If the casualty is unresponsive and
not breathing normally, you must
ensure that the emergency services
have been called. If you have had
practical first aid training and are
confident, start to give CPR with
rescue breaths. If you haven’t had
practical training, you should give
hands-only CPR, without rescue
breaths. If available, you should ask
someone else to find and bring a
defibrillator (AED) to use.
Circulation You should only move on to the final
step of the primary survey if the
casualty
starts
to
breathe
independently. For this step, check
the casualty for any signs of severe
bleeding.
● If the casualty is bleeding heavily,
you need to control and reduce the
bleeding. Apply direct pressure to the
wound with a sterile dressing, if
possible, or a clean cloth. You should
also ensure that the emergency
services have been called if they
haven’t already.
● If they aren’t bleeding severely and
you have been able to work through
the previous stages of the primary
assessment, you should try and
reassure them that help is coming.
Stay with them until medical help
arrives.
● If the casualty isn’t bleeding, but
is unresponsive and breathing
normally, you must put them into the
recovery position. This will keep their
airway open, preventing them from
choking if they vomit. The emergency
services should be called if they
haven’t already been.
● Control any bleeding and dress open wounds: The
second priority is to stem any bleeding and cover any
open wounds to prevent further infection or
contamination of the wound site.
● Check for fractures: Do not move the patient but ask
them if they feel any other injuries to their body. In
serious incidents, a patient may not feel an obvious
fracture or dislocation, so check them over carefully,
without moving the patient. If you are not sure if the
injury is a dislocation or a fracture, treat it as a fracture.
● Immobilize limb: If possible, place a padded splint
next to the injured limb before bandaging. Use a wide
bandage to prevent movement of the joints at either
end of the fracture. Check that the bandages are not
too tight so they restrict blood flow, or too loose so they
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do not immobilize the injury. Check every 15 minutes
until the patient is attended to by a professional.
● For knee or elbow injuries: splint the entire leg or
arm to prevent movement. Hold the limb to support it
and pass the bandage through the natural hollows of
the body. Do not move the limb in order to secure the
bandage.
● For leg fractures: immobilize the foot and ankle
using a ‘figure eight bandage’ – passing the bandage
across the top side of the ankle towards the right, under
the arch of the foot, across the foot to the left side, and
back over the top from the other side. Repeat a few
times and secure.
● For collarbone fractures: Immobilize and support
the arm on the injured side of the body. For dislocation
injuries: Rest, elevate the dislocation and apply ice to
the joint.
Sprain/Strain
● Provide nursing care for a client who sustains a
sprain.
○ Immobilize or elevate the injured joint, and administer
ice packs as soon as possible.
○ Assist with the application of tape, splints, or casts as
needed.
○ If a significant sprain is present, prepare the client for
surgical repair or reattachment.
● Administer prescribed medications, which may
include nonopioid analgesics.
Splints
● Elevate the limb with the splint.
● Inspect your splint and the skin around it daily, this is
to check for redness/soreness.
● Keep splint clean and dry
● Check straps are firm but not tight and are supporting
the injury.
● Check the position of the splint and it is supporting
your injury.
Covering Open Fractures
● The wound should be extensively irrigated with at
least one liter of saline or a combination of saline and
betadine, followed by the application of a sterile or
betadine-soaked dressing and limb should be
immobilized in a well-padded splint.
● Antibiotics should be given as quickly as possible in
a prehospital or emergency room environment.
● The tetanus status of all patients with open fractures
should be assessed.
Immobilization
● Maintain bed rest or limb rest as indicated. Provide
support of joints above and below the fracture site,
especially when moving and turning.
● Secure a bed board under the mattress or place the
patient on the orthopedic bed.
● Support fracture site with pillows or folded blankets.
Maintain a neutral position of the affected part with
sandbags, splints, trochanter roll, footboard.
● Use sufficient personnel when turning. Avoid using
an abduction bar when turning a patient with a spica
cast.
● Keep ropes unobstructed with weights hanging free;
avoid lifting or releasing weights.
● Assist with placement of lifts under bed wheels if
indicated.
● Position the patient, so that appropriate pull is
maintained on the long axis of the bone.
Shock
● Check for a response.
● Give rescue breaths or CPR as needed.
POSITION OF THE CLIENT/PATIENT:
- Lay the person flat, face-up but do not move him or
her if you suspect a head, back, or neck injury.
- Raise the person’s feet about 12 inches. Use a box,
etc. If raising the legs will cause pain or further injury,
keep him or her flat. Keep the person still.
- Do not raise the feet or move the legs if hip or leg
bones are broken. Keep the person lying flat.
● Check for signs of circulation. If absent, begin CPR.
● Keep the person warm and comfortable. Loosen belt
(s) and tight clothing and cover the person with a
blanket.
● NPO (Nothing by Mouth): Even if the person
complains of thirst, give nothing by mouth. If the person
wants water, moisten the lips.
● Reassure the person. Make him or her as
comfortable.
● Fluid and blood replacement: Open IV line on both
hands with two wide bore cannulas and start fluid
rapidly as advised.
● Administer oxygen via face mask.
● Identify the cause and treat accordingly.
● Vasoactive medications to improve cardiac
contractility, Dopamine, Dobutamine, Noradrenaline
Fainting
● Position the person on his or her back.
○ If feasible, raise the person's legs above heart level
— about 12 inches (30cm) — if there are no injuries
and the person is breathing. Belts, collars, and other
constrictive garments should be loosened.
○ To reduce the chance of fainting again, don't get the
person up too quickly.
● Check for breathing.
○ If the person isn't breathing, begin CPR.
● If the person was hurt in a fall caused by a faint,
treat any bumps, bruises, or cuts as soon as
possible. Direct pressure can be used to stop
bleeding. Position the person on his or her back.
● Reevaluate medications, review any that may
cause syncope (fainting) with MD
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● Monitor for changes in
consciousness.
● Promote adequate fluid intake
the
level
of
Seizure
● Safe Environment
○ Make your house, and if possible, your work or study
place, safe in the event of a seizure. Pad sharp corners,
use non-slip carpet, avoid scatter rugs, and establish
barriers in front of fireplaces and hot stoves, for
example.
- Pay special attention to heights, railings and nearby
pools or bodies of water.
- Shut your door when you are home alone, so you
don't wander outside or into dangerous areas.
- Make sure someone else (neighbor, friend) has a key
to get in and check on you!
- If you fall during seizures, "fall-proof" your home and
other areas. Put in carpets, cover sharp corners, and
avoid glass tables.
- Some people with frequent falls may need to consider
wearing a protective helmet.
● Support Head
○ Do not try to move them; instead, gently support them
and cushion their head. Put nothing, even your fingers,
in their mouth. Put something soft and flat beneath his
or her head, such as a folded jacket.
● Promote airway clearance.
○ Suction as needed; oversee supplemental oxygen or
bag ventilation as needed postictally; maintain in lying
position, flat surface; turn head to side during seizure
activity; loosen clothing from neck, chest, and
abdominal areas; turn head to side during seizure
activity.
● Recovery Position
1. Kneel on the floor to one side of the person.
2. Place the person’s arm that is nearest to you at a
right angle to their body, so that it is bent at the elbow
with the palm facing upwards. This will keep it out of the
way when you roll them over.
3. Gently pick up their other hand with your palm
against theirs (palm to palm). Turn any rings inward to
avoid scratching their face. Now place the back of their
hand onto their opposite cheek (for example, against
their left cheek if it is their right hand). Keep your hand
there to guide and support their head as you roll them.
4. Use your other arm to reach across to the person’s
knee that is furthest from you, and pull it up so that their
leg is bent and their foot is flat on the floor.
5. Gently pull their knee towards you so that they roll
over onto their side, facing you. Their body weight
should help them to roll over quite easily.
6. Move the bent leg that is nearest to you, in front of
their body so that it is resting on the floor. This position
will help to balance them.
7. Gently raise their chin to tilt their head back slightly,
as this will open up their airway and help them to
breathe. Check that nothing is blocking their airway. If
there is an obstruction, such as food in their mouth,
remove this if you can do so safely. Stay with them,
giving reassurance, until they have fully recovered.
urine from the bladder when a
person cannot urinate.
● Enforce education about the disease.
○ Review the pathology and prognosis of the condition,
as well as the patient's specific trigger factors (flashing
lights, hyperventilation, loud noises, video games, and
TV viewing); understand and instill the importance of
good oral hygiene and regular dental care; review the
medication regimen, the importance of taking drugs as
prescribed, and not discontinuing therapy without
physician supervision; and include directions for
missed doses.
Materials needed for First Aid
Elastic Wrap
Bandage
Long strip of stretchable cloth
that you can wrap around a
sprain or strain. It's also called
a Tensor bandage. The gentle
pressure of the bandage helps
reduce swelling, so
it may help the injured area
feel better.
Adhesive Tape
Used to attach bandages,
gauze, and other dressings to
skin around wounds. It is also
good when necessary to tape
fingers and or toes together.
Bandage strips and
“butterfly”
bandages
Piece of material used either
to covering wounds, to keep
dressings in place, to applying
pressure controlling bleeding,
to support a medical device
such as a splint, or on its own
to provide support to the body.
It can also be used to restrict
a part of the body.
used to close the two sides of
clean minor cuts, such as
knife cuts or paper cuts. It
dries fast to stop the bleeding.
Superglue
Rubber tourniquet
16 French catheter
Nowts ni Estelle :>
constricting or compressing
device used to control arterial
and venous blood flow to a
portion of an extremity for a
period of time.
French catheter is a flexible
plastic tube used to drain
Non-stick
bandages
sterile
Roller gauze
Eye shield
Large
triangular
Bandage (Cravat)
Aluminum
splint
finger
Non-stick sterile bandages
are designed for open
wounds,
using
highly
absorbent material to stay dry
and clean. The gentle
two-sided dressing allows
wounds to be compressed
and heal without disruption
or residue.
A roller gauze is a strip of
gauze or cotton material
prepared in a roll. Roller
bandages can be used to
immobilize injured body parts
(sprains and torn muscles),
provide pressure to control
internal or external bleeding,
absorb drainage, and secure
dressings.
An eye shield is made of
aluminum for rigidity yet
contains many apertures to
allow for air circulation and to
reduce weight. This allows the
client to protect the injured
eye and blocks external
pressure from being applied
directly
to
the
injury,
preventing further damage. It
is kept in place by an elastic
strap and is to protect an eye
pad dressing or to keep the
light out of a sensitive eye.
Also known as a cravat
bandage,
a
triangular
bandage is a piece of cloth put
into a right-angled triangle,
and often provided with safety
pins to secure it in place. It can
be used fully unrolled as a
sling, folded as a normal
bandage, or for specialized
applications, as on the head.
An aluminum finger splint has
malleable aluminum finger
strips that are padded with
closed cell foam. Finger
splints are a type of medical
equipment that can benefit
individuals who have an
injured finger. Finger splints
prevent
further
damage,
provide stabilization, and can
Instant cold packs
Cotton balls
cotton swabs
and
Disposable
non
latex
examination
gloves, several pairs
Duct tape
Petroleum jelly
Plastic
bags,
assorted sizes
Nowts ni Estelle :>
help treat various injuries,
such as damaged tendons
and fractures.
An instant cold pack is a
device that consists of two
bags; one containing water,
inside a bag containing
ammonium nitrate, calcium
ammonium nitrate or urea.
Cotton balls help when you
are trying to clean a wound.
Cotton balls have many uses,
but in first aid scenarios, they
are a go-to tool for applying
the antibiotic ointment. Cotton
swabs can also be used to
clean the area surrounding a
wound, cleaning the external
ear and applying make-up.
Latex gloves are close-fitting
and strong. They work well for
high-risk
tasks
and
environments.
Disposable
gloves offer an added barrier
against infection in a first aid
situation. The first aider
should wear them whenever
there is a likelihood of contact
with bodily fluids. To prevent
cross
contamination
disposable gloves should only
be used to treat one casualty,
they should be removed as
soon as the treatment is
completed.
Duct tapes are used to clean
or dry an area when
administering
first
aid.
Waterproof assorted size
bandages. We use this
especially to cover and protect
minor cuts, burns, blisters.
Petroleum Jelly has many
uses and can be used all over
the body. It heals dry skin,
helps protect minor cuts,
scrapes and burns, and
protects skin from wind burn
and chapping. It also reduces
the appearance of fine, dry
lines.
Plastic bags such as freezer
bags can be used as
emergency protection in case
of hemorrhage, or to dispose
of
soiled
waste
(dirty
bandages), or to collect
sputum of blood and vomit
(collected to be shown to a
doctor for further evaluation).
Safety
pins
assorted sizes
Scissors
tweezers
in
and
Hand sanitizer
As a first aid necessity, it
should have small, medium
and large safety pins that can
be used to hold and secure
wraps and bandages during
the performance of first aid.
Each size has 144 pins per
box.
The most common use of
scissors is for cutting gauze
and
sometimes
even
adhesive bandages to an
appropriate length. Scissors
are also used for other tasks
such as cutting away clothing
to expose injured areas to be
able to treat wounds better
(thus the blunted blade).
Tweezers can be used to
remove debris such as glass,
dirt, or splinters from a wound.
They can also be used to
remove stingers left behind by
bees.
These are useful first aid
supplies that prevent the
spread of infection and
bacteria.
Antibiotic ointment
Used to prevent and treat
minor skin infections caused
by small cuts, scrapes, or
burns.
Antiseptic solution
and towelettes
Antiseptic wipes or sprays are
handy for cleaning injuries
when there's no clean water
nearby.
Eyewash solution
Used to rinse eyes when they
become contaminated with
foreign
particles
or
substances. By ensuring there
are bottles of eye wash to
hand, the injured person can
flush their eyes immediately
following an incident.
To
measure
body
temperature.
Thermometer
Turkey baster or any
suction devices
A turkey baster can help in
irrigation. It can hold a
Sterile saline
Surgical mask
First-aid manual
Hydrogen peroxide
Splints
generous amount of water
and is used in flushing
wounds. It can also be used to
flush out eyes that have been
infected with debris.
Sterile saline solution has
several purposes. It is utilized
for cleaning out wounds and
sterilizing
medical
tools.
Another use is to clean fresh
cuts and scrapes. This
solution can be used to flush
out eyes if an eyewash
solution is unavailable.
This is for those with
symptoms of an acute
respiratory
infection, this
helps to reduce the spread of
infection to other people.
Very crucial in helping us
handle medical emergencies
as quickly as possible. In an
emergency, a delay of just a
single minute can cause
irreconcilable damage. These
kits offer basic and instant
care for common medical
injuries like injuries, burns,
cuts.
Excellent
for
disinfecting
wounds
and
sterilizing
medical
tools.
It’s
antibacterial, antiviral, and
antifungal properties make it a
crucial material in the first-aid
kit. It is also used in subduing
allergic reactions.
Supportive device used to
keep in place any suspected
fracture in one's arm or leg.
The uses of splints are to
provide pain relief of the
fractured limb, support bone
ends of the fracture site.
Beginning Skills in Bandaging and Splinting
I. Bandaging – The application of a strip or roll of cloth or
other material that may be wound around a part of the
body in a variety of ways to secure a dressing, maintain
pressure over a compress, or immobilize a limb or other
part of the body
Materials needed for Bandaging: Cravats
Procedure Guide for Bandaging
Triangular Bandages Making a broad-fold
bandage
1. Open out a triangular bandage and lay it flat on a
clean surface. Fold the bandage in
half horizontally, so that the point of triangle touches
the center of the base
2. Fold the triangular bandage in half again, in the same
direction, so that the first folded
edge touches the base. The bandage should now form
a broad strip
Making a narrow fold bandage
1. Fold a triangular bandage to make a broad
fold bandage
2. Fold the bandage horizontally in half again. It
should form a long, narrow, thick strip of
material.
Forehead or Scalp Bandage
1. Fold a hem along the base of the bandage. Place the
bandage on the casualty’s head with the hem
underneath and the center of the base just above his
eyebrows.
2. Wrap the ends of the bandage securely around the
casualty’s head, tucking the hem just above his ears.
Cross the two ends at the nape of the casualty’s neck,
over the point of the bandage.
3. Bring the crossed-ends to the front of the casualty’s
head. Tie ends in a reef knot (opposite) at the centre of
the forehead, positioning it over the hem of the
bandage. Tuck the free part of each end under the knot.
4. Steady the casualty’s head with one hand and draw
the point down to tighten the bandage. Then fold the
point up over the ends and pin it at the crown of his
head. If you do not have a pin, tuck the point over the
ends
Arm Sling
1. Ensure that the injured arm is supported with its hand
slightly raised. Fold the base of the bandage under to
from a hem. Place the bandage with the base parallel
to casualty’s body and level with her little fingernail.
Pass the upper end under the injured arm and pull it
around the neck to the opposite shoulder.
2. Fold the lower end of the bandage up over the
forearm and bring it to meet the upper end at the
shoulder.
3. Tie a reef knot on the injured side, at the hollow
above the casualty’s collar bone. Tuck both free ends
of the bandage under the knot to pad it.
4. Fold the point forwards at the casualty’s elbow. Tuck
any loose fabric around the elbow, and secure the point
to the front with a safety pin. If you do not have a pin,
twist the point until the fabric fits the elbow snugly; tuck
it into the sling at the back of the arm.
5. As soon as you have finished, check the circulation
in the fingers. Recheck every 10 minutes. If necessary,
loosen and reapply the bandages and sling.
Elevation sling
1. Ask the casualty to support his injured arm cross his
chest, with the fingers resting on the opposite shoulder.
Nowts ni Estelle :>
2. Place the bandage over his body, with one end over
the uninjured shoulder. Hold the point just beyond his
elbow.
3. Ask the casualty to let go of his injured arm. Tuck the
base of the bandage under his hand, forearm, and
elbow.
4. Bring the lower end of the bandage up diagonally
across his back, to meet the other end at his shoulder.
5. Tie the ends in a reef knot at the hollow above the
casualty’s collar bone. Tuck the ends under the knot to
pad it.
6. Twist the point until the bandage fits closely around
the casualty’s elbow. Tuck the point in just above his
elbow to secure it. If you have safety pin, fold the fabric
over the elbow, and fasten the point at the corner.
7. Regularly check the circulation in the thumb. If
necessary, loosen and reapply the bandage and sling.
II. Splinting – The process of immobilizing, restraining or
supporting a body part; stabilization, immobilization and/
or protection of an injured body part with a supportive
appliance
II. Material needed for Bandaging: Hard Splints
Procedure Guide for Splinting
Triangular Bandages Arm Sling and Binder
1. Support the arm
2. Position the arm on a rigid splint
3. Secure the splint
4. Check circulation
5. Position the triangular bandage.
6. Bring the lower end of the bandage to the opposite
side of the neck.
7. Tie the ends.
8. Secure the point of the bandage at the elbow.
9. Tie a binder bandage over the sling around the chest.
Splinting the leg
1. Gently slide 4 or 5 bandages or strips of cloth under
both legs
2. Put padding between the legs.
3. Gently slide the uninjured leg next to the injured leg.
4. Tie the bandages.
Nowts ni Estelle :>
MATERNAL CHILD NURSING
NCM 107 RLE
Care of Mother, Child, Adolescent (Well-Client) RLE
Cebu Doctors’ University
December 2, 2021
3F – TRANSFER AND AMBULATION
Crutches
- Wooden or metal staff used to
DEFINITION OF TERMS
aid
a
patient’s
mobility
impairment
or
an
injury
that
Alignment
limits
walking
ability
- Is the equal activity balance in the upper and
lower parts of the body that reduces the risk of
having back injury
Ambulation
- Ability to walk from place to place independently
with or without assistive deices
Ambulatory
- Promotion and assistance with walking to remain
or restore autonomic and voluntary body
functions during treatment and recovery from
illness or injury
Braces
- Orthopedic appliance used to support, align, or
hold a bodily part in the correct position
Canes
- Assists in ambulation or walking
- Improves balance by increasing a person’s base
of support
- When used correctly, cane unloads the leg
opposite to the hand, the cane is up to twenty
five percent
- Types of canes:
o C cane
o Functional
grip cane
o Quad cane
o Hemi walker
Carry
- To hold or support while moving
The sea does not like to be restrained.
MABALOT, Christianne Jacob O.
BSN2-E
Gait
-
Manner or style of walking that depends on the
person’s ability to support their weight and
balance
Hydraulic lift
- Indications:
o Patients who cannot bear weight
o Patients with physical limitations
(amputations or quadriplegia)
o Patients who are extremely heavy and
cannot be transferred by members of
the healthcare team
- They are portable lifts that support all of the
patient’s weight using a sling that is attached to
a stand on wheels
Lift sheet
- Materials:
plastic,
rubber, or cotton and is
half the size of a regular
sheet
- Purpose
o Supports
the
body from the
upper back to
mid-thigh
during lifting
o Lifts immobile patients from their bed
1
MATERNAL CHILD NURSING
NCM 107 RLE
Care of Mother, Child, Adolescent (Well-Client) RLE
Cebu Doctors’ University
Mobility
- Ability to move freely, easily, rhythmically, and
purposefully in the environment, is an essential
part of living
Movement
- Act or instance in moving or a change in place
or position
Non-ambulatory
- Person who is unable to walk but can be mobile
with the help of a wheelchair or other mobility
devices
Orthostatic hypotension
- Blood pressure that decreases when the client
sits or stands which is the result of peripheral
vasodilation in which blood leaves the central
body organs, especially the brain, and moves to
the periphery often causing the person to feel
faint
Stretcher
- Sheet of canvas stretched to a frame with four
handles or a cart with four wwheels and a flat top
used for transportation of patients hwo are sick
or injured
Transfer
- Moving of a patient or object from one place to
another
Transfer belt
- Otherwise called gait belt
- Has been traditionally used
to transfer a client from one
position to another and for
ambulation
- They contain handles that
allow the nurse to control
the movement of the client
during transfer or ambulation
Walker
- Mechanical devices for
ambulatory clients who
need more support
than a cane provides
and lack the strength
The sea does not like to be restrained.
MABALOT, Christianne Jacob O.
BSN2-E
December 2, 2021
-
and balance required for crutches
Comes in different sizes and shapes suited for
individual needs
Weight
- Person’s heaviness, mass, and measure of
health
Wheelchair
- Chair mounted on large wheels that are used by
people who are unable to walk or have difficulty
in walking
IMPORTANCE OF TRANSFER AND
AMBULATION
TRANSFER
Allows minimum strength of the nurse when
using proper body mechanics
2. Uses patient’s independence and aids in
rehabilitation
3. Mobilizes the patient without causing injury
4. Changes the patient’s surroundings
5. Prevents systematic hazards of immobilization
1.
AMBULATION
Strengthens the muscles (abdomen and legs)
Helps joint flexibility (hips, knees, and ankles)
Stimulates circulation
Prevents phlebitis or the inflammation of the
veins and the development of stroke-causing
clots
5. Prevents constipation because the movement of
the abdominal muscles stimulates the intestinal
tract
6. Prevents osteoporosis due to mineral loss from
bones when they do not bear weight
7. Prevents urinary incontinence and infection
when residents are able to go to the bathroom
on their own, incontinence is reduced
8. Relivees pressure on the body and skin;
prevents pressure ulcers
9. Improves self-esteemi ndependence and the
resident’s
10. Improves resident’s ability to socialize
1.
2.
3.
4.
INDICATIONS AND
CONTRAINDICATIONS OF TRANSFER
OF TRANSFER AND AMBULATION
-
INDICATIONS
TRANSFER
Needs to transfer to another room/unit
Patient has treatment/diagnostic test
Perimitted out of the bed (client
2
MATERNAL CHILD NURSING
NCM 107 RLE
Care of Mother, Child, Adolescent (Well-Client) RLE
Cebu Doctors’ University
-
AMBULATION
Patient needs help in moving
Patient has undergone surgery
Continued bed exercise to regain muscle
strength
CONTRAINDICATIONS
TRANSFER
Recent operation (spinal cord)
Extensive burns, severe wounds
Presence of active bleeding
Spinal injury
-
AMBULATION
Both legs are paralyzed
Contraindicated by the doctor
-
BASIC GUIDELINES IN
TRANSFERRING AND AMBULATING
CLIENTS
GENERAL
Follow the rules of good body mechanics
Check walking aids frequently to make sure they
are in good condition.
3. Always explain the procedure to the patient
ahead of time
4. Make sure all devices are fitted properly to the
patient
5. Make sure all tips of canes, walkers and crutches
are flat on the floor with rubber tips.
6. Make sure the patient is not placing the walker
too far from him or her
7. Watch signs for patient discomfort or fatigue
8. Have the patient wear comfortable shoes with
non-skid soles
1.
2.
1.
2.
3.
4.
TRANSFERRING
Raise the side rails of the bed opposite to the
nurse
Elevate the level to a comfortable height
Assess the client’s mobility and strength
Nurse should always assess the patient before
and after transferring 5. The nurse should know
the client’s mental and physical capabilities
AMBULATION
The nurse should remain physically close to the
patient and provide safety
2. Encourage patient to assume normal walking
and gait as much as possible
3. Encourage patient to ambulate independently
4. The nurse should walk on client’s weaker side
December 2, 2021
FACTORS AFFECTING TRANSFERRING
AND AMBULATING CLIENTS
-
-
-
-
ASSISTIVE DEVICES
Object or piece of equipment designed to help a
patient with activities of daily living (walker, cane,
gait belt, or mechanical lift)
GENERAL HEALTH
Client’s general health status is reflected on how
the individual moves
Illness, disability, inactivity, and chronic fatigue
have unfavorable effects on musculoskeletal
function
ATTITUDES AND VALUES
Clients who are ocnscious with body mechanics
and gait would protect their body structures and
posture from injury
NEUROMUSCULAR AND SKELETAL IMPEDIMENTS
- Disease and injuries that affect the
neuromuscular or skeletal systems can hinder
movement
-
AGE
Affects activity and has an impact in the way we
transfer our clients.
PRINCIPLES INVOLVED IN
TRANSFER AND AMBULATION
-
-
1.
The sea does not like to be restrained.
MABALOT, Christianne Jacob O.
BSN2-E
ENVIRONMENT
Determines our level of activity and social
participation
In the process of encountering the environment,
starting from taking a step outside from the
house and street, the patient may face many
barriers like subsequently reducing their social
participation and are more isolated
-
BODY MECHANICS
Involves the coordinated effort of muscles,
bones, and nervous system to maintain balance,
posture, and alignment during moving,
transferring, and positioning patients
Allows individuals to carry out activities without
excessive use of energy and helps prevent
injuries for patients and healthcare providers
PSYCHOLOGY
Patient may feel insecure, loses their selfesteem, and may feel isolated. Therefore, the
client should address the need of the paitnet
which will help them to participate activity and to
an extent that satisfies their social needs
3
MATERNAL CHILD NURSING
Care of Mother, Child, Adolescent (Well-Client) RLE
Cebu Doctors’ University
-
-
-
SAFETY AND SECURITY
Helping the patient to do daily activities with
proper assistance from the healthcare provider
would promote patient safety and prevent
further disability
SOCIOLOGY
The healthcare provider must explain the
procedure to the patient
ANATOMY AND PHYSIOLOGY
Healthcare provider must be aware of the
patient’s condition and what parts of the body
are affect so that they will know what to do and
what safety precautions should be considered in
assisting the patient
MECHANICAL DEVICES USED IN:
NCM 107 RLE
December 2, 2021
Wheelchair
- A wheeled mobility device in which the user sits
- The device is propelled manually (by the HCP)
or via various automated systems
Indications
- People who find walking difficult or impossible
due to illness, injury, or disability
Material
- Four wheels
o 2 large wheels in
the rear – used
for propelling the
wheelchair
§ Supports
majority
of
the
TRANSFERRING PATIENTS USING
Stretcher
- Carries a person while lying down, incapacitated
to the extent that they cannot walk, move, or
unconscious
o Some injuries, even if unconfirmed,
require the use of a stretcher (e.g.,
suspected neck injury)
- Often attached to a wheelbase to be pushed
along on wheels
- Stretcher removes the need for the injured
person to make unnecessary movements which
would potentially worsen their condition
Material:
o
individual’s weight and provides
primary means of propulsion
2 small wheels in the front – swivels and
are also called casters
§ Facilitates maneuverability
Transfer belt/Gait belt
- Used by caregivers during transfers of a patient
from a bed to a wheelchair or commode bath and
while walking
Indications
- Assists a patient or an older adult when out for a
supervised walk
- Lifts elderly and the frail with minimum strain on
the caregiver
Material
-
Made of lightweight metal (aluminum)
Long rectangular shape of a comfortable length
and width for a person to lie on
Contains carrying handles at each end so that it
can be lifted
Sometimes padded for comfort, but are used
without padding depending on the injury (e.g.,
spinal injury)
-
Come in vast assortment of styles/sizes
Shaped like a regular belt that will be looped
around the patient’s waist
Hand-holds are given for the caregiver to hang
on to in order to support patients as they change
position or transfer patients
Hydraulic lift
- Used to transfer a patient who can’t bear weight
or help herself during transfer or who’s too heavy
to be lift safely
The sea does not like to be restrained.
MABALOT, Christianne Jacob O.
BSN2-E
4
MATERNAL CHILD NURSING
-
Care of Mother, Child, Adolescent (Well-Client) RLE
Cebu Doctors’ University
This can safely move patient from bed to
stretcher, bed to chair or wheelchair, and bed to
bathtub or commode, and then back to bed
Does all the work, requiring very little effort on
the part of the caregiver or attendant
Material
- Designed with a
hydraulic pump that
has a crank, utilizing
hydraulic fluid as the
force to mobilize the
hoisting mechanism,
lifting the patient into
the air with the
attached lift sling
NCM 107 RLE
December 2, 2021
-
Indications: patients with poor balance and
mobility
Crutches
- Type of walking aids that increases the size of
an individual’s base of support
- It transfers weight from the legs to the upper
body and
Indications –
- Used by people who cannot use their legs to
support their weight
- Examples – short-term injuries to lifelong
disabilities
Material
AMBULATING PATIENTS USING
Canes
- Known as walking sticks when used for nonmedical purposes
- Provides balance support in standing and
walking, take some pressure off one or both legs,
and improve feeling of safety/security when
walking
- Used on the most unaffected/strongest side of
the body
o However, this may depend on the
individual’s preferences and abilities.
Material
- Made of wood or
metal
with
a
usually
curved
handle at one
end
that
is
grasped
to
provide stability in
walking
or
standing
Walkers
- A walking aid that
has 4 points of
contact with the
round and has 3
side with the side
closest to the
patient
being
open
- Provides a wider base of support than a walking
stick
The sea does not like to be restrained.
MABALOT, Christianne Jacob O.
BSN2-E
-
Can come in singly or in pairs
Types of crutches:
o Axilla or underarm crutches
o Forearm crutches
o Gutter crutches (or adjustable arthritic
crutches, forearm support crutches)
MEASUREMENT OF CRUTCHES
The nurse should obtain the correct length for the
crutches and the correct placement of the handpiece
2 METHODS OF MEASURING CRUTCH LENGTH
1. Client lies in supine
position and the nurse
will measure from the
anterior fold of the axilla
to the heel of the foot
and add 2.5cm (1 inch)
2. Client stands erect and
positions the crutch with
the elbow bent at 30
degrees and the patient
standing erect, to the
ground 4 inches away
from the side of the foot
a. The nurse should
make sure that
the shoulder rest of the crutch should be
at least 3 finger widths (2.5-5cm or 1-2
inches) below the axilla
5
MATERNAL CHILD NURSING
NCM 107 RLE
Care of Mother, Child, Adolescent (Well-Client) RLE
Cebu Doctors’ University
To determine the correct placement of the
hand bar:
1. Patient should stand upright and supports their
body weight by the handgrips of the crutches
2. Nurse measures the angle of the patient’s elbow
flexion (must be 30 degrees)
a. Goniometer may be used in order to
verify the correct angle
PROPER USE OF CRUTCHES
1.
Follow the training regimen that was created for
them to strengthen their arm muscles before
they start crutch walking
2. Consult a HCP to determine the proper length of
their crutches and location of the handpieces
a. If crutch is too long à pulls your
shoulders upward and makes pushing
your body off the ground difficult
b. If crutch is too short à you will have to
bend down and establish an incorrect
body posture
3. Must their arms than their axillae (armpits)
because the arms will bear the weight of your
body
a. Continues pressure on axillae due to
improper use can damage the radial
nerve à crutch palsy (weakness of
forearm, wrist, and hand muscles)
4. Must maintain in an upright posture to avoid
muscle and joint strain and to keep their balance
5. Each crutch step should be at a comfortable
distance for the patient
a. Preferable to begin with a small step
rather than a large one
6. Patient must check the crutch tips on a regular
basis and replace them if they are worn
a. To maintain their friction à they must be
kept dry and clean
b. Wet tips à thoroughly dry before use
7. Wear low-heeled shoes that grip the gorund
a. Slipping is less likely with rubber soles
b. Adjust shoelaces so they don’t come
undone or fall to the floor where they
might catch on the crutches
i. If the patient can’t access the
laces, look for shoes with a
different type of closure (Velcro)
The sea does not like to be restrained.
MABALOT, Christianne Jacob O.
BSN2-E
December 2, 2021
DIFFERENT GAITS
TWO-POINT GAIT
- Right food and left
crutch are advanced
simultaneously,
then
the left foot and right
crutch are moved
forward
-
-
-
-
THREE-POINT GAIT
In which crutches
and the affected
leg are advanced
together and then
the normal leg is
moved forward
FOUR-POINT GAIT
A gait in forward
motion
using
crutches, first on
crutch
is
advanced, then
the opposite leg,
then the second
crutch, then the
second leg, etc.
SWING TO-GAIT
Crutches are advanced
and the legs are swung
to the same point
SWING THROUGH GAIT
In which crutches are
advanced and then
the legs are swung
past them
6
MATERNAL CHILD NURSING
Care of Mother, Child, Adolescent (Well-Client) RLE
Cebu Doctors’ University
TYPES OF CARRY
-
CRADLE
Used when victim
has little or no arm
strength
Place one arm
under the victim’s
legs and the other
around their back
NCM 107 RLE
December 2, 2021
-
-
-
-
-
-
PIGGY BACK
Used when victim
is responsive and
not expected to
lose
consciousness,
Piggyback carry
by having the
victim around your
shoulders while
you support their
weight with your
arms
placed
under their thighs
FIREMAN CARRY
Lift the victim so that
their
torso
is
supported by your
shoulders hold the
victim by grabbing
their thigh with one
hand and arm with the
other
PACKSTRAP CARRY
Used when victim is
unconscious and cannot
be safely dragged
Bounce the weight of the
victim on your hips and
support them with your
legs
HUMAN CRUTCH
The sea does not like to be restrained.
MABALOT, Christianne Jacob O.
BSN2-E
-
-
-
Used when the victim can
walk with assistance
Help
the
victim
stay
balanced, try to minimize the
amount of weight that must
go on an injured leg
DOUBLE HUMAN CRUTCH
Used when you have a
helper and victim can walk
with assistance
Help the victim stay
balanced and try to
minimize the amount of
weight that must go on an
injured leg
TWO-HANDED SEAT
Used when you have a
helper and the victim is
conscious
and
can
cooperate while facing
each other
You and the helper
should
grasp
one
another’s wrist with the
hands that will be in
front, your other arm
should
grasp
your
helper’s shoulders and
their arm should grasp yours, forming a
Hammock-like seat for the injured person
TWO-PERSON FRONT BACK
Used when the victim must
be carried downstairs
Communicate with your
helper when lifting the
victim and lift at the same
time
BEGINNING SKILLS IN
TRANSFERRING PATIENTS FROM BED TO CHAIR TO
WHEELCHAIR
1. Before transferring the client, assess the
following:
- The client’s body size
- Ability to follow instructions
- Ability to bear weight
7
MATERNAL CHILD NURSING
Care of Mother, Child, Adolescent (Well-Client) RLE
Cebu Doctors’ University
-
Ability to position down with arms and
lean forward
- Ability to achieve independent sitting
balance
- Activity tolerance
- Muscle strength
- Joint mobility
- Presence of paralysis
- Level of comfort
- Presence of orthostatic hypotension
- The technique with which the client is
familiar
- The space in which the transfer will need
to be maneuvered (bathrooms, for
example, are usually cramped)
- The number of assistants (one or two)
needed to accomplish the transfer
safely.
2. Always lock the brakes on both wheels of the
wheelchair when the client transfers in or out of
it.
3. Raise the footplates before transferring the
client into the wheelchair.
4. Lower the footplates after the transfer, and
place the client’s feet on them.
5. Ensure the client is positioned well back in the
seat of the wheelchair.
6. Useseatbeltsthatfastenbehindthewheelchairtop
rotectconfusedclients
from falls. Note: Seat belts are a form of restraint
and must be used in
accordance with policies and procedures that
apply the use of restraints.
7. Back the wheelchair into or out of an elevator,
rear large wheels first.
8. Place your body between the wheelchair and the
bottom of an incline.
TRANSFERRING A PATIENT FROM BED TO
STRETCHER AND VICE VERSA
1. Perform hand hygiene
2. Check room for additional precautions
3. Introduce yourself to the patient
4. Confirm your patient using the two identifiers
(name and birthday)
5. Listen and attend patient cues
6. Ensure patient’s privacy and dignity
7. Always predetermine the number of staff
required to safely transfer a patient horizontally.
8. Explain what will happen and how the patient can
help (tuck chin in, keep hands on chest). Collect
supplies.
9. Raise bed to safe working height. Lower head of
bed and side rails.
10. Position the patient closest to the side of the bed
where the stretcher will be placed.
The sea does not like to be restrained.
MABALOT, Christianne Jacob O.
BSN2-E
NCM 107 RLE
December 2, 2021
11. Roll the patient over and place slider board
halfway under the patient, forming a bridge
between the bed and the stretcher.
12. Place sheet on top of the slider board. The sheet
is used to slide patient over to The patient is
returned to the stretcher . the supine position.
13. Patient’s feet are positioned on the slider board.
14. Position stretcher beside the bed on the side
closest to the patient, with stretcher slightly
lower . Apply brakes. Two health care providers
climb onto the stretcher and grasp the sheet.
The lead person is at the head of the bed and
will grasp the pillow and sheet. The other health
care provider is positioned on the far side of the
bed, between the chest and hips of the patient,
and will grasp the sheet with palms facing up.
The two caregivers on the stretcher grasp the
draw sheet using a palms up technique, sitting
up tall, and keeping their elbows close to their
body and backs straight.
15. The caregiver on the other side of the bed
places his or her hands under the patient’s hip
and shoulder area with forearms resting on bed.
The designated leader will count 1, 2, 3, and start
the move.
16. The person on the far side of the bed will push
patient just to arm’s length using a back-to-front
weight shift. At the same time, the two caregivers
on the stretcher will move from a sitting-up-tall
position to sitting on their heels, shifting their
weight from the front leg to the back, bringing the
patient with them using the sheet.
17. The two caregivers will climb off the stretcher
and stand at the side and grasp the sheet,
keeping elbows tucked in. One of the two
caregivers should be in line with the patient’s
shoulders and the other should be at the hip
area. On the count of three, with back straight
and knees bent, the two caregivers use a frontto-back weight shift and slide the patient into the
middle of the bed.
18. At the same time, the caregiver on the other side
slides the slider board out from under the
patient.
19. Replace pillow under head, ensure patient is
comfortable, and cover the patient with sheets.
20. Lower bed and lock brakes, raise side rails as
required, and ensure call bell is within reach.
PROPER TRANSPORT OF PATIENT ON:
Guidelines:
1. Before transferring a client, assess
following:
o The client’s body size and weight
o Ability to follow instructions
o Activity tolerance
o Level of comfort
the
8
MATERNAL CHILD NURSING
Care of Mother, Child, Adolescent (Well-Client) RLE
Cebu Doctors’ University
The space in which the transfer is
maneuvered
o The number of assistants (one to four)
needed to accomplish the transfer
safely
2. Lock the wheels of the bed and stretcher before
the client transfers in or out of them.
3. Fasten safety straps across the client on a
stretcher, and raise the siderails.
4. Never leave a client unattended on a stretcher
unless the wheels are locked and the side rails
are raised on both sides and/or the safety straps
are securely fastened across the client.
5. Always push a stretcher from the end where the
client’s head is positioned. This position protects
the client’s head in the event of a collision.
6. If the stretcher has two swivel wheels and two
stationary wheels: a. Always position the client’s
head at the end with the stationary wheels and b.
Push the stretcher from the end with the
stationary wheels. The stretcher is maneuvered
more easily when pushed from this end.
7. Maneuver the stretcher when entering the
elevator so that the client’s head goes in first.
o
Stretcher
Importance considerations:
1. Patients, especially children must not be left
unattended on or with a stretcher at any time.
2. Stretcher top must be in the lowest position
when patients are getting on or off the stretcher,
with access from either side only.
3. Maximum static patient load capacity on the
backrest must not exceed 100kg distributed
evenly or damage to locking struts and frame
may occur.
4. Maximum static patient load capacity on the
stretcher is 300kg and must not be exceeded.
Weight must be distributed as evenly as possible
on the stretcher top. Any weight loading above
150kg must be wheeled on smooth, level flooring
and attended by more than one staff member.
5. Only apply brakes when the stretcher is
stationary.
6. Brakes are to be fully applied during bed /
stretcher transfers and attended by qualified
clinical staff.
Guidelines
1. Verify the doctor’s order.
2. Consult with the physical therapist to coordinate
rehabilitation
orders
and teaching.
3. Perform hand hygiene.
The sea does not like to be restrained.
MABALOT, Christianne Jacob O.
BSN2-E
NCM 107 RLE
December 2, 2021
4. Confirm the patient’s identity using at least two
patient identifiers according to your facility’s
policy.
5. Explain the procedure to the patient and answer
any questions to decrease anxiety.
6. As much as possible, nurse must not attempt to
carry patients alone.
7. Backrest must be raised and lowered with care
to prevent possible strain to the operator.
8. Check that all fingers, hands and limbs of the
patient are clear before lowering backrest.
9. Stretchers must never be left on sloping
surfaces unattended, even with brakes fully
engaged.
10. Traversing side on, across slopes is to be
avoided under any circumstances
11. On wet or slippery flooring do not lean or apply
unnecessary force against the stretcher, as it
may slide: even with brakes fully applied.
12. Clips, locks and retainers are supplied by the
manufacturer for patient / staff safety and must
not be removed.
13. When covering the mattress with a sheet, always
ensure that there is sufficient non-slip base
material (more than 75% area of the mattress)
contacting the stretcher top surface, to prevent
slippage or movement of the mattress.
Wheelchair
Flat or level surfaces
When pushing a wheelchair, look ahead and watch for
areas such as holes or any unevenness in the pavement
that could cause potential problems. If you hit that type
of area too fast the resident may pitch forward and fall
out of the wheelchair.
Ramps or inclines surfaces
•
You may need to secure a resident by placing a
hand on their shoulder. In these situations, it may
be necessary to turn the resident and wheelchair
around so you are backing up (pulling the chair
and resident).
• If you are going down an incline, you may need
to do the same thing; turn the wheelchair and
resident around in order to go down the incline
backwards.
• To get over a raised area, put your foot on the
lower back bar of the wheelchair and tip back as
this helps lift the front tires.
Through doors and elevators
1. Watch the resident's arms and legs when going
through doorways to make sure they are in
towards their body to prevent pinching them
between the doorway and wheelchair.
9
MATERNAL CHILD NURSING
2.
Care of Mother, Child, Adolescent (Well-Client) RLE
Cebu Doctors’ University
When entering the elevator, turn the resident
and wheelchair around so you are backing in first
and the resident is facing the elevator doors.
NCM 107 RLE
December 2, 2021
7.
Ensure tubes and attachments are properly
placed prior to the procedure to prevent
accidental removal.
Using canes
Safety Considerations:
• Complete risk assessment for safer patient
handling
• Complete QPA including safety.
• Ensure proper fitting footwear is used.
• Use rubber tips to prevent the device from
slipping.
• Avoid scatter rugs.
• Inspect rubber ends after being outside, and
remove any gravel.
• Ensure tubes and attachments are properly
placed prior to the
procedure to prevent accidental removal.
Steps:
1. Ensure proper footwear is on the patient, and let
the patient know how far you will be ambulating.
Proper footwear is non-slip or slip-resistant
footwear. If in acute care, check prescriber’s
orders for any activity restrictions related to
treatment or surgical procedures.
2. Ensure crutch height is correct.
3. Explain and demonstrate how to walk with
crutches.
4. From a sitting position, advise the patient to push
up from the chair’s armrest to a standing
position. Stand to gain balance. Advise the
patient to not lean on the underarm supports
5. Advise patient accordingly:
Steps:
1. Let patient know how far you plan to ambulate.
Proper footwear is non-slip or slip-resistant
footwear.
2. Ensure cane height is correct.
3. Explain and demonstrate how to walk with
crutches.
4. Encourage the patient to get to a standing
position.
5. Advise the patient to move the cane forward a
short distance.
6. Step forward with injured / weak leg. Put weight
onto the cane handle. Then step with the strong
leg.
7. Ascending stairs:
• Stand close to and facing the bottom
step.
• Step up with the strong leg.
• Ensure balance is maintained.
• Step up with the injured / weak leg.
• Bring cane up.
• Repeat
Ambulation method #1:
1. Establish balance.
2. Move both crutches forward slightly.
3. Move injured leg forward.
4. Push down on the crutch hand grips.
5. Step through the crutches with the good leg.
6. Ensure balance is maintained.
7. Repeat.
Using crutches
Safety considerations:
1. Complete risk assessment for safer patient
handling
2. Complete QPA including safety.
3. Ensure proper fitting footwear is used.
4. Use rubber tips to prevent the device from
slipping.
5. Avoid scatter rugs.
6. Inspect rubber ends after being outside, and
remove any gravel.
The sea does not like to be restrained.
MABALOT, Christianne Jacob O.
BSN2-E
Ambulation method #2:
1. Establish balance.
2. Move the crutches and the injured leg forward
simultaneously.
3. Push down on the crutch hand grips.
4. Step through the crutches with the good leg.
5. Ensure balance is maintained.
6. Repeat.
a. Ascending stairs:
1. Stand close to and facing the bottom step.
2. Step up with the strong leg.
3. Ensure balance is maintained.
4. Move the weak / injured leg onto the step.
5. Move the crutches up.
6. Repeat.
b. Descending stairs:
1. Stand close to the top step and face the stairs.
2. Move crutches to the next step down keeping
weight on the hand grips
3. Step down with weak / injured leg.
4. Ensure balance is maintained.
5. Step down with good / strong leg.
6. Repeat.
10
MATERNAL CHILD NURSING
Care of Mother, Child, Adolescent (Well-Client) RLE
Cebu Doctors’ University
Using walkers
Safety Considerations:
• Complete risk assessment for safer patient
handling
• Complete QPA including safety.
• Ensure proper fitting footwear is used.
• Use rubber tips to prevent the device from
slipping.
• Avoid scatter rugs.
• Inspect rubber ends after being outside and
remove any gravel.
NCM 107 RLE
December 2, 2021
limb wasting or amputation and their mobility. We
need to check the following:
o Is their weight within safe working limits
for the wheelchair being used?
o Can they be correctly positioned when in
the wheelchair
o Are they likely to shift or tip when in the
wheelchair?
Steps:
- Ensure proper footwear is on the patient, and let
the patient know how far you will be ambulating.
Proper footwear is non-slip or slip-resistant
footwear. If in acute care, check prescriber’s
orders for any activity restrictions related to
treatment or surgical procedures.
- Measure client for walker height
- Explain and demonstrate how to walk with a
walker.
- From a sitting position, instruct patient to push
up from the chair’s armrest to a standing
position.
- Firmly grip both sides of the walker. Move the
walker forward a short distance.
- Step forward with the injured or weak leg first,
taking weight through one’s hands. Then step
with the stronger leg. To turn: Advise to take
small steps, moving the walker and then the legs.
EXPLORE SAFETY POINTS OR
ISSUES WHEN A PATIENT IS ON
-
Stretcher
Opt for level ground when possible
Check the wheels on the stretcher
Assess weight of the patient
Look at the stretcher’s legs
Properly place stretcher
Hold handles during transfers
Wheelchair
Floor surfaces should be clear
Space to maneuver the wheelchair
Door frames that are wide enough/suitable
thresholds
Changes in floor height
Ensure lighting is good
Space to park the wheelchair
We need to consider the person’s body
proportions, their upper torso height and mass,
whether they are obese, or if there is any lower
The sea does not like to be restrained.
MABALOT, Christianne Jacob O.
BSN2-E
11