WEEK 7: OXYGENATION

RESPIRATORY SYSTEM ❖ When oxygenated blood reaches tissues

within the body, oxygen is released from
❖ To provide the body with constant supply the hemoglobin, and CO2 is picked up
of oxygen and to remove carbon dioxide and transported to the lungs for release on
❖ Ventilation – muscles and structures of the exhalation
thorax that creates mechanical ❖ 3 major mechanisms on how CO2 is
movement of air in and out of the lungs transported throughout the body:
❖ Respiration – gas exchange where blood is ▪ Dissolved CO2
oxygenated and carbon dioxide is ▪ Attachment to water as HCO3-
removed that takes place in the alveolar (Bicarbonate is a byproduct of the
level of the lungs body’s metabolism)
❖ Several respiratory conditions can affect a ▪ Attachment to the hemoglobin in RBC
patient’s ability to maintain adequate
OXYGEN THERAPY
ventilation and respiration, it can enhance
❖ Oxygen – colorless, odorless, tasteless gas
the client’s oxygenation status through
that is essential for the body to function
medications
properly and to survive
CARDIOVASCULAR SYSTEM 21% of oxygen is the air we breathe
❖ In order for oxygenated blood to move
from the alveoli in the lungs to the various ❖ Oxygen Therapy – administration of O2 at
organs and tissues of the body, the heart a concentration of pressure greater than
must adequately pump blood through the found in the environmental atmosphere
systemic arteries Key treatment in respiratory care
❖ Cardiac Output – amount of blood that
Purposes of Oxygen Therapy:
the heart pumps in 1 minute
❖ Perfusion – passage of blood through the ✓ If the patient requires supplemental
arteries of an organ or tissue oxygen due to inadequate oxygen levels
❖ Several cardiac conditions can adversely in the blood decreases and
affect cardiac output and perfusion in the ✓ To increase O2 saturation when the
body. Several medications can enhance patient’s saturation level are low due to
the patient’s cardiac output and maintain illness or injury
adequate perfusion to organs and tissues
throughout the body Indications for client that requires O2 therapy:
❖ Blood flow: ❖ Acute Respiratory Failure
Superior vena cava & Inferior Vena Cava ❖ Acute myocardial infarction
→ Right Atrium → Tricuspid valve → Right ❖ Cardiac failure
Ventricle → Pulmonary Valve → Pulmonary ❖ Shock
Artery → Lungs ❖ Hypermetabolic state induced by trauma,
burns or sepsis
HEMATOLOGICAL SYSTEM
❖ Although the blood stream carries small ❖ Anemia
amounts of dissolved oxygen, the majority ❖ Cyanide poisoning
of oxygen molecules are transported ❖ During CPR
throughout the body by attaching to ❖ During anesthesia for surgery
hemoglobin within the RBC
❖ Saturated hemoglobin- where the
hemoglobin carries 4 oxygen molecules.
Each hemoglobin protein is capable of
carrying four oxygen molecules.

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 OXYGEN AS A PRESCRIBED DRUG OXYGEN DELIVERY SYSTEMS // METHODS OF
• A dependent nursing care/ intervention OXYGEN ADMINISTRATION
• O2 is a prescribe drug that must indicate
the following: 1. Nasal Cannula or Prongs (O2 Concentration:
✓ Must be written legibly by the 22-44%)
doctor ▪ A disposable, plastic device with two
✓ Date of prescription protruding prongs for insertion into the
✓ Duration of O2 therapy nostrils and connected to an oxygen
✓ O2 concentration source
✓ Flow Rate ▪ Used for low medium concentration of
oxygen
SOURCES OF OXYGEN ▪ FiO2 (Fraction Inspired Oxygen) –
estimation of the O2 content a person
inhales and as a result involved in gas
exchange at the alveolar level
Understanding oxygen delivery and
interpretation of the FiO2 values
takes place a vital importance on
the proper treatment of patients
with hypoxemia
FiO2 and oxygen concentration
are just the same

FiO2 of Nasal Cannula:

1. Oxygen cylinder
Flow Rate – Amount of FiO2 – oxygen
➢ Delivered with a protective cap to
oxygen delivered (In concentration that the
prevent accidental force against liters/min) client inhales
the cylinder outlet 1 L/min 24%
Parts: 2 L/min 28%
a. Reduction gauge - that measures 3 L/min 32%
the amount of oxygen in the tank 4 L/min 36%
b. Regulator - release oxygen safety 5 L/min 40%
at a desirable route 6 L/min 44%
c. Flow meter – regulates the control
of oxygen in LPM (Liters per
minutes) ▪ Advantages:
d. Humidifier – a small contain that is ✓ Client able to talk and eat with
consisted of small amount of sterile oxygen in place
water that prevents the mucous ✓ Easily used in home setting
membranes of the client’s ✓ Safe and simple
respiratory from becoming dry ✓ Easily tolerated
✓ Delivers low concentrations of O2
Oxygen Key / O2 wrench – used to open portable ▪ Disadvantages
oxygen cylinders Unable to use with nasal
obstruction
2. Wall-outlet oxygen
Dries the mucous membranes,
➢ Supplied from a central source
flow rate that is greater than
through a pipeline
4L/mins requires to be humidified
➢ Only a flow meter and humidifier
Can dislodge from nares easily
are required
Causes skin irritation or
breakdown over ears or at nares

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 Not good for mouth breathers
3. Partial Rebreather Mask (FiO2: 40-70%)
Clients’ breathing pattern affects
▪ FiO2: 40-70%
the FIO2
▪ Flow rate: 6-15 L/min (Flow rate must
▪ Nursing Interventions
be maintained at its minimum (6
❖ Be alert for skin breakdown over
L/min) to ensure the client doesn’t
the ears and in the nostrils from
rebreathe large amounts of exhaled
too tight an application
air
❖ Always observe for mucosal
▪ Mask that contains a reservoir bag
dryness
that must remain inflated during both
❖ Check frequently that both
inspiration and expiration
prongs are in the clients’ nares
▪ Collects part of the patient’s exhaled
air
2. Simple Oxygen Mask (FiO2: 35-60% of O2)
▪ Remaining exhaled air exits through
▪ Flow rate: 6-10 liters per minute
vents
▪ FiO2: 35-60%
▪ Advantages:
▪ Used when increased delivery of O2 is
Clients can inhale room air
needed in a short period of time (less
through openings in mask if
than 12 hours)
oxygen’s supply is briefly
▪ Simple mask made of clear, flexible,
interrupted
plastic or rubber that can be molded
▪ Disadvantages:
to fit the face
Requires tight seal (eating and
▪ Held to the head with elastic bands
talking might be difficult and
▪ Contains a metal clip that can be
uncomfortable)
bent over the bridge of the nose for a
▪ Nu. Interventions
comfortable fit
❖ Set flow rate so mask remains
▪ It has vents on its sides that allows
two-thirds full during inspiration
room air to leak in at many places,
❖ Keep reservoir bag free of
diluting the source of oxygen
twists and kinks
▪ Advantages:
4. Non-rebreather mask
✓ Can provide increased
▪ Highest concentration of O2 device
delivery of oxygen for short
▪ FiO2: 95-100%
period of time
▪ Flow rate: 6-15 L/min
▪ Disadvantages:
▪ Similar to partial rebreather except
Tight seal of the mask is
two one-way valves prevent
required to deliver higher
conservation of exhaled air
oxygen concentration
▪ The bag has O2 reservoir
Difficult to keep mask in
▪ When the patient exhales air the one-
position over nose and mouth
way valve closes, all of the expired air
Potential for skin breakdown
is deposited into the atmosphere, not
(eg. Pressure, moisture)
the reservoir bag (Patient is not
Uncomfortable for the client
rebreathing any expired gas)
while eating or talking
▪ Advantages:
Expensive with nasal tube
✓ Delivers the highest possible
▪ Nursing Interventions:
O2 concentration
❖ Monitor client frequently to
✓ Suitable for clients with
check placement of the mask
spontaneous with severe
❖ Secure physician’s order to
hypoxemia
replace mask with nasal
▪ Disadvantages:
cannula during meal time
Not suitable for long term
therapy

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 Malfunction can cause CO2 6. Oxygen Hood
build up ▪ Used for babies who can breathe on
Suffocation their own but still needs extra oxygen
Expensive and uncomfortable ▪ A dome or box that has a warm, moist
▪ Nu. Intervention oxygen inside
❖ Maintain flow rate so reservoir ▪ Placed over the baby’s head
bag collapses only slightly 7. Oxygen Tent
during inspiration ▪ Canopy placed over the head and
❖ Check the valves and rubber shoulders or over the entire body of a
flaps are functioning properly patient to provide oxygen at a higher
(must be open for expiration) level than normal
❖ Monitor SaO2 (O2 saturation) ▪ Made of see-through plastic material
with pulse oximeter ▪ It can envelop the patient’s bed with
5. Venturi Mask (FiO2: 40-50%) the end sections held in place by a
▪ A high flow oxygen delivery device mattress to ensure that the tent is
▪ Flow rate: 4-15 L/min airtight
▪ The mask is constructed so that there ▪ The enclosure has a side opening with
is a constant flow of room air blended a zipper
with a fixed concentration of oxygen 8. AMBU Bag (Artificial Manual Breathing Unit or
▪ Designed with wide-bore tubing and Bag Valve Mask Ventilation)
various color-coded jet adapters that ▪ Hand held device commonly used to
corresponds to a precise O2 provide positive pressure ventilation to
concentration and a specific flow rate patients who are not breathing or not
breathing adequately
Color Code Flow rate FiO2 9. Tracheostomy Collar/Mask
Blue 2-4 L/min 24%
▪ Inserted directly to the trachea
White 4-6 L/min 28%
▪ Indicated for chronic O2 therapy
Orange 6-8 L/min 31%
▪ Flow rate: 8-10L
Yellow 8-10 L/min 35%
▪ Provides accurate FiO2 and good
Red 10-12 L/min 40%
humidity
Green 12-15 L/min 60%
▪ Comfortable and more efficient
▪ Used for clients with COPD
10. T-Piece
▪ Advantages:
▪ Used on end of ET tube when weaning
✓ Delivers most precise oxygen
from ventilator
concentration
▪ Provides accurate FiO2 and good
✓ Doesn’t dry mucous
humidity
membranes
▪ Disadvantages: SIDE EFFECTS AND COMPLICATION OF O2
Uncomfortable THERAPY
Risk for skin irritation
Produce respiratory depression
in COPD patient with high O2 1. Oxygen Toxicity
concentration of 50% ➢ Occurs when inspiration of a high
▪ Nursing Interventions concentration of O2 is prolonged
❖ Requires careful monitoring to in a period of time
verify FiO2 is at the flow rate ➢ O2 concentration is greater than
ordered by the physician 50% over 24-48 hours can cause
❖ Check that air intake valves pathological changes in the lungs
are not blocked

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 2. Retrolental Fibroplasia Evaluation
➢ Occurs in premature infants
✓ Breathing pattern must be regular and at
➢ Blindness due to vasoconstriction
normal rate
and ischemia
✓ Nail beds, conjunctiva of the eyes and lips
3. Absorption Atelectasis
must be pink in color
➢ During O2 delivery, the nitrogen in
✓ Patient has no signs of confusion,
the alveoli is washed out and
disorientation, difficulty with cognition
replaced by oxygen
✓ Arterial oxygen concentration or
➢ O2 is extremely soluble in blood
hemoglobin, and oxygen saturation must
and diffuses very quickly into the
be within normal limits
pulmonary vasculature that leaves
not enough gas in the alveoli to Documentation: (Document the following in the
maintain patency that leads to the patients chart)
alveoli to collapse that causes
absorption atelectasis ✓ Date and time the oxygen started
✓ Method of delivery (Oxygen delivery
SAFETY PRECAUTIONS DURING O2 THERAPY device used)
❖ O2 is a highly combustible gas. It can ✓ Oxygen concentration and its given flow
cause fire in the pt’s room if it contacts a rate
spark from an open flame or electrical ✓ Patient observation while O2 is
equipment administered
❖ O2 must be prescribed and adjusted only ✓ Add oronasal care to the NCP
with a health care provider’s order
❖ Place an “Oxygen in Use” sign on the INCENTIVE SPIROMETER
patient’s door and in the patient’s room ❖ Simple, plastic medical device that
❖ If the oxygen is used at home, placed a exercise the lungs
sign on the door of the house ❖ Commonly used if the client is recovering
❖ No smoking on the oxygen premises to a certain illness, surgery, or chest and
❖ Keep oxygen delivery system 10 feet from abdomen injury to achieve and return the
any open flames patient’s normal O2 level
❖ Determine if all electrical equipment in the ❖ Used to prevent lung infection by
room is functioning correctly expanding, strengthening the lungs by
❖ Secure the oxygen cylinders not to fall keeping the lung inflated and clearing the
over. Store them upright and either mucus and other secretions from the chest
chained or secured in appropriate holders and lungs
❖ Check the O2 level of portable tanks
How to use:
before transporting a patient to ensure
that there is enough oxygen in the tank 1. Allow the patient to sit at the edge of the
patient’s bed. If client’s wasn’t able to sit,
TECHNIQUE OF OXYGEN ADMINISTRATION the client can able to sit on their bed
Technique of Oxygen Administration
2. Hold the incentive spirometer in an upright
position
3. Place the mouthpiece in the patient’s
mouth and tightly seal the patient lips
around it
4. Breathe in as slowly and deeply as
possible. The yellow piston in the
spirometer will be observed as the client
breathes rising toward the top of the
column. The yellow should reach the blue
outlined area

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 8. After each set of 10 deep breath, tell the
5. Tell the client to hold their breath for as
client to cough deeply to clear the lungs.
long as possible for at least 5 seconds. Tell
If the client has a surgery incision, firmly
the client to exhale slowly that allows the
press a pillow or rolled up towel against
piston to fall to the bottom of the column
the incision when coughing to provide
support.
6. Allow the client to rest for a few seconds,
and repeat at least 10 times during the
9. Once the client can get out of the bed
patient’s waking hours
safely, ambulation and practice coughing
is recommended. The discontinuing use of
7. Place the yellow indicator on the side of
the spirometer is based on the instruction
the incentive spirometer to show what
of the healthcare provider.
goal that the client needed to achieve.
Use the indicator as a goal to work toward
10. If the patient felt dizziness or being
during each slow and deep breath.
lightheaded while using the spirometer,
immediately stop using the device and
alert the healthcare provider.

WEEK 8: FLUIDS AND ELECTROLYTES

❖ An average adult human body is

b. Hypotonic – less than Na
consisted of 60% of body fluids, where
and increase of solvent
water is the primary body fluid
(water) that causes the
❖ Intracellular Fluid (ICF) – contains the two-
cells to swell
thirds (4o% body weight) of body fluids
c. Hypertonic – increased
that is found within the cells of the body
levels of Na and the
❖ Extracellular Fluid (ECF) – contains one
solvent moves away from
thirds (20% body weight) of the body fluids
the cell that causes the
and found at the sides of the cells
cell to shrink or burst
▪ Found in between the spaces of the
*Both hypertonic and hypotonic
cell
undergoes hemolysis or apoptosis
o Two Compartments of ECF
❖ Filtration – when water and dissolved
▪ Intravascular Fluid or
substances move through a membrane of
Plasma – 5% of ECF found in
unequal pressure on the two sides of the
the vascular system
membrane
▪ Interstitial Fluid – 15% of ECF
▪ Urine is formed in the kidneys by
surrounding the cells
filtration
❖ Osmosis – movement of water through
▪ Podocyte cells – cells in the urinary
semipermeable membrane from high
system that filters urine
water concentration to low water
❖ Active Transport – movement of molecules
concentration
through the use of ATP
▪ Capable in fluid absorption (eg.
Blood transfusion) FLUID BALANCE
▪ Types of solution: Consists of the following:
a. Isotonic – equal
1. Fluid Distribution
concentration of Na
2. Fluid Intake
(Sodium)
▪ Cells are in an equilibrium ▪ Average adults drinks 1500 ml of
shape water a day, 2500 ml for normal
functioning
▪ Used in BT transfusion for
▪ Regulated by the hypothalamus
adverse reactions

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 ▪ Fluid intake can be: angiotensin I, then converted
a. Enteral – PO (Per Orem), to angiotensin II
Gastric Gavage ▪ Increases blood pressure as
b. Parenteral – IVT, BT (Blood RAAS function to promote or
Transfusion), TPN (Total increase sodium and water
parenteral nutrition) retention.
3. Fluid Output c. Atrial Natriuretic Peptide
▪ Fluid losses from the body that ▪ Released from the cells in the
counterbalance the intake of fluid atrium of the heart that
▪ Fluid output routes: counteracts aldosterone
a. Urine – excreted by the ▪ Inhibits thirst and lowers blood
kidney, 200 cc is normal pressure
range, 1400-1500 within 24 ▪ Secretes excess sodium
hours through urine
b. Feces – excreted from the
Gastrointestinal tract, 200- FLUID IMBALANCES
300ml of fluids is excreted 1. ECF imbalances
❖ Increase of volume: Hypervolemia
per day, more than 300 cc
is the client has diarrhea ▪ Also known as third space volume
c. Insensible Losses – fluid ▪ Shifts from the vascular space into
an area where it is not accessible
output that are not
as ECF
measurable and not
noticeable ▪ Shifting of fluid to the organs that
• Sweat – excreted must not contain fluid
▪ E.g. Ascites, Pleuritis
by the skin through
❖ Decrease of Volume: Hypovolemia
perspiration
• Lungs – excreted ▪ Overhydration or fluid volume
through water excess
▪ Edema – both intravascular and
vapor
interstitial spaces have an
4. Hormones
▪ Mechanisms that control the fluid increased water and sodium
and electrolyte balance content
▪ Pitting edema – an edema that
a. Antidiuretic hormone – released in
leaves a small depression after
the posterior part of the pituitary
gland finger pressure is applied in the
▪ The more ADH produced swollen area.
- Skin turgor/elasticity has not
decreases the urine output
returned more than 2 seconds
that causes to become
concentrated, dark orange ▪ Dehydration – water is lost in the
to red in color body, the sodium increases
2. Osmolality imbalances
b. Renin-Angiotensin-Aldosterone
System ▪ Hypernatremia – water deficit and
▪ Renin is found in the kidney excess sodium in the ECF that
causes the cells to become
▪ Angiotensin is found in the
hypertonic (to shrink or burst)
liver
▪ Aldosterone – found in the ▪ Hyponatremia – Water excess and
adrenal cortex sodium deficit in the ECF that
causes the cells to become
▪ RAAS is a weak hormone that
hypotonic (to swell)
is converted by the renin to
angiotensinogen to 3. Clinical Dehydration
▪ Deficit in extracellular volume and
hypernatremia combined

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 ACID-BASE IMBALANCES
❖ Normal Arterial Blood pH ranges between
ELECTROLYTES FUNCTIONS AND IMBALANCES 7.36 and 7.44 (H+ between 44 and 36
Electrolyte Function Normal Imbalances
Values nEq/L)
Sodium Controlling 135- ↑ Na+: ❖ Blood is slightly alkaline and can be
and 145 Hypernatremia assessed through ABG (Arterial Blood Gas)
regulating mmol/ ↓ Na+:
water L Hyponatremia Types of Acidosis
balance 1. Respiratory Acidosis
Chloride To regulate 96-106 ↑ Cl-:
• Carbonic acid levels increases
serum mmol/ Hyperchloremia
and pH fall below 7.35 caused
osmolality L ↓ Cl-:
by CO2 retention,
and blood Hypochloremia
volume hypoventilation or impaired
Phosphate Functioning 1.22 ↑ PO43+: lung function
of muscles, to Hyperphosphat
nerves and 1.45 emia 2. Metabolic Acidosis
RBC mmol/ ↓PO43+: • Bicarbonate levels are low in
L Hypophosphate relation to the amount of
mia carbonic acid in the body
- Small 3.5-5.3 ↑ K+: • May occur to renal failure
amount of mmol/ Hyperkalemia • Metabolic acidosis stimulates
ECF that is L ↓ K+: the respiratory center that
vital for Hypokalemia increases the RR and depth of
Potassium skeletal,
respirations
cardiac,
and smooth Types of Alkalosis
muscle
activity 1. Respiratory Alkalosis
- For heart • More CO2 than the normal is
muscle exhaled that causes the
contraction carbonic acid levels to fall
Calcium For 2-2.6 ↑ Ca2+: and pH rises greater than 7.45
regulation mmol/ Hypercalcemia • Caused by psychogenic or
of L ↓Ca2+: anxiety-related
neuromusc Hypocalcemia
hyperventilation or fever and
ular
respiratory infections
function,
2. Metabolic Alkalosis
including
muscle • Amount of bicarbonate in
contraction, the body exceeds the normal
relaxation 20:1 ratio
and • Caused by ingestion of
cardiac bicarbonate (soda)
function • Respiratory center is
Magnesium For 0.85- ↑ Mg2+: depressed that lead to slow
intracellular 1.10 Hypermagnese RR and shallow breathing
metabolism, mmol/ mia
for the L ↓Mg2+:
production Hypomagnesem
and use of ia
ATP

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 b. Right heart failure –
systemic swelling
INTRAVENOUS THERAPY: NURSING PROCESS
(ASSESSMENT) - Oliguric renal disease – micturition,
kidney is not able to produce urine
1. Gather client’s subjective data (history)
a. Age 3. Daily weights – indicator of fluid status
- Infants have more fluid that 4. Fluid Intake and Output (I & O)
leads to increased
- 24-hour I & O: Compare intake versus
metabolic rate
- Elderly has less fluid output
b. Environment - Intake – all liquids eaten, drunk or received
- Client’s exposure to hot or
through IV
cold temperature
- Output – urine, diarrhea, vomitus, gastric
c. Dietary Intake
- Fluids, salt, foods rich in suction, wound drainage
potassium, Ca, Mg
d. Lifestyle 5. Laboratory Studies
- Alcohol intake history
(alcohol can be a diuretic
that causes INTRAVENOUS THERAPY: NURSING PROCESS
hypomagnesemia (moving (DIAGNOSIS)
slowly) and hypovolemia • Excess fluid volume
(due to excessive urination) • Deficient fluid volume
e. Medications • Risk for electrolyte imbalance
- Over the counter • Deficient knowledge regarding disease
medications or prescribed management

2. Client’s medical history INTRAVENOUS THERAPY: NURSING PROCESS

f. Recent surgery (Physiological (INTERVENTION/ IMPLEMENTATION)
Stress) – clients scheduled for
surgery and under general
A. Fluid Balance
anesthesia are NPO for 6-8
• Urine output will intake of 1500ml in 2
hours
days
g. Gastrointestinal output - Flatus
• Mucous membranes will be moist in 24
is an indication of patient’s
hours
stable (indication of bowel
• Skin turgor will return to normal within 24
movement)
hours
h. Acute Illness or trauma
• Daily weights will not vary by more than
- Respiratory disorders
2 lbs over the next 2 days
- Burns – 2nd degree burns
have no perspiration,
B. Electrolyte and Acid-base balance
only plasma secretion
• Serum electrolyte and blood counts will
that can cause infection
be within normal limits within 48 hours
and dehydration
- Trauma
C. Acute Care
i. Chronic Illness
• Enteral replacement of Fluids
- Cancer
• Restriction of Fluids
- Heart failure
• Parenteral replacement of
a. Left heart failure -
fluids and electrolytes
difficulty of breathing
▪ TPN
▪ Crystalloids (Electrolytes)

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 ▪ Drip chamber
▪ Colloids (Blood and
▪ Roller valve
blood components
▪ Screw clamp
INTERVENTIONS ▪ Tubing with secondary ports
▪ Protective cap over the
1. Interventions for electrolyte imbalances connector to the IV catheter
• Supported prescribed medical
therapies B. Before IV preparation
• Aim to reverse the existing • Assesses patient’s/ family
acid-base imbalance caregiver’s health literacy
• Provide for patient safety • Assess patient’s knowledge and
prior experience with infusion
2. Interventions for acid-base imbalances therapy and feelings about
• Arterial blood gases procedure
3. Restorative care • Introduce self and verify the client’s
• Home intravenous therapy identity using agency protocol
• Nutrition support • Explain the procedure
• Medication safety • Position the client appropriately
▪ Medications • Apply medication label to the
▪ OTC drugs solution container (If any)
▪ Herbal preparations C. Initiating IV therapy
1. Open and prepare the infusion set
INTRAVENOUS THERAPY: NURSING PROCESS
▪ Remove the IV solution from
(EVALUATION)
the packaging and gently
apply pressure to the bag
Patient outcomes
while inspecting for tears
➢ Evaluate the effectiveness of interventions and leaks
using the goals and outcomes established ▪ Check the color and clarity
for the patient’s nursing diagnoses of the solution
▪ Do hand hygiene/gloving
▪ Remove the primary IV
INTRAVENOUS THERAPY: RETURN tubing from the packaging
DEMONSTRATION 2. Move the roller clamp so that it is
halfway up the tubing and clamp it
3. Remove the cover from the tubing
A. Preparation port on the bag of IV fluid
1. Review pt’s MER for accuracy of 4. Remove the cap from the insertion
health care provider’s order. Follow spike on the tubing. While
the rights of medication maintaining sterility, insert the spike
administration. into the tubing port of the bag of IV
✓ Date and time fluid
✓ IV solution 5. Squeeze the drip chamber 2-3
✓ Route of administration times to fill the chamber halfway
✓ Volume 6. Hang the solution container
✓ Rate 7. Adjust the pole 1m above the
✓ Duration client’s head
✓ Signature 8. Loosen the cap from the end of the
2. Prepare the equipment – make sure all IV tubing and open the clamp to
parts of the infusion set is complete prime the tubing
➢ Infusion set parts
▪ Insertion spike

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 9. Once primed, clamp the IV tubing. Problem 2: D50.3NaCl÷L x 12˚
Check the entire length of the
𝑡𝑜𝑡𝑎𝑙 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑣𝑜𝑙𝑢𝑚𝑒 (𝑑𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟)
tubing for air bubbles. Tap the 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛 =
𝑡𝑜𝑡𝑎𝑙 𝑡𝑖𝑚𝑒 𝑜𝑓 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑖𝑛 𝑚𝑖𝑛𝑢𝑡𝑒𝑠
tubing gently to remove any air
10. Replace or tighten the cap on the 1000 𝑐𝑐 (20)
end of the tubing 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛 =
60 𝑚𝑖𝑛𝑢𝑡𝑒𝑠 𝑥 12
11. Label the IV fluid
20000
12. Perform handwashing 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛 =
720
CONNECTING THE IVF TO THE VENTIPUNCTURE 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛 = 20 𝑑𝑟𝑜𝑝𝑠 𝑝𝑒𝑟 𝑚𝑖𝑛𝑢𝑡𝑒
SITE
1. Assess the patient’s venipuncture site for Problem 3: Pt is receiving 250 ml normal saline
signs and symptoms of vein irritation or over 4 hours, using tubing w/ drip factor of 10
infiltration. Do not proceed with drops/mL. How many drops per minute should be
administering fluids at this site if there are delivered?
any concerns.
Total infusion volume - 250 ml
2. Vigorously cleanse the catheter cap on
Drop factor – 10 gtts/mL
the pt’s IV port with an alcohol pad/scrub
Total infusion time – 4 hours
hub (or the agency required cleansing
agent) for at least 5 seconds and allow it Solution:
to dry
𝑡𝑜𝑡𝑎𝑙 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑣𝑜𝑙𝑢𝑚𝑒 (𝑑𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟)
3. Remove the protective cap from the end 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛 =
of the primary tubing and attach it to the 𝑡𝑜𝑡𝑎𝑙 𝑡𝑖𝑚𝑒 𝑜𝑓 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑖𝑛 𝑚𝑖𝑛𝑢𝑡𝑒𝑠
IV port while maintaining sterility 250 𝑚𝑙 (10)
4. Regulate the drop rate or set the infusion 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛 =
60 𝑚𝑖𝑛𝑢𝑡𝑒𝑠 𝑥 4
rate based on the provider order
2500 𝑚𝑙
𝑔𝑡𝑡𝑠/𝑚𝑖𝑛 =
FORMULA FOR CALCULATING DROPS PER 240
MINUTE (ggts/min) 𝐷𝑟𝑜𝑝𝑠 𝑝𝑒𝑟 𝑚𝑖𝑛𝑢𝑡𝑒 = 10 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛

*gtts = guttae (latin word meaning drops)

𝑡𝑜𝑡𝑎𝑙 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑣𝑜𝑙𝑢𝑚𝑒 (𝑑𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟)
𝑔𝑡𝑡𝑠/𝑚𝑖𝑛 = *drops per minute = gtts/min
𝑡𝑜𝑡𝑎𝑙 𝑡𝑖𝑚𝑒 𝑜𝑓 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑖𝑛 𝑚𝑖𝑛𝑢𝑡𝑒𝑠
FORMULA FOR CALCULATING MILLILITERS PER
Problem 1: D5LR÷L x 8˚ (Interpretation:1000 cc of
HOUR (mL/hour)
D5LR for 8 hours, 20 is the given drop factor) 𝑡𝑜𝑡𝑎𝑙 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑣𝑜𝑙𝑢𝑚𝑒 (𝑐𝑐/𝑚𝐿)
𝑚𝐿/ℎ =
Solution: 𝑡𝑜𝑡𝑎𝑙 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑟𝑎𝑡𝑒

𝑡𝑜𝑡𝑎𝑙 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑣𝑜𝑙𝑢𝑚𝑒 (𝑑𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟) Problem 1: D5LR÷L x 8˚

𝑔𝑡𝑡𝑠/𝑚𝑖𝑛 =
𝑡𝑜𝑡𝑎𝑙 𝑡𝑖𝑚𝑒 𝑜𝑓 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑖𝑛 𝑚𝑖𝑛𝑢𝑡𝑒𝑠
1000 𝑐𝑐 𝑥 20 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛 60 minutes is just the Total Infusion rate: 8 hours
𝑔𝑡𝑡𝑠/𝑚𝑖𝑛 = conversion kung How many liters per IV fluid: 1000 mL/1000 cc/ 1
60 𝑚𝑖𝑛𝑢𝑡𝑒𝑠 𝑥 8
ilang minutes meron
sa 8 hours, that’s
liters
20,000
𝑔𝑡𝑡𝑠/𝑚𝑖𝑛 = why nagkaroon ng 1000 𝑐𝑐
480 60 minutes. 𝑚𝐿/ℎ = 𝑚𝐿/ℎ = 122 𝑐𝑐/ℎ𝑟
8 ℎ𝑜𝑢𝑟𝑠
𝑔𝑡𝑡𝑠
= 41 − 42 𝑔𝑡𝑡𝑠/𝑚𝑖𝑛
𝑚𝑖𝑛
*Always round up your answer to whole number

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 ✓ Phlebitis
Problem 2: D50.3NaCl÷L x 12˚
✓ Local infection
Total Infusion rate: 12 hours ✓ Bleeding at the infusion site
How many liters per IV fluid: 1000 cc • Continuing Peripheral IV access

𝑚𝐿/ℎ =
1000 𝑐𝑐
mL/hr = 83 𝑐𝑐/ℎ𝑟 BLOOD TRANSFUSION
12 ℎ𝑜𝑢𝑟𝑠
• Blood component therapy = IV
*cc and mL is just the same administration of whole blood or blood
component
Problem 3: Patient needs 2000 ml of saline IV over • Blood groups and types
4 hours for a patient with deficient fluid volume. • Transfusing blood
How many milliliters per hour will you set on a • Transfusion reactions and other adverse
controller? effects
Total Infusion rate: 4 hours BLOOD TYPING AND CROSS MATCHING
How many liters per IV fluid: 2000 ml • Blood transfusions must be matched to
2000 𝑚𝐿 each patient to avoid incompatibility
𝑚𝐿/ℎ = mL/hr = 500 𝑚𝐿/ℎ𝑟
4 ℎ𝑜𝑢𝑟𝑠 • If incompatible blood is transfused, the pt’s
FORMULA FOR CALCULATING INFUSION TIME antibodies trigger RBC destruction in a
potentially dangerous transfusion reaction
(H)
*How many hours will pass = indication of infusion OBJECTIVES OF BLOOD TRANSFUSION
time 1. To increase circulating blood volume after
𝑡𝑜𝑡𝑎𝑙 𝑣𝑜𝑙𝑢𝑚𝑒 𝑡𝑜 𝑖𝑛𝑓𝑢𝑠𝑒 (𝑚𝐿) surgery, trauma or hemorrhage
𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑡𝑖𝑚𝑒 =
𝑚𝑖𝑙𝑙𝑖𝑡𝑒𝑟 𝑝𝑒𝑟 ℎ𝑜𝑢𝑟 𝑏𝑒𝑖𝑛𝑔 𝑖𝑛𝑓𝑢𝑠𝑒𝑑 (
𝑚𝐿
) 2. Increasing the number of RBC’s and
ℎ𝑜𝑢𝑟
maintaining hemoglobin levels in patients
Problem 1: D5LR÷L x 8˚, ml/hr: 122 cc/hr w/ severe anemia
1000 𝑚𝐿 3. Providing selected cellular components as
𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑡𝑖𝑚𝑒 = 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑡𝑖𝑚𝑒 = 8 ℎ𝑜𝑢𝑟𝑠
122 𝑚𝐿/ℎ𝑟 replacement therapy (Eg. Clotting factors,
platelets, albumin)
Problem 2: D50.3NaCl÷L x 12˚, ml/hr: 83 cc/hr
1000 𝑚𝐿 NURSING RESPONSIBILITIES
𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑡𝑖𝑚𝑒 = 𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑡𝑖𝑚𝑒 = 12 ℎ𝑜𝑢𝑟𝑠
83 𝑚𝐿/ℎ 1. Check the agency policy and procedures
Problem 3: A patient is ordered to received 1000 before initiating blood therapy
mL of NSS to be administered at 125 mL/hr. How 2. Verify the following:
many hours will pass before you change the IV ✓ The blood product delivered must
bag? be the ones ordered
✓ Properly typed and cross matched
1000 𝑚𝐿
𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑡𝑖𝑚𝑒 =
125 𝑚𝐿/ℎ
𝑖𝑛𝑓𝑢𝑠𝑖𝑜𝑛 𝑡𝑖𝑚𝑒 = 8 ℎ𝑜𝑢𝑟𝑠 listed in record
✓ Right pt through identifiers
REMINDERS FOR IVT (INTRAVENOUS THERAPY) 3. The BT procedure begins when an
• Too rapid or excessive infusion of any IV intravenous IV line is placed onto the
fluid has the potential to cause serious patient’s body
problems ▪ Transfusion rate depends on
• Document all assessment and intervention physician order, simple BT lasts 1-4
hours
MONITORING CLIENTS WITH IVF THERAPY 4. Monitor for any adverse reactions
• Changing intravenous fluid containers,
▪ Blood transfusions are never
tubing and dressings
regarded as routine, overlooking
• Complications
any minor detail can have
✓ Fluid overload
dangerous and life-threatening
✓ Infiltration
events for a pt
✓ Extravasation

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 ▪ If there’s adverse reactions, stop S/s: Dyspnea, edema
the transfusion immediately and Tx: Give blood slowly, med ad of diuretics with
notify the health care provider or transfusion
emergency response team
5. Stay with the patient and monitor vitals
every 5 minutes
6. Prepare emergency drugs, kit, cart such
as antihistamines, corticosteroids per HCP
order
7. Save the blood container, tubing,
attached labels and transfusion record for
return to the blood bank
8. Obtain blood and urine specimen per
doctor’s order or protocol

BLOOD TRANSFUSION ADVERSE REACTIONS

1. Febrile Transfusion Reactions – most

common adverse reaction in BT
S/s: Chils, malaise, 1 degree rise in
temperature
Tx: Acetaminophen (Paracetamol)

2. Hemolytic Transfusion Reaction – worst

reaction due to ABO incompatibility
S/s: Fever, chills, pain at the site of
reaction, nausea, vomiting, shock, dark
urine
Tx: Stop BT transfusion, Lots of IV fluids,
diuretics

3. Allergic Reaction – secondary to

antibodies in the blood causes the allergic
reaction in BT
S/s: Urticaria, pruitis, hives, several cases of
anaphylaxis
Tx: Med ad of antihistamines, don’t stop
transfusion

4. Transfusion Related Acute Lung Injury

(TRALI) – common cause of death
associated to transfusions, better prognosis
than most ARDS
S/s: Dyspnea, hypoxemia, bilateral chest
infiltrates
Tx: Stop the transfusions, airway control,
supportive care
5. Transfusion Associated Circulatory
Overload (TACO) – occurs in elderly and
chronically anemic

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 Hygiene measures provide the best control
of body or breath odors
WEEK 10: BEDMAKING
• Noise and lighting sensitivity for ill patients.
Attempt to control noise level and explain
the source of unfamiliar noises such as IV
BEDMAKING pump and pulse oximeter alarms
• An art, way of preparing the appropriate especially when the client trying to sleep
bed based on the condition of the pt that
adopt scientific principles of nursing BEDS
• Promotes pt’s comfort • Piece of equipment in the hospital that is
• For nurses to be able to prepare hospital designed for comfort, safety, adaptability
beds in different ways for specific for changing positions
purposes: • Used by seriously ill patients that often
✓ Unoccupied bed for after-clients received remained in bed for a long time
the certain care • Hospital beds contains firm mattress on a
✓ Occupied bed for clients who is having metal frame that can be raised and lower
surgery that can be post-op or surgical horizontally that can be adjusted
bed electronically
▪ Low beds – to prevent falls and
PURPOSES OF BEDMAKING regulate mattress pressure to
• Promotes client’s comfort reduce pressure ulcers
• Provide clean environment for the clients • Maintain the bed height at the lowest
• Provide smooth, wrinkle-free bed horizontal position when pt is unattended
foundation, minimizing the sources of skin
irritation COMMON TYPES OF BED
• Conserve the client’s energy and maintain
current healthy status 1. Occupied bed – pt is not permitted to get
• Prevent microorganisms to come in out of the bed
contact the patient which could cause 2. Unoccupied bed – no pt is confined in the
tribulations bed, while a pt may be in the shower or
sitting up in a chair
PATIENT’S ROOM ENVIRONMENT - Types of unoccupied bed:
• Attempts to make the pt’s room as a. Open bed – top covers are folded
comfortable as home that is safe and back so the pt can get easily get
large to allow pt’s and visitors to move back into bed
freely b. Closed bed – top sheet blankets and
• Removal of barriers – reduces risk falls bedspreads and drawn up to the
• Control room temperature, ventilation, head of the mattress under the
noise and odors – keeps the room neat pillow, prepared in a hospital room
and orderly that contributes to pt’s sense before a client is admitted to the
of well being room
c. Post-operative bed or recovery bed
MAINTAINING COMFORT
or anesthesia bed – for pt’s with
• Effective ventilation system keeps stale air
large cast or other circumstance
and odors from lingering in a room
that would make it difficult for the pt
• Protect acutely ill, infants, older adults from
to transfer easily into bed
drafts by ensuring that they are dressed
adequately and covered with lightweight KINDS OF LINENS
blanket 1. Blanket – large piece of cloth that is often
• Promptly empty and rinse commodes, bed soft, woolen, used for warmth as a bed
pans and urinals cover
• Room deodorizers to remove unpleasant 2. Top sheet – to cover the pt to provide
odors. Ensure the patient that the warmth, made of cotton, thermal material
deodorizer used is not allergic or sensitive.

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 3. Cotton draw sheet – piece of cloth that • Purposes of pt positioning:
the rubber sheet is used to absorb and ✓ Provides optimal exposure to the
moisture surgical treatment site or surgical
4. Bottom sheet – used to cover the bed after specimen collection
mattress cover ✓ Maintaining the pt’s dignity by
5. Rubber sheet – protects the bottom sheet controlling unnecessary procedure
from soothing due to pt’s secretions and ✓ Providing airway management and
prevent pt’s from getting bedsore, usually ventilation
placed over the center of the bottom ✓ Maintaining body alignment and
sheet physiologic safety
6. Blanket – large piece of clothe that is • Goals of pt positioning:
often soft, woolen and used for warmth as ✓ Safeguard the pt from immobility
a bed cover injury and physiological
7. Cotton draw sheet – piece of cloth that complications
the rubber sheet used to absorb and ✓ Provide pt comfort and safety
moisture ▪ Pt’s airway and maintain
circulation
GUIDELINES IN BEDMAKING ▪ Preventing nerve damage by
preventing unnecessary extension
or rotation of the body
✓ Maintaining pt’s dignity and privacy
(minimizing exposure of the pt who
often feels vulnerable
perioperatively)
✓ Allows maximum visibility and
access – ease surgical access as
well as for anesthetic administration
during the perioperative phase

GUIDELINES FOR PT’S POSITIONING

❖ Proper execution is needed during pt
positioning to prevent injury for both pt
and nurse

1. Explain the procedure

PATIENT POSITIONING ▪ Explain why the client’s position is
• Different bed positions promote pt changed and how it will be done
comfort, minimize symptoms, promotes ▪ Establishing rapport with the pt will
lung expansion, improve access during make them more likely to maintain
certain procedures and eliminates the new position
musculoskeletal strain 2. Encourage the client to assist as much as
• Involves properly maintaining a pt’s possible
neutral body alignment by preventing ▪ Determine if the client can full or
hyperextension and extreme lateral partially assist
rotation to prevent complications of ▪ Clients who can assist will save
immobility and injury strain on the nurse and can be a
• An essential aspect of nu. practice and a form of exercise, increasing client’s
nurse’s responsibility independence and self-esteem
3. Get adequate help
▪ Positioning is not a one-person task,
ask for the help from other

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 caregivers when planning to move ▪ Variations:
or reposition the client a. Low fowlers – 15-30
4. Use mechanical aids degrees
▪ Bed boards, slide boards, pillows, b. Semi-fowlers – 30-45
patient lifts, and slings can facilitate degrees
the ease of changing positions c. High fowlers – nearly
vertical
KINDS OF PT POSITIONING ▪ Promotes lung expansion – gravity
pulls the diaphragm downward
1. SUPINE OR DORSAL RECUMBENT
allowing greater chest and lung
▪ Pt lies flat on the back with head &
expansion
shoulders slightly elevated using a ▪ Useful for NGT – pt’s with cardiac,
pillow respiratory or neurological
▪ Legs may be extended or slightly
problems
bent
▪ Prepare the pt for walking – nurses
▪ Provides comfort for pt’s under must watch out for dizziness or
recovery from surgery (surgical faintness during a change of
procedures that involves anterior
position
surface of the body such as ▪ Used in surgeries – for neurosurgery
abdominal, cardiac, thoracic) or shoulders
▪ Common used position for general
▪ Use a footboard – recommended
examination or physical
to keep the pt’s feet in proper
assessment alignment to prevent foot drops
▪ Reminders:
✓ Watch out for skin breakdown
3. ORTHOPNEIC OR TRIPOD POSITION
and pad bony prominences –
▪ The client is in a sitting position
risk for pressure ulcers and with an overbed table in front to
nerve damage lean on and several pillows to rest
✓ Support for supine position –
on
pillows placed under the
▪ Maximum lung expansion – for
head to lumbar curvature. clients who have difficulty
Heels must be protected from breathing
pressure by using a pillow or
▪ Helps in exhaling – the lower part
ankle roll that prevents
of the chest against the edge of
prolonged plantar flexion the overbed table
and stretch injury of the feet
by placing a padded
4. PRONE POSITION
footboard.
▪ Patient lies on the abdomen with
✓ Supine position in surgery – their head turned to one side and
placing a pillow or donut hips are not flexed
should stabilize the head.
▪ Allows full extension of hips and
Extreme rotation of the head knee joints – the only position that
during surgery can lead to allows full extension of lower
occlusion of the vertebral
extremities and prevent flexion
artery
contractures
▪ Contraindicated for spine
2. FOWLER’S OR SEMI-SITTING POSITION problems – produces marked
▪ Pt’s head is elevated 45-60
lordosis or forward curvature of
degrees
the spine. Prone position must be
▪ Named after George Ryerson only used when client’s back is
Fowler, used it as a way to correctly aligned
decrease the mortality of peritonitis

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 receiving enemas or undergoing
▪ Used in neck and spine surgeries examinations and treatments of
▪ Always put a small pillow under the perineal area
the head or a towel roll under the ▪ Comfort for pregnant women –
abdomen position comfortable for sleeping
▪ Promote body alignment with
5. LATERAL SIDE LYING pillows – place a pillow
▪ One side of the body with the top underneath pt’s head, under the
leg in front of the bottom leg and upper arm, and pillow between
hip and knee flexed the legs to prevent internal
▪ Flexing the top hip and knee rotation
placing this leg in front of the 7. LITHOTOMY POSITION
body creates wider, triangular ▪ Pt is on their back with hips and
base of support and achieve knees flexed and thighs apart
greater stability ▪ Commonly used vaginal
▪ Increase flexion of top hip and examinations and childbirth
knee: greater stability and ▪ Variations:
balance a. Low lithotomy position –
▪ Reduces lordosis and promotion pt’s hips are flexed until
of good back alignment the angle posterior
▪ Relieves pressure on the sacrum surface of the pt’s thighs
and heels – for people who sit or and OR bed is parallel
confined to bed rest in supine or and 40-60 degrees in
fowler’s angle
▪ Body weight distribution – body b. Standard lithotomy - 80-
weight is distributed to the lateral 100 degrees
aspect of the lower scapula, ilium, c. Hemi-lithotomy –
and greater trochanter of the patient’s non-operative
femur leg is in position of
▪ Support pillows are need to standard lithotomy, while
correctly and comfortably the operative leg is in
position the patient in side-lying traction
position d. High lithotomy position –
110-120 degrees
6. SIMS POSITION e. Exaggerated Lithotomy –
▪ Patient assumes a posture 420 – 450 degrees
halfway between the lateral and
prone positions 8. TRENDELENBURG’S POSITION
▪ Lower arm is positioned behind ▪ Involves lowering the head of
the client and its upper arm is the bed and raising the foot of
flexed at the shoulder and elbow the bed of the pt. Pt’s arms
is acutely flexed at the both the should be tucked at their sides
hip and knee ▪ Promotes venous return – for
▪ Prevents aspiration of fluids – may hypotensive clients
be used for unconscious clients ▪ Postural drainage – to provide
▪ Reduces lower body pressure – postural drainage of the basal
may be used for paralyzed lung lobes but watch out for
patients that reduces pressure dyspnea due to some pts
over the sacrum and greater require moderate tilt or short
trochanter of the hip period of time in this position
▪ Perineal area visualization and
treatment – used for clients

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 9. REVERSE TRENDELENBURG heart (risk for deep vein
▪ Head of the bed is elevated thrombosis)
with the foot lowered down ▪ Support paddings or pillows to
▪ Gastrointestinal problems – support the body and reduce
helps to minimize esophageal pressure on the pelvis, back and
reflux abdomen
▪ Prevent rapid change of
position – for pt’s with 12. KIDNEY POSITION
decreased cardiac output. ▪ A modified lateral position where
Watch out for rapid the abdomen is placed over the
hypotension that can be lift of the OR able that bends the
minimized gradually changing body
pt’s position ▪ Pt is turned on their contralateral
▪ Prevent esophageal reflux – side with their back placed on the
promotes stomach emptying and edge of the table
prevents reflux for clients with ▪ Contralateral kidney is placed
hiatal hernia over the break in the table or the
kidney body elevator
10. KNEE-CHEST POSITION ▪ Uppermost arm is placed in a
▪ Lateral knee-chest position gutter rest at a 90-degree
▪ Pt lies on the side and torso lies abduction flexion
diagonally across the table, knees ▪ Access to retroperitoneal area –
and hips are flexed allows access and visualization of
▪ Prone knee-chest position – the retroperitoneal area, a kidney
patient kneel on the table and rest or a small pillow is placed
lowers their shoulders onto the under the pt at the location of the
table, so the chest and face rest lift
the table (for sigmoidoscopy, ▪ This position is risk for falls that the
gynecologic and rectal pt may fall of the table until the
examinations, and pt’s dignity position is secured
that can be embarrassing to ▪ Padding and stabilization support
some clients) may require since the
contralateral arm is underneath
11. KRASKE OR JACK KNIFE the body is that requires padding.
▪ Pt’s abdomen lies flat on the bed, The contralateral knee is flexed,
the bed is scissored where it ends and the uppermost leg is left
as the hips are lifted and the legs straight to improve stability. A
and head are low large soft pillow is placed in
▪ Surgeries – for surgeries that between the legs. A kidney strap
involves anus, rectum coccyx, and tape are placed over the hip
certain back surgeries and to stabilize the patient
adrenal surgery
▪ Requires team effort – four people SUPPORT DEVICES FOR PT POSITIONING
1. Bed boards – plywood boards placed
are required to perform the
under the mattress’ entire surface area
transfer and position the patient
on the operating table and useful for increasing back support and
▪ Cardiovascular effects – boy alignment
2. Foot boards – rigid plastic or heavy foam
compression of the inferior vena
shoes that keep the foot flexed at the
cava from abdominal
compression also occurs that proper angle. It is recommended to
decreases venous return to the remove 2-3 times a day to assess the
integrity and joint mobility

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT
 3. Hand rolls – maintains the fingers to be
slightly flexed and functional position and
the thumb slightly adducted in opposition
to the fingers
4. Hand-wrist splints – individually molded for
the client to maintain proper alignment of
the thumb in slight adduction and the wrist
in slight dorsiflexion
5. Pillows – provides support, elevate body
parts, and splint incision areas, reduces
postoperative pain during activity. Pillows
should be appropriate size for the body to
be positioned
6. Sandbags – soft devices filled with
substances that can be used to shape or
contour the body’s shape and provide
support. The immobilize extremities and
maintain specific body posture
7. Side rails – bars along the sides of the
length of the bed that ensures client safety
and useful for increased mobility. Side rails
can be used to assist the patient from
rolling side to side or sitting in bed
8. Trochanter rolls – prevents the external
rotation of the legs when the client is in the
supine position. To form a roll, use a cotton
bath blanket or sheet folded lengthwise to
a width extending from the greater
trochanter of the femur to the lowest
border of the popliteal space
9. Wedge Pillows – triangular pillows made of
heavy foam and used to maintain legs in
abduction following total hip replacement
surgery

TRANSCRIBED BY: YUTUC, JULIA FAYE M. (BSN 1A)

INSTRUCTOR: PROF. ODIELON FILOMENO AND PROF. JEANETTE MANLANGIT