RLE REVIEWER
WEEK 1
PHILIPPINE ● State of the World’s Health
HEALTHCARE ○ About half of the people in the world do not have access to universal health coverage
○ Cardiovascular & Ischemic diseases: No. 1 disease in the country
● Infants and adults
○ Bacterial Sepsis of the newborn
○ Respiratory distress
○ Pneumonia
○ Congenital Pneumonia
○ Neonatal Aspiration
PUBLIC & PRIVATE ● Public sector: largely financed through a tax-based budgeting system at both national and local levels,
SECTORS where healthcare is generally given for free
● Private sector: for-profit and non-profit organizations…
● PhilHealth is applicable to both
DOH ● Leading agency in health
● Has field offices in every region
Secretary of Health of ● Vision: Filipinos are among the healthiest people in Asia by 2040
the Philippines: ● Mission: two towards the development of an effective resilient….(la natapos)
Teodoro Herbosa ● 3 major roles
○ Leadership in health
○ Enabler and capacity builder
○ Administrator of specific services
● RA 7160: The Local Government Code
○ Transforms local government units into self-reliant communities and active partners in the
attainment of national goals through a more responsive and accountable local government structure.
GOALS OF DOH ● Overriding goal of DOH: Health sector reform agenda
● Rationale:
○ Slowing down of Infant Mortality Rates (IMR) and Maternal Mortality Rates (MMR)
○ Resistance to large variations in health status across populations
○ High burden of infectious diseases
○ Rising burden of chronic & degenerative diseases
○ The burden is heaviest on the poor
○ According to DOH, it will take 12 years for the Philippines to solve the shortage of nurses
● Need to take note:
○ SGD 5,6 & 8 are important (didn’t get to take note why)
○ SDG 5: Gender equality
○ SDG 6: Clean water and sanitation
○ SDG 8: Decent work and economic growth
MILLENNIUM ● To combat poverty
DEVELOPMENT
GOALS
WEEK 2 (ADPIE & TRANSCRIBING DATA)
COLLECTION OF ● Assessment:
SUBJECTIVE AND ○ First and most critical phase of the nursing process
OBJECTIVE DATA ○ Collection of subjective and objective data
○ Validation of data
○ Documentation of data
Subjective data (verified only by the client/ symptoms/ covert data)
○ sensations/symptoms
○ feelings/perceptions
○ Desires & preferences
○ Beliefs, ideas, values
○ Personal information: if the patient is admitted, no need to continually ask for their data; just read
the patient’s chart.
● Pain scale:
○ 1-3: mild
○ 4-6: moderate
○ 7-10: very painful
● Sources of data: Client, Client’s record, Other healthcare professionals
● Methods used: Client interview
● Skills needed: Interview (therapeutic communication skills), Caring ability, Empathy, Listening skills (eye-to-
eye contact)
● Major areas of subjective data
○ Biographical data
○ Reasons for seeking healthcare
○ History of present health concern
○ Personal health history
○ Family health history
○ Review of systems
○ Health and lifestyle practices
Objective data (signs/overt data)
● Physical characteristics (ex. skin color, posture)
● Body functions (heart rate/respiratory rate)
● Appetence (hygiene)
● Behavior (mood/affect)
● Measurements (BP, height, temperature)
● Results of laboratory tests ( platelet counts/x-ray findings)
● Sources of data:
○ observations & physical assessments
○ Documents & assessments
○ Observation by the family
● Methods: observation and physical exam
● Skills needed: Inspection, Palpation, Percussion, Auscultation (IPPA)
TRANSCRIBING ● Kardex:
DATA ○ Used during endorsement
○ Summary of all interventions
○ Updated every shift
● Transcribing (between nurses and doctors)
○ Written copy of the doctor’s order for the proper implementation of the client’s care and treatment
● Patients chart
○ Yellow: internal medicine (IM)
○ Green: surgery/ ENT / In & outpatient
○ Pink: pedia?
○ Blue: Obgyne
○ Co-management: Can be two colors / two physicians
● Signatures:
○ “Signature over printed name”
■ Prescription sheet
■ Chartings
■ Prepared by/requested by
■ Printed name and signature
○ “Full signature”
■ Nurses signature
■ Medications cards
■ ___
○ “Initials”
■ Medication sheet
■ Kardex
■ Per the physician in the prescription pad
○ Write “informed” when the action was done
● Shifts (IMH):
○ Morning shift: 7:00 am-6:59 pm (black pen)
○ PM shift: 7:00 pm-6:59 am (red pen)
● Standard timing
OD: once a day Q4H: every 4 hours
OD at HS: once at hours of sleep Q6H: Every 6hours
BID: twice a day Q8H: Every 8 hours
TID: thrice a day BID pre-meals (before breakfast)
QID: four times a day TID premeals (usually for diabetics)
Q12: Every 12 hours TID premeals and at HS
*always use EVEN numbers, though initial doses may have odd numbers
CARDS ● White cards (write the complete name of the patient, starting with their last name; for signature, use the full
signature)
IM, ID, subcutaneous tests (for skin Tracheotomy PAI (Pulmonary Aid Inhaling)
tests)
supporting, topical CBG DTF
Optic drops and ophthalmic drops Hair shampoo Weight monitoring (especially for
chemo patients)
Nasal drops/spray Hot water bag application PPD test
Perineal care Enema Meter dose inhaler medications
Colostomy care Vaginal flushing Mouth care
O2 sat monitoring Warm & cold compress Abdominal girth/status
Wound dressing Hot sitz bath FHB
● Green cards (don’t forget to slash the “N” in ANST with a red ballpen when the skin test is negative)
○ IVTI/ Direct IV
○ Bolus
● Yellow cards
○ IV Infusion/ Drips only
■ TPN solution, insulin drip
■ Mannitol, Totillac
■ PPI drip
■ Rapid Potassium
■ Albumin IVIG
■ Morphine drip
● Pink cards:
○ Oxygen
○ Blood/ Blood components/ Blood Transfusion
● Blue cards:
○ Bladder Training
○ Serial Monitoring of Blood Extraction
○ Compression stockings
○ 2Hr Urine Collection
○ Special Endorsement
○ Weaning
○ Borrowed Items, Medical Certificate, Reminders, etc.
● Prescription pads (for signatures, use Initials)
○ Patients data
○ Always write the generic name, not the brand
○ Dose, quantity, form
○ Doctor’s name/countersign
○ License & DTR if needed
○ Full name and signature of the folks/patient
■ If you’re giving antibiotics, use the same brands throughout the process
NURSING KARDEX ● If done with the procedure, write it if it was: “reported,” “sent,” “taken,” or “done.” (red ballpen)
○ It indicates whether the actions were done
● Time used is standard, not military time
● Kardex 2
○ Usually for IVs and Medications
○ If it has additives, write it in red
○ Allergies are also written in red
WEEK 3
IV CANNULATION ● Inserting an IV cannula directly into the vein
● To be changed every 72 hours
○ For IV fluids, it’s changed every 24 hours
INTRAVENOUS ● It is an effective and efficient method of supplying fluid directly into the extracellular fluid compartment,
THERAPY specifically the venous system, to the bloodstream
● Used to provide fluids, nutritional supplements to patients who cannot eat orally until they become stable
IV FLUIDS ● when the patient is: dehydrated, NPO
IV INFUSION ● Provides direct access to the bloodstream
● Could be a hazard when air is in tubing→causes the heart to be impeded the heart (a fatal risk)
● must follow strict aseptic technique
○ It’s a good entry for infections
○ Air bubbles may lead to air embolism (specifically 10cc of air), may cause thrombophlebitis, or
phlebitis (inflammation of a vein).
TYPES OF FLUID ● HYPOTONIC: saline with water; 0.45; cell expands
● ISOTONIC: equal, most commonly used in the hospital
○ 0.9% sodium chloride is the only solution for blood transfusions
● HYPERTONIC: 3%, mixed with saline; cell shrinks
● Hypertonic and isotonic are used for: burns, bleeding, dehydration
○ Ringer's lactate: used for surgeries
PARTS incomplete
Soluset: glass ● Side clamp
bottles ● Volume control chamber
Macroset: plastic *Pumps:
bags ● Infusion pump: once consumed, it will have an alarm that signals that it is fully done
● Syringe pump: usually used for insulin (also used for ICU)
PEDIA, MACRODRIP ● Pedia: 60 cc per hour ( always check the package)
& MICRODRIP ● Microdrip: 60 cc
● Macrodrip: 15cc, 10cc, 20cc; has needle in the middle
IV CATHETER
GAUGE
14 Orange Trauma & Rapid Infusion
16 Gray Trauma & Surgery
18 Green Blood transfusion
20 Pink IV fluids & medication; commonly used in hospitals
22 Blue Small veins & IV fluid
IV CANNULA The colors are universal
EQUIPMENT AND ● IV starter pack
SUPPLIES ○ Alcohol swab
○ Gauze
○ Transparent dressing
○ Hypoallergenic tape
○ Tourniquet
● Ordered solution (hypo, hyper, or iso)
● IV pole
● IV infusion set (macroset, microset, or volumetric chamber) with Luer lock
● IV splint (adults, neonate, pediatric→ usually 60cc/hour)
● Flow rate: 100cc/hour
● Drip rate: number of drops per hour
○ Ex: 125 cc per hour has 23 drops
*If the mother is experiencing contractions, check the doctor's order if there are any additives or plain orders
- When changing the IV from additives to plain NSS, you need to aspirate (usually 10 cc)
- If it's plain to additives, there’s no need to aspirate
- Priming: the removal of excess air
*In blood transfusions: always use plain NSS to prevent coagulation
INTAKE and OUTPUT
INTAKE and OUTPUT ● Intake: any fluids entering the body
● Output: anything excreted by the client’s body
● Purpose of measuring the I&O
○ Precise record keeping
○ To aid in analyzing in client’s fluid status
○ To contribute to an accurate assessment record
○ To prevent overhydration (circulatory overload)
● Indication of MIO
○ Fluid & electrolyte imbalance
○ Recent surgery
● For outputs
○ Weighing the new and old diapers
● MIO
○ It is done every 8 hours
○ 3 pm (am shift), 11 pm (pm shift), 7 am (night shift): always 1 hour before the end of the shift
NURSING CARE PLAN (NCP)
● It is a systematic approach in terms of decision-making
● Goal directed
● Cyclic and dynamic
● Client centered
● Problem-solving and decision-making focus
● Interpersonal and collaborative style
● Universal applicability
● Use of critical thinking and clinical reasoning
C N E N R E D
U U X U A V I
E R P R T A S
S S E S I L C
I C I O U H
N T N N A A
G E G A T R
D L I G
D I E O E
I O N N
A U T P
G T E L
N C R A
O O V N
S M E N
I E N I
S T N
I G
O
N
S P S I A M M
u h n n E e
b ( o d s T d
j P r e w : i
e r t p e a c
c o t e r l i
t b e n s l n
i l r d i e
v e m e “ n
e m n h t E
) L t o e n
d o w r v
a E n D ” v i
t g e w e r
a ( p i n o
E T e l t n
O t e n l i m
b i r d i o e
j o m e t n n
e l n h s t
c o * t e
t g U l a T
i y s C p r r
v ) i o e e
e n l t a
S g l h e t
d a e f m
a ( S b f e
t S M o p e n
a y A r a c t
m R a t t /
p T t i i T
t i e v h
o f v n e e
m o e t r
s r / a
) t s p
h o P y
e e m a
x e r H
: g t t e
( o h i a
p a i a l
r l n l t
o s g l h
b y
l r T
e e m e
m l e a
) a t c
t h
→ e i
d n
“ * g
r t j
e o u O
l s u
a t t t
t h m p
e e a a
d k t
p e i
t r e
o o t n
” b h t
l e
→ e D
m g i
( o e
a t
e
l
t
sS
i
u
o
f p
l
r p
o
o o
g
m r
y
t
)
t
h S
“ e p
a i
s e r
x i
e p t
v e u
i c a
d t l
e e
n d
c
e o
d u
t
b c
y o
” m
e
→
i
( n
s t
y o
m
p t
t h
o e
m
s p
) a
s
t
t
e
n
s
e
*Nursing interventions and rationale work together
*Risk: describes the problem that might develop if no action is taken
- Use this in the nursing + add info from subjective and objective data
- “Risk for” → (problem)→ “related to” → (symptoms)
COMPUTATIONS
IV FLOW RATE will input pics
OXYGEN ● It involves delivering oxygen at a higher concentration than what's naturally found in air to treat or prevent
ADMINISTRATION hypoxia (low oxygen in the body)
● This therapy is crucial in health care to address respiratory insufficiencies and maintain adequate oxygen
saturation in the blood
● This is ordered for clients with hypoxemia, anemia, and blood loss
● This is a dependent intervention where the primary care provider specifies concentration, methods of
delivery, and liters of flow per minute
● An emergency nurse stem initiate in low concentration, like 2liters, then called the PCP
● Check the right outside and O2 saturation before
● Could be portable or an outlet (ex, portable tanks)
VARIOUS METHODS ● Nasal cannula (the simplest)
& DELIVERY ● Face mask
SYSTEM ● Positive pressure ventilation
NORMAL VALUES ● Normal O2 saturation: 92-100
● Input with COPD, normal: 88-92
● ≤90: needs intervention
● Normal SPO2: 95-100%; <90:needs medical attention
PARTS ● Oxygen cylinder
● Gauge
● Oxygen flow rate meter (has a ball inside)
● Knob: Opens and closes the oxygen
● Humidifier: with water inside (sterile/distilled)
SAFETY ● Oxygen is a medication and prescribed and monitored
PRECAUTIONS ● Potential risk:
- Oxygen toxicity
● Handle and store with caution to prevent falls and leakage
● Highly flammable: no smoking, no nail polish remover, oil, or alcohol
METHODS OF ● Low-flow systems: delivering oxygen at lower flow rates
DELIVERY ● High-flow systems: delivering oxygen at higher flow rates
● Positive ____
*We are monitoring: arterial blood gas analysis for electrolyte balance
APPLY COLD AND WARM COMPRESS
COLD AND WARM ● Helps manage pain and inflammation, but the timing and specific conditions dictate which is best to do this
COMPRESS ● Usually, within the first 48 hours of acute injuries
● Warm compress: improves blood flow
● Cold compress: constricts blood flow
Capillary Blood Glucose (CBG)
● Normal value: 80-120mg/dl
● <80: hypoglycemia; 120>: hyperglycemia
○ If these ever happen, you should encircle them during documentation
EDD/EDC
EDD/EDC ● Date of delivery/confinement of a pregnant woman
● AOG: age of gestation
● Naegele's rule:
○ April to December
■ Determine the first day of LMP
■ Subtract 3 months
■ Add 7 days
■ Add 1 year
○ January to March
■ Determine the first day of LMP
■ Add 9 months to determine the month
■ Add 7 days
■ Copy the same year
○ Unique examples
(check pic sa dalom)
● AGE OF GESTATION
○ Number of weeks the pregnancy lasts
1. Calculate the number of days between the current date and the 1st day of LMP
2. Divide the total number of days by 7 to find AOG in weeks
● G: Gravida→ Number of pregnancies
● T: Term→ Number of infants born at 37 weeks after
● P: Preterm→ Number of infants born at 20-36 weeks after
● A: abortion→ Number of losses before 20 weeks
● L: Living→ Number of living children
● M: Multiple gestations→. Pregnancy with more than 1 baby at a time
la
