MODULE 1 ○​ Demons

●​ Healing practices included:

○​ Rituals
History of Nursing ○​ Magic
○​ Herbal medicine
and Its Significance ○​ Prayers
○​ Animal sacrifices
to the Discipline and ●​ Care was provided mainly by family
members or tribal healers.
Profession of Nursing
Nursing During This Period

●​ No formal nurses existed.

●​ Women cared for children, the elderly, and
I. HISTORY OF sick family members.
●​ Care focused on survival rather than
NURSING scientific treatment.

Importance
Definition
This period established the concept of caring for
The history of nursing is the study of the others, which became the foundation of nursing.
evolution of nursing from primitive caregiving to
the modern, evidence-based profession. It
explains how nursing developed through cultural
beliefs, religion, wars, scientific discoveries,
education, and healthcare reforms.
B. Ancient Civilizations
Studying nursing history helps nurses understand Egypt
the profession's identity, appreciate its pioneers,
and apply historical lessons to present-day ●​ Physicians and priests provided
practice. healthcare.
●​ Medical knowledge was recorded in
papyrus documents.
●​ Cleanliness and hygiene were
emphasized.
II. EVOLUTION OF ●​ Herbal medicines were commonly used.

NURSING THROUGH India

HISTORY ●​ Hospitals were established as early as

250 BC.
●​ Nurses were expected to possess:
○​ Purity
A. Primitive Period (Before ○​ Intelligence
3000 BC) ○​ Skill
○​ Compassion
Characteristics
China
●​ Illness was believed to be caused by:
○​ Evil spirits ●​ Healthcare emphasized balance between
○​ Supernatural forces Yin and Yang.
○​ Angry gods
 ●​ Acupuncture and herbal medicine were ●​ Established hospitals and shelters for
developed. pilgrims.

Greece

Important contributions:
D. Middle Ages (500–1500 AD)
Hippocrates (Father of Medicine)
Characteristics
●​ Introduced scientific observation.
●​ Rejected supernatural explanations of ●​ Monasteries served as hospitals.
disease. ●​ Religious orders provided nursing care.
●​ Developed ethical principles for ●​ The Crusades increased the need for
physicians. organized nursing.

Rome Military Nursing Orders

●​ Built hospitals for soldiers. Examples:

●​ Improved sanitation systems.
●​ Established aqueducts and sewage ●​ Knights Hospitaller
systems. ●​ Knights of St. Lazarus
●​ Teutonic Knights

These organizations cared for wounded soldiers

and pilgrims.
C. Early Christian Era
During this period:

●​ Caring for the sick became a religious E. Renaissance (14th–17th

duty. Century)
●​ Monasteries became centers for
healthcare. Also called the Dark Period of Nursing.
●​ Religious men and women cared for:
○​ Sick
Characteristics
○​ Poor
○​ Orphans ●​ Decline of religious influence.
○​ Travelers ●​ Closure of monasteries.
●​ Hospitals became overcrowded.
Important Figures ●​ Nursing lost respect.

Phoebe
Nurses During This Period
●​ Considered the first visiting nurse.
Many nurses were:
●​ Mentioned in the Bible.
●​ Served as a deaconess. ●​ Prisoners
●​ Alcoholics
Fabiola
●​ Uneducated women
●​ Founded one of the first Christian ●​ Poorly trained servants
hospitals.
Nursing became associated with low social
●​ Dedicated her life to caring for the poor.
status.
Paula
 ●​ Discipline
F. Modern Nursing Era
●​ Clinical practice
The modern era began with Florence Nightingale. ●​ Ethics
●​ Scientific knowledge

Environmental Theory
III. FLORENCE
She believed that the environment greatly
NIGHTINGALE influences healing.

Major environmental factors:

Who was Florence
●​ Fresh air
Nightingale? ●​ Clean water
●​ Proper drainage
Florence Nightingale (1820–1910) is known as ●​ Cleanliness
the Founder of Modern Nursing. ●​ Adequate light
●​ Quiet surroundings
She transformed nursing into a respected
profession through education, research,
sanitation, and leadership.
Statistics

Florence used statistical graphs to demonstrate

Contributions causes of death among soldiers.

She became one of the first healthcare

Crimean War (1854) professionals to use statistics for improving
patient care.
She cared for wounded soldiers.

She improved:

●​ Cleanliness Legacy
●​ Ventilation
●​ Nutrition Florence Nightingale is remembered for:
●​ Water supply
●​ Waste disposal ●​ Professionalizing nursing
●​ Improving hospital sanitation
As a result: ●​ Establishing nursing education
●​ Promoting evidence-based practice
●​ Mortality rates decreased significantly.
●​ Inspiring modern nursing worldwide
●​ Hospital conditions greatly improved.

Nursing Education
IV. HISTORY OF
She established the first professional nursing
school in 1860 at St. Thomas' Hospital in London. NURSING IN THE
Her school emphasized: PHILIPPINES
 ●​ Highly educated nurses
Pre-Spanish Era
●​ Professional licensure examination
Healthcare was provided by: ●​ Evidence-based practice
●​ Global recognition
●​ Babaylan ●​ Advanced specialization
●​ Herbalists
●​ Traditional healers

Common treatments:

●​ Herbal medicine
V. SIGNIFICANCE OF
●​
●​
Rituals
Massage
NURSING HISTORY
●​ Spiritual healing
Studying nursing history helps students:

●​ Appreciate the profession.

●​ Understand nursing values.
Spanish Era ●​ Learn from past successes and mistakes.
●​ Build professional identity.
Hospitals established included: ●​ Develop pride in nursing.
●​ Understand healthcare evolution.
●​ San Juan de Dios Hospital
●​ San Lazaro Hospital
●​ Hospital de San Jose

Religious sisters became the primary caregivers.

VI. SIGNIFICANCE OF
NURSING TO THE
American Era DISCIPLINE
Major developments:

●​ Formal nursing education began.

Definition of Discipline
●​ American nurses introduced scientific
A discipline is a specialized field of knowledge
nursing.
with its own theories, concepts, research, and
●​ Modern hospitals were established.
educational foundation.
●​ Nursing licensure was introduced.
Nursing is considered both an art and a science.

Japanese Occupation
Why Nursing is a Discipline
●​ Shortage of nurses
●​ Limited supplies
●​ Nurses cared for war victims
1. Has a Unique Body of Knowledge

Includes:

●​ Nursing theories
Modern Philippine Nursing ●​ Nursing process
●​ Health assessment
Characteristics: ●​ Evidence-based practice
 Nurses:

2. Uses Scientific Research ●​ Analyze patient problems.

●​ Make clinical decisions.
Research improves: ●​ Prioritize interventions.
●​ Evaluate outcomes.
●​ Patient safety
●​ Clinical practice
●​ Healthcare quality
6. Supports Lifelong Learning

Nursing requires continuous education because

3. Has Nursing Theories healthcare constantly evolves.

Examples:

●​ Florence Nightingale's Environmental

Theory
●​ Virginia Henderson's Need Theory
VII. SIGNIFICANCE
●​ Dorothea Orem's Self-Care Theory
●​ Jean Watson's Theory of Human Caring
OF NURSING TO THE
These theories guide nursing practice. PROFESSION
Definition of Profession
4. Has a Standardized Nursing Process
A profession is an occupation requiring:
The nursing process consists of:
●​ Specialized education
Assessment ●​ Ethical standards
●​ Licensure
↓ ●​ Accountability
●​ Continuing competence
Diagnosis

Planning Why Nursing is a Profession

↓
1. Requires Formal Education
Implementation
Nurses complete accredited nursing programs
↓ before becoming licensed.

Evaluation

This process ensures systematic and 2. Requires Licensure

patient-centered care.
In the Philippines, graduates must pass the
Philippine Nurse Licensure Examination (PNLE).

5. Promotes Critical Thinking

3. Guided by Ethical Standards

Nurses follow: 8. Protects Patient Safety

●​ Code of Ethics Nurses monitor patients continuously and identify
●​ Professional standards complications early.
●​ Patient rights
●​ Confidentiality

4. Provides Essential Healthcare

VIII. DISCIPLINE VS.
Nurses promote: PROFESSION
●​ Health Discipline Profession
●​ Disease prevention
●​ Recovery Body of knowledge Type of occupation
●​ Rehabilitation
Focuses on theories Focuses on practice and
●​ Comfort
and research service
●​ Health education
Generates new Applies knowledge in
knowledge patient care

5. Demonstrates Professional Academic Legal and ethical

Accountability foundation practice

Nurses are legally responsible for their actions Emphasizes Emphasizes competency
and decisions. education and and accountability
research

6. Collaborates with Healthcare Teams

Nurses work with: IX. HIGH-YIELD EXAM

●​ Physicians POINTS
●​ Pharmacists
●​ Therapists ●​ Florence Nightingale is the Founder of
●​ Nutritionists Modern Nursing.
●​ Social workers ●​ The Crimean War marked the beginning
●​ Other healthcare professionals of modern nursing.
●​ Florence Nightingale established the first
professional nursing school in 1860.
●​ Nursing is both an art and a science.
7. Promotes Leadership ●​ A discipline refers to nursing's
specialized body of knowledge.
Nurses function as: ●​ A profession refers to the practice of
nursing based on education, licensure,
●​ Leaders
ethics, and accountability.
●​ Managers
●​ Nursing history explains the evolution of
●​ Educators
caregiving into a respected healthcare
●​ Researchers
profession.
●​ Advocates
 ●​ The nursing process includes
Assessment, Diagnosis, Planning, ENVIRONMENTAL
Implementation, and Evaluation
(ADPIE). THEORY
●​ Evidence-based practice strengthens
nursing as a scientific discipline.
●​ Ethical practice, accountability, and Founder
lifelong learning are essential
characteristics of the nursing profession. Florence Nightingale (1820–1910)

Known as the Founder of Modern Nursing,

Florence Nightingale believed that the
INTRODUCTION TO environment plays a significant role in healing.
Her experiences during the Crimean War
NURSING demonstrated that improving environmental
conditions greatly reduced mortality among
PHILOSOPHIES wounded soldiers.

What is a Nursing
Philosophy? Definition
A nursing philosophy is a set of beliefs, values, The Environmental Theory states that a
and principles that guides nurses in providing person's environment directly affects health and
patient care. It influences how nurses think, make recovery. Nurses can promote healing by
decisions, interact with patients, and carry out modifying the patient's surroundings.
their professional responsibilities.

Nursing philosophies emphasize that caring for

patients involves more than treating illness—it
includes addressing physical, emotional,
Major Assumptions
psychological, social, cultural, and spiritual needs.
●​ Nature can heal patients if the
environment is appropriate.
Importance of Nursing Philosophies
●​ The nurse's role is to place the patient in
the best possible condition for nature to
●​ Provides a framework for nursing practice.
act.
●​ Guides ethical and professional
●​ Prevention is as important as treatment.
decision-making.
●​ A clean environment reduces disease and
●​ Promotes holistic and patient-centered
infection.
care.
●​ Strengthens critical thinking and clinical
judgment.
●​ Improves patient outcomes and quality of
care. Five Essential Environmental
Factors
1. Pure or Fresh Air
A. FLORENCE ●​ Ensures proper ventilation.

NIGHTINGALE'S ●​ Removes foul odors and airborne

contaminants.
●​ Promotes oxygenation.
2. Pure Water ●​ Promote rest.
●​ Prevent infection.
●​ Safe drinking water prevents infection and ●​ Observe the patient's response to
dehydration. environmental changes.
●​ Clean water is essential for hygiene.

3. Efficient Drainage

●​ Proper waste disposal prevents

Application in Nursing
contamination. Practice
●​ Reduces the spread of infectious
diseases. Examples:

4. Cleanliness ●​ Opening windows for fresh air.

●​ Encouraging hand hygiene.
●​ Includes cleanliness of: ●​ Keeping linens clean and dry.
○​ Patient ●​ Reducing nighttime noise.
○​ Nurse ●​ Maintaining a comfortable room
○​ Hospital room temperature.
○​ Equipment
●​ Reduces microorganisms and infection.

5. Light (Especially Sunlight) Strengths

●​ Natural sunlight promotes healing. ●​ Easy to apply.
●​ Improves mood and well-being. ●​ Foundation of infection prevention.
●​ Helps destroy certain microorganisms. ●​ Promotes holistic care.
●​ Improved hospital sanitation worldwide.

Additional Environmental
Factors Limitations
●​ Quiet surroundings ●​ Focuses mainly on environmental factors.
●​ Proper nutrition ●​ Does not fully consider modern medical
●​ Comfortable bed technology.
●​ Warmth ●​ Less emphasis on psychological and
●​ Rest and sleep social influences.
●​ Personal hygiene
●​ Emotional support

B. JEAN WATSON'S
Nurse's Role
PHILOSOPHY AND
The nurse should:
THEORY OF
●​ Maintain a clean environment.
●​ Provide adequate ventilation. TRANSPERSONAL
●​ Encourage nutrition and hydration.
●​ Reduce unnecessary noise. CARING
 A caring science focused on promoting health
Founder
and healing.
Jean Watson (1940–present)

Watson believed that caring is the essence of

nursing. She emphasized that nurses should Transpersonal Caring
develop meaningful, healing relationships with
patients. Relationship
A transpersonal caring relationship occurs
when the nurse connects deeply with the patient
beyond physical care.
Definition
Characteristics:
The Theory of Human Caring states that caring
promotes healing beyond physical treatment. The ●​ Trust
relationship between the nurse and patient is ●​ Compassion
central to nursing practice. ●​ Respect
●​ Empathy
●​ Authentic presence
●​ Emotional support
Philosophy
Watson believed:
Watson's Ten Carative
●​ Caring is the foundation of nursing.
●​ Every person deserves dignity and Factors (Original)
respect.
●​ Healing involves mind, body, and spirit. 1.​ Practice loving-kindness.
●​ Genuine human relationships improve 2.​ Instill faith and hope.
health. 3.​ Cultivate sensitivity.
4.​ Develop helping-trusting relationships.
5.​ Promote expression of feelings.
6.​ Use scientific problem-solving.
7.​ Promote teaching-learning.
Major Concepts 8.​ Create a healing environment.
9.​ Assist with human needs.
1. Human Being 10.​Accept spiritual and existential
dimensions.
A unique individual with physical, emotional,
social, and spiritual needs. These later evolved into the Ten Caritas
Processes, emphasizing caring as a moral and
2. Health spiritual practice.

Harmony of the mind, body, and spirit.

3. Environment Nurse's Role

Supports healing physically, emotionally,
The nurse should:
spiritually, and socially.
●​ Listen actively.
4. Nursing ●​ Respect patient beliefs.
●​ Show empathy.
 ●​ Encourage expression of feelings. Benner developed the Novice to Expert Theory,
●​ Provide emotional support. explaining how nurses gain clinical competence
●​ Promote hope. through education and experience.
●​ Protect patient dignity.

Definition
Clinical Application
Clinical expertise develops gradually through
Examples: real-life nursing experiences rather than
education alone.
●​ Holding a patient's hand during a difficult
procedure.
●​ Listening without judgment.
●​ Respecting religious beliefs.
●​ Providing privacy.
●​ Supporting family involvement.
Five Stages of
Nursing Expertise
Strengths 1. Novice
●​ Promotes holistic care. Characteristics:
●​ Improves patient satisfaction.
●​ Enhances nurse-patient relationships. ●​ No clinical experience.
●​ Encourages compassionate practice. ●​ Relies on rules and instructions.
●​ Limited ability to prioritize.

Examples:

Limitations ●​ First-year nursing student.

●​ Newly enrolled nursing trainee.
●​ Difficult to measure caring scientifically.
●​ Requires time and emotional commitment.
●​ Can be challenging in busy clinical
settings.
2. Advanced Beginner
Characteristics:

●​ Some clinical exposure.

C. BENNER'S ●​ Recognizes recurring situations.
●​ Requires supervision.
STAGES OF NURSING
Examples:
EXPERTISE ●​ Nursing student during clinical duty.
●​ Newly hired graduate nurse.
Founder
Patricia Benner (1942–present)
3. Competent
Usually after 2–3 years of experience. Expert Intuitive, highly skilled, and
flexible
Characteristics:

●​ Organized.
●​ Able to prioritize care.
●​ Plans patient management effectively. Importance
●​ Increased confidence.
Benner's theory:

●​ Guides nursing education.

●​ Supports competency assessment.
4. Proficient ●​ Encourages lifelong learning.
●​ Helps develop clinical judgment.
Characteristics:

●​ Understands situations as a whole.

●​ Anticipates patient needs.
●​
●​
Makes better clinical decisions.
Flexible in managing care.
D. JEAN WATSON'S
CARATIVE CARING
5. Expert
THEORY
Note: The Carative Caring Theory
Characteristics:
was developed by Jean Watson, not
Erik Erikson.
●​ Extensive experience.
●​ Intuitive decision-making.
●​ Excellent clinical judgment.
●​ Serves as mentor and leader.
Definition
Examples:
Watson's Carative Caring Theory emphasizes
●​ Senior nurse manager. that caring is the moral ideal of nursing. The
●​ Clinical nurse specialist. nurse promotes healing by building authentic,
compassionate, and trusting relationships with
patients.

Summary Table
Stage Characteristics
Seven Core Assumptions
Novice No experience; follows rules
Watson believed:
Advanced Limited experience; needs
Beginner guidance ●​ Caring can be demonstrated effectively
only through interpersonal relationships.
Competent Organized; plans care ●​ Caring promotes health and growth.
effectively ●​ Caring accepts individuals as they are and
as they may become.
Proficient Sees the whole clinical ●​ A caring environment supports
picture development.
 ●​ Caring is more "health-generating" than Nighti al promote
curing alone. ngale improvement recovery
●​ Caring is central to nursing.
●​ Caring integrates scientific knowledge with Theory Jean Caring Holistic
compassion. of Watso relationships healing of
Human n mind, body,
Caring and spirit

Novice Patrici Professional Clinical

Carative Factors (Caritas to a development expertise
Processes) Expert Benne grows
r through
The ten Caritas Processes include: experience

1.​ Loving-kindness Carative Jean Compassion Caring is the

2.​ Authentic presence Caring Watso ate nursing moral ideal
3.​ Spiritual practice Theory n care and essence
4.​ Trusting relationships of nursing
5.​ Acceptance of emotions
6.​ Creative problem-solving
7.​ Genuine teaching and learning
8.​ Healing environment
9.​ Assisting with basic human needs
HIGH-YIELD EXAM
10.​Openness to spiritual and existential
experiences
POINTS
●​ Florence Nightingale developed the
Environmental Theory.
●​ Nightingale identified fresh air, pure
Clinical Applications water, efficient drainage, cleanliness,
and light as essential environmental
Examples: factors.
●​ Jean Watson believed caring is the
●​ Providing emotional support to a patient
essence of nursing.
with cancer.
●​ A transpersonal caring relationship is a
●​ Comforting a grieving family.
deep, meaningful connection between
●​ Respecting cultural practices.
nurse and patient that supports healing.
●​ Using therapeutic communication.
●​ Watson's Ten Carative Factors later
●​ Preserving patient dignity and privacy.
evolved into the Ten Caritas Processes.
●​ Patricia Benner developed the Novice to
Expert Theory, describing five stages of
nursing expertise: Novice, Advanced
Beginner, Competent, Proficient, and
COMPARISON OF Expert.
●​ Clinical competence develops through
THE THEORIES education combined with experience.
●​ Erik Erikson did not develop a nursing
Theory Foun Main Focus Key caring theory; he is known for the
der Concept Psychosocial Development Theory.

Environ Floren Healing Clean, safe

mental ce through surroundings
Theory environment
INTRODUCTION TO Founder

CONCEPTUAL Dorothea Elizabeth Orem (1914–2007)

MODELS OF
NURSING Definition
Orem believed that individuals have the ability
What is a Conceptual Model? and responsibility to care for themselves. Nursing
becomes necessary when individuals cannot
A conceptual model is a broad framework that meet their own self-care needs.
explains the concepts, principles, and
relationships that guide nursing practice, The theory explains when nursing is needed
education, research, and administration. It and how nurses should assist patients in
provides nurses with a systematic way of becoming as independent as possible.
understanding patients, health, the environment,
and nursing care.

Unlike nursing theories, conceptual models are Three Related Theories

broader and serve as the foundation upon which
nursing theories are developed.
1. Theory of Self-Care

People perform activities to maintain:

Importance of Conceptual ●​ Life

●​ Health
Models ●​ Well-being

●​ Provides direction for nursing practice. These activities are called self-care requisites.
●​ Promotes holistic and patient-centered
care.
●​ Guides nursing assessment and
interventions. 2. Theory of Self-Care Deficit
●​ Supports evidence-based practice.
●​ Enhances critical thinking and clinical A self-care deficit occurs when an individual
decision-making. cannot perform necessary self-care activities.
●​ Serves as a framework for nursing
education and research. This is the point at which nursing intervention
becomes necessary.

Examples:

●​ Stroke patient unable to bathe

A. DOROTHEA ●​ Postoperative patient unable to feed
independently
OREM'S SELF-CARE ●​ Elderly patient requiring assistance with
mobility
DEFICIT NURSING
THEORY 3. Theory of Nursing Systems
Explains how nurses help patients. Developmental Requisites
A. Wholly Compensatory System Needs related to growth and life changes.

The nurse performs all care because the patient Examples:

cannot.
●​ Pregnancy
Example: ●​ Adolescence
●​ Retirement
●​ Comatose patient
●​ Patient under general anesthesia

Health Deviation Requisites

B. Partly Compensatory System
Needs resulting from illness or injury.
Both nurse and patient participate in care.
Examples:
Example:
●​ Medication adherence
●​ Patient recovering after surgery ●​ Rehabilitation
●​ Patient with fractured arm ●​ Medical follow-up

C. Supportive-Educative System
Nursing Process According
The patient can perform self-care but needs to Orem
education or guidance.
1.​ Assess self-care ability.
Example: 2.​ Identify self-care deficits.
3.​ Plan nursing assistance.
●​ Newly diagnosed diabetic learning insulin
4.​ Implement nursing interventions.
administration
5.​ Evaluate patient independence.
●​ Hypertensive patient learning lifestyle
modifications

Strengths
Self-Care Requisites ●​ Encourages patient independence.
●​ Applicable in hospitals and community
Universal Requisites settings.
●​ Promotes patient education.
Basic needs required by everyone:
●​ Supports rehabilitation.
●​ Air
●​ Water
●​ Food
●​ Elimination Limitations
●​ Activity and rest
●​ Social interaction ●​ Less applicable to unconscious patients.
●​ Prevention of hazards ●​ Focuses primarily on individual self-care.
●​ Promotion of normal functioning ●​ Limited emphasis on family and
community influences.
 Represents the unique characteristics of each
individual.

B. MARTHA ROGERS' Every person has a unique energy pattern.

SCIENCE OF
Pandimensionality
UNITARY HUMAN
Humans are not limited by time or space.
BEINGS Health involves physical, emotional, social, and
spiritual dimensions.
Founder
Martha Elizabeth Rogers (1914–1994)
Principles of Homeodynamics
1. Integrality
Definition
Continuous interaction between the person and
Rogers viewed humans as unitary beings who the environment.
are constantly interacting with the environment
through energy fields.

Health is influenced by the continuous exchange 2. Resonancy

of energy between the individual and the
environment. Energy fields change continuously.

Health is dynamic rather than static.

Major Concepts
3. Helicy
Energy Field
Human development is unpredictable and
The fundamental unit of both person and constantly evolving.
environment.
People continuously adapt and grow.
Humans and environments continuously
exchange energy.

Nurse's Role
Openness
●​ Promote harmony between patient and
environment.
Energy flows freely between the person and the
●​ Encourage holistic healing.
environment.
●​ Support physical, emotional, and spiritual
Neither exists independently. well-being.

Pattern
 working together to achieve mutually
Clinical Applications
agreed-upon health goals.
●​ Therapeutic touch
Communication is the key to successful nursing
●​ Music therapy
care.
●​ Meditation
●​ Guided imagery
●​ Stress reduction
●​ Healing environments
Three Interacting Systems
Personal System
Strengths Focuses on the individual.
●​ Holistic approach.
Includes:
●​ Encourages complementary therapies.
●​ Promotes wellness rather than disease ●​ Perception
treatment alone. ●​ Growth and development
●​ Self
●​ Body image
●​ Time
Limitations ●​ Space

●​ Highly abstract.
●​ Difficult to measure scientifically.
●​ Challenging to apply in acute care. Interpersonal System

Occurs when two or more individuals interact.

Includes:

C. IMOGENE KING'S ●​ Communication

●​ Interaction
GENERAL SYSTEMS ●​ Role
●​ Stress
FRAMEWORK (GOAL ●​ Transaction

ATTAINMENT
THEORY) Social System

Large organized groups.

Founder Examples:

Imogene King (1923–2007) ●​ Family

●​ Schools
●​ Hospitals
●​ Communities
Definition ●​ Government

King believed that nursing is a process of

interaction between the nurse and the patient,
 Neuman viewed the patient as an open system
Goal Attainment Process
constantly interacting with internal and external
1.​ Perception stressors.
2.​ Communication
The nurse's role is to prevent stressors from
3.​ Interaction
disrupting the patient's stability.
4.​ Transaction
5.​ Goal attainment

Major Concepts
Nurse's Role
Client System
●​ Assess patient needs.
Composed of five variables:
●​ Communicate effectively.
●​ Set realistic goals with the patient.
●​ Physiological
●​ Evaluate achievement of goals.
●​ Psychological
●​ Sociocultural
●​ Developmental
●​ Spiritual
Strengths
●​ Encourages patient participation.
●​ Improves communication. Stressors
●​ Promotes collaborative care.
Factors that threaten system stability.

Intrapersonal

Limitations Within the individual.

●​ Requires active patient participation. Example:

●​ Less effective for unconscious or
cognitively impaired patients. ●​ Anxiety
●​ Infection

Interpersonal

Between individuals.
D. BETTY NEUMAN'S
Example:
SYSTEMS MODEL ●​ Family conflict

Extrapersonal
Founder
Outside the individual.
Betty Neuman (1924–2022)
Example:

●​ Financial problems
●​ Job stress
Definition
Lines of Defense
Flexible Line of Defense Strengths
First protective barrier. ●​ Holistic.
●​ Applicable in all healthcare settings.
●​ Strong emphasis on prevention.

Normal Line of Defense

Patient's usual level of wellness.

Limitations
●​ Complex model.
Lines of Resistance ●​ Broad concepts may be difficult to apply
consistently.
Activated when stressors penetrate the normal
defense.

E. SISTER CALLISTA
Prevention Levels
ROY'S ADAPTATION
Primary Prevention
MODEL
Prevents stress before it occurs.

Examples: Founder
●​ Vaccination Sister Callista Roy (1939–present)
●​ Health education

Secondary Prevention Definition

Early diagnosis and treatment. Roy believed that humans are adaptive systems
who respond continuously to environmental
Examples: changes.

●​ Screening The nurse promotes positive adaptation to

●​ Immediate treatment improve health.

Tertiary Prevention Four Adaptive Modes

Rehabilitation and prevention of recurrence.
1. Physiological Mode
Examples:
Physical functioning.
●​ Physical therapy
●​ Follow-up care Examples:
 ●​ Nutrition Contributing factors.
●​ Oxygenation
●​ Elimination Example:

●​ Anxiety

2. Self-Concept Mode

Psychological and spiritual integrity. Residual Stimulus

Includes: Unknown or unclear influences.

●​ Self-esteem Example:
●​ Personal beliefs
●​ Previous experiences

3. Role Function Mode

Nurse's Role
Social roles and responsibilities.
●​ Assess adaptive responses.
Examples:
●​ Promote effective coping.
●​ Parent ●​ Enhance adaptation.
●​ Student
●​ Employee

Strengths
4. Interdependence Mode ●​ Holistic.
●​ Encourages coping and resilience.
Relationships and support systems. ●​ Widely used in nursing education.

Includes:

●​ Family
●​ Friends Limitations
●​ Community
●​ Complex assessment process.
●​ Time-consuming.

Types of Stimuli
Focal Stimulus
F. DOROTHY E.
Immediate concern.
JOHNSON'S
Example:

●​ Pain
BEHAVIORAL
SYSTEM MODEL
Contextual Stimulus Founder
Dorothy E. Johnson (1919–1999)

7. Achievement

Mastery, success, and goal accomplishment.

Definition
Johnson viewed the individual as a behavioral
system made up of interconnected behavioral
subsystems. Nurse's Role
Illness disrupts behavioral balance, and nursing ●​ Assess behavioral imbalances.
aims to restore equilibrium. ●​ Identify disrupted subsystems.
●​ Restore behavioral stability.
●​ Promote healthy coping behaviors.

Seven Behavioral
Subsystems
Strengths
1. Attachment–Affiliative ●​ Focuses on behavioral health.
●​ Useful in psychiatric and rehabilitation
Need for relationships and social bonds.
nursing.
●​ Promotes holistic assessment.

2. Dependency

Seeking help and nurturing. Limitations

●​ Less emphasis on biological processes.
●​ Some behaviors are difficult to measure
3. Ingestive objectively.

Eating and drinking behaviors.

4. Eliminative

Excretion of body wastes.

COMPARISON OF
5. Sexual CONCEPTUAL
Reproduction and gender identity. MODELS
Model Fou Main Key Concept
nder Focus
6. Aggressive–Protective
Self-Care Doro Patient Nursing is
Protection and self-defense. Deficit thea indepe needed when
ndence self-care
 Ore abilities are stressors; prevention occurs at primary,
m insufficient secondary, and tertiary levels.
●​ Sister Callista Roy – Humans adapt
Science of Mart Energy Humans and through physiological, self-concept, role
Unitary ha fields environment function, and interdependence modes.
Human Rog are inseparable ●​ Dorothy Johnson – Human behavior is
Beings ers energy fields organized into seven behavioral
subsystems, and nursing restores
General Imog Nurse- Goals are behavioral balance.
Systems ene patient achieved
Framework King interact through
(Goal
Attainment)
ion communication
and
NURSING
collaboration
THEORISTS OF
Systems Betty Stress Nursing
Model Neu and protects the HISTORICAL
man prevent client from
ion stressors and SIGNIFICANCE
maintains
stability

Adaptation Siste Adaptat People

Model r
Calli
ion continuously
adapt to
INTRODUCTION
sta internal and
Roy external stimuli
Who are Nursing Theorists?
Behavioral Doro Human Nursing
System thy behavi restores Nursing theorists are pioneers who developed
Model John or balance among theories that explain the nature, goals, and
son behavioral practice of nursing. Their theories provide a
subsystems scientific and philosophical foundation for nursing
education, research, leadership, and clinical
practice.

These historical nursing theories continue to

HIGH-YIELD EXAM influence modern nursing by promoting holistic,
evidence-based, and patient-centered care.
POINTS
●​ Dorothea Orem – Self-Care Deficit
Nursing Theory (Self-care, Self-care
Deficit, Nursing Systems). A. MYRA ESTRIN
●​ Martha Rogers – Humans are unitary
energy fields interacting continuously LEVINE'S
with the environment.
●​ Imogene King – Goal attainment is CONSERVATION
achieved through nurse-patient
communication and mutual goal setting. MODEL
●​ Betty Neuman – Patients are open
systems affected by intrapersonal,
interpersonal, and extrapersonal Founder
Myra Estrin Levine (1920–1996) Nursing Interventions:

●​ Respect privacy.
●​ Encourage independence.
●​ Involve patients in decision-making.
Definition ●​ Respect cultural beliefs.

Levine's Conservation Model emphasizes that

the goal of nursing is to promote adaptation and
maintain the patient's wholeness by conserving 4. Conservation of Social Integrity
energy and preserving the integrity of the
individual. Maintaining family and social relationships.

Nurses help patients recover by minimizing Nursing Interventions:

unnecessary energy expenditure and maintaining
physical, psychological, and social stability. ●​ Encourage family participation.
●​ Promote communication.
●​ Support community involvement.
●​ Respect social roles.
Four Principles of
Conservation
Strengths
1. Conservation of Energy
●​ Holistic approach.
Maintaining a balance between energy supply ●​ Promotes patient adaptation.
and demand. ●​ Useful in rehabilitation and chronic illness.
Nursing Interventions:

●​ Encourage adequate rest.

●​ Promote proper nutrition. Limitations
●​ Control pain.
●​ Schedule activities with rest periods. ●​ Less emphasis on emotional processes.
●​ Broad concepts may be difficult to
measure.

2. Conservation of Structural Integrity

Maintaining or restoring body structure.

Nursing Interventions: B. HILDEGARD

●​ Prevent pressure ulcers. PEPLAU'S THEORY
●​ Promote wound healing.
●​ Prevent infection. OF INTERPERSONAL
●​ Maintain skin integrity.
RELATIONS
3. Conservation of Personal Integrity Founder
Protecting the patient's identity, dignity, values, Hildegard E. Peplau (1909–1999)
and self-worth.
Known as the Mother of Psychiatric Nursing.

Nursing Roles
Definition Peplau identified several nursing roles:

Peplau believed nursing is a therapeutic ●​ Stranger

interpersonal process between the nurse and the ●​ Resource person
patient that promotes growth, problem-solving, ●​ Teacher
and healing. ●​ Leader
●​ Counselor
Communication is the foundation of effective ●​ Technical expert
nursing care. ●​ Surrogate

Four Phases of the Strengths

Nurse–Patient Relationship
●​ Improves communication skills.
●​ Promotes therapeutic relationships.
1. Orientation Phase ●​ Highly applicable in mental health nursing.

●​ Patient recognizes the need for help.

●​ Nurse establishes trust.
●​ Problems are identified.
Limitations
●​ Time-consuming.
2. Identification Phase ●​ Requires patient participation and effective
communication.
●​ Patient begins to participate in care.
●​ Goals are established.
●​ Trust deepens.

C. IDA JEAN
3. Exploitation (Working) Phase
ORLANDO'S THEORY
●​ Patient actively uses available nursing
resources. OF THE DELIBERATE
●​ Nurse provides education, support, and
interventions. NURSING PROCESS
●​ Patient works toward goals.

Founder
4. Resolution (Termination) Phase Ida Jean Orlando (1926–2007)

●​ Goals are achieved.

●​ Patient becomes independent.
●​ Professional relationship ends
appropriately.
Definition
Orlando believed nursing should respond to the ●​ Encourages individualized care.
patient's immediate needs rather than following ●​ Promotes critical thinking.
routines or assumptions. ●​ Prevents assumptions.

The nurse must validate perceptions with the

patient before acting.

Limitations
●​ Requires effective communication.
Major Concepts ●​ Less applicable for unconscious patients.

Patient Behavior

Behavior may indicate:

●​ Need for help

D. JOYCE
●​
●​
Pain
Anxiety
TRAVELBEE'S
●​
●​
Fear
Distress HUMAN-TO-HUMAN
RELATIONSHIP
Nurse's Reaction MODEL
The nurse:
Founder
●​ Observes patient behavior.
●​ Interprets its meaning. Joyce Travelbee (1926–1973)
●​ Confirms interpretation with the patient.

Deliberate Nursing Action Definition

After validation, the nurse performs interventions Travelbee believed nursing is an interpersonal
specifically designed to meet the patient's process that helps individuals and families find
immediate need. meaning in illness, suffering, and life experiences.

The relationship is person-to-person, not merely

nurse-to-patient.

Nursing Process
1.​ Observe.
2.​ Interpret.
Major Concepts
3.​ Validate with the patient.
4.​ Act deliberately. Human-to-Human Relationship
5.​ Evaluate the response.
A meaningful relationship based on:

●​ Compassion
●​ Respect
Strengths ●​ Empathy
 ●​ Trust

Suffering
E. LYDIA HALL'S
Suffering is unique to every individual. CORE, CARE, CURE
The nurse helps patients understand and cope THEORY
with suffering.

Founder
Hope Lydia Eloise Hall (1906–1969)

Hope motivates recovery and improves coping.

Definition
Five Phases Hall believed nursing consists of three
interconnected components: Core, Care, and
1.​ Original Encounter Cure.
2.​ Emerging Identities
3.​ Empathy These components work together to promote
4.​ Sympathy healing and independence.
5.​ Rapport

Three Components
Nurse's Role
Core
●​ Build therapeutic relationships.
●​ Provide emotional support. Focuses on the person.
●​ Help patients find meaning.
●​ Promote hope. Includes:

●​ Feelings
●​ Goals
●​ Beliefs
Strengths ●​ Emotional needs

●​ Holistic. The nurse encourages self-awareness and

●​ Excellent for palliative and psychiatric personal growth.
nursing.
●​ Encourages compassionate care.

Care

Focuses on nursing care.

Limitations
Includes:
●​ Difficult to measure scientifically.
●​ Requires time to build rapport. ●​ Comfort measures
 ●​ Hygiene
●​ Nutrition F. FAYE GLENN
●​ Safety
●​ Patient education ABDELLAH'S
This is the unique function of nursing. TWENTY-ONE
NURSING PROBLEMS
Cure
Founder
Focuses on medical treatment.
Faye Glenn Abdellah (1919–2017)
Includes:

●​ Diagnosis
●​ Medications
●​ Surgery Definition
●​ Medical interventions
Abdellah shifted nursing from disease-centered
The nurse collaborates with physicians and other care to patient-centered care by identifying 21
healthcare professionals. nursing problems that guide assessment,
planning, and intervention.

Nurse's Role
Classification of the 21
●​ Provide direct care.
●​ Support emotional needs. Nursing Problems
●​ Coordinate medical treatment.
●​ Encourage patient participation. Basic Physical Needs

●​ Hygiene and comfort

●​ Activity and rest
●​ Safety
Strengths ●​ Oxygenation
●​ Nutrition
●​ Promotes holistic care.
●​ Elimination
●​ Clearly defines nursing responsibilities.
●​ Fluid and electrolyte balance
●​ Encourages interdisciplinary collaboration.

Emotional and Psychological Needs

Limitations
●​ Feelings and emotions
●​ Less emphasis on family involvement. ●​ Communication
●​ Limited application in community nursing. ●​ Interpersonal relationships
●​ Self-acceptance

Social Needs
 ●​ Family relationships Conserva Myra Adaptati Maintain
●​ Community resources tion Levin on energy and
●​ Social functioning Model e integrity
through
conservation

Restorative Needs Interpers Hildeg Therape Nurse–patient

onal ard utic relationship
●​ Rehabilitation Relations Pepla communi promotes
●​ Health teaching u cation healing
●​ Problem-solving
●​ Prevention of complications Deliberat Ida Immediat Nursing actions
e Nursing Jean e patient should be
Process Orlan needs validated
do before
intervention
Nursing Process
Human-t Joyce Meaning Compassionate
Abdellah emphasized: o-Human Travel and relationships
Relations bee suffering promote
●​ Assessment
hip healing
●​ Identification of patient problems
●​ Planning Core, Lydia Holistic Balance
●​ Nursing interventions Care, Hall care emotional care,
●​ Evaluation Cure nursing care,
Theory and medical
care

Twenty-O Faye Patient-c Nursing

Strengths ne Glenn entered addresses
Nursing Abdell care patient
●​ Patient-centered.
Problems ah problems
●​ Organized nursing assessment.
systematically
●​ Supports evidence-based practice.
●​ Applicable in all healthcare settings.

HIGH-YIELD EXAM
Limitations
POINTS
●​ Broad classification.
●​ Less emphasis on family and community ●​ Myra Levine developed the
systems. Conservation Model, focusing on
energy, structural, personal, and social
integrity.
●​ Hildegard Peplau is the Mother of
Psychiatric Nursing and described the
COMPARISON OF four phases of the nurse–patient
relationship: Orientation, Identification,
THE THEORIES Exploitation (Working), and Resolution.
●​ Ida Jean Orlando emphasized
Theory Foun Main Key Concept responding to the patient's immediate
der Focus need through the Deliberate Nursing
Process.
 ●​ Joyce Travelbee believed nursing is a The Nursing Process is a systematic,
human-to-human relationship that helps organized, scientific, and patient-centered
patients find meaning in illness and method used by nurses to identify, prevent, and
suffering. treat actual or potential health problems. It serves
●​ Lydia Hall proposed the Core, Care, as the foundation of professional nursing practice
Cure Theory, integrating emotional and promotes individualized, holistic, and
support, nursing care, and medical evidence-based care.
treatment.
●​ Faye Glenn Abdellah introduced the The nursing process is cyclic, meaning that after
Twenty-One Nursing Problems, shifting evaluation, the nurse may reassess the patient
nursing toward patient-centered care. and begin the process again if necessary.

Characteristics of the Nursing

Process
The nursing process is:

●​ Systematic – follows an organized

sequence of steps.
●​ Dynamic – changes according to the
patient's condition.
●​ Cyclic – continues until patient goals are
achieved.
●​ Patient-centered – focuses on the
patient's unique needs.
●​ Goal-oriented – aims to achieve
measurable health outcomes.
●​ Evidence-based – uses current scientific
knowledge.
●​ Collaborative – involves the patient, family,
and healthcare team.

FIVE STEPS OF THE

MODULE 2
NURSING PROCESS
INTRODUCTION TO (ADPIE)
THE NURSING A – Assessment

PROCESS D – Diagnosis

P – Planning

Definition I – Implementation (Intervention)

E – Evaluation
 3. Emergency Assessment

Performed during life-threatening situations.

A. ASSESSMENT Priority follows the ABCDE approach:

●​ Airway
Definition ●​ Breathing
●​ Circulation
Assessment is the systematic collection, ●​ Disability (neurologic status)
organization, validation, and documentation of ●​ Exposure/Environment
information about a patient's health status.

It is the first and most important step, because

the quality of the remaining steps depends on
4. Ongoing (Time-Lapsed) Assessment
accurate assessment data.
Repeated regularly to evaluate patient progress
and response to treatment.

Purpose of Assessment
●​ Establish baseline data. Types of Data
●​ Identify health problems.
●​ Determine patient strengths.
Subjective Data
●​ Identify risk factors.
●​ Gather information for diagnosis.
Information reported by the patient.
●​ Monitor changes in health status.
Examples:

●​ "I have chest pain."

Types of Assessment ●​ "I feel dizzy."

Also called symptoms.

1. Initial Assessment

Performed upon admission or first encounter.

Objective Data
Purpose:
Observable and measurable findings.
●​ Obtain baseline information.
●​ Identify immediate health concerns. Examples:

●​ Blood pressure: 150/90 mmHg

●​ Temperature: 38.5°C
2. Focused Assessment ●​ Surgical wound
●​ Cyanosis
Concentrates on a specific problem.
Also called signs.
Example:

●​ Assessing lung sounds in a patient with

shortness of breath.
Sources of Data
Primary Source

The patient.
Validation
Validation confirms that collected information is
Secondary Sources accurate and complete.

●​ Family members Example:​

●​ Caregivers Rechecking an unusually high blood pressure
●​ Medical records before recording it.
●​ Laboratory reports
●​ Diagnostic tests
●​ Other healthcare professionals
Documentation
Assessment findings must be:
Methods of Data Collection ●​ Accurate
●​ Complete
Health History ●​ Objective
●​ Timely
Includes: ●​ Legible

●​ Chief complaint
●​ History of present illness
●​ Past medical history
●​
●​
Family history
Medication history B. NURSING
●​ Allergies
●​ Lifestyle habits DIAGNOSIS
Definition
Physical Examination
A nursing diagnosis is a clinical judgment
Techniques: about a patient's responses to actual or potential
health problems or life processes.
Inspection
It identifies problems that nurses can
Visual observation. independently manage.

Palpation Nursing diagnoses are standardized by NANDA

International (NANDA-I).
Using hands to assess temperature, tenderness,
texture, masses, and pulses.

Percussion
Purpose
Tapping body surfaces to determine underlying
structures. ●​ Identify patient problems.
●​ Guide nursing interventions.
Auscultation ●​ Improve communication.
●​ Promote individualized care.
Listening to body sounds using a stethoscope.
 S – Signs and Symptoms (as evidenced by)

Example:
Types of Nursing Diagnosis
Acute Pain related to surgical incision as
1. Problem-Focused Diagnosis evidenced by verbal report of pain rated 8/10
and guarding behavior.
Describes an existing health problem.

Example:

●​ Acute Pain
●​ Impaired Physical Mobility
C. PLANNING
Definition
2. Risk Diagnosis
Planning is the process of establishing priorities,
Patient is vulnerable to developing a problem. setting measurable goals, and selecting nursing
interventions to achieve desired patient
Example: outcomes.

●​ Risk for Infection

●​ Risk for Falls
Purpose
●​ Prioritize care.
3. Health Promotion Diagnosis
●​ Promote continuity.
●​ Coordinate healthcare services.
Patient is ready to improve health.
●​ Improve patient outcomes.
Example:

●​ Readiness for Enhanced Nutrition

Priority Setting
Often uses Maslow's Hierarchy of Needs.
4. Syndrome Diagnosis
Priority order:
Cluster of related nursing diagnoses.
1.​ Physiological needs
Example:
2.​ Safety
3.​ Love and belonging
●​ Post-Trauma Syndrome
4.​ Esteem
5.​ Self-actualization

The ABCs (Airway, Breathing, Circulation) also

PES Format guide priority setting in emergencies.

Used for problem-focused nursing diagnoses.

P – Problem
Goal Setting
E – Etiology (related to)
Goals should follow the SMART criteria:
 ●​ S – Specific Collaborative Interventions
●​ M – Measurable
●​ A – Achievable Performed with other healthcare professionals.
●​ R – Realistic/Relevant
●​ T – Time-bound Examples:

Example: ●​ Physical therapy

●​ Dietitian referral
The patient will report pain reduced from 8/10 to ●​ Respiratory therapy
3/10 within 30 minutes after analgesic
administration.

D. IMPLEMENTATION
Types of Goals
(INTERVENTION)
Short-Term Goals

Expected within hours or days. Definition

Implementation is the phase in which the nurse
carries out the planned interventions to achieve
Long-Term Goals the patient's goals.

Expected over weeks or months.

Steps in Implementation
Nursing Interventions 1.​ Reassess the patient.
2.​ Determine the need for assistance.
Independent Interventions 3.​ Perform nursing interventions.
4.​ Document all care provided.
Performed without a physician's order. 5.​ Continue monitoring the patient's
response.
Examples:

●​ Health teaching
●​ Position changes
●​ Emotional support
Types of Nursing
Interventions
Direct Care
Dependent Interventions
Performed through direct interaction with the
Require a physician's order.
patient.
Examples:
Examples:
●​ Medication administration
●​ Medication administration
●​ Oxygen therapy
●​ Wound dressing
●​ Intravenous fluids
●​ Catheter insertion
Indirect Care Types of Outcomes
Performed away from the patient but benefits
patient care. Goal Met

Examples: Expected outcome completely achieved.

●​ Documentation
●​ Care coordination
●​ Ordering supplies Goal Partially Met

Some improvement noted, but additional care is

needed.

Documentation During
Implementation Goal Not Met
Document:
Desired outcome not achieved.
●​ Interventions performed
The nurse should reassess the patient and revise
●​ Time completed
the nursing care plan.
●​ Patient response
●​ Unexpected events
●​ Communication with healthcare team

Evaluation Process
The nurse compares:
E. EVALUATION ●​ Actual patient outcomes
●​ Expected outcomes
Definition Questions to ask:

Evaluation is the final step of the nursing process ●​ Were the goals achieved?
where the nurse determines whether the patient's ●​ Were interventions effective?
goals and expected outcomes have been ●​ Does the care plan need revision?
achieved. ●​ Are new problems present?

Evaluation is continuous and may lead to

reassessment and revision of the care plan.

IMPORTANCE OF THE
Purpose NURSING PROCESS
●​ Determine effectiveness of nursing
The nursing process:
interventions.
●​ Assess patient progress. ●​ Promotes individualized care.
●​ Modify the care plan when necessary. ●​ Improves patient safety.
●​ Improve quality of care. ●​ Encourages critical thinking.
●​ Enhances communication.
●​ Supports evidence-based practice.
 ●​ Provides legal documentation. the abdomen, the sequence is
●​ Improves continuity of care. Inspection, Auscultation, Percussion,
●​ Increases patient satisfaction. and Palpation (IAPP) to avoid altering
bowel sounds.
●​ A nursing diagnosis focuses on the
patient's response to health problems,
while a medical diagnosis identifies the
COMPARISON OF ●​
disease or pathology.
NANDA-I provides standardized nursing
THE FIVE STEPS ●​
diagnoses.
SMART goals should be Specific,
Measurable, Achievable,
Step Main Key Activities
Realistic/Relevant, and Time-bound.
Purpose
●​ Nursing interventions are independent,
Assess Collect History taking, dependent, or collaborative.
ment information physical examination, ●​ Evaluation determines whether patient
data validation outcomes were met, partially met, or not
met, and findings guide revision of the
Nursing Identify Analyze data, care plan.
Diagno nursing formulate NANDA-I
sis problems diagnoses

Plannin Develop Set priorities, write

g goals and SMART goals, choose
interventions interventions

Implem Carry out Perform nursing

entatio the care interventions,
n plan document care

Evaluat Determine Compare outcomes II. VITAL SIGNS AND

ion effectivenes with goals, revise care
s plan if needed PHYSICAL
ASSESSMENT
HIGH-YIELD EXAM
POINTS INTRODUCTION
●​ ADPIE stands for Assessment, Definition of Vital Signs
Diagnosis, Planning, Implementation,
and Evaluation. Vital signs are objective measurements that
●​ Assessment is the foundation of the reflect the body's basic physiological functions.
nursing process; inaccurate data can lead They provide baseline information about a
to incorrect nursing diagnoses and patient's health status and help detect changes
interventions. that may indicate illness or improvement.
●​ Subjective data are symptoms reported
by the patient, while objective data are The four traditional vital signs are:
observable or measurable signs.
●​ Inspection, Palpation, Percussion, and ●​ Temperature (T)
Auscultation (IPPA) are the four ●​ Pulse (P)
techniques of physical assessment. For ●​ Respiration (R)
 ●​ Blood Pressure (BP) Fever (Pyrexia)
Many healthcare facilities also consider Pain as Temperature above 38°C (100.4°F)
the fifth vital sign, and some include oxygen
saturation (SpO₂). Causes:

●​ Infection
●​ Inflammation
●​ Heat stroke
A. BODY
TEMPERATURE Hyperthermia

Uncontrolled increase in body temperature due to

Definition failure of heat regulation.

Body temperature is the balance between heat

produced by the body and heat lost to the
environment. Hypothermia

Normal Body Temperature Temperature below 35°C (95°F)

Route Normal Range Causes:

Oral 36.5–37.5°C (97.7–99.5°F) ●​ Cold exposure

●​ Shock
Rectal 37.0–38.1°C
●​ Severe illness
(98.6–100.6°F)

Axillary 36.0–37.0°C (96.8–98.6°F)

Tympanic 36.5–37.5°C (97.7–99.5°F)

Temporal 36.5–37.5°C (97.7–99.5°F)

B. PULSE
Definition
Factors Affecting The pulse is the rhythmic expansion of an artery
Temperature produced by the heartbeat.

●​ Age
●​ Circadian rhythm
●​ Exercise Normal Adult Pulse
●​ Hormonal changes
●​ Stress 60–100 beats/minute
●​ Environment
●​ Infection

Pulse Assessment
Abnormal Temperature Assess:

●​ Rate
 ●​ Rhythm
Respiratory Assessment
●​ Strength (Amplitude)
●​ Equality Observe:

●​ Rate
●​ Rhythm
Common Pulse Sites ●​ Depth
●​ Effort
●​ Temporal ●​ Breath sounds
●​ Carotid
●​ Apical
●​ Brachial
●​ Radial Abnormal Respiratory
●​ Femoral
●​ Popliteal Patterns
●​ Posterior tibial
●​ Dorsalis pedis Tachypnea

Rapid breathing (>20 breaths/minute)

Bradypnea
Abnormal Pulse
Slow breathing (<12 breaths/minute)
Tachycardia
Apnea
Greater than 100 bpm
Absence of breathing

Dyspnea
Bradycardia
Difficulty breathing
Less than 60 bpm

Orthopnea

Difficulty breathing when lying flat

C. RESPIRATION Cheyne-Stokes Respiration

Alternating periods of deep breathing and apnea

Definition
Kussmaul Respiration
Respiration is the process of inhaling oxygen and
exhaling carbon dioxide. Deep, rapid breathing (commonly seen in diabetic
ketoacidosis)

Biot's Respiration
Normal Adult Respiratory
Irregular breathing with periods of apnea
Rate
12–20 breaths/minute
D. BLOOD Factors Affecting Blood
Pressure
PRESSURE
●​ Age
●​ Stress
Definition ●​ Exercise
●​ Medications
Blood pressure is the force exerted by circulating ●​ Blood volume
blood against arterial walls. ●​ Cardiac output
●​ Peripheral resistance

Components
Systolic Pressure E. PAIN (FIFTH VITAL
Pressure during ventricular contraction. SIGN)
Pain is whatever the patient says it is.

Diastolic Pressure Pain Assessment Tools:

Pressure during ventricular relaxation. ●​ Numeric Rating Scale (0–10)

●​ Wong-Baker Faces Scale
●​ FLACC Scale (children/nonverbal
patients)

Normal Adult Blood Pressure

Less than 120/80 mmHg

PHYSICAL
Blood Pressure Classification
ASSESSMENT
Category Blood Pressure
Definition
Normal <120/<80
Physical assessment is the systematic
Elevated 120–129/<80 examination of the body to identify normal and
abnormal findings.
Hypertension Stage 130–139 or
1 80–89

Hypertension Stage ≥140 or ≥90

2 Four Techniques
Hypotension Generally <90/60 Inspection

Visual observation.
Palpation Auscultation

Using hands to assess: ↓

●​ Texture Percussion
●​ Temperature
●​ Tenderness ↓
●​ Masses
Palpation

Percussion

Tapping body surfaces to assess underlying HEAD-TO-TOE

structures.
ASSESSMENT
Assess:
Auscultation
●​ General appearance
Listening with a stethoscope. ●​ Level of consciousness
●​ Skin
●​ Head
●​ Eyes
Order of Physical ●​ Ears
●​ Nose
Assessment ●​ Mouth
●​ Neck
General Assessment ●​ Chest
●​ Lungs
IPPA ●​ Heart
●​ Abdomen
Inspection ●​ Extremities
●​ Neurological status
↓

Palpation

↓
III. POSITIONING
Percussion

↓
PATIENTS IN BED
Auscultation AND PROPER BODY
MECHANICS
Abdomen

IAPP PURPOSE OF
Inspection POSITIONING
↓
Proper positioning:
4. Sims' Position
●​ Promotes comfort
Semi-prone with upper leg flexed.
●​ Prevents pressure injuries
●​ Improves breathing Uses:
●​ Promotes circulation
●​ Prevents contractures ●​ Rectal examination
●​ Facilitates examinations and procedures ●​ Enema administration
●​ Suppository insertion

COMMON PATIENT 5. Fowler's Position

POSITIONS Low Fowler's

15–30°
1. Supine Position
Patient lies flat on the back.
Semi-Fowler's

Uses: 30–45°

●​ Physical examination High Fowler's

●​ Surgery
●​ Rest 60–90°

Uses:

●​ Improves lung expansion

2. Prone Position ●​ Feeding
●​ Reduces aspiration risk
Patient lies on the abdomen.

Uses:

●​ Improves oxygenation (especially in 6. Trendelenburg Position

severe respiratory distress)
●​ Spinal surgery Head lower than feet.

Uses:

●​ Temporary management of hypotension

3. Lateral (Side-Lying) (as ordered)
●​ Central venous catheter insertion
Patient lies on one side.

Uses:

●​ Prevents pressure ulcers 7. Reverse Trendelenburg

●​ Oral care
●​ Recovery position Head elevated above feet.

Uses:
 ●​ Reduces intracranial pressure ●​ Use leg muscles rather than back
●​ Promotes gastric emptying muscles.
●​ Certain abdominal surgeries ●​ Push instead of pulling when possible.
●​ Use assistive devices when needed.
●​ Ask for help with heavy patients.

8. Lithotomy Position
Supine with hips and knees flexed, legs Benefits
supported in stirrups.
●​ Prevents musculoskeletal injuries.
Uses: ●​ Reduces fatigue.
●​ Promotes patient safety.
●​ Vaginal examination ●​ Improves work efficiency.
●​ Childbirth
●​ Gynecologic procedures

IV. LEVELS OF
9. Knee-Chest Position
Patient rests on knees and chest.
PREVENTION
Uses: Definition
●​ Rectal examination
Levels of prevention are strategies used to
●​ Certain spinal procedures
promote health, prevent disease, detect illness
early, and minimize disability.

Developed within public health, they guide nurses

in providing preventive care across the health
BODY MECHANICS continuum.

Definition
Body mechanics refers to the coordinated use of
body movements to maintain balance, prevent
A. PRIMARY
injury, and use energy efficiently.
PREVENTION
Definition
Principles of Proper Body
Actions taken before disease occurs to prevent
Mechanics its development.

●​ Maintain a wide base of support.

●​ Bend at the knees, not the waist.
Goal
●​ Keep the back straight.
Promote health and reduce risk factors.
●​ Hold objects close to the body.
●​ Avoid twisting while lifting.
Examples
●​ Tighten abdominal muscles during lifting.
 ●​ Immunization Rehabilitation and quality of life.
●​ Health education
●​ Hand hygiene Examples
●​ Smoking cessation
●​ Proper nutrition ●​ Physical therapy
●​ Regular exercise ●​ Cardiac rehabilitation
●​ Use of seat belts and helmets ●​ Occupational therapy
●​ Family planning ●​ Speech therapy
●​ Safe water and sanitation ●​ Prosthetic training
●​ Support groups
●​ Long-term medication management

B. SECONDARY
PREVENTION ROLE OF THE NURSE
IN PREVENTION
Definition
Primary Prevention
Measures that detect disease early and provide
prompt treatment. ●​ Provide health education.
●​ Administer vaccines.
Goal ●​ Promote healthy lifestyles.

Prevent progression and complications.

Secondary Prevention
Examples ●​ Conduct screenings.
●​ Recognize early symptoms.
●​ Blood pressure screening ●​ Refer patients for diagnostic evaluation.
●​ Blood glucose testing
●​ Mammography
Tertiary Prevention
●​ Pap smear
●​ Colonoscopy ●​ Assist with rehabilitation.
●​ Tuberculosis screening ●​ Prevent complications.
●​ Vision and hearing screening ●​ Support chronic disease management.
●​ Educate patients and families.

C. TERTIARY
PREVENTION COMPARISON OF
LEVELS OF
Definition PREVENTION
Interventions after disease has been diagnosed to
Lev Timi Goal Examples
reduce disability, restore function, and prevent
el ng
further complications.

Goal
Pri
mar
Befor
e
Prevent
disease
Immunization,
exercise, health
INTRODUCTION TO
y disea
se
education
PHARMACOLOGY
Sec Early Early Screening tests,
ond disea detection and BP monitoring, Definition
ary se prompt Pap smear
treatment Pharmacology is the branch of science that
studies drugs, including their sources,
Tert After Reduce Rehabilitation, properties, mechanisms of action, therapeutic
iary diagn disability and physical therapy, uses, adverse effects, interactions, and
osis restore support groups movement through the body.
function
It is one of the most important areas of nursing
because nurses are responsible for the safe
preparation, administration, monitoring, and
evaluation of medications.
HIGH-YIELD EXAM
POINTS
Basic Terminologies
●​ Normal adult temperature: 36.5–37.5°C
(oral).
Drug
●​ Normal adult pulse: 60–100
beats/minute. A chemical substance used to:
●​ Normal adult respiratory rate: 12–20
breaths/minute. ●​ Prevent disease
●​ Normal blood pressure: Less than 120/80 ●​ Diagnose disease
mmHg. ●​ Treat disease
●​ The four techniques of physical ●​ Relieve symptoms
assessment are Inspection, Palpation, ●​ Restore normal body functions
Percussion, and Auscultation (IPPA).
For the abdomen, use Inspection,
Auscultation, Percussion, and
Palpation (IAPP). Medication
●​ High Fowler's position (60–90°)
improves lung expansion and decreases A drug prepared and intended for administration
aspiration risk. to produce a therapeutic effect.
●​ Sims' position is commonly used for
rectal procedures such as enemas and
suppository insertion.
●​ Primary prevention prevents disease Therapeutic Effect
before it occurs.
●​ Secondary prevention focuses on early The desired beneficial effect of a medication.
detection through screening.
Example:​
●​ Tertiary prevention aims to reduce
Paracetamol lowers fever.
disability and promote rehabilitation after
disease has developed.

Side Effect
An expected secondary effect that occurs in Contraindication
addition to the desired effect.
A condition in which a medication should not be
Example:​ used because it may be harmful.
Drowsiness after taking antihistamines.

Drug Interaction
Adverse Drug Reaction (ADR)
Occurs when one drug alters the effect of another
An unintended, harmful reaction occurring at drug, or when food, herbs, or supplements affect
normal therapeutic doses. a medication.

Example:​ Types:
Severe allergic reaction after antibiotic
administration. ●​ Drug–drug interaction
●​ Drug–food interaction
●​ Drug–herbal interaction

Toxic Effect

Occurs when excessive amounts of a drug

accumulate in the body.
A.
Example:​
Digoxin toxicity. PHARMACOKINETICS
AND
Allergy PHARMACODYNAMIC
An immune-mediated hypersensitivity reaction to S
a medication.

Examples:

●​ Rash
PHARMACOKINETICS
●​ Urticaria (hives)
●​ Angioedema Definition
●​ Anaphylaxis
Pharmacokinetics is the study of what the body
does to the drug.

Drug Tolerance It describes how a drug moves through the body.

Decreased response to a drug after repeated use, Four Processes (ADME)

requiring higher doses to achieve the same effect.

1. Absorption
Drug Dependence
Movement of a drug from the site of
Physical or psychological need for a medication.
administration into the bloodstream.
Factors Affecting Absorption Main organ:

●​ Route of administration Kidneys

●​ Blood flow
●​ Surface area Other routes:
●​ Gastric pH
●​ Lungs
●​ Food intake
●​ Sweat
●​ Drug formulation
●​ Saliva
Example: ●​ Breast milk
●​ Feces
Intravenous medications have 100%
bioavailability because they enter the
bloodstream directly.

PHARMACODYNAMIC
2. Distribution S
Movement of the drug from the bloodstream to
body tissues and organs. Definition
Factors affecting distribution: Pharmacodynamics is the study of what the
drug does to the body.
●​ Blood circulation
●​ Plasma protein binding It explains how drugs produce their effects.
●​ Capillary permeability
●​ Body fat composition

Mechanism of Action
3. Metabolism Most drugs act by binding to receptors.

(Biotransformation) Drug effects may include:

Conversion of drugs into inactive or active ●​ Stimulating receptors (agonists)

metabolites. ●​ Blocking receptors (antagonists)
●​ Inhibiting enzymes
Primary organ: ●​ Altering cell membrane permeability

Liver

Purpose:
Drug Effects
●​ Detoxify drugs
●​ Prepare drugs for excretion Therapeutic Effect

Desired effect.

4. Excretion
Removal of drugs from the body. Side Effect

Predictable secondary effect.

 1. Oral (PO)

Adverse Effect Medication is swallowed.

Unexpected harmful effect. Advantages:

●​ Convenient
●​ Safe
Toxic Effect ●​ Economical

Occurs with excessive drug levels. Disadvantages:

●​ Slow onset
●​ Subject to first-pass metabolism
Idiosyncratic Reaction ●​ Not suitable for unconscious or vomiting
patients
Unusual or unpredictable response due to genetic
differences.

2. Sublingual (SL)

Allergic Reaction Placed under the tongue.

Advantages:
Immune response to a drug.
●​ Rapid absorption
●​ Bypasses first-pass metabolism

Therapeutic Index Example:

Nitroglycerin
Measures drug safety.

A high therapeutic index indicates a safer

medication because there is a larger difference
between the effective dose and the toxic dose. 3. Buccal

Placed between the gum and cheek.

Advantages:

B. ROUTES OF DRUG ●​ Rapid absorption

●​ Avoids first-pass metabolism
ADMINISTRATION
Definition 4. Rectal (PR)

The route of administration is the path by which a Inserted into the rectum.
drug enters the body.
Uses:

●​ Vomiting patients
●​ Children
●​ Unconscious patients (when appropriate)
ENTERAL ROUTES
 3. Intramuscular (IM)

Injection into muscle.

PARENTERAL Common Sites:

ROUTES ●​ Deltoid
●​ Vastus lateralis
●​ Ventrogluteal (preferred in adults)
Definition
Angle:
Administration by injection.
90°
Provides rapid drug action because the
medication bypasses the gastrointestinal tract. Volume:

●​ Deltoid: up to 1 mL
●​ Ventrogluteal: 2–5 mL (depending on
1. Intradermal (ID) patient)

Injection into the dermis.

Common Uses: 4. Intravenous (IV)

●​ Tuberculin skin test (PPD) Medication administered directly into a vein.

●​ Allergy testing
Advantages:
Angle:
●​ Immediate effect
5–15° ●​ 100% bioavailability
●​ Precise dosage control
Volume:
Disadvantages:
Up to 0.1 mL
●​ Higher risk of infection
●​ Difficult to reverse once administered
●​ Requires sterile technique
2. Subcutaneous (SC)

Injection into subcutaneous tissue.

Examples:
TOPICAL ROUTES
●​ Insulin
●​ Heparin ●​ Skin creams
●​ Ointments
Angle: ●​ Eye drops
●​ Ear drops
●​ 45° (thin patients) ●​ Nasal sprays
●​ 90° (average or obese patients) ●​ Transdermal patches
Volume:

Usually up to 1 mL

INHALATION
Medication delivered into the respiratory tract. Example
Examples: Order:

●​ Bronchodilators Amoxicillin 500 mg

●​ Nebulized medications
Available:
Advantages:
250 mg per capsule
●​ Rapid onset
●​ Direct effect on lungs Calculation:

500 ÷ 250 × 1

= 2 capsules

VAGINAL ROUTE
Used for:

●​ Antifungal medications LIQUID MEDICATION

●​ Hormonal preparations
EXAMPLE
Order:

C. DRUG AND IV Paracetamol 250 mg

Available:
FLUID COMPUTATION
125 mg per 5 mL

Calculation:
IMPORTANCE
250 ÷ 125 × 5
Accurate drug computation prevents:
= 10 mL
●​ Medication errors
●​ Overdose
●​ Underdose
●​ Adverse drug events
INTRAVENOUS FLOW
RATE COMPUTATION
FORMULA FOR
Formula (Drops per Minute)
TABLETS OR LIQUID Volume (mL) × Drop Factor (gtt/mL) ÷ Time
MEDICATIONS (minutes)

Desired Dose ÷ Dose on Hand × Quantity =

Example
Amount to Administer
Order:
1000 mL over 8 hours Prescription:

Drop factor: 10 mg/kg/day divided into 2 doses

15 gtt/mL Daily dose:

Convert time: 20 × 10 = 200 mg/day

8 × 60 = 480 minutes Per dose:

Calculation: 200 ÷ 2 = 100 mg every 12 hours

1000 × 15 ÷ 480

= 31 gtt/min

SIX RIGHTS OF
MEDICATION
INFUSION PUMP ADMINISTRATION
COMPUTATION 1.​ Right Patient
2.​ Right Medication
Formula:
3.​ Right Dose
4.​ Right Route
Volume (mL) ÷ Time (hours)
5.​ Right Time
6.​ Right Documentation
Example

1000 mL over 8 hours

1000 ÷ 8

= 125 mL/hour
ADDITIONAL RIGHTS
(COMMONLY
TAUGHT)
PEDIATRIC DOSAGE ●​ Right Assessment
●​ Right Education
COMPUTATION ●​ Right Evaluation
●​ Right Response
Formula: ●​ Right to Refuse
●​ Right Reason
Weight (kg) × Prescribed Dose (mg/kg/day)

If divided into multiple doses:

Divide the total daily dose by the prescribed

number of doses. MEDICATION SAFETY
Example: GUIDELINES
Child weighs 20 kg
●​ Verify physician's order.
 ●​ Check allergies before administration. ●​ The liver is the primary site of drug
●​ Perform three label checks. metabolism, while the kidneys are the
●​ Identify the patient using two identifiers. primary organs responsible for drug
●​ Monitor for adverse reactions. excretion.
●​ Document immediately after ●​ Intravenous (IV) administration has 100%
administration. bioavailability because the drug enters
●​ Never administer medications you did not the bloodstream directly.
prepare without proper verification. ●​ Injection angles:
●​ Do not use medications with expired ○​ Intradermal (ID): 5–15°
labels or damaged packaging. ○​ Subcutaneous (SC): 45° or 90°
○​ Intramuscular (IM): 90°
●​ Drug computation formula:​
Desired Dose ÷ Dose on Hand ×
Quantity
COMPARISON OF ●​ IV flow rate (gravity infusion):​
Volume × Drop Factor ÷ Time (minutes)
PHARMACOKINETICS ●​ Infusion pump rate:​
Volume ÷ Time (hours) = mL/hour
VS ●​ Always follow the Six Rights of
Medication Administration to reduce

PHARMACODYNAMIC medication errors.

S
Pharmacokinetics Pharmacodynami
cs

What the body does to the What the drug

drug does to the body

ADME (Absorption, Mechanism of

Distribution, Metabolism, action and drug
Excretion) effects

Determines drug Determines drug

concentration response

Influenced by liver, Influenced by

kidneys, and circulation receptors and
target organs

HIGH-YIELD EXAM
POINTS
●​ Pharmacokinetics = ADME: Absorption,
Distribution, Metabolism, and Excretion.
●​ Pharmacodynamics explains the drug's
mechanism of action and effects on the
body.
 ●​ Build trust and rapport.
●​ Gather accurate patient information.
●​ Encourage expression of thoughts and
feelings.
●​ Reduce anxiety and stress.
●​ Promote problem-solving and
decision-making.
●​ Provide emotional support.
●​ Improve patient compliance with
treatment.
●​ Enhance patient safety and satisfaction.

CHARACTERISTICS
OF THERAPEUTIC
MODULE 3
COMMUNICATION
INTRODUCTION TO Effective therapeutic communication is:

THERAPEUTIC ●​
●​
Patient-centered
Goal-oriented
COMMUNICATION ●​
●​
Honest and respectful
Empathetic
●​ Nonjudgmental
●​ Confidential
Definition
●​ Professional
●​ Based on active listening
Therapeutic communication is a purposeful,
goal-directed form of communication used by
nurses and other healthcare professionals to
establish a helping relationship with patients. It
promotes trust, understanding, emotional support,
and collaboration in care. COMPONENTS OF
Unlike social conversation, therapeutic COMMUNICATION
communication is focused on the patient's
needs, concerns, feelings, and goals.
1. Sender

The person who initiates the message.

PURPOSES OF
2. Message
THERAPEUTIC
The information being communicated.
COMMUNICATION
Therapeutic communication helps the nurse to:
3. Receiver
The person who receives the message. ●​ Personal space

Remember: Nonverbal communication often

conveys more meaning than words.
4. Feedback

The receiver's response that confirms whether the

message was understood.
THERAPEUTIC
5. Channel
COMMUNICATION
The method by which the message is delivered TECHNIQUES
(spoken, written, electronic, etc.).

1. Active Listening
6. Environment Giving full attention to the patient without
interrupting.
The setting in which communication takes place.
Example:

Patient:​
"I'm scared about my surgery."

TYPES OF Nurse:​
"Tell me more about what worries you."
COMMUNICATION
Verbal Communication
2. Using Silence
Uses spoken or written words.
Allows the patient time to think, reflect, or express
Examples: emotions.

●​ Health teaching Example:

●​ Interviews
●​ Patient education The nurse quietly remains with a crying patient
without interrupting.

Nonverbal Communication

Uses body language rather than words. 3. Accepting

Examples: Acknowledging the patient's feelings without
judgment.
●​ Facial expressions
●​ Eye contact Example:
●​ Posture
●​ Gestures "I understand."
●​ Touch
"I hear what you're saying."
●​ Tone of voice
 "What happened before the pain started?"

4. Giving Recognition
Acknowledging the patient without making 9. Making Observations
judgments.
Commenting on what is observed.
Example:
Example:
"I noticed you walked to the hallway today."
"You seem quieter today."

5. Offering Self
10. Encouraging Description
Making oneself available to the patient.
of Perceptions
Example:
Helping the patient describe sensory experiences.
"I'll stay with you for a while."
Example:

"Can you describe what the voices are saying?"

6. Giving Broad Openings (Commonly used in psychiatric nursing.)

Allowing the patient to choose the topic.

Example:
11. Encouraging Comparison
"What would you like to talk about today?"
Helping patients compare experiences.

Example:

7. Offering General Leads "Has this happened before?"

Encouraging the patient to continue.

Examples:
12. Restating (Paraphrasing)
●​ "Go on."
Repeating the patient's ideas in different words.
●​ "Tell me more."
●​ "And then?" Patient:

"I can't sleep because I keep worrying."

Nurse:
8. Placing Events in Time or
Sequence "You're having difficulty sleeping because you're
worried."
Helping organize events.

Example:
 Patient:​
13. Reflecting
"Someone is trying to poison me."
Directing feelings or questions back to the patient.
Nurse:​
Patient: "I understand you're frightened, but I don't see
anyone trying to harm you."
"Do you think I'll recover?"

Nurse:

"What are your thoughts about your recovery?"

18. Voicing Doubt
Expressing uncertainty when the patient's
perception differs from reality.

14. Focusing Example:

Concentrating on one important topic. "I'm having difficulty believing that happened
exactly as you described."
Example:

"Let's talk more about your chest pain."

19. Verbalizing the Implied

Putting into words what the patient may be
15. Exploring feeling.

Seeking additional information. Example:

Example: "You seem disappointed."

"Tell me more about what happened."

20. Encouraging Evaluation

16. Seeking Clarification Helping patients evaluate situations.

Ensuring understanding. Example:

Example: "How did that solution work for you?"

"I'm not sure I understand. Could you explain

what you mean?"

21. Summarizing
Reviewing important points discussed.
17. Presenting Reality
Example:
Helping patients distinguish reality from
misperceptions. "Today we talked about your pain, medication,
and discharge plan."
Example:
THERAPEUTIC USE
OF TOUCH NON-THERAPEUTIC
Touch may communicate:
COMMUNICATION
●​ Caring
●​ Comfort
●​ Reassurance Definition
●​ Support
Non-therapeutic communication consists of
Always consider: responses that block communication, discourage
patient expression, or create barriers to the
●​ Culture therapeutic relationship.
●​ Patient preference
●​ Age These techniques can make patients feel judged,
●​ Gender ignored, misunderstood, or reluctant to share
●​ Situation information.

EMPATHY VS COMMON
SYMPATHY NON-THERAPEUTIC
TECHNIQUES
Empathy
Understanding another person's feelings while 1. Giving False Reassurance
maintaining professional boundaries.
Examples:
Example:
●​ "Everything will be fine."
"That sounds very difficult. I'm here to support ●​ "Don't worry."
you."
Problem:

May minimize the patient's feelings and provide

unrealistic hope.
Sympathy
Feeling pity or sorrow for another person's
situation.
2. Giving Personal Advice
Example:
Example:
"I feel so sorry for you."
"If I were you, I'd quit my job."
Nurses should demonstrate empathy rather
than sympathy, as empathy promotes support Problem:
without becoming emotionally overinvolved.
The nurse makes decisions for the patient instead
of encouraging independent decision-making.
3. Asking "Why" Questions 7. Arguing
Example: Never argue with a patient.

"Why did you stop taking your medication?" Instead, acknowledge feelings and present reality
when appropriate.
Problem:

May make the patient feel defensive or judged.

A better alternative: 8. Probing

"Can you tell me what made it difficult to take your Excessive questioning beyond what is necessary.
medication?"
Problem:

May invade privacy and increase anxiety.

4. Changing the Subject

Problem:
9. Minimizing Feelings
Ignores the patient's concerns.
Example:

"It's not that bad."

5. Giving Approval or Problem:

Disapproval Dismisses the patient's emotions.

Examples:

●​ "Good."
●​ "You shouldn't feel that way." 10. Stereotyped Comments
Problem: Examples:

Encourages patients to seek approval rather than ●​ "Keep your chin up."
express themselves honestly. ●​ "Time heals all wounds."

Problem:

Appears impersonal and dismissive.

6. Defending
Example:

"The doctor knows what's best." 11. Interrupting

Problem: Problem:

Discourages discussion and may invalidate the Prevents patients from fully expressing
patient's concerns. themselves.
 ●​ Fear
●​ Pain
●​ Cultural differences
12. Making Judgments ●​ Environmental noise
●​ Use of medical jargon
Examples:
●​ Lack of privacy
●​ "You shouldn't have done that."
●​ "That was wrong."

Problem:
NURSE'S ROLE IN
Creates shame or guilt.
THERAPEUTIC
COMMUNICATION
13. Requesting an
The nurse should:
Explanation
●​ Listen actively.
Example: ●​ Maintain appropriate eye contact.
●​ Use open-ended questions.
"Explain why you did that."
●​ Respect silence.
Problem: ●​ Validate patient feelings.
●​ Clarify unclear statements.
Can sound accusatory. ●​ Maintain confidentiality.
●​ Demonstrate empathy.
●​ Respect cultural differences.
●​ Avoid judgment and personal opinions.

14. Testing or Quizzing

Example:

"Do you remember what I taught you yesterday?" COMPARISON OF

Problem: THERAPEUTIC AND
May make patients feel embarrassed or
inadequate.
NON-THERAPEUTIC
COMMUNICATION
Therapeutic Non-Therapeutic
BARRIERS TO Communication Communication

EFFECTIVE
COMMUNICATION Encourages
expression
Blocks communication

●​ Language differences
●​ Hearing impairment
Builds trust Creates barriers
●​ Cognitive impairment
●​ Anxiety
 ●​ Presenting reality is appropriate for
Uses active Interrupts or changes the patients experiencing delusions or
listening subject hallucinations while still acknowledging
their feelings.
●​ Effective communication requires
awareness of verbal and nonverbal
Accepts feelings Judges or criticizes
messages, cultural sensitivity, and
without judgment
confidentiality.

Uses open-ended
questions
Uses excessive "why"
questions
II. ASEPSIS AND
INFECTION
Promotes patient
independence
Gives advice or makes
decisions for the patient
CONTROL

Clarifies and Assumes or minimizes

validates feelings
INTRODUCTION
Definition of Asepsis
Asepsis refers to the absence of disease-causing
HIGH-YIELD EXAM microorganisms (pathogens). It includes practices
and procedures that prevent contamination and
POINTS reduce the spread of infection.

Aseptic techniques are essential in all healthcare

●​ Therapeutic communication is
settings to protect patients, healthcare workers,
purposeful, patient-centered, and
and the community from healthcare-associated
designed to promote healing.
infections (HAIs).
●​ Active listening, silence, offering self,
reflection, restating, clarification,
focusing, and summarizing are common
therapeutic techniques.
●​ Empathy means understanding and
acknowledging the patient's feelings while IMPORTANCE OF
maintaining professional boundaries;
sympathy involves sharing or feeling pity ASEPSIS
for the patient's emotions.
●​ Open-ended questions encourage Asepsis helps to:
patients to elaborate, whereas
closed-ended questions usually require ●​ Prevent healthcare-associated infections
short or yes/no responses. (HAIs)
●​ Avoid false reassurance, giving advice, ●​ Reduce transmission of microorganisms
asking "why" questions, changing the ●​ Protect patients, healthcare workers, and
subject, arguing, defending, and visitors
making judgments, as these are ●​ Promote faster healing
non-therapeutic. ●​ Decrease morbidity and mortality
●​ Improve quality and safety of patient care
 Live on or inside another organism.

Examples:

BASIC ●​ Plasmodium
●​ Ascaris lumbricoides
MICROBIOLOGY
Microorganisms 5. Prions

Microorganisms are living organisms too small to Abnormal proteins that cause neurodegenerative
be seen with the naked eye. diseases.

Common Types Example:

●​ Creutzfeldt-Jakob disease (CJD)

1. Bacteria

Single-celled organisms that may be beneficial or

harmful.

Examples: INFECTION
●​ Escherichia coli
●​ Staphylococcus aureus Definition
●​ Streptococcus pneumoniae
An infection occurs when microorganisms invade
the body, multiply, and cause tissue damage or
disease.
2. Viruses

Require living host cells to reproduce.

Examples:
THE CHAIN OF
●​ Influenza virus
●​ Human Immunodeficiency Virus (HIV) INFECTION
●​ Hepatitis B virus
●​ SARS-CoV-2 The Chain of Infection consists of six links.
Breaking any link prevents the spread of infection.

1. Infectious Agent
3. Fungi
The microorganism that causes disease.
Include yeasts and molds.
Examples:
Examples:
●​ Bacteria
●​ Candida albicans ●​ Viruses
●​ Dermatophytes ●​ Fungi
●​ Parasites

4. Parasites
2. Reservoir Transmission by insects or animals.

The place where microorganisms live and

multiply.
5. Portal of Entry
Examples:
How microorganisms enter a new host.
●​ Humans
●​ Animals Examples:
●​ Water
●​ Food ●​ Respiratory tract
●​ Soil ●​ Gastrointestinal tract
●​ Medical equipment ●​ Urinary tract
●​ Broken skin
●​ Mucous membranes

3. Portal of Exit

How microorganisms leave the reservoir. 6. Susceptible Host

Examples: A person at risk of infection.

●​ Respiratory secretions Risk factors include:

●​ Blood
●​ Urine ●​ Extremes of age
●​ Feces ●​ Chronic illness
●​ Wound drainage ●​ Immunosuppression
●​ Malnutrition
●​ Stress
●​ Invasive procedures
4. Mode of Transmission

How microorganisms spread.

Direct Contact
TYPES OF ASEPSIS
Person-to-person contact.

Indirect Contact 1. Medical Asepsis (Clean

Contaminated objects (fomites).
Technique)
Practices that reduce the number and spread of
Droplet
microorganisms.
Large respiratory droplets (e.g., coughing,
Examples:
sneezing).
●​ Hand hygiene
Airborne
●​ Cleaning equipment
Tiny particles that remain suspended in the air. ●​ Routine environmental cleaning
●​ Proper disposal of waste
Vehicle ●​ Wearing clean gloves

Contaminated food, water, blood, or medications.

Vector
2. Surgical Asepsis (Sterile HAND HYGIENE
Technique)
Practices that eliminate all microorganisms, Definition
including spores.
Hand hygiene is the single most effective
Used during: measure for preventing the spread of infection.

●​ Surgical procedures
●​ Sterile dressing changes
●​ Catheter insertion
●​ Invasive procedures
Types of Hand Hygiene
1. Handwashing with Soap and Water

Use when:

MEDICAL ASEPSIS ●​ Hands are visibly dirty.

●​ After using the restroom.
PRINCIPLES ●​ Before eating.
●​ After contact with spore-forming
●​ Perform hand hygiene before and after organisms (e.g., Clostridioides difficile).
patient contact.
●​ Keep the environment clean. Duration:
●​ Avoid touching contaminated surfaces.
●​ Dispose of waste properly. ●​ At least 40–60 seconds.
●​ Use personal protective equipment (PPE)
appropriately.
●​ Follow standard and transmission-based
precautions.
2. Alcohol-Based Hand Rub (ABHR)

Use when hands are not visibly soiled.

Duration:

SURGICAL ASEPSIS ●​ At least 20–30 seconds.

PRINCIPLES
●​ Only sterile items touch sterile items.
●​ If sterility is uncertain, consider the item THE WORLD HEALTH
contaminated.
●​ Keep sterile objects above waist level and ORGANIZATION
within sight.
●​ Moisture contaminates a sterile field (WHO) FIVE
(strike-through contamination).
●​ Do not reach over a sterile field. MOMENTS FOR
●​ The outer 2.5 cm (1 inch) edge of a sterile
field is considered contaminated.
●​ Minimize talking, coughing, or sneezing
HAND HYGIENE
over sterile fields.
1.​ Before touching a patient.
2.​ Before a clean or aseptic procedure.
3.​ After body fluid exposure risk.
 4.​ After touching a patient.
5.​ After touching the patient's surroundings.

STANDARD
PERSONAL PRECAUTIONS
PROTECTIVE Applied to all patients, regardless of diagnosis.

Include:
EQUIPMENT (PPE)
●​ Hand hygiene
●​ Appropriate PPE
Purpose ●​ Respiratory hygiene/cough etiquette
●​ Safe injection practices
PPE protects healthcare workers and patients ●​ Proper handling of sharps
from exposure to infectious materials. ●​ Cleaning and disinfection of equipment
●​ Safe handling of linen and waste

Types of PPE
●​ Gloves TRANSMISSION-BAS
●​ Gown
●​ Surgical mask ED PRECAUTIONS
●​ Respirator (e.g., N95)
●​ Goggles Used in addition to standard precautions for
●​ Face shield patients with known or suspected infectious
diseases.

Order of Donning PPE

1. Contact Precautions
1.​ Gown
2.​ Mask or respirator Used For
3.​ Goggles or face shield
4.​ Gloves Diseases spread by direct or indirect contact.

Examples:

●​ Methicillin-resistant Staphylococcus
Order of Doffing PPE aureus (MRSA)
●​ Vancomycin-resistant Enterococci (VRE)
1.​ Gloves ●​ Clostridioides difficile
2.​ Goggles or face shield ●​ Scabies
3.​ Gown
4.​ Mask or respirator (remove after leaving
PPE
the patient care area, if appropriate)
●​ Gloves
Perform hand hygiene immediately after PPE
●​ Gown
removal.
2. Droplet Precautions
Preca PPE Examples
ution
Used For

Diseases spread by respiratory droplets.

Stand Based on All patients
Examples: ard anticipated
exposure
●​ Influenza
●​ Pertussis
●​ Mumps
●​ Meningococcal meningitis Conta Gloves, Gown MRSA, VRE, C.
ct difficile, Scabies
PPE

●​ Surgical mask Dropl Surgical Mask Influenza, Mumps,

et Pertussis
Maintain approximately 1 meter (3 feet) or more
from the patient when possible.

Airbor N95 Respirator TB, Measles,

ne Varicella

3. Airborne Precautions
Used For

Diseases spread by airborne particles.

STERILIZATION VS
Examples:
DISINFECTION
●​ Pulmonary Tuberculosis (TB)
●​ Measles (Rubeola)
●​ Varicella (Chickenpox) Sterilization
PPE Destroys all microorganisms, including bacterial
spores.
●​ Fit-tested N95 respirator or equivalent
●​ Negative-pressure isolation room Methods:
(Airborne Infection Isolation Room)
●​ Steam under pressure (Autoclave)
●​ Ethylene oxide gas
●​ Hydrogen peroxide plasma

Used for:
ISOLATION
●​ Surgical instruments
PRECAUTIONS ●​ Implantable devices

SUMMARY
Disinfection
Eliminates many or most pathogenic ●​ Perform proper hand hygiene.
microorganisms but not necessarily bacterial ●​ Use appropriate PPE.
spores. ●​ Maintain aseptic technique.
●​ Assess patients for signs of infection.
Used for: ●​ Educate patients and families on infection
prevention.
●​ Medical equipment ●​ Safely handle sharps and contaminated
●​ Environmental surfaces materials.
●​ Clean and disinfect equipment.
Levels:
●​ Follow isolation protocols.
●​ High-level ●​ Report and document infections promptly.
●​ Intermediate-level
●​ Low-level

COMPARISON OF
HEALTHCARE-ASSO MEDICAL AND
CIATED INFECTIONS SURGICAL ASEPSIS
(HAIs) Medical Asepsis Surgical Asepsis

Definition
Reduces Eliminates all
Infections acquired during healthcare delivery that microorganisms microorganisms, including
were not present or incubating at the time of spores
admission.

Common HAIs:
Clean technique Sterile technique
●​ Catheter-associated urinary tract infection
(CAUTI)
●​ Central line-associated bloodstream Used for routine Used for invasive
infection (CLABSI) patient care procedures
●​ Surgical site infection (SSI)
●​ Ventilator-associated pneumonia (VAP)

Clean gloves are Sterile gloves and sterile

usually sufficient equipment required

NURSING
RESPONSIBILITIES IN
INFECTION HIGH-YIELD EXAM
CONTROL POINTS
●​ Asepsis is the absence of
The nurse should:
disease-causing microorganisms.
 ●​ The Chain of Infection has six links:
Infectious Agent, Reservoir, Portal of
Exit, Mode of Transmission, Portal of
Entry, and Susceptible Host. Importance of Nutrition
●​ Hand hygiene is the most effective way
Proper nutrition helps to:
to prevent the spread of infection.
●​ Medical asepsis reduces
●​ Promote normal growth and development
microorganisms, while surgical asepsis
●​ Provide energy for daily activities
eliminates all microorganisms, including
●​ Build and repair body tissues
spores.
●​ Maintain immune function
●​ WHO Five Moments for Hand Hygiene
●​ Prevent malnutrition and disease
should be practiced consistently in patient
●​ Promote wound healing and recovery
care.
●​ Maintain normal body weight
●​ Standard precautions apply to every
patient, regardless of diagnosis.
●​ Contact precautions: Gloves and gown
(e.g., MRSA, C. difficile).
●​ Droplet precautions: Surgical mask (e.g.,
influenza, pertussis). BASIC NUTRIENTS
●​ Airborne precautions: N95 respirator
and negative-pressure room (e.g., TB, There are six essential nutrients required by the
measles, varicella). body.
●​ Sterilization destroys all microorganisms,
including spores; disinfection reduces or
eliminates most pathogens but may not
destroy spores.

Certainly! Here's a comprehensive reviewer on

1. CARBOHYDRATES
Nutrition and Diet Therapy, covering the
essential concepts commonly tested in Definition
Fundamentals of Nursing, Medical-Surgical
Nursing, Community Health Nursing, and the Carbohydrates are the body's primary source of
PNLE. energy.

Functions

●​ Provide energy
INTRODUCTION TO ●​ Spare protein from being used as energy
●​ Aid fat metabolism
NUTRITION ●​ Supply dietary fiber

Food Sources
Definition
●​ Rice
Nutrition is the science of food and nutrients and ●​ Bread
how the body uses them for growth, energy, ●​ Pasta
maintenance, repair of tissues, and regulation of ●​ Cereals
body processes. ●​ Potatoes
●​ Corn
Good nutrition promotes optimal health, ●​ Fruits
strengthens immunity, supports healing, and ●​ Sugars
helps prevent chronic diseases.
Deficiency
 ●​ Fatigue Fats are the body's most concentrated source of
●​ Weight loss energy.
●​ Ketosis
●​ Muscle wasting Functions

●​ Energy storage
●​ Insulation
●​ Organ protection
2. PROTEINS ●​ Absorption of fat-soluble vitamins (A, D, E,
K)
●​ Cell membrane formation
Definition
Food Sources
Proteins are the building blocks of the body.
●​ Oils
Functions ●​ Butter
●​ Nuts
●​ Growth and tissue repair ●​ Seeds
●​ Enzyme production ●​ Avocado
●​ Hormone production ●​ Fatty fish
●​ Antibody formation
●​ Maintenance of muscle mass Types of Fat
●​ Fluid balance
Saturated Fat
Food Sources
Examples:
●​ Meat
●​ Butter
●​ Fish
●​ Lard
●​ Chicken
●​ Fatty meats
●​ Eggs
●​ Milk Excess intake increases cardiovascular risk.
●​ Cheese
●​ Beans
●​ Soy products
●​ Nuts Unsaturated Fat

Deficiency Examples:

●​ Olive oil
●​ Muscle wasting
●​ Canola oil
●​ Poor wound healing
●​ Fish oil
●​ Edema
●​ Nuts
●​ Increased infection risk
Generally considered heart-healthy.

3. FATS (LIPIDS) Trans Fat

Found in some processed foods.

Definition Associated with increased cardiovascular disease
risk.
 ●​ Egg yolk

4. VITAMINS Vitamin E

Functions:
Definition
●​ Antioxidant
Organic substances needed in small amounts for ●​ Protects cell membranes
normal body functions.
Sources:

●​ Nuts
●​ Seeds
Fat-Soluble Vitamins ●​ Vegetable oils

Vitamin A

Functions: Vitamin K
●​ Vision Functions:
●​ Skin integrity
●​ Immune function ●​ Blood clotting

Deficiency: Deficiency:

●​ Night blindness ●​ Bleeding tendencies

●​ Dry eyes
Sources:
Sources:
●​ Green leafy vegetables
●​ Carrots
●​ Sweet potatoes
●​ Liver
●​ Spinach
Water-Soluble Vitamins
Vitamin C
Vitamin D
Functions:
Functions:
●​ Collagen synthesis
●​ Calcium absorption ●​ Wound healing
●​ Bone health ●​ Immune support
●​ Iron absorption
Deficiency:
Deficiency:
●​ Rickets (children)
●​ Osteomalacia (adults) ●​ Scurvy

Sources: Sources:

●​ Sunlight ●​ Citrus fruits

●​ Fortified milk ●​ Tomatoes
●​ Fatty fish ●​ Bell peppers
 ●​ Broccoli Sources:

●​ Red meat
●​ Liver
B-Complex Vitamins ●​ Spinach
●​ Beans
Functions:

●​ Energy metabolism
●​ Nervous system function Potassium
●​ Red blood cell production
Functions:
Examples:
●​ Muscle contraction
●​ B1 (Thiamine) ●​ Cardiac function
●​ B2 (Riboflavin) ●​ Fluid balance
●​ B3 (Niacin)
●​ B6 (Pyridoxine) Sources:
●​ B9 (Folate)
●​ B12 (Cobalamin) ●​ Bananas
●​ Potatoes
●​ Oranges

5. MINERALS Sodium

Functions:
Major Minerals
●​ Fluid balance
Calcium ●​ Nerve transmission

Functions: Excess intake may contribute to hypertension.

●​ Bone and teeth formation

●​ Muscle contraction
●​ Blood clotting

Sources:
6. WATER
●​ Dairy products
●​ Green leafy vegetables Functions
●​ Maintains hydration
●​ Regulates body temperature
Iron ●​ Transports nutrients
●​ Removes waste products
Functions: ●​ Lubricates joints
●​ Maintains blood volume
●​ Hemoglobin formation
●​ Oxygen transport

Deficiency:

●​ Iron-deficiency anemia BALANCED DIET

A balanced diet provides all essential nutrients in ●​ Before surgery
the proper amounts to meet an individual's needs. ●​ After surgery
●​ Acute gastrointestinal illness
Characteristics:

●​ Variety
●​ Moderation
●​ Balance 3. Full Liquid Diet
●​ Adequacy
Includes clear liquids plus milk-based liquids.

Examples:

●​ Milk
THERAPEUTIC DIETS ●​ Cream soups
●​ Yogurt
●​ Custard
Definition ●​ Ice cream

Therapeutic diets are modified diets prescribed to

manage or treat specific diseases or medical
conditions.
4. Soft Diet
Easy to chew and digest.

TYPES OF Examples:

●​ Soft rice
THERAPEUTIC DIETS ●​ Eggs
●​ Mashed potatoes
●​ Cooked vegetables
1. Regular Diet
No restrictions.

Used for patients without dietary limitations. 5. Mechanical Soft Diet

Foods are chopped, mashed, or ground.

Used for:
2. Clear Liquid Diet
●​ Patients with chewing or swallowing
Contains transparent liquids that leave little difficulties
residue.

Examples:

●​ Water 6. Low-Sodium Diet

●​ Clear broth
●​ Apple juice Restricts sodium intake.
●​ Tea
Indications:
●​ Gelatin
●​ Hypertension
Uses:
●​ Heart failure
 ●​ Kidney disease ●​ Underweight patients
●​ Cancer
Avoid: ●​ Hyperthyroidism

●​ Processed foods
●​ Canned goods
●​ Salty snacks
11. Renal Diet
Limits:

7. Diabetic (Consistent ●​ Sodium

●​ Potassium
Carbohydrate) Diet
●​ Phosphorus
Controls carbohydrate intake to maintain blood ●​ Fluids (when prescribed)
glucose.
Protein intake varies depending on kidney
Emphasizes: function and dialysis status.

●​ Whole grains
●​ Vegetables
●​ Lean proteins 12. Cardiac Diet
●​ Portion control
Emphasizes:

●​ Low sodium
●​ Low saturated fat
8. Low-Fat Diet
●​ Low cholesterol
Restricts saturated and trans fats. ●​ High fiber

Indications:

●​ Gallbladder disease
●​ Pancreatitis
●​ Hyperlipidemia
ENTERAL NUTRITION
Definition
9. High-Protein Diet Delivery of nutrients directly into the
gastrointestinal tract through a feeding tube.
Used for:
Examples:
●​ Burns
●​ Nasogastric (NG) tube
●​ Wound healing
●​ Orogastric tube
●​ Trauma
●​ Gastrostomy (G-tube)
●​ Malnutrition
●​ Jejunostomy (J-tube)

10. High-Calorie Diet Indications

Used for:
●​ Stroke with dysphagia
 ●​ Neurologic disorders ●​ Non-functioning gastrointestinal tract
●​ Head and neck cancer ●​ Severe malabsorption
●​ Inability to swallow with a functioning GI ●​ Bowel obstruction
tract ●​ Severe pancreatitis (selected cases)
●​ Prolonged inability to eat

Nursing Responsibilities
Nursing Responsibilities
●​ Verify tube placement according to agency
policy. ●​ Maintain strict aseptic technique.
●​ Elevate the head of the bed to 30–45° ●​ Monitor blood glucose levels.
during feeding and for at least 30–60 ●​ Monitor electrolytes.
minutes afterward to reduce aspiration ●​ Inspect the IV site for infection.
risk. ●​ Do not stop TPN abruptly unless
●​ Flush the tube before and after feedings instructed; sudden discontinuation may
and medications. cause hypoglycemia.
●​ Monitor gastric residual volume if required ●​ Use an infusion pump for accurate
by institutional policy. delivery.
●​ Assess for nausea, vomiting, diarrhea,
abdominal distention, and aspiration.

MALNUTRITION
PARENTERAL
Definition
NUTRITION
An imbalance between nutrient intake and the
body's requirements.
Definition
Administration of nutrients directly into the
bloodstream. Types
Types:
Undernutrition
Total Parenteral Nutrition (TPN)
Caused by inadequate nutrient intake.
Provides complete nutrition through a central
Signs:
venous catheter.
●​ Weight loss
●​ Muscle wasting
●​ Weakness
Peripheral Parenteral Nutrition (PPN) ●​ Delayed wound healing
Provides partial nutritional support through a
peripheral IV line.
Overnutrition

Caused by excessive nutrient intake.

Indications
Examples:
Lower infection risk Higher infection risk
●​ Obesity
●​ Hyperlipidemia

More physiologic and More complex and

less expensive costly

NURSING
Examples: NG, Examples: TPN, PPN
RESPONSIBILITIES IN G-tube, J-tube

NUTRITION
The nurse should:

●​ Assess nutritional status. HIGH-YIELD EXAM

●​ Measure height, weight, and Body Mass
Index (BMI).
●​ Monitor laboratory values (e.g., albumin,
POINTS
prealbumin, hemoglobin, electrolytes) as ●​ There are six essential nutrients:
indicated. Carbohydrates, Proteins, Fats,
●​ Assist patients during meals if needed. Vitamins, Minerals, and Water.
●​ Monitor food and fluid intake. ●​ Carbohydrates are the body's primary
●​ Encourage adequate hydration. energy source.
●​ Provide nutrition education. ●​ Proteins are essential for growth, tissue
●​ Collaborate with the dietitian and other repair, enzyme and hormone
healthcare professionals. production, and immune function.
●​ Fats provide the most concentrated
source of energy and aid in the
absorption of fat-soluble vitamins (A, D,
E, and K).
COMPARISON OF ●​ Vitamin A supports vision, Vitamin D
promotes calcium absorption, Vitamin C
ENTERAL AND aids wound healing, and Vitamin K is
necessary for blood clotting.
PARENTERAL ●​ Iron deficiency commonly leads to
iron-deficiency anemia.
NUTRITION ●​ Clear liquid diets are commonly used
before surgery or after gastrointestinal
procedures.
Enteral Nutrition Parenteral Nutrition ●​ Low-sodium diets are indicated for
hypertension, heart failure, and some
kidney diseases.
●​ Enteral nutrition is preferred over
Uses the Bypasses the
parenteral nutrition when the GI tract is
gastrointestinal tract gastrointestinal tract
functional.
●​ During enteral feeding, keep the head of
the bed elevated 30–45° to reduce
Requires a Used when the GI tract aspiration risk.
functioning GI tract is nonfunctional ●​ TPN is administered through a central
venous catheter and requires close
 monitoring for infection, electrolyte The male reproductive system is responsible for:
imbalance, and hyperglycemia.
●​ Producing sperm cells (spermatogenesis)
●​ Producing testosterone
●​ Transporting sperm
MODULE 4 ●​ Delivering sperm during ejaculation

REPRODUCTIVE
Structures and Functions
HEALTH,
1. Testes
PREGNANCY, AND
Functions:
MATERNAL NURSING
●​ Produce sperm
●​ Secrete testosterone

Located inside the scrotum to maintain a

temperature about 2–3°C below body
I. THE MALE AND temperature, which is necessary for sperm
production.
FEMALE
REPRODUCTIVE
2. Scrotum
SYSTEM Functions:

●​ Protects testes
Learning Objectives ●​ Regulates temperature through
contraction and relaxation
After studying this topic, you should be able to:

●​ Identify the structures of the male and

female reproductive systems.
●​ Describe the functions of each 3. Epididymis
reproductive organ.
Functions:
●​ Explain the menstrual and ovarian cycles.
●​ Relate anatomy and physiology to ●​ Maturation of sperm
conception and pregnancy. ●​ Storage of sperm

4. Vas Deferens
A. MALE
Functions:
REPRODUCTIVE ●​ Transports sperm from epididymis to
SYSTEM ejaculatory duct

Functions 5. Seminal Vesicles

Functions:

●​ Produce fructose-rich fluid

●​ Nourishes sperm Structures and Functions
●​ Contributes approximately 60% of semen
volume External Genitalia (Vulva)

Includes:

6. Prostate Gland ●​ Mons pubis

●​ Labia majora
Functions: ●​ Labia minora
●​ Clitoris
●​ Produces alkaline fluid ●​ Vestibule
●​ Enhances sperm motility ●​ Bartholin glands
●​ Neutralizes vaginal acidity
Functions:

●​ Protection
7. Bulbourethral (Cowper's) Glands ●​ Sexual stimulation
●​ Lubrication
Functions:

●​ Produce lubricating mucus

●​ Neutralize acidic urine in the urethra Ovaries

Functions:

8. Penis ●​ Produce ova

●​ Secrete estrogen and progesterone
Functions:

●​ Copulation
●​ Urination Fallopian Tubes (Uterine Tubes)
●​ Ejaculation
Functions:

●​ Transport ovum
●​ Site of fertilization (usually the ampulla)
B. FEMALE
REPRODUCTIVE Uterus
SYSTEM Functions:

●​ Implantation
Functions ●​ Nourishes fetus
●​ Labor and delivery
●​ Produce ova (eggs)
●​ Support fertilization Layers:
●​ Support fetal growth and development
●​ Childbirth ●​ Endometrium
●​ Lactation ●​ Myometrium
●​ Perimetrium
 Triggered by LH surge.

Cervix Most fertile period.

Functions:

●​ Connects uterus and vagina Luteal (Secretory) Phase

●​ Produces cervical mucus
●​ Dilates during labor Corpus luteum secretes progesterone.

If fertilization does not occur:

●​ Progesterone decreases
Vagina
●​ Menstruation begins
Functions:

●​ Birth canal
●​ Menstrual flow passage
●​ Receives penis during intercourse HORMONES
FSH → Follicle development

LH → Ovulation
MENSTRUAL CYCLE Estrogen → Female secondary sex
characteristics and endometrial growth
Average cycle:
Progesterone → Maintains pregnancy and
28 days
prepares endometrium for implantation

Four Phases
II. NURSING CARE
Menstrual Phase

Days 1–5
FOR THE FAMILY IN
Shedding of endometrium.
NEED OF
REPRODUCTIVE LIFE
Follicular (Proliferative) Phase PLANNING
FSH stimulates follicle growth.
Definition
Estrogen increases.
Reproductive life planning helps individuals and
couples achieve their desired number and
spacing of children while promoting reproductive
Ovulation health.

Approximately Day 14
Goals Hormonal Methods

●​ Prevent unintended pregnancy ●​ Combined oral contraceptives

●​ Improve maternal and child health ●​ Progestin-only pills
●​ Promote responsible parenthood ●​ Injectable contraceptives
●​ Reduce maternal and infant mortality ●​ Implants
●​ Transdermal patch
●​ Vaginal ring

Mechanism:

METHODS OF FAMILY ●​ Inhibit ovulation

●​ Thicken cervical mucus
PLANNING ●​ Alter endometrium

Natural Methods
Intrauterine Devices (IUDs)
●​ Calendar (Rhythm) Method
●​ Basal Body Temperature Method Types:
●​ Cervical Mucus (Billings) Method
●​ Symptothermal Method ●​ Copper IUD
●​ Lactational Amenorrhea Method (LAM) ●​ Hormonal IUD

Advantages: Advantages:

●​ No medications ●​ Long-acting
●​ No devices ●​ Highly effective
●​ Accepted by many cultures and religions ●​ Reversible

Disadvantages:

●​ Requires motivation and correct use Permanent Methods

●​ Higher failure rate with inconsistent use
Female:

●​ Tubal ligation

Artificial (Modern) Methods Male:

●​ Vasectomy
Barrier Methods

●​ Male condom
●​ Female condom
●​ Diaphragm
●​ Cervical cap NURSING
Benefits: RESPONSIBILITIES
●​ Prevent pregnancy
●​ Assess reproductive goals.
●​ Condoms reduce STI transmission
●​ Explain all family planning methods.
●​ Discuss effectiveness, advantages,
disadvantages, and side effects.
●​ Respect cultural and religious beliefs.
 ●​ Encourage informed decision-making. ●​ Alcohol
●​ Provide follow-up and education. ●​ Stress
●​ Certain medications

III. NURSING CARE

Diagnostic Tests
OF THE FAMILY
Female:
HAVING DIFFICULTY ●​ Ovulation testing
CONCEIVING A ●​
●​
Pelvic ultrasound
Hysterosalpingography (HSG)
CHILD ●​ Hormonal studies

Male:

Definition of Infertility ●​ Semen analysis

●​ Hormonal evaluation
Failure to achieve pregnancy after 12 months of
regular, unprotected intercourse (or after 6
months if the woman is 35 years or older).

Treatment
Causes ●​ Lifestyle modification
●​ Ovulation-inducing medications
Female Factors ●​ Intrauterine insemination (IUI)
●​ In Vitro Fertilization (IVF)
●​ Ovulation disorders ●​ Surgical correction when indicated
●​ Polycystic Ovary Syndrome (PCOS)
●​ Endometriosis
●​ Tubal obstruction
●​ Uterine abnormalities
Nursing Care
●​ Provide emotional support.
Male Factors
●​ Encourage healthy lifestyle changes.
●​ Low sperm count ●​ Educate regarding fertility treatments.
●​ Poor sperm motility ●​ Maintain privacy and confidentiality.
●​ Abnormal sperm morphology ●​ Refer to counseling or support groups if
●​ Erectile dysfunction needed.
●​ Varicocele

Shared Factors IV. NURSING CARE

●​ Advanced age
●​ Obesity
RELATED TO
●​ Smoking
PSYCHOLOGICAL Urinary

AND ●​ Increased urinary frequency

●​ Increased glomerular filtration rate

PHYSIOLOGICAL
CHANGES OF Musculoskeletal
PREGNANCY ●​ Lordosis
●​ Back pain
●​ Relaxation of pelvic ligaments
Physiological
Changes
Integumentary
Reproductive System ●​ Chloasma (mask of pregnancy)
●​ Linea nigra
●​ Uterus enlarges. ●​ Striae gravidarum
●​ Cervix softens (Goodell's sign).
●​ Uterine isthmus softens (Hegar's sign).
●​ Cervix becomes bluish (Chadwick's sign).

Psychological
Cardiovascular Changes
●​ Increased blood volume
●​ Increased cardiac output First Trimester
●​ Slight decrease in blood pressure during
●​ Ambivalence
the second trimester
●​ Mood swings
●​ Anxiety

Respiratory
Second Trimester
●​ Increased oxygen consumption
●​ Increased tidal volume ●​ Acceptance of pregnancy
●​ Mild dyspnea is common ●​ Increased maternal-fetal attachment

Third Trimester
Gastrointestinal
●​ Excitement
●​ Nausea and vomiting ●​ Fear of labor
●​ Constipation ●​ Concern about parenthood
●​ Heartburn
 Four abdominal palpation techniques used to
Nursing Care determine:

●​ Provide reassurance. ●​ Fetal lie

●​ Encourage expression of feelings. ●​ Presentation
●​ Teach normal pregnancy changes. ●​ Position
●​ Promote family involvement. ●​ Engagement
●​ Refer when significant anxiety or
depression is suspected.

Laboratory Tests
●​ Blood type and Rh factor
V. NURSING CARE IN ●​ Complete Blood Count (CBC)
●​ Urinalysis
THE ASSESSMENT ●​ Blood glucose screening
●​ HIV testing
OF A PREGNANT ●​ Hepatitis B screening
●​ Syphilis screening
FAMILY ●​ Rubella immunity

Components of
Prenatal Assessment Warning Signs During
Pregnancy
Health History Report immediately:
●​ Last Menstrual Period (LMP) ●​ Vaginal bleeding
●​ Estimated Date of Delivery (EDD) ●​ Severe headache
●​ Obstetric history (GTPAL) ●​ Blurred vision
●​ Medical and surgical history ●​ Persistent vomiting
●​ Family history ●​ Decreased fetal movement
●​ Lifestyle habits ●​ Leakage of amniotic fluid
●​ Severe abdominal pain
●​ Facial or hand swelling

Physical Assessment
●​ Height and weight
●​ Blood pressure VI. NURSING CARE
●​ Edema
●​
●​
Fundal height
Fetal heart rate
TO PROMOTE FETAL
●​ Fetal movement AND MATERNAL
HEALTH
Leopold's Maneuvers
Health Promotion HEALTH DURING
●​
●​
Attend regular prenatal visits.
Take prenatal vitamins.
PREGNANCY
●​ Maintain a balanced diet.
●​ Exercise as recommended.
●​ Avoid smoking, alcohol, and illicit drugs.
Importance of Nutrition
●​ Obtain adequate sleep and rest.
Adequate maternal nutrition supports:
●​ Manage stress.
●​ Fetal growth and development
●​ Placental function
●​ Maternal tissue growth
Immunizations ●​ Prevention of complications
●​ Successful lactation
Recommended during pregnancy (as
appropriate):

●​ Influenza vaccine
●​ Tdap vaccine
Nutritional Requirements
Calories

Increase during the second and third trimesters to

Fetal Monitoring support fetal growth.

●​ Daily fetal movement counting (kick

counts)
●​ Non-Stress Test (NST) Protein
●​ Biophysical Profile (BPP)
●​ Ultrasound examinations Supports fetal tissue growth, placenta, uterus,
and breast development.

Sources:

Nursing Responsibilities ●​ Lean meat

●​ Fish (low-mercury)
●​ Monitor maternal and fetal well-being. ●​ Eggs
●​ Identify high-risk pregnancies. ●​ Dairy products
●​ Teach danger signs. ●​ Legumes
●​ Promote medication adherence.
●​ Encourage family support.
●​ Coordinate referrals when needed.
Iron

Prevents maternal anemia.

VII. THE NURSING Sources:

●​ Red meat
ROLE IN PROMOTING ●​ Green leafy vegetables
●​ Iron-fortified cereals
NUTRITIONAL
Take with vitamin C-rich foods to improve
absorption.
Folic Acid
Management of Common
Prevents neural tube defects. Nutritional Concerns
Recommended before conception and during
early pregnancy. Morning Sickness

Sources: ●​ Eat small, frequent meals.

●​ Eat dry crackers before getting out of bed.
●​ Leafy vegetables ●​ Avoid greasy or spicy foods.
●​ Citrus fruits
●​ Fortified grains

Heartburn

Calcium ●​ Eat small meals.

●​ Avoid lying down immediately after eating.
Supports fetal bone and teeth development. ●​ Limit spicy and fatty foods.

Sources:

●​ Milk Constipation
●​ Cheese
●​ Yogurt ●​ Increase fiber intake.
●​ Tofu ●​ Drink plenty of fluids.
●​ Exercise regularly if approved by the
healthcare provider.

Vitamin D

Promotes calcium absorption and bone health.

HIGH-YIELD EXAM
Water POINTS
Adequate hydration helps maintain amniotic fluid ●​ Fertilization usually occurs in the
volume, supports circulation, and reduces ampulla of the fallopian tube.
constipation and urinary tract infections. ●​ LH surge triggers ovulation.
●​ Progesterone maintains the endometrium
and supports pregnancy.
●​ Goodell's sign = Softening of the cervix.
●​ Hegar's sign = Softening of the uterine
Foods to Avoid isthmus.
●​ Chadwick's sign = Bluish discoloration of
●​ Alcohol
the cervix and vagina.
●​ Unpasteurized milk and cheeses
●​ Infertility is generally defined as failure to
●​ Raw or undercooked meat, eggs, and
conceive after 12 months of regular,
seafood
unprotected intercourse (or 6 months if
●​ High-mercury fish (e.g., shark, swordfish,
the woman is 35 years or older).
king mackerel, tilefish)
●​ Leopold's maneuvers determine fetal lie,
●​ Excess caffeine
presentation, position, and engagement.
 ●​ Folic acid helps prevent neural tube
defects.
●​ Iron helps prevent maternal anemia. MODULE 5
●​ Teach pregnant patients to report vaginal
bleeding, severe headache, blurred vision,
leakage of fluid, severe abdominal pain,
and decreased fetal movement
I. PREPARING THE
immediately. FAMILY FOR
CHILDBIRTH AND
EASY MNEMONICS
PARENTING
Female Hormones
Preparing the family for childbirth and parenting is
FLEP an essential component of prenatal care. It
involves educating expectant parents about
●​ F – FSH (Follicle development) pregnancy, labor, birth, newborn care, parenting
●​ L – LH (LH surge → Ovulation) roles, and available birth options. Effective
●​ E – Estrogen (Endometrial growth) preparation reduces anxiety, promotes informed
●​ P – Progesterone (Pregnancy decision-making, and improves maternal and
maintenance) neonatal outcomes.

Presumptive Signs of Pregnancy

AMEN

●​ A – Amenorrhea
A. CHILDBIRTH
●​
●​
M – Morning sickness
E – Enlarged breasts EDUCATION
●​ N – Nausea

Pregnancy Warning Signs

Definition

BLEED Childbirth education is a structured educational

process that prepares expectant parents
●​ B – Bleeding physically, emotionally, psychologically, and
●​ L – Leakage of fluid socially for labor, birth, postpartum recovery, and
●​ E – Extreme headache/Edema newborn care.
●​ E – Eyes blurred
●​ D – Decreased fetal movement It aims to help families make informed decisions,
reduce fear, and actively participate in the
childbirth experience.

Goals of Childbirth Education

●​ Increase knowledge about pregnancy and
childbirth.
●​ Reduce fear and anxiety.
●​ Promote healthy pregnancy practices.
●​ Prepare parents for labor and delivery.
 ●​ Teach pain management techniques.
Benefits of Childbirth
●​ Prepare parents for newborn care.
●​ Encourage breastfeeding. Education
●​ Promote family participation and bonding.
For the Mother:

●​ Greater confidence
●​ Reduced anxiety
Topics Commonly Included ●​ Better coping during labor
●​ Increased participation in decision-making
Pregnancy
For the Partner:
●​ Normal physiological changes
●​ Warning signs ●​ Better understanding of labor
●​ Prenatal care ●​ Improved ability to provide support
●​ Nutrition ●​ Increased involvement in parenting
●​ Exercise
●​ Common discomforts For the Family:

●​ Stronger family bonding

●​ Improved newborn care skills
●​ Increased confidence in parenting
Labor and Birth

●​ Stages of labor
●​ Signs of labor
●​ When to go to the hospital
●​ Pain management options B. THE CHILDBIRTH
●​ Breathing and relaxation techniques
●​ Labor positions PLAN
Definition
Postpartum Care
A childbirth plan (birth plan) is a written
●​ Uterine involution document that communicates a pregnant
●​ Lochia woman's preferences regarding labor, birth, pain
●​ Breastfeeding management, newborn care, and postpartum
●​ Emotional changes practices.
●​ Family planning
●​ Postpartum danger signs It serves as a guide for the healthcare team while
recognizing that changes may be necessary for
the safety of the mother and baby.

Newborn Care

●​ Bathing
●​ Umbilical cord care
Purpose
●​ Breastfeeding
●​ Promote informed choices.
●​ Safe sleep
●​ Improve communication between the
●​ Immunizations
family and healthcare providers.
●​ Newborn danger signs
●​ Respect patient autonomy and cultural
beliefs.
 ●​ Enhance satisfaction with the childbirth
experience.

Nursing Responsibilities
●​ Encourage discussion of birth
Components of a Birth Plan preferences.
●​ Explain available options.
Labor Preferences ●​ Ensure informed consent.
●​ Respect cultural and religious beliefs.
●​ Preferred labor positions ●​ Support the family's choices whenever
●​ Walking during labor safely possible.
●​ Use of birthing ball ●​ Explain when changes are medically
●​ Continuous labor support necessary.
●​ Music or dim lighting

Pain Management Preferences C. METHODS TO

●​
●​
Natural childbirth
Epidural anesthesia
MANAGE PAIN IN
●​
●​
Intravenous analgesics
Nitrous oxide CHILDBIRTH
●​ Hydrotherapy
●​ Massage Pain during labor is influenced by uterine
contractions, cervical dilation, fetal descent,
emotional state, previous experiences, and
cultural beliefs.
Delivery Preferences
Pain management methods are broadly classified
●​ Preferred pushing position into non-pharmacological and pharmacological
●​ Delayed cord clamping (if appropriate) approaches.
●​ Immediate skin-to-skin contact
●​ Presence of partner or support person

NON-PHARMACOLO
Newborn Care Preferences

●​ Breastfeeding initiation
GICAL METHODS
●​ Vitamin K administration
●​ Eye prophylaxis 1. Breathing Techniques
●​ Rooming-in
●​ Circumcision (if applicable) Controlled breathing helps:

●​ Reduce anxiety
●​ Improve relaxation
Emergency Preferences ●​ Increase oxygenation
●​ Enhance concentration
The family should understand that emergency
interventions (e.g., cesarean birth) may be Examples:
required to protect maternal and fetal health.
●​ Slow-paced breathing
 ●​ Modified-paced breathing
6. Hydrotherapy
●​ Patterned breathing
Warm shower or warm water immersion may
reduce pain and promote relaxation.

2. Relaxation Techniques
Include:
7. Heat and Cold Therapy
●​ Guided imagery
Warm compresses:
●​ Progressive muscle relaxation
●​ Meditation ●​ Relax muscles
●​ Reduce discomfort
Benefits:
Cold packs:
●​ Decreases muscle tension
●​ Reduces fear ●​ Decrease inflammation
●​ Promotes coping ●​ Provide pain relief

3. Position Changes 8. Continuous Labor Support

Examples: Support from:
●​ Walking ●​ Partner
●​ Squatting ●​ Family member
●​ Side-lying ●​ Doula
●​ Hands-and-knees ●​ Nurse
●​ Sitting on a birthing ball
Benefits:
Benefits:
●​ Shorter labor
●​ Improve comfort ●​ Reduced anxiety
●​ Promote fetal descent ●​ Increased satisfaction
●​ Enhance labor progress ●​ Lower cesarean birth rates

4. Massage PHARMACOLOGICAL
Provides comfort by reducing muscle tension and METHODS
promoting relaxation.
Systemic Analgesics

Administered intravenously or intramuscularly.

5. Counterpressure Benefits:

Firm pressure applied to the lower back, ●​ Reduce pain perception

especially helpful for back labor.
Limitations:
 ●​ May cause maternal sedation
●​ May depress neonatal respiration if given
close to birth Pudendal Nerve Block

Provides anesthesia to the perineum during the

second stage of labor or operative vaginal birth.
Epidural Analgesia

Most common pharmacologic pain relief during

labor.

Advantages:
D. THE BIRTH
●​ Excellent pain control SETTING
●​ Mother remains awake
●​ Allows participation in labor The birth setting should provide a safe,
supportive, and respectful environment for
Possible Risks: childbirth.

●​ Maternal hypotension
●​ Urinary retention
●​ Prolonged second stage of labor
●​ Headache (rare, due to dural puncture) Hospital Birth
Nursing Responsibilities: Advantages:

●​ Monitor maternal blood pressure. ●​ Immediate access to emergency care

●​ Monitor fetal heart rate. ●​ Availability of specialists
●​ Assist with positioning. ●​ Pain relief options
●​ Observe for complications. ●​ Neonatal intensive care if needed

Spinal Anesthesia
Birthing Center
Commonly used for planned cesarean birth.
Suitable for low-risk pregnancies.
Provides rapid and profound anesthesia.
Advantages:

●​ Home-like environment
●​ Less medical intervention
Combined Spinal-Epidural (CSE)
●​ Family-centered care
Combines the rapid onset of spinal anesthesia
with the prolonged effect of an epidural.

Home Birth
Local Anesthesia May be considered for carefully selected low-risk
pregnancies attended by qualified healthcare
Used for: professionals, where appropriate emergency
plans and access to hospital care are available.
●​ Episiotomy
●​ Perineal repair Potential Benefits:
 ●​ Familiar surroundings Uses self-hypnosis, breathing, and relaxation to
●​ Greater comfort reduce fear and pain.
●​ Increased family participation

Potential Risks:

●​ Limited emergency resources Lamaze Method

●​ Delays if complications arise
Emphasizes:

●​ Controlled breathing
●​ Relaxation
Nursing Responsibilities ●​ Education
●​ Partner support
●​ Ensure maternal and fetal safety.
●​ Respect patient preferences.
●​ Prepare for emergencies.
●​ Maintain infection prevention practices.
●​ Support informed decision-making. Bradley Method
Focuses on:

●​ Natural childbirth
●​ Active partner participation
E. ALTERNATIVE ●​ Relaxation
●​ Nutrition and exercise during pregnancy
METHODS OF BIRTH
Alternative birth methods focus on minimizing
unnecessary interventions while supporting
Birth Ball
physiologic birth.
Promotes:

●​ Pelvic mobility
Water Birth ●​ Comfort
●​ Fetal descent
The mother labors, and in some settings may give
birth, in warm water.

Potential Benefits:
Vaginal Birth After Cesarean
●​ Relaxation (VBAC)
●​ Reduced pain
●​ Greater mobility A trial of labor after a previous cesarean birth may
be appropriate for carefully selected women,
Considerations: depending on obstetric history and clinical
assessment.
●​ Appropriate patient selection
●​ Infection control Benefits:
●​ Continuous monitoring
●​ Shorter recovery
●​ Lower surgical risks

Risks:
Hypnobirthing
 ●​ Uterine rupture (rare but serious) ●​ Adapted education

Women with Chronic Medical

F. WOMEN WITH Conditions
UNIQUE NEEDS Examples:
Certain pregnant women require individualized ●​ Diabetes mellitus
care because of medical, social, psychological, or ●​ Hypertension
obstetric factors. ●​ Heart disease
●​ Kidney disease
●​ Autoimmune disorders

Adolescents Nursing Care:

●​ Frequent assessment
Needs:
●​ Medication review
●​ Emotional support ●​ Multidisciplinary collaboration
●​ Nutrition education ●​ Monitoring maternal and fetal well-being
●​ Parenting education
●​ Family involvement when appropriate

Women with Mental Health

Conditions
Women of Advanced Maternal
Age (35 Years and Older) Examples:

●​ Depression
Higher risk for:
●​ Anxiety disorders
●​ Hypertension ●​ Bipolar disorder
●​ Gestational diabetes
Nursing Responsibilities:
●​ Chromosomal abnormalities
●​ Cesarean birth ●​ Screen for mental health concerns.
●​ Encourage adherence to treatment.
Nursing Care:
●​ Coordinate referrals.
●​ Close prenatal monitoring ●​ Promote family support.
●​ Education regarding screening options
●​ Emotional support

Women Experiencing
Domestic Violence
Women with Disabilities
Nursing Responsibilities:
May require:
●​ Assess privately and safely.
●​ Accessible facilities ●​ Provide nonjudgmental support.
●​ Individualized birth planning ●​ Document findings accurately.
●​ Additional physical assistance
 ●​ Follow local reporting laws and
institutional policies. HIGH-YIELD EXAM
●​ Refer to appropriate community
resources. POINTS
●​ Childbirth education prepares families
for pregnancy, labor, birth, postpartum
recovery, and newborn care.
Women with Cultural or ●​ A birth plan communicates a woman's
Religious Needs preferences but may need modification if
maternal or fetal safety requires it.
The nurse should: ●​ Non-pharmacological pain relief
includes breathing, relaxation, massage,
●​ Respect cultural practices. hydrotherapy, position changes, and
●​ Encourage culturally sensitive care. continuous labor support.
●​ Use interpreters when needed. ●​ Epidural analgesia is the most common
●​ Incorporate patient preferences whenever pharmacologic method for labor pain
safe and feasible. relief; monitor for maternal hypotension
and fetal heart rate changes.
●​ Lamaze focuses on breathing and
relaxation, while the Bradley Method
emphasizes partner coaching and natural
NURSING childbirth.
●​ Water birth and home birth should only
RESPONSIBILITIES IN be considered for carefully selected
low-risk pregnancies with qualified
PREPARING THE healthcare providers and emergency
plans.
FAMILY FOR ●​ Women with unique needs (e.g.,
adolescents, advanced maternal age,
CHILDBIRTH chronic illness, disability, mental health
conditions, or exposure to domestic
violence) require individualized,
The nurse should:
family-centered nursing care.
●​ Assess the family's knowledge and
learning needs.
●​ Provide individualized childbirth education. EASY MNEMONICS
●​ Encourage partner participation.
●​ Promote informed decision-making.
Childbirth Education Goals
●​ Teach pain management strategies.
●​ Discuss available birth settings and PREPARE
options.
●​ Encourage breastfeeding preparation. ●​ P – Parenting skills
●​ Promote newborn care education. ●​ R – Reduce anxiety
●​ Support family bonding. ●​ E – Education
●​ Respect cultural, spiritual, and personal ●​ P – Pain management
preferences. ●​ A – Active participation
●​ R – Recovery preparation
●​ E – Early newborn care

Non-Pharmacological Pain Relief

BRM PHHC

●​ B – Breathing
●​ R – Relaxation Major Theories of Labor
●​ M – Massage
●​ P – Position changes 1. Hormonal Theory
●​ H – Hydrotherapy
●​ H – Heat/Cold therapy Labor begins because of hormonal changes,
●​ C – Continuous labor support including:

Birth Plan Components ●​ Increased oxytocin sensitivity

●​ Increased prostaglandin production
LPDN ●​ Increased estrogen levels
●​ Functional decrease in progesterone
●​ L – Labor preferences activity
●​ P – Pain management
●​ D – Delivery preferences Effects:
●​ N – Newborn care preferences
●​ Strong uterine contractions
●​ Cervical ripening
●​ Cervical dilation
II. NURSING CARE OF
THE FAMILY DURING
2. Uterine Stretch Theory
LABOR AND BIRTH
Excessive stretching of uterine muscle fibers
Labor is a normal physiologic process in which stimulates contractions.
regular uterine contractions bring about
Examples:
progressive cervical effacement and dilatation,
leading to the birth of the fetus, placenta, and ●​ Multiple pregnancy
membranes. The nurse plays a critical role in ●​ Polyhydramnios
assessing maternal and fetal well-being, ●​ Large fetus (macrosomia)
monitoring labor progress, providing comfort
measures, preventing complications, and
supporting the family throughout childbirth.
3. Placental Aging Theory

As pregnancy reaches term, placental function

gradually declines, contributing to hormonal
A. THEORIES OF changes that favor labor.

LABOR
4. Fetal Theory
Definition
The mature fetal hypothalamic-pituitary-adrenal
The exact cause of labor remains uncertain, but axis increases fetal cortisol production, which
several theories explain what initiates labor. It is contributes to prostaglandin production and the
generally accepted that labor results from a onset of labor.
combination of maternal, fetal, hormonal, and
mechanical factors.
5. Prostaglandin Theory ●​ Breech
●​ Shoulder
Prostaglandins soften (ripen) the cervix and
stimulate uterine contractions.

Fetal Position

Relationship of the presenting fetal part to the

B. THE maternal pelvis.

COMPONENTS OF Example:

Left Occiput Anterior (LOA) – the most favorable

LABOR (THE FIVE Ps) position for vaginal birth.

Successful labor depends on the interaction of

five major components.
Fetal Attitude

Relationship of fetal body parts to one another.

1. Passenger Normal attitude:

The fetus and placenta. General flexion.

Important fetal factors:

●​ Size
●​ Presentation 2. Passageway
●​ Lie
●​ Position The maternal pelvis and soft tissues.
●​ Attitude
Pelvic Types

Gynecoid
Fetal Lie
●​ Most favorable for vaginal birth.
Relationship between the fetal spine and
Android
maternal spine.
●​ Heart-shaped pelvis.
Types:
●​ Increased likelihood of operative delivery.
●​ Longitudinal
Anthropoid
●​ Transverse
●​ Oblique ●​ Oval pelvis.
●​ Often compatible with vaginal birth.

Platypelloid
Fetal Presentation
●​ Flat pelvis.
The body part entering the birth canal first. ●​ Labor may be prolonged.

Types:

●​ Cephalic (most common)

3. Powers
Forces responsible for fetal descent. FIRST STAGE
Primary Powers Begins:

●​ Involuntary uterine contractions Onset of true labor

●​ Cause cervical effacement and dilation
Ends:
Secondary Powers
Complete cervical dilation (10 cm)
●​ Maternal pushing efforts
Longest stage of labor.
●​ Assist fetal descent during the second
stage
Phases

Latent Phase

4. Position (Maternal Position) ●​ Cervix: 0–5 cm (definitions may vary by

guideline)
Changing maternal position may: ●​ Mild contractions
●​ Patient is usually talkative
●​ Improve fetal descent
●​ Enhance uteroplacental blood flow
●​ Increase maternal comfort
●​ Reduce labor pain Active Phase

Examples: ●​ Cervix: 6–10 cm

●​ Strong contractions
●​ Upright ●​ Rapid cervical dilation
●​ Squatting ●​ Increased discomfort
●​ Side-lying
●​ Hands-and-knees

SECOND STAGE
5. Psyche Begins:

Maternal emotional state influences labor. Complete cervical dilation (10 cm)

Fear and anxiety may: Ends:

●​ Increase catecholamine release Birth of the baby

●​ Decrease uterine contractions
Characteristics:
●​ Prolong labor
●​ Increase pain perception
●​ Strong urge to push
●​ Crowning
●​ Delivery of the fetus

C. THE STAGES OF
LABOR THIRD STAGE
Begins: ●​ Increased cardiac output
●​ Increased blood pressure during
Birth of the baby contractions
●​ Increased heart rate
Ends:

Delivery of the placenta

Normally lasts:
Respiratory

Approximately 5–30 minutes. ●​ Increased oxygen consumption

●​ Increased respiratory rate
Signs of placental separation:

●​ Gush of blood
●​ Lengthening of umbilical cord Gastrointestinal
●​ Uterus becomes firm and globular
●​ Uterus rises in abdomen ●​ Slowed gastric emptying
●​ Nausea and vomiting may occur

FOURTH STAGE Urinary

Begins: ●​ Bladder compression
●​ Urinary frequency
After placental delivery ●​ Risk of bladder distention
Ends:

Approximately 1–4 hours postpartum

Musculoskeletal
Critical recovery period.
●​ Fatigue
Focus: ●​ Increased pelvic pressure
●​ Back pain
●​ Maternal stabilization
●​ Prevention of hemorrhage
●​ Bonding
●​ Breastfeeding initiation
Fetal Responses
Normal fetal adaptations include:

●​ Temporary heart rate fluctuations

D. MATERNAL AND ●​ Fetal molding
●​ Caput succedaneum
FETAL RESPONSES ●​ Mild metabolic changes during
contractions
TO LABOR Persistent abnormal fetal heart rate patterns
require prompt evaluation.
Maternal Responses
Cardiovascular
 Occurs when the widest diameter of the fetal
E. MEASURING presenting part passes through the pelvic inlet.

PROGRESS IN Usually corresponds to 0 station in cephalic

presentation.
LABOR
Cervical Effacement
F. MATERNAL AND
Shortening and thinning of the cervix.

Measured in percentages:
FETAL ASSESSMENT
0%–100% DURING LABOR
Maternal Assessment
Cervical Dilatation Monitor:

Opening of the cervix. ●​ Vital signs

●​ Pain level
Measured: ●​ Contraction pattern
●​ Cervical changes (as indicated)
0–10 cm
●​ Bladder status
●​ Emotional status
Complete dilation:
●​ Intake and output
10 cm

Uterine Contractions
Fetal Station
Assess:
Relationship of presenting part to the ischial
spines. Frequency

Measurements: Beginning of one contraction to beginning of the

next.
-5 to +5

0 Station:
Duration
Presenting part level with ischial spines.
Beginning to end of one contraction.
Positive stations indicate descent below the
spines.

Intensity

Engagement Strength:

●​ Mild
●​ Moderate
 ●​ Strong
First Stage Nursing Care
●​ Assess contraction pattern.
●​ Monitor fetal heart rate.
Fetal Assessment ●​ Encourage breathing techniques.
●​ Promote hydration.
Fetal Heart Rate (FHR) ●​ Assist with position changes.
●​ Provide emotional support.
Normal baseline: ●​ Encourage bladder emptying.
●​ Monitor cervical progress.
110–160 beats/minute

Methods:

●​ Doppler Second Stage Nursing Care

●​ Electronic fetal monitoring
●​ Prepare delivery equipment.
●​ Encourage effective pushing.
●​ Monitor fetal heart rate frequently.
Fetal Movement ●​ Support the perineum as directed by the
birth attendant.
Monitor throughout labor when appropriate. ●​ Provide reassurance.
●​ Assist with immediate skin-to-skin contact
if appropriate.

Amniotic Fluid

Assess:
Third Stage Nursing Care
●​ Color
●​ Odor ●​ Observe for signs of placental separation.
●​ Amount ●​ Administer uterotonic medications (e.g.,
oxytocin) as prescribed.
Normal: ●​ Assess uterine tone.
●​ Monitor bleeding.
Clear to pale yellow. ●​ Inspect placenta for completeness.

Abnormal findings:

●​ Green (meconium)
●​ Foul odor (possible infection) Fourth Stage Nursing Care
●​ Bloody fluid (requires evaluation)
Assess:

●​ Fundus (firm, midline)

●​ Lochia

G. THE CARE OF THE ●​

●​
Vital signs
Perineum

WOMAN IN THE ●​
●​
Bladder
Pain

FOUR STAGES OF ●​
●​
Bonding
Breastfeeding initiation

LABOR Monitor closely for postpartum hemorrhage.

 ●​ Severe headache
●​ Visual disturbances
●​ Epigastric pain
H. THE WOMAN WITH ●​
●​
Elevated blood pressure
Seizure precautions if indicated

UNIQUE CONCERNS
IN LABOR
Women with Multiple
Certain women require specialized nursing care Gestation
because of increased maternal or fetal risk.
Higher risk for:

●​ Preterm labor
●​ Hemorrhage
Adolescent Mothers
●​ Malpresentation
Needs: ●​ Umbilical cord complications

●​ Emotional support
●​ Childbirth education
●​ Family involvement when appropriate Women with Previous
Cesarean Birth
May be candidates for:
Advanced Maternal Age (35
●​ Trial of Labor After Cesarean (TOLAC),
Years and Older)
depending on clinical circumstances
Higher risk for:
Monitor for signs of uterine rupture.
●​ Gestational diabetes
●​ Hypertensive disorders
●​ Cesarean birth
●​ Fetal complications Women with Mental Health
Conditions
Provide:
Women with Diabetes
●​ Calm environment
Monitor: ●​ Emotional support
●​ Frequent communication
●​ Blood glucose ●​ Coordination with mental health services
●​ Fetal status when indicated
●​ Risk for neonatal hypoglycemia after birth

Women Experiencing
Women with Hypertensive
Domestic Violence
Disorders
Provide:
Assess for:
 ●​ Privacy ●​ Normal fetal heart rate is 110–160
●​ Safety assessment beats/minute.
●​ Nonjudgmental care ●​ Effacement is measured in percentages,
●​ Referral to appropriate support services while dilation is measured in centimeters
according to local protocols (0–10 cm).
●​ Station describes fetal descent relative to
the ischial spines; 0 station indicates
engagement in a cephalic presentation.
●​ The nurse should frequently assess
NURSING contractions, fetal heart rate, maternal
vital signs, bladder status, and labor
RESPONSIBILITIES progress.

DURING LABOR
EASY MNEMONICS
The nurse should:
Five Ps of Labor
●​ Assess maternal and fetal well-being.
●​ Monitor labor progress. PPPPP
●​ Recognize signs of complications.
●​ Provide pain relief measures. ●​ P – Passenger
●​ Promote maternal comfort. ●​ P – Passageway
●​ Encourage family participation. ●​ P – Powers
●​ Maintain aseptic technique. ●​ P – Position
●​ Prepare for emergency interventions if ●​ P – Psyche
needed.
●​ Support informed decision-making. Stages of Labor
●​ Document all assessments and
interventions accurately. Baby–Baby–Placenta–Recovery

●​ 1st – Cervical dilation

●​ 2nd – Baby is born
●​ 3rd – Placenta is delivered
HIGH-YIELD EXAM ●​ 4th – Recovery and stabilization

POINTS Signs of Placental Separation

GURL
●​ Labor is influenced by the Five Ps:
Passenger, Passageway, Powers, ●​ G – Gush of blood
Position, and Psyche. ●​ U – Uterus becomes firm and globular
●​ True labor causes progressive cervical ●​ R – Rises in the abdomen
effacement and dilation; false labor does ●​ L – Lengthening of the umbilical cord
not.
●​ The first stage begins with true labor and Labor Progress
ends with 10 cm cervical dilation.
●​ The second stage extends from complete E-D-S
dilation to the birth of the baby.
●​ The third stage ends with delivery of the ●​ E – Effacement (%)
placenta. ●​ D – Dilatation (cm)
●​ The fourth stage is the first 1–4 hours ●​ S – Station (-5 to +5)
postpartum, when close observation for
hemorrhage is essential.
 The process by which a woman gradually
III. NURSING CARE develops confidence and competence in caring
for her infant and assumes the maternal role.
OF A POSTPARTAL
FAMILY
Rubin's Maternal Behavioral
Phases

INTRODUCTION 1. Taking-In Phase

Time Frame:​
Definition of the Postpartum First 24–48 hours after birth

(Postpartal) Period Characteristics:

The postpartum (postpartal or puerperium) ●​ Mother is passive and dependent.

period begins immediately after the delivery of ●​ Focuses on her own needs and recovery.
the placenta and continues for approximately 6 ●​ Frequently talks about labor and birth
weeks (42 days), during which the mother's experiences.
reproductive organs and body systems return to ●​ Requires rest and emotional support.
their pre-pregnancy state.
Nursing Care:
This period involves significant physiological,
●​ Encourage rest.
psychological, emotional, and social
●​ Listen to birth experiences.
adjustments for the mother, newborn, and family.
●​ Provide comfort and reassurance.
Nursing care focuses on promoting recovery,
●​ Assist with infant care while encouraging
preventing complications, supporting infant
gradual participation.
feeding, strengthening parent-infant bonding, and
preparing the family for discharge and parenting.

2. Taking-Hold Phase

Time Frame:​
A. PSYCHOLOGICAL Approximately 2–10 days postpartum

CHANGES OF THE Characteristics:

POSTPARTAL ●​ Mother becomes more independent.

●​ Shows eagerness to learn infant care.
PERIOD ●​ May experience anxiety about parenting
abilities.

Following childbirth, mothers experience Nursing Care:

emotional and psychological adjustments as they
adapt to their new role. ●​ Teach newborn care.
●​ Encourage breastfeeding.
●​ Provide positive reinforcement.
●​ Build maternal confidence.
Maternal Role Attainment
(Maternal Identity)
3. Letting-Go Phase Signs:

Time Frame:​ ●​ Persistent sadness

Weeks to months after birth ●​ Loss of interest
●​ Sleep disturbances
Characteristics: ●​ Appetite changes
●​ Feelings of guilt or worthlessness
●​ Accepts the maternal role. ●​ Difficulty bonding with the infant
●​ Adjusts family relationships. ●​ Thoughts of self-harm or harming the
●​ Establishes new routines. infant (requires immediate evaluation)
●​ Integrates the infant into family life.
Nursing Care:
Nursing Care:
●​ Screen using validated tools (e.g.,
●​ Encourage family involvement. Edinburgh Postnatal Depression Scale).
●​ Promote healthy coping strategies. ●​ Provide emotional support.
●​ Support emotional adaptation. ●​ Encourage professional mental health
referral.
●​ Ensure maternal and infant safety.

Emotional Changes
Postpartum Psychosis
Postpartum Blues ("Baby A rare but life-threatening psychiatric emergency.
Blues")
Symptoms:
Usually occur within the first week postpartum
●​ Hallucinations
and resolve within 2 weeks.
●​ Delusions
Signs: ●​ Confusion
●​ Severe mood changes
●​ Mood swings ●​ Disorganized behavior
●​ Tearfulness
●​ Fatigue Nursing Care:
●​ Irritability
●​ Ensure immediate safety.
●​ Anxiety
●​ Notify the healthcare provider urgently.
●​ Difficulty sleeping
●​ Arrange emergency psychiatric care.
Nursing Care:

●​ Reassure the mother that symptoms are

usually temporary.
●​ Encourage rest and adequate nutrition. B. PHYSIOLOGIC
●​ Promote family support.
●​ Assess for worsening symptoms. CHANGES OF THE
POSTPARTAL
Postpartum Depression (PPD) PERIOD
Occurs within the first year after birth and lasts
longer than the baby blues.
 Color:
Reproductive System
Whitish or yellow-white

Uterine Involution Contains:

The uterus gradually returns to its pre-pregnancy Leukocytes and mucus

size.
Report:
Immediately after birth:
●​ Foul odor
●​ Fundus is firm and approximately at the ●​ Heavy bleeding
level of the umbilicus. ●​ Large clots
●​ Return to bright-red bleeding after it had
The fundus typically descends about 1 cm (one lightened
fingerbreadth) per day.

By approximately 2 weeks, it is no longer

palpable abdominally.
Cervix
●​ Soft immediately after birth.
●​ Gradually regains tone.
Lochia ●​ External cervical os remains slightly open
after vaginal birth.
Postpartum vaginal discharge consisting of blood,
decidual tissue, mucus, and leukocytes.

Lochia Rubra
Perineum
Days 1–3
May have:
Color:
●​ Edema
Bright red ●​ Bruising
●​ Episiotomy
Contains: ●​ Lacerations

Blood and decidual tissue Assess using the REEDA scale:

●​ R – Redness
●​ E – Edema
Lochia Serosa ●​ E – Ecchymosis
●​ D – Discharge
Days 4–10 ●​ A – Approximation of wound edges

Color:

Pink to brown

Cardiovascular
Lochia Alba System
Approximately Day 10 to Week 6 ●​ Cardiac output remains elevated for the
first 24–48 hours.
 ●​ Diuresis occurs as excess pregnancy fluid Rich in:
is eliminated.
●​ Hypercoagulability persists, increasing the ●​ Antibodies (especially IgA)
risk of thromboembolism. ●​ Protein
●​ White blood cells
●​ Vitamins

Provides passive immunity to the newborn.

Urinary System
●​ Increased urine output (postpartum
diuresis)
●​ Risk of urinary retention
C. NURSING CARE
●​ Bladder distention can interfere with
uterine contraction
OF A WOMAN AND
FAMILY DURING THE
FIRST 24 HOURS
Gastrointestinal AFTER BIRTH
System The first 24 hours are critical because the mother
is at greatest risk for postpartum hemorrhage
Common findings:
and other complications.
●​ Decreased bowel motility
●​ Constipation
●​ Hemorrhoids

Maternal Assessment
Monitor:
Endocrine System ●​ Vital signs
●​ Fundal height and firmness
After placental delivery:
●​ Lochia
●​ Estrogen and progesterone levels decline ●​ Bladder status
rapidly. ●​ Perineum (REEDA)
●​ Prolactin supports milk production. ●​ Pain level
●​ Oxytocin promotes milk ejection and ●​ Breast assessment
uterine contractions. ●​ Emotional status

Lactation BUBBLE-HE
Colostrum
Assessment
Produced during the first few days postpartum. A commonly used postpartum assessment
mnemonic.
 ●​ B – Breasts ●​ Wipe front to back.
●​ U – Uterus ●​ Observe for signs of infection.
●​ B – Bladder
●​ B – Bowel
●​ L – Lochia
●​ E – Episiotomy/Perineum Breast Care
●​ H – Homan's sign (historically taught;
current practice emphasizes assessment For breastfeeding mothers:
for signs of deep vein thrombosis such as
●​ Proper latch technique
unilateral leg pain, swelling, warmth, and
●​ Breastfeeding on demand
redness rather than performing Homan's
●​ Nipple care
sign)
For mothers not breastfeeding:

●​ Wear a supportive bra.

●​ Avoid breast stimulation.
Nursing Interventions ●​ Apply cold compresses if needed for
discomfort.
●​ Massage a boggy uterus as indicated.
●​ Encourage early ambulation when
appropriate.
●​ Encourage bladder emptying. Nutrition
●​ Monitor bleeding.
●​ Promote skin-to-skin contact. Encourage:
●​ Assist with breastfeeding initiation.
●​ Balanced diet
●​ Encourage hydration and nutrition.
●​ Adequate fluids
●​ Provide pain relief.
●​ Iron-rich foods
●​ Support family bonding.
●​ Continued prenatal vitamins if prescribed

Activity
D. NURSING CARE
●​ Gradually increase activity.
OF A WOMAN AND ●​ Avoid heavy lifting until cleared.
●​ Encourage walking.
FAMILY IN ●​ Perform pelvic floor (Kegel) exercises as
advised.
PREPARATION FOR
HEALTH AGENCY Sexual Activity
DISCHARGE Generally resume after lochia has stopped,
healing has occurred, and the healthcare provider
has given clearance.
Discharge Teaching
Perineal Care
Family Planning
●​ Wash hands before and after care.
●​ Change perineal pads frequently.
Discuss postpartum contraception options, Certain families require individualized postpartum
including: care.

●​ Lactational Amenorrhea Method (LAM)

when criteria are met
●​ Barrier methods
●​ Progestin-only methods (if appropriate) Women After Cesarean Birth
●​ Intrauterine devices (timing depends on
Nursing Care:
clinical circumstances)
●​ Monitor incision
●​ Assess pain
●​ Encourage early ambulation
Warning Signs (Seek Immediate
●​ Promote respiratory exercises
Medical Care) ●​ Prevent infection
●​ Monitor bowel function
●​ Heavy vaginal bleeding (e.g., soaking a
pad in an hour)
●​ Large blood clots
●​ Fever
●​ Foul-smelling lochia Women with Postpartum
●​ Severe abdominal pain
●​ Severe headache or visual changes
Hemorrhage
●​ Chest pain or difficulty breathing
Assess:
●​ Unilateral leg pain, swelling, warmth, or
redness ●​ Excessive bleeding
●​ Symptoms of depression that worsen or ●​ Boggy uterus
thoughts of self-harm ●​ Tachycardia
●​ Hypotension

Interventions:
Newborn Teaching
●​ Massage the uterus if indicated.
Teach: ●​ Administer uterotonic medications as
prescribed.
●​ Umbilical cord care ●​ Notify the healthcare provider promptly.
●​ Feeding ●​ Monitor vital signs and urine output.
●​ Safe sleep (back to sleep)
●​ Bathing
●​ Immunizations
●​ When to seek medical care
Women with Infection
Monitor for:

E. NURSING CARE ●​
●​
Fever
Uterine tenderness
●​ Foul-smelling lochia
OF A POSTPARTAL ●​ Wound redness or drainage

WOMAN AND FAMILY Administer antibiotics as prescribed and monitor

response.
WITH UNIQUE NEEDS
 ●​ Parenting education
Women with Hypertensive
●​ Emotional support
Disorders ●​ Family involvement
●​ Community resource referral
Monitor:

●​ Blood pressure
●​ Neurologic status
●​
●​
Urine output
Signs of seizure activity when appropriate
NURSING
RESPONSIBILITIES
The nurse should:
Women with Diabetes
●​ Assess maternal recovery.
Monitor: ●​ Monitor for postpartum complications.
●​ Promote breastfeeding and newborn care.
●​ Blood glucose ●​ Encourage parent-infant attachment.
●​ Wound healing ●​ Teach self-care and infant care.
●​ Breastfeeding support ●​ Assess emotional well-being.
●​ Promote family support.
●​ Prepare the family for safe discharge.
●​ Coordinate referrals for specialized care
Women with Mental Health when needed.

Concerns
Provide:

●​ Emotional support HIGH-YIELD EXAM

●​ Mental health screening
●​ Referral when needed POINTS
●​ Family education
●​ The postpartum period lasts about 6
weeks (42 days).
●​ Rubin's phases: Taking-In, Taking-Hold,
and Letting-Go.
Families Experiencing ●​ Postpartum blues are common, begin
Perinatal Loss within the first week, and usually resolve
within 2 weeks.
Provide: ●​ Postpartum depression lasts longer and
requires evaluation and treatment.
●​ Compassionate, individualized care ●​ Postpartum psychosis is a psychiatric
●​ Opportunities to grieve emergency requiring immediate
●​ Memory-making if desired (photos, intervention.
footprints, keepsakes) ●​ Lochia progression:
●​ Referral to bereavement support services ○​ Rubra (Days 1–3)
○​ Serosa (Days 4–10)
○​ Alba (Day 10–Week 6)
●​ The uterus should be firm and midline; a
Adolescent Mothers boggy uterus increases the risk of
postpartum hemorrhage.
Needs:
 ●​ Use the BUBBLE-HE assessment for
systematic postpartum evaluation.
●​ Colostrum is rich in IgA antibodies and
provides passive immunity.
●​ Teach mothers to report heavy bleeding,
fever, foul-smelling lochia, severe
headache, chest pain, unilateral leg
swelling or pain, and worsening
depression.

EASY MNEMONICS
Rubin's Phases

In → Hold → Go

●​ Taking-In
●​ Taking-Hold
●​ Letting-Go

Lochia Progression

RSA

●​ R – Rubra (Red)
●​ S – Serosa (Pink/Brown)
●​ A – Alba (White/Yellow)

Postpartum Assessment

BUBBLE-HE

●​ B – Breasts
●​ U – Uterus
●​ B – Bladder
●​ B – Bowel
●​ L – Lochia
●​ E – Episiotomy/Perineum
●​ H – History/Leg assessment (watch for
signs of DVT)
●​ E – Emotional status
MODULE 6 & 7
Danger Signs

BLEEDS NURSING CARE OF A

●​
●​
B – Bleeding (heavy)
L – Leg pain/swelling
FAMILY
●​
●​
E – Elevated temperature (fever)
E – Extreme headache/vision changes EXPERIENCING A
●​ D – Depression (persistent or severe)
●​ S – Smelly lochia SUDDEN
PREGNANCY 1. Spontaneous Abortion
(Miscarriage)
COMPLICATION
Definition

Loss of pregnancy before 20 weeks' gestation or

before fetal viability (definition may vary slightly
INTRODUCTION by country).

Pregnancy complications are conditions that

Types
threaten the health or life of the mother, fetus, or
Threatened Abortion
both. Early recognition, prompt assessment, and
appropriate nursing interventions are essential to Characteristics:
reduce maternal and neonatal morbidity and
mortality. ●​ Vaginal bleeding
●​ Cervix closed
The nurse's role includes: ●​ Fetus may still be viable

●​ Early recognition of complications Nursing Care:

●​ Continuous maternal and fetal
assessment ●​ Assess bleeding.
●​ Emergency management ●​ Monitor fetal heart activity if appropriate.
●​ Emotional support ●​ Advise pelvic rest if ordered.
●​ Patient and family education ●​ Provide emotional support.
●​ Collaboration with the healthcare team

Inevitable Abortion

I. BLEEDING DURING Characteristics:

●​ Cervix dilated
PREGNANCY ●​ Bleeding
●​ Pregnancy cannot continue

Definition
Bleeding during pregnancy is never considered Incomplete Abortion
normal until proven otherwise and requires
Some products of conception remain in the
prompt evaluation.
uterus.
Bleeding is classified according to the trimester in
Treatment:
which it occurs.
●​ Uterine evacuation when indicated
●​ Monitor bleeding

A. FIRST-TRIMESTER
Complete Abortion
BLEEDING All products of conception have been expelled.
Missed Abortion ●​ Emergency surgery if ruptured

Fetal death without expulsion of the products of

conception.
Nursing Care

●​ Monitor vital signs.

●​ Assess for signs of internal bleeding.
2. Ectopic Pregnancy ●​ Prepare for surgery if indicated.
●​ Provide emotional support.
Definition

Implantation of the fertilized ovum outside the

uterine cavity.
3. Hydatidiform Mole (Molar
Most common site:
Pregnancy)
Fallopian tube (ampulla).
Definition

Abnormal proliferation of trophoblastic tissue with

Risk Factors nonviable pregnancy.

●​ Previous ectopic pregnancy

●​ Pelvic inflammatory disease (PID)
●​ Tubal surgery Signs
●​ Assisted reproductive technology
●​ Smoking ●​ Vaginal bleeding
●​ Uterus larger than expected
●​ Very high β-hCG levels
●​ Severe nausea/vomiting
Signs and Symptoms ●​ Possible early-onset hypertension

●​ Unilateral pelvic pain

●​ Vaginal spotting
●​ Amenorrhea Treatment
●​ Shoulder pain (from diaphragmatic
irritation if bleeding into the abdomen) ●​ Suction curettage
●​ Signs of shock if rupture occurs ●​ Follow serial β-hCG until undetectable
●​ Avoid pregnancy during the recommended
follow-up period

Diagnosis

●​ Positive pregnancy test

●​ Transvaginal ultrasound
●​ Serial β-hCG measurements
B. THIRD-TRIMESTER
BLEEDING
Treatment 1. Placenta Previa
●​ Methotrexate (selected stable cases)
●​ Laparoscopic surgery Definition
Placenta partially or completely covers the Risk Factors
internal cervical os.
●​ Hypertension
●​ Trauma
●​ Cocaine use
Types ●​ Smoking
●​ Previous abruption
●​ Low-lying placenta
●​ Marginal previa
●​ Partial previa
●​ Complete previa Signs

●​ Painful vaginal bleeding (bleeding may

be concealed)
Signs ●​ Rigid, tender uterus
●​ Frequent contractions
●​ Painless, bright-red vaginal bleeding ●​ Fetal distress
●​ Soft uterus ●​ Maternal shock
●​ Fetal heart rate often reassuring initially

Nursing Care
Diagnosis
●​ Monitor maternal vital signs.
Ultrasound confirms placental location. ●​ Assess fetal heart rate continuously.
●​ Administer oxygen as ordered.
Digital vaginal examination should be avoided
●​ Establish IV access.
until placenta previa has been excluded, as it
●​ Prepare for emergency delivery if
may precipitate severe hemorrhage.
indicated.

Nursing Care
DIFFERENTIATING
●​ Monitor bleeding.
●​ Monitor fetal heart rate.
PLACENTA PREVIA AND
●​ Avoid unnecessary vaginal examinations. ABRUPTION
●​ Prepare for cesarean birth if indicated.
●​ Administer blood products if prescribed.
Placenta Previa Placental
Abruption

2. Placental Abruption
Bright-red bleeding Dark or concealed
(Abruptio Placentae) bleeding

Definition
Painless Painful
Premature separation of a normally implanted
placenta.

Soft uterus Rigid, tender uterus

 ●​ Ultrasound cervical length
Usually no uterine Marked uterine ●​ Fetal fibronectin testing (selected cases)
tenderness tenderness

Fetal distress less Fetal distress Medical Management

common initially common
●​ Tocolytics (to delay labor when
appropriate)
●​ Corticosteroids (to accelerate fetal lung
maturation)
●​ Magnesium sulfate for fetal

II. PRETERM LABOR neuroprotection in selected preterm births

●​ Antibiotics if infection or Group B
Streptococcus prophylaxis is indicated
Definition
Regular uterine contractions causing cervical
change between 20 weeks and before 37 Nursing Care
completed weeks of gestation.
●​ Monitor contractions.
●​ Monitor fetal heart rate.
●​ Encourage hydration if appropriate.
●​ Administer medications as prescribed.
Risk Factors ●​ Assess cervical changes.
●​ Educate regarding signs of labor.
●​ Previous preterm birth
●​ Multiple pregnancy
●​ Uterine abnormalities
●​ Infection
●​ Smoking
●​ Short cervical length III. PRETERM
●​ Polyhydramnios
PREMATURE
RUPTURE OF
Signs
MEMBRANES
●​
●​
Regular contractions
Pelvic pressure (PPROM)
●​ Low back pain
●​ Cervical dilation
●​ Cervical effacement Definition
●​ Vaginal spotting
PPROM is rupture of the amniotic membranes
●​ Increased vaginal discharge
before the onset of labor and before 37 weeks'
gestation.

(PROM refers to rupture before labor at any

Diagnosis gestational age.)

●​ Cervical examination
Risk Factors
●​ Infection
●​ Smoking IV. HYPERTENSIVE
●​ Multiple pregnancy
●​ Previous PPROM DISORDERS DURING
●​ Cervical insufficiency
PREGNANCY

Signs Types
●​ Sudden gush or continuous leakage of Gestational Hypertension
fluid
●​ Positive pooling of amniotic fluid on sterile New-onset hypertension after 20 weeks without
speculum examination proteinuria or severe features.
●​ Reduced amniotic fluid volume on
ultrasound

Preeclampsia

Hypertension after 20 weeks with proteinuria or

Complications evidence of maternal organ
dysfunction/end-organ involvement.
Maternal:

●​ Chorioamnionitis
●​ Endometritis Severe Features of Preeclampsia
Fetal: May include:
●​ Prematurity ●​ Severe hypertension
●​ Umbilical cord prolapse ●​ Severe persistent headache
●​ Cord compression ●​ Visual disturbances
●​ Pulmonary hypoplasia (with prolonged ●​ Right upper quadrant or epigastric pain
early rupture) ●​ Elevated liver enzymes
●​ Low platelet count
●​ Pulmonary edema
●​ Renal dysfunction
Nursing Care
●​ Assess fetal heart rate.
●​ Monitor maternal temperature. Eclampsia
●​ Observe for signs of infection (fever,
uterine tenderness, foul-smelling fluid, Preeclampsia complicated by generalized
maternal/fetal tachycardia). tonic-clonic seizures not attributable to another
●​ Limit vaginal examinations unless clinically cause.
necessary.
●​ Administer corticosteroids, antibiotics, and
other medications as prescribed.
●​ Educate the patient to report changes in Risk Factors
fetal movement or fluid leakage.
 ●​ First pregnancy ●​ Corticosteroids if preterm delivery is
●​ Multiple gestation anticipated
●​ Chronic hypertension ●​ Delivery is the definitive treatment once
●​ Diabetes mellitus clinically appropriate
●​ Kidney disease
●​ Obesity
●​ Previous preeclampsia
●​ Extremes of maternal age
Nursing Care
●​ Monitor blood pressure.
●​ Assess deep tendon reflexes and clonus.
Signs and Symptoms ●​ Monitor urine output.
●​ Monitor fetal status.
●​ Elevated blood pressure ●​ Maintain a calm environment.
●​ Proteinuria (not required for diagnosis if ●​ Implement seizure precautions.
other severe features are present) ●​ Administer medications as prescribed.
●​ Edema (may occur but is not diagnostic) ●​ Monitor for magnesium sulfate toxicity.
●​ Severe headache
●​ Blurred vision or visual disturbances
●​ Hyperreflexia
●​ Right upper quadrant pain Magnesium Sulfate Toxicity
●​ Oliguria
Signs:

●​ Loss of deep tendon reflexes

●​ Respiratory depression
Complications ●​ Decreased urine output
●​ Altered consciousness
Maternal: ●​ Cardiac arrest (severe toxicity)

●​ Stroke Antidote:
●​ Seizures
●​ HELLP syndrome Calcium gluconate
●​ Placental abruption
●​ Organ failure

Fetal:

●​ Growth restriction
V. HELLP SYNDROME
●​ Prematurity
●​ Hypoxia
●​ Stillbirth
Definition
HELLP syndrome is a severe complication of
preeclampsia characterized by:

Medical Management ●​ H – Hemolysis

●​ EL – Elevated Liver enzymes
●​ Antihypertensive medications when ●​ LP – Low Platelet count
indicated
●​ Magnesium sulfate for seizure It is considered an obstetric emergency.
prevention/treatment in preeclampsia with
severe features or eclampsia
 ●​ Stabilize mother.
Risk Factors
●​ Administer magnesium sulfate if indicated.
●​ Severe preeclampsia ●​ Control blood pressure.
●​ Previous HELLP syndrome ●​ Blood component therapy if needed.
●​ Multiparity ●​ Expedite delivery when maternal or fetal
●​ Maternal age over 25 years (risk varies) status warrants.

Signs and Symptoms Nursing Care

●​ Severe right upper quadrant or epigastric ●​ Monitor vital signs.

pain ●​ Monitor laboratory values.
●​ Nausea and vomiting ●​ Assess for bleeding.
●​ Malaise ●​ Monitor fetal heart rate.
●​ Headache ●​ Prepare for delivery.
●​ Hypertension (may not always be severe) ●​ Provide emotional support.
●​ Proteinuria (may or may not be present) ●​ Collaborate with the multidisciplinary
team.

Laboratory Findings
●​ Hemolysis
GENERAL NURSING
●​ Elevated AST and ALT
●​ Platelet count <100,000/mm³ (commonly
RESPONSIBILITIES
used criterion)
FOR SUDDEN
PREGNANCY
Complications COMPLICATIONS
Maternal:
The nurse should:
●​ Liver rupture
●​ Perform rapid maternal and fetal
●​ Disseminated intravascular coagulation
assessments.
(DIC)
●​ Monitor vital signs frequently.
●​ Acute kidney injury
●​ Assess fetal heart rate.
●​ Stroke
●​ Establish and maintain IV access when
●​ Maternal death
indicated.
Fetal: ●​ Administer oxygen if prescribed or
clinically indicated.
●​ Placental abruption ●​ Monitor laboratory results.
●​ Prematurity ●​ Prepare for emergency interventions or
●​ Fetal distress delivery if necessary.
●​ Stillbirth ●​ Educate the patient and family.
●​ Provide psychological support.
●​ Document assessments, interventions,
and responses accurately.

Medical Management
 Placenta Previa vs Placental Abruption
HIGH-YIELD EXAM
Previa is Painless; Abruption Agonizes
POINTS
●​ Previa → Painless, bright-red bleeding,
●​ Bleeding during pregnancy is always soft uterus
considered abnormal until evaluated. ●​ Abruption → Painful, tender/rigid
●​ Placenta previa causes painless, uterus, fetal distress
bright-red bleeding; avoid digital vaginal
examination until it has been ruled out. Magnesium Sulfate Toxicity
●​ Placental abruption causes painful
bleeding, uterine tenderness, and fetal RRLU
distress.
●​ R – Respiratory depression
●​ Preterm labor occurs before 37
●​ R – Reflexes absent
completed weeks with regular
●​ L – Low urine output
contractions and cervical change.
●​ U – Use Calcium Gluconate as antidote
●​ PPROM is rupture of membranes before
labor and before 37 weeks.
●​ In PPROM, monitor closely for
chorioamnionitis and avoid unnecessary NURSING CARE OF A
vaginal examinations.
●​ Preeclampsia is hypertension after 20 FAMILY
weeks with proteinuria or other signs of
end-organ involvement.
●​ Magnesium sulfate is used to prevent
EXPERIENCING A
and treat eclamptic seizures.
●​ Calcium gluconate is the antidote for
SUDDEN
magnesium sulfate toxicity.
●​ HELLP syndrome stands for Hemolysis,
PREGNANCY
Elevated Liver enzymes, and Low
Platelets and requires urgent
COMPLICATIONS
management.
(CONTINUATION)
EASY MNEMONICS Topics Covered
HELLP Syndrome ●​ Multiple Pregnancies
●​ Polyhydramnios
HELP the Liver & Platelets ●​ Oligohydramnios
●​ Post-Term Pregnancy
●​ H – Hemolysis ●​ Rh Incompatibility
●​ EL – Elevated Liver enzymes
●​ LP – Low Platelets

Preeclampsia Warning Signs

HEAD
I. MULTIPLE
●​ H – Headache
PREGNANCIES
●​ E – Epigastric pain
●​ A – Altered vision
●​ D – Deep tendon reflexes increased
Definition
A multiple pregnancy occurs when a woman is ●​ Cesarean birth
carrying more than one fetus, such as twins,
triplets, or higher-order multiples.

Fetal Complications
Types of Twins ●​ Preterm birth
●​ Low birth weight
1. Monozygotic (Identical) Twins ●​ Intrauterine growth restriction (IUGR)
●​ Malpresentation
●​ Develop from one fertilized ovum that ●​ Umbilical cord prolapse
splits into two embryos. ●​ Twin-to-twin transfusion syndrome
●​ Genetically identical. (monochorionic twins)
●​ Same sex. ●​ Increased perinatal mortality
●​ May share the placenta and/or amniotic
sac depending on when the embryo
divides.
Diagnosis
●​ Ultrasound (gold standard)
2. Dizygotic (Fraternal) Twins ●​ Larger-than-expected uterine size
●​ Elevated maternal serum alpha-fetoprotein
●​ Develop from two separate ova fertilized
(MSAFP)
by two different sperm.
●​ Multiple fetal heart tones
●​ Genetically different.
●​ Palpation of multiple fetal parts
●​ May be the same or different sexes.
●​ Each fetus has its own placenta and
amniotic sac (although placentas may
fuse).
Nursing Care
●​ Encourage frequent prenatal visits.
●​ Monitor maternal weight gain.
Risk Factors ●​ Encourage a balanced, high-protein diet.
●​ Assess for signs of preterm labor.
●​ Advanced maternal age
●​ Monitor fetal growth and well-being.
●​ Family history (especially maternal)
●​ Promote adequate rest.
●​ Fertility medications
●​ Provide emotional support.
●​ Assisted reproductive technology (ART)
●​ Prepare parents for possible NICU care.
●​ Multiparity

Maternal Complications II. POLYHYDRAMNIOS

●​ Hyperemesis gravidarum
●​ Anemia Definition
●​ Gestational hypertension or preeclampsia
●​ Gestational diabetes Polyhydramnios is an excessive amount of
●​ Polyhydramnios amniotic fluid.
●​ Placental abruption
●​ Postpartum hemorrhage
A commonly used ultrasound criterion is an
Diagnosis
Amniotic Fluid Index (AFI) greater than 24–25
cm or a deepest vertical pocket greater than 8 ●​ Ultrasound
cm. ●​ Amniotic Fluid Index (AFI)
●​ Fetal anomaly assessment

Causes
Medical Management
Maternal
●​ Treat the underlying cause when possible.
●​ Diabetes mellitus ●​ Therapeutic amnioreduction in selected
severe cases.
Fetal ●​ Medications (e.g., indomethacin) may be
used in selected situations under
●​ Gastrointestinal obstruction (e.g., specialist supervision.
esophageal or duodenal atresia)
●​ Neural tube defects
●​ Impaired fetal swallowing
●​ Multiple pregnancy (especially twin-to-twin
transfusion syndrome) Nursing Care
●​ Monitor maternal respiratory status.
●​ Assess uterine size.
●​ Monitor fetal heart rate.
Signs and Symptoms ●​ Observe for signs of preterm labor.
●​ Educate regarding decreased fetal
●​ Rapid abdominal enlargement movement and warning signs.
●​ Difficulty breathing ●​ Prepare for possible preterm birth.
●​ Edema
●​ Maternal discomfort
●​ Uterus larger than expected
●​ Fetal parts difficult to palpate
III.
OLIGOHYDRAMNIOS
Complications
Maternal: Definition
●​ Preterm labor Oligohydramnios is a decreased amount of
●​ Premature rupture of membranes amniotic fluid.
●​ Placental abruption
●​ Postpartum hemorrhage Common ultrasound criteria include an AFI of 5
cm or less or a single deepest pocket less
Fetal: than 2 cm.

●​ Malpresentation
●​ Umbilical cord prolapse
●​ Preterm birth
●​ Fetal distress Causes
Maternal:
 ●​ Dehydration ●​ Encourage hydration when appropriate.
●​ Hypertension ●​ Monitor fetal heart rate.
●​ Placental insufficiency ●​ Monitor fetal movement.
●​ Prepare for possible induction or cesarean
Fetal: birth if indicated.
●​ Provide emotional support.
●​ Renal agenesis
●​ Urinary tract obstruction

Pregnancy-related:

●​ Post-term pregnancy DIFFERENCE

●​ Premature rupture of membranes
BETWEEN
POLYHYDRAMNIOS
Signs
AND
●​ Small uterus for gestational age
●​ Easily palpable fetal parts OLIGOHYDRAMNIOS
●​ Decreased fetal movement
●​ Low AFI on ultrasound
Polyhydramnios Oligohydramnios

Complications Too much amniotic fluid Too little amniotic

fluid
Maternal:

●​ Difficult labor Large uterus Small uterus

Fetal:

●​ Cord compression Fetal parts difficult to Fetal parts easily

●​ Fetal distress palpate palpated
●​ Musculoskeletal deformities
●​ Pulmonary hypoplasia (especially with
early severe oligohydramnios) Risk of cord prolapse Risk of cord
●​ Stillbirth compression

Preterm labor common Fetal distress

Diagnosis common

●​ Ultrasound
●​ AFI measurement
●​ Biophysical profile (BPP)

IV. POST-TERM
Nursing Care PREGNANCY
 ●​ Ultrasound
Definition
●​ Non-Stress Test (NST)
A post-term pregnancy extends to 42 weeks ●​ Biophysical Profile (BPP)
(294 days) or more from the first day of the last
menstrual period.

Medical Management
●​ Increased fetal surveillance
Risk Factors
●​ Induction of labor when indicated
●​ Previous post-term pregnancy ●​ Cesarean birth if necessary
●​ First pregnancy
●​ Male fetus
●​ Incorrect pregnancy dating
Nursing Care
●​ Monitor fetal well-being.
●​ Assess fetal movement.
Maternal Complications
●​ Monitor for meconium-stained amniotic
●​ Prolonged labor fluid.
●​ Cesarean birth ●​ Prepare for induction if ordered.
●​ Perineal trauma ●​ Provide education regarding warning
●​ Infection signs.
●​ Postpartum hemorrhage

Fetal Complications V. Rh
●​ Macrosomia
INCOMPATIBILITY
●​ Meconium aspiration syndrome
●​ Placental insufficiency
●​ Oligohydramnios
Definition
●​ Fetal hypoxia
Rh incompatibility occurs when an Rh-negative
●​ Stillbirth
mother carries an Rh-positive fetus, allowing
maternal exposure to fetal Rh-positive red blood
cells. The mother may develop antibodies
(sensitization) that can affect future Rh-positive
Signs pregnancies.

●​ Decreased fetal movement

●​ Reduced amniotic fluid
●​ Aging placenta
●​ Non-reassuring fetal testing
Rh Factor
Rh-positive:

Presence of the Rh (D) antigen.

Diagnosis
Rh-negative:
●​ Accurate pregnancy dating
Absence of the Rh (D) antigen.
 ●​ Direct Coombs test
●​ Bilirubin level
●​ Hemoglobin and hematocrit
Pathophysiology
1.​ Fetal Rh-positive red blood cells enter the
maternal circulation.
2.​ The Rh-negative mother becomes Prevention
sensitized and produces anti-D antibodies.
3.​ In a subsequent Rh-positive pregnancy, Rho(D) Immune Globulin (RhoGAM)
maternal IgG antibodies cross the
placenta. Given to unsensitized Rh-negative mothers to
4.​ These antibodies destroy fetal red blood prevent antibody formation.
cells.
Common timing:
This can result in Hemolytic Disease of the
Fetus and Newborn (HDFN). ●​ Around 28 weeks of gestation
●​ Within 72 hours after delivery of an
Rh-positive infant
●​ After events with potential fetomaternal
hemorrhage (e.g., miscarriage, ectopic
Causes of Sensitization pregnancy, abdominal trauma, certain
invasive procedures)
●​ Childbirth
●​ Miscarriage Important: Rho(D) immune globulin is not
●​ Ectopic pregnancy effective once sensitization has already
●​ Abdominal trauma occurred.
●​ Invasive prenatal procedures (e.g.,
amniocentesis, chorionic villus sampling)
●​ Placental abruption

Nursing Care
●​ Determine maternal blood type and Rh
Signs in the Fetus/Newborn status.
●​ Review antibody screening results.
●​ Fetal anemia ●​ Administer Rho(D) immune globulin as
●​ Jaundice prescribed.
●​ Hepatosplenomegaly ●​ Educate parents regarding Rh
●​ Hydrops fetalis incompatibility.
●​ Heart failure ●​ Monitor the newborn for jaundice and
●​ Severe hyperbilirubinemia after birth anemia.
●​ Support parents emotionally.

Diagnosis
Mother: GENERAL NURSING
●​ Blood type
●​ Rh typing
RESPONSIBILITIES
●​ Antibody screen (Indirect Coombs test)
The nurse should:
Newborn:
●​ Assess maternal and fetal status regularly.
 ●​ Monitor fetal heart rate and fetal
movement. EASY MNEMONICS
●​ Educate the patient regarding warning
signs. Multiple Pregnancy Complications
●​ Encourage adherence to prenatal
appointments. PALM
●​ Promote adequate nutrition and hydration.
●​ Monitor for signs of labor and ●​ P – Preterm birth
complications. ●​ A – Anemia
●​ Prepare for emergency interventions if ●​ L – Low birth weight
needed. ●​ M – Malpresentation
●​ Provide emotional support to the family.
●​ Collaborate with the interdisciplinary Polyhydramnios
healthcare team.
POLY = Plenty

●​ P – Plenty of fluid
●​ P – Preterm labor

HIGH-YIELD EXAM ●​
●​
P – Prolapsed cord
P – Presentation abnormalities

POINTS Oligohydramnios
●​ Multiple pregnancies increase the risk of OLIGO = Little
preterm birth, gestational hypertension,
gestational diabetes, postpartum ●​ L – Low fluid
hemorrhage, and fetal growth ●​ L – Limited fetal movement
restriction. ●​ L – Lung hypoplasia (if early/severe)
●​ Monozygotic twins arise from one ●​ L – Labor complications from cord
fertilized ovum, while dizygotic twins compression
arise from two separate ova.
●​ Polyhydramnios = excess amniotic Rh Incompatibility
fluid; associated with maternal diabetes,
fetal anomalies, and risks such as cord Rh = Red Cells Harmed
prolapse and preterm labor.
●​ Oligohydramnios = decreased amniotic ●​ Rh-negative mother
fluid; associated with placental ●​ Rh-positive fetus
insufficiency, rupture of membranes, ●​ Anti-D antibodies
and fetal cord compression. ●​ RhoGAM prevents sensitization
●​ A post-term pregnancy lasts 42 weeks
or more and increases the risk of
meconium aspiration, macrosomia,
oligohydramnios, and stillbirth.
●​ Rh incompatibility occurs when an
Rh-negative mother carries an
Rh-positive fetus and becomes
sensitized.
●​ Rho(D) immune globulin (RhoGAM)
prevents maternal sensitization and is
routinely administered to unsensitized
Rh-negative mothers at approximately
28 weeks and within 72 hours
postpartum if the newborn is Rh-positive.
 The goals of newborn nursing care are to:

●​ Promote successful adaptation to

extrauterine life.
●​ Prevent complications.
●​ Support growth and development.
●​ Encourage parent-infant bonding.
●​ Educate parents regarding newborn care.

A. DESCRIBE THE
NORMAL
CHARACTERISTICS
OF THE NEWBORN
Classification of Newborns
By Gestational Age

Preterm

●​ Born before 37 completed weeks of

gestation.
MODULE 8
Term

I. NURSING CARE OF ●​ Born between 37 weeks and 41 weeks 6

days of gestation.

A FAMILY WITH A Post-term

NEWBORN ●​ Born at 42 weeks or more.

By Birth Weight

INTRODUCTION Classification Birth Weight

The newborn (neonate) is an infant from birth to

28 days of life. This period is marked by rapid
physiological adaptation from intrauterine to Low Birth Weight Less than 2,500 g
extrauterine life. Nursing care focuses on (LBW)
supporting this transition, maintaining warmth,
ensuring effective respiration and circulation,
preventing infection, promoting nutrition, and
educating the family.
 Chest Circumference
Very Low Birth Less than 1,500 g
Weight (VLBW) Average:

30–33 cm

Extremely Low Less than 1,000 g The head circumference is normally 2–3 cm
Birth Weight larger than the chest circumference.
(ELBW)

Normal Birth 2,500–3,999 g Vital Signs

Weight

Param Normal Value

eter
Macrosomia 4,000 g or more
(definitions may vary by
guideline)
Tempe 36.5–37.5°C (axillary)
rature

Heart 120–160 beats/minute

Normal Physical Rate
Characteristics
Weight Respir 30–60 breaths/minute
atory
Average: Rate

2.5–4.0 kg

A physiologic weight loss of up to 10% may occur Blood Approximately 60–80/40–50 mmHg
during the first week, with recovery by about Pressu (varies with gestational age and age
10–14 days. re after birth)

Length

Average: Skin
48–53 cm Normal Findings:

●​ Vernix caseosa
●​ Lanugo
Head Circumference ●​ Milia
●​ Mongolian spots (congenital dermal
Average: melanocytosis)
●​ Erythema toxicum
33–35 cm ●​ Acrocyanosis during the first 24–48 hours

Abnormal Findings:
 ●​ Persistent central cyanosis Normal Findings:
●​ Extensive petechiae
●​ Jaundice within the first 24 hours (requires ●​ Strong suck and rooting reflexes
evaluation) ●​ Epstein pearls
●​ Intact palate

Head
Chest
Fontanels
●​ Symmetrical movement
Anterior fontanel: ●​ Periodic breathing may occur
●​ Breast enlargement may be present due
●​ Diamond-shaped to maternal hormones
●​ Closes around 12–18 months

Posterior fontanel:

●​ Triangular Abdomen
●​ Closes by about 2–3 months
Normal Findings:

●​ Soft
●​ Rounded
Common Birth Findings
●​ Active bowel sounds
Caput Succedaneum ●​ Umbilical cord with two arteries and one
vein
●​ Edematous swelling of the scalp
●​ Crosses suture lines
●​ Resolves spontaneously

Cephalohematoma
Genitalia

●​ Bleeding beneath the periosteum Male

●​ Does not cross suture lines
●​ May increase the risk of jaundice ●​ Testes descended (in most term
newborns)
●​ Urinary meatus at the tip of the penis

Female
Eyes
●​ Labia majora cover the labia minora in
Normal Findings: term infants
●​ Possible white vaginal discharge or small
●​ Edema
amount of blood (pseudomenstruation)
●​ Temporary strabismus
due to maternal hormone withdrawal
●​ Ability to briefly fix and follow objects

Red reflex should be present.

NEWBORN
Mouth REFLEXES
Reflex Normal Disappears
NORMAL GROWTH
Response
AND DEVELOPMENT
Rooting Turns head 3–4 months APGAR Score
toward cheek
stimulation Performed at 1 minute and 5 minutes after birth.

Sucking Sucks when Around 4 Comp 0 1 2

mouth is months onent
stimulated (becomes
voluntary)
Appear Blue/P Acrocya Completely pink
ance ale nosis
Moro Symmetric 4–6 months
extension then
flexion of arms Pulse Absent <100 ≥100 bpm
bpm

Palmar Grasps 4–6 months

Grasp examiner's finger Grimac No Grimace Vigorous
e respon cry/cough/sneez
se e
Plantar Toes flex 9–12 months
Grasp
Activity Limp Some Active
flexion movement
Babinski Toes fan outward 12–24 months

Respir Absent Slow/irr Good cry

Steppin Walking About 2 months ation egular
g movements when
held upright
Interpretation

Tonic Extension of arm 4–6 months 7–10: Good adaptation

Neck on face side
4–6: Moderate difficulty; may require intervention
(Fencer)
0–3: Severe distress; requires immediate
resuscitation

B. ASSESS A Physical Assessment

NEWBORN FOR Assess:
 ●​ Airway
Growth Monitoring
●​ Breathing
●​ Circulation Expected Growth:
●​ Temperature
●​ Weight ●​ Regain birth weight by 10–14 days
●​ Length ●​ Weight gain of approximately 20–30 g/day
●​ Head circumference during the first few months
●​ Reflexes
●​ Skin
●​ Fontanels
●​ Umbilical cord
●​ Elimination
C. IMPLEMENT THE
NURSING PROCESS
Elimination IN THE CARE OF THE
Urine NEWBORN
First void:
Assessment
Usually within 24 hours
Assess:

●​ Airway and breathing

Meconium ●​ Vital signs
●​ Skin color
First stool: ●​ Temperature
●​ Feeding
Usually passed within 24–48 hours
●​ Elimination
●​ Reflexes
Characteristics:
●​ Parent-infant bonding
●​ Thick
●​ Sticky
●​ Black-green
Nursing Diagnoses
(Examples)
Feeding Assessment ●​ Risk for ineffective thermoregulation
●​ Risk for infection
Evaluate: ●​ Ineffective breastfeeding
●​ Risk for impaired skin integrity
●​ Sucking ability
●​ Readiness for enhanced family processes
●​ Swallowing
●​ Latch (if breastfeeding)
●​ Feeding frequency
●​ Weight changes
●​ Signs of dehydration Planning
Goals:

●​ Maintain body temperature.

 ●​ Establish effective feeding.
Evaluation
●​ Prevent infection.
●​ Promote parent-infant attachment. Expected Outcomes:
●​ Ensure normal growth and development.
●​ Stable vital signs
●​ Adequate feeding
●​ Appropriate weight gain
Interventions ●​ Normal elimination
●​ Stable temperature
●​ No signs of infection
Thermoregulation
●​ Positive parent-infant interaction
Maintain a neutral thermal environment by:

●​ Drying the infant immediately after birth

●​ Skin-to-skin contact
●​ Using warm blankets and a radiant D. THE CARE OF THE
warmer when needed
●​ Delaying the first bath until the newborn is NEWBORN AT BIRTH
stable and normothermic
The immediate newborn period is the first
minutes to hours after birth, during which rapid
assessment and interventions support the infant's
Infection Prevention transition to extrauterine life.

●​ Perform hand hygiene.

●​ Use aseptic technique.
●​ Provide proper cord care.
●​ Monitor for signs of infection. Immediate Priorities
1. Airway
Nutrition ●​ Position the head in a neutral ("sniffing")
position.
Encourage: ●​ Clear secretions only if needed (routine
suctioning of vigorous newborns is not
●​ Early breastfeeding (preferably within the
recommended).
first hour when possible)
●​ Feeding on demand (typically 8–12
feedings/day for breastfed newborns)
2. Breathing

●​ Dry and stimulate the newborn.

Safety ●​ Assess respiratory effort.
●​ Provide positive-pressure ventilation if
Teach parents:
indicated according to neonatal
resuscitation guidelines.
●​ Safe sleep ("Back to Sleep")
●​ Never shake the baby
●​ Proper car seat use
●​ Identification procedures in the hospital
3. Circulation

●​ Assess heart rate.

●​ Evaluate skin color and perfusion.
 ●​ Begin advanced resuscitation if indicated.

Vitamin K Administration
Delayed Cord Clamping Give Vitamin K intramuscularly shortly after birth
to prevent Vitamin K Deficiency Bleeding
When appropriate and the newborn is stable, (VKDB).
delaying umbilical cord clamping for at least
30–60 seconds improves neonatal iron stores
and blood volume.

Newborn Screening
Perform according to national or local guidelines.
Identification
May include:
Apply identification bands to:
●​ Metabolic screening
●​ Infant ●​ Hearing screening
●​ Mother ●​ Pulse oximetry screening for critical
●​ Partner/support person (per institutional congenital heart disease (where available)
policy)

Obtain footprints according to facility protocol.

Umbilical Cord Care

●​ Keep the stump clean and dry.
Thermoregulation ●​ Fold the diaper below the cord.
●​ Observe for redness, foul odor, swelling,
Prevent heat loss through: or discharge.
●​ The cord usually falls off within 1–3
●​ Drying weeks.
●​ Skin-to-skin contact
●​ Warm blankets
●​ Radiant warmer when needed

Mechanisms of Heat Loss Breastfeeding Initiation

●​ Evaporation – Dry immediately after birth. Encourage:
●​ Conduction – Warm surfaces before
placing the infant. ●​ Skin-to-skin contact immediately after birth
●​ Convection – Protect from drafts. when stable.
●​ Radiation – Keep away from cold objects ●​ Breastfeeding within the first hour
and walls. whenever possible.

Benefits:

●​ Promotes bonding
Eye Prophylaxis ●​ Improves milk production
●​ Supports newborn glucose stability
Administer prophylactic ophthalmic medication ●​ Provides colostrum for passive immunity
according to local policy to help prevent
ophthalmia neonatorum.
PARENT EDUCATION II. NUTRITIONAL
Teach parents about: NEEDS OF THE
●​
●​
Breastfeeding
Umbilical cord care
NEWBORN
●​ Safe sleep (supine position)
●​ Bathing
●​ Diaper care
●​ Recognition of jaundice
●​ When to seek medical attention INTRODUCTION
●​ Immunization schedule
●​ Importance of follow-up visits Nutrition during the neonatal period (birth to 28
days) is essential for growth, brain development,
immune function, and adaptation to extrauterine
life. The ideal nutrition for most healthy newborns
is exclusive breastfeeding for the first 6
HIGH-YIELD EXAM months of life, as recommended by the World
Health Organization (WHO) and the American
POINTS Academy of Pediatrics (AAP).

The nurse plays a vital role in:

●​ The newborn period extends from birth
to 28 days. ●​ Assessing nutritional status
●​ A term newborn is born between 37 ●​ Promoting breastfeeding
weeks and 41 weeks 6 days. ●​ Educating parents about formula feeding
●​ Normal birth weight is 2.5–4.0 kg. when indicated
●​ Normal newborn vital signs: ●​ Monitoring feeding effectiveness
○​ Temperature: 36.5–37.5°C ●​ Preventing feeding-related complications
○​ Heart Rate: 120–160 bpm ●​ Preparing families for discharge
○​ Respiratory Rate: 30–60
breaths/min
●​ The APGAR score is assessed at 1 and 5
minutes after birth.
●​ Caput succedaneum crosses suture
lines, while cephalohematoma does not.
A. NUTRITIONAL
●​ The umbilical cord normally contains two
arteries and one vein.
ALLOWANCES FOR A
●​ The first urine should be passed within
24 hours, and meconium within 24–48
NEWBORN
hours.
●​ Prevent heat loss through attention to
evaporation, conduction, convection,
Energy Requirements
and radiation.
Healthy term newborns require approximately:
●​ Administer Vitamin K to prevent Vitamin
K Deficiency Bleeding (VKDB). ●​ 100–120 kcal/kg/day
●​ Encourage early skin-to-skin contact
and breastfeeding within the first hour This amount supports:
when mother and infant are stable.
●​ Rapid growth
●​ Brain development
●​ Maintenance of body temperature
 ●​ Organ function Functions:

●​ Brain development
●​ Energy source
●​ Absorption of fat-soluble vitamins (A, D, E,
Fluid Requirements K)

Approximate daily requirements:

Age Fluid Requirement Carbohydrates

Main carbohydrate:

Day 1 60–80 mL/kg/day Lactose

Functions:
Day 2 80–100 mL/kg/day
●​ Primary energy source
●​ Supports brain growth
●​ Promotes calcium absorption
Day 3 100–120 mL/kg/day

Day 4 onward 120–150 mL/kg/day Vitamins and Minerals

Important nutrients include:
Fluid needs may vary depending on gestational
age, illness, and clinical condition. Vitamin K

Given intramuscularly shortly after birth to prevent

Vitamin K Deficiency Bleeding (VKDB).
Protein Requirements
Approximately:
Vitamin D
●​ 1.5–2.0 g/kg/day for healthy term
newborns Breastfed infants generally require 400 IU/day of
vitamin D supplementation beginning soon after
Protein supports: birth unless receiving adequate fortified formula.

●​ Tissue growth
●​ Muscle development
●​ Enzyme production Iron
●​ Immune function
Healthy term infants are born with iron stores that
usually meet their needs for approximately the
first 4–6 months.

Fat Requirements Exclusively breastfed infants generally begin iron

supplementation around 4 months, unless
Fat provides about 40–50% of the newborn's otherwise directed.
caloric intake.
Calcium and Phosphorus 1. Colostrum
Essential for: Produced during the first 2–4 days after birth.
●​ Bone growth Characteristics:
●​ Tooth development
●​ Muscle contraction ●​ Thick
●​ Nerve function ●​ Yellow or golden
●​ Small in volume but nutrient-dense

Rich in:

Signs of Adequate ●​
●​
Immunoglobulin A (IgA)
White blood cells
Nutrition ●​
●​
Protein
Vitamins
●​ Growth factors
A well-fed newborn should have:
Benefits:
●​ Strong suck
●​ Effective swallowing ●​ Provides passive immunity
●​ Good muscle tone ●​ Coats and protects the intestinal lining
●​ Appropriate weight gain ●​ Helps pass meconium
●​ Normal urine output ●​ Reduces jaundice risk by promoting stool
●​ Regular stooling pattern passage
●​ Contentment after feeds

2. Transitional Milk
B. BREASTFEEDING Produced approximately:

Day 5 to 2 weeks
Definition
Contains:
Breastfeeding is the feeding of an infant with
human breast milk directly from the breast or ●​ Increased fat
expressed breast milk. ●​ Increased lactose
●​ More calories
The WHO recommends:

●​ Exclusive breastfeeding for the first 6

months
●​ Continued breastfeeding with 3. Mature Milk
complementary foods until 2 years of age
or beyond Present after approximately 2 weeks.

Contains:

●​ Water
●​ Fat
Composition of ●​ Protein
●​ Lactose
Breast Milk ●​ Vitamins
 ●​ Minerals ●​ Football hold
●​ Antibodies ●​ Side-lying
●​ Enzymes

Signs of a Good Latch

Advantages of ●​
●​
Mouth wide open
Lips flanged outward

Breastfeeding ●​
●​
Chin touching the breast
More areola visible above than below the
baby's mouth
●​ Rhythmic suck-swallow pattern
Benefits to the Infant ●​ Minimal or no nipple pain
●​ Ideal nutrition
●​ Easily digested
●​ Reduced risk of infections
Feeding Frequency
●​ Lower risk of allergies
●​ Reduced incidence of diarrhea Feed:
●​ Reduced respiratory infections
●​ Lower risk of obesity later in life ●​ 8–12 times per 24 hours
●​ Supports healthy brain development ●​ On demand whenever hunger cues are
●​ Promotes bonding present

Benefits to the Mother Hunger Cues

Early cues:
●​ Promotes uterine involution through
oxytocin release ●​ Rooting
●​ Reduces postpartum bleeding ●​ Hand-to-mouth movements
●​ Burns additional calories ●​ Lip smacking
●​ May delay return of ovulation (when ●​ Increased alertness
criteria for Lactational Amenorrhea
Method are met) Late cue:
●​ Reduces risk of breast and ovarian cancer
●​ Convenient and economical ●​ Crying (feeding should ideally begin
before crying)

Proper Breastfeeding Signs of Effective Breastfeeding

Technique ●​
●​
Audible swallowing
Infant appears satisfied after feeding
●​ Adequate urine and stool output
Positioning ●​ Appropriate weight gain

Common positions:

●​ Cradle hold
●​ Cross-cradle hold
 Breastfeeding may not be appropriate in certain
Common situations, depending on maternal or infant
conditions. Follow current local and international
Breastfeeding guidelines. Examples include:

Problems ●​ Certain maternal infections or medications

●​ Classic galactosemia in the infant
●​ Maternal illicit drug use
Engorgement
Management:

●​
●​
Frequent breastfeeding
Warm compress before feeding
C. FORMULA
●​
●​
Cold compress after feeding
Gentle breast massage
FEEDING
Definition
Sore Nipples Formula feeding provides commercially prepared
infant formula designed to meet the nutritional
Management: needs of infants when breastfeeding is not
possible or is not chosen.
●​ Correct latch
●​ Air dry nipples
●​ Apply expressed breast milk to nipples
●​ Avoid harsh soaps
Types of Formula
Cow's Milk-Based Formula
Mastitis Most commonly used for healthy term infants.

Signs:

●​ Breast pain Soy Formula

●​ Redness
●​ Fever May be used in selected infants with specific
●​ Flu-like symptoms indications.

Management:

●​ Continue breastfeeding or expressing milk

Hydrolyzed Formula
unless otherwise advised
●​ Antibiotics if prescribed
Contains partially or extensively broken-down
●​ Adequate rest and fluids
proteins.

Used for:

●​ Certain protein allergies

Contraindications to ●​ Malabsorption disorders (depending on
clinical indication)
Breastfeeding
Specialized Formula

Examples:

●​ Premature infant formulas

Disadvantages
●​ Metabolic disease formulas
●​ High-calorie formulas ●​ No maternal antibodies
●​ Higher cost
●​ Requires preparation
●​ Greater risk of contamination if improperly
prepared

Formula Preparation ●​ Increased risk of gastrointestinal infections

compared with breastfeeding

Parents should:

●​ Wash hands thoroughly.

●​ Follow manufacturer's mixing instructions
exactly. D. DISCHARGE
●​ Use clean, sterilized feeding equipment as
appropriate. PLANNING FOR
●​ Prepare with safe water according to local
recommendations. NEWBORN
●​ Refrigerate prepared formula promptly if
not used immediately. NUTRITION
●​ Discard leftover formula after a feeding.
Before discharge, parents should demonstrate
confidence in feeding the newborn.

Bottle Feeding
Technique Breastfeeding
●​ Hold the infant semi-upright. Education
●​ Keep the bottle tilted so the nipple
remains full of milk. Teach parents to:
●​ Never prop the bottle.
●​ Burp the infant during and after feeds. ●​ Feed on demand (usually 8–12 times/day)
●​ Feed based on hunger and satiety cues ●​ Recognize hunger cues
rather than forcing a fixed volume. ●​ Ensure proper latch and positioning
●​ Alternate breasts as comfortable
●​ Recognize signs of adequate milk intake
●​ Store expressed breast milk safely
according to current guidelines
Advantages of
Formula Feeding
●​ Allows others to assist with feeding Formula Feeding
●​ Easier measurement of intake
●​ Useful when breastfeeding is Education
contraindicated or not possible
Teach parents to: Parents should contact a healthcare provider if
the newborn:
●​ Prepare formula correctly
●​ Avoid overfeeding ●​ Refuses several consecutive feedings
●​ Hold the infant during feeds ●​ Has poor sucking or difficulty feeding
●​ Burp the infant ●​ Has fewer wet diapers than expected
●​ Clean feeding equipment properly ●​ Has persistent vomiting (especially
●​ Follow safe storage recommendations green/bilious vomiting)
●​ Appears excessively sleepy and is difficult
to arouse for feeds
●​ Has fever (temperature ≥38°C in infants
younger than 3 months requires urgent
Monitoring Adequate ●​
evaluation)
Shows increasing jaundice
Intake ●​ Has signs of dehydration (dry mouth,
decreased tears when age-appropriate,
poor urine output)
Parents should monitor:

Wet Diapers

By about Day 5, expect at least 6 wet

diapers/day in a well-fed infant. Nursing
Responsibilities
Stool Pattern The nurse should:

Breastfed infants: ●​ Assess feeding effectiveness.

●​ Monitor weight and hydration.
●​ Yellow, loose, seedy stools after milk ●​ Promote breastfeeding.
comes in ●​ Educate regarding formula preparation
when indicated.
Formula-fed infants:
●​ Encourage skin-to-skin contact.
●​ Identify feeding difficulties early.
●​ Usually firmer and tan to brown stools
●​ Reinforce follow-up appointments.
●​ Provide individualized discharge teaching.

Weight

Normal:

●​ Up to 10% physiologic weight loss in

HIGH-YIELD EXAM
the first week
●​ Return to birth weight by approximately
POINTS
10–14 days
●​ Exclusive breastfeeding is
recommended for the first 6 months.
●​ Healthy newborns require approximately
100–120 kcal/kg/day.
●​ Newborns generally feed 8–12 times per
Warning Signs (Seek day.
●​ Colostrum is rich in IgA antibodies and
Medical Care) provides passive immunity.
 ●​ Vitamin K is given after birth to prevent ●​ D – Defends against infection
Vitamin K Deficiency Bleeding (VKDB).
●​ Vitamin D (400 IU/day) is recommended
for most exclusively breastfed infants.
●​ Physiologic weight loss of up to 10% is
expected during the first week, with
recovery by 10–14 days.
●​ By about Day 5, a well-fed infant typically
has 6 or more wet diapers daily.
●​ Never prop a bottle, as it increases the
risk of choking and ear infections.
●​ Breastfeeding promotes uterine
involution through oxytocin release and
provides optimal nutrition for most healthy
infants.

EASY MNEMONICS
Breastfeeding Benefits

BOND

●​ B – Brain development
●​ O – Optimal nutrition
●​ N – Natural immunity
●​ D – Decreased infections

Signs of a Good Latch

LATCH

●​ L – Lips flanged
●​ A – Areola mostly in mouth
●​ T – Tongue under the nipple
●​ C – Chin touching the breast
●​ H – Heard swallowing

Adequate Feeding

WUG

●​ W – Wet diapers (≥6/day after Day 5)

●​ U – Urine clear to pale yellow
●​ G – Good weight gain

Colostrum

GOLD

●​ G – Golden yellow
●​ O – Offers antibodies (IgA)
●​ L – Lines the intestine