WHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 1: FUNDAMENTALS OF NURSING

I. NURSING THEORIST Florence Nightingale Virginia Henderson Faye Abdellah Dorothy Johnson Imogene King Madeleine Leininger Myra Levin Betty Neuman Dorotheo Orem Hildegard Peplau Martha Rogers Sister Callista Roy Lydia Hall Jean Watson Rosemarie Rizzo Parse II. NURSING HISTORY Moses Father of Sanitation Hippocrates Father of Scientific Medicine Clara Barton, founded the American Red Cross Caroline Hampton Robb, The first to nurse to wear gloves while working as an operating room nurse. Dona Hilaria de Aguinaldo, organized Filipino Red Cross. Anastacia Giron Tupas, First Filipino nurse to hold the position of Chief Nurse Superintendent; founder of the Philippine Nurses Association. Environmental Theory 14 Basic Needs Patient Centered Approaches to Nursing Model / 21 Nursing Problems Behavioral System Model Goal Attainment Theory Transcultural Nursing Model Four Conservation Principles Health care System Model Self-Care and Self-Care Deficit Theory Interpersonal Model Science of Unitary Human Beings Adaptation Model Care,Core,Cure Human Caring Model Human Becoming PLANNING PHASE Prioritize problems Formulate goals Select actions Write nursing orders Types of Planning Initial planning, admission assessment. Ongoing planning Discharge planning: M edications E xercise T reatment/therapy H ygiene O ut-patient follow up D iet/nutrition S exual activity/spirituality

INTERVENTION / IMPLEMENTATION Determining needs for assistance Putting into action the plan Supervising delegated care Documenting nursing activities

Types of Intervention Independent Dependent Collaborative Cognitive or Intellectual Skills Such as analyzing the problem, problem solving, critical thinking and making judgments regarding the patient's needs. Interpersonal Skills Which includes therapeutic communication, active listening, conveying knowledge and information, developing trust or rapport-building with the patient Technical Skills Which includes knowledge and skills needed to properly and safely done the procedure Collecting data related to outcome Comparing data Drawing conclusion Continuing, modifying or terminating the nursing care plan

III. NURSING PROCESS ASSESSMENT PHASE Data Collection Organize Data Validate Data Document Data Subjective Data also referred to as symptoms or covert data Objective Data also referred to as signs or overt data, are detectable by an observer Primary source is the client Secondary source is family or anyone else that is not the client Methods of Data Collection Observing To observe is to gather data by using the sense. Interviewing Is a planned communication or a conversation with purpose Examining Is a systematic datacollection method that uses observation (i.e., the senses of sight, hearing, smell, and touch) to detect health problems. DIAGNOSIS PHASE Analyze Data Identify Health Problem Formulate Diagnostic Statements Diagnostic Statements Problem (P): statement of the clients response. Etiology (E): factors contributing Signs and Symptoms (S): defining characteristics manifested by the client Types of Nursing Diagnosis Actual diagnosis is a client problem that is present at the time of the nursing assessment. Risk nursing diagnosis is a clinical judgment that a problem does not exist, but the presence of risk factors Wellness diagnosis Possible nursing diagnosis is one in which evidence about a health problem is incomplete or unclear. Syndrome diagnosis is a diagnosis that is associated with a cluster of other diagnoses .

EVALUATION PHASE

IV. ROLES AND FUNCTIONS OF THE PROFESSIONAL NURSE Direct Care Provider - provides total care using the nursing process . Communicator communicates with clients, support person and colleagues to facilitate all nursing action. Teacher provides health teaching Counselor helps the client to recognize and cope with stressful pyschological or social problem, Client Advocate the nurse becomes an activist speaking up for the client who cannot or will not speak for self. Change Agent initiates changes and assists the client make modifications in the lifestyle to promote health. Leader nurse through the process of interpersonal influence . Manager the nurse plans, gives directions, develops staff, monitors operation. Case Manager coordinates the activities of other member of the health care team. Researcher participates in scientific investigation and uses research findings in practice. Collaborator works in a combined effort with all those involved in care delivery.

POSSIBLE TOPICS ON FUNDAMENTALS OF NURSING FOR THE UPCOMING DECEMBER 2012 PNLE

*Patterned on the previous board exams from December 2006 July 2012 the purpose of this note is to GUIDE students on the possible topics that might be part of the upcoming December 2012 PNLE

WHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 1: FUNDAMENTALS OF NURSING
V. HEALTH / DISEASE / ILLNESS Health is the complete physical, mental, social (totality) well-being and not merely the absence of disease or infirmity. FOUR MODELS OF HEALTH BY SMITH 1. Clinical Model Man is viewed as a Physiologic Being If there are no signs and symptoms of a disease, then you are healthy 2. Role Performance Model As long as you are able to perform SOCIETAL functions and ROLES you are healthy 3. Adaptive Model Health is viewed in terms of capacity to ADAPT Failure to adapt is disease 4. Eudaemonistic Model Because health is viewed in terms of Actualization Disease is a pathologic change in the structure or function of the mind and body Illness is a highly subjective feeling of being sick or ill C. Airborne Transmission 1. Droplet of nuclei 2. Dust particle in the air containing the infectious agent 3. Organisms shed into environment from skin, hair, wounds or perineal area. D. Vector borne Transmission, arthropods such as flies, mosquitoes, ticks and others. VII. ISOLATION PRECAUTIONS Standard Precautions / Universal Precautions Applies to ALL BODY FLUIDS Includes: 1. HAND WASHING 2. Personal Protective Equipment (sequence of removing PPEs) gloves-mask-gown-eyewear-cap 3. Safe use of sharps 4. Removing spills of blood and body fluids 5. Cleaning and disinfecting equipment Transmission Based Precautions Airborne precautions A single room under negative pressure ventilation with a wash hand basin The door must be kept closed at all times except during necessary entrances and exits. Disposable paper towels A high efficiency mask, if available, should be worn when entering the room of a patient with known or suspected tuberculosis. Droplet precautions Put on a standard mask prior to entering the isolation room. Hands must be washed with an antiseptic preparation and must be dried thoroughly with a disposable paper towel or washed with a waterless alcohol hand rub/gel: 1. AFTER contact with the patient or potentially contaminated items, 2. AFTER removing gloves, and 3. BEFORE taking care of another patient. Contact precautions Non-sterile, disposable gloves are needed when there is contact with an infected site, with dressings, or with secretions. A mask when performing procedures that may generate aerosols or when performing suctioning is recommended. Hands washing (see droplet precautions) VIII. NUTRITION MODE OF TRANSMISSION it indicates the potential of the disease; conveyance of the agent to the host; it can be by common source transmission, contact source, air-borne transmission. There are four main routes of transmission A. By Contact Transmission 1. Direct contact ( person to person ) 2. Indirect contact ( usually an inanimate object) 3. Droplet contact ( from coughing, sneezing, or talking, or talking by an infected person) B. By Vehicle Route ( through contaminated items) 1. Food salmonellosis 2. Water shigellosis, legionellosis 3. Drugs bacteremia resulting from infusion of a contaminated infusion product 4. Blood hepatitis B, Food Sources Protein Carbohydrates Fats / Lipids Meat, fish, eggs, milk, poultry, cheese, beans, mongo Grains, Legumes, Potatoes, Cereals, Breads Saturated: coconut oil, and palm kernel oil, dairy products (especially butter, , cream, and cheese), meat (beef), dark meat of poultry, and poultry skin, chocolate Unsaturated: Avocado, Nuts, Vegetable oils such as soybean, canola, and olive oils Eggs, carrots, squash, all green leafy vegetables Fish, liver, egg, milk, margarine Note: excess vit.D may lead to fetal cardiac problem Green leafy vegetables, fish, corn

STAGES OF ILLNESS AND HEALTH-SEEKING BEHAVIOR BY SUCHMAN Symptom Experience Client realizes there is a problem Client responds emotionally Sick Role Assumption Self-medication / Self-treatment Communication to others Assuming a Dependent Role Accepts the diagnosis Follows prescribed treatment Achieving recovery and rehabilitation Gives up the dependent role and assumes normal activities and responsibilities VI. CHAIN OF INFECTION

Vit. A Vit. D Vit. E

POSSIBLE TOPICS ON FUNDAMENTALS OF NURSING FOR THE UPCOMING DECEMBER 2012 PNLE

*Patterned on the previous board exams from December 2006 July 2012 the purpose of this note is to GUIDE students on the possible topics that might be part of the upcoming December 2012 PNLE

WHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 1: FUNDAMENTALS OF NURSING
Vit.K Vit. C Folic Acid Vit. B Calcium and Phosphorus Iron Iodine IX. NURSING SKILLS A. Hygiene A complete bed bath consists of washing a dependent clients entire body in bed; a complete bed bath with assistance involves helping the client to wash. A partial bed bath consists of or buttocks that may cause discomfort or odor if le washing only parts of the clients body such as feet ft unwashed. A tub bath or shower provides a more thorough cleansing than a bed bath; the amount of nursing assistance is determined by the clients age and health and safety consideration. A therapeutic bath is ordered by a physician for a specific purpose. Therapeutic baths include: Sitz bath to reduce inflammation and clean the perineal area. Tepid sponge bath to reduce fever. Medicated tub bath to relieve skin irritation. Nursing Consideration Avoid unnecessary exposure and chilling. Expose, wash, rinse and dry only a part of the body at one time. Avoid draft Use correct temperature of water. Observe the patients body closely for physical signs such as rashes, swelling, discoloration, sore, burns etc. Give special attention to the following body areas; behind the ears, axilla, under the breast, umbilicus, pubic region, groin and spaces between the fingers and toes. Do the bath quickly but unhurriedly, use even, smooth but firm strokes. Use adequate amount of water and change as frequently as necessary. If possible, do such procedure as vaginal douche, enema, shampoo, oral care etc. before bath. B. Physical Assessment Provide privacy. Make sure that all needed instruments are available before starting the physical assessment Be systematic and organized when assessing the client. Inspection, Palpation, Percussion, Auscultation. EYES: Visual acuity is tested using a snellen chart. The room used for this test should be well lighted EARS: Webers Test assesses bone conduction, this is a test of sound lateralization, Rinne Test compares bone conduction with air condition. NECK: Let the client sit on a chair while the examiner stands behind him. THORAX: The client should be sitting upright without support and uncovered to the waist. HEART: Anatomic areas for auscultation of the heart Aortic valve Right 2nd ICS sternal border. Pulmonic Valve Left 2nd ICS sternal border. Tricuspid Valve Left 5th ICS sternal border. Mitral Valve Left 5th ICS midclavicular line Leafy green vegetables, particularly the dark green ones such as: Spinach, Broccoli, Malunggay, Avocado Tomatoes, guava, papaya, citrus fruits Asparagus, organ meat, green leafy vegetables ( foods rich in protein ) Milk, cheese, green leafy vegetables, whole grains, seafood, tofu Pork liver, lean meat, kamote leaves, soybeans, seaweeds, mongo Iodized salt, seafood, milk, egg, bread BREAST

ABDOMEN: Place the client in a supine position with the knees slightly flexed to relax abdominal muscles. (Inspection,Auscultation,Percussion,Auscultation)

C. Vital Signs Temperature (NV 36 37.5 C) Elderly people are at risk of hypothermia Hard work or strenuous exercise can increase body temperature Oral: most accessible 2-3 mins. * 15 minutes interval after ingestion of hot or cold drinks Rectal: most accurate 2-3 mins. Axillary: most safest 6-9 mins.

Pulse (NV 60-100 bpm) Wave of blood created by contraction of the left ventricle of the heart Radial: best site for adult Brachial: best site for children Apical: best site for 3 years old below Respiration (NV 12/16-20) Normal Breath Sound Vesicular Bronchovesicular Bronchial Soft, low pitch Medium pitch Loud, high pitch Lung periphery Larger airway blowing Trachea

Abnormal Breath Sound Crackles Rhonchi Wheezes Pleural Friction Rub Dependent lobes Trachea, bronchi All lung fields Lateral lung field Random, sudden reinflation of alveoli fluids Fluids, mucus Severely narrowed bronchus Inflamed Pleura

Blood Pressure (NV 120/80 mm/hg) This is the force exerted by the blood against a vessel wall The pressure rises with age. A rest of 30 minutes is indicated before the blood pressure can be readily assessed after stressful activity. Interval of 30 minutes is needed after smoking or drinking caffeine. After menopause, women generally have higher blood pressures than before. Pressure is usually lowest early in the morning, when the metabolic rate is lowest, then rises throughout the day and peaks in the late afternoon or early evening

POSSIBLE TOPICS ON FUNDAMENTALS OF NURSING FOR THE UPCOMING DECEMBER 2012 PNLE

*Patterned on the previous board exams from December 2006 July 2012 the purpose of this note is to GUIDE students on the possible topics that might be part of the upcoming December 2012 PNLE

WHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 1: FUNDAMENTALS OF NURSING
Common Errors in Blood Pressure Assessment Errors Effect Bladder cuff too narrow Erroneously high Bladder cuff too wide Erroneously high Arm unsupported Erroneously high Insufficient rest before the Erroneously high assessment Repeating assessment too Erroneously high quickly Cuff wrapped too loosely or Erroneously low unevenly Deflating cuff too quickly Erroneously low systolic and high diastolic reading Deflating cuff too slowly Erroneously high diastolic reading Failure to use the same arm Inconsistent measurements consistently Arm above level of the heart Erroneously low Assessing immediately after a Erroneously high meal or while client smokes Failure to identify Erroneously low systolic auscultatory gap pressure pressure and erroneously low diastolic D. Medication Administration FIVE RIGHTS The Right Drug with The Right Dose through The Right Route at The Right Time to The Right Patient Standard Order, Carried out until cancelled by another order. PRN Order, As needed, or only when necessary. Stat Order, Carried out immediately and for one time only. Always clarify doubtful /unclear order Do not leave medicine with the client to take by himself Do not give drug that shows physical changes or deterioration Report an error in medication immediately to the nurse in charge. Check medication 3 times before taking to the client: o When taking the medication from the storage area o Before placing medication into the medicine rack/glass o Before placing medicine to the storage area The nurse who prepares the medication must be responsible for administering and recording it. Never endorse it to another nurse. Always observe asepsis in preparing and administering drugs. Ascertain clients identity before administering medications. Check room or bed or card, call out clients name, check I.D., wrist band Care must be taken to prevent instilling medication directly into cornea. ORAL: If patient vomits within 20 30 minutes of taking the drug, notify the physician. Do not re-administer the drug without doctors orders. SUBLINGUAL ROUTE drugs that is placed under the tongue, where it dissolves. BUCCAL ROUTE a medication is held in the mouth against the mucous membranes of the cheek until the drugs dissolves EYES MEDS: Apply ointment along inside edge of the lower eyelid from inner to outer canthus. EAR MEDS: Infants: draw the auricle gently downward and backward. Adults: lift pinna upward and backward Intradermal: Parallel to the skin, do not massage Subcutaneous: 45 degree above the skin, if obese 90 degree Intramuscular: 90 degree above the skin, aspirate to check if blood vessel was hit. D. Urinary Catheterization Use appropriate size of catheter Male: Fr 16-18 Female: Fr 12-14 Place the client in appropriate position: Male: Supine, legs abducted and extended Female: Dorsal recumbent Locate the urinary meatus properly: Male: at the tip of the glans penis Female: between the clitoris and vaginal orifice Lubricate catheter with water soluble lubricant before insertion Male: 6 7 inches Female: 1 2 inches Length of catheter insertion: Male: 6 9 inches Female: 3 -4 inches Anchor catheter properly: Male: laterally or upward over the lower abdomen / upper thigh Female: inner aspect of the thigh Nursing Interventions to Induce Voiding/Urination Provide privacy Assist the patient in the anatomical position of voiding Serve clean, warm and dry bedpan (female) or urinal (male) Allow the client to listen to the sound of running water Dangle fingers in warm water Pour warm water over the perineum Promote relaxation Provide adequate time for voiding Last resort: URINARY CATHETERIZATION

E. Nasogastric Tube (NGT) Gavage (feeding) / Lavage (suctioning) Select the nostril that has greater airflow. Assist the client to a high fowlers position NEX technique (nose-ear-xiphoid) Checking the patency: Aspirate stomach contents and check the pH, which should be acidic Introduce 10-30 ml of air into the NGT and auscultate at the epigastric area, gurgling sound is heard The most accurate method of assessing the placement of NGT is X-ray study Before feeding assess residual feeding contents. To assess absorption of the last feeding, if 50 ml or more, verify if the feeding will be given. Height of feeding is 12 inches above the point of insertion. Ask the client to remain in position for at least 30 min Common Problems of Tube Feedings Vomiting Aspiration Diarrhea Hyperglycemia F. Enema Administration Position the client: Adult: Left lateral Infant/small children: Dorsal recumbent Lubricate the tube about 5 cm ( 2 in ) Insert 7 10 cm ( 3 to 4 inches) or rectal tube gently in rotating motion Raise the solution container and open the clamp to allow fluid to flow High Enema: 12-18 inches above the rectum Low Enema: 12 inches above the rectum If the client complains of fullness or pain, use the clamp to stop the flow for 30 sec. and then restart the flow at a slower rate Encourage the client to retain the enema, ask the client to remain lying down

POSSIBLE TOPICS ON FUNDAMENTALS OF NURSING FOR THE UPCOMING DECEMBER 2012 PNLE

*Patterned on the previous board exams from December 2006 July 2012 the purpose of this note is to GUIDE students on the possible topics that might be part of the upcoming December 2012 PNLE

WHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 1: FUNDAMENTALS OF NURSING
G. Colostomy Care Stoma should appear red, similar to the mucosal linin of the inner cheek Slight bleeding initially when the stoma is touched is normal, but other bleeding should be reported. Change colostomy appliance if it is 1/3 full. Use warm water, mild soap (optional), and cotton balls or a washcloth and towel to clean the skin and stoma. Apply skin barrier over the skin around the stoma to prevent skin breakdown. Changing is best in the morning before breakfast. Control Odor: (deodorizer, charcoal disk and prevent odor causing foods) Type of Discharge Liquid fecal drainage Drainage is constant and cannot be regulated Contains some digestive enzymes Odor is minimal bec of fewer bacteria are present Liquid fecal drainage Drainage is constant and cannot be regulated Odor is a problem requiring control Malodorous, mushy drainage Solid fecal drainage Normal fecal characteristics Check for cross matching and blood typing. To ensure compatibility Obtain and record baseline VS, Note: If patient has fever do not transfuse Practice strict, ASEPSIS At least 2 nurses check the label of the blood transfusion, Check the following: - Serial Number - Blood component - Blood type - Rh factor - Expiration date - Screening test Check the blood for gas bubbles and any unusual color or cloudiness. Note: Gas bubbles indicate bacterial growth, Unusual color or cloudiness indicate hemolysis Warm blood at room temperature before transfusion. Identify client properly, two nurses check the clients identification Gauge of needle: #18 Drop Factor: KVO Duration: RBC 4 hours; Platelets, FFP 20 minutes When reactions occurs: STOP transfusion KVO with PNSS Send remaining blood, a sample of client blood and urine sample to the laboratory. Notify the physician Monitor VS Monitor I & O Common BT reactions: Hemolytic: flank /back pain Anaphylactic: rashes, itching, DOB (worst) Febrile: fever and chills Circulatory Overload: DOB, crackles Sepsis: Fever and chills

Ileostomy

Ascending Colostomy

Transverse Colostomy Descending Colostomy Sigmoidostomy H. Suctioning

Suction only when necessary not routinely Use the smallest suction catheter if possible Client should be in semi or high Fowlers position Use sterile gloves, sterile suction catheter Hyperventilate client with 100% oxygen before and after suctioning Insert catheter with gloved hand (3-5 length of catheter insertion) without applying suction. Three passes of the catheter is the maximum, with 10 seconds per pass. Apply suction only during withdrawal of catheter The suction pressure should be limited to less than 120 mmHg When withdrawing catheter rotate while applying intermittent suction Suctioning should take only 10 seconds (maximum of 15 seconds)

K. Assistive Device Canes COAL (cane opposite affected leg) Angel is 20-30 degrees Walkers Hand bar below the clients waist and the elbow is slightly flexed. Crutches Length of the Crutches: Subtract 40 cm or 16 inches to the height of the client obtain the approximate crutch length. 20 to 30 degrees of flexion at the elbow. Four point gait: * right crutch, the left foot, the left crutch, right foot. Two point gait: * left foot and right crutch, right foot and left crutch Three point gait: * left foot and both crutches, right foot. Swing Through Gait: . * Advance both crutches, Lift both feet and swing forward, Land the feet in front of crutches. Going up the stairs: (good goes to heaven, bad goes to hell)

I. Tracheostomy Care Assist the client to a semi-Fowlers or Fowlers position. Hydrogen peroxide moisten and loosens dried secretions Rinse the inner cannula thoroughly in the sterile normal saline. When changing the ties: tie one end of the new tie to the eye of the flange while leaving old ties in place. Put two fingers under the tapes before tying it.

J. Blood Transfusion A B AB O Compatible A/O B/O A / B / AB / O O Incompatible AB / B AB / A A / B / AB

L. Chest Physiotheraphy ( CPT ) Steam Inhalation Place the client in Semi-Fowlers position Cover the clients eyes with washcloth to prevent irritation Place the steam inhalator in a flat, stable surface. Place the spout 12 18 inches away from the clients nose or adjust distance as necessary To be effective, render steam inhalation therapy for 15 20 minutes

POSSIBLE TOPICS ON FUNDAMENTALS OF NURSING FOR THE UPCOMING DECEMBER 2012 PNLE

*Patterned on the previous board exams from December 2006 July 2012 the purpose of this note is to GUIDE students on the possible topics that might be part of the upcoming December 2012 PNLE

WHAT YOU SHOULD KNOW BEFORE THE PNLE DECEMBER 2012 PNLE PEARLS OF SUCCESS PART 1: FUNDAMENTALS OF NURSING
Postural drainage Use of gravity to aid in the drainage of secretions. Patient is placed in various positions to promote flow of drainage from different lung segments using gravity. Areas with secretions are placed higher than lung segments to promote drainage. Patient should maintain each position for 5-15 minutes depending on tolerability. If there is NO fluctuation in the water seal bottle, it may mean TWO things Either the lungs have expanded or the system is NOT functioning appropriately. In this situation, the nurse refers the observation to the physician, who will order for an X-ray to confirm the suspicion. In the event that the water seal bottle breaks, the nurse temporarily kinks the tube and must obtain a receptacle or container with sterile water and immerse the tubing. She should obtain another set of sterile bottle as replacement. She should NEVER CLAMP the tube for a longer time to avoid tension pneumothorax. In the event the tube accidentally is pulled out, the nurse obtains vaselinized gauze and covers the stoma. She should immediately contact the physician.

M. Closed Chest Drainage ( Thoracostomy Tube ) Types of Bottle Drainage One-bottle system The bottle serves as drainage and water-seal Immerse tip of the tube in 2-3 cm of sterile NSS to create water-seal. Keep bottle at least 2-3 feet below the level of the chest Observe for fluctuation of fluid along the tube. The fluctuation synchronizes with the respiration. Observe for intermittent bubbling of fluid; continues bubbling means presence of air-leak In the absence of fluctuation: Suspect obstruction of the device Assess the patient first, then if patient is stable Check for kinks along tubing; Milk tubing towards the bottle (If the hospital allows the nurse to milk the tube) If there is no obstruction, consider lung reexpansion; (validated by chest x-ray) Air vent should be open to air. Two-bottle system If not connected to the suction apparatus The first bottle is drainage bottle; The second bottle is water-seal bottle Observe for fluctuation of fluid along the tube (water-seal bottle or the second bottle) and intermittent bubbling with each respiration. Three-bottle system

N. Oxygen Therapy Nasal Cannula (24% - 45% ) at flow rate of 2 6 L/min. Simple Face Mask (40% - 60%) at liter flows of 5 - 8 L/min Partial Rebreather Mask (60% - 90%) at liter flows of 6 10 L/min. Non-Rebreather Mask (95% - 100%) at liter flows of 10 15 L/min. Oxygen is colorless, odorless, tasteless and a dry gas that support combustion, therefore leakage cannot be detected. Place cautionary signs reading No SMOKING: Oxygen in Use Avoid materials that generate static electricity, such as woolen blankets and synthetic fibers. Set up the oxygen equipment and the humidifier filled with distilled/sterile water. CANNULA: Put over the clients face, with the outlet prongs fitting into the nares. FACE MASK: Fit the mask to the contours of the clients face, apply it from the nose downward

The first bottle is the drainage bottle; The second bottle is water seal bottle The third bottle is suction control bottle. Observe for intermittent bubbling and fluctuation with respiration in the water- seal bottle Continuous GENTLE bubbling in the suction control bottle. Suspect a leak if there is continuous bubbling in the WATER seal bottle or if there is VIGOROUS bubbling in the suction control bottle. The nurse should look for the leak and report the observation at once. Never clamp the tubing unnecessarily.

POSSIBLE TOPICS ON FUNDAMENTALS OF NURSING FOR THE UPCOMING DECEMBER 2012 PNLE

*Patterned on the previous board exams from December 2006 July 2012 the purpose of this note is to GUIDE students on the possible topics that might be part of the upcoming December 2012 PNLE