This slide presentation contains simple steps on how a nurse can answer the greatest calling which is to care for patients with God's amazing grace and everlasting love.

1. PRAYER

Father, the human mind cannot fathom the reason for
the quake bringing destruction to Bohol , Cebu and
other nearby provinces and cause the lives of our
brethren. Please Jesus, send forth Your Holy Angels to
ease the pain and the sufferings there.
With your merciful heart, we commend the souls of
the departed faithful, and we claim healing for the
wounded.
In Jesus name we pray.
AMEN.

2. Josephine T. R. Holgado,M.D., D.P.P.S.
October 16, 2013
CMC Function Room

3. INTRODUCTION


4. INTRODUCTION

Florence Nightingale – Lady with the Lamp
ACHIEVEMENTS
Established the first professional training school for nurses, the Nightingale
Training School at St Thomas' Hospital in 1860
Established a School of Midwifery Nursing at King's College Hospital
Campaigned tirelessly to improve health standards in the hospital through
infection control measures and a healthy diet for the patient
Published over 200 books, reports and pamphlets on hospital planning and
organisation like "Notes on Nursing: What It Is and What It Is Not".

5. INTRODUCTION

“If a patient is cold, if a patient is feverish, if a patient is
faint, if he is sick after taking food, if he has a bed-sore,
it is generally the fault not of the disease, but of the
nursing.”
Florence Nightingale
“Notes on Nursing: What It Is and What It Is Not“.”

6. OBJECTIVE

To know the 7 secrets to do a correct physical
assessment through complete personality adjustment
based on the acrostic N.U.R.S.I.N.G.

7. FIRST SECRET


8. NEVER ASSUME

L.A.M.P.

9. NEVER ASSUME.

Look for the right equipment or tools.

10. NEVER ASSUME

TOURNIQUET TEST

11. NEVER ASSUME

TOURNIQUET TEST

12. NEVER ASSUME

Adjust the scales or equipment to zero.

13. NEVER ASSUME

Make a table of the normal values for age.

14. NEVER ASSUME

Put your reading accurately on the graph or
TPR sheet to establish trending.

15. SECOND SECRET


16. 
SENSES
SIMPLE TOOLS
SKILLS
USE YOUR S.S.S.

17. USE YOUR SENSES

SIGHT
HEARING
SMELL
TOUCH

18. USE YOUR SIMPLE
TOOLS

BLOOD PRESSURE APPARATUS
STETHOSCOPE
THERMOMETER
WEIGHING SCALE
HEIGHT SCALE
TAPE MEASURE
VERNIX CALIPER

19. USE YOUR SKILLS

PRACTICE!
PRACTICE!
PRACTICE!

20. NEWBORN
ASSESSMENT

A.P.G.A.R. Score
A – Appearance
P – Pulse
G – Grimace
A – Activity
R – Respiratory effort

21. Component of
Acronym
Score of 0 Score of 1 Score of 2
Appearance
(Complexion)
blue or pale all
over
blue at
extremities
body pink
(acrocyanosis)
no cyanosis
body and
extremities pink
Pulse Rate Absent <100 >100
Grimace (Reflex
no response to
irritability)
stimulation
grimace/feeble
cry when
stimulated
cry or pull away
when
stimulated
Activity none some flexion flexed arms and
legs that resist
extension
Respiratory
Effort
Absent Weak, irregular,
gasping
Strong, lusty cry
APGAR SCORE

22. NEWBORN
ASSESSMENT

Physical Maturity Rating
P – Plantar crease
L – Lanugo
S – Skin
B – Breast bud
E – Ear
G – Genitalia
Ballard Score is Age = (2*score+120) /5

23. NEWBORN
ASSESSMENT

Neuromuscular Maturity Rating
S – Scarf sign
H – Heel to ear
Ar – Arm recoil
P – Posture
P – Popliteal Angle
S – Square window

24. GENERAL SURVEY

Activity
Appearance
Appetite

25. VITAL SIGNS

Blood Pressure
Formula ( 2y/o & up)
50th percentile of SBP 90 + 2 (age in years)
10th percentile of SBP 70 + 2 (age in years)
Cut off point in Hypertension (95th percentile)
Newborn – 7 days > 95 mmHg
8-30 days > 105 mmHg
1 month – 2 y/o > 115/75 mmHg
2 – 5 y/o > 130/80 mmHg
6-11 y/o > 135/85 mmHg
> 11 y/o > 140/90 mmHg

26. VITAL SIGNS

Cardiac Rate/ Pulse Rate
Fetal Heart Rate 120-160/minute
Newborn 120-160/minute
1 – 7 y/o 100-110/minute
> 7 y/o < 100/minute

27. Average Cardiac Rate of Filipino Infants and Children By
Age and Sex
Age Group Mean CR
(MALES)
+ 2SD Mean CR
(FEMALES)
+ 2SD
0-1 month 147 30.5 145 26.2
2-6 months 139 31.4 141 33.5
7-12 months 133 32.4 134 31.9
13-24 months 128 34.1 129 34.3
2-4years 109 32.6 110 29.5
5-9 years 93 23.7 92 23.2
10-14 years 86 20.4 86 20.7
From P.D. Santos Ocampo, A. Librea and M. Borja

28. VITAL SIGNS

Respiratory Rate
Birth – 6 weeks 45-60/minute (40-60/minute)
6 weeks – 2 y/o 40/minute
2-5 y/o 30/minute
6-10 y/o 25/minute
> 10 y/o 20/minute

29. Average Respiratory Rate of Filipino Infants and Children
By Age and Sex
Age Group Mean RR
(MALES)
+ 2SD Mean RR
(FEMALES)
+ 2SD
0-1 month 59 18.2 56 22.0
2-6 months 52 22.5 52 21.6
7-12 months 45 24.6 48 22.8
13-24 months 38 14.9 36 22.5
2-4 years 30 12.1 29 12.0
5-9 years 25 6.1 25 6.1
10-14 years 22 3.5 22 3.6
From P.D. Santos Ocampo, A. Librea and M. Borja

30. VITAL SIGNS

Temperature (Average reading)
Axillary = 37.2 C
Oral = 37.6 C
Rectal = 38.0 C
Ear/Tympanic = 38.0 C

31. ANTHROPOMETRICS

Weight (kgs. , lbs.)
Length (cm, in) or Recumbent Height
Height (cm, in) (occiput, upper part of the back,
buttocks, heels)

32. ANTHROPOMETRICS

Head Circumference:
glabella, supraorbital ridge, occiput
Chest Circumference
xiphoid process in neonate,
nipple area in infants & older children
at mid inspiration
Abdominal Circumference
umbilicus
widest abdominal girth
Mid-arm Circumference
midway between the acromion process and olecranon

33. 
Color
Rashes
Texture
SKIN

34. H.E.E.N.T.

Head (shape, size, fontanel)
EYE (size, color, mass, discharge, epicanthal fold)
EAR (shape, discharge, low set, skin tag)
NOSE (patency, discharge, turbinates, nasal bridge)
THROAT (lips, tongue, palate, ulcer, tooth)

35. 
Mobility
Mass
Webbedness
Tenderness
NECK

36. CHEST/LUNGS

Respiratory Rate
Shape of thorax
Retractions
Breath sounds

37. 
Rate
Rhythm
Murmur
PMI
HEART

38. ABDOMEN

9 Regions
Shape, size, bowel sounds, mass, tenderness
Umbilical cord (color, discharge, smell)

39. The 9 Abdominal Regions

40. EXTREMITIES

Pulses
Extra Numerary digit
Nail beds (color, clubbing)
CRT (Capillary Refill Time)

41. 1 2 3 4 5 6
Eyes Does not
open
eyes
Opens eyes in
response to
painful stimuli
Opens eyes in
response to
speech
Opens eyes
spontaneously
N/A N/A
Verbal No
verbal
response
Inconsolable,
agitated
Inconsistently
inconsolable,
moaning
Cries but
consolable,
inappropriate
interactions
Smiles,
orients to
sounds,
follows
objects,
interacts
N/A
Motor No motor
response
Extension to
pain
(decerebrate
response)
Abnormal
flexion to pain
for an infant
(decorticate
response)
Infant
withdraws
from pain
Infant
withdraws
from touch
Infant moves
spontaneously
or
purposefully
Pediatric Glasgow Coma Scale*
* Any combined score of less than eight represents a significant risk of mortality.

42. THIRD SECRET


43. BE RESPONSIBLE.

Be Time conscious.
Adapt yourself to the needs of the moment.
Support your team.
Know your patient.

44. FOURTH SECRET


45. BE SENSITIVE.

Compassionate
Aware
Lovely
Meek

46. FIFTH SECRET


47. TAKE THE INITIATIVE.

Focus on the essential.
Act swiftly.
Step up.
Teach the skills.

48. SIXTH SECRET


49. NURTURE YOUR

Listen
Observe
Voice out
Embrace
PATIENT.

50. SEVENTH SECRET


51. BE GOD’S GRACE.

Praise and Thank the Lord.
Read the scriptures.
Ask for healing.
Yield to God.

52. SUMMARY

Never assume.
Use your senses, simple tools and skills.
Be Responsible.
Be Sensitive.
Take the Initiative.
Nurture your patient.
Be God’s grace.

53. The Nurse’s Prayer

Dear Lord, You are a Great Healer
You are the God of all;
Thank You for making me
A real prophet of life.
Make me a living witness
Of Your unconditional love;
May my open arms and touch
Be a sign of Your warm embrace.

54. The Nurse’s Prayer

As I perform my task
Every day and every night,
Protect every child, every patient
You put under my care.
When I am tired and ailing,
Be my strength and healing;
When conflicts arise in my workplace
May I bring harmony and peace.

55. The Nurse’s Prayer

Make me a true guardian,
A source of light, hope and happiness;
For I am an angel of God,
A Nurse is God’s Embracing Love.

56. 
Email address: drajoy31@yahoo.com /
drajoy31@gmail.com
Facebook account: Josephine Holgado

57. 
THANK YOU!