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.

PRAYER

Josephine T. R. Holgado,M.D., D.P.P.S.

October 16, 2013

CMC Function Room

INTRODUCTION

Florence Nightingale – Lady with the Lamp

ACHIEVEMENTS

Established the first professional training school for nurses, the NightingaleTraining 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 throughinfection control measures and a healthy diet for the patient

Published over 200 books, reports and pamphlets on hospital planning andorganisation like "Notes on Nursing: What It Is and What It Is Not".

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“.”

INTRODUCTION

To know the 7 secrets to do a correct physicalassessment through complete personality adjustmentbased on the acrostic N.U.R.S.I.N.G.

OBJECTIVE

FIRST SECRET

L.A.M.P.

NEVER ASSUME

Look for the right equipment or tools.

NEVER ASSUME.

TOURNIQUET TEST

NEVER ASSUME

TOURNIQUET TEST

NEVER ASSUME

Adjust the scales or equipment to zero.

NEVER ASSUME

Make a table of the normal values for age.

NEVER ASSUME

Put your reading accurately on the graph or TPR sheet to establish trending.

NEVER ASSUME

SECOND SECRET

SENSES

SIMPLE TOOLS

SKILLS

USE YOUR S.S.S.

SIGHT

HEARING

SMELL

TOUCH

USE YOUR SENSES

BLOOD PRESSURE APPARATUS

STETHOSCOPE

THERMOMETER

WEIGHING SCALE

HEIGHT SCALE

TAPE MEASURE

VERNIX CALIPER

USE YOUR SIMPLE TOOLS

PRACTICE!

PRACTICE!

PRACTICE!

USE YOUR SKILLS

A.P.G.A.R. Score

A – Appearance

P – Pulse

G – Grimace

A – Activity

R – Respiratory effort

NEWBORN ASSESSMENT

Component of Acronym

Score of 0 Score of 1 Score of 2

Appearance (Complexion)

blue or pale all over

blue at extremitiesbody pink(acrocyanosis)

no cyanosisbody and extremities pink

Pulse Rate Absent <100 >100

Grimace (Reflex irritability)

no response to 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

Physical Maturity Rating

P – Plantar creaseL – LanugoS – SkinB – Breast budE – EarG – Genitalia

Ballard Score is Age = (2*score+120) /5

NEWBORN ASSESSMENT

Neuromuscular Maturity Rating

S – Scarf sign

H – Heel to ear

Ar – Arm recoil

P – Posture

P – Popliteal Angle

S – Square window

NEWBORN ASSESSMENT

Activity

Appearance

Appetite

GENERAL SURVEY

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 mmHg8-30 days > 105 mmHg1 month – 2 y/o > 115/75 mmHg2 – 5 y/o > 130/80 mmHg6-11 y/o > 135/85 mmHg> 11 y/o > 140/90 mmHg

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

VITAL SIGNS

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

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

VITAL SIGNS

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

Temperature (Average reading)

Axillary = 37.2 C

Oral = 37.6 C

Rectal = 38.0 C

Ear/Tympanic = 38.0 C

VITAL SIGNS

Weight (kgs. , lbs.)

Length (cm, in) or Recumbent Height

Height (cm, in) (occiput, upper part of the back, buttocks, heels)

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

ANTHROPOMETRICS

Color

Rashes

Texture

SKIN

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)

H.E.E.N.T.

Mobility

Mass

Webbedness

Tenderness

NECK

Respiratory Rate

Shape of thorax

Retractions

Breath sounds

CHEST/LUNGS

Rate

Rhythm

Murmur

PMI

HEART

9 Regions

Shape, size, bowel sounds, mass, tenderness

Umbilical cord (color, discharge, smell)

ABDOMEN

The 9 Abdominal Regions

Pulses

Extra Numerary digit

Nail beds (color, clubbing)

CRT (Capillary Refill Time)

EXTREMITIES

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.

THIRD SECRET

Be Time conscious.

Adapt yourself to the needs of the moment.

Support your team.

Know your patient.

BE RESPONSIBLE.

FOURTH SECRET

Compassionate

Aware

Lovely

Meek

BE SENSITIVE.

FIFTH SECRET

Focus on the essential.

Act swiftly.

Step up.

Teach the skills.

TAKE THE INITIATIVE.

SIXTH SECRET

Listen

Observe

Voice out

Embrace

NURTURE YOUR PATIENT.

SEVENTH SECRET

Praise and Thank the Lord.

Read the scriptures.

Ask for healing.

Yield to God.

BE GOD’S GRACE.

Never assume.

Use your senses, simple tools and skills.

Be Responsible.

Be Sensitive.

Take the Initiative.

Nurture your patient.

Be God’s grace.

SUMMARY

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.

The Nurse’s Prayer

As I perform my taskEvery day and every night,Protect every child, every patientYou put under my care.

When I am tired and ailing,Be my strength and healing;When conflicts arise in my workplaceMay I bring harmony and peace.

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.

The Nurse’s Prayer

Email address: drajoy31@yahoo.com / drajoy31@gmail.com

Facebook account: Josephine Holgado

THANK YOU!