Fundamentals of Nursing

TYPES OF NURSING INTERVENTION

  1. INDEPENDENT

  2. DEPENDENT

  3. INTERDEPENDENT

INDEPENDENT

  • Within scope of nursing practice

  • Part of the Philippine Nursing Law or R.A 9173 

  • Health education, positioning and transferring

  • Does not require a doctor’s order


DEPENDENT

  • Requires a doctor’s order

  • Prescribing antibiotics

  • Malpractice if outside the scope of nursing


INTERDEPENDENT

  • Collaborative

  • Can be done with different therapists and dietician (specialties)


NURSING CARE DELIVERY SYSTEMS

  • FUNCTIONAL 

  • TOTAL PATIENT CARE

  • TEAM NURSING

  • PRIMARY NURSING

  • CASE MANAGEMENT


FUNCTIONAL

  • Task based nursing care

  • Non holistic care

  • Most economical


TOTAL PATIENT CARE

  • Shift-based nursing care

  • Holistic only until the end of the shift

  • A different patient may be assigned already to the nurse

  • Concern: continuity of care


TEAM NURSING

  • Involves collaboration

  • Group of HCP takes care of a group of PT

  • RN, LPN, UAP - assign and delegate tasks accordingly

  • Competence is important with delegation 


PRIMARY NURSING

  • 24 hour nursing care

  • Involved from admission to discharge

  • Primary nurse develops nursing care plan with the associate nurses who continues the care


CASE MANAGEMENT

  •  Coordinating different health care services

  • Calls for the physician and nurses

  • Case manager does not do bedside care

  • “Mangingialam” - hired by the HMO (health maintenance organization = insurance + health maintenance)

  • Goal is for the patient to be discharged early

  • To reduce out of pocket health care spending

METAPARADIGM FOR NURSING

  • Dictates our nursing care

  • Apple “PEHN”

    • Person

    • Environment

    • Health

    • Nursing


NURSING THEORIES 

FLORENCE NIGHTINGALE

  • First nurse researcher

  • Professionalized nursing 

  • Environmental Theory - environment affects the health


VIRGINIA HENDERSON

  • 14 Basic Needs

  • Nursing is about meeting the basic needs 


FAYE ABDELLAH

  • 21 Nursing Problems

  • EH EH EH EH EH 2 NE 1


MYRA LEVINE

  • Conservation theory

  • “Pampabata” - MYRA E 

  • 4 Conversation Principles (ESPS)

    • Conservation of Energy - food

    • Conservation of Structural Integrity - skin, barrier

    • Conservation of Personal Integrity - mental health

    • Conservation of Social Integrity - no man is an island


IMOGENE KING

  • Goal Attainment Theory

  • King has a goal


DOROTHEA OREM

  • Self Care Deficit Theory

  • Activities of self care

    • Wholly compensatory - coma

    • Partial compensatory - hemiplegia (half)

    • Educative-supportive  

  • Things you DO for yourself


SISTER CALISTA ROY

  • Adaptation Theory


LYDA HALL

  • Coined nursing process

  • ADPIE


BETTY NEUMAN

  • Health Care System Model

  • Be THREE degrees of prevention: 1st, 2nd, 3rd


DOROTHY JOHNSON

  • Behavioral System Model - BE

  • Johnson’s BEBE powder


PATRICIA BENNER

  • Clinical context of nursing

  • Experience is key

  • Theory is not enough, practice is important

  • NACPE

    • Novice - no nursing experience

    • Advance beginner - minimal acceptable performance (75%)

    • Competent - 2-3 yrs of nursing experience, with confidence

    • Proficient - 3-5 yrs of nursing experience, holistic view 

    • Expert - >5 yrs of nursing experience, fluid, intuitive


VITAL SIGNS

  • Reflects physiologic functioning of the body


TEMPERATURE

  • Hypothalamus - temperature regulating center

  • Infant w/ infection -> hypothermia; immature hypothalamus

  • Elderly w/ infection -> CNS changes (restless, confusion)

  • 2 types of body temperature:

    • Surface - superficial e.g. axillary

    • Core - deep tissue, more accurate e.g. rectal (most accurate), oral, tympanic

  • Estimation of normal body temp: 36.5 to 37.5 deg celsius

  • Fever: 37.5 to 38.5 deg celsius

    • Do not give paracetamol right away

  • High fever: > or = 38.5 deg celsius

    • Immediately give paracetamol 

  • Temperature conversion:

  • Factors affecting body temperature:

    • BMR (Basal Metabolic Rate) - slow metabolism, cold temp; fast metabolism, hot;  hypothyroidism low temp ‘n cold intolerance 

    • Environment

    • Time of the day / circadian rhythm - body clock

      • Lowest: 4-6 AM

      • Highest: 4-6 PM

    • Infection

  • Types of Fever

    • Intermittent Fever - on ‘n off fever WITHIN THE DAY

    • Relapsing Fever - on ‘n off OVER FEW DAYS

    • Constant Fever - continuous high fever < 2 deg C of MINIMAL fluctuations

    • Remittent Fever - continuous high fever with WIDE fluctuations >2 deg C

  • HIGH Temp = inc pulse, inc RR, dec BP (vasodilation)

  • Methods of temp taking

    • Oral - side of frenulum, ask if pt ate or drink hot or cold temp then wait for 30 mins before taking, not best for children may be uncooperative; 3rd most accurate

    • Rectal 

      • Most accurate 

      • Position: left sim’s position (colon arrangement) - ascending colon right, transverse colon left

      • Water based lubricant e.g. KY jelly

      • Insert: 1-2 inches, labatiba 3-4 inches

      • Contraindicated: hemorrhoids, rectal surgery, heart problems, diarrhea, inc ICP, dec platelet (due to risk for bleeding)

      • No to vagus nerve stimulation CN X - runs from heart to pwet -> slower HR

    • Axillary - safest, pat dry

    • Tympanic 

      • 2nd most accurate

      • Child for 3 y/o below - pinna down n back

      • Adult 4 y/o up- pinna up n back

      • Not for px with ear infection

    • Temporal artery

      • Should be in contact for more accurate results

      • Slide from center of forehead to temporal artery


PULSE

  • Reflection of heart beat and circulation 

  • Pulse deficit = Apical pulse – peripheral pulse

  • For dysrhythmias or atrial fibrillation

  • Popliteal, temporal 

  • Pulse strength or amplitude

    • 0 no pulse

    • 1 faint pulse

    • 2 slightly more diminished pulse

    • 3 normal

    • 4 bounding pulse (hypervolemia)

  • Stethoscope

  • Diaphragm - high pitch, heart murmur

  • Bel (LOW)l - low pitch

  • Normal heart sounds 

    • Lub dub due to valve closure

    • AV valves - mitral (left), tricuspid (right); closes at same time

    • S1 - closure of AV valves

    • Semilunar valves - large blood vessels: pulmonary valve, aortic valve

    • S2 - closure of semilunar valves; pulmonary stenosis - split sound

    • S3 - CHF (congestive HF) 

    • S4 - hypertension (resistance) - 4 syllables in hypertension

  • Apical Pulse or PMI - mitral area, 5th ICS LMCL

  • Angle of louis - 2nd ICS


RESPIRATION

  • Medulla oblongata - respiratory center (premature in infants) 

  • Pons - rhythm of heart

  • Normal: 12-20 

  • Apnea - 10 secs pause in breathing

  • Depth

    • Hypoventilation - shallow

    • Hyperventilation - deep

  • Rhythm

    • Cheyne-stokes - periods of hyperpnea & hypopnea & apnea; seen in dying patients; deep deep deep shallow shallow shallow stop

  • Kussmaul’s - rapid hyperventilation; DKA 350 mg/dL to release excess acids eg CO2; rapid deep respiration; form of compensation

  • Normal breath sounds

    • Vesicular - ALL AREAS except sternum scapula 

      • I > E

    • Bronchial - TRACHEA

      • Tubular breath sounds

      • E > I

    • Bronchovesicular - STERNUM, SCAPULA 

      • I = E

  • Abnormal breath sounds / Adventitious

    • Stridor - harsh sound during Inspiration

      • Airway issue, narrowing of airways

      • Eg laryngospasm - tetanus anaphylactic rxn epiglottitis

      • Equip: tracheostomy

    • Wheezing - musical sound during Expiration

      • Bronchoconstriction - asthma

      • Unting air nakakapasok 

      • Bronchodilator

    • Rhonchi - snoring low pitch 

      • Inc secretion in bronchi

      • Disappears with coughing

      • Cystic fibrosis

    • Crackles/ Rales - gurgling sound. + fluid in alveoli

      • Left sided heart failure, CHF, acute respiratory distress, severe pneumonia

      • More dangerous than rhonchi

      • Chest physiotherapy

    • Pleural friction - grating sound during Inhalation

      • Eg pleuritis / pleurisy

      • Pleuritic chest pain - prob is pulmonary in origin


BLOOD PRESSURE

  • Cardiac output x Total vascular resistance

  • Narrow = inc resistance; Wider = low pressure

  • Direct measurement - intra arterial BP monitoring, ICU

  • Indirect - aneroid, mercurial, digital 

  • Rest for 30 mins, no smoke, coffee, exercise, outdoor

  • Use app bp cuff ⅔ cover extremities

  • TOO NARROW - False HIGH

  • TOO WIDE - False LOW

  • TOO LOOSE - FALSE HIGH

  • Wrap bp snugly

  • Arm level of heart

    • Above level - false LOW

    • Below level - false HIGH

  • Do not cross legs - false HIGH

  • Deflate bp cuff slowly rate 2-3 mmHg/sec

  • Listen to korotkoff sound

    • Phase I - systole

    • Phase II

    • Phase III

    • Phase IV

    • Phase V - diastole then silence 

  • Pulse pressure = systole - diastole

    • Normal - 40 

    • Narrow <30 - shock 

    • Widened >50 - inc ICP 

  • Do not confuse with pulse deficit

  • Hypertension - high bp on at least 2 occasions

    • 2017 AHA 120/80 not normal


PAIN

  • Both subjective and objective

  • Acute - deviated VS, pupil dilation, bronchodilation except GIT GUT (dec salivation, indigestion, dec acid secretion, dec peristalsis, constipation, dec blood flow to kidney, urinary retention, oliguria)

  • Chronic pain - acetylcholine response, normal vital signs

  • White - more sensitive; Asians - stoic 

  • Pain threshold - min stimuli to feel pain, almost same for everyone

  • Pain tolerance - max amt of pain willing to bear 

  • Analgesics - pain reliever, give pain meds RTC

  • Non-opioids - reduce pain chemicals = alaxan, mefenamic acid, aspirin paracetamol, acetaminophen, Nsaids (ibuprofen, naproxyn - GI ulcer, should be taken w/ meals), cox-2 inhibitors (dec prostaglandin synthesis in blood stream - NO GI irritation)

  • Opioids - acts on thalamus in cerebral cortex (pain center) ->  CNS depression

  • Morphine - better pain reliever, not for prolonged use

  • Do not give demerol for long term -> causes seizure

  • Codone, morphine - semi-synthetic

  • Strongest opioids - fentanyl 20x stronger than morphine

  • Check LOC and RR due to respiratory depression

  • Naloxone / narcan - antidote for opioid toxicity

  • Adjuvant drugs - antimalarial drugs for SLE and rheumatoid arthritis eg hydroxychloroquine

  • TCA / Tricyclic antidepressants - inc serotonin endorphin eg amitriptyline, imipramine

    • Endorphin - endogenous morphine

  • Gabapentin - post herpetic neuralgia, anticonvulsant

    • Best for neuropathic pain

  • Nonpharmacologic pain management

    • Physical intervention - massage

    • Cutaneous stimulation

    • Immobilization

    • TENS - transcutaneous electrical nerve stimulation; electric current delivered disrupts brain signals and chemicals to distract brain 

    • Distraction

    • Biofeedback - control physiologic functioning (VS)

    • Guided imagery 


PHYSICAL ASSESSMENT

  • Standard: IPaPeA

    • Inspection - observe color, size

    • Palpation - masses, tenderness, organ enlargement

    • Percussion 

      • Dull sound - soft tissue

      • Resonant - lungs (AIR)

      • Hyperresonant - too much air eg COPD air trapping

      • Tympany - fluids eg ascites in liver cirrhosis

    • Auscultation

      • Bell(ow) - low pitched sound eg pulse

      • Diaph(igh)ragm  - high pitched sound eg lung sounds 

  • Abdominal assessment: IAPerPal / IAPePa - Yah Pe Pa (pig)

  • Each area 5 mins of auscultation of bowel sounds 

  • Follow the pattern of large intestines 

  • RLQ → RUQ → LUQ → LLQ

  • N bowel sounds 5-20 sounds / min 

  • <5 bowel sounds / min - hypoactive / constipation

  • >20 min sounds - hyperactive / diarrhea

  • Key points for assessment

  • Respiratory - upright position, orthopnea for DOB 

  • Abdominal - dorsal recumbent

  • Painful area palpated last 



HEARING / AUDITORY ASSESSMENT

  • Whisper test: behind the patient, cover one ear, whisper approx 60 cm away from the uncovered ear, one ear at a time

  • Rinne’s test: air conduction vs bone conduction (Normal AC>BC; ABnormal BC>AC in conductive HL)

  • Weber’s test: lateralization, normal equally heard

    • 2 types of hearing loss

    • Conductive HL: transmission does not reach ear eg otitis external media, otosclerosis; localize in poor ear

    • Sensorineural HL: nerve eg ototoxicity (CN VIII), meneire’s disease; localize in good ear


VISION TEST

  • Visual acuity: linaw ng mata

    • Snellen’s test 20/20 vision (adults) 10/10 (children)

    • Legally blind 20/200, no driver’s license for safety

    • N/D - N (distance from chart) / D (read from chart)

    • Inc denominator - malabo

    • Inc numerator - sobrang linaw


LABORATORY AND DIAGNOSTICS


SPUTUM EXAM

  • Best time is Early AM - gargle w/ water, no mouthwash or toothbrush

  • To detect complications with pneumonia and culture/sensitivity (to determine best antibiotic)

  • For culture and sensitivity

  • Not usually performed in children


STOOL EXAM

  • Fresh specimen 1” stool to determine + parasitism

  • FOBT (fecal occult blood test) or Guaiac test - detect hidden blood in stool 

    • False POSITIVE = inc iron (red meat, liver), meds that cause GI bleeding (high dose aspirin, anticoagulants 3-7 days pause)withdhold prior

    • False NEGATIVE  = vit c high >250 mg/day, orange, pomelo, vegetables such as melons, radish, turnips

    • Meds 7 days prior withhold (aspirin, anticoagulants, NSAIDs, steroids)

    • + guaiac = blue/green reaction

    • - guaiac  = no reaction or no color change 

    • Screen test for PUD and colorectal cancer 

URINE EXAM

  • Mid stream urine collection

    • Early AM,perform perineal care

    • Discard first and last flow of urine, not the whole of first urine output

    • For women, spread labia majora using non dominant hand

    • For men, spread penile skin 

    • Routine urinalysis: 30-50 mL

    • Culture and sensitivity: 5-10 mL (ecoli common cause of UTI)

  • 24 hr urine collection: creatinine clearance, Schilling’s test (pernicious anemia), pheochromocytoma (vanillylmandelic acid test)

    • 8 AM:discard first urine then start timing

    • Collect subsequent urine

    • 24 urine collection container

    • 8 AM: next day

    • Male - urinal 

    • Female - urine hat on top of toilet bowl

    • Preserve ref ice 

  • Catheterized urine specimen 

    • Self sealing rubber port - for syringe + needle

    • Luer lock (syringe)

    • Do not discontinue catheter

    • Clamp 10-20 mins distal to the rubber port the aspirate


BLOOD EXAM

  • FBS (fasting blood sugar)  

    • NPO 6-12 hrs post midnight except water

    • Withhold insulin eg glipizide metformin or OHA 

    • Normal <100 mg/dL

    • Prediabetes 100-125 mg/dL

    • Diabetes >125 mg/dL

  • Lipid profile 

    • Assesses cardiovascular risk 

    • NPO 8-12 hrs post midnight except water 

    • CTLH - 200, 150, 100, 50

    • Cholesterol: <200 mg/dL

    • Triglycerides: <150 mg/dL

    • LDL: <100 mg/dL (taba dinadala sa blood vessels)

    • HDL (good): >50 mg/dL (taba dinadala sa liver)

    • LOW score in exam is BAD, High score is GOOD

    • Lipoprotein - transporters of fats (low vs high density)

  • Complete Blood Count 

    • No fasting needed

    • RBC: Male 5M-6M, Female 4.5 M-5.5M

    • Hgb: Male 14-18, Female 12-16 g/dL

    • Hct: Male 41-51%, Female 36-46%

      • RBC divided by whole blood

      • Inc hct = less fluid = dehydration in shock

      • Dec hct = more fluid = diluted 

    • WBC: 5k-10k; dec WBC in leucopenia high risk for infxn, inc WBC in leucocytosis infxn, inflammation

      • Neutrophils (most abundant wbc) - 1.5k - 6k cells / mm3

      • ANC = absolute neutrophil count - assess level / risk of infection

      • Mild risk for infxn 1k-1.5k

      • Moderate 500-1k

      • Severe <500

      • For moderate and severe, observe reverse / protective / neutropenic isolation

      • For px with leucopenia, avoid fresh fruits or flowers, pitcher with water, infected individuals 

      • Shift to left of wbc → inc in immature wbc → sx of infxn

    • Platelet/thrombocytes: 150k-450k; dec - risk for bleeding

      • Dec platelet = thrombocytopenia, high risk for bleeding 

      • Avoid contact sports due to easy bruising, straight razor (only use electric razor), regular toothbrush (soft bristled only), invasive procedures (IV line allowed for platelet transfusion but apply pressure dressing), no rectal temperature taking  

  • Coagulation studies

    • Bleeding time: N 1-10 min

    • Prothrombin time (PT): n 10-12 sec

    • Meds vitamin K to create a clot

    • Blood thinner

      • Anticoagulants - heparin IV/subq, warfarin oral



KIDNEY FUNCTION TEST

  • Nitrogen as waste product

  • Kidney disease: inc bun and creatinine

  • BUN: 10-20 mg/dL

  • Serum Creatinine: 0.6-1.2 mg/dL; best indicator, more sensitive

  • Inc in kidney prob


LIVER FUNCTION TEST

  • SGOT/AST: 10-40 iu/L

  • SGPT/ALT: 10-40 iu/L

  • Albumin 3.5 - 5 g/dL

    • Responsible for oncotic pressure → pulling force

    • Dec albumin → edema 

  • Liver cirrhosis mababa albumin - walang humihila ng tubig  


PANCREATIC ENZYMES

  • amylase : 25-150 u/L

  • Pancreatitis 5x N

    • Inc 6 hrs after onset of pain

    • In 24 hrs highest level

    • Within 2-3 days return to baseline/normal

    • Autodigestion of pancreas → nagdudgo → bangungot


SERUM ELECTROLYTES 

  • Na 135-145 mEq/L

  • Cl 95-105 mEq/L

    • If too high NaCl → toxic to CNS → seizure → coma 

  • Magnesium 1.5-2.5 mEq/L

  • Potassium 3.5-5 mEq/L

    • K+ inc or dec = cardiac dysrhythmia 

  • Calcium 4.5-5.5 mEq/L / 9-11 mg/dL

    • Too high Ca Mg → muscle weakness

    • Too low Ca Mg → muscle spasm 

      • Carpopedal signs

      • Chvostek’s sign related to hypocalcemia 

      • Trousseau’s Sign - induction of spasm by inflation of BP for 3 minutes 


ARTERIAL BLOOD GAS

  • Ensure patency of radial and ulnar arteries - to check for patency, use Allen’s Test


BREAST SELF EXAM

  • Detect breast cancer

  • Age: 20 y/o monthly 

  • Best time 5-7 days pre menstruation

  • Menopause: monthly, same day of the month

  • Painless lump on upper outer quadrant

  • Steps for BSE:

    • Inspection - use mirror to check for size and color 

      • N slightly asymmetrical; AbN profound asymmetry

      • AbN peau de orange or orange peel skin

      • Dimpling of skin - in front of mirror, hands lean forward then hands on the knees bend forward

    • Palpation - during shower or when supine in bed

      • Soapy hands can more easily palpate mumps

      • Supine - small pillow under shoulder 

      • Palpate for all areas of the breast and pinch nipples

      • Most common area of breast tumor - upper outer quadrant due to presencce of tail of spence (group of lymph node in axilla)


MAMMOGRAPHY

  • Xray of the breast - can detect lump earlier before it is palpated

  • Baseline: 35-39 y/o

  • Annually at 40 y/o

  • No deodorant, lotion, cream, powder - obscures view 

  • Inform them of discomfort during the procedure - iniipit dede

  • Px can take about before or after mammography 


PAP SMEAR

  • Detect cervical cancer or HPV virus 

  • Age 21 y/o; frequency every 3 years 

  • Lithotomy position with feet on top of stirrups - dapat sabay pinapatong baka mapunit ligament 

  • No sex, spermicide, vaginal douching 3 days before test

  • Vaginal speculum - advise deep breaths during insertion, use water lubricant eg ky jelly

  • Cotton applicator and slide needed 

  • Detect + squamous cells for biopsy 


TESTICULAR SELF EXAM

  • Best time after warm shower (relaxed, left lower)

  • Monthly palpate one testicle at a time

  • Starts at age 13 y/o

  • Frequency: monthly after warm shower (when relaxed)

  • Inspection - mirror for size

    • N asymmetrical with left lower 

  • Palpation -  painless lump 


CANCER WARNING SIGNS

ENDOSCOPY

  • Upper

    • Respiratory - laryngoscopy, bronchoscopy

    • GIT - EGD / esophagogastroduodenoscopy

  • Lower

    • Colonoscopy 

  • Preparation (CNAVA)

    • Consent

    • NPO post midnight (6-12 hrs)

    • A+ SO4 - atropine sulfate (SNS response → reduce salivation to prevent aspiration)

    • Valium (conscious sedation)

    • Anesthetic spray (lidocaine)

  • During: side/fowler’s position

  • Post-procedure: 

    • NPO until gag reflex returns

    • Assess for complications

      • Bleeding - frequent swallowing

      • Perforation - abdominal pain, board like abdomen 


COLONOSCOPY

  • Preparation

    • Low residue diet 3 days before - low fiber diet

    • NPO post midnight

    • Laxative the evening before procedure

    • Cleansing enema

  • During 

    • Left sim’s position

  • Post-procedure

    • Assess complications: bleeding, perforation


BARIUM STUDIES

  • + fluoroscopy: series of xray

  • Barium swallow - UGIS (upper GI series)

    • Prep: NPO post midnight, assess barium allergy

    • During: fowler’s, +fluoroscopy

    • After: excrete barium → impaction → obstruction

      • Inc fluid

      • Inc fiber

      • Laxative (should poop w/in 24-48 hrs stool white color)

  • Barrium enema - LGIS (lower GI series)

    • Prep: same with colonoscopy

    • During: infuse Ba solution via colonoscopy

    • After: excrete barium  


FIRE SAFETY

FIRE EXTINGUISHER

  • For small fires

  • For beginning / incipient stages of fire

TYPES OF FIRE EXTINGUISHER 

  • Class A (bo)   ⃤⃤⃤   Ordinary combustibles - paper, plastic, wood, cloth

  • Class B (ox)   ⃞   Flammable liquids - gasoline, oil, grease, paint

  • Class C (uryente) ◯ Electrical fires - office equipment

  • Class D (ecember) ☆ Metal fires - sodium, aluminum, magnesium, potassium 

RACE PASS

  • Remove / rescue the patient (unahin sarili at lumabas ng bahay)

  • Activate the alarm / ask for help

  • Confine the fire

  • Extinguish the fire (under control if only one room is affected or the door knob is still not hot to touch)

  • Pull pin

  • Aim nozzle at the place of the fire (pailalim)

  • Squeeze

  • Sweep side to side


FALLS

MORSE FALL SCALE

  • May be source of malpractice 

  • Assist every shift 

  • If 50 and up - high risk  (Fall - Fifty)

  • W/ hx of falling : Yes - 25

  • Secondary Dx : Yes - 15

  • Ambulatory aids : crutches / canes / crutches / walker - 15 ; furniture - 30

  • IV / Heparin Lock / FC (contraptions) : Yes - 20

  • Gait 

    • Weak : 10

    • Impaired : 20

  • Mental status impaired : 15  

PREVENTION

  • Fall alert - place near nurses station

  • Bed at lowest position

  • Side rails up - all side rails up not allowed considered as false imprisonment; only two to three is allowed

  • Call bell

  • Night light 

  • Supervision 

2 RISK FACTOR FOR FALLS

  • Intrinsic factor - within pt’s condition eg dizzy, mobility impaired, seizure disorder

  • Extrinsic factor - environmental eg unorganized, wet floor (better if carpet floor than tiled floor)

POSITIONING

  • Use gait belt then put one forward forward → slide to the floor

  • Position self behind the client - to easily catch patient

  • If w/ visual impaired - position self in front of client


DISASTER

EXTERNAL DISASTER

  • Outside the hospital 

  • Eg house fire, terrorist attack

INTERNAL DISASTER

  • Within the facility

  • Eg fire within hospital

  • Rule of thumb: save as many people as you can (not necessarily the most critical)