Insorio, Maricon M.

Topics for reporting: Nurses

1. Vital signs (all ages)

Vital signs are one of the measurements that nurses needed to know for the
continuity of care. It is vital physiological processes that provide insight into an
individual's general state of health. Nurses needed to monitor it so that they will
know the changes that is happening in every patient whenever a medication or a
procedure is done because deviations from normal ranges can indicate a possible
health issues to the patient. Vital Signs includes the following:

- Heart Rate (pulse): The number of heartbeats per minute. Normal : 60 to

100 beats per minute
- Blood pressure: The force of blood against the walls of the arteries. The
materials we needed to prepare prior to the blood pressure are the
stethoscope and sphygmomanometer. Normal : 120/80 mmHg
- Respiratory rate: The number of breaths taken per minute. Normal : 12 to 18
breaths per minute
- Body temperature: The measure of the body's internal heat. We need to have
a thermometer to get the body temperature. Normal: 36.5 to 37.5

In doing the vital signs reading, we should first wash our hands so that we can
avoid transmission of microorganisms that can harm our patients, next is we need
to gather all the materials needed so that it will be more organize and be more
prepared , after that, we need to go and introduce ourselves to our patient and
build rapport for more cooperation and for them to gain trust. We also need to
explain what we will do to them so that they will be more aware of the procedure
and the importance of it.

For doing the pulse rate measurement, we need to place the index and middle
fingers on the inside of the opposite wrist, just below the base of the thumb. Apply
light pressure and use gentle pressure to avoid compressing the artery excessively.
We also need to Press with the fingertips and not the thumb, as the thumb has its
own pulse. Counting the beats should be in a full minute. As they say , we can
count for 30 seconds and then multiply by 2 to get the beats per minute. But I
think , it will be more accurate to count it in a 60 seconds time frame to know if
there will be an abnormality on the rhythm in that full minute.

Next is doing the blood pressure , so after ensuring the materials needed which
is the blood pressure cuff and the stethoscope we need to ensure the patient to be
seated on the bed comfortably. We need to encircle the upper arm with the blood
pressure cuff approximately one inch above the elbow joint. The lower edge of the
cuff should be situated two to three centimeters above the elbow bend. After that
palpate the brachial artery on the inner side of the arm, just below the cuff and that
will be the site where we put our stethoscope. Ensure that the valve on the bulb is
closed and then we need to Inflate the cuff 20 mmHg above the expected systolic
pressure. Slowly release the pressure in the cuff by opening the valve on the bulb.
Listen for the first sound (Korotkoff sounds), which is the systolic pressure.
Continue to slowly release the pressure until the sounds disappear (diastolic
pressure). Then we deflate the cuff and remove it.

For checking the body temperature, we need a thermometer. So first is we need

to expose the axilla of the patient then tap it with a tissue or a dry towel to remove
any excess moist and avoid rubbing it to prevent causing friction. After that, with
the use of alcohol pad we need to wipe the thermometer from the bulb to the end
then put it to the patient’s axilla snugly and wait up until the result from the
thermometer shows up or when it beeps. Then remove the thermometer from the
patient and record it.

Lastly the respiratory rate , it is more accurate to do this when the patient is not
aware that we are observing their respiratory rate for them to not be conscious of
their breathing, we can do this by waiting for the body temperature to beep or
doing them simultaneously with pulse rate checking. Doing this , we need to
observe the patient’s chest or abdomen rising and falling. We can do this visually by
watching as they breathe. Count the number of breaths for one minute.

1.1 GCS

One popular neurological assessment technique for determining and measuring

a person's degree of consciousness and neurological functioning is the Glasgow
Coma Scale. A person's eye, verbal, and motor responses can all be used for
assessing their level of consciousness. It provides a numerical score that indicates
the severity of impairment. As it is a tool, it means that it is a standardized
language for healthcare professionals to communicate about a patient's neurological
status. This is important for consistency and clarity in medical records, handovers,
and discussions among different healthcare team members.

GCS based the assessment on three components: eye-opening response, verbal

response, and motor response. Each component is scored independently, and the
total GCS score ranges from 3 to 15. Here's how to perform the Glasgow Coma
Scale assessment:

1. Eye-Opening Response: Assess the person's eye-opening response. Score as

follows:
- 4 points: Spontaneous – The person opens their eyes without any stimulus.
- 3 points: To speech – The person opens their eyes in response to a verbal
command.
 - 2 points: To pain – The person opens their eyes in response to a painful
stimulus, such as a pinch.
- 1 point: No response – The person does not open their eyes even in response
to pain.

2. Verbal Response: Evaluate the person's verbal response. Score as follows:

- 5 points: Oriented – The person is able to respond coherently and
appropriately to questions about their name, location, and the current time.
- 4 points: Confused – The person is disoriented and responds inappropriately
to questions.
- 3 points: Inappropriate words – The person speaks words but not coherent
sentences.
- 2 points: Incomprehensible sounds – The person makes sounds that do not
form recognizable words.
- 1 point: No response – The person does not make any verbal sounds.

3. Motor Response: Examine the person's motor response. Score as follows:

- 6 points: Obeys commands – The person follows simple commands such as

"squeeze my hand" or "raise your eyebrows."

- 5 points: Localizes pain – The person moves towards a painful stimulus,

such as withdrawing their hand when pricked with a pin.
- 4 points: Withdraws from pain – The person withdraws or moves away from
a painful stimulus.
- 3 points: Flexion to pain (decorticate response) – The person shows
abnormal flexion in response to pain. This is characterized by arms flexed at
the elbows and wrists.
- 2 points: Extension to pain (decerebrate response) – The person shows
abnormal extension in response to pain. This is characterized by rigid
extension of the arms and legs.
- 1 point: No response – The person does not show any motor response.

In terms of scoring and interpretation, the overall GCS score, which varies
from 3 to 15, is obtained by adding the results from the three components. greater
GCS scores correspond to greater states of awareness, and lower scores correspond
to lower states of consciousness.

2. Indwelling foley catheter

We humans, naturally have a tendency to release and urinate as often as

possible; nevertheless, urine retention can occur when the signal that allows us to
release and urinate is not sent to the brain. An indwelling foley catheter is a
medical device that can assist our patient in emptying their bladder when they are
unable to do it on their own or effectively. This can be due to various conditions,
such as enlarged prostate, neurogenic bladder, or post-surgery recovery. It is also
used for patients or individuals with chronic urinary incontinence or mobility issues,
indwelling catheters may provide a solution for managing urine drainage.

2.2 insertion

Indwelling foley catheter should be inserted aseptically to reduce any risk of

infections. To facilitate the insertion, first, we need to check the doctor’s order for
the procedure and after that we need to gather the appropriate supplies such as a
sterile catheter, a sterile water-filled syringe, lubricant, antiseptic solution, sterile
drapes, gloves, and a drainage bag. We need to perform hand hygiene and then
inform the patient about the procedure . We used a lubricant to facilitate insertion
and we also secure it in place by using 10 ml sterile water using a syringe. This
catheter is connected to a drainage bag to collect urine.

2.3 care

To avoid tension or pulling on the catheter, we must constantly inspect and

use a securement device to secure the catheter tubing to the patient's leg.
Additionally, keep an eye out for any indications of difficulties in the patient, such as
pain, bleeding, or infection symptoms.

2.4 termination ( removal)

For the termination of the indwelling foley catheter, first, we need to check
the doctor’s order for the removal and after that we need to gather the appropriate
supplies such as a clean gloves, a syringe, antiseptic solution, and a receptacle for
the catheter. We need to perform hand hygiene and then inform the patient about
the removal . We need to position the patient comfortably, usually lying down.
Clean the genital area with an antiseptic solution to maintain cleanliness. Connect a
syringe to the inflation port of the catheter balloon. Withdraw the volume of water
used to inflate the balloon and this will deflate the balloon. After that, while
maintaining gentle traction, remove the catheter from the urethra. We should ask
the patient to take a deep breath and exhale during the removal to help them relax.
Monitor the patient for any signs of discomfort or pain during and after catheter
removal.

We need to document the procedure and the patient’s response and we need
to ensure that the patient is able to urinate after catheter removal. Some patients
may experience temporary difficulty initiating urination. It is also necessary to
provide an education to the patient regarding aftercare instructions, including signs
of potential complications and when to seek medical attention.
3. Capillary blood glucose (cbg) monitoring

As nurses, we may occasionally deal with a patient who has diabetes. In this
case, we must be aware that regular blood glucose monitoring, or CBG monitoring,
is necessary for the patient to control their condition and make educated decisions
about their lifestyle and course of treatment. The most common method used at
the bedside is fingerstick testing. Capillary glucose monitoring is an essential part of
diabetes care because it offers useful data for daily management, medication
modifications, and the avoidance of both short- and long-term problems related to
diabetes.

3.1 procedure and care

In doing CBG monitoring, we begin by performing hand hygiene. Introduce

ourselves to the patient and explain the procedure to gain cooperation. After that
we prepare the glucometer and insert a test strip into the glucometer. Load a lancet
into the lancet device then choose a fingertip for blood collection. After that, use an
alcohol swab to clean the chosen testing site. Allow it to dry completely before
obtaining the blood sample. Use the lancet device to prick the fingertip gently. Hold
the device against the finger and press the release button to obtain a small drop of
blood.

The glucometer will display the blood glucose reading after a few seconds.
Record the result and safely dispose the lancet and used test strip in an appropriate
sharps container.

3.2 insulin administration

Insulin administration is an essential part of treating diabetes, which is

characterized by the body's reduced ability to produce or use insulin. A hormone
called insulin controls blood sugar, or glucose, levels. Depending on the patient’s
needs, insulin may be administered through injections or insulin pumps. As a nurse,
we should follow the prescribed insulin schedule, considering the onset and duration
of the specific insulin type. We also choose an injection site, rotating sites to
prevent lipodystrophy (changes in fat tissue). The Common sites include the
abdomen, thighs, and upper arms.

To Administer the Insulin we need to hold the syringe or pen at a 90-degree

angle to the skin. Insert the needle into the skin and inject the insulin slowly and
steadily. Then withdraw the needle or pen or if using a syringe, withdraw the needle
from the skin. If using a pen, remove it from the skin after completing the injection.
We need to apply pressure: If there is any bleeding, apply gentle pressure with a
cotton ball or tissue. Safely dispose of needles and syringes in a designated sharps
disposal container.
3.2.1 types of insulin

Because of advance care in diabetes management, the availability of different

types of insulin is aimed at providing more flexibility and options for individuals with
diabetes to manage their blood sugar levels effectively. Technological advancements
have led to the development of ultra-rapid insulins and improved insulin delivery
systems (such as insulin pumps) to better meet the evolving needs of individuals
with diabetes. This leads to improved glycemic control to the patients. Some
examples of types of medications are the following:

Rapid Acting Insulin Analogs : such as insulin Aspart, insulin Lyspro, Insulin
Glulisine which have an onset of action of 5 to 15 minutes. With all doses, large and
small, the onset of action and the time to peak effect is similar, The duration of
insulin action is, however, affected by the dose – so a few units may last 4 hours or
less, while 25 or 30 units may last 5 to 6 hours. As a general rule, assume that
these insulins have duration of action of 4 hours.

NPH Human Insulin: which has an onset of insulin effect of 1 to 2 hours. Very small
doses will have an earlier peak effect and shorter duration of action, while higher
doses will have a longer time to peak effect and prolonged duration.

Long acting insulin analogs : such as Insulin Glargine, Insulin Detemir which have
an onset of insulin effect in 1 1/2-2 hours

3.2.2 action/ mechanism ( peak/low)

Rapid Acting Insulin Analogs :Peak effect in 1 to 2 hours and duration of action that
lasts 4-6 hours.

NPH Human Insulin : which has a peak effect of 4 to 6 hours, and duration of action
of more than 12 hours.

Long acting insulin analogs : The insulin effect plateaus over the next few hours
and is followed by a relatively flat duration of action that lasts 12-24 hours for
insulin detemir and 24 hours for insulin glargine.

3.2.3 handling / storage

Insulin needs to be kept out of direct sunlight, the kitchen, enclosed vehicles,
green houses, the top of refrigerators, and televisions. It should also be kept in a
dark, cool environment that stays below 30°C (A3). When not in use, insulin pens
and vials should be refrigerated but not frozen (A1). Needles should never be kept
in storage with pens. When a refrigerator is not accessible, it is best to wrap the
vial in a plastic bag, fasten it with a rubber band, and store it in an earthenware
pitcher or wide-mouthed bottle of water.
Do not use the insulin if :

-If the clear soluble insulin has turned cloudy.

- If the insulin is discolored.

- If the insulin has been frozen or exposed to high temperatures because insulin
should never be frozen.

Also, patients should not use insulin that has changed in appearance
(clumping, frosting, precipitation, or discoloration). • Unused insulin should be
stored in a refrigerator (4°C-8°C). • After first usage, an insulin vial should be
discarded after 3 months if kept at 2°C to 8°C or 4 weeks if kept at room
temperature. However, for some insulin preparations, manufacturers recommend
only 10 to 14 days of use in room temperature

Patients with diabetes need to be educated about temperature variations and

duration of storage of insulin vials for maintaining the efficacy of insulin. Keeping
insulin in clay pots is likely to cause contamination as it is difficult to keep it clean:
this should be avoided.

4. Blood transfusion

Blood or blood components are transferred from one person (donor) to another
(receiver) during a blood transfusion. This treatment is essential to the
management of several medical diseases and is carried out for a variety of medical
reasons. An instant boost in hemoglobin and red blood cell count can be obtained
through blood transfusions, which enhances oxygen transport capacity and
alleviates anemia-related symptoms including weakness and exhaustion. During
and after surgery or trauma, transfusions assist restore blood volume, regulate
blood pressure, and guarantee proper oxygen delivery to tissues and organs.
During complicated medical procedures, transfusions are utilized to guarantee
optimal oxygen supply to important organs and to preserve hemodynamic stability.

4.1 blood products

Red Blood Cells (RBCs): Function: Red blood cells transfer oxygen from the
lungs to the rest of the body and transport carbon dioxide back to the lungs for
expiration. Uses: Red blood cell transfusions are frequently used to treat anemia,
blood loss problems following surgery, trauma, and other medical treatments.

Platelets: Function: Platelets are crucial for blood clotting and wound healing.
Uses: Platelet transfusions are often required for individuals with low platelet counts
due to conditions such as chemotherapy, bone marrow disorders, or liver disease.
 Plasma: Function: Plasma is the liquid component of blood that contains water,
electrolytes, proteins, hormones, and waste products. Uses: Plasma transfusions
are used to treat clotting disorders, liver disease, and conditions where there is a
deficiency of clotting factors.

Fresh Frozen Plasma (FFP): Function: FFP is plasma that has been separated
and frozen shortly after donation, preserving clotting factors. Uses: FFP is often
used in the treatment of bleeding disorders, liver disease, and conditions requiring
the replacement of clotting factors.

Cryoprecipitate: Function: Cryoprecipitate is a portion of plasma rich in clotting

factors, including fibrinogen. Uses: Cryoprecipitate is used in the treatment of
bleeding disorders, such as hemophilia or conditions where there is a deficiency of
fibrinogen.

Albumin: Function: Albumin is a protein found in plasma that helps maintain

blood volume and pressure. Uses: Albumin is used to treat conditions associated
with low blood volume, such as severe burns, liver disease, and certain surgeries.

Immunoglobulins (IVIG): Function: Immunoglobulins are antibodies that play a

key role in the immune system's defense against infections. Uses: Intravenous
immunoglobulin (IVIG) is used to treat various autoimmune disorders, primary
immunodeficiencies, and certain neurological conditions.

Factor VIII and Factor IX Concentrates: Function: These concentrates contain

specific clotting factors (Factor VIII or Factor IX). Uses: Used in the treatment of
hemophilia, where there is a deficiency of these specific clotting factors.

Packed Red Blood Cells (PRBCs): Function: PRBCs are red blood cells that have
been separated from plasma and other blood components. Uses: PRBC transfusions
are administered to increase oxygen-carrying capacity in cases of anemia, surgery,
or trauma.

4.1transfusion protocol

The set rules and processes known as blood transfusion protocols are made to
guarantee the safe and efficient delivery of blood and blood products. Healthcare
facilities use these guidelines to reduce the possibility of problems and to give
transfusion recipients uniform care.

A licensed medical professional must prescribe the blood transfusion in

accordance with the clinical evaluation and indications. The patient is informed by
the medical staff about the goals, advantages, and possible dangers of receiving a
blood transfusion. Before receiving a transfusion, the patient or their legal
representative must give their informed consent, demonstrating their
comprehension and agreement. The patient's blood type (A, B, AB, or O) and Rh
factor (positive or negative) are ascertained by blood typing. Crossmatching: This
technique minimizes the incompatibility between the donor and patient blood by
ensuring that the risk of transfusion reactions.

4.2 handling/ storage

Blood Storage Shell life
products temperature
Red cells 2–6 ºC 42 days
Platelets 20–24 ºC 7 days
Fresh frozen At or below 12 months
plasma (FFP), –25 ºC
cryodepleted
plasma,
cryoprecipitate

Minimize the amount of time that chilled components are handled outside of
refrigeration to prevent exceeding the maximum temperature requirements. Every
time, red cell components must be kept at room temperature for no more than 30
minutes. Until they are used, keep the parts in a temperature-controlled area. Take
care when handling and storing parts to reduce the chance of product tampering.

4.3 reaction

An unfavorable event that might happen during or after the administration of

blood or blood products is known as a blood transfusion reaction. These reactions
can be minor to severe and have a number of causes, such as immunological
responses, additional problems, or blood incompatibility between the donor and
recipient. As nurses, blood transfusion reactions are closely watched, and prompt
action can be necessary.

Even when given the appropriate blood type, some recipients of transfusions
experience adverse reactions to the blood. Itching and hives are among the
symptoms in these situations. Antihistamines can be used to treat this, just like
they do most allergic reactions. However, if the reaction worsens, we should inform
a physician.

After receiving a transfusion, having a fever is not that alarming since it is

the body’s natural reaction to the white blood cells in the blood transfusion . But , if
the patient also has nausea or chest pain, that could indicate a dangerous reaction.
If further symptoms or side effects are experienced, we should speak and inform
their physicians.
 5. Suctioning

Suctioning is a medical procedure used to remove secretions, blood, or other

fluids from a patient's airway or other body cavities using a suction device. The
procedure helps maintain a clear airway, improve breathing, and prevent
complications related to the accumulation of fluids or obstructions.

5.1 procedure (nasal/oral/ ET)

oral suctioning procedure

- Assess patient need for suctioning (respiratory assessment for signs of
hypoxia)
- Explain to patient how the procedure will help clear out secretions and will
only last a few seconds. If appropriate, encourage patient to cough.
- Position patient in semi-Fowler’s position with head turned to the side.
- Perform hand hygiene, gather supplies, and apply non-sterile gloves. Apply
mask if a body fluid splash is likely to occur.
- Fill basin with water.
- Attach one end of connection tubing to the suction machine and the other
end to the yankauer.
- Turn on suction to the required level. Test function by covering hole on the
yankaeur with your thumb and suctioning up a small amount of water.
- Remove patient’s oxygen mask if present. Nasal prongs may be left in place.
Place towel on patient’s chest.
- Insert yankauer catheter and apply suction by covering the thumb hole. Run
catheter along gum line to the pharynx in a circular motion, keeping
yankauer moving.
- Encourage patient to cough.
- If required, replace oxygen on patient and clear out suction catheter by
placing yankauer in the basin of water.
- Ensure patient is in a comfortable position and call bell is within reach.
Provide oral hygiene if required.

Et suctioning procedure:
- Ensure emergency airway management equipment is available.
- If parents are present explain the procedure, the reason for suction and
inform them of what to expect during the procedure
- Perform hand washing according to unit policy
- Check the length required to pass the suction catheter down to the tip of the
ETT and its corelating colour or number.
- Measurement of length to suction should be performed at the beginning of
the shift, by adding the length of the ETT and any additional length of the
adapter.
- Unlock the suction by twisting the thumb control valve by 180 degree.
- Advance the catheter to the tip of the ETT (Shallow suctioning). Pass the
catheter down the ET tube 1-2cm a time until you see the appropriate colour
(as calculated before) in the observation area.
- Depress the thumb control valve completely and wait 1-2 seconds. Slowly
pull back the catheter until you see the BLACK MARK in the rinse chamber
next to the saline flush port, keeping the suction on by depressing the thumb
valve.
- Rinse the suction catheter
- If oxygen is increased prior to the procedure , return to previous setting.

6. Nasogastric tube
A medical device called a nasogastric tube (NG tube) is passed down the
esophagus and into the stomach after being implanted through the nose. It is
mostly utilized for the delivery of fluids, drugs, or the removal of stomach
contents, among other diagnostic and therapeutic uses. In hospitals and
clinics, among other medical settings, nasogastric tubes are frequently used.
The following are some important features of the nasogastric tube: Patients
who cannot sufficiently take oral nutrition are fed enterally through
nasogastric tubes. This can apply to people who have trouble swallowing,
have neurological conditions, or are recuperating from surgery. In cases such
as acute vomiting, gastric ileus, or intestinal obstruction, asogastric tubes are
used to remove the stomach's contents and decompress the stomach. In
some cases, nasogastric tubes are used post-operatively to prevent the
accumulation of gastric secretions and reduce the risk of complications.

6.1Insertion
- Gather necessary equipment, including the nasogastric tube, water-soluble
lubricant, cup of water, adhesive tape, and a syringe for checking tube
placement.
- Position the Patient: Place the patient in a high Fowler's position for optimal
comfort and ease of insertion.
- Measure the Tube: Measure the distance from the tip of the nose to the
earlobe and then to the xiphoid process to determine the appropriate
insertion length.
- Lubricate the Tube: Apply water-soluble lubricant to the distal end of the tube
to facilitate insertion.
 - Insert the Tube: Gently insert the lubricated tube through one nostril and
advance it along the floor of the nasal passage, directing it posteriorly toward
the back of the throat.
- Confirm Placement: Confirm tube placement by checking for gastric aspirate
using a syringe, testing the pH of the aspirate, and obtaining an X-ray if
needed.
- Secure the Tube: Once placement is confirmed, secure the tube in place
using adhesive tape or other securing devices.
- Initiate Feeding or Other Procedures: Connect the tube to the appropriate
equipment for feeding, medication administration, or gastric decompression,
as indicated.

6.2Care

Care and Monitoring: Aspiration Precautions: Keep the head of the bed elevated to
reduce the risk of aspiration.

Oral Care: Provide frequent oral care to prevent mucosal irritation and infection.

Tube Patency: Regularly assess and maintain tube patency by flushing with water
before and after each feeding or medication administration.

Securement: Ensure the tube is securely taped and anchored to prevent accidental
displacement.

Monitoring and Documentation: Monitor for signs of complications, such as

respiratory distress, discomfort, or tube dislodgment. Document tube placement,
care, and patient response. Nasogastric tube insertion and care should be
performed by trained healthcare professionals to ensure patient safety and
minimize the risk of complications. Careful attention to proper technique, patient
comfort, and ongoing monitoring.

6.3 termination

Verify the provider’s orders to remove the NG tube.

• Gather the necessary supplies: Fluid-impermeable pads, 20-60 mL syringe,

Nonsterile gloves, Stethoscope, Oral hygiene supplies, Tissues, Garbage bag

• Verify the client and introduce ourselves to build rapport and cooperation.

• Explain the procedure to the client.

• Place the client in high Fowler’s position.

• Perform hand hygiene.

• Assess the client’s gastrointestinal function prior to removing the NG tube.

 • Place a fluid impermeable pad on the client’s chest.

• Disconnect the tube from feeding and suctioning if present.

• Remove the tape or securement device from the nose.

• Unclip the NG tube from the client’s gown.

• Verify tube placement and then clear the NG tube by inserting 10 to 20 mL of

air into the tube to prevent aspiration of any remaining gastric contents.

• Instruct the client to take a deep breath and hold it.

o Holding one’s breath closes the epiglottis and prevents aspiration.

• Kink the NG tube near the nare and gently pull out the tube in a swift, steady
motion, wrapping it in your hand as it is being pulled out. Inspect the tube
for intactness. Dispose of the tube in the garbage bag.

o Kinking the tubing prevents any residual gastric contents from flowing
out of the tube upon removal.

• Offer tissue and/or clean the nares for the client.

• Offer oral care for client comfort and to prevent transmission of

microorganisms.

• Discard used supplies, remove gloves, and perform hand hygiene.

• In an inpatient setting, help the patient into a comfortable position and place
personal items, the tray table, and the call light within easy reach. Make sure
the patient knows how to use the call light to summon assistance. To ensure
the patient’s safety, raise the appropriate number of side rails and lower the
bed to the lowest position. Ensure the bed is locked.

• Perform hand hygiene.

• Document the procedure and assessments.

• After tube removal, continue to monitor the client for signs of gastrointestinal
(GI) dysfunction, including nausea, vomiting, abdominal distention or
discomfort, and food intolerance. Notify the provider of GI dysfunction
because reinsertion of the NG tube may be required.

Documentation Cues:

• Client’s GI assessment and status before tube removal

• Date and time of NG tube removal; the color, consistency, and any amount
of gastric drainage

• Visual inspection and intactness of the tube upon removal

• Client tolerance of the procedure

• Client and family (if applicable) education, their understanding of that

teaching, and any need for follow-up teaching.

• Any type of unexpected outcome and the interventions performed

6.4 feeding ( OGT/ PEG)

1. Clamp the tube on the feeding bag.

2. Add the formula to the bag.

3. Unclamp the tube and allow the formula to fill the tubing. Reclamp when the
formula reaches the feeding bag connector.

4. Program the pump and attach feeding bag connector to feeding port on the
PEG tube.

5. Unclamp all clamps and start the pump.

6. Disconnect when the feeding is complete.

7. Flush the PEG tube with water using a syringe (see description under “Bolus
Feedings”).

8. Clean syringe with soapy water. Rinse well with warm water and air dry.

7. Drugs and Solutions

Drugs and solutions can play a crucial role in healthcare, and their importance
depends on various factors, including the individual's health condition, the nature of
the illness, and the goals of treatment.

7.1administration
Oral route
Oral route is the most convenient and usually the safest and least expensive, it is
the one most often used. However, it has limitations because of the way a drug
typically moves through the digestive tract.When a drug is taken orally, food and
other drugs in the digestive tract may affect how much of and how fast the drug is
absorbed. Thus, some drugs should be taken on an empty stomach, others should
be taken with food, others should not be taken with certain other drugs, and still
others cannot be taken orally at all.

Injection routes
Administration by injection (parenteral administration) includes the following
routes:

• Subcutaneous (under the skin)

• Intramuscular (in a muscle)

 • Intravenous (in a vein)

• Intrathecal (around the spinal cord)

A drug product can be prepared or manufactured in ways that prolong drug

absorption from the injection site for hours, days, or longer. Such products do not
need to be administered as often as drug products with more rapid absorption.

Sublingual and buccal routes

A few drugs are placed under the tongue (taken sublingually) or between the
gums and teeth (buccally) so that they can dissolve and be absorbed directly into
the small blood vessels that lie beneath the tongue. These drugs are not
swallowed.

Rectal route
Many drugs that are administered orally can also be administered rectally as a
suppository. In this form, a drug is mixed with a waxy substance that dissolves or
liquefies after it is inserted into the rectum. Because the rectum’s wall is thin and
its blood supply rich, the drug is readily absorbed.

Otic route
Drugs used to treat ear inflammation and infection can be applied directly to the
affected ears. Ear drops containing solutions or suspensions are typically applied
only to the outer ear canal

Nasal route
If a drug is to be breathed in and absorbed through the thin mucous membrane
that lines the nasal passages, it must be transformed into tiny droplets in air
(atomized). Once absorbed, the drug enters the bloodstream. Drugs administered
by this route generally work quickly.

Inhalation route
Drugs administered by inhalation through the mouth must be atomized into
smaller droplets than those administered by the nasal route, so that the drugs can
pass through the windpipe (trachea) and into the lungs. How deeply into the lungs
they go depends on the size of the droplets. Smaller droplets go deeper, which
increases the amount of drug absorbed. Inside the lungs, they are absorbed into
the bloodstream.

7.2 types and preparation

Medicines often come in some of the following preparations:

Liquid

The active part of the medicine is combined with a liquid to make it easier to take
or better absorbed. A liquid may also be called a ‘mixture’, ‘solution’ or ‘syrup’.

Tablet

The active ingredient is combined with another substance and pressed into a round
or oval solid shape. There are different types of tablet. Soluble or dispersible tablets
can safely be dissolved in water.

Capsules

The active part of the medicine is contained inside a plastic shell that dissolves
slowly in the stomach. You can take some capsules apart and mix the contents with
your child’s favourite food. Others need to be swallowed whole, so the medicine
isn’t absorbed until the stomach acid breaks down the capsule shell.

Topical medicines

These are creams, lotions or ointments applied directly onto the skin. They come in
tubs, bottles or tubes depending on the type of medicine. The active part of the
medicine is mixed with another substance, making it easy to apply to the skin.

Drops

These are often used where the active part of the medicine works best if it reaches
the affected area directly. They tend to be used for eye, ear or nose.

Inhalers

The active part of the medicine is released under pressure directly into the lungs.
Young children may need to use a ‘spacer’ device to take the medicine properly.
Inhalers can be difficult to use at first so your pharmacist will show you how to use
them.

Injections

There are different types of injection, in how and where they're

injected. Subcutaneous or SC injections are given just under the surface of the
skin. Intramuscular or IM injections are given into a muscle. Intrathecal injections
are given into the fluid around the spinal cord. Intravenous or IV injections are
given into a vein. Some injections can be given at home but most are given at your
doctor’s surgery or in hospital.

7.3 computation drugs/ IV fluid

Accurate calculations prevent medical errors; underdosing a patient may lead

to inadequate treatment, and overdosing a patient may lead to drug toxicity.
Additionally, calculations require the knowledge of commonly used units; certain
medications are dispensed in metric system units such as mg or mL, whereas
others may be dispensed in other measurement systems.

Drugs may be administered through various routes of administration, oral,

IV, IM, parenteral, etc.; these factors must be accounted for when computing
calculations and consistency when converting units across different measurement
systems is important in maintaining accuracy in pharmacy calculations. It may also
be important to account for patients' weight when calculating the correct dose for
certain drugs.

When calculating the drip rate, first identify which IV tubing you will be
using, microdrip or macrodrip, so you can use the proper drop factor in your
calculations. The drop factor is the number of drops in one mL of solution and is
printed on the IV tubing package. Macrodrip and microdrip refers to the diameter of
the needle where the drop enters the drip chamber. Macrodrip tubing generally
delivers 10 to 20 gtt/mL and is used to infuse large volumes or to infuse fluids
quickly. Microdrip tubing delivers 60 gtt/mL and is used for small or very precise
amounts of fluid, as with neonates or pediatric patients. IV drip rate is calculated by
this simple formula: IV Drip Rate (gtt/min) = Total Volume (mL)/Time (min) x Drop
Factor (gtt/mL)

If you simply need to figure out the infusion rate, or the mL per hour to infuse, take
the total volume in mL, divided by the total time in hours that the medication is
ordered to be infused over, to equal the rate in mL per hour.