FUNDAMENTALS OF NURSING

Think about it ABCDEFGHIJKLMNOPQRSTUVWXYZ Is represented as 1 2 3 4 5 6 7 8 9 10 11 12

13 14 15 16 17 18 19 20 21 22 23 24 25 26

Educator/Teacher involves nursing activities, health promotion, the primary concern and psychological support

Counselor providing emotional, intellectual Manager/Coordinator manages the nursing

care.

Then: H-A-R-D-W-O-R-K 8+1+18+4+23+15+18+11=98% K-N-O-W-L-E-D-G-E 11+14+15+23+12+5+4+7+5=96 % A-T-T-I-T-U-D-E 1+20+20+9+20+21+4+5=100 % And look how far the love of God will take you L-O-V-E-O-F-G-O-D 12+15+22+5+15+6+7+15+4=101 %
NURSING Is the extent to which an individual or group is able to realize aspirations and satisfy needs and change or cope with environment. It is the complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. Major Nursing Goals

Change agent assists client to modify

behavior

Leader influences other to work together

towards a mutually envisioned goal.

Clinician use of technical expertise to

administer nursing care

Advocate promotes what is best for the

client, protects the client rights

Researcher participates in scientific

investigation; uses research findings in practice

Collaborator initiates nursing action within

the health team NURSING THEORIES Florence Nightingale

Promotive an action or measures designed

to support behavior conducive to health

mother of modern nursing developed and described the first theory of

nursing

Preventive any actions or measures

designed to protect individuals, families, groups, communities from harm to their health

environmental theory
Virginia Henderson

Curative any actions or measures designed

to correct or remove disease or any illness.

defined nursing to assist the individual , sick or

well, in the performance of those activities contributing to health or its recovery that he would [perform unaided if he ad the necessary strength, will or knowledge.

Rehabilitative any actions or measures

designed to restore health and promote recovery from any alteration of health Roles and Responsibilities of Nurses:

Caregiver helping clients promote, restore, and maintain dignity, health and wellness Communicator/Helper central role of nurses in identifying needs of the client

introduced the nature nursing model identified fourteen (14) components of basic
nursing

Faye Glenn Abdellah

identified three (3) classifications of nursing

systems Wholly compensatory dependent on others Partly compensatory both nurse and patient perform care Supportive-Educative can perform but with assistance Imogene King

defined nursing as service to individuals,

families and society.

introduced patient-centered approaches to

nursing model

identified twenty one (21) nursing problems

Dorothy Johnson

nursings primary goal is foster equilibrium

within the individual, which allows for the practice with individuals at any point in the health-illness continuum.

nursing is a process of action, reaction, and

interaction whereby nurse and client share information about their perception in the nursing situation

conceptualized the behavioral system model identified seven (7) behavioral subsystem
Hildegard Peplau

postulated the Goal Attainment Theory

Martha Rogers

nursing is an art and science that is humanistic

and humanitarian

conceptualized the science of unitary human

beings and principles of homeodynamics Jean Watson

defined nursing as a healing art of human relationship between an individual who is sick, or in need of health services, and a nurse to recognize and respond to the need for help. viewed nursing as an interpersonal process conceptualized four (4) sequential phases of interpersonal relationship characteristics of Interpersonal Relationship Goal oriented Understanding, emphatic Concreteness Honest, open communication Acceptance, nonjudgmental attitude

conceptualized the human caring model emphasized that nursing is the application of
the art and human science through transpersonal caring transactions through self knowledge, self control, self care and self healing Ida Jean Orlando

conceptualized the dynamic nurse patient

relationship model

advocated the three (3) elements composing

nursing situation; client behavior, nurse reaction and nurse action. Joyce Travelbee

Lydia Hall

nursing is participation in care, core and cure

aspects of patient care

key concepts of three interlocking circles

Dorothea Orem

postulated interpersonal aspect of nursing

model

nursing is needed when the self care demands

are greater than the self care abilities

viewed that interpersonal process is a human

to human relationship formed during illness and experience of suffering NURSING PROCESS Nursing Process

defines three steps in nursing process key concepts of self care deficit theory of
nursing

 the cornerstone of the nursing profession. it is synonymous to problem solving approach it is originated from the theory of Lydia hall,
Dorothy Johnson and Ida Jean Orlando

identify appropriate nursing interventions write a nursing care plan

Implementation

It is problem-oriented, goal-oriented,
organized, systematic, humanistic care / interpersonal, dynamic, cyclical and universal Assessment

collecting, validating, organizing and recording

data

skills performed competently perform in appropriate environment clients safety protected putting nursing care plan to action carry out planned nursing interventions to help
attain goals and achieve optimal level of health

to establish data base collection of data methods of collection data making information is accurate clustering facts into groups of information
Diagnosing

to determine the order in which nursing

interventions are carried out

relevant documentations should be done

Evaluation

assessing the clients response to nursing

interventions

appraise the extent to which goals and

outcome criteria of nursing care have been achieved

clinical art of identifying problems identify the clients needs and to prepare
diagnostic statements

analyze the reasons for the outcomes

MEDICATION Pharmacokinetic Process

use PES format organize cluster or group data compare data against standards analyze data after comparing with standards. determine the clients health problems, health
risks and strength Planning

Absorption Distribution Metabolism Excretion

Types of Doctors Order

formulating and documenting client focused

goals

provide individualized care promote client participation allow involvement of support people establishing priorities short term goal and long term goal SMART well stated outcome criteria

Standing Order Single Order STAT order PRN order

Therapeutic Actions of Drugs

Palliative

 Curative Supportive Substitutive Chemotherapeutic Restorative

7 Rights of Medications

A patient is to receive NPH 50 u s.c. daily. Stock is 100 u/ml in 10 vial. How many milliliter should be administered? Answer is: _______ Example 5: The physician order reads Administer 0.02 gram furosemide (Lasix) IM. Stock is 20 mg /ml ampule. How many milliliters will you administer? Answer is: ________

Pediatric Dose:
A. Clarks Rule weight in lbs X usual adult dose = Safe CD 150 lbs Example 6: Baby Tina weighs 30 lbs and the adult dose 25 mg. What is the safest dose for Baby Tina? Answer is: _______ B. Freids Rule Age in months X usual adult dose = Safe CD 150 months Example 7: Baby Joey is now 11 months old, the adult dose is 50 mg. What is the safest childs dose according to Freids rule? Answer is: ________ C. Youngs Rule Age in years X usual adult dose = Safe childs dose Age in years + 12 Example 8: Baby Jay is 5 years old last December 16, 2007, the adult dose is 75 mg. What is the safe childs dose? Answer is: ________ 4. Right Route a. Oral

Right Client Right Medication Right Dosage Adult Dose:

Oral Medication (Solid) Desired dose = safe adult dose Stock dose Example 1: An hypertensive agent, minoxidil (Loniten) 5 mg p.o. is ordered. Stock is 2.5 mg/tab. How many tablets should be administered? Answer is: _______ Example 2: An hypertensive agent, Captopril (Capoten) grain p.o. is ordered. Stock is 60 mg/tab. How tablet will you give to your patient? Answer is: _______

Parenteral / Oral Medication (Liquid)

Desired dose X Quantity of Dilution = safe AD Stock dose Example 3: The expectorant guiafenesin (Robitussin) 300 mg p.o. has been ordered. The bottle is lab 100 mg/ 5ml. How many milliliters should be given? Answer is: ________ Example 4:

Advantages Disadvantages Drug Forms

marasmus
Protein

b. Sublingual

Advantages Disadvantages

growth and repair of tissues maintain fluid and acid base balances meat, fish, dairy products, eggs, nuts,
legumes, cereals

c. Buccal

kwashiorkor
Vitamin D

Right Time Right Advise / Attitude / Approach Right Documentation / Recording

PRINCIPLES IN ADMINISTERING MEDICATIONS

calcium and phosphorous absorption, bone

mineralization

dairy products, eggs, yolks and fatty fish rickets (in children), osteomalacia (in adults)
Vitamin K

Observe the rights in giving medications. Practice asepsis. Nurses who administer medications are
responsible for their action.

blood clotting green vegetables hemorrhages

Calcium

Be knowledgeable about the medications that

you administer.

bone and tooth formation, muscle function and

nerve transmission

Keep narcotic in locked place.

containers.

Use only medications that are clearly labeled Do not leave the medications at the bed side. If the patient vomits after taking the
medication, report.

milk products, dark green leafy vegetable,

salmon, orange juice, tofu

stunted growth in children, osteoporosis in

adult

Preoperative medications are discontinued

during the postoperative, unless ordered.

99% is in the bone major component of renal calculi

Magnesium

When a medication is omitted for any reason,

record with the reason.

When a medication error is made, report it

immediately. NUTRITION Carbohydrates

bone and tooth formation whole grain, nuts, legumes, dark green leafy
vegetables

growth failure in children

Potassium

provides energy; protein sparing cereal, fruits, vegetables, milk

major intracellular cation fluid balance, nerve and muscle function meat, milk, vegetables, legumes, bananas

Iron

components of hemoglobin red meat, organ meat, egg yolk anemia

Fluoride

formation of bones and teeth fluoridated water and toothpastes higher frequency of tooth decay
Vitamin B1

37 C (98.6 F) - normal temperature Hypothalamus thermoregulation center Pyrexia temperature of 38-40 C Hyperpyrexia very high temperature as 41 C Rectal most accurate Rectal 2-3 minutes Oral 3-5 minutes Axillary 6-9 minutes
0 0 0

Types of Fever

Thiamine muscle nerve function whole grains, pork, cereals, legumes, seeds
and nuts

fever no

Intermittent fever fever no

remains

Remittent fever fluctuates but above normal Relapsing fever elevated for few normal temp. for 1-2 days

Beriberi, poor coordination

Vitamin B3

days then

Niacin coenzyme for energy metabolism whole grains, meats, fish, nuts and eggs
Vitamin B9

Constant fever fluctuates minimally and consistently high Factors Affecting Heat Loss

Folic acid aids in metabolism of genetic material (DNA,

RNA)

Radiation transfer of heat from the surface of the object without contact between two objects. Conduction transfer of heat from one surface to another. Convection transfer of heat by air currents Evaporation insensible heat loss

green leafy vegetables, nuts, legumes, grain

products

poor growth, birth defects

PHYSICAL ASSESSMENT Methods

Inspection Palpation Percussion Auscultation

Conversion Centigrade to Fahrenheit F = (Temperature in C) X 1.8 + 32

Temperature

Example: Convert 41 C to F: Answer is ________

Convert 38 C to F: Answer is ________ Convert 36.5 C to F: Answer is _______

Pulse Deficit Respiration

Volume

Convert 39.4 C to F: Answer is _______ Conversion Fahrenheit to Centigrade C = (Temperature in F ) 32 / 1.8 Example:

Convert 105.8 F to C: Answer is _______ Convert 100.4 F to C: Answer is _______ Convert 97.7 F to C: Answer is ________

Ventilation Inspiration and Expiration

Respiratory Center pons and medulla oblongata 12 20 breaths per minute - normal 500 ml normal tidal volume

Convert 102.9 F to C: Answer is _______ Pulse 60-100 bpm Age Sex / Gender Exercise Fever Medications Hemorrhage Stress Position

Carbon dioxide major chemical stimuli for respirations Hering Breuer reflex prevents the lungs from over expanding Assessing Respirations Rate tachypnea, bradypnea, eupnea

Depth /Volume Hyperventilation, Hypoventilation Rhythm Cheyne-Stokes, Kussmaul, Biots Quality / Effort / Character - dyspnea, orthopnea, apnea Chest movements Intercostals retractions - ribs Substernal retractions Suprasternal retractions above

Pulse sites

Temporal Carotid Apical Brachial Radial Femoral Popliteal Posterior Tibial

breastbone

the clavicle Blood Pressure Systolic pressure (100-130 mmHg) Diastolic pressure (60-90mmHg) Pulse pressure Mean Arterial pressure Korottkoffs sound

Dorsalis Pedis Assessment of the Pulse Rate Rhythm

Determinants of Blood Pressure

MOUTH and PHARYNX

(cardiac

Pumping action of the heart output) Peripheral Vascular Resistance Blood Volume Blood Viscosity

Firth teeth (central lower incisors) appear 5 to 8 months, 20 temporary teeth at 2 years old, losing them at 6-7 years old, replaced by 32 permanent teeth with appearance of wisdom tooth (3rd molar), buccal mucosa, 3 pairs of salivary glands, tonsils, uvula, cranial nerves 9, 10, 12 NECK

Elasticity or Compliance of Blood Vessels Factors Affecting Blood Pressure Age Exercise Stress Race Obesity Gender / Sex Medications Diurnal Variations Disease Process

Occipital, Postauricural, preauricular, submandibular, submental, anterior cervical, posterior cervical, deep cervical, supraclavicular, trachea, thyroid gland, bruits, thyroid storm, jugular veins, sternocleidomastoid and trapezius, cranial nerve 11 THORAX and LUNGS

Barrel chest, Pigeon chest, Funnel chest, vesicular, bronchovesicular, bronchial, crackles, gurgles, friction rub, wheezes, resonant, dullness, hyper-resonance CARDIOVASCULAR

Assessing Blood Pressure ( common error) HEAD

Skull, scalp, hair

Systole, Diastole, Aortic, Pulmonic, Erbs point. Tricuspid, Mitral, S1, S2, Murmurs ABDOMEN

EYES and VISION PERRLA, Anisocoria, 3-7 mm, snellen chart, 20/20, 20/200, myopia, hyperopia, presbyopia, astigmatism, tonometry, perimetry, ophthamoscopy, genioscopy, Cranial Nerves 2, 3, 4, 6, comjunctiva, ishihara chart, peripheral fields EARS and HEARING

Sequence IAPP, bowel sounds, borborygmi, light palpation, deep palpation, costovertebral angle tenderness, 4 quadrants, 9 regions, dullness MUSCULOSKELETAL

3 divided parts, otoscope, tunning fork, up and back, down and back, weber test, rinne test, conductive hearing loss, schwabach test, cranial nerve 8, watch tick test NOSE and PARANASAL SINUSES

Assessed for muscle strength, contractures, muscle tone, muscle strength, fasciculation, tremors, signs of inflammation, abnormal spinal curvature, flatness, active range of motion limitation, joints for swelling and tenderness, SKIN

Facial sinuses, nasal speculum, penlight, cranial nerve 1

The first line of defense

Composed of the superficial epidermis and the true skin dermis Pallor Cyanosis Jaundice Erythema

Patient to take a deep breath, hold for 3 seconds, and cough deeply 2 to 3 times Perform 2 to 3 hours postoperatively

Contraindicated for eye surgery DEEP BREATHING Expands alveoli and mobilizes secretions Place patient in fowlers or sitting

NERVOUS SYSTEM

Mental status, level of consciousness, reflexes, DTR, superficial cutaneous reflexes, pathologic reflexes, motor functions, sensory function, stereognosis, graphesthesia, cerebellar function, cranial nerves FEMALE and MALE GENITALS

Place clients hands (palm) along the lower rib cage to feel diaphragm movement Inhale fully through the nose, hold for 2 to 3 seconds Exhale slowly through the mouth PURSED LIP BREATHING Allows a gradual decline in intrapulmonic pressure hence preventing lung collapse Takes a deep breath, hold it for a moment then exhale slowly through a pursed lip Builds pressure backwards keeping the airways open through out exhalation More air escapes during exhalation and helps prevent air trapping CHEST PHYSIOTHERAPY Help clear excessive bronchial secretions from airways by shaking mucus from the walls of the airways and draining them from the lungs Produce mechanical wave of energy that is transmitted through chest wall (Percussion) With the use of hand placed on clients chest with rapid and vigorous vibration as client exhale Use of gravity to assist in the movement of secretion (postural drainage) NASOGASTRIC TUBE FEEDING Provide enteral nutrition for clients who cannot swallow, with esophageal obstruction, unconscious, and cannot consume oral feeding.

History of menstruation, LMP, external genitalia, internal genitalia, history of voiding changes, pubic hair, penis, scrotum, inguinal areas, rectum BASIC CONSIDERATIONS FOR BASIC NURSING PROCEDURES HAND WASHING Single most effective and least expensive method to prevent nosocomial infection Part of every beginning and end of nursing procedures Use warm running water

Apply soap and rub palms, wrists, and back of hand firmly with circular motion, interlace fingers and thumbs and rub with lather and friction mechanically loosen dirt. Rinse hands and wrist with hands held lower that forearm Dry with paper towel or blower, wiping from fingertips toward the forearm, turn off faucet with clean paper towel COUGHING

Single most effective measure to control respiratory secretions upward Splint incision, if any, with pillow

Measure the distance from the tip of the nose to earlobe through the bottom of the xiphoid process Use water soluble jelly as lubricant Advance tube forward, head bent forward closes the epiglottis and trachea

clients

To reverse hypoxemia To improve tissue oxygenation Decrease work of breathing in dyspneic Decreases myocardial workload

NURSING IMPLICATION Oxygen is colorless, odorless, tasteless gas so leakage cannot be detected Oxygen is a dry gas, it can irritate mucous membrane of the airways Oxygen supports combustion, it can cause fire

High fowlers, if contraindicated place right side lying position with head slightly elevated to prevent aspiration. Flush with 30-60 ml of water after feeding If NGT is to removed, instruct client to exhale and remove tube with smooth, continuous pull Inject 10 ml of air and auscultate for gurgling sound in the epigastrium. Aspirate for residual stomach content (ph 1-3 of yellow to green) Immerse tip of the NGT into water and observe for bubbling. X-ray confirms FECAL IMPACTION REMOVAL

OXYGEN THERAPY

Position the client in semi-fowlers position

Insert flowmeter, with humidifier (oxygen dries up) Regulate the prescribed flow rate (LPM) Assess vital signs, oxygen saturation, color, breathing pattern and orientation Oxygen Toxicity: Retrolental fibroplasia retinal damage leading to irreversible blindness due to exposure to 100% oxygen in adult and to high oxygen flow rate (40% or more) in neonate, especially premature (retinopathy of prematurity) BLOOD GROUPS Transfusion Reaction Allergic Reaction Flushing, urticaria, wheezing, rashes

Prepare all materials (gown, gloves, bedpan, water soluble lubricant) in anticipation of strong odor and large quantity of stool. Rule out contraindications related to vagal stimulation (innervating GIT, decreases PR and lead to dysryhtmia for weak and cardiac patients).

Side lying position, insert index finger with a gentle hooking position, careful as perforation may occur Note for any signs of fatigue, pallor, diaphoresis, and changes in pulse rate. Prepare for quick evacuation as hardened stool blocking the lumen is removed. OXYGEN THERAPY

Pyrogenic / Febrile Reaction Fever and chills Headache and body malaise

Hemolytic Reaction Facial flushing, chills, low back pain, hypotension, hematuria leading to anaphylactic shock

CLEANSING ENEMA Non-Retention Enema Solutions used are as follows:

Most rapid route of absorption of medication Route can be use for clients with compromised gastrointestinal function or peripheral circulation Large doses of medication can be administered Purposes: Fluid and electrolytes imbalance Provide food Vehicle for medication For blood transfusion

Tap water (500-1000 milliliters)

Soap suds (20 ml of soap in 500 - 1000 ml of water) Normal Saline Solution (9 ml of NaCl to 1000 ml of water) Hypertonic solution / fleet enema (90-120 ml) Position: Adult: left lateral position Infant/Children: dorsal recumbent

Equipments: IV Fluid, IV set, Micropore, tourniquet, cotton balls, alcohol, splint Complications of I.V. Therapy Infiltration Thrombophlebitis Nerve damage Circulatory Overload Air Embolism Speed shock Drug Overload

Sizes of rectal tube: Adult - Fr 22-32 Children - Fr 14-18 Infant - Fr 12 Height of Solution: 18 inches above the rectum

Temperature of Solution: 115 125 F on preparation Time of retention: 5 -10 minutes for better cleansing effect Retention Enema Solutions used are as follows:

Carminative Enema

IV Fluid Formula Volume X Drop Factor Time 60 Example: The doctor ordered for 2 liters of D5LR to run for 18 hrs with drop factor of 20. How many drops per minute? Answer is :________ The doctor ordered for 1L of PNSS to run for 10 hrs with drop factor of 15. How many drops per minute? Answer is :________

Oil (90-120 ml of mineral, olive or cotton seed oil Height of Solution: 12 inches above the rectum Temperature of Solution: 105 110 F on preparation Time of retention: 1 -3 hours until therapeutic effect is obtained I.V. Therapy Intravenous

Direct IV, IV Push, IV infusion

urinary bladder. Purposes To relieve discomfort due to bladder distention. To assess the amount of residual urine if the bladder empties incompletely. To obtain urine specimen.

The doctor ordered for 500ml of 0.45 NaCl to run for 6hrs with drop factor of 10. How many drops per minute? Answer is :________ The doctor ordered for 100ml of D5 water to run for 1hr with drop factor of 60mcgtts. How many drops per minute? Answer is :________ SUCTIONING

surgery.

To empty the bladder completely prior to

Use appropriate catheter size: F 5-8 for infants; F 8-10 for children; F 1218 for adult Position client fowlers (for those with intact gag reflex); side lying (for unconscious) to prevent aspiration Adjust pressure:

To Facilitate accurate measurement of urinary output. To provide intermittent or continuous bladder drainage. To prevent urine from contacting an incision after perineal surgery. To manage incontinence when other measure have failed. Position Male : Supine, legs abducted and extended Female : Dorsal Recumbent position Location of urinary meatus Male : at the tip of the glands penis

Wall unit - 50-75 mmHg in infants, in children 95-100 mmHg, in adults 100-120 mmHg Portable unit 2-5 mmHg in infants, in children 5-10 mmHg, in adults 10-15 mmHg

orifice

Female : between the clitoris and vaginal

Size of Catheter Male: Fr 16-18

Female : Fr 12-14

Pre-oxygenate client Lubricate Catheter

Length of catheter insertion Male : 6-9 inches

Female : 3-4 inches

Exert suction by closing the open port, withdrawing catheter in rotating motion within 510 seconds only Hyper-oxygenate for a full minute between subsequent suctioning. Encourage deep breathing Urinary Catheterization is the introduction of catheter through the urethra into the

Assessment Determine the most appropriate method of catheterization. Use a straight catheter if only a spot urine specimen is needed. Use indwelling/retention catheter if the bladder must remain empty/continuous urine measurement collection is needed. Determine when the client last voided or was last catheterized.

Percuss the bladder to check for fullness or distention. POSITIONING Side lying position client lies on the side with weight on the hip and shoulder, with pillows support legs, arms, head and back. choice position for clients with pressure sore on bony prominence contraindicated post hip replacement and other orthopedic surgery tonsillectomy to promote drainage of secretions seizure to prevent backward falling of the tongue pyloric stenosis (right) after meals to facilitate entry of stomach contents into the intestines lumbar puncture (lateral during the procedure) to facilitate the entry of the needle between L3-L4 hemorroidectomy to prevent pain

congestive heart failure to improve oxygenation autonomic dysreflexia to prevent hypertensive stoke Semi-fowlers position

semi-sitting with head elevation of 30-45 degrees clients with DOB, eating and improvement of cardiac output contraindicated with post spine surgery

abdominal aneurysm surgery to prevent pressure on the graft appendicitis (if ruptured) to prevent the upward spread of infection bronchoscopy (post procedure) to prevent aspiration cataract (post op) to prevent edema on the operative sit cerebral aneurysm to prevent pressure in the aneurysm site supratentorial craniotomy to facilitate venous drainage from the head CVA to reduce ICP hypophysectomy to prevent increased

liver biopsy (right) post procedure to prevent bleeding Sims position

client lies on the side with weight distributed toward the anterior ileum, humerus, and clavicle with pillows support on flexed arms and legs. choice position for clients with pressure sore on bony prominence contraindicated with spine or orthopedic condition Fowlers position sitting position raises clients bed head to 90 degrees clients with DOB, eating and improvement of cardiac output contraindicated with post spine surgery

ICP

laryngectomy to maintain patent airway and minimize edema

lobectomy to promote breathing

paracentesis to facilitate removal of fluid in the abdominal cavity thyroidectomy to prevent hyperflexion and hyperextension of the neck, to prevent tension on the suture line myelogram (if water based dye Amipague) to prevent upward dispersion of the dye hiatal hernia (after meals) to prevent reflux of the stomach contents

placenta previa (sitting) to minimize bleeding pulmonary edema to facilitate breathing thoracentesis (during the procedure) to facilitate removal of fluid in the chest wall

Dorsal recumbent

client lies supine with legs flexed and rotated outward for vaginal examination Knee chest position lies prone with buttocks elevated and knees drawn to the chest rectal procedures and examination contraindicated for arthritis and other joint deformity prolapsed cord to prevent pressure on the cord

Enema

Lung and Lymph Node biopsy Pulmonary Function Studies Arterial Blood Gas Studies Thoracentesis Holter Monitoring Magnetic Resonance Imaging

proctosigmoidoscopy to facilitate visualization Trendelenburg lies supine with head 30-40 degrees lower than the feet for postural drainage and promotion of venous return contraindicated may result in increase intracranial and intraocular pressure and may result hypotension. shock to promote venous return to the heart

Computed Tomography

Upper Gastrointestinal Series / Barium Swallow Lower Gastrointestinal Series / Barium

Endoscopy Proctosigmoidoscopy Colonoscopy

TPN during tube insertion to prevent air embolism DIAGNOSTIC EXAMINATIONS AND PROCEDURES

Mantoux Test Chest X-ray Bronchography Bronchoscopy Lung Scan Sputum Examination

Liver Biopsy Paracentesis Gastric Analysis Bone Marrow Aspiration Intravenous Pyelography Angiography

Lumbar Puncture Electroencephalogram Electrocardiography

Endoscopic Retrograde Cholagiopancreotography (ERCP) Close Thoracostomy Tube Sengstaken Blakemore Tube