RABE 2 Reviewer (chymeee) • Lactiferous ducts—connect alveolar

Health Assessment: glands to nipple

 Thorax & Lungs
Inspection - is the first step of the examination.   Abdomen Assessment
This is a very important part of the exam, since Inspection
many abnormalities can be detected by merely  Know if there are any pulsations
inspecting the thorax as the patient is (rhythmical throbbing or vibrating),
breathing. mostly one finger above belly button
Palpation - is the first step of the assessment,  See if the patient has any wounds.
where we will touch the patient.  Many  Ask the patient how he/she feels.
breathing difficulties can be seen during this  See what type of stool is putting out,
step.  Some systemic problems can be detected the smell, and kung kailangan na paltan
during this part of the exam as well as just yung bag.
mechanical breathing problems.  Listen to the bowel sounds with a
Percussing - is usually helpful only in a limited stethoscope in a clockwise rotation.
capacity to the examiner, as we will discuss Auscultation:
later.  Listen for sounds in the area of the 4
Auscultation - is the process of listening to the quadrants, identify for normal or
breath sounds with the use of a stethoscope.  abnormal sounds around the area.
We will describe the characteristics of normal
Percussion:
and common abnormal breath sounds.
 percussion is (medicine) the tapping of
 Breast & axillae
BREAST ASSESSMENT - screening method
used in an attempt to detect early breast
cancer. The method involves the woman
herself looking at and feeling each breast
for possible lumps, distortions or swelling.

Breast Anatomy:
• Areola—central pigmented area
• Nipple—protruding central area of the body as an aid to medical diagnosis
areola  Lightly percuss (gently tap) with a finger
• Lobes—internal structures that the abdomen to determine the location
radiate around nipple of the pain.
• Lobules—located within each lobe  As if the patient feels any pain along the
and contain clusters of alveolar area
glands Palpation:
• Alveolar glands—produce milk when  palpation is (medicine) the act of feeling
a woman is lactating (producing or pushing on various parts of a
milk) patient's body to determine medical
condition such as the normality of
 organs or the presence or absence of is not in the bladder. Deflate the balloon
tumors, swelling, muscle tension, etc. and insert the catheter further into the
 Ramdamin yung texture, location at bladder. ALWAYS ensure urine is flowing
before inflating the balloon. Note that in a
tenderness nung organ body part.
child under 6 months a balloon is not
Funda: typically used. In this case be especially
 Catheterization mindful that strapping is secure.
 A urinary catheter is a hollow, partially  Withdraw the catheter slightly until
flexible tube that collects urine from the resistance is felt and attach to drainage
bladder and leads to a drainage bag. system
Urinary catheters come in many sizes and  Remove gloves and perform hand hygiene
types. They can be made of: Rubber, plastic,  Secure the catheter to the thigh with either
silicone a catheter securement device or tape
PROCEDURE INSERTION  Clean trolley and dispose of used articles
Female child into yellow biohazard bag
 Perform hand hygiene  Perform hand hygiene 
 Place child in supine position with knees
Male child
bent and hips flexed
 Perform hand hygiene
 If soiling evident, clean genital area with
soap and water first  Place child in supine position
 Perform hand hygiene  If soiling evident, clean genital area with
soap and water first
 Open dressing pack (aseptic field) and
prepare equipment needed using aseptic  Perform hand hygiene
technique  Open catheter pack (aseptic field) and
 Pour sterile normal saline onto tray prepare equipment needed using aseptic
technique
 Perform aseptic hand wash and don sterile
gloves  Pour sterile saline onto tray
 Apply sterile drapes/towel  Perform aseptic hand wash and don sterile
gloves
 Separate labia with one hand and expose
urethral opening. In neonates, the urethral  Lift the penis and retract the foreskin if non-
meatus is immediately above the hymeneal circumcised. Do not force the foreskin back,
fringes. especially in infants. A sterile gauze swab
can be used to hold the penis. 
 Using swabs held in forceps in the other
hand clean the labial folds and the urethral  Using other hand, clean the urethral
opening. Move swab from above the opening with swabs held in forceps. Use a
urethral opening down towards the rectum. circular motion from the urethral opening
Discard swab after each urethral stroke into to the base of the penis.  Discard swab into
waste bag or designated waste area. waste bag or designated waste area. 
 Remove catheter wire if a 6Fr catheter is  For boys older than 3 years insert the
used Xylocaine gel into the urethra. Gently hold
the urethra opening closed and wait 2 - 3
 Lubricate catheter
minutes to give the gel time to work. For
 Insert catheter into the urethral opening,
infants apply sterile lubricant to catheter
upward at approximately 30 degree angle
before insertion. Post urology surgery
until urine begins to flow.
consider using two syringes of xylocaine gel
 Inflate the balloon slowly using sterile water
to increase lubrication of the urethra and
to the volume recommended on the
decrease risk of trauma.
catheter. Check that child feels no pain. If
 Remove the wire if using a 6Fr catheter
there is pain, it could indicate the catheter
  Hold the penis with slight upward tension Sheet Order:
and perpendicular to the child's body. Insert
 Tray & Tray Lining
the catheter.
 When the first sphincter is reached (at level  Pillow
of pelvic floor muscles) gently bring the  Pillow Cover
penis down to face the child's toes, apply
 Bed Cover
constant gentle pressure. If resistance is felt
the following strategies should be  Blanket
considered:  Top Sheet
 Remove the catheter and utilize a  Draw sheet
2nd tube of lubricant
 Rubber Mackintosh
 Increase traction on penis and
apply gentle pressure on the  Bottom sheet
catheter  Bed Bath
 Ask the child to take a deep breath
To get ready to give someone a bed
 Ask the child to cough and bear
down e.g. try to pass urine bath, start by gathering materials. You
 Gently rotate the catheter. will need:
- Four or more face cloths or bath
Special precautions
sponges.
Rapid drainage of large volumes of urine
from the bladder may result in hypotension and/or - Three or more towels.
hemorrhage. If concerned clamp catheter if the - Two wash basins (one for soapy
volume seems excessive. Release clamp after 20 water, one for rinsing).
minutes to allow more urine to drain. A medical
review of the child should be requested.
- Soap (a bar of soap, liquid soap, or
For post obstructive diuresis IV replacement wipes).
of fluid and electrolytes may be required. This should - "No-tears" or no-rinse shampoo.
be discussed with the treating medical team.
- Body lotion.
- A waterproof mat or sheet to keep
 Perineal Care the bed dry.
1. Gather supplies.
2. Provide privacy for the patient. 3. Wash
hands and put on gloves.
4. With the patient on their back, instruct
them to open their legs. 5. Cleanse the
perineum, using front to back motions. Use
a fresh washcloth for each pass from front
to back.
6. Never wash back to front; this causes
contamination and can cause infections.
7. Dry the area thoroughly.

 Bed Making
- A table or stand to hold the back side. (If you can't roll a
materials. person by yourself, get
- Ask the person if the room is too someone to help you so that
warm or too cool, and change the you don't hurt your back.)
temperature if needed.
Then help the person roll onto
- Wash and dry your hands, and put on their back.
gloves if you choose to wear them. o Pour out the water (which by
- Let the person undress and wash as now may be cold) and replace
much as they are able. Remove it with fresh warm water.
clothing only from the area you are o Using a new face cloth, clean
going to wash. For example, uncover the genital area first and then
an arm, wash and dry it, and then put the anal area.
it back into a shirt or gown. - Remove gloves if you are wearing
- Wash with the face cloth and soapy them. Change the water and wash the
water or wipes, and then rinse using hair. You can use water and a no-
another face cloth and the clear water. tears or no-rinse shampoo. Look
- Start with the cleanest areas of the carefully at the scalp for any redness
body and finish with the areas that are or sores.
less clean. After you wash an area, - Rinse the hair with clean, warm water.
turn the face cloth so you can use a - When you are finished with the
new, clean part of it for the next area. bath, apply an unscented body
Use a new face cloth when you need lotion to protect the skin and
one. keep it from becoming dry. Don't
put lotion on areas that can
o Wash the eyelids, starting
become moist, such as under the
from the inside and moving breasts or in the folds of the
out. groin. Help the person as needed
o Wash the face, ears, and to finish dressing. Put away your
supplies and wash your hands.
neck.
o Wash the arms one at a time,
and then the hands.  Types of Bed Bath
o Wash the chest and belly, - complete bed bath
including the belly button. - partial bath
o Wash one leg, and then the - tub or shower bath
other.
o Wash the feet and in between
 Bed Shampoo
the toes.
- Put a small amount of
o Help the person roll on his or
shampoo on the person's head
her side so you can wash the
 and gently rub his hair and - The fetal outline can also be
scalp now palpated by the examiner
- Rinse the person's hair with through the abdomen.
warm water until the shampoo
is gone  Discomforts during pregnancy
- Apply conditioner to the hair, if management
desired, and rinse well. - Abdominal Pain
- Remove the tray or trough and - Backache
replace it with a towel. - Breast Discomfort
 Oral Care - Breathlessness
Mother: - Constipation
 Psysiological changes during - Contractions
pregnancy, systemic, local - Cystitis (Bladder Infection)
- Chadwick’s sign or a change in - Dizziness and Faintness
the color of the vagina from - Fatigue
pink to violet is a probable sign - Headaches
of pregnancy. - Heartburn
- Goodell’s sign is a probable - Hemorrhoids
sign that depicts a softening of - Leg Pains and Cramps
the cervix. - Morning Sickness
- Hegar’s sign is the softening of - Mouth and Gum Discomfort
the lower uterine segment. - Nasal Congestion
- Ballottement is described as or Nosebleeds
the rise of the fetus felt - Numbness
through the abdominal wall
when the uterine segment is
tapped on a bimanual
examination.
- An evidence of a gestational
sac found during ultrasound is
another probable sign.
- Braxton-Hicks contractions are
periodic uterine tightening and
contractions.
- Skin Changes and Stretch
Marks  Nutritional need of mothers
- Sleep Problems - A mother's need for iodine and choline
and Insomnia increases during lactation. The Dietary
Guidelines for Americans recommend
- Leg Swelling
lactating parents consume 290 mcg of
- Taste Changes iodine and 550mg of choline daily
- Urination Problems throughout the first year postpartum.
- Vaginal Iodine can be found in dairy products,

Discharge or Itching

 Prenatal care, health teaching,

schedule of visits
- Every four (4) weeks until the
28th week or one (1) prenatal
visit in a month.
- Every two (2) weeks until the
36th week or one (1) prenatal
visit every two (2) weeks.
- Every week until delivery or
one (1) prenatal visit every
week.

 Ultrasound, vaccines
- women get an ultrasound in
their second trimester at 18 to
20 weeks of pregnancy.
- Some also get a first-trimester
eggs, seafood, or in iodized table salt.
ultrasound (also called an early
ultrasound) before 14 weeks of
 Leopolds Maneuver, estimate
pregnancy.
AOG
- The number of ultrasounds and - First Maneuver (Upper pole). Palpate
timing may be different for uterine fundus, identify where the
women with certain health baby’s head is facing
conditions like as asthma and - Second Maneuver (Sides of maternal
Abdomen). Palpate side of abdomen to
obesity locate back and front of the fetus and
 to auscultate and get the fetal heart Motivation
rate of the fetus. 1. In every person, there is a
- Third Maneuver (Lower pole), palpate fundamental desire to learn.
symphysis pubis & xyphoid process and Awakening this desire is called
motivation
determine if there are any obstructions 2. Two types of motives
in the fetus way 1. primary motives-are driving
- Fourth Maneuver (Presenting part forces initiating people into
evaluation) palpate symphysis pubis & action
xyphoid process and push fetus, if it 2. secondary motives –are
bounce back meaning it is not yet created by outside forces or
incentives
engage and not ready to go out
3. Need for incentives is a first step in
learning to change
Health Education 4. Incentives may be positive or
negative
 Principles of HE 5. Main aim of motivation is to change
Credibility behavior
1. It is the degree to which the message 6. Motivation is contagious: one
to be communicated is perceived as motivated person may spread
trustworthy by the receiver motivation throughout a group
2. Good health education must be
consistent and compatible with Comprehension
scientific knowledge and also with 1. Always communicate in the language
the local culture, educational system people understand.
and social goals 2. Teaching should be within the
mental capacity of the audience.
Interest
1. Health teaching should be related to
the interests of the people Reinforcement
2. Health programme should be based 1. Repetition of message at intervals
on the “FELT NEEDS”, so that it is necessary
becomes “people’s programme 2. If the message is repeated in
3. Felt needs are the real health needs
different ways, people are more
of the people, that is needs the
people feel about themselves
likely to remember it

Participation Learning by doing

1. A high degree of participation tends 1. The importance of learning by
to create a sense of involvement, doing can be best illustrated by
personal acceptance and decision – the Chinese proverb “if I hear, I
making forget; if I see, I remember; if I
2. It provides maximum feedback do, I know”
3. The Alma- Ata Declaration states
“The people have a right and duty to Known to unknown
participate individually and We must proceed
collectively in the planning and  “from the concrete to the
implementation of their health care”
abstract”
4. Health programmers are unlikely to
 “from the particular to the
succeed if community participation
is not an integral part general”
  “from the simple to the more - A nurse has the legal responsibility to
complicated” be the advocate for the patient in all
 “from the easy to more difficult” health care instances, including
 “from the known to unknown” emergencies. The nurse will be the
Here health communicator uses the liaison between the physician and the
existing knowledge of the people as pegs patient. The nurse has the legal duty to
on which to hang new knowledge monitor the patient and watch for any
abnormalities or complications that
Feedback
may occur.
1. The health educator can modify the
elements of the system (e.g., - A nurse is obligated to stay up-to-date
message, channels) in the light of on all the latest developments
feedback from his audience regarding a patient's care. They also
2. For effective communication, have the responsibility to monitor the
feedback is of paramount patient's care and treatment and
importance.
express all concerns and findings to the
Leaders patient's doctor or other healthcare
 Leaders are agents of change and professional.
they can be made use of in health
education work.
 The attributes of a leader are;
 He understands the needs  Rights of patient
and demands of the 1. Right to Appropriate Medical Care and
community
 Provides proper guidance,
Humane Treatment
takes the initiative, is 2. Right to Informed Consent
receptive to the views and 3. Right to Privacy and Confidentiality.
suggestions of the people; 4. Right to Information
 Identifies himself with the 5. The Right to Choose Health Care
community; Provider and Facility.
 Selfless, honest, impartial,
6. Right to Self-Determination
considerate and sincere;
 Easily accessible to the 7. Right to Religious Belief.
people; 8. Right to Medical Records
 Able to control and 9. Right to Leave
compromise the various 10. Right to Refuse Participation in Medical
factors in the community; Research.
 Possesses the requisite skill
11. Right to Correspondence and to Receive
and knowledge of eliciting
cooperation and achieving Visitors.
coordination of the various 12. Right to Express Grievance
official and non-official 13. RIght to be Informed of His Rights and
organizations. Obligations as a Patient.

 Structure personality ID, Ego,

 Roles & Responsibilities Superego
ID
- The id is that part of the psyche that is
the source of instinctive
- energy, impulses and drives.
(Unconscious mind)
- Based on the pleasure principle, it
directs behavior towards
- self-gratification.
- Demand to take care of needs
immediately.
- The ID is also not in contact with reality.
It only knows that it wants
- what it wants right away regardless of
the present circumstances or the
- consequences.
- When needs are not satisfied, such as
the need for food, it begins to
- demand more and more attention, until
there comes a point where the
- person can’t think of anything else.
Ego
- It is focused on helping the person
achieve their goal in ways that are
realistic and acceptable.
- a person's sense of self-esteem or self-
importance.
Superego
- The superego develops last as the
person incorporates standards,
restrictions, taboos, ideals imposed by
parents and other individuals whom the
child associates with to guide behavior,
thoughts and feelings.

 Piaget theory
- Jean Piaget (Swiss) felt that there were
four major stages in the development
of logical thinking with each stage
building on each other