nursing fundamentals lecture

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 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 % Educator/Teacher – involves nursing activities, health promotion, the primary concern Counselor – providing emotional, intellectual and psychological support Manager/Coordinator – manages the nursing care. 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 • 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 NURSING THEORIES Florence Nightingale • • • • Promotive – an action or measures designed to support behavior conducive to health Preventive – any actions or measures designed to protect individuals, families, groups, communities from harm to their health Curative – any actions or measures designed to correct or remove disease or any illness. Rehabilitative – any actions or measures designed to restore health and promote recovery from any alteration of health • mother of modern nursing • developed and described the first theory of • environmental theory Virginia Henderson nursing • 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. 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 • • defined nursing as service to individuals, • introduced patient-centered approaches to • identified twenty one (21) nursing problems Dorothy Johnson nursing model families and society. 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 • nursing’s primary goal is foster equilibrium • conceptualized the behavioral system model • identified seven (7) behavioral subsystem Hildegard Peplau 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 • 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 • 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 Jean Watson • • • • 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. Lydia Hall • nursing is participation in care, core and cure aspects of patient care • key concepts of three interlocking circles Dorothea Orem Joyce Travelbee model • postulated interpersonal aspect of nursing • viewed that interpersonal process is a human to human relationship formed during illness and “experience of suffering” NURSING PROCESS Nursing Process • • • nursing is needed when the self care demands are greater than the self care abilities 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 It is problem-oriented, goal-oriented, organized, systematic, humanistic care / interpersonal, dynamic, cyclical and universal • • • • • • • • write a nursing care plan Implementation 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 determine the order in which nursing interventions are carried out relevant documentations should be done Assessment data • collecting, validating, organizing and recording • to establish data base • collection of data • methods of collection data • making information is accurate • clustering facts into groups of information Diagnosing Evaluation • assessing the client’s response to nursing • appraise the extent to which goals and outcome criteria of nursing care have been achieved interventions • • • • • • • clinical art of identifying problems identify the client’s needs and to prepare diagnostic statements use PES format organize cluster or group data compare data against standards analyze data after comparing with standards. determine the client’s health problems, health risks and strength • analyze the reasons for the outcomes MEDICATION Pharmacokinetic Process • Absorption • Distribution • Metabolism • Excretion Types of Doctor’s Order Planning • • • • • • • • 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 identify appropriate nursing interventions • Standing Order • Single Order • STAT order • PRN order • Palliative • Curative • Supportive Therapeutic Actions of Drugs • Substitutive • Chemotherapeutic • Restorative 7 Rights of Medications 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. Clark’s 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. Freid’s 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 child’s dose according to Freid’s rule? Answer is: ________ C. Young’s Rule Age in years X usual adult dose = Safe child’s 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 child’s 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) ½ 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: 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: •Advantages •Disadvantages •Drug Forms b. Sublingual • • • • • •Advantages •Disadvantages c. Buccal meat, fish, dairy products, eggs, nuts, legumes, cereals kwashiorkor Vitamin D calcium and phosphorous absorption, bone mineralization dairy products, eggs, yolks and fatty fish rickets (in children), osteomalacia (in adults) • Right Time • Right Advise / Attitude / Approach • Right Documentation / Recording PRINCIPLES IN ADMINISTERING MEDICATIONS 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 • Keep narcotic in locked place. • • • • • • Use only medications that are clearly labeled containers. Do not leave the medications at the bed side. If the patient vomits after taking the medication, report. Preoperative medications are discontinued during the postoperative, unless ordered. When a medication is omitted for any reason, record with the reason. When a medication error is made, report it immediately. you administer. • • • • • • • • bone and tooth formation, muscle function and nerve transmission milk products, dark green leafy vegetable, salmon, orange juice, tofu stunted growth in children, osteoporosis in adult 99% is in the bone major component of renal calculi Magnesium bone and tooth formation whole grain, nuts, legumes, dark green leafy vegetables growth failure in children Potassium NUTRITION Carbohydrates • provides energy; protein sparing • cereal, fruits, vegetables, milk • marasmus Protein • major intracellular cation • fluid balance, nerve and muscle function • meat, milk, vegetables, legumes, bananas Iron • • growth and repair of tissues maintain fluid and acid base balances • 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 • Rectal 2-3 minutes • Oral 3-5 minutes • Axillary 6-9 minutes Types of Fever • • • • • • • • • • • • • • Intermittent fever – fever – no – fever – no Remittent fever – fluctuates but remains above normal Relapsing fever – elevated for few days normal temp. for 1-2 days Constant fever – fluctuates minimally and consistently high Thiamine muscle nerve function whole grains, pork, cereals, legumes, seeds and nuts Beriberi, poor coordination then Vitamin B3 Niacin coenzyme for energy metabolism whole grains, meats, fish, nuts and eggs • Factors Affecting Heat Loss Vitamin B9 Folic acid aids in metabolism of genetic material (DNA, RNA) green leafy vegetables, nuts, legumes, grain products poor growth, birth defects •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 Conversion Centigrade to Fahrenheit F = (Temperature in C) X 1.8 + 32 PHYSICAL ASSESSMENT Methods • • • • Inspection Palpation Percussion Auscultation Temperature • 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 0 0 0 •Example: •Convert 41 C to F: Answer is ________ •Convert 38 C to F: Answer is ________ •Convert 36.5 C to F: Answer is _______ •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 ________ •Convert 102.9 F to C: Answer is _______ Pulse 60-100 bpm •Carbon dioxide – major chemical stimuli for respirations • • • • • • • • •Hering Breuer reflex – prevents the lungs from over expanding Assessing Respirations Age Sex / Gender Exercise Fever Medications Hemorrhage Stress •Rate – tachypnea, bradypnea, eupnea •Depth /Volume – Hyperventilation, Hypoventilation •Rhythm – Cheyne-Stokes, Kussmaul, Biots •Quality / Effort / Character - dyspnea, orthopnea, apnea Chest movements Position Pulse sites •Temporal •Carotid •Apical •Brachial •Radial •Femoral •Popliteal •Posterior Tibial •Dorsalis Pedis Assessment of the Pulse • • • Intercostals retractions - ribs Substernal retractions – breastbone Suprasternal retractions – above the clavicle Blood Pressure •Systolic pressure (100-130 mmHg) •Diastolic pressure (60-90mmHg) •Pulse pressure •Mean Arterial pressure •Korottkoff’s sound Determinants of Blood Pressure • • • Rate Rhythm Volume • • • • • • • • • Pumping action of the heart (cardiac output) Peripheral Vascular Resistance Blood Volume Blood Viscosity Pulse Deficit Respiration •Ventilation •Inspiration and Expiration •Respiratory Center – pons and medulla oblongata Elasticity or Compliance of Blood Vessels Factors Affecting Blood Pressure Age Exercise Stress Race •12 – 20 breaths per minute - normal •500 ml – normal tidal volume • • • • • Obesity Gender / Sex Medications Diurnal Variations Disease Process •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 •Systole, Diastole, Aortic, Pulmonic, Erb’s point. Tricuspid, Mitral, S1, S2, Murmurs ABDOMEN •Skull, scalp, hair 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 cranial nerve 1 MOUTH and PHARYNX •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, •The first line of defense •Composed of the superficial epidermis and the true skin dermis •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 •Pallor •Cyanosis •Jaundice •Erythema NERVOUS SYSTEM •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 •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 •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 •Takes a deep breath, hold it for a moment then exhale slowly through a pursed lip open through out exhalation prevent air trapping CHEST PHYSIOTHERAPY •Builds pressure backwards keeping the airways •More air escapes during exhalation and helps •Help clear excessive bronchial secretions from airways by shaking mucus from the walls of the airways and draining them from the lungs •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 •Produce mechanical wave of energy that is transmitted through chest wall (Percussion) •With the use of hand placed on client’s chest with rapid and vigorous vibration as client exhale •Use of gravity to assist in the movement of secretion (postural drainage) NASOGASTRIC TUBE FEEDING •Single most effective measure to control respiratory secretions upward •Provide enteral nutrition for clients who cannot swallow, with esophageal obstruction, unconscious, and cannot consume oral feeding. •Splint incision, if any, with pillow •Patient to take a deep breath, hold for 3 seconds, and cough deeply 2 to 3 times •Measure the distance from the tip of the nose to earlobe through the bottom of the xiphoid process •Perform 2 to 3 hours postoperatively •Contraindicated for eye surgery DEEP BREATHING •Use water soluble jelly as lubricant •Advance tube forward, head bent forward closes the epiglottis and trachea •Expands alveoli and mobilizes secretions •Place patient in fowler’s or sitting •Place client’s hands (palm) along the lower rib cage to feel diaphragm movement •High fowler’s, 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 sound in the epigastrium. yellow to green) for bubbling. •Inhale fully through the nose, hold for 2 to 3 seconds •Inject 10 ml of air and auscultate for gurgling •Aspirate for residual stomach content (ph 1-3 of •Immerse tip of the NGT into water and observe •Exhale slowly through the mouth PURSED LIP BREATHING •Allows a gradual decline in intrapulmonic pressure hence preventing lung collapse • X-ray confirms FECAL IMPACTION REMOVAL 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 –Pyrogenic / Febrile Reaction  Fever and chills  Headache and body malaise •Note for any signs of fatigue, pallor, diaphoresis, and changes in pulse rate. –Hemolytic Reaction  Facial flushing, chills, low back pain, •Prepare for quick evacuation as hardened stool blocking the lumen is removed. OXYGEN THERAPY •To reverse hypoxemia •To improve tissue oxygenation •Decrease work of breathing in dyspneic clients •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 hypotension, hematuria leading to anaphylactic shock CLEANSING ENEMA Non-Retention Enema Solutions used are as follows: •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 • Sizes of rectal tube: OXYGEN THERAPY •Position the client in semi-fowler’s position •Insert flowmeter, with humidifier (oxygen dries up) Adult - Fr 22-32 Children - Fr 14-18 Infant - Fr 12 •Regulate the prescribed flow rate (LPM) •Assess vital signs, oxygen saturation, color, breathing pattern and orientation •Height of Solution: 18 inches above the rectum •Temperature of Solution: 115 – 125 F on preparation •Time of retention: cleansing effect 5 -10 minutes for better 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 :________ Retention Enema Solutions used are as follows: •Carminative Enema •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: effect is obtained I.V. Therapy Intravenous 1 -3 hours until therapeutic •Direct IV, IV Push, IV infusion •Most rapid route of absorption of medication •Route can be use for clients with compromised gastrointestinal function or peripheral circulation Purposes: •Large doses of medication can be administered •Fluid and electrolytes imbalance •Provide food •Vehicle for medication •For blood transfusion Equipments: 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 •Use appropriate catheter size: F 5-8 for infants; F 8-10 for children; F 1218 for adult •IV Fluid, IV set, Micropore, tourniquet, cotton balls, alcohol, splint Complications of I.V. Therapy •Position client fowlers (for those with intact gag reflex); side lying (for unconscious) to prevent aspiration •Infiltration •Thrombophlebitis •Nerve damage •Circulatory Overload •Air Embolism •Speed shock •Drug Overload •Adjust pressure: •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 •Pre-oxygenate client •Lubricate Catheter •Exert suction by closing the open port, withdrawing catheter in rotating motion within 510 seconds only •Male : 6-9 inches •Female : 3-4 inches 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 •Hyper-oxygenate for a full minute between subsequent suctioning. Encourage deep breathing Urinary Catheterization – is the introduction of catheter through the urethra into the 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. To empty the bladder completely prior to surgery. • 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 •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 •liver biopsy (right) post procedure to prevent bleeding Sims position •Female : Dorsal Recumbent position Location of urinary meatus •Male : at the tip of the glands penis •client lies on the side with weight distributed toward the anterior ileum, humerus, and clavicle with pillows support on flexed arms and legs. •Female : between the clitoris and vaginal orifice Size of Catheter •Male: Fr 16-18 •choice position for clients with pressure sore on bony prominence •contraindicated with spine or orthopedic condition Fowler’s position •sitting position raises client’s bed head to 90 degrees •Female : Fr 12-14 Length of catheter insertion •clients with DOB, eating and improvement of cardiac output •contraindicated with post spine surgery •myelogram (if water based dye – Amipague) to prevent upward dispersion of the dye the stomach contents Dorsal recumbent outward •placenta previa (sitting) to minimize bleeding •pulmonary edema to facilitate breathing •thoracentesis (during the procedure) to facilitate removal of fluid in the chest wall •congestive heart failure to improve oxygenation •hiatal hernia (after meals) to prevent reflux of •client lies supine with legs flexed and rotated •for vaginal examination Knee chest position drawn to the chest •autonomic dysreflexia stoke Semi-fowler’s position degrees to prevent hypertensive •semi-sitting with head elevation of 30-45 •clients with DOB, eating and improvement of cardiac output •lies prone with buttocks elevated and knees •rectal procedures and examination •contraindicated for arthritis and other joint deformity •contraindicated with post spine surgery •abdominal aneurysm surgery to prevent pressure on the graft spread of infection •prolapsed cord to prevent pressure on the cord •proctosigmoidoscopy to facilitate visualization Trendelenburg the feet return •appendicitis (if ruptured) to prevent the upward •bronchoscopy (post procedure) to prevent aspiration •lies supine with head 30-40 degrees lower than •for postural drainage and promotion of venous •contraindicated may result in increase intracranial and intraocular pressure and may result hypotension. •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 •shock to promote venous return to the heart •TPN during tube insertion to prevent air embolism DIAGNOSTIC EXAMINATIONS AND PROCEDURES •CVA to reduce ICP •hypophysectomy to prevent increased ICP •laryngectomy to maintain patent airway and minimize edema •Mantoux Test •Chest X-ray •Bronchography •Bronchoscopy •Lung Scan •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 •Sputum Examination •Lung and Lymph Node biopsy •Pulmonary Function Studies •Arterial Blood Gas Studies •Thoracentesis •Holter Monitoring •Magnetic Resonance Imaging •Computed Tomography •Upper Gastrointestinal Series / Barium Swallow •Lower Gastrointestinal Series / Barium Enema •Endoscopy •Proctosigmoidoscopy •Colonoscopy •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