FUNDAMENTALS OF NURSING

NURSING THEORIES Theories that focus on the environment Florence Nightingale to facilitate the bodys reparative process by manipulating the environment Theories that focus on the Client as an Individual/ Holistic Approach Holistic Delivery of Health care to meet the social , physical, intellectual , creative, emotional and spiritual needs of the client and family( 21 problems) Faye Abdellah to work interdependently with other health caregivers. Focus is on the independent satisfaction of 14 human needs( Complementary supplementary) Virginia Henderson Client is an individuaql with a need that when met diminishes distress, increases adequacy and enhances well-being. Three elements comprises a nursing situation ; 1.) Client behavior , 2) Nurse Raection and 3) Nurse actions Ida Orlando Focuses on how the client adapts to illness and how actual or potential stress can affect ability to adapt. The goal of nursing is to reduce stress. Clients basic needs are categorized according to behavioral subsystems Dorothy Johnson Nursing care is necessary only if the client is unstable to fulfill biological, psychological, developmental or social needs Dorothea Orem The client is an adaptive system, thus the goal of nursing is to help the person adapt to this changes in physiological needs, self-concept, role function and interdependent relations during health and illness. Sis. Callista Roy The client is composed of overlapping parts; person(core), pathologic state and treatment() cure) and body ( care) Lydia Hall first introduced the Nursing process Focus is interaction between Client and environment Health is viewed in terms of conservation of clients energy, structural, personal and social integrity Myra Levine Believes that nursing incorporates knowledge of basic sciences, physiology and nursing practice. Views nursing primarily as a science and is committed to research. The humanistic science of nursing,man is changing and coexisting with the environment Martha Rogers Focuses on the interrelationship between Client and Nurse

To develop interaction between the client and the nurse( Psychodynamic Nursing) Hildegard Peplau To identify problems and to identify goals- focuses on the dynamic interpersonal relationship between the client and the nurse. Communication is used to help client rte-establish positive adaptation to the environment Imogene King DEFINITIONS OF NURSING DIAGNOSIS AND TREATMENT OF HUMAN RESPONSES TO ACTUAL OR POTENTIAL HEALTH PROBLEMS NURSING SCIENCE-COGNITIVE BRAIN OF NURSING NURSING ESTHETICS- ART AND HEART OF NURSING NURSING ETHICS- KNOWLEDGE OF PROFESSIONAL STANDARDS OF CONDUCT PERSONAL KNOWLEDGE-CONSCIOUS AWARENESS OF ONES OWN VALUES. HEALTH CARE DELIVERY SYSTEM LEVELS OF PREVENTION
PRIMARY PREVENTION-IDENTIFIES RISK FACTORS, ATTEMPTS TO ELIMINATE STRESSOR AND FOCUSSES ON PROTECTING THE DEFENSE, REACTION HAS NOT YET OCCURRED. To encourage optimal health and to increase the persons resistance to illness. - health promotion -specific protection SECONDARY PREVENTION- INTERVENTION OR ACTIVE TREATMENT AFTER SYMPTOMS HAVE OCCURRED.STRENGTHEN RESISTANCE. Also known as health maintenance- early diagnosis/ detection/screening; prompt treatment TERTIARY PREVENTION- INTERVENTION, READAPTATION AND STABILITY- establishment of high level wellness.

HEALTH AND ILLNESS BASIC HUMAN NEEDS MODEL HEALTH ILLNESS CONTINUUM MODEL( health seeking and illness behavior) HOLISTIC HEALTH MODEL HEALTH BELIEF MODEL HEALTH PROMOTION MODEL THE NURSING PROCESS ASSESSMENT- SYSTEMATIC COLLECTION OF DATA TO DETERMINE PATIENTS STATUS ASSESSMENTAND TO IDENTIFY ANY ACTUAL OR POTENTIAL HEALTH PROBLEMS INITIAL ASSESSMENT-SPECIFIED TIME AFTER ADMISSION FOCUS OR ONGOING ASSESSMENT-ONGOING PROCESS INTEGRATED WITH NURSING CARE

EMERGENCY ASSESSMENT-DURING ANY PHYSIOLOGIC OR PSYCHOLOGIC CRISIS OF THE CLIENT TIME-LAPSED- SEVERAL MONTHS AFTER INITIAL ASSESSMENT

ANALYSIS/NURSING DIAGNOSIS- IDENTIFICATION OF ACTUAL OR POTENTIAL HEALTH PROBLEMS AMENABLE TO RESOLUTIONS BY NURSING ACTIONS DIAGNOSIS FORMAT(p>e>s>) PROBLEM STATEMENT(ALTERED,IMPAIRED,INEFFECTIVE,ACUTE AND CHRONIC ETIOLOGY(RELATED TO / SECONDARY TO) DEFINING CHARACTERISTICS (SIGNS AND SYMPTOMS) DIAGNOSTIC PROCESS ANALYSIS- SEPARATION INTO COMPONENTS SYNTHESIS PUTTING TOGETHER OF PARTS INTO WHOLE Critical thinking-cognitive process-person reviews data and considers explanations before forming an opinion. REMEMBER THE 3 CS PLANNING- DEVELOPMENT OF GOALS AND A PLAN OF CARE DESIGNED TO ASSIST THE PLANNINGPATIENT IN RESOLVING THE NURSING DIAGNOSIS ( ORGANIZE,ANALYSE,SYNTHESIZE AND PRIORITIZE) (IDENTIFY PROBLEM,PNT.CHARAC. AND ETIOLOGIES) PLANNING- DESIRED OUTCOME PLANNING-

GOALS SHOULD BE: SYSTEMATIC MEASURABLE ATTAINABLE REASONABLE TIME-FRAMED

IMPLEMENTATION- ACTUALIZATION OF THE PLAN OF CARE THROUGH NURSING IMPLEMENTATIONINTERVENTIONS ( COORDINATION,DELEGATION-CAPABILITIES ,LIMITATIONS AND SUPERVISION PROTOCOLS- STANDARDS OF CARE POLICIES AND PROCEDURES- GOVERN THE HANDLING OF FREQUENT OCCURING SITUATIONS STANDING ORDER- POLICIES,RULES, REGULATIONS AND ORDERS OF CLIENT CARE( authority to carry out specific actions under certain circumstances) EVALUATION-DETERMINATION OF PATIENTS RESPONSES TO THE INTERVENTIONS AND EVALUATION-DETERMINATION EXTENT TO WHICH GOALS HAVE BEEN ACHIEVED(FEEDBACK)

ONGOING INTERMITTENT TERMINAL

NURSING DOCUMENTATION FORMATS

1)NURSING CARE PLANS-TRADITONAL OR STANDARDIZED 2)CRITICAL PATHWAYS-MANAGED CARE SYSTEMS(INTERVENTIONS FOR SPECIFIC DISEASES 3)KARDEX-CONCISE METHOD OF ORGANAZING AND RECORDING DATA ABOUT A CLIENT,MAKING INFORMATION READILY ACCESIBLE TO ALL HEALTH RPOFESSIONALS 4) PROGRESS NOTES NARRATIVE CHARTING IS A DESCRIPTION(NARRATION) OF INFORMATION AND CHRONOLOGIC CHARTING. SOAP FORMAT / SOAPIER PIE CHARTING FLOWSHEETS (GRAPHIC OR TABULAR)MED.,MIO,DAILY NURSING CARE RECORD CLINICAL RECORDS( GCS, CVP) FOCUS CHARTING- OUTLINES OCCASIONS FOR AND ACTIVITIES OF NURSING CARE(DATA , ACTION AND RESPONSE)

ETHICS AND VALUES MORALITY OF HUMAN BEHAVIOR BIO-ETHICS APPLIED TO LIFE CODE OF ETHICS- STANDARD OF GROUPS IDEALS AND VALUES VALUES- BOTH INTRINSIC AND EXTRINSIC ENDURING BELIEFS AND ATTITUDES WORTH OF A PERSONS OBJECTIVES , IDEA OR ACTION MORALS PRINCIPLES AND RULES OF RIGHT CONDUCT. PRIVATE AND PERSONAL COMMITMENT DEFENDED IN DAILY LIFE ETHICS PROFESSIONALLY AND PUBLICLY STATED. INQUIRY OR STUDY OF PRINCIPLES AND VALUES VALUE STANDARDS MORALS STANDARDS OF RIGHT AND WRONG INTUITIONISM NOTION AUTONOMY INDEPENDENCE NON-MALEFICENCE DO NO HARM BENEFICENCE DOING GOOD JUSTICE FAIRNESS FIDELITY FAITHFULLNESS AND COMMITMENT VERACITY TRUTHFULNESS ADVOCACY- INFORMED SUPPORT / ENHANCE AUTOMOMY JURISPRUDENCE LAW- RULES THAT REGULATE SOCIAL CONDUCT IN A FORMALLY PRESCRIBED AND LEGALLY BINDING MANNER RIGHTS-PRIVILEDGES RESPONSIBILITIES-OBLIGATIONS GRIEVIANCE-DISPUTE/CONTROVERSY STARE DECICIS-TO STAND BY THINGS DECIDED Classified into: PUBLIC OR CRIMINAL LAWS-ACTIONS AGAINST SAFETY AND WELFARE OF THE PUBLIC FELONY(SERIOUS) MISDEMEANOR(LESS SERIOUS)

CIVIL/PRIVATE LAWS CONTRACTS TORTS WRONG AGINST PERSON OR PROPERTY UNINTENTIONAL-NEGLIGENCE INTENTIONAL INTENTIONAL TORTS ASSAULT AND BATTERY INVASION OF PRIVACY DEFAMATION MALPRACTICE AND NEGLIGENCE FALSE IMPRISONMENT FRAUD JURISPRUDENCE LIVING WILL DECLARATION OF A COMPETENT INDIVIDUAL DNR COMPETENT CLIENTS AND VALUES PRIORITY ADVANCE DIRECTIVES- CLEARLY DOCUMENTED , RECIEWED AND UPDATED PROVIDE COMFORT MEASURES IF NURSE IS NOT COMFORTABLE CONSULT NURSE MANAGER MEET STANDARDS OF CARE CRITERIA- TERMINAL/BRAIN DEATH TO PREVENT SUFFERING RESTRAINTS-NOT INSTITUTED FOR THE PURPOSE OF CONVENIENCE AND AS A TREATMENT OF MEDICAL SYMPTOMS(FALSE IMPRISONMENT) BOTH PHYSICAL AND CHEMICAL INFORMED CONSENT-DURATION REQUIRED NOT PRN ALTERNATIVE MEASURES FIRST REMOVE Q2h for skin care and ROM DONE TO PREVENT HARM OR INJURY OR COMPLICATION IF PNT. DISORIENTED (SAFETY) INCIDENT REPORTS INCIDENT REPORTS-STATEMENT OF FACTS AND PATIENTS PHYSICAL RESPONSE FROM UNEXPECTED OCCURRENCE THAT (COULD/) AFFECT THE CLIENT----SEQUENCE, W/IN 24 HOURS---RISK MANAGERCOMPR. SITUATIONS NO-REFERENCE , INAPPROPRIATE TERMS OR WORDS, JUDEGMENTAL STATEMENTS, -----MONITORING AND DOCUMENTATION TELEPHONE ORDERS- REPEAT ORDER TO THE AP AND LET HIM SIGN WITHIN 24 HOURS

AGGREED UPON FACTS KNOWN TREATMENT EXPLANATION RISK UNDERSTOOD

INFORMED CONSENT

CONSENT CONSIDERATIONS OB , STD,REHAB ,BLOOD DON. ( MINOR CAN GIVE) ER, LIFE THREATENING(IMPLIED) MENTALLY ILL(INCAPABLE) MODELS FOR DELIVERY OF NURSING CASE METHOD-TOTAL CARE-CONSISTENCY

FUNCTIONAL METHOD-TASK ORIENTED- CENTRALIZED DIRECTION AND CONTROL TEAM NURSING-TEAM COORDINATED CARE-INDIV. ROLES EFFICIENCY PRIMARY NURSING-COMPREHENSIVE,INDVIDUALISTIC, CONSISTENT TECHNICAL KNOWLEDGE AND MNGT.SKILLS CASE MNGT. COMPREHENSIVE CONTINOUS CARE MANAGED CARE- COST CONTAINMENT DIFFERENTIATED-COMPETENCY-DELINEATION TEACHING AND LEARNING ANDRAGOGY VS PEDAGOGY DEPENDENCE TO INDEP. PREVIOUS EXPERIENCE READINESS TO LEARN(DEV. TASK) PERSONAL USEFULNESS and VALUE DOMAINS-COGNITIVE, AFFECTIVE AND PSYCHOMOTOR A KEY ELEMENT IN THE CHANGE PROCESS IS TRUST DESIRE + ACTING - COMPLIANCE STRESS GAS ALARM-RESISTANCE-EXHAUSTION COPING AND STRESS MANAGEMENT ANXIETYMILD SLIGHT AROUSAL AND INCREASED PERCEPTION MODERATE-INC. TENSION AND SELECTIVE INATT. SEVERE DEC. PERCEPTION AND FOCUSSED ENERGY PANIC OVERPOWERING AND LOSS OF CONTROL LOSS ,GRIEVING AND DEATH DEATH CONCEPTS 1-5Y.O IMMOBILITY AND INACTIVITY Wishes and unrelated action responsible for action 5-10 final but can be avoided 9-12 understands own mortality and fears death 12 18 fears and fantasizes avoidance 18-45 increased attitude awareness 45-65 accepts mortality Above 65 multiple meanings, encounters and fears SENSORY DEPRIVATION SENSORY OVERLOAD SENSORY DEFICITS SENSORY PERCEPTION AND COGNITION

PROTECTING HEALTH Universal Precautions Strict Isolation-highly transmissible diseases by direct contact and airborne routes of transmission Isolation-highly Private room,gowns, mask , gloves, handwashing,double bagged techniques for soiled articles Diptheria(pharyngeal),Herpes Zoster, Varicella , Pneumonia( S.Aureus , Strep,group A) Respiratory Isolation-droplet transmission(3 feet) Isolation-droplet Private rom,patient w/ same organism,mask,handwashing,labelled plastic bags for soiled articles H. influenza, measles, mumps, N. Meningitidis Tuberculosis/ AFB isolation-suspected / active TB isolation-suspected

Private room with negative pressureventilation so that air room is vented outside, mask, handwashing, bronchoscopy and dental examination postponed until 2 weeks of antibiotic therapy Contact Isolation infectious disseases or multiple resistant microorganisms that are spread by direct contact or close contact Private room , mask gown , gloves diptheria( cutaneous), Herpes simplex, MRSA , Pediculosis , Scabies , Syphilis Enteric Precautions infectious diseases transmitted through direct or indirect contact with infected feces. Handwashing , gloves , gowns worn only when handling contaminated objects with feces Aseptic meningitis, AGE , Hepa A , Typhoid fever, diarrhea (CDT ) Drainage / Secretions precautions patients with wound drainage or infected wounds Gloves, gowns indicated if clothing is likely to be contaminated Burns Universal Blood and Body fluids precautions blood borne , body fluids pathogens ( blood , semen , vaginal secretions , CSF , synovial fluid , pleural fluid , peritoneal fluid , pericardial fluid , amniotic fluid and tissues. Gloves , mask, protective eyegears, gown , contaminated needles not recapped and sharps in puncture resistant containers Aids , Hepatitis B and C , STDs Reversed Isolation - Patient is protected from pathogens and nosocomial infections by instituting reversed transmission precautions Burns and open wounds, patients with artificial airway , immunocompromised patients leukemia , AIDS , steroid therapy , radiation or cancer chemotherapy , medication effect of leukopenia or agranulocytosis REST AND SLEEP Stages of Sleep: Non-Rapid Eye Movement (NREM)- for body restoration Very Light Sleep- drowsy, and readily awakened Light Sleep- Heart and respiratory rate decreases and the body temperature gradually falls. PNS domination- Difficult to arouse Deep Sleep- Decrease metabolism and very difficult to arouse Rapid Eye movement (REM)- increase synthetic processes of the brain Paradoxical Sleep Dream state of the sleep Close to wakefulness but difficult to arouse ACTIVITY AND EXERCISE

ERGONOMICS

TYPES AND PRINCIPLES ROM AND ISOMETRICS PROBLEMS OF IMMOBILITY AND NURSING INTERVENTIONS ACTIVITY ORDERS POSITIONING FOR SPECIAL CONDITIONS ABDOMINAL ANEURYSM SURGERY-FOWLERS ASTHMA ORTHOPNEIC POSITION AUTNOMIC DYSREFLEXIA-HIGH FOWLERS POST BRONCHOSCOPY-SEMI FOWLERS CARDIAC CATHETERIZATION-KEEP INSETION SITE EXTENDED FOR 4-6 HOURS TO PREVENT ARTERIAL OCCLUSION CAST ELEVATE EXTREMITY CATARACT SEMI FOWLERS CEREBRAL ANEURYSM SEMI - FOWLERS

CLEFT LIP SUPINE CLEFT PALATE PRONE CHF HIGH FOWLERS CRANIOTOMY SUPRATENTORIAL SEMI FOWLERS ;INFRATENTORIAL FLAT ICP LEVATE HEAD DUMPING SYNDROME SUPINE AFTER MEALS EPISTAXIS LEAN FORWARD FLAIL CHEST AFFECTED SIDE FEMORO-POPLITEAL BYPASS GRAFT AFFECTED EXTREMITY EXTENDED GLAUCOMA(POST OP) AFFECTED SIDE HEMORROIDECTOMY SIDE LYING HIATAL HERNIA- UPRIGHT HIP SURGERY LEGS IN ABDUCTION LAMINECTOMY BACK AS STRAIGHT AS POSSIBLE LIVER BIOPSY RIGHT SIDE LYING LOBECTOMY SEMI FOWLERS POST LP FLAT MASTECTOMY ELEVATE EXTREMITY ON PILLOW MYELOGRAM WATER BASED DYE ELEVATE THE HEAD --- OIL BASED DYE - FLAT POSTURAL DRAINAGE LUNG SEGMENT UPPERMOST POSITION PROLAPSED CORD KNEE-CHEST PULMONARY EDEMA FOWLERS PYLORIC STENOSIS RIGHT SIDE LYING RADIUM IMPLANT FLAT ON BED RETINAL DETACHMENT AFFECTED SIDE TOWARDS THE BED SEIZURE SIDE-LYING SHOCK MODIFIED TRENDELENBURG SCI IMMOBILIZE TONSILLECTOMY SIDELYING / PRONE THYROIDECTOME SEMI FOWLERS THROMBOPHLEBITIS ELEVATE LEG TPN TRENDELENBURG DURING INSERTION THORACENTESIS FOWLERS(DURING) AFTER POSITION OF COMFORT BEDSIDE SAFETY/EMERGENCY MATERIALS / EQUIPMENTS AMPUTATION TOURNIQUET AUTONOMIS HYPERREFLEXIA CATHETER CHEST TUBE DRAINAGE- EXTRA BOTTLE- FORCEPS VASELINIZED GAUZE CHOLINERGIC AND MYASTHENIC CRISIS ENDOTRACHEAL TUBE / TRACHEOSTOMY SET EPIGLOTITIS - ENDOTRACHEAL TUBE / TRACHEOSTOMY SET PIH PADDED MOUTH GAG PARKINSONS SUCTION APPARATUS RADIUM IMPLANT LEAD CONTAINER , FORCEPS SENGSTAKEN BLAKEMORE TUBE SCISSORS SCI AND THYROIDECTOMY TRACHEOSTOMY TONSILLECTOMY FLASHLIGHT TRACHEOSTOMY TUBE OBTURATOR , HEMOSTAT HYGIENE AND COMFORT

INFANT BATHING COMPLETE ADULT BED BATH TUB BATH THERAPEUTIC

SALINE OATMEAL CORNSTARCH NACHO3 KMnO4 PERINEAL / GENITAL CARE FOOT AND NAIL CARE HAIR CARE ORAL CARE BEDMAKING PRESSURE ULCER GRADING PREVENTION TREATMENT

THERAPEUTIC DIET FOR SPECIFIC CONDITIONS AGE CLEAR LIQUID AGN LOW NA , LOW CHON ADDISONS HIGH NA , LOW K ANEMIA , PERNICIOUS HIGH CHON , VIT. B. ANEMIA SICKLE CELL HIGH FLUID GOUT PURINE RESTRICTED ADHD AND BIPOLAR FINGER FOODS BURN HIGH CAL. HIGH CHON CELIAC GLUTEIN FREE CHOLECYSTITIS HIGH CHON, HIGH CARB, LOW FAT CHF LOW NA , LOW CHOL. CROHNS HIGH CHON AND CHO, LOW FAT CYSTIC FIBROSIS HIGH CAL., HIGH NA LITHIASIS----ACID ASH FOR ALK. STONES------ALK. ASH FOR ACID STONES DECUBITUS ULCERS HIGH CHON , HIGH VIT C DIARRHEA HIGH K AND NA DUMPING SYNDROME HIGH FAT, HIGH CHON,DRY HEPATIC ENCEPHALOPATHY-LOW CHON HEPATITIS HIGH CHON,HIGH CAL. HIRSPRUNGS LOW RESIDUE, HIGH CHON AND CHO CIRRHOSIS LOW CHON MENIERES LOW NA MI AND HPN LOW CHOL.,FATS,NA HYPERTHYROIDISM- HIGH CAL. AND CHON HYPOTHYROIDISM LOW CAL. , LOW CHOL, LOW SAT. FAT NEPHROTIC SYNDROME LOW NA, HIGH CHON , HIGH CAL. HYPERPARATHYROIDISM LOW CALCIUM HYPOPARATHYROIDISM HIGH CA, LOW PHOSPHORUS OSTEOPOROSIS HIGH CALCIUM AND HIGH VIT. D PANCREATITIS LOW FAT PUD HIGH FAT, HIGH CARB. LOW CHON PKU LOW CHON / PHENYLALANINE PIH HIGH CHON RENAL FAILURE (ACUTE) LOW CHON,HIGH CARB LOW NA (OLIGURIC PHASE) HIGH CHON , HIGH CAL AND RESTRICTED FLUID (DIURETIC PHASE

RENAL FAILURE (Chronic) LOW CHON , LOW NA , LOW K

OXYGENATION PULMONARY FUNCTION TESTS DIAGNOSTIC LABORATORIES(ABG, SPUTUM CS AND THROAT CULTURE) VISUALIZATION AUSCULTATION OXYGEN DELIVERY EQUIPMENT CHEST PHYSIOTHERAPY ARTIFICIAL AIRWAYS THORACOCENTESIS,THORACOSTOMY.TRACHEOSTOMY AND ET INTUBATION SUCTIONING CHEST TUBES AND DRAINAGE SYSTEMS BOWEL ELIMINATION TOILET TRAINING FACTORS AFFECTING PROBLEMS MANAGEMENT-CATHARTICS , ENEMA , SURGERY

DIAGNOSTIC AND THERAPEUTIC PROCEDURES ENEMA COLOSTOMY/ILEOSTOMY,OTHER SURGERIES BARIUM STUDIES SCOPIC EXAMS ROENTOLOGIC EXAMS URINARY ELIMATION BLADDER TRAINING LABS AND DIAGNOSTIC TESTS CONDITIONS CATHETERIZATION AND IRRIGATIONS WOUND CARE WOUND TYPES HEALING DRESSING DRAINS

THERAPEUTICS MEDICATION ADMINISTRATION IVF INFUSIONS(INCLUDING MIO) BLOOD TRANSFUSION PHYSICAL AND OCCUPATIONAL THERAPY SUPPLEMENTS

NORMAL VALUES DIAGNOSTIC TESTS

PREVENTION AND EARLY DETECTION OF DISEASE GROWTH AND DEVELOPMENT DEVELOPMENTAL TASKS---MILESTONES ----DELAYS(FIXATIONS/LAG) IQ = MA / CA X 100 JUDGEMENT , COMPREHENSION AND LISTENING DDST BIRTH TO 6 YEARS PERSONAL SOCIAL, FINE , GROSS MOTOR AND LANGUAGE SKILL HEALTH SCREENING OB GYNE / REPRODUCTIVE TESTS UTZ-5 WKS CONFIRM PREGNANCY AND AOG AMNIOCENTESIS 16 WKS-DETECT GENETIC DISORDERS 30 WEEKS L/S RATIO ( 24 WKS RESULT)(EMPTY Bladder) OCT (28 WKS)FHR DECELERATIONS IV OXYTOCIN 15-20 MIN----3 CONTRACTIONS OBTAINED WITHIN 10 MINUTES- REACTIVE NST FHR ACCELERATIONS (32-34 WKS) 2-MORE FHR ACCELERATION OF 15BPM/MORE LASTING 15 SECS -20 MINS. AND RETURN OF FHR TO NORMAL/BASELINE REACTIVE DOPTONE- 12 WEEKS (18 20 WKS-AUSCULTATION) AFPT-FETAL SERUM CHON , -DETECT NEURAL TUBE DEFECTS 16-18 WKS CHORIONIC VILLI SAMPLING FETAL ABNORMALITIES- 10-12 WKS NEWBORN/INFANT HEALTH SCREENING PKU GUTHRINE BLOOD TEST-EAT CHON FOR 2 DAYS MIN.(PHEONISTICS DIAPER) SICKLE CELL DISEASE ABNORMALLY SHAPED Hg , ELISA AND WESTERN BLOT CARRIER SCREENING FOR CYSTIC FIBROSIS AND SWEAT CHLORIDE TEST SCHOOL AGE HEARING AND VISION TESTS ALLEN PICTURE CARDS SNELLEN CHART-20/40 AT TODDLER AND 20/20 AT SCHOOL AGE WEBERS-SENSORINEURAL AND CONDUCTIVE RINNES- CONDUCTIVE DENTAL EXAM STARTS AT 2 YEARS ADOLESCENT PPD INDURATION 72 HOURS BSE (18-20 YRS.) POST MENSTRATION/MONTHLY TSE MONTHLY (18-20 YRS) PELVIC EXAM WITH PAP SMEAR IF SEXUALLY ACTIVE OR 18 Y.O. ANNUALLY ADULT/ELDERLY HPN , DM, HEARING AND VISION PROSTATE ANNUALLY@40 Ca CHECK-UPS-Q3Y-20YO ; QY 40 YO SIGMOIDOSCOPY- > 50 Y.O. =Q3-5 YRS FECAL OCCULT BLOOD TEST- > 50 = ANNUALLY DIGITAL RECTAL EXAM - > 40 Y.O. = YEARLY PELVIC EXAM 18-40 Y.O. =PERFORMED Q 1 3 YEARS WITH PAP TEST MAMMOGRAM 35 39 y.o. = once BASELINE

40 49 y.o. = Q2Y 50 older = every year

NORMAL VITAL SIGNS NEWBORN= 1 4 YEARS= 5 12 YEARS= ADULT= 30 50 / MIN; 20 40 / MIN; 15 25 / MIN; 12 20 / MIN; 120 140 / MIN; 80 140 /MIN; 70 115 / MIN; 60 100 / MIN ; 60/40 80/50 mmHg 90/60 99/65 mmHg 100/56 110/60 mmHg 90 / 60 140 / 90 mmHg

NOTHING Here on earth can harm you except yourself..nothing here cannot be done unless you choose to give upfailure cannot overcome you unless you permit itAIM HIGH AND HIT THE MARK