Republic of the Philippines

J.H. CERILLES STATE COLLEGE

Pagadian City Campus
West Capitol Road, Balangasan District,
Pagadian City

SUBJECT : Medical Surgical Nursing

LESSON : 5
NAME OF STUDENT : Sulong, Yamie Bae P.

Activity Sheet

1. Identify therapeutic techniques with their definition and therapeutic value.

Therapeutic Communication Definition Values

Technique
Open-ended questions questions which require at least gathers broad information;
several words in responding allows relevance and depth;
establishes 2 way
communication
Closed-ended questions questions that can be answered gathers specific information;
with one or two words focused; allows only a limited
choice of responses
Using silence utilizing the absence of verbal allows the patient and the nurse
communication time to think, collect thoughts,
or formulate a response. Invite
a response. Allows the nurse
time to assess the patient
Giving information the act of informing, receiving supplies factual data which in
or giving data of accurate facts turn allows the patient to make
choices; change or stimulate
behavior, promotes
participation; increase
awareness, problem solve/
make decisions
Clarifying attempts to find the meaning of clarifies unclear or vague
the communicated message communications, eliminates
misperceptions; validates info,
prevents erroneous conclusions
Focusing concentration on a specific prevents fragmented dialogue.
thought, feeling or behavior Help to prevent the patient
from jumping from topic to
topic
Offering self being available to the patient conveys interest, acceptance
and expressing interest and the and desire to understand or
desire to understand when interact
communication is either
minimal or absent
Giving broad openings allows the patient to take the invites the patient's
lead or direction of the participation; gives patient a
dialogue sense of control and
involvement
 Republic of the Philippines
J.H. CERILLES STATE COLLEGE
Pagadian City Campus
West Capitol Road, Balangasan District,
Pagadian City

Accepting conveys openness and positive gives value to the patient's

regard thoughts, feelings, or
behaviors. Does not imply
agreement
Restarting repeating the main idea or implies the nurse is listening
words that the patient has and offers the patient an
spoken opportunity to further continue,
clarify or explain
Consensual validation confirming observations and clarifies that both the nurse and
interpretations patient share a mutual
understanding of the
communication
Collaboration to work jointly promotes involvement.
prevents power struggles
Making an observation/sharing verbalizing what is observed or encourages patient to notice
perceptions perceived behavior in order to describe
thoughts and feelings for
mutual understanding
Giving recognition acknowledges and indicates establishes connection. Fosters
awareness. The awareness interest and concern
expressed should be
nonjudgmental
General lead encourages the patient to encourages the patient to say
continue in expression of more
thought or dialogue
Formulating a plan of action specific behaviors in which to arms the patient with ability to
act upon problem solve
Encouraging description of asking the patient to verbalize determines reality or accuracy
perception what is being perceived of patient's perception. Often
used with patients experiencing
hallucinations
Reflection questions and feelings are give opportunity for discussion
referred back to the patient for and exploration of concerns
recognition and consideration
Exploring delving further into a subject, to achieve depth for accuracy
idea, or experience and cohesiveness
Voicing doubt expresses uncertainty as to the gives pause for reconsideration
reality of the patient's of ideas and perceptions
perception
Verbalizing the implied putting into words what the clarifies that which is implicit
patient has only implied rather than explicit
Supportive confrontation acknowledging the difficulty in non-threatening attempt to
changing behavior, thoughts, eliminate or discourage
and feelings, but pushing for nonproductive behaviors. Set
positive action limits
Summarization reviewing main points and brings together important
conclusions points of discussion to enhance
understanding
Role-playing practicing new behaviors to allows the patient to practice at
facilitate change new behaviors. Reduce anxiety
 Republic of the Philippines
J.H. CERILLES STATE COLLEGE
Pagadian City Campus
West Capitol Road, Balangasan District,
Pagadian City

or fear of the unknown. Allows

the nurse to assess for strengths
or deficits

2. Tabulate the physical indicators of nutritional status with signs of good nutrition
and poor nutrition.

Physical signs Good Nutrition Poor Nutrition

General appearance Alert: Responsive Listless, apathetic, cachectic
Weight Weight normal for height, age Obesity 10 % above ideal body
and body build weight or underweight
Posture Erect posture; straight arms Sagging shoulders, sunken
and legs chest, humped back
Muscles Well-developed, firm, good Flaccid, poor tone, impaired
tone, some fat under skin ability to walk properly
Nervous system control Good attention span, not Inattention, irrability,
irritable or restless, normal confusion, paresthesia,
reflexes, psychological weakness and tenderness of
stability muscles, decrease or loss of
ankle and knee reflexes
Gastrointestinal function Good appetite and digestion, Anorexia, indigestion,
normal regular elimination, no constipation, diarrhea, liver or
palpable organs or masses spleen enlargement.
Cardiovascular function Normal heart rate and rhythm, Rapid heart above 100
lack of murmurs, normal blood beats/min enlarged, abnormal
pressure for age rhythm, elevated blood
pressure
General vitality Endurance, energy, sleeps well Easily fatigued, no energy,
falls asleep early, tired and
apathetic
Hair Shiny, lustrous, firm, not easily Stringy, dull, brittle, dry, thin,
plucked, healthy scalp and sparse, depigmented,
easily plucked
Skin (general) Smooth and slightly moist skin Rough, dry, scaly, pale,
with good color pigmented, irritated, bruises,
subcutaneous fat loss.
Face and Neck Uniform color, smooth, pink, Greasy, discolored, scaly,
healthy appearance, not swollen, dark skin over cheeks
swollen and under eyes, lumpiness or
flakiness of skin around nose
and mouth
Lips Smooth, good color, moist, not Dry, scaly, swollen, redness
chapped or swollen and swelling, angular lesions at
corners of mouth, fissures or
scars
Mouth, oral membranes Reddish-pink mucous Swollen, boggy oral mucous
membranes in oral cavity membranes
Gums Good pink color, healthy and Spongy gums that bleed easily,
red, no swelling or bleeding marginal redness,
inflammation, receding
 Republic of the Philippines
J.H. CERILLES STATE COLLEGE
Pagadian City Campus
West Capitol Road, Balangasan District,
Pagadian City

Tongue Good pink or deep reddish Swelling, scarlet and raw

color, no swelling, smooth, magenta, hyperemic and
presence of surface papillae, hypertrophic papillae, atrophic
lack of lesions papillae
Teeth No cavities, no pain, bright, Unfilled caries, missing teeth,
straight, no crowding, well- worn surfaces, mottled, mal-
shaped jaw, clean with no positioned
discoloration
Eyes Bright, clear, shiny, no sores at Eye membranes pale, redness
corner of eyelids, moist and of membrane, dryness, signs of
healthy pink conjunctivae, infection
prominent blood vessels, no
fatigue circles
Neck (glands) No enlargement Thyroid or lymph node
enlargement
Nails Firm, pink Spoon shape, brittleness, ridges
Legs, feet No tenderness, weakness or Edema, tender calf, tingling
swelling, good color weakness
Skeleton No malformations Bowlegs, knock- knees, chest
deformity at diaphragm,
prominent scapulae and ribs

3. Identify factors associated with potential nutritional deficits and their possible
consequences.

Factor Possible Consequences

Dental and oral problems Inadequate intake of high-fiber foods
Nothing by mouth Inadequate caloric and protein intake;
dehydration
Prolonged use of glucose and saline intravenous Inadequate caloric and protein intake
fluids
Nausea and vomiting Inadequate caloric and protein intake; loss of
fluid, electrolytes, and minerals
Diarrhea Loss of fluid, electrolytes, and minerals;
malabsorption of nutrients
Stress of illness, surgery, and/or hospitalization Increased protein and caloric requirement;
increased catabolism
Wound drainage Loss of protein, fluid, electrolytes, and minerals
Pain Loss of appetite; inability to shop, cook, eat
Fever Increased caloric and fluid requirement;
increased catabolism
Gastrointestinal intubation Loss of protein, fluid, and minerals
Tube feedings Inadequate amounts; variation of nutrients in
each formula
Gastrointestinal disease Inadequate intake and malabsorption of
nutrients
Alcoholism Inadequate intake of nutrients; increased
consumption of calories without other nutrients;
vitamin deficiencies
Depression Loss of appetite; inability to shop, cook, eat
 Republic of the Philippines
J.H. CERILLES STATE COLLEGE
Pagadian City Campus
West Capitol Road, Balangasan District,
Pagadian City

Eating disorders Inadequate caloric and protein intake; loss of

fluid, electrolytes, and minerals
Medications Inadequate intake due to medication side effect,
such as dry much, loss of appetite, decreased
taste perception, difficulty swallowing, nausea
and vomiting, malabsorption of nutrients
Restricted ambulation or disability Limited ability to shop, cook or help self to
food, liquids, other nutrients