10 Medical Surgical Nursing Intensive Review PDF

LECTURE 10: MEDICAL SURGICAL NURSING
MEDICAL-SURGICAL NURSING ○ excess fluid collection (>20 mL) in

Dr. Leila R. Ferrer pericardial sac that interferes with
heart filling (diastole).
CARDIOVASCULAR SYSTEM ○ SIGNS: BECK’S TRIAD
■ Jugular Venous Distention
PERICARDIUM with CLEAR LUNGS
Description (Heart Failure - with crackles)
● Outermost covering of the heart ■ Pulsus paradoxus -
■ Narrowed pulse pressure
2 LAYERS (ICP - wide pulse pressure)
1. PARIETAL PERICARDIUM (Formula: systolic - diastolic)
2. VISCERAL PERICARDIUM Normal Pulse Pressure: 30 -
- encloses the heart; closely hugging the 40 mmHg
heart. ■ Muffled Heart Sounds
PERICARDIAL FLUID Medical Treatment

Description ● Pericardiocentesis
● the space between the parietal and visceral procedure to remove fluid from pericardial
pericardium sac
● NORMAL VALUE: 5 to 20 mL ● Dialysis
caused by uremia (elevated waste in the
Abnormalities body)
● Radiation
1. Pericardial Effusion - fluid >20 mL
to treat neoplasm
2. Cardiac Tamponade - more than the
pericardial effusion.
HEART
3 LAYERS
PERICARDITIS
Etiology 3. ENDOCARDIUM
o contain VALVES
● VIral
4. MYOCARDIUM
● Post MI (Dressler’s Syndrome)
o pumping action
● Neoplasms - tumor
5. EPICARDIUM
● Renal Failure; Radiation
o exterior layer
● Connective Tissue diseases (e.g. SLE)
Description
Assessment
● weighs approximately 300g about the size
● Chest Pain - most important symptom
of the fist.
○ Aggravated by breathing
● 4 Chambers
(inspiration)
● Valves:
○ relieved with sitting or leaning
○ AV Valves
forward
■ Tricuspid Valve - right side
● Increased WBC (leukocytosis), Fever ,
■ Mitral Valve - left side
Malaise (generalized body weakness)
ATM closure = S1, first heart sound
● Friction rub (on auscultation) - most
○ Semi-lunar Valves
common sign
■ Pulmonic Valve - right side
● ST elevation
■ Aortic Valve - left side
Both MI and pericarditis has ST elevation by
SPA closure = S2, second heart
pericarditis has fever and is relieved with
sound
sitting or leaning forward, while MI cannot
Abnormal Heart Sounds:
be relieved.
S3 - ventricular gallop
S4 - atrial gallop
Nursing Diagnosis
● Pain - most common VALVULAR DISORDERS
● Risk of Decreased CO ● Regurgitation - incomplete closure of
● Risk of Ineffective Breathing Pattern related valves
to pain ● Stenosis - valve cannot completely open
Management Mitral Low pitch Rumbling Diastolic

● Determine the cause Stenosis Murmur
● Analgesics - NSAIDs (mefenamic,
ibuprofen) Aortic Widened Blowing Diastolic
● Monitor s/s of CARDIAC TAMPONADE Regurgitation PP Murmur
INTENSIVE REVIEW│RTRMF │1
b. 10
Mitral High Blowing Systolic
Regurgitation Murmur c. 30
d. 40
Aortic Harsh Systolic
Stenosis Murmur 4. Patient A has undergone mitral valve
replacement suddenly experiences continuous
Mitral Valve SYSTOLIC CLICK bleeding from the surgical incision during
Prolapse postoperative period. Which of the following
medications should Nurse A prepare to administer
Implementation
to patient?
● Monitor heart sounds a. Vitamin A
● Monitor signs of Decreased Cardiac Output b. Warfarin
(low BP) c. Aquamephyton - Vitamin K
● Monitor signs of Endocarditis d. Coumadin
Medication HEART
● Antibiotic for Infective Endocarditis Circulation
(Penicillin G) ● RIGHT SIDE - Pulmonary circulation
● Failure of right side - Distended jugular vein,
Surgery Hepatomegaly, Ascites Jaundice, Edema
● Valve replacement ● LEFT SIDE - Systemic circulation
○ Anticoagulant - to prevent
thrombus HEART FAILURE
(e.g. Heparin, warfarin, enoxaparin) Etiology
■ New Drugs: ● Myocardial Infarction
● Oral antithrombin ● Incompetent valves
inhibitor: ● Cardiomyopathy - irregular pumping
Dabigatran function of the heart
■ Novel anticoagulants
● Oral factor Xa Signs and Symptoms (Right Sided Heart Failure
Inhibitors:
● Distended neck vein
Apixaban, Edoxaban,
● Edema - limit fluids, low salt diet
Rivaroxaban
● Hepatomegaly
Antidote for Warfarin: Vitamin K
● Jaundice
(Phytomenadione, Aquamephyton)
● Ascites
Antidote for Heparin: Protamine
sulfate
Signs and Symptoms (Left Sided Heart Failure -
○ Warfarin (Coumadin) if appropriate
More on Respiratory Symptoms
■ Monitor PT (INR) - warfarin
■ Monitor PTT - heparin ● Pulmonary edema
■ Monitor bleeding (side effect) ● Pink frothy sputum
epistaxis, melena, ● Crackles
hematemesis, hemoptysis ● Orthopnea - dyspnea flat on bed
○ POSITION: High Fowler's position
QUESTIONS ● PND (Paroxysmal Nocturnal Dyspnea)
1. Among the following signs and symptoms, which Management
would most likely be present in a client with mitral ● Diuretics - given on the morning not to
valve regurgitation? - MV is at the left interrupt sleep
a. Peripheral edema - right sided
b. Exertional Dyspnea QUESTIONS
c. Jaundice - right sided 1. Mrs. A a 72 yo client is admitted with the
d. Chest pain diagnosis of Heart Failure secondary to Aortic
Regurgitation - AV is at the left. The nurse expects
2. Weak and delayed pulse (pulsus parvus et to hear when listening to client’s lung indicative of
tardus) is seen in: heart failure?
a. Aortic stenosis a. S2 Splitting
b. MVP b. Crackles - a type of Left sided Heart Failure
c. Mitral regurgitation c. Wheezes
d. Aortic regurgitation d. Friction Rub - seen in pericarditis
3. Pulsus paradoxus refers to a fall in systolic Diagnostics

pressure > __ mmHg with inspiration ● CXR - Cardiomegaly
a. 20 ● Echocardiogram
● Decreased ejection fraction d. All of the above

● CVP (used in the heart side of the heart
which measures the pressure in the right 5. Which of the following is a calcium channel
atrium) - elevated in RSHF blocker used in the treatment of HPN?
Management (4DS) a. Nebivolol - beta blocker
● Diuretics - decreased congestion; given in b. Carvedilol - beta blocker
the morning in order not to interrupt sleep c. Norvasc
SIDE EFFECT: Hypokalemia d. Irbesartan - ARBs
(ECG: U WAVE) 6. Hypertension is asymptomatic. However, in
● VasoDilators - decrease preload many individuals, the most common symptom is:
○ Preload - the stretching of the heart a. Epistaxis
○ Afterload - amount to overcome to b. Back pain
eject blood c. Oliguria - heart failure
○ Digoxin - improve cardiac d. Edema - heart failure
contractility (positive inotropic,
negative chronotropic - PINC)
NORMAL VALUE: 0.5 to 2 ng/mL ENDOCARDITIS
■ Positive inotropic - improve Definition
the contraction of heart ● Involves cardiac valves
■ Negative Chronotropic - ● Murmur - use the bell of the stethoscope
decreases heart rate; ● Prone to endocarditis: IV drug addicts and
Monitor heart rate patients with dental caries
Signs and Symptoms of Toxicity: Cause
○ Anorexia ● Acute - sudden
○ Blurred vision - green halos ○ Staphylococcus aureus - most
○ Nausea vomiting - Monitor common organism; mostly seen in
potassium level (Hypokalemia) - U the skin
wave is seen on ECG ● Subacute - gradual onset
NORMAL VALUE: 3.5 - 5 mEq/L ○ Streptococcus viridans
● Diet - Low salt (notorious); seen in dental caries
○ Use electric toothbrush - for patients
Management for CHF who have gum bleeding to avoid
● Monitor daily weights vigorous brushing - organisms may
● Physiological rest to decrease heart enter the bloodstream through the
workload gums
● POSITION: Orthopneic or High Fowlers ○ Prophylactic antibiotics prior to
● DIET: Low Salt routine dental care
○ Papaya - good fruit for Heart Failure Assessment
to avoid straining ● Acute:
○ Fever and chills
QUESTIONS ○ WBC elevation
1. Mrs. K has developed CHF. Nursing care plan ● Subacute:
include? ○ Fever of Unknown Origin
a. Positioning patient flat in bed ○ Anorexia
b. Elevate the HOB ○ Cough
c. Elevate knee to promote venous flow ○ Elevated ESR
d. Encourage Vasalva’s maneuver ○ Dyspnea
○ Normal WBC
2. The most common change one might see in the
blood vessels of a 92 year old elderly? QUESTIONS
a. Decreased peripheral resistance 1. A 73 year old elderly patient with BP 150/90
b. Increased peripheral resistance edema and congestive changes on the lungs
c. Increased response to medications secondary to infective endocarditis is given Digoxin.
d. Increased response to carotid stimulation This medication is given:
3. Which of the following does not include age a. To lower blood pressure
related changes that occur in the heart of an older b. Improve cardiac output
patient? c. Reduce adventitious breath sounds
d. Reduced peripheral edema
4. Which of the following results to fatigue?
a. Decreased exercise tolerance Assessment:
b. Increase exercise tolerance ● (+) Blood Culture
c. Hypotension ● Murmurs
● Roth spots ● SVT - Adenosine

● Ventricular Tachycardia with pulse:
Nursing Diagnosis Amiodarone
● Deficient Knowledge: Prevention of ● Ventricular Tachycardia without pulse:
repeated infection Defibrillation
● Ventricular Fibrillation: Defibrillation
Implementation ● Asystole: CPR, Epinephrine
● Assess infection ● Heart block: Pacemaker
● Anti Embolism stockings to prevent
thrombus formation - prevent DVT Symptoms:
● Loss of consciousness
Medication ● Chest pain
● Penicillin G - Antibiotics by IV route ● Easy fatigue
● Must be given for 6 weeks ● Ecg patterns originating from AV node
CARDIOMYOPATHY Management:
Definition ● Nursing and therapeutic management
● Affects the myocardium - which is the ● Atropine or Isoproterinol or Pacemaker for
muscle layer of the heart symptomatic heart block
● Abnormality of heart muscle
ATRIAL FLUTTER
Types Definition
● Dilated Cardiomyopathy - most common ● Occurs in COPD, Thyrotoxicosis
Implementation: Symptoms:
● Monitor Heart failure signs ● Saw tooth appearance
● Encourage rest to decrease heart’s ● Chest pain
workload ● Shortness of breath
● No medical therapy to cure or prevent ● Low BP
● Avoid alcohol
● Cardiac depressant Management:
● Medication ● Beta blocker
● Diet to prevent Heart failure = L8ow salt diet ● Digitalis
Cardiac Conducting System QUESTIONS

● Atrial Depolarization - P WAVE 1. A patient had (PVC’s). The nurse plans to have
● Ventricular Depolarization - QRS WAVE which medication available for immediate use?
● Ventricular Repolarization - T WAVE a. Digoxin (Lanoxin)
b. Verapamil (Isopton)
AV Block c. Metoprolol (Lopressor
d. Amiodarone
● 1st Degree Heart block - prolonged PR
interval
● More than 3 PVC's (premature ventricular
● 2nd degree Heart Block - missing QRS
tachycardia) = Ventricular tachycardia
○ Mobitz Type 1 (Wenckebach) - there
is prolongation of PR but QRS
SVT
comes back
Management:
○ Mobitz Type 2 - fixed PR, missed
QRS (DOC: Atropine) ● Vagal maneuver
● 3rd degree (Complete Heart Block) - P not ● Adenosine
related to QRS
Ventricular Tachycardia
QUESTIONS Management:
1. The normal PR interval is? ● Amiodarone
a. 0.30 - 0.40s ● Defibrillation - PULSELESS VT
b. 0.04 - 0.12s
c. 0.12 - 0.20s Most important risk factors for CAD
d. 0.12 - 0.28s ● Premature coronary disease
● Hypertension
Management for Block: ● Diabetes mellitus
● Sinus Bradycardia: Atropine ● Hyperlipidemia
● Flat line: Epinephrine
CORONARY ARTERY DISEASE QUESTIONS

● Right coronary artery - supplies the 1. Dr. B orders a which of the following is the most
inferior wall of the heart essential nursing action for a client on continuous
● Left coronary artery - supplies the intravenous streptokinase infusion suffering from
anterior wall of the heart myocardial infarction?
a. Monitoring urine output frequently
MYOCARDIAL INFARCTION b. Monitoring blood pressure an RR every shift
Management for Block: c. Monitoring bleeding episodes
● Pain is crushing or substernal d.Obtaining ECG rhythm strip from SVT
● May radiate to jaw, neck and left arm
● Unrelieved by NTG or rest Interventions
● Assess pain
Priority Nsg Dx ● O2 - priority intervention even before
● Pain Morphine administration
● Semi-Fowler’s, Bedrest
MI: ECG
● ST Elevation - injury Surgical Interventions
● T wave inversion - ischemia ● Assist in treatment modalities:
● Abnormal Q wave - necrosis (heart attack) ○ PTCA - Percutaneous Transluminal
Coronary Angioplastly
QUESTIONS ○ CABGS - Coronary Artery Bypass
1. Which of the following will appear abnormal in Graft Surgery
the ECG when there is angina from ischemic
disease? PERCUTANEOUS TRANSLUMINAL CORONARY
a. Prolonged QT interval ANGIOPLASTY
b. ST Segment ● A balloon tipped catheter is used to open
c. Absent P wave blocked coronary vessels and resolve
d. Prolonged PR Interval ischemia to increase blood flow by
compressing, cracking atheroma.
Complications of AMI
● Cardiogenic Shock Preoperative Teaching
● Arrythmia Consent:
● Avoid vigorous coughing
QUESTIONS ● Leg exercise to prevent emboli formation
1. The nurse assesses Mrs. A. for coronary risk ● Incentive Spirometer
factors. Which finding obtained during the health
history represents the greatest risk? PTCA: Post
a. Pt.’s brother had MI, sister has HPN ● Treat Post-op pain
b. Pt. smoke 20 cigarettes per day for 5 years ● Report symptoms of infection
c. The patient has a sedentary lifestyle
d.The patient works long hours in a stressful CABGS: Vessel Used
environment ● Saphenous Vein
● Internal Mammary Artery (IMA)
Interventions ● Radial Artery
● Morphine - MI drug of choice
● Anticoagulants (medications ending in Nursing Intervention
"-parin" ● Pain relief
● Nitrates - (e.g. Nitroglycerin: drug of choice ● O2(2-4 Lpm)
for angina) ● VS Monitoring
● Aspirin - antiplatelet ● Bedrest initially
● Statins - used for cholesterol control (e.g. ● Reduce Anxiety
Atorvastatin, Simvastatin) ● Monitor complications
Reperfusion Treatment ANGINA

● Medical STABLE ANGINA
➔ Thrombolytic - dissolve thrombus or Definition
clot in coronary arteries ● Predictable consistent pain
T-PA (alteplase - side effect: ● Relieved by rest and NTG (Sublingual: 3x
bleeding every 5 mins or Spray)
Streptokinase - side effect: ● Occurs during exertion
bleeding
UNSTABLE ANGINA c. Pain in the calf or foot that occurs at rest

Definition d. Burning or cold sensation that increases
● AKA preinfarction angina with exercise and is relieved by elevating the legs
● Crescendo angina
● Symptoms increased in frequency BUERGER'S DISEASE (Arterial Problem)
● Not relieve by rest and NTG ● Intermittent arteriolar vasovonstriction
VARIANT/PRINZMETAL ANGINA Signs and symptoms

Definition ● Coldness
● Cause: Vasospasm ● Pain
● Pain at rest ● Pallor
QUESTIONS Cause
1. The diagnosis of Prinzmetal’s variant angina ● Unknown
means that the patient's pain?
a. Occurs with crushing pain and Risks
diaphoresis ● Female (BW: 16-40)
b. Occurs most frequently during rest ● Smoking
c. Occurs in paroxysms while reclining Treatment
d. Not relieved by NTG ● Calcium Channel Blockers - e.g.
Nifedipine (vasodilator)
Medications
● Nitrates - drug of choice for angina QUESTIONS
● Beta blockers (e.g. Metropolol, -olol) 1. Which statement does not describe Raynaud’s
● Calcium Channel Blockers disease?
● Antiplatelets (e.g. Aspirin, Clopidogrel) a. Characterized by episodic digital vasospasm
● Anticoagulants associated with skin color changes
b. It usually occurs in men ages
QUESTIONS c. It is precipitated by exposure to cold or by
1. What is the narcotic of choice for a client with emotional stress
myocardial infarction? d. It typically is seen in the fingers
a. Nitroglycerin
b. Tramadol PERIPHERAL VASCULAR DISEASE (Venous
c. Morphine Sulfate Ulcers)
d. Paracetamol 1. Varicose veins
2. Thrombophlebitis
PERIPHERAL VASCULAR DISEASE
BUERGER'S DISEASE (Arterial Problem) VARICOSITIES/VARICOSE VEINS
● Acute inflammatory condition small-medium Definition
size arteries and veins of upper extremities ● Abnormal dilation of vein in lower
and lower extremities extremities due to incompetent vein
● Due to incompetent valves
Cause
● Unknown Risk
● Obese
Signs and Symptoms ● Women
● Intermittent Claudication ● Pregnant women
➔ Leg pain upon walking relieved by
rest Factors
● Cold sensitivity - Instruct to use gloves ● Hereditary
● Ulceration ● Congenital weakness of veins
● Gangrene ● Obesity
● Pregnancy, prolonged immobility
Prevention
● Instruct to stop smoking Interventions
● Elevate legs above heart level → increase
QUESTIONS venous return (2-3 pillow elevation)
1. Intermittent claudication refers to: ● Measuring circumference of leg to
a. Leg pain that occurs after exercise determine swelling
and is relieved after rest ● Wear anti-embolic stockings
b. Non healing ulcers on the lower leg near
the ankle
THROMBOPHLEBITIS/DVT baseline and

● Inflammation of veins related to blood clots symptoms free - once
or thrombus normal, patient can
Risk go home
● Smoking
● Sedentary lifestyle
● Obesity - hyperlipidemia QUESTIONS
● Prolonged use of OCPs (Oral Contraceptive 1. Atrial .depolarization is presented by:
Pills - prevent lipolysis a. T wave
b. U wave
Signs And Symptoms c. P wave
● (+) Homan’s sign - pain on calf muscle upon d. R wave
dorsiflexion
● Echocardiography - Ultrasound of the
Treatment heart; used to evaluate the wall motion of
the heart and valves
● Anticoagulant
PRE-TEST:
● Prevent complications
➔ Remain still
➔ Pulmonary embolism
➔ Explain - no pain nor electrical
shocks
Diagnostic Test
POST-TEST:
● Troponin ➔ Cleanse lubricant from chest wall
➔ Onset is before CK-MB (for the
heart) QUESTIONS
➔ More specific to cardiac injury for MI 1. Which of the following represents ventricular
● Lactic Dehydrogenase (LDH) repolarization?
➔ Useful in delayed diagnosis of MI a. T wave
● Serum Lipids (Cholesterol) b. ST segment
➔ NORMAL VALUE: <200 mg/dL c. QRS complex
➔ Fasting: 10 to 12 hours; NPO post d. PR interval
midnight
● Types: ● Coronary Angiography
➔ LDL: <100 mg/dL ➔ Invasive
➔ HDL: >40 - mg/dL (exercise to ➔ Cardiologist inject dye into coronary
increase level which is good for the arteries
heart) ➔ Used to visualize the disease
➔ TG: <150mg/dL - predispose to process in coronary arteries
atherosclerosis PRETEST:
● ECG - monitors electrical activity of the ➔ Consent
heart ➔ Assess history - allergies to dye and
1. Holter Monitoring shellfish
➔ a non-invasive test, POST TEST:
continuous ambulatory ECG ➔ Same as cardiac catheter
monitoring overtime (usual
24hrs) QUESTIONS
➔ Used to determine the 1. During the first several hours after a CABGS, it
existence of arrhythmia would be most essential for nurse A to..
➔ Instruct to resume the a. Maintain head at neutral position and
activities elevate client’s bed at 45 degrees
➔ Instruct the patient not to b. Instruct the client to cough and deep
take a bath breathe every 2 hours
2. Stress Test c. Monitor client’s apical pulse and blood
➔ continuous multilead ECG pressure - because the patient is susceptible to
monitoring during controlled bleeding
increased supervised d. Monitor client’s urine output every hour
exercise usually on treadmill
➔ PRE TEST: QUESTIONS
◆ Consent 1. A 54 y/o male client with a long CAD and angina
◆ Eat light meal (1 to 2 is to be scheduled for Holter monitor. During
hrs before exam) teaching, Nurse C should inform the client that the
➔ POST TEST: primary purpose of the procedure is…
◆ Monitor ECG, BP a. To determine the existence of arrhythmia -
until client returns to Holter Monitor is a 24 hour ECG
b. To visualize the disease process in the coronary

arteries
c. To obtain the heart chambers pressure
d. To evaluate wall motion of the heart
QUESTIONS
1. From an ECG reading, a QRS complex
represents..
a. Ventricular depolarization
b. Ventricular Repolarization
c. End of ventricular depolarization
d. Atrial depolarization
LECTURE 10: MEDICAL-SURGICAL NURSING
CARDIAC CATHETERIZATION  With severe hypertension or hypotension

 Insertion of catheter into the heart and
sorrounding vessels EMERGENCY NURSING
 Invasive procedure
 Performed in the Catheter Laboratory (Cath Lab) BITES
 Obtain diagnosis information and function of the
heart 1. Dog Bites- 90% of cases
 Degree of Atherosclerosis  Rabies (virus)
 Degree of blockage (status of the artery)  Do not go to the blood because it is neurotropic
 When you inject a dye (Angiography)  The higher the bite size, the shorter travel time
 Done simultaneously with Angiography
2. Human Bites
Pre-test:  No rabies
 Cleanse only with Soap and Water
 Consent  Antibiotics (if there is bites) and Tetanus Toxoid as
 History: Allergies to dye, iodine and shellfish prescribed
 Check creatinine (contraindicated to patients with
renal failure)- DYE are toxic to the kidney 3. Snake bites
 Called Contrast Dye  Most common site: Upper extremities
 Coral Snake (Red, yellow, black color)- poisonous
Post-test:
 Bedrest 4-6 hours

 Keep affected extremities straight
 Monitor pulses (distal to insertion site) - if
pulselessness or malamig or signs of shock
Poisonous Non-poisonous
HEMODYNAMIC MONITORING  Large fangs  Small fangs
1. Cental Venous Pressure (CVP)  Elliptical pupils  Round pupils
 Right Side of the Heart (right atrium)  Pit (hole between
 Measures Right heart filling pressure the mouth and
 Monitoring system in the Vena Cava eyes)
 Normal: 2-8 cm. H2O, if higher that 8:
Hypovolemia (increased fluids in the lungs) Classic Signs of Envenomation (give Anti-
 Or 2-6 mmHg (monitor fluid volume status) venom):
 Monitor degree of hydration (ex. Burn patients)
 For fluid rescucitation  Edema
 For Hypovolemia  Ecchymosis
 To monitor O2- use pulse oximeter  Hemorrhagic bullae
 ABG analysis- blood
Other Signs:
Surgeon inserts single-lumen or multilumen  Lymph node tenderness
catheter through:  Nausea and vomiting
 External Jugular  Numbness
 Antecubital (most common)  Metallic taste
 Femoral vein  Diaphoresis
2. Pulmonary Artery Pressure (Swan-Ganz) FIRST AID

 Left Side of the Heart Snake Bite
 Assess Left Ventricular function
 Don't run and don't elevate because it will
 Pulmonary artery catheter (balloon-tipped) and
circulate in the body, just LIE DOWN
pressure monitong system are used (expensive
 Immobilize injured part below level of the heart
procedure)
 Cleanse with soap and water
Pulmonary Capillary Wedge Pressure (PCWP)
 cover with light sterile dressing
 pressure monitoring is extended to the area of
your pulmonary artery
 Surrogate for Left Atrium pressure CITE MNEMONICS:
Mnemonic: PLS  NEVER CUT THE SKIN- can cause infection

 Pulmonary Artery Pressure  NEVER APPLY ICE- cause rapid venom
 Asess Left heart pressure absorption
 Swan-Ganz  NEVER APPLY TOURNIQUET- can cause loss
of limb
3. Intra-arterial BP Monitoring  NEVER USE ELECTRIC SHOCK- can cause
 Invasive type of BP monitoring severe injury
 Site: Radial arterty
 To obtain direct and continuous BP measurement
 For critically ill patients
 All bites can apply Ice, except SNAKE BITES
 Spiny Fish
 Sea Urchin
Priorities of Care:
 Airway
 Breathing Treatment:
 Compress
 Flush Site with SEA WATER
 Immobilize site
 Conscious- ABC  Soak in hot water x 30 min
 Arrested- CPR-COMPRESSION first  Clean and cover wound
INSECT STINGS JELLYFISH

Signs and Symptoms:  NEVER TOUCH/NEVER RUB tentacles with bare
hands ❌
 Mark from the bites or sting  Pour VINEGAR on affected area/soak- because it
 Pain denatures the toxin
 Redness  If wala, use RUBBING ALCOHOL or BAKING
 Swelling SODA
 Venom Sac  NEVER RINSE WITH FRESH WATER- can cause
 Stinger stinging to fire
If stinger is still present- remove it:  Stridor- CHOKING OBSTRUCTION

 GENTLE PRICK OF CARD or Edge of  Crackles- HEART FAILURE
KNIFE  Wheezes- ASTHMA
 NEVER USE FORCEPS NEVER USE  Friction Rub- PERICARDITIS
HANDS, has danger to get inside
 Cholera- TETRACYLCINE
Drug of Anaphylactic: Epinephrine
Antihistamine- for itchiness BLS in UNRESPONSIVE
 Compression
Treatment:  Airway
 Breathing
 Never scrub area  Defibrillation
 Lower site of bite  Assess for scene safety
 Apply cold compress to relieve pain and swelling  To check for unresponsiveness
 Check for Pulse-10 seconds to check pulse
BEE STING  Baby/Infant- Brachial
 BEE- Apply paste or use BAKING SODA and  Child/1 year old above- Carotid
WATER to relieve the pain of bee sting  No pulse, begin CPR
 Use VINEGAR or LEMON JUICE to relieve pain
of WASP STING
Single Rescuer
 Compression Ventilation Ratio of Infant-
Poisonous Insect: 30:2
BLACK WIDOW  Compression Ventilation Ratio of Child- 30:2
 Systemic effect within 30 minutes  Compression Ventilation Ratio of Adult- 30:2
 sharp pain and prick pain, very painful- black  Infant- 4 cm or 1- and one-half inches
widow  Adult- 5 cm or 2 inches
 painless brown widow
2 Rescuers
Treatment:
 Compression Ventilation Ratio of Infant and
 Ice to site Child-
 ⬇️Systemic Toxin Delivery  15:12
 Antivenin- effective  Compression Ventilation Ratio of Adult-
 30:2
 Compression per minute: 100/min: Infant
BROWN WIDOW and Adult
 Brown recluse spider
 bite doesn't heal
 Wound care: Soap H20 Hyperbaric O2 tx Check:
(Hyperbaric Oxygen Chamber)  Lower half of the sternum
 Interlocking
 Push hard and push fast
First Aid In Marine Life  Jaw Thrust- use if has a history of fall
 Stingray
o Anaphylactic
 Hemo/tension pneumothorax
COR SEQUENCE
Infant BLS  Asphyxia
 Open fractures long bone (fat embolism)
 Check for Brachial  2-3 burns 15-40%
 Compression- 2 fingers for 1 rescuer
 2 thumb- encircling hands for 2 fingers YELLOW - Delayed
 Fracture requiring open reduction
Adult BLS  GUT disruptions
 Compression  Eye and CNS injuries
 atleast 100/min  Maxillofacial injury without airway
 approx 1 1/2 in 4 cm
compromise
 15:2- 2 rescuers
 Stable abdominal wounds
 30:2 for 1 rescuer
GREEN - Minimal
TRIAGE  Behavioral disorders
 French word "tier"
 Upper extremity
 Life over limb
 greatest good for the greatest number  Minor burns
 Sprains
In Hospital BLACK - Expectant

1. Emergent
 highest  Profound shock with multiple injuries
 Life threatening  Unresponsive pts with penetrating head
 Must be seen immediately wounds
 RED  Seizures/vomiting within 24 hrs. after
 Allergy radiation exposure
2. Urgent  High spinal cord injury (SCI)
 Non-life threatening  Agonal respiration, no BP, no pulse, pupils
 Must be seen in 1 hr. fixed
 YELLOW
 2-3 burns in excess of 60% TBSA
 Eye Injury
3. Non urgent
 can be addressed within 24 hrs PRIMARY SURVEY
4. Fast Track  Airway
 requires simple first aids or basic primary  Breathing
care  Circulation
 maybe treated in ED or referred to a clinic  Disability - neurologic
o GCS - 15 highest; 3 lowest
Reverse Triage
 priority para pauwiin SECONDARY SURVEY
 benign is priority kasi okay na siya
 Diagnosis
FIELD TRIAGE/DISASTER TRAIGE  Interventions
Triage The term given to category of triage that refers

Priority Color to life threatening requiring immediate
Category
Immediate 1 RED treatment:
Delayed 2 YELLOW a. Non urgent
Minimal 3 GREEN b. Emergent
Expectant 4 BLACK c. Fast track
d. Urgent
CONDITIONS
RED - Immediate
 Sucking Chest wounds
 Airway obstruction secondary to mechanical
cause
 Shock
Types
o Hypovolemic
o Cardiogenic
o Neurogenic
o Septic
5. Evaluation
Green Tag:
a. Has significant injuries, can wait hours  Evaluate
b. Injuries that are life threatening by  Future
survival is good with minimal
intervention Mitigating phase includes measures to reduce
c. Extensive injuries, chances of survival harmful effects of a disaster by attempting to
are unlikely even with definitive care limits its impact, the following procedures are
d. Minor injuries, treatment can be under this phase except:
delayed from hrs. to days a. Establishing standard
b. Education and training
c. Requirement for building permit
Which is the most important goal of triage?
d. Fire exit plan
a. Assigning each client to most
appropriate treatment area
b. Giving priority of care to the most
Defined as fires, explosions, mass transit
critically ill
accidents such as train crashes or bridges
c. Providing thorough assessment
collapses that cause numerous deaths and
d. Obtaining appropriate monitoring
injuries.
a. Mass casualties
DISASTER NURSING b. Outbreak
 Destructive event c. Chemical emergencies
 Disrupts normal functioning of community d. Radiation emergency
 Ecological disruption or emergencies
TYPES OF DISASTER Defined as an ecological disruption or threat

 Natural that extends that adjustment capacity of the
 Man-made affected community
a. Man-made disaster
Man-made Disasters b. Natural disaster
 Fire, explosion
 Armed conflicts and acts of war The following are categories of man-made
 Chemical spills, radiologic events disaster except
 Transportation accidents a. Bioterrorism
b. Acts of fire
BASIC PHASES FOR DISASTER MANAGEMENT c. Wildfires
PROGRAM d. Chemical emergencies
1. Preparedness
 Proactive planning
 Planning potential vulnerabilities A phase of disaster management program
 Warning defined as activities undertaken to handle a
 Earthquake drills, fire drills disaster when it strikes
a. Preparedness
2. Mitigating b. Response
c. Mitigating
 Measures to reduce harmful effects of a
d. Recovery
disaster by attempting to limits it impact
 e.g. fire permit, building permit
The following are undertaken during the
3. Response response phase in disaster management
 During disaster program except:
 React: actual implementation of the disaster a. React
plan b. Rescue
 Relief c. Relief
 Rescue d. Rebuild
4. Recovery
 Return to predisaster state
 Rebuilding
 Repairing and Rehabilitation
The actual implementation of the disaster

management plan was under what phase?
a. Mitigating
b. Recovery
c. Preparedness
d. response
Warning and public information on the

possible outcome of the disaster was under:
a. Preparedness
b. Recovery
c. Mitigating
d. Response
 > 1 y/o and adult - Heimlich
 Infants - 5 back slap and chest thrusts
After the typhoon strikes, the phase of
o Avoid blind finger sweep
returning the community from what it was
 Obese patients - 5 chest thrust
before falls under:
a. Preparedness  DO NOT use abdominal thrusts to relieve
b. Recovery choking in infants
c. Mitigating
d. Response What is the underlying pathophysiology of all
forms of shock?
a. inadequate tissue perfusion
Phase of disaster management where b. multiple organ failure
measures are done to reduce its harmful c. release of inflammatory mediators
effects d. the release of clotting factors
a. Preparedness
b. Recovery
c. Mitigating Which electrolyte should the nurse most
d. Response closely monitor in a client who has seizure
episode?
FOREIGN BODY AIRWAY OBSTRUCTION a. Low Sodium
b. Low Potassium - heart ECG
MILD AIRWAY OBSTRUCTION c. High Calcium
 Can cough forcefully d. High Magnesium
 May wheeze between coughs
Which client is at greatest risk for
SEVERE AIRWAY OBSTRUCTION hypokalemia?
 Weak cough a. 65-yo with diabetes mellitus
 Stridor - wheezing during inspiration b. 45- yo with Cushing's disease
 Unable to speak c. 55-yo with Addison's disease
d. 35-yo with diabetes insipidus
UNIVERSAL DISTRESS SIGNAL - Levine Sign
BURN
- categorize by depth
1st Degree Burn
 Superficial- Partial Thickness
Example: Sunburn
 Epidermis possibly portions of the dermis
 Type of Burn: Reddened; blanches with
pressure
 Pain soothed by cooling
Nursing Diagnosis
 Pain
2st Degree Burn
 Deep Partial Thickness o HYPERKALEMIA - PEAKED T

Example: Scald, Flash Flame WAVE/TALL T WAVE
 Epidermis & Dermis  Hyponatremia
 Type of Burn: Blistered; weeping surface  Generalized Dehydration- plasma
 Recovery: 2-4 weeks leaked/damage capillaries
o Increased Hematocrit due to
Nursing Diagnosis dehydration. Known as
 Pain HEMACONCENTRATION
Metabolic Acidosis
3rd Degree Burn
 Full thickness Burn
Acute Intermediate Phase
Example: Electrical Burns, Chemical
 Naadmit na siya
contact
 Prevent and treat infection
 Epidermis, Dermis, Muscle, Bone
 Hydrotherapy – wound cleansing
 Type of Burn: Dry, Leathery, Pale White
 Nutritional support and wound closure
 Possible Loss of Digits and Extremities
 Painless/Pain Free Rehabilitation Phase
 Hypovolemic Shock
 Prevent of scars/contractures
Nursing Diagnosis  Rehabilitation – physical/occupational
 Fluid Volume Deficit - Hypovolemia  Cosmetic reconstruction
 Psychosocial counseling
Medical Management
 Escharotomy – to release circumferential
burn eschar and improve circulation to a
distal extremity or to improve ventilation.
 Priorities on trauma patient
 Assess using ABC
 If patient is arrested, circulation is
priority so perform CPR immediately.
 Pain
 Opiods, NSAIDS, anxiolytics
 nonpharmacologic measures
 therapeutic touch.
 Performed in 1st and 2nd degree
burn.
 Wound cleaning
 Hydrotherapy – active exercise,
cleaning the body
 Posterior Trunk- 18%  Wound of non-ambulatory can be
 Anterior Trunk- 18% cleansed by
 Whole Circumference of head- 9% 1. Using shower carts
 Whole Left Arm- 9% 2. Mobile stretchers made with
 Whole Right Arm- 9% removable sides
 Whole Left Leg- 18% 3. Drainage holes
 Whole Right Leg- 18% 4. Positioning capabilities
3 Phases of Burn Care  Antimicrobial therapy
Emergent/Resuscitative Phase 1. Silver sulfadiazine (Silvadene)
 From onset of injury to completion of fluid = (Flammazine is the most common)
Resuscitation 1% - bactericidal, antibiotic for burn
 First Aid wound
 PLAIN LR- good IV fluid for fluid resuscitate 2. Mafenide acetate (Sulfamylon),
 Priority: Airway Actioat effective gm (+,-)
- Gram + (Blue or Violet)
 Asses: Rule of Nine
- Gram – (Pink)
Assessment: 3. Silver nitrate 0.5% solution _
 POTASSIUM inside, SODIUM outside bacteriostatic fungicidal
(PISO) = HYPERKALEMIA
o K Excess- massive cellular trauma Surgical Management
causes release of K to ECF  Debridement – removal of necrotic tissue
 Natural (tissue sloughs away)
 Mechanical (daily dressings changes)

 Chemical (application of topical enzymes)
 Surgical (use of forceps and scissors)
Fluid Requirement
110 lb pt-50% TBSA burn
Formula: 2-4 ml/kg/%TBSA
2ml x 50 kg x 50 % TBSA = 5000 ml/24h
Plan to administer 1st 8 hours = 2,500 ml or 313

ml/hr
Next 16 hours = 2500 ml or 156ml/hr TYPES OF AORTIC DISSECTION

1. With secondary dissection into the media
Use Isotonic Saline - PLR going to the MEDIAL HEMORRHAGE
- Nagisi yung tunica intima, napunta yung
blood sa media
- Danger: RUPTURE
AORTIC DISSECTION
- There is an intimal tear; tearing of tunica
intima
- Tunica intima is in touch with the blood
- In patients with aortic dissection, there is
hemorrhage which enters the tunica media
because of the torn of tunica intima
- The danger is when this layer ruptures
- Creates a false lumen; this makes this a

danger of developing aortic rupture
- Lumen is intima
CLASSIFICATION OF AORTIC DISSECTION
DEBAKEY CLASSIFICATION:
THREE LAYERS OF THE ARTERY
1. Tunica Intima – inner layer  Type 1 – Ascending and Descending Aorta
2. Tunica Media – middle layer  Type 2 – Ascending Aorta
3. Tunica Adventitia – outer layer  Type 3 – Descending Aorta
STANFORD CLASSIFICATION:
 Type A – Ascending Aorta (Proximal

Dissection)
 Type B – Descending Aorta (Distal
Dissection)
Problem: Elevated blood pressure

Goal: Control blood pressure
ANATOMY OF HEART
Risk Factors
1. Ascending aorta
2. Transverse aorta  Elevated blood pressure or history of
3. Descending aorta hypertension
 Aortic trauma c. It is converted to bilirubin

 Coarctation of the Aorta (COA) producing jaundice
 Third Trimester of Pregnancy d. Kidneys produce erythropoietin from
bone marrow stimulation
Signs and Symptoms 4. A.B. a new nurse is evaluating the response of
a 22-year-old client with Renal Failure with PE
 Sudden pain – front, back, or chest findings of edema and pallor. Peripheral blood
 Chest Pain smear was requested. Which results reflect
increased RBC production by the bone
 Dyspnea (difficulty)
marrow?
 Hypertension a. Reticulocytes
 Pulmonary edema b. Serum Ferritin
 Myocardial Ischemia c. Hemoglobin
d. Erythrocytes
Diagnosis
5. The nurse who is assessing a client with
Vitamin B12 deficiency may note for:
 MRI – metal is not allowed (e.g. bone
a. Cheilitis
prosthesis); if with contrast check the
b. Pharyngitis
creatinine of the patient c. Glossitis (inflammation of the
 CT tongue)
 Hemodynamic Monitoring d. Cheilosis
6. Which of the following food choices made by a
Medications
22-year-old client with iron deficiency anemia
 IV Propranolol, Esmolol (Beta-Blockers)– best indicates that the nurse instruction about
foods rich in iron has been successful?
achieve HR approximately 60 bpm
a. Papaya and banana
o Monitor HR b. Cauliflower and green leafy vegetables
 Nitroprusside Infusion (Vasodilator) – to (still good source of folic acid or iron)
lower systolic BP to 120 mmHg c. Milk and orange juice
o Side effects: headache and d. Lean meats (liver)
hypotension
o Monitor BP
Treatment
 Emergent or Urgent Surgical Correction

(undergo -plasty or repair)
QUESTIONS:
1. A client with high output heart failure came in

with pallor and paresthesia. He was given
Vitamin B12. What will happen to erythrocytes
when B12 is deficient?
a. Reduced RBC size
b. Increased Hgb count
c. Decreased DNA synthesis in RBC
d. Cell is smaller in shape and deficient in
Hgb
2. A 65-year-old male patient with COPD and
CKD on dialysis is receiving erythropoietin
treatment. At home he is maintained on O2 at
4 LPM via nasal cannula. What is the role of
hypoxia in RBC production?
a. Hypoxia stimulates increase in Hgb
and Hct
b. Erythropoietin is released by kidney
when there’s hypoxia
c. Reticulocytes are less transformed to
erythrocytes
d. RBC turns to crescent shape
3. Mr. J was admitted with SVT. He was pale,
icteric with splenomegaly. What happens to
the heme in erythrocyte destruction?
a. Heme is conjugated with globin in
spleen
b. It binds with elastin leading to jaundice
SENSORY Nerves supply of eye

EYES
3 LAYERS
a. Outer
b. Middle
c. Inner
Outer Middle Inner
Sclera Iris Retina
Cornea Ciliary Body
Choroid 1. CN 2 – optic nerve, nerve of sight, visual
acuity
ANATOMY • Assessment: Snellen’s chart
a. Outer 2. CN 3, 4, 6 – extraocular muscles, eye
1. Sclera movement
• white part of the eye • 3 – oculomotor
• Icterus (yellow - jaundice) o Pupil
2. Cornea – ▪ Needs: Penlight
• avascular layer, no blood supply ▪ Constriction - light
• abraded and injured if there are foreign ▪ Dilation - dark
body in the eye • 4 - trochlear
• Infection: Keratitis • 5 - abducens
3. CN 5 – trigeminal nerve, supplies corneal
b. Middle layer reflex
• Uveal tract • What do u need when you assess
• Infection: Uvitis corneal reflex? Cotton wisp
• Touch outer part of the cornea
1. Iris • If your corneal reflex is not longer intact
• Colored part of the eye the patient is deteriorating
• Pupil – the black circular opening in • How many trigeminal nerve?
the iris that lets light in • 2 trigeminal (right and left eye)
o Constricts – if light is shine • Has 3 branches
through o Eyes/cornea
o Dilates – in darkness o Maxilla – you can feel the
sensation of the blush on
2. Ciliary body o Mandibular - chewing
• Maintains IOP by aqueous humor
production QUESTION
• Aqueous Humor – surrounds The nurse assesses corneal reflex. Which of the
following will he need?
around the eye, when elevated
a. Penlight
causes glaucoma
b. Snellen’s chart
o Glaucoma is irreversible c. Cotton wisp
• Normal IOP: 10-21 mmHg d. Tonometer
3. Choroid DIAGNOSTICS
• Contains blood vessels Snellen’s Chart
• A part of the eye which produce • Test for visual acuity
aqueous fluid – ciliary body
• Rosenbaum Chart / Jaeger’s Chart
• Near vision testing
c. Inner layer
• Cranial Nerve 2
1. Retina
• Inflammation: Retinitis Ishihara Chart
• Contains rods & cones
• Color vision test
o Rod – dim, dark vision
o Cons – light
Slit Lamp
AGE RELATED CHANGES OF THE EYE • Examines anterior ocular structures under
PRESBYOPIA microscopic magnification
• age related changes of the eye • Non invasive
• Far sightedness • Where cataracts and foreign body can be
seen
*Presbycusis – deafness
BATCH RUBY │INTENSIVE REVIEW│RTRMF │1

Tonometry d. penlight
• Uses tonometer
• Measure IOP EYE SURGERY NURSING MANAGEMENT
• Normal: 10-21 mmhg Preoperative
• Elevated IOP – Glaucoma • Expect preanesthetic meds & eyedrops
• Aqueous Humor is produced by the ciliary
body 1. Mydriatic eyedrops – dilate pupil
2. Cycloplegic eyedrops - paralyze ciliary
QUESTION muscles
What condition results when rays of light are 3. Myotic – to constrict, for glaucoma
focused behind the retina?
a. Myopia – near sighted Postoperative
b. Hyperopia – far sighted • Monitor v/s, level of consciousness and
c. Presbyopia – age related dressing
d. Emmetropia – normal vision
• Elevate HOB - 30- 45 degrees
• Lie on unaffected site
ERROR OF REFRACTION
MYOPIA • Avoid activities that increase IOP as this will
lead to pain.
• Light focus in front the retina
o Sneezing
• Nearsightedness
o Coughing
• Treatment: concave lens
o Straining/Valsalva Maneuver
o Vomiting
HYPEROPIA
• Diet: papaya, high fiber
• Light fall behind the retina
• Nauseated: we can give antiemetics as
• Farsightedness
prescribed
• Treatment: convex lens
• Priority: Safety
o Side rails up
EMMETROPIA
• Assess complications - sudden sharp eye
• Light focus exactly at the retina
pain
o Pain is an indication that there is an
ASTIGMATISM
increased IOP and hemorrhage
• Irregular curvature of the cornea
(hypovolemic shock)
• Cylindrical lenses
• Wear eyeglasses day and night – to prevent
rubbing of eyes
QUESTION
The nurse reviews the chart of a client who was
QUESTION
diagnosed with legal blindness and is expecting to
Correction for astigmatism makes use of which of
note which of the following?
the following?
a. 20/80
a. Spherical lenses
b. 20/200 – legal blindness
b. Plano lenses
c. 20/50
c. Cylindrical lenses
d. 20/20
d. Pseudophakic lenses
OCULAR MEDICATION
EYE DISEASES
• Eye drops – ophthalmic/ocular drops GLAUCOMA
• *Ear - otic drops • Miotics are needed
• Eye ointment • There is imbalance between aqueous humor
• Ocular medications Production and Drainage
o Placed on the Lower conjunctival sac ➔ leads to an Increased IOP; NV
▪ Pressure between the eyes and nose IOP: 10 -21 mmHg
(nasolacrimal duct), to prevent • Lead to irreversible blindness
Systemic Absoprtion of the Drug • Lower the IOP
(SAD)
▪ How many % SAD if sad will happen: 2 TYPES:
7% SAD
1. OPEN ANGLE GLAUCOMA
QUESTION S/S:
Which of the ff tools will the nurse use in
examining trigeminal nerve? • Loss of PERIPHERAL vision
a. Cotton wisp • Halos around lights
b. Ophthalmoscope • Leads to TUNNEL VISION
c. Snellen’s chart • Not allowed to drive because they can’t see
the side mirror.

a. Assess blood glucose level

2. CLOSED ANGLE/ ANGLE CLOSURE b. Assess heart rate
GLAUCOMA c. Monitor temperature
• Notorious to increase IOP and cause severe d. Assess for platelet count
PAIN and headache Client education following eye surgery:
• Proper techniques eye patch
Diagnostics: • Eye drops instillation - In the lower
• History conjunctiva, put pressure to avoid systemic
• Tonometry examinations – measures IOP pressure that happens at 7%
QUESTION • Beta blockers can cause bradycardia. Watch
A client states that the physician has told her that out for heart rate of the patient. For
her intraocular was 14. The client asks you if that Bradycardia: Atropine
number is “okay”. Which of the following is the
nurse’s best response?
a. “is it somewhat high” QUESTION
b. “it is low” A client after undergoing cataract surgery
c. “Your pressure is within normal limits” develops eye pain? The nurse is aware that pain
d. “Further testing needs to be done” after surgery is indication that there is?
a. On going infection
Priority nursing diagnosis b. Restoration to normal vision
c. Wearing off anesthesia
• Safety – priority
d. Increasing IOP & possible hemorrhage
• Risk for Injury
• Fall -> perform Jaw thrust
There is a time for everything!
Implementation Ecclesiastes 3:1-8
• Administer as ordered: CATARACTS
• To Lower IOP: • Opacity of the lens
✓ Miotics (constrict the pupil)
✓ Pilocarpin (antiobiotics);
Risk Factors
✓ Topical beta blockers – Timolol (eye drop)
• Put pressure to avoid systemic pressure • Eye Injury
that happens at 7% • Smoking
• Put the patient in an open light room • Aging
because of the need to constrict the pupil • Diabetes
of the patient. • Trauma
• Prolonged use of steroids
Surgery • Chronic sun exposure
• To facilitate Aqueous Humor drainage
• Iridectomy (removed) /otomy QUESTION
• Iridotomy – opening A cataract is a condition in which
a. Ciliary muscle no longer expand
• Trabeculoplasty
b. The retina degenerates
• Medical management if the patient does not
c. The lens of the eye becomes opaque
want a surgery
d. Vitreous humor is lost from the eye
QUESTION
Which of the following nursing medication is not
Assessment
used for glaucoma treatment?
a. Pilocarpine (Miotics) • Painless BLURRING of vision
b. Carbachol (Miotics) • Presence of WHITE/CLOUDY Pupil
c. Latanoprost (Prostaglandin Analogs)
d. Atropine (Midriatic) Treatment
• No medications. Treatment is SURGERY.
The nurse is to administer prescribed eye drop in • SURGICAL REMOVAL OF LENS
a client with glaucoma. The nurse reviews • Lens Replacement through Lens Implant or
physician orders, expecting which type of eye Opaque glasses and Corrective lenses.
drops to be prescribed?
a. Miotic agent APHAKIA – Condition without lens temporarily
b. Cycloplegic because he/she is undergoing a procedure.
c. Ofloxacin eye drop QUESTION
d. Mydriatic medication Which of the following manifestations is
associated with cataract?
Betaxolol hydrochloride eye drops have been a. Color blindness
prescribed for client with glaucoma. Which of the b. Loss of peripheral vision only
following nursing actions is most appropriate c. Painless progressive loss of vision
related to monitoring the side effects of this d. Constant pain the eye
medication?

Implementation ✓ Use of eye shield at night to prevent from

• SAFETY immediate rubbing of their eye
QUESTION • Avoid activities that may Increased IOP

Treating a cataract primarily involves which of the ✓ Sneezing
following? ✓ Vomiting – give antiemetics; Anesthetics
a. Instillation of miotics (Glaucoma) wearing off
b. Instillation of mydriatics ✓ Straining
c. Removal of the lens ✓ Coughing
e. Enucleation – removal of the eye
• DIET: HIGH FIBER
Surgery • Report sharp pain
PHACOEMULSIFICATION:
• Ultrasound vibrations to Break lens into QUESTION
fragment After cataract removal surgery, the client is
instructed to report any complaints of a sharp
Priority Nursing Diagnosis pain in the operative eye because this could
indicate which of the following post-op
• Safety complications?
• Side rails up a. Detached retina
b. Prolapsed of the iris
Preoperative: c. Extra copsular erosion
• Preanesthetic meds & eyedrops - In the d. Intraocular hemorrhage
lower conjunctiva, put pressure to avoid
systemic pressure that happens at 7% Priority
• Mydriatic eyedrops that dilate pupil
• SAFETY
• Cycloplegic eyedrops to paralyze ciliary
• SIDE RAILS UP
muscles
• Wear eyeglass
Client education following EYE SURGERY
RETINAL DETACHMENT
• Leave eye shield in place until surgeon’s • Separation of retinal pigment epithelium from
visit sensory layer
• Eye shield at night for protection • Painless
• Wear eye glasses to protect them from glare • Only Glaucoma is Painful.
of sunlight
• APHAKIA – No lens Causes
• AVOID rubbing, squeezing, putting pressure
• DM retinopathy
on the eye
• Aphakia
• Tumor
QUESTION
• Inflammation
Which of the following activities should be avoided
to achieve the goal of decreasing intraocular • High myopia
pressure after eye surgery?
a. Lying supine CR:
b. Coughing • Sensations of CURTAINS around the eye
c. Deep breathing • Flashes of light, floaters
d. Ambulation • Sense of CURTAIN being drawn over the
eye
Postoperative
Preoperative management
• Avoid rubbing, avoid touching the eye
• V/S • Cover both eye with eye patches to prevent
• LOC further detachment
• Dressing • All activities with rapid eye movement are
contraindicated
• Lie on UNAFFECTED SIDE
• Teach client to leave eyepatch or shield in
Surgery
place until changed or remove by surgeon at
post op visit, usually within 24 – 48 hrs (2 A. SCLERAL BUCKLE
days) until such time the patient may • MD compresses sclera (indecent sclera) to
undergo a follow-up. promote reattachment.
• Remember that the 2 layers have been
• When taking a bath: separated. Goal is to reattached.
✓ Avoid bending; avoid tying shoes
Most popular surgery: RETINATOPLASTY
• Eye Protection B. CRYOTHERAPHY
✓ Use of sunglasses during day • Creates local inflammation that will adhere
retina to choroid.

• Proper contact lenses care – to prevent

C. PNEUMATIC RETINOPEXY: keratitis
• After surgery: Prone as advised. Float gas • Reduce pain
bubble • Warm compress
• Injection of gas bubble or silicone oil into • For eye trauma – we apply cold compress
vitreous cavity to help push sensory retina,
up against RPE (Retinal Pigment MACULAR DEGENERATION
Epithelium). • Deterioration of macula area of central
• Most important here is the position of the vision.
patient, which is PRONE as prescribed. • Straight lines appear wavy
o Or you may try to place the patient into • Happen also as a result of aging
side lying.
o Prone position helps the gas bubble or QUESTION
silicone oil to float and help reattached 1. A client with cataract would most likely
the 2 layers. complain of which symptoms?
a) Halos and rainbows around lights –
Management: Post-Operative Period Glaucoma
• Avoid activities that increase IOP b) Eye pain, irritation that worsens at
• Avoid activities that induce rapid eye night – Glaucoma
movement c) Blurred vision and hazy
o Ex. reading, sewing, driving for d) Eye strain and headache when doing
these are activities that will require close work
eye movement.
QUESTION CHEMICAL BURNS

1. The nurse is developing a plan of care for a • Flush eye with water for 15-20 mins
65-year-old client with post cataract surgery. o Home setting: flush eye with running
Which of the following includes in the nurse water.
plan of care? o Hospital setting: flush eye with
a) advise to wash hair the next day PNSS
b) encourage deep breathing & coughing • Flush on the lower conjunctiva
c) avoid vigorous brushing o Flushing the sclera can cause pain
d) encourage to wear tight collar shirts
QUESTION
2. A client suspected to have glaucoma is to 1. A 62-year-old woman has accidentally
undergo measurement of intraocular sprayed an insecticide into her left eye while
pressure. Which of the following instrument is working in her garden. The nurse instructs the
to be prepared by the nurse? woman which of the following?
a) Gonioscope - measures the angle of a) Call the physician
the anterior chamber of the eye b) Come to the emergency room
b) Slit lamp c) Irrigate the eyes with water
c) Tonometer d) Cover the eye with pressure patch
d) Ophthalmoscope
2. A nurse is caring client diagnosed with
glaucoma. Which of the following includes in
KERATITS nursing assessment?
• Inflammation of the cornea a) Sensation of curtains
b) Tunnel vision
Treatment: c) White pupil
• We prescribe an antibiotic. d) Lid edema – Blepharitis, inflammation
of the eyelid.
EYE INFECTIONS MANAGEMENT:
• Antibiotics 3. The nurse is caring for a client after sustaining
o There are ocular antibiotics that are chemical injury on the left eye. The initial
given either in the form or eyedrop or nursing action.
eye ointment. a) Cover the eye with a patch
o Sore eyes – medical term is b) Begin visual acuity test
conjunctivitis c) Irrigate the eye with sterile normal
• Anti-viral saline
• Antihistamines – given via oral route d) Place the client flat on bed
• Corticosteroids
4. The goal of therapy in clients with glaucoma is
• Analgesics – given via oral route
a) to prevent infection
b) to lower IOP
Other Management:
c) to prevent pupil constriction
• Proper handwashing d) to prevent uveitis

CONDUCTIVE SENSORY NEURAL

5. Most characteristic of a client with cataract HEARING LOSS HEARING LOSS
a) painful blurring of vision External Ear and
Inner ear
b) sensation of curtains in the eye Middle Ear
c) painless blurring of vision • Labyrinthitis
d) loss of peripheral vision • Otitis media & • Meniere’s disease
externa • Presbycusis
6. A client with Cataract has? • Foreign body • Also, drug toxicity –
a) opacity of the cornea ototoxic drugs
b) opacity of choroid
c) opacity of the lens ASSESSMENT OF EAR
d) opacity of the retina
• Otoscopic examination – visualization
o Adult: Up and back
o Child (less than 3): Down and back
“Lamp of the body is the eye. If therefore your eye is • Normal ear canal – pink, cerumen
good, your whole body will be full of light, but if your o Impacted cerumen – conductive
eye is bad your whole body will be full of darkness.”
hearing loss, due to excessive
cerumen.
EAR o If erythematous becomes otitis
EAR ANATOMY externa.
• Tympanic membrane – normally is pearly
EXTERNAL INNER EAR gray
MIDDLE EAR
EAR (LABYRINTH) o Erythematous tympanic membrane –
composed of otitis media, red or bulging tympanic
tympanic membrane
composed of membrane, composed of
external ear malleus, incus, cochlea and HEARING LOSS
canal and stapes, as well semicircular A. CONDUCTIVE HEARING LOSS
auricle as the canals
• external and middle ear obstruction
Eustachian
tube
Cause:
Inflammation – Inflammation – Inflammation –
Otitis Externa Otitis media Labyrinthitis • Any physical obstruction to transmission of
sound waves of the external and middle ear.
• In case where an insect enters the ear, don’t
use instrumentation. B. SENSORINEURAL HEARING LOSS
• For foreign body don’t irrigate – better bring • Any problem in the inner ear
the patient to the hospital for removal. • The problem is in the labyrinth
QUESTION Causes:
1. Ear bones that transmit sound vibration to the • Defect in the Cochlea, CN8, Brain
oval window of the cochlea are found in the • Labyrinthitis
a) middle • Meniere’s disease
b) inner • Presbycusis
c) outer
d) canal TUNING FORK TEST
• Age related changes in the ear: Presbycusis • Either the Weber or Rinne’s test.
o A sensorineural hearing loss • Evaluation of hearing loss
associated with aging o If either conductive or sensorineural.
• Functional hearing loss – example is can’t
hear the ringing of the phone. WEBER’S TEST
• Detects unilateral hearing loss
QUESTION • A person with normal hearing, sound can be
1. The nurse is planning care of a client heard in both ears.
diagnosed with Presbycusis knowing that the • Tuning fork is placed in the midline of the
condition is patient’s forehead and you ask if they can
a) Nystagmus that occurs with aging hear the sound in both ears.
b) Tinnitus that occurs with aging o Both ear – normal “(+) Weber”
c) Sensorineural loss that occurs with o If sound is heard best in the
aging poor/diseased/affected ear, there is
d) Conductive hearing loss that occurs conductive hearing loss.
with aging o If sound is heard best in the better ear
there is sensorineural hearing loss.
Labyrinthitis
Meniere’s disease
Presbycusis

RINNE’S TEST • Before the surgery, make sure the patient

• Compares your air and bone conduction does not have coughs or colds
• Allow the fork to vibrate and place it in the • Goal is to prevent pressure on the middle ear
mastoid bone, ask the patient if he/she can • Give antiemetics PRN to avoid vomiting
no longer hear the sound/vibration. If the o Nauseated will increase the pressure
patient states they can no longer hear it, o Eg. Metoclopramide or Placil
place the fork in front of the pinna.
o Diet: High fiber diet
o If they heard it longer in the pinna
this mean: Air Conduction is longer • Stool softeners - to avoid straining
than Bone Conduction – normal • Avoid activities increasing middle ear
o If bone conduction is greater - pressure
problematic
• Normally air conduction is longer than bone QUESTION
conduction. The nurse has conducted discharge teaching after
o Normal – Rinne A > B ear surgery. Which indicate that teaching was
o Sensorineural hearing loss – A > B effective?
• To know if the patient really has a problem
do the weber’s test. a. I will take stool softeners as prescribed by my
doctor
AUDIOMETRY b. I should drink liquids through straw for 2 – 3
• Measures hearing acuity weeks
• CN8 – vestibulocochlear nerve, cranial nerve c. I can resume my bowling lessons next week
for hearing.
d. I can now travel through airplane next week
QUESTION
CLIENT EDUCATION FOLLOWING EAR
Which of the following nursing actions is appropriate
SURGERY:
for a nurse in caring a hearing-impaired client?
• Avoid activities that increase middle ear
a. Speak frequently pressure
b. Speak at affected side o Sneezing
c. Speak at normal tone o Coughing
d. Speak loudly o Straining
o Vomiting
Otic Drugs – the name of medications we used in • Diet: High fiber diet or High residue diet
the ear
OTIC IRRIGATION AVOID!!
• Check: irrigate temperature is 37 C (closer to • Drinking through straw
body temp) • Rapid head movements
• Ensure that tympanic membrane is intact (do • Strenuous activities
not irrigate if perforated) • Traveling by air
• Do NOT irrigate if TM is perforated • Contact persons with colds
• Do irrigation to impacted cerumen
OTITIS EXTERNA
QUESTION Description
Which of the following is an important nursing action • Also called the Swimmer’s Ear
for a client undergoing otic irrigation? • Mostly affected are patients who went
swimming and debris in the ear
a. Make sure client is seated comfortably • Inflammation of the ear canal (external) –
b. Reassure the client there will be no pain expect it to be red because of infection
c. Ensure intactness of tympanic membrane • TYPE: Conductive hearing loss
d. Use of aseptic technique
Note: Just clean your ears 3 times a week
NURSING MANAGEMENT
PREOPERATIVE: Ear Surgery Causes
• Teach to reduce anxiety • Staphylococcus Aureus
• Safety is priority (handrails, absence of throw • Pseudomonas
rugs)
• Teach what to expect regarding the surgery Pathognomonic Sign
• (+) Aural Tenderness
POSTOPERATIVE: Ear Surgery
• Most likely the patient does not have fever
• Monitor vital signs, LOC, bleeding, drainage,
pain
• Lying NOT on operative side

Management • Swelling behind the ear (mastoid)

• Antibiotics • TYMPANIC MEMBRANE on otoscopic
• Analgesics examination: (DIRT)
o Dull
o Immobility
OTITIS MEDIA
o Reddened
Description
o Thick
• Middle ear infection
• Affects the EARDRUM or TYMPANIC Treatment
MEMBRANE
• MASTOIDECTOMY WITH
• Consequence of URTI (Upper Respiratory TYMPANOPLASTY
Tract Infection) o Removal of mastoid ear cells
• TYPE: CONDUCTIVE HEARING LOSS o Most common treatment
o BC > AC in Rinne’s test
• WEBERS TEST: Heard best in POOR EAR Complications
• Damage to CN 6 (Abducens – affects lateral
Symptoms
movement of the eye) and CN 7 (Facial)
• OTALGIA - middle ear pain as a result of • Meningitis
infection • Dizziness
• Fever • Vertigo
• High ear pressure
• Bulging eardrum QUESTION
• Ear discharge An otoscopic examination was performed by the
nurse on a client. The tympanic membrane is dull
Treatment and red color. The nurse determines that the client
• Apply heat locally 3x for 20 minutes has:
• Antibiotics
• Analgesics a. Normal eardrum
b. Swimmer’s ear
Surgical Procedure c. Mastoiditis
• MYRINGOTOMY/ TYMPANOTOMY - d. Acoustic neuroma
surgical perforation of TYMPANIC
MEMBRANE
QUESTION
o The goal is to relieve pain and drain
Which of the following would be a plan of care for a
the secretions of middle ear
client who had mastoidectomy?
• TYMPANOPLASTY - repair of EARDRUMS
a. Monitor for signs of injury to CN8
QUESTION
b. Monitor for signs of dizziness, pain, and
The nurse is caring for a client with otitis media
nausea
undergone myringotomy. The nurse evaluates
c. Keep client flat on bed
whether the client obtained relief from which of the
d. Instruct the client to lie on the affected side
following symptoms after the procedure.
a. Tinnitus OTOSCLEROSIS
b. Aural tenderness Description
c. Vertigo • No infection
d. Ear pain • Abnormal growth of tissue in the STAPES -
located near the cochlea but does not affect
the eardrum
QUESTION
• Hereditary
• Common in: PREGNANT WOMAN
Otalgia is a classic symptom of? • TYPE: Conductive Hearing Loss
a. Otitis media
A pregnant woman is complaining of hearing loss on
b. Otosclerosis
both ears. On otoscopic examination, the tympanic
c. Otitis externa
membrane is pinkish, (-) Rinne. The client is
d. Meniere’s disease
probably suffering from?
MASTOIDITIS a. Meniere’s disease

Description b. Otosclerosis
• Inflammation of MASTOID EAR CELLS c. Presbycusis
• Results from untreated Otitis Media d. Cerumen impaction
Symptoms

Treatment d. Facial paralysis

• STAPEDECTOMY - removal of diseased
stapes Attacks may be triggered by:
• HEARING AID • Increased Na intake
• Vasoconstriction (eg. Coffee)
QUESTION • Allergies (Management: antihistamine)
A client diagnosed with Otosclerosis asks about her
condition. Best response of the nurse include: Treatment
a. It involves the incus • Antiemetic

• Antihistamine
b. Hearing aid may help
c. It is consequences of otitis media
Interventions
d. Elderly are more prone
• DIET: LOW SODIUM DIET/LOW SALT -
where sodium is water follows
QUESTION • Endolymphatic Drainage
The nurse notes that the physician has documented • Vestibular Nerve Resection
a diagnosis of otosclerosis on the client’s chart. The • LABYRINTHECTOMY - removal of the
nurse plans knowing that the condition… LABYRINTH
a. Tinnitus occurs with the condition QUESTION

b. Will produce sensorineural hearing loss The nurse is caring for a client following
c. Produce conductive hearing loss mastoidectomy. Assessment of which of the
d. Will produce vertigo following cranial nerves is important if infection is not
adequately removed?
MENIERE’S DISEASE
Description a. CN 4
• Inner ear disorder b. CN 3
• Increased ENDOLYMPHATIC FLUID in the c. CN 6
membranous labyrinth d. CN 8
• TYPE: SENSORINEURAL HEARING
LOSS
• Diet: Low salt QUESTION
• Can be given with diuretics The nurse caring for client with Meniere’s disease.
Priority nursing diagnosis include:
QUESTION
A 86 year old client has been diagnosed age related a. Risk of fluid deficit
hearing loss. The nurse documents this as: b. Risk of injury
c. Risk of fatigue
a. Otalgia
b. Meniere’s disease d. Risk of isolation
c. Otosclerosis
d. Presbycusis QUESTION
The nurse includes diet as part of discharge teaching
TRIAD: for a client with Meniere’s disease:
• Vertigo – most common complaint
a. Low fat diet
o Priority nursing diagnosis: risk for
b. Low cholesterol diet
injury
c. Low sodium diet
o Safety is priority
d. Low carbohydrate diet
• Sensorineural HL
• Tinnitus
QUESTION
Note: A client is admitted with a diagnosis of Meniere’s
• Priority nrsg diagnosis: risk for injury disease. The nurse should place highest priority on
• Priority nursing intervention: safety doing which of the following?
QUESTION a. Allowing client to keep flat on bed

A client with Meniere’s syndrome is extremely b. Assess for risk of infection
uncomfortable because of which of these? c. Preventing the client on the risk of injury
d. Psychological support
a. Vertigo and resultant nausea
b. Many perceptual difficulties
c. Severe earache

QUESTION • May be due to pneumonia or heart failure

When monitoring a patient who has respiratory (left sided)
acidosis, nurse would expect which of the ff ABG
levels? QUESTION
a. pH 7.25, PaCO2 50, HCO3 24 Discrete, non-continuous sounds produced by
b. Ph 7.35, Paco2 35, HCO3 24 moisture in TBT. Heard best on inspiration.
c. Ph 7.25, Paco2 36, HCO3 24 a. Rales
d. Ph 7.25, Paco2 27, HCO3 24 b. Rhonchi
c. Tracheal sounds
RESPIRATORY SYSTEM
• Pleura – covering of the lung 2. RHONCHI
• Pneumonia – inflammation of the lung • Continuous sounds
• Pleurisy – inflammation of the pleura • Produced by secretions
• Right lung – 3 lobes • Can be removed
• Left lung – 2 lobes
• Alveoli – where gas exchange takes place 3. FRICTION RUBS
• Continuous sounds
• Crackling, grating sounds, originating in an
NORMAL BREATH SOUNDS inflamed pleura
• Heard in pericarditis (most frequent sign;
1. TRACHEAL BREATH SOUNDS auscultatory findings)
• harsh, discontinuous - Most frequent symptom = chest pain
• heard over tracheal area
DIAGNOSTIC PROCEDURES
2. BRONCHIAL BREATH SOUNDS
• Loud, high pitched 1. BRONCHOSCOPY
• Bronchial area • Direct visualization of the larynx, trachea,
and bronchi with fiber optic bronchoscope
QUESTION • Requires consent
As you are preparing to suction the client with • Baseline bleeding studies (PT, PTT)
tracheostomy to which position will you render the • Patient is under sedation
client to promote coughing and deep breathing? • After procedure, assess gag reflex
a. Sim’s • Initially, patient may be NPO
b. Supine
c. Side lying PRE-PROCEDURE
d. Semi-Fowler’s • Consent
• NPO
3. BRONCHOVESICULAR BREATH SOUNDS
• Medium pitched POST-PROCEDURE
• Between scapulae • Prepare suction
• Sedation as prescribed
4. VESICULAR BREATH SOUNDS • Test gag reflex = use of tongue depressor;
• Characterized as low pitched bs CN 9 and 10
• Heard at lower lobe of the lungs • Vitals signs
• Semi-Fowler's
QUESTION • Check gag reflex
A healthy client comes to the clinic for a routine • RR = assess for labored breathing may be
due to perforation
examination, When auscultating his lower lobes, the
• Sputum = asses if bloody
nurse should expect to hear:
a. Bronchial
b. Tracheal 2. THORACENTESIS
c. Vesicular • Aspiration
d. bronchovesicular
• Removal of fluid or air in the pleural space
via transthoracic aspiration
ABNORMAL BREATH SOUNDS • Sitting position
• Chest x-ray after the procedure
1. RALES
• Done in:
• discrete, non-continuous sounds produced o Pneumothorax
by moisture in the tracheobronchial tree o Pleural effusion
• More rales = crackles • If too much fluid in pleura, CTT is performed

• Do not cough, deep breath – during o bronchiectasis

procedure • Check vs prior to procedure
• If cannot sit, place to unaffected side
• HOB should be elevated PRE-PROCEDURE
• Patients are at risk of having pneumothorax • Perform in the morning on arising 1 hour
• Allowed to have a repeat chest x-ray before meals
(bedside) after the procedure for comparison • 2-3 hours after meals
• Administer bronchodilators (e.g., ventolin,
POST PROCEDURE combiven) (if prescribed) 15 minutes before
procedure
• v/s = assess for hypotension or hemorrhage
• Stop if cyanosis or exhaustion occurs
• respiratory status
• Provide mouth care after procedure
• pressure dressing • Following CPT, patient may have labored
o assess for bleeding breathing
• patient is at risk for hypovolemic shock
5. TRACHEOSTOMY
3. ABG • To maintain patent airway in a respiratory
• Help assess acid base state emergency
• Measure dissolved O2, co2 in arterial blood • Prevent / relieved obstruction caused by
• Allen’s test = assess patency accumulations of secretions in pulmonary
• Site = radial artery tree
o if not patent, use ulnar artery • Patients with prolonged et or ventilator
• Place specimen on ice
• Note O2 and type of ventilation client is PRINCIPLES
receiving on lab form • Maintain patent airway
• Avoid suctioning before drawing ABG • Prevent infection
o When suctioning, pre-oxygenate • Prevent drying and crusting of mucosa
patient prior • If moist or wet dressing, do not reinforce
o Moist dressing is favorable for
QUESTION bacteria to grow
As you plan to suction the client with tracheostomy • Be aware of signs of respiratory distress
tube, which protective items will you wear to perform o gasping respirations, sternal
this procedure? retraction, labored breathing,
tachycardia, cyanosis
a. mask, sterile gloves and cap
b. gown, mask, and sterile gloves QUESTION
c. goggles, mask, sterile gloves After you finished suctioning the tracheostomy tube
d. mask, gown, and cap of the client, you determine the effectiveness of
procedure by monitoring which item
QUESTION
A pulse oximeter gives what type of information a. respiratory rate
about a client? b. breath sounds
c. capillary refill
a. amount of carbon dioxide in blood d. O2 saturation refill
b. percentage of hemoglobin carrying oxygen
c. amount of oxygen in the blood
d. respiratory rate QUESTION
You are caring for a client who had tracheostomy
4. CHEST PHYSIOTHERAPY and noticed for a noisy breathing. This means
• Percussion, vibration, and postural drainage
• Done when patient present with lung a. Tube dislodgement
infections b. tube obstruction
• Performed over thorax c. air moves through fenestrations
• Goal: to loosen secretions in affected lung d. normal findings
area
• CONTRAINDICAITONS:
o Unstable vs
o ICP increased
• Done in patients with:
o pneumonia
o bronchitis
o COPD

PNEUMONIA ● Alcoholism – respiratory depressant

Description ● Ingestion of infected cattle with M. bovis
● Inflammation of the lungs M. Bovis – causes bovine TB
● Streptococcus Pneumoniae- Most
common cause of Community acquired Mode of Transmission
pneumonia (prior to covid) ● Airborne particles
● SARS-CoV 2 – causes your covid ● More than 1 meter of travel
pneumonia
● Aspiration of food is also one factor that Symptoms: (PLAN)
causes pneumonia. Question: when the ● P – Productive cough
patient aspirate food where does it go? It ● L – Low grade afternoon fever
goes to the right lung because the right lung (pathognomonic sign)
is more shorter and wider than the left lung. ● A – Anorexia
● Haemophilus Influenzae - The most ● N – Night sweats
common cause of pneumonia for children
● HIB Vaccine - Vaccine for children Diagnostics:
Monteux Test - screening
Predisposing Factors
● Test for exposure
● Smoking ● Positive Mantoux test indicated that there is
● Air Pollution exposure
● Immunocompromised ● Positive Mantoux – 10 mm induration
o Cancer patient ● If with HIV, positive Mantoux test is <5 mm
o AIDS patient ● Result is read after 48 to 72 hours (2-3
o Bed ridden days)
o Prolonged immobility
● Aspiration of food Chest X-ray
o When the patient aspirates the food, ● To determine the extent of lesions.
it goes to the right lung because the
right lung is more shorter and wider Confirmatory Tests:
than the left lung. ● Sputum culture (1st choice)
● Gene Xpert (2nd choice if wala ang sputum
Signs and Symptoms culture sa exam choices)
● Greenish to rusty sputum – ● Specimen for gene xpert: SPUTUM
Pathognomonic sign
● Dyspnea Management:
● Fever ● RIPES (can also be RHZES)
● Pleuritic Chest pain on deep inhalation - Rifampicin
o Splint the chest with pillow - Isoniazid
● Rales/Crackles - Pyrazinamide
● Increased WBC count - Ethambutol
- Streptomycin
DIagnostics
● Chest x-ray – confirmatory test 1. Streptomycin
● CBC – increased WBC if bacterial ● Ototoxic and Nephrotoxic
pneumonia ● Causes Sensorineural hearing loss
● Sputum gram stain – done prior to the ● Check the creatinine
administration of antibiotic ● Given IM ANST
● Culture and sensitivity
2. RIFAMPIN, ISONIAZID and
Management PYRAZINAMIDE
● O2 ● Hepatotoxic
● Force fluids to liquefy secretion ● Causes jaundice
● Nebulize and suction PRN ● Check ALT
o Bronchodilators
o Beta II agonists (salbutamol) 3. Ethambutol
● Toxic to the eyes
PULMONARY TUBERCULOSIS (KOCH’S ● Causes blurring of vision
DISEASE)
● Vitamin B6 or pyridoxine - Antidote for
Description
INH poisoning
● Infection of lung tissue caused by ● Peripheral Neuropathy/neuritis - Side
Mycobacterium Tuberculosis effects of INH
Predisposing Factors
● Malnutrition COPD
● Overcrowding ● Cough 3 months for 2 consecutive year

● Right sided heart failure/ cor pulmonale-

CHRONIC BRONCHITIS prone to develop
● Inflammation of the bronchi
● “Blue bloaters” ➢ Hypoxic drive – primary drive to breath.
● There is increase in number and size of The low level of oxygen is their primary
your mucus glands drive to breathe. Teach pursed lip-breathing
to prevent loss of hypoxic drive.
Predisposing factors:
● Smoking Management:
● Air pollution ● Force fluids
● Low inflow 02 – only up to 6L because
Signs and symptoms: mawawala ang hypoxic drive
● Productive cough ● Administer medications as ordered
● Scattered rales/rhonchi o Corticosteroids
● Right-sided heart failure o Antimicrobials
o Mucolytics/expectorants
Complications: o Bronchodilators
● Right Side Heart Failure ● SEMIFOWLER’S position- promote lung
● Pneumothorax expansion and drainage.
● Cor pulmonale – primary lung problem
Client teaching
Difference between Emphysema and Chronic ● Instruct patient to stop smoking
Bronchitis: ● Teach pursed-lip breathing
● Emphysema – problem is alveoli
● Chronic bronchitis – problem is airway Monitor for:
● Right sided HF
Management: ● Pneumothorax
Administer meds as ordered:
● C – Corticosteroids BRONCHIAL ASTHMA
● A - Antimicrobials Description:
● M – Mucolytics/ expectorants ● Reversible inflammatory lung condition
● B – Bronchodilators Hypersensitivity to allergens
o Use Steroids – anti-inflammatory
Client Education: ● Narrowing of smaller airways
● Pursed lip breathing o Bronchodilators
o Exhalation must be longer than Such as Salbutamol (Ventolin)
inhalation Caused by:
● Stop Smoking ● Allergens
● Pollens
EMPHYSEMA (Pink Puffers)
● Terminal and irreversible stage of COPD Triad of Asthma
● I- Inelasticity if alveoli ● Cough
-leads to air trapping, there is no good recoil. ● Dyspnea
● B - Barrel Chest- ● Wheezing on expiration
increase in the anteroposterior diameter of the ➢ Wheezing on Inhalation is stridor
chest seen in FBAO
● A - Air Trapping-
Normally, the alveoli is like a rubber, it recoils. ● High fowler’s - position of dyspneic patient
Risk factors: Management

● Smoking ● Enforce CBR
● Air pollution ● Administer medications as ordered
● Alpha 1 antitrypsin deficiency – protects our o Bronchodilators
alveolar wall, without it, mas madali mag ▪ Side FX: Palpitation, tachycardia
collapse and ating alveoli. ▪ B2 agonist
● Salbutamol (Ventolin) /
Signs and Symptoms: Albuterol- side effect is
● Productive cough palpitation and tachycardia.
● Dyspnea at rest Avoid 3C (Coffee, chocolate,
● Rales cola) and Tea.
● Crackles ● Corticosteroids- GI Irritant
● Barrel Chest ● Usually given by inhalation
● Rales/crackles ● Short-acting b2-agonist
● Increased AP diameter- Because of air (SABAs)
trapping o Salbutamol

• Combivent- Combination of ● Decreased breath sounds on affected side

Salbutamol and Ipratropium ● Decreased chest expansion
• Theophylline or
Methylxanthine Diagnostics:
● Long acting B2 agonists. ● Chest x-ray
o MDI- metered dose ● ABG- tells hypoxemia
inhaler
o Most common side fx Management
is palpitations ● Thoracentesis
o May be in combination ● CTT – attached to water sealed drainage
with steroids
o Examples: salmeterol, Nursing management:
formoterol, given twice Monitor fluctuations and bubbling:
daily ● Normal Fluctuations – (+) positive fluctation
o MDI = fluticasone ● Normal Bubbling – intermittent bubbling
(corticosteroid) + (means that the system is intact)
salmeterol ● Continuous or remittent bubbling – means
Gargle after us to prevent candidiasis AIR LEAKAGE
▪ Anticholinergics
● Ipratropium—in combination CTT
with salbutamol (combivent) 1. 1 way bottle
▪ Methylxanthines ○ Function of 1st bottle is drainage
● Doxophylin 2. 2 way bottle
● Theophylline ○ Function of 2nd bottle is water
o Avoid caffeine sealed
o Bronchodilator effect 3. 3 way bottle
by inhibition of ○ The function of 3rd bottle is Suction
phosphodiesterases in Control
airway
▪ Do not drink caffeinated drinks ● Positive Fluctuation – system is intact;
▪ Steroids – if needs control there is rise and fall of the water level
● Negative fluctuation – there is obstruction
● Combivent - salbutamol and ipratropium is or the patient is already well. Check for
combined loops/kinks/ clots; it indicates re-expansion
of lungs
Controlled Therapies ● Intermittent Bubbling -normal, system is
● Inhaled corticosteroids ICS intact
● Side effects ● Continuous bubbling -air leakage
● Hoarseness (dysphonia) ● To know if lungs have re-expanded:
● Oral candidiasis- gargle after use Assess the X-ray
● Indication to remove CTT – if the lung has
Controllers – corticosteroids re-expanded. Teach the patient Valsalva
Relievers – bronchodilators while removal because it is painful.
● If disconnected, immerse it in a bottle of
water. Do not clamp=may cause tension
PNEUMOTHORAX pneumothorax
Description
BRONCHIECTASIS
● Accumulation of atmospheric air in pleural
space, w/c results in rise in Intrathoracic Description:
pressure. ● Irreversible dilation of bronchial tree
● Normally, there is negative pressure ● Just like COPD
● Problem with expansion
Difference between COPD and Bronchiectasis
Risk Factors ● COPD – same signs and symptoms; same
● Common in Tall and lean individuals management.
● Smokers ● Bronchiectasis – same signs and
symptoms; same management. Prone to
TENSION PNEUMOTHORAX this if paulit-ulit ang infection.
● Occurs from blunt chest injury or from
Predisposing Factors:
mechanical ventilation
● Recurrent RTI (Respiratory Tract
Signs and Symptoms: Infection) - acquired
● Tracheal Deviation – Pathognomonic sign. ● Cystic Fibrosis- common in pedia
Can be seen in CXR of the patient
● Dyspnea Signs and Symptoms:
● Dullness o Consistent productive cough

o Dyspnea Management:
o Rakes, crackles ● No Surgery.
o Hemoptysis – coughing of blood ● Monitor the patient
● Pain = Analgesics.
Good to Know ● High Fowler’s
o Hematemesis - vomiting of blood. ● O2
o Hematochezia - defecating blood. ● Monitor increased Respiratory distress
o Hematuria - urinating blood.
o Melena - defecating blackish stools. Common Drugs encountered in Respiratory
System
Diagnosis: • Bronchodilators - Asthma; COPD
● ABG (low pO2) • Corticosteroids
● Bronchoscopy • RIPES for TB.
○ Check gag reflex using tongue
depressor BRONCHOGENIC CARCINOMA
Description:
Management: (FLEAS) ● Cigarette smoking - Leading cause of Lung
● Force Fluid Cancer.
● Low inflow 02
● Enforce CBR Other risk factors:
● Administer as ordered: (CAMB) ● Inhaled environmental substances
○ Corticosteroids ○ Asbestos. Causes cancer of the
○ Antimicrobials Pleura.
○ Mucolytics/expectorants ● Genetic Predisposition
○ Bronchodilators
● Semi to High-fowler’s position Signs and Symptoms (PLEAD)
● Persistent cough (with or w/o hemoptysis)
Client Teaching
● Localized chest pain
● Stop smoking. Most important health ● Enlarged Lymph Nodes
education. ● Anorexia. Loss of Appetite
● Dyspnea
CHEST INJURIES
RIB FRACTURE Good to Know
Description: • Ageusia - Loss of Taste
● From direct blunt chest trauma got from • Anosmia - Lost of Smell
Vehicular Accidents. • Aphasia - Loss of Speech
● They heal in time. • Formula for Cigarette Pack Years
● More than 2 fractured rib = FLAIL CHEST
Signs and Symptoms:

● Pain at site of injury increases with
inspiration
● Will NOT undergo surgery unless there are
arteries and vessels involves.
Diagnostics:
Management:
● BIOPSY – definitive examination to know if
● Unite spontaneously
the patient has cancer.
● Maintained at High-fowler’s
● CHEST X-RAY – mass visible
● Monitor respiratory distress (the use of
● CT SCAN
accessory muscle upon respiration = called
● MRI – metals are not allowed. E.g
LABORED BREATHING)
Prosthesis, Prosthetic Heart Valves, etc.
● Check creatinine kung may contrast dye
FLAIL CHEST
yan.
Description: ● Bronchoscopy
● Occurs from blunt chest trauma associated
with accidents If patient has LUNG CANCER
● 2 or more fractured rib • Surgery
• Chemotherapy
Signs and Symptoms • Radiotherapy
● May develop paradoxical breathing
○ Inward movement of segment of Management:
thorax during inspiration with
● Surgical Resection
outward movement during expiration
o Pneumonectomy - Removal of 1 Lung.
o Lobectomy - Removal of 1 Lobe.

o Segmentectomy - Removal of 1
Segment.
o Wedge Resection - Only a part of the
Lobe is Removed.
HISTOPLASMOSIS
● Fungal infection caused by inhalation of
contaminated dust with histoplasma
capsulatum from bird’s manure. (Starling
● Chemoradiation Bird)
● Pneumonectomy – Entire lung removal ● Signs and symptoms resemble TB
● Lobectomy – Removal of lobe
● Segmentectomy – removal of a segment of
Predisposing Factor:
the lungs
● Inhalation of contaminated dust with
POSITIONING (LUPA) histoplasma
1. Post Lobectomy Signs and Symptoms
Unaffected side to promote drainage
2. Post pneumonectomy ● PTB and Pneumonia-like symptom
Affected side to promote lung expansion o Pneumonia - Rusty Sputum
(Pathognomonic)
PLEURAL EFFUSION o PTB - Low Grade Fever at the Afternoon
(Pathognomonic)
Description:
● + histoplasmin skin test
● Collection of fluid in pleural space
Management:
Signs and Symptoms:
● Administer as ordered
● Pleuritic chest pain ○ Antifungal – amphotericin B
● Dry non-productive cough (Nephrotoxic)
● Decreased breath sounds over affected ○ If Nephrotoxic, it's Kidney. Check
area Creatinine.
● Resembles like Pneumothorax. ● Check for creatinine
● Some develop infection, tuberculosis,
pneumonia, and cancer. Prevention:
Management: ● Minimize exposure to dust in contaminated
environments
● Thoracentesis ● Wear protective equipment: MASK
● CTT ● Improve Immune System, Histoplasmosis is
● Identify and treat cause an opportunistic infection.
● High-fowler’s
● Prepare for Thoracentesis, Don't forget the ONCOLOGIC NURSING
Breathing Parameters. CANCER
• disease where cells mutate into abnormal
cells and professional abnormally
• Cancer cell metastasis to vital organ
• Common cause mortality: LUNG CANCER
• Most Common Cancers:
o Males - Prostate Cancer
o Females - Breast Cancer
o Both - Lung Cancer
Characteristic of normal cells

• G0 – Resting Hhase
o Chemotherapeutic drugs will not
commonly act on G0.
• G1 – RNA Synthesis

• S phase – DNA Synthesis

• G2 - Premitotic phase 7 WARNING SIGNS OF CANCER
o DNA synthesis is complete • Change in bowel habit
o MNEMONIC: • A sore that does not heal
G2, compleTWO (DNA Synthesis). • Unusual bleeding of discharge
• M – mitosis , time when cell divide • Thickening or lump in the breast
o Chemo drugs turn to be cell specific • Indigestion of difficulty swallowing
• Obvious change in wart or mole
• Cell Specific Chemotherapeutic Drug: • Nagging cough or hoarseness
o M-Phase
• Unexplained anemia
• Non-Cell Specific Chemotherapeutic Drug: • Sudden weight loss
o G0, G1, S, and G2 Phases
Definitive diagnosis
BENIGN MALIGNANT
• BIOPSY
• Slow growing • Fast growing
• Encapsulated, • Capsulated, Prevention of cancer
easily remove difficult to 1. PRIMARY
remove a. Educate and teach pt
• Localized • Diffused b. Avoid alcohol
• Non- invasive • Invasive c. Diet: high fiber, low fat
• Does not • Metastasize d. Exercise, maintain healthy weight (5
times a week, 30 minutes)
metastasize
e. Avoid sun exposure 10 am -3 pm
(best time for swimming – night)
Route of spread
f. Use lotion SPF15 and above
1. Blood
2. Lymphatic 2. SECONDARY - SCREENING
3. Direct seed a. Breast self-exam
• Start at 20 years old
Steps in carcinogenesis • Upright, supine
1. Initiation – irreversible step of • Pillow under the breast being
carcinogenesis examined
o Alter genetic structure of DNA 1. Examine your breast in the
2. Promotion – repeated exposure to shower.
promoting agents 2. Examine your breasts in the
a. Expression of abnormal mutant mirror with your arms down,
genetic up, and on your hips.
3. Progression – time that the altered cell 3. Stand and press your fingers
exhibit malignant behavior on your breast, working
around the breast in a
Epidemiology circular motion.
1. AGE – single most important risk 4. Lie down and repeat step 3.
o Breast – common in girls 5. Squeeze your nipples to
o Prostate cancer – common in boy check for discharge. Check
o Lungs cancer – common cause of under the nipple last.
mortality in both sex b. Clinical breast exam CBE
o Viruses that cause cancer: • Every 3 years
1. HPV type 16 c. Mammogram
2. Hep B • 40 years old
3. EBV Eipstein Barre virus – d. Fecal Occult Blood Test (FOBT)
nasopharyngeal cancer • All 50 years old
• Digital rectal examination and
Risk factors flexible sigmoidoscopy should
1. Asbestos – cancer of pleura be done every 5 years
2. Benzene- leukemia e. Colonoscopy
3. Ionizing radiation • Every 10 years
4. Race 3. TERTIARY
5. Smoking a. Rehab
6. Diet – high fat, low fiber
Risk factors
Diagnosis 1. BRCA – 1, 2
1. History 2. INCREASE AGE
2. PE 3. Family history
4. Early estrogen exposure
Signs and symptoms - Oophorectomy or tamoxifen for treating
• Palpate mass – hard mass breast cancer

5. Early menarche, late menopause • Bone pain

6. Nulliparous
7. Childbirth after 30 years Treatment
1. Surgery – standard tx
Symptoms a. Radical prostatectomy
1. Nontender mass, non-movable b. Orchiectomy – removal of testis
2. Hard and irregular border
3. Skin dimpling QUESTIONS:
4. Orange peel skin 1. Client with (+) Mantoux Test will be sent for CXR.
For which reason this is done?
STAGING a. To confirm the diagnosis
Stage 1: Tumor less than 2 cm b. To determine if repeat skin test is needed
Stage 2: Tumor more than 2 cm but less than 5 cm c. To determine the extent of lesions
Stage 3: Tumor is more than 5 cm, + axillary lymph d. To determine if this is primary or secondary
node infection
Stage 4: Distant metastasis. Ex liver, lungs
2. Client had a PPD test for tuberculosis is reddened
Management and raised about 3mm where the test was given.
1. Surgery This PPD should be read as having which results?
a. Lumpectomy – bukol a. Indeterminate
i. Breast conserving b. Needs to be redone
mastectomy c. Negative
b. Simple mastectomy – breast d. Positive
c. MRM – Breast and lymph node
d. Radical mastectomy – breast, 3. A 43 year old patient had Latent tuberculosis and
lymph node, pectoralis muscles has treatment that include the use of isoniazid (INH)
e. Quadrantectomy – remove one and which of the following?
quadrant of the mass but the entire a. Salbutamol inhaler
breast is still there b. Ceftriaxone
2. Chemotherapy c. Rifampicin
3. Radiation therapy d. Vit. B6
Pre-op nursing consideration 4.What TB drug should the client be evaluated for
1. Psychosocial support Rinne and Weber Test
2. Arm exercises – to prevent lymph edema a. INH
b. Rifampicin
Post-op nursing consideration c. Streptomycin
d. Pyrazinamide
1. Semi-fowlers
2. Monitor drainage – jackson pratt
a. Less than 30 ml – pwede na tangalin 5.The nurse understand that Gene Xpert test is done
3. Affected arm precaution for which of the following?
a. Pertussis
Surgical Resection b. PTB
c. Pneumonia
• Pneumonectomy d. COVID
- Entire lung removal
• Lobectomy 6.The priority item in discharge teaching for a client
- Lobe of lung with chronic bronchitis?
• Segmentectomy a. Fluid restriction
- Segment b. Avoidance of Crowds
• Post-lobectomy c. Smoking cessation
- Unaffected side to promote drainage d. Side Effects of drugs
• Post- Pneumonectomy
- Affected side to promote lung expansion 7.You would call the MD if which is present in
emphysema?
PROSTATE CANCER a. Increased AP diameter of the chest
b. More cough with change in character of
Risk factors secretions
• Fam history c. Pursed lip breathing
• Age d. Afebrile
• Heavy metal exposure
8.Following CTT on the right lung, a 56 yo patient
Symptoms was sent for chest Xray. This is requested to?
a. To determine lung expansion
• Gross painless hematuria
b. To evaluate pneumonia
• Difficulty in initiating urination – hesitancy
c. To rule out infection
• Urinary retention d. To rule out subcutaneous emphysema

9.Which Findings suggests Tension Pneumothorax?

a. Hypotension
b. Tachypnea
c. Tracheal deviation
d. Wheezing
10.Which is expected in fractured rib?

a. Paradoxical respiration
b. Pain with inspiration
c. Rapid, deep respiration
d. Slow deep respiration
11.You are caring for a client who had a flail chest.

You would expect to note
a. Paradoxical respiration
b. Pain with inspiration
c. Rapid, deep respiration
d. Slow deep respiration
12.A client with AIDS has Histoplasmosis. A nurse

assesses the client for which of the following signs
and symptoms?
a. Weight gain
b. Headache
c. Dyspnea
d. Hypothermia

MALIGNANT LYMPHOMA • Intracavitary (Intraperitoneal)

• Affects lymphatic system • Intravesical- directly in the organ
• Results to proliferation of lymphocytes
SIDE EFFECTS:
1. HODGKIN’S DISEASE 1. ALOPECIA
• Common in white men • wash hair 3x a week
• Reed Sternberg cell- hallmark; tumor • Advice to wear wig early on
originates INSIDE the lymph node • Avoid hair dryer
• Can be seen • 6 weeks from the start of chemo, after 2nd
• Cause: Unknown cycle
• 2 weeks after stopping chemo, will grow
B Symptoms again
• Fever without chills
• Night sweats 2. BONE MARROW SUPPRESSION
Normal WBC: 5,000-10,000
Management • Decreased WBC (leukopenia) result to
• PE: Palpation- examination of cervical Immunosuppression
lymph nodes Management:
• If enlarge: use BIOPSY • Assess for infection
• Avoid fresh vegetables because it may
2. NON-HODKIN’S DISEASE harbor bacteria Diarrhea
• tumor originates OUTSIDE the lymph node • Reverse Isolation
• Most COMMON form of Lymphoma • Handwashing
• It cannot be seen • Limit visitors
• linked to infection with H. Pylori • Temp: Axillary
• Avoid crowded places
B Symptoms Normal Hemoglobin:
• Fever without chills • Male- 14g/dl
• Night sweats • Female: 12 g/dl
Decreased Hemoglobin and Hematocrit
Management • Pallor, fatigue, palpitation
• PE: Palpation- examination of cervical • Rest in between activities
lymph nodes • Avoid caffeinated beverages
• If enlarge: use BIOPSY
Normal Platelet: 150,000-400,000
RADIATION THERAPY • Decreased platelet count
• Assess bleeding
- Has the same most common symptom:
• Monitor stool, urine for occult blood
Fatigue
• May have hematochezia or
• Avoid contact sports
CHEMOTHERAPY
• Avoid IM injections
• Administration of cytotoxic medication to
• Avoid dental floss
promote tumor cell death
• Affects normal cells resulting - no hair/ • Avoid aspirin, NSAIDs
alopecia
QUESTION:
1. INTRAVENOUS You are monitoring the lab results of a client
• IV- most common route receiving antineoplastic medication by the IV
• Extravasation- leaking of chemotherapeutic route. You plan to initiate bleeding precautions
agents to tissue, complication of IV if which lab results is noted?
chemotherapy A. Ammonia level of 20 mcg/L
o No consent; but need to be further B. Clotting time of 10 mins
explained C. Platelet count of 50,000/mm3
• Vesicants - irritate the skin D. WBC 5,000/mm3
• Avoid direct manual Pressure in 3. VOMITING
extravasation • Administer Anti-emetic prior to
• Aspirate remaining chemotherapy drug chemotherapy (Ondansetron, Palonosetron)
4. DIARRHEA
2. TOPICAL • Low fiber/ Low residue diet
• Intrathecal- LP-CSF • Assess fluid and electrolyte imbalance (poor
• Ommaya - reservoir skin turgor, dry tongue- sign of dehydration)
5. STOMATITIS QUESTION:
• Inflammation of Oral mucosa A client undergoing radiation therapy has
• Because of decreased WBC, prone to severely depressed WBC. Priority nursing
infection intervention.
• Soft bristle toothbrush A. Place client in private room and
• Electric toothbrush maintain strict aseptic technique
• Avoid mouthwash containing alcohol (ex. B. Encourage fresh fruits in diet
Bactidol) C. Avoid shaving with razor
• Avoid dental floss D. Encourage frequent visitors to
• Avoid smoking and alcohol reduce isolation feelings
3. ANKYLATING AGENTS
• Interfere DNA replication (S Phase) QUESTION:
• Busulfan A client undergoing chemotherapy needs further
teaching if she states.
• Cyclophosphamide (Cytoxan) Common side
A. I will avoid use of hair dryer
effect: Hemorrhagic cystitis (simple UTI with
B. I will choose a wig before hair loss
blood)
occurs
• Monitor Hematuria
C. My hair will go back after
• Increase Oral fluid intake
chemotherapy
D. I will wash my hair everyday
4. ANTIMETABOLITES
• Interfere metabolites
• 5-fluorouracil RADIATION THERAPY
• Methotrexate • Reduce tumor size
• Side effect: Megaloblastic Anemia • Used to kill tumor
• Relieve obstruction
5. CYTOTOXIC ANTIBIOTICS • Decrease pain
• Inhibit DNA (S phase) and RNA (G1 phase)
synthesis EXTERNAL RADIATION THERAPY
• Bleomycin • TELETHERAPY
• Doxorubicin (Cardio-toxic) - monitor chest • No risk for radiation exposure of others
pain • Ex. Cobalt therapy
• Check ECG, 2D echo findings Side effects:
• GI: Diarrhea, mucositis and stomatitis
• Tissue damage to target area
Question:
• Fatigue (most common)
A client with ovarian Ca is being treated with
vincristine (Oncoverin). You monitor the • Radiation pneumonia
client, knowing that which of the ff. indicates a
side effect specific to this medication? Nursing Interventions:
A. Diarrhea • Protect skin from sun exposure
B. Hair loss • Avoid rubbing treatment site
C. Chest pain • Wash marked skin with plain water
D. Numbness, tingling of fingers • Do not use powder, lotion, soap
and toes • Wear loose-fitting clothing- tx are
INTERNAL RADIATION THERAPY

6. PLANT ALKALOIDS
• BRACHYTHERAPY
• Vincaloids - neurotoxic
o Tingling sensation 1. Sealed-brachy
o Numbness
• Implant- cervical
o Paresthesia
• Bedrest- avoid implant dislodge
• Vincristine
• Use long-handed forceps if nahulog
• Vinblastine
• Put in a lead-line container
• Phase specific inhibiting cell division (M
phase)
2. Unsealed-brachy
• Cell cycle specific
• IV
• Oral
• Systemic effect
• Excrete body fluids may be radioactive
• Flush CR 3x (contaminated secretions)
Side effects: Treatment

• GI: Diarrhea and stomatitis • May undergo radiation (External radiation-
• Tissue damage to target area Cobalt) to shrink tumor
• Fatigue (most common) • Seizure precaution
• Radiation pneumonia • How do we know if it is resolving? Edema is
disappearing
Safety precautions: • CT scan or MRI
• Assign- private room
• Pregnant staff are not assigned to patient’s SPINAL CORD COMPRESSION
care • From pressure-expanding tumor
• S/Sx: Back, leg pain paresthesia’s
Protection from radiation exposure: • Tx: Reduce tumor size
• Time: 30 min total/ 8-hour shift • May undergo surgery
• Distance:6 feet when possible
• Shield: Use lead line gown CARDIAC TAMPONADE
QUESTION: • Beck’s Triad: Jugular Vein distention,
A client on chemotherapy experiences nausea. Muffled heart sounds, narrowed pulse
Which of the following is an important nursing pressure
intervention for the client? • Tx: Pericardiocentesis
A. Encourage client to eat full meal prior
to chemotherapy DISSEMINATED INTRAVASCULAR
B. Offer warms liquids during the therapy COAGULATION
C. Administer antiemetics during the • Sepsis clot formation depletes clotting
therapy factor bleeding
D. Administer antiemetics before
chemotherapy QUESTION:
A client on brachytherapy calls the nurse for
QUESTION: implant dislodgement. Priority nursing action is
A 64 y/o client refuses to be screened for cancer A. Have the client pick up the implant
and states I’m too old to get a cancer. Which B. Notify radiologist to dispose implant
nursing statement is correct in response to the C. Apply gloves and place implant in
client? biohazard bag
A. The incidence of cancer decreases with D. Use long handled forceps to pick up
advancing age implant
B. Age is not a significant factor in cancer QUESTION:
development The nurse is evaluating a client receiving
C. Unless symptomatic, patient may not chemotherapy. Which finding affects nutritional
undergo screening intake?
D. Advancing age increase the incidence A. Pale skin
of Ca B. Ecchymotic areas on hands
C. Moist mucous membranes
ONCOLOGIC EMERGENCIES D. Ulcerations of oral mucosa
QUESTION:
TUMOR LYSIS SYNDROME/ TUMOR CELL A 54 y/o client consult clinic about prostate
LYSIS cancer. The nurse evaluates that client has
• Potassium understood teaching when he makes the
• Inside statement.
• Sodium A. I don’t need screening unless with
• Outside symptoms
o Hyperkalemia B. I should have PSA done yearly
o Hyperuricemia C. I should have DRE yearly
o Hypercalcemia D. I should have PSA and DRE done yearly
QUESTION:
SUPERIOR VENA CAVA SYNDROME A 32 y/o client with benign neoplasm asks the
• Compression of SVC nurse about her condition. The nurse is correct in
her statement if he says that:
Signs and Symptoms A. Benign neoplasms are usually
unencapsulated, with rapid division.
• Periorbital edema
B. Incidence of benign neoplasm decreases
• Jugular Vein distention
with age.
C. Benign neoplasms are associated with QUESTION:

higher mortality. A 35 y/o male was admitted following episodes of
D. Benign neoplasms are encapsulated gastroenteritis. PE showed sunken eyeball, poor
with localized growth. skin turgor, and heart murmur, diastolic rumbling
QUESTION: grade. The heart assessment is likely due to:
A client who had mastectomy refuses to look at A. Mitral Stenosis
her incision site. The nurse can assist the client to B. Mitral Regurgitation
cope with disturbed body image by doing which of C. Aortic stenosis
the following? D. Mitral valve prolapse
A. Delay wound care until client is prepared
to look at the wound HEAT STROKE
B. Have the client assist with dressing • Exposure to environment temperature >39
change degrees Celsius
C. Tell the client eventually she will accept • Effect: Low blood
the loss body part • Common in Elderly
D. Encourage client to express feeling
about loss of the body part HEAT STROKE
QUESTION: • Form of heat stroke
Dr. B orders an Enoxaparin for the client suffering
from COVID-19 and myocardial infarction. Which Assessment:
of the following is the most essential nursing • Anhidrosis
action? • Bizarre Behavior
A. Monitoring heart rate and urine output • CNS Dysfunction
every shift • Delirium
B. Monitoring blood pressure every 4 hours • Elevated body temperature, hot, dry skin
C. Monitor bleeding episodes
• Hypotension, tachycardia, tachypnea
D. Obtaining cardiac monitor of the drug
QUESTION: Management:
During the 10th day off hospitalization of a 34 y/o • Airway
male client after COVID. Which of the following is
• Breathing
an expected outcome?
• Circulation
A. Able to perform self-care activities without
• Patient clothing is removed
pain
• Cool sheets/ towels
B. Severe chest pain
C. Can recognize the MOT of COVID • Continuous sponging with cool water
D. Can have communication in sentence • Ice applied neck, groin, chest, axillae while
spraying with tepid water
QUESTION: • Cooling blankets
A 54 y/o male client with COVID-19 is having • Monitor VS, ECG, UO, CVP
Ventricular Tachycardia. Nurse C should inform • Antiseizures to control seizure
the physician and
A. Assess for patient’s pulse
NEAR DROWNING
B. Prepare for defibrillator
• Survival for at least 24 hours after
C. Obtain atropine
submersion that cause respiratory arrest.
D. Call a code
• Hypoxemia- common consequence (blood
QUESTION:
deprived of O2)
During admission of a patient with COVID and At risk:
Heart Failure taking Digoxin, it would be most
• Hypothermia
essential for nurse to…
• Inability to dive
A. Promote active ROM
• Diving injuries
B. Instruct the client to cough and deep
breathe every 2 hours • Alcohol
C. Frequently monitor client’s apical • Exhaustion
pulse • Hypoxia
D. Monitor clients BP and temperature every • Hypercapnia
shift • Bradycardia
• Dysrhythmias
FRESH WATER ASPIRATION results to

• Loss of surfactant
• Inability of lung to expand- leads to lung
collapse
SALTWATER ASPIRATION results to Legal Blindness

• Pulmonary edema • Visual acuity 20/200
• Hypernatremia • Peaks at 85 y/o
• Older men > older women
Management of Near drowning:
• Adequate oxygenation, maintain cerebral Sensorineural Hearing loss
perfusion • Presbycusis- hearing impairment as a result
• Immediate CPR (cardiac arrest) of aging
• Manage hypoxia, hypothermia and acidosis • Impaired ability to hear high pitches
• Tinnitus
GERIATRICS ✓ Objective- pulsatile sounds with turbulent blood
NORMAL AGE-RELATED CHANGES flow through the ear
Xerostomia • Ex. Hypertension
• Dry mouth ✓ Subject- perception of sound without sound
stimulus
Eye • Ex. Medication, Infection
• Subcu atrophy- wrinkling of skin around eyes • A>B
• Decreased orbital
ANTIDOTES
Cornea
• Lipid deposits around cornea results to arcus Acetaminophen N-Acetylcysteine
senilis Anticholinergics Physostigmine
• Lenses thicken Benzodiazepines Flumazenil
• Difficult identifying color- blue, green, violet Carbon monoxide Oxygen
• Light sensitivity declines with age (decreased Cyanide Sodium nitrite
Rods photoreceptor) Iron Deferoxamine
• Night vision diminishes < Dark adaptation
Lead DMSA, BAL, Ca EDTA
Organophosphates Atropine, Pralidoxime
Hearing
Snake (pit viper) Crotalidate, antivenin
• External Ear- conductive Hearing loss
RENAL
• Increased cerumen production
KIDNEY
• Inner ear- SHL
• Maintain blood homeostasis
• Atrophy of organ of Corti (organ of hearing),
• Prone to develop ANEMIA
cochlear neurons
• Erythropoietin is necessary for RBC
• Loss of sensory hair cells
production
Taste • Treatment: Epogen (SC 3x/week)
• For anemia, artificial Erythropoietin
• Diminished sense of taste
• Excrete end products of body metabolism
• Hypogeusia- salt (1st taste that is lost),
sweetness
Acid-Base balance
• In covid: Ageusia (absence of taste)
• Reduced HCO3 in kidney disease- metabolic
• Affects gustatory function
acidosis
• Poor dentition- improper chewing
• Waste products of kidney: Creatinine, BUN
• Improperly fitting dentures
• If in failure, hindi na mailabas, increased
• Oral infections- release of acidic substances Creatinine- AZOTEMIA
- altered taste
• Urine production
• Edentulous teeth- kulang na
• Decreased urine production (400 ml/day)-
• Sarcopenia (decreased muscle mass)- if low Oliguria (renal shutdown)
protein diet
• Urinary bladder- storage
• Milk rich in protein
NEPHRONS
Smell
• Functional unit of kidney
• Hyposmia (decreased smell) • If there is protein in the urine, problem in
• Anosmia (absence of smell) nephron
• Nephron contains: GLOMERULUS
Tactile sensation • Upper renal tract infection: Kidney, ureter
• Diminished with age • Lower urinary tract symptoms (LUTS):
• Decreased ability to detect temperature Bladder, prostate
extremes • Total bladder capacity: 1L
• Normal Adult urine output: 700-1,500 ml/day
RENAL FAILURE Post-procedure (with biopsy):

• Creatinine • VS
• Uremia- problem in LOC • Increased OFI if prescribed
• Leg cramps because of lithotomy
URINALYSIS • Deep breathing- relieves bladder spasms
• Wash perineal area • Monitor- Bright red urine/ Clots
• 10-15 ml of 1st morning voiding
CYSTITIS (UTI)
CREATININE CLEARANCE • Inflammation of bladder
• 24-hour urine specimen • Most common organism- Escherichia coli
• Common in women
KUB (Kidneys, ureter, bladder Radiography) Symptoms:
• X-ray of the Urinary system to detect calculi • Frequency, urgency, cloudy urine
• No specific preparation • Lower abdominal discomfort back pain
Management:
QUESTION: • Antibiotics
Which intervention is inappropriate for a client on • Increased OFI 3L/day
hemodialysis? • Avoid caffeine, Alcohol
A. Palpate for a thrill on arm with fistula • Perineal care- catheter
B. Auscultate for bruit on arm with fistula • Front to back
C. Report absence of thrill/bruit on arm with • Cotton underwear
fistula
D. Take BP or start IV on arm with fistula
QUESTION:
A client diagnosed with cystitis. Client teaching
IVP (Intravenous Pyelography) aimed at preventing a recurrence should include
• Intravenous injection of radiopaque Dye which instruction?
• To identify abnormality A. Bathe in a tub
• Needs consent B. Wear cotton underwear
• Assess allergy to iodine, seafoods C. Use a feminine hygiene spray
• NPO After midnight D. Limit intake of cranberry juice
Post-procedure:
• Monitor VS, UO, Bleeding (venipuncture site)
• Signs: possible allergic reaction PYELONEPHRITIS
• Instruct- drink at least 1L fluid • Bacteria ascend to the kidney
• Increase fluid intake to eliminate the dye • E.coli (85%), K. pneumonia, P. mirabilis
Inflammation of renal pelvis and parenchyma
QUESTION: • Fever, Flank pain and Chills (Triad)
The client is scheduled for IVP. Before the test, • Positive CVA tenderness
priority nursing intervention would be… Management:
A. Restrict fluids • Antibiotics
B. Administer sedative • Increased OFI 3L/day to prevent dehydration
C. Administer oral preparation of radiopaque • Warm compress to flank
dye • VS, UO, Renal failure
D. Determine history of iodine or seafood
allergies
QUESTION:
QUESTION:
A client admitted for pyelonephritis is about to
A client is injected with radiographic contrast
start antibiotic therapy. Which symptom would be
medium and immediately showed signs of
excreted in this client?
dyspnea, flushing and pruritus. Which intervention
A. Hypertension
should take priority?
B. Flank pain on affected side
A. Check VS
C. Pain radiates on unaffected side
B. Make sure airway is patent
D. No tenderness on deep palpation of
C. Apply cold pack to IV site
CVA
D. Call MD
CRYSTOSCOPY GLOMERULONEPHRITIS
• Bladder mucosa- examined • Immunologic/Autoimmune
• No special preparation • GABS (Grp A Beta Hemolytic Strep)
• Monitor signs of hematuria
• History of pharyngitis or tonsillitis 2-3 weeks A. An older client with diabetes mellitus
before symptoms B. A client with human immunodeficiency
• History of Upper Respiratory Tract infection virus (HIV)
Symptoms: C. A client with spinal cord injury
• Gross hematuria D. A postoperative client who is
• Cola-colored, red brown urine ambulating
• Proteinuria, Oliguria QUESTION:
• Increased ASO (Antistreptolysin O)- blood A nurse is assessing a client who has treated for
specimen a viral respiratory infection that precipitates
• Hypertension asthma attack. The nurse determines that the
• Edema client’s respiratory status has worsened if which
• Low salt diet of the following is noted?
A. Loud wheezing
B. Wheezing during inspiration and
QUESTION: expiration
When teaching a client how to prevent C. Wheezing on expiration only
recurrences of acute glomerulonephritis (AGN), D. Diminished breath sounds
which instruction should the nurse include?
QUESTION:
A. Avoid physical activity
A nurse is caring for a client with meningitis that
B. Strain all urine
results to a brainstem injury. The nurse monitors
C. Seek early treatment for respiratory
which of the following as the priority?
infection
A. Respiratory rate and rhythm
D. Monitor urine specific gravity per day
B. Electrolyte results
C. Peripheral vascular status
D. Radial pulse rate
Medical Management: QUESTION:
• No specific treatment exist guided by the A client with COVID-19 was admitted. When
symptoms and the underlying abnormality suctioning the client through an endotracheal
• Bed rest tube. Which of the following indicates
• Na restricted diet (edema, HPN) complication of procedure?
• Diuretics, and hypertensives A. Blood pressure of 138/88 mmHg
• Antimicrobial (Penicillin)- Pen G best choice B. An irregular heart rate
• Vitamins to improve general resistance C. A skin color in the client’s face
• Oral Iron supplements (anemia) - with D. A pulse oximeter level of 95%
Vitamin C for better absorption QUESTION:
• Corticosteroids, and immunosuppressive Which of the following is at risk for developing
agents PTB?
Nursing Management: A. An alcoholic patient
• Monitor BP B. An obese patient
• Bed rest especially if (+) BP Increased, C. A 24 y/o college student
edema D. A 54 y/o with arthritis
• Measure I and O
• Increase Biologic protein: Vegetables
• Diet: UROLITHIASIS
• Calculus (stone) in UT
NEPHROTIC SYNDROME • Nephrolithiasis (kidney)
• Proteinuria • Ureterolithiasis (ureter)
• Hypoalbuminemia Major Nursing diagnosis:
• Edema • Pain
• Hyperlipidemia Cause:
• Egg whites: good for edema • Hyperparathyroidism, excessive vitamin D,
• Monitor daily weight intake, dehydration
• Decreased Sodium, CHON diet • Hyperparathyroidism → Parathyroid
hormone releases large amount of Calcium
• Antihypertensives, antihyperlipidemic
form the bone → Stones
• Avoid canned foods
• Obstructive d/o (enlarged prostate)
• Gout (UA crystallizes), osteoporosis
QUESTION:
• Prolonged immobility
A nurse is assessing the risk factors for acquiring
Assessment Findings:
Staph pneumonia during hospitalization for a
group of clients. The nurse determines that which • Sudden, sharp, severe flank PAIN that
of the following clients is at lowest risk? travels to external genitalia (Renal colic)
✓ Urinalysis • Ureter, bladder, prostrate

• Gross or Mircroscopic Hematuria • B/W kidney and urethral meatus
✓ Radiography (KUB) • BPH
✓ IVP • Ureteral calculi
✓ Ultrasonography • Bladder tumor
• All detects stone (calculi)
Medical Management: FOUR PHASES:
✓ Small calculi
• Increased OFI INITIATION PHASE
• Strain urine
• Ambulate OLIGURIC PHASE:
• Passed naturally with no specific • edema, hypertension
interventions
• Sudden decrease of UO
• Vigorous Hydration
• UO <400 ml/day)
• Analgesics (opioids and NSAIDs)
• Hypervolemia- give diuretics
✓ Larger Calculi
• Edema, HPN, Pleural and pericardial
• Antimicrobials
effusions, pulmonary edema, CHF)
• ESWL DIURETIC PHASE:
Patient education in prevention:
• Dehydration
• Avoid strawberries, tea, peanuts during the
• Hypotension
day, drink fluids every 1-2 hr
• Avoid activities that may cause dehydration • polyuria, hypovolemic shock,
• Recovery phase
Ques:
A client urolithiasis… RECOVERY PHASE
BLADDER CANCER
Risk factors: ASSESSMENT OF ARF:
• Cigarette smoking
• High cholesterol intake Metabolic Acidosis:
• Exposure to paint • Kussmaul’s respiration- deep rapid breathing
• Bladder stones • Azotemia- increased creatinine, BUN
• Diet- low protein
RENAL FAILURE • Decreased HCO3- give Bicarb
• Inability of nephrons to maintain F&E, Acid-
base balance, excrete nitrogen waste Hyperkalemia:
products and perform regulatory function • normal: 3.5-5
• Kayexalate- to decrease Serum K levels
ACUTE RENAL FAILURE • IV infusion of insulin and glucose
• Sudden, rapid loss of renal function • Dialysis
• Reversible - early, aggressive treatment • Salbutamol Nebulization
• Diet: low CHON, high calories, low Na, Low
CHRONIC RENAL FAILURE K
• Slow, progressive irreversible loss in renal • Avoid nephrotoxic drugs (aminoglycosides,
function NSAIDs)
PRE-RENAL CRF/ESRD
• anything above, shock, outside Causes:
• Decreased blood flow to kidney • DM, HPN
• Hypovolemic shock • Autoimmune disorders (SLE)
• DHN, Diuretic TP • Recurrent infections
• Chronic urinary obstruction
INTRA-RENAL:
• Inside the kidney GI Bleeding:
• Within the kidney • monitoring decreased Hgb and Hct
• Drugs • Occult blood
• Diseases • Avoid ASA (aspirin)
• Dyes (contrast)
Hema:
POST-RENAL:
• Anemia
• below the kidney
• From decreased erythropoietin and RBC

production
• BT if prescribed
• Epoetin Alpha- to stimulate RBC production
Infection:
• Avoid urinary catheters if possible
• Strict asepsis during invasive procedures
(they are immunocompromised)
Hyperkalemia:
• monitor serum K level
• Serum K level >6 mEq/l can cause
• Tall, peaked T wave
• Asystole
Management:
• Place client on cardiac monitoring
• Loop diuretics to excrete K (furosemide)
• Avoid K- sparing medications
(spironolactone, triamterene)
• Avoid foods high in potassium: avocados,
bananas, kiwi fruit
Description
Renal Cancer Triad ● Peritoneum acts as dialyzing membrane
● Painless hematuria Ultrafiltration
● Flank pain Diffusion
● Mass in the flank Osmosis
● This is with a catheter
Signs and Symptoms of transplant rejection ● So this uses a hypertonic solution
(HOW) containing glucose
● Hypertension ● Warm the dialysate solution to body
● Oliguria temperature
● Weight gain ● Danger of hyperglycemia
Treatment is Nephrectomy ● Main problem is infection because of the
catheter
DIALYSIS
QUESTION:
HEMODIALYSIS What is the purpose of glucose contained? It
Description increases osmotic pressure to produce
ultrafiltration. (based on principles).
● Procedure to remove waste from the body
by filtering client’s blood using a machine
Complications
Interventions ● Infection- because of catheter
● Peritonitis- board-like rigid abdomen
● Do not cover the area with fistula because
● Recent abdominal surgery
you won’t know the area if bleeding
● Abdominal adhesions
● Affected arm precaution
● Impending renal transplant
✔ Avoid Fistula, Affected arm
precautions.
Interventions
✔ Avoid restrictive clotting /dressing
over site ● Assess catheter site dressing for bleeding
✔ Avoid IV infusion, injections, or or wetness, infection, pain. A wet dressing
taking BP in fistula extremity is conducive to bacterial growth.
● Before procedure, weigh client ● Do not allow dwell time to extend beyond
● Wear protective eye wear or goggles, MD’s order – increase risk of
gown, gloves (3Gs) for protection during hyperglycemia
haemodialysis ● Input should be equal with your output or
● Patient can eat, watch TV before or during else it may lead to HYPERGLYCEMIA
dialysis ● You are instructing a client with DM about
● Heparin is used as anticoagulant during the peritoneal dialysis. You tell the client that it
procedure is important to maintain prescribed dwell
● Hold antiHPNsives + can affect BP until time for the dialysis because of risk of
after dialysis as prescribed. Withhold HYPERGLYCEMIA
Metformin (for diabetes)
QUESTION:
QUESTION: There is an indwelling catheter for peritoneal
Which of the following abnormal blood values will dialysis, the patient spills water on the catheter
not be improved in dialysis? dressing while bathing, the nurse should
ANEMIA - this cannot be improved with immediately? Change dressing
hemodialysis but we can give medication which is
Epogen. ENDOCRINE
Complications QUESTIONS:
1. After a recent head injury, a patient develops
● Air embolus – dyspnea, chest pain
● Interventions: SIAH. Which findings indicate to the nurse that the
➢ STOP dialysis treatment the patient is receiving for this condition
➢ Give O2 is not effective.
● Disequilibrium Syndrome –headache, a. Decrease in body weight
HPN, Restlessness, confusion (Change in b. Increase BP and decrease pulse
LOC) c. Increased urine output
● Intervention: d. Decrease in urine osmolality
➢ Stop dialysis
➢ Notify MD 2. Which of the following electrolytes would the
● Dialysis Encephalopathy nurse expect to be abnormal in pt with a PTH
➢ Aluminum toxicity from dialysate
deficiency?
water sources containing aluminium
a. Sodium
PERITONEAL DIALYSIS b. Potassium
c. Glucose
d. Phosphorus ● Hypervolemia, hypertension, anorexia,

nausea, vomiting
3. The nurse knows that the purpose of medication ● Increased bp, osmolality
therapy in the pt with acromegaly is to ● Low sodium may lead to seizure, priority is
a. Replace gonadotropin hormones SAFETY
b. Regulate glucose intake ● Urine is yellow, concentrated.
● DOC: Demeclocycline
c. Increase GH levels of production and
● Goal: Lower ADH
secretion
d. Decreased somatotropin levels of QUESTION:
production and secretion A nurse is caring for a patient with SIADH, which
lab values the nurse should monitor? Sodium
4. The nurse teaches a preoperative pt that the
surgical approach of choice for a pituitary gland Nursing Interventions
removal is accomplished via
● Monitor vital sign
a. Stereotactic ● Neurologic status
b. Transsphenoidal ● Limit fluid
c. Burr holes
d. Laparoscopic DIABETES INSIPIDUS
Description
5. Diastolic rumbling murmur ● Low ADH
a. Mitral stenosis ● Everything is low
b. Mitral regurgitation ● Polyuria
c. Aortic regurgitation ● Polydipsia
d. Mitral valve prolapse ● Patient is at risk for dehydration lead to
hypovolemic shock
● Hypothalamus secretes ADH and ● Weakness
Oxytocin ● Postural hypotension
● Pituitary Gland aka Hypophysis ● May lead to SVT - give Adenosine
● Hypophisecetomy – removal of pituitary ● Diluted urine
gland ● Goal: Add or replace ADH.
● Anterior pituitary 🡪 adenohypophysis ● Give Desmopressin
(hyper) ● Route: Intranasal
● Posterior 🡪 neurohypophysis (hypo; store
ADH and Oxytocin = Diabetes Insipidus) Nursing Interventions
● Provide adequate fluid (force fluid)
ANTERIOR PITUITARY ● Monitor LOC
● Prolactin - Galactorrhea ● Cardiovascular
● FSH/LH – Gonadtropin ● Urine specific gravity
✔ precocious puberty
✔ Decreased - Infertility QUESTION:
● TSH – Thyrotropin Diabetes Insipidus is a disorder of which gland?
✔ Decreased - Hypothyroidism a. Adrenal gland
● ACTH – Corticotropin b. Parathyroid gland
✔ Increased – Cushing’s c. Pituitary gland
✔ Decreased - Addison’s Disease d. Thyroid gland
● GH – Somatotropin
✔ Growth of body tissues and bone
THYROID
✔ Gigantism – children; proportional
overgrowth of all body tissues with Description
emarkable height ● 2 thyroid gland connected by isthmus
✔ Acromegaly – Adulthood; gradual, ● T3- Triiodothyronine
marked enlargement bones of face, ● T4- Thyroxine
jaw, hands, feet, diaphoresis, ● Calcitonin
hyperglycemia o lowers blood calcium level
✔ Dwarfism - Decreased o helps calcium enter the bone
Increased – hyperpituitarism HYPERTHYROIDISM

Decreased – Hypopituitarism Description
● Most common cause: GRAVE’S DISEASE
SYNDROME OF INAPPROPRIATE ● C/M: THYROTOXICOSIS
ANTIDIURETIC HORMONE (SIADH) ● Complication of untreated hyperthyroidism:
Description THYROID STORM/CRISIS
● Everything is increased except sodium
(hyponatremia) Manifestations
● Water intoxication lead to hypervolemia ● Increased thyroid hormone
● Control thyroid hormone - Can use or apply lotion

● Hypertension ● Lethargic sleeping pattern
● Tachycardia
● Fast metabolism Other Signs and Symptoms
● Diarrhea ● Alopecia
● Low fiber diet ● Brittle nails, Bradycardia
● Weight loss ● Coarse hair
○ Diet: High calorie, high protein ● Dry skin
● Heat intolerance ● Slow metabolism lead to constipation,
● Moist skin obesity
● Insomnia
Management
Management
● Goal: Increase TH
● Goal: lower thyroid hormone ● Thyroid hormone replacement
● Drug of Choice: ○ Levothyroxine (Synthroid)
○ Anti-thyroid drug ○ Liothyroxine (Cytomel)
- Block synthesis of TH ○ Liotrix (Thyrolar)
o PTU (Propylthiouracil) Side effect: Hyperthyroidism
o Tapazole (Meyimazole) Monitor heart rate and BP
Side effects: Hypothyroidism
● Beta-Blockers (-olol) QUESTION:
○ Propanolol The nurse should anticipate administration of
- To lower heart rate/ which of the following medications to client with
tachycardia.
hypothyroidism?
- Contraindicated to patients
with asthma. a. Dexamethasone
● Radioactive Iodine: Unsealed b. PTU
Brachytherapy c. Levothyroxine
o I 131 d. Tapazole
✔ destroys hyperactive thyroid
gland PARATHYROID
✔ SE: hypothyroidism Description
✔ Instruct to flush the toilet 3x. ● Increased PTH, Calcium, Vitamin D
● Post-Op Care (Thyroidectomy) : ● Everything goes up, Phosphorus goes
o Semi-Fowler’s Position down
o SSKI/Lugol’s solution ● Lead to:
- reduce vascularity thyroid o Nephrolitiasis
gland before undergoing o Osteoporosis
procedure o Fractures
Complications - Priority: SAFETY
● Haemorrhage
● Airway obstruction HYPERPARATHYROIDISM
- Prepare tracheostomy set Management
● Tetany due to disruption of Calcium ● Increased fluid to force diuresis
- Prepare Ca Gluconate ● Strain urine - to check for stones
● Recurrent laryngeal nerve damage ● Prevent injury due to fracture
● Thyroid Crisis/Storm ● Monitor dysrhythmias
● ECG
HYPOTHYROIDISM ○ Shows Short QT interval
Description (Hypercalcemia)
● Myxedema - in adult
● Cretinism - hypothyroidism in children HYPOPARATHYROIDISM
Signs
Manifestation ● Chvostek’s
● Low thyroid hormone ○ facial nerve - facial twitching
● Increase thyroid hormone ● Arrhythmia
● Bradycardia ○ prolonged QT interval seen in ECG
● Hypotension due to hypocalcemia
● Slow metabolism ● Trousseau
● Constipation ○ to evaluate you need you BP App;
- Encourage high fiber diet, laxative Tetany
● Cold intolerance ○ due to hypocalcemia prepare
- Must be provided with blanket tracheostomy set
● Weight gain ● Seizure
- Low calorie and protein
● Dry skin Interventions
● Calcium Gluconate IV d. Insulin

○ for hypocalcemia
● Arrhythmia precaution ADRENAL CORTEX
● Tracheostomy set ● Glucocorticoids (Cortisol)
● Seizure precaution ● Aldosterone- promote Sodium retention
and potassium loss
QUESTION: ● Sex hormones (Androgens)
1. A patient with primary hyperparathyroidism is
encouraged to drink at least 3l of fluids/day to CUSHING SYNDROME
prevent complication of: Description
a. Hypertension and MI ● everything is elevated (glucose, sodium, bp
b. Hemorrhage, Hypotension except potassium
c. Infection and Renal Stone ● Due to decreased otassium patint can eat
d. Dropping BP and Pulse banana or any potassium containing food
2. A patient has undergone thyroidectomy, if ● Hypokalemia- “U wave” is seen in ECG
parathyroid was accidentally removed, client ● Pendulous abdomen
will most likely experience? ● Buffalo hump, Moon face
a. Facial twitching
Management
b. Dysphagia
c. Dyspnea ● Adrenalectomy if there is tumor in adrenal
d. Loss of speech gland (cause is hyperfunctioning of tumor)
● Hypophysectomy
● Vital sign- check for edema
3. What is the best indicator for determining if a
client with Addison’s disease is receiving the ADDISON’S DISEASE
correct amount of glucocorticoid replacement? Description
a. Temperature
● Everything goes down except potassium
b. Daily weight
(low bp, sodium and glucose) increased
c. Skin turgor potassium.
d. Blood pressure ● Hypoglycaemia
● Hyponatremia- may lead to hypovolemic
4. Hydrocortisone given IV is treatment of: shock
a. Addison’s disease ● Hypotension
b. Cushing’s syndrome
c. Hypothyroidism Management
d. Hypoparathyroidism ● Steroids
● Combat shock
5. Appropriate nursing actions for a client with ● Administer fluids
Adrenal Insufficiency would include: ● Hydrocortisone
a. restricting fluids to 1500ml/ day ● Monitor VS
b. administer insulin ● Provide rest period
c. avoid physical, emotional; stress
d. encourage a low sodium diet HYPERALDOSTERONISM (CONN’S
SYNDROME)
6. In assessing the client with MI, which of the Description
following will you check first before giving ● Problem is focused on lowering sodium
Morphine? ● Hypertension
a. Urine output ● Metabolic alkalosis
● Cardiac arrhythmias (due to hypokalemia)
b. Breath sounds
c. Vital signs
Management
d. History of breast cancer
● Sodium restriction
● Spironolactone (Aldactone) as ordered.
7. Which of the following are the effects of
NSAIDS?
ADRENAL MEDULLA
a. Relief of pain
b. Diuresis
ADRENAL MEDULLA
c. Increase cardiac contractility
Secretes
d. Promote bowel evacuation
CATECHOLAMINES:
● Epinephrine
8. The first drug to be given in patient with
● Norepinephrine
Addison.
a. Hydrocortisone
PHEOCHROMOCYTOMA
b. Glimepiride
Description
c. Gliclazide
● Tumor of adrenal medulla - hyperfunction DIABETES MELLITUS

● A rare often benign tumor that originates ● Chronic metabolic disease characterized
from the CHROMAFFIN CELLS and by hyperglycemia
secretes catecholamine excess ● HYPOGLYCEMIA: <60 mg/dL
5H ● HYPERGLYCEMIA: >126 mg/dL
● Hypertension - hallmark manifestation of ● FBG: 100 - 125 mg/dL
these tumors
Types
● Hyperglycemia
1. TYPE 1 DIABETES MELLITUS
● Hyperhidrosis
○ Also known as insulin-dependent
● Hypermetabolism
diabetes
● Headache
○ Juvenile
○ Onset is <30 years old, THIN at
Diagnostics
diagnosis
● 24-Hour Urine Specimen for
○ PROBLEM: Destruction of BETA
determination of CATECHOLAMINE
CELLS which secretes the
METABOLITES:
INSULIN
○ MN - metanephrine
○ No insulin production
○ VMA - Vanillylmandelic acid
○ TREATMENT: INSULIN
2. TYPE 2 DIABETES MELLITUS
Medical Management
○ Also known as adult-onset
● HOB elevated diabetes (AODM) or non-insulin
● Drugs: dependent diabetes
○ Phenoxybenzamine ○ Affects people who are >30 years
- calcium blocker old and OBESE
○ Nifedipine ○ PROBLEM: INSULIN
○ Propranolol RESISTANCE - decreased tissue
- beta blocker; controls the sensitivity to insulin
blood pressure ○ There is insulin but decreased, and
● Surgery: ADRENALECTOMY insulin resistance is present
○ Surgical removal of tumor ○ Most patient can control blood
glucose through WEIGHT LOSS, if
Nursing Interventions obese - LIFESTYLE RELATED
● Monitor:
○ Blood pressure Signs and Symptoms (5PS)
○ ECG changes ● POLYURIA
○ Blood glucose ● POLYPHAGIA - increased appetite or food
intake
QUESTIONS: ● POLYDIPSIA - increased thirst
1. MJ is admitted to the hospital with a serum ● PRURITUS - caused by BILE SALTS
glucose level of 520 mg/dL. Awake, oriented with a ● POLYNEURITIS - nerve endings are
temperature of 37.8; HR: 116 bpm, BP: 110/70. affected because of the low blood supply to
Based on MJ’s assessment findings, which peripheral organs
nursing diagnosis takes highest priority?
a. Fluid volume deficit QUESTION
b. Decreased cardiac output related to 1. Which type of diabetes is controlled primarily
tachycardia through diet, exercise and oral anti diabetic
c. Altered nutrition less than body requirements agents?
related to insulin deficiency a. Diabetes Insipidus
d. Ineffective thermoregulation related to b. Diabetic Ketoacidosis
dehydration c. Type 2 Diabetes mellitus
d. Type 1 diabetes
2. The nurse should include which instruction
when teaching a client about insulin Medical Management
administration.
● Sulfonylureas
a. Administer insulin after the first meal of day
- Stimulate beta cells to secrete
b. Administer insulin at a 45 degree angle into
insulin.
deltoid
- SIDE EFFECT: HYPOGLYCEMIA
c. Shake the vial of insulin vigorously before
- Examples:
withdrawing the medication
■ Chlorpropamide
d. Draw up clear insulin first when mixing 2
■ Glipizide
types of insulin in 1 syringe
■ Glyburide
■ Glimepiride
Aspart (Novolog)
■ Gliclazide ● ONSET: 5-15 mins
● Biguanide ● PEAK: 40-50 mins
○ Metformin ● DURATION: 2 hours
- Lowers hepatic glucose production Glulisine (Apidra)
WITH MEALS. ● ONSET: 5-15 mins
- SIDE EFFECT: LACTIC ACIDOSIS ● PEAK: 30-60 mins
● DPP4 Inhibitors
○ Sitagliptin, Vildaflipitin Short Acting Regular (Humalog R, Novolin
- Enhances the incretin effect which - CLEAR R)
helps to promote INSULIN ● ONSET: 30 mins - 1 hr
● PEAK: 2-3 hours
- Promotes insulin secretion
● DURATION: 4-6 hours
● Sodium-Glucose Cotransporter 2 Intermediate NPH
(SGLT2) Inhibitors - CLOUD ● ONSET: 2-4 hours
○ Empagliflozin, Canagliflozin Y ● PEAK: 4-12 hours
- Inhibits glucose reabsorption, ● DURATION: 16-20 hours
lowers the renal threshold for Humulin N
glucose ● ONSET: 3-4 hours
- Urinary, gernical mycotic infections Lente
- common
Very Long Glargine (Lantus) and Levemir
● Insulin
- CLOUD - 24 hour insulin
- Route: Subcutaneous Y ● ONSET: 1 hour
- DO NOT (SAM) ● PEAK: Continuous
○ Shake the vial ● DURATION: 24 hours
○ Aspirate site of injection
○ Massage the site of injection
NOTE: DRAW UP CLEAR BEFORE CLOUDY
- Administer at ROOM
INSULIN
TEMPERATURE - to prevent
lipoatrophy
QUESTIONS:
- ROTATE SITE of injection - to
1. Rotating injection sites when administering
prevent lipodystrophy
insulin prevents which of the following
complications?
INSULIN PUMP
a. Insulin edema
● A computerized device that delivers insulin
b. Insulin resistance
to patients automatically to patients
c. Insulin lipodystrophy
throughout the day
d. Systemic allergic reactions
● Change needle or catheter EVERY 3
2. In which of the following effects digoxin is
DAYS
associated?
● TYPE OF INSULIN USED: REGULAR
a. Red - green color perception
INSULIN or RAPID ACTING INSULIN
b. Tophi
● The pump is worn either on a belt or in a
c. UTI
pocket.
d. osteoporosis
● Should have a GLUCOMETER - to monitor
3. Which of the following drugs is used for heart
glucose.
failure is expected by the nurse to be prescribed to
● Insulin can be administered via the basal
reduce pulmonary edema?
rate (usually 0.5-2.0 units/hr)
a. Furosemide
b. Mannitol
QUESTION
c. Methotrexate
1. Which medications are used in
d. Steroid
hyperthyroidism?
4. This drug is given on an empty stomach that
a. Levophed
adheres to ulcer crater.
b. Lactulose
a. Maalox - this is an antacid
c. Levothyroxine
b. Ranitidine
d. Tapazole
c. Cimetidine
d. Sucralfate
TYPES OF INSULIN 5. Levothyroxine is used in?
a. Shock
Rapid Acting Lispro (Humalog) b. Hypothyroidism
- CLEAR ● ONSET: 10-15 mins c. Hyperthyroidism
● PEAK: 1 hr d. Angina
● DURATION: 2-4 hours
6. An anticholinergic drug
a. Atropine ● It usually results from excessive evening

b. Morphine insulin dosing. The pathophysiology involves
c. Nexium hypoglycemia, leading to counterregulatory
d. Sucralfate hormone secretion and resultant liver
7. Thrombolytics side effects: production of glucose.
a. Infection ● This increase in glucose level, along with
b. Urinary retention insulin resistance secondary to increased
c. Decubitus ulcer hormone levels, is thought to contribute to
d. Bleeding REBOUND HYPERGLYCEMIA.
8. Alpha blocker:
a. Nifedipine DAWN PHENOMENON
b. Nicardipine ● Early morning (4 to 8 AM) increase in blood
c. Doxazosin glucose level without preceding nocturnal
d. Propranolol hypoglycemia.
9. Digoxin is toxic to.
a. Joints
DKA HHNS
b. Eyes (DIABETIC (HYPEROSMOLA
c. Muscles KETOTIC R
d. Bladder ACIDOSIS) HYPERGLYCEMIC
NONKETOTIC
HYPOGLYCEMIA SYNDROME)
● CBG: <60 mg/dL
Patient Type 1 Type 2
Signs and Symptoms affected
● MILD
○ Hunger Onset Rapid <24hrs Slower - days
○ Tremors
pH <7.3 NORMAL
● MODERATE
○ Unable to concentrate Ketone + -
○ Drowsiness
● SEVERE Blood > 250 mg/dL > 600 mg/dL
○ Difficult arousing from sleep Glucose
○ Seizure
Mgt PNSS PNSS
HEMATOLOGY
Cellular Component of Blood
1. RBC
● Reticulocyte - baby RBC
● Erythrocytes - adult RBC
↑ RBC = Polycythemia
↓ RBC = Anemia
2. WBC
● Blastocysts - baby WBC
● Leukocytes - adult WBC
↑ WBC = Leukocytosis
↓ WBC = Leukopenia
3. Platelets
● Megakaryocytes - baby Platelet
Management ● Thrombocytes - adult Platelets
● CONSCIOUS ↑ Platelets = Thrombocytosis (>400,000)
○ 4-6 oz fruit juice ↓ Platelets = Thrombocytopenia
○ 6-10 hard candies
○ 2-3 tsp of sugar or honey RED BLOOD CELLS
○ Softdrinks Description
● UNCONSCIOUS ● LIFE SPAN: 120 days
○ 25-50 mL D50W IV
○ 1 mg glucagon - SC or IM
GOOD TO KNOW:
SOMOGYI PHENOMENON
■ Can cause constipation

Diet: High fiber
○ Administer oral iron
■ Give with Vit C to increase
absorption
■ Use straw because oral iron
can stain teeth
○ Parenteral Iron
■ Deep IM via Z-track
method to prevent staining
of the tissue.
QUESTION
1. Which food groups do not increase iron
● What happens to aged erythrocytes? absorption?
○ GLOBIN goes to the blood a. Strawberries
○ HEM - further converted to b. Broccoli
BILIRUBIN c. Yogurt
● RBC INDEX: d. Tomatoes
Mean Corpuscular Volume (MCV) - 2. Iron is stored in the intestine as:
measures the size of RBC
a. Hemoglobin
○ DECREASED MCV = Microcytic
b. Myoglobin
RBC
c. Ferritin
○ INCREASED MCV = Megaloblastic
d. Transferrin
anemia
■ Vitamin B12 3. Discharge instruction re: Iron intake, except:
(Cyanocobalamin) - a. Take iron on empty stomach
Pernicious anemia b. Take 1 hour before or 2 hours after meal
■ Vitamin B9 (Folic acid) - Folic c. Iron absorption is increased with
Acid Deficiency dairy products
d. Iron absorption is decreased with food
IRON DEFICIENCY ANEMIA 4. Which of the following tests reflects low iron
● Abnormal decrease of RBC in the amount stores?
of Hemoglobin in Blood a. Low Hemoglobin
● DECREASED MCV = Microcytic b. Low Hemosiderin
Hypochromic Anemia c. Low Ferritin
● Low serum ferritin - stored iron d. Low MCV level
● CAUSES:
○ Inadequate intake of Iron ________________________________________
○ Blood loss
○ Menorrhagia - heavy menstruation REVIEW (CARDIO)
○ Pregnancy
● SIGNS AND SYMPTOMS: DRUG OF CHOICE:
○ Spoon nails: KOILONYCHIA ➔ High blood pregnant
○ Cheilosis ◆ HYDRALAZINE
○ Dizziness ➔ Myocardial Infarction
- Priority intervention: ◆ MORPHINE
SAFETY ➔ Atrial Fibrillation and Atrial Flutter
○ Fatigue ◆ DIGOXIN
○ Pallor ➔ Ventricular Tachycardia
○ Palpitations ◆ AMIODARONE
● MANAGEMENT: IRON-RICH FOODS ➔ Heart block and Bradycardia
○ Meat ◆ ATROPINE
○ Sea foods ➔ Anaphylaxis
○ Eggs ◆ EPINEPHRINE
○ Liver
○ Fish CLASSES OF ANTIARRHYTHMIC DRUGS
● TREATMENT:
○ Ferrous sulfate Class I Class 1a - intermediate
■ Given on EMPTY (Sodium Channel acting
STOMACH 1 hour before Blockers) Procainamide, Quinidine
meal
Class 1b - quick acting
■ Stools will appear black
Lidocaine
Class 1c - slow acting

Flecainide
Class II Propranolol
(Beta Blockers) Esmolol
Metoprolol
Class III Amiodarone

(Potassium Sotalol
Channel Ibutilide
Blockers)
Class IV Verapamil
(CCB) Diltiazem
QUESTION
1. Beta Blocker (Metoprolol) is what class of
antiarrhythmic?
a. I
b. II
c. III
d. IV
2. This drug of choice for AV block?
a. Lidocaine
b. Propranolol
c. Atropine
d. Diltiazem
MEDICAL-SURGICAL NURSING FOLIC ACID ANEMIA
Dr. Leila R. Ferrer VITAMIN B9 DEFICIENCY
• Megaloblastic anemia
MEGALOBLASTIC ANEMIA • Increased mcv
Deficiency of:
• B12 – Pernicious Anemia Cause:
o Surgery common in: Bilroth 1 and 2 • Poor Nutrition
• B9 – Folic Acid Deficiency Anemia • Hemodialysis (Hep. C prone to pt undergoing
o Common in alcoholic dialysis)
• Both B12 and B9 have the same signs and • Alcohol Abuse
symptoms • Methotrexate - chemodrug which is not given
• “Beefy red tongue” can develop folic acid deficiency
o Glossitis – inflammation of the tongue • Pregnant
Characterized by Assessment:
• Increased MCV • Beefy red tongue
• Decreased Hemoglobin • Glossitis
• Decreased DNA synthesis • Pallor
PERNICIOUS ANEMIA Management:

VITAMIN B12 DEFICIENCY • B9 replacement
• Folic Acid Deficiency Anemia • Food sources of folate includes:
• Common in alcoholic and pregnant • Beans and legumes
• Characterized by MACROCYTIC RBC • Citrus fruits and juices
• Develops after total gastrectomy • Whole grains
o Half of the stomach is attached to the • Dark green leafy vegetables
duodenum (Bilroth 1) • Poultry
o Attached to the half of the jejunum • Pork
(Bilroth 2) • Shellfish
▪ Peptic ulcer disease –
• Liver
damaged
• Inability to absorb vit. B12 because of lack of
SICKLE CELL ANEMIA
INTRINSIC factor
• Hereditary/Genetics
• Intrinsic factor is necessary for the B12 to
• Crescent shape RBC
be absorbed in the intestines.
• It needs genetics
• Intrinsic factor can be found in the stomach.
• Filipino: A1C – measures the glucose in the
RBC for the past 3 months
S/S:
• Glossitis – inflammation of the tongue Cause:
• Beefy red tongue
• Hypoxia
• Glossitis
• RBC will be in crescent shape due to hypoxia
• *Liver – hepatomegaly (side notes) and may occlude the blood vessels
• *Enlargement of the Tongue – Macroglossia • Avoid High altitude places. Pt. may undergo
(side notes)
• Avoid cold skiing
• Paresthesia - tingling in extremities; tingling
• May develop hemolytic anemia
sensation
• HbS gene is inherited in African race
• Vit. B12. Anemia – is more on NEURO
INVOLVEMENT
Complication of Sickle cell anemia
Diagnostics: • Pulmonary Hypertension – causing
obstruction to the blood flow
• Absence of free HCL in a pH maintained at
• Impotence, infection
3.5
• Stroke
• Achlorhydria (absence of hydrochloric acid)
intrinsic factor are both excreted in the • Acute chest syndrome
stomach • Pt. may have JAUNDICE
• What confirms Dx of Pernicious anemia: 24h
urine for Schilling test Risk factors:
o Specimen: urine • Disease of the CHILDHOOD
• *IDA Dx: Peripheral Blood Smear (PBS) • Patient may have vasocclusive crisis
• Common in children
Management:
• Replacement of B12 Priority Nsg. Dx:
• Food sources of vitamin B12: • PAIN
• Eggs meat, poultry, shellfish, milk and milk
products

S/S:
• PAIN - most common symptom – crisis APLASTIC ANEMIA
• JAUNDICE – Heme will be converted to Remember
bilirubin. Bilirubin has high affinity to the • Pancytopenia – everything goes down.
protein of the eye, elastin, converted to o RBC, WBC and Platelet are all low.
JAUNDICE.
• INFECTION – Can trigger crisis Etiology
Important Nsg advised: • Unknown
• Avoid infection because it can trigger crisis • Damage to bone marrow stem cells
o Bone marrow produces blood cells,
PRIAPISM RBC, WBC and platelets.
• Persistent Painful Penile Erection o One of the theories is that there are
antibodies that damages or destroys
Nursing Intervention: the bone marrow.
• Warm Bath o As the bone marrow is destroyed,
• Empty bladder at onset of attack blood cells depletes, RBC, WBC and
• Exercise platelets.
• >3hrs o Remember that your bone marrow is
• Nifedipine - vasodilator divided into two, yellow marrow and
• Analgesics red marrow. Red marrow produces
o Opioids – given because of severe blood cells and the yellow marrow
pain produces fat.
o Drug of choice: Morphine, for o In here due to the destruction of the
patients with sickle cell anemia. red marrow, there is replacement of
o Sickle cell is a genetic anaemia. your bone marrow with fat cells.
• Replacement of bone marrow with fat
Definitive Dx: o Low RBC - anemia
• Hemoglobin electrophoresis – part of the ❖ Fatigue
definitive diagnosis ❖ Pallor
• When they age 40: High mortality ❖ Dizziness
❖ Nursing interventions:
1. Provide rest in
A client with thrombophlebitis is treated with between activities
Heparin. The nurse should have an antidote just
in case the client develops bleeding o Low WBC – leukopenia
complications. What is that drug? ❖ Infection
a. Vit K ❖ Orange is better to give to
b. Protamine sulfate these patients than grapes,
c. Streptokinase as grapes may harbour
d. Furosemide microorganism. Whereas in
orange you can first peel it.
❖ Nursing interventions:
Management for Sickle Cell Anemia: HOPIA 1. Wear mask and do
• Triggered by HYPOXIA – Clients are not handwashing
allowed to be in high altitude places. 2. Limit visitors
• OPIOID: Morphine, for pain management. 3. Don’t got the crowded
• Symptom experienced during crisis: PAIN places
OR PRIAPISM 4. Raw vegetables can
• INFECTION – prevention harbour bacteria
• ADEQUATE HYDRATION – to prevent 5. Diet: Low Fiber
clumping of the crescent shaped rbc. /Residue
o At least 3 liters of water a day 6. Temperature taking
are done by placing
thermometer on axilla
Assessment findings in iron deficiency Anemia, to prevent infection.
except:
a. Palpitation and dizziness – happen to o Low Platelet – thrombocytopenia
all types of anemia. ❖ Bleeding
b. Brittleness of hair and nails ❖ Nursing interventions:
c. Dyspnea & weakness 1. No IM injections
d. Weak bones or spinal defects 2. No dental floss

3. Soft bristled and
electric toothbrush is B Symptoms
preferred. • Fever without chills
• Night sweats
Treatment
• Patient may undergo bone marrow biopsy – Management
to distinguish blood cells depletion • PE: Palpation- examination of cervical
lymph nodes
• If enlarge: use BIOPSY
What hematologic disorder has been associated
with Vit B12 deficiency? 2. NON-HODKIN’S DISEASE
a. Aplastic anemia • tumor originates OUTSIDE the lymph node
b. Pernicious Anemia
• Most COMMON form of Lymphoma
c. Polycythemia Vera
d. Red Cell Aplasia • It cannot be seen
• linked to infection with H. Pylori
Theory B Symptoms
• Bone marrow has been destroyed by the • Fever without chills
antibody; this antibody is produced by the • Night sweats
lymphocyte of the spleen.
• One of the treatments to treat aplastic Management
anemia is to destroy the antibody. • PE: Palpation- examination of cervical
• A way to do that is to remove the source of lymph nodes
antibody which is your spleen, so we perform • If enlarge: use BIOPSY
splenectomy or patient may receive your
steroids. DISORDERS RELATED TO ALTERED
COAGULATION
o Immunosuppressive therapy – • HEMOPHILIA’S - common problem is
prevent patients’ lymphocytes from bleeding
destroying stem cells
❖ Steroids, to supress antibody A. HEMOPHILIA A
o Splenectomy • Most common type “Classic Hemophilia”
❖ Patient will be prone to • Factor 8 deficient
infection • Treatment: Factor 8 replacement
Implementation B. HEMOPHILIA B
• Reverse isolation – to prevent infection and • Factor 9 deficiency
avoid fresh or raw vegetables as they may • “Christmas Disease”
harbour bacteria causing diarrhea.
• Monitoring bleeding – due to low platelet — Both leads to bleeding
count
Signs and Symptoms
• Prolonged bleeding from small cuts & injury
The iron containing pigment derived from • GI bleeding
breakdown of hemoglobin • Bleeding of joints – hemarthrosis
a. Ferritin – stored iron
b. Hemosiderin
c. Hemoglobin – comes from RBC
d. Myoglobin
MALIGNANT LYMPHOMA
• Affects lymphatic system
• Results to proliferation of lymphocytes
1. HODGKIN’S DISEASE
• Common in white men
• Reed Sternberg cell- hallmark; tumor
originates INSIDE the lymph node
• Can be seen
• Cause: Unknown

HEMOPHILIA You are monitoring a client for signs and symptoms
SIGNS AND SYMPTOMS related to paragonimiasis. Which of the following
• Prolonged bleeding from small cuts and assessment is seen in the patient?
injury a. Icteresia
• NO contact sports b. Constipation
• GI bleeding c. Skin rash
o Hematochezia – fresh blood d. hemoptysis
o Melena- black stool
o Hemarthrosis – bleeding of the joints Which of the following patients should the nurse
identify as at risk for the development of E.coli
MANAGEMENT infection following teletherapy?
a. A 50 yo patient whose urinary output is
• Replacement of deficient coagulation factor
averaging 400mL/24 hours
• Control of topical bleeding (pressure, b. A 30 yo patient with vomiting
application of ice) c. A 60 yo patient receiving Aldactone for fluid
• Bleeding precautions volume
d. A 20 yo patient on a high fiber, low
DISSEMINATED INTRAVASCULAR cholesterol diet
COAGULATION
DESCRIPTION Mr. X 74 yo with PTB category 1 who is being cared
• Abnormal initiation and acceleration of for at home by his 63 yo wife. Which nursing
clotting and hemorrhage diagnosis has the highest priority for teaching his
o Clients are critically ill wife how to manage symptoms?
o Mortality rate is high a. Imbalanced nutrition: less than body
• There is depletion of clotting factors requirements related to fatigue and increased
• Commonly starts if the patient has SEPSIS – metabolism
PRIMARY TIGGER b. Constipation related to decreased activity and
• end story of hema disorders medication regimen
c. Activity intolerance related to dyspnea and
SIGNS AND SYMPTOMS fatigue
• Ecchymosis d. Chronic pain related to infection
• Hematoma
Immediately following varicella, it is important to
• Bleeding from puncture sites
remind the client that:
• GI
a. He is not contagious to an HIV individual
• Oliguria
b. He should take a bath daily
o < 400 mL/day
c. He should be placed on isolation
• Hematuria
d. He is contagious for 1 week
• Signs of Shock
o Hypovolemic shock MUSCULOSKELETAL SYSTEM
• 206 bones
MEDICAL MANAGEMENT
• Treatment of the underlying disease BONES
• Blood products FUNCTIONS
o FFP (fresh frozen plasma)
• Locomotion
o Platelets
• Blood production
o Cryoprecipitate
o Red bone marrow – produces blood
• Vasopressors to support blood pressure
o Yellow bone marrow – produces fat
o Dopamine
cells
▪ Increases BP
• Mineral deposition
o Levophed
o Calcium
▪ Generic name:
norepinephrine
BONE CELLS
OSTEOCYTES (BONE CELLS)
AA, a 20 yo client with salmonella infection is
receiving PNSS 1L for 12 hours. Which among the • Osteoblast
following should the nurse assistant to monitor with o Bone formation
regards to the disease? o Calcitonin – stimulates the bone
a. It can cause thrombocytopenia formation; makes calcium go back to
b. Signs of flushing the bone (good guy)
c. Dry mucosa and changes in sensorium • Osteoclast
d. Report for symptoms of back pain

o Bone resorption (destroy bone • Skeletal = cervical tongs and halo fixation
cells) device, balanced suspension (BSST)
o PTH – stimulates the bone to release o risk for infection
calcium (bad guy) • Skin = buck's, cervical, russel's, pelvic
dunlop's traction
*Periosteum – covering of the bone o use of elastic bandage
*Pericardium – covering of the heart o skin has no risk of infection
• If patient experiences pain, assess for
LIGAMENTS alignment
DESCRIPTION
• Connects bone to bone
• SPRAIN Which weight is commonly applied to an extremity
o Excessive stretching of ligaments for Buck’s traction in an adult?
▪ Mgt: RICE a. 1-2 lb
• Rest b. 1-5 lb
• Ice c. 5-7 lb (should be less than 8 lb in weight)
• Compression d. 8-10 lb
• Bandage
• Elevate
NEUROVASCULAR STATUS MONITORING (6
TENDONS
Ps)
DESCRIPTION
1. Pain
• Attached muscles to bone 2. Paresthesia = tingling sensation
• STRAIN 3. Pallor
o Excessive stretching muscle or 4. Pulselessness
tendon 5. Poikilothermia
• If mild, we use RICE 6. Paralysis
• If severe stretch, patient may undergo • Do not look for erythema or infection unless
surgery skeletal traction
JOINTS
DESCRIPTION TRACTION NI:
• Two or more bones are connected • Monitor N/V status - involved extremity;
o Synarthrodial – NO movement (eg. distal to involved site
Skull) • Monitor S/S - immobility complications
o Ampiarthrodial – SLIGHT o constipation
movement (eg. Pelvis) o skin breakdown, disuse of
o Diarthrodial – FREELY movable unaffected extremity
(eg. Knees and hands) o renal (UTI)
o lung complication
*Arthritis – inflammation of joints ▪ pneumonia; most common
*Dislocation - misalignment of joints cause = streptococcus
*Subluxation – partial dislocation of joints pneumoniae (prior to covid)
• Increased oral fluid intake
TYPES OF MUSCLE TISSUE • DBCE = deep breathing and coughing
SMOOTH CARDIAC SKELETAL exercises
involuntary involuntary Voluntary
nonstriated striated striated SKELETAL TRACTION
DESCRIPTION
• applied to bone with pins, wires, or tongs
MUSCULOSKELETAL MODALITIES
• applied directly; risk for infection
A. TRACTION • NURSING INTERVENTION
o monitor color, motion, sensation of
DESCRIPTION
extremity
• Exertion of pulling force applied in two o monitor insertion site = pain,
directions drainage, redness (erythema),
o Relief of muscle spasm (relief of pain) swelling
o immobilization o WBC = increased (leukocytosis)
o bone alignment
• Patient cannot be turned side to side
o Risk for constipation

BSST (BALANCED SUSPENSION SKELETAL PELVIC BELT TRACTION
TRACTION) • to relieve low back pain, hip, leg pain
DESCRIPTION • is conservative treatment for lower back
• used with skin or skeletal traction pain
• used to approximate fracture - tibia, femur • to reduce muscle spasm
• produced by counterforce other than the • avoid gas forming foods (onions)
client
• weight should hang freely and should not
touch the floor DUNLOP’S TRACTION
• ROM on unaffected extremity to prevent • horizontal traction used to align fracture of
atrophy the humerus
• NURSING INTERVENTION • vertical traction - maintains forearm in
o low fowler's proper alignment
o maintain 20-degree angle from thigh • NI:
to bed o same as Buck's
o provide pin care
o Maintain proper body alignment
o clean pin sites (NSS, hydrogen
o ensure weights hang freely
peroxide, betadine) o do not remove weights
o ensure pulleys are not obstructed,
SKIN TRACTION ropes in pulleys move freely
DESCRIPTION
• uses elastic bandages or adhesive
• no risk for infection as they do not use pins QUESTION HERE (KANAN ASSESS
• TYPES ALIGNMENT ADA)
1. Buck's = foot
2. Cervical
3. Russel's Which type of traction is used for leg traction
4. Pelvic = avoid gas forming foods a. Bryant's (congenital hip dislocation)
b. buck's
c. pelvic
d. Russell’s
BUCK’S
• goal is to alleviate muscle spasm
• maintain straight pull on limb with use of
weights BRYANT’S
• used for leg or arm traction • used for children who weigh <35 lbs
• not > 8 lbs should be applied • for congenital hip dislocation
• NI:
o elevate foot of bed
CERVICALSKIN (HEAD HALTER) TRACTION

• uses head halter or chin pad to attach
traction
• patients with cervical spondylosis (arthritis
of neck)
RUSSELL’S
• stabilize fractured femur before surgery
• provides double pull using knee sling that
pulls at knee and foot
• NI:
o if patient complains of pain, assess
body alignment
o don’t remove weights, free
movement of knee sling

MEDICAL-SURGICAL NURSING
Dr. Leila R. Ferrer
CAST
• Immobilizing tool
• GOAL: Provides immobilization of fractured
bone
• COMMON PROBLEM: Compartment
Syndrome
• 2 Types of Cast:
1. Plaster of Paris. Takes 72 hours to dry.
2. Fiberglass. Expensive and easy to put
to patient. Takes about 45 minutes to
dry.
Interventions
• Allow the cast to dry.
• Handle a wet cast with the PALMS. We don't
use Gloves kasi didikit man yan sya.
• Keep the casted extremity ELEVATED using
a pillow. Goal is to prevent edema of the
casted extremity.
• Yung iba nagsasabing mainit dao, they put
whole in it.
• DO NOT USE DRYER for plaster cast.
• Monitor your 6 P's for Neurovascular Status:
o Pain
o Paresthesia 1. 2 point gait
o Pallor • For partial weight bearing limitations with
o Pulselessness BILATERAL Lower Extremity
o Poikilothermia Prosthesis.
o Paralysis • Dalawang Paa ang injured or casted
kasi BILATERAL Lower Extremity
CRUTCH WALKING Prosthesis.
• Weight is on the palm, never rest on the axilla • Crutch on 1 side – opposite foot
because it can damage the brachial plexus advanced same time.
nerve. 2. 3 point gait
• Could damage brachial plexus. • For partial or no weight bearing on
• Distance between axilla and arm 2-3 finger affected leg
widths • Isa lang ang injured or casted.
• Stand on the affected side of the patient. • Crutches and affected foot advanced
• Should there be tingling sensation or then unaffected extremity. Example, if
paresthesia felt by the patient, STOP Right Leg ang casted, then sabay
immediately the ambulation. imomove ang Casted Right Leg and 2
Crutches, then yung unaffected left leg.
Crutch gaits
3. 4 point
• Dito, magaling na ang patient mo.
Patient is already on the healing
process.
• Used if weight bearing is allowed.
• R crutch, L foot, then L crutch, R foot
4. Swing to gait; swing through gait
• Used when there’s adequate muscle
power & balance in arms and legs
• Both crutches advanced, both legs are
lifted

OSTEOPOROSIS
• Decreased bone mass density (BMD)
• Thin/Lean people are more common –
lesser bone mas
Risk factors
• Sedentary lifestyle
• Smoking
• Alcohol
• Diet
• Old age
• Menopausal
CANES AND WALKERS
• Immobility
• Stand on client’s affected side.
• Canes – elbow flexed at 15-30 degrees
Assessment
• Elderlies and people with Parkinson’s use
these devices. These devices are called • Low stature
Assistive Devices. • Fracture
• Bone pain
FRACTURED HIP – Post Operative • Osteopenia – low level of calcium in the
Nursing Interventions: bone
• Prevent internal and external rotation ➢ Xerostomia – dryness of the mouth
• MOST IMPORTANT: Avoid crossing the
legs. Diagnostics
• Kapag ang patient ay naoperahan ng • DEXA-scan – detects bone mass density
Fractured Hip, ang pinakamagandang • X-ray detects fracture
POSITION is Abduction. To maintain
abducted position lage, dapat may unan sa Management
magkabilang leg niya. Bawal Adduction.
• Diet therapy – dark, green leafy vegetables,
• Elevate HOB 30-45 degrees for meals only.
dairy products
• Use walker – AVOID weight bearing
• Drugs
• AVOID crossing leg by putting pillow, hip
• Calcium supplement
flexion >90 degrees, low chairs
o Side effect is constipation
• Elderlies are the most common patients who
• Bisphosphonates: Ibandronate – may cause
acquired Fractured Hip.
esophageal ulcer
o Take in empty stomach in the morning,
HERNIATED
full glass of water
INTERVETERBRAL DISK
o Sit upright 30 mins after intake
• Nucleus of disk protrudes to annulus causing
o Given once a month
impediment of the nerve
• Prevent injury
• Nerve compression
• Exercise – isometric weight bearing
• Cervical disk herniation C5-C6, C6-C7. Mgt:
• AVOID bending, strenuous lifestyle
cervical traction
Note:
• Paresthesia, weakness UE (upper
• Osteopenia
extremities) Mgt: Cervical Traction
- lack of calcium on the bone
Management - Can lead to osteoporosis
• Bedrest, analgesics, avoid prone - Bones become brittle
Avoid:
• Cervical traction, collar, brace
- Smoking
LUMBAR DISK HERNIATION - Alcohol
• L4-L5, L5-S1 Lower back pain - Diet (caffeine, chocolate, cola)
• Pain to 1 hip down the leg (sciatica) QUESTION:
• Pain is radiated to the other leg
• Pain is aggravated by coughing, straining In Alendronate (Fosamax) the teaching plan is?
• best for herniation: MRI a. Crush it and mix with food
Nursing intervention b. Dissolve it under the tongue
c. Remain upright for 30 mins after
• Bedrest
swallowing
• Pelvic traction. Mgt: avoid gas-forming food d. Take it with 1 swallow of water

CALCITONIN o There is fever and everything is
painful for the patient.
• Good guy ● Joints commonly involved:
• Route: SQ, IM, Nasal spray (SIN) o Cervical
➢ PTH - resorption, tells the bone to release o Ankle
calcium o Temporomandibular Joint (TMJ)
➢ Calcitonin – it make the calcium to go to into o Elbow
the bone ● With deformity
● Raynaud’s phenomenon, autoimmune,
ARTHRITIS
systemic, bilateral
• Our goal is to relieve pain
OSTEOARTHRITIS QUESTION:
• wear and tear of joints Which diagnostic test should the nurse expect to
• The more you use, the more it hurts see ordered as screening tool for RA?
• Spur formation is seen on X-ray
• Obese patients a. ANA
• Most common form of degenerative joint b. CBC
disorder c. ESR - 2nd choice if wala sa exam
• Involvement is asymmetrical yung RF because it is an
• Multiarticular/polyarticular or weight bearing inflammatory marker
joints: cervical, lumbar, knee joints d. RF
Predisposing factors Diagnostic

• Joint trauma ● Rheumatoid factor – specific to RA
• Aging o blood exam
● X-ray – shows bony erosion
• Obesity
● Arthrocentesis – numerous WBC
Pathophysiology
MNEMONICS - (RAS)
• Prevent joint damage
● R - Rheumatoid nodule
• Injury
Raynaud’s Phenomenon
• Genetics Rheumatoid factor (blood exam)
• Advanced age ● A - Autoimmune
• Obese ● S - Systemic and bilateral (symmetrical)
Signs and symptoms Deformities of RA (BUS)

• Pain ● B - Boutonniere's deformity of the thumb
• Stiffness of joints – less than 30 minutes ● U - Ulnar deviation of metacarpophalangeal
• Heberden’s nodes – at distal joints
• Bouchard’s nodes – at proximal ● S - Swan-neck deformity of the fingers
• Bony hypertrophy
Management
Management ● Diet – high calorie
• Rest ● Joint movement – the more you rest, the
• Diet - low calorie, low protein more painful
• Exercise o The pain is reduced upon movement
• Weight reduction of the extremities.
• Topical analgesics ● COX-2 inhibitors
• Intra-articular steroids ● NSAIDS
• Paracetamol, NSAIDS o Number 1 treatment for RA
(celecoxib)
• Celecoxib (mga -coxib)
o Causes GI bleeding
o Do not give to elderly patients
RHEUMATOID ARTHRITIS
o Paracetamol - preferred for elderly
● Autoimmune joint disorder
● DMARDS (disease modifying antirheumatic
● Immunologic
drugs)
● Inflammatory arthritis – pain
o Gold salts
● Gender specific, common in girls
o Antimalarial
● Involves lean individuals
o Penicillamine
● Chronic, Connective Tissue Disease
o Sulfasalazine
● Systemic (fever)
● Methotrexate – current standard treatment

o Avoid in patients with megaloblastic • Colchicine – drug of choice for pain/
anemia Podagra
● Biologic response modifiers QUESTION:
o Etanercept
o Infliximab A nurse id providing nutritional consulting to a
● Steroids – for persistent erosive, client with diagnosis of gout. Which of the
inflammation client’s favorite food should she instruct him to
o Prednisone limit?
o Hydrocortisone
a. Blackberries
b. Tofu
Characteristic of a Chronic problem
c. Liver
● Remission and exacerbation
d. Tomatoes
● May time na magaling and may time na hindi.
Nursing interventions In an acute attack of gout: pain

➢ Gout is a metabolic Arthritis
● Splints to immobilize affected extremity
➢ OA- degenerative
● Cold packs – acute phase of pain
➢ RA- autoimmune
● Heat application – inflammation subsides
➢ OA and RA are polyarticular
● Alternate warm and cold
➢ Gout is monoarticular, involve is the big toe.
● High calorie diet - Kasi payat yung patient.
➢ Tophi- Uric deposition in the joint.
Sometimes this uric acid crystals can cause
QUESTION: renal stones or nephrolithiasis. This can
also be seen in the ears and elbows.
Which client is most at risk for developing RA?
QUESTION:
a. 25 year old woman
b. 40 year old man Which is allowed in the diet of a patient with
c. 65 year old woman gout?
d. 70 year old man
a. Sardines
PODAGRA
b. Cheese
● is gout which affects the joint located c. Liver
between the foot and the big toe, known as d. Beef
the metatarsophalangeal joint
● Pulang-pula/ red
Nursing management
● DO NOT ADMINISTER PYRAZINAMIDE
• Management of pain
GOUTY ARTHRITIS • Increase fluid intake – prevent stone
● Deposition of uric acid crystals in joint and formation
body tissues • Podagra- acute gout with erythema
● Common cause: Purine metabolism disorder • Avoid Pyrazinamide
● Metabolic • DIET (food to avoid) - Foods high in
● Monoarticular
● Common in the great toe QUESTION:
● TOPHI Which of the following drugs are used in the
acute attack of gout:
Causes
• Primary Cause: Purine metabolism d/o a. Probenecid
Rich in Purine food: b. Allopurinol
➢ Alcohol c. Colchicine
➢ Shellfish (Tahong) d. Methotrexate
➢ Organ meat (Atay, balon-balonan)
• Over secretion or under secretion of Uric PURINE
Acid o Alcohol, anchovies
• Goal is to reduce the pain because of the o Sardines, shellfish
inflammation o Organ meats
• Secondary: excessive uric acid in the blood
such as Leukemia, Anemia, Multiple Medical management
Myeloma, Psoriasis • Colchicine – used during acute attack to
• Tumor Lysis Syndrome- more production of inflammation and pain
uric acid • Indomethacin
• Multiple Myeloma- plasma proteins in • Corticosteroid
bones, nagkakaroon ng hypocalcemia,
fracture parin ang ending.

• Uricosuric: Probenecid – enhance • Sudden twisting motion

excretion of uric acid, it will not deal with the
pain Management
• Allopurinol – blocks formation of uric acid; • Emergency management: immobilization
new drug: Febuxo Stat (Lowers uric acid by of any suspected fracture
inhibiting xanthine oxidase, available in 40 • Immobilization through applying casts,
and 80mg tablet) tractions, or splints
• Febuxo stat is not for pain • Do not move the pt. unless the pt has
- SE of Allopurinal: rash, diarrhea, n/v external devices such as casts, tractions, or
splints that have been applied to the body of
Food to avoid: High in purine the injured or affected area.
➢ Alcohol, anchovies
➢ Sardines, shellfish Types
➢ Organ meats
Acute Gout – Avoid foods high in purine

Chronic – Limit only
Nursing management
➢ Encourage ideal body weight 1. Oblique – angle of the bone
➢ Pain management 2. Comminuted – fragments, bone have been
➢ Increase fluids divided to several parts
➢ Complications: Renal stones or 3. Spiral – twist around the shaft of the bone
nephrolithiasis 4. Compound – open fracture, there is a break
in the skin, risk of infection & tetanus
G- great toe 5. Incomplete – also known as green stick
O- avoid Organ Meat fracture
U- increased Uric Acid
T- Tophi (deposition of uric Acid) Sign and Symptoms
• Pain
QUESTION: • Loss of function
A client has been diagnosed with gout and wants • Obvious deformity
to know why colchicine is used in the treatment • Shortening, swelling – you cannot straighten
of gout. Which action of colchicine explains why the extremity because of the pain
it is effective for gout? • Crepitus – grating sound that you hear when
the bone rub each other
a. replaces estrogen
b. decreases infection Goal
c. decreases bone inflammation
• is to relieve pain use of analgesics
d. decreases bone demineralization
Diagnostic
• X-ray - commonly utilized, reveal of broken
Quick review:
bone or fragment that is involved
✓ Degenerative- OA
✓ Autoimmune- RA
Medical Management
✓ Metabolic- Gout
✓ Monoarticular- Gout • Goal of medical mgt: Reduction,
✓ Polyarticular- OA and RA immobilization, and restoration of function
With fever- RA • Reduction:
✓ Obese- OA o Open or closed imoblization
✓ Low calorie Diet- OA immobiliation restoration of fcunton
✓ High calorie Diet- RA
✓ TMJ- RA 1. Closed reduction – done through manual
✓ Gender specific-RA traction and manipulation under conscious
sedation for the bone to be aligned; OPD;
FRACTURE stretching of the extremity and is usually
• Break in the continuity of bone done by the surgeon
2. Open reduction – there is use of Internal
Causes Fixation Devices (IFD);
o Open Reduction Internal Fixation
• Direct blows
(ORIF) – done through surgery, with
• Extreme muscle contraction
use of IFD; use of internal fixation
• Crushing forces – vehicular accidents devices to align the bone; so that

there is a restoration of function of 4. Avascular necrosis – no blood supply,
extremities tissue will die cause blood carries oxygen;
▪ MRI is contraindicated – also called aseptic necrosis
because of metals, you 5. Heterotrophic ossification or myositis
have to ask the pt if they ossificans – Abnormal muscle or bone that
have any metal prosthesis grew in between fractured fragment results to
prior to MRI procedure; also delayed healing
claustrophobia
QUESTION
IMMOBILIZATION Which serious complications is most frequently
External immobilization devices seen with long bone fracture
a. Bone emboli
• Casts, tractions, splints
b. Fat emboli – respiratory failure most
• Casts – monitor for compartment syndrome common death in at emboli, as a result
(if cast is too tight) of the fat cells coming out from the
• Tractions - monitor 6Ps (neuromuscular fractured bone and may occlude in the
status) area of the lungs and will develop hypo
o Pain tachy tachy. Common in femoral and
o Paresthesia pelvis.
o Pallor c. Platelet emboli
o Pulseless d. Serous emboli
o Poikilothermia
o Paralysis COMPARTMENT SYNDROME
• Pathognomonic sign: pain aggravated by
Internal fixation devices – done through ORIF ROM
• Metallic pins, rods, screws, wires • Can be a Combination of 2 pressure -
internal and external
• Patient may develop infection, delayed
o Haemorrhage (internal)
healing process because of the presence of
o Too tight cast (external)
foreign body inside the anatomical
compartment • Treatment: Fasciotomy – opening of the
fascia to release/drain pressure
• Done through ORIF
• Monitor 6Ps
o Pain
FRACTURE COMPLICATIONS o Paresthesia
Early o Pallor
o Pulseless
1. Shock – hypovolemic shock
o Poikilothermia
• S/sx: Hypotension, Tachycardia,
o Paralysis
Tachypnoea (Hypo Tach Tach)
• Pain, deep, unrelieved pain by opioids
• Cold Clammy
• *HYPER BRA BRA - ICP QUESTION
2. Fat Embolism Syndrome – fat cells are Treatment of compartment syndrome includes
liberated from the yellow marrow and will which of the following?
travel to the lungs and occlude causing a. Amputation
dyspnea b. Casting
• Priority: airway – mechanical ventilation, c. Fasciotomy
endotracheal tube (ET) d. Observation, no tx needed
• S/sx: Hypotension, Tachycardia,
Tachypnoea and Petechial rashes on At the scene of an accident, which intervention
the chest applies to a client with suspected fracture
a. Don’t move the client
3. Infection
b. Move the client to safety immediately
4. Compartment syndrome – too tight cast c. Sit the client up to facilitate his airway
• Pathognomonic sign: pain aggravated d. Immobilize the extremity and move
by ROM the client to safety
5. DVT – Homan’s sign
• Danger: pulmonary embolism A client with right hip fracture is complaining of
left sided leg pain and edema and has a positive
Delayed complications Homan’s sign. Which condition would show
these symptoms
1. Delayed union – healing but not on the right
a. Deep vein thrombosis
time
b. Fat emboli
2. Malunion – healing but not in the correct c. Infection
position d. Pulmonary embolism
3. Non-union – no healing took place

Which nursing intervention is appropriate for NEUROLOGIC SYSTEM

client with traction? Divided into 2
a. Assess pin sites every shift and as • CNS – central nervous system
needed
▪ Brain – encephalitis
b. Add and remove weights as the clients
▪ Spinal cord – myelitis
wants
c. Make sure the knots in the rope catch on • PNS – peripheral nervous system
the pulley ▪ Autonomic nervous system
d. Give ROM to all joints ✓ Sympathetic – everything
goes up (ex. Tachycardia,
J a 14 yo chihld having dengue was reported to fight and flight, hypertension,
have a platelet count of 90,2000/mm3. Based on pupil dilatation, dry mouth)
this laboratory value, the nurse tells the client to ✓ Parasympathetic –
avoid doing which of the following everything goes down except
a. Eating any raw fruits and vegetables your secretions (ex.
b. Crowded places Hypotension, bradycardia,
c. Using a manual razor for shaving
sleep, salivation, pupil
d. Straining at bowl movement
constriction,
Which discharge instruction would be included bronchoconstriction)
in the care plan for Mt. X who had bladder ▪ Cranial nerves
cancer from Schistosoma haematobium ▪ Somatic nervous system
infection who is to undergo unsealed
brachytherapy? Lobes of the brain
a. Flush the toilet for 3x • Frontal – Memories, motor
b. Keep on bed rest – sealed • Parietal – Sensory
c. Report any radiation burns and do not
• Temporal – Hearing
apply lotion to the area - tele
d. Do not remove target marks on the skin • Occipital – Vision
and increase fluid intake
*stroke on the right side, deficit on the left side.
In reviewing the laboratory report of blood count
for a client who had COVID 19, which finding DIENCEPHALON
alerts the nurse to the possibility of fatigue? - Thalamus – relay center of the sensory,
a. The Hemoglobin is 9g/dl" dadaan lahat ng sensation sa thalamus
b. The total white blood cell count is - Hypothalamus
7000/mm o Sleep
c. The Prothrombin time is 11 seconds o Endocrine control
d. The platelet count is 42,000/mm3
o Emotional
A 43 yo female newly diagnosed with CAP o Temperature
moderate risk admitted at the medical ward, o Thirst
having
WBC of 2,800 mm/3, the nurse should include CEREBELLUM
which intervention in the plan of care? - Responsible for equilibrium or balance
a. Administering Acetaminophen if the - Assessment
temperature exceeds 37.8 - infection ▪ Heel-to-shin
b. Providing rest periods in between ▪ Finger-to-nose/Point-to-point test
activities – problem in RBC – hemoglobin ▪ Romberg’s test – test for balance
c. Inspecting the skin for petechiae every 8 - Diagnostic: CT scan & MRI
hrs – bleeding
d. Placing the client in strict isolation
BRAINSTEM
When planning health teaching program, the - Midbrain
nurse should take into account that, the risk for - Pons – cardiac acceleration center
Schistosoma infection are those who have - Medulla – respiratory center, controls our
a. Had intake of partially cooked crabs breathing
b. Had swimming on contaminated o Vomiting and coughing center
water - If the brainstem is dying it will lead to
c. Mosquito bite herniation → death
d. Had multiple bite from a dog - Due to compression of cranial nerves
CEREBRAL FUNCTION – mental status

- CN
- Motor function – muscle strength
- Sensory function – proprioception
- Reflexes

- Combination of sensory and motor
Glasgow coma scale (INSERT TABLE) - Mixed cranial nerve
• highest score = 15 - “Tri” because it has three divisions: Eyes
• lowest score = 3 (cornea), Face, Mandibular
• NO ZERO SCORE
• GCS scoring: Eye opening, Verbal CN 7 – Facial
response, Motor response - Anterior 2/3 of the tongue
• Eye opening highest score of 4 - Facial expression – ask the pt. to smile and
• Verbal response highest score of 5 frown
• Motor response highest score of 6 - Pag nasira ang CN 7 – Bell’s Palsy
• Assess cerebral function
CN8 – Vestibulo-cochlear
- Hearing acuity
- Audiometry
CN 9 – Glossopharyngeal
- Gag reflex
- Posterior 1/3 of the tongue
- Taste sensation
CN 10 – Vagus
- Bradycardia (Atropine)
CN 11 – Spinal accessory
- Ask the patient to shrug the shoulder
- Usually stroke patients
CN 12 – Hypoglossal
- Ask the patient to protrude the tongue
- If there is tongue deviation, can be a sign of
stroke
GRADING OF MOTOR FUNCTION

- Grading of your muscle strength
• DECORTICATE – motor score 3; arms, wrist - Highest is 5/5
finger FLEXION - Lowest 0/5
• DECEREBRATE – motor score 2; arms,
wrist EXTENSION Sensory
- Highest 100
*Decorticate and decerebrate are LATE SIGNS of - Close the eyes and ask the patient to localize
deterioration. the cotton
CRANIAL NERVES Reflexes
CN 1 – Olfactory
- Normal Babinski – negative
- 2 olfactory nerves
- Positive Babinski – abnormal; toe flexion,
- Smell and indicates corticospinal tract lesion
- Hyposmia – decreased sense of smell
- Anosmia – loss of smell QUESTION:
Glaucoma is conservatively managed with miotic
CN 2 – Optic eye drops. Mydriatic eye drops are
- Snellen’s chart is necessary to asses visual contraindicated for glaucoma. Which drug is a
acuity mydriatic:
CN 3, 4, 6 – Extraocular muscle movement e. Neostagmine

f. Atropine
- Tell patient to follow the movement of hand
g. Pilocarpine
w/o moving the head
h. Timolol
CN 5 – Trigeminal
- Corneal reflex (cotton wisp)
Diagnostics
- Sensation of face
- Mastication • EEG

o Withhold sedatives, stimulants
o No caffeine
o Meal not omitted
o Cannot cause electrical shock
• CT Scan
o If contrast medium is used, assess
allergies to seafood
o Consent
o Check the C – Creatinine
• MRI
o Magnetic waves
o Metals are not allowed
o Loud thumping sound, so patient can
have music
QUESTION:
Unethical after lumbar puncture:
a. Help client to maintain flexed position
b. Pressure dressing at the site
c. Maintaining bed rest
d. Monitoring client for headach

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LECTURE 10: MEDICAL SURGICAL NURSING

MEDICAL-SURGICAL NURSING ○ excess fluid collection (>20 mL) in

PERICARDIAL FLUID Medical Treatment

Management Mitral Low pitch Rumbling Diastolic

3. Pulsus paradoxus refers to a fall in systolic Diagnostics

● Decreased ejection fraction d. All of the above

● Roth spots ● SVT - Adenosine

Cardiac Conducting System QUESTIONS

CORONARY ARTERY DISEASE QUESTIONS

Reperfusion Treatment ANGINA

UNSTABLE ANGINA c. Pain in the calf or foot that occurs at rest

VARIANT/PRINZMETAL ANGINA Signs and symptoms

THROMBOPHLEBITIS/DVT baseline and

b. To visualize the disease process in the coronary

CARDIAC CATHETERIZATION  With severe hypertension or hypotension

 Bedrest 4-6 hours

2. Pulmonary Artery Pressure (Swan-Ganz) FIRST AID

Mnemonic: PLS  NEVER CUT THE SKIN- can cause infection

INSECT STINGS JELLYFISH

If stinger is still present- remove it:  Stridor- CHOKING OBSTRUCTION

In Hospital BLACK - Expectant

Triage The term given to category of triage that refers

TYPES OF DISASTER Defined as an ecological disruption or threat

The actual implementation of the disaster

Warning and public information on the

 Deep Partial Thickness o HYPERKALEMIA - PEAKED T

 Mechanical (daily dressings changes)

110 lb pt-50% TBSA burn

Formula: 2-4 ml/kg/%TBSA

2ml x 50 kg x 50 % TBSA = 5000 ml/24h

Plan to administer 1st 8 hours = 2,500 ml or 313

Next 16 hours = 2500 ml or 156ml/hr TYPES OF AORTIC DISSECTION

- Creates a false lumen; this makes this a

CLASSIFICATION OF AORTIC DISSECTION

 Type A – Ascending Aorta (Proximal

Problem: Elevated blood pressure

 Aortic trauma c. It is converted to bilirubin

 Emergent or Urgent Surgical Correction

1. A client with high output heart failure came in

SENSORY Nerves supply of eye

BATCH RUBY │INTENSIVE REVIEW│RTRMF │1

BATCH RUBY │INTENSIVE REVIEW│RTRMF │2

a. Assess blood glucose level

BATCH RUBY │INTENSIVE REVIEW│RTRMF │3

Implementation ✓ Use of eye shield at night to prevent from

QUESTION • Avoid activities that may Increased IOP

BATCH RUBY │INTENSIVE REVIEW│RTRMF │4

• Proper contact lenses care – to prevent

QUESTION CHEMICAL BURNS

BATCH RUBY │INTENSIVE REVIEW│RTRMF │5

CONDUCTIVE SENSORY NEURAL

BATCH RUBY │INTENSIVE REVIEW│RTRMF │6

RINNE’S TEST • Before the surgery, make sure the patient

BATCH RUBY │INTENSIVE REVIEW│RTRMF │7

Management • Swelling behind the ear (mastoid)

MASTOIDITIS a. Meniere’s disease

BATCH RUBY │INTENSIVE REVIEW│RTRMF │8

Treatment d. Facial paralysis