COMPETENCY APPRAISAL II

FINAL EXAMINATION
S.Y. 2014-2015

CHN, IMCI, COPAR

Community Health Nursing is a service rendered by a
professional nurse with communities, groups, families,
individuals at home, in health centers, in clinics, in schools,
in workplace for promotion of health, prevention of illness,
care of the sick at home and rehabilitation.
- Dr. Ruth B. Freeman

Act 3573 the Law on Reporting of Communicable
Diseases, enacted in 1929, mandated the reporting of
diseases listed in the law to the nearest health station.

Ultimate outcome of the Community Health Nurse
involvement in health program planning should be to:
Facilitating & encourage self-reliance

Case Management Process
1. Assess the child or young infant
2. Classify the Illness
3. Identify treatment
4. Treat the child
5. Counsel the mother
6. Give follow- up care

IMCI Main symptoms:
Cough of difficulty breathing
Diarrhea
Fever
Ear problem

Types of Diarrhea in IMCI:
1. Loose or watery stools diarrhea that causes
dehydration. An example of which is cholera which
constitute a small portion of the incidence.
2. Acute diarrhea is the diarrhea that lasts less than 14
days. This type of diarrhea causes dehydration that
contributes to the increasing mortality rate of children
and malnutrition.
3. Persistent diarrhea the diarrhea that lasts 14 days or
more. It is the primary diarrhea that causes nutritional
problems that contribute to deaths in children.
4. Dysentery diarrhea and blood in the stool with or
without mucus. Caused by Shigella bacteria.

Soothe the throat and relieve cough with Safe remedy:
Breastmilk for exclusively breastfed infant
Tamarind, Calamansi and Ginger

Harmful remedies to discourage:
Codeine cough syrup
Other cough syrup
Oral and nasal decongestant

COPAR Characteristics:
Continuous and sustained process.
Goal is community transformation or development.
Process of increasing awareness, facilitating
organization and initiating responsible action.
Never applicable to all communities.
Biased in favor of the poor and oppressed sectors of the
society.

Basic approach in Community Organizing: Primary
Health Care (Legal basis: LOI 949 signed by the former
president Ferdinand Marcos)

Criteria of Selection of Project Site
- Area is relatively economically depressed
- It must have a population of 100-200 families
- It must have a relative concentration of poor people
- There is not strong resistance from the community
- Peace and order problems must be seriously considered
- Local leaders and community are receptive and
supportive.
- COPAR is feasible for the elimination or reduction of
diseases.
- Area must have relatively high prevalence of diseases.
- Free from other similar agencies

MEDICAL SURGICAL NURSING

Prostate Specific Antigen Sensitive test but not specific
for prostate cancer. In the absence of prostate cancer, serum
PCA levels vary with age, race and prostate volume. A
number of conditions may cause high PSA levels like BPH,
Acute Urinary Retention and Acute Prostatitis.

Finasteride (Proscar) inhibit the conversion of
testosterone to DHT and cause the enlarged prostate to
shrink in size. Proscar may cause impotence, decrease
libido and decreased volume of ejaculate.

Terazocin (Hytrin) relieve obstruction and increase the
flow of urine. These medications can lead to Orthostatic
Hypotension.

BPH risk factors & causes:
Cause: Unknown
Risk factors: Age, Family history, race (highest in
African American and lowest in native Japanese), Diet
high in meat and fats.

Transurethral resection of the prostate (TURP)
Remains the benchmark for surgical treatment of BPH.
Surgical removal of the inner portion of the prostate
through an endoscope inserted through the urethra
No external skin incision is made.

Thromboangiitis Obliterans
An inflammatory disease of the small and medium
sized arteries and veins of the extremities.
Often seen and appears to be directly related to
smoking.

Varicose veins
Tortuous (twisted) distended veins occurring where
blood has pooled, often in the legs.
Seen as bulging distended veins with bluish streaks.
Treatment includes the following:
Vein stripping surgical stripping of affected vein.
Elevation of the legs to assist blood flow return to the
heart.
Avoidance of tight fitting clothes at the top of the legs
or waist it could restrict blood flow.
Walking and exercise to increase muscle strength and
contraction of the leg muscles to increase blood flow
return to the heart.
Elastic support hose for the lower legs to compress
the veins, assisting blood flow return to the heart.

Intermittent Claudation:
Causes pain due to the inability of the arterial system to
provide adequate blood flow.
Body increases the lactic acid production.

Types of Liver Cirrhosis
1. Postnecrotic (Macronodular) Cirrhosis is the most
common form worldwide and is associated with
Postacute viral (type B and C) hepatitis.
2. Billary Cirrhosis is characterized by Chronic stasis of
bile in intrahepatic ducts.
3. Cardiac Cirrhosis is associated with severe right sided
long term heart failure,
4. Alcoholic Cirrhosis is associated with alcohol abuse.

Sengstaken Blakemore Tube applies direct pressure
to ruptured esophageal varices. This stops bleeding.

Adrenal glands
Stimulated by the SNS secrete epinephrine during
stressful reactions.
Ensuing alarm reaction involves rapid adjustment of
the body to meet the emergency situations.

Cortisol blood test determination: 8 am, when cortisol
should be at its peak, and again at about 4 pm, when the
level should have dropped.

Addisons disease
Characterized by hyposecretion of adrenal cortex gland
hormones.
Manifestation: Hypoglycemia , Hyperkalemia and
Hyponatremia.

Hypoparathyroidism
Decrease in the normal amount of parathormone
secreted which leads to abnormally low blood calcium
levels.
Low blood calcium levels (hypocalcemia) causes
irritability to muscles called tetany.
Testing for hypocalcemia and hypoparathyroidism
involves the checking for Chvosteks (Tapping over
facial nerve causes facial muscle spasm) and
Trousseaus signs (Pressure to nerves and vessels of
upper arm causes muscle spasm).
Treatment: Calcium and Vitamin D (Controls
absorption of calcium from the Gastrointestinal tract).

Metformin (Glucophage) side & adverse effect:
Nephrotoxicity & Lactic Acidosis.

MS facts:
Thyroid medication needs to be taken lifetime
Regular insulin are taken typically 30 minutes pre-
meals.
Aspirin is contraindicated in patients with thyroid
storm because it blocks the binding of T3 and T4.
Early signs of hypoglycemia are lightheadedness,
lethargy/irritability, and sweating.
Stress and illness affects blood sugar by elevating it.
Pro-BNP indicates the severity of the heart failure.
U wave seen in patients with Hypokalemia. The
value of 3 meq/L is low (Potassium normal level: 3.5
to 5.0 meq/L).
Lanoxin nursing consideration: Take apical pulse for 1
full minute, noting rate, rhythm and quality before
administering. If pulse is below the 60 beats per
Minute withhold the dose.
Side effect of Nitrates (e.g. Nitroglycerin): Headache
& dizziness
Treatment for Supraventricular Tachycardia: Carotid
Massage & Adenosine.

(ECG of Supraventricular Tachycardia)
Warfarin therapy: Avoid Vitamin K rich foods e.g.
Green leafy vegetable.
Side effect of Capoten: Cough
Statins should be routinely checked for SGOT, SGPT.
Pacemaker batteries go for a long time and entails
surgical opening to change batteries.
Spinolactone (Aldactone) is a potassium sparing
diuretic. Its diuretic action is scant and it works to
retain potassium. It is very often used in combination
with more powerful diuretic.
Bleeding is a concern after Thrombolytic therapy (e.g.
Streptokinase)
Chemical cardioversion is giving medications to
convert an arrhythmia into a normal sinus rhythm.
The initial joules for defibrillation using a monophasic
machines are 200 joules and it is increased until it
reaches the maximum 360 joules.
An inflated ET cuff makes the patient unable to speak
since the vocal cords are impeded but in a busted ET
the balloon is not inflated well hence the patient can
speak and may even be able to shout.
An incentive spirometry will provide visual feedback
on the performance of the patient since it can measure
the effort being given by the patient. The patient is able
to achieve to of the pre-operative value of the
incentive spirometry post-operatively.
Set change and Re-insertion of the intravenous catheter
should be done after 3 days / 72 hours.
Keeping the client airway is a priority hence suctioning
should be as done as needed & necessary.
Providing extra oxygen prior to suctioning helps
prevent hypoxemia.
Aspiration Pneumonia happens when Aspiration of
stomach contents into the respiratory system. It is
evidenced by coughing, dyspnea, crackles or wheezes
on auscultation.
COPD patients are usually given O2 via Nasal cannula
at 2LPM.
An endotracheal (ET) or tracheostomy cuff provides a
closed system for mechanical ventilation allowing a
desired tidal volume to be delivered to the patients
lungs. The recommended cuff pressure is 20 to 25 cm
H2O.
Warm sitz bath is done for 20 minutes per session. This
is done to relieve pain and is used for patients who
were post rectal surgery, an episiotomy during
childbirth, painful hemorrhoids or vaginal
inflammation. This is best done after bowel movement.
When replacing tracheostomy ties and an assistant is
not available. Do not remove old tracheostomy ties
until new ones are secure.
Prior to extubation, the ABG of the patient should
near-normal if not normal.
During insertion of the urinary catheter, when the
patient complained of pain during the inflation of
balloon, the nurse should deflate the balloon
immediately and the catheter should be inserted further
because probably the balloon was inflated in the
urethra, thus causing severe pain.
Accdg. to Kozier, for an adult patient, the appropriate
suction pressure is 100-120 mmHg to avoid trauma
Condom catheter should be used especially for male
patients who are experiencing incontinence during bed
time for maximum comfort.
Central Venous Pressure (CVP) is an indicator of fluid
status and measures if you have fluid volume deficit or
excess.
Processed foods are rich in sodium.
Whenever there is a suspected medication error. An
incident report should be accomplished.
Food that contributes to Oxylate type of Renal Calculi
are: Rhubarb, beets, okra, spinach, Swiss chard, sweet
potatoes, nuts, tea, chocolate and soy products.
Dopamine at renal dose: 3 mcg/kg/min aimed to
increase renal perfusion in the patients with renal
failure.
Dialysis disequilibrium results from cerebral fluid
shifts. Signs and symptoms include headache, nausea
and vomiting, restlessness, decreased level of
consciousness, and seizures. It is more likely to occur
in acute renal failure or when blood urea nitrogen
levels are very high (exceeding 150 mg/dL).
Decreased bladder capacity is an geriatric specific
change that happens to the elderly.
If air embolism is suspected the dialysis must be
discontinued to prevent complication.
There is mucus production, overinflation of alveoli and
inflammation of the airway in COPD.
Pluerodesis Instillation of a sclerosing substance
into the pleural space in a thoracotomy tube.
Loss of alveoli elasticity is seen in COPD.
Oxygen in the athmosphere is about 21%.
Possible bleeding occurrence with Heparin therapy:
Hemoptysis, Hematuria, bleeding gums, eechymosis
2 Main actions of the Antibiotics:
a. Bacteriostatic inhibits the growth of bacteria
b. Bactericidal kills bacteria.
Amount X drop factor = drip rate
Duration in minutes
Allens test
a. Performed to assess the patients collateral blood
supply.
b. After Release pressure on the ulnar artery, Color
should return to the patients hand in 15 seconds. If
the color doesnt return, select another site for an
arterial puncture.

Ventricular Tachycardia

2 Types of Ventricular Tachycardia:
Sustained ventricular tachycardia = 30 seconds or more
of sustained Wide QRS complexes

Non-sustained ventricular tachycardia = Less than 30
seconds of Wide QRS complexes


Diabetes insipidus
Condition in which abnormally large volumes of dilute
urine are excreted as a result of deficient production of
vasopressin.

Holter Monitoring
Used for 24 hours to monitor the heart rhythm of the
client continuously.
Correlates the cardiac rhythm with activity.
Instructions:
Holter monitor should not get wet
A diary should be maintained.
Used to check the efficacy of anti-arrhythmic therapy.

Patient Instruction Exercise Stress test / Exercise
Electrocardiogram:
Patient is instructed not to eat, smoke or drink
beverages containing caffeine for several hours prior to
the test.
Certain drugs such as beta blockers, maybe held for 24
hours prior to the procedure
Patients are instructed to wear comfortable shoes.

Terbutaline Sulfate (Bricanyl)
Side effects causes side effects like nervousness,
tremors and light headedness.
Used to treat reversible airway obstruction caused by
asthma, bronchitis and emphysema.
Used to increase heart rate in patients with severe
bradycardia.

Example of Cardiovascular Agents:
1. Inderal Propanolol (beta blocker)
2. Isoptin Verapamil (calcium channel blocker)
3. Vasotec Enalapril (ACE inhibitor)
4. Dilatrend Carvedilol (beta blocker)

Hypertension symptoms:
Headache
Dizziness
Increased blood pressure
a. Systolic > 140 mmhg
b. Diastolic > 90 mmhg

Blood transfusion guidelines:
Platelet concentrates are transfused as fast drip,
Universal Recipient is AB and Universal Donor is O.
Rh negative and Rh positive in blood banking.

Fentanyl
Used for pain treatment and as adjuncts to Anesthesia.
Classified under Opioids. Opioids are drugs of choice
for moderate to severe pain that cannot be controlled
with other classes of analgesia.
Powerful CNS depressant and can cause sedation
which maybe either a therapeutic effect or a side effect.
Other adverse effects include respiratory depression,
nausea and vomiting.
Primary nursing consideration in administering opioids
is checking for the level of consciousness and
respiratory rate due to the known side effects.
It should not be administered for Respiratory Rate less
than 12 breaths per minute
Naloxone (Narcan) a narcotic antagonist should be
readily available to be administered if the Respiratory
Rate falls down below 10 breaths per minute.

Chest Tube a catheter inserted through the thorax to
remove air and fluids from pleural space to prevent air or
fluid from reentering the pleural space or to reestablish
normal intrapleural and intrapulmonic pressure.

Nursing Care:
o Clamping a chest tube is contraindicated when
ambulating or transporting the client. Clamping the
chest tube will possibly result in a tension
pneumothorax. Air pressure builds in the pleural space,
collapsing the lung and creating a life-threatening
event.
o Maintain the drainage device below the patients chest.
o If the tubings disconnects, instruct the client to exhale
as much as possible and to cough. This maneuver rids
the pleural space of as much air as possible.
o Check tubings for kinks, dependent loops or clots is
essential because it maintains a patent freely draining
system, preventing fluid accumulation in chest cavity.
Drainage remaining in the tubings increases the
clients risk for infection, atelectasis and tension
pneumothorax.
o Positioning: Semi-fowlers to evacuate air
(pneumothorax) and High-Fowlers position to drain
fluid (hemothorax, effusion). This permits optimal
drainage of fluid and / or air.

Procedure for 24 hour urine collection:
Issue proper container
Day 1: 7AM, Patient voids and discards specimen;
collects all urine for the next 24 hours.
Day 2: 7AM, Patient voids and adds this urine to
previously collected urine.
Submit to laboratory.

Fecal Impaction:
Passage of liquid or semi-liquid stools results from
seepage of unformed bowel contents around the
impacted stool in the rectum.
Clients with fecal impaction don't pass hard, brown,
formed stools because the feces can't move past the
impaction.
Cients typically report the urge to defecate (although
they can't pass stool) and a decreased appetite.
Clinical manifestations: Liquid portion of feces located
higher in the colon seeps around the impacted mass.
Loss of appetite, Anorexia, Rectal pain, Nausea and
Vomiting, Abdominal distention and cramping and
Inability to pass a stool for several days despite the
repeated urge to defacate.

CPAP:
Stands for Continuous Positive Airway Pressure.
Principal action: Use of ir pressure whichwill prevent
airway collapse.

Open ended question to get broad information
Close ended question to get direct answers

Omega 3 rich foods
Include Salmon, Tuna and Sardines.
Lowers triglycerides and increases HDL cholesterol
levels.

Types of medication order:
Standing Order - May be an ongoing order or maybe
given for a specific number of doses or days.
PRN / As needed medication - Given at the clients
request and nurses judgment
Stat - Given once, immediately.
One time or single order - Given once and usually at a
specific time

Fecal Occult Blood Test (Guaiac Stool exam)
High fiber diet for 48 to 72 hours.
Meat free diet for 24 to 48 hours (Meat, Poultry, Fish).
False positive: Meat intake and selected vegetables.
False negative: Ascorbic acid.
Pre-op Colon resection
- Target: No fecal matter
- 3 days prep
- Diet: Low residue (to prevent fecal matter production /
accumulation) then liquid then NPO.
- Management: Laxative or Castor oil.
- Target: Bacterial flora is decreased.

Funnel chest Depression in the lower portion of the
sternum.

Pigeon chest Sternum is displaced anteriorly, increasing
the anteroposterior diameter.

Barrel chest increased anteroposterior diameter and is
associated with COPD.