Medical Surgical Nursing Bullets
QUESTIONS
CARE OF THE ELDERLY
What are the physiologic changes in elderly?
What are the common psychosocial concerns?
What are the common mental health concerns?
What are the common physiologic and
psychosocial needs of the elderly?
ANSWER/S
Integumentary- loss of pigment, wrinkling
Neurologic- slowed reflexes, loss of balance,
short term memory decline
Musculoskeletal- decrease muscle mass,
strength, atrophy of muscle, mobility, ROM,
flexibility, coordination, gait
Cardiovascular- diminished energy and
endurance, with lower tolerance to stress
Respiratory- decreased stretch and compliance
of the chest wall
Hematologic- Hgb and Hct level towards the
low end of normal
Immune- tendency of lymphocytes to be low
Gastrointestinal- decreased need for calorie
because of low BMR
Endocrine- decreased secretion of hormones
Renal- decreased kidney size, function and
ability to concentrate urine
Reproductive- decreased testosterone and size
of testes, vaginal changes
Special senses- decreased visual, hearing,
touch
Adjustment to deterioration in physical and
mental health
Threat to independent functioning
Adjustment to retirement
Loss of skills
Coping with changes
Diminished quantity and quality of
relationships
Dependence
Access to social support system
Cost of health care and medication
Depression
Grief
Isolation
Suicide
Communication- use normal tone
Promoting independence
Promoting hygiene and skin care
Care of visual aids and denture
 Promotion of exercise and good body
alignment
Regulation of body temp
Promotion of sleep pattern
Provision of nutritional needs- increase fiber
and fluids
Promotion of urinary elimination- establishes
pattern
Sexuality- still capable of sexual arousal and
orgasm
Provision of emotional needs- needs someone
to talk to
What are the common physiologic changes in Altered memory
elderly that influences medication Less vision acuity
administration? Decrease in renal function
Decrease GI function
Decrease liver function
Decrease organ sensitivity
Altered quality of organ responsiveness
Common problems among elderly? Confusion/dementia
Osteoporosis
Postural hypotension
High blood pressure
Types of elder abuse? Psychologic
Physical
Financial
Neglect
Infringement of personal rights
Sexual
DIAGNOSTIC AND LABORATORY TESTS
What are the diagnostic/laboratory tests for Skin test: mantoux test
respiratory system? CXR
Chest fluoroscopy
Bronchography
Bronchoscopy
Lunn scans
Sputum exam
Lung biopsy
Lymph node biopsy
PFT/S
ABG
Thoracentesis
What are the diagnostic/laboratory tests for CBC
Cardiovascular and hematologic system? ESR
Blood coagulation tests
BUN
 Blood lipids
Blood cultures
Enzyme studies
Urinalysis
Blood uric acid
Serologic tests
Serum electrolytes
ECG/EKG
Holter monitoring
Intensive hemodynamic monitoring
PAP and PCWP
Sonic studies
Stress testing or exercise testing
Radiologic tests
MRI
Myocardial scintigraphy
Noninvasive hemodynamic monitoring
Limb blood pressure
Doppler ultrasonography
Ultrasonic duplex scanning
CT scan
Plethysmography
Venography
Vascular endoscopy
What are the diagnostic/laboratory tests for GI CEA
system? D-xylose absorption test
Exfoliative cytology
Fecal analysis
Gastric analysis
Berstein test
Radiographic tests
Endoscopy
Colonoscopy
Ultrasonography of the abdomen
MRI of the abdomen
What are the diagnostic/laboratory tests for Fat metabolism indicator
hepatobiliary and pancreatic system? Protein metabolism indicator
Serum enzymes
Biopsy of the liver
Paracentesis
ERCP
What are the diagnostic/laboratory tests for Pancreas:
endocrine system? FBS
2 Hr PPBS
OGTT
Glycosolate Hgb
 Thyroid:
T3 T4 levels
RAUI
Thyroid scan
Fine needle biopsy
BMR
Kinemometry

Adrenal medulla:
VMA test
Total plasma catecholamine Concentration
Clonidine Suppression Test
CT scan, MRI, Ultrasound
What are the diagnostic/laboratory tests for GU Routine Urinalysis
system? Creatinine clearance
Blood studies
Cystoscopy
KUB
IVP
RPG
Voiding Cystourethogram
Cystometrogram
Renal Arteriogram
Ultrasound of Kidneys, Ureters and Bladder
Renal Biopsy
What are the diagnostic/laboratory tests for Skull films
nervous system? Spine films
CAT scan
EEG
Electromyelography and nerve conduction
velocity
Brain scan
Cerebral angiography
Lumbar tap
Myelography
MRI
Pneumoencephalography
Ventriculography
PET scan
Evoked potentials (auditory, visual)
What are the diagnostic/laboratory tests for Blood tests
Musculoskeletal system? X-rays
Bone scans
Arthroscopy
Arthrocentesis
 Arthrography
Myelography
EMG
What are the diagnostic/laboratory tests for Eyes:
Eyes and Ear? Snellens Chart Test
Ishihara Plate
Retinoscopy
Cover-Uncover test
Tonometry
Gonioscopy
Perimetry
Bjerrum Tangent Screen
Opthalmoscopy
Slit Lamp Biomicroscopy

Ears:
Rinnes test
Webers test
Whisper voice test
Audiometry
Tympanogram or impedance audiometry
Oculovestibular test or caloric test
INFECTION CONTROL
Known as clean technique Medical asepsis
Procedures used to reduce and prevent the
spread of microorganisms
Examples of medical asepsis hand
hygiene; using clean gloves to prevent
contact with blood and body fluids; and
routine environmental cleaning.
Procedures used to eliminate all Surgical asepsis
microorganisms including pathogens and
spores from an object or area
An area or object is considered
contaminated if touched by any object that
is not sterile
Commonly performed in the operating
room, labor and delivery, and major
diagnostic areas, and can be used at clients
bedside
What are the types of infection? Colonization
Local
Systemic
Acute
Chronic
Hospital Associated infection? Nosocomial Infections
In order for an infection to develop all of
these factors must be present:
Bodys Normal Defenses Against Infection
Signs & Symptoms of Infection
Lab Tests to Screen for Infection
Infectious agent - microorganisms
including bacteria, viruses, fungi, and
protozoa
Reservoir or source - a place where the
pathogen can survive but may or may not
multiply
Portal of exit - after multiplying the
pathogen needs a place to exit the body and
enter the host & cause disease
Mode of Transmission transmission of
organisms from the reservoir to the host
Portal of entry organisms can enter the
body by the same routes used for existing
Susceptible Host based the clients
susceptibility to an infectious agent
Non Specific Defenses
-Intact skin and mucus membranes
Body defense systems
-Normal body flora internal and external
-Inflammatory response
Specific Body Defenses
-Antibody mediated defense
-Cell-mediated defense
Systemic:
Generalized symptoms
Fever
Increased Pulse and Respirations if fever
Malaise and loss of energy
Lymphadenopathy
Nausea & vomiting and anorexia
Sedimentation rate or ESR up to
15mm/hr for men and 20 mm/hr for
women.
WBC count- 4,500 -11,000/mL
Neutrophils 55%-70%
Lymphocytes 20-40%
Monocytes 2% - 8%
Eosinophils 1%-4%
Basophils 0 2%
Blood and Urine cultures normally sterile
no microorganisms.
Wound, sputum, and throat cultures No
WBC.
 Stages of Infection Incubation
Prodromal
Illness
Convalescence
What Factors Increase Susceptibility to Age
Infection? Heredity
Stressors
Nutritional Status
Medical Therapies
Medications
Diseases
Process that eliminates many or all Disinfection
microorganisms; except for bacterial spores
from inanimate objects
What are the examples of disinfectants? Alcohols, chlorines, and phenols
Chemicals can be caustic and toxic to
tissues
The complete elimination or destruction of Sterilization
all microorganisms, including spores
Examples of sterilizing agents: Steam under pressure; ethylene oxide gas
(ETO); hydrogen peroxide plasma; and
chemicals
INFLAMMATORY RESPONSE Vascular and Cellular
Hyperemia Heat
Edema
Pain
Impaired function

Second Stage
Exudate Production
Fluid
Fibrinogen
Thromboplastin
Platelets

Third Stage
Reparative Stage
Regeneration
Cicatrix
Events in Inflammatory Response Vascular and cellular responses

Formation of inflammatory exudates

Tissue repair
CARE OF CLIENTS WITH RESPIRATORY
DISORDERS
 What causes acute bronchitis?
What is the treatment for acute
bronchits?
It is a highly contagious infection of the Pertussis
lower respiratory tract with a gram-
negative bacillus, Bordella Pertussis
What are the symptoms of pertussis
What is an acute inflammation of the
lung parenchyma (alveoli) that is
mostly caused by a microorganism?
What are the types of pneumonia?
What is the critera for HAP?
What is the criterion for VAP?
What is a cause of pneumonia for
individuals with HIV?
What are the clinical manifestations of
pneumonia
What is the route and dosage of
tuberculin test (PPD)?
after how many hours would it be
interpreted?
What will chest x-ray show for TB?
Usually occurs during or after a viral infection
(influenza).
Supportive, fluids, rest, and antiinflammatory
agents.
Cough suppresants or bronchodilators for
nocturnal cough or wheezing.
Antiviral drugs initiated within 48 hours of the
onset of symptoms
Whooping cough.
More frequent at night.
Cough may last for 6 to 8 weeks.
Pneumonia
CAP, HAP (VAP and HCAP), aspiration and
opportunistic.
Hospital Acquired Pneumonia-Pneumonia
occurring 48 hours or longer after hospital
admission and not incubating at the time of
hospitalization
Ventilator Acquired Pneumonia-Pneumonia
that occurs more than 48 hours after
endotracheal intubation.
Pneumocystis jiroveci (PCP)
Sudden onset of fever,shaking, chills, SOB,
cough productive of purulent sputum (may be
rust colored), and pleuritic chest pain.
0.1 intradermal
48-72 hours rechecked for induration
Test positive should not be tested again.
Upper lobe infiltrate, cavitary infiltrates, and
lymph node involvement.
 It is a high-pitched, short popping Fine crackles
sounds heard during inspiration, caused
by sticking alveoli
it is a low pitched, bubbling, most Coarse crackles
sound
it is a musical, high pitched sound Wheeze (sibilant)
caused by constricted airway, common
with asthma
it is a low pitched snoring or moaning, Rhonchi
caused by constriction of large airway
It is a harsh respiratory honking sounds, Stridor
found in children, due to constriction of
trachea/larynx
What is the difference between Atelectasis: collapse lung due to interference
Atelectasis and Pneumothorax? with natural force for expansion
Pneumothorax: collapse lung do to air/gas in
inter-pleural space
it refers to the destruction of tissue Emphysema
around alveoli, caused decreased
resonance
Where is the sternal angle? where the second rib attaches
Where do you auscultate the right 4th and 5th intercostal space
middle lobe?
The purpose of this procedure is to reexpand Chest tube
the lungs by draining air, blood, pus or water
from the pleural space
CARE OF CLIENTS WITH
CARDIOVASCULAR DISORDERS
At what stage of hypertension is Hypertension, Stage 1
medication prescribed?

Thiazides tend to _______ potassium, retain

although not as much as other K+
diuretics.

Why are loop diuretics given in the So the pt will not pee at night and increase
morning? their risk for fall

If you give furosemide (Lasix) IV push, over 2 minutes, slow

it must be pushed over ____ minutes. If Ototoxicity (deafness, ear damage, tinnitus)
you don't do this, what could happen?

Identify the normal action of calcium Calcium goes to heart and causes contraction,
within the heart. which raises HR
Identify the normal action of calcium in Calcium causes contraction, which raises BP
 the peripheral arterioles
ACE inhibitors tend to increase what Potassium
electrolyte?
Identify where the following beta Beta 1 - heart
receptors are commonly found.
Beta 2 - lungs
Beta 1 - Tip: 1 heart for Beta 1, 2 lungs for Beta 2

Beta 2 -

What is the normal physiology of beta Increase heart rate, increase contraction of
1 receptors? heart

Identify the normal physiology of beta Bronchodilation, causes airway to open so

2 receptors. person breathes better

What zone of MI indicates the

following: Injury- elevated ST segment
injury Ischemia- inverted T wave
ischemia Infarction- bizarre Q wave
infarction
What beta blocker only works on beta 1 Cardioselective
receptors
What are the adverse effect(s) of Headache (common), orthostatic
nitroglycerin? hypotension, tachycardia

What is the nursing action if the patient put patch on thigh.

experiences headache after
nitroglycerine administration?
Is hardening of arteries. It affects the tunica Arteriosclerosis
media.
Is narrowing/occlusion of lumen of arteries due Atherosclerosis
to accumulation of fatty plaques in the tunica
intima.
Is localized, irreversible dilation of an artery Aneurysm
due to an alteration in the integrity of its wall?
The different types of aneurism are as follows: The different types of aneurism are as follows:
Fusiform aneurism. Fusiform aneurism. Both sides of the arterial
Saccular aneurism. wall are dilated.
Dissecting aneurism. Saccular aneurism. One side of the arterial wall
is dilated
Dissecting aneurism. There is separation
between the tunica media and tunica
Is intermittent vasospasm of arteries in the Raynaulds Disease
digits as a result of exposure to cold and
emotional stress. It is aggravated by cigarette
smoking.
It is venous thrombosis and inflammation in a Superficial Thrombophlebitis (SVT)
superficial vein.
It is venous thrombosis and inflammation in a Deep Vein Thrombosis (DVT)
deep vein
Virchows triad: Virchows triad:
Vessel wall injury (e.g., cigarette smoking)
Venous stasis (e.g., prolonged bedrest)
Hypercoagulability of the blood (e.g. use of
contraceptive pills, dehydration,
hyperglycemia)
Dilated veins, usually in the lower extremities. Varicose Veins
It is diffuse inflammation of the small and Buergers Disease (Thromboangitis Obliterans)
medium arteries, followed by the veins. It is
also involves inflammation and fibrosis of
nerves.
Synchronous application of an electrical shock Cardioversion- synchronous application of an
of short duration to the heart through the use of electrical shock of short duration to the heart
chest paddles. through the use of chest paddles.
unsynchronized passing of an electric shock of Defibrillation- unsynchronized passing of an
short duration through the heart to terminate electric shock of short duration through the
ventricular fibrillation or ventricular heart to terminate ventricular fibrillation or
tachycardia without pulse ventricular tachycardia without pulse
Inflammation of the pericardium which occurs Pericarditis/ Dresslers Syndrome
approximately 1 to 6 weeks after acute MI Inflammation of the pericardium which occurs
approximately 1 to 6 weeks after acute MI
a state of circulatory congestion produced by Congestive Heart Failure
myocardial dysfunction a state of circulatory congestion produced by
myocardial dysfunction
Characterized by random and chaotic discharge Ventricular Fibrillation
of impulses within the ventricle at rates that - Characterized by random and chaotic
exceed 300 beats per minute. It is an discharge of impulses within the
EMERGENCY. ventricle at rates that exceed 300 beats
per minute. It is an EMERGENCY.

CARE OF CLIENTS WITH PERIPHERAL

VASCULAR DISORDERS
Effects of PVDs in Extremities: Pain, burning and stinging
Cramping and numbness
Intolerance to local heat and cold
Inability to sense temperature changes
Decrease touch sensations
Edema
Color changes (rubor/ redness, pallor,
cyanosis)
 Lesions
Poor Healing
The three layers of the arteries are 1. Tunica Intima. The inner layer of
endothelium.
2. Tunica Media. The middle layer of the
connective tissues, smooth muscles, or
elastic fibers.
3. Tunica Adventitia. The outer layer of
connective tissues.
are thin-walled vessels which transport veins
deoxygenated blood from the capillaries back
to the right heart.
thick-walled vessels which transport oxygen Arteries
and blood via the aorta from the heart to the
tissues.
thin-walled vessels located in the tissues. capillaries
Is an abnormal elevation of BP; systolic Hypertension
pressure above 140 mm Hg and or diastolic
pressure above 90 mmHg for atleast two
readings.
is hardening of arteries. It affects the tunica Arteriosclerosis
media.
is narrowing/occlusion of lumen of arteries due Atherosclerosis
to accumulation of fatty plaques in the tunica
intima.
Is localized, irreversible dilation of an artery Aneurysm
due to an alteration in the integrity of its wall.
The different types of aneurism are as follows: The different types of aneurism are as follows:
Fusiform aneurism. Fusiform aneurism. Both sides of the arterial
Saccular aneurism. wall are dilated.
Dissecting aneurism. Saccular aneurism. One side of the arterial wall
is dilated
Dissecting aneurism. There is separation
between the tunica media and tunica
Is intermittent vasospasm of arteries in the Raynaulds Disease
digits as a result of exposure to cold and
emotional stress. It is aggravated by cigarette
smoking.
It is venous thrombosis and inflammation in a Superficial Thrombophlebitis (SVT)
superficial vein.
It is venous thrombosis and inflammation in a Deep Vein Thrombosis (DVT)
deep vein
Virchows triad: Virchows triad:
Vessel wall injury (e.g., cigarette smoking)
Venous stasis (e.g., prolonged bedrest)
Hypercoagulability of the blood (e.g. use of
 contraceptive pills, dehydration,
hyperglycemia)
Dilated veins, usually in the lower extremities. Varicose Veins
It is diffuse inflammation of the small and Buergers Disease (Thromboangitis Obliterans)
medium arteries, followed by the veins. It is
also involves inflammation and fibrosis of
nerves.
Arterial Disorders Venous Disorders
Pain: Intermittent claudication Homans pain
Aggravated by walking and elevation Improved by exercise and elevation of legs.
of legs
Thin, shiny skin in the legs Brown pigments around ankle
Loss of hair in the legs
Thick toenails Normal toenails
Pale skin on elevation of legs. Redness of skin on dependency
Skin is cool to touch Skin is warm to touch (thrombophlebitis)
Decreased sensation, numbness, Itching
paresthesia, itching
Pulse is diminished or absent Pulse is present
Edema is absent Edema is present, worse at the end of day;
improved with elevation
Ulcers occur in toes Ulcers occur in ankles
Gangrene may develop Gangrene does not develop
CARE OF CLIENTS WITH BLOOD
DISORDERS
The site of hematopoiesis, or blood cell bone marrow
formation
Have the ability to self-replicate, thereby stem cells
ensuring a continuous supply of cells
throughout the life cycle. These cells are
committed to produce specific types of blood
cell.
Composed of special tissue macrophages, RETICULOENDOTHELIAL SYSTEM
which are derived from monocytes
Lymphoid stem cells produce either T or B lymphocytes
Myeloid stem cells differentiate into three broad cell types: RBCs, WBCs, and
platelets
an abnormally low amount of circulating Anemia
RBCs, Hgb concentration, or both
Anemias are due to: Blood loss.
Inadequate RBC production
(hypoproliferative).
Increased RBC destruction
(hemolytic).
Deficiency of necessary
 components such as folic acid, iron,
and/or vitamin B12.
A condition in which the hemoglobin IRON- DEFICIENCY ANEMIA
concentration is lower than normal
Results when the dietary intake of iron is
inadequate to produce hemoglobin
A condition characterized by decreased APLASTIC ANEMIA
number of RBC as well as WBC and platelets
Anemias characterized by abnormally large MEGALOBLASTIC ANEMIAS
RBC secondary to impaired DNA synthesis
due to deficiency of Folic acid and/or vitamin
B12
Due to the absence of intrinsic factor secreted PERNICIOUS ANEMIA
by the parietal cells
Intrinsic factor binds with Vit. B12 to promote
absorption
A severe chronic incurable hemolytic anemia SICKLE CELL
that results from heritance of the sickle
hemoglobin gene.
Refers to an INCREASE volume of RBCs POLYCYTHEMIA
Malignant disorders of blood forming cells LEUKEMIA
characterized by UNCONTROLLED
proliferation of WHITE BLOOD CELLS in
the bone marrow- replacing marrow elements .
The WBC can also proliferate in the liver,
spleen and lymph nodes.
A coagulopathy that is an autoimmune disorder IDIOPATHIC THROMBOCYTOPENIC
in which the life span of platelets is decreased PURPURA (ITP)
by antiplatelet antibodies. This can result in
severe hemorrhage following a cesarean birth
or lacerations
CARE OF CLIENTS WITH
GASTROINTESTINAL DISORDERS
Contains the amylase enzyme (ptyalin) that Saliva
aids in digestion.
Collapsible muscular tube about 10 inches Esophagus
long, Carries food from the pharynx to the
stomach
Kills microorganisms, breaks food into small Hydrochloric acid
particles, and provides a chemical environment
that facilitates gastric enzyme activation.
Is necessary for the absorption of vitamin B12. Intrinsic factor
reduces maltose to monosaccharide glucose Maltase
Activates trypsinogen to trypsin. Enterokinase
Lines the abdominal cavity and forms the Peritoneum
mesentery that supports the intestines and
blood supply
Backward flow of gastric or duodenal contents
into the esophagus
Dietary and Lifestyle Management for GERD
Types of Hernia:
gastroesophageal junction and fundus of
stomach slide through the esophageal hiatus
the gastroesophageal junction is in normal
place but part of the stomach herniates through
the esophageal hiatus; hernia can become
strangulated; client may develop gastritis with
bleeding
characterized by impaired peristalsis of smooth
muscle of esophagus and impaired relaxation
of lower esophageal sphincter
inflammation of stomach lining from irritation
of gastric mucosa which is normally protected
from gastric acid and enzymes by mucosal
barrier
excavation or ulceration that penetrates the
mucosal wall of the GI tract
Types:
a. Duodenal ulcers:
b. Gastric ulcers:
c. Zollinger- Ellison syndrome:
GASTROESOPHAGEAL REFLUX
DISEASE (GERD)
> elimination of acid foods
> avoiding food which relax esophageal
sphincter or delay gastric emptying
> maintain ideal body weight
> eat small meals and stay upright for
> elevate the head of bed
> no smoking
> avoid bending and wear loose fitting clothing
Sliding Hiatal Hernia: gastroesophageal
junction and fundus of stomach slide through
the esophageal hiatus
Paraesophageal hiatal hernia: the
gastroesophageal junction is in normal place
but part of the stomach herniates through the
esophageal hiatus; hernia can become
strangulated; client may develop gastritis with
bleeding
Achalasia
GASTRITIS
PEPTIC ULCER DISEASE (PUD)
Types:
a. Duodenal ulcers: most common; affect
mostly males ages 30 to 55; ulcers found near
pylorus
b. Gastric ulcers: affect older persons; found on
lesser curvature and associated with increased
incidence of gastric cancer
c. Zollinger- Ellison syndrome:
> peptic ulcer disease caused by
gastrinoma
> excess gastric acid leads to
ulceration and often bleeding and perforation

functional disorder of motility characterized by
abdominal pain, constipation and/or diarrhea
inflammation of peritoneum, lining that covers
wall (parietal peritoneum) and organs (visceral
peritoneum) of abdominal cavity
includes two separate but closely related
conditions: ulcerative colitis and Crohns
disease; both have similar geographic
distribution and genetic component
Types:
a. Ulcerative colitis
b. Crohns disease
condition on which intestinal mucosa
ineffectively absorbs nutrients, resulting in
excretion of nutrients in stool
chronic malabsorption disorder due to
sensitivity to gluten, protein found in barley,
rye, oats, wheat; commonly affects Caucasians
of European descent
occurs in tropical climates; cause unknown;
> excess hydrochloric acid
production also leads to diarrhea and
steatorrhea
IRRITABLE BOWEL SYNDROME (IBS)
(Spastic Bowel, Functional Colitis)
PERITONITIS
INFLAMMATORY BOWEL DISEASE
Types:
a. Ulcerative colitis
> inflammatory process usually
confined to rectum and sigmoid colon
> inflammation leads to mucosal
hemorrhages and abscess formation, which
leads to necrosis and sloughing of bowel
mucosa
> mucosa becomes red, friable, and
ulcerated; bleeding is common
> chronic inflammation leads to
atrophy, narrowing, and shortening of colon
b. Crohns disease
> can affect any portion of GIT, but
terminal ileum and ascending colon are more
commonly involved
> inflammatory aphthoid lesion of
mucosa and submucosa develops into ulcers
and fissures that involve entire bowel wall
> fibrotic changes occur leading to
local obstruction, abscess formation and
fistula formation
> fistula develops between loops of
bowel; bowel and bladder; bowel and skin
> absorption problem develops
MALABSORPTION SYNDROME
Celiac Disease (nontropical sprue)
Tropical Sprue
pathological changes similar to celiac disease
but not affected by gluten
condition involving malnutrition in clients who Short Bowel Syndrome
have had surgical resection of significant
portions of the small intestine
defect in abdominal wall that allows abdominal HERNIA
contents to protrude out of abdominal cavity
Types:
a. Reducible hernia
b. Incarcerated hernia
c. Strangulated hernia
varicose veins, varices, or varicosities of veins
in anus, anal canal region
Types:
a.
affect venous plexus above mucocutaneous
junction of anus
b.
affect venous plexus below the mucocutaneous
junction
CARE OF CLIENTS WITH HEPATO
BILIARY AND PANCREATIC DISORDERS
Removal of ascitic fluid from
peritoneal cavity
Excess fat in stools
enlargement of liver
Stage of hepatitis marked by jaundice,
light or clay colored stools, dark urine,
and pruritis
Stage of hepatitis marked by malaise,
severe headache, R. upper quadraant
Types:
a. Reducible hernia
> abdominal contents protrude
through abdominal wall to form a sac covered
by skin and subcutaneous tissues
> contents move into a sac when
intra-abdominal pressure increases
> contents return inside when
pressure returns to normal or when manual
pressure applied
b. Incarcerated hernia: contents of
hernia cannot be returned to abdominal cavity
c. Strangulated hernia: blood supply to
bowel contents in hernia is compromised
leading to necrosis; if left untreated, it can
result in perforation and peritonitis
HEMORRHOIDS (Piles)
Types:
a. Internal hemorrhoids affect venous
plexus above mucocutaneous junction of anus
b. External hemorrhoids affect venous
plexus below the mucocutaneous junction
Paracentesis
Steatorrhea
enlargement of liver
Icterus
Preicterus
 pain, anorexia, nausea, vomiting, fever,
arthralgia, rash, enlarged lymph nodes,
uticaria, enlargement and tenderness of
liver
Stage of hepatitis marked by fatigue, Posticterus
malaise, liver enlargement,
Golden yellow color of skin, mucous Jaundice
membranes, and sclera of the eye
Chronic, progressive Liver disease Cirrhosis
Enlargement of breast tissue in males Gynecomastia
Surgical removal of gallbladder Cholecystectomy
Obstruction of common bile duct Choledocholithiasis
Presence of gallstones Cholelithiasis
Accumulation of excess fluid in the Ascites
peritoneal cavity
Removal of ascitic fluid from the Paracentesis
peritoneal cavity
Product of normal breakdown of old Bilirubin
red blood cells in the liver
Delivers blood from the intestines to Portal vein
the liver
Ingest old red blood cells & bacteria Kupffer cells
Stores bile from liver and releases it Gallbladder
into duonedum
Delivers blood from aorta to the liver Hepatic artery
Connect pancreas to the duonenum Pancreatic duct
Formed by the hepatic duct and cystic Common bile duct
duct joining
Large organ responsible for metabolism Liver
of glucose, protein,and lipids. Also
responsible for detoxification,
Production of antibodies&
metabolizing adrenocortical hormones,
estrogen, testosterone and aldosterone
Passage that delivers bile produced in Cystic duct
liver to the gallbladder
Removal of a small specimen of liver Liver Biopsy
tissue for study
Complication of liver biopsy if the lung Pneumothorax
is accidentally punctured during the
procedure
The use of sound waves to produce an Ultrasonography
image of an internal organ
A radioactive substance is injected into Liver scan
 a vein, and visualized in a radiograph to
reveal tumors or abscesses
Complication of liver biopsy, because Hemorrhage
of the rich blood supply and potential
for impaired coagulation
Infectious hepatitis, caused by HAV & Hepatitis A
transmitted through water, food or
medical equipment that has been
contaminated with infected fecal matter
Unknown cause, but may be from Noninfectious Hepatitis
exposure to toxins
caused by alcoholism the liver becomes Alcoholic Cirrhosis
enlarged and knobby and then shrinks
Caused by obstruction of bile flow Billiary Cirrhosis
Results from Venous congestion and Cardiac Cirrhosis
hypoxia
excessive ammonia in blood resulting hepatic encephalopathy
in swelling of brain tissue and cognitive
disturbances
Portal hypertension causes collateral Esophageal varices
vessels to develop in the esophagus and
anterior abdominal wall. they are
fragile and bleed easily and may cause
fatal hemorrhage
Obstruction of blood coming into the Portal Hypertension
liver causes blood to back up into the
portal system
Renal failure following diuretic Hepatorenal syndrome
therapy, Paracentesis, or GI
hemorrhage in the Cirrhosis patient,
reason is unknown
Build up of fat cells in the liver caused Fatty liver
by excess alcohol consumption. is
reversible if alcohol intake ceases
inflammation of liver caused by heavy Alcoholic hepatitis
alcohol consumption
Advantages of the use of shunts for provides a mechanism to collect protein rich
cirrhotic ascites ascitic fluid and return it to the vascular system
and Increases urine output which eliminates
excess sodium and water
Liver failure associated with injury. Fulminate liver failure
Used to prevent liver transplant Corticosteroids and immunosuppressant agents
rejection
Pancreatic enzymes Tripsin - protein digestion
Amylase - Starch, sucrose & fructose digestion
 Lipase - fat digestion
Synthesis of glucose from substances Gluconeogenesis
other than carbohydrates
Episodic colicky pain in epigastric are Cholecystitis
which radiates to back and shoulder,
Indigestion or chest pain after eating
fatty or fried foods, Nausea, vomiting
or flatulence. These signs and
symptoms are found in?
Abdominal pain, anorexia, ascities, Cirrhosis
fatigue, jaundice, nausea, vomiting.
These are symptoms of?
Abdominal tenderness and distention,
abrupt onset of pain in epigastric region
radiating to shoulder, substernal area Pancreatitis
back and flank. Aching, burning,
stabbing, pressing abdominal pain,
nausea, vomiting, tachycardia, and
tachypnea, this are the clinical
manifestations of?

Blood chemistry reveals increased Cholecystitis

alkaline phosphotase, bilirubin, direct
bilirubin, transaminase, amylase, lipase,
aspartate aminotransferase(AST) and
lactate dehydrogenase (LD) levels.
Cholangiogram shows stones in biliary
tree. These are the test results of a
client with?
CARE OF CLIENTS WITH ENDOCRINE
DISORDERS
Hyposecretion of one or more of the pituitary Hypopituitarism
hormones caused by tumors, trauma,
encephalitis, autoimmunity, or stroke.
Hyposecretion of ADH caused by strokes or Diabetes insipidus
trauma, or may be idiopathic
Hyposecretion of adrenal cortex hormones Addison's disease
(glucocorticoids and mineralocorticoids)
state resulting from hyposecretion of thyroid Hypothyroidism
hormones T3 and T4.
characterized by the destruction of the Type 1 diabetes mellitus
pancreatic beta cells, which produce insulin;
this results in absolute insulin deficiency.
usually arises because of insulin resistance, in Type 2 diabetes mellitus
which the body fails to use insulin properly,
combined with relative (rather than absolute)
insulin deficiency.
3 Ps of diabetes mellitus Polyuria, polydipsia, polyphagia
Characterized by a hypersecretion of Cushing's disease and Cushing's syndrome
glucocorticoids from the adrenal cortex (hypercortisolism)
Excess ADH is released, but not in response to Syndrome of inappropriate antidiuretic
the body's need for it. hormone (SIADH)
Hypersecretion of growth hormone by the Hyperpituitarism
anterior pituitary gland in an adult; caused
primarily by pituitary tumors.
CARE OF CLIENTS WITH NEUROLOGIC
DISORDERS
Inflammation of brain tissue Encephalitis
Weakness on one side of the body Hemiparesis
Paralysis on one side of the body Hemiplegia
Pressure within the cranium or skull Intracranial pressure
Nerve pain Neuralgia
Biochemical messengers at nerve Neurotransmitters
endings that activate receptors to
stimulate or inhibit a response
Convulsions, series of involuntary Seizures
contractions of voluntary muscles
Main cell body Neuron
Conduct impulses away from the cell Axon
body
Conduct impulses toward the cell body Dendrites
Considered as common Acetycholine, Norepinephrine, epinephrine,
neurotransmitters: dopamine
Consist of brain and spinal cord CNS
All nerves including spinal and cranial Peripheral Nervous system
nerves
Fight or flight response Sympathetic nervous system
Returns body to resting state Parasympathetic nervous system
Controls awareness and alertness Brain stem and Diencephalon
through reticular activating system.
composed of fibers scattered through
the mid-brain,pons and medulla
Abnormal electrical activity may be Partial Seizures
generated in localized areas of brain
Occurs in part of 1 central hemisphere - Simple Seizures
consciousness not impaired. May
include motor, somatosensory,
autonomic or psychic symptoms
Abnormal brain activity remains Focal motor seizures
 localized to a specific motor area, May
or may not occur with "Jacksonian
March"
Term for when an abnormal activity in Jacksonian March
one area "marches" (spreads) to
adjacent areas
can progress to involve entire brain = Partial Seizure
partial seizures with secondary
generalization
Involves entire brain from onset. Generalized Seizure
Consciousness is lost
In a ___ _____seizure, there is transient Complex Seizure
staring, feelings of fear, lip smacking,
eye blinking, chewing, swallowing, and
purposeless behaviors.
CARE OF CLIENTS WITH
MUSCULOSKELETAL DISORDERS
Bones serve as an attachment for Tendons, Muscles
muscles, which are connected to bones
by _____. Bones act as a lever for
_____, Movement occurs as a result of
of muscle contractions applied to these
levers.
Describe the 3 types of bone cells. Osteoblasts- basic bone-forming cells
(synthesize organic bone matrix)
Osteocytes- mature bone cells
Osteoclasts- participate in bone remodeling by
assisting in the breakdown of bone tissue
_____ _______ is the removal of old Bone remodeling
bone by osteoclasts
______ is an inflammation of a bursa Bursitis
sac. The inflammation can be acute or
chronic.
Deficiency of what electrolyte can Calcium
cause tetany, the involuntary
contraction of skeletal muscle.
Decrease in _____ ____ can contribute Bone density
to loss of height due to vertebral
compression, back pain, deformity such
as dowager's hump (kyphosis) caused
by vertebral compression
What is crepitation? The noise produced by rubbing bone or
irregular cartilage surfaces together, as in
arthritis.
CARE OF CLIENTS WITH EYE AND EAR
DISORDERS
The __________is the bony structure of the orbit
skull that surrounds the eye and offers
protection to the eye.
the dense transparent outer layer cornea
the fibrous white of the eye sclera
Middle layer of the eye is consists of choroid, ciliary body, and iris
the dark brown membrane located between the choroid
sclera and the retina that has dark pigmentation
to prevent light from reflecting internally
connects the choroid with the iris and secretes ciliary body
aqueous humor that helps give the eye its
shape; the muscles of the ciliary body control
the thickness of the lens.
the colored portion of the eye, located in front iris
of the lens, and it has a central circular opening
controls the amount of light admitted into the pupil
retina
(darkness produces ________and light Dilation
produces_____________) constriction
bordered externally by the choroid and sclera retina
and internally by the vitreous.
Compares air conduction from bone Rinne Test
conduction; differentiates conductive and Normal : air conduction is
sensorineural hearing loss. better than bone air
conduction (the tone is
louder in front of the
ear)
Conductive hearing loss:
bone conduction is
better than the air
conduction (the tone is
louder behind the ear)
Sensorineural hearing
loss: same as the normal
finding
It the single most important diagnostic Audiometry
instrument in detecting hearing loss.
It involves interference with conduction of Conductive hearing loss
sound impulses through the external auditory
canal, the ear drum or the middle ear.
It involves both conduction and sensorineural Mixed hearing loss
hearing loss.
It results from disease or trauma to the inner Sensorineural hearing loss
ear or acoustic serve.
This is an inflammation of the outer ear which Otitis Externa
is lined by skin. The condition is usually
bilateral and the symptoms start with itching.
The patient scratches the ear which becomes
infected, painful and sometimes blocked by a
thin muco purulent discharge.
Characterized by accumulation of endolymph Menieres Disease (Endolymphatic Hydrops)
in the inner ear. It is chronic, with remissions
and exacerbations.
Types of Ear Surgeries:

Myringoplasty- closure of perforated tympanic membrane

Tympanoplasty- closure of perforated tympanic membrane if

middle ear is involved

Myringotomy- simple incision in the tympanic membrane

Ossiculoplasty- ossicular reconstruction

Stapedectomy- removal of stapes followed by prosthesis

replacement

Stapedotomy- use of laser to create a hole in the footplate of

the stapes and prosthesis is placed in the hole.

Labyrinthectomy- surgical removal of membranous labyritnth

through the oval window or through mastoid
bone.
a rare, severe, bilateral, granulomatous uveitis Sympathetic Ophthalmia (Sympathetic Uveitis)
of unknown cause
occurs anytime from 10 days to several years
following penetrating injury near the ciliary
body or following a retained foreign body.
Eye deviation o Esotropia inward /
o Esotropia convergent deviation of
o Exotropia the eyes
o Hypertropia o Exotropia outward /
o Hypotropia divergent deviation of
the eyes
o Hypertropia upward
deviation of the eyes
o Hypotropia downward
deviation of the eyes.
CARE OF CLIENTS WITH FLUID ,
ELECTROLYTE AND ACID-BASE
IMBALANCES
 Laboratory Values: (Serum) Laboratory Values: (Serum)
Na= Na= 135-145 mEq/L
Cl= Cl= 95-105 mEq/L
K= K= 3.5-5 mEq/L
Ca= Ca= 4.5- 5.5 mEq/L
Mg= Mg= 1.5-2.5 mEq/L
PO4= PO4= 1.8-2.6 mEq/L
Serum osmolality= Serum osmolality= 280-300
Urine osmolality= mOsm/L
Urine osmolality= 250-900
mOsm/L

Body water- distribution vary with age Body water- distribution vary with age
and sex and sex
Infant- Infant- 80% body weight
Male- Male- 60% body weight
Female- Female- 50% body weight (fat
is water free. Females have
more adipose tissues, so they
have lesser percentage of body
water)
Normal Fluid Intake and Loss in Adults Normal Fluid Intake and Loss in Adults
Intake Intake
Water in food Water in food 1,000ml
Water from oxidation Water from oxidation 300ml
Water as liquid Water as liquid 1,200ml
Total: Total: 2,500ml
Output Output
Skin Skin 500ml
Lungs Lungs 300ml
Feces Feces 150ml
Kidneys Kidneys 1,500ml
Total: Total: 2,500ml
Body Fluids Body Fluids
Intracellular fluid (ICF) Intracellular fluid (ICF) 70%-
Extracellular fluid (ECF) inside the cells
Interstitial fluid Extracellular fluid (ECF) 30%-
Intravascular fluid outside the cells
Transcellular fluid Interstitial fluid (25%)-
surrounds the cells
Intravascular fluid 5%-
inside the blood vessels
Transcellular fluid-
(approximately 1-2%)
digestive juices, water
and solutes in the renal

Types of Solutions:
1.
a. Have the same osmolality as
body fluids
b. Increase extracellular fluid
volume
c. Do not enter the cells because
no osmotic force exists to shift
the fluids
2.
a. Are more dilute solutions and
have a lower osmolality than
body fluids
b. Cause the movement of water
into cells by osmosis
c. Should be administered
slowly to prevent cellular
edema
3.
a. Are more concentrated
solutions and have a higher
osmolality than body fluids
b. Concentrate extracellular
fluid and cause
movement of water from cells
into the extracellular fluid by
osmosis
4.
a. Also called plasma expanders
b. Pull fluid from the interstitial
compartment into the vascular
compartment
c. Used to increase the vascular
volume rapidly, such as in
hemorrhage or severe
hypovolemia
ABG ANALYSIS
Normal Values
o Blood pH:
o PO2:
o PCO2:
o HCO3:
o BE/ BD:
Identify the Acid-Base Imbalance
tubules and bladder,
pleural fluid, CSF
Types of Solutions:
1. Isotonic solutions
a. Have the same osmolality as
body fluids
b. Increase extracellular fluid
volume
c. Do not enter the cells because
no osmotic force exists to shift
the fluids
2. Hypotonic solutions
a. Are more dilute solutions and
have a lower osmolality than
body fluids
b. Cause the movement of water
into cells by osmosis
c. Should be administered
slowly to prevent cellular
edema
3. Hypertonic solutions
a. Are more concentrated
solutions and have a higher
osmolality than body fluids
b. Concentrate extracellular
fluid and cause
movement of water from cells
into the extracellular fluid by
osmosis
4. Colloids
a. Also called plasma expanders
b. Pull fluid from the interstitial
compartment into the vascular
compartment
c. Used to increase the vascular
volume rapidly, such as in
hemorrhage or severe
hypovolemia
ABG ANALYSIS
Normal Values
o Blood pH: 7.35- 7.45
o PO2: 80-100 mmHg (TORR)
o PCO2: 35- 45 mmHg (TORR)
o HCO3: 22- 26 mEq/ L
o BE/ BD: 2
pH= decreased, PaCO2= increased, HCO3=
increased Compensated respiratory acidosis

pH= increased d, PaCO2= increased, HCO3=

increased Compensated metabolic alkalosis

pH= decreased, PaCO2= decreased, HCO3=

decreased Compensated metabolic acidosis

pH= increased, PaCO2= decreased, HCO3=

decreased Compensated respiratory alkalosis

pH= decreased, PaCO2= increased, HCO3=

normal Respiratory acidosis

pH= increased, PaCO2= normal, HCO3=

increased Metabolic alkalosis

pH= increased, PaCO2= decreased, HCO3=

increased Simultaneous Respiratory and Metabolic
Alkalosis
What is the major ECG change for . Prominent U- wave
hypokalemia
What are the major ECG changes for tall and peaked T- wave
hyperkalemia?
The concentration of more than 20- 40 Phlebitis
mEqs of potassium can cause ______
to the vein?
What drug toxicity can aggravate digitalis toxicity
hypokalemia?
After traumatic injury, what is the most Hyperkalemia
common electrolyte imbalance?
What organ of the body is responsible Kidney
for 80% of the excretion of potassium?

What IV must be infused in IV calcium gluconate

management of patients with
hyperkalemia?
What is the most common bowel Constipation
symptom will the patient with
hypercalcemia present?
What electrolyte imbalances will the Hyperphosphatemia
increase intake of antacids result?
What electrolyte imbalance can be seen Hypomagnesemia
 commonly in critically- ill alcoholic
patient?
Potassium- sparing diuretics can result
to increase in serum level of potassium
and _____
What IV fluid is infused to antagonize
the effect of hypermagnesemia?
What IV fluid is infused to increase
renal excretion of magnesium?
CARE OF CLIENTS WITH GENITO-
URINARY DISORDERS
Pair of bean shape, brownish red structures
located retroperitoneally
The three regions of the renal tubules are
The female urethra is ____________, while the The female urethra is 1 and 2 inches, while
male is ____________________ in length. The the male is 5 to 6 inches up to 8 inches in
shorter urethra among females increases
propensity to _________________.
Direct visualization of urethra, bladder wall,
trigone, urethral opening through a lighted
instrument (cystoscope
X-ray visualization or renal circulation as
contrast medium is injected into renal artery
through catheter
The two types of renal failure are as follows:
Acute Renal Failure.
Chronic Renal Failure.
three stages of acute renal failure are as
follows:
o There is decreased urine output;
increased BUN,
hypermagnesemia;
hyperphosphatemia;
hyponatremia; and metabolic
acidosis. This stage lasts for 1-3
weeks.
Magnesium
IV calcium
Saline infusions
Kidneys
Proximal convoluted tubules, loop of henle and
the distal convoluted tubules.
length. The shorter urethra among females
increases propensity to urinary tract infection.
Cystoscopy
Renal Arteriogram
The two types of renal failure are as follows:
Acute Renal Failure. It is sudden loss of renal
function; but it is potentially reversible. The
renal tubules are damaged, but the glomeruli
remain intact.
Chronic Renal Failure. It is gradual,
progressive loss or renal function. It is
irreversible. The glomeruli are damaged
three stages of acute renal failure are as
follows:
o Oliguric phase. There is
decreased urine output; increased
BUN, hypermagnesemia;
hyperphosphatemia;
hyponatremia; and metabolic
acidosis. This stage lasts for 1-3
weeks.
 o This signifies that the kidneys
are starting to regain their
functions. There is increased
urine output (3-5 L/day), with
excessive loss of potassium
(hypokalemia). This stage lasts
for 1 week.
o It takes 3-12 months for the
kidneys to recover. During this
time, the client should avoid
nephrotoxic drugs
stages of chronic renal failure are as
follows:
o 40-50% Remaining GFR
(glomerular filtration rate).
o 20-40% Remaining GFR.
o 10-20% remaining GFR.
o less than 10% remaining GFR.
Urinary stones are called?
It is gradual enlargement of the prostate gland
with hypertrophy and hyperplasia of normal
tissues.
CARE OF CLIENTS WITH BURNS
Name the three Components of
Adequate Blood Flow
Types of burns
exposure to dry heat (flame), moist
heat(steam)
skin contact with acid or alkaline
direct current, as with lightning strike
from sunburn or treatments
Classification of burns
Superficial partial thickness
Deep partial thickness
Full thickness
o Diuretic phase. This signifies
that the kidneys are starting to
regain their functions. There is
increased urine output (3-5
L/day), with excessive loss of
potassium (hypokalemia). This
stage lasts for 1 week.
o Recovery phase. It takes 3-12
months for the kidneys to
recover. During this time, the
client should avoid nephrotoxic
drugs
stages of chronic renal failure are as
follows:
o Renal Impairment: 40-50%
Remaining GFR (glomerular
filtration rate).
o Renal Insufficiency: 20-40%
Remaining GFR.
o Renal Failure: 10-20%
remaining GFR.
o End-Stage-Renal Disorder
(ESRD). It is also called
Uremia- less than 10%
remaining GFR.
Urinary Calculi
BPH
1. Adequate cardiac pump
2. Effective vasculature or circulatory system
3. Sufficient blood volume
Types of burns
Thermal- exposure to dry heat (flame),
moist heat(steam)
Chemical-skin contact with acid or
alkaline
Electrical- direct current, as with
lightning strike
Radiation- from sunburn or treatments
Classification of burns
Superficial partial thickness (1st
degree)- involve epidermis, painful,
reddened with possible blisters
 Deep partial thickness (2nd degree)-
involves epidermis and upper dermis,
painful, blistered, mottled, weeping
surface
Full thickness (3rd degree)- involves
epidermis, dermis and sometimes
subcutaneous, pain free, dry, pale,
white, leathery or charred
Rule of Nine: Rule of Nine:
Head, face, neck Head, face, neck 9%
Anterior trunk Anterior trunk 18%
Posterior Trunk Posterior Trunk 18%
Upper extremities (each) Upper extremities (each) 9%
Lower extremities (each) Lower extremities (each) 18%
Genitals Genitals 1%
Crystallized Resuscitation (Baxter and Crystallized Resuscitation (Baxter and
Parkland) Parkland)
Formula: 4mls LR x wt. in kg x %TBSA
1st 24H 1st 24H
- 1st 8H= - 1st 8H= 50%
- 2nd 8H= - 2nd 8H= 25%
- 3rd 8H= - 3rd 8H= 25%

Fluid Replacement Fluid Replacement

Types of fluids: Types of fluids:
Colloids: Colloids: blood, plasma
Electrolytes: expanders
Non- electrolyte: Electrolytes: Lactated Ringers
Non- electrolyte: D5W

CARE OF CLIENTS WITH SHOCK

Shock caused by decrease in Hypovolemic
intravascular volume

Shock caused by pump failure Cardiogenic

Shock caused by nervous system injury Neurogenic

or impairment that leads to alteration of
vascular smooth muscle tone

Shock caused by systemic infection Septic

 Shock caused by hypersensitivity Anaphylactic shock
reaction

shock states that are caused by loss of circulatory shock

vascular muscle tone

Three types of circulatory shock septic, neurogenic, anaphylactic

What are the 3 Physiological Responses 1. Hypo perfusion of tissues

common to all types of shock 2. Hyper metabolism
3. activation of inflammatory response

CARE OF CLIENTS WITH FEMALE

REPRODUCTIVE DISORDERS
Inflammation of vaginal epithelium, Candidiasis
producing itching, reddish irritation
White, cheese like discharge clinging to
epithelium
Usually no edema or erythema of vulva Gardnerella-associated
or vagina bacterial vaginosis
Gray-white to yellow-white discharge
clinging to external vulva and vaginal
walls
Inflammation of vaginal epithelium, Trichomonas vaginalis
producing burning and itching vaginitis (STD)
Frothy yellow-white or yellow-green
vaginal discharge
Erythema around vestibular gland Bartholinitis (infection
Swelling and edema of greater vestibular
Abscessed vestibular gland gland)
Profuse purulent discharge Cervicitis: acute and
Backache chronic
Urinary frequency and urgency
Discharge and irritation from alkaline Atrophic vaginitis
pH of vaginal secretions
Removal of the uterus, ovaries, Radical hysterectomy
fallopian tubes, proximal vagina, and bilateral
lymph
nodes through an abdominal incision
Stages of Ovarian Cancer I Cancer is contained within the ovary (or
ovaries).
II Cancer is in one or both ovaries and has
involved other
 organs (ie, uterus, fallopian tubes, bladder, the
sigmoid colon, or the rectum) within the pelvis.
III Cancer involves one or both ovaries, and
one or both of
the following are present: (1) cancer has spread
beyond
the pelvis to the lining of the abdomen; (2)
cancer has spread to lymph nodes.
IV The most advanced stage of ovarian cancer.
Cancer is in one or both ovaries. There is
distant metastasis to
the liver, lungs, or other organs outside the
peritoneal
cavity; ovarian cancer cells in the pleural
cavity are evidence of stage IV disease.
CARE OF CLIENTS WITH MALE
REPRODUCTIVE DISORDERS
also called impotence, is the inability Erectile Dysfunction
to achieve or maintain an erect penis
defined as the occurrence of Disorders of Ejaculation
ejaculation sooner than desired, either before
or shortly after
penetration, causing distress to either one or
both partners
an inflammation of the prostate gland that is Prostatitis
often associated with lower urinary tract
symptoms and symptoms of sexual discomfort
and dysfunction.
the most common procedure used, can be Transurethral Resection of the Prostate
carriedout through endoscopy. The surgical
and optical instrument
is introduced directly through the urethra to the
prostate, which can then be viewed directly.
The gland is removed in
small chips with an electrical cutting loop
a relatively uncommon disorder, is defined as a Priapism
persistent penile erection that may or may not
be related to sexual stimulation.
an acquired, benign condition that involves the Peyronies disease
buildup of fibrous plaques in the sheath of the
corpus cavernosum.
is the surgical excision of the foreskin Circumcision
(prepuce) of the glans penis
CARE OF CLIENTS WITH SEXUALLY
TRANSMITTED DISORDERS
What STD's are reportable to the health a. syphillis
 department?
What is the virus associated in the
development of cervical cancer?
True or False. Chlamydia can be
asymptomatic
What are the female symptoms of
Chlamydia?
What are the male symptoms of
Chlamydia?
b. gonorrhea
c. hpv (genital warts)
d chlamydia
e. HIV ( except herpes simplex virus)
Human Papilloma Virus
o True.
o a. mucourethral drainage
b. cervical bleeding
c. ectopic pregnancy
d. infertility
a. epidydimitis
b. prostitis
c. male infertility

True or False. If Chlamydia crosses the True

placenta, it can cause blindness in the
baby.
Describe female symptoms of o *salpingitis
Gonorrhea *changes in vaginal discharge
*spotting after sex
Describe male symptoms of Gonorrhea *prostatitis
*epidydimitis
*dysuria
*swollen testicle
*penile discharge
What type of symptoms does the MSM *anal itching
have from Gonorrhea? *anal bleeding
*anal infection
What is considered as a silent STD? Chlamydia
A viral disease caused by human virus, which Acquired immunodeficiency syndrome (AIDS)
destroys T cells, thereby increasing
susceptibility to infection and malignancy
High-risk groups for Acquired 1. Heterosexual or homosexual
immunodeficiency syndrome (AIDS) contact with high-risk
individuals
2. Intravenous drug abusers
3. Persons receiving blood
products
4. Health care workers
5. Babies born to infected
mothers
INTEGUMENTARY
outer most layer, thin but tough, Epidermis
 replaced every 4 weeks
inner supportive layer, consist of Dermis layer
connective tissue (collagen), nerves,
sensory receptors, blood vessels,
lymphatics, hair follicles, sebaceous
glands, and sweat glands
Identify the 4 appendages to the skin in Hair
the integumentary system. Sebaceous glands - produce sebum
Sweat glands
Nails - hard, keratin plates
It is a primary skin lesion,flat Macule
unelevated patch, 1mm to 1 cm. Ex.
freckles
What to consider in Past Medical any systemic problems,
History for Skin, Hair, Nails any problems specific to skin, hair, nails
Family history to consider for skin, skin cancers, psoriasis, allergies, infestations
hair, nails
Personal and Social History of skin, self-care habits
hair nails exposure to environmental/occupational stress
alcohol/street drug use
A rough thickened, hardened epidermis Lichenification
resulting from chronic irritation or
rubbing
FLAT (unlike keloid), irregular Scar
connective tissue left after a lesion or
wound. New scars may be red or
purple, older scars may be silvery or
white
A flat, nonpalpable, irregular-shaped Patch
macule more than 1 cm in diameter.
Elevated, firm, and rough lesion with Plaque
flat top surface greater than 1 cm in
diameter
Elevated irregular-shaped area of Wheal
cutaneous edema; solid, transient;
variable diameter
Elevated, firm, circumscribed lesion; Nodule
deeper in dermis than a papule; 1 to 2
cm in diameter
Vesicle greater than 1 cm in diameter Bulla
Irregular-shaped, elevated, Keloid
progressively enlarging scar; grows
beyond the boundaries of the wound
A reddish purple, non blanchable spot Ecchymosis
of variable size. This is caused by
 trauma to the blood vessel resulting in
bleeding under the tissue.
EMERGENCY AND DISASTER NURSING
are sudden catastrophic events that disrupt
patterns of life and in which there is possible
loss of life and property in addition to multiple
injuries.
up to 10 people involved
more than 10 not more than 100
more than 100
sorting prioritizing
for patient with highest chance of
survival
for patient with most life- threatening
injury
Triage Categories:
patients have the highest prioritytheir
conditions are life threatening, and they must
be seen immediately
patients have serious health problems, but not
immediately life threatening ones; they must
be seen within 1 hour
patients have episodic illnesses that can be
addressed within 24 hours without increased
morbidity
These patients require simple first aid or basic
primary care. They may be treated in the ED or
safely referred to a clinic or physicians office.
Color-coded triage system:
dead
critical/ life-threatening (ABC, Cardio,
head injury..etc)
serious/ urgent, can wait for
transportation (fracture, burn less than
40%)
minimal, ambulatory, can be treated by
non- professional
Four emergency action principles:
Disaster
Multiple Patient- up to 10 people
involved
Multiple Casualty Disasters- more than
10 not more than 100
Mass Casualty Disasters- more than
100
Triage
Military triage- for patient with highest
chance of survival
Civilian triage- for patient with most
life- threatening injury
Triage Categories:
Emergent- patients have the highest priority
their conditions are life threatening, and they
must be seen immediately
Urgent- patients have serious health problems,
but not immediately life threatening ones; they
must be seen within 1 hour
Non-urgent- patients have episodic illnesses
that can be addressed within 24 hours without
increased morbidity
Fast Track- These patients require simple first
aid or basic primary care. They may be treated
in the ED or safely referred to a clinic or
physicians office.
Color-coded triage system:
Black- dead
Red- critical/ life-threatening (ABC,
Cardio, head injury..etc)
Yellow-serious/ urgent, can wait for
transportation (fracture, burn less than
40%)
Green- minimal, ambulatory, can be
treated by non- professional
Four emergency action principles:
Survey the scene
 Primary assessment
Activate EMS
Secondary assessment
When to terminate CPR: When to terminate CPR:
spontaneous circulation and ventilation
have been restored
resuscitation efforts have been
transferred to another equally
responsible individual
a physician assumes responsibility for
resuscitation procedure
the victim is transferred to an
emergency medical service
the rescuer is exhausted and is unable
to continue
The patient is placed supine on a firm, flat Log rolling technique
surface. If the patient is lying face down, the
body is turned as a unit so that the head,
shoulders, and torso move simultaneously with
no twisting
After one hand is placed on each side of the Jaw-thrust
patients jaw, the angles of the victims lower
jaw are grasped and lifted, displacing the
mandible forward. This is a safe approach to
opening the airway of a victim with suspected
neck injury because it can be accomplished
without extending the neck
Remove stinger by scrapping it
one of the most common toxic gases; it cannot Carbon Monoxide
be filtered with the use of cloth face mask;
Toxicity occurs because of the higher affinity
of the hemoglobin
poisonous substances absorbed through the Contact Poison
skin or mucousmembranes
most common form poisoning by ingestion is Ingested Poison
by ingestion ofpoisonous substance and
ingestion of an excessive amount of drug.
Intervention Guidelines SIRES Stabilize the Individual
Identify the Toxic Substance
Reverse the Effect
Eliminate the Substance from the Body
Syrup of Ipecac
Gastric lavage/ gut lavage
Absorptive
Cathartics
Support the person/ significant others

death after submersion in very cold water,
thought to be caused from dysrrhythmias.
refers to injury to two or more body systems
and occurs with such severe injuries.
PERI-OPERATIVE NURSING
The total surgical episode is called?
.What is the effect of Cortisone or
steroid use in surgery?
At what age group is ECG required
prior to surgery?
What is the best position of the clients
for capping exercises?
Up to how many hours will the client
be on NPO prior to surgery?
Is enema required for all types of
surgery?
What is the focus in the care of the
client during intra- operative period?
When is the final preparation for
surgical procedure done?
What are the roles of the circulating
nurse
What is the role of the scrub nurse?
physically and psychologically
Immersion Syndrome
MULTIPLE TRAUMA
Peri- operative nursing
Stress of operation may require higher doses of
steroid during early recovery. However, long-
term use impairs wound healing.
Males older than 40 and females older than 50
years old.
sitting or supine position
8-10 hours
No. only for procedures involving the GI tract,
perineal and pelvic area
clients emotional well- being, and physical
factors such as safety, positioning and asepsis
begins 1- 2 hours before surgery for the clients
in the hospital or upon admission for same-
day admission clients
Ensuring All equipment are working properly
Guaranteeing sterility of the instruments
assisting with positioning
Performing surgical skin preparation
Monitoring the room and team members for
break in sterility
Assisting anesthesia personnel with induction
and physiologic monitoring
Handling specimens
Coordinating activities in other departments
Documenting care provided
Minimizing conversation and traffic within the
operating suite
gathering all the equipment for the procedure
Preparing all supplies and instruments using
the sterile technique
Handling instruments and supplies during the
surgery
Maintaining accurate counts of sponges and

What is the last sense to be depressed
during induction of general anesthesia?
What are the characteristics of an
intravenous kind of GA?
Anesthesia is commonly achieved
using the combination of what?
What is the route of administration of
inhalation anesthesia?
What does the word volatile in
inhalation anesthesia means?
Up to how long will the spinal
headache be present post-op for client
who had undergone spinal anesthesia?
What are the commonly used gases
anesthetic for inhalation anesthesia?
What are the nursing intervention for
clients having spinal headache
What is cryothermia?
This is a genetic disorder characterized
by uncontrolled skeletal muscle
contraction leading to potentially fatal
hyperthermia
What combination of anesthetics can
pose great risk for the clients for
possible malignant hyperthermia?
What is the drug of choice to decrease
muscle rigidity during malignant
hyperthermia?
Up to how many centigrade will the
temperature rise in malignant
hyperthermia?
ORGAN TRANSPLANT
TYPES OF TRANSPLANT
Autograft-
Allograft-
Isograft-
Xenograft-
Split-
Domino-
Heterotrophic-
Orthotopic-
instruments with the circulating nurse before
and after surgery.
Hearing
Client experience rapid loss of consciousness
(within 30 seconds). It can act as a calming
agent
oxygen, narcotic and neuromuscular blocking
agent
through a mask or endotracheal tube
the medication can be exhaled through the
lungs
may last a week
nitrous oxide and isoflurane
Apply tight abdominal binder
Provide fluids
administer analgesics as ordered
is the use of cold to induce anesthesia
malignant hyperthermia
combination of succinylcholine and inhalation
( halothane)
Dantrolene
up to 43 degree Celsius
TYPES OF TRANSPLANT
Autograft- self
Allograft-donor of the same species but
different genetic makeup
Isograft- donor of the same species and
same genetic makeup
Xenograft- Tissue from an animal of
one species used as a temporary graft
(as in cases of severe burns) on an
 Bioengineered grafts- individual of another species
Split- divided into parts
Domino- continuous
Heterotrophic- different site
Orthotopic- same site
Bioengineered grafts- synthetically
made
determines the degree to which the donor Tissue typing determines the degree to
and recipient tissue match which the donor and recipient tissue match
tests the recipient for antidonor Cross-matching tests the recipient for
antibodies that may have developed from antidonor antibodies that may have
a prior organ transplant, blood developed from a prior organ transplant,
transfusion or pregnancy blood transfusion or pregnancy
Rejection Rejection
Hyperacute Hyperacute occurs 2-3 days
Acute after transplantation
Chronic Acute occurs 4 days to 3
months after transplantation
Chronic occurs 4 months to
years after transplantation
1905: First successful transplant by Eduard cornea transplant
Zirm
GENETIC RISK AND HEREDITARY
What is genetics? The field of science that looks at how traits
(such as eye color) are passed down from
parents to their children through genes
What is the genome? The totality of the approximately 25000
genes that humans have in their genetic
make-up.
genes are contained in ___ Chromosomes
Chromosomes are located within the ____ cell nucleus
____
__ __ is a display of its genome, revealing Human karyotype
all the chromosomes present in an
individual.
__ pairs of chromosomes are autosomes. 22
One pair of chromosomes is a __ Sex
chromosome.
What are the 4 chemicals that compose -Adenine
DNA -Thymine
-Cytosine
-Guanine
What is the name of the enzyme that helps dihydropyrimidine dehydrogenase DPD
metabolize the drug fluorouracil?
What is heterozygous? alleles of a particular gene are non-identical
What is homozygous? alleles of a particular gene are identical
 What are X linked traits?
What are the common X linked recessive
traits?
PAIN AND PAIN MANAGEMENT
What are some alternative methods or
behaviors nurses can do to decrease
pain?
Is it better to treat pain around the clock
or PRN? Why?
What are some objective indicators of
pain?
How can we advocate for the patient
when it comes to pain treatment being
ineffective?
Who can we refer patients to for pain
management?
How do TENS units work?
Surgical severing of the dorsal spinal
roots
Destruction of the ganglia by incision
or injection
Removal of part of the nerve
An incision into the anterolateral tracts
of the spinal cord to interrupt the
transmission of pain
Anesthesiologic approaches to pain
Types of medications used to treat pain
How does age as a factor affect pain
response?
Describe chronic intractable
nonmalignant pain syndrome.
sensory nerve fibers that conduct pain
impulses from the periphery to the
central nervous system
CONCEPT OF CRITICALLY ILL
PATIENT
A nurse is observing a patient during a
Traits that are passed from parents to
offspring on the X chromosome
colorblindness and hemophilia
massage, changing positions, change linens,
oral care
Around the clock. Less medication is used, it
decreases hospital stay, and increases quality
of life.
Grimacing, restlessness, stillness, verbal or
nonbverbal vocalization, holding something
tight (side rails)
Call the healthcare provider
Pain CNS-RN (pain specialists), support
groups
Electrodes stimulate the A-Beta touch fibers to
close the pain gate.
Rhizotomy
Sympathectomy
Neurectomy
Cordotomy
Nerve blocks, epidural steroid injections,
intraspinal drug administration, trigger point
injections, invasive nerve stimulation
NSAIDs, Narcotics, Antidepressants,
Anticonvulsants, Local anesthetics
Not controlled well in elderly, studies are
being conducted in neonates
Clients are unable to cope well with the pain.
Pain may be mild to severe. The pain itself
becomes the pathologic process.
Nociceptors
Reassure patient that those sensations are
cardiac catheterization procedure. During
the procedure, the patient reports feeling
chest flutters and have an irregular
heartbeat. What should be the nurses
initial action?
A patient with a history of acute renal
failure is about to have cardiac
catheterization. The nurse caring for the
patient should anticipate administering
which medication before the procedure?
A nurse is assessing a patient who received
a prescribed dose of nitroglycerin 5
minutes ago. The patients current blood
pressure is 90/40 mmHg. What should be
the nurses next action?
Which of the following complications is
associated with the use of glucophage for a
patient undergoing a cardiac angiogram
procedure?
The nurse administered the 1st dose of
NTG sublingual for a patient experiencing
chest pain. The nurse should know that
pain relief should be evident:
A nurse working in the telemetry unit is
assessing the latest ECG readings for the
patients in the unit. Which of the following
cardiac rhythm indicates that a patient has
recently experienced an MI?
The nurse is caring for a patient on a
mechanical ventilator with an NG tube in
place. Upon assessment, the nurse notes
normal.
Sensations that may be experienced during
cardiac catheterization include palpitations
as the catheter is passed up the left
ventricle, and a feeling of heat or hot flash
as the medium is injected into either side of
the heart.
Mucomyst
Fluids and acetylcysteine (mucomyst) may
be given 12-24 hours before the procedure
for renal protection.
Lower the head of the bed
If the patients BP is less than 100 mmHg
systolic or 25 mmHg lower than the
previous reading, lower the head of the bed
and notify primary healthcare provider.
Hypotension can be dramatic, and
intensified by the upright position.
Development of lactic acidosis
Combination of contrast medium and
glucophage could cause the development of
lactic acidosis. Drug should be
discontinued the day before the procedure
and 48-72 hours post-procedure.
Within 1-3 minutes of taking the drug
Pain relief with NTG use should begin
within 1-2 minutes and should be clearly
evident in 3-5 minutes. After 5 minutes,
assess the patients pain level and vital
signs.
Sinus tachycardia with premature
ventricular contractions
Sinus tachycardia with PVCs frequently
occurs in the first few hours after an MI.
With acute MI, PVCs may be considered
warning dysrhythmias, possibly triggering
ventricular tachycardia or ventricular
fibrillation.
Administer PRN dose of antacid
Stress ulcers occur in many patients
 that the gastric aspirate from the NG tube
has a pH level of 4.0. Based on the finding,
what should be the most appropriate
nursing action?
During assessment, the nurse notes high-
pitched noise during inspiration and
excessive coughing for a patient who had
an endotracheal tube removed several
hours ago. Which of the following should
be the initial action by the nurse?
INFECTIOUS DISEASE AND IMMUNITY
A.
1. is immediate.
2. This type of response provides
protection against acute, rapidly
developing bacterial and viral
infections.
B.
1. is delayed; this is also called delayed
hypersensitivity.
2. This type of response is active
against slowly developing bacterial
infections and is involved in
autoimmune responses, some allergic
reactions, and rejection of foreign cells.
Known as clean technique Medical asepsis
Procedures used to reduce and prevent
the spread of microorganisms
Examples of medical asepsis hand
hygiene; using clean gloves to prevent
contact with blood and body fluids; and
routine environmental cleaning.
Procedures used to eliminate all
microorganisms including pathogens
and spores from an object or area
An area or object is considered
contaminated if touched by any object
that is not sterile
Commonly performed in the operating
room, labor and delivery, and major
diagnostic areas, and can be used at
clients bedside
Bodys Normal Defenses Against
receiving mechanical ventilation. These
ulcers complicate the patients nutritional
status and increase the risk for systemic
infections. Antacids are often prescribed as
soon as the patient is intubated.
Call rapid response team
Stridor, a high-pitched noise during
inspiration caused by laryngospasm, is a
late manifestation of a narrowed airway
and requires prompt attention. Reintubation
may be needed.
A. Humoral response
1. Humoral response is immediate.
2. This type of response provides
protection against acute, rapidly
developing bacterial and viral
infections.
B. Cellular response
1. Cellular response is delayed; this is
also called delayed hypersensitivity.
2. This type of response is active
against slowly developing bacterial
infections and is involved in
autoimmune responses, some allergic
reactions, and rejection of foreign cells.
Surgical asepsis
Non Specific Defenses
 Infection -Intact skin and mucus membranes
Body defense systems
-Normal body flora internal and external
-Inflammatory response
Specific Body Defenses
-Antibody mediated defense
-Cell-mediated defense
a collagen disease; it is a form of systemic Polyarteritis nodosa
vasculitis that causes inflammation of the
arteries in visceral organs, brain, and skin
a chronic connective tissue disease similar to Scleroderma (systemic sclerosis)
SLE that is characterized by inflammation,
fibrosis, and sclerosis
Chronic, progressive, systemic inflammatory Systemic lupus erythematosus (SLE)
disease that can cause major organs and
systems to fail with common feature of
Erythema butterfly or rash of the face
also called native or innate immunity. Natural immunity
It is present at birth and includes biochemical,
physical, and mechanical barriers of defense,
as well as the inflammatory response.
is received passively from the mother's Acquired or adaptive immunity
antibodies, animal serum, or antibodies
produced in response to a disease.
is the absence or inadequate production of Immunodeficiency
immune bodies.
is an abnormal, individual response to certain allergy
substances that normally do not trigger such an
exaggerated reaction.
a serious and immediate hypersensitivity Anaphylaxis
reaction that releases histamine from the
damaged cells.
Body is unable to recognize its own cells as a Autoimmune disease
part of itself.
is a rare autoimmune disease that occurs Pemphigus
predominantly between middle and old age.
The cause is unknown, and the disorder is
potentially fatal. Treatment is aimed at
suppressing the immune response that causes
blister formation.
an autoimmune disorder; autoantibodies are Goodpasture's syndrome
made against the glomerular basement
membrane and alveolar basement membrane.
is an infection caused by the spirochete Lyme disease
Borrelia burgdorferi, acquired from a tick bite
(ticks live in wooded areas and survive by
attaching to a host)
a viral disease caused by human Acquired immunodeficiency syndrome (AIDS)
immunodeficiency virus (HIV), which destroys
T cells, thereby increasing susceptibility to
infection and malignancy

Proverbs 3:5-6

Trust in the Lord with all your heart and lean not on your own understanding; Acknowledge
Him in all your ways and He shall make your path straight.