MS - ONCO

BIOPSY is the primary diagnostic technique for

confirming the presence of cancer cells.
MS
Chronic Obstructive Pulmonary Disease - progressive
airflow limitation associated with abnormal
inflammatory response of lungs and is not completely
reversible
1. Emphysema
2. Chronic Bronchitis
Mgt:
- Low concentration of O2 (1-2 L/min)
- abdominal breathing techniques and purse-lip breathing
- high-calorie and high protein diet
-Fluid intake up to 3000ml/ day to thin secretions
- FOWLER or ORTHOPNEIC position to facilitate
breathing
MS
Chest Tube Drainage System
Water seal Chamber
~ tip of the tube is underwater, allowing fluid and air to
drain from pleural space
~ prevents air from entering lungs
~ water OSCILLATES (moves up when client inhales
and moved down when client exhaled
*excessive bubbling = air leak
MS
ECG
Ischemia ~ ST segment DEPRESSION
Infarction ~ ST segment ELEVATION
MS
Coronary Arteries (CA)
Circumflex Artery supplies blood to LEFT atrium and
the LATERAL and POSTERIOR surfaces of LEFT
ventricle
*Past Board exam Question
MS
ANGINA
-chest pain caused by INADEQUATE myocardial blood and
oxygen supply
Pain:
~ quick less than 5 minutes
~ unaffected by breathing
~ relieved by REST
Mgt:
~ pain relief
~ rest
~ semi- fowler's position

MS
Pericarditis
- inflammation of pericardium leading to loss of
elasticity and accumulation of fluids within the sac
- pericardial FRICTION RUB upon auscultation
MS
PERICARDITIS
Characteristics of Pain:
~ grating
~ aggravated by breathing (inspiration), coughing and
swallowing
~ worse in supine position
~ relieved by LEANING FORWARD
MS
THROMBOSIS
Virchow's Triad
~ vessel wall: presence of injury
~ flow: hypercoagubility
~ blood: stasis occurs
MS
Peripheral Vascular Disease
Arterial
- numb, pale and cool to touch
- insufficient blood flow
Venous
- red, painful, swelling and warm to touch
- inability of blood to return to the heart
MS
Cardiac Tamponade
Beck's Triad
~ distended neck vein
~ muffled heart sounds
~ hypotension
MS
Radiation Therapy
1. Teletherapy~ external beam radiation.
*Patient does not emit radiation and does not pose
hazard to anyone.
Mgt:
- wash irradiated area gently with warm water or with
mild soap or water using hands
- dry with patting motion with a clean, soft towel or
cloth

MS
Radiation Therapy
2. Brachytherapy ~ internal or within the client, direct
and continous contact with tumor tissues for a specific
time.
*Patient emits radiation and can pose hazards to others
MS
An early indication of deterioration in the condition of a
client with Increased ICP is decreased level of
consciousness (LOC).
LOC is the MOST SENSITIVE INDICATOR of
nuerologic status of a person.
ALERT ALERT ALERT!!! COMMON BOARD
QUESTION
MS
Tremors (resting, non- intentional) is an INITIAL
MANIFESTATION of Parkinson's Disease
MS
Elevating the head of bed to 30 degrees following
infratentorial craniotomy is contraindicated. This causes
compression and edema of the involved area of the
brain.
INFRA FLAT
SUPRA-SEMI - F
ALERT ALERT ALERT!!!!
MS
Early morning stiffness is an early sign of rheumatoid
arthritis (RA)
MS
When using crutches the client bears the weight of the
body on the palms of the hands, not on the axillae to
PREVENT CRUCTH PALSY
MS
The most common manifestation of bladder cancer is
PAINLESS HEMATURIA
MS
Oliguria is a common initial manifestation of impaired
renal function, like in renal failure
MS
Amphogel is a phospate binder. It is administered to the
client with renal failure to relieve hyperphophatemia.

MS
LUGOLS SOLUTION-add fruit juice or a glass of water
and ice cubes to the medication. To improve the
palatability of the solution. It should be administer
through straw to prevent staining of the teeth.
MS
Insulin should be administer slowly and not rapidly to
prevent lipodystrophy.
Ms - neuro
S/sx of Alzheimer's dse
5 As
*Anomia - inability to remember names of things
*Apraxia - misuse of objects because of failure to
identify them
*Agnosia - inability to recognize familiar things
*Amnesia - memory loss
*Aphasia - inability to express oneself through speech
MS - neuro
2 types of AMNESIA
anterograde amnesia
- loss of short-term memory
retrograde amnesia
- loss of long-term memory
Ms - neuro
2 types of Aphasia
expressive aphasia
(Broca's Aphasia) frontal lobe is affected
nsg'mgt
~provide PICTURE BOARD
receptive aphasia
(Wernicke's Aphasia) temporal lobe is affected
-USE MAGIC SLATE
Ms - neuro
Triad signs of Multiple Sclerosis (ANI)
ataxia - unsteady gait (+)romberg's test
Nystagmus
intentional tremors
MSN - NEURO
MRI is the primary diagnostic tool for MS (Multiple
Sclerosis)

Ms - neuro
Acetylcholine
If decrease -> Myasthenia Gravis
If increase ->Bipolar disorder
Dopamine
If decrease ->Parkinson's dse
If increase ->Schizophrenia
Ms - neuro
Normal ICP 0-15mmhg
Myasthenic Crisis
*undermedication
*stress
*infection
S/s
*the client is unable to see, swallow, speak, breath .
Tx
*administer cholinergic agents as ordered
Ms - neuro
Cholinergic crisis
*overmedication
S/s
*pns
*tensilon test doesn't improve MG
Tx
*administer anticholinergic agents (atropine sulfate) past
board exam question
Pathognomonic signs
*abdominal aortic aneurysm
- pulsating abdominal mass , dissecting pulse
DO NOT PALPATE .
* Abruptio placenta
-painful dark red vaginal bleeding
*Addison's dse
- bronZe like skin pigmentation
* Amyottrophic lateral sclerosis
- bilateral babinski reflex
*Angina Pectoris
- Levine's sign hand clutching of the chest

PYSCH
Regression or reverting to an earlier developmental stage
may be characterized by bed wetting or using baby talk.
PYSCH
During the orientation or introductory phase, termination
and separation of the relationship are discussed in
anticipation of the time limited nature of the
relationship.
PSYCH
If a client forgets to take the scheduled dose of Lithium,
the client needs to wait for the next scheduled time to
take the dose. REMEMBER: taking two doses at one
time may lead to Lithium Toxicity.
PSYCH
LITHIUM blood level should be drawn in the morning
about 12 hours after last oral dose and before taking first
morning dose.
PSYCH
Taking mood stabilizing drugs should be taken with
meals in order to reduce nausea and vomiting. Driving
should be avoided and not attempted until dizziness
fatigue or blurring vision has subsided.
PSYCH
Flooding is a form of Rapid Desensitization in which a
behavioral therapist confronts the client with the phobic
object until it no longer produces anxiety.
PYSCH
In PTSD, the symptoms occur 3 months or more after
the trauma, which distinguishes PTSD from acute stress
disorder.
PYSCH
The defense mechanism usually used by client with
OCD includes repression, displacement, and undoing.
PSYCH
In handling patients with OCD, it is important for the
nurse not to interrupt or attempt to stop a ritual because
doing so would escalate the client's anxiety dramatically.

PSYCH
Countertransference occurs when the therapist displaces
onto the client attitudes or feelings from his/her past

PYSCH
For a client with suicidal ideation, client safety is the
priority. The nurse protects the client from self harm, self
destruction. Nutrition, sleep, and hygiene are also
important concerns but they are secondary to safety.
PSYCHIATRIC NURSING
Self awareness- Initial phase of therapeutic
communication
Self evaluation- Assessing oneself's strengths and
weaknesses
Therapeutic use of self - Using oneself as a tool to
provide holistic care for mentally ill patients.

PSYCHIATRIC NURSING
Components of MENTAL HEALTH
Mastery of once environment
Integral capacity (strengths)
Self awareness
Autonomous behavior
Self actualization
PSYCHIATRIC NURSING
SODOMY- Anal intercourse
INCEST- Sexual intercourse with the relatives or family
FETISHISM- Objects or parts of the body
VOYEURISM- Peeping tom / a person who gets sexual
pleasure from secretly watching people undressing or
engaging in sexual activity.
TRANSVESTISM- Wearing clothes of an opposite sex.
e.g. Male wearing dress, Female wearing barong
TRANSSEXUALISM- Sex change

PSYCHIATRIC NURSING
SELFCONCEPT: Johari Window
I (Puclic Self)
-Known to self
-Known to others
II (Blind self)
-Unknown to self
-Known to others
III (Secret self)
-Unknown to others
-Known to self

PYROMANIA- Sexual intercourse with a presence of

fire
PSYCH
In handling patients with OCD, it is important for the
nurse not to interrupt or attempt to stop a ritual because
doing so would escalate the client's anxiety dramatically.
Flooding is a form of Rapid Desensitization in which a
behavioral therapist confronts the client with the phobic
object until it no longer produces anxiety.

IV (Unknown self)
-Unknown to self
-Unknown to others

PSYCH
Taking mood stabilizing drugs should be taken with
meals in order to reduce nausea and vomiting. Driving
should be avoided and not attempted until dizziness
fatigue or blurring vision has subsided.

PSYCHIATRIC NURSING
Goal:
-Promote mental health
-Prevent mental illness
-Find meaning to it's experiences

PSYCH
If a client forgets to take the scheduled dose of Lithium,
the client needs to wait for the next scheduled time to
take the dose. REMEMBER: taking two doses at one
time may lead to Lithium Toxicity.

PSYCH
Countertransference occurs when the therapist displaces
onto the client attitudes or feelings from his/her past

PSYCH
CRISIS: any situation that overwhelms person's normal
coping mechanism

PSYCH
For clients in CRISIS PHASE (assault cycle), the nurse
must act immediately, using restraints and an
intramuscular tranquilizer to prevent injury to others or
further property damage.
PSYCH
For a patient with Alzheimers disease, the nursing care
plan should focus on safety measures

Goal of Crisis Intervention: return the client to PRECRISIS functioning

PSYCH
Disulfiram (Antabuse) is administered orally as an
aversion therapy to treat alcoholism
PSYCH
SCHIZOPHRENIA
- disordered though process
- disrupted interpersonal relationships
PSYCH
BIPOLAR DISORDER
- episodes of MANIA and DEPRESSION with periods
of normal mood and activity in between
DISSOCIATIVE AMNESIA
- inability to recall important personal information as it
provokes anxiety
SOMATOFORM DISORDERS
- persistent worrying or complains regarding physical
illness WITHOUT physical findings
PSYCH
OBSESSION: preoccupation with persistently intrusive
thoughts and ideas
COMPULSION
- performance of rituals or repititive behaviors to
decrease anxiety

PSYCH
TOLERANCE: Increased amounts of a substance over
time are needed to achieve the same effect as obtained
previously with smaller doses/ amounts.
-- tinataasan ang iniintake para ma achieve ang same
effect
ADDICTION: The repeated, compulsive use of a
substance that continues in spite of negative
consequences
CLANG ASSOCIATION: Association of words by
SOUND rather than meaning. -- RHYMING WORDS!!
Example: She cried till she died but could not hide from
the ride.
DELUSION OF PERSECUTION - believes that others
are out to harm or persecute in some way. Example:
Client believes their food is being poisoned or they are
being watched.
DELUSION OF GRANDEUR Exaggerated/unrealistic
sense of importance, power, identity; example is when a
client thinks he/she is the President or Jesus Christ.
PSYCH
The immediate nursing action for a client with
ANXIETY is to decrease stimuli in the environment and
provide a calm and quiet environment.
PSYCH
AVERSION THERAPY
- negative reinforcement = behavior change
- attractive stimulus paired with unpleasant event
- example: si client, alcoholic, ang aversion therapy is
disulfiram, na pag uminom ulit sya ng alcoholic drink
(attractive stimulus), malalagay sya sa life-threatening
situation (tachycardia, nausea and vomiting, chest pain)
(unpleasant event)

PSYCH
DESENSITIZATION
- ineexpose si client sa kinakatakutan nya gradually
paired with increasing level of relaxation, by which,
magiging tolerable yung fear.

PSYCH
Stages of Group Therapy
1. INITIAL STAGE
- mababaw lang yung relationship
- members are aware of similiarities with each
other
- members may be unclear of goal of the group
- roles and responsibilities are established
2. WORKING STAGE
- real purpose is done
- members familiar with each other; they address
concerns freely
- members learn to work with each other
2. TERMINATION STAGE
- members' feeling are explored
- provides opportunity to learn to deal more
realistically and comfortanly with normal human
experience
PSYCH -- CBQ!!!
GROUP THERAPY: involves a therapist and, ideally,
FIVE to EIGHT members working on his or her
individual goals within the context of a group, which
presumably increases the opportunity for feedback and
support

PSYCH - DEFENSE MECHANISM

SUPPRESSION: CONSCIOUS exclusion of
unacceptable thoughts and feelings from conscious
awareness
Example: A woman tells a friend she cannot think about
her sons death right now.
REPRESSION: Excluding emotionally painful or
anxiety-provoking thoughts and feelings from
UNCONSCIOUS awareness
Example: Woman has no memory before age 7 when she
was removed from abusive parents.
FIXATION: Immobilization of a portion of the
personality resulting from unsuccessful completion of
tasks in a developmental stage.
EXAMPLE: Lack of a clear sense of identity as an adult
DISPLACEMENT: Ventilation of intense feelings
toward persons LESS THREATENING than the one
who aroused those feelings
EXAMPLE: Dae Wong is mad at his boss, he yells at his
spouse.
DENIAL: Failure to acknowledge an unbearable
condition; failure to admit the reality of a situation, or
how one enables the problem to continue
EXAMPLE: Waiting 3 days to seek help for severe
abdominal pain.
CONVERSION: Expression of an emotional conflict
through the development of a physical symptom, usually
sensorimotor in nature
EXAMPLE: A teenager forbidden to see X-rated movies
is tempted to do so by friends and develops blindness,
and the teenager is unconcerned about the loss of sight.
COMPENSATION: overachievement in one area to
offset deficiencies in another area
Example: Nurse Toni has a low self-esteem, she works
double shifts so her supervisor will like her.
SUBSTITUTION: Taking a more attainable goal
because original goal is not attainable

PSYCHIATRIC NURSING
According to psychoanalytic theory, the superego is the
part of the psyche thats composed of morals, values,
and ethics. It continually evaluates thoughts and actions,
rewarding the good and punishing the bad.(kunsenya)
According to psychoanalytic theory, the id is the part of
the psyche that contains instinctual drives.
(Remember i for instinctual and d for drive.)
According to Psychoanalytic theory, ego is the
organized, realistic part that mediates between the
desires of the id and the super-ego.(balance)

FUNDA
INCENTIVE SPIROMETRY
- client must be in upright position
- instruct to place mouth tightly around mouthpiece
- inhale SLOWLY and maintain flow rate between 600900 marks
- hold breath for 5 seconds, exhale through PURSED
LIPS
- repeat for 10 times every hour
FUNDA
- incentive spirometry
This is done to enhance deep inhalation
As the patient INHALES the BALLS in the spirometry
GOES UP..
* it signifies GOOD LUNG EXPANSION
FUNDA
- Colostomy Irrigation
Position :
Semi - Fowler if bedrest
Sitting on the toilet if ambulatory
Hang irrigation bag so that the bottom of the bag is at the
level of client's shoulder or slightly higher (12 to
18inches) above the stoma
500-1000ml of warm normal saline soln or lukewarm tap
water
AVOID FREQUENT IRRIGATION with water .. w/c
can lead to loss of fluids and electrolytes
*if cramping occurs during irrigation
CLAMP TUBING,
Release tubing as cramping subsides.
FUNDA
- COLOSTOMY care
EMPTY POUCH when
* 1/3 to 1/2 full of stool
( to prevent leakage of stool as the adhesive of pouch is
detached )

FUNDA
- Enema
Position
Adult: left lateral position
Infant / small children : Dorsal recumbent
Lubricate 5cm (2inches) of rectal tube
Insert 7-10cm (3-4inches) of the rectal tube gently
* in ROTATING MOTION..
if abdominal cramps occur during introduction of soln
* temporary STOP the flow until peristalsis relaxes
FUNDA
- TPN
Usual site: subclavian vein
Position in catheter insertion:
TRENDELENBURG
(TO engorge the vein and facilitate insertion And also
PREVENTS air embolism )
Administer it @ RoomTemperature
CONSUME w/in 24hrs to prevent contamination.
If infusion if DELAYED do not catch up.. *notify the
physician for recalculation of infusion rate.
FUNDA
- TPN
Infection is the most common complication
If administration is interrupted or discontinued, give *
D10W to prevent hypoglcemia..
FUNDA
Wheezes are caused by narrowing of the airway.
Stridor is a sign of respiratory distress, possibly airway
obstruction.
FUNDA
Upon auscultation of the abdomen, ensure that the client
has EMPTY BLADDER not to interfere with sounds.
FUNDA
DISCHARGE PLANNING begins the moment a patient
is ADMITTED to a health care facility.

FUNDA
HEALTH: state of complete PHYSICAL, MENTAL,
and SOCIAL well-being, and not merely the absence of
disease or infirmity. (WHO)
FUNDA
PAIN HISTORY
"OLDER SAAB"
> Onset
> Location
> Description (what does it feel like)
> Exacerbating factors
> Radiation
> Severity
> Associated symptoms
> Alleviating factors
> Before (ever experience this before)
FUNDA
ABCs of PAIN
- Ask about the pain
- Believe when clients say they have pain
- Choiceslet clients know their choices
- Deliver what you can, when you said you would
- Empower/Enable clients' control over pain
FUNDA
COVER-UNCOVER TEST (Eyes) is used to detect
weakness in EXTRAOCULAR MUSCLES. It is done by
covering, then uncovering client's eye, then the nurse
observes for SHIFT in GAZE.
FUNDA
PAIN ASSESSMENT
"PQRST" (think of ecg waves)
> What PROVOKES the pain?
> What is the QUALITY of the pain?
> Does the pain RADIATE?
> What is the SEVERITY of the pain?
> What is the TIMING of the pain?
FUNDA
PERRLA
- Pupils Equally Round and Reactive to Light and
Accommodation

FUNDA
Stool AssessmentA.C.C.T.
Amount
Color
Consistency
Timing
FUNDA
OS is left eye
OD is the right eye
OU is the both eye
FUNDA
ASSESSMENT OF FISTULA
THRILL = Palpation
BRUIT = Auscultation
THRILL + BRUIT = PATENT FISTULA
FUNDA
In SUCTIONING, the nurse must PREOXYGENATE
the client first, then should be limited to 10 SECONDS.
If prolonged, HYPOXEMIA may occur.
FUNDA
UREMIA: Full-blown manifestations of kidney failure
- sometimes referred to as the UREMIC SYNDROME
especially if the cause of the renal failure is unknown
FUNDA
NOCTURIS: Awakening prematurely from sleep
because of the need to empty the bladder
FUNDA
Heimlich Manuever is now known as ABDOMINAL
THRUST MANEUVER
FUNDA
When the prescribed O2 is higher than 4L/min, we must
HUMIDIFY the delivery system.
FUNDA
PACK-YEARS: number of packs smocked per day
multiplied by number of years the patient has smoked
FUNDA
LEVIN TUBE
- single-lumen NGT
- used to remove gastric contents via intermittent suction
- can be used to provide feedings

FUNDA
NASOGASTRIC TUBE
- used to intubate stomach
- inserted from the nose to stomach
- to DECOMPRESS stomach by removing fluids or gas
to promote abdominal discomfort
FUNDA
ENTERIC-COATED tablets and sustained-released
capsules delay absorption until the medication reaches
the small intestine; these medications should NOT be
CRUSHED.
FUNDA
ABBREVIATION
AC - "Ante Cebum" Before Meals
PC - "Post Cebum" After Meals
FUNDA - CONVERSION -- CBQ!!
1 gr (grain) - 65 mg
15 gr - 1000 mg or 1 gram
FUNDA
In elderly, RED and YELLOW = last lost colors
In elderly, BLUE and GREEN = 1st lost in their vision
FUNDA
Apply the restraint at the BED FRAME not on the side
rails
The best knot to use in a restraint is SQUARE KNOT, it
will not cause slipping.
FUNDA
RETURN DEMONSTRATION: best way to assess
learning
FUNDA
MAGNETIC RESONANCE IMAGING: noninvasive
procedure that identifies tissues, tumors, and vascular
abnormalities.
- simiar to CT scan but provides more detailed pictures

FUNDA
TANK COLORS in the PHILIPPINES (varies in other
countries)
Yellow : ISOFLOVANE
Green : OXYGEN
Blue : Nitrous Oxide (NO2, Laughing Gas)
Red : Halothane
Brown : HELIUM
Black : Compressed Gas
FUNDA
WOUND HEALING PROCESS
PRIMARY INTENTION
- wound that is closed
CAUSES: surgical incision, sutured wound
HEALING: by epithelialization; heals quickly with
minimal scar formation
SECONDARY INTENTION
- wound edges not approximated
CAUSES: pressure ulcers, surgical wounds with tissue
loss
HEALING: by granulation tissue formation, wound
contraction and epithelialization
TERTIARY INTENTION
- wound left open for several days, then approximated
CAUSES: wounds that are contaminated and requires
observation for signs of inflammation
HEALING: closure of wound is delayed until risk of
infection is resolved

FUNDA
PHLEBITIS: inflammation of the inner layer of a vein
S/Sx of PHLEBITIS:
- redness
- tenderness
- pain
- warmth along course of vein starting at access site
Nursing Management for PHLEBITIS
- STOP the infusion and discontinue IV line
- Start new IV line in other extremity or proximal to
previous site if necessary
- Apply warm moist compress for superficial phlebitis
FUNDA
Procedures in wearing a FULL PPE (Personal Protective
Equipment)
1. Hand Hygiene
2. Gowning
3. Apply mask
4. Wear Eyewear or Goggles
5. Don Gloving
After: Gloves, Eyewear, Gown, last is the Mask
FUNDA
CONDOM CATHETER - lumabas to ng DEC 2013!
- alternative to catheterization
- for comatose or incontient male clients with
COMPLETE and SPONTANEOUS bladder emptying
FUNDA
COMPONENTS OF MEDICATION ORDER:
- Date and time order was written
- Medication name
- Medication dosage
- Route of administration
- Frequency of administration
- Physicians or health care providers signature
FUNDA
RECONSTITUTION: the dissolving of a powder
medication with a sterile diluent before use; usually,
sterile water or normal saline is used

FUNDA
ASSAULT: threat to touch another person unjustifiably
-- THREAT!!
BATTERY: willful touching of a person that may/may
not cause harm -- WITH TOUCH!
FUNDA
In a client with HEMIANOPSIA, approach the client
from UNAFFECTED side. Dun sa may paningin sya!
FUNDA
Heart Sounds: "All People Enjoy the Mall"
(All) Aortic: 2nd right intercostal space
(People) Pulmonic: 2nd left intercostal space
(Enjoy) Erbs Point: 3rd left intercostal space
(The) Tricuspid: 4th left intercostal space
(Mall) Mitral or Apex: 5th left intercostal space
FUNDA
3 processes of respiration
1. VENTILATION: movement of gases in and out of the
lungs
2. DIFFUSION: exchange of gases from area of higher
pressure to an area of lower pressure
3. PERFUSION: availability and movement of blood for
transport of gases, nutrients, and metabolic waste
products
FUNDA - COMMON BOARD QUESTION!!!
For ear examination, a child LESS THAN 3 y/o, the
nurse must PULL the ear lobe DOWN & BACK
FUNDA
Key questions needed in an emergency history taking
situation - "AMPLE"
Allergies
Medication
Past medical history
Last meal
Events and environment related to injury

FUNDA
- ROLES & FUNCTIONS OF A PROFESSIONAL
NURSE
Direct Care Provider assists client physically and
psychologically while preserving clients dignity
Communicator RNs identify client problems, then
communicate to other members of the health team
Teacher RN helps client learn about their health and
health care procedures they need to perform to restore/
maintain health
Client advocate RN acts to PROTECT the cliet. RN
may represent clients needs and wishes to other health
professionals.
Counselor to provide emotional, intellectual and
psychologic support to help the client to cope
Change Agent RN assists client to make modifications
in their own behaviour.
Leader influences others to work together to
accomplish a specific goal
Manager manages nursing care of individuals,
families, groups and communities. Nurse-manager also
delegates nursing activities to ancillary workers, other
nurses, supervises and evaluates performances
Case Manager manages work with
MULTIDISCIPLINARY health care team
Researcher - participates in scientific investigation and
uses research findings in practice

FUNDA
- Illness & Disease
Illness
- State in which a persons physical, emotional,
intellectual, social developmental or spiritual functioning
is diminished or impaired.
- A highly personal state
- May or may not be related to disease
- Only person can say he or she is ill

Disease
- Alteration in body function
- A reduction of capacities or a shortening of the normal
life span
- pathologic change in the structure or function of the
mind and body
Acute Illness/ Disease
- Characterized by severe symptoms of relatively
SHORT duration, usually < 6 months
- Sx appear ABRUPT, subside QUICKLY
Chronic Illness/ Disease
- Lasts for ann extended period
- Slow onset
- Possibly with periods of remissions & exacerbatons
- Client teaching: learn to live with PHYSICAL
LIMITATION and DISCOMFORT
FUNDA
- MODELS OF HEALTH
Medical Model
- narrowest interpretation of health
- people = physiologic systems
- HEALTH = absence of S/Sx of disease or injury
- DISEASE opposite of Health
Travis Health-Illness Continuum
- persons perceived level of wellness
- Health and illness/disease opposite ends of a health
continuum
- Wide ranges of health or illness
Iceberg Model
- Tip of Iceberg = state of physical health or illness
- To completely understand, look beneath the surface to:
o Lifestyle
o Psychological Beliefs
o Spirituality

FUNDA - NURSING THEORY

Concept- abstract ideas or mental images of phenomena
- BUILDING BLOCKS of theories
Paradigm- pattern of shared understanding and
assumptions about reality and the wordld
- Derived from cultural beliefs
Metaparadigm- concepts that can be superimposed on
other concepts
4 MAJOR METAPARADIGMS IN NURSING
1. PERSON
2. ENVIRONMENT
3. HEALTH
4. NURSING
FUNDA - never pa tong lumabas sa exam, malay natin!
The hearing aid thats marked with a blue dot is for the
left ear; the one with a red dot is for the right ear.
FUNDA - LUMABAS NA ITO SA BOARD EXAM!!!!
To obtain an accurate blood pressure, the nurse should
inflate the manometer to 20 to 30 mm Hg above the
disappearance of the radial pulse before releasing the
cuff pressure.

FUNDA
LEFT MIDCLAVICULAR LINE, 5th INTERCOSTAL
SPACE is the approximate location of the MITRAL
VALVE of the left ventricle. This is the usual POINT OF
MAXIMAL IMPULSE.
FUNDA
PERRLA is an abbreviation for normal pupil assessment
findings:
Pupils
Equal
Round
Reactive to
Light with
Accomodation
FUNDA -- COMMON BOARD QUESTION!
In a liquid IRON preparation, the client must take it
through a straw to avoid staining of the teeth.
FUNDAMENTALS OF NURSING:
Hemoglobin and hematocrit increase with dehydration as
the blood becomes more concentrated, and decrease with
hypervolemia and resulting hemodilution.
Hemoglobin is the main intracellular protein of
erythrocytes. It carries oxygen to and removes
carbondioxide from red blood cells.

ELIXIRS and SYRUPS with sugar is NOT given to

patients with DIABETES
FUNDA
Cheyne-Stokes Breathing: Rhythmic WAXING &
WANING from very deep to very shallow and temporary
apnea
FUNDA NURSING - GERIA
REMINISCENCE is a way for an older adult to relive
and restructure life experiences and is part of achieving
ego integrity.

Leukocyte or White blood cell count determines the

number of circulating WBC per cubic millimeter of
whole blood. High WBC are often seen in the presence
of bacterial infection; by contrast, WBC counts may be
low if a viral infection is present.
Hematocrit measures the percentage of red blood cells in
the total blood volume.

Funda
FUNDA
4 C's of Spiritual care in a DYING patient
Comfort
Companionship
Consolidation
Conversation

- Physical examination
Sequence of examining the abdomen is as follows
RLQ
RUQ
LUQ
LLQ

Funda - P.E.
To palpate the neck for lymphadenopathy or
enlargement of the THYROID GLAND the nurse
stands BEHIND THE CLIENT ..
Funda
For Vaginal examination
Pour warm water over the vaginal speculum before
use
To ensure comfort

Funda
- urine specimen collection
Best time : early morning
Do perineal care before collection of urine
specimen
Amount: 30-50mls (midstream urine)
5-10mls (c&s)
Discard the first flow especially among males
(maybe contaminated with semen)
Label it properly , send immediately to the
laboratory

Funda - 24hr urine specimen

Discard 1st voides specimen
Collect all specimens thereafter, until the same time
the following day.
E.g Monday 10am (discard the urine collected at
this time then the next urine will be collected) until
Tuesday 10am
Funda - catheterized urine specimen
Clamp catheter for 30mins to 1hr.
Cleanse the drainage port of 2way foley cath with
alchohol swab or cotton ball.
Use sterile needle and syringe to aspirate urine
specimen.

CHN
1 Community Health Nurse = 20,000 people
CHN - Role of Community Health Nurse
Clinician - the health care provider
Health Advocate - speaks in behalf of the client
CHN
CHN is a unique blend of nursing and public health
practice aimed at developing and enhancing health
capabilities of people. It is involved in entire spectrum of
health services for the community (Freeman)
CHN
CHN is the utilization of the nursing process in the
different levels of clientele (Individual, Family, Group,
Community) concerned with:
PROMOTION of HEALTH, PREVENTION OF
DISEASE and REHABILITATION (Maglaya)
CHN - Past NLE Topic!
Community Health Nurse is a GENERALIST Nurse
CHN
VITAL STATISTICS
- Indices of the health and illness status of the
community
- Serves as the bases for planning, implementing,
monitoring and evaluating community health nursing
programs and services
CHN
Philosophy of CHN: "Based on worth and dignity of
man" (Dr. Margaret Shetland)
ULTIMATE GOAL of CHN: To raise the level of the
citizenry.
CHN
Primary Health Care (PHC)
Legal Basis: LOI (Letter of Instruction) 949 signed by
President Ferdinand Marcos on October 19, 1979
CHN
Community is derived from Latin word "comunicas",
meaning A GROUP OF PEOPLE

CHN
Client is considered ACTIVE partner, NOT PASSIVE
recipient of care
CHN
4 Levels of Clientele:
*Individual
*Family
*Population Group (sharing common characteristics)
*Community
CHN - Role of Community Health Nurse
Clinician - the health care provider
Health Advocate - speaks in behalf of the client
CHN
Sentrong Sigla Movement 4 Pillars
*Quality Assurance
*Grants and Technical Assistance
*Health Promotion
*Award
CHN - Alternative Therapy
KAVAKAVA is known to be the MOST POTENT antianxiety herbal medication WITHOUT prescription. It is
non-addictive and given during HOURS OF SLEEP.
CHN
4 Stages of CHICKENPOX
1- Macules
2- Papules
3- Vesicles
4- Crusts
CHN - HIV
ELISA - 1st SCREENING test for HIV
WESTERN BLOT - CONFIRMS (+) ELISA
WESTERN BLOT -- CONFIRMATORY TEST FOR
HIV!
CHN
A person can become infected with malaria if bitten by
an infective female Anopheles mosquito.
CHN
Epidemiologic Triangle (HAE)
Host - Agent - Environment

CHN
IMCI is an approach to strengthen the provision of
comprehensive and essential health package to the
children.
CHN - Roles of Nurses
HEALTH EDUCATOR - aims towards health promotion
and illness prevention through dissemination of correct
information; educating people.
CHN
PRIMARY Level of Prevention: Health Promotion and
Illness Prevention

CHN
POLIOMYELITIS is also known as HEINEMEDIN disease and INFANTILE PARALYSIS
CHN - HERBAL PLANT
Plant Name: Lagundi
Scientific Name: Vitex negundo
Indications: Asthma, cough & colds, fever, pain &
inflammation
CHN
CHN is a unique blend of nursing and public health
practice aimed at developing and enhancing health
capabilities of people. It is involved in entire spectrum of
health services for the community (Freeman)
CHN is the utilization of the nursing process in the
different levels of clientele (Individual, Family, Group,
Community) concerned with:
PROMOTION of HEALTH, PREVENTION OF
DISEASE and REHABILITATION (Maglaya)
CHN
Primary Focus: HEALTH PROMOTION
CHN
CHN practice is extended to benefit not only the
individual, but the whole family and th community.
CHN
The goal of CHN is achieved through
MULTISECTORAL approach.
CHN

FAMILY is the unit of service

CHN- Health Educator vs Counselor
Health Educator: gives advice
Counselor: gives option (never gives direct advice)
CHN
Appropriate Technology must be:
*Scientifically sound
*Socially acceptable
FUNDA/CHN
LILLIAN WALD is the founder of Public Health
Nursing (PHN)
CHN
NATIONAL HEALTH PLAN- long term directional
plan for health. It is the blueprint defining country's
health.
CHN
Ideal birth spacing: 3-5 years
CHN
Growth and Health Monitoring Chart is a standard tool
used in health centers to record vital information related
to child growth and development.
CHN
3 Aspects of HEALTH EDUCATION (IEC)
Information
Education
Communication
CHN
Sequence of steps in health education:
Creating awareness
Creating motivation
Decision making action
CHN
Four Cornerstones/Pillars in Primary Health Care
Active Community Participation
Intra and Inter-sectoral Linkages
Use of Appropriate Technology
Support mechanism made available

CHN

OPV and AMV are the most sensitive vaccines in EPI. It

must be stored at temperature of -15'C - 25'C
CHN
2 Types of COMMUNITY DIAGNOSIS
1. Comprehensive CDx
aims to obtain GENERAL INFORMATION about the
community
2. Problem-Oriented CDx
Problem-Oriented CDx is the type of assessment that
responds to a PARTICULAR NEED
CHN - COMMUNITY DIAGNOSIS
DEMOGRAPHY is the study of population size,
composition and spatial distribution as affected by
births, deaths and migration.
CHN - IMCI Update
ALL sick children are ROUTINELY CHECKED for:
*Nutritional & Immunization status
*HIV status in HIGH HIV settings
CHN - IMCI
PINK - urgent hospital referral
YELLOW - initiation of specific outpatient treatment
GREEN - supportive home care
CHN - Specialized Fields
Community Mental Health Nursing: A unique clinical
process which includes an integration of concepts from
nursing, mental health, social psychology, psychology,
community networks, and the basic sciences
Occupational Health Nursing: The application of nursing
principles and procedures in conserving the health of
workers in all occupations
School Health Nursing: The application of nursing
theories and principles in the care of the school
population

BIRTH CERTIFICATE may be signed by:

Public Health Nurse
Rural Health Midwife
Municipal Health Officer
Kumadrona
Attending Doctor
Hilot
(PD 651)
CHN
FOURmula One for Health:
Health Financing
Health Regulation
Health Service Delivery
Health Governance
CHN
RAPID CLASSROOM INSPECTION: done as routine
procedure when frequent and regular visits can be made
to a school during the year, in addition to individual
health assessment
CHN
SHINGLES is the reactivation of HERPES ZOSTER
virus
CHN
In selecting a community in COPAR, it should be a
DOPE:
Depressed
Oppressed
Poor
Exploited
CHN/MSN
RISUS SARDONICUS or "Grin Smile" is a sustained
spasm of the facial muscle that is most often observed as
a characteristic of TETANUS.
CHN - Census
DE JURE: People were assigned to the place they
usually live regardless of where they are at the time of
census.

CHN
A company or organization must employ a COMPANY
NURSE if they reached 101 employees

CHN

CHN

MISSION OF CHN
Health Promotion
Health Protection
Health Balance
Disease prevention
Social Justice
CHN - COPAR
COPAR is a progressive cycle of ACTIONREFLECTION-ACTION (ARA) which begins with
small, local and concrete issues identified by the people
and the evaluation and the reflection of and on the action
taken by them
CHN - INTRODUCTION
OBJECTIVES OF PUBLIC HEALTH (C.O.D.E.S.)
Control of communicable diseases
Organization of Medical and Nursing services
Development of social machineries
Education (Health Education)
Sanitation of the environment
CHN
HEALTH EDUCATION is an essential task of EVERY
health worker
CHN - IMCI 2014
General Danger Signs (C.U.L.U.V.) -- COLOR: PINK -URGENT REFERRAL!!
* Falling under 2 categories, either the nurse will LOOK
or ASK
> Convulsion history (ASK) or convulsing now (LOOK)
> Unconscious or
> Lethargic (LOOK)
> Unable to drink or breasfeed (ASK)
> Vomits everything (ASK)
CHN - FAMILY PLANNING (FP)
BENEFITS OF NATURAL FP (S.A.V.E.S.)
Spacing pregnancy
Achieving pregnancy
Value-based marital bonding
Empowerment
Safe motherhood

CHN - DOH - UPDATE!

VISION by 2030
A global leader for attaining better health outcomes,
competitive and responsive health care systems and
equitable health financing.
CHN - EPI VACCINE
BCG: 0.05ml ID
DPT: 0.5ml IM
OPV: 2gtts PO
HepB: 0.5ml IM
AMV: 0.5ml SC
CHN - RABIES
MARCH: Rabies prevention month
CHN - RABIES
RABIES: acute viral encephalomyelitis by
RHABDOVIRUS
CHN - RABIES
MODES OF TRANSMISSION:
> Bite/s of a rabid animal
> Airborne (in caves with thousands of bats)
> Organ Transplant (Cornea)
CHN - RABIES
Incubation: 2-8 weeks depending on severity of wound,
site of wound (distance to brain) and amount of virus
CHN - RABIES
S/ Sx: FHAP D RABIES
Fever
Hydrophobia
Apprehension; Aerophobia
Paralysis
Delirium
Initial Symptoms (WHO): fever/ unusual and
unexplained tingling/burning/pricking sensation at the
wound site
CHN - RABIES
NO DIAGNOSTIC PROCEDURE before the onset of
clinical disease

CHN - RABIES

Leading sources:
Asia and Africa including Philippines: DOGS!
America (NCLEX): Bats!
CHN - RABIES
Management of local wound: wash thoroughly with
SOAP and WATER/ Povidone Iodine/ Alcohol for 10
minutes
Proper pet care: vaccine on 3rd month of age and year
thereafter.
CHN - RABIES
NATIONAL RABIES PREVENTION AND CONTROL
PROGRAM
(DOH Program)
GOAL: Philippines be declared as RABIES-FREE by
2015.
> eliminate human and canine rabies by 2015
> program by Department of Agriculture, DOH, DECS,
DILG and NGOs
> Strategies:
a. Manpower development
b. Social mobilization
c. Local program implementation
d. DOG IMMUNIZATION (BEST STRATEGY!)
CHN / BATAS
PD 856: Water supply in Code Sanitation
- regulation of water refilling station
- MONTHLY: bacteriological quality
- Q6 MONTHS: physical and chemical properties
- ANNUALY: biological quality and radiological
propertiea
CHN
4 RIGHTS IN FOOD SAFETY
1. Right Source
2. Right Preparation
3. Right Cooking
4. Right Storage
CHN - FOOD SAFETY
1. RIGHT SOURCE
- buy fresh ingredients
- look for expirations
- avoid canned goods not in good condition
- drink water from clean and safe sources only
- if a water is in doubt, boil for 2 minutes

2. RIGHT PREPARATION
- avoid contact of raw and cooked foods
- buy pasteurized milk only
- wash vegetables well
- wash hands and kitchen utensils
3. RIGHT COOKING
- cook food in 70 degrees C'
- eat cooked food immediately
- wash hand before and after eating
4. RIGHT STORAGE
- Food must not be left unconsumed for more than 2
hours
- storage must be in a tightly sealed container
- store foods higher than 60' Celsius and below 10'
Celsius for 4-5 hours because organisms multiply within
10'-60' Celsius
- food for infants must be freshly prepared
- reheat stored food before eating
CHN
Golden rule in food safety: "WHEN IN DOUBT,
THROW IT OUT!"
CHN
4 Core programs of DOH
1. Child Health
2. Maternal Care and Family Planning
3. Control of Infectious Diseases
4. Promotion of Healthy Lifestyle
CHN / BATAS
RA 7160: Local Government Code of 1991
- 5% of calamity funds is for EMERGENCY
OPERATIONS
CHN - LOCAL GOVERNMENT CODE OF 1991
DISASTER: disruption of functioning of society, losses
exceed tha ability of society to cope using its OWN
RESOURCES
CHN - LOCAL GOVERNMENT CODE OF 1991
EMERGENCY: any occuerrence which requires
immediate response

CHN - LOCAL GOVERNMENT CODE OF 1991

HAZARDS: any phenomenon with potential to cause
disruption or damage to humans and environment
CHN - LOCAL GOVERNMENT CODE OF 1991
RISK: level of loss or damage that can be predicted from
the point of view of the community
Components:
a. SUSCEPTIBILITY: factors allowing hazard to cause
an emergency
b. VULNERABILITY: factors whih allows hazard to
cause a disaster
CHN - SENTRONG SIGLA
Levels of Certification
1. BASIC SENTRONG SIGLA CERTIFICATION:
minimum input, process, and output for 4 core programs
and basic curative services
2. SPECIALTY AWARDS: 2nd level quality standards
for 4 core programs
3. AWARD FOR EXCELLENCE: highest level quality
standards for maintaining level 2 for at least 3
consecutive years
Purpose of Disaster Plan:
* Effective Response to both internal and external
disaster
* Identify hospital capability
* Identify responsibilities of individuals and departments
* Identify standard operating guidelines for emergency
CHN
HIV Transmission: Vertical Versus Horizontal
VERTICAL : from mother to infant during birth; a baby
comes out vertically from the pelvis
HORIZONTAL: through body fluids; sexual intercourse
occurs in a horizontal position
CHN
REQUIREMENTS OF A BLOOD DONOR:
- Weight: 45 kg (100 lbs) for 250 ML of blood
- Weight: 50 kg (110 lbs) for 450 ML of blood
- Be in GOOD HEALTH
- 16-65 y/o (16-17 with parental consent)
- SBP: 90-160 mmHG, DBP: 60-100 mmHG
- HgB: 12.5 g/dl

CHN
VITAL STATISTICS
- Indices of the health and illness status of the
community
- Serves as the bases for planning, implementing,
monitoring and evaluating community health nursing
programs and services
CHN -- CBQ!!
According to RA 9173, NURSES working in a PUBLIC
HEALTH INSTITUTION must have a salary not lower
than SALARY GRADE 15 (P 24,887)
CHN
HEALTH THREAT: conditions conducive to disease,
accident or failure to realize one's potential.
Example:
> Familial Hx of Disease
> Unhealthy lifestyle
CHN
HEALTH DEFICIT
- failure in health maintenance
- gap between actual and achievable health status
Example:
> Disability
> Leg amputation
> no regular check up
CHN
FORESEEABLE CRISIS
- anticipated periods of unusual demand on the
individual or family in terms of adjustment or family
resources
Example:
> Marriage
> Pregnancy
> Menopause

CHN
PRIORITIZING HEALTH PROBLEMS
- Nature of the Problem: categorized into Health Deficit,
Health Threat and Foreseeable Crisis (Search in the
Group for Definition)
Health Deficit: 3
Health Threat: 2
Foreseeable Crisi: 1

- Modifiability of the Problem: probability of success in

minimizing, alleviating or totally eradicating problem
through intervention
Easily modifiable: 2
Partially modifiable: 1
Not modifiable: 0
-Preventive Potential: nature and magnitude of future
problems that can be minimized or totally prevented if
intervention is done
High: 3
Moderate: 2
Low: 1
- Salience: family's perception and evaluation of the
problem in terms of seriousness and urgency of attention
needed
Serious Problem; Immediate attention: 2
A problem; not needing Immediate attention: 1
Not a felt need: 0
CHN
ELEMENTS of Primary Health Care
Education for Health
Locally Endemic Disease Control
EPI
Maternal and Child Health
Essential Drugs made available
Nutrition
Treatment of CD and NON-CD
Sanitation: Water and Environment
CHN
Cornerstone of PHC (S.C.A.M.)
Support Mechanism made available
Community's Active Participation
Appropriate Technology
Multi-Sectoral Linkages

CHN - CD
"All Contagious Disease are INFECTIOUS, but NOT all
Infectious Disease are contagious"
CHN - CD
Stages of Disease
1. Incubation Period
2. Prodromal Period
3. Stage of Illness
4. Convalescence
Stages of Diseases
1. INCUBATION PERIOD: period from FIRST
EXPOSURE to causative agent to appearance of FIRST
SIGNS & SYMPTOMS
2. PRODROMAL PERIOD
- aka Catarrhal Period
- 1st appearance of Signs and Symptoms to appearance
of PATHOGNOMNIC SIGN
3. STAGE OF ILLNESS
- manifestation of ALL SIGNS & SYMPTOMS of
disease
4. CONVALESCENCE
- stage of recovery
- signs & symptoms are gradually DISAPPEARING
CHN
Ratio to Population
Midwife- 1:5,000
Physician- 1:20,000
Nurse- 1:20,000
Dentist- 1:50,000

CHN
Framework of DOH = FOURmula One for HEALTH
"Be.Mor.E."
BEtter Health Outcome
MORe Responsive Health System
Equitable Health Care Financing
CHN
4S Laban sa Dengue
Search and Destroy
Seek Early Treatment
Self-protection measures
Say NO to Indiscriminate fogging
CHN
PLASMODIUM KNOWALESI - newest known stray of
malaria
CHN
We use the principle of F.E.F.O - First Expiry, First Out
to assure that all vaccines are utilized before its expiry
date
CHN
Temperature monitoring of vaccine is done TWICE to
monitor break in COLD CHAIN
1. Early in the morning
2. Afternoon, before going home
PHARMA / CHN / CD
TB DRUGS
RIFAMPICIN
- S/E is Red - oRange urine -- Reassure!
- taken before meals
ISONIAZID
- inhibits RNA synthesis
- given with Vit. B6 (Pyriddoxine) preventing Peripheral
Neuritis
- alcohol is PROHIBITED
PYRAZINAMIDE
- increase fluid intake
- nephro and hepatotoxic
- Benadryl should be at bedside
- may cause pruritis

ETHAMBUTOL
- not given to children < 6 y/o, may cause OPTIC
NEURITIS manifested by COLOR BLINDNESS
- assess Visual Acuity and Color Discrimination every 24 weeks
STREPOMYCIN
- may cause OTOTOXICITY
- inhibits protein synthesis
R.E.P. (Rifampicin, Ethambutol, Pyrazinamide) are
known REPlication Inhibitor
CHN / CD
TB CATEGORY & TREATMENT
CATEGORY I
- new smear (+) PTB
- new smear (-) PTB with extensive parenchymal lesion
on CXR
- Extrapulmonary PTB
CATEGORY I treatment
Intensive: 2RIPE
Continuation: 4RI
CATEGORY II
- treatment failure
- RELAPSE!!!
- return after default
CATEGORY II treatment
Intensive: 2 months RIPES / 1 month RIPE
Continuation: 5 months RIE
CATEGORY III
- new smear (-) PTB with minimal parenchymal lesions
on CXR
CATEGORY III treatment
- same as CATEGORY I
- Intensive: 2 months RIPE
- Continuation: 4 months RI

CATEGORY IV
- chronic (still smear positive after supervised retreatment)
CATEGORY IV treatment
- Refer to specialized facility
- refer to DOTS center
- refer to Provincial/ City NTP coordinator
CHN
COMMUNITY ORGANIZING
- includes: social organization, ideology and change
agents
- this change is termed "EMPOWERMENT"
- building capability of people for future community
action
5 STAGES OF C.O. (C.D. Ibalik, Please, Dali!)
1. (C.) Community Analysis
2. (D.) Design & Initiation
3. (Ibalik) Implementation
4. (Please) Program Maintenance - Consolidation
5. (Dali)Dissemination Reassessment
1. COMMUNITY ANALYSIS
- assessing & defining needs, opportunities and
resources
- aka COMMUNITY DIAGNOSIS, mapping,
health education planning
2. DESIGN & INITIATION
- establish core planning group
- choosing organizational structure
- recruit org members
- define mission & goals
- clarify roles & responsibilities
- provide training
3. IMPLEMENTATION
- put design plans into action
- generate broad citizen participation
- develop sequential work plan
- use comprehensive, integrated strategies
- integrate community values into programs and
materials
4. Program Maintenance - CONSOLIDATION
- has some degrees of success
- CO is gaining acceptance
- integrate interventions into community
networks
- establish positive organizational culture

- establish ongoing recruitment plan

- disseminate results
5. Dissemination - Reassessment
- continuous assessment
- Formative Evaluation (to provide timely
modification of activities)
- updating CDx
- Assess effectiveness of programs
- chart future directories
- summarize and disseminate results
CHN
AO 2010-0036: AHA:UHC
Aquino Health Agenda: Achieving Universal Health
Care
CHN
Universal Health Care
- also referred as Kalusugan Pangkalahatan (KP)
- provision to every Filipino of the highest possible
quality of health care that is ACCESSIBLE,
EFFICIENT, EQUITABLY DISTRIBUTED,
ADEQUATELY FUNDED, FAIRLY FINANCED and
APPROPRIATELY used by informed and empowered
public

UHC'S 3 THRUSTS (A.F.I.)

1. Attainment of Health-related MDGs
2. Financial Risk Protection
3. Improved Access to Quality Hospitals and Health
Care Facilities
CHN
ALAGA KA program
- to ensure that indigent members are made aware of
how to avail basic health services in rural health units
and health centers.

CHN
NURSE DEPLOYMENT PROJECT 2014 (NDP) is
sometimes referred as RN Heals 2014 (Registered
Nurses for Health Enhancement and Local Service)
CHN / PEDIA
Newborn Screening costs 550.00 PESOS
FUNDA/ CHN
VULNERABLE POPULATIONS- group of patients
who are more likely to develop health problems as a
result of excess health risks (children, mothers, elders)
CHN
Primary Responsibility: HEALTH TEACHING
CHN
FAMILY: unit of service in the community
CHN
In the community, nurses are considered as
GENERALISTS.
CHN
MAYOR = serves as CHAIRMAN of MUNICIPAL
HEALTH BOARD
MUNICIPAL HEALTH OFFICER = VICECHAIRMAN
CHN
BAR GRAPH: to present comparison of values
LINE GRAPH: trends over time or age
PIE GRAPH: population composition or distribution
SCATTER DIAGRAM: correlation of two variables.

MCN
The gynecoid pelvis is most ideal for delivery.
Other types include platypelloid (flat), anthropoid
(apelike), and android (malelike).
MCN
Uterine Contractions
Frequency - is the time from the beginning of one
contraction to the beginning of the next.
(measured in minutes)
MCN
STAGES F LABOR
First Stage - begins with the onset of labor and ends with
full cervical dilation at 10 cm.
Second stage - begins with full cervical dilation and ends
with the neonates birth.
Third Stage - begins after the neonates birth and ends
with expulsion of the placenta.
Fourth Stage - Recovery. (postpartum stabilization)
lasts up to 4 hours after the placenta is delivered. This
is the time needed to stabilize the mothers physical and
emotional state after the stress of childbirth.
MCN
PLACENTA PREVIA
ABRUPTIO PLACENTA
PAIN
PP - Painless ( since abnormal implantation lang naman)
AP - Painful ( since premature separation naman ang
nangyari.)

MCN
Nursing Interventions for PLACENTA PREVIA
1. Bed Rest.
2. Positioning the patient on her left side for maximum
fetal perfusion
3. Monitoring fetal heart tones
4. Monitor the bleeding.
Time it began.
Color: the redder the blood indicates the blood is
fresher or is continuing
Mother's estimation of the amount of blood and what
she has done for the bleeding
5. Administering I.V. fluids and oxygen, as ordered.
ABRUPTIO PLACENTA
Position - LATERAL (this is to prevent pressure on the
vena cava)

PEDIA
CREDES PROPHYLAXIS prevents ophthalmia
neonatorum due to gonorrhea or chlamydia
PEDIA
Wong-Baker Faces Pain Rating Scale

PEDIA -- UPDATE!
6 Detectable Metabolic Disorders in Newborn Screening
(before, it was only 5)
1. Congenital Hypothyroidism
2. Congenital Adrenal Hyperplasia
3. Glucose6 Phosphate Dehydrogenase (G6PD)
4. Galactosemia
5. Phenylketonuria (PKU)
6. Maple Syrup Urinary Disorder (MSUD) -- newest!
Treatment includes eating a protein-free diet since it
cannot metabolize or break down aminoc acids.

PEDIA
SOLITARY PLAY : Infancy (Plays alone)
PARALLEL PLAY : Toddler (2 toddlers play
alongside with SAME TOY)

PEDIA - Diagnostic Exams

Down Syndrome - Chromosomal Analysis
Huntington Disease - DNA Analysis
Sickle Cell Anemia - Hemoglobin Electrophoresis
Thalassemia - Complete Blood Count (CBC)

PEDIA
ANTERIOR FONTANEL closes between 12-18 months
(BUNBUNAN)

PEDIA -- COMMON BOARD QUESTION!!!

Weight of an infant (from date of birth) must be:
within 6 months = DOUBLED!
within 12 months = TRIPLED!!

PEDIA
At 5 y/o, a child can draw a person with 6 body parts,
can name 6 colors, can walk well and hop and can draw
a square.

PEDIA
MEDULLABLASTOMA is the most common brain
tumor in children.

PEDIA
RETROLENTAL FIBROPLASIA is blindess as a result
of administering high level of oxygen to a premature
neonate
PEDIA
Solid food introduction
Start: 4 months
Best: 6 months
Rice cereal fruits vege egg yello
PEDIA - TODDLER must be given PRAISE
(Characteristics of Toddlers)
Parallel Play
Ritualistic (Routinary)
Autonomous
Include parents for Supervision
Safe environment provision
Explorer; Elimination (Must be toilet trained)

PEDIA
(+) BABINSKI REFLEX is the toe fanning when
stroked from heel-to-toe. It is NORMAL from 0-18
months (before the child learns to walk independently)
PEDIA
LECITHIN:SPINGOMYELIN RATIO
> determing fetal lung maturity
> Normal L:S Ration is 2:1
PEDIA
ESPHAGEAL ATRESIA is the failure of the esophagus
to form continuous passage from the pharynx to the
stomach during embryonic development
PEDIA
In an infant, a bulging fontanel is the most significant
sign of increasing intracranial pressure.

PEDIA
FAILURE TO THRIVE: infant who falls below the fifth
percentile for weight and height on a standard
measurement chart.
PEDIA - PUBERTY
THELARCHE: budding of the breast; 1st sign of
puberty in GIRLS
MSN / PEDIA
REYE'S SYNDROME: acute encephalopathy after a
viral illness. Diagnosed by LIVER BIOPSY
PEDIA
LOGAN BAR: apparatus used to protect surgical
incision for cleft lip repair
PEDIA
COORDINATION of the large muscle is gained by age
3.
Age 3 = can ride a TRIcycle.
PEDIA
LATCHKEY CHILDREN: children having NO ADULT
SUPERVISION
PEDIA - IICP - COMMON BOARD EXAM
QUESTION!
A high shrill cry in an infant can be a sign of IICP.
PEDIA - EENT
STRABISMUS
> eyes NOT aligned because there is NO coordination of
extraocular muscles
S/Sx
> Crossed eyes (shown in picture above)
> loss of binocular vision
> frequent headaches
> diplopia (double vision)
> photophobia
Management:
> Corrective lenses
> Patching the GOOD EYE strengthening the weak eye
(REMEMBER!!)

Surgical Management:
> Strabismus surgery aka Extraocular muscle surgery -realign weak extraocular muscle before 2 years of age
Normal 1-4 months strabismus
more than 4 months pathological
PEDIA - ENT
PRESBYCUSIS- sensorineural hearing loss assoc with
AGING
S/Sx
- gradual and bilateral hearing loss
- client states having no problem hearing but cannot
understand what the words are
- client thinks speaker is mumbling
PEDIA
CLEFT PALATE increases the risk of OTITIS MEDIA
(male)
PEDIA
TEMPER TANTRUMS
in Toddler: an effort to exert independence
in Children: way of expressing feelings or frustrations
Advise parents to IGNORE, but ensure safety!
PEDIA
Erythroblastosis fetalis is the destruction of red blood
cells that results from an antigen-antibody reaction.
- characterized by hemolytic anemia or
hyperbilirubinemia.
It is due to Rh incompaibility of the mother and the
newborn.
PEDIA
CRYPTORCHIDISM- failure of ONE or BOTH testes to
descend to scrotum; risk for TESTICULAR CANCER if
not corrected.
PEDIA
CELIAC DISEASE- aka gluten enteropathy or celiac
sprue
- intolerance to gluten (found in wheat, barley, rye, oats)

PEDIA - APGAR
APGAR score of:
7-10: No immediate distress
4-6: Moderate distress
0-3: Severe distress
CHN / PEDIA
PREMATURITY is the leading cause of NEONATAL
deaths in 2010
ASPHYXIA is the 2nd leading cause.
PEDIA
IMPERFORATE ANUS: Incomplete development or
absence of the anus in its normal position in the
perineum
PEDIA
In administering medications in infants, the nurse must
perform procedure quickly; then offer comfort measures,
such as holding, rocking, and cuddling.
PEDIA
SUDDEN INFANT DEATH SYNDROME (SIDS) refers
to unexpected death of an apparently healthy infant
younger than 1 year for whom an investigation of the
death and a thorough autopsy fails to show an adequate
cause of death.
-- EXACT CAUSE IF UNKNOWN!

PEDIA - ERIKSON'S PYSCHOSOCIAL DEV'T

1. INFANCY: Trust vs Mistrust
- 0 to 18 months
- TASK: attachment to main provider
- SUCCESS: trust in persons; faith and hope about the
environment and future
2. EARLY CHILDHOOD: Autonomy vs Shame and
Doubt
- 18 months to 3 years
- TASK: gaining basic control over self and environment
- SUCCESS: (+) sense of control and adequacy
3. LATE CHILDHOOD: Initiative vs Guilt
- 3 to 6 years
- TASK: becoming purposeful and directive
- SUCCESS: initiate one's own activities
4. SCHOOL AGE: Industry vs Inferiority
- 6 to 12 years
- TASK: Developing social, physical and learning skills
- SUCCESS: Ability to learn and work; Competence
5. ADOLESCENCE: Identity vs Role Confusion
- 12 to 20 years
- TASK: Developing sense of identity
- SUCCESS: Sense of personal identity

PEDIA - FREUD'S PSYCHOSEXUAL DEV'T

1. INFANCY: Oral stage
- explores the world by mouth, esp. the tongue
- provide oral stimulation; encourage breastfeeding
2. TODDLER: Anal stage
- learns to control urination & defecation
- help achieve bowel & bladder control even hospitalized
without undue emphasis on its importance
3. PRESCHOOL: Phallic stage
- child learns sexual identity by genitalia awareness
- accept children's interest such as fondling own genitalia
- parents should answer questions on birth or sexual
differences
4. SCHOOL AGE: Latent stage
- child's personality development appears nonactive/
dormant
- help children to have positive experiences with
learning to let self-esteem grow
5. ADOLESCENT: Genital stage
- adolescent develops sexual maturity and establish
satisfactory relationship with opposite sex
- provide opportunities to relate with opposite sex; allow
verbalization on new relationships
PEDIA - NEURO
HYRDROCEPHALUS- imbalance of CSF absorption or
production caused by malformations, tumors,
hemorrhage, infections or trauma
- results in head enlargement and increased ICP
Types of Hydrocephalus
1. COMMUNICATING: impaired ABSORPTION
within subarachnoid space
2. NONCOMMUNICATING: OBSTRUCTION of CSF
in ventricular system
S/Sx in infants
- increased head circumference
- Macewen's sign on percussion (Thin, widely separated
bones producing cracked-pot sound)
- Bulging, nonpulsating anterior fontanel
- dilated scalp vein
- frontal bossing
- setting sun eyes

Surgical Management: prevent further CSF

accumulation by draining fluid from ventricles
- Ventriculoperitoneal shunt: CSF drains into peritoneal
cavity from lateral ventricle
- Ventriculoatrial shunt: CSF drains into right atrium of
the heart from lateral ventricle, bypassing the obstruction
PEDIA - NEURO
MENINGITIS
- an infectious process of the central nervous system
caused by bacteria or viruses
- Diagnosis: Lumbar Puncture testing the CSF
- (+) Meningitis: fluid is cloudy with increased pressure,
increased white blood cell count, elevated protein, and
decreased glucose levels.
MENINGITIS:
- Causes:
a. BACTERIAL MENINGITIS: Haemophilus influenzae
type B, Streptococcus pneumoniae, or Neisseria
meningitidis; MOT is by droplets from nasopharyngeal
secretions
b. VIRAL MENINGITIS: mumps, paramyxovirus,
herpesvirus, and enterovirus.
MENINGITIS:
S/Sx include:
- Fever, chills, headache
- Vomiting, diarrhea
- Poor feeding or anorexia
- Nuchal rigidity
- Poor or high shrill cry
- Positive Kernigs sign (inability to extend the leg when
the thigh is flexed anteriorly at the hip) and Brudzinskis
sign (neck flexion causes adduction and flexion
movements of the lower extremities) in children and
adolescents -- CBQ!!
Interventions
- Respiratory isolation precautions until 24 hours after
the start of antibiotic therapy
- Administer antibiotics and antipyretics as prescribed
- Monitor for seizures
- Assess for changes in level of consciousness and
irritability
- Monitor for a purpuric or petechial rash and for signs
of thromboemboli
-

SPINA BIFIDA
- results from failure of the neural tube to close during
embryonic development
Types of SPINA BIFIDA
1. SPINA BIFIDA OCCULTA
- Posterior vertebral arches fail to close in the
lumbosacral area.
- Spinal cord remains intact and usually is not visible.
- Meninges are not exposed on the skin surface.
- Neurological deficits are not usually present.
2. SPINA BIFIDA CYSTICA
- Protrusion of the spinal cord or its meninges or both
occurs.
- Defect results in incomplete closure of the vertebral
and neural tubes, resulting in a sac-like protrusion in the
lumbar or sacral area, with varying degrees of nervous
tissue involvement.
- Defect can include meningocele, myelomeningocele,
lipomeningocele, and lipomeningomyelocele.
3. MENINGOCELE
- Protrusion involves meninges and a sac-like cyst that
contains CSF in the midline of the back, usually in the
lumbosacral area.
- Spinal cord is not involved.
- Neurological deficits are usually not present.
4. MYELOMENINGOCELE
- Protrusion of the meninges, CSF, nerve roots, and a
portion of the spinal cord occurs.
- The sac (defect) is covered by a thin membrane prone
to leakage or rupture.
- Neurological deficits are evident.

PEDIA - ENT
CONJUNCTIVITIS
- Also known as pinkeye; an inflammation of the
conjunctiva
- Caused by allergy, infection, or trauma.
S/Sx include:
- Itching, burning, or scratchy eyelids
- Redness
- Edema
- Discharge
Interventions:
- Advise good handwashing and not sharing towels and
washcloths.
- Administer antibiotic or antiviral eye drops or ointment
as prescribed if infection is present
- Instruct the parents that the child should be kept home
from school or day care until antibiotics have been
administered for 24 hours -- CBQ!
FUNDA / PEDIA
We should advise the mother to AVOID putting
medications in foods because it may cause an unpleasant
taste to the food, and the child may refuse to accept the
same food in the future.
PEDIA
ACROCYANOSIS: blueness of hands and feet, is a
normal newborn phenomenon in the first 24 to 48 hours
after birth.
** RN to explain it is NORMAL!
** No further management!
PEDIA
CAPUT SUCCEDANEUM: edema of the soft tissue
over bone
-- nawawala rin after ilang araw
PEDIA
Bowel Control is achieveb by 18mos.
*Daytime Bladder Control by 24mos.
*Nightime Bladder Control by 36mos

PEDIA
Associative or Coorperative play is the play of
preschoolers such as dramatic play or lego erector
set(6yrs old).
Solitary Play is for infants.
Parallel Play is for toddlers.
Competitive Play is for school age and
Adolescents.
PEDIA
Babies weight doubles by 5-6months
Triples by 1 year
Quadruples by 2-2 1/2years
ALERT ALERT ALERT THIS IS A COMMON BOARD
QUESTION!!!
PEDIA
Masturbation among preschoolers is a sign of boredom
therefor the best nursing intervention is to DIVERT
THEIR ATTENTION TO OTHER ACTIVITIES which
are productive.
PEDIA
Masturbation among preschoolers is a sign of boredom
therefor the best nursing intervention is to DIVERT
THEIR ATTENTION TO OTHER ACTIVITIES which
are productive.
PEDIA
Children are able to write legibly when they reach 10
years old
PEDIA
FIRST SIGN of sexual maturation in boys is
Enlargement of Penis and testes while the last sign is
production of viable sperm.
PEDIA
NORMAL HOMOSEXUALITY is evident among 8
year old children.
PEDIA
Oxytocin is the hormone responsible for letdown reflex.
Prolactin is the hormone for breastmilk production.

PEDIA
Silverman Anderson Index is a tool used to evaluate the
respiration of the newborn.
Ballards and Dobowitz is the tool to determine the age of
Gestation.
Apgar Scoring is used to determine newborns' wellbeing
PEDIA
Cyanotic Heart Defect follows right to left shunting
while Acyanotic is left to right shunting
PEDIA
Classic characteristic of Coarctation of Aorta is that Bp
is higher on upper extremeties while lower on lower
extremities.
Tet spells, squatting and polycythemia are characteristics
of Tetralogy of Fallot.
PEDIA
Hemophilia has an X linked recessive pattern of
inheritance. In such case the mother is the carrier and the
son is usually the affected. If the father is affected, he
would transmit the disease to his daughter offspring.
ALERT ALERT ALERT!!! COMMON BOARD
QUESTION!!!
PEDIA
Infant Skills
4 to 5 MONTHS
-Grasps object*
-Switch objects from hands
-Rolls over for the first time*
-Enjoys social interaction
-Begins to show memory
-Aware of unfamiliar surroundings
8 to 9 MONTHS
-Sits steadily unsupported*
-Crawls*
-May stand while holding on*
-Begins to stand without help
10 to 11 MONTHS
-Can change from prone to sitting position*
-Walks while holding on to furniture*
-Stands securely*

12 to 13 MONTHS
-Walks with one hand held*
-Can take a few steps without falling
-Can drink from a cup
14 to 15 MONTHS
-Walks alone*
-Can crawl up stairs*
-Shows emotions such as anger and affection
PEDIA
Infant NUTRITION
Solid foods are introduced at 6mos. It could be
STRAINED, PUREED or FINELY MASHED.
Give solids one at a time with 4 to 5 days intervals, to
identify FOOD ALLERGIES
PEDIA
Infant NUTRITION
AVOID solid foods that places infant at risk for
CHOKING, such as NUTS, foods with SEEDS,
RAISINS, POPCORN, GRAPES and HOTDOG
PIECES.
Or anything ROUND similar to the size of the airway.
Pedia
Infant NUTRITION
Sequence of introduction of solid foods:
Iron- fortified rice cereal, fruits, vegetables, then meats!
PEDIA
Essential Newborn Care/Unang Yakap
- under A.O 2009-0025
-mandated on Dec 09, 2009
PEDIA
Signs of Increase ICP
-bulging fontanelles
-widened suture lines
-high pitch cry
-projectile vomiting
-hyperthermia
-decrease PR
-decrease RR
-high blood pressure

PEDIA
Nevus Flammeus
-"port wine stain"
-flat and does not disappear
-macular purple or dark red capillary angioma
PEDIA
Telangiectatic Nevi
-"stork's bite"
-red or light pink dilated capillaries
-flat and does not disappear
Pedia
Cleft Lip and Cleft Palate are congenital anomalies that
occur as a result of failure of soft tissue or bony structure
to fuse during embryonic development.
o Cheiloplasty/Z-plasty- cleft lip repair is performed by
age of 3 to 6 months (as per sucking and oral needs
o Uranoplasty/Palatoplasty- cleft Palate repair is
performed between 6 and 24 months to allow palatal
changes and closed as early as possible to facilitate
speech development. they are at risk of having EAR
problems.
Cheiloplasty/Z-plasty
PRE-OP:
- Feeding technique: dropper with SAP: drop at the sides
of the mouth
- Do not use nipple since the baby cant have negative
pressure
POST-OP:
- NEVER POSITION ON PRONE and on the side of the
repair
- To prevent tension on the suture lines and hold sutures
in place use LOGAN bar
- Anticipate needs to lessen crying
- Use of arm or elbow restraint to prevent traumatizing
the site
- Restraints removed every 2 hours; THIS NEEDS
CONSENT
- Clean suture lines after feeding with normal saline;
monitor for signs of infection

Uranoplasty/Palatoplasty
POST- OP:
- SHOULD BE POSITIONED ON PRONE: To promote
natural drainage of secretions
- Observe for bleeding: Frequent swallowing is the
common sign
- Use ELBOW RESTRAINT: To protect suture lines and
prevent the child touching the suture site
- Feeding device post-op
Drink from CUPS
AVOID use of oral suction or placing objects on mouth
such as tongue depressor, thermometer, straw, spoon and
forks or pacifiers.
- Speech Rehabilitation/Hearing Test
Pedia
Cleft lip
- predisposing factors
heredity
maternal smokin (low birth wt)
fetal withdrawal syndrome (no nosebridge)
sex - common in male
Pedia
Rule of 10 for Cheiloplasty
10 wks - stable immune system
10 pounds - because no feedin after surgery
10k Wbc
10 hgb
Pedia
ESOPHAGEAL ATRESIA
No connection between the upper and lower segment of
the esophagus ending in a blind pouch
Manifestations
- Frothy saliva in the mouth and nose and excessive
drooling
Pedia
TRACHEOESOPHAGEAL FISTULA
- Fistula between esophagus and trachea
Problems:
Aspiration
Possible cause of death
Nutrition
Manifestations
Observe reaction of baby to feeding:

3 Cs during feeding:
- COUGHING
- CHOKING
- CYANOSIS
Regurgitation and vomiting
Esophageal Atresia and Transesophageal Fistula
Management:
- Maintenance of airway
- prevention of aspiration pneumonia
- gastric or blind pouch decompression
- supportive therapy
- surgical repair
Pedia
Gastroesophageal Reflux Disease
- it is a backflow of gastric contents into esphagus as a
result of relaxation or incompetence of lower esophageal
or cardiac sphincter.
- common manifestation: NON-PROJECTILE
VOMITING
- if severe, surgery may be done. FUNDOPLICATION
(a wrap to the stomach fundus is made around the distal
esophagus to restore competence of lower e. sphincter)
Management:
- Upright position 30 mins after feeding
- provide small, frequent meals with predigested formula
- use thickened formula by adding rice cereal to milk
formula
- use of cross- cut nipples
- avoid feeding child with fatty foods, chocolate, tomato
products, carbonated liquids, fruit juices, citrus products
and spicy foods

Pedia
Pyloric Stenosis
- hypertrophy of the circular muscles of pylorus causes
narrowing of the pyloric canal between the stomach and
the duodenum and blocking food from entering the
baby's small intestine
- PYLORUS is a muscular valve that holds food in the
stomach until it is ready for the next stage in the
digestive process.
Manifestations
- Positive peristaltic wave (waterbed)
- PROJECTILE VOMITING (yellow, acidic, sour
smell): Milk (curdles)
- Palpable olive-shaped mass in RUQ
- (+) string sign on Upper GI series (narrowing in the
pylorus)
- Dehydration
- Metabolic alkalosis
- Hypokalemia
- Weight loss
Surgery
Fredet-Ramstedt Procedure: Pyloromyotomy with
pyroplasty
- incision through the muscle of pylorus may be with
laparoscopy
Pre-op
- Correct existing fluid and electrolyte imbalance
IVF for dehydration
KCL for hypokalemia and alkalosis
- Correct nutritional imbalance
Thickened formula/TPN PRN
Rice cereal (cerelac)
Denser, heavier feeding are more difficult to vomit
Pedia
INTUSSUSCEPTION
- telescoping or invagination of portion of the intestine
into the lumen of another
- results to obstruction to the passage of intestinal
contents
- obstructing blood supply to the affected part
Manifestations:
- bile stained vomiting (green, bitter) since it comes
small intestines
- currant jelly stools (blood with mucus in the stool)
- collicky abdominal pain

- sausage-shaped mass on abdomen

- Appendix might burst leading to perforation then
peritonitis
Management:
- Barium Hydrostatic Reduction Technique: use to
reduce telescoping given under pressure

Pedia
IMPERFORATE ANUS
- More common in girls
Manifestations:
- Failure to pass out meconium stool
- absence or stenosis of anal rectal canal
- presence of anal membrane
- external fistula to perineum
----> If female: meconium passes via vagina (rectovaginal fistula)
----> If male: meconium passes through urinary bladder greenish urine (recto-vesical fistula)
Pedia
Hirschsprung's Disease
- also known Congenital Aganglionic Megacolon
- Ganglion cells- nerve supply, nerve cells
- aganglionic: absence of parasympathetic nerve supply
(ganglion cells) on the large intestines
- mechanical obstuction may occur because of
inadequate motility in affected part
- 4 segments of large intestine that may be affected:
Ascending,Transverse, Descending, Recto-sigmoid
Manifestations:
Early sign: Delayed meconium
Late signs:
- Constipation (stool is very hard, quality!)
- Ribbon-like/pellet-like stool early signs
- Abdominal distention with possible fecaloid vomitus
- Weight loss
MSN - CARDIO

AUTOMATICITY- the ability of cardiac cells to initiate

an impulse spontaneously and repetitively without
external neurohormonal control

ANGINA PECTORIS
Decreased Myocardial Oxygenation ---> Anaerobic
Metabolism ---> Lactic Acidosis ---> Chest Pain

MSN - CARDIO
PERCUTANEOUS TRANSLUMINAL CORONARY
ANGIOPLASTY (PTCA) - invasive nonsurgical dilation
of arteries with a balloon catheter to open vessel lumen
and improve arterial blood flow

ANGINA PECTORIS (S.A.V.E.R.S.)

Substernal
Anterior Chest
Vague
Exertion-related
Relieved by rest or nitrogylcerine
Short duration (< 30 minutes)

MSN - CARDIO
ARTERIOSCLEROSIS- hardening of the arteries.
- diffuse process whereby the muscle fibers and the
endothelial lining of the walls of small arteries and
arterioles become thickened.

MSN - CARDIO
Myocardial Ischemia: < 30 minutes
Myocardial Infarction; > 30 minutes, treatment is
MONA (Morphine, O2, Nitrates, Aspirin)

MSN - CARDIO
ENDOCARDITIS - inflammation of the endocardium or
heart valves.

According to American Nurses today, the order should

be: OANM. Oxygen, Aspirin, Nitrates, Morphine.

S/Sx:
> Weakness & fatigue
> weight loss & anorexia
> arthralgia
> splenomegaly
> heart murmurs

MSN - CARDIO
NITROGLYCERIN THERAPY
NTG- direct relaxing effect on vascular smooth muscle =
GENERALIZED VASODILATION
- CORONARY VASODILATION redistributes
myocardial blood flow efficiency

MSN - CARDIO
ANGINA PECTORIS (MYOCARDIAL ISCHEMIA)
- transient chest pain caused by INSUFFICIENT
BLOOD FLOW to the myocardium
- myocardial O2 demand > myocardial O2 supply

NITROGLYCERIN THERAPY
- client must assume sitting/ supine position
- MAX of 3 doses, 5 minute interval
- gradual change of position
- offer sips of water before sublingual nitrates; dryness
of mouth may inhibit drug absorption
- advise client to always carry 3 tablets

Indication that the patient is suffering from angina:

Levine's Sign
Management: sublingual nitroglycerin. If conditions
persist continue to give NTG every 5 mins for a total of
3 NTG. If pain persists and not relieved after rest and
drugs, contact local emergency department, the patient
may be experiencing MI
Adminiter Morphine as prescribed by the Physician to
reduce pain and allay anxiety. Then provide
supplemental oxygen and obtain ECG.
Morphine is administered IV, 2-4mg every 10-15
minutes.
MSN - CARDIO

MSN - CARDIO
3 areas which is developed in MI:
1. ZONE OF INFARCTION: pathologic Q wave
2. ZONE OF INJURY: elevated ST segment
3. ZONE OF ISCHEMIA: T wave inversion
Tschemia(inverted t wave), injuryST(st segment
elevation) and infarQ(prolonged or pathologic Q wave)

MSN - CARDIO

MYOCARDIAL INFARCTION: formation of localized

areas within myocardium. It is followed by abrupt
cessation of blood and oxygen to the heart muscle.
MSN - CARDIO
BUERGER'S DISEASE
- aka Thromboangitis Obliterans
- diffuse inflammation of small and medium arteries,
followed by veins
- inflammation and fibrosis of nerves
- MALES are commonly affected
- most common etiologic factor is CIGARETTE
SMOKING
- most characteristic clinical manifestation is
INTERMITTENT CLAUDICATION (pain on calf, foot
or thigh DURING exercise)
Health teaching:
SMOKING CESSATION!
MSN - CARDIO
Angina Precipitating Factors: 4 Es
Exertion: physical activity and exercise
Eating too much
Emotional distress
Extreme temperatures: hot or cold weather
MSN - CARDIO
PACEMAKER: is an electronic device that provides
electrical stimuli to the heart muscle
- usually used when a patient has a slower-than-normal
impulse formation or a conduction disturbance that
causes symptoms.

MSN - CARDIO
PACEMAKER is a temporary or permanent device that
provides electrical stimulation and maintains heart rate
when client's intrinsic pacemaker fails to provide
perfusing rhythm.

MSN - CARDIO (HEMA)

BLOOD TRANSFUSION
- to improve oxygen transport (RBC)
- for volume expansion (Whole blood, Plasma, Albumin)
- provision of proteins
- provision of coagulation factors
- provision of platelets
MSN - CARDIO (HEMA)
IRON DEFICIENCY ANEMIA (IDA)
- microcytic, hypochromic RBCs caused by inadequate
absorption or excessive loss of Iron
-- maputla na, maliit pa ang RBC!
MSN - CARDIO -- CBQ!!
Parts of ECG
P WAVE: atrial depolarization
QRS Complex: ventricular depolarization
T WAVE: ventricular repolarization
PR SEGMENT
- end of P wave to start of Q wave
- conduction time of AV node
- PROLONGED in 1st DEGREE HEART BLOCK
MSN - CARDIO (HEMA)
ANEMIA: hemoglobin concentration is lower than
normal
- fewer than normal number of erythrocytes within the
circulation
- amount of O2 delivered to tissues is diminished
Anemia is NOT a DISEASE! It is a sign of an
underlying disorder!
MSN - CARDIO (HEMA)
IRON DEFICIENCY ANEMA is the most common type
of anemia in all age groups and in the world.
MSN - CARDIO
CK-MB level is used to assess TISSUE DAMAGE in
MYOCARDIAL INFARCTION
MSN - CARDIO (HEMA)
PERNICIOUS ANEMIA results from malabsorption of
Vitamin B12 in the GIT
MSN - CARDIO
MYOCARDIAL INFARCTION pain results from
myocardial ischemia caused by anoxia
MSN - CARDIO -- CBQ!!

INTERMITTENT CLAUDICATION (pain during

ambulation/ movement relieved by rest) is a classic
symptom of ARTERIAL INSUFFICIENCY in the leg
MSN - CARDIO (HEMA)
POLYCYTHEMIA VERA treatment:
- O2 administration
- Radioisotope therapy (Chlorambucil, Nitrogen
mustard) suppressing bone marrow growth
MSN - CARDIO
LEFT-SIDED HEART FAILURE: results in
PULMONARY CONGESTION due to back up of
circulation in the left ventricle
MSN - CARDIO
RIGH-SIDED HEART FAILURE: results in
PERIPHERAL CONGESTION due to back up of
circulation in the right ventricle
MSN - CARDIO
MITRAL STENOSIS: scar tissue is formed secondary to
rheumatic fever forms on the mitral valve
MSN - CARDIO
MITRAL STENOSIS
- results to narrowing and increasing resistance to blood
flow between the left ventricle and left atrium
- heart needs to pump harder to maintain blood flow.
MSN - CARDIO
RHEUMATIC FEVER
- inflammatory, AUTOIMMUNE disease
- affects connective tissues of heart, joints, subq and
blood vessels
Rheumatic Fever's most serious complication is
RHEUMATIC HEART DISEASE (RHD) affecting
Mitral Valve
MSN - CARDIO - CBQ!!!
RF manifests AFTER 2-6 wks after untreated or partially
treated GROUP A BETA-HEMOLYTIC STREP INFXN
of upper respi tract

Jones Criteria for Dx of RF

MAJOR CRITERIA (C.A.K.E.S.)
- Carditis
- Arthralgia
- Korea (Chorea)
- Erythema Marginatum
- SubQ nodules
MINOR CRITERIA
- Fever
- Elevated ESR
- (+) C-reactive Protein
- Prolonged PR interval on ECG
Diagnosis of RF through Jones Criteria
- 2 Major Sx OR
- 1 Major Sx + 2 Minor Sx
-- in addition to elevated ASO (Antistreptolysin O titer)
MSN - CARDIO
ECG CHANGES
Hyperkalemia
- TALL and PEAKED T waves
- PR prolongation
- flat P waves
- widened QRS
HyperK = Hyper din ang T waves = Tall and Peaked!
HYPOKALEMIA
- depressed ST segment
- shallow, flat, inverted T wave
- prominent U wave
-- HYPOK - low = depressed ST seg., baligtad ang T
wave, may bonus pang U wave
HYPOCALCEMIA
- prolonged ST segment
- prolonged QT interval
hypOOcalcemia = prolooonged ST and QT
HYPERCALCEMIA
- shortened ST segment
- widened T wave
HYPERCAL = baligtad kay HYPOCAL, short lang ang
ST segment

HYPOMAGNESEMIA
- Tall T waves
- depressed ST segment
HypoMag - eto lang ang hypo na may TALL T wave
HYPERMAGNESEMIA
- prolonged PR interval
- widened QRS complex
HYPERMAGNESEMIA - pinaka mahabang word, lahat
mahaba = prolonged PR, widened QRS
MSN - CARDIO
AORTIC STENOSIS
- narrowing of aortic valve
- can classified as acquired or rheumatic
- characterized by angina pectoris, dyspnea, palpitations,
syncope
MSN - CARDIO
CORONARY ARTERY DISEASE: narrowing/
obstruction of one or more coronary arteries from
atherosclerosis
MSN - CARDIO
ANGINA PECTORIS goal of treatment: RELIEF of the
acute attack
MSN - CARDIO
STABLE ANGINA
- exertional angina
- from exertion ot emotional stress
- relieved by rest/ NTG
MSN - CARDIO
UNSTABLE ANGINA
- aka preinfarction angina
- unpredictable
- pain may not be relieved by NTG
MSN - CARDIO
VARIANT ANGINA
- aka Prinzmetal's/ Vasospastic Angina
- from coronary artery spasm
- may occur AT REST