TOP THE BOARD EXAM • MDG target- reduction of maternal mortality by

80/100,000 live births (mdg5)

BE A TOP NOTCHER THIS YEAR
• 2/3- reduction of child mortality rate (mdg4)
NLE 2019
• Mdg 5- TARGET 2015

• SDG 3– HEALTH and WELL being Centered ( disease

#NP1 focus : HIV/AIDS , Malaria)

• Primary Health Care and CHN • SDG 6 – SANITATION centered

1. PHC is – essential health care made universally 2030 Agenda for Sustainable Development.
Accessible “Transforming our world”

2. Alma Ata USSR 1st PHC international conference is at- 17 goals target year is 2030
RUSSIA
• Goal 3: Good Health and Well-being (health centered)
3. Implementation of PHC is declared by – WHO
• Goal 6: Clean Water and Sanitation(sanitation
4. 1st Asian country who adopts and implement PHC is – centered)
Philippines
• Goal 11: Sustainable Cities and Communities
5. The legal basis of PHC in the Philippines- L.O.I # 949
Agenda 21 - To Reduce population in the cities
Public health surveillance is - the ongoing / continuous
• VIT C prevents SCURVY(increase intake of fruits)
systematic collection, analysis, and interpretation of
data, closely integrated with the timely dissemination of • Solutions like alcohol must be must be placed in the
these data to those responsible for preventing and BACK of the Public health Bag
controlling disease and injury

Public health surveillance is the cornerstone of public

health practice 4P is Pantawid Pamilyang Pilipino Program

• Active surveillance: a system employing staff members Purpose: cash grants, social assistance, break
to regularly contact heath care providers or the intergenerational poverty
population to seek information about health conditions.
Cash grants :
• Passive surveillance: a system by which a health
300.00 per child up to 3 children a month for education
jurisdiction receives reports submitted from hospitals,
clinics, public health units, or other sources. 500.00 per household per month for 5 years for
nutrition and health
DISASTER is_______ : A disaster is an occurrence
disrupting the normal conditions of existence and
causing a level of suffering that exceeds the capacity of • Vitamin A for postpartum – 200,00 IU one dose
adjustment of the affected community.
• Vitamin A for pregnant– 10,00 IU 2x a week starts at 4
A flash flood is a sudden local flood characterized by a months
great volume of water and a short duration. It occurs
within minutes or hours of heavy rainfall • Vitamin A for Children 12 months and above – 200,00
IU dose every 6 months
PDCA cycle is PLAN DO CHECK ACT
• Tuberculosis / PTB- a highly infectious chronic disease • In August of 1854 Soho, a suburb of London, was hit
that usually affects the lungs. hard by a terrible outbreak of cholera.

Causative Agent: Mycobacterium Tuberculosis (acid fast • John Snow to be the pioneer of public health research
bacteria) in a field known as father of MODERN EPIDEMIOLOGY
in part because of his work in tracing the source of a
• Robert Koch- German physician and scientist, cholera outbreak in Soho, London, in 1854
presented his discovery of Mycobacterium tuberculosis
• Cholera is an acute diarrhoeal infection caused by the
• Case finding – Direct Sputum Smear Microscopy and bacterium Vibrio cholera
X-ray examination of TB symptomatics who are negative
after 2 or more sputum exams • Humans are the only relevant reservoir,

• Sputum smear and culture or DSSM - confirms the • VERY common in RAINY SEASON
diagnosis
• Rice watery stool – sign of cholera
• Tuberculin test (Mantoux test- detects the presence of
antibodies
BUBONIC PLAQUE – BLACK DEATH
(Results read within 48-72 hours from skin testing,
posistive if within duration of 10mm or more. • Describe the definition of the Black Death- A
widespread epidemic of the Bubonic Plague the
• DOTS- declared in 1996
occurred in the 14th century, killing millions of people
• Inhale or deep breath then cough up 3-5ml sputum “DARK AGE of EUROPE”.
proper way to collect
• What type of flea carried the Disease?- The oriental
• Hemoptysis is contraindication of sputum collection rat flea

• 3x in a month – collection of sputum for case finding • What was the most common strain of the Black
Death?- The Bubonic Plague
• Bcg – do not give to immunosuppressed baby- with
leukemia and hiv • In what season were the fleas most active?- Summer

• Leprosy

• RA 4073- Liberization and Treatment of Leprosy HElminths

(February as Leprosy Month)
• Helminths - most common is ascariasis , hookworm
• Hansen's disease - BACTERIA ,trichuris (whipworm)

• SSS – slit skin smear is the diagnostic test Taeniasis is not common in philippines

• Multi-Drug-Therapy (MDT) • Beef tapeworm - Taenia saginata- ingestion of

undercooked beef
• LEPROMATOUS TYPE is the most disfiguring type of
LEPROSY • Ancylostomiasis/Hookworm – causes anemia -
penetration of skin - walking barefooted
1 week of MDT or multi drug therapy patient is not
communicable already • Pinworms/ enterobiasis .- best way to diagnose this
infection is through a tape test
CHOLERA
• PARAGONIMUS WESTERMANI (Paragonimiasis) is a • Koplik spots—bluish-gray specks or “grains of sand” on
lung fluke cause by ingestion of raw crustaceans like a red base—develop on the buccal mucosa
crabs and lobsters which is SOMETIMES MISTAKENLY
Diptheria-
DIAGNOSED AS PTB

Hepatitis Diphtheria is an infectious disease caused by the

bacteriumCorynebacterium diphtheria, which primarily
• Hepatitis A , E or Infectious Hepatitis: oral-fecal route infects the throat and upper airways, and produces a
toxin affecting other organs.
• Hepatitis B or Serum Hepatitis: blood-borne, oral-oral,
sex Diphtheria is an infection caused by the bacterium
Corynebacterium diphtheriae.
• Hepatitis C: blood-borne,
Signs and symptoms usually start 2 – 5 days after
• Red tide poisoning/Paralytic shellfish poisoning- first exposure and range from mild to severe.
aid Drinking pure coconut milk
sore throat and fever.
Rabies/ Lysa
In severe cases, the bacteria produces a poison (toxin)
• People are usually infected following a deep bite or that causes a thick grey or white patch at the back of
scratch from an animal with rabies, and transmission to throat (PSEUDOMEMBRANE)
humans by rabid DOGS accounts for 99% of cases.
This can block the airway making it hard to breathe or
• most common transmission is by infected SALIVA of swallow and also create a barking cough. The neck may
rabid animal swell in part due to enlarged lymph nodes.
ACTIVE IMMUNIZATION – The poison may also get into the blood stream causing
PCEC (Purified Chick Embryo Vaccine), RABIPUR and the complications that may include inflammation and
new cheap drug VEROWELL damage of the heart muscle, inflammation of nerves,
kidney problems, and bleeding problems due to low
Passive vaccine is ERIG and HRIG blood platelets. The damaged heart muscles may result
in an abnormal heart rate and inflammation of the
ERIG or EQUINE RABIES is derived from HORSE serum
nerves may result in paralysis.
Rubeola (measles)
How is diphtheria spread?
• Viral infection
Diphtheria spreads easily between people by direct
• RNA virus of the genus Morbillivirus within the family contact or through the air though respiratory droplets,
Paramyxoviridae like from coughing or sneezing. It may also be spread by
contaminated clothing and objects.
HUMAN is the only reservoir
How is diphtheria diagnosed?
Nasal and Throat secretions can be the transmission
1. Schick test, method for determining SUSCEPTIBILITY
• Communicable just 4 days before rash appears to diphtheria

• Pre-Eruptive Stage: 2. Moloney test is - a test to detect a high degree of

SENSITIVITY to diphtheria toxoid
• fever, coughing, sneezing, and running of nose and
redness of eyes.
 Zika virus Signs and symptoms

• a virus transmitted by Aedes mosquitoes. The incubation period (the time from exposure to
symptoms) of Zika virus disease is estimated to be 3–14
Key facts days.
• Zika virus disease is caused by a virus transmitted The majority of people infected with Zika virus do not
primarily by Aedes mosquitoes, which bite during the develop symptoms.
day.
Symptoms are generally mild including fever, rash,
• Symptoms are generally mild and include fever, rash, conjunctivitis, muscle and joint pain, malaise, and
conjunctivitis, muscle and joint pain, malaise or headache, and usually last for 2–7 days.
headache. Symptoms typically last for 2–7 days. Most
people with Zika virus infection do not develop Complications of Zika virus disease
symptoms.
 Microcephaly and other congenital abnormalities
• Zika virus infection during pregnancy can cause infants
to be born with microcephaly and other congenital  pregnancy complications such as fetal loss, stillbirth,
and preterm birth.
malformations, known as congenital Zika syndrome.
Infection with Zika virus is also associated with other  Zika virus infection is also a trigger of Guillain-Barré
complications of pregnancy including preterm birth and syndrome, neuropathy and myelitis, particularly in
miscarriage. adults and older children.
• An increased risk of neurologic complications is Transmission
associated with Zika virus infection in adults and
children, including Guillain-Barré syndrome, neuropathy Zika virus is primarily transmitted by the bite of an
and myelitis. infected mosquito from the Aedes genus, mainly Aedes
aegypti, in tropical and subtropical regions.
Zika virus is a mosquito-borne flavivirus that was first
identified in Uganda in 1947 in RHESUS monkeys. It was Zika virus is also transmitted from mother to fetus
later identified in humans in 1952 in Uganda and the during pregnancy, through sexual contact, transfusion of
United Republic of Tanzania. blood and blood products, and organ transplantation.

The first recorded outbreak of Zika virus disease was Diagnosis

reported from the Island of Yap (Federated States of
Pcr- polymerase chain reaction test
Micronesia) in 2007. This was followed by a large
outbreak of Zika virus infection in French Polynesia in Treatment
2013 and other countries and territories in the Pacific.
In March 2015, Brazil reported a large outbreak of rash no treatment available
illness, soon identified as Zika virus infection, and in July
• Community Diagnosis:
2015, found to be associated with Guillain-Barré
syndrome. o Descriptive research

In October 2015, Brazil reported an association between o Profile general picture of comm., a direct health
Zika virus infection and microcephaly. indicator

o Process by which the people in the conn & H team

assess the comm. H problems & needs as bases for H
programs devt.
o A learning process for the comm. to identify their own • Types of Data:
H problems & needs
• Constant- value remains the same from person to
o A profile that deposits the H problems & potentials of person, time to time, place to place Ex. Minutes/ hour,
the comm. speed

• 2 Types of Community Dx • Variable- Ex. Temperature Qualitative- categories are

simply used to label to distinguish & group to another,
• Comprehensive- provides the general health profile of rather than a basis for saying that 1 group is greater,
the comm. higher than the other. Ex. Sex, Religion, Color
• Specific or problem oriented- yields a comprehensive • Quantitative- numerical • Can be measured •
profile of a particular H problem. Discrete- whole number or integral values • Continuous-
• Method of Survey: tool is Questionnaire fractions, decimals, can attain any decimal

• Census (100%) : Most ideal, enumeratx of data • Common Epidemiologic Studies:

conducted 6 mos. • Retrospective (Past)
• Sample Survey : Most practical study representative of • Cross- Sectional (Present)
a comm. Size matters in terms of validity
• Prospective Cohort (future)
• Interview method
• *Independent variable (Cause) - The one to be
• Instrument- interview guide/ schedule manipulated ( symbol is “y”)
 Records review • Instrument: checklist • *Dependent (Effect) - Will always be the interest of
 Ocular inspection/ observation • Instrument: checklist the researcher ( symbol is “X”)

 Participant observation

• Finalize sampling design & methods • Leptospirosis – Vector is Rat

 Probability: Equal chances- random- ( simple, Causative Agent: - bacteria--- Leptospira interrogans
stratified, cluster) • Sign/Symptoms: High fever, Chills, Vomiting, Red/
 Non- probability: Everyone will not have equal orange eyes, Diarrhea, Severe headache, muscle aches,
chances may include jaundice (yellow skin and eyes), abdominal
pain
• STATISTICS - A science- collection, organization,
analysis, interpretation of numerical data. Biostatistics: • Treatment: PET - Penicillins G, Erythromycin,
refers to the application of statistical method to the life Tetracycline
science like biology, medicine. • Doxycycline as prophylactic drug
• Demography: Study of pop size, composition & spatial DENGUE
distribution as affected by births, deaths & migration.
• Dengue - mosquito-borne infection
• Phenomenon of Variation - Tendency of a measurable
character to change from 1 individual or 1 setting to • Vector is female aedes aegypti mosquito, day biting,
another or from 1 instant of time to another within the low flying, satagnant clear water,stripes black white
same individual or setting body.
• Agent is a Virus.. dengue virus 1,2,3,4 • Primary source = fruit bats or flying foxes , old world
bats
- female aedes aegypti in stagnant water
• Other sources:
treatment is supportive therapy.
o Chimpanzees
 Intravenous fluids
o Gorillas
 A platelet transfusion
o fruit bats
• DENGUE DIAGNOSIS:
o monkeys
- Tourniquet test (capillary fragility test or Rumpel Leads
Test), a presumptive test which is positive in the o antelope
presence of more than 20 petechiae within an inch
o porcupines
square, after 5 minutes of test

• DENGUE ns1 – ANTIGEN CAPTURE - CONFIRMATORY o symptomatic humans

• Ebola largest outbreak in West Africa was first

• TOURNIQUET TEST - (BP Cuff):
reported in March 2014,
• RA 9482 or “The Rabies Act of 2007”, rabies control
• Virus is named after the ebola river
ordinances shall be strictly implemented.

• 99 % of cases is from DOG BITE • There are 5 strains of EBOLA virus

• EBOZ or ebola ZAIRRE strain is the most deadliest

• Saliva of infected animals is the reservoir
strain
• *Head (NERVOUS SYSTEM)- most affected part and
• RESTV or EBOR (ebola reston) species, found in
most fatal or dangerous site for dog bite
Philippines and the People's Republic of China, have
• EQUINE rabies vaccine is derived from HORSE been found to infect humans but they do not cause
illness or death
• HRIG is from human serum Rabies vaccine is an
artificial active • ***antibody-capture enzyme-linked immunosorbent
assay (ELISA)
• given on days 0, 3, 7, 14, 30, and 90,
HERBAL MEDS
• avoid gluteal area
• Niog Niogan (Quisqualis Indica) • Anti-helminthic
• Rabies vaccine should be administered in the deltoid every 6 months 2 hours p supper
muscle
• No to less than 4 y/o
• In both pre-exposure and post-exposure
immunization, the full 1.0 mL dose should be given 9 • Tsaang Gubat (Carmona Retusa) • Diarrhea
intramuscularly
• Ampalaya (Momordica Charantia) • DM Type 2-
EBOLA obesity

• Ebola: Mapping the outbreak • Sambong as anti urolithiasis

From the section of WEST Africa • Akapulko for fungal parasites

 Anthrax • camels - major reservoir host for MERS-CoV and an
animal source of MERS infection in humans
• (Splenic fever, Siberian ulcer, Charbon, Milzbrand)
• Highest Risk : IMMUNOSUPRESSION (CANCER)
• Bacillus anthracis.
• Symptoms- Mild-severe respiratory illness
• most common in wild and domestic herbivores (eg,
cattle, sheep, goats, camels, antelopes) Gastrointestinal symptoms

• B anthracis spores can remain viable in soil for many • Complications-pneumonia, kidney failure
years.
• Signs and symptoms
• Raw or poorly cooked contaminated meat is a source
of infection for zoo carnivores and omnivores; anthrax A- airway problems
resulting from contaminated meat consumption has B- breathing difficulty
been reported in pigs, dogs, cats, mink, wild carnivores,
and people C- cough and colds

• diagnostic tests include bacterial culture, PCR tests, D- diarrhea

and fluorescent antibody stains to demonstrate the
E- elevated temperature
agent in blood films or tissues
• Treatment: No specific treatment
• Treatment
• No vaccine or specific treatment is currently available.
• Oxytetracycline given daily in divided doses also is
effective. • avoid contact with camels, drinking raw camel milk or
camel urine, or eating meat that has not been properly
• Ciprofloxacin,Amoxicillin, Gentamicin, ,Erythromycin
cooked.
Doxycycline, Streptomycin,
• Avoid contact to camel droplets
• Middle East respiratory syndrome coronavirus
(MERS-CoV) • Cover your nose and mouth with a tissue when you
cough or sneeze, then throw the tissue in the trash.
- CAMEL FLU or SARS of MIDDLE EAST
• Avoid touching your eyes, nose and mouth with
• a viral respiratory disease caused by a novel
unwashed hands.
coronavirus (MERS-CoV) that was first identified in Saudi
Arabia in 2012. • Avoid personal contact, such as kissing, or sharing
cups or eating utensils, with sick people.
• 1st case - april 2012
I. ENVIRONMENTAL HEALTH
2nd case - sept. 2012
• Health- is a state of complete physical, mental and
• 1st Outbreak
social well-being and not merely the absence of disease
- SAUDI ARABIAN PENINSULA (WHO)

• MERS COV IS A CLADES "B" VIRUS • Public health- refers to all organized measures to
prevent disease, promote health, and prolong life
• Republic of South Korea is the largest outbreak among the population as a whole
outside of the Middle East year 2015
• Environmental health- is the discipline that focuses on
the interrelationships between people and their
environment, promotes human health and well-being, analytic- examines casual hypotheses between
and fosters a safe and healthful environment exposures and health conditions

Ecological study • measure of lethality of disease

• Observational study which focuses on groups rather CFR%= number of deaths due to disease/number of
than individuals cases of disease x 100 during a time period

Cross Sectional Studies • John Snow- linked cholera to contaminated water

• A type of prevalence study in which the distribution of used natural experiment and spacial analysis
a disease (or other health-related outcome) and
exposure are determined at one particular time and • Sr. Percival Pott- first to describe environmental cause
of cancer
studies more than one disease at once

Case control study chimney sweep and scrotal cancer

• Black death – bubonic Plague- Yersinia- bacteria

• Subjects who participate in the study are defined on
the basis of the presence or absence of disease (or transmitted by flea on rat
other outcome of interest). Exposure is then
determined retrospectively, meaning the exposure • lyme disease- borrelia
occurred in the past, by interviewing subjects or
deer ticks spread
reviewing medical and occupational records.
• rocky moutain spotted fever - ricketssia
Cohort study
SOLID WASTE MANAGEMENT
• Classifies subjects according to their exposure to a
factor of interest and then observes the subjects over Black - Non-infectious dry waste
time to document the occurrence of new cases.
Green - Non-infectious wet waste (kitchen, dietary etc.)
• Demography- the study of human population
Yellow -- Infectious and Pathological waste
• Hippocrates- father of medicine
Yellow with black band ---Chemical waste including
emphasised role of env as influence of health those w/ heavy metals
• Bernardo Ramazzini Orange--- Radioactive waste
- founded field of occupational medicine Red---- Sharps and pressurized containers
books highlighted hazardous chemicals, dusts and
metals in workplace FIELD HEALTH SERVICES AND INFORMATION SYSTEM
(FHIS)- RECORDING AND REPORTING SYSTEM
• what type of data does environmental epi use-
observational data All are Objectives ,except

• most common methodology for study design- case- --- complete the picture of acute and chronic diseases
control and cohort
Fundamental building block ---family treated record
• two classes of epidemiology studies

- descriptive- depiction of occurance of disease in pops

according to classification Monthly FHS activity report, component ---- tally report
Tally sheet, recommended frequency----- daily Henry Street settlement ------Lillian Wald- model for
public health nursing
Monitor long term regimen, reporting system
Public Health Nurse emphasis on?
--- target/clients list
---populations instead on individuals
Community health nursing describes
Assurance is _____
---a setting for practice of nursing and does not require
specific education training. ------responsibility of public health agencies to be sure
that activities are carried out to meet public health
Outcome is defined as goals policy developmentstarts with assessment but
----created products, energy, and information that relies heavily on planning
emerge from the system into the environment. Root Cause Analys is______
A clinic treating a child for otitis media is an example ---- process by which medical errors are identified and
-------community-based care addressed in facilities

What are the three core functions of public (SATA) Declaration of Alma-Ata

------health assessment, policy development, assurance -----WHO (Russia 1978) Health for All!!!

Identifying a specific health problem is ? ---assessment WHO 4 groupshealth policies SATA

Complaints about a service- assigned a public nurse to social & economic development provision of health care
work with community to evaluate program? health status

----Assurance Conducting a windshield survey is an example of?

personal observation 3 critical components of a
A nurse that provides direct care services to clients with community are?
a disease? ---community -based nursing
---people , place, social interactions (function)
Community -oriented framework includes
Environmental Hazard----windshield survey
----community-oriented nursing and public health
nursing Health Manpower----Survey

The assessment phase includes? Pasteur-------safety in milk (immunity & host resistance)

---collecting, analyzing, disseminating information. John Snow --------Father of epidemiology- Cholera

What is instructive district nursing? ---Health education Epidemiology is

Who was the founder of district nursing? -----study of population to monitor the health in
population & identify determinants of health & disease,
----William Rathbone & investigate & evaluate interventions to prevent
disease & maintain health
Public health nurse role has changed due to ?

---changes in health care

 NP2

Fundus at the Level of umbilicus -20 weeks post op interventions after cleft lip ----sitting position
(feeding)
Phocomelia is caused by -Antiemetic drug use in
pregnancy like thalidomide Not taking folic acid in pregnancy causes--/- Neural tube
defect
Chief ingredient of prenatal vitamins -Folic acid
Initiate of breastfeeding ----within 30 mins (½ hour)
Nausea and vomiting in pregnancy is Presumptive-
subjective room in baby to mother ----- up to 24 hours

Nausea and vomiting is caused by- increased level of Placenta is fully developed at ----- 8 weeks
ESTROGEN
Successful teaching, episiotomy care
40-50 days interval of menstruation -
------ wipe from front to back using biotting motion
OLIGOMENORRHEA
Small constant trickle of blood, suspects
IM to infant and children to prevent peripheral
discomfort - Z-tract technique ------ perineal lacerations

(Vastus lateralis) Severe abdominal cramps, explain the cause release of

------oxytocin during breastfeeding session
connection between to atria- foramen ovale
Unrelieved pain by ibuprofen, assess for what Presence
March 30 ovulation occurs at march 16
of -----perineal hematoma
Leukorrhea due to progesterone
Above umbilicus deviated to the right best nursing
Position to close foramen ovale - right side lying action -----ambulate & assist to void

Colleague commit mistake other nurse report it to z track technique IM site for 1y.o baby
supervisor but the supervisor didn't take heed because
---- vastus lateralis
they are understaff - moral dilemma
patient is scheduled for CS then request for lab to
Hallmark of nephrotic syndrome generalized edema
whom will you relay the result
/anasarca
-----OB
incubation period of chicken pox 10-21 days
start solid food ----- 4 months
Right time for toothbrush?- First eruption of tooth
HIV test should be repeated
Start to drink from a cup -2 years old
---- every 3 to 6 months
6 months milestone observed -1st tooth bud eruption
most number of HIV cases?
Play of infancy- solitary
--- NCR
8 months old toy- Large blocks
Least HIV transmission
2 years old toy -Wagon cart
----DERMIS of the SKIN
first prior giving medications : to pedia identify med to
the bracelet of pt. stated name and date of birth
HIV major mode of transmission Signs that a child with cystic fibrosis is responding to
pancreatic enzymes are the absence of steatorrhea,
--SEXUAL INTERCOURSE improved appetite, and absence of abdominal pain
HIV infection in the body the confirmatory test is ? ninety degree-ninety degree traction is used for fracture
----Western blot of a child’s femur or tibia.
What race is at the highest HIV risk One sign of developmental dysplasia is limping during
case? ambulation.

---- Black MSM and Gay Hispanics When bottle-feeding a newborn with a cleft palate, hold
the infant’s head in an upright or sitting position.
treat HIV wasting syndrome?
nonstress test is considered nonreactive (positive) if
Megestrol Acetate fewer than two fetal heart rate accelerations of at least
15 beats/minute occur in 20 minutes.
Effects, of cold stress; NOT included----- increased ICP
 A nonstress test is considered reactive (negative) if
Alert when caqring for preterm newborn hypoglycemia
two or more fetal heart rate accelerations of 15
NEWBORN Stabilize temp; does not drop below 97.7 ‘F beats/minute above baseline occur in 20 minutes.

Preterm Exhibits ----elbow past the middle of chest  A nonstress test is usually performed to assess fetal
well-being in a pregnant patient with a prolonged
Primary purpose of evaluating nursing care pregnancy (42 weeks or more), diabetes, a history of
poor pregnancy outcomes, or pregnancy-induced
-------achieve quality improvement
hypertension.
Plan, DO, Check and act,design an assessment
 Implantation in the uterus occurs 6 to 10 days after
stool,phase of the process
ovum fertilization.
----- plan phase
 Placenta previa is abnormally low implantation of the
Team evaluate care as a being administered to pedia placenta so that it encroaches on or covers the cervical
clients, os.

----this represents concurrent audit  Abruptio placentae is premature separation of a

normally implanted placenta. It may be partial or
Sentinel events signal the needs for complete, and usually causes abdominal pain, vaginal
bleeding, and a boardlike abdome
-----immediate investigation and response
 The classic triad of symptoms of preeclampsia are
The most adequate diet for an infant in the first 6
hypertension, edema, and proteinuria. Additional
months of life is breast milk.
symptoms of severe preeclampsia include hyperreflexia,
An infant can usually chew food by 7 months, hold cerebral and vision disturbances, and epigastric pain.
spoon by 9 month, and drink fluid from a cup by 2 year
 Ortolani’s sign (an audible click or palpable jerk that
Failure to thrive is a term used to describe an infant occurs with thigh abduction) confirms congenital hip
who falls below the fifth percentile for weight and dislocation in a neonate.
height on a standard measurement chart.
  The first immunization for a neonate is the hepatitis B reflex, and a simian crease on the hands.
vaccine, which is administered in the nursery shortly
after birth. Lochia rubra is the vaginal discharge of almost pure
blood that occurs during the first 3 days after childbirth.
If a patient misses a menstrual period while taking an
oral contraceptive exactly as prescribed, she should  Lochia serosa is the serous vaginal discharge that
occurs 4 to 7 days after childbirth.
continue taking the

contraceptive.  Lochia alba is the vaginal discharge of decreased

blood and increased leukocytes that’s the final stage of
 If a patient misses two consecutive menstrual periods lochia. It occurs 7 to 10 days after childbirth.
while taking an oral contraceptive, she should
 Colostrum, the precursor of milk, is the first secretion
discontinue the contraceptive
from the breasts after delivery.
and take a pregnancy test.
 If a pregnant patient’s rubella titer is less than 1:8, she
 If a patient who is taking an oral contraceptive misses should be immunized after delivery.
a dose, she should take the pill as soon as she
 The administration of oxytocin (Pitocin) is stopped if
remembers or take two at the next scheduled interval
and continue with the normal schedule. the contractions are 90 seconds or longer.

#NP3 Part 1 KEY POINTS

 If a patient who is taking an oral contraceptive misses
two consecutive doses, she should double the dose for In CUSHINGS disease Because of changes in fat
2 days and then distribution, adipose tissue accumulates in the trunk,
resume her normal schedule. She also should use an face (moonface), and dorsocervical areas (buffalo
additional birth control method for 1 week. hump).
 Eclampsia is the occurrence of seizures that aren’t Chvostek’s sign is elicited by tapping the client’s face
caused by a cerebral disorder in a patient who has lightly over the facial nerve, just below the temple. If
pregnancy -induced the client’s facial muscles twitch, it indicates
hypocalcemia.
hypertension.

 In placenta previa, bleeding is painless and seldom Hyponatremia is indicated by weight loss, abdominal
cramping, muscle weakness, headache, and
fatal on the first occasion, but it becomes heavier with
each subsequent episode. postural hypotension.
 Treatment for abruptio placentae is usually immediate Hypernatremia can cause CEREBRAL EDEMA
cesarean delivery.
Hypokalemia causes paralytic ileus and muscle
 Drugs used to treat withdrawal symptoms in neonates weakness. Clients with hypermagnesemia exhibit a loss
include phenobarbital (Luminal), camphorated opium of deep tendon reflexes, coma, or cardiac arrest.
tincture (paregoric), and diazepam (Valium).
Hyperglycemia, which develops from glucocorticoid
 Infants with Down syndrome typically have marked excess, is a manifestation of Cushing’s syndrome. With
hypotonia, floppiness, slanted eyes, excess skin on the successful treatment of the disorder, serum glucose
back of the neck, flattened bridge of the nose, flat facial levels decline.
features, spadelike hands, short and broad feet, small
male genitalia, absence of Moro’s
Hirsutism is common in Cushing’s syndrome; therefore, Severe SIADH can cause such complications as vascular
with successful treatment, abnormal hair growth also fluid overload, signaled by neck vein distention.
declines.
Pheochromocytoma causes excessive production of
Osteoporosis occurs in Cushing’s syndrome; therefore, epinephrine and norepinephrine, natural
with successful treatment, bone mineralization in catecholamines that raise the blood pressure.
creases.
Phentolamine is the drug of choice, an alpha-adrenergic
Amenorrhea develops in Cushing’s syndrome. blocking agent given by I.V. bolus or drip, antagonizes
the body’s response to circulating epinephrine and
Regular insulin, which is a short-acting insulin, has an norepinephrine, reducing blood pressure quickly and
onset of 15 to 30 minutes and a peak of 2 to 4 hours. IF effectively.
the nurse gave the insulin at 2 p.m., the expected onset
would be from 2:15 p.m. to 2:30 p.m. and the peak from methyldopa is an antihypertensive agent available
4 p.m. to 6 p.m.
in parenteral form, it isn’t effective in treating
Agitation, irritability, poor memory, loss of appetite,and hypertensive emergencies.
neglect of one’s appearance may signal depression,
which is common in clients with Cushing’s syndrome. Mannitol, a diuretic, isn’t used to treat hypert ensive
emergencies.
Neuropathy affects clients with diabetes mellitus
Excessive secretion of aldosterone in the adrenal cortex
Hyperthyroidism typically causes such signs as goiter, is responsible for the client’s hypertension.
nervousness, heat intolerance, and weight loss despite
increased appetite. The adrenal medulla secretes the catecholamines —
epinephrine and norepinephrine.
Tetany may result if the parathyroid glands are excised
or damaged during thyroid surgery. Addison’s disease decreases the production of all
adrenal hormones, compromising the body’s normal
Hemorrhage is a potential complication after thyroid stress response and increasing the risk of infection.
surgery but is characterized by tachycardia,
Addisons most appropriate Nursing diagnosis is RISK of
hypotension, frequent swallowing, feelings of fullness at
the incision site, choking, and bleeding. infection

Other appropriate nursing diagnoses for a client with

Thyroid storm is another term for severe
hyperthyroidism — not a complication of Addison’s disease include Deficient fluid volume and
thyroidectomy. Hyperthermia.
Laryngeal nerve damage may occur postoperatively, but Acarbose delays glucose absorption, so the client should
its signs include a hoarse voice and, possibly, acute take an oral form of dextrose rather than a product
airway obstruction. containing table sugar when treating hypoglycemia.
Levothyroxine is the preferred agent to treat primary After a transsphenoidal hypophysectomy, the client
hypothyroidism and cretinism, although it also may be must refrain from coughing, sneezing, and blowing the
used to treat secondary hypothyroidism. It is nose for several days to avoid disturbing the surgical
contraindicated in Graves’ disease and thyrotoxicosis graft used to close the wound.
because these conditions are forms of hyperthyroidism.
The head of the bed must be elevated, not kept flat, to
SIADH secretion causes antidiuretic hormone prevent tension or pressure on the suture line.
overproduction, which leads to fluid retention.
Within 24 hours after a hypophysectomy, transient facial nerve in front of the ear is tapped) and a positive
diabetes insipidus commonly occurs; this calls for Trousseau’s sign (carpal spasm when a blood pressure
increased, not restricted, fluid intake. cuff is inflated for a few mi nutes).

Visual, NOT auditory, changes are a potential The normal serum amylase level is 25 to 151 units/L.
complication of hypophysectomy. With chronic cases of pancreatitis, the rise in serum
amylase levels usually does not exceed three times the
The client must continue to monitor the blood glucose normal value.
level during glipizide therapy.
In acute pancreatitis, the value may exceed five times
For client with necrosis , wet-to-dry dressings are most the normal value.
appropriate because they clean the foot ulcer by
debriding exudate and necrotic tissue, thus promoting The client with cirrhosis needs to consume foods high in
healing by secondary intention. thiamine. Thiamine is presentin a variety of foods of
plant and animal origin. Pork products are especially
In the client with hyperthyroidism, Imbalanced rich in this vitamin. Other good food sources include
nutrition: Less than body requirements the most nuts, whole grain cereals, and legumes.
important nursing diagnosis. During the insertion of a nasogastric tube, if the client
Serum osmolarity is the mostimportant test for experiences difficulty breathing or any respiratory
confirming HHNS distress, withdraw the tube slightly, stop the tube
advancement, and wait until the distress subsides.
A client with HHNS typically has hypernatremia and
osmotic diuresis. ABG values reveal acidosis, and the If the nasogastric tube is in the stomach, the pH ofthe
potassium level is variable. contents will be acidic. Gastric aspirates have acidic pH
values and should be 3.5 or lower.
Insulin should never be shaken because the resulting
froth prevents withdrawal of an accurate dose and may When the nurse removes a nasogastric tube,the client is
damage the insulin protein molecules. instructed to take and hold adeep breath. This will close
the epiglottis. This allows for easy withdrawal through
Insulin also should never be frozen because the insulin the esophagus into the nose. The nurse removes the
protein molecules may be damaged. tube with one smooth, continuous pull.

Intermediate-acting insulin is normally cloudy. If a client has a nasogastric tube connected to

suction,the nurse should wait up to 30 minutes before
if client is having hypoglycemic episode, the nurse
reconnecting the tube to the suction apparatus to allow
should first administer a fast-acting
adequate time for medication absorption.
carbohydrate, such as orange juice, hard candy, or
When the client has a Sengstaken-Blakemore tube, a
honey.
pair of scissors must be kept at the client’s bedside at all
If the client has lost consciousness, the nurse should times. The client needs to be observed for sudden
administer either I.M. or subcutaneous glucagon or an respiratory distress, which occurs if the gastric balloon
I.V. bolus of dextrose 50%. ruptures and the entire tube moves upward. If this
occurs, the nurse immediately cuts all balloon lumens
The client who has undergone athyroidectomy is at risk and removes the tube. An obturator and a Kelly clamp
for developing hypocalcemia from inadvertent removal are kept at the bedside of a client with a tracheostomy.
or damage to the parathyroid gland. An irrigation set may be kept at the bedside, but it is not
the priority item.
The client with hypocalcemia will exhibit a positive
Chvostek’s sign (facial muscle contraction when the
 therapetuic serum level should be 1.5 - 2.5 ng/ml.

Np3 part 2 Digibind (digoxin immune Fab)

Hepatitis A is transmitted by the fecal-oral route via -is an ANTIDOTE for severe digoxin toxicity.
contaminated food or infected food handlers.
In a Billroth II procedure, the proximal remnant of the
Hepatitis B, C, and D are transmitted bloodborne most stomach is anastomosed to the proximal jejunum.
commonly via infected blood or body fluids.
IN BILLROTH II the most complication is DUMPING
Laboratory indicators of hepatitis include elevated liver SYNDROME
enzyme levels, elevated serum bilirubin levels, elevated
Dumping syndrome is a term thatrefers to a
erythrocyte sedimentation rates, and leukopenia.
constellation of vasomotor symptoms that occurs after
Meperidine (Demerol) rather than morphine sulfate is eating, especially following a Billroth II procedure.
the medication of choice to treat pain in pancreatitis
Early manifestations of DUMPING SYNDROME usually
Morphine sulfate --is a drug than can cause spasms in occur within 30 minutes of eating and include vertigo,
the sphincter of Oddi. tachycardia, syncope, sweating, pallor, palpitations, and
the desire to lie down.
Elevation of serum lipase is the mostreliable indicator of
pancreatitis because this enzyme is produced solely by The nurse should instruct the client to decrease the
the pancreas. amount of fluid taken at meals and to avoid high-
carbohydrate foods, including fluids such as fruit
The appropriate sequence for abdominal examination is nectars; to assume a low-Fowler’s position during
inspection, auscultation, percussion, and palpation. meals; to lie down for 30 minutes after eating to delay
gastric emptying; and to take antispasmodics as
Furosemide (Lasix) is a loop diuretic.
prescribed. 23.
--- Excessive use of furosemide will most likely lead to a
Coughing is avoided following umbilical hernia repair to
metabolic alkalosis due to hypochloremia and
prevent disruption of tissue integrity, which can occur
hypokalemia.
because of the location of this surgical procedure.
Mannitol causes HYPERNATREMIA
Following inguinal hernia repair, the client should be
Digoxin is a cardiac medication. Increases cardiac instructed to elevate the scrotum and apply ice packs
contractility and decreases heart rate while in bed to decrease pain and swelling.

Digoxin posesses positive inotropic action, negative Bloody diarrhea is expected to occurin ulcerative colitis.
chronotopic action, and negative dromotropic action.
Nutrition: less than body requirements, imbalanced is
POSITIVE INOTROPIC ACTION: this is the main function the more likely nursing diagnosis.
of digoxin and it increases myocardial contractility.
Rectum and sigmoid is the affected site
NEGATIVE CHRONOTROPIC AND NEGATIVE
LLQ is the pain site
DROMOTROPIC ACTIONS:
Crohn’s disease is characterized by nonbloody diarrhea
negative chronotropic- decreases heart rate
of usually not more than four to five stools daily. Over
SIDE EFFECTS: nausea, vomiting, diarrhea, dizziness, tim e, the diarrhea episodes increase in frequency,
visual disturbances, rash, hallucinations, confusion, duration, and severity.
dizziness, n delirium.
 palloranorexia, nausea, and vomiting. The client also
may have moderate to severe hypertension (not
Women with condylomata acuminata are at risk for hypotension), oliguria or anuria (not polyuria),
cancer of the cervix and vulva. headache, reduced visual acuity, and abdominal or flank
Pyelonephritis is diagnosed by the presence of pain.
--leukocytosis, hematuria, pyuria, and bacteriuria. The symptoms of Candida albicans include itching and a
Ketonuria indicates a diabetic state. scant white discharge that has the consistency of
cottage cheese
DKA kussmauls fruity breath odor is due to KETONES
for a client to be diagnosed with AIDS are the following:
Obese is ENDOMORPH
• HIV positive CONFIRMED BY WESTERN BLOT
obesity is the number 1 T2DM predisaposition
• CD4+ T-cell count below 200 cells/microliter
STD's
• Have one or more specific conditions that include
Symptoms of gonorrhea in men include purulent, foul- acute infection of HIV
smelling drainage from the penis and painful urination.
HIV is MOST EASILY transmitted in blood, semen and
Rashes on the palms of the hands and soles of the feet vaginal secretions.
are symptoms of the secondary stage of syphilis.
To determine if a preexisting infection is present a test
Cauliflower-like warts on the penis are a sign of should be doneimmediately and is

human papillomavirus. repeated again in 3 months time (12 weeks) to detect

seroconversion as a result of the needle stick.
Painful red papules on the shaft of the penis may be a
sign of the first stage of genital herpes. The ELISA test is the first screening test for HIV.

TURP Western blot test confirms a positive ELISA test.

After TURP, urine normally appears red to pink, and HIV was identified in 1983,
normal saline irrigant usually is infused at a rate of 40 to
60 drops/minute or according to facility protocol. By 1988 two strains ofHIV existed, HIV-1 and

TURP is the most widely used procedure for prostate HIV-2.

gland removal. Because itrequires no incision. SLE, the classic sign is the butterfly rash over
- If the catheter is blocked by blood clots, it may be the cheeks and nose.
irrigated according to physician’s orders or facility
protocol . The nurse should SLE must avoid eating STEAKS

use sterile technique to reduce the risk of infection. lab findings for clients with SLE usually show:

AGN • Pancytopenia

Generalized edema, especially of the face and • Elevated ANA titer

periorbital area, is a classic sign of acute
• Decreased serum complement levels
glomerulonephritis of sudden onset. Other classic signs
and symptoms of this disorder include hematuria (not
green-tinged urine), proteinuria, fever, chills, weakness,
Adults and children with gonorrhea may develop -Can cause respiratory distress, the nurse should take
gonococcal conjunctivitis by touching the eyes with immediate action to maintain a patent airway and
contaminated hands provide adequate oxygenation

body’s thermostat is located in the hypothalamus Systemic absorption of atropine sulfate can cause
tachycardia, palpitations, flushing, dry skin, ataxia, and
Sensory D/O confusion.
sudden appearance of light flashes and floaters in front
NP3 last part
ofthe affected eye is characteristic of retinal
detachment. Collaborative interventions are therapies that require:

Difficulty seeing cars in another driving lane suggests Multiple health care professionals.
gradual loss of peripheral vision, which may indicate
glaucoma. Nursing care and nurse client interventions is

Headache, nausea, and redness of Independent interventions

the eyes are signs of acute (angle-closure) glaucoma. Physician and nurse interventions are.

Parkinsons Disease dependent interventions

Parkinson’s crisis, dopamine-related symptoms are All of these are the behavior intervention to stress
severely exacerbated, virtually immobilizing the client. management. EXCEPT:

-A client confined to bed during such a crisis is at risk for -pharmacotherapy

aspiration and pneumonia.
Multiple sclerosis
- the nursing diagnosis of Ineffective airway clearance
Vision changes, such asdiplopia, nystagmus, and blurred
takes highest priority.
vision, are symptoms ofmultiple sclerosis.
STAPEDECTOMY
Deep tendon reflexes may
- For 30 days after a stapedectomy, the client should
be increased or hyperactive — not absent.
avoid airtravel, sudden movements that may cause
trauma, and exposure to loud sounds and pressure Babinski’s sign may be positive.
changes (such as from high altitudes).
Tremors at rest aren’t characteristic of multiple
- Immediately after surgery, the client should lie flat sclerosis;
with the surgical ear facing upward; nose blowing is
permitted but should be done gently and on one side at intentional tremors, or those occurring with purposeful
a time. voluntary movement, are common in clients with
multiple sclerosis.
--- The client’s first attempt at postoperative
Fatigue is acommon symptom in clients with multiple
ambulation should be supervised to prevent falls caused sclerosis. Lowering the body temperature by resting in
by vertigo and light-headedness. an air-conditioned room may relieve fatigue; however,
extreme cold should be avoided.
-- The client must avoid shampooing and swimming to
A hot bath or shower can increase body temperature,
keep the dressing and the ear dry.
producing fatigue. Muscle relaxants, prescribed to
A cervical spine injury (above C3 and C4) reduce spasticity, can cause drowsiness and fatigue.
Planning for frequent rest periods and naps can relieve Refer to who else (collaboration) -----dietician
Fatigue- the measures to reduce fatigue in the client
with multiple sclerosis include treating depression, Criteria for the diseases to be transmitted ----both
parents must be carriers
using occupational therapy to learn energy conservation
techniques, and reducing spasticity. Teaching plan -----MLT mental retardation
AGN description -- auto-immune, inflammation,signs Father & mother is a carrier, pattern of inheritance-----
and symptoms 1:4 in each pregnancy
Diagnosis---- mild protenuria, marked Milk formula------ LOFENALAC
hematuria,support of glomerulonephritis
Avoid foods like -------Eggs and fish
Priority intervention ---limit activity, safety
NP4 Part 1
Worsening sign ---increase in weight
Protecting the client from injury is the immediate
Sequel ---- impetigo contagiosa
priority during a seizure. Place pillow in head
Tonsilitis
The client who has had spinal surgery, such as
Diagnosis- confirmed because spinal fluid has elevated laminectomy, must be logrolled to keep the spinal
CHON level column straight when turning.

Route enter infants CN’s - cranial apertures or sinuses The client who has had a thoracotomy or cystectomy
may turn himself or may be assisted into a comfortable
Maintaining isolation for-- 48 hours after antibiotic position.
therapy
CT scan commonly involves use of a contrast agent, the
Post serious complication --peripheral circulatory nurse should determine whether the client is allergic to
collapse iodine, contrast dyes, or shellfish.

Alert for ------ increased BP vomiting, ALS nursing diagnosis is -- Powerlessness because ALS
seizures,complaints of head pain may lead to locked-in syndrome, characterized by an
active and functioning mind locked in a body that can’t
perform even simple daily tasks.
CHD If a neckinjury is suspected, the jaw thrust maneuver is
Major characteristic--- increased blood flow to the lungs used to open the airway.

Congenital heart defects (sata----) acyanotic The client undergoing lumbar puncture is positioned
VSD,COA,PDA lying on the side, with the legs pulled up to the
abdomen and the head bent down onto the chest. This
COA,,Vital Sign ----- elevated BP in the upper arm position helps open the spaces between the vertebrae.

Difficulty feeding -----ineffective sucking and swallowing The head of the client with increased intracranial
pressure should be positioned sothe head is in a neutral
PDA, correctly explains ------connection between
midline position. The nurse should ---- position the head
pulmonary artery and aorta
of the bed raised to 30 to 45 degrees.
PHENYLKETONURIA
Leakage of cerebrospinal fluid (CSF) from the ears or
Preterm inheritance ---autosomal recessive nose may accompany basilar skull fracture.
 ----- providing accurate information about the client’s
condition, giving expert care and positive
CSF can be distinguished from other body fluids because
the drainage will separate into bloody and yellow feedback to the client, and encouraging relaxation and
concentric rings on dressing material, called a halo sign. distraction.

The most frequent cause of autonomic dysreflexia is Verbalizing feelings is the client’s first step in coping
adistended bladder. with the situational crisis.

Straight catheterization should be done every 4 to 6 A client with a cerebellar brain tumor may suffer injury
from impaired balance as well as disturbed gait and
hours, and foley catheters should be checked frequently incoordination.
to prevent kinks in the tubing.
Radiation therapy may cause fatigue, skin toxicities, and
Nursing actions during a seizure include providing for anorexia regardless of the treatment site.
AIRWAY, loosening restrictive clothing
Chemotherapy commonly causes nausea and vomiting,
client with dysphagia is started on a diet, the gag and which may lead to fluid and electrolyte imbalances.
swallow reflexes must have returned. The client is
assisted with meals as needed and is given ample time Human papillomavirus is a risk factor for cervical cancer.
to chew and swallow. Food is placed on the Other risk factors for this disease include

------ unaffected side of the mouth. ---- frequent sexual intercourse before age 16, multiple
sex partners, and multiple pregnancies.
--------Liquids are thickened to avoid aspiration.
Leucovorin is administered with methotrexate to
Myasthenic crisis often is caused by undermedication protect normal cells, which methotrexate could destroy
and responds or be treated with to the administration if given alone.
of cholinergic medications, such as neostigmine
(Prostigmin) and pyridostigmine (Mestinon). Colorectal polyps are common with colon cancer.

Cholinergic crisis (the opposite problem) is caused by Weight loss — — is an indication of colorectal cancer.
excess medication and responds to withholding of
In thrombocytopenia it impairs blood clotting, the
medications.
nurse should inspect the client regularly for signs of
Clients with myasthenia gravis are taught to space out
---- bleeding, such as petechiae, purpura, epistaxis, and
activities over the day to conserve energy and restore
muscle strength. bleeding gums.

The American Cancer Society recommends a

Overeating is a cause of exacerbation of symptoms, as is
exposure to heat, crowds, erratic sleep habits, and mammogram yearly for women over age 40.

The incidence of prostate cancer increases after age 50.

emotional stress.
The digital rectal examination, which identifies
Guillain-Barré syndrome is a clinical syndrome of enlargement or irregularity of the prostate, and PSA
unknown origin that involves cranial and peripheral test, a tumor marker for prostate cancer, are effective
nerves. diagnostic measures that should be done yearly.

Client with Guillain-Barré syndrome experiences fear If a radioactive implant becomes dislodged, the nurse
and anxiety from the ascending paralysis and sudden should pick it up with long-handled forceps and place it
onset of the disorder. The nurse can alleviate these fears in a lead-lined container, then notify the radiation
by therapy department immediately.
 Time – limit contact to 5 minutes each time. (30mins
per shift)
A client taking Tamoxifen must report changes in visual
acuity immediately because this adverse effect may be Shielding – use lead shield during contact with client.
irreversible.
fatal side effect of Cytoxan.
The liver is one of the five most common cancer
-----Hemorrhagic cystitis is the potentially
metastasis sites.

Halstead surgery also called radical mastectomy involves Cancer stages

the removal of entire breast, pectoralis major and minor Stage I – tumor size up to 2 cm.
muscles and neck lymph nodes.
Stage II – tumor size up to 5 cm with axillary and neck
Removal of the entire breast, pectoralis major muscle lymph node involvement.
and the axillary lymph nodes is a surgical procedure
called modified radical mastectomy. Stage III –tumor size is more than 5 cm with axillary and
neck lymph node involvement.
Simple mastectomy is the removal of the entire breast
but the pectoralis muscles and nipples remain intact. Stage IV – metastasis to distant organs (liver, lungs, bone
and
Chemotherapy is contraindicated in cases of infection
(chemotherapeutic agents are immunosuppressive), brain).

Diarrhea not constipation is the side effect of radiation Classic symptoms that define breast cancer includes:
therapy. Firm, nontender, nonmobile mass. Solitary, irregularly
shaped mass. Adherence to muscle or skin causing
Radiation therapy makes the platelet count decrease. dimpling effect. Involvement of the upper outer
Thus, nursing responsibilities should be directed at quadrant or central nipple portion. Asymmetry of the
promoting safety by avoiding episodes of hemorrhage breasts. “Orange peel” skin. Retraction of nipple.
or bleeding such as physical trauma and aspirin Abnormal discharge from nipple.
administration.
Exercise after mastectomy---- combing hair
No soap should be used on the skin of the client
undergoing radiation. Soap and irritants and may cause If a biopsy was performed during a bronchoscopy,
dryness of the patient’s skin. Only water should be used blood-streaked sputum is expected for several hours.
in washing the area. Frank blood indicates hemorrhage. A dry cough may be
expected.
Metochlopramide (Metozol) – antiemetic.
The common clinical manifestations of pulmonary
Succimer (Chemet) – chelating agent for lead poisoning. embolism are tachypnea, tachycardia, dyspnea, and
chest pain.
Anastrazole (Arimidex) – hormone regulator.

Busulfan (Myleran) – alkylating agent A therapeutic theophylline level is 10 to 20 mcg/ml. The

client is currently receiving 0.5 mg/kg/hour of
Principles of Radiation protection follows theDTS aminophylline.
system. Distance (D), Time (T) and Shielding (S). SATA
Side effects : tachycardia and Diarrhea
Distance – at least 3 feet should be maintained when a
nurse is not performing any nursing procedures. Constant or continous bubbling in the chamber
indicates an air leak and requires immediate
intervention.
 The client with a pneumothorax will have intermittent In a patient with emphysema albuterol acts as---
bubbling in the water-seal chamber. Clients without a bronchodilator.
pneumothorax should have no evidence of bubbling in
The ABG results reveal respiratory alkalosis. The best
the chamber.
intervention to raise the PaCO2 level would be to ------
If the tube is obstructed, the nurse should notice that have the client breathe into a paper bag.
the fluid has stopped fluctuating in the water-seal
chamber. The therapeutic serum theophylline concentration
ranges from 10 to 20 mcg/ml.
Erythromycin is the drug of choice for treating
legionnaires’ disease. Theophyline side effect : diarrhea

The client with COPD retains carbon dioxide, which

Pursed-lip breathing helps----- prevent early airway
collapse. inhibits stimulation of breathing by the medullary
center inthe brain.
In pursed-lip breathing, the client mimics a normal
inspiratory- expiratory (I:E) ratio of 1:2. (A client with Pursed-lip breathing helps prevent early airway collapse.
Learning this technique helps the client control
emphysema may have an I:E ratio as high as 1:4.)
respiration during periods of excitement, anxiety,
Codeine’s is the analgesic of choice for moderate pain exercise, and respiratory distress

a pH value of 7.25 and a PaCO 2 value of 50 mm Hg Continuous gentle bubbling should be noted in the
confirms respiratory acidosis. suction control chamber. Bubbling should be continuous
and not intermittent.
A pH value of 5.0 with a PaCO2 value of 30 mm Hg
indicates respiratory alkalosis. The presence of fluctuation of the fluid level in the
water seal chamber indicates a patent drainage system.
In a client with COPD, high oxygen concentrations
decrease the ventilatory drive, leading to When the chest tube is removed, the client is asked to
perform the Valsalva maneuver (take a deep breath,
-----respiratory acidosis exhale, and bear down). The tube is quickly withdrawn,
Albuterol is a beta2 adrenergic agonist, which causes and an airtight dressing is taped in place.
dilation of the bronchioles. If the tube is dislodged accidentally, the initial nursing
action is to grasp the retention sutures and spread the
#NP4 part 2
opening. Covering the tracheostomy site will block the
If a chest drainage system is disconnected, the nurse airway.
may -----place the end of the chest tube in a container
Stridor indicates airway edema and places the client at
of sterile saline or water to prevent air from entering
risk for airway obstruction.
the chest tube, thereby preventing negative respiratory
pressure. Basic symptoms of a closed pneumothorax are
shortness ofbreath and chest pain. A larger
The nurse shouldn’t clamp the chest tube because
pneumothorax may cause tachypnea, cyanosis,
clamping increases the------- risk of tension
diminished breath sounds, and subcutaneous
pneumothorax.
emphysema.
A pH value of 5.0 with a PaCO2 value of 30 mm Hg
A sucking sound at the site of injury would be noted
indicates -----respiratory alkalosis.
with an open chest injury.
After bronchoscopy, the nurse keeps the client on NPO
status until the gag reflex returns because the
preoperative sedation and local anesthesia impair Kinks should be check for possible obstruction if no
bubbling is noted in the water seal bottle.
swallowing and the protective laryngeal reflexes for a
number of hours. After thoracentesis the client is placed or turned to the
------unaffected side to prevent leakage of fluid in the
Paradoxical respirations are seen with flail chest.
thoracic cavity.
Flail chest results from fracture of two or more ribs in at
DIET for COPD----- high calorie, high protein and low
least two places each.
carbohydrate diet
This results in a “floating” sec tion of ribs. Because this
TPN solutions should be changed every ---24 hours in
section is unattached to the rest of the bony rib cage,
this segment results in paradoxical chest movement. orderto prevent bacterial overgrowth due to
hypertonicity of the solution. Option 1 is incorrect;
Pneumothorax is characterized by restlessness, medication therapy can continue
tachycardia, dyspnea, pain with respiration,
Weight bearing exercises are beneficial in the treatment
asymmetrical chest expansion, and diminished or
absent breath sounds on the affected side. DEVIATED of osteoporosis.
trachea is a sign of tension pneumothorax
NP5
nstructions for using a metered-dose inhaler include
shaking the canister, holding itright side up, inhaling Cognitive behavioral therapy is a treatment that takes a
slowly and evenly through the hands-on approach to problem-solving and attempts to
assist the patient to change their thought processes that
-MOUTH lead to behaviors that create psychological or
physiological problems.
NP4 part 3
Turners sydrome s/sx
Nursing interventions before bronchogram:
Amenorrhea, web neck, low hair line, short stature is a
• Secure written consent symptom of Turner’s syndrome, which appears at
puberty.
• Check for allergies (seafoods and iodine or anesthesia)
surgical treatment for retinal detachment- Scleral
• NPO 6-8 hours
buckling
• Pre-op meds: atropine sulfate and valium, topical
Accoustic neuroma - inner ear
anesthesia sprayed followed by local anesthetic into the
larynx Retained peripheral vision - macular degeneration

• Have oxygen and antispasmodic agents ready Central vision - glaucoma

Nursing Interventions after bronchogram Retinal hemorrhage - shaken baby syndrome

• Side-lying position acute narrow-angle glaucoma, a nurse expects to give

which of the following medications?
A water seal bottle is expected to be observed for
intermittent bubbling. a. Acetazolamide (Diamox)

- for an air leak would be the nurse’s action if the water

seal has continuous bubbling.
cataract surgery, the nurse is to administer prescribed RESEARCH varriables
eye drops. The nurse reviews the physician’s orders,
expecting which type of eye drops to be instilled? Affixing titles after names like R.N, MAN etc. -- liable for
misdeamenor case or false representation or
c. A mydriatic medication misrepresentation

right cataract removal surgery. In which position should Written defamatory act is - libel
the nurse place the client?
Orally Spoken defamatory act is- Slander
c. Left side or supine.
Process standards include care plans, nursing procedure
surgical approaches for removing an acoustic neuroma; to be done to address the needs of the patients.
select all that apply
He plans to use a Likert Scale to determine
retrosigmoid
A. degree of agreement and disagreement
translabyrinthine approach
Raphael is interested to learn more about transcultural
middle cranial fossa approach (Facial nerve repair) nursing because he is assigned at the family suites
where most patients come from different cultures and
Otoscope examination in a client with mastoiditis countries. Which of the following designs is appropriate
reveals a red, dull, thick and immobile tympanic for this study
membrane, with or without perforation.
B. Ethnography
alcohol withdrawal?
Activated charcoal action -- stops toxins from being
Diazepam Or ATIVAN absorbed in the stomach by binding to them to leave
 Naltrexone --- suppress cravings for alcohol or the body in the feces.
opiate drugs. risperidone for schizophrenia -related delusions.
 Obstructive Sleep Apnea -- snoring is common Breath Alcohol content ==== 0.05%--0.08% legal limit
 Best position for OSA when sleeping ----Lateral Early signs and symptoms of alcohol withdrawal include
position TACHYCARDIA ,anxiety, anorexia, tremors, and insomnia.
 Instilling a medication drops in the ear--- less Al-Anon is a support group for families of alcoholics.
than 2 yo. Pull down and back A patient who is taking disulfiram (Antabuse) -----avoid
ingesting products that contain alcohol, such as cough
 Tinnitus sign of aspirin toxicity
syrup, fruitcake, and sauces and soups made with
 X-ray------ not considered as technologically cooking wine.
advanced modality or non sophisticated
every 4 hours ----standard VS monitoring
 Tympanometry ----- used to test the condition
Carotid is VS below the JAW
of the Middle Ear
The nurse should follow these guidelines when caring
 Autonomy---decision making
for a patient who is experiencing alcohol withdrawal:
 Malpractice ---- stepping beyonds ones
1. Maintain a calm environment, keep intrusions to a
authority
minimum, speak slowly and calmly,
2. adjust lighting to prevent shadows and glare manic phase of bipolar disorder. To help the client
maintain adequate nutrition, the nurse should plan to:
3. call the patient by name,
----offer finger foods and sandwiches.
4. have a friend or family member stay with the patient,
if possible. A client in the manic phase of bipolar disorder
constantly belittles other clients and demands special
alcohol withdrawal delirium most commonly occurs 3 favors from the nurses. Which nursing intervention is
to 4 days after admission. Check for TACHYCARDIA most appropriatefor this client?
IN SEIZURE PRIORITY IS SAFETY (protect head) Correct answer: Set limits with consequences for
SUICIDE belittling or demanding behavior.

A patient who has a chosen method and a plan to Manic phase------ walk with patient for exercise to
commit suicide in the next 48 to 72 hours is at high risk release excess energy.
for suicide. A client with bipolar disorder, manic phase, is yelling at
REMOVE BOTTLES OF ORANGE JUICE INSIDE WARD visitors. The client’s face is flushed and his fists are
clenched. Which nursing action should be taken first?
LITHIUM Correct answer: Direct the client to his room

The therapeutic serum level for lithium is 0.5 to 1.5 NP5 part 2
mEq/L.
Not an early sign of OTOSCLEROSIS -----hearing loss
Signs of lithium toxicity include diarrhea, tremors,
nausea, muscle weakness, ataxia, andconfusion. family nurse utilizes this diagrammatic representation of
members of a family and their relationships-----
Phobia are treated with desensitization therapy, which genogram
gradually exposes a patient to an anxiety-producing
stimulus. Complications of otosclerosis- hearing loss, prolonged
vertigo, infection, and facial nerve damage.
Otosclerosis
Preoperative interventions
- Abnormal bone growth around the footplate of the
stapes, resulting in the stapes becoming fixed, limiting --- prevent middle ear or external ear infections.
its movement and reducing the sound that is transferred
----avoid excessive nose blowing.
to the cochlea
---not to clean the ear canal with cotton-tipped
Main types of Otosclerosis
applicators and to avoid trauma or injury to the ear
Conductive hearing loss canal.

-Affects the middle ear Postoperative interventions

-Cochlear implants Hearing is initially worse after the surgical procedure

because of swelling and that no noticeable
-Stapedectomy (removal of stapes and insertion of improvement in hearing may occur for as long as 6
micro prosthesis) weeks.
-Stapedotomy (Small hole/opening in the stapes
footplate and insertion of micro prosthesis)
Gelfoam ear packing essential in caring for every nurse to be able to
demonstrate------therapeutic use of self
-----interferes with hearing but is used to decrease
bleeding. POMR is ---------Problem Oriented Medical Recording

Labyrinthitis In PIE, except-------discharge

-----infection of the labyrinth that occurs as a Preparation for termination of the nurse-patient
complication of acute or chronic otitis media. may result relationship begins during the------ oirentation phase
from growth of a cholesteatoma, a benign overgrowth
Anticipation of personal questions is given adequate
of squamous cell epithelium in the middle ear
attention during -------working phase
Assessment
tricyclic antidepressant drug:-----Imipramine (Tofranil)
---Hearing loss that may be permanent on the affected
side “bloodshot eyes”-----marijuana

Cannabis sativa----marijuana
Tinnitus

Spontaneous mystagmus to the affected side  Body dysmorphic disorder is characterized by a

belief that the body is deformed or defective in
Vertigo a specific way.

Nausea and vomiting  working phase------ the nurse continues to

encourage cohesiveness among its members.
Interventions
 orientation phase, or the initial phase, the nurse
Monitor for signs of meningitis, the most common
leading the group------- should explain the
complication, as evidenced by headache, stiff neck, and
purpose and goals of the group.
lethargy
 termination phase, or the final phase, the
Advise the client to rest in bed in a darkened room
leader -------encourages a discussion of feelings
Administer anti emetics and antivertiginous medications associated with termination.
as prescribed
 histrionic personality disorder, which is marked
statement reflects the scope of mental health by-----// excessive emotionality and attention
psychiatric nursing ----------it is an integral aspect of all seeking.
nursing and a specialty service to all people affected by
 paranoid personality disorder is--- suspicious,
mental illness.
cold, hostile, and argumentative.
essential component that the nurse must bring to the
 Avoidant personality disorder is characterized
relationship-------empathy
by ----anxiety, fear, and social isolation.
preparation of a patient for ECT ideally is MOST similar
 Borderline personality disorder is characterized
to
by, SPITTING, impulsive, unpredictable behavior
-----similar to preparation to general anesthesia and unstable, intense interpersonal
relationships.
After ECT, the nurse should do this action before giving
the client fluids, food or medication:  Projection is falsely ------attributing to another
person one’s own unacceptable feelings.
-----assess the gag reflex
  Hallucinations, which characterize most Succimer is an antidote for lead poisoning
psychoses, are perceptual disorders of the five
Patient taking Disulfiram best teaching ------
senses; the client may see, taste, feel, smell, or
hear something in the absence of external taught to read ingredient labels carefully to avoid
stimulation products containing alcohol such as aftershave lotions.
(Carbonated beverages, toothpaste, and cheese don’t
Visual - they see their dead love ones
contain alcohol and don’t need to be avoided by the
Auditory--- hears commanding voices client. )

----ask what those voices are telling to him (therapeutic) RA 6972----anti child abuse

Olfactory---smells something RA 9262----Violence against women and

Gustatory---tasted something Children

Tactile----feels something Victims of domestic violence must be assessed for their

readiness to leave the perpetrator and their knowledge
The body’s thermostat is located in the ---- of the resources available to them.
hypothalamus;
the nurse should suspect child abuse.
Mannitol-----helps to
-------abused children is lack of crying when they
Decrease ICP undergo a painful procedure (IV or parenteral med
to treat status epilepticus, -------diazepam maybe given injection)
every 10 to 15 minutes or are examined by a health care professional.
Atropine sulfate is a -------cholinergic blocker. ( It isn’t a Numbness and tingling in the hands and feet are
parasympathomimetic agent) symptoms of peripheral polyneuritis, which results from
A client with bacterial meningitis should be --------kept in inadequate intake of vitamin B1 (thiamine) secondary to
isolation for at least 24 hours after admission prolonged and excessive alcohol intake.

Cones of the eye provide daylight color, RODs Provide self-esteem is the ----highestrisk factor for anorexia
vision at night nervosa. (Constant dieting to get down to a "desirable
weight" is characteristic of the disorder. )
''headache ''may be an indication that the aneurysm is
leaking. Haloperidol is the drug of choice for treating Tourette
syndrome.
Chlordiazepoxide (Librium) and other tranquilizers help
reduce the symptoms of alcohol withdrawal. An open-ended statement or questions -----are the most
therapeutic response.
Haloperidol (Haldol) for psychotic, severe agitation and
delirium priority goal in alcohol withdrawal is ------maintaining
the client’s safety.
Naloxone (Narcan) ----is administered for narcotic
OPIATES overdose. Behavioral clues that suggest the potential for violence
include a rigid posture,restlessness, glaring, a change in
antidote for acetaminophen toxicity is acetylcysteine. usual behavior,

Deferoxamine mesylate is the antidote for iron

intoxication.
predominant behavioral characteristic of the client with
borderline personality disorderis --------impulsiveness,
especially of a physically self-destructive sort.

Acute withdrawal symptoms from alcohol may begin----

6 hours after the client has stopped drinking and peak 1
to 2 days later.

Total abstinence is the only effective treatment for

alcoholism.

Delirium tremens may occur 2 to 4 days — even up to 7

days — after the last drink.

client with anorexia nervosa may discard food or induce

vomiting in the bathroom, the nurse should

---- provide one- on-one supervision during meals and

for 1 hour afterward.

Tachycardia, a heartrate of 120 to 140 beats/minute, is

----- a common sign of alcohol withdrawal.

 Bulimia nervosa complications----- including

diabetes, heart disease, and hypertension.

 Al-Anon is an organization that assists family

members to share common experiences and
increase their understanding of alcoholism.

(Alcoholics Anonymous is an organization that helps

alcoholics recovers by using a twelve-step program.)

The client’s history of delinquency, running away from

home, vandalism, and dropping out of school are
characteristic of------- antisocial personality disorder.

 Obsessive-compulsive personality disorder is

characterized by a -----preoccupation with
impulses and thoughts that the client realizes
are senseless but can’t control.

 Narcissistic personality disorder is marked by a

pattern of ------grandiosity, and demand for
constant attention.