FINAL COACHING: MEDICAL SURGICAL NURSING

PROF. REX B. YANGCO

SPECIAL SENSES: Give the disease condition
1. Blurring of Vision/Foggy/ Cloudy/ Cataract FLUIDS AND ELECTROLYTES: Give the electrolyte imbalance
Hazy Vision Torsades de pointes- Prolonged QT Hypocalcemia
2. Floaters around light Retinal Detachment interval
Detachment of the retinal pigmented 4F’s Peaked T wave- Tall tented T wave Hyperkalemia
epithelium layer from the sensory Flashes of lights Prolonged QT interval Hypocalcemia
layer of the retina. Floaters Presence of U wave Hypokalemia
SURGERY: Scleral Buckling Falling of curtain Chvostek sign- facial spasm Hypocalcemia
Fainless Trousseau sign- carpo pedal spasm Hypocalcemia
3. Narrowed vision/ Tunnel/ Loss of Glaucoma Weakness of the lower extremities- Hypokalemia
peripheral vision early sign
- increase of IOP (10-21 mmHg) Paralytic ileus- complication of Hypokalemia
OPEN- degenerative, chronic prolonged constipation/ decrease in
-asymptomatic at first peristaltic movement
CLOSED- acute emergency Laryngospasm- fatal- airway Hypocalcemia
- Sudden severe headache obstruction:
- OBSTRUCTION- BEDSIDE:
iridocorneal angle Tracheostomy set
DOC: Pilocarpine Calcium Gluconate
- Miotic Metabolic Acidosis Hyperkalemia
- Pulls the trabecular Increase H- acid
meshwork – increases the H blood- cell
drainage of the aqeous K cell- blood
humor/ outflow- decrease Metabolic Alkalosis Hypokalemia
IOP Decrease H- alkaline
H cell- blood
4. Tunnel vision Glaucoma K blood- cell
5. Loss of red reflex- opacity of the Cataract “Cellular Ion Exchange
lens/ deposition of the grayish Increasing ICP Hyponatremia
substances in the lens due to abnormal Water Intoxication- water from the
ocular metabolism blood- cell- cell swelling
6. PAIN Closed Angle Glaucoma Cerebral Edema
7. Curtain falling in the visual field Retinal Detachment Increase water, less Na
8. Loss of central vision Macular Degeneration Hemodilution
MD- degeneration of the macula lutea Cushing’s Disease Hypernatremia
Macula lutea- center of the retina, Increase 3 S: Salt, sugar and sex Hypokalemia
contains millions of cones Aldosterone, Cortisol and Androgen
(photoreceptor- color, day and central Water and Na retention
vision) Inc Na, Dec K
DRY/ATROPHIC- accumulation of SIADH Dilutional
the debris- DRUSEN (yellow) Increase ADH- water reabsorption Hyponatremia
WET/ EXUDATIVE- neovascular Inc water, less Na
formation- RED Addison’s Disease Hyponatremia
9. DRUSEN- yellow Atrophic/ Dry Macular Decrease in 3S Hyperkalemia
Degeneration Increasing water and Na excretion
10. Sudden severe headaches- Closed Angle Glaucoma Dec Na, Inc K
mistaken as migraine Diabetes Insipidus Hypernatremia
11. Halos around light Glaucoma Decreasing ADH- water excretion-
12. Cloudy vision Cataract POLYURIA
13. Increasing IOP- aqeous humor Glaucoma Water Deficit- DHN
14. Myopia- nearsightedness Retinal Detachment Dec water, Inc Na-
Most common cause of RD hemoconcentration
15. Opacity of the lens Cataract

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 FINAL COACHING: MEDICAL SURGICAL NURSING
PROF. REX B. YANGCO
appearance of the breast
SIADH/ Diabetes Insipidus (D.I.) Reed Sternberg Cell- confirmatory Hodgkin’s Disease
(ADH- water reabsorption in the kidney tubules) Immature lymphoid cell
Signs/ Symptoms SIADH D.I.
Bence Jones CHON- urine Multiple Myeloma
Inc ADH Dec ADH
MM- abnormal proliferation of
Polyuria
plasma cell in the bone marrow
Concentrated urine- Oliguria/ Bone destruction- bone resorption of
decrease UO Ca
Urine specific gravity= 1.009- Hypercalcemia
diluted (polyuria) Auer rods Acute Myelogenous
Normal USG: 1.010- 1.025 Leukemia
Weight loss- water loss/ excretion Philadelphia chromosomes Chronic Myelogenous
Edema- water retention A piece of chromosome 9 and 22 Leukemia
break off and trade places
Dehydration- water deficit due to
Most common leukemia in children Acute Lymphocytic
water loss
Leukemia
Serum sodium = 120 mEq/L-
Dukes classification Colorectal Ca
Hyponatremia
A intestinal mucosa
Noraml: 135-145 mEq/L
B muscle
C lymph nodes
Constipation- water deficit D distant metastasis
Increased blood osmolarity- Tamoxifen- Anti Estrogen DOC Breast Ca
Hemoconcentration- Increase Hct WOF: Endometrial Ca
level Expected: bone pain- effective
Increased urine specific gravity- Flourouracil- Antimetabolite Colorectal Ca
concentrated urine- decreased UO Cell Cycle Specific
Hemodilution- Decrease Hct level Attacks the cell- S phase- DNA
Hypervolemia synthesis
Diluted urine- polyuria Painless Hematuria- early sign Bladder Ca
Polydipsia- compensation due to Hematochezia fresh blood in the stool Colorectal Ca
water loss Most common site: sigmoid and
Hypertension- Increase circulating rectum
blood volume Schistomiasis Bladder Ca
Pulmonary edema Painless swelling of the lymph nodes- Hodgkin’s Disease
cervical lymph nodes, upper part of
Decreased blood osmolarity- the body
Hemodilution
Abdominal enlargement- increasing Liver/ Ovarian Ca
Decreased urine specific gravity- size of the tumor
diluted urine- increasing urine
HPV- Multiple sexual partner Cervical Ca
excretion
Nulliparity Breast Ca
Water- like urine
Multiparity Cervical Ca
Growth retardation Tail of Spence- first site of metastasis, Breast Ca
Pituitary Gland – hypofunctioning axillary lymph nodes located
Urine sp gr = 1.040- concentrated Hepa Virus- Hepa B Hepatocellular Ca
urine A- Fecal oral
B- Body secretions and blood
CELLULAR ABERRATION: Give the specific kind of cancer C- Post BT hepatitis
1 case for female- morbidity Breast Ca D- Post Hepa B
1 mortality for both sexes- death Lung Ca E- Fecal oral
Caused primarily by smoking- 90% of Lung Ca Asbestos Lung Ca
its cause is smoking Hemoptysis Lung Ca
Passive smokers are 4 to 5x risker
High fat diet- low fiber diet Colorectal Ca
than active active smokers
High nitrate diet- salt cured/ Gastric Ca
SIADH- Small Cell Lung Carcinoma Lung Ca
preservatives; hotdogs, bacon, ham
- Ability to secrete ADH
Burkitt’s Lymphoma Non-Hodgkin’s Disease
Peau d orange- orange peel Breast Ca
Lymphosarcoma

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 FINAL COACHING: MEDICAL SURGICAL NURSING
PROF. REX B. YANGCO

NHD- (-) reed Sternberg cell

Right- sided CHF/ Left- sided CHF
CA 125 tumor marker Ovarian Ca Signs/Symptoms RIGHT LEFT
HYPERTHYROIDISM/
BRCA 1 and 2 Hyperthy
Breast CaHypothyr Systemic Pulmonar
HYPOTHYROIDISM
CA 15-3- old roidism
Breast Caoidism y
Signs/ Symptoms Everything Everything
CA 19-9 Pancreatic Ca Paroxysmal nocturnal dyspnea
is high, fast is low, slow
AFP Alpha feto CHON Liver Caand dry Dyspnea on exertion
and wet
CEA carcino embryonic Rales/crackles
Increased appetite to eat antigen Colorectal Ca
Enlarged spleen splenomegaly
HeatProstate
PSA intolerance
specific antigen Prostate Ca
Jaundice- liver – hepatomegaly
Constipation-
Dribbling decrease
of urine in peristalsis
– early sign Prostate Ca Ascites- accumulation of fluid in the
Fatigue- decrease metabolism
Cryptorchidism- undescended testes Testicular Ca peritoneal cavity due to third space
Weight loss- hyper metabolism
shifting- decrease colloid oncotic
Protrusion of eyeballs- Exophthalmus
pressure
Obesity
Polycythemia decrease perfusion- Decrease
Restlessness, Nervousness compensation circulating
Fine, oily hair O2 level
Dry, sparse hair Hypokalemia
Hypocalcemia- parathyroid hormone Decrease CO- decrease renal
insufficiency perfusion- RAAS- Hypernatremia/
Hypercalcemia Hypokalemia
Fine tremors early sign Leg edema
Infrequent blinking of eyes- protrusion of Clubbing of fingers- decrease O2
eyeball Hypoxia
Tachycardia Leg varicosities
Hypertension Blood- tinged frothy sputum-
Hyperlipidemia- increasing cholesterol Pulmonary Edema
level- decrease metabolism Elevated CVP – measures the pressure
Brittle nails at the R side of the heart
Thickened, hyperpigmented skin in the Elevated PAP – Pulmonary Artery
pretibial area- increase capillary fragility – Pressure
blood leaks from the vessel Enlarged liver
Dry, scaly skin Hypertension
Diarrhea Hemolytic anemia- Splenomegaly
Diaphoresis Liver cirrhosis
Bradycardia Syncope- due to decrease cerebral
Slow physical and mental reaction perfusion
Weight loss Fatigue, weakness
Elevated body temperature
BMR = (-) 25 %
Treated with Synthroid- thyroid hormone TYPES OF DIABETES
Treated with Tapazole Signs/Symptoms Type I Type II
Treated with PTU Absence of Islets of Langerhans
Treated with Lugol’s solution/ SSKI Onset after age 30 years
Given pre op: decrease vascularity- prevent Thin
bleeding Prone to DKA- absence of insulin- fat
Dull look converted into ketones
Exophthalmos/ Proptosis Associated with obesity
Von Graefe’s sign- lid lag Lifelong insulin therapy
Jeffrey’s sign- absence of folds at the Treated with Byetta- OHA
forehead Associated with autoimmune disorders-
Dalyrimple’s sign- thyroid stare destruction of the beat cells in the islet in
Treated with Cytomel the islet of langherhans
Requires low calorie diet Treated with OHA
Requires high fiber diet- constipation Occurs among children- Congenital/
High calorie diet- metabolism and energy IDDM
Requires cool, quiet environment Prone to HHNK
Requires warm environment during cold Presence of insulin- prevents fats to be
climate converted to ketones
Hyperactive Tendon of Achilles Brittle DM
Reflex Non- insulin dependent – NIDDM/
Adult Onset

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 FINAL COACHING: MEDICAL SURGICAL NURSING
PROF. REX B. YANGCO
Ketosis- resistant – presence of insulin occur
Onset before age 30 years/ Juvenile DM Common: N/V and abdominal pain
Associated with heredity Poor wound healing
Obese Muscle weakness- hypokalemia
Insulin- dependent DM Depression- mental and behavioral
Best managed with diet, activity, and changes
exercise Buffalo hump
Cell resistance Hypernatremia Increasing Aldosterone
Enough insulin to carry glucose to the Hyponatremia
cell Hirsutism in females elevated Androgen
Cell- resistance- glucose stays in the level
blood Gynecomastia in males
Obesity/ Lifestyle – causes the Increased virilism in females
resistance Decrease female hormone, strong male
characteristics
ADDISON’S DISEASE/ CUSHING’S DISEASE
Signs/ Symptoms Addison’ Cushing’
s s NEUROMUSCULAR DISORDERS
Decrease Increase Signs/Symptoms Disorders
3S 3S Resting tremors Parkinson’s Disease
Hypotension- water and Na excretion Intentional tremors- Charcot’s Multiple Sclerosis
Hyperglycemia- increase Cortisol TRIAD: SIN
Gluconeogenesis- formation of new Scanning speech
glucose Intentional tremors
Glycogenolysis- breakdown of glycogen Nystagmus
Edema- Na and water retention Ascending paralysis GBS
(Aldosterone) Tiptoe walking Cerebral Palsy
Hyperkalemia Ataxic gait- loss of balance and MS/ PD
Decrease in Aldosterone coordination
Decrease Na, Increase K Pillrolling tremors PD
Delayed wound healing- CHON Treated with Levodopa PD
catabolism- effect of CORTISOL Muscle weakness associated with Myasthenia Gravis
Easy bruising activity
Moon face- deposition of fats Treated with Mestinon- Cholinergic MG
Hyponatremia (decrease aldosterone) Bradykinesia- slowed movement PD
Thinning of scalp hair Cogwheel rigidity PD
Dehydration loss of water and Na Treated with Cogentin- PD
Hypertension water and Na retention- Anticholinergic
Hypervolemia Decreased dopamine production PD
Eternal tan appearance of the skin Decreased acetylcholine receptor MG
Hyperpigmentation sites- autoimmune- destruction of the
Bronze Colored skin acetylcholine receptor site
Due to hyperstimulation of MSH- Positive tensilon test MG
negative feedback mechanism Ptosis, strabismus, diplopia- PS MG
Hirsutism elevated Androgen level Sticky skin- increase perspiration/ MG
Osteoporosis- CHON catabolism secretion
Hypoglycemia decrease cortisol level Bladder and bowel dysfunction GBS
Tachycardia Scanning speech MS
Compensation- decrease circulating blood Soft, monotonous voice PD
volume due to water and Na excretion Treated with Comtan (Entacapone) PD
Hypovolemia Treated with Baclofen- muscle MS
Purple striae on the abdomen- truncal spasticity
obesity Treated with cholinergic MG
Obesed trunk, thin arm and legs Flattened affect- mask like face PD
Weight loss Treated with Baclofen MS
Loss of appetite to eat increased Na and Treated with anticholinergic PD
glucose level
Stooped posture PD
Hypocalcemia- associated with
Small, shaky handwriting PD
hypoparathyroidism
Associated with swine flu vaccine GBS
Fatigue
Shuffling gait PD
Nausea, vomiting, diarrhea
Charcot’s triad MS
Addison’s Disease- GI symptoms
Backpain on passive flexion of neck Meningitis
Diarrhea- less common but may still
(Brudzinski)
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 FINAL COACHING: MEDICAL SURGICAL NURSING
PROF. REX B. YANGCO
Absence of arm swing when walking PD joints
Morning stiffness
ANTIDOTES Pain-on-use of joints
Drugs/ Conditions Pain-on-nonuse of joints
1. Morphine Naloxone/ Narcan Boutouniere’s deformity- flexion in
2. Magnesium Sulfate Ca Gluconate proximal
3. Hyperkalemia- prevent Cardiac Ca Gluconate Extension at the distal
arrest Swan neck- flexion at the distal
4. Beta adrenergic blockers Glucagon Extension at the proximal
5. Calcium channel blockers Glucagon Excessive dryness of eyes, mouth, and
6. Acetaminophen poisoning Acetylcysteine vagina
7. Lead Poisoning EDTA Leukopenia, splenomegaly- felty’s
8. Heparin Protamine Sulfate syndrome
9. Coumadin Vitamin K Hemolytic anemia
10. Opiate addiction Methadone Localized inflammation
11. Digitalis toxicity Digibind/ Digitalis Unilateral affectation of joints
Immune Fab Ulnar drift of the hand
12. Alcohol abuse Metadoxine Cock- up toe
13. Myasthenic crisis- underdose Prostigmine/ Neostigmine
14. Cholinergic crisis-overdose Atropine SO4
15. Diazepam Flumazenil/ Romazicon
16. Hemosiderosis accumulation of Deferoxamine
iron in the blood- Thalassemia Iron Chelation Therapy

DIFFERENT TYPES OF ANEMIA

Different Types of Arthritis

Signs/ Symptoms RA OA GA
Autoimmune disorder
Degenerative disorder
Metabolic disorder
Females more commonly affected
Males more commonly affected
Inflammation affects both side of the body
Cartilage of joints wear off- degeneration
Synovial membrane affected
Tophi- urate crystals
Obese elderly commonly affected
Joints of fingers commonly affected
Weight- bearing joints most commonly
affected
Big toe commonly affected and ankle
Heberden’s nodes- distal interphalangeal
joints
Bouchard’s nodes- proximal interphalangeal
joints
Sjogren’s syndromeautoimmune d/o
Dry mouth/eye
Felty’s syndrome
TRIAD:
RA
Splenomegaly
Neutropenia
Elevated urine and serum uric acid
Crepitus- cracking or popping sound at the

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 FINAL COACHING: MEDICAL SURGICAL NURSING
PROF. REX B. YANGCO
Signs and Symptoms IDA Folate Deficiency Pernicious Aplastic Thalassemia
Microcytic, Hypochromic Anemia- small
and pale RBC
Iron- gives color to the RBC
Cause of IDA:
Blood loss
Malnutrition
Pancytopenia decrease in all blood cells
Anemia
Leukopenia
Thrombocytopenia
Megaloblastic/ Macrocytic anemia- RBC: WOF: Neural
large and dark red Tube Defect
Cheilosis- crack at the side of the lips
Beefy red Tongue
Spoon- shaped Fingernails- Koilonychia
Intrinsic factor deficiency- absence of
parietal cells- produces the intrinsic factor
Decrease absorption of Vit. B 12
Abnormal hgb, short lifespan of RBC
Vitamin B12 Deficiency
Atrophic glossitis, dysphagia, stomatitis-
Vinson Plummer Syndrome
Hemosiderosis

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