Maternal SL Notes

Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City
 Age of Gestation (AOG) - 24-26 weeks, 400-

Lesson 1 600 grams
Prenatal Care - It is when a pregnant woman  Life of viability / Uterine life - 24-28 week of
/mother gets check-ups throughout pregnancy gestation
Ultrasound - knows when the baby is due; hears the  Grandmulti Gravida - has had 6 or more
baby's heartbeat pregnancies
5-6 weeks - fetus can be measured  PrimiPara - a woman who has completed one
8-18 weeks – Best state to know gestational period pregnancy to age of viability
via ultrasound  MultiPara - a woman who has completed 2
pregnancies to age of viability
AIMS TO PRENATAL CARE:
1. To screen high risk cases (hypertension, heart FUNDAL HEIGHT – Gross estimate of expected data of
disease, high level of sugar (Diabetes/GDM). delivery/confinement (EDD)
2. To prevent, direct, or treat at any earliest
complication.
3. To ensure continues surveillance
4. To educate the mother about the physiology
and development of the infant/fetus.
5. To discuss to the couple of the place, time.
6. To motivate the couple of family planning (2-3
years)
Philippine Law for giving birth = maximum of

3 children
OBJECTIVE OF PRENATAL CARE: ESTIMATING FETAL GROWTH

1. To ensure a normal pregnancy / delivery of a 1. MC DONALD’S RULE
healthy baby and make sure that the mother is safe,  is a method of determining that the fetus is
well, and healthy. growing in the utero by measuring the fundal
2. Prenatal Visits/Check-ups height.
WEEK 1-32 Once a month (Normal)  Is made from the notch of the symphysis
(FIRST TRIMESTER) Once a week (High risk) pubis to over the top of the uterine fundus as
WEEK 32-36 Every two weeks the woman lies supine
(SECOND TRIMESTER)
WEEK 36-40 Every week
PROCEDURE: ESTIMATING FUNDIC HEIGHT BY
(THIRD TRIMESTER)
MCDONALD’S METHOD:
40 WEEKS OR MORE Full term
1. Explain the procedure to the mother
2. Ask the mother to empty the bladder
REPRODUCTIVE:
3. Position mother on a dorsal recumbent
 Gravida – total no. of pregnancies that a
4. Drape
woman has have
5. Measure the distance abdominally from the top of
 Primi Gravida - gave birth for the first time/
the symphysis pubis over the curve of the
first time mom abdomen to the top of the uterine fundus
 Nulli Gravida - never been pregnant
 Multi Gravida - has more than 2 pregnancies
 Parity -no. of pregnancies that reached
Gestational Age
BALDO, MYKA MARGARETTE L.

BSN 2-D
Tamag, Vigan City
 The months with 30 days are September,

April, June, and November while the other
months are 31 days.
EXAMPLE:
LMP = 8 December 2019
+1 year = 8 December 2020
−3 months = 8 September 2020
+7 days = 15 September 2020
COMPUTE USING MC DONALD’S RULE

Duration of pregnancy in lunar months
a) FH in cm x 2 divided by 7 Lunar months
(months and day)
b) FH in cm x 8 divided by 7 (AOG in weeks:
weeks and day)
Example: 34 cm
34 cm x 2/7 = 9.71 (months)
34 cm x 8/7 = 38.85 or 38-39 weeks
BARTHOLOMEW’S RULE
MC DONALD’S RULE EXAMPLE
Determines the AOG of the fetus depending on the
1. Mrs. Brown's fundal height is 8 cm. How far along is
height of the fundus.
she? Use the formula when getting for the Lunar
12 weeks symphysis pubis
month.
16 weeks between symphysis pubis and umbilicus
**8cm
20 weeks umbilicus
8cm (multiplied by) 2 divided by 7 = 2.2 or 2months &
24 weeks two cm above umbilicus
2 days
28 weeks between umbilicus and xyphoid process
32 below xyphoid process
COMPUTATION OF EDD AND AOG
36 xyphoid process
NAEGELE’S RULE
40 below xyphoid process
 is a standard way of calculating the due date
for a pregnancy. The rule estimates the
Age of gestation (AOG)
expected date of delivery (EDD) by adding one
Age of a fetus or a newborn (NB)
year, subtracting three months, and adding
STEPS:
seven days to the first day of a woman's last
1. Determine the 1st day of the LMP
menstrual period (LMP). The result is
2. Subtract the total # of days of the calendar
approximately 280 days (40 weeks) from the
month from the day of LMP
start of the last menstrual period.
3. Add the total number of days of the month
 Another method is by adding 9 months and 7
following the month of the LMP up to the
days to the first day of the last menstrual
present date
period.
4. Divide it to 7
 When solving for an EDD with Nagele'sRule it
is important to remember the months that
EXAMPLE:
have 30 (thirty) days vs. 31 (thirty-one) days,
LMP : January 5, 2019
 And of course, February has 28 days. Always
EDC: October 12, 2019
give February 28 days (regardless of leap year)
DOV: April 4, 2019
to avoid confusion.
AOG: 12 weeks and 5 days
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Tamag, Vigan City
jan - 26 LEOPOLD’S MANEUVER

feb - 28  systematic method of observation and
march - 31 palpation to determine fetal presentation
april - 4 and position
______ First Maneuver- Fetal presentation
89/7= 12 weeks and 5 days Second Maneuver – Fetal back
Third Maneuver- Engagement
RECORDING THE OBSTRETIC HISTORY (GTPAL) Fourth Maneuver- Fetal attitude
 Provides important information about the
patient’s past pregnancy/ies. FETAL PRESENTATION:
 2 important components of a patient’s OB  CEPHALIC – head in the uterus
history  BREECH – head in the xiphoid, feet in the
• G – Gravida uterus
• P – Para  SHOULDER – shoulder in the uterus (side
 G: Gravida – the total number of pregnancies fetus)
 T: Term – the number of pregnancies that
ended at term (at or beyond 38 weeks of FETAL SIZE
gestation)  Fetal head
 P: Preterm – the number of pregnancies that  Use to determine/measure the size of the
ended after 20 weeks and before the end of baby -> FETAL BIOMETRY
37 weeks gestation
 A: Abortions – the number of pregnancies FETAL ATTITUDE
that ended before 20 weeks gestation  Normally Fully Flexed
 L: Living – the number of children delivered  Describes the degree of flexion of the fetus
who are alive when the history was taken  The relationship of fetal baby parts to itself
 Chin on chest
Lesson 2  Rounded back
 Flexed arms and legs
ASSESSING FETAL WELL BEING
A. Fetal Movement / fetal Quick Count (SANDOVSKY
FETAL LIE
METHOD)
 Longitudinal-fetus' long axis is in line with the
Best time is early morning( 8-9am)
mother's uterus with its head down
After a meal, flat recumbent position for 1
 Transverse- refers to a fetal presentation in
straight hr: no changing positions, no
which the fetal longitudinal axis lies
interruptions; once a week.
perpendicular to the long axis of the uterus.
Quickening at 18-20 weeks of pregnancy
 Oblique – cephalic but nape of the head in
30 weeks and above AOG- to start counting
the uterus of the baby.
kicks
NORMAL- 2 times every 10 mins or 10-12  Longitudinal lie a situation in which the long
times/hr axis of the fetus is parallel to that of the
Less than 5- fetus experiencing distress, poor mother; in presentation, either the head or
placental perfusion breech p resents first.
B. Fetal Heart Rate Monitoring  Transverse lie a situation in which the long
NORMAL – 120-160bpm axis of the fetus is transverse to that of the
It can be heard using Doppler as early as 11th mother.
week or use stethoscope  Oblique lie a situation in which the long axis
Use of Leopold’s Maneuver of the fetal body crosses that at an angle close
to 45 degrees; in PRESENTATION, the
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Tamag, Vigan City
shoulder usually presents first, but the arm or FETAL PRESENTATION:

part of the trunk may also come first.
Head down-Facing down
 Head first presentations (cephalic). the back
of the head (occiput) is the reference.
Head down-Facing up
 Baby is presenting headfirst (cephalic) with its
head facing up (occiput posterior). In this
position, the baby might have a harder time
extending his or her head from under the
pubic bone.
Frank breech presentation

 With both hips flexed and both knees
extended and the feet close to the head. The
frank breech presentation is the most
common type of breech presentation.
Complete breech presentation

 This baby is in a complete breech
presentation- with both hips and both knees
flexed. In an incomplete breech, one or both
hips are not flexed and one or both feet or
knees le below the buttocks. In either
presentation, you might feel kicking in your
lower abdomen.
Lying sideways
 This baby is in a transverse le-positioned
horizontally across the uterus, rather than
vertically, in a transverse lie, the baby's back
might be positioned:
 Down, with the back facing the birth canal.
 With one shoulder pointing toward the birth
canal
 Up, with the hands and feet facing the birth
canal
Twins
 Twins can usually be delivered vaginally if the
lower twin is presenting headfirst (cephalic).
 If only the lower twin is head first, as shown
here, your health care provider might deliver
the lower twin vaginally.
 If the lower twin isn't positioned headfirst or
neither twin is headfirst, both twins are
usually delivered by C-section.

BSN 2-D
Tamag, Vigan City
ABNORMAL PRESENTATION
FACE ABNORMAL PRESENTATION:
- The fetus face is aligned with the uterus.
BROW ABNORMAL PRESENTATION
- The fetus forehead is aligned with the uterus.
TWINS
- The first baby is positioned cephalic and the
other is breech.
LEOPOLD’S MANEUVER
PREPARATIONS
1. Prepare the client.
a. Explain the procedure.
b. Instruct the client to empty her bladder.
c. Position the woman supine with knees slightly 1ST MANEUVER
flexed. Place a small pillow or rolled towel under one
side.
d. Wash your hands using warm water.
e. Observe the woman's abdomen for longest diam-
eter and where fetal movement is apparent.
2. Perform the first maneuver.
a. Stand at the foot of the client, facing her, and place
both hands flat on her abdomen.
b. Palpate the superior surface of the fundus. Deter-
mine consistency, shape, and mobility.
3. Perform the second maneuver.
a. Face the client and place the palms of each hand on
either side of the abdomen.
b. Palpate the sides of the uterus. Hold the left hand 2ND MANEUVER
stationary on the left side of the uterus while the right
hand palpates the opposite side of the uterus from
top to bottom. Then hold the right hand steady, and
repeat palpation using the left hand on the left side.
4. Perform the third maneuver.
a. Gently grasp the lower portion of the abdomen just
above the symphysis pubis between the thumb and
index finger and try to press the thumb and finger
together. Determine any movement and whether the
part is firm or soft.
5. Perform the fourth maneuver.
a. Place fingers on both sides of the uterus approxi-
mately 2 inches above the inguinal ligaments, pressing 3RD MANEUVER
downward and inward in the direction of the birth
canal. Allow fingers to be carried downward.

BSN 2-D
Tamag, Vigan City
EXAMINING THE PELVIC SIZE:  Convergent side walls, prominent ischial

►Provides information on the health of the internal spines, narrow pubic arch
and external reproductive organs Anthropoid
►Steps:  Apelike pelvis
1. Ask the patient if she has douched with in the past  Anterioposterior diameter of the inlet is
24H greater than transverse diameter
2. Instruct the patient to empty her bladder before Platypelloid
the examination  "flattened pelvis”
3. Explain what examination entails and why it is  Transverse diameter greater than AP
necessary  diameter, with wide side walls
4. Assist the patient to lie in a Lithotomy position in
the examining table stirrups
5. Draped the patient with a draw sheet over the
abdomen and extending over the legs
PELVIMETRY
 Pelvimetry is the assessment of the
dimensions & capacity of adult female
pelvis in relation to the birth of a
baby.
 Pelvimetry was heavily used in leading
the decision of natural, operative
vaginal delivery or CS.
Diagonal conjugate
 The distance between the anterior surface of
the sacral prominence and the anterior
surface of the inferior margin of the
symphysis pubis
TYPES of PELVIS  If the measurement obtained is more than 5"
Gynecoid or 12.5cm, the pelvic inlet is considered
 Female pelvis found in 50% of women adequate for childbirth
 Anterioposterior & transverse diameters are
relatively equal, with straight pelvic sidewalls Steps in measuring diagonal conjugate
 Ischial spines are not usually prominent; wide 1. To measure it, introduce two fingers vaginally
pubic arch Round in shape and press inward and upward until your
Android middle finger touches the sacral prominence
 Male pelvis; heart-shaped

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Tamag, Vigan City
2. With your other hand, mark the part of your

examining hand where it touches the
symphysis pubis
3. Withdraw your examining hand and measure
the distance between the tip of your middle
finger and the marked point on the glove on
that hand by comparing it with a ruler
True conjugate or conjugate vera

 The measurement between the anterior
surface of the sacral prominence and the
posterior surface of the inferior margin of the
symphysis pubis
 The usual depth of the symphysis pubis 1⁄2" -
3/4" or 1- 2cm is subtracted from the diagonal
conjugate measurement
 The distance remaining is the true conjugate
or actual dm of the pelvic inlet through which
the fetal must pass
 The average true conjugate dm 4"-4" (10-
11cm)
Obstetric Conjugate
 Distance between midpoint of inner surface
of symphysis pubis to midpoint of sacral
promontory transverse sacral promontory
 The True Conjugate = 11 cm
The Obstet. Conjugate = 10.5cm
The Diagonal Conjugate = 12 cm
Ischial tuberosity
 The transverse dm of the pelvic outlet
 This measurement is made at the medial and
lowermost aspect of the ischial tuberosities,
at the level of the anus
 A diameter of 10.5cm or 4 1/4" is considered
adequate for passage of the fetal head
through
 the outlet

BSN 2-D
Tamag, Vigan City
Low calorie diet – need for weight control

Lesson 1: NUTRITION Low salt and low-fat diet – need for blood
AND DIET THERAPY pressure control
Introduction to Nutrition and Diet Therapy Note: Whether it is a typical intake or a
Nutrition helps people attain good health special diet, it should follow the principle of
balanced diet. Balanced diet provides the correct
and long existence. Proper nutrition is essential amount of essential nutrients.
to preventing deviations from the normal state or Eating a balanced diet means choosing a
the establishment of acute or chronic diseases. wide variety foods and drinks from all the food. It
All of life’s food choices bring upon health effects also means eating a certain thing in a small
for the better or for worse. A single day’s intake amount like saturated fats, cholesterol, simple
of nutrient may exert only a minor effect on the sugar, salt and alcohol.
body, but over years and decades, the repeated The goal is to take in all of the nutrients
effects accumulate to have major impacts. In need for health at the recommended levels and
people with certain medical condition, modified perhaps restrict those things that are not good
diets serve to manage the symptoms and help for the body.
achieve a better quality of life.
4. Food – is anything edible which
Definition of Terms: derived from plants and animals. It is necessity of
life. All foods and drinks which are acceptable for
1. Nutrition – is the science of food, the a particular society, culture or religion. Food acts
nutrients and the substances therein, as body fuel that gives the energy required for
their action, interaction and balance in bodily functions.
relation to health and disease, and the
process by which the organism ingests,
WHAT DOES ARE
digests and absorbs, transports, utilizes FOOD DO?
and excretes food substances. (CAMA) Foods gives us a feeling of comfort and
2. Diet – the food and drink that a person satisfaction. Eating certain foods established our
regularly consumed. It is the sequence identity. What we eat and how we eat makes up
and balance of meals in a day. It is our food habit. Most of our food habits are
concerned with the eating patterns of learned in the home from our parents. As we
individuals or a group. grow up, our experience and learning help us to
3. Diet Therapy – a broad term for the change some of these food habits. You are
practical application of nutrition as a learning about food and nutrition in order to be
preventive and/or corrective treatment of able to teach and help mothers to change their
disease. It involves modification of an food habits for the better.
existing dietary lifestyle to promote Note: No single food provides all the
optimum health. nutrients required by the body in sufficient
quantities, so variety of foods must be eaten.
A person follows a special diet, which is a 5. Nutrients – is a food component. It is
selection of food based on health conditions or applied to chemical substances present in food
disease management goals. and is used in the body for one or more functions
For example: such as:

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Tamag, Vigan City
a. To provide energy; 4. To replace cells. Most cells live only a short time.
b. To build and repair tissues; and The body must build new cells to replace those that
c. Regulate life processes die.
Skin is the good example. The outside layer of
the skin is already dead. All the time new cells are
growing under the dead sells to preplace them. When
a person washes and dry the skin, it removed the
All nutrients are equally and dead cells.
physiologically important in the body regardless On the other hand, wearing shoes for a long
of their concentration. It has adverse effects time caused holes in the soles. But walking without
shoes, do not caused holes in the feet, because new
when taken in excessive amounts and when
skin cells grow under the old cells to replace them.
intake is insufficient, can lead to deficiency
disorder. 5. To repair tissues. After injury or illness, the body
Note: No one nutrient is more important makes new cells to repair the damaged tissues.
than the others. Each nutrient does specific jobs.
The nutrients work together to keep us healthy. 6. To provide energy. The body burns nutrients to
make energy for the body’s activities including the
brain and muscle functions. The energy-giving
HOW DOES THE BODY USE nutrients yield calories when metabolized in the body.
NUTRIENTS?
Using Nutrients to Build the Body
1. For Growth. A child starts to grow as a single cell
Lesson 2:
inside its mother. The cell absorbs nutrients; it grows CLASSIFICATION OF
and divides into two cells. The cell uses nutrients as
building materials for a new cell and other nutrients NUTRIENTS
for energy to do the work of building. Each cell then There are two main classification of nutrients
absorbs more nutrients to grow larger and divide – the Macro and Micro Nutrients and there are six
again. The cells continue to absorbs nutrients and to essential nutrients that the body needs. It is
grow and divide until there are millions of cells which important that these nutrients consume by everyone
form different tissues such as skin, muscle and bone. on a daily basis to help build and maintain healthy
The child’s body also makes fluids such as blood, body. Deficiencies, excesses and imbalances in diet
which nourishes and protects the cells. can produce negative impacts on health, which may
cause development of certain illness or disease.
2.For Pregnancy. During Pregnancy, a woman
needs body building nutrients to: A. Macronutrient
a. Provide the baby and placenta with nutrients Macro means large, these are nutrients which people
to grow need to eat regularly and in a fairly large amount. It
b. Increase the size of her uterus and breasts includes the carbohydrates, protein, fats and water. It
b) c.Make more blood and stores of fat that can provides a lot of calories but the number or amount of
be mobilized during lactation, and other calories provided varies, depending on food source.
nutrients. These are needed for the supply of energy and
growth, for metabolism and other body functions.
3. To secrete fluids. The body has to keep making
fluids such as saliva, digestive juices, tears and TERMS TO REMEMBER
breastmilk because they are continually used up.

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Tamag, Vigan City
Calorie (kcal) – is the energy required to raise the 6. Act as Structural component
temperature of one kilogram of water one degree
Celsius. A unit of heat used to indicate the amount of
energy that foods will produce in the human body.
Metabolism – means the process involved in the
generation of energy and all the building blocks
required to maintain the body and its functions.
Note: Each gram of carbohydrate and protein
provides four calories while fat provides nine calories It is important to know he classes of
for each gram. carbohydrates to enable to give relevant advice to
B. Micronutrient patients with special needs like diabetes, this
Micro means small, these are nutrients which people condition has problems regulating the amount of
need only small amount in their diet. These include glucose in the body.
trace minerals and vitamins. Although most foods are Monosaccharides and disaccharides are
mixtures of nutrients, many of them contain a lot of referred to as simple sugars or simple carbohydrates
one nutrient and a little of the other nutrients. that the body can easily utilize. For this reason, people
with diabetes mellitus shouldn’t eat too many of
Six Essential Nutrients these carbohydrates. (e.g. sugar, honey, sweet fruits
1) Carbohydrates and sugar cane)
 provide most of the energy in the majority of
human diets. Glucose – known as dextrose sugar or grape sugar;
 are organic compounds composed of carbon, the circulating sugar in the body
hydrogen, and oxygen which provide the Fructose – found in fruits and honey; the amount of
major source of energy. fructose in fruits depends on the degree of ripeness
 carbohydrates containing the most nutrients Galactose – the component of lactose
are the complex carbohydrates, such as Sucrose – known as the table sugar
unrefined grains, tubers, vegetables, and Lactose – the sugar in milk
fruits Maltose – the intermediate product of starch
 simple carbohydrates or sugars should be digestion
eaten in moderation, since they are high in Polysaccharides are called complex carbohydrates and
calories but low in nutrients. need to be broken down into simple sugars to be used
Recommended Intake of Carbohydrates by the body. This can be consumed by diabetic
 recommended intake of CHO: 55-70% patients without restriction.
(majority come from complex carbohydrate)
 Recommended intake of dietary fiber: 25- Two Types:
30g/day 1. Digestible Polysaccharides – complex
Example: A 5’3” individual needing 200 kcal/day will carbohydrates that can be broken down into sugar
have a carbohydrate allowance of 300g. units like starch and dextrin.
How: 2000 x 0.60 = 1200kcal=300grams 2. Nondigestible or Nonstarch Polysaccharide – are
4kcal/g complex carbohydrates that contain sugar units held
Functions of Carbohydrates: together by bonds that human digestive system
1. Protein sparer cannot break, thus they yield little energy (if any).
2. Fat sparer They are also known as dietary fiber which has two
3. Sole energy source for the brain and nerve classes:
tissues a. Insoluble Fiber – do not dissolve in
4. Reserve fuel supply water due to tough, fibrous structures
5. Regulator of normal bowel movement of fruits, grains and vegetables.
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b. Soluble Fiber – readily dissolved in

water; often impart gummy or gel-like
characteristics to foods.

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Tamag, Vigan City
Other Forms of Sugars:

Artificial sweetener – sometimes called non-nutritive HEALTH EFFECTS
sweeteners Sugars - nutrient deficiencies, dental carries, obesity,
e.g. aspartame (Equal, Nutrasweet) atherosclerosis
Note: make food taste sweet without causing damage Starch & Fibers - weight loss, satiety value, lower risk
of tooth enamel. of the disease, lower risk of diabetes, enhanced
Sugar alcohol - sometimes referred to as nutritive health of the colon.
sweeteners, the substitute for sucrose, are sugar like 2) Protein
compounds that are sweet to taste but yields less  Vital for growth, improve immune function,
kcal/g. and maintenance of the body.
Note: Excess intake of sugar alcohol may result in  Play an important role in making essential
abdominal discomfort since they are fermented to hormones and enzymes, in tissue repair,
gases in the large intestine by bacteria. However, less preserving lean muscle mass and supplying
likely to cause dental carries (e.g. chewing gum) energy in times when carbohydrates are not
Brown sugar - Refined white sugar crystals to which available.
manufactures have added molasses syrup with  Acts as a chemical messenger within the body
natural flavor and color.  About 10-35% of calories should come from
Raw sugar - Sugars that has actually gone through protein.
about half the refining process.  Requirements for protein vary between 40-65
Confectioner’s sugar - Finely powdered sucrose g/day depending on physical activity, stress
Corn Syrup - Contain mainly glucose, produced by the and grown cycles
action of enzymes on cornstarch.  Excess is stored as fat
Granulated sugar - Crystalline sucrose  Pregnant women need protein to build their
Molasses - A thick brown syrup left over from bodies and that the baby and placenta to
sugarcane juice during sugar refining. make extra blood and for fat storage.
Maple syrup - A sugar purified from concentrated sap Breastfeeding mothers need protein to make
of the sugar maple tree. breastmilk.
 made up off smaller units called amino acids.
o Building blocks of CHON
o there are 24 amino acids of which 9
are essential amino acids and the
remaining are non-essential amino
acids.
Recommended Intake of Protein

Protein allowance = DBW (kilo) x protein allowance per k
DBW
Note: Starch – are plants foods which is abundant in

rice and rice products
Dextrin – is an intermediate product of starch Example: A 7y/o child with a DBW of 22 kg has a
digestion and is used as an ingredient in commercial protein allowance of 33 g/day
formula and food products. 22k x 1.5 g/k = 33grams

BSN 2-D
Tamag, Vigan City
Classification of Protein: Food Sources of CHON:

1. Complete Protein – animal protein food; provide all Complete Fish, shellfish, chicken, turkey,
essential amino acids in sufficient amount to meet the CHON duck*, beef*, tofu, hard cheese,
body’s need. cheddar, lamb*, pork*, egg*, milk,
2. Incomplete Protein – plant protein food yogurt, ice milk/reduced-fat ice
Note: Plant protein foods are not inferior to animal cream
CHON foods; if a combination of plant CHON is eaten Cereal Oatmeal, wheat
together then the essential amino acids, which are Grains Corn, oats, barley,
Incomplete spaghetti, bread,
limited in one, are provided by the other.
CHON bagels
Vegetables Broccoli, potatoes,
9 Essential amino acids
green peas, leafy
1. Histidine green vegetables
2. Isoleucine Legumes Black-eyed peas,
3. Leucine lentils, beans,
4. Lysine peanuts/peanut
5. Methionine butter, chickpeas,
6. Phenylalanine split peas
7. Threonine
8. Tryptophan
9. Valine
Basic Non-essential amino
1. Alanine
2. Arginine
3. Asparagine
4. Aspartic acid
5. Cysteine acids
6. Tyrosine
7. Glutamic acid
8. Glutamine
9. Glycine
10. Proline
11. Serine
Note: Trytophan also called “nature’s sleeping pill”:
precursor of serotonin and “provitamin B3”: precursor
of niacin 60mg tryptophan = 1mg niacin); Glutamine is
termed as “antistress nutrient” and is present in
largest amount in plasma
Functions of CHON:
1. Building antibodies
2. Building enzymes, hormones and other compounds
3. Maintaining fluid and electrolyte balance
4. Maintaining acid-base balance
5. Providing energy
6. Transforming energy
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Tamag, Vigan City
Other Tempeh Fermented

Sources soybean Classification and Food Sources of Fats:
Powdered Dried fish or beans
Protein
Note: * indicates possible high-fat source of CHON

Egg: called reference protein: provides all essential
amino acids
Protein Supplementation – is a dietary strategy of

combining two protein foods in a meal so that each
food provides the missing amino acids. The
combination of rice and black beans, bread and
peanut butter, tokwa and stir-fried vegetables,
champorado with milk, spaghetti with cheese are
examples of applying this principle.
HEALTH EFFECTS OF PROTEIN

High CHON diets must be avoided unless the
body needs an increased supply of amino acids. A diet
high in meat could lead to increase in blood
cholesterol or other diseases, such as gout. Another
potential problem is that a high protein diet may put a
strain on the kidneys. Extra waste matter, which is the
end product of protein metabolism, is excreted in the
urine.
In addition, person deprive of protein may
cause Protein Energy Malnutrition (PEM), food rich in
animal protein tend to be rich in saturated fats is also
associated with heart disease, studies have found
there is a significant relationship between Colon
Cancer and high meat diets, and too much protein-
rich food like fat-rich contributes to development of
Obesity.
3) Fats
 are concentrated sources of energy
 carriers of fat-soluble vitamins and a source of
essential fatty acids. Functions of Fats:
 Male meals tastier and satisfying
 Each gram of fat burned in the body will yield They provide energy -- 9 kcal every gram and
9 calories emergency fuel.
 Recommended intake of fats: 30-40%/day; Fats serve as vehicle for fat soluble vitamins –
infants: 20-30%/day conveyor for Vitamin ADEK
Fats support viscera such as kidney, heart and
intestine.

BSN 2-D
Tamag, Vigan City
They act as thermal insulators for skin and 4. Using minimal water in cooking vegetables
protector pads inside body cavity to protect 5. Storing cut up foods, especially vitamin C rich foods
organs from shock in airtight wrappers and juices in closed storage
Essential fatty acids are required for the body Safe Upper Limit of Intake for Adults (19-70years)
growth and structural integrity. Thiamine 50mg Vitamin C 1000mg
Health Effects if Fats Rivoflavin 200mg Vitamin A 10,000
1. Eating high-fat diets regularly may exceed energy I.U.
needs and gain weight leading to obesity. Niacin 35mg Vitamin D 2000 I.U.
2. Insufficient fat in the diet results in weight loss and Vitamin B6 100mg Vitamin E 1200 I.U.
thinness causes undernutrition. Vitamin 3000mg Vitamin K 30mg
3. Inadequate fat in the diet leads to fat-soluble B12
vitamin deficiencies because fat is necessary for the Folic Acid 1000mg Pantothenic 1000mg
proper utilization of these vitamins. Acid
Biotin 2500mg
4. Trans-fatty acids influence blood cholesterol the sae
5) Mineral
way saturated fats do. Bad LDL cholesterol will raise
 are necessary for body-building, for building
and lower good HDL cholesterol.
of bones, teeth and structural parts of soft
Lipoprotein – lipids in combination with protein
tissues.
which are formed in the liver and contain
 also play a role in regulation of processes in
cholesterol, neutral fat and fatty acids
4) Vitamins
 Vital factor in the diet – protective foods –
facilitators of body processes
 Occurs in foods in small amount and are
needed by the body in small quantity as well
 increase the breakdown and absorption of
proteins, carbohydrate, and fats – that release
energy from energy-yielding nutrients
Classifications of Vitamins:
1. Fat-soluble vitamins: ADEK – insoluble in water, so
these are utilized only if there is enough fat in the the body.
body  Has 21 inorganic element, which are essential in
2. Water-soluble vitamins: C and B Complex (Thiamin, the growth, repair and healthy functioning of body
Rivoflavin, niacin, pantothenic acid, biotin, folate, B6, tissues
B12 – since soluble in the body, they cannot be stored  In organic because the body cannot synthesize
them, they have to be provided by the diet
in the body
 Needs vit d and parathormone for utilization
Note: Water-soluble vitamins are easily affected by
 Calcium occurs in greatest amount among the
cooking process and exposure to air. minerals in the body = 1.5% and 2% of BW
Niacin – is the most stable of the B vitamins in normal  Distribution + 99% in the hard tissues of the body;
cooking process 1% in the blood and soft tissues (lungs and heart);
Vitamin C – quickly destroyed by heat (dry or moist), soft tissue and blood plasma (9-11mg/dl)
exposure to air and presence of water 6) Water
Food must be handled carefully to preserve them by:  serves as the solvent for nutrients and waste
1. Cutting fruits into serving bites only when they are products in the body
about to be eaten Importance of Water:
2. Not overcooking or adding baking soda on green 1. carries nutrients and waste products
vegetables throughout the body
3. Avoid prolonged storage
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Tamag, Vigan City
2. acts as a lubricant and cushion around joints, Metabolic Water:

and inside the eyes, the spinal cord, in For every 100 grams of: 1. fat – 107ml 2. CHO –
pregnancy 55ml 3. CHON – 41ml
3. helps in the regulation of body temperature
4. Maintain blood volume REMEMBER THIS!
Water intake is supplied to the body via three 1. Limit consumption of fruit juices and smoothies to
routes: no more than a combined total of 150ml/day, because
1. Ingestion of liquids they are high in sugar
2. From preformed fluid of foods 2. Undesirable effects of dehydration
3. From the production of water during  1 – 2% body weight loss – thirst, fatigue,
metabolism of energy nutrients weakness, vague discomfort, loss of appetite
Water Excretion:  3 – 4% body weight loss – impaired physical
1. Kidneys performance, dry mouth, reduction in urine,
2. GIT flushed skin, impatience, apathy
3. Lungs  5 – 6% body weight loss – difficulty in
4. Skin concentrating, headache, irritability,
Note: The body constantly losses fluid through sleepiness, impaired temperature regulation,
breathing, sweating or going to the toilet and increased respiratory rate
therefore this needs to be replaced. Aim is to drink 6 –  7 – 10% body weight loss – dizziness, spastic
8 glasses of fluid each day to help keep the body muscles, loss of balance, delirium, exhaustion
hydrated and collapse.
Summary of Function, Sources, and Health Effects of Vitamins
Food Sources Major Functions Health Effects
Thiamine (B1) in moderate Helps the body turn carbohydrates Deficiency: beriberi, loss of appetite,
amount – pork, beef, liver, into energy, supports normal mental confusion, muscle weakness, water
whole or enriched grains, appetite, supports normal function of retention, fatigue, nerve damage, paralysis,
legumes the heart, nerves, and muscles heart failure
Excess: nausea, anorexia, lethargy, ataxia
Rivoflavin (B2) milk, yogurt, Helps the body produce energy from Deficiency: Ariboflavinosis, cheilosis, sore
meats, cottage cheese, carbohydrate, protein and fats, throat, swollen red tongue, magenta
enriched cereals, green Supports normal vision and skin tongue, eye irritation (hypersensitivity to
vegetables health light), skin rash
Niacin (B3) meat, peanuts, Helps the body release energy from Deficiency: Pellagra (flaky skin rash on
legumes, whole grains and carbohydrate, fats and protein areas exposed to sunlight, diarrhea),
enriched breads, unrefined For healthy skin weakness and loss of appetite, Glossitis
cereals, milk, fish poultry, nuts Keeps the normal activity of stomach, (black, smoothness of the tongue) failure
and all protein-containing food intestines and nervous system to grow, dementia, confusion
Excess: diarrhea, heartburn, nausea and
vomiting, ulcer irritation, fainting,
dizziness, abnormal liver function,
abnormal glucose tolerance, low blood
pressure
Biotin – widespread in foods Helps the body turn food into energy Natural deficiency unknown
Required in taking of amino acids,
fatty acids, and purines
Needed for the formation of glycogen
in muscle and liver.
Pantothenic Acid – Helps release energy from the body Deficiency: vomiting, intestinal distress,
widespread in foods Helps to make fatty acids and insomnia, fatigue, and muscle cramps
cholesterol

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Tamag, Vigan City
Vitamin B6 (pyridoxamine, Helps the body use amino acids to Deficiency: anemia, irritability, depression,
pyridoxine) whole grains, form tissue proteins neuritis, convulsions, abnormal brain wave
poultry, meat fish and Helps make RBC pattern, muscle twitching, greasy
shellfish, seeds, liver, kidney, Supports the synthesis of dermatitis and rashes
milk, eggs, fruits, legumes, neurotransmitter and the myelin
green and leafy vegetables coating around nerves
Vitamin B12 (cyanocobalamin) Helps in the formation of new cells Deficiency: Megaloblastic or Pernicious
liver, meat, fish, poultry, eggs, including RBC anemia (due to lack of intrinsic factor),
none in plants Helps maintain nerve cells fatigue, deterioration of the nerves leading
to paralysis, hypersensitivity of the skin
Folic Acid (Vitamin B9, folate, Maturation of RBC, AA necessary for Megaloblastic anemia, glossitis
folacin, pteroylglutamic acid) utilization Heart burn, diarrhea or constipation,
beans, lentils, spinach, mental confusion, fainting
asparagus, lettuce, avocado,
brocolli, tropical fruits,
oranges, bread
Biotin (Vitamin H) milk, liver, Helps the body turn food into energy No known deficiency and toxic effects
egg yolk, and few Required in the making of fatty acids,
veggies amino acids and purine Needed for
the formation of glycogen in muscle
and liver
Pantothenic Acid (Vitamin B5) It helps to make fatty acids and Deficiency: irritability, numbness, fatigue,
liver, bran, sunflower seeds, cholesterol muscle cramps, weakness, paresthesia,
whey powder, mushrooms, apathy, hypoglycemia
caviar, cheese, sun-dried Excess: overdose is rare
tomatoes, fish, avocados
Vitamin C – red and green hot Needed in the formation and Deficiency: Scurvy, anemia, Tendency to
chili peppers, guavas, bell maintenance of intracellular bruise easily, Failure of wounds to heal,
peppers, fresh herbs, dark cementing Frequent infections, Bone fragility, joint
leafy green vegetables, Converts folic acid to its active form pain, Children: Moeller Barlow Disease
brocolli, cauliflower, kiwi Healing of wounds & bone fractures Excess: headache, fatigue, insomnia,
fruits, papaya, oranges, Prevents megaloblastic anemia & worsening gout
strawberries pinpoint hemorrhages
Building of body resistance
Production of steroid hormone
Improves iron absorption
Brain metabolism
Antioxidant
Vitamin A (retinol, retinoic Normal eyesight, for strong immune Deficiency: hypovitaminosis A, night
acid) liver, red pepper, sweet system by keeping the outer skin blindness, xeropthalmia, xerosis, cessation
potatoes, carrots, dark leafy of bone growth, painful joints, tendency
greens, butternut squash, for tooth decay, diarrhea, kidney stones
dried herbs, lettuce, dried and impaired growth
apricots, cantaloupe Excess: RBC breakage, nosebleeds, bone
pain, growth retardation, nausea and
vomiting, abdominal cramps, weight loss,
dry skin, rashes, and loss of hair
Vitamin D (calciferol, Self-synthesis with sunlight; fortified Deficiency: Tetany

ergocalciferol, cholecalciferol, or irradiated milk, butter, margarine, Rickets
dihydroxy vit. D, sunshine cereal, egg, liver Delayed dentition and closing of the
vitamin) cod liver oil, fish, FXN: for proper absorption of calcium fontanel
fortified cereals, oysters, and phosphorus via the intestine; osteomalacia
BSN 2-D
Tamag, Vigan City
caviar, fortified soy products, Stimulates retention of kidneys Toxicity: nausea, diarrhea, polyuria, weight
salami, ham, sausages, For strong bones and teeth loss, demineralization of bones, renal
fortified dairy products, eggs, damage & uremia, hypercalcemia
mushrooms
Vitamin E (tocopherol) tofu, antioxidant functions, helps sustain Deficiency: hemolysis of RBC, weakness,
spinach, nuts, sunflower tissue integrity difficulty walking, leg cramps
seeds, avocados, shellfish, fish, Excess: general discomfort
plant oils, broccoli, squash and
pumpkin
Vitamin K maintenance of prothrombin level in Deficiency: bleeding tendencies,
☻Phylloquinone – vit. K1 blood plasma hemorrhagic disease
series formation of protein that binds Excess: hemolytic anemia and severe
☻Menaquinones – vit. K2 calcium in the bones jaundice, vomiting, albuminuria,
series kernicterus
☻Menadione – vit. K3 series
herbs,dark leafy greens, spring
onions, brussels sprouts,
broccoli, chili powder, curry,
asparagus, cabbage, pickled
cucumber, prunes
substances necessary to regulate chemical

Lesson 3 processes.
TERMINOLOGIES: Food - is any substance consumed to provide
Health - Is the extent to which an individual or nutritional support for an organism.
group is able to realize aspirations and satisfy
needs and change or cope with environment. It is Nutrition Concepts
the complete physical, mental and social well- Nutrition is the science that interprets the
being and not merely the absence of disease or nutrients and other substances in food in relation
infirmity. to maintenance, growth, reproduction, health
Nursing - is a caring profession; practiced with an and disease of an organism. It includes food
intake, absorption, assimilation, biosynthesis,
earnest concern for the art of care and science of
catabolism and excretion. It is a part of food that
health.
is used by our cells and metabolized by the body
Nutrition - is defined as the processes by which to make all the contributions that our body
an animal or plant takes in and utilizes food needs.
substances. In humans, nutrition is mainly achieved
Nutritionist – is a professional primarily work through the process of putting foods into our
with individual clients with an expert in food and mouths, chewing and swallowing it.
nutrition, advises people how to live a healthier A career in nutrition is ideal for those
lifestyle and achieve health-related goals. seeking to promote a balanced lifestyle and
Nutritionists and dietitians develop a diet and improve people's diets, while helping them to
exercise plan for individual. keep a healthy weight, boost their immune
Nutrients - are compounds in foods essential to system, increase their energy levels, and reduce
the risk of developing certain diseases.
life and health, providing us with energy, the
Good nutrition is an important part of
building blocks for repair and growth and
leading a healthy lifestyle. Combined with
physical activity, diet can help to reach and
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Tamag, Vigan City
maintain a healthy weight, reduce the risk of Faye Glenn Abdellah identified twenty-one (21) key
chronic diseases, and promote the overall health. nursing problems related to health needs of people
Also, Good nutrition is one of the keys to a that include nutrition
healthy life and can improve health by keeping a
balanced diet. Classification of Nutrients
Good nutrition can help reducing the risk
Nutrients can be grouped into two categories:
of some diseases, including heart disease,
macronutrients and micronutrients.
diabetes, stroke, some cancers, and osteoporosis.
It reduces the high blood pressure and lowers Macro means big – big nutrients.
high cholesterol. It can also improve the well- Macronutrients are the main nutrients that make up
being, improve the ability to fight off illness and the foods we eat.
to improve the ability to recover from illness or Nutrients required in large amounts that provide the
injury. energy needed to maintain body functions and carry
out the activities of daily life.
Nutrition plays a critical role in human
resource development since deficiencies in Micronutrients are essential elements needed by life
essential nutrients lead to malnutrition, which in small quantities.
affects an individual's mental and physical state, Micronutrients, just like water do not provide energy,
resulting in poor health and poor work however, the body need adequate amount to ensure
performance. A well-nourished, healthy that all body cells function properly.
workforce is a pre- condition for sustainable Most of micronutrients are known to be essential
development. nutrients meaning can only be obtained from the food
in which we eat.
Nursing Theories and discovery related to
There are six nutrients that are further classified
Nutrition according to size and energy. Carbohydrate, protein,
The concept of metabolism, the transfer of food and fat are macronutrients while vitamins and
and oxygen into heat and water in the body, minerals including water are all micronutrients.
creating energy, was discovered in 1770 by
Macronutrients
Antoine Lavoisier, the “Father of Nutrition and
Chemistry.” Carbohydrates
Carl von Voit is considered by many to be the It is an organic compound containing C, H, O, Derived
"father" of modern dietetics. from the Greek word saccharide meaning
Abraham Maslow who postulated the Hierarchy starches and sugars and chiefly found in plants.
It is produced by the process of photosynthesis from -
of Basic Human Needs which consists of:
H2O, CO2 and sun.
1. Physiologic Needs; 2. Safety and Security; 3. The Total Energy Requirement is ranging from 50%
Love and belonging; 4. Self-Esteem Needs; 5. Self- to 70% of body energy needs is from CHO.
Actualization Needs. He mentioned that under CHO has one (1) gram of CHO which is equivalent to 4
Physiologic needs nutrition is third and explains calories upon complete hydrolysis. The building blocks
that physiologic needs must be filled up first are called monosaccharide.
before going to another level of human needs.
The digestion begins in the mouth with salivary
Virginia Henderson identified fourteen (14)
amylase released during the process of chewing
components of basic nursing needs and postulated
and are absorbed across the membrane of the small
that the unique function of the nurse is to assist the
intestine and transported to the liver distributed to
clients, sick or well, in the performance of those
the rest of the body.
activities contributing to health or its recovery.
The absorption process begins around 3-6 hours after
eating.

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Tamag, Vigan City
The classification of carbohydrates is the following: Republic Act 9288 – New born Screening Test
(1) monosaccharide considered as the simplest form DISACCHARIDES are sugars (carbohydrate molecules)
of sugar of sugar which is small molecules that require that form when two simple sugars i.e.
little or no digestion before they can be used by the monosaccharides combine to form a disaccharide. Or
body and the source is the digestive end product of two sugar molecules
lactose hydrolysis. Sucrose -”cane sugar”, “table sugar”, “beet sugar”
A. Glucose Sucrose = glucose + fructose
Along with fat, glucose is one of the body’s preferred Maltose -”malt sugar”, derived from the digestion of
sources of fuel in the form of carbohydrates. starch Maltose = glucose + glucose
People get glucose from bread, fruits, vegetables, Lactose -”milk sugar”, least sweet among sugars
and dairy products. You need food to create the Lactose = glucose + galactose
energy that helps keep you alive. While glucose is Source: milk and milk products
important, like with so many things, it’s best in
moderation. Glucose levels that are unhealthy or out COMPLEX CARBOHYDRATES OR POLYSACCHARIDES is
of control can have permanent and serious effects. a large molecule made of many smaller
You may know glucose by another name: “physiologic monosaccharides linked together.
sugar” or “blood sugar”,”dextrose” ”grape sugar”.
Glucose is key to keeping the mechanisms of the body A. Starch - Probably the most important storage
in top working order. It is the principal form used by polysaccharides on the planet, glycogen and starch
the body,moderate use of sweet sugar works for the are produced by animals and plants, respectively or a
body”s brain,nerve cells,RBC, Glucose stores last for storage form of carbohydrates in plants, It supplies
only hours Gluconeogenesis is the process where energy for a long period of time. Source: cereal grains,
rice, wheat
protein is converted to glucose, while Ketosis is
B. Dextrin is not found in free food, it is
known as less available CHO or very low in
intermediate product of starch digestion, maltose + 2
Carbohydrates for energy, more fats to be broken glucose units.
down to form ketone bodies, sources could be found Source: toasted bread + application of dry heat
abundantly in fruits, sweet corn, corn syrup C. Glycogen or known as “animal starch”, a storage
form of CHO in the body found in the liver and
Lycopene is a carotenoid, a natural pigment that gives
muscle, Muscle glycogen supplies energy directly to
some vegetables and fruits their red color.
surrounding tissues during work and exercise, Liver
Carotene is an orange and yellow pigment found in glycogen is converted to glucose to be used in the
plants and fruits, especially carrots and colorful body through the process called “GLYCOGENESIS”,
vegetables. Source: liver, oysters, muscle meat
Anthocyanin-are blue, red, brown or purple pigments
found in plants, especially flowers, fruits, and tubers. Fibers also known as roughage because they form
In acidic condition bulk of the diet is the part of plant-based foods
Cruciferae- commonly known as the mustards, the (grains, fruits, vegetables, nuts, and beans) that the
crucifers, or the cabbage family - white and green body can’t break down. It passes through the body
undigested, keeping your digestive system clean and
B. Fructose is a type of simple sugar, “fruit sugar”, healthy, easing bowel movements, and flushing
sweetest of all sugar, “levulose”, good sources are cholesterol and harmful carcinogens out of the body.
ripe fruits and honey It acts as broom in our digestive tract, indigestible
C. Galactose are not found in nature, not found in part of food and primary constituent of plant cell wall,
free foods, it is a sugar found in milk, It produced from it is not digested by human due to lack of enzyme that
lactose (milk sugar) by digestion and is converted to will split or break it. Daily requirement is 20-35 g
glucose
Galactosemia are rare genetic metabolic disorders, FUNCTIONS OF CARBOHYDRATES
Infants born with an inability to metabolize galactose. Carbohydrates is the Chief source of energy, protein
sparing, it supplies energy to the body and takes part
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Tamag, Vigan City
in building body tissues to some limited extent. It acts a. most widely distributed
as the regulator of intestinal peristalsis and provider b. traces placed in liver, egg yolk and
of bulk. vegetable oil
LACK OF CARBOHYDRATE RESULTS TO: c. added to food products such as
Underweight and/or rapid weight loss, General cheese and margarine to aid
weakness. Poor physical performance, Fainting or emulsification Cephalin
collapse in severe deficiency, Hypoglycemia in acute d. needed to form thromboplastin for
carbohydrate deficiency blood clotting
EXCESSIVE CARBOHYDRATE MAY RESULS IN: e. Sphigomyelin - found in brain and
Dental caries, Obesity/overweight, Diabetes mellitus other nerve tissue; serves as insulator
and Gas formation around nerve fibers
2. Glycolipids - fatty acids combined with CHO
Health Effects of Starch and Fibers and nitrogen
1. Promote weight loss/ weight control – increase fibers, 3. Lipoprotein - lipids combination of protein
low fats and added sugar a. Chylomicrons - transport diet-derived
2. Protect against heart disease and stroke – high in lipids; mostly triglycerides
carbohydrates b. Pre-beta lipoprotein - VLDL (very low-
3. Protect against cancer – high in carbohydrates density lipoprotein); fat circulating in
4. Fight against diabetes – high in carbohydrates and low the blood during fasting state
fats control weight c. Beta lipoprotein - LDL (low density
5. Promote gastrointestinal health – increase fibers lipoprotein); transport in the artery wall
enhances healthy large intestine d. Alpha lipoprotein – scavengers; GOOD
CHOLESTEROL
FATS also known as Lipids, It is Organic nutrient
containing C,H,O attached in a glycerol base. One (1) III. Derived lipids – fat substances found
gram fat is equal to nine (9) calories, the total Energy produced ............ from fats and fat compounds
Requirement of 20%-30% is from fat. It remains in the 1. Fatty Acids – basic structural unit of fat
stomach for the longest period of time, A good a) Saturated fatty acids – palmitic and
approach when it comes to breaking up your fat stearic acids; examples are bacon,
calories is to eat 40 percent of your daily fat grams at butter, grated coconut, coconut cream,
breakfast, 40 percent between your midday meal, and coconut oil, margarine, mayonnaise,
20 percent at dinner. It is important to avoid fatty cream cheese, sandwich spread,
foods at night. It can take 2-4 hours for fat to digest, whipping cream, chicharon
so if you eat it too late in the evening, your body b) Monounsaturated – oleic acid;
won't have as much time to utilize this energy before examples are avocado, peanut butter,
storing it. Bile contains bile salts, which act as an peanut oil, pili nut, olive oil, shortening
emulsifier of lipids. This breaks the large fat droplets c) Polyunsaturated fatty acids – linoleic
into smaller droplets that are then easier for the fat- acid, vegetable oil: examples are corn,
digesting enzyme pancreatic lipase to digest. Fats are soybean, rapeseed, canola, sunflower,
mainly digested in the small intestine. Steatorrhea is sesame
the presence of excess fat in feces 2. Glycerol - water soluble component of
CLASSIFICATION OF FATS .................................triglycerides; available for the
I. Simple Lipids - neutral fats, chemical name is ..................................formation of .......glucose in the
triglycerides, glycerol is derived from a water ..............................diet
soluble form of CHO 3. Steroids - fat related substances that contain
II. Compound lipids - combination of fats with ........ sterols; main member is cholesterol
other components; important in human – important constituent of body cells
nutrition and tissues.
1. Phospholipids - fatty acids, phosphoric acids Foods rich in cholesterol: egg yolk, organ meats,
and nitrogenous base Lecithin shellfish dairy products, butter, milk cheese, ice

BSN 2-D
Tamag, Vigan City
cream substrates are called catabolic enzymes, enzymes that

FUNCTIONS OF FATS build more complex molecules from their substrates
Fats (1) supplies food energy in concentrated form for are called anabolic enzymes
body activities. (2) Protects vital body tissue and Anabolism – repairing worn out body tissue,
insulates body (3) Supplies essential fatty acids. (4) Catabolism – continued wear and tear going on in the
Serves as a carrier of the fat- soluble vitamins body. Proteins also builds resistance to infection by
(A,D,E,K) and (5) Adds palatability and satiety value helping form antibodies, Supplies additional energy,
(sense of fullness) to your meals. Contributes to numerous body secretions and fluids
LACK OF FAT IN THE DIET RESULTS IN: and Maintain water balance.
Underweight, Sluggishness, Skin irritation similar to SOURCES OF PROTEIN
eczema in infants and Signs and symptoms of fat- ANIMAL SOURCE like egg, milk, milk products, meat,
soluble vitamin deficiency fish, poultry and seafoods, and PLANT SOURCE like
EXCESS INTAKE OF FAT RESULTS IN: cereals (wheat, rice, corn), legumes (munggo beans,
Obesity /overweight and cardiovascular diseases peas, peanuts, soybeans), processed vegetable
protein (vegemeat, tofu)
PROTEIN LACK OF PROTEIN RESULTS IN:
Is an Organic compound containing C,H,O,N derived Retarded growth in children, Low resistance to
from the Greek word “proteios” meaning to hold first infection at any age, Slow recovery from illness, Low
place or is the prime importance. Building blocks are birthweight, Protein energy malnutrition (Marasmus
called ‘’amino acid’’ about 10%-15% of total energy and Kwashiorkor), Loss of weight, Edema, skin lesions
needs is supplied by CHON, 1 gram CHON= 4 calories and mental sluggishness.
upon complete hydrolysis, Protein digestion occurs in PROTEIN-ENERGY MALNUTRITION
the stomach and duodenum in which 3 main KWASHIORKOR – protein deficiency, a disease caused
enzymes, pepsin secreted by the stomach and trypsin by severe shortage of protein, associated with post
and chymotrypsin secreted by the pancreas, break weaning diets ↑ cereals and ↓ in quality and quantity
down food proteins into polypeptides that are then protein, Usual onset is from 1-6 years old, edema,
broken down by various exopeptidases and enlarged liver due to accumulation of fat, Altered skin,
dipeptidases into amino acids, protein is digested and hair pigmentation and Moon’s face.
absorbed in the small intestine. MARASMUS – protein caloric deficiency, a disease
Simple proteins- albumin is soluble in water, caused by inadequate protein and calories, from semi-
coagulated by heat (2) globulins is insoluble in water, starvation resulting from mother’s failure to nurse her
soluble in salt solution, coagulated by heat infant, Onset is from 6 months-4 years old with Loss
ACCORDING TO ESSENTIALITY of subcutaneous fat-very underweight and old man’s
1. ESSENTIAL AMINO ACID (EAA) OR INDISPENSABLE face is observed.
AMINO ACID-is one that cannot be synthesized by the EFFECTS OF EXCESSIVE PROTEIN INTAKE
body i.e Histidine, Phenylalanine, Isoleucine, - Kidney function – high CHON diet - increase
Threonine, Leucine, Tryptophan, Lysine, Valine, work of kidneys
Methionine - Mineral losses – increase CHON diet -
2. SEMI-ESSENTIAL AMINO ACID OR SEMI calcium excretion rises
INDISPENSABLE AMINO ACID-reduce a need for a - Obesity – high CHON diet – increase intake
particular EAA and partially spares it i.e Arginine, rich fat foods
Tyrosine, Cystine, Glycine, Serine - Heart disease – foods rich in animal protein
3. NON-ESSENTIAL AMINO ACID (NEAA)- is not dietary – rich n saturated fats
essential because the body can synthesize it i.e - Cancer – increase in CHON diet – increases
Glutamic acid, Aspartic acid, Alanine, Proline, rich saturated fats foods intake
Norleucine, Citrulline, Hydroxyglycine, Hydroxyproline
FUNCTIONS OF PROTEINS MICRONUTRIENTS

Proteins builds and repairs body tissue for growth and Vitamins came from Latin word meaning vita ( life
maintenance. Enzymes that break down their )and amine means nitrogen compound, They do not
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Tamag, Vigan City
give energy but merely help convert food into energy, Food Sources: Liver, egg yolk, dairy product, green,
bile is needed for the absorption of fat-soluble yellow and orange fruits and vegetable
vitamins, Co-enzyme for energy metabolism of CHO, Vitamin D
CHON and fats Calciferol Precursor: Ergosterol
Terms Accounted with Vitamins It can be warmed or kept for long period of time
Precursors / Provitamins – compound that can be without deteriorating, calcium and phosphorous
changed to active vitamins absorption, bone mineralization
Preformed Vitamins – occurring vitamins that are Functions: It helps build and maintain strong bones
inactive form and ready for biological use and sound teeth, Absorbs calcium and phosphorus
Avitaminosis – lack of vitamins, deficiency And promotes normal growth and development.
Hypervitaminosis – vitamin toxicity, excessive Lack of Vitamin D results in: Tetany ( muscle
accumulation of vitamins in the body Vitamin twitching), Malformed or soft bones (rickets),Poor
malnutrition – mal – bad; too much or too little is not development of teeth, Stunted growth (osteomalacia,
good for the health Vitamin like compounds – osteoporosis), Lowered amount of calcium and
substances have physiological roles like vitamins but phosphorus in blood.
in large amounts partially synthesized in the body like Excess intake of Vitamin D results in: Loss of appetite,
inositol, choline etc. Nausea and vomiting, Intense thirst and frequent
Antivitamins or vitamin antagonist – substance that urination,Severe constipation and/or diarrhea,
interfere the normal functioning of the vitamin like Muscular weakness, Headache and drowsiness
dicumerol against Vitamin K, avidin against biotin. Food Sources: dairy products, eggs, yolks and fatty
CLASSIFICATION OF VITAMINS: fish
1. Fat soluble vitamins - dissolve in fat before they Vitamin E
are absorbed in the blood stream, not absolutely Tocopherol, stored in adipose tissue, aided by bile and
needed daily from food sources, It also have fats, stable to heat and acid
precursors, stored in the body and deficiency Functions: Vit E Maintains nerves, muscles and a
develops slowly. Example: Vitamins A, D, E, K healthy reproductive system, Helps protect tissues
2. Water soluble vitamins - dissolve in water and and membranes against the damage of oxidation,
are not stored in the body, absolutely needed daily Helps in the formation of red blood cells and in the
because excess excreted in the urine, do not have utilization of Vitamin K
precursor and deficiency develops fast Example: Food Sources: vegetable oils, nuts, seeds, whole
Vitamin B complex, Vitamin C grains
Fat-Soluble Vitamins Vitamin K
Vitamin A Retinol, Precusor: carotene, Absorbed Menadione, Pytomenadione, Phylloquinone
through lymphatic system and portal blood to liver Synthesized by normal intestinal flora, Maintenance
Functions: It helps maintain normal vision, keep lining of prothrombin level in blood plasma
of the mouth, nose, throat and respiratory tract Functions: Vit K helps in the normal clotting of the
healthy, helps skin and hair glossy, teeth strong, blood, Increases calcium absorption and Maintains
Promotes growth, Maintains the stability of the cell strong healthy bones
membrane and Assists in immune reaction. Lack of vitamin K results in: Slow clotting of blood, a
Lack of vitamin A results in: Biot’ s Spot ( mild form), Tendency to bleed easily, Hemorrhages following
Xeropthalmia ( severe form), Inability to see in dim operations or in the umbilical cord of newborn infants
light or “night blindness”, Eyes sensitive to bright Food Sources: green vegetables
light, Rough dry skin and membranes of nose and
throat, Low body resistance to disease Affects health Water Soluble Vitamins – fresh food vitamins
of skin, hair, nails and poor growth, Blindness in Vitamin C: Ascorbic Acid, Easily absorbed from small
severe deficiency intestines
Excess intake of Vitamin A results in: Yellow Functions: Vit C increases the body resistance to
discoloration of the skin or “carotenemia”, Dry, itchy infection ,helps keep gums and teeth healthy, Aids in
skin and coarse hair, Nausea, headache, Irritability the absorption of iron and calcium in the body, Helps
and Loss of appetite. in the formation of red blood cells, Prevents scurvy

BSN 2-D
Tamag, Vigan City
and acts as an antioxidant. and fold of nose, itching burning eyes,Sore, swollen
Lack of Ascorbic Acid results in: Bleeding gums; loose and chapped lips, swollen, fissured, and painful
teeth, Skin hemorrhages (black and blue spots). Slow tongues and Retarded growth
wound healing, Bone changes, Anemia and Scurvy in Food Sources: pork, grains, cereal products, meats
severe deficiency fish, green leafy vegetables
Food Sources: citrus fruits, broccoli, cantaloupe, kiwi, Vitamin B3 Niacin / Nicotinic Acid, co-enzyme for
cabbage, strawberries, tomatoes, melons energy metabolism
Vitamin B Complex Functions: It promotes normal digestion and keep
Vitamin B complex is composed of eight B vitamins: nerve in healthy condition, Keeps skin healthy,and
B-1 (thiamine),B-2 (riboflavin), B-3 (niacin),B-5 Promotes growth
(pantothenic acid),B-6 (pyridoxine),B-7 (biotin),B-9 Lack of Niacin results in: Rough, red skin which later
(folic acid),B-12 (cobalamin), It has short life that becomes pigmented, Sore mouth, tongue and throat,
needs to be replaced continually Boiling meat – 15- Digestive and nervous disturbances, Loss of appetite
40% loss of Vitamin B and weight, Pellagra or “3D disease” (dementia,
Frying – 40-50% dermatitis, diarrhea) in severe deficiency, Irritability
Roasting – 30-60% and mental confusion
Remember: - lost vitamins are transferred to the Food Sources: whole grains, legumes, green
cooking liquids,It is best turn these liquids to sauces vegetables, meats, fish, nuts and eggs
and gravies. Vitamin B5 Panthothenic Acid
Vitamin B1 thiamin, or thiamine, enables the body to Functions: Essential for carbohydrate, protein and fat
use carbohydrates as energy. metabolism, Maintenance of normal growth, healthy
Functions: It is essential for glucose metabolism, and skin and integrity of CNS and Co-enzyme for energy
it plays a key role in nerve, muscle , Prevents beriberi metabolism
/ nutritional polyneuritis, plays key role in nerves for a Lack of Panthothenic results in: Insomia , Tingling
healthy condition, muscle nerve function, Promotes sensation of the extremities, Muscle cramps ,and
good appetite and normal digestion and Promotes Vomiting
good growth Food Sources: liver, meats, eggs, milk cheese and
Lack of thiamine results in: Mental legumes
confusion/depression, Poor appetite, Nervousness, Vitamin B6 also known as pyridoxine, is one of eight
Loss of ankle and knee jerk reflexes, Painful calf vitamins in the B complex group.
muscles (cramps), Constipation, Fatigue, weakness, Functions: It aids in metabolism of amino acids and
Retarded growth Food Sources: whole grains, pork, protein, Helps the body use carbohydrate, fat and
cereals, legumes, seeds and nuts protein, Neurotransmitter synthesis, avoided to
Type of Beri-beri patient with parkinson’s, Supplemented in anti- TB
1. Infantile -occurs in infant 2 to 5 months of age therapy, Converts tryptophan to niacin and linoleic
and gets the disease from mother’s milk acid to arachidonic acid
suffering from beri-beri, symptoms are loss of Lack of pyridoxine results in: Loss of appetite, nausea
voice (aphoria) and cyanosis and vomiting ,Nervous irritability and convulsions,
2. Wet - edema on both extremities progress Dermatitis around the eyes, mouth, on the nose and
upwards to heart and lungs behind the ears
3. Dry – involves peripheral nerves - parasthesia Food Sources: whole grains, spinach, broccoli,
leading to paralysis legumes, vegetable oils of corn
Vitamin B2 Riboflavin, co-enzyme for energy Vitamin B9 Known as Folic Acid / Folate
metabolism, it is essential for protein, fat and Functions: It aids in metabolism of genetic material
carbohydrates metabolism, vitamin readily destroyed (DNA, RNA), Helps cure a form of anemia, poor
in cooking growth, birth defects, Synthesizes DNA which control
Functions: It keeps eyes and skin healthy, aids in cell function, heredity and tissue growth, and
normal functioning of nervous system and promotes Regenerates red blood cell and essential formation of
growth WBC in the bone marrow
Lack of riboflavin results in: Sores in angles of mouth Lack of folic acid results in: Poor growth, Fatigue,

BSN 2-D
Tamag, Vigan City
depression and confusion, Macrocytic anemia, functioning of the body enzymes; Relaxes muscle after
Glossitis, Diarrhea, Malformation in the offspring contraction; Promotes resistance to tooth decay by
especially neural tube defect and Gastrointestinal holding calcium in the tooth enamel
disturbances
Food Sources: green leafy vegetables, nuts, legumes,
grain products LACK OF MAGNESIUM RESULTS IN: Irritability,
Vitamin B12 Known as Cyanocobalamin / Cobalamin, Emotional tension, depression Muscular weakness
Folate metabolism, nerve function, intrinsic EXCESS IN MAGNESIUM: Nausea and Vomiting
factor ,deficiency requires lifetime treatment Food Sources: whole grain, nuts, legumes, soy beans,
Functions: Facilitates maturation of red blood cells, dark green leafy vegetables
Protects the “myelin” or the fatty material that Sodium chief cation in the Extacellular Fluid (ECF)
transmit electrical impulses (messages) between blood serum normal value – 135 to 145 mEq/lite
nerve cells, helps metabolizes carbohydrate, protein, FUNCTIONS: Maintains proper water balance within
fat, nucleic and folic acid in the body and normal the body; Preserves the normal movement of the
functioning of all cells. muscles, nerve impulse transmission
Lack of Cobalamin results in: Pernicious anemia, LACK OF SODIUM RESULTS IN: Nausea Vertigo Mental
Changes in the nervous system, Retarded growth apathy; Muscular weakness Cramps
Food Sources: foods of animal in origin, fermented EXCESSIVE SODIUM MAY CAUSE: Edema
foods Minerals The element in their simple inorganic Hypertension Kidney disease
form Primary function of the small intestine is the Food Sources: spinach, celery, pickles, canned soup,
absorption of nutrients and minerals found in food. processed cheese, condiments
Phytates, Oxalates & Tannins which are compounds Potassium chief cation in the Intra-cellular Fluid (ICF)
found in foods that can bind to calcium, iron, zinc and blood serum normal value 3.5 to 5.5 mEq/liter
other minerals and interfere with their absorption. FUNCTIONS: Helps in muscle contraction, nerve
impulses, and the proper functioning of the heart and
Macronutrient minerals – Ca, Na, P, K, S, Cl, Mg kidneys; Regulates blood pressure and water balance
Micronutrient minerals – Fe, I, Zn, Se, Mn, Cu, Mo, in the cells Important in CHO and CHON metabolism
Co, Cr LACK OF SODIUM RESULTS IN: Hypokalemia/Muscular
weakness Increased nervous irritability Mental
Calcium (Ca) disorientation; Cardiac irregularities
99% is in the bone EXCESS POTASSIUM LEAD TO: Hyperkalemia, Heart
major component of renal calculi block
blood serum - normal value 4.5 to 5.5 mEq/liter
Food Sources: bananas, meat, milk, legumes,
FUNCTIONS: Build and maintain strong bones and
Bananas, oranges, cantaloupe, honeydew, apricots,
teeth
Promotes normal blood clotting, regular heartbeat, grapefruit (some dried fruits, such as prunes, raisins,
cell metabolism and other muscle contractions; and dates, are also high in potassium), cooked
Prevents rickets in children and osteomalacia in adults spinach, cooked broccoli, potatoes, sweet potatoes,
Lowers risk to fracture mushrooms, peas and cucumbers. Some low-
LACK OF CALCIUM RESULTS IN: Stunted growth; potassium foods include: berries, such as strawberries
Defective structure of teeth and bones called rickets and blueberries, apples, pineapple, cranberries and
in very young children Soft bones or osteomalacia in cranberry juice and cauliflower.
adults; Decreased bone density; Increased porosity Phosphorous (P) important in pH regulation
(demineralization) of the bones; called osteoporosis principal anion in the Intra-cellular cell
Low peak bone mass; Increased risk to fracture FUNCTIONS: Helps in proper bone and tooth
Food Sources: milk products, dark green leafy development; Facilitates quick release of energy for
vegetable, salmon, orange juice, tofu muscle contraction Transports lipids and fatty acid in
Magnesium (Mg) the blood; Transports nutrient in and out of the cell
blood serum normal value 1.5 to 3.0 mEq/liter Prevents rickets, demineralization of bone
FUNCTIONS: Helps regulate body processes including LACK OF PHOSPHORUS RESULTS IN: Weakness of the
regulation of normal heart rhythm Aids in the normal muscles Stunted growth; Defective structure of teeth
BSN 2-D
Tamag, Vigan City
and bones; Impairment of the body’s use of iron and survival, plays a role in making red blood cells and
calcium maintaining nerve cells and the immune system. It
Food Sources: milk products, meat and organ meat, also helps the body form collagen and absorb iron,
poultry, seafoods, legume, cheese, dried beans, and plays a role in energy production.
sunflower and pumpkin seeds, nuts and whole grains. FUNCTIONS: Helps the body to use iron; Helps build
Sulfur (S) - plays an important role in crucial functions hemoglobin in the blood; Takes part in the
in body, such as making protein, regulating gene metabolism of ascorbic acid in the body Helps the
expression, building and repairing DNA, and helping body use fatty acids
body metabolize food. LACK OF COPPER RESULTS IN: Anemia, anorexia,
FUNCTIONS: Determines the contour of protein hypotonia, edema and retarded growth (CNS
LACK OF SULFUR RESULTS IN: Lack of sulfur- abnormalities)
containing amino acid, in cases of severe deficiency EXCESS: Wilson’s disease - a genetic disorder in which
Food Sources: Protein containing foods excess copper builds up in the body. Symptoms are
Chloride (Cl) major anion in the Extracellular Fluid typically related to the brain and liver. Liver-related
(ECF) formation of gastric juice symptoms include vomiting, weakness, fluid build up
FUNCTIONS: Helps maintain the osmotic pressure and in the abdomen, swelling of the legs, yellowish skin
acid-base equilibrium in the body Helps balance the and itchiness.
ph level of the blood; Maintains the strong acidity of Food Sources: organ meat, egg yolk, oysters, nuts,
the stomach as part of HCl cereals, whole grains
EFFECTS of Chloride in the Body: Alkalosis - excessive Iodine (I) mineral component of the hormone
loss of Chloride ions from the gastric secretions; thyroxine
vomiting and gastric lavage or suctioning; Acidosis - FUNCTIONS: Helps in normal functioning of the
excessive supply of Chloride ions from the gastric thyroid gland in regulating energy metabolism Helps
secretions; diarrhea, during the state of NPO or diet in protein synthesis, tissue growth and reproduction;
Food Sources: pickles, canned soup, processed Prevents goiter
cheese, condiments LACK OF IODINE RESULTS IN: Enlarged thyroid gland
Iron (Fe) components of hemoglobin Ferrous SO4 – (Goiter) Painful swallowing; Cretinism (mental and
with meals – orange juice (Vitamin C)- black tarry physical retardation accompanied by irreversible
stools Z-track method – IM injection ferrous is better hearing and speech problem – insufficient of iodine
absorbed than ferric iron in green leafy vegetable is intake by the mother during pregnancy)
poorly absorbed coffee taking iron – iron absorption is Myxedema – adults who had problem with low iodine
reduced throughout their childhood and adolescence.
Type of Iron Increased risk of abortion, stillbirths, miscarriage and
-Heme Iron – found only in meat, fish and poultry infant deaths
-Non-Heme Iron – found in cereals and vegetables EXCESS IODINE RESULTS IN: Thyrotoxicosis Induced
FUNCTIONS: Helps build and maintain blood supply acne-like skin lesions Worsening of pre-existing acne
and give healthy red color to the blood Prevents Food Sources: seafood, seaweeds, iodized salt
simple anemia Manganese (Mn) constituents of vitamin B1
LACK OF IRON RESULTS IN: Nutritional anemia-IDA contributes to many bodily functions, including the
(iron deficiency anemia) Easy fatigability; General metabolism of amino acids, cholesterol, glucose, and
weakness; Poor physical performance; Paleness in the
carbohydrates. The human body cannot produce
face, conjuctiva, lips and fingernails; Weight loss
manganese, but it can store it in the liver, pancreas,
Koilonychia- spoon shaped nail, a nail deformity in
which the outer surface becomes concave bones, kidneys, and brain. A person usually obtains
EXCESS IRON MAY LEAD TO: High iron stores leading manganese from their diet.
to iron toxicity like hemochromatosis and FUNCTIONS: Is an essential constituent for bone
hemosiderosis structure, reproduction and normal functioning of
Food Sources: liver, red meat, organ meat, egg yolk, nervous system; Takes part in enzymatic actions in the
green and red mongo, soy beans body
Copper (Cu) - essential trace mineral necessary for LACK OF MANGANESE: Skeletal abnormality

BSN 2-D
Tamag, Vigan City
Food Sources: nuts, cereals, legumes, dried fruits, LACK OF CHROMIUM RESULTS IN: Impaired action of
green leafy and non-leafy vegetables insulin Low blood glucose level
Cobalt (Co) constituents of B12 Food Sources: corn oil, clams, cereals, vegetables and
Deficiency: Pernicious Anemia meats
Excess: Polycythemia Vera
FUNCTIONS: Forms cobalamin or vitamin B12 that Nutrients to Take – or Avoid Taking – Together for
Best Absorption 5 Nutrient Absorption Guidelines
helps treat a certain type of anemia
Pair: Iron + Vitamin C
LACK OF COBALT RESULTS IN: Poor growth Poor
Pair: Vitamin D + Calcium. Pair: Vitamin B12 + Folate.
appetite Restlessness Pair: Vitamin D + Omega-3s. Avoid: Iron + Calcium.
Progressive emaciation Water
Food Sources: liver, oysters, clams, poultry, salt water 60-70% total body weight
fish deprivation of 10% water – illness; 20% - death next
Zinc (Zn) anti-oxidant mineral to O2 for maintenance of life
FUNCTIONS: Helps the body use protein and 45 liters – water found in the body of normal adult 30
carbohydrates; Is vital for growth and development, liters intracellular (inside or within the cells)
synthesis of cell protein (formation of DNA & RNA), 15 liters extracellular (outside the cells)
proper functioning of the immune system; Is vital for large intestine absorbs water and changes the waste
the development of male reproductive function, from liquid into stool.
specifically the formation of testosterone, making of Functions: Acts as solvent for all products of digestion
sperm Helps hasten wound healing Taste acuity (universal solvent); Carries nutrients to the tissues;
LACK OF ZINC RESULTS IN: Growth failure; Impaired Removes waste products from the tissue; Helps
wound healingImpaired sense of taste and smell regulate body temperature and the acid-base balance;
Sexual infantilism in teenagers Sends messages between cells so you can think, see,
EXCESS IN ZINC: Nausea and vomiting Abdominal touch, hear, feel and move
cramps Diarrhea Gastrointestinal irritation Lack water results in: Dehydration with the following
Food Sources: meat, milk, legumes, nuts, poultry, fish, symptoms: Fatigue decrease blood pressure increase
whole grain cereals and breadsFluoride (Fl) body temp Headache weight loss Collapse decrease
FUNCTIONS: Helps prevent tooth decay; Favors urine output
deposition of calcium thereby strengthening the Three possible sources of water for the body are:
bones LACK OF FLUORINE RESULTS IN: Lowered Water contained in foods; Fluids taken as such; Water
resistance to dental caries formed by the oxidation of foods in the body
EXCESS INTAKE OF FLUORINE: Mottling of the tooth INPUT: fluids in the form of water, juices, parenteral
enamel (dental fluorosis) Stained and corroded OUTPUT: urine, vomitus, feces, stomach content,
appearance of the teeth drainage, bleeding, perspiration Approximate Average
Food Sources: fluoridated water and toothpastes Daily Intake and Output – 2200 to 2500 ml/day
Selenium (Se) anti-oxidant mineral Abnormalities of Water Balance
FUNCTIONS: Serves as an integral component of
certain enzymes Acts as an antioxidants which help
fight cell damage Helps prevent certain types of
protein-energy malnutrition Regulates proper
immune response Aids in proper functioning of the
heart muscle
LACK OF SELENIUM Keshan’s disease, Cancer Less
able immune system to fight off diseases
EXCESS: Liver Damage
Food Sources: organ meats, cereals dairy products
Chronium (Cr)
FUNCTIONS: Takes part in glucose metabolism; Helps
the body use carbohydrates and fats; Stimulates
synthesis of fatty acids and cholesterol in the liver
BSN 2-D
Tamag, Vigan City
THE IDEAL DRUG

LESSON 1: FUNDAMENTAL Safe
CONCEPTS OF Selective
Effective
PHARMACOLOGY Reversible
PHARMACOLOGY IN HISTORY Predictable
Asclepius No adverse effect
is a hero and god of medicine in ancient No irritation
Greek religion and mythology. Cheap and simple
Hippocrates (440 BBC) PRESCRIPTION
The Father of Medicine the written direction for the preparation and
Greek physician the administration of the drug.
“Let food be thy medicine and let thy INDICATIONS
medicine be food” list of conditions for which a drug is mean to
Edward Jenner be used.
"I shall endeavor still further to prosecute this ex. insulins are indicated for the treatment of
inquiry, an inquiry I trust not merely DM
speculative, but of sufficient moment to CONRAINDICATIONS
inspire the pleasing hope of its becoming conditions for which a drug should not be
essentially beneficial to mankind." given.
ex. Vit A supplements are C/I for the first
DEFINITION OF TERMS trimester of pregnancy.
PHARMACOLOGY CAUTIONS
is the study of medicines. It includes how list of potential risk or danger when taking
drugs the drug.
are administered and how the body ex. tramadol (pain reliever) has S/E of
responds. drowsiness. CAUTION: do not drive or
GREEK words: manipulate heavy equipment.
“pharmakon" - drugs DOSE
"logos/logia" - knowledge a quantity of a medicine or drug taken or
includes history, source, physical and recommended to be taken at a particular
chemical properties, compounding, time.
biochemical and physiological effects, THERAPEUTIC EFFECT
therapeutic and other uses, precautions, primary effect/intended
adverse effects, interactions and contra- the reason the drug is prescribed.
indications of drugs. ex. diphenhydramine -allergy/itchiness
DRUG SIDE EFFECT
These are substances when taken by a living secondary effect/unintended
organism, modify one or more of their are usually predictable and may be either
functions. harmless.
-“Droog” - dry. ex. diphenhydramine - drowsiness
"Drogue" - dry herb. DRUG ALLERGY
MEDICINE is immunological reaction to a drug.
is a substance administered for diagnosis, Ex. some antibiotics can cause skin rashes and
cure, treatment, mitigation or prevention.
All medicines are drugs but all drugs are not pruritus.
medicines. ADVERSE EFFECT
BSN 2-D
Tamag, Vigan City
Adverse Reaction Ex. Ascorbic Acid, Multivitamins

heightened side effects TOLERANCE
unpredictable and harmful. a decreasing response to repetitive drug
Ex. sildenafil causes priapism doses
ABCDEF OF ADVERSE REACTIONS Ex. Sleeping pills
A - Augmented - dose-related AR ILLICIT DRUG
B - Bizarre- non-dose-related AR also called street drug are those sold illegally.
C – Chronic - dose and time-related AR
D - Delayed - time-related AR
E - End of Use - AR from withdrawal BIOAVAILABILITY
F - Failure - ineffectiveness of therapy means that the drug has reached the
DRUG TOXICITY circulation and is therefore available for all
harmful effect of the drug on an organism or the tissues.
tissue, resulting from overdose or external fraction of drug administered reaching the
use. systemic circulation.
S/E are more severe. THERAPEUTIC INDEX
Ex. lithium ( treatment of manic episodes of is a measure of the danger of poisoning from
Bipolar Disorder). the drug
DRUG INTERACTION the wider the TI, the safer the drug is.
occurs when administration of one drug
before or after alter effect of one or both
drug.
DRUG MISUSE
is the improper use of common medications
in way that lead to acute and chronic toxicity.
ex: Laxatives, Antacids, Antihistamines
DRUG ABUSE
is an inappropriate intake of substance either
continually or periodically.
DRUG DEPENDENCE
is a persons reliance on or need to take drug
DRUG SOURCE
or substance.
Natural Source
Ex. Sleeping pills, Laxatives
Drugs are derived from plants, animals,
DRUG DEPENDENCE (2 TYPES)
microorganisms, and minerals
1. Physiological
Synthetic
is due to biochemical changes in the body’s
Semi-synthetic
tissue.
Biosynthetic
these tissue come to require substance for
Plants
normal function.
Some drugs are derived from plants
2. Psychological
ex. morphine from Poppy
is emotional reliance on a drug to maintain a
atropine from Belladonna
since of wellbeing accompanied feeling of
digoxin from Digitalis leaf
need.
lagundi syrup from Lagundi leaves
Ex. Anxiolytics
Animals
DRUG HABITUATION
denotes a mild form of psychological
dependence.
BSN 2-D
Tamag, Vigan City
ex: thyroxine from porcine or bovine’s thyroid The Nurse's Role in Pharmacology
gland Appropriate assessment before, during
insulin from pancreas omega-3 from fish oil and after administering the drug
Synthetic Evaluating the safety of the drug for this
chemically manufactured in laboratories unique client
ex: Aspirin (chemically known as Minimizing and evaluating adverse effects
Acetylsalicylic Acid (ASA). Educating the client and/or family
Semi-synthetic
prepared by chemical modification of natural
drugs
ex: Ampicillin from Pencillin G
Biosynthetic 8 Questions
Prepared by cloning human DNA (Genetic 1. Why would a patient need this drug?
Engineering) 2. How would I know if this drug was doing what it
ex: Human insulin was intended to do?
Human growth hormones 3. How would I know if the patient was experiencing
Human erythropoieitin adverse effects because of this drug?
4. Are there any special lab tests I should monitor
DRUG NAME before or during treatment because of this
Chemical name medication?
The chemical constitution of the drug as well 5. Why should a patient not take this drug or only take
as the exact placement of its atoms or it with caution?
molecular groupings. 6. How does this drug impact other disease
Ex:6-[D(−)β-amino processes?
phydroxyphenylacetamido.] penicillanic acid 7. What would happen if the patient received "too
C16H19N3O5S much" of this drug?
Generic name 8. What do I need to teach the patient about this drug
is simpler than the chemical name. to keep them safe and increase the effectiveness of
It may be used in any country and by any this drug?
manufacturer.
Ex: amoxicillin
Brand name
is followed by the symbol ®
this symbol indicates that the name is
registered and that the use of the name is
restricted to the owner of the drug, which is
usually the manufacturer.
most drug companies place their products on
the market under brand names rather than
generic names.
Official Name
listed in the official compendia, United States
Pharmacopeia (USP) and National Formulary
(NF)
Usually they use the generic name/s of the
drug in the official list by the US FDA

BSN 2-D
Tamag, Vigan City
E. Evaluation
F. Recording and Reporting
Drugs Affecting the Body System
A. Reproductive System
B. Cardiovascular
C. Respiratory
D. Gastro-intestinal
E. Endocrine
F. Renal System
G. Central Nervous System & Pheriperal
Nervous System
H. Other Drugs
1. Chemotherapeutic Agents
LESSON 1: FUNDAMENTAL 2. Drugs for Eye and Ear Disorders
CONCEPTS OF 3. Drugs Acting on the Immune Sys
4. Dietary Supplements
PHARMACOLOGY 5. Alternative & Complementary
A. Drug Definitions and Classification Therapies “Halamang Gamot”
B. Drug Standards and Drug Information PHARMACOLOGY
C. Pharmacodynamics - can be defined as the study of drugs and their
1. Therapeutic Index & Drug Safety origin, nature, properties, and effects on living
2. Graded Dose Response Relationship organisms.
& Therapeutic Response. - includes, history, source, physical and chemical
3. Potency & Efficacy properties, compounding, biochemical and
4. Cellular Receptors & Drug Action physiological effects, therapeutic and other uses,
5. Types of Drug Receptor Interactions precautions, adverse effects, interactions andcontra-
D. Pharmacokinetics indications of drugs.
1. Liberation HISTORICAL TRENDS
2. Absorption In 1920’s - discovery of Insulin and vitamins
3. Distribution In 1930’s - modern anaesthetics
4. Metabolism (Biotransformation) In 1940’s – penicillins
5. Excretion In 1950’s - antihypertensive drugs
E. Factors Influencing Responses to Drugs In 1960’s – neuroleptics
F. Drug Legislation Controlled Substances, In 1970’s - H2-blockers, anti-asthmatics
..........Generic Drugs, Orphan Drugs, & Over- In 1980’s – immunosuppressive and antiviral drugs
the-..........Counter Drugs Drug
Nursing Process in Pharmacology - is a word derived from a French word ‘Drogue’
A. Assessment which means dry herb.
1. Drug History - any substance that brings about a change in biologic
B. Planning function through its chemical action.
C. Intervention - can’t create new function but alter existing function.
1. Drug Administration Therapeutic effect
2. Medication Orders - is the primary effect intended that is the reason the
3. Medication Safety drug is prescribed.
4. Seven Rights Ex. Morphine sulfate- analgesia
5. Dosage Calculation Side effect of morphine sulfate
D. Client Education CNS: confusion, sedation, dizziness…
BSN 2-D
Tamag, Vigan City
Resp: RESPIRATORY DEPRESSION Illegal drugs

CV: hypotension, bradycardia  sometimes referred to as recreational drugs.
GI: constipation, nausea, vomiting  are drugs or chemical substances used for
DRUG CLASSIFICATIONS nontherapeutic purposes.
A drug class is a term used to describe medications  these substances are obtained illegally/have
that are grouped together because of their similarity. not received approval for use by the FDA.
- four (4) dominant methods of classifying these
groups:
1. By their therapeutic use.
 (meaning the types of condition they are
used to treat/ what disorder or symptom slide
they are used to treat). 39
Example of drugs used to treat:
 High blood pressure - Antihypertensive drugs
e.g. captopril (Capoten), losartan (Cozaar), BRANCHES OF PHARMACOLOGY
carvedilol (Coreg), atenolol, amlodipine. Pharmacokinetics - Movement through body
 Nausea – Antiemetic drugs Pharmacotherapeutics – Use/Purpose
e.g.promethazine (Phenergan), Pharmacodynamics – Effect
metoclopramide (Reglan). Pharmacology – Origin
 Fibrates (Fibric acid derivatives) Toxicology – Side Effects
 example of fibrates:
 clofibrate (Atromid-S) PHARMACOKINETICS – What the body does to the
 gemfibrozil (Lopid) drug? LADME
 fenofibrate (Antara, Lofibra, and Triglide) PHARMACODYNAMICS – What the drug does to the
body? Mechanism of action, Pharmacological
2. chemical structure
actions, Adverse effects, Drug interactions
 amphipathic carboxylic acids
3. mechanism of action
 (specific biochemical reaction that occurs
when a drug is taken).
 PPAR agonists
 - are drugs which act upon the peroxisome
proliferator - activated receptor.
4. mode of action
 (meaning the specific way in which the body
responds to a drug).
 (reduce blood triglycerides)
Drugs may be further classified as:

prescription
 drugs require an order by a health PHARMACOKINETICS
professional who is licensed to prescribe Liberation
drugs, such as a physician.
 the process by which medication enters the
nonprescription
body and liberates the active ingredients
 (over-the-counter (OTC) drugs)
that has been administered.
 - are sold without a prescription in a
pharmacy or in the health section of
department or grocery stores.
BSN 2-D
Tamag, Vigan City
 the pharmaceutical drug must separate from • Drugs diffuse across a cell membrane from a
the vehicle or the excipient that it was region of high concentration to one of low
mixed with during manufacture. concentration.
 “drug carrier” • Since the cell membrane is lipoid, lipid-soluble
 is any substrate used in the process of drug drugs diffuse most rapidly.
delivery which serves to improve the • Small molecules tend to penetrate
selectivity, effectiveness, and/or safety of membranes more rapidly than larger ones.
drug administration. • Most drugs are weak organic acids or bases,
 are primarily used to control the release of a existing in un-ionized and ionized forms in an
drug into systemic circulation. aqueous environment.
This can be accomplished either:
1. by slow release of the drug over a long period
of time (typically diffusion) or,
2. by triggered release at the drug's target by
some stimulus, such as changes in pH,
application of heat, and activation by light.
TYPE OF DRUG CARRIERS
 liposomes The proportion of the un-ionized form present (and
 micelles thus the drug’s ability to cross a membrane) is
 microspheres determined by:
 nanoparticles 1. Environmental pH
Liberation is the release of the drug from it's dosage (pH of body fluid)
form. 2. Drug’s pKa (acid dissociation constant)
Absorption - is the drug pH at which concentrations of ionized
 the transfer of drugs from it sites of and un-ionized forms are equal.
administration to systemic circulation (blood
stream). FACILITATED PASSIVE DIFFUSION
Mechanisms of Drug Absorption • A carrier molecule in the membrane
Drug absorption is determined by the drug’s: combines reversibly with the substrate
 physicochemical properties molecule outside the cell membrane, and the
dosage forms carrier-substrate complex diffuses rapidly
(e.g., tablets, capsules, solutions) across the membrane, releasing the substrate
 formulation at the interior surface.
consisting of the drug plus other ingredients. ACTIVE TRANSPORT
 route of administration • Active transport is selective, requires energy
(e.g. oral, buccal, sublingual, rectal, expenditure, and may involve transport
parenteral, topical, inhalational). against a concentration gradient.
 Note:Regardless of route of administration, PINOCYTOSIS
drugs must be in solution to be absorbed. • in pinocytosis, fluid or particles are engulfed
Drugs may cross cell membranes by: by a cell.
 Passive diffusion • The cell membrane invaginates, encloses the
 Facilitated passive diffusion fluid or particles, then fuses again, forming a
 Active transport vesicle that later detaches and moves to the
 Pinocytosis cell interior.
PASSIVE DIFFUSION • Energy expenditure is required.
• Pinocytosis probably plays a small role in drug
transport, except for protein drugs.

BSN 2-D
Tamag, Vigan City
Distribution FACTORS AFFECTING DISTRIBUTION

 it is the process by which a drug reversibly 1. Blood flow
leaves the blood stream and enters the 2. Size of the Organ
interstitial fluid and/or the cells of the 3. Lipid: Water Partition Coefficient
tissues. 4. Binding
 the movement of drug from the blood to and Other Factors
from the tissues. Fat: Lean Body Mass Ratio, Pregnancy
BLOOD FLOW
- This is an important determinant of the rate
of uptake of drug.
- drugs are first taken up by highly perfused
Intravascular – Blood plasma found in blood vessels.
tissues and these tissues will often achieve
Intracellular – Fluid with cells.
high tissue concentrations more rapidly
Interstitial – Fluid surrounding cells.
than poorly perfused tissues.
SIZE OF THE ORGAN
- Organs of large size take up large amount of
 Is dependent on the following:
drug driven by the concentration gradient.
 Permeability of each component
- Organs of smaller size: distribution of only
 Ph w/in each component
small amount of drug into it will raise the
tissue concentration.
LIPID
- Drugs that are highly lipid soluble will
readily cross cell membranes and thus be
more distributed.
- Example: rifampin (antibiotic) - A highly fat-
soluble drug.; penicillin- a water-soluble
drug.
BINDING
- binding of a drug to macromolecules in

the blood (plasma proteins) or a tissue
compartment will tend to increase the
drug’s concentration in that compartment.
- the drug circulates in the blood either in the
free form or bound to plasma proteins. This
. binding is reversible.
- Free form- pharmacologically active
- bound- pharmacologically inactive
- So the plasma proteins act as a reservoir or
temporary storage place.
Clinical Significance
1. When drugs are given, each with a high affinity for
plasma protein, they compete for the available
binding sites
Tolbutamide- - which is normally 95% bound.
BSN 2-D
Tamag, Vigan City
Sulfonomide - - which has higher affinity for the “One of the features which is thought to distinguish
plasma protein. man from other animals is his desire to take
The 2nd drug will now displace the 1st drug. This will medicine“. - Sir William Osler (1849 – 1919)
lead to a rapid increase in concentration of free drug
(active drug) in the plasma (Now 100% free)
2. In hypoalbuminemia, binding may be reduced and DRUG METABOLISM
high concentrations of free drug may be attained. E.g.
Phenytoin and Furosemide Metabolism
3.Drugs that are highly plasma protein bound may - -is the metabolic breakdown of drugs by
have a longer duration of action and hence longer half living organisms, usually through
life because the drugs in bound form cannot be specialized enzymatic systems.
metabolized or excreted. Thus they require less - -The chemical modification of drugs with
frequent dosing. the overall goal of getting rid of the drug.
Half life - t 1/2 “xenobiotics”

- the period of time required for the concentration - any foreign substances or exogenous
of the drug or amount of drug in the body to be chemicals w/c the body does not recognize.
reduced by one-half.
- the time it takes to eliminate 50% of a drug. Xenobiotic Metabolism

- 95% is always eliminated after~ 4.5 half-lives.
Example: t1/2=1hr, Co= 8mg/L - is the set of metabolic pathways that
modify the chemical structure of
xenobiotics, which are compounds foreign
to an organism's normal biochemistry, such
as any drug or poison.
Fat: Lean Body Mass Ratio

Those people having high Fat: Lean body mass ratio
will have less distribution of the drug.
Pregnancy
During pregnancy the fetus may take up drugs and
thus increase distribution of the drug.
Pathological states
- Congestive heart failure (alteration of body
water)
- Liver cirrhosis – decreased synthesis of
plasma proteins
- Uremia – accumulation of metabolites that
displace drugs from binding sites.

BSN 2-D
Tamag, Vigan City
Chemical factors
- Enzyme induction
- it is the phenomenon of increased drug
metabolizing ability of enzymes by several
drugs & chemicals.
Biological Factors
Sex difference
- Metabolic differences between males &
females have been observed for certain
compounds.
- Such variation is generally observed following
puberty. So, sex related differences in the rate

BSN 2-D
Tamag, Vigan City
of metabolism could probably due to sex

hormones.
- Metabolism of diazepam, paracetamol is
faster in females than males while oxidative
metabolism of lidocaine, chlordiazepoxide
are faster in male than in females.
DRUG EXCRETION
Kidney
- is the most important organ for the excretion
of drugs and/or their metabolites.
- drug excretion may involve one or more of
the following processes.
Kidney:
o Renal Glomerular Filtration
o Renal Tubular Secretion
o Renal Tubular Reabsorption
Clearance
- the volume of plasma that gets filtered of
drug per unit time.
GFR (Glomerular Filtration Rate)

- Flow rate of drug that is being filtered.
- Is approximately equal to the clearance of
creatinine.

BSN 2-D
Tamag, Vigan City
PHARMACODYNAMICS Dose Response Relationship

- is the study of the ways drugs affect the body. Dose
- drug response ca causes a primary or - amount of drug administered to the patient.
secondary effect. Response
- the primary effect is desirable, & the - effect shown by the body.
secondary effect may be desirable or
undesirable.
- Example: diphenhydramine (Benadryl)
Therapeutic Index (TI)

- estimates the margin of safety of a drug
through the use of a ratio that measures the
Dose Response Relationship
effectiveness of people (therapeutic) dose
- a relationship used to analyze a kind of
(ED) in 50 % of people (ED50) and the lethal
response obtained after administering specific
dose (LD) in 50% (LD50).
dose of drug.
- Note: The closer the ratio is to 1, the greater
2 Components of DRR
the danger of toxicity.
 Dose Plasma Concentration Response
- Drugs with a low therapeutic index have a
Relationship
narrow margin of safety.
 Plasma Concentration Response Relationship
- Drug dosage might need adjustment, &
plasma (serum) drug levels need to be
Dose Response Curve
monitored because of the small safety range
- a typical curve showing the dose response
between the ED and LD.
relationship.
Example NTI drugs:
- is useful to predict potency, efficacy & safety
 Warfarin
of drug.
 levothyroxine
 carbamazepine
 digoxin
 lithium carbonate
 phenytoin
 theophylline.
- Drugs with a high therapeutic index have a
wide range margin of safety and less danger
of producing toxic effects.
- Plasma (serum) drug levels do not need to be
monitored routinely for drug with a high TI.
Dose response curve is required:

- Deciding dose of the drug.
- Comparing dosage to of people showing
different effects.

BSN 2-D
Tamag, Vigan City
Types of dose response curve  Few drugs work without a receptor being
- Graded dose response curve involved.
- Quantile dose response curve - e.g., Mg (OH)2 for gastric acidity;
mannitol for diuretic; etc.
Types of receptors
 Transcription Factors
(e.g., steroids, vitamin D, retinoids)
 Ligand Gated Ion Channels
(e.g., GABAA, glutamate, aspartate, glycine, etc.)
 G-Protein Coupled Receptors (GPCRs)
(e.g., neurotransmitters)
 Enzyme-linked Receptors
(e.g., kinases)
 Protease-Activated Receptors
(e.g., thrombin-cleavage…; TNFa converting
enzyme)
4 important Values DRR
Transcription Factors
Drug Efficacy
- (or sequence-specific DNA binding factor)
- Refers to the ability of drug to elicit a
- protein that controls the rate of
response when it binds to a receptor.
transcription of genetic information from
- e.g., Morphine produces a degree of analgesia
DNA to messenger RNA, by binding to a
not obtainable with any dose of aspirin hence
specific DNA sequence.
Morphine is more efficacious than aspirin.
Drug Potency
Transcription factors
- Refers to amount of drug needed to produce
- TF are proteins involved in the process of
a response.
converting, or transcribing, DNA into RNA.
- e.g., if 10mg of morphine is = 100mg of
pethidine, morphine is 10 times more potent
Ligand Gated Ion Channels
than pethidine
- also commonly referred to as ionotropic
Slope
receptors.
Variability
- are a group of transmembrane ion-channel
proteins which open to allow ions such as
Cellular Receptors & Drug Action
Na+, K+, Ca2+, and/or Cl− to pass through the
Receptors
membrane in response to the binding of a
- are specific proteins, situated either in cell
chemical messenger such as a
membranes or, in some cases, in the cellular
neurotransmitter.
cytoplasm.
- is the specific chemical constituent of the cell
G-Protein Coupled Receptors (GPCRs)
with which a drug interacts to produce its
pharmacological effects. - are the largest and most diverse group of
 Most drugs work through a receptor. membrane receptors in eukaryotes.
- e.g., testosterone or steroidal sex - These cell surface receptors act like an inbox
hormones; calcium channel blockers; for messages in the form of light energy,
growth factors. peptides, lipids, sugars, and proteins.
Enzyme-linked Receptors
BSN 2-D
Tamag, Vigan City
- also known as a catalytic receptor. Different Concepts:

- transmembrane receptor, where the binding
 Affinity
of an extracellular ligand causes enzymatic
- the strength of a bond to a receptor site.
activity on the intracellular side.
- the higher the affinity the stronger the bond.
Drug targets - example:
o Fentanyl has a high affinity to
 Cellular receptors (52%)
opiate receptors.
 Hormones and factors (11%)
o in order to combat symptoms of
 Enzymes (28%)
overdose, we give Narcan.
 DNA (2%)
- Narcan has a higher affinity to opiate
 Unknown (7%)
receptors.
- Because of this elevated affinity, Narcan
pushes Fentanyl out of the receptor &
Theory of Drug Action reverses the symptoms of opiate overdose.
 Fischer’s ‘Lock and Key’ Hypothesis  Selectivity
- The lock is the receptor, and the key is the
drug. Only the correct key opens the lock. - specific affinity for certain receptors.
- The drug (the key) combines with a receptor - is the degree to which a drug acts on a given
(the lock) to produce a pharmacological site relative to other sites.
effect. - example:
- Drugs that will fit into the receptor are said to - Atrophine a drug given to relax muscles in
have an “affinity” for that receptor-site. the digestive tract, may also relax muscles
- Only drugs that fit into the receptor will in the eyes & in the respiratory tract.
produce a pharmacological response.
 Agonist
- is a chemical that binds to a receptor and
 Koshland’s ‘Induced-Fit’ Hypothesis activates the receptor to produce a
- states that the binding of a substrate or some biological response.
other molecule to an enzyme causes a change - any drug that binds to receptor &
in the shape of the enzyme to enhance or prevents the activation of the receptor.
inhibit its activity. - any pharmacologic antagonist that
‘competes’ with the binding of agonist at
the binding site.
Drug Receptor Interactions
- drugs interact with receptors by means of

chemical forces or bonds.
 Covalent
- When the active site on the enzymes makes  Electrostatic
contact with the proper substrate, the  Hydrogen bonds
enzyme molds itself to the shape of the  Lipophilic
molecule.

BSN 2-D
Tamag, Vigan City
 The manpower objective of the Citizen Armed

LESSON 1: Force shall conform to projected and actual needs.
It is not envisioned by the State to have a nation
“Take the LEAD, Soar as ONE”
under arms, unless extremely necessary.
Republic Act 7077 SECTION 7. Mission.
Scope  The mission of the Citizen Armed Force, alternately
 General Identification referred to as Reserve Force, is to provide the base
 Salient Provisions for the expansion of the Armed Forces of the
o Organization Philippines in the event of war, invasion or
o Training rebellion; to assist in relief and rescue during
disasters or calamities; to assist in socio-
o Equipage
economic development; and to assist in the
o Development operation and maintenance of essential
o Administration government or private utilities in the furtherance
o Mobilization/Utilization of overall mission.
General Identification
THE AFP REVERIST ACT of 1991 Organization
 An act that provides for the Development, Salient Provisions
Administration, Organization, Training, 1. Army Reserve Command
Maintenance and Utilization of AFP Tanza, Cavite
Reservists. Headquarters: ARMY RESERVE COMMAND
SECTION 1. Title.— 2. Naval Reserve Command
 This Act shall be known as the “Citizen Armed Roxas Blvd, Manila
Force or Armed Forces of the Philippines 3. Air Force Reserve Command
Reservist Act.” Clark Air Base, Pampanga
SECTION 2. The regular force 4. AFP Reserve Command
 It is the policy of the State to maintain a standing CGEA, Quezon City
or regular force in times of peace consonant to its
adequate and actual needs for the security of the
State but which can be rapidly expanded by the
The Affiliated Reserves
well-disciplined Citizen Armed Force in the event
of war, invasion or rebellion.
SECTION 3. The Security and Socioeconomic Development
of the State
 The Citizen Armed Forces shall be provided
maximum opportunity to participate in
safeguarding the security of the State and in
assisting in socioeconomic development.
SECTION 4. The Call to Personal Military and Civil Service
 The Citizen Armed Force shall be organized,
trained, developed and maintained as to ensure
their readiness to immediately respond to the call
of service.
SECTION 5. The Public Awareness
 The State shall promote and develop public
support to and awareness of the important role of
the Citizen Armed Force as protector of the people
and the State.
SECTION 6. The Manpower of the Citizen Armed Force.—

BSN 2-D
Tamag, Vigan City
Reserve Officers’ Training Corps (ROTC). – Military

training for students enrolled in colleges, universities
and similar institutions of learning
Sources of Reservist: Advance Reserve Officers’ Training Corps (ROTC). –
• Graduates of Reserve Officer Training Corps The students undergoing advance ROTC shall be
(ROTC) referred to as advance ROTC cadets which entitle with
• Graduates of pre-reservist training (Basic Scholarship Incentives that are being given by the
Citizen Military Training and Military CSAFP and Maj Svc Cmdrs.
Orientation Training)
• Incorporated retired military personnel who Reserve Force Development:
were honorably discharge from the service Specialization Trainings
• Commissioned and NCO of Affiliated Reserve • Commandant and MTI Seminar (CMTIS)
Unit • Air-to-Ground Operations Seminar (AGOS)
• Graduates of the National Defense College of • Search and Rescue Auxiliary Training (SARAT)
the Philippines • Intelligence Security Indoctrination Training
(ISOT)
Categorization: • Bomb Awareness Seminar (BAS)
First Category Reserve - reservist whose ages are • Basic Aircraft Marshalling Seminar (BAMS)
between eighteen (18) years and thirty-five (35) years, • Health Emergency Management Seminar
inclusive. (HEMS)
Second Category Reserve - reservist whose ages are
between thirty-six (36) years and fifty-one (51) years, Equipage
inclusive. Salient Provisions
Third Category Reserve - reservist who are above Mobilization Stock - The Chief of Staff, AFP, shall see
fifty-one (51) years of age. to it that the basic minimum essential individual and
organizational equipment and supplies shall be
Classification: provided, stored and maintained for selected Ready
Ready Reserve – The Ready Reserve shall be Reserve units to enhance their rapid transition to
composed of citizen soldiers belonging mostly to the readiness required for employment in the shortest
First Category Reserve possible time.
Standby Reserve – The Standby Reserve shall be
composed of citizen soldiers belonging mostly to the Development
Second Category Reserve and the third Category Salient Provisions
Reserve Maintenance Training
Retired Reserve – The Retired Reserve shall be • Active Duty Training (ADT)
composed of citizen soldiers who have qualified for • Unit Active Duty Training (UADT)
retirement through length of service, old age or Reserve Officers’ Non-resident Instruction. – Each
disability. For this purpose, sixty-five (65) years shall major service shall conduct on a continuing basis non-
be considered as the retirement age resident instruction for the purpose of maintaining
and updating the proficiency of its reservist officers,
Training particularly key officers of Ready Reserve units.
Salient Provisions • Basic Air Force Officer Course (BAFOC)
Reserve Force Development: • Squadron Officer Course (SOC)
Basic Citizen Military Training (BCMT). – Registrants • Command and General Staff Course (CGSC)
finally selected for military training shall undergo a • Master in National Security Administration
basic military training for a period of not more than (MNSA)
six (6) months.
BSN 2-D
Tamag, Vigan City
Training of Individual Reservists and Reserve Units. – Selective Mobilization - shall be by authority of the
Maximum opportunity shall be afforded the reservists President. Selective mobilization may be ordered to
to update their skills for the purpose of enhancement meet a local threat or emergency situation. When so
of the readiness of the individual reservists and ordered, only selected units of the Ready Reserve of
reserve units to respond to the call to service the Localities involved are activated
Compulsory training - of not less than thirty (30) days
but not more than sixty (60) days for reserve units
and/or individual reservists in a given year.
Voluntary training subject to the capability of the
AFP to provide the training. Individual reservists,
commissioned and non-commissioned officers shall be
encouraged to undergo training on a voluntary basis
to upgrade their proficiency.
Auxiliary Service – For the purpose of helping
Administration maintain local peace and order, meeting local
insurgency threat, assisting in rescue and relief
Salient Provisions
operations during disasters and calamities, health
Status of Reservists on Training. – Reservists on
welfare activities and participating in local
compulsory training shall be subject to military law.
socioeconomic development projects.
They shall not receive pay but shall be entitled to
Civil Auxiliary Service - covers services rendered in
allowances and burial benefits as provided by law.
helping maintain law and order, assisting in rescue
Reservists on voluntary training are also subject to
operations, participating in socioeconomic
military law but shall not be entitled to allowances.
development projects, delivery of health services and
Accounting of Reservists. – All
any other non-military activity.
reservists, particularly those belonging to the Ready
and Standby Reserves, shall be accounted for, their records
Military Auxiliary Service. - covers service rendered in
and status updated and present where-about ascertained meeting local insurgency threat. Reservists serving
in order to ensure their readiness to the call to duty. under this category will be organized Ready Reserve
• PAF Reservist Database Management Information Units. They must be issued and allowed to carry
System (PRDMIS) firearms: provided, that these reservists will be
• Participation in National Reservist Week utilized only for the defense of their localities and will
• Assembly Test not be employed outside their localities.
Mobilization/Utilization Status of Reservists on Auxiliary Service. – A reservist
Salient Provisions performing auxiliary service shall not receive pay but
The utilization of the Reserve Force in times of shall be entitled to receive allowances and burial
emergency to meet threats to national security. benefits as provided by law.
Full Mobilization - shall be through the joint act of With his consent, a reservist on auxiliary service
Congress and the President. When full mobilization is whether civil or military, may continue to render such
ordered, all units of the Ready and Standby Reserves service without receiving the allowances due him. A
will be activated, the reservists constituting them are reservist serving military auxiliary service is subject to
called to active duty, and the units activated are military law. whereas, a reservist serving civil auxiliary
placed on operational readiness. service is not.
Partial Mobilization. – shall be through the joint act
of Congress and the President. When partial
mobilization is ordered, only the units of the Ready
Reserves are activated units and placed on
operational readiness.

BSN 2-D
Tamag, Vigan City
 RELIGIOUS COMMUNITIES
 ONLINE COMMUNITIES
 PROFESSIONAL/ OCCUPATIONAL
COMMUNITIES
TOPIC 1: 

INTEREST-BASED COMMUNITY
EDUCATIONAL COMMUNITIES
COMMUNITY HEALTH NURSING (LEC)
 HEALTH SUPPORT COMMUNITIES
Community Health Nursing – is a specialized field of
nursing that focuses on promoting and preserving the  ENVIRONMENTAL AND CONSERVATION
health of individuals, families, and communities. COMMUNITIES
3 MAJOR CONCEPTS  HOBBIES AND RECRRATIONAL
 COMMUNITY COMMUNITIES
 HEALTH  PARENTING COMMUNITIES
 NURSING  ADVOCACY AND ACTIVIST COMMUNITIES
What Is a Community?  SENIOR AND RETIREMENT COMMUNITIES
• A community is a group of people who are  ECONOMIC OR BUSINESS COMMUNITIES
located in a particular space, have shared values,  SPORTS COMMUNITIES
and interact within a social system. Community health nursing - is a specialized field of
The four components of community are: nursing that focuses on promoting and maintaining
-People -A location in space the health of populations within a community. - It
-Social interaction - Shared values involves working with individuals, families, and
communities to prevent disease, promote healthy
Attributes of a Community behaviors, and provide healthcare services.
 Shared Identity
Basic Concept and Principles of Community
 Social Interaction
Health Nursing
 Common goal/Interest
 POPULATION CENTERED CARE
 Mutual Support
 PRIMARY PREVENTION
 Shared Values and Norms
 HEALTH PROMOTION AND EDUCATION
 Communication Channels
 ASSESSMENT AND SURVEILLANCE
 Leadership and Governance
 COLLABORATION
 Sense of Belonging
 CULTURAL COMPETENCE
 Geographical Location
 ENVIRONMENTAL HEALTH
 Cultural Diversity
 ACCESS TO HEALTHCARE
 Voluntary Membership
 EMPOWERMENT
 Shared History
 ADVOCACY
 Economic Activities
 DISASTER PREPAREDNESS
 Advocacy and Activism
 CONTINUUM OF CARE
 Generational Diversity
 Celebrations and Traditions
ROLES OF A NURSE IN CARING FOR
COMMUNITIES AND POPULATION GROUPS
Types of Communities
 ASSESSMENT
 GEOGRAPHICAL COMMUNITY
 HEALTH PROMOTION
 CULTURAL OR ETHNIC COMMUNITIES
 DISEASE PREVENTION
BSN 2-D
Tamag, Vigan City
 CARE COORDINATION - The government initiated various public health

 HOME VISITS campaigns, including vaccination programs and
 CARE MANAGEMENTS maternal and child health services.
- Community health nurses played a crucial role in
 COMMUNITY ENGAGEMENT
these programs, working in collaboration with local
 CRISIS RESPONSE
health workers.
 ADVOCACY 1980s-Present:
 ENVIRONMENTAL HEALTH - The Philippines has continued to develop its
 MENTAL HEALTH SUPPORT community health nursing practice, adapting to
 SCHOOL HEALTH changing healthcare needs and challenges.
 RESEARCH AND EVALUATION - Community health nurses have been involved in
 HEALTH SURVEILLANCE disaster response, health promotion, disease
prevention, and primary care services.
 HEALTH EQUITY
- The government has expanded its efforts to reach
 PATIENT ADVOCACY
underserved populations, especially in rural areas,
through the Barangay Health Workers (BHW) program
BRIEF HISTORY OF COMMUNITY HEALTH NURSING and other community-based initiatives.
PRACTICE IN THE PHILIPPINES
Pre-Colonial Period (Before 1521):
- In pre-colonial Philippines, healthcare was primarily
provided by traditional healers, known as "albularyos"
TOPIC 2:
populations, especially in rural areas, through the
or "hilot," who used indigenous knowledge and herbal
Barangay Health Workers (BHW) program and other
remedies.
community-based initiatives.
- Communities relied on indigenous practices and
rituals to maintain health and treat illnesses.
Spanish Colonial Period (1521-1898):
- During Spanish colonization, the Spanish introduced
Western medicine and established hospitals and
clinics in major cities.
- Nuns and friars played a significant role in providing
healthcare to the local population.
American Colonial Period (1898-1946):
- The American colonial government introduced
modern nursing education to the Philippines.
- Nursing schools and training programs were
established to produce a workforce of Filipino nurses
. - Public health nursing began to take shape with the
establishment of public health programs and the
training of community health nurses.
World War II and Post-War Era (1941-1950s):
- The Rural Health Unit (RHU) system was established
to provide basic healthcare services to rural
communities.
Post-Independence Period (1950s-1980s):
- Community health nursing became more organized
and structured during this period.

BSN 2-D

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Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

 Age of Gestation (AOG) - 24-26 weeks, 400-

Philippine Law for giving birth = maximum of

OBJECTIVE OF PRENATAL CARE: ESTIMATING FETAL GROWTH

BALDO, MYKA MARGARETTE L.

 The months with 30 days are September,

COMPUTE USING MC DONALD’S RULE

jan - 26 LEOPOLD’S MANEUVER

shoulder usually presents first, but the arm or FETAL PRESENTATION:

Frank breech presentation

Complete breech presentation

BALDO, MYKA MARGARETTE L.

BALDO, MYKA MARGARETTE L.

EXAMINING THE PELVIC SIZE:  Convergent side walls, prominent ischial

BALDO, MYKA MARGARETTE L.

2. With your other hand, mark the part of your

True conjugate or conjugate vera

BALDO, MYKA MARGARETTE L.

Low calorie diet – need for weight control

BALDO, MYKA MARGARETTE L.

BALDO, MYKA MARGARETTE L.

b. Soluble Fiber – readily dissolved in

BALDO, MYKA MARGARETTE L.

Other Forms of Sugars:

Recommended Intake of Protein

Note: Starch – are plants foods which is abundant in

BALDO, MYKA MARGARETTE L.

Classification of Protein: Food Sources of CHON:

Other Tempeh Fermented

Note: * indicates possible high-fat source of CHON

Protein Supplementation – is a dietary strategy of

HEALTH EFFECTS OF PROTEIN

BALDO, MYKA MARGARETTE L.

2. acts as a lubricant and cushion around joints, Metabolic Water:

BALDO, MYKA MARGARETTE L.

Vitamin D (calciferol, Self-synthesis with sunlight; fortified Deficiency: Tetany

substances necessary to regulate chemical

BALDO, MYKA MARGARETTE L.

BALDO, MYKA MARGARETTE L.

cream substrates are called catabolic enzymes, enzymes that

FUNCTIONS OF PROTEINS MICRONUTRIENTS

BALDO, MYKA MARGARETTE L.

BALDO, MYKA MARGARETTE L.

BALDO, MYKA MARGARETTE L.

THE IDEAL DRUG

Adverse Reaction Ex. Ascorbic Acid, Multivitamins

BALDO, MYKA MARGARETTE L.

Resp: RESPIRATORY DEPRESSION Illegal drugs

Drugs may be further classified as:

BALDO, MYKA MARGARETTE L.

Distribution FACTORS AFFECTING DISTRIBUTION

- binding of a drug to macromolecules in

Half life - t 1/2 “xenobiotics”

- the time it takes to eliminate 50% of a drug. Xenobiotic Metabolism

Fat: Lean Body Mass Ratio

BALDO, MYKA MARGARETTE L.

BALDO, MYKA MARGARETTE L.

of metabolism could probably due to sex