Pointers

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 The Philippine Health Agenda 1. Continue and maintain current

Framework 2016-2022 under the macroeconomic policies, including
Duterte Administration. The new fiscal, monetary, and trade policies.
health system framework aims for:
2. Institute progressive tax reform and
1. Financial Protection: Filipinos, more effective tax collection,
especially the poor are protected indexing taxes to inflation. A tax
from high cost of health care. reform package will be submitted to
Congress by September 2016.
2. Better Health Outcomes: Filipinos
attain the best possible health 3. Increase competitiveness and the
outcome with no disparity. ease of doing business. This effort
will draw upon successful models
3. Responsiveness: Filipinos feel used to attract business to local
respected, valued and empowered in cities (e.g., Davao) and pursue the
all of their interaction with the health relaxation of the Constitutional
system. restrictions on foreign ownership,
except as regards land ownership, in
 The Department of Health said that the order to attract foreign direct
new health agenda framework will be investment.
attainable through the ACHIEVE
strategy: 4. Accelerate annual infrastructure
spending to account for 5% of GDP,
A Advance health promotion, primary care and quality with Public-Private Partnerships
playing a key role.
C Cover all Filipinos against financial health risk
5. Promote rural and value chain
H Harness the power of strategic HRH development toward increasing
I Invest in eHealth and data for decision-making agricultural and rural enterprise
productivity and rural tourism.
E Enforce standards, accountability and transparency
6. Ensure security of land tenure to
V Value clients and patients encourage investments, and address
bottlenecks in land management and
E Elicit multi-stakeholder support for health
titling agencies.
 RH Law, otherwise known as
Republic Act 10354 or the 7. Invest in human capital
Responsible Parenthood and development, including health and
Reproductive Health Act education systems, and match skills
and training to meet the demand of
businesses and the private sector.
 Here are the 10-point Socioeconomic 8. Promote science, technology, and the
Agenda of the Duterte creative arts to enhance innovation
Administration: and creative capacity towards self-
sustaining, inclusive development.
9. Improve social protection programs,
including the government’s
Road to Success by: JONAS MARVIN ANAQUE

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Conditional Cash Transfer program,  September 28 as the World Rabies
to protect the poor against instability Day.
and economic shocks.
 Stop walking or moving.
10. Strengthen implementation of the
Responsible Parenthood and  Stay still and be calm.
Reproductive Health Law to
 Do not panic or make loud noises.
enable especially poor couples to
make informed choices on  Avoid direct eye contact with the
financial and family planning. dog.
RABIES PREVENTION AND  Say "No" or "Go Home" in a firm,

CONTROL PROGRAM deep voice.
 Stand with the side of your body
Vision: To Declare Philippines Rabies- facing the dog.
Free by year 2020  Avoid facing a dog directly since it
can appear aggressive to the dog.
Goal: To eliminate human rabies by the
year 2020  keep your body turned partially or
completely to the side.
 Slowly raise your hands to your
Program Strategies: neck, with your elbows in.
 Wait for the dog to pass or slowly
To attain its goal, the program employs the
back away.
following strategies:
 Do not run from a dog.
1. Provision of Post Exposure
Prophylaxis (PEP) to all Animal Bite  Remain motionless (e.g., "be still
Treatment Centers (ABTCs) like a tree") when approached by an
unfamiliar dog or attempt to sit.
2. Provision of Pre-Exposure
Prophylaxis (PrEP) to high risk individuals  Avoid retrieving objects from the
and school children in high incidence zones dog's mouth
 Do not disturb the dog while the
4. Health Education animal is eating.
Rabies prevention  Curl into a ball with your head
tucked and your hands over your ears
 RA 9482 or “The Rabies Act of and neck if a dog knocks you over.
2007”, rabies control ordinances
shall be strictly implemented.  Immediately let an adult know about
 March as the Rabies Awareness stray dogs or dogs that are behaving
Month strangely.
What Breeds Have the Strongest Bite?

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- Kangal dogs Examples of active vaccines are PCEC (Purified Chick Emb
the new cheap drug VEROWELL
 - It will give 2 years immunity against rabies if the do
Post-exposure prophylaxis (PEP)
 extensive washing and local Postexposure Prophylaxis for Non-immuniz
treatment of the wound as soon as
possible after exposure;
 a course of potent and effective Treatment Regimen
rabies vaccine that meets WHO
standards; and Wound All postexposure prophylaxis should begin wi
 the administration of rabies
cleansing cleansing of all wounds with soap and water. I
immunoglobulin (RIG), if indicated.
such as povidine-iodine solution should be use
Categories of contact with suspect Post-exposure

RIGprophylaxis
If possible, the full dose should be infiltrated a
rabid animal measures
remaining volume should be administered IM
Category I – touching or feeding from vaccine administration. Also, RIG shoul
animals, licks on intact skin None same syringe as vaccine. Because RIG might
production of antibody, no more than the reco
Category II – nibbling of uncovered
skin, minor scratches or abrasions Immediate vaccination and
without bleeding local treatment of the wound
Vaccine HDCV or PCECV 1.0 mL, IM (deltoid area ),
Category III – single or multiple 14.
transdermal bites or scratches, licks on Immediate vaccination and
broken skin; contamination of mucous administration
* Aof
5thrabies
dose on day 28 may be
membrane with saliva from licks, immunoglobulin; local
contacts with bats. treatment ofrecommended
the wound for immunocompromised
persons.
 Head is the most fatal site for dog
bite
 Legs are the most common site for
Postexposure Prophylaxis for Previously
dog bite
 Rabies vaccine is an artificial active Immunized Individuals
 given on days 0, 3, 7, 14, 30, and 90,
 avoid gluteal area
 Rabies vaccine should be Treatment Regimen
administered in the deltoid muscle
 In both pre-exposure and post- Wound All postexposure prophylaxis
exposure immunization, the full 1.0 cleansing should begin with immediate
mL dose should be given 9 thorough cleansing of all wounds
intramuscularly with soap and water. If available,
 Sanofi Pasteur created both a virucidal agent such as
antirabies and antidengue vaccine povidine-iodine solution should
 antirabies horse serum
 HRIG is from human serum

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RESTV species, found in Philippines and
the People's Republic of China, have been
Postexposure Prophylaxis for Previously
found to infect humans but they do not cause
Immunized Individuals illness or death
Treatment Regimen Diagnosis

***antibody-capture enzyme-linked
immunosorbent assay (ELISA)
be used to irrigate the wounds.
RIG RIG should not be administered. Principles of Primary Health Care
1. 5 A's = Accessibility, Availability,

Vaccine HDCV or PCECV 1.0 mL, IM Affordability & Acceptability,
(deltoid area), one each on days Appropriateness of health services.
0 and 3.
2. Community Participation
 heart and soul of PHC
Ebola: Mapping the outbreak
From the section of WEST Africa Four Cornerstones/Pillars in Primary
Ebola crisis Health Care
The hunters breaking an Ebola ban
on bushmeat- FRUIT BATS 1. Intra and Inter-sectoral Linkages
2. Use of Appropriate Technology
Primary source = fruit bats or flying 3. Support mechanism made available
foxes , old world bats 4. Active Community Participation
Other sources:
community is the patient in CHN,
1. Chimpanzees the family is the unit of care or
2. Gorillas service
3. fruit bats
4. monkeys
5. antelope Herbal Medicine (LUBBY SANTA)
6. porcupines Herbal USES
7. symptomatic humans Medicine
Ebola outbreak in West Africa was first Lagundi Skin diseases
reported in March 2014, ( Vitex Headache,
Negundo) Asthma,fever,cough&colds
discovery in 1976. SHARED Rheumatism
The total number of reported cases is more Eczema
than 28,607. Dysentery
Ulasimang Lowers uric acid
Virus is named after the ebola river Bato

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(Peperonia  5 years renewable Cotract of
Pellucida) copar
Bawang Hypertension and Toothache Entry Phase
( Allium • Self Awareness and Leadership
Sativum) HAT Training (SALT)
Bayabas Anti septic, Anti-diarrheal Community Organization and Capability
( Psidium Building Phase
Guajava) • Development of management
systems:
Yerba Buena Rheumatism and other body
(Delineation of the roles, functions and
(Mentha aches, analgesics
task of officers)
Cordifolia)
• A-R-A-S
Sambong (Action- Reflection- Action-
(Blumea Diuretic- kidney stones Session)
Balsamifera) Community Action Phase
Akapulko Fungal infection, skin
diseases • PIME of health services
(Project Implementation Monitoring and
Evaluation)
Niog Niogan Anti-helminthic every 6
(Quisqualis months 2 hours p supper
Measles 9m0s.- At least 85% of IMMUNIZATION SCHEDULE
Indica) No to lee than 4 y/o
11m0s. measles can be  Give every child a dose of Vitamin A
Tsaang Gubat Diarrheaprevented by every six months from the age of 6
(Carmona immunization at this months.
Retusa) age.  Give every child mebendazole every
Ampalaya DM Type 2- obesity 6 months from the age of one year.
(Momordica
Charantia) 6 weeks DPT+HIB-1** Hep B1 OPV1
RTV1**** PCV1*****
COPAR COPAR 10 weeks DPT+HIB-2 Hep B2 OPV2 RTV2
PCV2
 A social development approach that aims
to transform the apathetic, individualistic
and voiceless poor into dynamic,  9 months Measles ***
participatory and politically responsive  12 months MMR
community.  18 months DP
****Rotavirus Vaccine is available as
 2 dose or 3 dose schedule
Social Mobilization
 Process of generating and sustaining the ORAL HEALTH

active and coordinated participation of  Advise mother to bring the child to a
all sectors at various levels to facilitate dentist
and accelerate improvement  every 6 months for dental check-up

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FOR PROPHYLAXIS IN HIV 3. Reporting/Tally Forms
CONFIRMED OR EXPOSED CHILD: 4. Output Reports...
 ANTIBIOTIC FOR
PROPHYLAXIS: Oral
Cotrimoxazole Rubeola (measles)
Communicable just before the rash
OPV (Oral Polio Vaccine) appears to 4-5 days after rash
“Sabin vaccine” appears=highly contagious
 polio vaccine that is taken by mouth
and contains the three serotypes of • The first sign of measles is usually a
poliovirus in a weakened live state— high fever (often >104o F [40o C])
called also Sabin oral vaccine that typically lasts 4-7 days.
Measles- Subcutaneous • Koplik spots—bluish-gray specks or
Cold Chain under EPI “grains of sand” on a red base—
develop on the buccal mucosa
o 6months- Regional Level opposite the second molars
o Not more than 5days- • First 24 hours
Health centers using – Fever, malaise, cough,
transport boxes. coryza, conjunctivitis
 Most sensitive to heat: Freezer (-15 • In 48 hours
to -25 degrees C) – “Koplik spots” (small,
o OPV irregular, red spots with
o Measles minute bluish-white center)
Schedule for Receiving Vitamin A first seen on buccal mucosa
Supplement Middle East respiratory syndrome
coronavirus (MERS-CoV)
 Post Partum Mother • a viral respiratory disease caused by
 200,000 IU a novel coronavirus (MERS‐CoV)
Within one month that was first identified in Saudi
 After delivery of each child only Arabia in 2012.
Republic of Korea is the largest outbreak
outside of the Middle East
Home Based Mother’s Record (HBMR)
 Tool used when rendering prenatal Source of the virus
care containing risk factors and originated in bats and was transmitted to
danger signs camels sometime in the distant past.
• camels - major reservoir host for
MERS-CoV and an animal source of
MERS infection in humans
• No vaccine or specific treatment is
Fundamental or building block of FHSIS? currently available.
= Individual treatment record or Family • avoid contact with camels, drinking
treatment record raw camel milk or camel urine, or
eating meat that has not been
Composition of FHSIS properly cooked.
1. Family Tx Record
2. Target Cx List

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• Cover your nose and mouth with a Tanzania, Egypt, Central African
tissue when you cough or sneeze, Republic, Sierra Leone, Gabon and
then throw the tissue in the trash. Senegal) and then in some countries
• Avoid touching your eyes, nose and in Asia (India, Malaysia, the
mouth with unwashed hands. Philippines, Thailand, Vietnam and
• Avoid personal contact, such as Indonesia).
kissing, or sharing cups or eating
utensils, with sick people. • In 2007, an actual epidemic broke
Diphtheria out in Micronesia (Yap Islands in
• Diphtheria is an acute infection the Pacific Ocean), causing 5,000
caused by infections.
• bacteria Corynebacterium
• In 2013 and 2014, 55,000 cases of
diphtheriae.
Zika were reported in French
• The throat infection causes a gray to
Polynesia. The epidemic then spread
black, tough, fiber-like covering,
to other islands in the Pacific,
which can block your airways
namely New Caledonia, the Cook
Tetanus
Islands and Easter Island.
• caused by the bacterium Clostridium
tetani, the spores of which are • The Zika virus was detected for the
widespread in the environment first time in the northwest of Brazil
• present with trismus (“lockjaw”), in May 2015 and it quickly spread to
which is the inability to open the other regions of the country. Brazil
mouth secondary to masseter muscle has declared the highest number of
spasm. Zika cases ever recorded with
• Nuchal rigidity and dysphagia are between 440,000 and 1,300,000
also early complaints that cause risus suspected cases reported.
sardonicus, the scornful smile of
tetanus, resulting from facial muscle • The virus has been present in
involvement Colombia, El Salvador, Guatemala,
• generalized muscle rigidity with Mexico, Panama, Paraguay,
intermittent reflex spasms in Suriname, Venezuela and Honduras
response to stimuli (eg, noise, touch). since October 2015.
• Tonic contractions cause
opisthotonos (ie, flexion and
adduction of the arms, clenching of
the fists, and extension of the lower Fighting the disease
extremities).
ZIKA- Treatment
• The Zika virus was detected for the
There is currently no vaccine for preventing
first time in a rhesus monkey
Zika virus infection and no specific
• Virus was named after a forest
medication for treating the disease.
in Uganda in 1947. A year later, it
was isolated in an Aedes mosquito
Treatment involves taking pain killers to
from the same region.
relieve the painful symptoms. However,
• The first human cases appeared in
aspirin should be avoided until infection by
the 1970s in Africa (Uganda,
the dengue virus has been ruled out because,

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in this case, the anticoagulant effect of the Goal 1: No Poverty
drug could cause bleeding. Goal 2: Zero Hunger
Goal 3: Good Health and Well-being (health
Diagnosis related)
As soon as symptoms appear, blood and Goal 4: Quality Education
urine samples are taken to confirm the Goal 5: Gender Equality
diagnosis using an RT-PCR (Reverse Goal 6: Clean Water and Sanitation(health
Transcriptase-Polymerase Chain Reaction) related)
Goal 7: Affordable and Clean Energy
method to detect the presence of the virus's
Goal 8: Decent Work and Economic Growth
genes.
Goal 9: Industry, Innovation and Infrastructure
Goal 10: Reduced Inequalities
Prevention
Goal 11: Sustainable Cities and Communities
The only way of protecting against the Zika Goal 12: Responsible Consumption and
disease is to protect yourself from mosquito Production
bites both day and night, especially in the Goal 13: Climate Action
early morning and early evening when Goal 14: Life Below Water
mosquitoes are most active, using physical Goal 15: Life on Land
and chemical methods — wear clothes that Goal 16: Peace, Justice and Strong Institutions
cover up your skin (long sleeves, pants), use Goal 17: Partnerships for the Goals
suitable repellents on your clothes and areas
of exposed skin, and use insecticide-  Anthrax
 (Splenic fever, Siberian ulcer,
impregnated mosquito nets and electric
Charbon, Milzbrand)
insecticide diffusers indoors.
 Anthrax is a zoonotic disease caused by
Pregnant women living in high-risk areas the spore forming bacterium Bacillus
must protect themselves from mosquito bites anthracis.
using the above methods, particularly during  Anthrax is most common in wild and
the first six months of pregnancy when the domestic herbivores (eg, cattle, sheep,
goats, camels, antelopes)
risk of birth defects is at its highest.
 B anthracis spores can remain viable in
soil for many years.
Pregnant women wishing to travel to areas  Raw or poorly cooked contaminated
affected by the Zika epidemic must weigh meat is a source of infection for zoo
up the risks beforehand with their family carnivores and omnivores; anthrax
physician. resulting from contaminated meat
consumption has been reported in pigs,
mosquito breeding sites control, for example dogs, cats, mink, wild carnivores, and
stagnant water in flower pots, gutters and people.
old tires, must be removed. It is particularly
advisable to empty any water containers
located around your home after each spell of
rain.  GI anthrax (including pharyngeal
anthrax) may be seen among human
populations after consumption of
 title of the agenda is Transforming
contaminated raw or undercooked meat.
our world: the 2030 Agenda for
Sustainable Development.  people may develop a highly fatal form
of disease known as inhalational anthrax
17 goals or woolsorter’s disease. Inhalational

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anthrax is an acute hemorrhagic  by species but resembles, for the most
lymphadenitis of the mediastinal lymph part, anthrax in cattle.
nodes, often accompanied by
hemorrhagic pleural effusions, severe
septicemia, meningitis, and a high
mortality rate.  Specific diagnostic tests include
bacterial culture, PCR tests, and
fluorescent antibody stains to
demonstrate the agent in blood films or
tissues
 Treatment, Control, and Prevention:
 B anthracis was used successfully as a

weapon of terrorism in 2001, killing 5  The nonencapsulated Sterne-strain
people and causing disease in 22. vaccine is used almost universally for
Probably because of the method of livestock immunization. Vaccination
delivery (via mail), no known animal should be done at least 2–4 wk before
disease resulted from this attack. the season when outbreaks may be
Weaponized spores represent a threat to expected. Because this is a live vaccine,
both human and animal populations. antibiotics should not be administered
 Pathogenesis: within 1 wk of vaccination.
 After wound inoculation, ingestion, or  Oxytetracycline given daily in divided
inhalation, spores infect macrophages, doses also is effective. Other
germinate, and proliferate. In cutaneous antibacterials,
and GI infection, proliferation can occur including amoxicillin, chloramphenicol,
at the site of infection and in the lymph ciprofloxacin, doxycycline, erythromyci
nodes draining the site of infection. n, gentamicin, streptomycin, and
 Lethal toxin and edema toxin are sulfonamides also can be used, but their
produced by B anthracis and effectiveness in comparison with
respectively cause local necrosis and penicillin and the tetracyclines has not
extensive edema, which are frequent been evaluated under field conditions.
characteristics of the disease.
 incubation period is 3–7 days (range

1−14 days).
 The disease in horses may be acute.
 Cognitive behavioral therapy (CBT) is
Signs may include fever, chills, severe
colic, anorexia, depression, weakness, an effective treatment for depression
bloody diarrhea, and swellings of the
neck, sternum, lower abdomen, and  approach of CBT is educational. The
external genitalia. Death usually occurs therapist uses structured learning
within 2–3 days of onset. experiences that teach patients to
monitor and write down their negative
thoughts and mental images.

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 CBT lasts 14 to 16 weeks.  reducible hernia protruding mass
spontaneously retracts into the
 Cognitive therapy is based on abdomen.
the cognitive model, which states
that thoughts, feelings and behavior  Atropine increases heart rate.
are all connected, and that
individuals can move toward  A mechanical ventilator indicated to
overcoming difficulties and meeting a patient can't maintain a safe PaO2
their goals by identifying and or PaCO2 level.
changing unhelpful or inaccurate  goal of treatment for a patient with
thinking, problematic behavior, and angina pectoris is to reduce the
distressing emotional responses heart's workload, thereby reducing
 Cognitive behavioral for the myocardial demand for O2 &
preventing MI.
 Addiction
 Drainage of more than 3L of fluid
 Anxiety disorders daily from a NGT may suggest
 Bipolar disorder intestinal obstruction.
 Low self-esteem  Ecstasy is also known as

(MDMA /Molly)- methylenedioxy-
 Phobia methamphetamine (MDMA)
 popular in the nightclub scene and at
 Schizophrenia all-night dance parties ("raves"), but
 Substance abuse the drug now affects a broader range
of people who more commonly call
 Suicidal ideation the drug Ecstasy or Molly.
 MDMA's effects last about 3 to 6

hours
 Behavior therapy is
effective treatment for attention-
deficit/hyperactivity
disorder (ADHD) that can improve  sildenafil (Viagra®)
a child's behavior, self-control, and
self-esteem. ... behavior  MDMA acts by increasing the
therapy must be initiated before activity of three brain chemicals:
prescribing ADHD medicine. dopamine, norepinephrine, and
 Metrorrhagia (bleeding between serotonin.
menstrual periods) - first sign of  Effects include euphoria, increased
cervical cancer. energy, distorted perception,
involuntary teeth clenching,

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dangerously high body temperature,  deer ticks = LYME'S DISEASE.
and depression.  REVERSE TRIAGE is system of

 After a corneal transplant avoid lying categorization of patients in a mass
on the affected site , soapsuds and casualty situation based on decisions
sex as to which can most safely be
DISCHARGED rather than on
 Persistent bleeding after open heart
priority for treatment.
surgery may require the
administration of protamine sulfate  About 50% of people who
to reverse the effects of heparin experience a systemic allergic
sodium used during surgery. reaction will have a recurrent
reaction when re-stung.
 The risk of cancer is nearly doubled
in frequent users of Priming IV Tubing
ACETAMINOPHEN.
 Prime all lines very slowly. When a line is
 A triage nurse gathers information primed quickly, minute amounts of air are
left in the line.
upon a patent's arrival to a hospital
 When priming all lines, invert each port and
emergency room, including name, hit with a pen to dispel the air bubble. If this
age, symptoms and the current is not done there will be air in the line.
medical condition of the patient.
If you see a small bubble of air here or there, that
isn’t a big thing but patients can get anxious, so
 Dopamine—causes a surge in get them out of the line by flicking the tubing with
your finger.
euphoria and increased
energy/activity Remember that air rises so hold the portion of the
tube that is towards the end higher than where the
 Norepinephrine—increases heart rate bubble is so the bubble will move along. If you see
bubble in the “Y” connectors along the line, turn
and blood pressure, which are them upside down to get the air bubbles to dislodge
particularly risky for people with and move along.
heart and blood vessel problems Finishing the skill of priming an IV line requires you
secure the IV tubing to the patient. Make sure you
 Serotonin—affects mood, appetite, don’t tape over the transparent dressing that is on
sleep, and other functions. It also the insertion site or you will have trouble
removing the line without damaging the dressing.
triggers hormones that affect sexual
arousal and trust. The release of large  If there is air in primed tubing, stretch the
line and strum very rapidly or stretch the
amounts of serotonin likely causes line around a pen and wrap the line forcing
the air upward. Air always rises therefore
the emotional closeness, elevated while strumming or wrapping make sure that
mood, and empathy felt by those you are forcing the air where you want it to
go. You can also use a sterile syringe to
who use MDMA. aspirate air through a port.
 Spike bags upright and keep the tubing
upright. If the bag must be placed in a

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horizontal position, clamp off the tubing  *Acid-Base imbalance: Metabolic
below the drip chamber with your fingers to
prevent air from getting in the neck of the
acidosis
drip chamber. If air gets into the neck of the
drip chamber it is very hard to dispel. Using Administering Oral Inhalation Therapy
the roller clamp will not prevent air from
getting into the neck if the bag is horizontal.  Shake the inhaler immediately
before using it. Remove the cap
 If the tubing is dripping, just raise your arm from the mouthpiece.
above the drip chamber. This will stop the
dripping and is easier and quicker than using  Ask client to clear their throat.
the roller clamp.
 Ask the client to breath out slowly
 Tubing is usually changed every 96 hours until no more air can be expelled
and the drop factor for tubing can change by from the lungs then hold their
the manufacturer. The drop factor is always breath.
listed on the box.
 Place the mouthpiece in the
 DROPLET PRECAUTIONS for mouth holding the inhaler upright.
Meningitis, and pertussis Close the lips tightly around the
mouthpiece.
 Contact precaution for MERS and
 Squeeze the inhaler as client
EBOLA
breathes in deeply through the
 PROGNATHISM - INITIAL mouth. This is often difficult to
do.
MANIFESTATION of
ACROMEGALY.  Tell client to hold breath up to a
count of five seconds.
 Shick test for susceptibility to  Before breathing out remove
diphtheria: A + shicks means no inhaler from the mouth. Wait at
immunity or suceptible; (antigen least two minutes between puffs,
test) unless there are other directions.
 Repeat process if two puffs are
 Moloney test – for sensitivity of ordered.
diptheria
 If you have two or more inhalers
 Triad of ADHD: Inattention, always use the steroid
Hyperactivity, Impulsivity medication last. Then rinse mouth
out with water.
 Latanoprost eye solution control the  Clean mouthpiece of inhalers
progression of glaucoma or IOP frequently and dry it thoroughly.
 Burns: Emergent Phase  Remove gloves, wash your

hands with soap and water, and
 *Fluid shifts: IV to IS dry thoroughly.
 *Electrolyte imbalances:
Hyponatremia & Hyperkalemia

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Anaphylaxis may cause respiratory a complication of pneumonia or
(bronchoconstriction) and shock tuberculosis.
(vasodilation). It's considered a crisis.
 GERD is also known as chalasia.
 Mastoidectomy is required in 50% of
cases of MASTOIDITIS.  Z-Track Injection
 Pure-tone audiometry is a behavioral  adult, the most commonly used

test used to measure hearing needles are 1’(inch)or 1/2, 22 to 25
sensitivity. gauge thick
 The most common cause of corneal  Preparation

 Verify doctor’s order on the patient’s
ulceration is prolonged or improper
chart.
use of contact lenses.  Hand washing.
 Use a proper needle. Rule of thumb
 A person with Antisocial Personality
in needle selection for IM injection
Disorder lacks superego and needs are as follows:
immediate gratification.  Aspirate the prescribed medication
into the syringe. Draw 0.2-0.5 cc of
 After a patient undergoes a femoral- air (depending on the hospital
popliteal bypass graft, the nurse must policy) to create an air lock. (Air-
closely monitor the peripheral pulses lock technique is used with this
distal to the operative site and procedure.)
circulation.  Replace the needle with a new one
after preparing the drug so that no
 Osteoarthritis is also known as drug remains outside the needle
Degenerative Joint Disease. It shaft. This prevents tracking the drug
into the subcutaneous tissue during
commonly affects the weight-bearing
injection.
joints (spine, hips and knees).
 Colonoscopy is the "screening" for  Pancolitis refers to inflammation of

colorectal cancer. the entire colon.
 Biopsy is the confirmatory.  hallmark of Ulcerative colitis
 Veracity: habitual observance of is bloody diarrhoea / rectal
truth in speech or statement; bleeding.
TRUTHFULNESS.  Recurrent Ulcerative colliotis treat
 The closest predisposition to Type 2 with sulfasalazine
DM (NIDDM) is obesity.
 Dyspnea and sharp, stabbing pain

 Tracheoesophageal fistula:
that increases with respiration are
symptoms of pleurisy, which can be

NLE POINTERS
•Distal esophagus arises from • Pain.
trachea; proximal esophagus • Iron deficiency.
ends blindly. • Hematochezia: massive blood
• Stuff swallowed ends up in loss.
trachea.
• Food regurgitates in mouth.  Inflammatory bowel disease:
 Gastroesophageal reflux disease:  Ulcerative colitis:
GERD or chalasia:
• Most common.
 Caused by:  *Rectum and sigmoid
• Smoking, alcohol, caffeine, • Ulcerations.
chocolate, hiatal hernia.  Crohn's disease:
 Findings: • Granulomatous,
• Chest pain, cough, asthma, ulceroconstrictive disease.
heartburn, acid injury to • Discontinuous spread
enamel, Barrett's esophagus. throughout entire GI tract.
 Achalasia:  Irritable bowel syndrome:
• Incomplete relaxation of •Alternating bouts of diarrhea

LES. and constipation.
• Absent ganglion cells of  **Diverticulitis – LLQ pain
myenteric plexus.
• No peristalsis.
 Causes:  Barrett's esophagus:

• Chagas disease. • Complication of GERD.
• Abnormal barium swallow: • Glandular metaplasia in distal
beak-like (bird-beak) tapering esophagus.
at distal end of esophagus. • Ulceration, glandular
dysplasia; adenocarcinoma
 Congenital pyloric stenosis: risk.
• Projectile vomiting.
 Colon cancer:
• Hypertrophy of muscles in
pyloric sphincter. • Increasing age.
• Low-fiber diet.
 Findings in small bowel disease: • Smoking.
• Colicky pain: pain occurs in • Familial polyposis, ulcerative
intervals. colitis.
• Diarrhea. • Common location:
• Anemia: malabsorption of rectosigmoid.
iron, folate, vitamin B12. • Test: fecal occult blood test,
colonoscopy, barium enema.
 Findings in large bowl disease: • Constipation and diarrhea
• Diarrhea. with or without bleeding.

NLE POINTERS
• Spreads to: liver (common), Management and approach
lungs, bone, brain. √ Nursing Research
 Colorectal √ Maslow
cancer – √ PALMAR
primary
√ Meniers, parkinsons, GBS, ALS,
diagnostic test
is colonoscopy drugs, surgery, limit, diet, exercise
and management
 Acute appendicitis: √ MaskuloSkeletal Disorder ( gouty,
• Children: lymphoid osteo, rheumatoid) drugs, diet,
hyperplasia. exercise and management
• Adults: fecalith obstruction √ Gait, posture, strain and braces
of proximal lumen.
√ pediatric bones disorder
• Initial colicky periumbilical
pain. √ BURNS
• Nausea, vomiting, fever. √ EENT disorders, drugs, surgery,
• Tenderness at McBurney's management and diet
point (Blumberg's sign). √ Nursing Theories
• Laboratory: neutrophilic √ RAPE management
leukocytosis.
• Diagnosis: CT scan.  STEP 1 – Making preparations to offer
• Complications: medical care to rape survivors
periappendiceal abscess;
pylephlebitis.  STEP 2 – Preparing the survivor for the
• Treatment: appendectomy. examination
 A person who has been raped has

 Mental health stigma types: social experienced trauma and may be in an
stigma and perceived stigma or self- agitated or depressed state. She often
feels fear, guilt, shame and anger, or any
 Stigma is when someone views you combination of these.
in a negative way because you have
a distinguishing characteristic or  Ensure that a trained support person or
personal trait that's thought to be, or trained health worker of the same sex
actually is, a disadvantage (a accompanies the survivor throughout
the examination.
negative stereotype)
 Stigma can lead to discrimination.  STEP 3 – Taking the history
 STEP 4 – Collecting forensic evidence

 Pyschiatric nursing, approach,
disorder, drugs, approach, LITHIUM • Documenting injuries and
THERAPHY, collaborative and collecting samples, such as
management, diagnostic and blood, hair, saliva and sperm,
screening. within 72 hours of the incident
√ Geriatrics Nursing, Drugs,

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• **place evidence in a paper  Close your office door or find a quiet
bag not in a zip lock plactics space, and meditate for five minutes.
to prevent deterioration
 Distract yourself from your anger
 STEP 5 – Performing the physical and
• visit your favorite website, play
genital examination
a song that you like, daydream
 STEP 6 – Prescribing treatment about a hobby that you enjoy,
or take a walk.
 STEP 7 – Counselling the survivor
 STEP 8 – Follow-up care of the survivor

 CRISIS management
•
√ Anger Management  CRISIS INTERVENTION
 Anger is a powerful force that  TECHNIQUES OF CRISIS INTERVENTION

can jeopardize your
relationships, your work, and
your health, if you don't learn  v Catharsis: the release of feelings that
to manage it effectively. takes place as the patient talks
emotionally charged areas
 To manage anger,
acknowledge that you have a  v Clarification: encouraging the patient
problem, keep a hostility log, to express more clearly the relationship
and build a support network between certain events.
based on trust.
 v Manipulation: using the patient’s
emotions, wishes or values to benefit
 Also, use techniques to
the patient in the therapeutic process.
interrupt your anger, listen,
empathize, be assertive with  v Reinforcement of behavior: giving
others, and learn to relax, as the patient positive reinforcement to
well as laugh at yourself. adaptive behavior.
 Yell "Stop!" loudly in your thoughts. This  v Support of defenses: encouraging the
can interrupt the anger cycle. use of healthy, adaptive defenses and
discouraging those that are unhealthy
 Use physical relaxation techniques
or maladaptive.
like deep breathing or centering
 v Increasing self- esteem: helping the
 Count to 20 before you respond.
patient to regain feelings of self worth.
 Manage your negative thoughts
with imagery and positive thinking

NLE POINTERS
 v Exploration of solution: examining and after traction
alternative ways of solving the placement.
immediate problem.  Assess the skin, especially
bony prominences for
 Catharsis - . As feelings about the events
breakdown.
are realised, tension is reduced. The
 Assess neurovascular
nurse solicits the patient's feelings
status.
about the specific situation, recent
events, and significant people involved
 Regularly check the
in the particular crisis. The nurse asks
condition of the traction
open-ended questions and repeats the
equipment: ropes,
patient’s words so that more feelings
pulleys, and weights.
are expressed. The nurse does not
 For the client in skeletal
discourage crying or angry outbursts traction, assess the pin
but rather sees them as a positive site for signs and
release of feelings. symptoms of infection.
 Role of the Nurse in

Caring for Patients in
•
Traction
√ CVA  RNs shall not apply or set
 Pheochromocytoma is the formation up skeletal or cervical
of a benign tumor in adrenal medulla traction.
causing hypertensive crisis.  RNs shall not remove,
add, or lift up on weight
 DOC: Phentolamine Mesylate when the patient is in
(Regitine) In otitis media, the traction for the treatment
tympanic membrane is bright red and of fractures.
lacks its characteristic light reflex
(cone of light).
Glucometer Testing
 Dopamine is the drug of choice for
shock. (Maybe,CIC)  Puncture the body part as
directed by the delegating RN.
 Vital Signs The best practice is to change
the puncture site for each test.
Tip: fingertips are less
 Assess the client for the sensitive on the sides of the
following while in finger.
traction.  Provide direct pressure to stop
the bleeding if needed
 Monitor skin integrity of
 Remove gloves.
the affected part before
 Wash and dry your hands.

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• Increased vessel diameter;
lumen fills with debris and
Gastrostomy Feedings clots.
• Findings: usually
 Remove the dressing - never asymptomatic.
use scissors to cut it off.
 Anchor the tube as instructed by
the delegating nurse.  Hypertension:
 Encourage the client to be in a • BP over 140/90 mm Hg.
sitting or semi-reclining position.  Depends on:
 The delegating nurse may ask
you to check gastric contents by • Diastolic blood pressure.
putting on gloves and • Systolic blood pressure.
withdrawing some of the • Sodium level.
contents of the stomach with a
large syringe.  Essential hypertension:
 Administer the formula or the • 95% cases of hypertension.
medication as directed by the • Genetic factors reduce Na
delegating nurse. elimination; unknown factors
cause vasoconstriction of
 Flush the feeding tube with 30-
arterioles.
60 ml of water before and after
• Obesity, stress.
each feeding and after giving all
medications.  Secondary hypertension:
 Remove gloves. • 5% cases of hypertension.
 Wash your hands. • Renal artery occlusion.
• Activation of renin-
 Arteriolosclerosis: angiotensin-aldosterone
• Hardened arterioles. system.
• Protein deposition occludes • Renal artery has beaded
lumen. appearance.
• Caused by diabetes mellitus;
hypertension.
• Onion skin appearance of  Complication:
arterioles. • Rupture causes severe back
 Aneurysms: pain followed by
hypotension.
• Weak vessel walls followed
by dilation.
• Tendency of vessel wall to • most common type of hernia
rupture. is the hiatus hernia, in
 Abdominal aortic aneurysm: which the stomach passes,
• AORTA is located at the partly or completely, into the
EPIGASTRIC REGION chest cavity through the hole
 Atherosclerosis weakens wall. ("hernia") for

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the oesophagus (which is also  vomiting and pain in the upper
known colloquially as the abdomen soon after eating.
"windpipe" or "gullet").  Complications may include
bleeding, perforation and
 Complications of hernias obstruction due to scarring.
 impossible to return to their normal  Medical treatment may include the
state (irreducible). use of antacids to relieve symptoms
 swollen and fixed within their sac and / or anti-secretory drugs to heal
(incarcerated). the ulcer(s)
 cut-off from their blood supply,
becoming painful and eventually  gastroscope to confirm the diagnosis
gangrenous (strangulated).
of a gastric ulcer
 treatment for hernias surgical repair.
• Irritable Bowel Syndrome is  Effects / symptoms of a peptic ulcer

also known as "IBS", "spastic can include:
colon", and "mucous colitis"  abdominal pain - often just below
the sternum (="breastbone"), can be
• Cause is unknown but IBS is a persistent burning pain that
often associated with stress or extends to he person's back.In some
anxiety cases this pain may begin approx.
20 mins after eating, or it may
 Treatment might involve: awaken the person at night.
 reducing or removing anxiety (e.g.  heartburn
psychotherapy)  regurgitating food
 dietary adjustment  vomiting
 faecal softening agents  bitter taste in the mouth
 drugs to reduce spasm and / or
reduce sensitivity to pain
 Osteomyelitis:
• Bone infection due to: S
 gastric ulcers aureus (most common).
 The action of acid, pepsin, and bile • Findings: fever, bone pain.
on the lining of the stomach • In sickle cell anemia: S.
(mucosa). However, the output of paratyphi.
stomach acid is not usually • In foot due to rubber
increased. footwear puncture: P.
 Taking NSAIDs (non-steroid anti- aeruginosa.
inflammatory drugs) or  Osteoporosis:
corticosteroids may be pre-
disposing factors. • Loss of bone matrix and
 helicobacter pylori is often present. minerals.

NLE POINTERS
• Primary: idiopathic, senile, •HLA-DR4 association.
postmenopausal (lack of •Type III hypersensitivity
estrogen). reaction.
• Secondary: disease, drugs, • Joint B-cells produce
space travel. rheumatoid factor.
• Prevention: vitamin D, • Rheumatoid factors activate
calcium, weight-bearing complement, attracting
exercise. neutrophils.
• Treatment: bisphosphonates, • Synovial tissue proliferates
calcitonin. forming a pannus.
• Findings: MCP/PIP involved;
 Paget's disease knees, ankles, hips involved;
• Elderly men. lungs, hematologic disease,
• Idiopathic. carpal tunnel syndrome,
• Osteoclastic resorption of rheumatoid nodules,
bone; shaggy-appearing vasculitis, popliteal cyst.
lesions.  Sjogren's syndrome:
• Increased alkaline
phosphatase. • Autoimmune disease;
• Thick weak bone - mosaic dominant in females.
bone. • Destruction of salivary and
• Increased osteoclastic bone lacrimal glands.
resorption causing increased • Findings: rheumatoid
bone turnover. arthritis, dry eyes, dry mouth.
• Causes may include • Labs: anti-SS-A (Ro) and
paramyxovirus infection. anti-SS-B (La) antibodies.
• Some findings include: bone • Confirm with lip biopsy.
pain and deformity, hearing  Juvenile rheumatoid arthritis:
loss.
 Osteoarthritis: •Children younger than 16.
•Still's disease: fever, rash,
• Non-inflammatory joint polyarthritis;
disease. lymphadenopathy,
• Universal after 65 years of neutrophilic leukocytosis.
age.  Gouty arthritis:
• Degeneration of articular
cartilage in weight-bearing • Multifactorial inheritance.
joints. • Due to underexcretion of uric
• Osteophyte formation. acid.
• Bone rubs on bone. • Recurrent acute arthritis:
podagra (gout in great toe;
 Findings: painful); fever, pain,
• PIP/DIP enlargement. neutrophilic leukocytosis.
 Rheumatoid arthritis: • Chronic gout: tophi cause
erosive arthritis.

NLE POINTERS
 Findings: • Thymus-synthesized auto-
• Urate neuropathy, renal antibodies against ACh
stones, hypertension, receptors.
coronary artery disease, lead
poisioning.  Findings:
• Ptosis, dysphagia, risk for
 Labs: thymoma.
• Hyperuricemia.
 Confirmation:
 Lyme disease: • Tensilon (edrophonium) test.
• B. burgdorferi.
• Ixodes tick transmission;  Potassium disorders:
white-tailed deer is reservoir. • Controlled by aldosterone
• Early: bull's eye lesion. (direct relationship), arterial
• Late: arthritis, Bell's palsy, pH (more pH, less K).
myocarditis and pericarditis; • Hypokalemia: muscle
babesiosis (secondary weakness, U waves on ECG,
infection). polyuria, rhabdomyolysis.
• Diagnosis: serologic tests, • Hyperkalemia: ventricular
biopsy, silver stains. arrhythmias, peaked T waves
 Duchenne's muscular dystrophy: on ECG, muscle weakness.
 K loss caused by:
•
Deficiency of dystrophin
gene. • Decreased intake, GI loss,
renal loss, alkalosis.
• XR disease.
• Type I and II fiber atrophy.  Acid-base disorders:
• Weakening and wasting of  Respiratory acidosis:
pelvic muscles.
• Death by age 20. •Hypoventilation and
• Labs: increased serum CO2 retention.
creatine kinase at birth; • Basic blood (increased
increased serum creatine HCO3) compensates for
kinase in female carriers. acidic lungs (decreased pH)
 Myotonic dystrophy: by causing metabolic
alkalosis. Very high pCO2.
•AD disease. • Findings: somnolence,
•Trinucleotide repeat disorder. cerebral edema.
•Findings: facial weakness,  Respiratory alkalosis:
myotonia, frontal balding,
cataracts, testicular atrophy, • Hyperventilation with
cardiac involvement. CO2 elimination.
• Increased serum creatine • Acidic blood (decreased
kinase. HCO3) compensates for basic
 Myasthenia gravis: lings (increased pH) by

NLE POINTERS
causing metabolic acidosis.  Hemolytic disease of newborn:
Very low pCO2. ABO HDN:
• Findings: light-headedness, • Mom = type O; baby = type
tetany (Ca binds to albumin, A or B.
so decreased Ca). • Jaundice develops 24 hours
 Pulmonary Embolism: after birth.
• Anemia.
• Originates in femoral vein, • + Coombs' test on baby
pelvic vein, or vena cava; blood.
occludes pulmonary artery
branches; sudden death.  Hemolytic disease of newborn: Rh
 Position to Left side lying HDN:
 Metastasis: • Mom is RH negative; baby is
Rh positive.
• Hepatic portal vein: liver.
• Mom exposed to fetal blood,
• Vena cava: lungs.
develops anti-D-IgG
 Effects of cancer: antibodies.
• Cachexia. • First pregnancy plays no role.
• Anemia. • During second pregnancy,
anti-D-IgG enters placenta
• Hemostasis abnormalities
coats baby RBCs.
like DIC, etc.
 Treatment:
• Fever.
• Paraneoplastic syndromes.
•At 28th week of pregnancy,
 Transfusion Reactions: Acute give mom anti-D globulin (it
Hemolytic Transfusion Reaction: covers and eliminates "Rh+"
baby blood before mom's
• Intravascular: ABO body officially mounts an
incompatibility; type II attack against it), which lasts
hypersensitivity. ~3 months.
• Extravascular: donor RBCs  Findings:
coated with antibodies;
jaundice.
•Jaundice, kernicterus,
 Findings: positive direct/indirect
Coombs' test.
• Fever, back pain, • Use blue fluorescent light on
hypotension, DIC, oliguria. newborn skin.
 Blood urea nitrogen (BUN):
 Hemolytic Disease of Newborn:
• End product of amino acid
• Maternal IgGs coat infant
and pyrimidine metabolism.
RBCs.
• Produced by liver.
• Increased in CHF.

NLE POINTERS
 Azothemia: • Unilateral palpable mass;
• Increased BUN and hypertension.
creatinine levels. • Metastasis to lungs.
 Prerenal:  No to palpation
 Congestive Heart Failure:
• Causes: decreased CO.
 Renal:  Left-sided HF:
• Causes: parenchymal damage • Blood cannot be ejected into

to kidneys; tubular necrosis, aorta.
renal failure. • Pulmonary edema.
 Postrenal: • Caused by concentric LVH.
• Alveolar macrophages
• Causes: urinary tract contain hemosiderin (heart
obstruction below kidneys. failure cells).
• Difficulty breathing.
 Renal function tests: • Left-sided S3 sound.
 Creatinine clearance: • Mitral-valve regurgitation.
• Paroxysmal nocturnal
•Correlates with GFR. dyspnea.
•Detects renal dysfunction.  Right-sided HF:
•Increased in pregnancy;
decreased in elderly people, • Blood cannot be pumped into
renal disease, etc. lungs.
 Nephrotic syndrome: • Prominent jugular veins.
• Right-sided S3 sound.
• Increased proteinuria. • Tricuspid valve regurgitation.
• Pitting edema, ascites. • Painful hepatomegaly.
• Hypoalbuminemia. • Pitting edema and ascites.
• Infections, eg., S.
pneumoniae.  Angina pectoris:
• Hypertension,  Stable angina:
hypercoagulability,
hypercholesterolemia, • Caused by atherosclerotic
hypogammaglobinemia, fatty coronary artery disease.
casts. • Exercise-induced chest pain.
• ST depression.
 Wilm's Tumor: • Relieved by resting or
• 2-5 years of age. nitroglycerine.
• AD disease; chromosome 11.  Prinzmetal angina:
• WAGR syndrome: Wilm's
tumor, aniridia, genital • Coronary artery vasospasm at
abnormalities, retardation. rest.
• Beckwith-Wiedemann • Vasoconstriction.
syndrome. • ST-elevation.

NLE POINTERS
•Nitroglycerine and Ca- • Increased CK-MB; peaks at
channel blocker. 24 hours.
 Unstable angina: • Troponins: cTnl and cTnT.
• LDH 1-2; "flip."
• Severe atherosclerotic • Inverted T waves.
disease. • Elevated ST segment.
• Chest pain even at rest. • New Q waves.
• May progress to MI.
• Balloon angioplasty.  Rheumatic fever:
• Stents. • Immune disease that follows
group A streptococcal
 Chronic ischemic heart disease: pharyngitis infection.
• Ischemic damage to • Pericarditis.
myocardial tissue causes • Myocarditis.
CHF. • Endocarditis.
• Findings: CHF, angina, • Sterile, verrucoid-appearing
dilated cardiomyopathy. vegetations near valve.
• Mitral and aortic valve
 Myocardial infarction:
regurgitation.
• Disruption of atheromatous • Infection.
plaque; platelet thrombus • Migratory polyarthritis.
formation.
• Sydenham's chorea.
• TXA2 plays important role in
• Antistreptolysin O (ASO)
platelet thrombus formation.
titers; throat culture;
• Causes of MI: cocaine use, leukocytosis; increased PR
vasclitis, embolization, etc. interval; CRP.
 Transmural / Q-wave:
•Involves full thickness of  Rubella (German measles):

myocardium.
• RNA togavirus.
 Findings:
• 3-day measles.
•
Sudden retrosternal pain. • Painful lymphadenopathy.
•
Not relieved by • Findings: polyarthritis in
nitroglycerine; lasts 45 adults.
minutes.  Varicella-zoster virus:
• Radiates to left arm and jaw.
• Sweating, anxiety, •DNA herpesvirus.
hypotension. •Varicella (chickenpox): rash;
 Complications: + Tzanck test; Reye
syndrome; pneumonia;
• Arrhythmias, CHF, rupture, cerebellitis.
mural thrombus, pericarditis, • Herpes zoster (shingles).
ventricular aneurysm, right  Eczema:
ventricular acute MI.
• Inflammatory dermatoses.

NLE POINTERS
• Acute: weeping, • Seen in newborns (enlarged
erythematous rash. head) and adults (dementia,
• Chronic: dry, thickened skin wide-based gait, urinary
due to scratching. incontinence).
• Atopic dermatitis: type I IgE-
mediated hypersensitivity  Cerebrovascular accidents:
reaction in children.  Atherosclerotic (thrombotic)
• Contact dermatitis: allergic; stroke:
type IV hypersensitivity
reaction. •Most common.
• Photodermatitis: UV light •Platelet thrombus develops
reaction. over disrupted plaque: MCA
or ICA near bifurcation.
• Findings: pale infarction,
 Psoriasis: swelling of brain, gliosis,
• Genetic predisposition. cystic area.
• Undifferentiated proliferation • Clinical findings: strokes.
of keratinocytes.  Meningitis:
• Association with
streptococcal pharyngitis. • Pia mater (brain cover)
• Koebner phenomenon: rash inflammation.
in areas of trauma. • Fever, nuchal rigidity,
• Plaques, pitting of nails. headache.
• Munro microabscesses:
 Labs:
neutrophils collect in stratum
corneum. • Viral: increased CSF protein;
normal CSF glucose.
• Bacterial/fungal: increased
 Hydrocephalus: CSF protein; decreased CSF
• Ventricle enlargement due to glucose.
increased CSF volume.  Encephalitis:
 Communicating/non-obstructive:
• Brain inflammation.
•Increased CSF production. • Fever, headache, altered
•Obstruction of CSF mental status.
absorption by arachnoid
granulations.  Demyelinating disorders:
 Non-communicating (obstructive):  Multiple sclerosis:
•CSF can't flow out due to • More common in females.

stricture of aqueduct of • HLA-DR2.
Sylvius, fourth ventricle • CD8 T-cell destruction of
tumor, etc. myelin and oligodendrocytes.
 Findings:

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 Findings: causing deficiency of
• Sensory and motor dopamine.
dysfunction, visual and
speech disturbances, ataxia,  Findings:
tremor, nystagmus, bilateral • Muscle rigidity,
internuclear ophthalmoplegia. resting/rolling pill tremor,
expressionless face, shuffling
 Labs: gait.
• Increased CSF leukocyte,
protein, myelin basic protein;  Treatment:
normal CSF glucose; • Dopamine replacement.
oligoclonal bands on CSF  Huntington's disease:
electrophoresis; central
pontine myelinolysis. • AD disease.
 Alzheimer's disease: • Trinucleotide repeat disorder
involving chromosome 4.
• Important role of beta- • Atrophy of striatal neurons.
amyloid (A-beta) protein
coded by chromosome 21.  Findings:
• Defective degradation of • Chorea, muscle rigidity,
APP. dementia.
• Apolipoprotein gene E on  Friedreich's ataxia:
chromosome 19.
• Defective tau protein; located • AR disease.
on chromosome 14. • Trinucleotide repeat disorder.
 Findings:  Findings:
• Cerebral atrophy, dilated • Ataxia, lack of joint
ventricles, NF tangles in sensation, peripheral
neuron cytoplasm, senile neuropathy, hypertrophic
plaques, amyloid angiopathy. cardiomyopathy.
 Lou Gehrig's disease (ALS):
 Confirmation:
• Postmortem examination of • Degeneration of UMNs and
brain. LMNs.
 Parkinsonism: • Mutated chromosome 21.
• Findings: UMN: spasticity,
• Altered dopaminergic Babinski's sign; LMN:
pathways. muscle weakness causing
• Defective control over respiratory paralysis.
voluntary muscle movement.
 CNS and alcohol abuse:
 Pathology: • Cortical and cerebellar
• Idiopathic degeneration of atrophy.
neurons in substantia nigra • Central pontine myelinolysis.

NLE POINTERS
• Wernicke-Korsakoff  Complications:
syndrome due to thiamine
deficiency. • Obstructive uropathy, bladder
• Findings: ataxia, confusion, infections, prostatic infarcts.
nystagmus, ophthalmoplegia.
• Anterograde and retrograde  Prostate cancer:
amnesia. • Most common cancer in adult
males next to lung Cancer.
• Risk: age, familial, black,
 Guillain-Barre syndrome (GBS): smoking, high saturated fats
• Autoimmune demyelination in diet.
syndrome. • DHT is mediator.
• Associated with M.  Findings:
pneumoniae pneumonia, C.
jejuni enteritis, CMV, EBV, •Obstructive uropathy, back
and HIV. pain, alkaline phosphatase is
• Weakness of ascending motor increased, spinal cord
neurons. compression.
• Findings: increased CSF  Diagnosis:
protein.
• Treatment: plasmapheresis. • Screening (DRE/PSA).
 Idiopathic Bell's palsy:  Confirmation:
• Unilateral facial paralysis due • Needle biopsy.

to LMN palsy.  Spreads to:
• Inflamed facial nerve.
• Lungs, liver.
• Associated with HIV,
sarcoidosis, Lyme disease.
• Findings: drooping corner of
mouth; can't speak; can't  Erectile dysfunction:
close eye.
• Psychogenic, decreased
• Causes: eg., vincristine,
testosterone, vascular
hydralazine.
insufficiency, neurologic
• Deficiency of vitamins: disease (defect in
thiamine, B12, pyridoxine. parasympathetic S2-S4
(erection) or sympathetic
 Benign prostatic hyperplasia: T12-L1 (ejaculation)), drugs,
endocrine disease, penis
• Digital rectal exam 50% disorders.
sensitive.
 Treatment:
• DHT is mediator.
• Estrogen is co-mediator. • Sildenafil (Viagra); Yohimbe.
 Findings:  Cervical cancer:
• Obstruction, hematuria, PSA. • Uncommon.

NLE POINTERS
• Detected early: CIN and Pap.  Findings:
• Risk: Early age for having • Dysmenorrhea, painful
sex, multiple sex partners, menses, intestinal
smoking, oral contraceptives, obstruction, ectopic
HPV, immunodeficiency. pregnancy, enlarged ovaries.
• Findings: Malodorous
discharge; postcoital  Treatment:
bleeding. • Laparoscopy.
• Distant metastasis.
• CIN I: mild.  Fallopian Tube Disorders:
• CIN II: moderate.  Pelvic Inflammatory Disease:
• CIN III: severe.
• Causes: N. gonorrhoeae or C.
 Oral contraceptive pills: trachomatis.
• Estrogen + progesterone. • Gives rise to hydrosalpinx.
• Estrogen: prevents mid-cycle • Complication: oophoritis.
estrogen surge.  Ectopic Pregnancy:
• Progesterone: inhibit LH.
• Hostility to sperm.  Causes:
• Most common cause is
 Changes during pregnancy:
scarring from previous PID;
• Increased plasma volume and endometriosis, altered tubal
RBC mass. motility, SIN.
• Respiratory alkalosis.
• Increased serum thyroxine  Findings:
and cortisol. • Pain, bleeding, adnexal mass,
 Menopause: hypovolemic shock.
• Increased FSH, LH;  Complications:
decreased estrogen and
progesterone. • Rupture, hematosalpinx.
• Secondary amenorrhea, hot  Diagnosis:
flushes, night sweats.
• Beta-hCG, ultrasound,
 Increased testosterone (ovaries) or laparoscopy.
increased DHEA-sulfate (adrenal  Placenta previa:
origin) cause:
• Implantation over cervical os;
• Hirsutism or virilization.
bleeding, painless.
 Endometriosis:
 Abruptio placentae:
• Glands and stroma located
• Premature placental
outside uterus.
separation; due to smoking,
 Locations: cocaine, hypertension,
advanced age.
• Most common is ovaries.

NLE POINTERS
 Preeclampsia/eclampsia: • BRCA1 and BRCA2.
• Toxemia of pregnancy. • Li-Fraumeni syndrome:
• Abnormal placentation. inactivated TP53 suppressor.
• Decreased natural • RAS, ERBB2, RB
vasodilators. suppressor.
• Increased vasoconstrictors. • Due to: prolonged estrogen
• Premature aging of placenta. exposure; smoking, radiation,
• Infarctions, atherosclerosis of endometrial cancer.
spiral arteries. • Painless mass.
 DOC: Mg SO4 • Skin, nipple retraction.
 Findings:  •BSE – SUPINE 7 days after
menstruation
• Hypertension, proteinuria,  Mammography: screening; cannot
edema, seizures, renal and differentiate benign from malignant.
liver disease, HELLP • Spreading: first by
syndrome. lymphatics, then
hematogenously.
 Hydatidiform moles: • Spreads to: lungs, bone, liver,
• Benign tumor of chorionic brain, ovaries.
villus. • Treatment: radical
• Neoplastic placenta. mastectomy; damage to long
• 46XX. thoracic nerve causes
• Findings: preeclampsia, large winged-scapula;
uterus, increased hCG; lumpectomy; radiation.
snowstorm appearance on
 Breast cancer in men:
ultrasound.
 DOC: Methotreaxate same with • BRCA2 mutated;
ectopic Klinefelter's syndrome.
• Poor prognosis.
 Choriocarcinoma:most dreaded
complication of h mole  Atelectasis:
 Resorption atelectasis:
• Malignant tumor made of
syncytiotrophoblast and
cytotrophoblast. •
Collapsed lung.
• Spreads to: lungs, vagina; •
Air doesn't reach alveoli.
lesions are hemorrhagic. •
Caused due to: mucus,
 Treatment: foreign material,
bronchogenic carcinoma.
 Chemotherapy. • Fever, dyspnea.
• Absent breath sounds.
• Ipsilateral elevation of
 Breast cancer: diaphragm, and tracheal
• Mean age: 64 years old. deviation.
• Family history, genetics.  Pulmonary edema:
• AD disease.
• Altered Starling pressure.

NLE POINTERS
• Increased hydrostatic; • Severe underlying disease.
decreased oncotic pressure. • Antibiotic therapy.
• Infections, drugs, aspiration, • Immunosuppression.
high-altitude.  In immunocompromised hosts:
 Acute respiratory distress
syndrome: • AIDS, bone marrow
transplants.
•
Pulmonary edema due to • CMV; P. jiroveci; A.
alveolar-capillary damage. fumigatus.
• Caused by: sepsis, gastric  Tuberculosis:
aspiration, trauma/shock,
infections, smoke, heroin. • M. tuberculosis.
• Cyokines released; leakage of • PPD test.
protein-rich exudate; • Primary and secondary
decreased surfactant. (reactivation) TB.
 Pneumonia: • Fever, night sweats, weight
loss.
 Pulmonary infections: • Miliary spread within lungs
 Community acquired pneumonia: and extrapulmonary sites.
• Granulomatous hepatitis;
•Often due to S. pneumoniae. Pott's disease (vertebra).
•Acute bronchitis; lung has  Silicosis:
areas of consolidation.
 Lobar pneumonia: • Quartz dust inhaled.
 Emphysema:
•
Complete consolidation of
lobe. • Enlargement of respiratory
• Complications: lung unit.
abscesses, empyema, sepsis. • Causes: smoking, AAT
• Findings: fever, cough, deficiency.
positive Gram stain, • Increased compliance;
leukocytosis. decreased elasticity.
 Community-acquired pneumonia: • Centriacinar emphysema:
common in smokers; upper
•M. pneumoniae. lobes.
•C. pneumoniae. • Panacinar emphysema: AAT
•C. trachomatis. deficiency; AD disease;
•RSV, influenzavirus, lower lobes.
adenovirus. • Pink puffers; dyspnea and
• Insidious onset; fever, hyperventilation.
productive cough.  Chronic bronchitis:
• Flu-like symptoms.
• No consolidation. • Productive cough for 2
 Nosocomial pneumonia: months - 3 years.
• Smoking, cystic fibrosis.

NLE POINTERS
•
Hypersecretion of mucus • Permanent dilation of bronchi
from bronchi. and bronchioles.
• Acute inflammation. • Cartilage and elastic tissue
• Dyspnea. destruction.
• Cyanosis of skin. • Causes: CF, TB, bronchial
• Blue bloaters; stocky obstruction, primary ciliary
patients. dyskinesia.
• Cor pulmonale (hypertrophy • Lower lobes.
of right ventricle due to lung • Productive cough; copious
disease). sputum.
• Respiratory acidosis.  Cystic fibrosis:
 Asthma:
• AR disease.
• Episodic and reversible • Three nucleotide deletion on
airway disease. chromosome 7.
• Defective CFTR for chloride
 Extrinsic asthma: ions.
• Type I hypersensitivity; CD4 • Increased Na/Cl in sweat,
Th2 cells; causing dehydration.
bronchoconstriction, mucus • Nasal polyps, respiratory
production, influx of infections and failure.
leukocytes. • Malabsorption.
• IL4 = isotype switching to • Type 1 diabetes mellitus.
IgE production. • Male infertility.
• IL5 = production and
activation of neutrophils.  Lung tumors:
• Histamine released. • Most common cancers:
• Late phase reaction: eotaxin adenocarcinoma; weak
produced; eosinophils cause smoking association.
airway constriction.
 Association with smoking:
• Charcot-Leyden crystals in
terminal bronchioles. • Squamous cell carcinoma;
• Expiratory wheezing, small cell lung carcinoma.
nocturnal cough, increased  Metastatic lung cancer:
anteriorposterior diameter.
• Most common.
 Intrinsic asthma: • Primary site: breast.
• Non-immune. • Secondary site: colon, renal.
• Caused by viral infections, • Dyspnea.
air-pollutants, drug- • Cough, hemoptysis, weight
sensitivity, stress, exercise, loss, chest pain.
smoking. • Pancoast tumor: Horner's
 Bronchiectasis: syndrome.
• Superior vena cava
syndrome.

NLE POINTERS
 Metastasis sites: • Sudden dyspnea, chest pain.
• Most common: hilar nodes.
 Tension pneumothorax:
• Also spreads to adrenal
glands, liver. • Ruptured tension
pneumatocysts.
 Mediastinal masses: • Trauma to lungs; knife
• Commonly: neurogenic wound.
tumors. • Increased pleural cavity
• Thymoma: located in anterior pressure; compression
mediastinum. atelectasis.
• Absent breath sounds.
 Pleural fluid: • Trachea and mediastinal
• Moves from parietal pleura to structures deviate to opposite
pleural space to lungs. side.
 Treatment:
 Plural effusion:
• Movement of fluid from •Insert needle into pleural
lymphatic vessels into cavity to relieve pressure.
pulmonary tissue.  Syndrome of Inappropriate ADH
 Causes: (SIADH):
•Increased hydrostatic • Causes: small cell carcinoma

pressure, decreased oncotic of lung, CNS injury, drugs,
pressure, lymphatic pulmonary infections.
obstruction, increased vessel • Findings: mental status
permeability, metastasis to dysfunction, hyponatremia.
pleura. • Restrict water intake.
 Transudate:
 Thyroid gland disorders:
•Ultrafiltrate; disturbed  Function tests:
Starling pressures;
protein/serum less than 0.5. •Total serum T4:
 Exudate: •Represents bound (to TBG)
and unbound serum T4.
• Protein-rich, and cell-rich • Increased TBG synthesis
fluid; pneumonia, infarction, increases T4 and vice versa.
metastasis; protein/serum  Serum TSH:
greater than 0.5.
• Best indicator of thyroid
 Spontaneous pneumothorax:
function.
• Idiopathic; hole in pleura. • Increased TSH: primary
• Pleural hole. hypothyroidism.
• Pleural cavity pressure = • Decreased TSH:
atmospheric pressure. thyrotoxicosis (Grave's
• Trachea deviates to side of disease); hypopituitarism.
pneumothorax.  I-131 uptake:

NLE POINTERS
•Indicates synthetic activity of  Findings:
thyroid. • Exophthalmos, pretibial
• Increased I-131 uptake: myxedema.
increased T4 synthesis; also,  Plummer's disease:
hot nodule / goiter.
• Decreased I-131 uptake: • Goiter.
decreased gland activity; also  Thyrotoxicosis: findings:
cold nodule / cancer.
 Thyroglobulin: • Weight loss, fine hand
tremor, heat intolerance,
• Thyroid marker. diarrhea, anxiety, lid stare,
tachycardia, atrial fibrillation,
 Hypothyroidism:
hypertension, HF.
 Lab findings:
 Causes:
• Hashimoto's thyroiditis, •Increased T4, decreased TSH.
cretinism. •Increased I-131 uptake in
Graves' disease and goiter.
 Findings:
• Decreased I-131 uptake in
• Weight gain, fatigue, cold thyroiditis and patients taking
intolerance, constipation, excess thyroid hormone.
hypertension, muscular • Hyperglycemia,
myopathy. hypocholesterolemia,
hypercalcemia,
 Lab findings:
lymphocytosis.
• Decreased T4, increased  Treatment of Graves' disease:
TSH; antimicrosomal and
antithyroglobulin antibodies, • Beta-blockers; thionamides.
hypercholesterolemia.  Nontoxic goiter:
 Treatment:
• Enlargement from excess
• Levothyroxine. colloid.
• Deficiency of thyroid
 Excess thyroid hormone:
hormone.
• Due to: thyrotoxicosis and • Hyperplasia/hypertrophy.
hyperthyroidism.
• Treatment: levothyroxine.
 Findings:  Types of goiters:
• Increased BMR.  Endemic:
 Graves' disease:
• Iodide deficiency.
• HLA-Dr3; IgG against TSH
 Sporadic:
receptor.
• Hyperthyroidism and • Goitrogens (eg., cabbage),
thyrotoxicosis. enzyme deficiency, puberty,
pregnancy.

NLE POINTERS
 Thyroid tumors: appearance of skul),
• Follicular adenoma: most hypertension.
common benign tumor.
• Papillary adenocarcinoma:  Lab:
radiation exposure; female • Increased PTH, Ca;
dominant; Orphan-Annie decreased Ph; normal anion
nuclei; spreads to cervical gap metabolic acidosis.
nodes, lungs.
• Follicular carcinoma: most  Diagnosis:
common female dominant • Technetium-99-m-sestamibi
thyroid cancer; spreads to radionuclide scan.
lungs and bone.
• Medullary carcinoma: MEN  Treatment:
IIa/IIb. • Surgically remove adenoma.
 Parathyroid gland disorders:
 Parathyroid gland disorders: secondary hyperparathyroidism:
 Hypoparathyroidism:
• Hyperplasia of all
•Hypocalcemia. parathyroid glands.
•Causes: surgery, • Decreased Ca; increased
autoimmune, DiGeorge PTH.
syndrome, hypomagnesemia.
• Findings: tetany, basal  Adrenal Gland Disorders:
ganglia calcification,  Hypofunction:
cataracts.
• Lab: hypocalcemia,  Acute adrenocortical insufficiency:
hyperphosphatemia, • Causes: Waterhouse-
decreased PTH. Friderichsen syndrome (N.
 Primary hyperparathyroidism meningitides, DIC, adrenal
(HPTH): hemorrhage).
 Chronic Addison's disease:
• Common cause of
hypercalcemia. • Autoimmune.
• MEN I/IIa association. • Tuberculosis/histoplasmosis.
• Adrenogenital symdrome.
 Causes:
• Metastasis.
• Adenoma. • Findings: weakness,
• Primary hyperplasia. hypotension,
• Carcinoma. hyperpigmentation.
 Findings:  Lab:
• Calcium stones, peptic ulcers, • ACTH test shows no increase
acute pancreatitis, in cortisol or 17-OH.
constipation, osteitis fibrosa • Metyrapone test: increased
cystica (salt and pepper ACTH only.

NLE POINTERS
•Increased plasma ACTH. receptor deficiency;
•Hyponatremia, hyperkalemia, infections; impaired glucose
metabolic acidosis. tolerance; gestational
• Fasting hypoglycemia. diabetes mellitus.
• Eosinophilia, lymphocytosis, • Younger patients.
neutropenia. • AD inheritance.
 Hyperaldosteronism: • HLA-DR3 and HLA-DR4
genetic associations.
 Primary:
 Syndrome X:
• AKA Conn's syndrome.
• Findings: Hypertension, • Insulin resistance.
muscle weakness, tetany, • Hyperinsulinemia: increased
metabolic acidosis. VLDL, hypertension,
• Labs: hypernatremia, coronary artery disease.
hypokalemia, metabolic
alkalosis, decreased plasma  Pathology:
rennin. • Poor glycemic control:
hyperglycemia.
 Secondary: • Nonenzymatic glycosylation:
• Compensatory reaction to combination of glucose with
decreased cardiac output. proteins.
• Increased plasma rennin. • Osmotic damage: damage to
• Activated rennin-angiotensin- tissue, retina, vessels.
aldosterone system. • Diabetic microangiopathy:
 Pheochromocytoma: decreased type IV collagen
synthesis.
• Unilateral, benign adenoma.
 Findings:
• N-methyltransferase converts
NOR to EPI. • Hypoglycemia.
• Characteristics: brown, • Diabetic ketoacidosis.
hemorrhagic, necrotic. • Hypertriglyceridemia.
• Findings: hypertension, • Muscle wasting.
palpitations, anxiety, sweats, • Labs: hyperglycemia,
headache, chest pain. hyponaremia, hyperkalemia,
• Labs: increased urine VMA increased anion gap
and metanephrine, metabolic acidosis, prerenal
hyperglycemia, neutrophilic azotemia.
leukocytosis.
 Gestational diabetes:
• Diabetes of pregnancy due to
 Diabetes mellitus: anti-insulin effect of human
placental lactogen and
 Causes: increased placental size.
• Pancreatic, endocrine, or
genetic disease; insulin-

NLE POINTERS
• Risk to newborns:  Preeclampsia:
macrosomia, RDS, neural • Hypertension, proteinuria,
tube defects, hypoglycemia. pitting edema during 3rd
trimester of pregnancy.
 Hypoglycemia:
• HELLP syndrome; hemolytic
 Reactive type: anemia, elevated
transanimases, low platelets.
 Causes:
• Insulin treatment for type 1  Fulminant hepatic failure:
diabetes.  Causes:
• IGT or type 2 diabetes.
• Idiopathic postprandial • Viral, drugs, Reye syndrome.
syndrome.  Findings:
 Findings: • Encephalopathy.
• Sweating, trembling, anxiety. • Decreased transaminases;
 Fasting type: increased PT and ammonia.
 Prehepatic obstruction of blood
 Causes:
flow:
• Alcohol, renal failure,
malnutrition, liver disease, • Blood doesn't flow to liver.
insulinoma, hypopituitarism, • Hepatic artery thrombosis;
ketotic hypoglycemia in transplant rejection;
childhood. vasculitis.
• Portal vein thrombosis;
 Findings: pylephlebitis, polycythemia
• Dizziness, confusion, vera, carcinoma.
headache, lack of  Intrahepatic obstruction of blood
concentration, motor
flow:
disturbances, seizures, coma.
• No sinusoidal blood flow;
 Reye syndrome: cirrhosis.
• Children younger than 4 • Centrilobular hemorrhagic
years. necrosis; LHF, RHF.
• Follows chickenpox or • Nutmeg liver.
influenza infection. • Pain, increased
• Mitochondrial damage. transaminases.
• Encephalopathy
 Liver cirrhosis:
hepatomegaly.
• Transaminasemia, increased • Liver fibrosis + formation of
bilirubin and ammonia. regenerative nodules.
• Compressed hepatic arteries
and veins.
 Causes:

NLE POINTERS
• Alcohol, viral, autoimmune, • Hepatitis.
metabolic disease.
 Laboratory confirmation of
 Complications: cirrhosis:
 Hepatic failure: • Increased BUN,
hypoglycemia, respiratory
• Hypoalbuminemia, hepatic alkalosis, lactic acidosis,
encephalopathy, portal increased PT, hypocalcemia.
hypertension, ascites,
hepatorenal syndrome,  Liver tumors: Benign:
hyperestrinism in males.  Cavernous hemangioma:
 Primary biliary cirrhosis: • Most common.
• Autoimmune disorder.  Liver cell adenoma:
• Destruction of bile ducts and
portal triads. • Women of child-bearing age.
• Pruritis, hepatomegaly,
jaundice.  Liver tumors: Malignant:
• Antimicrobial antibodies, • Metastasis: most common
increased IgM. cancer.
 Heptocellular carcinoma:
 Hereditary hemochromatosis:
• AR disease. • Most common.
• Unrestricted reabsorption of • HBV, HCV.
iron in SI. • Focal, muitifocal, infiltrating
• Iron deposits in organs. cancer.
• Bronze diabetes. • Portal and hepatic vein
• Type I diabetes mellitus. invasion.
• Malabsorption. • Fever, enlargement of liver,
• Cardiomyopathy, joint ascites.
degeneration. • Increased AFP; ectopic
• Increased iron, ferritin, TIBC. production of erythropoietin
and insulin-like factor.
 Wilson's disease: • Spreads to lungs.
• AR disorder.  Gallstones (cholelithiasis):
• Decreased ceruplasmin
synthesis. •Most are cholesterol stones.
• Increased serum copper; •Supersaturation of bile with
increased copper in urine. cholesterol.
• Kayser-Fleischer ring. • Female, fat, forties; oral
contraceptives, rapid weight
 Alpha-antitrypsin deficiency: loss.
• AD disease.  Acute pancreatitis:
• Accumulation of Alpha-
antitrypsin in hepatocytes • Alcohol, gallstones.
causing liver damage.

NLE POINTERS
•Activated pancreatic • Pitting edema; ascites.
proenzymes. • Fatty liver.
• Trypsin plays a role in • Diarrhea.
activating enzymes. • Anemia; deficient immunity.
• Fever, nausea, vomiting,
midepigastric pain radiating  Marasmus:
to back, shock, hypoxemia, • Inadequate intake of protein
Grey-Turner's sign (flank and other food.
hemorrhage), Cullen's sign • Muscle wasting.
(periumbilical hemorrhage), • Growth retardation; anemia;
tetany. deficient immunity.
• Increased pancreatic amylase,
lipase; neutrophilic  Anorexia nervosa:
leukocytosis, hypocalcemia, • Self-induced starvation.
hyperglycemia. • Distorted body-image.
• Complications: pancreatic • Amenorrhea; osteoporosis;
pseudocyst, ARDS, lanugo; increased stress
pancreatic abscess, DIC. hormones (cortisol, GH, etc.).
 Chronic pancreatitis:
 Bulimia nervosa:
•Idiopathic. • Binging with self-induced
•Alcohol, Cystic Fibrosis, vomiting.
malnutrition.
 Obesity:
• Repeated attacks of acute
pancreatitis, calcification of • BMI over 30 kg/m2.
ducts. • Excess fat on waist is more
• Pain, malabsorption, type 1 harmful.
diabetes mellitus, pancreatic • Genetic predisposition: 50-
pseudocyst. 80%.
• Increased lipase, amylase. • Defective leptin gene;
 Exocrine pancreatic cancer: syndrome X.
 Obesity causes:
• Smoking, pancreatiris.
• Activated K-RAS gene; • Depression, cancer, diabetes
mutant TP16 and TP53 mellitus 2, hypertension,
genes. obstructive sleep apnea, and
• Jaundice, epigastric pain, more.
weight loss, light-colored  Transplantation immunology:
stools.
• ABO blood group
• Increased CA19-9.
compatibility.
• Poor prognosis.
• Best chance of success with
 Kwashiorkor: matching HLA-A,-B,-D loci.
• Inadequate protein intake.  Rejection reactions:
• Too much carbohydrate  Hyperacute:
intake.

NLE POINTERS
• Recipient ABO • IgG anti-SS-A (Ro)
incompatibility or preformed antibodies cross placenta and
anti-HLA antibodies react cause neonatal heart block.
against donor.  Drug-induced SLE:
• Type II hypersensitivity
reaction. • Procainamide, and
• Eg., blood group A person hydrazaline.
receives blood group B heart. • Findings: Anti-histone
 Acute: antibodies; low CNS and
renal involvement.
• Type IV: CD4 T cells activate  Lab findings in SLE:
macrophages; CD8
proliferation; donor-graft • ANA in almost all cases.
destruction. • Anti-dsDNA antibodies and
• antibody-mediated type II anti-Sm antibodies: very
hypersensitivity reaction: specific.
CD4 T cells activate B-cells. • Anti-Ro antibodies.
• Anti-phospholipid antibodies:
 Treatment: vessel damage and
• Immunosupressive agents; thrombosis.
risk for cervical squamous • Anti-cardiolipin antibodies:
cell cancer, malignant may generate false-positive
lymphoma, squamous cell syphilis test.
carcinoma of skin.  Systemic sclerosis (scleroderma):
 Chronic:
• Small vessel endothelial
• Irreversible reaction that damage; ischemic injury.
occurs over months to years. • Excess cytokines cause
 Graft-vs-host reaction: excess collagen synthesis.
• Raynaud's phenomenon.
• Donor T cells activate host • Tightened facial features;
CD4/8 T cells. also affects GI, lungs,
• Bile duct necrosis, jaundice, kidneys.
diarrhea, dermatitis. • Calcification of subcutaneous
tissue, dysphagia, esophageal
 Systemic lupus erythematous
reflux.
(SLE): • Lungs, kidneys also affected.
• Child-bearing age. • Serum ANA +.
• B-cell activation after • Anti-topoisomerase antibody.
exposure to certain triggers • Anti-centromere antibodies.
(eg., procainamide). • CREST syndrome.
• Affects: blood, lymph nodes,
joints, skin, heart, lungs, and  AIDS:
kidneys. • RNA retrovirus.
• HIV 1: US.

NLE POINTERS
• HIV 2: developing countries.  Products of alcohol metabolism:
• HIV envelope protein gp120
attaches to CD4 T-cell. • Reduced NADH.
• Infects all APCs.
• Macrophages and dendritic • Acetyl CoA.
cells are reservoirs for the
virus. • Alcohol induction of
 Tests: cytochrome P-450 increases
alcohol metabolism,
•ELISA (screening), Western increasing tolerance.
blot (confirmatory test), p24
antigen (indicates active viral • Females have less gastric
replication). alcohol dehydrogenase.
 Phases:
 Lab findings in alcohol abuse:
• Acute, latent, early
symptomatic. • Fasting hypoglycemia:
• CD4 T-cell count less than pyruvate, which is a substrate
200 cells/mL. for gluconeogenesis, is
• Most common infection: converted to lactate.
cryptococcosis.
• Increased anion gap
 Leading causes of disease: metabolic acidosis.
• Alcohol and tobacco.
• Other findings:
 Tobacco use causes: Hyperuricemia,
• CV disease, lung cancer, hypertriglyceridemia, AST
stroke. greater than ALT, increased
GGT.
• Nicotine is the most addictive
substance in tobacco.  Other drugs:
 Cocaine:
• This also includes chewing
tobacco and second-hand • Stimulant; mydriasis,
(passive) smoke. tachycardia, hypertension,
AMI, CNS infarction.
 Alcohol use:
• Stomach absorption.  Heroin:
• Metabolism in liver and • Opiate; miotic pupils,

stomach. frothing at mouth, nephrotic
syndrome.
• Alcohol dehydrogenase is the
rate-limiting metabolism  Marijuana:
enzyme.

NLE POINTERS
• Stimulant; red conjunctiva, cholestasis with jaundice,
euphoria, delayed reaction cholesterol gallstones.
time.
 Burns
 Complications of IV drug abuse:
• Hepatitis B, HIV, tetanus,  RACEEE and PASS
infective endocarditis.  R - RESCUE /REMOVE anyone in
immediate danger
 Overall effects of drugs: A - Activate the Manual Fire
• Cerebral atrophy; damaged ALARM
neurotransmitter sites. C - CONFINE the fire (close the
door)
 Adverse effects of certain E - EXTINGUISH small controllable
medications: fires/or
 Acetaminophen: E- EXIT
E-EVACUATE
• Damage to liver and kidneys; 
production of free radicals. P - PULL the pin
A - AIM the nozzle at the base of the
 Aspirin (also known as fire
acetylsalicylic acid or salicylate) S - SQUEEZE handle
overdose: S – SWEEP from side to side
 **** IMPORTANT NOTES:
• Tinnitus, vertigo, altered R - Rescue
mental status, tachypnea, Move patients and assist visitors or
respiratory alkalosis, impaired employees away from
metabolic acidosis with immediate danger of fire or smoke IF
increased anion gap, YOU CAN DO THIS WITHOUT
hyperthermia, hemorrhagic PUTTING YOURSELF IN
gastritis, fulminant hepatitis. IMMEDIATE DANGER and IF
THERE ARE OTHER STAFF
 Exogenous use of estrogen without AVAILABLE TO COMMUNICATE
progesterone: THE EMERGENCY AND TURN IN
• Cancer, venous THE ALARM.
thromboembolism,  A - Alert others
intrahepatic cholestasis with Activate manual pull station alarm as
jaundice, myocardial soon as possible. Call #6688 and
infarction, stroke. state the location, type of fire and
size. Notify co-workers - and make
 Use of oral contraceptives: sure everybody in the area, and in
• Cancer, venous other departments in your area, know
thromboembolism, folate as well.
deficiency, hypertension,
 C - Confine
hepatic adenoma, intrahepatic
Close all doors and windows. Pack
sheets and towels under doors to

NLE POINTERS
contain smoke.  NEVER open a door if it is hot to
If there is oxygen in the area: the touch.
Oxygen to a patient can be shut off
by a nurse at the bedside after other  Familiarize yourself with the
staff have the patient and are institution's policy.
ventilating them.
Oxygen to a zone (a whole unit) can  Some may use additional processes
ONLY be shut off by Maintenance including, but not limited to: (1)
and Engineering after nursing staff placing a pillow on the floor outside
authorize it (patients on oxygen are the door to signify the room is
cared for). empty;
Oxygen to the building is only shut
off after the Fire Marshal orders it  (2) placing a wet towel along the
and after nursing staff authorize it bottom of the closed door to prevent
(patients on oxygen are cared for). smoke from escaping, if the fire
 E - Extinguish started in this room; or
Select the appropriate fire
extinguisher. Use the P-A-S-S  (3) placing a towel on the door
technique to extinguisher the fire. handle to a room where a non-
(see below for P-A-S-S technique) ambulatory patient remains (not
evacuated).
 E - Find the EXIT then Evacuate
 "R"- RESCUE/REMOVE:  Evacuation
 *Rescuing patients is every  **Horizontal evacuation, which is

healthcare worker's primary the type of evacuation used first,
concern and is usually performed consists of moving patients down the
simultaneously with activating the corridor, through at least one set of
alarm fire doors to safe area.
• Rescue/remove critically ill  **Vertical evacuation consists of

patients in their beds. moving patients down the stairs to a
lower level of safety and ultimately
• Ambulatory patients may out of the building.
walk to safety on their own
with supervision. • • NEVER use elevators to
Rescue/remove semi- evacuate a fire area.
ambulatory patients first,
then non-ambulatory • Evacuate ambulatory patients
patients. before non-ambulatory
patients.
 NEVER attempt to enter a room
where a fire is contained without • Move patient charts with
FIRST checking to see if the door patients. ALL healthcare
is warm or hot to the touch. workers must know primary

NLE POINTERS
and secondary safe areas and doors and windows can prevent the
route of evacuation. smoke from spreading, cut off the
flow of oxygen to the fire and save
 "A"- Alarm: Should you see smoke lives. Confine the fire as long as no
or flames, use the fire emergency one is in danger. Never open a door
call box or pull station. Dial the if it is hot to the touch. Keep fire
institution's emergency number and doors closed and automatically
give the page operator your name, closing fire doors, corridors and
the phone number you are calling stairwells free of obstructions.
from, exact location (building, floor
and room or office number), and  "E"- Extinguish: Handheld fire
state what you are reporting (sight or extinguishers (of the appropriate
smell of smoke, or sight of fire and classification for the type of hazard
location). likely to occur in the area) are
located throughout the Institution.
 ***If you discover smoke or flames
in an occupied patient room, call out  **The most commonly used fire
to a co-worker to call the emergency extinguisher is the ABC type and it
number and activate the fire call can be used for most types of fires. If
box/pull station while you rescue the a specialty extinguisher is required in
patient. a particular area, you will be oriented
to its use.
 Whenever you hear a fire alert, listen
for the building location of the fire  Never use water on grease or
emergency. electrical fires.
• Do not use elevators. Only  **You should attempt to extinguish

use the stairs. only small, contained fires (no larger
than a waste basket), where your
• Close all doors. Reassure all safety is assured, you have an escape
patients, and visitors. route behind you, and a staff member
or other healthcare worker is
 If you need to re-open a door, make available to assist.
sure it is closes and latches securely
behind you.  The rescuing of those in immediate
danger,.sounding the alarm, and
• Listen for the all-clear code. confining fire and smoke should be
You may then resume your accomplished by other staff members
normal activity. Once the fire or healthcare workers. Even if you
emergency has been cleared extinguish the fire, the fire should
you will be notified. still be reported by. All fire
extinguishers operate in the same
 "C"- Confine/Contain: Fire, smoke way-
and toxic combustion products must
be confined to the area where the fire  "P.A.S.S." (Pull, Aim, Squeeze and
started as much as possible. Closing Sweep).

NLE POINTERS
 "P"- Pull: Pull the pin from the fire  Second-degree:
extinguisher handle at the top of the
fire extinguisher. (Remember not to • Blister formation; usually
squeeze handles when removing the heal without scarring.
pin.)
 Third-degree:
 "A"- Aim: Take 3 steps back and
then aim the horn or hose at the base • Painless; full thickness burns.
of the fire, not at the smoke or
flames. You want to be about 8 to 10 • Scarring is inevitable.
feet away from the fire.
• Keloids and potential for
 "S"- Squeeze: Squeeze the top developing squamous cell
handle to the bottom handle to carcinoma.
discharge the extinguishing agent.
"S"- Sweep: Sweep the nozzle from  P. aeruginosa
side to side across base of the fire.
• Infection is common in burn
 *log roll yourself when you are in victims.
fire
 .
 The principles of STOP, DROP, and
ROLL are simple  Ionizing radiation injury:
• Most sensitive tissues:
 Stop, do not run, if your clothes lymphoid, bone marrow,
catch on fire. mucosa of GI tract; germinal
Drop to the floor in a prone position. tissue.
Cover your face with your hands to
protect it from the flames.  Iron-overload disorders:
Roll over and over to smother the • Hemochromatosis and
hemosiderosis.
fire. Don't stop until the flames
 Give desferal or deferoxamine.
have been extinguished.
 Acute leukemia:
 If you are near someone whose
• Fever, bleeding, fatigue.
clothing catches on fire, be sure to • Bone pain, tenderness.
stop • Anemia, thrombocytopenia.
them from running and make them • Metastatic disease: liver,
STOP, DROP, and ROLL. CNS, lymph nodes, skin.
 Chronic leukemia:
• Insidious onset.
 First-degree: • Involved: liver, lymph nodes.
• Eg., sunburn; heal without • Thrombocytopenia, anemia.
scarring.  Chronic lymphocytic leukemia:

NLE POINTERS
• Over 60 years of age.  Preparedness Disaster &
• "Smudge cells." Management
• Most common leukemia.
• Lymphadenopathy.  Onco-
• Immune hemolytic anemia.
• Neutropenia.  Triage
 Prof Adjustment
 Hodgkin's Lymphoma:  LMR

• EBV association. Leadership Style
• Reed-Sternberg cells;
Research
CD15/CD30 positive; two
mirror image nuclei. Assisting patient in commode
• Reactive cells: eosinophils,  Assisting client under maintatinance
plasma cells, drug for hypertension
• Fever, weight loss, night  S/E of antihypertension
sweats.  Lead Poisoning
• Anemia.  Ampule dosage computation
 IV – priming
• Painless enlargement of
 IVF types
single group of lymph nodes;  Blood expanders – PLRS , crystalloids
cervical, supraclavicular,  Normal assessment of newborn
anterior mediastinal  Delegations
 Autonomy
– INTEGRATED POINTERS  Beneficence
 Misfeasance
 Heat exhaustion and stroke  Malpractice & negligence
 Bed Making
 Massage purposes
 Code of ethics
 LGU – Devolution code – RA 7160-
 DRUG COMPUTATION
Local Government Code  BT
 blood products computation,
 Leptospirosis
 Sputum culture
 Immunization  CVA,
 M.I
 3 vaccine with 3 doses – Dpt , OPV,  CARE WITH THE ELDERLY WITH
Hep. B INCONTINENCE
 CATHERIZATION
 Needs dilluent – bcg and AMV or  DROPLET PRECAUTION
measles  HIV/AIDS
 COLOSTOMY CARE
 6 weeks baby must receive – Penta 1,  RESEARCH
PCV1,OPV1  TRACHEOSTOMY CARE
 NUTRITION -GAVAGE FEEDING
 Therapeutic communications BURNS

NLE POINTERS
 TBSA  AAA - Aneurysm
 IMCI  ANGINA –
 PCA  DM - INSULINS –
 APPLIED RESEARCH  SLE
 DABDA PROCESS  *POSITIONING in bleeding
 NANDA -madami din  Positioning Post op – cataract, and
 POSITIONING THORACENTESIS
mastectomy
 BLOOD PRODUCTS
 *ASPIRIN
 INFECTION CONTROL
 LUNG CANCER
 SHOCK MANAGEMENT
 SMOKING  BRACHYTHERAPY
 AML & ALL  CHEMO AND RADIATION
 THEORISTS  PERIOPERATIVE
 FAMILY PLANNING PROCEDURES AND
 PHARMACOLOGY –
 Z TRACK IRON – 10 mins hold PRINCIPLE
 Leopolds  BUCKS & BRYANTS
 Menstrual cycle phases and hormones  SKELETAL TRACTIONS
 IUD & Hmole  Depression
 •vaccine--is damage by heat –  SLE
 COPD – bronchitis
measles – brown vial
 •pillars of PHC
 Partograph  Therapeutic communications
 NORMAL ASSESSMENT OF  marijuana - -cannabis sativa
 CONFLICT management ,
NEWBORN  PTSD –
 TYPES OF BREASTMILK - colostrum  BULIMIA –
 PID-Pelvic inflammatory disease signs  Suicide precation
and symptoms and predisposing factors  ALZHEIMER'S –
 PARKINSON'S –
(Gonorrhea &clamydia)  ANTI DEPRESSANTS –
 Trichomoniasis  SEIZURE –
 Candidiasis/moniliasis  neurotransmitter –
 HPV - Condylomata  Mydriatics and miotics
 30cm fundic height = 35 weeks AOG  Atropine
 ZIKA
 CLIENTS WITH DYSPHAGIA  EBOLA and MERS and ZIKA,

 Reynauds , Measles, Cholera
 thromboangitis,
 thyroidectomy,  Blood Transfusion
 Chest physiotherapy
 Hyperkalemia
Newborn Assessment
 Heparin Copar
 GCS BMI computations
 Cushings syndrome, Burns -Rule of 9
 periop.onco –
 CHRONS –
DM, IIP, PTB, HPN,Arthritis,
 M.I – Asthma,Pneumonia

NLE POINTERS
Eye Ear Procedures  Emphysema
InSomnia
Phobia  Grieving process – DABDA
Assault and Battery  Parathyroidism
Beneficence,
Addiction slogan- “Jail the pusher  Hyperthyroidism
save the user “
 Sub Q is it 25-27
Nsg Delegation
Nsg process  Cotton balls in thermometer cleaning
Maslow of hierarchy
Peer problems  Herbal meds – niyog niyogan –
Erick Erickson Theory antihelmithic
 Emphysema
Crude Birth Rate
 Respiratory depression signs and
symptoms
BEMONC
 Positioning of client in bed
 Unang Yakap
 Condom counseling
 ImCI
 HIV
 IV computation
 defamation
 Autonomy
 DM
 Veracity
 IIP
 Code of ethics
 PTB
 Pacemaker
 HPN
 Abdominal aortic aneurism
 Arthritis
 Penylketonuria
 Asthma
 Ebola
 Pneumonia
 Perioperative nursing Eye
 Charting of drug administration  Ear Procedures
 Malnutrition signs and symptoms  InSomnia – provide milk
 Log rolling patient and its procedure  Phobia.

NLE POINTERS
 Abnormal blood bleeding  Advantage over Foley Catheter
endometrial cancer
 source of Mers Cov Camel
 Oxytocin hormones influences milk
let down reflex  1st vaccine given at birth – Bcg
 Libel  Pink eye disease - Viral

conjunctivitis
 Apnea – respiratory arrest
 Who owns patient chart’? Answer:
 Iron hospital.
 oxytocin emergency drug for  Stages of COPAR.

postpartum bleeding
 Stages of Conflict Management
 position of patient for bedpan
 Rheumatic Fever infected mother –
 postpartum mother position for delivery in semifowlers or sitting
bleeding position
 AIDS support group
 diagnosed with Diabetes - above 5.5  Arterial Blood Gases. Metabolic

mmol/mol Acidosis & Alkalosis. Compensated
VS uncompensated.
 Normal: Below 42 mmol/mo
 Amphetamine/Cocaine overdose
 Obese- Endomorph body
 Seeing things Illusion falsely
 For ID injection: needle size is ¼
-1/2 inch26-27 gauge  Hearing sounds - hallucination
 Crede’s Prophylaxis – prevents  A teenage girl was raped. But she

Gonorrhea and Chlamydia to baby wants to keep it from her parents. –
disclosed the information or divulge
 little boy brought to health center. He and tell to the parents
has a lot of anting-antings -Welcome
the mom & child to health center  Affordable Rich in calcium –
Anchovies
 Generic Name of Dilantin? Answer:
Phenytoin  ADPIE process
 Snake Bite First Aid: Check the  Tracheostomy care!

wound
 charting,
 Condom catheter How to apply it:
spirally around the shaft of penis  SOAPIE.

NLE POINTERS
 Charting by exception, incident
report
 Heart. Hyperkalemia
 kidney failure – acid base imbalance
 Measles – SQ route (40-50 angle

degree)
 ECTOPIC – palpable adnexal mas
 H- mole – palpable mass are broad

and round
 PRC - The office who has the

custody of records of administrative
cases and investigations
 Note: that PRC fix the time and
place of examination
 Note: DECS or CHED has the power
to close Nursing schools
 Ratings - General average of at least

75%; With a rating of not below 60%
in any subject
 BON powers- to issue and, after due

investigation, suspend or revoke
certificates of registration
 replaces lost certificates of

registration - CBQ

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 The Philippine Health Agenda 1. Continue and maintain current

Road to Success by: JONAS MARVIN ANAQUE

RABIES PREVENTION AND  Say "No" or "Go Home" in a firm,

What Breeds Have the Strongest Bite?

Road to Success by: JONAS MARVIN ANAQUE

Categories of contact with suspect Post-exposure

Road to Success by: JONAS MARVIN ANAQUE

Treatment Regimen Diagnosis

RIG RIG should not be administered. Principles of Primary Health Care

1. 5 A's = Accessibility, Availability,

Road to Success by: JONAS MARVIN ANAQUE

 Process of generating and sustaining the ORAL HEALTH

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

 B anthracis was used successfully as a

 incubation period is 3–7 days (range

Road to Success by: JONAS MARVIN ANAQUE

 Low self-esteem  Ecstasy is also known as

 MDMA's effects last about 3 to 6

Road to Success by: JONAS MARVIN ANAQUE

and depression.  REVERSE TRIAGE is system of

Road to Success by: JONAS MARVIN ANAQUE

 Burns: Emergent Phase  Remove gloves, wash your

Road to Success by: JONAS MARVIN ANAQUE

 Pure-tone audiometry is a behavioral  adult, the most commonly used

 The most common cause of corneal  Preparation

 Colonoscopy is the "screening" for  Pancolitis refers to inflammation of

 Dyspnea and sharp, stabbing pain

Road to Success by: JONAS MARVIN ANAQUE

• Incomplete relaxation of •Alternating bouts of diarrhea

 Causes:  Barrett's esophagus:

Road to Success by: JONAS MARVIN ANAQUE

 A person who has been raped has

 Stigma can lead to discrimination.  STEP 3 – Taking the history

 STEP 4 – Collecting forensic evidence

Road to Success by: JONAS MARVIN ANAQUE

 STEP 8 – Follow-up care of the survivor

 Anger is a powerful force that  TECHNIQUES OF CRISIS INTERVENTION

Road to Success by: JONAS MARVIN ANAQUE

 Role of the Nurse in

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

• Irritable Bowel Syndrome is  Effects / symptoms of a peptic ulcer

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

• Causes: parenchymal damage • Blood cannot be ejected into

Road to Success by: JONAS MARVIN ANAQUE

•Involves full thickness of  Rubella (German measles):

Road to Success by: JONAS MARVIN ANAQUE

•CSF can't flow out due to • More common in females.

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

• Unilateral facial paralysis due • Needle biopsy.

Road to Success by: JONAS MARVIN ANAQUE