period of time (influenza, cholera,

plague, CoViD)
INFECTIOUS DISEASE
D. Epidemics vary in the rapidity of the spread.
CD Day 1 by Dr. Ferriol
a. Waterborne diseases such as
Transcribed by: Suataron, Selwyn C.
cholera, and hepatitis may cause
explosive outbreaks while diseases
I. Concepts of Infectious Diseases that spread by person-to-person
A. Localized Infections contact evolve more slowly.
a. These may be superficial or
deep-seated. Affects only certain III. Timeframe of Disease Process
parts of the body. A. Incubation period
B. Focalized Infections a. The organism comes to the host. It
a. More specific than localized tries to grow in the host before it
infections. starts showing up signs and
b. An infection in the face (Localized symptoms. This is the basis for
Infection), specifically in the nose having quarantine. The person
(Focalized Infection). should be quarantined based on the
C. Bacteremia incubation period of the suspected
a. The circulation of bacteria in the disease.
bloodstream (localized or focalized B. Prodromal period
like pimples). a. Initial signs and symptoms start
D. Septicemia showing up in this period. Mild and
a. A generalized bacteremia where generalized symptoms appear.
bacteria circulate and multiply in the C. Invasive stage
blood, form toxic products, and a. The maximum impact of the disease.
cause a swinging type of fever (may The hallmark signs and specific
reveal increased segmenters on symptoms of the disease can now
CBC and typically results in fever). be observed.
E. Viremia D. Decline stage
a. The circulation of the virus in the a. Subsiding or weaning off of signs
bloodstream. and symptoms.
F. Pyemia E. Convalescence (aka Resolution)
a. a condition in which pyogenic a. The patient no longer exhibits any
bacteria (bacteria that causes pus) signs and symptoms where the
produces septicemia with multiple return of normal functioning is
abscesses in the internal organs achieved.
such as the spleen, liver, and
kidneys. IV. Isolation Vs. Quarantine
A. Isolation
II. Classification of Diseases According to the a. separation of persons with CD from
Spread of Infection other persons (a patient with
A. Endemic Diseases communicable diseases is admitted
a. The ones that are constantly present in the Isolation Ward, separated from
in a particular area. Malaria is other patients with
endemic in most parts of Palawan. non-communicable diseases in the
B. Epidemic Diseases wards) to prevent either direct or
a. The ones that spread rapidly, indirect transmission of the disease
involving many persons in an area at B. Quarantine
the same time. Influenza causes a. limitation of the freedom of
annual winter epidemics in cold movement equivalent to the longest
countries. incubation period of that disease
C. Pandemic Diseases (14-day quarantine is required for
a. The ones that have spread from those who are exposed to COVID
country to country. It is an epidemic since the incubation period of
that spreads through many areas of COVID is 14 days).
the world involving very large
numbers of persons within a short V. Chain of Infection
 A. Etiologic/Infectious Agent a. Protection against antigens or
a. Bacteria, fungi, viruses, parasites diseases by a system of antibody
B. Reservoir (source) production.
a. human beings, animals, inanimate b. 1st Line of Defense - Skin and
objects, plants, and general Secretions
environments such as air, water, and c. 2nd Line of Defense - Cardinal Signs
soil. of Inflammation and Blood Elements
C. Portal of Exit such as WBC, platelets, etc.
a. Sputum, emesis, stool, blood d. 3rd Line of Defense - Immune
D. Modes of Transmission System
a. Contact, vehicle, airborne, e. Antibody - Produced by lymphocytes
vector-borne in response to antigen
b. Breaking the chain is a must to stop f. Antigen - Triggering agent of the
the spread of the disease, especially immune system
the mode of transmission. g. Vaccines contain antigen that is
E. Portal of Entry introduced to our body so that our
a. mucous membrane, non-intact skin, immune system makes its own
GI tract, GU tract, respiratory tract antibodies
F. Susceptible Host D. Immunoglobulins
a. Immunosuppressed children, elderly, a. IgG - The most prevalent antibody
chronically ill, and those with trauma 80% and is produced later in the
or surgery. immune response. The only Ig that
can cross the placenta (a mother
VI. Infection that had measles may pass the
A. A condition caused by the entry and immunization to her child that would
multiplication of pathogenic microorganisms last for 9 months: the reason why we
within the host body. give MMR vaccine on the 9th month
B. Factors Affecting Risk of Infection of the baby is to help the baby
a. Age (infants, elderly) produce its own antibodies)
b. Heredity (some diseases run in the b. IgA - Found in colostrum, tears,
family) saliva, and sweat. Secretory
c. Level of Stress immunoglobulin.
d. Nutritional Status (inadequate diet is c. IgM - Principal antibody of blood.
more prone) Quickly produced in response to an
e. Current Medical Therapy antigen. Responds to artificial
f. Pre-Existing Disease immunization (the one that’s being
g. Immunization Status (some vaccines tested like in the COVID antigen
only prevent you from acquiring the test)
disease, and some only lessen the d. IgE - Allergic reaction
severity of the disease) e. IgD - Unknown specific function.
Antigen receptor. Found in the
VII. Immunity surface of B cells.
A. The quality of being insusceptible to or
Immunoglobulins
unaffected by a particular disease.
B. Types of Immunity IgG Galing sa Ina
a. Innate - within the Host Immune
System (mother to infant, frequent IgA Ang baho ng secretions (saliva, sweat,
tears, colostrum)
exposure lets you build your own
immune system) IgM Madugo/Makikita sa blood
b. Acquired - inoculation and disease
(vaccines, having the disease will let IgE Ehem, Hatching: Allergies
you make certain antibodies)
IgD Di pa alam
c. Both innate and acquired immunity
have active and passive types of Remember GAMED - G na G kung lumaban
immunity f. Positive IgM means that the person
C. Immune system currently has the infection.
 g. Positive IgG means that the person IX. Active Immunity
has had the infection. A. Antibodies are produced by the body in
response to infection.
(+) IgM Meron ngayon
B. When we have a disease, our body makes
(+) IgG Galing sa sakit / Gumaling na antibodies simultaneously: the same reason
why there are certain diseases that can only
E. Immunization infect us once in our lifetime (eg. measles).
a. A process by which resistance to an C. Antigen is introduced, long duration.
infectious disease is induced or a. Natural Active - Disease
augmented. b. Artificial Active - Vaccines (eg.
b. Active and Passive immunization tetanus toxoid, DPT, CoViD
Vaccine)(multiple doses give
VIII. Expanded Program on Immunization protection after some time but
A. BCG provides longer immunity)
a. The baby should not have a fever D. Artificial Active
post-vaccine. a. Antigens (Vaccines or Toxoid) - are
b. Don’t pat dry the injection site. administered to stimulate antibody
c. It should form a weal. production. Reinforced by booster
d. If the infant developed a wound or dose to increase immunity.
swollen lymph nodes at the site of b. Killed Vaccines - Pertussis vaccine,
injection, this indicates that the infant typhoid vaccine
has been exposed to tuberculosis c. Live Vaccines - Attenuated,
prior to the vaccination. weakened (eg. OPV, sabin,
B. DPT measles)
a. The baby may develop pain at the d. Toxoid - Inactivated bacterial toxin
site. (eg. tetanus, diphtheria)
b. Cold compress and give E. DPT Nrs Mngmt
paracetamol round the clock (q4h for a. Assess if the baby develops
the first 24 hours). convulsion after the first dose of
C. Measles DPT - the baby may have had a
a. May be given as early as 6 months if reaction to the pertussis vaccine. If
there’s an epidemic. so, the succeeding doses of DPT will
b. Inform the mother that the baby be changed to DPAT: an acellular
could develop rashes and fever 5 type of pertussis.
days after. b. DPT booster may be given at 6
c. Advise the mother not to let the baby years of age. Failure to have booster
eat egg whites to distinguish if the shots of DPT after the age of 6, the
rashes are from the vaccine or not. booster shots to be given should
then be diphtheria and tetanus:
pertussis is no longer prevalent in
children older than 6.

X. Passive Immunity
A. Antibodies are produced by another source.
B. Antibodies are introduced, short duration
a. Natural Passive - Mother
b. Artificial Passive - Globulins (gives
protection right away but only gives
short immunity)
C. Artificial passive immunity
a. Is an immune serum (antibody) from
animals or humans.
b. It provides immediate protection (eg.
diphtheria antitoxin, tetanus
antitoxin).
c. Skin testing is a must.
 XI. Conditions Before an Infection Develops contagious agent near that signage),
A. A sufficient number of microorganisms eyeshields, and eye goggles.
B. Virulence of microorganisms
C. Resistance of the host XIV. Fundamentals of Standard Precautions
D. Immunity of the host A. Handwashing
E. Cycle of infection must be completed h. Gowns, Mask, Goggles, Face
Shields, Gloves
XII. Epidemiology
A. Sporadic (outbreak)
a. Occurs occasionally and irregularly
with no specific patterns
B. Epidemic
a. Occurs in a greater number than
what is expected in a specific area
over a specific time
C. Pandemic
a. Epidemic that affects several
countries or continents
D. Endemic
a. Present in a population or
community at times

XIII. General Nursing Care in CD

A. Preventive Aspect
a. Health Education - Teach the patient
how to prevent the acquisition of B. Air Filters
certain diseases C. Isolation
b. Immunization - complete set of a. Isolation is necessary when a
immunization person is known or suspected to be
c. Environmental Sanitation infected with pathogens that can be
d. Proper Supervision of Food transmitted by direct or indirect
Handlers contact.
B. Control Aspect b. The principle behind the isolation
a. Isolation - separation for the period technique is to create a physical
of communicability of infected barrier that prevents the transfer of
person infectious agents. To do this, you
b. Quarantine - limitation of freedom of have to know how the organisms are
movement of the person exposed to transmitted.
CD during the longest IP D. Strict Isolation
c. Disinfection - the killing of E. Contact Isolation
pathogenic agents by chemical or F. Respiratory Isolation
physical means G. Tuberculosis Isolation
d. Concurrent disinfection - While the H. Enteric Precaution
patient is having the disease, I. Drainage/Secretion Precaution
pathogens are being disinfected J. Blood/Body Fluids Precaution
e. Terminal Disinfection - When the
patient is already discharged, XV. Transmission-Based Precautions
disinfection of the environment is A. Contact transmission
started a. Most common; direct, indirect, and
f. Fumigation - the process of killing droplet spread (distance ourselves
animal forms accompanied by the for at least 3 feet/1 meter)
employment of gaseous agent B. Air-borne transmission
g. The practice of Medical Asepsis - a. suspended particles in the air
Gloving, gowning, hand washing, weighing <5 microns
placarding (placing signages to alert C. Vehicle transmission
people about the presence of a
 a. articles or substances that harbor
the organism until it is ingested or
inoculated
D. Vector-borne transmission
a. intermediate carrier (eg. mosquito,
flies)

XVI. Barrier Protection

A. Airborne
a. private room, Airflow or at least 6 air
exchanges per hour
B. Droplet
a. private room, mask, within 3 feet
C. Contact
a. Private room, mask, gown

f. Articles should be discarded,

cleaned, or sent for decontamination
and reprocessing
g. Room is to remain closed
h. The patient is to wear a mask during
transport
B. Strict Isolation
a. Visitors report to the nurses’ station
before entering the room
b. A private room is necessary. The
door must be kept closed
c. Gowns, masks, and gloves must be
worn by all persons entering the
room
d. Handwashing
XVII. Other Types of Isolation e. Articles must be discarded, or
A. AFB (Acid-Fast Bacilli) Isolation wrapped before being sent to
a. Visitors should report to the nurses’ Central Supply for disinfection or
station before entering the room sterilization
b. Masks are to be worn in the patient’s C. Respiratory Isolation
room a. Visitors report to the nurses’ station
c. Gowns are indicated to prevent before entering the room
clothing contamination b. A private room is necessary. The
d. Gloves are indicated for body fluids door must be kept closed
and non-intact skin c. Masks must be worn by all persons
e. Handwashing after touching the entering the room if susceptible to
patient or potentially contaminated diseases
articles, and after removing gloves d. Gowns and Gloves are not that
important to be worn
e. Handwashing
f. Articles contaminated by secretions
must be disinfected
g. Caution to all persons susceptible to
the specific disease, they should be
excluded from the area and must
wear masks.
D. Wound and Skin Isolation
a. Visitors should report to the nurses’
station before entering room
b. A private room is a must.
 c. Gowns and gloves must be worn by
all persons having direct contact with
CENTRAL NERVOUS SYSTEM
the patient
CD Day 1 by Dr. Ferriol
d. Masks to be worn during dressing
Transcribed by: Suataron, Selwyn C.
changes
e. Handwashing
f. Gloves must be worn by all persons I. Tetanus (Lockjaw)
having direct contact with infected A. Concepts
area a. Clostridium tetani - direct inoculation
g. Articles like instruments, dressing, resulting to tonic muscular spasms;
and linens should be discarded anaerobic bacteria gram (+)
properly b. Toxins - tetanospasmin (affects
E. Enteric Isolation muscles), tetanolysin (hemolyze
a. Visitors must report to the nurses’ RBC)
station before entering the room c. MOT - Otitis Media, tooth decay, Tet
b. Private room is necessary FOR Neonate
CHILDREN ONLY d. IP - 3-21 days Adult, 30 days
c. Gowns must be worn by all persons Newborn
having direct contact with the patient B. Immunity
d. Masks can not be worn a. Active - TT
e. Handwashing b. Passive - TAT and TIG
f. Gloves must be worn by all persons c. Natural - Active none, Passive (+)
having direct contact with patients or C. Clinical Manifestations
articles contaminated with fecal a. Trismus - lockjaw, neck and facial
material muscle, last to disappear
g. Articles contaminated with urine and
feces must be disinfected as part of
special precautions
F. Protective or Reverse Isolation
a. Visitors must report to the nurses’
station before entering the room
b. A private room is necessary. Doors
must be kept closed
c. Gowns and masks must be worn by
all persons entering the room
d. Handwashing
e. Gloves must be worn by all persons
having direct contact with patient

XVIII. Diagnostic Tools

A. Collection of specimen
B. Principles b. Risus sardonicus - maskface;
C. Types of specimen collection sardonic grin (Hallmark Sign)
D. Blood
E. Urine
F. Stool
G. Sputum
H. Wounds
I. Throat
XIX. Laboratory Tests
A. Microscopy
B. Culture
C. Antibiotic susceptibility testing
D. White blood cell count
E. Immunologic test
 DPT 2 1½ months old

DPT 3 after 4 weeks

1st Booster 18 months

2nd Booster 4-6 years old

Subsequent booster every 10 years thereafter

b. TT (0.5 mL IM)

Tetanus Toxoid Immunization

TT1 6 months pregnant

c. Opisthotonus - arching of the back TT2 4 weeks after

TT3 6 months after

TT4 at least 1 year after TT3

TT5 at least 1 year after TT4

Tetanus Anti-Toxins from horse

(TAT)

Tetanus from human

Immunoglobulin (TIG)

C. 3 Types of Patients with Skin Wounds

Post-Exposure Prophylaxis
a. (+) Immunization as a child with
boosters but last shot >10 years -
d. The rigidity of abdominal muscles Give TT
and extremities b. (-) immunization - TT + TIG/TAT
e. Difficulty in swallowing and breathing c. (+) tetanus - TIG/TAT + TT +
f. Urinary and bowel incontinence Antibiotic (ANTBC) + Wound
g. Pain, redness, and swelling cleansing + supportive therapy
D. Dx exam D. Planning and Implementation
a. wound history a. Preventive measure
b. wound culture b. Immunization
c. Proper wound care
II. Tetanus Neonatorum d. Avoidance of wound
A. Concepts E. 3 Objectives of Medical Management
a. Feeding and sucking abnormality a. Neutralize toxins - antitetanus toxins;
b. Voiceless crying epinephrine and corticosteroids
c. Sucking - Cyanosis present
d. Dehydration b. Kill the bacteria - penicillin, daily
e. Tonic or rigid muscular contraction cleansing of wound
f. Flaccidity - exhaustion - death c. Prevent muscle spasms - sedatives,
B. Immunization and muscle relaxants to increase the
a. DPT (0.5 mL IM) effect of sedatives
F. Nursing Care
DPT Immunization a. Avoid stimulation to avoid muscle
spasms
DPT 1 1½ months old b. Proper oral hygiene
c. Record intake and output
 d. Provide a quiet and well-ventilated
II mucosal, Vaccine is needed
room
non-bleeding
e. Always have a padded tongue
wounds, abrasions
depressor to maintain a patent
airway III bleeding bites and Vaccine is needed;
f. Never leave the patient alone above the neck, the open wound is not
G. Complications stray dogs, usually sutured but
a. Pneumonia laceration, multiple rather is injected with
b. Serum sickness in the form of bites the vaccine.
rashes or hives due to administration
of antitoxins
E. Clinical Manifestations of Rabid Animals
III. Rabies/Lyssa (Hydrophobia)
a. Dumb form - a complete change in
A. Concepts
disposition; very affectionate and
a. Zoonotic infection - meaning it came
walking to and from; paralysis and
from animals
coping flow of saliva
b. Rhabdovirus / filterable virus
b. Furious form - vicious, agitated, then
c. MOT - Saliva of infected animal
become paralyzed, emits excessive
d. Canine (human) and sylvatic
saliva, and dies
(animals)
F. Clinical Manifestations for Human
e. IP - 10 days - 15 years (Humans); 7
a. Invasive stage - numbness on site of
days - 7½ months (Dogs)
bites, headache, malaise,
B. Immunity:
restlessness, fever, photosensitivity,
a. Active - rabies vaccine
apprehension
b. Passive - HRIG, ERIG
b. Excitement stage - hydrophobia,
c. Natural - Active none, Passive none
spasms of laryngeal and pharyngeal
C. Manifestation
muscle, maniacal (climbing the wall
a. Hydrophobia - when offered with
and excessive salivation)
water, they have fear of choking
c. Paralytic stage - laryngospasm
b. Aerophobia - laryngospasms
stopped, last for how many seconds
c. Bite from warm-blooded animals
or hours, then the patient may go
d. Encephalitis/meningitis/respiratory
into a coma, and then eventually die
paralysis
G. Diagnostic Exam
e. Transmission of the virus is faster if
a. 10 days observation for maniacal
bitten from the waist and above.
s/sx
b. Brain biopsy of the animal - checking
for the Negri bodies

D. Category of Bites

Category of Bites c. Fluorescent rabies antibody -

specimen blood of individual
I Intact skin (lick) observe the animal
for 10-14 days
 a. Have pets immunized at 3 months
and every year after
b. Never allow pets to roam in street
c. Leash your dogs
d. Your pet’s actions are your
responsibility

Medical-Surgical Nursing: Digestive System

Transcribed by: Suataron, Selwyn C.

I. GastroIntestinal Tract (Alimentary tract)

A. Upper GIT
a. Starts from mouth to small intestine.
H. Planning and Implementation b. Where the complete digestion
a. Provide a dim, quiet, and occurs.
non-stimulating room for the patient B. Lower GIT
b. Wear a gown, mask, and goggles a. Starts from large intestine to anus.
c. All noises should be avoided b. No more digestion takes place.
d. Restrain the patient when needed c. Reabsorption of water takes place.
e. Stimulation of any senses by fluids
must be avoided
f. Anti-rabies vaccine
I. Preventive Measures
a. Immunization of animals
b. Keep away from stray animals
J. After the Bite
a. Wash it with soap and water
b. Give antibiotics and antitetanus
c. Observe dog for 14 days. if it dies,
consult a doctor
d. If the dog shows suggestive of
rabies, kill the dog immediately and
bring head for lab exam (+) Negri d. E. coli found in the colon are
bodies responsible for the synthesis of Vit k:
e. Submit for immunization while needed for production of clotting
waiting for results factors X,IX,VII,II
f. If the dog is not available for
observation, submit for immunization
K. Immunization
a. Rabies Vaccine
2mL IM deltoid

0, 3, 7, 14, 28 days (5 shots)

0.1mL ID deltoid

0, 3, 7 days (0.1mL deltoids 2 shots) e. Putrefaction is a process by which

E.coli act in fecal materials which
30, 90 days (0.1mL deltoid single shot)
produces gasses (flatus) which is
b. Rabies Immunoglobulin will be given composed of carbon dioxide, carbon
in a single shot: 40% in the wound; monoxide, methane, and ammonia
60% in the deltoid
L. Responsible Pet Ownership II. Accesory Organs of Digestion
 A. Liver, gall bladder, salivary gland and Chemoreceptors Trigger Zone
pancreas (CTZ). This is stimulated by:
i. any inflammation in the
III. Inflammatory Disorders of Digestive System abdominal region
A. Gastritis ii. any obstruction in the
B. Peptic ulcer disease abdominal region
C. Inflammatory bowel disease iii. Increase ICP
a. Crohn’s disease (Regional enteritis) iv. vertigo/dizziness
b. Ulcerative colitis v. anti cancer drugs
D. Appendicitis vi. Foul smell
E. Diverticulitis vii. Etc.
F. Cholecystitis b. Nursing Diagnosis
G. Pancreatitis i. Nausea
ii. Risk for Fluid Volume Deficit
IV. General Sign and Symptoms of iii. Risk for Metabolic Alkalosis
Inflammatory Disorders C. Indigestion
A. Pain a. AKA Dyspepsia
a. Pain Location b. Assessment (Auscultation)
i. Bowel movement can be
assessed through
auscultating bowel sounds.
ii. Normal bowel sound is 5-35
per minute.
iii. Listen in all quadrants for 1
full minute.
iv. Bowel sounds may be
hypoactive or hyperactive
which may manifest in
conditions such as
abdominal cramping,
diarrhea, or partial
obstruction.
v. Bowel sounds may be absent
in complete bowel
obstruction.
vi. Bowel sounds is not
indicative that there may be
indigestion because
indigestion if affected by too
many factors, not just bowel
movement.
b. Assessment
c. Nursing Diagnosis
General Assessment Order i. Indigestion
V. Non-Inflammatory Disorders of Digestive
Inspection-Palpation-Percussion-Auscultation System
A. Irritable bowel syndrome
Abdominal Assessment Order
a. Functional disorder - means there
Inspection-Auscultation-Percussion-Palpation are no structural defect, it’s just that
the bowels are not functioning the
Remember IPaPA and IAPePa way it’s suppose to.
c. Nursing Diagnosis b. Etiology: idiopathic
i. Acute Pain c. Secondary to a Neural
ii. Chronic Pain defect/hormonal defect that affects
B. Nauseas and vomiting the GI function
a. Vomiting happens when we d. Risk factor: Stress, Family history
stimulate the vomiting center of our e. IBS- d (diarrhea) = Mucoid
brain which is called f. IBS- c (constipation)
 g. IBS- a (alternating diarrhea and a. Hydrochloric acid from the stomach
constipation) may cause irritation and injury to the
h. Diagnostic tests are done to rule out esophagus which may lead to
other conditions esophagitis
i. Colonoscopy b. Possible Signs and Symptoms
ii. CBC i. Dysphagia - Difficulty
iii. ESR (erythrocyte swallowing
sedimentation rate) ii. Odynophagia - Painful
iv. ultrasound swallowing
i. Signs and Symptoms c. Frequent exposure of esophagus to
i. Indigestion the hydrochloric acid may cause
ii. Abdominal pain metaplastic change (from squamous
j. Management of IBS is palliative epithelial cells to columnar epithelial
k. Focus: Diarrhea cells)
l. Data: Mucoid stools d. Baret's esophagus - a risk factor for
m. Action: possible development of esophageal
i. Fluid Replacement cancer
ii. Oresol
iii. Diet: High protein, Low
residue
iv. Anti diarrheal drug -
Loperamide
n. Focus: Constipation
o. Action:
i. increase fluid intake
ii. diet: low fat high fiber
iii. Laxatives
p. Control symptoms=Low residue and
high fiber
B. Hiatal hernia

e. Diagnostic tests
i. esophagoscopy
ii. barium swallow (barium does
not contain iodine - don’t ask
a. Protrusion of the stomach into the
allergy to seafood)
hiatus of the diaphragm
f. Management for Hiatal Hernia
b. Etiology:
i. Goal - prevent reflux
i. Congenital
ii. Stay upright 1-2 hours after
ii. Acquired - may be caused by
eating
increased intra-abdominal
iii. Do not lie down after eating
pressure (obese,
iv. No bedtime snacks
pregnant,activities lifting
v. Elevate hob inches for sleep
heavy objects,straining)
to prevent nightmare reflux
c. Types:
vi. Avoid food/drinks that
i. sliding hernia
decreases the lower
ii. rolling hernia
esophageal sphincter
(paraesophageal hernia)
vii. Avoid drugs that decreases
iii. mixed type
lower esophageal sphincter -
d. Most prominent clinical
Fosamax, Valium
manifestation
viii. Avoid activities that increase
i. pyrosis (heart burn)
intra abdominal pressure
C. Gastroesophageal Reflux Disease (GERD)
 ix. Avoid constrictive clothings e. Fat metabolism happens in the liver.
x. Antacids to neutralize acidity f. Lipogenesis
(after meals) g. Lipolysis
xi. H2 receptor blockers like h. Gluconeogenesis - converting fats
ranitidine to decrease HCI into glucose
acid production
xii. *PPI - proton pump inhibitors
ex.omeprazole,
esomeprazole to decrease
HCI acid production
xiii. Surgery - Herniorrhaphy
(elective). Hernirrhaphy only
becomes emergency when
the herniated organ results to
strangulation.
D. Liver cirrhosis i. Carbohydrate metabolism also takes
a. Fibrosis or scarring of the liver place in the liver
b. Irreversible and progressive j. Glycogenesis
c. Etiology: k. Glycogenolysis
i. Alcohol (Laennec's)
ii. Infection (Post-Necrotic
Cirrhosis)
iii. Hepatotoxic Drugs
(Post-Necrotic Cirrhosis)
iv. Hepatoma
v. Idiopathic (Biliary Cirrhosis)
d. Signs and Symptoms may come out
from 2 Problems
i. Liver dysfunction
l. Protein metabolism
ii. Portal hypertension
m. Produces albumin - the major
E. Liver functions
protein in the blood which exerts
a. Bile production for emulsification of
oncotic pressure
fats.
n. Oncotic pressure is the pressure that
b. Bile is composed of Water, Bilirubin,
keeps the water in the blood vessel.
Cholesterol, and Bile salts.
o. Proteins are metabolized by the liver
c. Bile produced by the liver is stored in
and is converted into amino acids.
the gallbladder through the hepatic
Amino acids are then converted into
bile duct and the cystic duct where it
ammonia, Ammonia are then
is concentrated.
converted into urea. Urea can now
d. Bilirubin is taken up by the Liver to
be excreted by the kidneys.
produce Bile

p. Liver produces inactivated clotting

factors
 q. Inactivated clotting factors needs to c. The process by which the drugs and
be activated to form a clot: essential food are metabolized first in the liver
for managing bleedings. is called first-pass effect.
r. Liver needs Vit. K to produce d. The metabolized drugs and food will
vitamin-k-dependent clotting factors. drain into the hepatic vein where it
will bring the blood into the inferior
vena cava for the heart to pump.
e. The blood will then be pumped into
the respiratory circulation to
oxygenate the blood.
f. The heart will pump the blood into
the aorta down to the hepatic artery
to supply the liver with nutrient-rich
and oxygen-rich blood.
s. Liver is responsible in storing g. In liver cirrhosis, blood can’t get into
fat-soluble vitamins, Vit. A, D, E, K, the liver easily because of scarred
and some Vit. B tissue. Scarring will make the liver
t. Liver dysfunction my lead to enlarged called Hepatomegaly.
decreased storage of Vit. ADEK and G. Portal Hypertension
some vit. B a. Portal hypertension results due to
u. Metabolism/ biotransformation of the increased pressure in the portal
drugs also happens in the liver. vein caused by the scarring of the
liver tissue.
b. Increased portal pressure will push
the fluids into the peritoneal cavity
which may lead to ascites.
c. Portal hypertension will also cause
backflowing of the blood causing
distension of the blood vessles in the
preceding organs
d. Distended veins in the rectum will
cause hemorrhoids which has a
tedency to bleed.
e. More esophageal veins are formed
F. Portal circulation
as a compensatory mechanism of
our body to have more veins where
the backflowing blood could go to.
f. These newly formed esophageal
veins are fragile and weak causing
distention due to the increasing
pressure causing Esophageal
Varices.
g. Esophageal varices can easily
rupture and cause bleeding.
h. Recto anal varices are also fragile,
weak, and easily ruptured veins that
are formed as a compensatory
mechanism of our body

a. Everything that is absorbed in the

GIT will be absorbed by the venous
blood into the portal vein bringing it
to the liver wher it is metabolized.
b. At this time, the blood is nutrient-rich
but also oxygen-poor.
 a. Palliative - relieve s/sx
b. Possible liver transplant donor but is
still uncommon especially in our
country.
J. Early Stage Liver Cirrhosis
a. Focus:
i. Weight loss
ii. Weakness
iii. Fatigue
iv. Bipedal edema
b. Data
i. Caused by liver dysfunction
ii. Decrease fat and
carbohydrate metabolism
i. Caput medusae results as the blood iii. Albumin production
finds other veins in the GIT where it c. Nsg/ Dx:
can flow which can be seen in the i. Fluid volume excess
skin of the abdomen of the client. ii. Imbalance nutrition less than
j. Small blood vessels are starting to body requirement
form all over the skin of the client iii. Fatigue/activity intolerance
just to accomodate the increasing iv. Risk for injury/fall
backflowing of blood: Spider d. Action:
Angioma - a pathognomonic sign of i. Restrict fluid
liver cirrhosis ii. Restrict sodium
iii. MonitorI and O
iv. Monitor VS
v. Weigh patient daily
vi. Inc Albumin intake (egg
white)
vii. Diuretic as ordered
viii. Diet: restrict NA, Inc
Albumin,Low fat, Low
cholesterol, Iron rich food,
H. Diagnostic Tests for Liver Cirrhosis AVOID alcohol
a. Liver biopsy ix. Provide rest periods
i. The most definitive x. Promote safety pressure
diagnostic test xi. Slow down progression of
ii. Supine with pillow at the the disease
RUQ 1. Avoid alcohol
iii. most common complication 2. Follow the diet
of Liver biopsy is Bleeding 3. Avoid fatigue
that don’t clot easily. 4. Avoid stress
iv. Position the client in 5. Avoid infection
side-lying position with pillow 6. Avoid hepatotoxic
on the RUQ to add pressure drugs
to the site and prevent further K. Late Stage Liver Cirrhosis
bleeding. a. Data:
b. AST, ALT i. Bipedal edema
i. ALT: 7 to 55 U/L →ascites→difficulty of
ii. AST: 8 to 48 U/L breathing
iii. These enzymes will be ii. Weight loss→anorexia
significantly elevated in iii. Easy fatigability
clients with liver cirrhosis. iv. Weakness
c. Ultrasound v. Jaundice
d. MRI vi. Portal hypertension
e. Ct scan vii. Hepatomegaly
I. Management of Liver Cirrhosis viii. Esophageal varices
 ix. Recto anal varices
x. Hemorrhoids
xi. Bleeding
xii. Caput medussae
xiii. Spider angiomas
b. Complications:
i. Hepatic encephalopathy
ii. Primary peritonitis
iii. Hepatorenal syndrome
c. Action:
i. Restrict fluid
ii. Restrict sodium
iii. Monitor I and O
iv. Monitor VS
v. Weigh patient daily
vi. Ascites→DOB
1. position-reverse
trendelenburg
2. Paracentesis
xiv. Blood transfusion - packed
RBC
xv. Beta blockers for Portal
Hypertension
xvi. Clotting factors replacement
(cryoprecipitate) or Fresh
frozen plasma
xvii. Manage complications
1. Primary peritonitis -
massive doses of
antibiotics
2. Hepatorenal
syndrome - Dialysis
3. Hepatic
encephalopathy
vii. Diet: restrict sodium low
protein, low fat, low
cholesterol, iron rich foods Vit Stages of Hepatic Encephalopathy
ADEK/B rich food
viii. Provide rest periods Stage I Confused
ix. Promote safety (+) Asterixis (Liver Flap) - flapping
x. Skin care (jaundice) tremor of the fingers when arms are
xi. Avoid bleeding extended and hand is dorsiflexed
1. avoid trauma
Stage II Increased lethargy
2. avoid rupture of
(+) Asterixis
varices
3. avoid straining Stage III Stuporous
4. avoid coughing (±) Asterixis
xii. Prevent rupture of
esophageal varices Stage IV Comatose
xiii. Triple lumen tube ( (-) Asterixis
sengstaken lumen tube) use
to compress the esophageal
L. Hepatic encephalopathy
varices
a. irreversible, progressive
b. Management is palliative
c. Goal
i. To slow down progression
d. Focus:
 i. Increased ammonia in the
blood
e. Action:
i. Restrict protein in the diet
ii. Avoid bleeding

iii. Decrease putrefaction since

one of its byproduct gasses
is ammonia.
1. Laxatives - lactulose
2. Neomycin
3. Enema
f. Focus:
i. Altered Level of
Conciousness
g. Action:
i. Provide food and fluid
ii. Provide privacy
iii. Prevent complications from
immobilization
iv. Promote safety
v. Communicate
cate
CA1 MS DAY 1 D. Apply direct pressure to the area.

(Anna Dorothy Matias) R:To prevent rupture of the blood vessel

Which of the following instructions is Which of the following factors, if noted in a

appropriate for a nurse to give to a patient who patient’s history, would indicate a
has gastroesophageal reflux disease? predisposition for developing cholecystitis?

A. Take prescribed antacids before eating A. Obesity

R: Given after meals usually 30mns to 1hr after B. HPN

meals we will wait until all the acids are release
C. Depression
B. Place blocks under the legs of the head of
the bed. D. Childlessness

R: the pt will be positioning with upper portion A client with cirrhosis may have alterations in
of the body elevated (Prevent reflux) which of the following laboratory values?

C. Eat a high-fat, low-protein diet A. Carbon dioxide level

R-Not appropriate in gerd B. ALT

D. Lie down for one hour after eating R: if there is injury to the liver then this enzyme
will be elevated
R-Not appropriate in gerd
C. PH
A nurse would assess a patient who has
undergone a total gastrectomy for early D. Erythropoietin
symptoms of dumping syndrome, which
include A client with acute pancreatitis asks the nurse
when will he be able to eat again, the most
A .Diaphoresis and lightheadedness appropriate response is

R- the body is compensating bcz of the A. “If you do not have infection in the
decreasing blood volume pancreas anymore”

B. Facial flushing and paresthesia B. “When the doctor orders for it”

C. Disorientation and vomiting C. “When your blood test for enzymes

improves”
D. Diarrhea and abdominal distention
D. “Maybe after a week”

Which of the following statements, if made a

patient who has diverticulosis, would indicate The nurse would expect which of these
to a nurse that the patient is following the diet assessment findings in a client with duodenal
plan correctly? ulcers?

A. I eat meat five times a week A. Epigastric pain occurring at night

B. . I do not eat fried foods R: because there is continuous gastric

emptying when we sleep.
C. I drink decaffeinated coffee
B. Distended abdomen
D. I eat green salad every day
C. Epigastric pain relieved by vomiting
(gastric ulcer)

A nurse should expect a Sengstaken-Blakemore D. Positive fluid wave (ascites)

tube to be ordered for a patient who has
Bleeding esophageal varices in order to

A. Cause vasoconstriction of the splenic artery The client had a total gastrectomy. The nurse
should teach the client about long-term
B. Ensure airway patency treatment for which of these conditions?

C. Provide for enteral nutrition A. Vitamin K deficiency

B. Vitamin A deficiency I in IBS means

C Vitamin B12 deficiency a. Irritable

D Vitamin C deficiency b. Inflammatory

In caring for a client with hiatal hernia, which of c. Infectious

the following should be included in a teaching
plan regarding the causes d. Incredible

A. To avoid heavy lifting

R: because heavy lifting will increase intra

abdominal pressure that will promote herniation
of the stomach

B. A dietary plan based on soft foods

C Its prevalence in young adults

D Its prevalence in fair-skinned individuals A clinic nurse is providing health teaching for a
patient newly diagnosed with gastroesophageal
The most fatal complication of reflux disease (GERD). Which of the following
Choledocholithiasis is ascending cholangitis needs further teaching with the patient?
which may complicate to develop what type of
shock?

A. Hypovolemic Shock A Change of dietary pattern to small frequent

feedings and bedtime snack
B. Septic Shock
b. Avoiding wearing of tight clothings
C. Anaphylactic shock
C Use of magnesium carbonate (Gaviscon) to
D. Neurogenic shock neutralize acidity

A client with liver cirrhosis has severe ascites D Avoidance of bending, stooping, or slumping
and experience difficulty of breathing, which of posture
the following is the priority nursing
intervention?

A. Prepare for paracentesis Postoperatively, the patient develops dumping

syndrome. Which of the following statements, if
B. Administer diuretic as ordered made by the patient, should indicate to the
nurse that further dietary teaching is
C. Place the client is a reverse trendelenberg necessary?
position

D. All of the above

A. “I should eat bread with each meal.”
After pyloroplasty, which of the following
interventions prevent rapid gastric emptying? b. “I should eat smaller meals more frequently.”

A. Simple sugar in the diet C . “I should lie down after eating.”

B. Low protein intake D“I should avoid drinking fluids with my

meals.”
C. Liquid must be taken in between meals

D. All of the above

A client with a peptic ulcer in the duodenum
A client with possible appendicitis is being would probably describe the associated pain
assessed, which of the following is not as:
contraindicated in this client?

A. Cleansing enema(promote rupture)

a. An ache radiating to the left side
B. Digital Rectal Examination
b. An intermittent colicky flank pain
C. Warm compress(promote rupture)
c. A gnawing sensation relieved by food
D. None of the above
R: because when you eat the pyloric sphincter
will close so there is no further irritation to the
duodenal ulcer

d. A generalized abdominal pain intensified

by moving

A nurse is providing instructions to a client

about measures to minimize the risk of
dumping syndrome. The nurse tells the client to
do which of the following?

A. Increase fluid intake, particularly at mealtime

b. Maintain a high-carbohydrate diet

c. Maintain a low-Fowler’s position while eating

D Ambulate for at least 30 minutes after each

meal

A client being treated for esophageal varices

has a Sengstaken-Blakemore tube inserted to
control the bleeding. The most important
assessment is for the nurse to

a. Check that a hemostat is at the bedside

b. Monitor IV fluids for the shift

c.Regularly assess respiratory status

d.Check that the balloon is deflated on a

regular basis
CA1 MS DAY 2 a. The client stops breathing in
when pressure is applied to the
LAICA MAE S. BACTAT RUQ
1. Which of the following instructions is b. The client stops breathing out
inappropriate for a nurse to give to a patient when pressure is applied to the
who has gastroesophageal reflux disease? RUQ
a. Take prescribed antacids before eating c. The client stops breathing
in when pressure is applied to
b. Place blocks under the legs of the head of the LUQ
the bed.
d. The client stops breathing out
c. Eat a high-fat, low-protein diet must be when pressure is applied to the
avoided LUQ
d. Do not lie down for one hour after eating Rationale: Murphy's sign is clinical
Rationale: You don't give antacids before manifestations of cholecystitis (the gallbladder
eating because you give antacids after eating located to Right Upper Quadrant) -murphy's
sign you ask the patient to inhale and when the
2. A nurse would assess a patient who has patient inhale do you put deep palpation on the
undergone a total gastrectomy for late right upper quadrant and the patient stop
symptoms of dumping syndrome, which breathing when pressure is applied.
include
6. A client with liver cirrhosis manifest
a. Diaphoresis and lightheadedness asterixis, jaundice and anorexia due to

b. Facial flushing and paresthesia a. Liver dysfunction

c. Disorientation and vomiting b. Portal hypertension

d. Diarrhea and hypotension c. Both conditions

3. Which of the following statements, if made by d. Neither

a patient who has diverticulosis, would indicate
to a nurse that the patient is following the diet Rationale: Asterixis- Secondary to hepatic
plan correctly? Jaundice- Secondary to inability of the liver to
take up bilirubin Anorexia - is due to abnormal
a. I eat meat five times a week fat and carbohydrates metabolism

b. I do not eat fried foods 7. A client with acute pancreatitis complains of

severe pain, which of the following independent
c. I drink water instead of coffee nursing intervention is a priority?

d. D.I eat macaroni salad every day a. Narcotics as ordered

diverticulosis - prevent having constipation
b. Position the client comfortably
Rationale - Water can prevent constipation
c. Place the client on NPO
4. A nurse should expect a
Sengstaken-Blakemore tube to be ordered for a d. All of the above
patient who has bleeding esophageal varices in
order to apply direct pressure and Rationale: (no food, no fluid) this is the priority
in patient to relieve the pain in acute
a. Cause vasoconstriction of the splenic pancreatitis, if you get food or fluid to patient
artery that will cause too much secretion of the
pancreas that may cause further inflammation
b. Ensure airway patency (REST THE GIT)

c. Provide for enteral nutrition 8. The nurse would expect which of these
assessment findings in a client with gastric
d. Stop bleeding ulcers?
Rationale: Purpose of Sengstaken-Blakemore is a. Pain occurring at night
stop the bleeding
b. Pain relieved by eating
5. A client with cholecystitis is being assessed
for Murphy's sign, the nurse is correct when c. Gnawing epigastric pain
she/he noticed
d. All of the above
 Rationale: In gastric ulcer there is no pain at a. Simple sugar in the diet
night because you don't eat at night -gastric
ulcer the pain is relieved by vomiting when the b. Moderate fat intake
patient vomits that will relieve the pain
c. Liquid must be taken in between meals
9.The client had Billroth 1 procedure, the nurse
knows that this procedure involve d. Upright position after meals

a. Removal of the stomach and Rationale: Upright position will increase the
anastomosing the stump to the gastric emptying time the patient should be
duodenum lying down after meals to slow down emptying

b. Removal of the stomach and 14. A client with possible appendicitis is being
duodenum and anastomosing the assessed, which of the following is a sign of
stump to the jejunum complications

c. Bypassing the stomach and a. Severe vomiting

connecting it to the ileum b. High grade fever
d. Removal of the duodenum and c. WBC 15,000
anastomosing the stomach to the
jejunum Rationale: billroth 1 removal d. Rigid board like abdomen
of the stomach B- is billroth 2 C-
gastroenterostomy - surgical 15. I in IBD means
management intractable ulcer
a. Irritable
10. In caring for a client with hiatal hernia,
which of the following should not be included in b. Inflammatory
a teaching plan regarding the causes
c. Infectious
a. To avoid heavy lifting
d. Incredible
b. A dietary plan avoiding soda
16. A clinic nurse is providing health teaching
c. Its prevalence on obese persons for a patient newly diagnosed with
gastroesophageal reflux disease (GERD). Which
d. Its prevalence on women of the following needs no further teaching with
the patient?
11. The most fatal complication of
Choledocholithiasis is ascending cholangitis a. Change of dietary pattern to small
which may complicate to develop shock, the frequent feedings and bedtime
initial manifestation include the following, snack
except
b. Avoiding wearing of tight socks
a. Jaundice
c. Use of magnesium carbonate
b. b.HR 120/min (Gaviscon) to decrease acid
production
c. C. Hyperventilation
d. .Avoidance of bending, stooping, or
d. No exception slumping posture
Rationale: john this is not manifestation of Rationale: Letter A is wrong because of the
shock bedtime snack
12. A client with liver cirrhosis has severe 17. Postoperatively, the patient develops
ascites and being prepared for paracentesis, dumping syndrome. Which of the following
prior to the procedure the client is asked to statements, if made by the patient, should
indicate to the nurse that further dietary
a. Prepare for paracentesis teaching is unnecessary?
b. Empty the bladder a. “I should eat bread with
c. Place the client is a reverse trendelenberg each meal.”
position b. "I should eat meals more
d. All of the above frequently.

13. After pyloroplasty, which of the following c. "I should lie down after
interventions promote rapid gastric emptying? eating.”
 d. "I should drink fluids with my 22.When caring for a client with ascites the
meals." nurse should understand that the portal vein:

18. A client with a peptic ulcer disease would be a. Brings blood away from the liver
given the following medications, except
b. Enters the superior vena cava from the
a. Antacid cranium

b. Ranitidine c. Brings venous blood from the intestinal

wall to the liver
c. Metronidazole
d. Is located superficially on the
d. No exception anteromedial surface of the thigh
Rationale: Etiology of peptic ulcer H pylori Loss 23. The nurse administer Neomycin to a client
of protective barrier against HCI -We need to with hepatic encephalopathy to:
neutralize the acidity -We need to ill the bacteria
-Give metronidazole to kill bacteria -Other a. Kill bacteria
antibiotics that kill bateria *Amoxicillin
*Quinoles b. Prevent ammonia formation

19. Which of the following would predispose to c. Improve asterixis

the development of chronic pancreatitis?
d. None of the above
a. Cystic fibrosis
Rationale Purpose of giving neomycin to
b. Alcoholism manage hepatic encephalopathy Cause of
heparic encephalopathy - increase ammonia
c. Fatty foods
24. A nurse provides dietary instructions to a
d. All of the above client with a diagnosis of cholecystitis. Which
of the following food items identified by the
Rationale: Pancreatitis it can be acute or client indicates an understanding of foods to
chronic -Infection and alcoholism can be cause avoid?
of Pancreatitis -Alcoholism and Fatty foods
(acute) Cystic fibrosis- problem to exocrine a. Fresh fruit
gland- increase production mucus in the
pancreas (hereditary disease and it cannot be b. Fresh vegetables
prevented)
c. Poultry without skin
20.A client being treated for esophageal
varices has a Sengstaken-Blakemore tube d. Brown gravy
inserted to control the bleeding. The most Rationale: cholecystitis diet low fat, high
important assessment for the nurse is to carbohydrates, high proteine
a. Ability to swallow 25. An ambulatory care nurse is preparing a
b. Monitor IV fluids for the shift client scheduled for a liver biopsy. The nurse
reviews the client's record and expects to note
c. C. Ensure patent airway which of the following laboratory results
documented in the client's chart in preparation
d. Check that the balloon is deflated on a for this procedure?
regular basis
a. Prothrombin time
21. The nurse notes that there is documentation
of the presence of asterixis. To check for the b. White blood cell count
presence of this sign, the nurse would do which
of the following? c. Blood urea nitrogen (BUN)

a. Ask the client to extend arms d. Uric add level

b. Check for the presence of Homan's sign Rationale: liver biopsy they may be susceptible
to bleed -if there's liver cirrhosis the liver
c. Instruct the client to lean forward cannot produce enough clotting factor

d. Measure the abdominal girth 26. The patient has been treated for a peptic
ulcer. He enters the hospital reporting that he
Rationale: how do we asses asterixis- ask has vomited a very large amount of blood. The
client to extend the arm nurse should expect which sign to be present?

a. Decreased blood pressure

b. Decreased pulse c. Assessing if there is adequate renal
perfusion
c. Decreased respirations
d. Assessing for a patent airway and
d. Increased urinary output oxygenation
Rationale: if the blood pressure going down the Rationale: Giving duratex is not a measure to
heart earth is going down prevent the progress of hepatic coma
27. When caring for patient after open
cholecystectomy, the nurse should be aware
with the major complication of procedure which
is:

a. hemorrhage

b. atelectasis

c. .wound dehiscence

d. infection

Rationale: this is the reason why right after

surgery whereas the patient to have deep
breathing exercise.

28. The nurse is assessing a male client after 24

hours following a cholecystectomy. The nurse
noted that the T tube has drained 500 mL of
green-brown drainage since the surgery. Which
nursing intervention is appropriate?

a. Clamp the T tube

b. Irrigate the T tube

c. Notify the physician

d. Document the findings

Rationale: because 500ml is normal within 24

hours

29. During abdominal examination, the nurse

notices bluish discoloration at the periumbilical
area. This indicates pancreatic bleeding and is
referred to as:

a. Grey-Turner's sign

b. Cullen's sign

c. .Battle's sign

d. Kernig's sign

Rationale Battle signs- basilar skull structure

Grey-Turner's sigb- flank area Kernig's sign-
meningitis

30. An ineffective nursing measure to prevent

the progress of hepatic coma is:

a. Giving diuretics

b. Making certain that a low-protein diet is

served
CA1 S DAY 3 hyperglycemia may cause
dehydration secondary to polyuria)
MA. RIO SANTOS
b. Deficiency Knowledge:
1. A client with hypoglycemia due to DM Disease Process and treatment-
type 2 will manifest which of the following (there is nothing in the situation that
tells the patient has a deficient
a. Dehydration knowledge)
b. Hypertension c. Imbalanced nutrition: Less than
c. Tremor body requirement- (it cannot be the
answer because we need more than
d. All of the above body requirement not less)

ANSWER AND RATIONALE d. Disabled Family Coping:

Compromised
a. Dehydration- (is the
manifestation of hyperglycemia, that 3. A nurse develops a plan of care for a
may cause polyuria which will cause client with hyperthyroidism and includes
dehydration which of the following in the plan?

) a. Provide small meals

b. Hypertension- (is also a b. Provide extra blankets

hyperglycemia when there is too
much glucose in the blood attracts c. Provide high fiber diet
water so there will be hypervolemia d. Provide a restful environment
and hypertension) and this the
manifestation of hyperglycemia ANSWER AND RATIONALE
c. Tremor- (hypoglycemia is it can be a. Provide small meals- (if you
due to take any medication like want to provide the best diet for the
insulin and it can cause patient is have high caloric intake
hypoglycemia. And it has a s/s of because the patient is using too
tachycardia, pallor, diaphoresis, much calories already because of
tremors, dizziness and syncope) higher metabolic rate)
DM- metabolic disease, Mgt: good glucose b. Provide extra blankets- (the
control patients very feel hot already
because when the body does that
- the particular hormone is the problem in with the used glucose source of
patient with DM it is insulin that decrease energy you will release heat this is
glucose level in the blood lack insulin called DM the reason why the hall mark of
type 1. But the defective insulin, decrease hyperthyroidism is heat intolerane.)
insulin release and insensitivity of cells to
insulin call DM type 2. c. Provide high fiber diet- (the risk
increase of sympathetic response is
2. A nurse is preparing a care plan for a tachycardia and the risk increase of
client with DM who has hyperglycemia. The GIT function is the patient may
priority nursing diagnosis would be: manifest diarrhea and weight loss,
a. High risk for deficiency fluid you are using glucose as a source of
volume energy so there is no need to restore
glucose as fats so the patient will
b. Deficiency Knowledge: have weight loss, and if the patient
Disease Process and treatment having a diarrhea we cannot also
provide high fiber diet)
c. Imbalanced nutrition: Less than
body requirement d. Provide a restful environment-
(the risk increase metabolism so
d. Disabled Family Coping: even the CNS increase function so
Compromised the patient will be irritable and
restless)
ANSWER AND RATIONALE
T3- Tri- iodothyronine
a. High risk for deficiency
fluid volume- (Patient has T4- Tetra- iodothyronine (thyroxine)
hyperglygemia and we all know that
- T3 and T4 control the rate by which glucose d. Administer thyroid hormone
is used by the cells as source of energy.
Increase T3/T4 may cause hypermetabolic rate ANSWER AND RATIONALE
and the Decrease T3/T4 may cause
hypometabolic rate. a. Warm the client

- The patient with hyperthyroidism the risk b. Administer fluid replacement

increase rate even if the patient not doing c. Maintain an airway-
anything, just sitting down or lying down the (myxedema can actually accumulate
patient is doing nothing, the body is at least in other organs of the body like the
have glucose that the source of energy heart and even in the brain so this is
- Iodine- is needed for production of thyroid can up to lead to slowing down the
hormones and it is restored in the thyroid gland metabolism so that can be
and if there are leading in an area where the myxedema coma) and if the patient
less iodine in food the thyroid gland will is in coma we need to maintain the
compensate to be able to produce more than airway
amount of T3 and T4 the thyroid gland enlarges d. Administer thyroid hormone
itself so it can be store a lot of iodine. The
enlargement of the thyroid gland is called goiter Myxedema- is the clinical manifestation of
and the most common of goiter is iodine hypothyroidism no other condition will cause
deficiency. myxedema except hypothyroidism.
4. A client has just been diagnosed with - Myxedema= mucinous edema
Grave’s disease. Client’s education needs to
include which of the following? - Mucin= polysaccharides, and poly is actually
carbohydrates, now in patient with
a. Atropine-like medication hypothyroidism the body will help decrease the
rate by which the glucose is used by the cell as
b. Thyroid hormone replacement a source of energy.
c. A low calorie diet 6. The nurse should assess for which of
d. Propylthiouracil (PTU) the following clinical manifestations in the
client with Cushing’s syndrome?
ANSWER AND RATIONALE
a. Hypertension, diaphoresis,
a. Atropine-like medication nausea and vomiting

b. Thyroid hormone replacement b. Tetany, irritability, dry skin, and

seizure
c. A low calorie diet
c. Unexplained weight gain,
d. Propylthiouracil (PTU)- (the energy loss, and cold intolerance
clients education needs to include is
we need to decrease the production d. Water retention, moon face,
of T3 and T4. PTU will decrease the hirsutism and purple striae
synthesis of T3 and T4)
ANSWER AND RATIONALE
Grave’s disease- is the most common cause of
hyperthyroidism. But before you consider the a. Hypertension, diaphoresis,
hyperthyroidism as grave’s disease you need to nausea and vomiting- (cushing
consider this following: syndrome can cause hypertension
because aldosterone will cause
a. Enlarge gland sodium and water retention but it is
not causing diaphoresis, nausea and
b. Thyrotoxicosis vomiting)

c. Exopthalmus b. Tetany, irritability, dry skin, and

seizure- (and also it is not causing
5. A client id admitted to an emergency the answer above hehe)
room, and a diagnosis of myxedema coma is
made. Which action would the nurse carry c. Unexplained weight gain, energy
out initially? loss, and cold intolerance- (there
is weight gain and the weight gain is
a. Warm the client secondary to malteposition of fats
but there is no cold intolerance
b. Administer fluid replacement because it is the secondary of
c. Maintain an airway hypothyroidism)
 d. Water retention, moon face, b. Increase urine specific gravity-
hirsutism and purple striae- (it is (water retention stays in blood and it
the best answer because may lead to decrease water in the
aldosterone will increase sodium urine so the urine becomes
and water retention, moon face is concentrated therefor there is a
secondary malteposition of fats), increase urine specific gravity)
hirsutism is secondary increase
androgen and purple striae) c. Bipedal edema- (only
SIADH will give you least lightly
Cushing syndrome- the problem is over secretion bipedal edema, meaning the
with the hormone of adrenal cortex: cortisol, increase of water or the blood
aldosterone, and androgen. volume concentrates inside the
blood vessel so peripheral edema is
7. In an individual with the diagnosis of least lightly seen in client with
hypoparathyroidism, the nurse assess for SIADH)
which of the following symptoms
d. No exception
a. Fatigue, muscular weakness
ADH- also called vasopressin because it has to
b. Cardiac arrhythmias action:
c. Tetany - Kidneys- water retention
d. Constipation - Blood vessels- vasoconstriction
ANSWER AND RATIONALE SIADH- is over secretion, and the most common
cause of over secretion is tumor.
a. Fatigue, muscular weakness
Over secretion-> Water retention-> Hypervolemia->
b. Cardiac arrhythmias Hypertension
c. Tetany- (in peripheral nurse the 9. A daily dose of prednisone is prescribed
patient will manifest paresthesias, for a client regarding administration of the
and also be increase the impulse medication. The nurse instructs the client
transmission from the nerve to the that the best time to take this medication is:
muscle and will have tetany
(Chovstek’s sign, carpopedal a. At bedtime
spasm)
b. At noon
d. Constipation
c. Early in the morning
Parathyroid hormone- regulates the level calcium
in the blood, increases serum Ca, over secretion is d. Anytime, at the same time each
hyperPTH and there is hypercalcemia and under day
secretion is hypoPTH there is hypocalcemia.
ANSWER AND RATIONALE
Hypothyroidism->Hypocalcemia->Increase
irritability-> Increase impulse transmission a. At bedtime

8. A client with SIADH is admitted in the b. At noon

hospital and the nurse recognize the
common signs and symptoms to the include c. Early in the morning- (Because
of the following, except prednisone is the synthetic form of
cortisol and this is hormone. And the
a. Hypertension pattern of cortisol release is diurnal
pattern. And it is very low at night.
b. Increase urine specific gravity Because cortisol has anti stress
property this is our hormone for
c. Bipedal edema stress)
d. No exception d. Anytime, at the same time each
day
ANSWER AND RATIONALE
10. A nurse is assessing the lab data of the
a. Hypertension- (the over client diagnosed with cushing’s syndrome.
secretion may lead to water The nurse would expect to note which of the
retention and water retention will following laboratory values prior to initiation
cause hypervolemia and it can of drug therapy?
cause hypertension)
 a. Elevated plasma cortisol level - And when there is increase water loss it will
cause decrease water in the blood-> increase
b. Decreased blood glucose level serum concentration (increase serum
osmorality)
c. Decrease WBC count
12. A female adult client with a history of
d. Decreased sodium level chronic hyperparathyroidism admits to
ANSWER AND RATIONALE being non- compliant. Based on initial
assessment findings, the nurse formulated
a. Elevated plasma cortisol the nursing diagnosis of Risk for injury. To
level- (because is that what cushing complete the nursing diagnosis statement
for, when there is increase cortisol for this client, which “related to” phrase
the level of glucose will increase, should the nurse add?
patient with cushing will also have
hyperglycemia and patient with a. Related to bone
hypergly is will have s/s of DM) demineralization resulting in
pathologic fractures
b. Decreased blood glucose
level- (the glucose will be high b. Related to exhaustion
instead of low) secondary to an accelerated
metabolic rate
c. Decrease WBC count- (this is not
diagnostic of cushing) c. Related to edema and dry skin
secondary to fluid infiltration into
d. Decreased sodium level the interstitial spaces

11. After a traumatic brain I jury, client d. Related to tetany secondary to a

produces more than 200ml of urine in an decreased serum calcium level
hour, Diabetes insipidus is being
considered, the nurse should closely ANSWER AND RATIONALE
monitor which of the following as sign of a. Related to bone
this condition demineralization resulting in
a. Increase urine specific gravity pathologic fractures- ( PTH-
Increase osteoclast activity so there
b. Increase serum osmolality is own resorption and the become
very weak that may result to
c. Hypertension pathologic fracture).

d. Cerebral edema b. Related to exhaustion

secondary to an accelerated
metabolic rate

c. Related to edema and dry skin

secondary to fluid infiltration into
ANSWER AND RATIONALE
the interstitial spaces
a. Increase urine specific
d. Related to tetany secondary to a
gravity- (the patient will have
decreased serum calcium level
decrease urine specific gravity)
Increase PTH-> Increase calcium in the blood
b. Increase serum osmolality- (the
(hypercalcemia)
blood becomes concentrated
because of lack of water) 13. The nurse is admitting a patient diagnosed
with type 2 diabetes mellitus. The nurse
c. Hypertension- (the will have
should expect the following symptoms
hypotension because there is
during an assessment, except:
decrease water in the blood and it’s
hypovolemia can lead to a. Hypoglycemia
hypotension)
b. Frequent bruising
d. Cerebral edema- (the brain
cells will not swell, the brain cells will c. Ketonuria
shrink)
d. Dry mouth
What happened is?
ANSWER AND RATIONALE
lack of ADH-> increase water loss-> increase
water in the urine-> low urine specific gravity
 a. Hypoglycemia- (The DM ANSWER AND RATIONALE
type is characterized by
hyperglycemia and it will cause a. Increased appetite and
dehydration) weight loss- ( it is associated in
hyperthyroidism)
b. Frequent bruising- (it is also
symptoms of type 2 DM) b. Puffiness of the face and
hands- (Sabi lang ni doc this is the
c. Ketonuria- (since the patient has best answer hehe)
type 2 DM the release of ketone
bodies usually happen in type 1 DM c. Nervousness and tremors- (it is
and ketonuria or diabetes keto sympathetic effect and it is also
acidosis will lead slightly cause in associated in hyperthyroidism)
type 2 DM)
d. Thyroid gland swelling- (IT IS
d. Dry mouth- (dehydration may GOITER!! It can be hyper or hypo)
cause dry mouth)
16. A female client with hypothyroidism
14. A nurse provides instruction to a client (myxedema) is receiving levothyroxine
regarding the administration of the (Synthroid), 25mcg P.O daily. Which finding
prednisone and instruct the client that the should nurse Hands recognize as an
best time to take the medication is during? adverse drug effect?

a. Before breakfast a. Dysuria

b. After breakfast b. Leg cramps

c. Evening c. Tachycardia

d. Before bedtime d. Blurred vision

ANSWER AND RATIONALE ANSWER AND RATIONALE

a. Before breakfast- (IT IS WRONG a. Dysuria

LOL)
b. Leg cramps
b. After breakfast- (prednisone or
cortisol has increase HCL acid c. Tachycardia- (this is clinical
production and too much of cortisol manifestation of hyperthyroidism and
may result to GI toxicity and cortisol it is has adverse effect)
may increase osteoclast activity) d. Blurred vision
c. Evening- (Because prednisone is - Patient with hypothyroidism is given thyroid
the synthetic form of cortisol and this hormones so adheres effect with P1 primary
is hormone. And the pattern of when you overdosed it you manifest
cortisol release is diurnal pattern. hyperthyroidism.
And it is very low at night. Because
cortisol has anti stress property this - Levothyroxine- best time to give is morning
is our hormone for stress) because this is required for us to use glucose
as a source of energy.
d. Before bedtime-
(SYEMPRE GANON DEN YUNG 17. The nurse is aware that the following is the
EXPLANTION SA EVENING most common cause of
HAHAHAAH) hyperaldosteronism?
15. Nurse Oliver should expect a client with a. Excessive sodium intake
hypothyroidism to report which health
concerns? b. Pituitary adenoma

c. Deficient potassium intake

a. Increased appetite and weight d. Adrenal adenoma

loss
ANSWER AND RATIONALE
b. Puffiness of the face and hands
d. Adrenal adenoma- (this is the most
c. Nervousness and tremors common cause of over secretion of
hormone is tumor)
d. Thyroid gland swelling
18. Hydrocortisone given IV is the proper c. Hypernatremia, hyperkalemia,
treatment for which of the following hyperchloremia
disease?
d. Hyponatremia, hypokalemia,
a. Addison’s disease hypochloremia

b. Cushing syndrome ANSWER AND RATIONALE

c. Hyperthyroidism c.Hypernatremia, hypokalemia,

hypochloremia
d. Hypoparathyroidism
So the problem this is electrolyte that may cause
ANSWER AND RATIONALE Increase aldosterone-> increase sodium and
decrease potassium
a. Addison’s disease-
(PATIENT IS NOT STEROID!!! Why increase potassium? Because aldosterone
Addison’s disease is also called increase sodium reabsorption, increase water
adrenal insufficiency this lack of reabsorption that it will take decrease potassium
aldosterone, cortisol and androgen reabsorption.
this is what they called addisonian
crisis) 21. The nurse evaluates no need for further
instruction for self-care for patient with
19. A nurse is caring for Aling Magda, a client cushing syndrome who states:
with a diagnosis of Cushing’s syndrome.
The nurse plans which of these measures to a. “I know I should have salt to
prevent complications from this medical everything I eat.”
condition?
b. “I make a point to avoid
a. Monitoring glucose levels excessive exposure to sun.”

b. Encouraging daily jogging c. “I avoid to being exposed to

anyone with an infection.”
c. Monitoring epinephrine levels
d. “I am careful to wear well fitted
d. Encouraging visits from friends shoes.”
ANSWER AND RATIONALE ANSWER AND RATIONALE
a. Monitoring glucose levels- a. “I know I should have salt to
(because patient with cushing will everything I eat.”
have increase cortisol and increase
glucose level that may lead to b. “I make a point to avoid
hyperglycemia) excessive exposure to sun.”

b. Encouraging daily jogging c. “I avoid to being exposed to

anyone with an infection.”-
c. Monitoring epinephrine levels- (because cortisol has a property to
(cushing will not increase decreased WBC function so the
epinephrine levels this is something patient will become susceptible to
to do with adrenal medulla not infection and become
adrenal cortex) immunosuppressed)
d. Encouraging visits from friends d. “I am careful to wear well fitted
shoes.”
Cushing’s syndrome- is over secretion, too much
cortisol, too much aldosterone and too much 22. A 40 year old female client with
androgen. hyperthyroidism is taking propylthiouracil
(PTU) for 6 months now. The nurse should
20. The nurse caring for Aling Magda with monitor the client foe the most serious and
cushing’s syndrome anticipates that which toxic side effect of PTU, which is:
of the following electrolyte in balances will
be seen in the laboratory result? a. Autonomic dysfunction
a. Hyponatremia, hyperkalemia, b. Agranulocytosis
hyperchloremia
c. Pruritus
b. Hypernatremia, hypokalemia,
hypochloremia d. Constipation

ANSWER AND RATIONALE

 a. Autonomic dysfunction a. Hydration

b. Agranulocytosis- (PTU- is a very b. Insulin administration to lower

nice drug so the primary adverse blood glucose below 200md/Dl
effect is hypothyroidism but one
toxic serious effect is c. Sodium bicarbonate drip
agranulocytosis it may affect our
WBC) d. Potassium administration

c. Pruritus

d. Constipation

23. The nurse is caring for a client who has a

thyroidectomy and is at risk for
hypocalcemia. What should the nurse do?

a. Monitor laboratory values daily

for an elevated thyroid-
stimulating hormone

b. Observe for swelling of the

neck, tracheal deviation and
severe pain

c. Evaluate the quality of the

client’s voice post- operatively,
noting any dratic changes

d. Observe for muscle twitching

and numbness or tingling of the
lips, fingers and toes

ANSWER AND RATIONALE

a. Monitor laboratory values daily

for an elevated thyroid-
stimulating hormone

b. Observe for swelling of the

neck, tracheal deviation and
severe pain

c. Evaluate the quality of the

client’s voice post- operatively,
noting any dratic changes

d. Observe for muscle twitching

and numbness or tingling of the
lips, fingers and toes- (this is the
sign and symptoms of
hypocalcemia)

24. Head trauma, brain tumor, or surgical

removal of the pituitary gland can lead to
which of the following conditions?

a. Addison’s disease

b. Cushing syndrome

c. Diabetes insipidus

d. Hypothyroidism

25. What is the priority nursing management

for patient suffering HHNKS?
CA1 MS DAY 4 to discriminate pain caused by the non-cardiac
(Eaiza Marie Enrile) problem?

A."have you ever had this pain before?"

MS-4
B. "can you describe the pain to me?"
1. The most definite diagnostic test for myocardial
ischemia is C. "does the pain get worse when you breathe in?"

A. ECG ST elevatiom D. "can you rate the pain on the scale of 1-10, with
10 being the worst?"
B. CK MB elevation
Ans: C
C. Elevated CRP
Notes: MI pain- constant - not affected by breathing
D. Troponin elevation or movement of the chest

Ans: A.ECG ST elevation -more 30 min

Notes: 2type of MI -no relieving factors

1. STEMI- ST elevation MI 4. A client has developed artirial fibrillation, with

ventricular rate of 115 beats per minute. A nurse
2.NSTEMI- Non ST elevation MI assesses the client for:

-cardiac markers= troponin/ckmb A. Hypotension and dizziness

MI- ischemia and necrosis of cardiac cells >30 mins B. Nausea and vomiting
(pain)
C. Hypertension and headache
AP- imbalance bet 02 supply and cardiac workload
D. Flat nech veins
Most indicative enzyme-CKMB isoenzyme
Ans: A
Most reliable/sensitive/important blood-troponin
Note:AR < 300/min

Afib- controlled if the VR is normal

Myocardial ischemia= angina pectoris= <15
min(pain) Ventricles-> dec CO -> dec BP -> dec tissue
perfusiom
Pectoris- ECG=T wave inversion

5. A nurse is caring for a client with a diagnosis of

2. The nurse knowna that the initial manifestation of myocardial in fraction not lion called the nurse
left sided heart failure is because the client is experiencing chest pain the
nurse administers sublingual nitroglycerin tablet as
A. Bipedal edema prescribed. The chest pain is unrelieved by the
nitroglycerin. The next nursing action is which of
B. Progressive cough the following.
C. Orthopnea A. Administer another nitroglycerin tablet
D. Cyanosis B. Increase the flow rate of the oxygen.
Ans: B. Progressive Cough C. Contact the physician
Notes: C. Orthopnea= diff of breathing in supine D. Call the client's family
position
Ans: A

Notes:Can administer nitroglycerin 3x every 5mins

6. The nurse is admitting a 69-year old man to the

3. A client with no history cardiovascular disease clinical unit. The client has a history of left
comes to the ambulatory clinic with fluid symptoms. ventricularenlargement. During the assessment the
The client suddenly complains of chest pain. Which nurse notes +3 pitting edema of the ankles
of the following questions would best help a nurse bilaterally. The client doesnot have chest pain. The
nurse observes that the client does have dyspnea C. Client expression of relief
at rest. The nurse infers that theclient may have
D. Clearly audible heart sounds
a. Arteriosclerosis
Ans: A
b. Congestive heart failure
Notes:- obstructive shock, decrease bp, muffled
c. Chronic bronchitis Heart sound = beck's triad

d. Acute myocardial infarction 10. You are caring for a man with pericarditis his
systolic pressure begins to fall a heart sounds
Ans: B cannot be here nurse would

Notes: B – peripheral edema is a symptom of A. Do pericardiocentesis

congestive heart failure. Congestive heart failure
results when theheart chronically pumps against B. Prefer to the physician
increased resistance or is unable to contract
forcefully to pump the blood out intothe systemic C. Monitor bp again after 15 minutes
circulation. As a result, the ventricles become
overfilled and there is an accumulation of D. Scream
volumewithin the closed system. The client’s
symptoms do not indicate arteriosclerosis, chronic Ans: B
bronchitis, or acute MI.
11. A nurse evaluates a patient after
7. Toxicity from which of the following medications pericardiocentesis for cardiac tamponade which of
may cause a client to see a green halo around the following observation would indicate that the
light? procedure was unsuccessful

A. Digoxin A. Rising central venous pressure

B. Furosemide B. Rising blood pressure

C. Metoprolol C. Client expression of relief

D. Enalapril D. Clearly audible heart sounds

Ans A Ans:A

Notes:Digoxin- cardiac glycoside 12. A client with copd is asking the nurse the best
method to prevent infection in the lungs, the nurse
Metoprolol-beta blocker responds

Enalapril-ace inhibitor A. Avoid going to the crowded places

Furosemide-diuretic B. Increase your awareness to symptoms of

infection

C. Vaccination can prevent pneumonia

8. The nurse attempt to allay the anxiety of client
with congestive heart failure because restless D. Stay at home most of the time

A. Increase cardiac workload Ans: C best answer

B. Interfere with normal respiration Notes:COPD patient is immunocompromised, they

are suseptible to infection
C. Produce a elevation of temperature
13. Risk factor for emphysema includes
D. Decrease the amount of oxygen available
A. Smoking, hereditary, allergy
Ans: A
B. Secondhand smoking, environment pollutants,
9. A nurse evaluates a patient after hereditary
pericardiocentesis for cardiac tamponade which of
the following observation would indicate that the C. Smoking, age,gender, stress
procedure was unsuccessful
D. Environment,pollutant, rece, hypertension
A. Rising central venous pressure
Ans: B
B. Rising blood pressure
Notes: etiology C. Anxiety related to disease prognosis

1.pollutans-smoking D. In effective myocardial tissue perfusion related

to imbalance ventilation and perfusion ration
2 chronic asthma-> emphysema
Ans: B
3. Alpha 1 antitrpsin deficiency (hereditary)
Notes: ABC rule
14. A client with acute exacerbation of bronchial
asthma would have which of the following 17. A client with tension pneumothorax is an
laboratory test result emergency room, as an er staff the priority for client
is to prevent
A. Decrease sign capacity
A. Impaired gas exchange related to collapse
B. Decrease expiratory flow rate lungs
C. Decrease residual volume B. Decreased cardiac output due to the medicinal
shifting
D. Decrease airway resistance
C. Severe cyanosis
Ans: B
D. Distributive shock
Notes: bronchospasm- during expiration
Ans: B
Instrument to assess the degree of obstruction
-Peak flow meter 18. A client with bronchial asthma is taking
bronchodilators and prednisone for mounth, since
he is not having difficulty of breathing he asked the
nurse if you can stop prednisone the nurse is
-> dex expirtion volume correct in saying that
Decrease sign capacity =total vol of air maximally A. Prednisone must be continuous to prevent future
inhaled and maximally exhaled attack
Decrease expiratory flow rate = vol of air exhaled B. Sudden withdrawing of steroid can cause
rebound hyperfunctioning of the gland
Decrease residual volume= vol of air left in the
lungs after forceful expiration C. Prednisone must be tired to prevent adrenal
insufficiency

D. The doctor decide on whether prednisone must

be continuous or not
15. The nurse prepare which of the following
Ans: C
inclined with acute exacerbation of bronchial
asthma
19. A client with Acute Respiratory Distress
A. Bronchodilator Syndrome is in danger of acute respiratory
failure, which parameters would indicate that
B. Steroids inhalant such a patient needs a mechanical ventilator?

C. Abtibiotic a. pCO2 = 50
b. p02 = 70
D. O2 therapy c. 02 sat = 80%
d. pH 7.30
Ans:B
Rationale: Respiratory failure is a clinical condition
Notes: Bronchodilator dilate normal vessels that happens when the respiratory system fails to
maintain its main function, which is gas exchange,
16. Bronchiectasis is complication of chronic in which PaO2 is lower than 60 mmHg and/or
bronchitis, which of the following is priority nursing PaCO2 higher than 50 mmHg
diagnosis for this problem?
20. Which of the following conditions
A. Risk for infection related to present of mucus in predispose the client to pulmonary embolism?
the dilated airway
a. Clients who are undergoing physical
B. Ineffective airway clearance related to presence
rehabilitation after stroke
of pulmonary secretion
b. Clients who eat cholesterol and fats
c. A client with a unilateral hip spica cast
 d. Post op patient for discharge d. Increased appetite

Rationale: If you wear a plaster cast or brace for Rationale: Fluid buildup in the feet and legs, known
several days or weeks, the blood flow through your as pedal edema, is a common early sign of heart
veins is slower than if you can move normally. This failure.
increases the risk of a blood clot forming in a leg or
pelvic vein. Blood clots may end up blocking veins, 25. Which of the following would be an
preventing blood from flowing through them appropriate expected outcome for an adult
properly. client with well controlled asthma?

21. While assessing the chest tube drainage a. Chest x-ray demonstrates minimal
system of a client, the nurse observes a slight hyperinflation
rise and fall in the water level in the water seal. b. Temperature remains lower than 100°F
Does the nurse take the following actions? (37.8°C)
c. Arterial blood gas analysis demonstrates a
a. Notify the physician immediately decrease in Pa02
b. Have the client cough d. Breath sounds are clear
c. Continue to monitor the system
d. Reposition the chest tube Rationale: the characteristic breath sound is
whizzing
Rationale: Such finding is normal and second bottle
is normal functioning

22. In educating a group of clients with

pulmonary disorders about the use of
pursed-lip breathing, the nurse is asked how
this technique helps them to breathe, the best
response would be that pursed-lip breathing:

a. Improves lung expansion

b. Reduces anxiety that increased oxygen
demand
c. Keeps airway open
d. Helps the client regain control of the attack

Rationale: short expiratory phase> alveoli collapse

About pursed lip breathing > The prolonged
expiratory phase > prevent collapse > keep the
help airway open

23. Which of the following needs immediate

medical attention and emergency intervention?
the client who:

a. Complains of sharp pain upon taking a deep

breath and excessive coughing
b. Exhibits yellow, productive sputum,
low-grade fever and crackles
c. Has a shift of the trachea to the left, with no
breath sounds on the right
d. Has asthma, and complains of inability to
"catch her breath" after exercise

Rationale: It is the most priority and needs

immediate action because the pressure increases
resulting to tension pneumothorax

24. The nurse teaches a client with COPD to

assess for signs and symptoms of right sided
heart failure. Which of the following signs and
symptoms should be included in the teaching
plan?

a. Clubbing of nail beds

b. Peripheral edema
c. Hypertension
MS DAY 5: 🐱 Chrisanto Arzanan 🐱 - absence of vascular tone → smooth
muscle relaxation (dilatation) →
hypotension (low bp).
- Distributive / Circulatory shock =
OXYGENATION caused by massive vasodilation

Oxygenation = gas exchange. Causes of severe vasodilation:

6 types of the body that’s responsible for the ● Infection – infection → inflammation →
oxygenation of the body: (kulang) vasodilation → Septic shock
● Allergies → inflammation → vasodilation →
● Hematologic system – RBC carries Anaphylactic shock
oxygen. ● Spinal cord injury → inflammation →
- Anemia - decreased O2 carrying vasodilation and loss of sympathetic
capacity of the blood. response → Neurogenic shock

● Respiratory sys. – responsible for gas Distributive shock:

exchange.
- Hypoxemia - Decrease O2 in the ● Septic
blood. ● Anaphylactic
● Neurogenic
● Cardiovascular sys. – responsible for
distributing oxygenated blood to the tissues Capillaries = exchange vessels and not capable of
or tissue perfusion. distributing blood; made out of “tunica intima only”
- Ischemia - decreased tissue
perfusion

All of them will lead to “HYPOXIA” – decrease O2 PERIPHERAL VASCULAR DISEASES (PVD)
in the tissue.
Peripheral vascular diseases – small and
medium sized arteries and veins; usually affect the
upper and lower extremities.
3 components of cardiovascular sys:
3 classifications of PVD: (All are common in lower
● Blood extremities except for Reynaud’s disease).
- blood vol = 5 to 6L
- decrease blood vol → tissue ● Arterial insufficiency (Peripheral Arterial
perfusion → hypovolemic shock. Disease = PAD)
- shock = inadequate tissue perfusion
2 classification of PAD:
● Heart Arteriosclerosis Raynaud’s disease
- dec pumping ability of the heart → obliterans (ASO) (also known as
dec tissue perfusion → cardiogenic Blue-White-Red
shock. Disease)
- causes: Etio:
coronary causes, non-coronary Etio: unknown but associated w/
causes, and obstructive shock. arteriolar vasospasm
Idiopathic
- Vasospasm → tip of
- obstructive shock = compression
fingers/hands → bluish
of the heart / cardiac tamponade / RF: discoloration
tension pneumothorax Age (60 and above), male,
smoking, obesity, - Severe vasospasm →
● Blood vessels sedentary lifestyle, DM and white coloration on tip of
- arteries – carries o2 blood HPN the fingers
- veins – carries deoxy blood
RF:
- Arteries and veins are lined by exposure to cold temp.,
smooth muscles. women, smoking, HPN,
- smooth muscle relax = blood vessels stress
dilate
- smooth muscle contract = blood - reversible → increase in
vessels constrict blood flow → more red
than usual
- Vascular tone = dilation and
constriction of veins and arteries.
 - inflammation and thrombus
formation affecting the small and
● Venous insufficiency medium sized arteries and veins.
- Irreversible
2 classifications of Venous Insufficiency: - affects lower extremities
Varicose veins Deep vein
thrombosis (also Etiology:
known as Venous
- Idiopathic (unknown)
thromboembolism)
Risk factors:
- affects the superficial - stasis stagnation – dec
veins of the lower blood flow → blood
extremities become hypercoagulable
- smoking, young men
→ endothelial injury
- dilatation and tortuous Most important health teaching:
formation of the veins in
- can develop to pulmonary
the LE
embolism - Smoking cessation
Etio:
- the pt will have dyspnea, Symptoms:
incompetent valves
tachypnea, chest pain
Health teaching: - leg pain and claudication, dark skin, and
What to do first? Position
avoid the RF and wear
compression stockings
pt in semi fowlers, edema
administer o2, and refer to
the physician
RF:
prolonged standing,
Etio:
prolong sitting, crossing of ARTERIAL AND VENOUS INSUFFICIENCY
Unknown
legs, obesity, pregnancy
RF:
- medical management:
- immobilization
Sclerotherapy – a chemic
- Virchow’s triad = triad of
is inserted to harden the
veins; vein stripping and
possibility of thrombus Arterial Insufficiency Venous Insufficiency
formation
ligation.
2 types of DVT: Leg pain: Leg pain:
a. Thrombophlebitis –
inflammation and thrombus
- not enough function of the - Venous congestion –
formation.
arteries in the lower cause of pain in venous
- pain, redness, heat
extremities. insufficiency
b. Phlebothrombosis –
no inflammation. - not enough oxygenated - another possible cause is
- asymptomatic until blood going into the lower “Phlebitis” (inflammation of
sudden onset of leg pain. extremities. the pain)

Diagnosis: - Most common complaints - less severe and no

- Homan’s sign = of the patient are “leg claudication
dorsiflexion the foot and pain”.
pain are felt at the calf
area - Ischemia – cause of leg
- Angiography pain, the reason why the leg
- Doppler or duplex pain in arterial insufficiency
ultrasound is “severe and associated
with claudication”.
Management:
- Thrombolytic drugs - Claudication – more pain
(Urokinase, Streptokinase, when walking
Alteplase)
- anticoagulant Nsg Dx for leg pain with VI:
Nsg Dx for leg pain with AI: Acute pain related to
- antiplatelet Acute pain related to
- compression stocking = ineffective venous circulation
ineffective tissue perfusion
(Thromboembolic deterrent
hose) Skin pulses:
Skin pulses:
- dark, cyanotic, pigmented,
- pale, cool to touch, pulses are normal BUT
thinning of hair, abnormal difficult to palpate due to
pulses, no edema edema

Vascular ulcer: Vascular ulcer:

● Buerger’s disease (also known as - Arterial ulcer – small but - venous ulcer – larger w/
Thromboangitis Obliterans) deep w/ well circumscribed irregular borders, several
edges, w/ no or little granulation tissues
surrounded by dark skin
 granulation tissues cause of - positioning: Orthopneic position (sitting or
this is ischemia leaning forward)

Independent nursing Independent nursing What is the most definitive diagnostic test in
intervention: intervention: pericarditis?
- position the leg in reverse - elevate the leg
Trendelenburg - 2D echocardiography

- dependent position Another diagnostic test include:

- Chest x-ray, inc WBC, Elevated Erythrocyte
Sedimentation Rate (ESR)
- Culture and Sensitivity - most definitive
INFLAMMATORY HEART DISEASE diagnostic test for infection.
- Coronary angiography – for MI
- Antinuclear antibody test (ANA test) – for
SLE
3 layers of the heart: - Biopsy/Cytology – if it is malignancy

● Endocardium → inflammation → Constrictive Pericarditis – compression of the

endocarditis heart
● Myocardium → inflammation →
myocarditis Management
● Epicardium/visceral pericardium →
inflammation → pericarditis - Independent → positioning → orthopneic
● Parietal pericardium – another cover of - Pain relievers (NSAIDs)
the heart - Anti-inflammatory – Steroid
- Manage the cause
PERICARDITIS - Prevent and manage complications

Pericarditis – inflammation of pericardial sac Possible complications:

Causes: - Pericardial effusion – accumulation of fluid

in the pericardial sac
- Infection - Cardiac tamponade – life threatening
- Trauma complications characterized by too much
- MI – induced pericarditis fluid in the pericardial sac that the heart
- SLE cannot pump anymore à cardiogenic
shock (obstructive shock)

- Pericardiocentesis – aspirating fluid from

Etio: the peri-sac
- X-ray guided, ultrasound guided, and ECG
- Idiopathic guided during pericardiocentesis
- Malignancy
- Beck’s triad:
Prominent sign: - Hypotension
- Venous distension
- Friction rub: - Muffled heart sounds
- assessed by auscultate at the 4th intercostal
left parasternal area → scratching and
leathery sound, creaky sound heard best at ENDOCARDITIS
the end of expiration and when pt is sitting
and leaning forward. Endocarditis – inflammation of endocardium

Prominent symptom: Infective endocarditis: (most common type of

endocarditis)
- Pain Etio:
- chest pain characterized by pain that - Bacterial infection
worsens w/ deep inspiration, lying down, or
turning and relieved by sitting and leaning Signs and Symptoms:
forward.
- Systemic inflammation
Priority nursing intervention: - Intermittent fever
- Weakness
 - Malaise Medical management:
- (+) changes in murmurs
- Dec cardiac output → hypotension - Prevention (it is a medical management for
- Hemorrhage of retinal vessels with pale endocarditis)
centers called “Roth’s Spot”. - Prophylaxis
- Osler’s nodes – painful nodules in - Penicillin
fingertips and toes - Erythromycin
- Janeway lesions – painless macules on - Antibiotic
palms and toes - Antipyretic
- Splinter hemorrhages – brownish streaks - Drugs to support cardiac function
in fingernails and toenails - Manage heart failure
- Prevent and manage shock
Mnemonic: FROMJANE

- Fever
- Roth’s spots
- Osler’s nodes
- Murmur changes
- Janeway lesions
- Anemia
- Nail changes
- Ecchymosis/Embolization

RF:

- Pt has an existing cardiac disease

- Pt is immunocompromised
- Any invasive procedure or surgery

Causes:

- Group A Beta Hemolytic Streptococci

- Staphylococci
- Bacteria → entrer blood → Bacteremia –
bacteria proliferate in the blood → stasis –
stagnation → hypercoagulable →
endothelial injury → thrombus formation →
microthrombi (small thrombus) =
vegetations

- Embolus – when microthrombi gets

dislodged à blocking of the blood vessels
(Embolization).
- Pulmonary embolism – if they block
pulmonary vessels
- Cerebral embolism – if they block cerebral
vessel

Most definitive diagnostic test:

- Culture and Sensitivity

- CBC
- 2D echocardiography – to see thrombi
- Elevated ESR – will only tell us that there is
systemic inflammation

Nursing management:

- Manage fever
- Assess for changes in murmur → auscultate
every shift
- Monitor vs
- Provide rest - to support cardiac function
- Avoid stress
Medical Surgical 1 DAY 6 (CA1) b. Refer to the physician
c. Place the lower extremities on 2 pillows
(JOHN HARVEY P. PEREZ) d. Get the Ecart

CARDIOVASCULAR QUESTIONS Rationale: Modified Trendelenburg position (pooling

the blood back)
1. The nurse knows that the possible cause of
angina pectoris is 5. A 23-year-old nursing student complains
of palpitation, chest pain and easy fatigability.
a. Dysrhythmias triggered by stress After a thorough work up, she is diagnosed to
b. Coronary vasospasm have Mitral valve prolapse. This client should
c. Minute emboli through the narrowed lumen avoid which of the following?
of the coronary vessels
d. Spasms of the vessel walls owing to a. high volumes of fluid intake
excessive secretion of epinephrine b. aerobic exercise programs
c. caffeine-containing products
Rationale: Angina pectoris imbalance bet 02 v d. foods rich in protein
supply and cardiac workload
Rationale: Caffeine increasing palpitations
Causes
6. Upon assessment of a client with MVP,
● Increase cardiac workload and Increase which finding is expected of this client
demand for 02 (Stable angina) condition?
● decrease 02 supply due to
a. severe atherosclerosis (Unstable a. Murmur
angina) b. Systolic click over the apex\
b. coronary vasospasm (Prinz c. Mitral click on the 4th ICS left parasternal
metal/Variant) area
d. Atrial gallop
2. Ellen has nitroglycerine at her bedside to
take PRN. The nurse knows that nitroglycerine Rationale: Every time it closes the valve you hear
acts in all of the following ways except the characteristic systolic click

a. Causing venous pooling throughout the Where you auscultate;

body
b. Dilate coronary arteries affected ● aortic valve - 2nd ics right parasternal
c. Dilating coronary arteries to increase ● pulmonic valve - 2nd ics left parasternal
oxygen supply ● area tricuspid valve - 4th ics left u - bet 5th
d. Lowering systemic blood pressure and 6th ics left mid clavicular
● line (apex) - point of maximum impulse
Rationale: Nitroglycerin can dilate only normal
vessels 7. The nurse is developing a
discharge-teaching plan for the client
3. Ellen's angina has become prolonged and diagnosed with congestive heart failure and
has changed and becoming unrelieved by rest. will take digoxin at home. Which intervention
Variant angina is being considered. The nurse should be priority?
knows that priority intervention when another
attack happen is a. Notify health-care providers of a weight gain
of more than one (1) pound in a week.
a. Place the patient in a semi fowler's position b. Teach client how to count the radial pulse
b. Administer the prescribed nitroglycerine when taking digoxin.
dose c. Instruct the client to remove the salt shaker
c. Administer morphine as ordered from the dinner table.
d. Oxygen administration d. Encourage client to monitor ECG

Rationale: Rationale: The action of DIGOXIN is to decrease

heart rate so you can teach patient to count the
● table angina increases cardiac workload = radial pulse (adverse effect is bradycardia)
REST!
● Unstable/Prinz metal = NTG >02 8. The nurse enters the room of the client
diagnosed with congestive heart failure. The
4. After administering the prescribed NTG, client is lying in bed gasping for breath, is cool
her BP drops to 80/60, what is the initial action and clammy, and has cyanosis in the mouth.
by the nurse Which intervention would the nurse implement
first?
a. Administer 02
 a. Relieve patient's anxiety. a. Plan all activities throughout the day
b. Check medications taken. b. Put the client on complete bed rest
c. Take the client's vital signs. c. Monitor VS every 15 minutes
d. Elevate the head of bed high fowlers. d. Place oxygen on bedside

Rationale: The purpose of high fowler is pooling of Rationale: The activity intolerance because for
blood down slight limitations on activity of daily living

9. After rendering nursing interventions to a 13. Which cardiac enzyme would the nurse
client with congestive heart failure. Which expect to elevate first in a client diagnosed with
assessment indicates ineffectiveness of the a myocardial infarction?
nursing plan?
a. Creatine phosphokinase (CPK).
a. The client's peripheral pitting edema has b. Lactate dehydrogenase (LDH).
gone from 3+ to 1+. c. Myoglobin
b. The client's BP is 110/80 from 150/100. d. CK MB isoenzyme
c. The client is able to walk around the room
without dyspnea. Rationale: Myoglobin is the elevate first within 2
d. The client is using accessory muscles for hours CkMB isoenzyme 4-6 hrs and most
breathing. indicative and specific enzyme CPK and LDH is
6-12 hrs
Rationale: The accessory muscle is expiratory
muscle we don’t use them under normal 14. A client diagnosed with unstable angina
circumstances we use it if the patient having experienced chest pain while preparing to go
difficulty in breathing home. Which action should the nurse
implement first?
10. The nurse is assessing the client diagnosed
with congestive heart failure. Which laboratory a. Administer sublingual nitroglycerin.
data would indicate that the client is in severe b. Obtain a STAT electrocardiogram.
congestive heart failure? c. Have the client sit down immediately.
d. Assess the client's vital signs.
a. Pulmonary edema on Chest X ray and
cardiomegaly Rationale: Unstable angina needs nitroglycerine
b. An elevated creatine kinase (CKMB). stat
c. Cardiac catheterization
d. Decreased albumin in the blood 15.Two hours after Percutaneous Transluminal
Coronary angioplasty, which of the following
11. The patient diagnosed with congestive heart assessment data is most important?
failure is maintained on Furosemide (Lasix) 40
mg once a day, Digoxin 0.125 mg half tablet a. The client is not complaining of pain.
daily and Captopril 25 mg OD. The client b. The pressure dressing to the right femoral
experiences leg cramps at night. Which nursing area is intact.
interventions should be implemented? c. The client is complaining of numbness in
the right foot.
a. Check the client for peripheral edema and d. The client's right pedal pulse is 3+ and
make sure the client takes a diuretic early in bounding.
the day.
b. Monitor the client's potassium level and Rationale: PTCA is repairing the coronary artery, it
assess the client's intake of bananas and will open the artery and putting stent to keep it
orange juice. patent (C it is important assessment data because
c. Determine if the client has gained weight the nerves is compressed and it has hematoma
and instruct the client to keep the legs somewhere resulting to compression)
elevated.
d. Instruct the client to ambulate frequently 16.The nurse is caring for a client post-acute MI
and perform calf muscle stretching who develops an audible S3. Which of the
exercises daily. following should be done by the nurse first?

Rationale: Furosemide is potassium a. Monitor vital signs.

-wasting-diuretics and it causing hypokalemia b. Elevate the head of the client's bed.
c. Document this as a normal and expected
finding.
d. Administer morphine intravenously
12. The nurse is caring for a client with
congestive heart failure class II. It is most Rationale: Position the patient on high fowler
important for the nurse to position because the patient having audible s3
developed CHF
17.When the client asks the nurse about the b. Monitor for friction rub
cause of chest pain in coronary artery disease, c. Monitor vital signs
the nurse best response is d. Assess for signs of cardiac tamponade

a. "Chest pain is caused by decreased oxygen Rationale: to decrease the breathing effort of
to the heart muscle. individuals experiencing dyspnea or shortness of
b. "There is ischemia to the myocardium as a breath
result of hypoxemia"
c. "The heart muscle is unable to pump 22. The client with infective endocarditis is
effectively to perfuse 1 the body. admitted to the medical department. Which of
d. "Chest pain occurs when the lungs cannot the following order should be implemented
adequately oxygenate the blood" first?

Rationale: A is best answer and easy for the patient a. Administer intravenous antibiotic.
to understand b. Obtain blood cultures.
c. Schedule an echocardiogram.
B is also correct but avoid using medical d. Encourage bed rest with bathroom
terminology the patient will be confused privileges.

C and D is wrong Rationale: The most important is culturing

insensitivity, we have to culture the blood before
18. Which of the following assessment is giving IV antibiotic.
indicative of tricuspid regurgitation
23. Embolization can complicate infective
a. Murmur in the 4th ICS left parasternal endocarditis due to
b. Murmur in the apical area
c. Murmur in the 2nd ICS right parasternal a. Dislodgment of microthrombi
area b. Septicemia
d. Murmur in the 4th ICS right parasternal area c. Stasis of blood
d. All of the above
Rationale: Because there is back flowing of blood
that will create increasing turbulence of the flow 24. Which of the following procedures/
inside the heart resulting murmur in the 4th ICS left treatment will not require prophylactic
parasternal area antibiotic?

19.Which of the following is the most prominent a. Dental extraction

clinical manifestation of pericarditis? b. Normal Spontaneous Delivery
c. Cardiac catheterization
a. Wide pulse pressure d. None of the above
b. Complaints of fatigue and arthralgias.
c. Petechiae and splinter hemorrhages. Rationale: Any condition that causes of opening of
d. Increased chest pain with inspiration blood vessels may cause entry of microorganism

Rationale: The most prominent clinical 25. Which of the following is a priority
manifestation is increased chest pain with independent nursing intervention is the most
inspiration because a blood clot that gets stuck in a important to a patient with bacterial
lung (pulmonary) artery can block blood flow to lung endocarditis with mitral regurgitation?
tissue.
a. Manage fever with antipyretic drug
20.The client is diagnosed with acute b. Assess for changes in murmur
pericarditis. Which sign/symptom warrants c. Assess for microthrombi
immediate attention by the nurse? d. Assess for signs of ecchymoses
e. All of the above
a. Muffled third heart sounds
b. Flat jugular veins. Rationale:
c. Bounding peripheral pulses.
d. Altered consciousness B is the best INDEPENDENT nsg intervention and
the condition of patient will be severe
Rationale: Because the inability of the heart to
pump and decrease blood flow going to the brain A is dependent nsg intervention it is drug therapy

21.The client is admitted due to pericarditis and C is also dependent it will use 2d echo machine
in pain. It is most important for the nurse to do
which of the following in the emergency room. D is also independent nsg intervention but it is not
connected to the condition
a. Place the client in orthopneic position
26. The 66-year-old male client has his blood d. Pigmented skin.
pressure (BP) of 168/98. Which action should
the nurse implement first? Rationale: Chronic venous insufficiency causes
skin pigmentation of the leg ranging from small
a. Tell the client that this is normal for his age. patches of mild dyschromia to extensive areas of
b. Instruct the client to see his doctor as soon severe skin pigmentation. It is thought that the
as possible. pigmentation is mainly due to hemosiderin or
c. Discuss the importance of eating a low-salt, melanin deposition.
low-fat, low-cholesterol diet.
d. Tell the client to monitor BP monthly A, B and C is related to arterial insufficiency

Rationale: Before giving the teaching, the patient

will assess and examine by the doctor

27. After receiving the morning endorsement,

which client should the nurse assess first?

a. The client was diagnosed with coronary

artery disease who has a BP of 170/100.
b. The client was diagnosed with deep vein
thrombosis who is complaining of chest
pain.
c. The client was diagnosed with pneumonia
and a temperature of 40°C.
d. The client was diagnosed with ulcerative
colitis who has non bloody diarrhea.

Rationale: We need to prioritize the airway always

28. Which of the following statements made by

the client diagnosed with chronic venous
insufficiency is correct?

a. “I shouldn't cross my legs for more than 15

minutes."
b. "I need to elevate the foot of my bed while
sleeping."
c. "I should take a baby aspirin every day with
food."
d. "I should increase my fluid intake to 3000
mL a day."

Rationale: Simply elevating the legs above heart

level for 30 minutes three or four times per day can
reduce swelling and improve blood flow in the
veins.

29.The client comes to the emergency room

complaining of claudication and leg pain. The
nurse knows that this problem is due to

a. Peripheral vascular disease (PVD).

b. Arterial insufficiency.
c. Deep vein thrombosis (DVT).
d. Varicose veins

Rationale: Claudication is related to arterial

insufficiency

30. Which of the following assessments is

expected in a client with chronic venous
insufficiency?

a. Absent pedal pulses

b. Cool skin temperature.
c. Intermittent claudication.
 1. Tidal volume (TV) - vol of air that goes in
CA1 MS DAY 7 and out of the lung in normal breathing =
(HARDON BATACAN) 500 ml
2. Inspiratory reserve volume (IRV) - vol of air
Respiratory disorders that can still be inhaled after normal
1. Obstructive inspiration =3000 ml
> airway 3. Expiratory reserve volume (ERV) - vol of air
2. Restrictive that can still be exhaled after normal
> compliance expiration = 1100ml
4. Residual volume (RV) - vol of air that
● elastic remains in the lungs after forceful expiration
● strechable = 1200ml
● distensible 5. Dead space volume (DSV) - vol of air that
does not participate in gas exchange = 150
Obstructive lung diseases
ml (anatomic dead space) physiologic dead
● Bronchial asthma space = diseased alveoli
● COPD 6. Functional volume (FV) - vol of air that
● ARDS actually participate in gas exchange FV =
TV (500ml) - DSV (150 ml) FV = 35
Restrictive lung diseases
Capacities = combination of volumes
● Pleura effusion 1. Inspiratory capacity - total vol of air maximally
● Pneumothorax inhaled ( TV + IRV )
● Flail chest 2. Functional residual capacity - total vol of air left
oin the lungs after normal expiration (ERV + RV)
Bronchial asthma - bronchospasm
3. Vital capacity (VC) = total vol of air maximally
> reversible
inhaled and maximally exhaled (TV + IRV + ERV)
2 types
4. Total lung capacity (TLC) - total vol of air the
1. Intrinsic asthma - idiopathic lungs can hold
2. Extrinsic asthma - allergy
S/SX
histamine = swelling of the bronchioles ● dyspnea wheezing
leukotriene = bronchospasm (during expiration) ● use of accessory muscles (expiratory
> airway obstruction = wheezing ● muscles) = intercostal retraction, contraction
swelling of the goblet cells -> inc mucus production of ms nasal flaring
-> cough ● RR > 20/min
● 02 sat - decreased cough fatigue
Dtic test:
Nx Dx
1. Peak flow meter = degree of obstruction =
Ineffective airway clearance
FEV1
Ineffective breathing pattern
2. CXR - air trapping - hyperinflated lung
Impaired gas exchange
3. ABG
Activity intolerance
initial = hyperventilating = Respiratory alkalosis Risk for infection
late = Respiratory acidosis Risk for complications

1. 02 sat - decreased ● Pneumonia

2. Spirometry - measures the volumes and ● Status asthmaticus
capacities of the lungs, dec expiratory ● Acute respiratory failure (p02 < 50 mmHg
reserve volume, inc residual volume, inc pCO2 > 50 mmHg)
functional residual capacity ● chronic asthma can lead to emphysema

Spirometry - measurement of volumes and Mgt:

capacities
1. Position - Orthopneic position
Spirometer - Pulmonary function test
2. Bronchodilator
3. 02 administration

Volumes ******
 1. provide rest periods ● b - dilators
2. promote safety ● steroids
3. prevent infection - vaccination ● mechanical ventilator
4. treat infection
5. support lung function 11. Slow down progression of the disease

a. b- dilator ● AVOID smoking

b. steroids ● Avoid infection
c. montelukast - leukotriene receptor antagonist ● Avoid fatigue
 d. antihistamine 12. Prevent and manage complications
 e. mechanical ventilator
9. Manage complications ● ARF
● Pneumonia
1. Prevent an attack ● Chronic bronchitis - Bronchiectasis (due to
● avoid allergens repeated bacterial infection)
● Mast cell stabilizers = ex Nedocromil, ● Simple pneumothorax
Cromolyn sodium ● Polycythemia -emphysema (pink puffer)
COPD = chronic obstructive pulmonary disease ● Primary hypertension
● Cor pulmonale
● irreversible ● Right sided heart failure
● progressive
● Chronic bronchitis - inflammation of the
bronchioles -> mucus production (Cough) =
productive cough for 3 moths for 2
consecutive years
● Emphysema - overdistention and
destruction of alveoli (Dyspnea)

short expiratory phase -> alveolar collapse

air trapping -> dyspnea

Diagnostic tests

1. CXR - Barrel chest (hyperinflation +

hypertrophy of muscles)
2. ABG - respiratory acidosis
3. Pulse Ox - low 02 sat
4. spirometry - Dec ERV, Inc RV, Inc FRC, Inc
TLC hypoxemia - stimulus to the respiratory
center (hypoxic drive)

Respiratory center stimulated by

1. inc pCO2 = normal people

2. dec 02 = COPD

Mgt:

1. Position - orthopneic
2. B- dilator - inhalation
3. 02 administration - low flow
4. provide rest
5. promote safety
6. prevent infection
7. treat infection
8. manage dyspnea
9. manage cough
10. support lung function