lOMoARcPSD|57639342

CA 2 Pedia CD and MS - ca lectures

Competency Appraisal (Our Lady of Fatima University)

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

PEDIA - SIR V
STAGES AGE P. SOCIAL P. SEXUAL CD (JP) MORAL (LK)
(EE) (SF)
GROWTH AND DEVELOPMENT
Infant 0-1 y/o Trust vs. Oral Sensory- Amoral
Mistrust Motor
GROWTH - quantitative increase in size/ weight (lbs,
Toddler 1-3 Autonomy Anal Sensory- Preconventio
kg, grams), height (ft), circumferential diameters (cm, vs. Shame & Motor nal stage 1
Doubt
inches) - HC, CC, AC
Preschool 3-6 Initiative vs. Phallic Pre-operatio Preconventio
Guilt nal nal stage 2
Pre-concept
WEIGHT - best indicator of health bec. weight ual

fluctuates School age 6-12 Industry vs. Latency Concrete Conventional

Inferiority operational

Height tumitigil ng 18 and 21 Adolescent 12-18 Identity vs. Genital Post Post
Role operational/ conventional
Confusion formal
operational
33 to 35 - head circumference
31 to 33 - chest and abdominal circumference
STAGES MOST SIG FEAR/S PLAY TOYS QUESTION
Until 2 yrs need i-measure circumferential diameters PERSON

Infant Primary Stranger Solitary Rattles None

caregiver anxiety

<1 y/o HC> C/A Toddler Parents Separation

anxiety
Parallel Push and
pull
What -
object
1 yr - 2 y/o HC = C/A orientation

2 y/o C/A > HC Preschool Family and Ghost, dark, Associative Make Why -
neighbors monster Cooperative believe, reason
castration/ puzzle,
mutilation board games

School age Peers Death, Competitive Ball How -

A 7 month old infant is undergoing a well baby check failure in procedural
school,
up. Least likely to assess? intimidating
teacher
a. Temp
b. WT Adolescent Peer group Loss of
privacy,
Competitive Ball What if - life
situations
rejection
c. HC
d. HR
ANSWER: TEMP (walang lagnat)
PRINCIPLES OF GROWTH AND DEVELOPMENT

DEVELOPMENT - qualitative increase in the capacity 1. All of us are capable of growing and
to function development
2. G&D are innate in humans (natural)
Parameters of Development 3. G&D are predictable (developmental
1. Speech and Language - 2 same vowels like milestones = events/ tasks that are expected
mama, papa to happen in a specific age)
2. Body Language - gestures 4. We grow and dev in our own pacing (DDST/
3. Motor Development - gross first (easy task) MMDST = Denver Developmental Screening
(climb before going down) Test/ Metro Manila Developmental Screening
4. Sensory Development - visual, auditory, Test)
tactile, olfactory, gustatory = senses 5. Heredity sets limit in growth and
5. Self Esteem - as the child undergoes different development
theories and stages of growth and 6. There are patterns of growth and
development development
a. Cephalocaudal - head to toe
Most developed sense at birth = TACTILE (touch) b. Proximodistal - center to periphery
Last sense to disappear when you die = AUDITORY c. Gross to Refine - ex. palmar grasp
before pincer grasp
THEORIES OF G&D d. Simple to Complex - easy to difficult
- Psychosocial Development - Erik Erikson tasks (ex. unbuttoning the blouse first
- Psychosexual Development - Sigmund Freud before wearing, climbing first before
- Cognitive Development - Jean Piaget going down)
- Moral Development - Lawrence Kohlberg e. General to Specific - common names
before proper names (bird first before
agila)
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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

INFANT - BIRTH TO 1 YEAR OLD Stranger anxiety

DEVELOPMENTAL MILESTONES
(GOATS) 0 - 0 degree
Grow very fast 1 - 15 d
Oral stage 2 - 30 d
Amoral 3 - 45 d
Trust vs Mistrust 4 - 45 d>
Sensory - motor 6 - sits with support
Solitary play 8 - sits without support
Stranger anxiety 9 - crawling and creeping
10 - standing with support
Grow very fast - birth wt x2 by 6 mos, x3 by 12 mos, 11 - cruising
and x4 by 2 years old 12 - walking with support
- Ex. 6.5 lbs -> 6.5 x 3 divide by 2.2 = 8.86 kg 15 - walking without support
18 - running and jumping
Oral stage 2 y/o - feet are at the same level
3 y/o - can alternate his feet on the stairs
Amoral
Sign that can use bike - alternate the stairs = sense
Trust vs Mistrust - primary caregiver (mother if of balance
walang primary) - when the needs of infant are met,
trust is established Ability of infant to lift his head of the bead (0 to 45 d)
- Crying = hunger, pain, discomfort, attention
- Fear = stranger anxiety (mistrust) = starts - 6 4 months - sleep w/ prone position
mos, peak - 9 mos (8 mos), fades - 12 mos
- Lahat ng kasama sa bahay ay Less than 6 months - have fetal hemoglobin so IDA is
consider na primary caregiver kaya not commonly seen
infant walang mistrust so paglaki ay
madaling magtiwala 6 months - introduction of solid foods
- Kapag limited at wala halos primary
caregiver ay may strong mistrust so
paglaki ay reserved person or may Signs that Ready for Solid Foods:
trust issues
- Form of discipline for infants - time out (no. 1 1. Sits with support - maturation of cardiac
rule for good discipline = consistency) sphincter - 6 mos (prevents reflux)

Sensory - motor 2. Teething - 6 mos unang lumalabas ngipin - 2

lower central incisors, 7, 9, 10
Solitary - play - 10 mos - 4 teeth
- Rattle - best toy for infant (holding, w/ - Temporary/ milk/ deciduous = 20
sounds, colorful, soft hard smooth) - erupt in beginning of 6 months and
promotes motor development = 4 to 5 completes in 2 ½ to 3 years old
mos (palmar/ grasping reflex (dental check up)
disappear before 4 to 5 mos) - Falling off of temporary kapag palabas
- Musical mobile (earliest toy and for na permanent teeth kapag 6 to 7
sensory stimulation) = 2 mos years old - 32 permanent teeth
- Baby sleeps for too long for brain - Teething should not be accompanied
development by fever and diarrhea (toy must be
- No. 1 rule in choice of toy = safety washable)
- Choice of toy - Oral care every after feeding
a. Age appropriate - First toothbrush - when the first tooth
b. Size appropriate (not too erupts
small)
c. Nontoxic (lead poisoning) 3. Disappearance of extrusion reflex (spitting/
d. No detachable parts luwa) - protective and feeding reflex
(choking hazard)

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

SOLID FOODS Parents (MSP)- omnipotent- in authority

1. Iron fortified cereals (to prevent IDA)
2. Veggies (boiled and mash) then fruits (can Do not force the toddler to share, instead encourage
be mash - banana, apple, pear, papaya, the toddler to share.
mango and squeeze - orange, ponkan)
- Can clean the teeth of infant = PEAR Behavioral Indicators of Toddlers: selfish,
3. Meat - chicken, pork (boiled, shred, and chop), egocentric, self centered, negativistic, manipulative,
fish (mash), liver (chicken - soft) ritualistic
- Beef not allowed = hard to digest
(allowed when 1 yr old - must be soft) Theme: "holding on and letting go"
4. Egg yolk - hard boiled (egg white contains
albumin = allergic reaction) Autonomy vs Shame and Doubt
- Allow the toddler to choose/ make simple
decisions
Reflex (involuntary) - lahat nawawala - Allow to explore the environment (safety)

Rooting Reflex - to find food - will turn toward the side

Consistency
Sucking Reflex - sucks when area around mouth is
touched - gone by 4 mos Frustration: Temper tantrums (toddlers lack verbal
skills)
Palmar Reflex - when an object is placed in the
infant's hand, the fingers close and tightly grasp the Mgt: ignore TT except if toddler is hurting himself
object. gone by 4 mos
Anal Sphincter Control: walks well = toilet training
Moro/ Startle Reflex - pulling arms and legs in after - remains dry for long hours
hearing loud noise - brain injury - gone by 4 mos - can identify dry from wet diaper
- wants to please his parents
Tonic-Neck/ Fencing Reflex - when a baby's head is
turned to one side, the arm on that side stretches out start control is gained
and the opposite arm bends up at the elbow. Bowel training 1 1/2-2 y/o 2 1/2 to 3 y/o
no distraction during Bowel training
Parachute Reflex - when the baby is turned face no food, tv, toys, playmates
down towards the mat, the arms will extend as if the same time of the day Potty chair
baby is trying to catch himself Bladder training 2 1/2-3 3-4 y/o

Babinski Reflex - when the sole of the foot is firmly Separation Anxiety
stroked, the big toe bends back toward the top of the 1. Protest
foot and the other toes fan out - begin to disappear 3 2. Despair
mos, gone by 8 mos, totally gone by 12 3. Denial
4. Recovery
DONE INFANT
What - object orientation
HINDI PA MAAYOS DAHIL GALING SA
DISCUSSION DATI . AAYUSIN PA KAPAG
NAGDISCUSS PRE-SCHOOL - 3 TO 6 Y/O

TODDLER - 1 TO 3 YEARS OLD (MAGIC)

M -Mutilation/Castration
(PRAISE) A - Associative Play
P - Parents, Parallel, Push and Pull Toys G - Guilt
R - Ritual, Routines, Regression, Rivalry I - Imaginative, Imitator, Initiative
A - Anal, Autonomy vs. Shame and Doubt C- Curiosity
I - Involve the parent in the care of the toddler
S - Sensory-motor, separation anxiety, selfish Initiative vs Guilt
E - Egocentric, environment, explore, elimination Theme: to make, to try and to play
Phallic stage (genital) Gender orientation

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

Masturbation
Oedipal complex- Son to mother attachment PRESCHOOL - fall, burns, drowing, poisoning
Electra complex- Daughter to father attachment
Bonding sessions SCHOOL AGE - fall, fracture (rapid long bone
development) drowning motor accident
Sig. Persons: Family, neighbors/playmates
Role Modeling ADOLESCENT - motor/vehicular accidents, substance
Associative play/Make believe abuse
Toys: "sets", simple puzzle, coloring books, building
blocks
"Why" questions
Tall Tales - exaggerated stories
Imaginary friend - to satisfy the emotional needs of
the PS

SCHOOL AGE - 6 TO 12 Y/O

(DIMPLE)
D - Death
I - Industry vs Inferiority
M - Modesty
P - Peers
L - Loss of self control
E - Explain the procedure

[Link] Task: Industry vs. Inferiority

Failure in school
Intimidating teacher

school phobia
mgt: make the child attend the school everyday

Latchkey Children

ADOLESCENT

(PAIRS)
P - Peer group
A - Acceptance of bodily changes
I - Identity
R - Role confusion/role diffusion/ Rejection
S - Separation from peer group

Identity vs role confusion/diffusion

Genital- sexuality orientation
sexual activity

INFANT - aspiration of foreign bodies- toys

- fall, burns

TODDLER - AFB, Fall, Burns, drowning, poisoning

child-lock container

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

CD - DOC FERRER LATENT DISEASE - inactive become active

(chickenpox/ varicella -> zoster/ shingles - acyclovir
COMMUNICABLE DISEASE doc)
- Cause: infectious agent
- Transmitted directly or indirectly by agency,
vector, inanimate object (fomites) ACCORDING TO SOURCE OF INFECTION
- Directly - person to person like kissing, - FULMINATING INFECTION - results in the
coughing, sneezing, talking, laughing, sexual death over a short period of time
etc. - NOSOCOMIAL INFECTION - hospital
- Indirectly - use of fomites or inanimate acquired infection
(nonliving) like borrowing cell phone then you
have colds
- Agents - virus, bacteria, fungi PATTERNS OF INFECTION (COURSE OF
INFECTIOUS PROCESS) - IPIC/ I PROMISE I CARE
- INCUBATION PERIOD - time of entry to s/s
2 TYPES OF CD - PRODROMAL PERIOD - nonspecific to
specific s/s
CONTAGIOUS DISEASE - INVASION PERIOD/ PERIOD OF ILLNESS/
- Easily transmitted ACUTE - maximum impact of illness
- Spread by direct contact - CONVALESCENT PERIOD/ PERIOD OF
- Direct or indirect means DECLINE - recovery
- Ex. COVID

INFECTIOUS DISEASE CHAIN OF INFECTION

- Direct inoculation through a break on skin AGENTS -> RESERVOIR -> PORTAL OF EXIT ->
- Ex. Dengue, Malaria, Tetanus MODE OF TRANSMISSION -> PORTAL OF ENTRY
-> SUSCEPTIBLE HOST
“All contagious are infectious, but not all
infectious are contagious”

CLASSIFICATIONS OF DISEASE

BASED ON OCCURRENCE (SEEP): Can we break the chain? YES

- SPORADIC - isolated, occasional (tetanus, Easiest link to break? MOT
rabies) The final link and most important link? SUSCEPTIBLE
- ENDEMIC - constantly present (malaria - HOST
palawan)
- EPIDEMIC - outbreak, large no.
- PANDEMIC - worldwide (COVID, HIV) ETIOLOGIC AGENTS - cause (Very Bad For People)
- Viruses
- Bacteria
TYPES OF INFECTION - Fungi
- RECURRENT - same infectious agent - Parasite
(reappearance of symptoms/ renewed
presence)
- REINFECTION - new infection (another strain RESERVOIR - can be humans, carriers, fomites, and
of same species) animals
- SUPERINFECTION - additional infection (ex.
hepa B + hepa D) 1 + 1 If you are to cite ex. of the reservoir, which would you
- AUTOINFECTION - own self not mention?
a. Carrier b. Animals c. Fomites d. None of these
- ANSWER: NONE OF THESE
ACCORDING TO SEVERITY OR DURATION OF
INFECTIOUS DISEASE
1. ACUTE - short time (common colds)
2. CHRONIC - long time (TB)

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

MODE OF TRANSMISSION - Low fiber/ low residue, avoid fresh

1. CONTACT - direct (person to person)/ indirect vegetables, orange better than grapes
(use of fomites) - Tonsillitis, appendicitis (infection -
2. AIRBORNE - organisms travel more than 1 leukocytosis)
meter (varicella, TB, measles)
- DROPLET less than 1 meter ACQUIRED IMMUNITY - 3rd line of defense, B and T
- COVID, pertussis, influenza (droplets) cells
3. VEHICLE-BORNE - food, water, blood
transfusion
4. VECTOR BORNE - insect or arthropod TYPES
5. TRANSPLACENTAL 1. ACTIVE - natural, artificial - host produces
antibody (ako gawa antibody)
2. PASSIVE - natural, artificial - preformed
CONTROL MEASURES IN THE SPREAD OF antibodies/ given to host (pasa antibody sa
INFECTION akin)

● ANTISEPSIS - use of chemical agents on ANTIBODY - defense against any infection

living tissues/ skin to prevent spread of
microorganisms (naglagay ng alcohol sa skin) ACTIVE NATURAL - recovery from disease
ACTIVE ARTIFICIAL - vaccine/ immunization, tetanus
● DISINFECTION - use of chemical agents in toxoid
surfaces/ nonliving objects
PASSIVE NATURAL - mother - immunoglobulin/ IgG
● STERILIZATION - autoclaving = destroys the (placenta) & IgA (milk)
spores of bacteria PASSIVE ARTIFICIAL - rabies immunoglobulin,
measles immunoglobulin, immunoglobulin that injected
● ISOLATION - infected person (separation) to human beings - antitoxin - ATS/ anti tetanus serum
(needs skin test)
● QUARANTINE PERSON - susceptible person
(suspect) - limit movement - corresponds to
incubation period B cells - plasma cells -> 5 immunoglobulin
T cells - CD4T/ helper T cells - normal 500 (vital) and
CD8T/ cytotoxic T cells
CONCEPT OF IMMUNOLOGY
CD4T
TYPES OF IMMUNITY - minomonitor sa HIV = kapag mababa sa 500
- NATURAL/ INNATE IMMUNITY ay AIDS
(NONSPECIFIC) - before birth
- ACQUIRED IMMUNITY (SPECIFIC) - adaptive
= after birth CLASSES OF IMMUNOGLOBULIN
(ANTIBODY-MEDIATED IMMUNE RESPONSE) -
NATURAL IMMUNITY GAMED
- Anatomic and physiologic barrier (skin) - - IgG - crosses placenta - increase in chronic
1st line of defense infection
- Inflammation & WBC - 2nd line of defense - IgA (umaagos) - secretions (breast milk -
- 5 signs of inflammation (rubor - colostrum, tears, saliva)
redness, calor - heat, dolor - pain, - IgM (malaki & mauna) - largest - acute
tumor - swelling, and function laesa - - IgE - allergy, itchiness
loss of function) - IgD (deadma) - no role
- Normal wbc - 5k to 10k (anything
lower - leukopenia, higher -
leukocytosis) INFECTIONS - CD - EYES
- Risk of infection
(immunocompromised) - leukopenia CONJUNCTIVITIS - viral and bacterial
- Limit crowded place, wear a mask, - Swimming pool conjunctivitis - when the
handwashing (leukopenia - reverse water in the swimming pool is poorly or non
isolation) chlorinated (can be viral and bacterial)

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

- Viral = adenovirus 18,19 (no treatment) CD - NOSE

- Bacterial = chlamydia trachomatis (purulent
discharge/ nana), antibiotic (eye drop, RHINITIS
ointment) - Acute rhinitis (common colds - RSV -
- Eye redness, eye irritation = sore eyes respiratory syncytial virus)
- Ophthalmic eye drops/ ointment - Yellowish discharge (bacterial)
- Eye drop first - lower conjunctiva - put - Most common cause of sipon/ colds (virus)
pressure bet. eyes and nose/ punctual
pressure to prevent systemic
absorption of the drug (7% happens) CD - THROAT

KERATITIS TONSILLITIS
- Inflammation of cornea (abrasion/ gasgas) - Strep pyogenes, GABHS -> Glomerular
Rinitis)
UVEITIS - Difficulty of swallowing = dysphagia
- Uvea (middle layer of the eye = iris, ciliary - Painful swallowing = odynophagia
body, and choroid) - Management: antibiotic (bacterial)

MOT - ENTERIC
CD - EARS - From mouth, gastrointestinal tract
- External (ear canal) = Otitis Externa - Enteric isolation - proper food preparation,
- Middle (eardrum/ tympanic membrane) = hand hygiene
Otitis Media
- Inner ear (labyrinth - cochlea, semicircular (take care po ha)
canal) TYPHOID FEVER - contaminated food (handwashing)
CHOLERA
OTITIS EXTERNA POLIOMYELITIS
- Erythematous ear canal (red) HEPATITIS A & E - proper food preparation
- Cause: swimming AMOEBIASIS
- Swimmer’s ear
- Staphylococcus, pseudomonas TYPHOID FEVER
- No fever - Bacteria = salmonella typhi (food)
- S/s: conductive hearing loss - Antibiotic
- Weber’s test - loud on affected ear - Management: ciprofloxacin
(normal both) - Pathognomonic signs: rose spots
- Rinne’s test - bone > air (normal air> - Incubation period = 1 to 3 weeks
bone) - Prodromal stage: fever, abdominal pain, n/v,
- Aural tenderness (masakit kapag hinawakan diarrhea or constipation
tenga) - Plain LR
- Management: antibiotic , warm compress - Fastigia/ Pyrexial Stage: rose spots, fever,
splenomegaly (left upper - spleen)
OTITIS MEDIA - Defervescence Stage: after 2 to 3 weeks of
- Upper respiratory tract infection (ubo and illness - intestinal perforation (acute
sipon) abdomen - ruptured of intestines,
- S/s: otalgia (ear pain/ ear fullness), fever pathognomonic signs = boardlike rigidity of
- Management: antibiotic, myringotomy abdomen)
(opening of eardrum - to relieve otalgia - no - Lysis stage: relapse
anesthesia) - Dx: culture = blood, urine, cs, widal test
- Conductive hearing loss - Enteric isolation
- Strep pneumoniae

LABYRINTHITIS CHOLERA
- Sensorineural hearing loss (air is greater - Bacteria - vibrio cholerae
than bone conduction/ A>B on rinne’s test, - Antibiotic
loud on unaffected ear on weber’s test) - Management: tetracycline
- Pathognomonic signs: rice watery stool (no
blood)

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

- Profuse watery diarrhea - Diet: low fiber/ low residue, meat

- 3 deficits during cholera
- severe DHN CONSTIPATION
- hypokalemia - low potassium (below - High fiber
3.5 - U wave in ECG - give avocado,
banana, kiwi),
- metabolic acidosis - deep rapid ARF/ ACUTE RENAL FAILURE/ ACUTE KIDNEY
breathing - kussmaul’s - low ph (below INJURY - (ABCDE)
7.35), low bicarbonate/ HCO3 (below - Anemia - lack of erythropoietin (3 P’S - pallor,
22) pagod/ fatigue, palpitation) - low hemoglobin
- Stool culture (below 12 g/dl)
- Fluid volume deficit - BP - hypertension
- Tx: rehydration - plain LR - Calcium - decrease
- D vitamin - decrease
- Edema - fluid volume excess
POLIO
- Virus = legio debilitans Azotemia - high creatinine (avoid meat - low protein)
- Preventable by vaccine
- OPV - sabin - oral - NPO for 30 mins.
(common) AMEBIASIS
- Repeat kapag nagsuka na wala pang - Etiology: entamoeba histolytica
30 mins sa OPV - Human - principal host
- IPV - salk - MOT: infected food handlers
- Incubation period: 7 to 35 days - Parasite = protozoa
- Type 1 - brunhilde = most paralytogenic - Contaminated food
- Blood streaked stool
S/S: - DOC: metronidazole

1. Inapparent/ subclinical stage -

asymptomatic stage MOT: SKIN - THROUGH SWIMMING -
Schistosomiasis, Leptospirosis
2. Abortive (minor illness stage)
- Fever, sore throat SCHISTOSOMIASIS
- Low lumbar pain - Contaminated river (avoid swimming)
- Worm = schistosoma
3. Major illness stage - Antihelminth
a. Non paralytic/ pre paralytic or meningitic - Pathognomonic signs: swimmer’s itch
type - Tx: Praziquantel
- Pain arms, neck, back, legs, + pandy's - Causative agent/ etiologic agent = flatworm
test (csf), paresis (weakness) - Skin penetration - cercaria (infective stage in
b. Paralytic man) - free swimming larvae
- + hoyne’s sign: head drop - Miracidium - from egg -> miracidium (infective
- Tripod positioning stage in snail) enters the snails in river ->
- + kernig’s sign (knee cannot extend), miracidium become cercaria -> cercaria enters
brudzinski’s (batok) skin
- Causative agent - s. Japonicum = liver
- Diagnostics: blood and throat culture, stool cancer, s. Haematobium = bladder cancer
exam, lumbar tap (pandy’s test) - Transmitted by amphibious oncomelania
snails
- Incubation period - 4 to 6 weeks
DIARRHEA/ GASTROENTERITIS - Dx: kato katz technique (identification of
- Fluid volume deficit (dry lips, flat neck vein, eggs)
poor skin turgor) dry lips and tongue = - Prevention: proper sanitary disposal of
dehydration feces, snail control by use of chemicals,
- Hypovolemic shock education of people in endemic areas
- CBC - Hematocrit (high - hemoconcentration) - Signs of liver hepatitis to liver cancer
- No vegetables - Hepatomegaly, portal hpn

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

- Liver cirrhosis - Licking of open wounds

-> esophageal varices - bleeding - monitor - Incubation period: dogs - 1 week to 7 ½ mos,
vital signs humans - 10 days to 1 year
-> ascites - measure abdominal, weigh, low - Mass vaccination of dogs = Department of
salt diet, limit fluid, give egg white - albumin Agriculture/ DA
- Hepatic encephalopathy = high level of - March = Rabies Month
ammonia (low protein diet, increase biologic
protein - vegetables, lettuce) Clinical Manifestation
- Prodromal Stage
- Pain, numbness - site of bite
LEPTOSPIROSIS (WEIL’S DISEASE - - Flu like symptoms - fever, headache
COMPLICATION) - Sensitivity to light, sounds
- Flood (avoid swimming) - Keep the light close, avoid
- Bacteria = leptospira interrogans unnecessary noises
- Antibiotic - Excitement Stage
- Pathognomonic signs: orange eyes - Hydrophobia (water), aerophobia (air)
- Tx: Penicillin G (DOC) - Avoid oral fluids, aircon, e-fan
- Prophylaxis: Doxycycline - Paralytic Stage
- Zoonotic infectious - Respiratory paralysis -> death
- Carried by animals - urine contaminates
water - Pathognomonic signs - Negri bodies
- Jaundice/ icteric (naninilaw) + renal failure - Brain biopsy: detection of negri bodies
- Septic/ septicemic stage - fever, headache, - Clinical observation: 10 to 14 days
NAV (nausea, anorexia, vomiting), abdominal - No specific treatment
pain, diarrhea - Person to person = kapag kinagat ka ng tao
- Immune/ toxic stage na may rabies, di magkakaroon ng rabies
- Unicteric type - conjunctival suffusion (anti-tetanus)
- Icteric type - jaundice/ renal failure
(weil’s syndrome)
- Convalescent stage - relapse may occur WHO Category - Rabies
during 4th to 5th week
- Prevention and control: sanitation - home, Category 1
workplaces, farms and eradication of rats - Licks on intact skin
- No exposure, no prophylaxis needed if history
reliable
Infant scratch by cat. Treatment expected - vaccine
Category 2
24 yo pregnant bitten by a rat at lower eyelid - no - Minor scratches or abrasions w/o bleeding
rabies vaccine (rats don’t have rabies) - Vaccine alone

Category 3
MOT - SKIN - THROUGH WOUNDS - Rabies and - Single or multiple transdermal bites or
Tetanus scratches, licks on broken skin
- Immunoglobulin + vaccine
RABIES - kapag nakagat na dati, vaccine lang
- Etiologic agent: bullet shaped virus -
rhabdovirus Note: The lower the bite site, longer travel time. The
- neurotrophic - love the nerve - higher the bite site, the faster travel time.
directly infects the neuron - strong
affinity to nervous tissues
- do not go to the blood Management
- Source: saliva - rabid animal (dogs, cats, - Clean wound with soap and water
monkey) - Tetanus prophylaxis (ATS - passive - skin
- Reservoirs - bats test, Toxoid - active artificial)
- Spelunkers (people who love to go in the - Post exposure prophylaxis/ PEP
cave) (Non-immunized - di pa nakagat and
- Bite, scratch- infected animal immunized - nakagat na dati)

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

Non-Immunized EBOLA VIRUS

- Direct contact/ person to person (not
Passive Vaccination arthropod borne)
1. Human Rabies Immunoglobulin - MOT: Direct exposure, skin lesions,
2. Animal Serum Equine Rabies Immunoglobulin parenteral (accidental needlesticks or reuse
of needles)
Active Vaccination - Incubation period: 2 to 25 days
- Vero rab = IM - S/S: fever, rash (maculopapular), cough,
- Lyssavac = ID joint pain
- Management: pain management,
antipyretics, antiemetics, antidiarrheals
Nursing Management
- Isolate pt.
- Darken room, quiet environment MOT VIA SKIN - ARTHROPOD/ VECTOR BORNE -
- Stimulation of any senses by fluid - prohibited Chikungunya, Zika, Jap B, Malaria, Filaria, Dengue
Note: Assess the pt. then wash soap and water

NURSING INTERVENTION
3 Pronged Approach (DOH) - Apply insect repellent
- Responsible pet ownership - Wear long sleeves
- Victim immunization
- Dog immunization
ZIKA VIRUS INFECTION
- Etiology/ cause = virus
TETANUS - MOT: mosquito bite
- Etiologic agent: bacteria = clostridium tetani - Pruritic maculopapular rash (itchy)
- Antibiotic = Metronidazole - Conjunctival injection, microcephaly
- Pathognomonic signs = risus sardonicus/ - Arthralgias
sardonic smile
- Synonym = lockjaw/ trismus
- Sources of infection: soil, street dust, animal, CHIKUNGUNYA FEVER
human feces, rusty materials - Etiology = virus
- MOT = puncture wound - MOT: mosquito bite (aedes)
- Incubation Period: - Maculopapular
- Adult (low grade fever): 3 days to 3 - Fever chills, conjunctival injection
weeks - Arthralgias
- Newborn (high grade fever): 3 to 30
days - (DPT)
TREATMENT
Adults - Supportive management
- Low grade fever, diaphoresis
- Trismus, opisthotonus (arching of the back)
- avoid unnecessary stimulation, side JAPANESE ENCEPHALITIS/ JAP B
lying position - Etiology: virus
- Risus = pathognomonic - Significant viral encephalitis
- Vector: culex mosquitoes
Diagnostic Exam - S/S: diarrhea, cough, encephalitis
- Dx: made clinically (inflammation of brain)
- History of wound - Incubation period: 5 to 15 days
- Lack of immunization - Supportive management
- Preventable w/ vaccine
Avoid stimuli that trigger spasm
- Bright lights, noise
- Turning, touching FILARIASIS
- Etiologic agent: roundworm = wuchereria/
brugia
- Vector: culex and aedes

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

- Incubation period: 3 to 12 months - Stream clearing = itupi mga naka-hanger

- Pathognomonic sign: elephantiasis - Stream seeding = larvae eating fish
- Most common nursing diagnosis: disturbed - Fluids and paracetamol
body image - Avoid nsaids
- DOC: Diethylcarbamazine (Hetrazan)
- Apply insect repellent and wear long DENGUE MALARIA
sleeves Larvae eating fish goldfish tilapia

ADDITIONAL:
- Transmission of malaria does not occur in MALARIA
cold temperature - Etiology = parasite, protozoa, plasmodium
- Mosquito longevity is important as a - Vector = anopheles mosquito
determinant of malaria transmissibility - True - Treatment = co-artem (chloroquine - 2nd
- Snail longevity is also important - True choice)
- Most prevalent arthropod borne viral disease - Monitor RBC (anemia)
worldwide - Dengue - Pathognomonic sign: cold - chills, hot - fever,
wet - sweat
- Blood smear - diagnosis
MOSQUITO - zooprophylaxis
Dengue - aedes aegypti, aedes albopictus (virus)
Zika Virus - aedes (virus) ANOPHELES MOSQUITO - VECTOR
Chikungunya - aedes (virus) - Night biting mosquito, color brown
Jap B - culex (virus) - Large compared to ordinary mosquito
Filariasis - culex (worm) - Breeds in clear, flowing, shaded streams
Malaria - anopheles (parasite, protozoa, plasmodium) - Does not bite humans in motion

MOT VIA SKIN CAUSATIVE AGENTS

- MALARIA - PROTOZOA - Plasmodium Falciparum = most common in
- DENGUE - VIRAL (virus - flavi) PH
- Fatal
DENGUE - Blackwater fever
- Flavivirus (arbovirus) - Cerebral malarial
- Vector = aedes aegypti - Plasmodium Ovale = rare in PH
- Low flying, day-biters - Plasmodium Malariae
- In rainy season - quartan malaria
- Lay eggs in clean, stagnant water - fever and chills every 72 hours on the
- Bite of infected female aedes aegypti 4th day
mosquito - Plasmodium Vivax
- Incubation period - 6 to 7 days - Benign tertian
- Dengue fever (benign), dengue hemorrhagic - Fever and chills every 48 hours on the
(malignant) 3rd day
- Dehydration (fluid volume deficit),
hypovolemic shock
- Thrombocytopenia - low platelet count NOTE: If may error man or mali, pakitama na lang
(below 150k) or sabihin niyo rin sa akin. Thank you <33
- Maculopapular rash
- Fever, rashes, chills
- Tourniquet test/ Rumpel–Leede test
(presumptive test of dengue) - more than 20
petechiae - positive
- Confirmatory test: platelet count (monitor for
s/s of bleeding)
- Warning signs: abdominal pain, vomiting,
bleeding
- Preventive measures: wear long sleeves,
apply insect repellent
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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

MS - DOC FERRER Most important for the nurse to monitor in SIADH -

SODIUM
GI. ENDO. NEURO. RENAL. ENT

Which of the ff electrolytes would the nurse expect to DI/ DIABETES INSIPIDUS
be abnormal in pt with a PTH deficiency? - Disorder of pituitary gland
a. Sodium b. Potassium - Mababa ang ADH
c. Magnesium d. Phosphorus (answer) - All are low
- Ihi ng ihi/ increased urine output/ polyuria (3
REMEMBER: liters in 2 hours)
● LIVER - makes/ produces the bile - Dehydration/ fluid volume deficit = force
● GALLBLADDER - stores the bile fluids
● KIDNEY - produces urine - Polydipsia
● URINARY BLADDER - stores urine - DHN, weakness
- Decreased ADH, BP
- Postural hypotension
HYPOTHALAMUS - Hypovolemic shock
- Secretes ADH/ antidiuretic hormone (hindi ihi) - Tachycardia
and OXYTOCIN - Administer desmopressin intranasal
- Most important = check the patency of nose
PITUITARY GLAND/ HYPOPHYSIS - Monitor LOC, cardiovascular, urine sp.
- Stores ADH and OXYTOCIN gravity

HYPOPHYSECTOMY URINE SPECIFIC GRAVITY

- Removal of pituitary gland - Normal 1.010

ANTERIOR PITUITARY / ADENOHYPOPHYSIS

- Produces hormones THYROIDECTOMY
- Removal of thyroid
POSTERIOR PITUITARY/ NEUROHYPOPHYSIS
- Stores ADH and OXYTOCIN THYROID GLAND
- Thyroid hormones
OXYTOCIN - T3 = Triiodothyronine
- Uterine contraction - T4 = Tetraiodothyronine/ Thyroxine
- Milk letdown - Calcitonin (lower blood calcium level) =
hypocalcemia

ADH/ ANTIDIURETIC HORMONE/ VASOPRESSIN HYPERTHYROIDISM

- Mataas thyroid hormone
SIADH/ SYNDROME OF INAPPROPRIATE OF - Tx: PTU = antithyroid drugs = lower/ inhibit
ANTIDIURETIC HORMONE thyroid hormone production
- Mataas or sobra ang ADH - High BP/ hypertension
- All are high except sodium - Tachycardia/ palpitation
- Hindi ihi/ no urine output = mataas BP/ high - Avoid caffeine (coffee, cola, chocolate)
blood pressure at mataas tubig/ water - Fast metabolism
retention - Diarrhea = low fiber/ residue (meat)
- Water intoxication - Weight loss = high calorie
- Concentrated urine - Heat intolerance
- Hypervolemia, HPN, Anorexia, Nausea, - Moist skin
Vomiting - Insomnia
- Hyponatremia (less than 135) - Grave’s disorder (autoimmune) = most
- Demeclocycline (oral)- TX: Inhibit ADH common cause
secretion - Thyrotoxicosis = clinical manifestation
- Head injury = increase intracranial pressure - Thyroid storm/ crisis = complication
- Seizure = Risk for Injury = Safety (priority) - Tx: antithyroid medication = PTU
- Limit fluid intake (agranulocytosis = low WBC), tapazole =
- Monitor VS neuro status blocks TH synthesis

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

- Propranolol/ Inderal = control tachycardia/ Which of the potentially serious complications may
heart rate occur when treating hypothyroidism?
- Side effects = hypothyroidism - ANGINA OR CARDIAC ARRHYTHMIAS
- RAI/ Radioactive iodine = I 131 = destroys
hyperactive thyroid gland/ tissue Congenital hypothyroidism/ low TH
- Side effect = hypothyroidism - CRETINISM
- Thyroidectomy Matanda hypothyroidism
- before surgery SSKI/saturated - MYXEDEMA
solution of potassium iodine/
lugol’s solution (use straw, halo sa Where will you admit hypothyroid patient?
juice) = decrease vascularity of thyroid - PRIVATE ROOM
gland = inhibit thyroid hormone
release Where will you admit hyperthyroid patients?
- Post op care = semi fowlers - WARD NEAR NURSING STATION
- Observe complications =
hemorrhage, airway obstruction,
recurrent laryngeal nerve damage, PARATHYROID GLAND
thyroid crisis/ storm - Back/ posterior of thyroid gland
- Monitor calcium (hypocalcemia) = - Produces PTH that controls calcium
prepare calcium gluconate - Kapag mataas calcium = bagsak phosphorus
- Trousseau = use bp app (carpopedal
spasm) = hypocalcemia HYPERPARATHYROIDISM
- Chvostek = facial twitching = - All are mataas - PTG, PTH, CA, vit D except
hypocalcemia phosphorus
- PTG damage -> low PTH -> low - Stone formation/ Nephrolithiasis
calcium -> tetany -> airway obstruction - Osteoporosis = nawawalan calcium
(priority - airway) - Fracture = risk for injury = safety (priority)
- Prepare tracheostomy set after - Increase oral fluids = prevent infection and
surgery oral stones
- Ask the pt to speak after surgery = - Most important nursing diagnosis = risk for
to know if there is laryngeal damage injury
- Thyroid storm = high bp, hr, temp
- Monitor vital signs HYPOPARATHYROIDISM
- All are mababa except phosphorus
HYPOTHYROIDISM - Chvostek’s
- Mababa thyroid hormone - Arrhythmia
- Tx: Levothyroxine (Synthroid) - lahat ng L = - Trousseau, tetany
thyroid hormone replacement = elevate thyroid - Seizure
hormone - Limit water
- Side effects: hyperthyroidism - Intervention
- Monitor vital signs - Calcium gluconate iv - hypocalcemia
- Levo = palpitation -> arrhythmia - Arrhythmia precaution
- Low bp, hr/ bradycardia - Tracheostomy set
- Allowed for caffeine - Seizure precaution
- Slow metabolism
- GIT = Constipation = high fiber/ residue A patient has undergone thyroidectomy. If parathyroid
(lettuce) was accidentally removed, client most likely to
- Weight gain/ obese = low calorie experience - FACIAL TWITCHING
- Cold intolerance (give blanket/ kumot)
- Dry skin (lotion)
- Lethargic/ antukin ADRENAL GLAND
- S/S = alopecia, brittle nails, bradycardia, - Located at the top of kidneys
coarse hair, dry skin, slow metab = - Cortex = corticosteroid (glucocorticoid -
constipation, obesity glucose and aldosterone - sodium and
potassium)

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

CUSHING’S SYNDROME - Normal adult urine output = 1500 ml/day

- High glucocorticoid, aldosterone, sodium/ - Anemia - kulang erythropoeitin - need
hypernatremia but low potassium/ EPOGEN
hypokalemia (ECG - u wave) - Acidosis metabolic - mababa bicarbonate/
- Increase sodium - edema (fluid volume HCO3 - need HCO3
excess) - limit fluid - Azotemia - mataas creatinine - low protein
- Banana, avocado, kiwi is allowed because diet (can give biologic protein - vegetables)
high in potassium - BP - high
- Salt attracts water - CA - mababa
- Hypertension - D VIT - mababa
- Moon face - Edema - low sodium
- Diet = low sodium, high potassium
- Insulin is allowed A client is complaining of severe flank & abdominal
pain. Flat plate of the abdomen shows urolithiasis. W/c
ADDISON’S DISEASE intervention is important?
- Low corticosteroid, glucose, sodium, bp - STRAIN ALL URINE (increase fluid and
but high potassium ambulate = may stone yung pt)
- Avoid banana and insulin
- Salty foods are allowed
- Dehydration -> hypovolemic shock CYSTITIS (UTI)
- Fluid volume deficit = more fluids - Inflammation of bladder
- Hypotension - E. coli - gram negative
- Tx: corticosteroid - hydrocortisone - Common in women
- Sexually active, pregnant
- Frequency, urgency, cloudy urine
RENAL - Lower abd discomfort back pain
- Dysuria
KIDNEY - Increase oral fluid intake/ OFI 3L/ day
- Maintain blood homeostasis - Avoid caffeine, alcohol, feminine wash/
- Erythropoietin = produced by kidney spray
- Acid base balance - Perineal care - catheter
- Treatment for metabolic acidosis = tx: HCO3
(dahil mababa/ kulang ang HCO3/ A client is diagnosed with cystitis. Client teaching
bicarbonate) aimed at preventing recurrence should include which
- Excrete end products of body metabolism instruction?
- End products (waste) = creatinine - WEAR COTTON UNDERWEAR
- Increase or high level of creatinine/ azotemia
= bad = problem in kidney = need to undergo
dialysis to eliminate the waste PYELONEPHRITIS
- Uremic encephalopathy (creatinine go to the - Ascending infection - paakyat/ pataas yung
brain) infection
- Urine production (30 cc per hour - normal) - Inflammation of renal pelvis and
- Oliguria = less than 400 ml/ day parenchyma
- Anuria = less than 20 ml/ day - s/s: fever, flank pain, and chills (gabi gabi)
- If you have renal failure, low erythropoietin -> - [Link]
low bone marrow stimulation -> low RBC -> - Increase OFI 3L/day to prevent DHN
low hemoglobin -> anemia (caused by lack of - Warm compress to flank
erythropoietin) - Vs, UO, renal failure
- Anemia = give injection - artificial
erythropoietin (Epogen - subq - 3 A client is admitted for pyelonephritis is about to start
times a week) antibiotic therapy. Which symptom would be expected
- Nephrons = functional unit of kidney in this client?
- Nephron contains glomerulus - FLANK PAIN ON AFFECTED SIDE
- Glomerulus filters urine
- Nephritis = problems of nephrons
- If may protein sa urine, may problem
- Total bladder capacity 1L

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

GLOMERULONEPHRITIS CHRONIC RENAL FAILURE

- Descending infection (tonsillitis - GABHS - Slow, progressive irreversible loss in renal
muna then bumaba) function
- Immunologic/ autoimmune Most appropriate when caring for a client with a
- GABHS (Group A Beta Hemolytic Strep) nursing diagnosis of excess fluid volume related to
- Hx of pharyngitis or tonsillitis 2 to 3 weeks renal insufficiency?
before symptoms - Teach about sodium content of foods
- Gross hematuria
- Cola-colored, red brown urine (tea colored)
- Proteinuria, oliguria ACUTE AND CHRONIC RENAL FAILURE
- Increase ASO (antistreptolysin O) - Anemia, acid metabolic, azotemia
- Pen G - BP - increase
- ABCDE - Anemia, acidosis, azotemia, - C - decrease (increase Phosphorus)
edema - D vit - decrease
- Edema (increase sodium/ na)
When teaching a client how to prevent recurrences of - K - increase - hyperkalemia (life threatening)
(AGN) acute glomerulonephritis, w/c instruction should
the nurse include?
- SEEK EARLY TREATMENT FOR ACUTE RENAL FAILURE
RESPIRATORY INFECTION
Causes: Prerenal, Intrarenal, Postrenal
- Prerenal (bago/ before kidney)
UROLITHIASIS - Decrease blood flow to kidney
- Bato = kidney, lithiasis = stone/ bato - Hypovolemic shock
- Uro means it can be anywhere in urinary tract - Iba ibang klaseng shock (septic,
- Nephrolithiasis - stone found in kidney anaphy, neuro)
- Ureterolithiasis - stound found in ureter - DHN, diuretic therapy
- Cystolithiasis - stone found in bladder - Intrarenal
- Increase fluid and ambulate - within kidney
- Hyperpara, excessive vit d intake, DHN - Drugs, diseases, dyes (contrast)
- Obstructive (enlarged prostate) - Post renal
- Gout, osteoporosis - Below kidney
- Prolonged immobility - Bet. kidney and urethral meatus
- Assessment Findings: - BPH/ benign prostatic hyperplasia
- Sudden, sharp, severe flank pain - Ureteral calculi
- Urinalysis, radiography (KUB) - Bladder tumor
- IVP, ultrasonography
- Medical Management: 4 Phases: Initiation phase, Oliguric phase, Diuretic
- Small calculi phase, Recovery phase
- Passed naturally, vigorous - Oliguric Phase (sudden decrease UO)
hydration - UO less than 400 ml/day
- Analgesic (stone - nursing - Hypervolemia (edema, HPN, pleural
diagnosis - pain) and pericardial effusions, pulmonary
- Larger calculi edema, CHF)
- ESWL (extracorporeal shock - Diuretic Phase -> DHN/ dehydration ->
wave lithotripsy) hypotension

ARF: Assessments: Metabolic acidosis, Kussmaul’s

RENAL FAILURE respirations, Hyperkalemia, Azotemia (increase BUN,
- Inability of nephrons to maintain fluid and crea)
electrolytes, acid base balance, excrete - Hyperkalemia
nitrogen waste products - Kayexalate = to decrease Sr K/ serum
potassium levels IVinfusion of insulin
ACUTE RENAL FAILURE and glucose
- Sudden, rapid loss of renal function - Dialysis
- Reversible - early, aggressive tx

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

A client with ARF has bean treated with kayexelate by HEMODIALYSIS

mouth. The nurse would evaluate this theraphy as - Procedure to remove wastes from the body by
effective if which of the ff values was noted on the filtering client’s blood using a machine
follow up lab testing? - Client may eat before or during dialysis
- POTASSIUM 4.9 mEq/L - Complications: air embolism, dyspnea,
chest pain
Note: - Interventions: stop dialysis, o2,
- Diet - decrease CHON, high calories, notify md
decrease na and K - Disequilibrium syndrome (complication) -
- Na bicarbonate for acid base imbalance headache, hpn, restlessness, confusion
- Avoid nephrotoxic drugs (aminoglycosidesn
nsaids) - Intervention: stop dialysis and notify
md
On reading a client chart, with renal failure, you have
seen a serum K level of 6.0 mEq/L. You plan which of You are a nurse assessing a client with Chronic Renal
the ff important function? Failure, which most frequent cardiovascular signs
- PLACE CLIENT ON CARDIAC MONIOR occure frequently in client with CRF?
- HYPERTENSION
When caring for a client with ESRD, which of the ff diet
should the nurse recommend? A client with CRF is admitted with pulmonary edema
- RESTRICTED PROTEIN, INCREASED after missing his dialysis treatment. Blood is drawn for
CARBOHYDRATE analysis. Which results is expected?
- HYPERKALEMIA

CRF/ CHRONIC RENAL FAILURE You have completed the client’s teaching with
- Slow, progressive, irreversible loss in renal fxn hemodialysis about self monitoring bet. Hemodialysis
- ESRD treatments. You determine that the client best
- Requires dialysis or kidney transplant understands the info if the client states to record daily
- Causes: DM, HPN, autoimmune, recurrent the
infections, chronic urinary obstruction - INTAKE, OUTPUT, AND WEIGHT
- Cardiovascular = HPN, CHF
- GI Bleeding = monitor hemoglobin and You are the nurse supervisor of hemodialysis unit
hematocrit , occult blood observing a new nurse preparing to begin a
- Avoid asa (aspirin) hemodialysis on renal failure patient. You intervene if
- Hema = anemia from lack of eryhtropoeitin rbc the new nurse planned to
production - COVERS THE CONNECTION SITE WITH
- BT if prescribed BATH BLANKET TO ENHANCE EXTREMITY
- Epoietin alpha = to stimulate RBC WARMTH (bawal takpan para makita if
production nagbleed)
- Infection = avoid contact with persons who
have infections Which of the ff abnormal blood values (elevated serum
- Hyperkalemia = tall, peak T wave creatinine, hyperkalemia, low hgb, or hypernatremia)
- Avoid foods high in potassium would not be improved by dialysis treatment?
- Place client on cardiac monitoring - LOW HEMOGLOBIN
- Loop diuretics to excrete K
(furosemide - to lower potassium level) One of your case is a client undergoing PD who had
- Avoid K-sparing medications an outflow that is 100 ml less than the inflow for 2
(spironolactone, triamterene) - if 6 ang consecutive changes, your nursing mgt to take first is
potassium - CHANGE CLIENT’S POSITION4
- Hemodialysis = filters blood when the kidneys
can no longer do so For a nurse to assess a CRF client with disequilibrium
- Heparin - used as anticoagulant during syndrome ff hemodialysis, the nurse would document
procedure which of the ff symptoms?
- V/S = wear protective eye wear, gown, gloves - HEADACHE
for protection
- AV Fistula = avoid iv infusions, injections, or
taking BP in fistula extremity

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

PERITONEAL DIALYSIS is the ARACHNOID, a

- Peritoneum acts as dialyzing membrane web-like structure filled with
- Ultrafiltration fluid that cushions the brain.
- Osmosis The tough outer layer is called
- Diffusion the DURA MATER.
- Warm dialysis solution to body temperature
- Change dressing if nabasa dahil bawal - PNS
magmoist ang dressing - CRANIAL NERVES (12 pairs)
- Keep dressing clean and dry - SOMATIC NS = control
- Assess catheter site dressing for bleeding or - ANS/ autonomic nervous system
wetness, infection, pain (involuntary control)
- Do not allow dwell time to extend beyond MD - SYMPATHETIC = everybody
order - increases risk of hyperglycemia is up - increase bp, hr except
(hypertonic solution) secretions - dry mouth
- PARASYMPATHETIC =
The client with CRF has an indwelling abdominal everybody is down - decrease
catheter for peritoneal dialysis. The client spills water bp, hr except secretions -
on the catheter dressing while bathing. The nurse salivation
should immediately
- CHANGE DRESSING
TYPES OF CELLS IN NS
You are reviewing the list of components contained in - NEURONS = basic unit of nervous systems
the peritoneal dialysis solution with the client. The - NEUROGLIAL CELLS (supporting cells)
client asks you about the purpose of glucose contained - Astrocytes (astrocytoma)
in the solution. Your best response on knowing that the - Oligodendrocytes - CNS
glucose (oligodendroglioma)
- INCREASES OSMOTIC PRESSURE TO - Microglial cells
PRODUCE ULTRAFILTRATION - Ependymal cells (ependymoma)
- Schwann - PNS
You are teaching a client to perform peritoneal dialysis.
You review in detail which essential action that wil help - OLIGODENDROCYTES (CNS) AND
to prevent the major complications of PD SCHWANN (PNS) = produces myelin sheath
- MAINTAIN STRICT ASEPTIC TECHNIQUE - MULTIPLE SCLEROSIS = demyelination -
DURING CONNECTION AND destruction of myelin sheath in CNS
DISCONNECTION - GUILLAIN-BARRÉ SYNDROME (GBS) =
demyelination - destruction of myelin sheath in
You are instructing a client with DM about peritoneal PNS
dialysis. You tell the client that it is important to - MYELIN SHEATH = faster impulse
maintain the prescribed dwell time for the dialysis transmission
because of the risk of
- HYPERGLYCEMIA
MENINGITIS
- BACTERIAL = low glucose, VIRAL - normal
NERVOUS SYSTEM or high glucose
- Bacteria = Newborn - e. Coli, Children - hib,
- CNS (brain and spinal cord covered by Adult - strep pneum
meninges) - Viral = enterovirus
- ENCEPHALITIS = inflammation of the
brain
- MYELITIS = spinal cord BRAIN STEM
- ENCEPHALOMYELITIS = brain & - Midbrain
spinal cord - Pons
- MENINGITIS = meninges - Medulla = respiratory center
(leptomeninges = arachnoid and pia - Herniation = increase ICP
mater)
- The delicate inner layer is the
PIA MATER. The middle layer

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

CSF - V = 5 - Oriented, 4 - Confused, 3 -

- Produced in choroid plexus Inappropriate words, 2 - Incomprehensible
- Clear, colorless sp. gravity 1.007 sounds, 1 - none
- Minimal wbc, no rbc - M = 6 - obeys comman, 5 - localized pain, 4 -
- If csf has rbc, has hemorrhage or traumatic LP withdraw pain, 3 - decorticate, 2 - decerebrate,
1 - none

Which of the ff food group is allowed in a client with

increased ICP? ABNORMAL POSTURING
- HIGH FIBER (to prevent constipation) - DECORTICATE = flexion of upper and lower
extremities
- DECEREBRATE = extension of upper and
CEREBELLUM = balance lower extremities

BRAIN LOBES Which of the ff involve cerebellar test?

- FRONTAL LOBE = broca’s (speech) - left - FINGER TO NOSE TEST
frontal, memory, motor
- PARIETAL LOBE = sensory
- TEMPORAL LOBE = auditory receptive CEREBRAL
- OCCIPITAL LOBE = vision - Memory and ability to follow command

In a client's altered temperature, which part of the brain CEREBELLUM

is affected? - Pronate supinate hand
- HYPOTHALAMUS (sleep wake cycle, - Point to point test
emotions, temp) - ROMBERG’S Test

DIENCEPHALON Which of the ff has the reflex - vomiting center?

- THALAMUS - relay station for sensations - MEDULLA
- HYPOTHALAMUS
- Sleep - wake cycle, bp
- Endocrine, emotion PONS - controls of heart/ puso
- Temperature, hunger, appetite

You are assesing a geriatric patient with reduced

ASSESSMENT smell. This is documented as
- Cerebral function = mental status - HYPOSMIA
- Conscious
- Obtunded
- Lethargic = sleepy NOTE!
- Stuporous = pain - ANOSMIA - absence smell
- Coma - HYPOSMIA - decrease smell
- AGEUSIA - absence taste
Not included in GCS assessment - HYPOGEUSIA - decrease taste
- PUPIL REACTION TO LIGHT - XEROSTOMIA - dry mouth

GLASGOW COMA SCALE CRANIAL NERVES

- Eye Opening (E) 4 1
- Verbal Response (V) 5 1 CRANIAL NERVE 1 - OLFACTORY
- Motor Response (M) 6 1 - 2 olfactory nerves
15 3 - Smell

- E = 4 - Spontaneous, 3 - Voice, 2 - Pain, 1 - Examination of the optic nerve include

None - SNELLEN’S CHART

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

NOTE! - Stimulation - washing face, shaving, brushing

- ISHIHARA CHART = color vision teeth, eating, drinking
- PENLIGHT = CN3 Oculomotor - NI
- Small frequent meals at room temp
- Assist in recognizing stimulation
CN 2 - OPTIC
- 2 optic nerves
- Snellen’s chart BELL’S PALSY
- Involves cranial nerve 7
- Facial paralysis
CN 3 - OCULOMOTOR, 4 - TROCHLEAR, 6 - - Unilateral inflammation 7th cn
ABDUCENS - Idiopathic
- Extraocular muscles - Vascular ischemia, viral disease, autoimmune
- Conjugate eye movement - Mouth drooping, distorted taste
- Inability to close eyelid - affected side
- Incomplete eye closure, raise eyebrows
CN 5 - TRIGEMINAL - NI
- 2 trigeminal nerves - Apply moist heat to reduce pain
- 3 branches kaya tri = opthalmic, maxillary, and - Massage face - maintain muscle tone
mandibular - Protect eye - eye patch
- Corneal reflex (cotton wisp) - Facial muscle exercise
- Mastication

Which of the ff can occur in increased ICP?

CN 7 - FACIAL - RESPIRATORY ACIDOSIS
- Ask the pt to smile or frown

3 CONTENTS OF SKULLS
CN 8 - VESTIBULO-COCHLEAR - Brain 1200 g
- Balance and hearing - Blood 75 ml
- Tuning fork - CSF 75 ml

C 9 - GLOSSOPHARYNGEAL, 10 - VAGUS MONRO-KELLIE HYPOTHESIS

- Gag reflex (tongue depressor) - Alteration in anyone of components causes
change in volume of other

CN 11 - SPINAL ACCESSORY
- 2 nerves INCREASED ICP
- Shrug shoulder
- Causes:
- Head injury (traumatic brain injury,
CN 12 - HYPOGLOSSAL epidural, subdural hematoma)
- Tongue movement - Infection - CNS (menigitis,
encephalitis)
- Tumor - brain
Which of the ff is least needed when performing cranial - Stroke
nerves exam? - Cerebral edema - mannitol - osmotic diuretic
- NEUROLOGIC HAMMER - Decrease perfusion - flow - low o2
- Increase co2 > 45 mmhg -> resp acidosis
- Hypercapnia -> cerebral vasodilation
TRIGEMINAL NEURALGIA/ TIC DOULOUREUX - S/S = change in LOC = earliest sign
- Involves cranial nerve 5
- Unilateral, stabbing sensation
- Idiopathic = unknown cause Which of the ff is seen in increased ICP?
- Causes: vascular compression, pressure - BRADYCARDIA (HYPERTENSION,
- Pain - skin BRADYCARDIA, BRADYPNEA)

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

After a craniotomy, a 23 yo male developed SIADH.

Which findings indicate to the nurse that the treatment
the pt is receiving for this condition is effective.
- INCREASED IN URINE OUTPUT

DI
- Administer desmopressin intranasal - DDAUP
- Provide adeq fluids
- Loc, cv urine sp, gravity

Diabetes insipidus is a disorder of which gland

- PITUITARY GLAND

The nurse know that the purpose of medication

therapy in the pt with DI is to
- REPLACE/ INCREASE ANTIDIURETIC
CUSHING’S REFLEX HORMONE
- HPN
- Bradycardia
- Wide pulse pressure INCREASED ICP: NI
- Maintain patent airway
- Elevate HOB, suction with care
CUSHING’S RESPONSE - Avoid coughing
- Hpn, temp/ fever (central fever) - Maintain paco2 <30 mmhg
- Bradycardia (Standby ATROPINE) - Optimizing cerebral perfusion
- Bradypnea - Head kept neutral
- Enemas, valsava avoided
- Maintaing negative fluid balance
INCREASED CP - Osmotic and loop diuretics
- Late manifestations: increased bp,t and
decreased hr, rr
- Widened pulse pressure Which of the ff symptoms are expected in a pt with
- Loss pupillary, corneal, gag reflexes meningitis?
- PHOTOPHOBIA

Dx - avoid lp
NOTE!
Medical Management - dec. cerebral edema - - PARKINSON = pill rolling tremor
osmotic diuretic (mannitol), control fever - GBS = ascending
- MYASTHENIA GRAVIS = descending
Complications - brain stem herniation, SIADH, DI paralysis

SIADH MENINGITIS
- Increased ADH - Inflammation lining around brain, sc
- Water intoxication - Classified septic (bacterial) or aseptic (viral)
- Everbody up except sodium
- Hypervolemia, hpn, a/n/v CLINICAL MANIFESTATIONS
- Hyponatremia - Headache and fever (high grade)
- DEMECLOCYCLINE - drugs - Nuchal rigidity (stiff neck)
- Monitor VS neuro status - + Kernig’s sign
- Limit fluid intake - Pt lying with thigh flexed on abd, leg
cannot be completely extended
A nurse is caring for a client with SIADH. Which lab - Brudzinki’s sign
value is most important to monitor - Pt neck is flexed, flexion of knees and
- SODIUM hips is produced

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

- Rash (purpuric) = striking feature of N. CRANIOTOMY

meningitidis infection - Surgical opening of skull to gain access to
intracranial structure
DX = LP for CSF analysis - Used to remove a tumor, evacuate bld clot,
control hemorrhage, relieve increased ICP
Prevention - Supratentorial = above = elevate the bed
- Meningococcal meningitis in close contact - Infratentorial = flat on bed
- Rifampin, ciprofloxacin, ceftriaxone
(prophylaxis)
- Vaccination in child, adults against h. TYPES OF HEADACHE
Influenzae, strep. pneumoniae
1. TENSION HEADACHE (muscle contraction)
Medical Management - Associated with tension/ anxiety
- Antibiotics - Pain - bilateral, often back of neck
- Anti Seizures - phenytoin extends top of head
- Dilantin
- Gingival hyperplasia 2. MIGRAINE HEADACHE
- Throbbing, temporal or supraorbital
NI: Meningitis area lasts hours to days
- Nursing care for inc ICP, seizures - Women > men
- Keep room quiet and dark - Vascular origin: vasoconstriction
- Prevent complications of immobility - (aura) then vasodilation
pneumonia
3. CLUSTER HEADACHE
- Vascular origin, throbbing
TRAUMATIC BRAIN INJURY - Affects 1 side of face and head
- Recur several times/ day over 6 weeks
- Concussion = mild TBI, brain jarring with remission of wks/ mo
- No apparent structural damage
- Temporary loss of neurologic fxn NI: HEADACHE
- Quiet, dark environment
- Contusion (increased ICP) = moderate to - Identify factors that precipitates attack
severe TBI/ HI, surface bleed
- Brain is bruised with possible surface MEDS
hemorrhage - During acute attack
1. Non narcotic analgesics -
acetaminophen
DIFFUSE AXONAL INJURY 2. For migraine - ergotamine tartrate
- Widespread damage to axons in brain
- Immed coma, decortication, decerebration
Mrs. E, 78 yo was admitted at the ICU with pneumonia
and uncontrolled diabetes. She is at risk for is:
HEAD INJURY - DEHYDRATION
- Intracranial Hemorrhage
- Basilar Skull Fracture
- Racoon Eyes/ Periorbital Ecchymosis The most immediate goal of the nurse in a client with
- Battle’s Sign/ Mastoid Ecchymosis increased ICP on the right would be which of the ff?
- Rhinorrhea - leakage of CSF from nose - MAINTAIN FLUID AND ELECTROLYTE
- Otorrhea - leakage of CSF from ear

DX Test PARKINSON’S DISEASE

1. Skull x ray - Neurologic movt d/o
2. CT/ MRI scan - Cause: idiopathic; genetic, Atherosclerosis,
viral infection
Management - Head trauma, excessive antipsychotic use
- Tx: increased ICP - Basal ganglia destruction
- Surgery = removal of bld clots

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

- Decrease dopamine = tx: levodopa - to - Descending paralysis

increase dopa - Batang babae
- Increase ach = tx: anticholinergics - akineton, - Neuromuscular junction nangyayari
cogentin, benadryl - Mata grabe weakness
- Symptoms: tremor - pill rolling, rigidity - mask - Vulvar weakness
like, bradykinesia, postural instability - shuffling - Priority - AIRWAY
gait - Dec ach receptors at myoneural junction
- Thymoma 25%

A 65 yr old woman was admitted for parkinsons MYASTHENIA GRAVIS: C/M

diseas. The charge nurse is going to make an initial - 1st sx: diplopia and ptosis
assessment. Which of the ff is a characteristic of a pt - Difficulty in chewing and swallowing
with advanced parkinon’s disease: - Muscle weakness
- MASK-LIKE EXPRESSION - Result to respifailure

DIAGNOSTICS
PD - TREATMENT - Edrophonium (Tensilon) - dx of MG
- Control symptom - Atropine Sulfate (anticholinergic drug) -
- Maintain functional independence antidote of tensilon

TX MEDS
a. LEVODOPA - mainstay tx, most effective = A. Anti-cholinesterase
increase dopamine availability 1. Neostigmine
b. ANTICHOLINERGICS - lower acetylcholine 2. Pyridostigmine/ Mestinon
- Akineton, cogentin, artane, benadryl B. Corticosteroids (Prednisone)
- Side effects: blurring of vision, - Decrease ab production
constipation, urinary retention, dry
mouth
NURSING INTERVENTIONS
You monitor therapeutic effectiveness of artane in tx in
parkinson’s by evaulating decrease in - Anticholinesterase as ordered
- TREMORS - Exactly on time
- Give meds 30 mins before meals
NI - Check gag before feeding
- Provide safe environment - Suction equipment nearby
- Hard back or spring loaded chair
- ROM exercises - Monitor complications
- Allow sufficient time for meals, use - Myasthenic crisis and cholinergic crisis
warming tray
- Walking techniques to offset shuffling MYASTHENIC CRISIS
gait - Undermedication
- Weakness
- TX/ Antidote: Mestinon
MYASTHENIA GRAVIS
- Autoimmine, chronic - remission (gumagaling), CHOLINERGIC CRISIS
exacerbation (lumalala) - Parasymp
- Problems: - Overmedication
1. Antibody from thymus (sinisira receptor) - Decrease hr, salivation
- TX (removal of antibody) - Tx/ Antidote: Atropine (anticholinergic)
- Thymectomy
- Plasmapheresis
- Immunosuppressant MULTIPLES SCLEROSIS
2. Cholinesterase enzyme (sinira - Young women
cholinisterase) - Memory, motor, sensory
- Anticholinesterone/ Cholinergic - - May problem sa brain, mahina memroy
Mestinon/ pyridostigmine - Fatigue = rest
- Test the temp of water before taking a bath

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LEIGH HANNAH LOUISE SM. HECHANOVA BSN 4-Y2-10

MULTIPLES SCLEROSIS - Emergency Management

- Autoimmune - Immobilization, ABC
- Sensitized t cells - Cervical fractures - traction (tongs
- Demyelination cns (brain and spinal cord) calipers, use of halo cevice)
- Results of patchy destruction of myelin - Thoracic, lumbar inj-surgery
sheaths
- Young adults - Acute complications - Spinal Shock
- Memory loss, ataxia, diplopia, scotoma - Occurs immed after SCI
- Fatigue, spasticity, weakness, paresthesia - Absent reflex - bladder, bowel
- Constipation, urinary incontinence - Flaccid paralysis
- Dx: CT scan or MRI - plaques, CSF
electrophoresis (IgG bands) - Autonomic Dysreflexia
- Pharmacotheraphy - IV methylprednisone - Occurs only after spinal shock
- Baclofen: for muscle spasms resolved
- NI - Assitive devices - Occures with cord lesions above T6
- Proper positioning, suction machine - Pounding headache, profuse
- Nursing care sweating, paroxysmal hpn
- Avoid hot baths - Nasal congestion
- Teach use assistive devices (fatigue) - Bradycardia
- Mgt: sitting position to lower BP
- Urinary cath - empty bladder, check
GBS fecal impaction
- Walang problem sa brain - Skin examined for pressure, irritation
- Mahina (check temp of environment)
- Sensory - NI
- Autoimmune attack on peripheral myelin - Assess for the presence of
- Demyelination stimulus
- Antecedent event 2 weeks - Monitor bp
- Autonomic dysfunction - Administer antihypertensive
- Common in boys as ordered
- Initial - paresthesia, followed by limb
weakness DVT
- Ascending paralysis - Complication of immobility, risk for pul embol
- Medical Management - Prevention: anticoagulants, antiembolic
- ICU stockings
- Mechanical ventilation (resp failure) - Vena cava filters - prevent emboli from
- TPN and IVF migrating to lungs
- Plasmapheresis
- IV imunoglobulin SCI - NI
- NI - Assist in DBCE
- Maintain respi fxn - Improve mobility proper body alignment
- Prevent complications of immobility - Tronchanter rolls - prevent external
(DVT, pneumonia, pressure ulcer) rotation of hip jt
- Splints to prevent footdrop
- Contractures prevented by ROM exercises
SPINAL CORD INJURY (passive)

- Causes: VA, falls, violence-related,

sports-related injuries

- C/M:
- Can result paraplegia (lumbar) or
tetraplegia (cervical)
- High cervical SCI-ARF leading cause
of death

- DX: Spinal xray, CT scan, MRI

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