ORAL REVALIDA AND COMPREHENSIVE EXAM!

THEORY
Metabolism
 GIT Process
Ingestion-
Digestion-
Absorption-
Elimination-
Types of digestion
Mechanical
Chemical
Enzymatic
Trypsin-
Aging and the digestive system
>decreased secretory mechanism
>Decreased motility
>loss of strength and tone of the muscular

Nutrient Classification
Macronutrients
-carbs
-fats
-protien
Micronutrients
-Minerals -inorganic elements
-microminerals
-trace minerals
-vitamins- organic nutrients
Fat-soluble
Water-soluble
Primary malnutrition
Inadequate energy intake in children
Secondary malnutrition
Case by disease or condition interfere with nutrient in adult
Malnutrition associated with carbohydrate and calorie deficit:
Kwashiorkor-severe form of malnutrition protein deficiency
Marasmus- deficiency of all macronutrient
Mixed- edematous malnutrition
Eating disorder
Anorexia nervosa
Bulimia
UPPER GI PROBLEM
Nausea and vomiting
 Nausea is a vague, uncomfortable sensation of sickness or “queasiness”
that may or may not be followed by vomiting.
 Distention of the duodenum or upper intestinal tract is a common cause of nausea; and an early sign of
pathologic process.
 Vomiting is a physiologic protective response tat limits the effects of noxious agent by emptying the
stomach contents and sections of the small intestine
Triggered by:
odors, activity medications, or food intake
cause: 1. visceral afferent stimulation (i.e., dysmotility, peritoneal irritation,
infections, hepatobiliary or pancreatic disorders, mechanical obstruction);
2. CNS disorders (i.e., vestibular disorders, increased intracranial
pressure, infections, psychogenic disorder); and/or
3. irritation of the chemoreceptor trigger zone from radiation therapy, systemic disorders,
And endogenous and exogenous toxins, which may include specific classes of drugs (e.g.,
oncologic chemotherapy medications)

GERD
 fairly common disorder marked by backflow of gastric or duodenal contents into the esophagus
that causes troublesome symptoms and/or mucosal injury to the esophagus.
 The incidence of GERD seems to increase with aging and is seen in patients with irritable bowel
syndrome and obstructive airway disorders
 commonly cause symptoms such as heartburn and regurgitation. GERD may develop when your
lower esophageal sphincter becomes weak or relaxes when it shouldn't.
 risk factor
- nicotine
- high fat food
- caffeine
- Beta Adrenergic
- Elevated of estrogen and progesterone
Clinical manifestation
- Pyrosis (heart burn)
- Dyspepsia
- Regurgitation
- Dysphagia
- Odynophagia
- Hypersalivation
- Dental erosion
- Ulceration in the pharynx and esophagus
- Laryngeal damage
- Adenocarcinoma
- Pulmonary complication
A/DF
- endoscopy or barium swallow
- Ambulatory 12- to 36-hour esophageal pH monitoring is used to evaluate the degree of acid
reflux
Management
- Educate patient to avoid situations that decrease lower esophageal sphincter pressure or cause
esophageal irritation
- Low fat diet
- Avoid caffein
- Tabaco,
- beer
- milk
- food containing peppermint and spearmint
- carbonated beverages
- avoid eating or drinking before bedtime
- maintain normal body weight
- avoid tight-fitting clothes
- elevate the head of the bed 30 degree
-
Achalasia
 absent or ineffective peristalsis of the distal esophagus accompanied by failure of the esophageal
sphincter to relax in response to swallowing.
 Narrowing of the esophagus just above the stomach results in a gradually increasing dilation of the
esophagus in the upper chest. Achalasia may progress slowly and occurs most often in people 40 years or
older.
 Achalasia may be treated conservatively by pneumatic dilation to stretch the narrowed area of the
esophagus

Clinical manifestation
 main symptom is dysphagia (solids and liquids)
 prolonged distention of the esophagus by food that will not pass into the stomach
 report non-cardiac chest or epigastric pain
 pyrosis (heartburn) that may or may not be associated with eating.
 Secondary pulmonary complications may result from aspiration of gastric
A/DF
- x-ray
- Barium swallow
- CT scan of the chest
- endoscopy
- Bougienage: A procedure involving the use of a bougie.
Management
- eat slowly and to drink fluids with meals
- taking small bites
- avoiding swallowing large volumes of food or liquid
- muscles relaxant
Hiatal hernia
 the opening in the diaphragm through which the esophagus passes become enlarged
 part of the upper stomach moves up into the lower portion of the thorax
 Hiatal hernia occurs more often in women than in men.
 two types of hiatal hernia
- Sliding, or type I, hiatal hernia
occurs when the upper stomach and the
gastroesophageal junction are displaced
upward and slide in and out of the thorax
- paraoesophageal hiatal hernia occurs
when all or part of the stomach
pushes through the diaphragm beside
the esophagus. Paraoesophageal
hernias are further classified as types
II, III, or IV. Type IV has the greatest
herniation with other intra-abdominal viscera such as the colon, spleen, or small bowel
evidencing displacement into the chest along with the stomach
Clinical manifestation
- Heart burn
- Dysphagia
- Dyspnea
- Abdominal pain
- Nausea and vomiting
- Gastric detention bleeding
- Regurgitation
- Intolerance of food
- Intermittent epigastric pain
A/DF
- x-ray studies; barium swallow;
- esophagogastroduodenoscopy (EGD)
- esophageal manometry; or
- chest CT scan
NURSING MANAGEMENT
 frequent, small feedings
 no recline for 1 hour after eating
 elevate the head of the bed on 10-20 cm
MEDICATION
 Antacids
 Antiemetic
 H2 Blockers
Gastritis
 inflammation of the gastric or stomach mucosa) is a common GI problem
 lining of the stomach becomes irritate
 It affects women and men about equally and is more common in older adults.
 Gastritis may be acute, lasting several hours to a few days, or chronic, resulting from repeated exposure to
irritating agents or recurring episodes of acute gastritis
Classified:
Erosive
- wears away the stomach lining inflamed
- acute gastritis is most often caused by local irritants such as aspirin and other nonsteroidal anti-
inflammatory drugs (NSAIDs)
nonerosive
- does not erode the stomach however, the stomach still inflamed
- acute gastritis is most often caused by an infection with Helicobacter pylori (H. pylori)
risk factor
Acute
- ingestion of corrosive, erosive, infections substances
- excessive amount of tea, coffee, mustard, paprika, and pepper
- food eaten at extremely high temperature
- ingestion of corrosive agent
- prolonged emotional tension
Chronic
- Age and more common in older adults
- Peptic ulcer disease
- H Pylori
- Gastric surgery
Clinical manifestation
Acute
- Epigastric discomfort
- pyrosis
- Abdominal tenderness
- Cramping
- Belching
- Reflux
 - Severe N/V
- Hematemesis
- Diarrhea
Chronic
- anorexia
- feeling of fullness
- dyspepsia
- belching
- vague epigastric
- N/V
- Intolerance of spicy and fatty food
A/DF
- endoscopy and histologic examination of a tissue specimen obtained by biopsy
- complete blood count (CBC) may be drawn to assess for anemia as a result of hemorrhage or pernicious
anemia
- Diagnostic measures for detecting H. pylori infection
Medical management
- instructing the patient to refrain from alcohol and food until symptoms subside
- nonirritating diet is recommended
- Therapy is supportive and may include nasogastric (NG) intubation,
- antacids, histamine-2 receptor antagonists
selected pharmacotherapy for PUD and Gastritis
Parents: antibiotic
Children: amoxicillin, Clarithromycin, metronidazole, tetracycline
Parents: proton pump inhibitor of Gastric Acid
Children: esomeprazole, omeprazole, pantoprazole, rabeprazole
Family name: zole
nursing management
- reducing anxiety
- promoting optimal nutrition
- promoting fluid balance
- relieving pain

Peptic ulcer disease

 caused by h pylori infection
 h pylori due to eating raw or improper cooked meat
 referred to as a gastric, duodenal, or esophageal ulcer, depending on its location
 A peptic ulcer is an excavation (hollowed-out area) that forms in the mucosa of the stomach, in the
pylorus (the opening between the stomach and duodenum), in the duodenum or in the esophagus
 Decreased mucosa secretion
risk factors
- stress
- smoking
- alcohol
- caffeine
- ASA, NSAIDS, STEROIDS
- Gastritis
- Fatty, spicy, acid food
- Type O blood
- Genetics
A/DF
- EDOSCOPY
- Biopsy
- X-ray
- Histologic examination
- CBC’S
- Hyperchlorhydria (high levels of HCl)
Medical management
- Antibiotics
- Proton pump inhibitor
Surgical management
- Vagotomy
- Gastroduodenostomy
- Gastrojejunostomy
Nursing Process
Assessment
- describe the pain then as the patient if the pain occurs after meals, during the night
- it will relieve if you eat or take a medication
- ask for usual food within 72 hours, lifestyle and habits
- ask if alcoholism and use cigarette
 Intestinal obstruction
 Intestinal obstruction exists when blockage prevents the normal flow of intestinal contents
through the intestinal tract
 Two types of processes can impede this flow:
- Mechanical obstruction: An intraluminal obstruction or a mural obstruction from
pressure on the intestinal wall occurs. Examples are intussusception, polypoid tumors
and neoplasms, stenosis, strictures, adhesions, hernias, abscesses, and bezoars
Caused by occlusion of the lumen of the intestinal tract
- Functional or paralytic obstruction: The intestinal musculature cannot propel the
contents along the bowel. Examples are amyloidosis, muscular dystrophy, endocrine
disorders such as diabetes, or neurologic disorders such as Parkinson disease
Risk factor
- Abdominal or pelvic surgery which often causes adhesion
- Chron’s disease
- Cancer with abdomen
- Paralytic ileus
- Twisting of abdomen
- Diverticulitis
- Impacted feces
- Narrowing of the colon
- Accidents
Clinical manifestation
- Abdominal fullness gas,
- Abdominal pain, and cramping
- Breath odor
- Constipation
- Diarrhea
- Vomiting
- Fever
- Failure to pass stool cause paralytic ileus
- Fatigue
- Joint pain

Acute appendicitis
 an acute inflammation of the vermiform appendix. Typically presents as acute
abdominal pain starting in the mid-abdomen and later localizing to the right lower
quadrant. Associated with fever, anorexia, nausea, vomiting, and elevation of the
neutrophil count. Diagnosis is usually made clinically.

Peritonitis
 Peritonitis is inflammation of the peritoneum, which is the serous membrane lining the
abdominal cavity and covering the viscera. Usually is a result of bacterial infection but may occur
secondary to a fungal or mycobacterial infection; the organisms come from diseases or disorders
of the GI tract or, in women, from the internal reproductive organs
Clinical manifestation
- Rebound tenderness
- Anorexia
- Nausea and vomiting
- Hypovolemia
-
A/DF
- X-RAY, abdominal ultrasound, CT scan, MRI
Medical management
- fluid, colloid, electrolytes replacement
Nursing management
- Intensive care indeed
- Food intake gradually

Gastroenteritis
 a very common condition that causes diarrhea and vomiting. It's usually caused by a
bacterial or viral tummy bug. It affects people of all ages, but is particularly common in
young children. Most cases in children are caused by a virus called rotavirus.
 Ulcerative colitis
 a long-term condition where the colon and rectum become inflamed. The colon is the large intestine
(bowel) and the rectum is the end of the bowel where poo is stored. Small ulcers can develop on the
colon's lining, and can bleed and produce pus.
Cron’s disease
 Crohn’s disease is characterized by periods of remission and exacerbation. It is a subacute and
chronic inflammation of the GI tract wall that extends
 a type of inflammatory bowel disease (IBD). It causes swelling of the tissues (inflammation) in
your digestive tract, which can lead to abdominal pain, severe diarrhea, fatigue, weight loss and
malnutrition.
Clinical manifestation
- RLQ abdominal pain
- Diarrhea
- Abdominal cramping
- Abdominal tenderness and spasm
- Abdominal crampy and pain occurs after meals
- Weight loss
- Nutritional deficiencies
A/DF
- CT scan, MRI
- CBC is performed to assess hematocrit and hemoglobin levels
Complication
- Intestinal obstruction
- Perineal diseased

Hepatitis
 inflammation of the liver. The liver is a vital organ that processes nutrients, filters the blood, and fights
infections. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins,
some medications, and certain medical conditions can cause hepatitis.
 Stages of liver damage
Pancreatitis
 he redness and swelling (inflammation) of the pancreas. It may be sudden (acute) or ongoing
(chronic). The most common causes are alcohol abuse and lumps of solid material (gallstones) in
the gallbladder. The goal for treatment is to rest the pancreas and let it heal.
Cholelithiasis
 the presence of one or more calculi (gallstones) in the gallbladder. In developed countries, about 10% of
adults and 20% of people > 65 years have gallstones. Gallstones tend to be asymptomatic. The most
common symptom is biliary colic; gallstones do not cause dyspepsia or fatty food intolerance.
Cholecystitis
is a redness and swelling (inflammation) of the gallbladder. It happens when a digestive juice called bile
gets trapped in your gallbladder. The gallbladder is a small organ under your liver.
The endocrine system

Perception and coordination

 Altered level of consciousness
- present when the patient is not oriented, does not follow commands, or needs persistent stimuli
to achieve a state of alertness.
- Coma is a clinical state of unarousable unresponsiveness in which there are no purposeful
responses to internal or external stimuli, although no purposeful responses to painful stimuli and
brainstem reflexes may be present
-
 Increased intracranial pressure
 Headache
 Seizure Disorder, epilepsies, and status of epilepticus
 Stroke: ischemic, embolic & hemorrhagic
 Meningitis
 Head injury
 Brain injury
 Spinal cord injury
 Multiple sclerosis
 Myasthenia gravis
 Guillain Barre Syndrome
 Parkinson Disease
 Huntington’s disease
 Amyotrophic lateral sclerosis
 Low back pain
 Osteoporosis

 Retractive errors, vision impairment and blindness

Retractive errors
- refractive errors, vision is impaired because a shortened or elongated
eyeball prevents light rays from focusing sharply on the retina.
- Blurred vision from refractive error can be corrected with eyeglasses or contact lenses.
- Ophthalmic refraction is the determination of the refractive errors of the eye for the purpose of
vision correction and consists of placing various types of lenses in front of the patient’s eyes to
determine which lens best improves the patient’s vision.
- Emmetropia Patients for whom the visual image focuses precisely on the macula and who do not
need eyeglasses or contact lenses
- myopia is said to be nearsighted and have blurred distance vision.
- hyperopia is said to be farsighted and have excellent distance vision but blurry near vision
- Presbyopia, the loss of accommodative power in the lens, interferes with the ability to adequately
focus and is the factor responsible for most older adults requiring some form of corrective lenses
vision impairment and blindness
- Vision impairment is defined as having best corrected visual acuity of 20/40 or worse in the
better-seeing eye.
- Low vision describes visual impairment that requires the use of devices and strategies to perform
visual tasks.
- Blindness is having best corrected visual acuity that can range from 20/400 to no light
perception. The clinical definition of absolute blindness is the absence of light perception.
- Legal blindness is a condition of impaired vision in which a person has best corrected visual
acuity that does not exceed 20/200 in the better eye or whose widest visual field diameter is 20
degrees or less.
- Legal blindness ranges from an inability to perceive light to having some vision remaining.
A/DF
- thorough history
- examination of distance and near visual acuity
- visual field
- Contrast sensitivity - testing measures visual acuity in different degrees of light and dark
contrast to determine visual function.
- Glare - Glare testing is also used to determine visual function. Glare can reduce a person’s
ability to color perception see, especially in patients with cataracts.
- refraction
- low vision visual acuity charts
Medical management
- Managing vision impairment involves magnification
- Image enhancement through the use of low vision aids and strategies
- goals are to optimize the patient’s remaining vision and assist the patient to perform customary
activities
nursing management
- Nurses need to increase their sensitivity to the challenges faced by patients with visual
impairments.
- Coping with blindness involves emotional, physical, and social adaptation
- The emotional adjustment to blindness or severe visual impairment determines the success of
the physical and social adjustments of the patient.
- Promoting coping
- Promoting Spatial Orientation and Mobility
- Promoting Home, Community-Based, and Transitional Care

 Glaucoma
- used to refer to a group of ocular conditions characterized by elevated IOP/intraocular pressure
- If left untreated, the increased IOP damages the optic nerve and nerve fiber layer, but the degree of
harm is highly variable
- The optic nerve damage is related to the IOP caused by congestion of aqueous humor in the eye. A
range of IOPs are considered “normal,” but these may also be associated with vision loss in some
patients.
- Aqueous humor flows between the iris and the lens, nourishing the cornea and lens.
- IOP is determined by the rate of aqueous production, the resistance encountered by the aqueous
humor as it flows out of the passages, and the venous pressure of the episcleral veins that drain into
the anterior ciliary vein
Risk factor
 African American race
 Cardiovascular disease
  Diabetes
 Family history of glaucoma
 Migraine syndromes
 Nearsightedness (myopia)
 Older age
 Previous eye trauma
 Prolonged use of topical or systemic corticosteroids
 Thin cornea

There are several types of glaucoma.

 wide-angle glaucoma - a chronic condition with few symptoms
 narrow-angle glaucoma - a type of glaucoma that develops suddenly and can lead to sudden and
permanent loss of sight.
 congenital glaucoma - a rare disease due to genetically-determined abnormalities in the
trabecular meshwork and anterior chamber angle resulting in elevated intraocular pressure (IOP),
without other ocular or systemic developmental anomalies.
 glaucoma associated with other conditions, such as developmental anomalies or corticosteroid
use.
 Glaucoma can be primary or secondary, depending on whether associated factors contribute to
the rise in IOP.
Clinical manifestation
 “Silent thief of sight” - because most patients are unaware that they have the disease until they
have experienced visual changes and vision loss.
 blurred vision or “halos” around lights
 difficulty focusing
 difficulty adjusting eyes in low lighting
 loss of peripheral vision
 aching or discomfort around the eyes, and headache.

A/DF
 medical history must be detailed to investigate the history of predisposing factors
 tonometry to measure the IOP
 ophthalmoscopy to inspect the optic nerve, and central visual field testing

Medical management
 Lifelong therapy is necessary because glaucoma cannot be cured.
 Treatment focuses on pharmacologic therapy, laser procedures, surgery, or a combination of
these approaches, all of which have potential complications and side effects.
Nursing management
 Educating Patients About Self-Care
 Continuing and Transitional Care


 Cataract
- cataract is a lens opacity or cloudiness
- On visual inspection, the lens appears gray or milky
Risk factor
Aging
 Accumulation of a yellow-brown pigment due to the breakdown of
 lens protein
 Clumping or aggregation of lens protein (which leads to light
 scattering)
 Decreased oxygen uptake
 Decrease in levels of vitamin C, protein, and glutathione (an
 antioxidant)
 Increase in sodium and calcium
 Loss of lens transparency
Associated Ocular Conditions
 Infection (e.g., herpes zoster, uveitis)
 Myopia
 Retinal detachment and retinal surgery
 Retinitis pigmentosa
Toxic Factors
 Alkaline chemical eye burns, poisoning
 Aspirin use
 Calcium, copper, iron, gold, silver, and mercury, which tend to deposit
 in the pupillary area of the lens
 Cigarette smoking
 Corticosteroids, especially at high doses and in long-term use
  Ionizing radiation
Nutritional Factors
 Obesity
 Poor nutrition
 Reduced levels of antioxidants

Physical Factors
 Blunt trauma, perforation of the lens with a sharp object or foreign
 body, electric shock
 Dehydration associated with chronic diarrhea, the use of purgatives in
 anorexia nervosa, and the use of hyperbaric oxygenation
 Ultraviolet radiation in sunlight and x-ray
Systemic Diseases and Syndromes
 Diabetes
 Disorders related to lipid metabolism
 Down syndrome
 Musculoskeletal disorders
 Renal disorders
Clinical manifestation
 Painless, blurry vision
 surroundings are dimmer
 Light scattering is common, and the person experiences reduced contrast sensitivity, sensitivity to
glare, and reduced visual acuity
 Astigmatism- refractive error due to an irregularity in the curvature of the cornea
 Diplopia- double vision, and color changes as lens becomes browner in color
A/DF
 Snellen visual acuity test, ophthalmoscopy, and slit-lamp biomicroscopic examination are used to
establish the degree of cataract formation
Medical/ surgical management
 Phacoemulsification- extracapsular cataract surgery, a portion of the anterior capsule is removed,
allowing extraction of the lens nucleus and cortex while the posterior capsule and zonular
support are left intact.
Nursing management
 Providing pre operative care- complete blood count, electrocardiogram, an urinalysis) commonly
performed for most surgeries is prescribed only if indicated by the patient’s medical history.
 Providing Postoperative Care- Before discharge, the patient receives verbal and written education
regarding eye protection, administration of medications, recognition of complications, activities
to avoid, and obtaining emergency care

 Retinal detachment
- Retinal detachment refers to the separation of the RPE from the neurosensory layer
The four types of retinal detachment
- Rhegmatogenous detachment is the most common form. In this condition, a hole or tear
develops in the sensory retina, allowing some of the liquid vitreous to seep through the sensory
retina and detach it from the RPE
- all rhegmatogenous retinal detachments are associated with proliferative retinopathy—a
retinopathy associated with diabetic neovascularization
- Tension, or a pulling force, is responsible for traction retinal detachment. An ophthalmologist
must ascertain all of the areas of retinal break and identify and release the scars or bands of
fibrous material providing traction on the retina
- Exudative retinal detachments are the result of the production of a serous fluid under the retina
from the choroid. Conditions such as uveitis and macular degeneration may cause the production
of this serous fluid.
Clinical manifestation
- sensation of a shade or curtain coming across the vision of one eye, cobwebs, bright flashing
lights, or the sudden onset of a great number of floaters
Assessment and Diagnostic Findings
- dilated fundus examination using an indirect ophthalmoscope as well as slit-lamp biomicroscopy.
Stereo fundus photography and fluorescein angiography are commonly used during the
evaluation
Surgical Management
- rhegmatogenous detachment, an attempt is made to surgically reattach the sensory retina to the
RPE
- Scleral Buckle- The retinal surgeon compresses the sclera (often with a scleral buckle or a silicone
band) to indent the scleral wall from the outside of the eye and bring the two retinal layers in
contact with each other
- Vitrectomy is an intraocular procedure that allows the introduction of a light source through an
incision; a second incision serves as the portal for the vitrectomy instrument.
Nursing management
 consists of educating the patient and providing supportive care
  patient must maintain a prone position that would allow the gas bubble to act as a
tamponade for the retinal break
 Patients and family members should be made aware of these needs beforehand so that
the patient can be made as comfortable as possible
 patient is seen the next day for a follow-up examination

 Hearing loss
- Genetic syndromes associated with hearing impairment include Waardenburg syndrome, Usher
syndrome, Pendred syndrome, and Jervell and Lange-Nielsen syndrome
- There are also acquired causes of hearing loss which may be caused by TORCH infections
(TOxoplasmosis, Rubella, Cytomegalovirus, Herpes) during pregnancy as well as trauma or chronic
exposure to loud noise
- Conductive hearing loss usually results from an external ear disorder, such as impacted cerumen,
or a middle ear disorder, such as otitis media or otosclerosis. In such instances, the efficient
transmission of sound by air to the inner ear is interrupted.
- sensorineural hearing loss involves damage to the cochlea or vestibulocochlear nerve.
- Mixed hearing loss and functional hearing loss also may occur. Patients with mixed hearing loss
have conductive loss and sensorineural loss, resulting from dysfunction of air and bone
conduction
- in older presbycusis is used to describe this progressive hearing loss
Clinical Manifestations
 Deafness is the partial or complete loss of the ability to hear.
 Early manifestations may include tinnitus, increasing inability to hear when in a group, and a
need to turn up the volume of the television.
 Hearing impairment can also trigger changes in attitude, the ability to communicate, the
awareness of surroundings, and even the ability to protect oneself, thus affecting a person’s
quality of life.
Prevention
 Many environmental factors have an adverse effect on the auditory system and with
time result in permanent sensorineural hearing loss. The most common is noise.
 Noise (unwanted and unavoidable sound) has been identified as one of today’s
environmental hazards. The volume of noise that surrounds us daily has increased into a
potentially dangerous source of physical and psychological damage.
 Loud, persistent noise has been found to cause constriction of peripheral blood vessels,
increased blood pressure and heart rate (because of increased secretion of adrenalin),
and increased gastrointestinal activity
Risk factor
 Hearing Loss
 Family history of sensorineural impairment
 Congenital malformations of the cranial structure (ear)
 Low birth weight (<1500 g)
 Use of ototoxic medications (e.g., gentamycin, loop diuretics)
 Recurrent ear infections
 Bacterial meningitis
 Chronic exposure to loud noises
 Perforation of the tympanic membrane
Medical Management
 If a hearing loss is permanent or untreatable or if the patient elects not to be treated, au

 External ear disease

- External otitis (i.e., otitis externa), refers to an inflammation of the external auditory canal.
- Causes include water in the ear canal (swimmer’s ear); trauma to the skin of the ear canal,
permitting entrance of organisms into the tissues; and systemic conditions, such as vitamin
deficiency and endocrine disorders. Bacterial or fungal infections are most frequently
encountered.
Clinical Manifestations
 Patients usually report pain; discharge from the external auditory canal;
 aural tenderness (usually not present in middle ear infections)
 occasionally fever
 cellulitis
 lymphadenopathy
 pruritus and hearing loss or a feeling of fullness in the ear.
 Discharge may be yellow or green and foul smelling
 In fungal infections, hairlike black spores may be visible.
Nursing Management
 Nurses should instruct patients not to clean the external auditory canal
with cotton-tipped applicators and to avoid events that traumatize the
external canal, such as scratching the canal with the fingernail or other
objects.
  Acute severe otitis media
- Ear infections can occur at any age; however, they are most commonly seen in children. Acute
otitis media (AOM) is an acute infection of the middle ear, lasting less than 6 weeks.
- Bacteria can enter the eustachian tube from contaminated secretions in the nasopharynx and the
middle ear from a tympanic membrane perforation. A purulent exudate is usually present in the
middle
Clinical Manifestations
 Symptoms of otitis media vary with the severity of the infection. The condition, usually unilateral in adults,
may be accompanied by otalgia. The pain is relieved after spontaneous perforation or therapeutic incision
of the tympanic membrane. Other symptoms may include drainage from the ear, fever, and hearing loss.
Surgical Management
A myringotomy (i.e., tympanotomy) is an incision in the tympanic membrane. The tympanic membrane is
numbed with a local anesthetic agent such as phenol or by iontophoresis (i.e., in which electrical current
flows through a lidocaine and epinephrine solution to numb the ear canal and tympanic membrane).
 Meiners disease
- Ménière disease is an abnormality in inner ear fluid balance caused by a malabsorption in the
endolymphatic sac or a blockage in the endolymphatic duct (NIDCD, 2015b). Endolymphatic
hydrops (dilation of the endolymphatic space) develops, and either increased pressure in the
system or rupture of the inner ear membrane occurs, producing symptomsof Ménière disease
Clinical Manifestations
 episodic vertigo,
 tinnitus (unwanted noises in the head or ear)
 fluctuating sensorineural hearing loss
 feeling of pressure
 fullness in the ear
 incapacitating vertigo
 nausea and vomiting
Medical Management
 Most patients with Ménière disease can be successfully treated with diet
and medication.
Surgical management
 Endolymphatic sac decompression, or shunting, theoretically equalizes the pressure in the
endolymphatic space.
 Vestibular nerve sectioning provides the greatest success rate (approximately 98%) in eliminating
the attacks of vertigo.
 Serous Otitis Media
Middle ear effusion, or serous otitis media, involves the presence of fluid,
without evidence of active infection, in the middle ear. In theory, this fluid
results from a negative pressure in the middle ear caused by eustachian
tube obstruction.
 Chronic Otitis Media
Chronic otitis media is recurrent AOM that causes irreversible tissue pathology. Chronic infections of the
middle ear damage the tympanic membrane, destroy the ossicles, and involve the mastoid but are rare in
developed countries.
Psychiatric Nursing

WARD DUTY
Osteomyelitis

Liver cirrhosis

Burn

 Severe dehydration secondary to acute gastroenteritis

Dehydration can also lead to a loss of strength and stamina. It's a main cause of heat exhaustion. You
should be able to reverse dehydration at this stage by drinking more fluids. If dehydration is ongoing
(chronic), it can affect your kidney function and increase the risk of kidney stones.
Patient: 19 years old
Status: single/ mother
Sign and symptoms
- Watery stool
- Vomiting
- Abdominal pain
- Poor skin turgor
- Over weight
risk factor:
 - Poor hygiene practices
- Poor sanitation
- Environment
Lab test
Fecalysis
- Color brown
- Mucoid
- Positive of amoeba
Urinalysis
- Yellow
- Ph-6
- Protein 1+
- RBC 2-5
- Pus cells 25-50
- Mucus thread is plenty
- Transparency is cloudy
Medication
- Paracetamol
- Omeprazole
- Metronidazole
- Cefuroxime
- Oral rehydration solution
- Racecadotril
Nursing management
- Encourage to drink more water
- Avoid non-bland diet
- BRAT diet; Banana, rice, applesauce/apple, and toast
- Soft diet
-

OR DUTY

CASE PRESENTATION
Osteomyelitis
Liver Cirrhosis
 Burn
 an injury to the skin or other organic tissue primarily caused by heat or due to radiation,
radioactivity, electricity, friction or contact with chemicals. Thermal (heat) burns occur when
some or all of the cells in the skin or other tissues are destroyed by: hot liquids (scalds)
 Burn can get in; chemicals, heat, electricity, and radiation
 4 phases of Burn
- Emergent – pre hospital, or the onset of event
- Resuscitative – in the hospital, prevent shock
- Acute – therapy of wound closure
- Rehabilitation – discharge and at home remedy, continue remedy at home
Risk factor
- Age group: early childhood age 5 years old
- Gender (female)
- Lack of adult supervision
- Environmental- access of chemicals gasoline
Sign and symptoms
- Swelling,
- redness,
- pain 8/10,
- facial edema
- blister
- moist wound
lab and Diagnostic test
- WBC- increased – leukocytosis
- Neutrophils-increased – neutrophilia
- Lymphocytes-decreased – lymphocytopenia
 - Platelet count- increased – thrombocythemia
Medication
- Ibuprofen
- Paracetamol
- Anti tetanus serum
- Tetanus toxoid
- Cefuroxime
- Silver sulfadiazine cream
- Lidocaine spray- anesthesia
Medical management
- Debridement
- Skin grafting
Nursing management
- Supporting patient and family process
- Restoring normal fluid balance
- Maintaining adequate nutrition
- Relieving pain and discomfort
- Preventing infection
- Promoting skin integrity
- Promoting physical mobility
- Monitoring and managing potential complication
Care plan
- Impaired parenting
- Negligence of parent
- Care giver role strains

 Breast cancer
disease in which cells in the breast grow out of control. There are different kinds of breast cancer. The
kind of breast cancer depends on which cells in the breast turn into cancer. Breast cancer can begin in
different parts of the breast.

SKILSS LAB
Musculoskeletal Assessment
Neurologic Assessment
Gastrointestinal Assessment
Blood Transfusion
IVTT medication
Mobility aids, Transferring of Patient