WEEK 1: Inflammation & Pain

JENAICA JUAN

Case Study: Pain Experience

Belle is a young, healthy adult who slipped off the stairs going down to the basement and
struck her forehead on the cement flooring. Belle did not lose consciousness but did
sustain a mild concussion and a hematoma that was 5cm in width and protruded about
6cm. she experienced immediate acute pain at the site of injury plus a pounding
headache.

1. after an immediate assessment of the localized pain, based on the patient’s

description, what does the nurse anticipate regarding the pain assessment?
- During pain assessment as a nursing student I will check the patient vital signs and
also assessing the chief complain of the patient, In Pain assessment  I will use the 
pain scale 1-10 or asking the intensity of pain and intensity associated anxiety and
behaviours. After that I will record and document the  pain has been shown to be
poor, and even high pain scores and if the doctor order to administering  analgesics
I will give to my patient to reduce the pain.

2. During the assessment process, the nurse attempts Belle’s physiologic and behavioral
responses to her pain experience. The nurse is aware that the patient can be in pain yet
appear to be “pain free” what is the behavioral response indicative of acute pain?

- I will assess Belle's facial expression because experience of pain is often represented
by changes in facial expression. Evidence of pain that is available from facial
expression has been the subject of considerable scientific investigation, facial
assessment in the study of patient also reviewed, facial assessment in patient are also
described. Alternative techniques that have the potential to overcome barriers to the
 application of facial assessment arising out of its resource intensiveness are described
and evaluated.

3. The nurse uses distraction to help Belle cope with her pain experience. What
suggested activities can help her cope?

- I will ask the patient to do the Learn deep breathing or meditation to help Belle to
relax, and asking her some question . Exhale slowly through the mouth, while pursing 
the lips, for a count of 10. After that Belle feel relaxing and feel comfortable.

4. After treatment, Belles is discharge to home while still in pain. What should the nurse
do?

- I will use the Nurse teaching skill to Belle by doing cold compress or ice pack
application for 20 to 30 minutes for the 48 hours following injury to reduce swelling,
rest and also follow the doctor's home medication. Cold numbs the affected area,
which can reduce pain and tenderness. Cold can also reduce swelling and
inflammation.
COURSE TASK- CU3
JENAICA JUAN

Answer the following questions base on the cited situation. Answer will be submitted
through CANVAS.

Study Questions:

ELECTROLYTE IMBALANCES:

Several patients were admitted in the medical ward. Answer the following questions
pertinent to the patients’ conditions.

PATIENT A–Presented in the emergency department with severe headache, irritability,

and tremors after finishing a full marathon. Laboratory values reveal Serum sodium level
of 130 mEq/L.

PATIENT B–Presented in the emergency department with severe body malaise,

diminished bowel sounds, and ECG reveals an extra U-wave in the tracing after 8 bouts
of watery diarrhea. Laboratory values further reveal a Serum potassium level of 3.0
mEq/L.

PATIENT C–A post thyroidectomy patient presented with severe muscle cramps and
prolongation of QT-interval in the ECG and was referred to the medical consultant for
co-management. Serum calcium level is 4.0 mEq/L.

PATIENT D–A patient receiving magnesium for the management of seizure disorder
suddenly presented with depressed deep tendon reflex and becomes stuporous.
Laboratory values reveal a Serum Magnesium level of 2.6 mg/dL.

1. Given the Patient B’s presentation, trace the pathophysiological cause of the
decrease in serum potassium level.

- In Patient B The physiological increase in potassium level during exercise has already
been mentioned. A similar increase in potassium level has been described as a result of
generalised muscle cramps such as in epilepsy. It may also be seen in generalized
 skeletal muscle breakdown such as rhabdomyolysis, trauma against skeletal muscles,
burns, and hyperthermia. Hyperkalaemic periodic paralysis is a rare genetic anomaly in
skeletal muscle ion channels causing depolarization of muscle cells and
hyperkalaemia. In these patients, exercise or ingestion of potassium rich nutrients may
provoke attacks of paralysis and hyperkalaemia that may be abated by inhalation of a
β2-adrenoceptor agonist at the beginning of the attack. Intravenous administration of
potassium may increase potassium level, cause hyperkalaemia, cardiac arrest, and
sudden death. Thus, intravenous potassium should always be given with utmost
precaution. Oral potassium intake combined with reduced potassium excretion may
cause hyperkalaemia. Several cardiovascular drugs ACE-inhibitors, AT2-inhibitors, β-
adrenoceptor antagonists, aldosterone antagonists, and digoxin—may increase
potassium level. Interestingly all of these drugs have a positive or neutral effect on life
expectancy in heart failure patients that may be due to a decreased risk of
hypokalaemia. Digoxin intoxication may be associated with hyperkalaemia due to
inhibition of skeletal muscle Na,K-pumps. Diabetes mellitus may be associated with
hyperkalaemia due to lack of insulin-stimulated Na,K-pump mediated potassium
uptake in skeletal muscles. Also, acidosis may due to reduced kidney excretion of
potassium cause an increase of potassium level and hyperkalaemia. It should be noted
that reduced oxidation arising from hypoxia only induces a modest increase in
potassium level due to high affinity of the Na,K-pump for oxygen.

2. What will be the emergency medication that should be readily available in

managing the disorder apparent for Patient D?

- The use of calcium and magnesium reduces both the incidence and time of
development of peripheral sensory neurotoxicity, oxaliplatin-limiting toxicity
Treatment of severe magnesium toxicity consists of circulatory and respiratory support
and administration of 10% calcium gluconate 10 to 20 mL IV. Calcium gluconate may
reverse many of the magnesium-induced changes, including respiratory depression. So
the Patient D may back the tendon reflexes after Calcium gluconate administered.
 3. Explain the relationship of thyroid surgery and the development of hypocalcemia
in Patient C.

- Hypocalcemia persists as a problem after thyroidectomy. We reviewed our experience

with 245 thyroidectomies to define the spectrum of hypocalcemia, elucidate the
mechanisms of hypocalcemia, and formulate a rational basis for its management. This
may well be thyrotoxic osteodystrophy. This hypocalcemia usually occurs early, is of
moderate degree, and is transient. Management includes calcium gluconate for acute
symptoms and calcium lactate with vitamin D2 for chronic symptom.

4. Explain the relationship of Patient A’s prior activity and the development of
hyponatremia.

- Since Patient A is an Athlete and joining in Marathon I think Patient A develop of

Hyponatremia because of the lifestyles, Hyponatremia develop during was initially
described in the 1980s in endurance athletes, and work done since then has
conclusively identified that overdrinking beyond thirst and non-osmotic arginine
vasopressin release are the most common etiologic factors. Exercise-associated
hyponatremia refers to a low blood sodium concentration ([Na+]) that develops during
or immediately following physical activity sport or recreation.

5. Explain the mechanism behind the development of prolonged QT –interval for

Patient C.

- The prolonged QT interval is both widely seen and associated with the potentially
deadly rhythm, While it can occur spontaneously in the congenital form, there is a
wide array of drugs that have been implicated in the prolongation of the QT interval.
Some of these drugs have either been restricted or withdrawn from the market due to
the increased incidence of fatal polymorphic ventricular tachycardia. The list of drugs
that cause QT prolongation continues to grow, and an updated list of specific drugs
that prolong The QT interval on the surface EKG represents the summation of action
 potential (AP) of ventricular myocytes. The action potential reflects the flow of ion
currents across a cell membrane through specialized channels made of protein
complexes. Malfunction of these protein channels can lead to either increased inward
current or reduced outward current. This subsequently increases the action potential
duration and hence QT interval prolongation.

6. Enumerate at least one (1) nursing diagnosis for Patient A, B, C, and D.

- Pt A- Hyponatremia
Knowledge deficit related to the hydration maintenance, as evidenced by behaviors
that resulted in current electrolyte imbalance
Pt B- Hypokalemia
Altered electrolyte balance related to active fluid loss secondary to vomiting and
diarrhea
Pt C- Hypocalcemia
High Risk for Injury R/T increased neuromuscular irritability resulting from
hypocalcemia
Pt D- Hypermagnesemia
Reduced cardiac output
Impaired gas exchange

ACID-BASE IMBALANCES:

Multitude of patient’s conditions can predispose them to different acid-base imbalances.

Several patients were admitted in the medical-surgical ward and are put under your care.
Answer the following questions pertinent to the patients’ conditions.

PATIENT A–admitted in the medical ward 30 minutes ago with chief complaint of
severe dizziness and vertigo accompanied by frequent vomiting. As the patient moves,
vomiting follows which is now recorded to be 7-8 times from the time of admission.
Diphenhydramine 1 ampule TIV and metoclopramide 1 ampule TIV as stat doses were
given to the patient.
PATIENT B–a dialysis patient who have stopped attending his dialysis session was
admitted in the ward due to changes in sensorium. Serum creatinine level is elevated as
well as the Blood Urea Nitrogen (BUN). Shallow respiration is noted upon the
assessment of the patient.

PATIENT C–a patient was rushed to the emergency department and later was admitted to
the ward with chief complaint of shortness of breath, numbness and tingling around
mouth and fingers, and lightheadedness after taking a major examination in school. The
patient was offered a brown bag by the admitting nurse.

PATIENT D–A patient with emphysema as admitted in the ward due to difficulty of
breathing. The patient appears reddish and is complaining of lightheadedness. The patient
was immediately hooked to oxygen therapy at 2 Lpm. Choose from the following ABG
results which will be consistent with the patient’s condition:

A.pH 7.50 PaC02 31 HCO3 17

B.pH 7.30 PaC02 30 HCO3 18

C.pH 7.48 PaC02 49HCO3 30

D.pH 7.32 PaC02 50 HCO3 28

Answer :

7. Patient A: Respiratory Alkalosis

8. Patient B: Metabolic Acidosis

9. Patient C: Metabolic Alkalosis

10. Patient D: Respiratory Acidosis

11. Explain why Patient B presented with shallow respiration in relation to the
patient’s condition.

- I think patient B experience Shallow breathing because from muscle weakness may
lower oxygen and increase the carbon dioxide levels in blood, causing muscles to
 become even weaker. With neuromuscular weakness, these muscles may become tired
(fatigued), making it difficult for you to inhale and exhale normally. This weakness
may cause you to take shallow breaths and feel short of breath when lying down or
sleeping.

12. Explain why Patient D experiences lightheadedness and why the patient appears
reddish in relation to the patient’s condition.

- Because patient D had emphysema chronic obstructive pulmonary disease (COPD) and
respiratory issues can cause shortness of breath, which leaves Patient D feeling dizzy,
weak, and fatigued. Not being able to breathe well depletes the oxygen levels in the
blood, affecting the body's ability to function properly, chronic obstructive pulmonary
disease (COPD) and other chronic respiratory issues can cause shortness of breath,
which leaves Patient D feeling dizzy, weak, and fatigued. Not being able to breathe
well depletes the oxygen levels in the blood, affecting body's ability to function
properly. That’s why patient D experience Lightheadedness.

13. Explain the purpose of offering brown bag to Patient C as an emergency

management for the patient’s condition.

- Breathing into a paper bag is a technique that can help Patient C regulate
hyperventilation. It works by putting some of the lost carbon dioxide back into the
lungs and body. This helps to balance oxygen flow in the body. Hyperventilating
breathing at an abnormally rapid rate does just the opposite, decreasing carbon dioxide
in the blood. So too, panic attacks. Along with the decrease to the body’s supply of
carbon dioxide, panic attacks often cause tightness in the chest and difficulty breathing.
In both the cases just described, health professionals recommend the paper bag
technique to offset the loss of carbon dioxide in the blood and provide relief for the
symptoms.
 14. Create a drug study for the medication: METOCLOPROMIDE specifying the
following:

· Drug classification

· Mechanism of action

· Indication (*for the case of the patient mentioned above)

· Contraindication

· Side effects

· Nursing Considerations

DRUG MECHANI INDICATIO CONTR SIDE NURSING

CLASSIFICATI SM OF N AINDI EFFECTS CONSIDERATION
ON ACTION CATIO
N
Generic Name: Potent Management Sensitiv CHF; -Report
central of diabetic ity or hypokalemia; immediately the
Metoclopramide
dopamine gastric stasis intolera kidney onset of
Brand Name:
receptor (gastroparesis nce to dysfunction; restlessness,
Clopra, Emex, antagonist. ); to prevent metoclo GI involuntary

Maxeran,Maxol Structurally nausea and pramide hemorrhage; movements, facial

on, Reglan related to vomiting ; allergy history of grimacing, rigidity,

Classifications: procainamid associated to intermittent or tremors.

e but has with sulfiting porphyria. Extrapyramidal
gastrointestinal
little emetogenic agents; symptoms are most
agent;
antiarrhyth cancer history likely to occur in
prokinetic agent
mic or chemotherap of children, young
(gi-stimulant); anesthetic y (e.g., seizure adults, and the older
autonomic activity. cisplatin, disorder adult and with high-
nervous system Exact dacarbazine); s; dose treatment of
agent; mechanism to facilitate concurr vomiting associated
of action not intubation of ent use with cancer
direct-acting
clear but small bowel; of drugs chemotherapy.
cholinergic
appears to symptomatic that can Symptoms can take
(parasympatho
sensitize GI treatment of cause months to regress.
mimetic);
smooth extrapyr
antiemetic gastroesopha -Be aware that
muscle to amidal
geal reflux. during early
effects of sympto
treatment period,
acetylcholin ms;
serum aldosterone
e by direct pheochr
may be elevated;
action. omocyt
oma; -Lab tests: Periodic

mechani serum electrolyte.

cal GI -Monitor for

obstruct possible
 ion or hypernatremia and
perforati hypokalemia,
on; especially if patient
history has CHF or
of breast cirrhosis.
cancer.
-Adverse reactions
Safety
associated with
during
increased serum
pregnan
prolactin
cy
concentration
(categor
usually disappear
y B) or
within a few weeks
lactation
or months after drug
is not
treatment is
establis
stopped.
hed.
COURSE TASK- CU6
JENAICA JUAN

Answer the following questions base on the cited situation. Answer will be submitted
through CANVAS.

Consider the scenario and answer the following questions:

Mr. Nathaniel is a 46 year-old man who has developed symptoms of acute pericarditis
secondary to viral infection. Diagnosis was based on characteristic sign of a friction rub
and pain over the pericardium. (30 points)
The patient is experiencing pericardial pain. To alleviate this discomfort, what position
could the nurse assist the patient with maintaining?

- Due to patient discomfort the nurse should assist Mr. Nathaniel in upright position the
patient head at 45 degree of bed elevated in this position Mr. Nathaniel helps to relief
his pain, bedrest with comfort position is the best way to relief the acute pericarditis.

When planning Mr. Nathaniel’s care, what should the nurse understand are the
objectives of pericarditis management?

- Nurse should make sure to provide oxygen support to Mr. Nathaniel, and also make
sure that always arrange the cardiac monitor to monitor the cardiac activities of the
patient, because chest pain is a life threatening due to pericarditis symptoms or such as
myocardial infarction pr aortic dissection. Nurse must be evaluate the hemodynamic
instability, and also as a nurse we should assess the Mr. Nathaniel condition and also
always monitor the hemodynamics like Heart rate, blood pressure and pulse rate and to
provide psychologic support always assess the neurologic status.

The nurse is auscultating Mr. Nathaniel’s chest for a pericardial friction rub. Where will
the nurse auscultate in order to locate the rub?

- In Mr. Nathaniel's condition the best auscultation is in the over of the left lower sternal
edge or apex during end expiration Mr. Nathaniel must be sitting up and leaning
forward.
COURSE TASK- CU7
JENAICA JUAN

Answer the following questions base on the cited situation. Answer will be submitted
through CANVAS.

Consider the scenarios and answer the following questions:

Scenario 1: Angina Pectoris

Lita a 65 year-old retired secretary, is admitted to the medical surgical area for
management of chest pain caused by angina pectoris. (20 points)

The patient asked the nurse “What is causing this pain?” What is the best response by
the nurse?

- The pain is usually because of not enough blood flow in the heart

The patient is diagnosed with chronic stable angina. The nurse can anticipate that her
pain may follow what type of pattern?

- I think the diagnosis in the patient is CHRONIC STABLE ANGINA, because this
disease are when the heart muscle doesn't get the oxygen it needs to function properly.
Patient heart works harder when they exercise or experience emotional stress. Certain
factors, such as narrowing of the arteries atherosclerosis, can prevent your heart from
receiving more oxygen. Patient need to rest and take nitroglycerin to relief this disease.

Lita has nitroglycerin at her bed side to take PRN. The nurse knows that nitroglycerin
acts in what ways?
- This nitroglycerin medication can provide relief to our patient that uncomfortable due
to sign and symptoms of stable angina, This medication can cause headache,
lightheadedness from the patient. It also can increase the physical exercise tolerance.

Lita took a nitroglycerin tablet at 10:00 AM, after her morning care. It did not relieve
her pain, so 5 minutes later, she repeated the dose. 10 minutes later, and still in pain, she
calls the nurse. What is the priority intervention of the nurse?

- The nurse intervention to the patient is always monitor the blood pressure and the
asking systolic blood pressure is less than 90 mmHg. for better result.

Scenario 2: Decreased Myocardial Tissue Perfusion

Mr. Santos, a 46 year-old teacher, is brought to the ER by ambulance with a suspected

diagnosis of MI. He appears ashen, is diaphoretic, and tachycardic, and has a severe
chest pain. The nursing diagnosis is Decreased Cardiac Output  related to Decreased
Myocardial Tissue Perfusion. (20 points)

The nurse is aware that there is critical time period for this patient. When should the
nurse be most vigilant in monitoring this patient?

- Nurses should be aware and attentive to patient any alteration in heart rate, rhythm and
some conduction because to reduce the frequency and severity of myocardial disease and
also to delay the progress of the underlying disease if possible, and to prevent
complications.

The nurse is interpreting the result of the ECG. What findings does the nurse understand
are indicative of initial myocardial injury?
- Patient had myocardial infarction, ST Elevation is a very serious type of heart attack
during which one of the heart's major arteries one of the arteries that supplies oxygen and
nutrient rich blood to the heart muscle is blocked.

What laboratory test are positive indicators of MI?

- Myocardial Infarction need to assess the patient if the sign and symptoms of MI is
present and also need to have a diagnosis like ECG, ST Elevation, Troponin, and also
other causes of biomarker elevation.

The nurse should closely monitor the patient for a complication of an MI that leads to
sudden death during the first 48 hours. Which complication should the nurse monitor
for?

1. CREATINE KINASE TOTAL

CK is a type of protein. The muscle cells in your body need CK to function. Levels of
CKcan rise after a heart attack, skeletal muscle injury, or strenuous exercise.

2. CREATININE KINASE MB FRACTION

CK–MB isoenzyme is found almost exclusively in the myocardium, and the appearance
of elevated CK–MB levels in serum is highly specific and sensitive for myocardial cell
wall injury.

3. TROPONIN I AND T

Cardiac troponin T (cTnT) and troponin I (cTnI) are structural proteins that act to
regulate muscle contraction (1,2). They are released into the bloodstream from injured
muscle cells during cardiac ischemia with no overlap with skeletal muscle troponinsunder
normal conditions (3,4).

4.  MYOGLOBIN
Myoglobin is an oxygen-binding protein found in cardiac and skeletal muscle.
Measurement of myoglobin provides an early index of damage to the myocardium, such
as occurs in myocardial infarction (MI) or reinfarction. Increased levels, which indicate
cardiac muscle injury or death, occur in about 3 hours.

5. LACTATE DEHYDROGENASE

An LDH test is most often used to: Find out if you have tissue damage. Monitor disorders
that cause tissue damage. These include anemia, liver disease, lung disease, and some
types of infections.

6. BRADYARRHYTHMIAS AND CONDUCTION DISTURBANCES

These can be further categorized on the basis of the level of disturbances in the hierarchy
of the normal cardiac conduction system.
COURSE TASK- CU8
JENAICA JUAN

1. Give the rationale for each of the following nursing interventions and selected
activities for the nursing care plan for ineffective airway clearance: (20 pts)

INTERVENTIONS RATIONALE

1.    Encourage the client to take several Deep breathing promotes oxygenation
deep breaths before controlled coughing.

Controlled coughing is accomplished by

2.    Encourage the client to take a deep
closure of the glottis and the explosive
breath, hold for 2 seconds, and cough two
expulsion of air from the lungs by the work
or three times in succession
of abdominal and chest muscles.

3.    Encourage use of incentive spirometry, Breathing exercise help maximize

as appropriate ventilation.

Adequate fluid intake enhances liquefaction

4.    Promote systemic fluid hydration, as
of pulmonary secretions and facilitates
appropriate
expectoration of mucus.

5.    Monitor rate, rhythm, depth, and effort To provide a basis for evaluating adequacy
of respirations of ventilation.

6.    Note chest movement, watching for

Presence of nasal flaring and use of
symmetry, use of accessory muscles, and
accessory muscles of respiration may occur
supraclavicular and intercostal muscle
in response to ineffective ventilation.
retractions

7.    Auscultate lung sounds after treatments Assists in evaluating prescribed treatments
to note results and individual outcomes.

People with pneumonia commonly produce

8.    Monitor client’s respiratory secretions
rust-coloured, purulent sputum.

9.    Monitor client’s ability to cough Respiratory tract infections alter the amount
 and character of secretions. An ineffective
effectively cough compromises airway clearance and
prevents mucus from being expelled.

10.  Monitor for increased restlessness, This clinical manifestations would be early
anxiety, and air hunger indicators of hypoxia.
2. Match the following concepts with each other. Write the letter only. Use CAPITAL
letters. (2 points each)

ANSWER COLUMN A COLUMN B

A.    Upper airway

obstruction, upper airway
bleeding, inability to clear
lower airway secretions,
E 1.    Tracheostomy laryngeal or tracheal
fracture, airway burns, need
for continuous ventilation,
decreased LOC with
inability to protect airway

B.    Nasal cannula, face

mask, non-rebreather, partial
B 2.    Oxygen Therapy
non-rebreather, venture
mask, face tent

C.   Reduced oxygen in the

H 3.    Assessments for need to suction blood characterized by a low
PO2 or Sa02

D.   Percussions over

congested areas can
C 4.    Hypoxemia mechanically dislodge
tenacious secretions from
the bronchial walls

E.    Surgical opening into

F 5.    Incentive Spirometry the trachea with the creation
of a stoma

G 6.    Tracheostomy precautions
A 7.    Indications for Tracheostomy
D 8.    Chest Percussion
F.    Improve pulmonary
ventilation, counteract the
effects of
anesthesia/hypoventilation,
loosen respiratory
secretions, facilitate
respiratory gaseous
exchange, expand collapsed
alveoli
G.   Keep duplicate tract
tube with obturator at
bedside, keep foreign objects
such as aerosols and
powders away from trach,
provide humidified air and
02, keep the stomata dry,
good oral and nasal hygiene,
medical/ surgical asepsis
H.   Restlessness, gurgling
sounds during respiration,
adventitious breath sounds
when chest is auscultated,
change in mental status, skin
color, rate and pattern of
respiration, pulse rate and
rhythm
Week 8: Individual Assignment: CAD, AP, MI
JENAICA JUAN

Create YOUR OWN infographic brochure for nursing management for caring for a 
client with your choice among the following disorders: (may be hand made or with the
use of computer software)

▪ CAD

▪ Angina pectoris; or

▪ Myocardial Infarction.
Week 9: Individual Assignment: Obstructive Disorder
JENAICA JUAN

Compare and Contrast using various aspect any 2 Obstructive Disorders of the Lungs. 

PNEUMONIA CHRONIC OBSTRUCTIVE

PULMONARY DISEASE

RISK FACTORS Pneumonia can affect anyone. • Exposure to tobacco

But the two age groups at
highest risk are:
• Children who are 2
years old or younger
• People who are age 65
or older
Other risk factors
include:
smoke. The most
significant risk factor
for COPD is long-term
cigarette smoking. The
more years you smoke
and the more packs you
smoke, the greater your
risk. Pipe smokers,
cigar smokers and

• Being hospitalized. marijuana smokers also

You're at greater risk of may be at risk, as well

pneumonia if you're in a as people exposed to

hospital intensive care large amounts of

unit, especially if you're secondhand smoke.

on a machine that helps • People with asthma.

you breathe (a Asthma, a chronic
ventilator). inflammatory airway

• Chronic disease. disease, may be a risk

You're more likely to factor for developing

get pneumonia if you COPD. The

combination of asthma
 have asthma, chronic
obstructive pulmonary
disease (COPD) or heart
disease.
• Occupational exposure
• Smoking. Smoking
damages your body's
natural defenses against
the bacteria and viruses
that cause pneumonia.
• Weakened or
suppressed immune • Exposure to fumes
system. People who
have HIV/AIDS,
who've had an organ
transplant, or who
receive chemotherapy
or long-term steroids
are at risk.
and smoking increases
the risk of COPD even
more.
to dusts and chemicals.
Long-term exposure to
chemical fumes, vapors
and dusts in the
workplace can irritate
and inflame your lungs.
from burning fuel. In
the developing world,
people exposed to
fumes from burning fuel
for cooking and heating
in poorly ventilated
homes are at higher risk
of developing COPD
SIGN AND SYMPTOMS Signs and symptoms of
pneumonia may include:
• Chest pain when you
breathe or cough
• Confusion or changes in
mental awareness
(in adults age 65 and
older)
• Cough, which may
produce phlegm
• Fatigue
• Fever, sweating and
shaking chills
• Lower than normal
body temperature (in
adults older than age 65
and people with weak
immune systems)
• Nausea, vomiting or
diarrhea
• Shortness of breath
COPD symptoms often don't
appear until significant lung
damage has occurred, and
they usually worsen over time,
particularly if smoking
exposure continues.
Signs and symptoms of COPD
may include:
• Shortness of breath,
especially during
physical activities
• Wheezing
• Chest tightness
• A chronic cough that
may produce mucus
(sputum) that may be
clear, white, yellow or
greenish
• Frequent respiratory
infections
• Lack of energy
• Unintended weight
loss (in later stages)
 • Swelling in ankles,
feet or legs

COMPLICATIONS Even with treatment, some • Respiratory infections.

people with pneumonia, People
especially those in high-risk with COPD are more
groups, may experience likely to catch colds, the
complications, including: flu and pneumonia. Any
respiratory infection can
• Bacteria in the
make it much more
bloodstream
difficult to breathe and
(bacteremia). Bacteria
could cause further
that enter the
damage to lung tissue.
bloodstream from your
lungs can spread the • Heart problems. For
infection to other reasons that aren't
organs, potentially fully understood, COPD
causing organ failure. can increase your risk of
heart disease, including
• Difficulty breathing.
heart attack
If your pneumonia is
severe or you have • Lung cancer. People
chronic underlying lung with COPD have a
diseases, you may have higher risk of
trouble breathing in developing lung cancer.
enough oxygen. You
may need to be
• High blood pressure in
hospitalized and use a
lung arteries.
breathing machine
COPD may cause high
 (ventilator) while your
lung heals.
• Fluid accumulation
around the lungs
(pleural effusion).
Pneumonia may cause
fluid to build up in the
thin space between
layers of tissue that line
the lungs and chest
cavity (pleura). If the
fluid becomes infected,
you may need to have it
drained through a chest
tube or removed with
surgery.
blood pressure in the
arteries that bring blood
to your lungs
(pulmonary
hypertension).
• Depression. Difficulty
breathing can keep
you from doing
activities that you enjoy.
And dealing with
serious illness can
contribute to the
development of
depression.

• Lung abscess. An
abscess occurs if pus
forms in a cavity.

PREVENTION • Get vaccinated. Unlike some diseases, COPD

Vaccines are available typically has a clear cause and
to prevent some types of a clear path of prevention, and
pneumonia and the flu. there are ways to slow the
Talk with your doctor progression of the disease.
about getting these The majority of cases are
shots. The vaccination directly related to cigarette
guidelines have changed smoking, and the best way to
 over time so make sure prevent COPD is to never
to review your smoke — or to stop smoking
vaccination status with now.
your doctor even if you
recall previously
receiving a pneumonia If you're a longtime smoker,

vaccine. these simple statements may

not seem so simple, especially
if you've tried quitting —
• Make sure children get
once, twice or many times
vaccinated.
before. But keep trying to
Doctors recommend a
quit. It's critical to find a
different pneumonia
tobacco cessation program
vaccine for children
that can help you quit for
younger than age 2 and
good. It's your best chance for
for children ages 2 to 5
reducing damage to your
years who are at
lungs.
particular risk of
pneumococcal disease.
Children who attend a Occupational exposure to
group child care center chemical fumes and dusts is
should also get the another risk factor for COPD.
vaccine. Doctors also If you work with these types
recommend flu shots for of lung irritants, talk to your
children older than 6 supervisor about the best ways
months. to protect yourself, such as
using respiratory protective

• Practice good hygiene. equipment.

To protect Here are some steps you can

yourself against take to help prevent
respiratory infections
 that sometimes lead to complications associated with
pneumonia, wash your COPD:
hands regularly or use
an alcohol-based hand
sanitizer. • Quit smoking to help reduce
your risk of

heart disease and lung cancer.

• Quit smoking to help
reduce your risk of heart
disease and lung

Week 10: Individual Assignment: Restrictive Disorders

JENAICA JUAN

Compare and Contrast using various aspect any 2 Restrictive Disorders of the Lungs. 

Instructions

Prepare the assignment in tabular form.

Use atleast 3 criterions or aspects.

Upload your output here in Canvas.

 Pulmonary Edema
Definition • Pulmonary
edema is a condition
involving fluid buildup occurs when a clot in another
in the lungs.
• Sudden onset
(acute) pulmonary
edema is a medical
emergency.
• Symptoms
include shortness of
breath, cough,
decreased exercise
tolerance or chest pain. If a clot develops in a vein and
Treatment To raise the patient’s blood
oxygen levels, oxygen is
given either through a face
mask or prongs – tiny plastic
tubes in the nose. A breathing
tube may be placed into the
trachea if a ventilator, or
breathing machine, is
necessary.
Pulmonary Embolism
A pulmonary embolism is a
blood clot in the lung that
part of the body (often the leg
or arm) moves through the
bloodstream and becomes
lodged in the blood vessels of
the lung. This restricts blood
flow to the lungs, lowers
oxygen levels in the lungs and
increases blood pressure in the
pulmonary arteries.
it stays there, it’s called
a thrombus. If the clot
detaches from the wall of the
vein and travels to another
part of your body, it’s called
an embolus.
Treatment of pulmonary
embolism is aimed at keeping
the blood clot from getting
bigger and preventing new
clots from forming. Prompt
treatment is essential to
prevent serious complications
or death.
Blood thinners
If tests show that the
pulmonary edema is because
of a problem in the circulatory enlarging and new clots from
system, the patient will be
treated with intravenous
medications to help remove
fluid volume and control
blood pressure
(anticoagulants). These drugs
prevent existing clots from
forming while your body
works to break up the clots.
Heparin is a frequently used
anticoagulant that can be
given through the vein or
injected under the skin. It acts
quickly and is often
overlapped for several days
with an oral anticoagulant,
such as warfarin, until it
becomes effective, which can
take days.
Clot dissolvers
(thrombolytics). While clots
usually dissolve on their own,
sometimes thrombolytics
given through the vein can
dissolve clots quickly.
Because these clot-busting
drugs can cause sudden and
severe bleeding, they usually
are reserved for life-
threatening situations.
Clot removal. If you have a
very large, life-threatening
clot in your lung, your doctor
may suggest removing it via a
 thin, flexible tube (catheter).

Causes • Pneumonia • When blood

• Sepsis (blood infection)
• Exposure to some chemicals
• Organ failure that causes
fluid accumulation -
congestive heart failure,
kidney failure, or liver
cirrhosis.
• Near-drowning
• Inflammation
• Trauma
• Reaction to certain
medications
• Drug overdose
collects (or “pools”) in
a certain part of the
body (usually an arm
or leg). Pooling of
blood usually occurs
after long periods of
inactivity, such as after
surgery or bed rest.
• When veins
have been injured,
such as from a fracture
or surgery (especially
in the pelvis, hip, knee
or leg).
• As a result of
another medical
condition, such as
cardiovascular disease
(including congestive
heart failure, atrial
fibrillation and heart
attack) or stroke.
• When clotting
factors in the blood are
increased, elevated, or
in some cases,
lowered. Elevated
clotting factors can
 occur with some types
of cancer or in some
women taking
hormone replacement
therapy or birth control
pills. Abnormal or low
clotting factors may
also occur as a result
of hereditary
conditions.
Symptoms • Cough, often • Sudden
with a pink frothy shortness of breath --
sputum whether you’ve been
active or at rest.
• Excessive sweating
• Unexplained
• Anxiety and sharp pain in your
restlessness chest, arm, shoulder,
• Feelings of neck or jaw. The pain
suffocation may also be similar to
symptoms of a heart
• Pale skin
attack.
• Wheezing • Cough with or
without bloody sputum
• Rapid or
(mucus).
irregular heart rhythm
• Pale, clammy
(palpitations)
or bluish-colored skin.
• Chest pain
• Rapid heartbeat
(pulse).
• Excessive
sweating.
• In some cases,

Diagnosis The patient will undergo a
physical exam first. The
doctor will use a stethoscope
to listen to the lungs for
crackles and rapid breathing,
and the heart for abnormal
rhythms.
Blood tests will be carried out
to determine blood oxygen
levels; the doctor will often
order other blood tests,
including:
• electrolyte levels
• kidney function
• liver function
• blood counts and
blood markers of heart
failure
An ultrasound of the heart, an
echocardiogram, and an
electrocardiogram (EKG) can
help determine the condition
of the heart.
feeling anxious, light-
headed, faint or
passing out.
• Wheezing.
• a blood test to
look for a protein
called D-dimer. High
levels of D-dimer in
your blood suggest
that pieces of blood
clot are loose in your
bloodstream.
• a computerise
d tomography
pulmonary
angiography
(CTPA) to see the
blood vessels in your
lungs. You are injected
with a dye that helps to
show your blood
vessels and a scanner
uses X-rays to build a
detailed picture of the
blood flow in your
lungs.
• a ventilation-
perfusion scan, also
called a V/Q scan or
isotope lung
 A chest X-ray may be used to
see whether there is any fluid
in or around the lungs and to
check the size of the heart.
A CT scan of the chest may
also be ordered.
Prevention Patients with an increased risk
of developing pulmonary
edema must follow their
doctor’s advice to keep their
condition under control.If
congestive heart failure is the
problem, following a healthy,
well-balanced diet, and
maintaining a healthy body
weight can help reduce the
risk of future episodes of
pulmonary edema.Regular
exercise also improves heart
health as does:
Reducing salt intake –
excess salt can lead to water
retention. This increases the
work the heart has to do.
Lowering cholesterol levels –
scanning, to examine
the flow of air and
blood in your lungs. If
the scan shows parts of
your lungs have air in
them but no blood
supply, this may be the
result of a pulmonary
embolism.
• Exercise regularly. If
you can’t walk around
due to bed rest,
recovery from surgery
or extended travel,
move your arms, legs
and feet for a few
minutes each hour. If
you know you will
need to sit or stand for
long periods, wear
compression stockings
to encourage blood
flow.
• Drink plenty of fluids,
like water and juice,
but avoid excess
alcohol and caffeine.
• If you need to be
stationary for long
periods of time, move
 high cholesterol can lead to
fatty deposits in the arteries,
which, in turn, increases the
risk of heart attack and stroke
and therefore pulmonary
edema.
Smoking cessation – tobacco
increases the risk of a number
of diseases, including heart
disease, lung disease, and
circulatory problems.
Altitude-induced pulmonary
edema can be minimized by
making a gradual ascent,
taking medications before
traveling, and avoiding excess
exertion while progressing to
higher altitudes
around for a few
minutes each hour:
move your feet and
legs, bend your knees,
and stand on tip-toe.
• Do not smoke.
• Avoid crossing your
legs.
• Do not wear tight-
fitting clothing.
• Lose weight if you are
overweight.
• Elevate your feet for
30 minutes twice a
day.
• Talk to your doctor
about reducing your
risk factors, especially
if you or any of your
family members have
experienced a blood
clot.

COURSE TASK- CU9

JENAICA JUAN

You are caring for a 34-year-old patient who experienced blunt chest trauma in a motor
vehicle crash. A chest tube was inserted to treat a simple pneumothorax and hemothorax.
The chest drainage system has drained  400ml of light red fluid during the 1st 6 hours
after insertion. The patient has become  increasingly short of breath during the past hour..
What physical assessment skills and strategies would you use to determine potential
changes in the patient’s respiratory condition? What are potential causes of this
increasing shortness of breath? What would you do to prepare for an emergency situation
in this patient? (30pts)

1. Respiratory conditions can affect breathing either through damage to the lungs or
excess secretions. To ensure that the correct treatment is implemented, a thorough
respiratory assessment should include both a comprehensive subject and objective
component to get a complete understanding of the clients function and baseline.
• A good careful observation is must to assess rate, shortness of breath, changes in skin
color, labored breathing and sign and symptoms or respiratory distress. It has been
noted that measuring and recording the respiratory rate is frequently overlooked, not
carried out accurately, or in up to 50% of cases is not carried out at all.
• Accurate recording of the respiratory rate forms an integral part of current evidence-
based clinical early warning scoring system and is the first parameter documented in the
national warning score.
• Sounds Underpinning knowledge of the importance of measuring this vital signs are
crucial.
• Should be done in maintaining poor hygiene with proper use of PPE with patient
consent, maintain privacy especially for females, with adequate light.
• The patient should be relaxed and resting in a quiet, well lit environment; otherwise,
recent activity should be noted.
• The patient should be positioned in a comfortable position - sitting upright if possible

GENERAL EXAMINATION
• Temperature
• Pulse
• Respiratory rate
• Blood pressure
• Oxygen saturation (SpO2)
• Nails - clubbing
• Eyes - pallor ( anaemia); Plethora ( high hemoglobin); Jaundice ( yellow color due to
liver or blood disturbance)
• Tonge and mouth - Cyanosis - hypoxemia

Observation of Chest
• Transverse diameter > AP diameter
• Kyphosis
• Kyphoscoliosis - retrive lung defect
• Pectus carinatum - pigeon chest
• Hyperinflation or barrel chest - AP = transverse - ribs horizontal

Measuring Chest Expansion (using a tape measure) Technique at residual volume - the
examiner’s hands are placed spanning the posterolateral segment of both bases, with the
thumbs touching in the midline posteriorly both the sides should move equally with 3-5
cm being the normal displacement.
• Supramammary - 1.5cm
• Mammary - 1.5cm
• Inframammary - 1cm
• Percussion - it is performed by placing the left hand firmly on the chest wall is that the
finger have good contract with the skin, the middle finger of the left hand is stuck over
the DIP joint with the middle finger of the right hand.
• Auscultation - the stethoscope provides important clues to the condition of the lungs
and pleura, all sounds can be characterized in the same manner as the percussion notes,
intensity, pitch, quality and duration.

2. Consider the scenario and answer the following questions.  Case Study: Community
Acquired Pneumonia. Teresa, a 20 year old college student, lives in a small dormitory
with 30 other students.  Four weeks after start of classes, she was diagnosed as having
bacterial pneumonia and was admitted to the hospital. (20 pts, 5 pts each)

(A) What intervention can the nurse provide to decrease the viscosity of secretions?
POTENTIAL CAUSES OF INCREASING SHORTNESS OF BREATH CAN BE:
• It can be due to drainage of large volume of blood from pleural space that can disturb
hemodynamics and cause shortness of breath.
• It can be a sign of pneumothorax that can be cause due to leaking of air into lungs.

(B) The nurse is assessing Teresa during the admission process. What manifestations of
bacterial pneumonia does the nurse expect to find?
Sign and Symptoms of Bacterial Pneumonia
• Cough with thick yellow, green or blood tinged mucus.
• Stabbing chest pain that worsens when coughing or breathing.
• Sudden onset of chills sever enough to make you shake.
• Fever of 102-105F or above (fever lower than 102F in older persons).
• Confusion of changes in mental awareness (in adult age 65 and older).
• Nausea, vomiting or diarrhea
• Shortness of breath

(C) The nurse assesses Teresa for arterial hypoxemia. What does the nurse understand is
the reason why this complication develops?
Arterial hypoxemia early caused by the persistent of pulmonary artery blood flow to
consolidated lung resulting in an intrapulmonary shunt, but also to a varying degree, it is
cause by intrapulmonary oxygen consumption by the lung during the acute phase and by
ventilation-perfusion mismatch later, It occurs due to hypoventilation.

(D) The nurse is assessing vital signs and lung sounds every 4 hours. What complications
should the nurse monitor for?
COMPLICATION OF BACTERIAL PNEUMONIA CAN BE:
• Empyema
• Pulmonary abscess
• Respiratory failure
• Acute respiratory distress syndrome
• Superinfection
COURSE TASK- CU10
JENAICA JUAN

Applying Your Knowledge: Consider the various scenarios and answer the questions. (20
points each scenario)

George is a 75 year-old patient with urosepsis being treated in the Intensive care unit
(ICU). The nurse assesses George and finds that he has blood in his urine and stool, and
is oozing blood from his central line site and his gums.

1. What does the nurse suspect maybe occurring with George?

- Nursing suspect in this situation is Urosepsis is an infection arising from the urinary or
genital organs that manifests with systemic signs and symptoms because blood in
Blood in your urine from bleeding in your kidneys or bladder. Blood in stools from
bleeding in intestines or stomach. Blood in stools can appear red or as a dark, tarry
color urine and stool, In oozing blood from his gums maybe Purpura and Petechiae
Bleeding or oozing from your gums or nose, especially nosebleeds or bleeding from
brushing in teeth. Heavy or extended menstrual bleeding in women.

2. What medications should the nurse avoid administering to George?

- Avoidance of NSAIDs, prompt glycemic control and prompt treatment of pyelitis

constitute the treatment for renal papillary necrosis. Avoid hypoglycemia in patients
on intensive insulin therapy.

3. The nurse is monitoring George’s vital signs every 15 minutes. What other
monitoring is essential to include along with the vital signs?

- The primary predictor was the frequency of vital signs monitoring including BP,
temperature, pulse, and respiratory rate. We abstracted all vital signs recordings
 available for the duration of each admission together with their associated date and
time. Vital signs monitoring was calculated as the total count for each recording of
vital signs divided by days in hospital. It is of help in monitoring change in position
and increase in size or number of renal stones.

4. What medication does the nurse anticipate infusing?

- Administer 30 mL/kg crystalloids within three hours of confirmed or suspected sepsis

or sepsis related hypo-perfusion.

• Crystalloids refer to IV fluids with a balanced electrolyte composition, such as

normal saline or lactated ringers solution (as opposed to colloids, such as albumin
or hetastarch).

• This initial fluid bolus is often referred to as a fluid challenge.

• In those patients diagnosed with sepsis, the nurse plays a critical role in monitoring
appropriate administration of fluids as the patient transitions between levels of care
(ICU)

Measure lactate level; if elevated (>2 mmol/L), ensure that a repeat level is obtained
within 6 hours.

• Lactate s a byproduct of glycolysis in anaerobic metabolism.

• In the septic patient, think of elevated lactate as a sign of tissue hypo-perfusion.

Fred, a 43 year-old construction worker, has a history of hypertension. He smokes two

packs of cigarettes a day, is nervous about the possibility of being unemployed, and has
difficulty coping with stress. His current concern is calf pain during minimal exercise,
which decrease with rest.

1. What does the nurse is the hallmark symptom of peripheral arterial occlusion disease?
 •  Hair loss on the feet and legs.

• Intermittent claudication – the thigh or calf muscles may feel pain when walking or
climbing stairs; some individuals complain of painful hips.

• Leg weakness.

• A foot or the lower leg may feel cold.

• Numbness in the legs.

• Brittle toenails.

• Toenails grow slowly.

• Sores or ulcers on the legs and feet that take a long time to heal (or never heal).

• The skin on the legs becomes shiny or turns pale or bluish.

• Difficulty in finding a pulse in the leg or foot.

• Erectile Dysfunction (impotence in men, problems achieving or sustaining an

erection).

2. The patient is having ankle-brachial index (ABI) determined. The right posterior
tibial reading is 75 mm Hg, and the brachial systolic pressure is 150mm Hg. What
would the ABI be for this patient?

- The ABI of this patient would be, 0.5 which is an abnormal value or ABI.

3. The nurse is educating Fred about managing his condition. What methods can the
nurse suggest to increase arterial blood supply?

- The nurse can suggest methods such as exercise, getting a massage, increasing fluid
intake, drinking green tea, dry brushing your skin daily, reducing stress through certain
activities such as; yoga, meditation, limiting your caffeine intake, chewing gum,
writing in a journal, listen to relaxing music, and also spending time with loved ones.
You can also cut back on alcohol, elevate your legs and also stretch.
 4. What is the best method for the nurse to assess Fred’s peripheral pulses to obtain
consistent results with other health care practitioners?

- The patient should be examined in a warm room with arrangements made such that the
patient's pulses can easily be examined on both sides of the bed. A cool atmosphere
can cause peripheral vasoconstriction and reduce the peripheral pulse. Palpation should
be performed with the fingertips and pulse amplitude rated on a scale of 0 to 4 + :0
indicating no palpable pulse; 1 + indicating a weak but detectable pulse; 2 + indicating
a pulse slightly lower than average; 3 + indicating a normal pulse. The examiner must
be alert to the possibility that the pulse he or she detects in his or her own fingertips
may be due to digital artery pulsations; this source of uncertainty may be resolved by
matching the pulse in question with his or her own radial pulse or the cardiac sounds
of the patient as determined by precordial auscultation. It is usually inadvisable to use
the thumb for peripheral pulses while palpating. With the examiner's own pulse, the
thumb has a greater chance of uncertainty and usually has a less discriminating feeling
than the fingertips. Inspection can often be an aid to the pulse position. The examiner
may be able to see the skin rise and fall along the course of an extremity artery with
each pulsation, particularly if a bright light is tangentially aimed across the skin
surface.

Georgia, a 30 year-old woman, is diagnosed as having secondary hypertension when

serial blood pressure recordings 170/100 mm Hg. Her hypertension is the result of renal
dysfunction.

1. How will Georgia’s kidney help maintain her hypertensive state?

- They might no longer work effectively if the kidneys' blood vessels are damaged.
Some waste and excess fluid from the body will not be removed from the kidney if this
occurs. Extra fluid can increase blood pressure further and build a risky cycle,
 resulting in more damage to the blood vessels, heading to renal failure.

2. The nurse informs Georgia that she should see her ophthalmologist. Why is it
important that Georgia adhere to follow up with an ophthalmologist?

- It is essential for Georgia to get an appointment with her ophthalmologist promptly

due to hypertension resulting from renal impairment, — particularly if she has been
diagnosed with stage 2 hypertension, which can negatively, impact the retina, choroid,
as well as the optic nerve, and also increased intraocular pressure (IOP). Both of her
diseases lead to retinopathy. In the eye, retinopathy entails damage to the blood
vessels.

3. Georgia is prescribed with Furosemide (Lasix) 20mg once every day. What does the
nurse understand about the action of Lasix?

- Prior to administering the medication to the patient, the nurse needs to consider the
mode of action and side effects of Furosemide. The patient will receive this because of
renal insufficiency and hypertension.It works mainly by preventing electrolyte re-
absorption from the kidneys and increasing the secretion of water from the body, this
also reduces blood pressure. Adverse effects such as dizziness, fatigue, diarrhea and
excessive urination have to be recognized by the nurse.

4. What health education can the nurse suggest to Georgia to reduce complications and
improve disease outcomes?

- Health education that the nurse can suggest to Georgia on prevention of hypertension
may be considering weight control, increasing physical activity, advice the client to eat
food with moderated sodium or salt restriction, instruct patient to avoid alcohol intake
and also quit smoking. Instruct the patient to have an increased potassium intake, have
a diet rich in fruits and vegetables and low-fat meat, fish, and dairy products, perform
appropriate diuretic therapy and lastly, promote healthy lifestyle.
COURSE TASK- CU13
JENAICA JUAN

1. A 92-year-old woman in a long-term care facility is a patient assigned to your care.

With visible discomfort, she tells you that she has noticed blood in the toilet bowl with
her last several bowel  movements and she has had blood on her underwear.
a. What other questions should you ask this woman to clarify potential
causes of this problem?
- In this situation I will ask my patient if she experiencing hemorrhoids that will appear
as a lump at her anal verge, protruding from her anus, and if she will be saw dark
bluish in color in that area? And also if she had frequent hemorrhoids?
a. Explain how the patient’s age might affect your focused assessment.
- A 92 year-old woman is has a potential to get colorectal cancer and hemorrhoids
because older adult is prone colorectal cancer is more likely to occur as people get
older, and more than 90% of people with this disease are diagnosed after age 50. Other
risk factors include a family history of colorectal cancer especially in close relatives,
and a personal history of inflammatory bowel disease such as ulcerative colitis,
colorectal polyps or cancers of other organs.

2. Over 50 studies have been conducted on the connection between exercise and the risk
of colon  cancer. Research shows that adults who increase their physical activity in
intensity, duration or frequency can reduce their risk of developing colon cancer by 30 to
40  percent, compared to adults  who are sedentary. Download a research article on
studies relating to the effect of exercise on colorectal cancer prevention and treatment.

“Colorectal cancer, screening and primary care: A mini literature review”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5597496/
doi: 10.3748/wjg.v23.i33.6049

- In this article that I choose, It despite the significant improvements in screening

techniques and our understanding of risk and protective factors, colorectal cancer remains
a major global health burden. The face a unique challenge in their capabilities and efforts
to alter this phenomenon; their role in implementing screening and preventive policies is
key to reducing the burden of colorectal cancer.
COURSE TASK- CU11
JENAICA JUAN

Study Questions:
1. Read about the Epidemiology of Cancer in the Philippines. Submit a 200-300-word
essay reflection.

https://doh.gov.ph/sites/default/files/health_programs/The-Philippine-Cancer-Control-
Program.pdf

“Breast cancer was the most frequent type of cancer among females in the Philippines.
There were a total of 10,083 new cases registered among females during 1998 to 2002.
The CR was 35.6 per 100,000 while the ASR was 52.2 per 100,000. The incidence rates
varied from 12.7 per 100,000 in Baras, Rizal to 75.9 per 100,000 in San Juan. The ASR
of PCS-MCR (56.1 per 100,000) was significantly higher than that of the overall (Table
3.10.1 & Figure 3.10.1). DOH-RCR on the other hand, had a significantly lower ASR
(48.6 per 100,000) than that of the overall. The DOH-RCR Metro Manila areas had a
significantly higher ASR (54.7 per 100,000) while Rizal Province exhibited a
significantly lower ASR (32.3 per 100,000).

The cities/municipalities that showed a significantly higher ASR than the overall were
Manila, Quezon City, Makati, Mandaluyong, Parañaque, Pasig and San Juan.
Contrastingly, those that presented significantly lower ASRs were Caloocan, Malabon,
Navotas, Taguig, Angono, Antipolo, Baras, Binangonan, Cardona, Jala- jala, Montalban,
Morong, Pililia, San Mateo, Tanay, Taytay and Teresa. The breast cancer ASRs observed
among women in the PCS-MCR area, Singaporean Chinese and Chinese residents in L.A.
were similar (Figure 3.10.2). Interestingly, the rate among female Filipino residents in
L.A. was almost double, and higher than those observed among Black residents in L.A.
and in Saarland. The highest rate was seen among the Non-Hispanic White residents in
L.A. The differences (or similarities) between populations could be largely attributable to
variations in reproductive behavior and lifestyle.”
- My opinion in this article presents an epidemiological profile of the major cancers in
Metropolitan Manila and the province of Rizal, Data from the two population based
registries, the Department of Health Rizal Cancer Registry and the Philippine Cancer
Society Manila Cancer Registry, were analyzed in detail with the age standardized
rates for each area being compared with the age standardized rates for all the areas
combined. Comparison with rates from other areas in the world are presented, as well
as incidence maps. In this article it shows that it is simplistic to ascribe increasing rates
of breast cancer in low and middle income countries to the lifestyles. This fails to
recognize that there are already substantial differences in breast cancer risk in those
populations which are not obviously explained by differences in those habits. For this
reason, etiological research in Asian and other middle income countries offers a
powerful opportunity to test hypotheses developed in high risk populations and thus
could provide much needed new ideas.

The aim of cancer prevention is to develop methods, plans or policy for interventions
that will benefit the population, as well as develop systems for monitoring and
evaluating these interventions in the future. The purpose of interventions is to reduce
the incidence, morbidity, mortality rates of cancer and cost of cancer management.
Because the modes of interventions that will be employed involve changes in lifestyles,
behavior, and environment, it is logical to assume that complex psychological,
physiological and cultural problems may arise. In cancer prevention and control,
priority should be given to those that cause the greatest morbidity and mortality, those
for which substantial risk is associated with certain exposures, and for which
apparently effective interventions are available
 2. Illustrate your own Pathophysiology of Cancer depending on
a case you have selected.

Predisposing factors: Predisposing factors:

AGE, GENDER, LATE AGE, GENDER, LATE
MENOPAUSAL MENOPAUSAL

Neoplasm format in the

breast

Primary tumor begins in

the great

Tumor becomes
invasive
 2.

2.

2.

2.

2.

2.

2.

2.

2.

2.

2.

2.

2.

2.

2.

2.
Create an original poster, infographic or one-page guide on ‘Recommendations for
the Early Detection of Cancer In Average-Risk Asymptomatic People.
COURSE TASK- CU12
JENAICA JUAN

Study Questions:

1. Summarize the guidelines for the early detection of breast cancercby developing a
teaching plan for breast self-examination for patients.
- For early detection of breast cancer, The most important screening test for breast
cancer is the mammogram. A mammogram is an X-ray of the breast. It can detect
breast cancer up to two years before the tumor can be felt by you or your doctor.
Women age 40 - 45 or older who are at average risk of breast cancer should have a
mammogram once a year.
- Breast self-examination is a useful and important screening tool, especially when
used in combination with regular physical exams by a doctor, mammography, and in
some cases ultrasound and/or MRI. Each of these screening tools works in a different
way and has strengths and weaknesses. Breast self-exam is a convenient, no-cost tool
that you can use on a regular basis and at any age. We recommend that all women
routinely perform breast self-exams as part of their overall breast cancer screening
strategy.

Step 1: Begin by looking at your breasts in the mirror with your shoulders straight and
your arms on your hips.

Here's what you should look for:

◦ Breasts that are their usual size, shape, and color

◦ Breasts that are evenly shaped without visible distortion or swelling

If you see any of the following changes, bring them to your doctor's attention:

◦ Dimpling, puckering, or bulging of the skin

◦ A nipple that has changed position or an inverted nipple (pushed inward instead of
sticking out)
 ◦ Redness, soreness, rash, or swelling

Step 2: Now, raise your arms and look for the same changes.

Step 3: While you're at the mirror, look for any signs of fluid coming out of one or both
nipples (this could be a watery, milky, or yellow fluid or blood).
Step 4: Next, feel your breasts while lying down, using your right hand to feel your left
breast and then your left hand to feel your right breast. Use a firm, smooth touch with the
first few finger pads of your hand, keeping the fingers flat and together. Use a circular
motion, about the size of a quarter.

Cover the entire breast from top to bottom, side to side — from your collarbone to the top
of your abdomen, and from your armpit to your cleavage.

Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple,
moving in larger and larger circles until you reach the outer edge of the breast. You can
also move your fingers up and down vertically, in rows, as if you were mowing a lawn.
This up-and-down approach seems to work best for most women. Be sure to feel all the
tissue from the front to the back of your breasts: for the skin and tissue just beneath, use
light pressure; use medium pressure for tissue in the middle of your breasts; use firm
pressure for the deep tissue in the back. When you've reached the deep tissue, you should
be able to feel down to your ribcage.
Step 5: Finally, feel your breasts while you are standing or sitting. Many women find that
the easiest way to feel their breasts is when their skin is wet and slippery, so they like to
do this step in the shower. Cover your entire breast, using the same hand movements
described in step 4.

2. A 48-year-old man is married with two young children and has been newly diagnosed
with ametastatic spinal cord tumor. Identify appropriate nursing interventions to
alleviate the patient’s and family’s physiologic and emotional stressors.
- Nurses, both inpatient and outpatient based, play an important role in early
recognition of symptoms, patient and family education and coordination of
appropriate referrals. Knowing who is at highest risk and educating these patients of
 the importance of what may seem like minor symptoms is a major step in early
intervention. In the outpatient setting, nurses may need to triage symptoms over the
phone, requiring knowledge of symptoms, risk factors and what questions to ask.
Many nurses take responsibility for coordinating referrals for imaging studies and
coordinate consultation with radiation oncologists and neurosurgeons. Time is critical
to positive outcomes and nurses can often expedite this process, helping patients and
families understand what is going on along the way. As we tirelessly advocate for our
patients, know that astute nursing care can help these patients maintain dignity and
quality of life.

3. Oxygen therapy is required for a 65-year-old patient with terminal lung metastatic
cancer.Discuss teaching and safety precautions indicated for the patient and his or
her family. Describe the patient teaching that will be required for the patients who
will be discharged from the hospital with a prescription for oxygen therapy.
- I will instructed patient or caregiver of the patient  about a few simple precautions
that can be taken to create a safe home environment when using oxygen. Oxygen
canisters should be kept at least 5 - 10 feet away from gas stoves, lighted fireplaces,
wood stoves, candles or other sources of open flames. Do not use electric razors while
using oxygen ( These are a possible source of sparks ). Do not use oil, grease or
petroleum - based products on the equipment. Do not use it near you while you use
oxygen. These materials are highly flammable and will burn readily with the presence
of oxygen. Avoid petroleum - based lotions or creams, like Vaseline, on your face or
upper chest. Check the ingredients of such products before purchase.

Step 1. Check your supply

◦ Pressurize your oxygen tank. This is for compressed tanks only. Other devices can
simply be turned on. Follow the directions from your healthcare provider or
medical supply company.
 ◦ Check the oxygen gauge on the tank to be sure you have enough. Your medical
supply company will tell you when to call for more oxygen. Or they will deliver
your oxygen on a regular schedule.

◦ Check the water level if you have a humidifier bottle. When the level is at or below
half full, refill it with sterile or distilled water. Ask the company how often to
change your humidifier bottle. This helps prevent germs.

Step 2. Attach the tubing

◦ Attach the nose tube (cannula) to your oxygen unit as you were shown.

◦ Check that the tubing is not bent or blocked.

Step 3. Set your flow rate

◦ Set the oxygen to flow at the rate your healthcare provider gave you. 

◦ Never change this rate unless your provider tells you to.

Step 4. Put the cannula in your nose

◦ Put the cannula in your nose. Breathe through your nose normally.

◦ If you are not sure if the oxygen is flowing, do a simple test. Put the cannula in a
glass of water. Oxygen is flowing if the water bubbles.
COURSE TASK- CU14
JENAICA JUAN

Study Questions:
1. You are caring for a 78-year-old patient after the creation of an ileal conduit. What is
the best description of the ileal conduit?
- An ileal conduit is a system of urinary drainage which a surgeon creates using the
small intestine after removing the bladder. To do this, the surgeon takes a short
segment of the small intestine and places it at an opening he has made on the surface of
the abdomen to create a mouth, or stoma. The ureters, which normally carry urine from
the kidneys to the bladder, are then attached to the other end of the segment of
intestine. The urine now travels from the kidneys, via the ureters and the newly formed
ileal conduit, to the stoma and out into a collecting pouch known as an ostomy bag or
urostomy. This is worn outside the body around the stoma 24 hours a day. Because the
nerves and blood supply are preserved, the new conduit is able to propel the urine out
of the body and into the urostomy.
Recuperation after the Surgery
- One of the advantages of the ileal conduit is that it requires less surgical time than
other, more complex, diversions. This procedure was developed during the 1940’s and
is still the most used technique for urinary diversion. When it was released from the
hospital, It came home with no tubes or catheters. Had no diet restrictions because only
a small part of the intestine is used. However, Understand many doctors will
recommend a low residue diet for the first few weeks post op. With conventional
surgery, the recuperation period is about 6-8 weeks.

2. Enumerate the Risk Factors for Cervical Cancers.

- A risk factor is anything that increases a person's chance of developing cancer.
Although risk factors often influence the development of cancer, most do not directly
cause cancer. Some people with several risk factors never develop cancer, while
others with no known risk factors do. Knowing your risk factors and talking about
 them with your doctor may help you make more informed lifestyle and health care
choices.
The following factors may raise a woman's risk of developing cervical cancer:
• Human papillomavirus (HPV) infection. The most important risk factor for
cervical cancer is infection with HPV. HPV is common. Most people are infected
with HPV when they become sexually active.
• Immune system deficiency. A lowered immune system can be caused by immune
suppression from corticosteroid medications, organ transplantation, treatments for
other types of cancer.
• Herpes. Women who have genital herpes have a higher risk of developing
cervical cancer.
• Smoking. Women who smoke are about twice as likely to develop cervical cancer
as women who do not smoke.
• Age. People younger than 20 years old rarely develop cervical cancer. The risk
goes up between the late teens and mid-30s.
• Socioeconomic factors. Cervical cancer is more common among groups of
women who are less likely to have access to screening for cervical cancer.
• Oral contraceptives. which are birth control pills, may be associated with an
increase in the risk of cervical cancer. However, more research is needed to
understand how oral contraceptive use and the development of cervical cancer are
connected.
• Exposure to diethylstilbestrol (DES). Women whose mothers were given this
drug during pregnancy to prevent miscarriage have an increased risk of
developing a rare type of cancer of the cervix or vagina.

3. A 55-year-old patient has been diagnosed with cervical cancer. She reports that she
has a strong family history of cancer; two sisters have breast cancer. Her mother
died of cancer when the patient was a child, and she is not certain of the type of
cancer. Because of her strong family history, she is concerned about the health status
of her twin daughters who are in their early 30s. She has asked you to discuss the
risks for cancer with them.
 Explain what counseling and education you will provide to the patient and her
daughters.
- I will explain to my patient and to her daughter that was instructed in cervical cancer
explaining of type of cancer and the therapeutic or surgical procedures to be
performed. Patient Undergoing Surgery, the patient was reviewed avoid coitus and
douching for 2 to 6 weeks after surgery, avoid heavy lifting and vigorous activities.
Patient Undergoing Cryosurgery/Laser Therapy , the patient was taught that perineal
drainage is clear and watery initially progressing to a foul-smelling discharge that
contains dead cells, reviewed perineal care and hygiene, recommended need for
regular Papanicolaou and pelvic examinations. Patient Undergoing Pelvic
Exenteration, the patient was instructed to obtain appropriate supplies for ostomy
care, the patient was taught on perineal care explaining the drainage may continue for
several month, the patient was reviewed in wound irrigation procedures and
application of sanitary pads, avoid prolonged sitting.

Identify the evidence base for the counseling and education and the strength of
that evidence.
Serve as a single point of contact for patients and families
• Assess patient barriers to care and help patients overcome barriers (e.g.,
transportation, childcare, financial counseling, lodging)
• Advocate for patients and coach patients to advocate for themselves
• Coordinate scheduling of appointments and procedures
• Contact patients who are at risk for missing appointments
• Discuss Advance Care Planning with patients and families
• Arrange interpreter services for patients with language barriers
• Direct patients and families to community resources and supportive services
• Refer patients to Social Work and Complementary Therapies
• Accompany patients to appointments
• Inform the clinical team of patient beliefs, cultural norms, and goals relevant to
their care
 • Maintain follow-up communications with patients in need of additional assistance

How will you approach your counseling and education?

- In behaviour therapy focuses on patient behaviour and aims to help people to modify
unwanted behaviours. Unwanted behaviour is defined as an undesired response to
something or someone in the environment. Using this approach, as a nurse counsellor
would identify the unwanted behaviour with a client and together they would work to
change or adapt the behaviour.
Problems which respond well to this type of therapy include phobias, anxiety attacks and
eating disorders. Patient might be taught skills to help them manage their lives more
effectively. For example, they may be taught how to relax in situations that produce an
anxiety response. Another method involves learning desirable behaviour by watching and
copying others. In general, the behavioural approach is concerned with the outcome
rather than the process of change.