PRELIMS

- Department clinical services

- Respiratory unit
Class of Hospitals
- General ICU
I. According to ownership - High risk pregnancy unit
a. GOVERNMENT - NICU
- Created by law - Tertiary clinical lab
b. PRIVATE - Blood station
- May be a single proprietorship, - Primary care facility
partnership, cooperative, - Custodial care facility
corporation, foundation, religious - Diagnostic care facility
non-government organization and - Specialized care facility
others.
II. Functional capacity
a. General hospital
- Provides medical, surgical care to

the sick, injured and maternity care
and should have the ff. medicine,
pediatrics, ob-gyne, surgery, etc.
b. Specialty Hospital
- Specializes in a particular disease or

condition or in one type of patient.
III. Trauma Capability
a. Trauma capable facility
- A DOH licensed hospital designated
as a trauma center

b. Trauma-reviewing facility
- A DOH licensed hospital within the
trauma service area which receives
trauma patients for transport to the
point of care or trauma center

LEVEL 1

- Medicine, pediatrics, OB-gyne,

surgery
- Emergency out-patient service
- Isolation facilities
- Surgical/maternity facilities
- Dental clinic

- Secondary clinical lab
- Blood station
- 1st level xray
- Pharmacy

LEVEL 2
MIDTERMS Ø It is relatively brief synopsis of the
circumstances justifying admission, what is
Medical Record
thought to be the patient’s problem and
Ø Is a chart that documents the patient’s
what is planned for the px during the period
experiences in the hospital from admission hospitalization
to discharge
Content:
Ø Contains relevant info regarding the the px
a. Reason for admission
medical hx and current conditions and b. Dx
details the plan for px care for admission to
c. Tx plan
discharge
- Urgent
Ø Purpose is to communicate clearly and - Elective
succinity info of statistical and
- Emergency
observational value for all members of the
health professional team Admission Orders
Ø Should be written consistently w/o
shortcuts and in not interpretative Purpose: are specific instructions to nursing personnel
to admit the px to the hospital provide for medication
Ø Contains clear, concise and is problem
and begin the in-patient portion of diagnosis and
oriented
Ø Erasing ot obliterating orders is illegal therapy
Ø Just draw a line if incorrect Content:
Major Parts: - Admitting doctor, service
- Diagnosis
a. Admission notes
- Condition of the px
b. Pre-operative notes
- Vital signs
c. Operative and post-op noptes
- Activity
d. Progress notes-SOAP
e. Discharge notes - Nursing care
- Diet
Supporting Components - IV fluid
- Medications
a. Orders
- Laboratory tests
b. Nursing notes
c. Lab test results Consultation
d. Consultations
- Formal request for input from
Personnel involved: another doctor or support service.
It permits the admitting doctor to
a. Physicians and dentist
gain advice and or active
b. Nurses participation from that other source
c. Physicians assistants
regarding selected aspects of the px
d. Social workers
evaluation and management
- Responses are expected from
promptly within 24 hrs
I. Admission Notes
Ø Is the initial entry in the progress notes History and Physical Examination
section of the patient record
 Ø Designed to gather as much info as possible experiences, social habits and
from the questioning and gross examination occupational history
of the px
Patient Evaluation and Case Selection
Specific interview technique
• Medications
a. Facilitation – use postures and words that o PRISE (meds sa TB)
communicate interest, making eye contact § Pyrazinamide
b. Reflection – examiner may repeat phrases or § Rifampacin
words used by the px to describe a § Isoniazid
condition/symptom § Streptomycin
c. Clarification – examiner should ask the patient § Ethambutol
to explain any unclear statements • Dialogue history
d. Empathic response – can recognize and support • Physical signs
the px feeling through action • Health questionnaire
e. Emphatic questioning- examiner should ask
about the px feelings regarding current Local Anesthesia
symptom
• 1:100,000 epinephrine = 0.018 mg
f. Confrontation – examiner should identify
• Vasoconstrictor computation of anesthetic
inconsistencies in the px story and actions
solution (2% lidocaine with 1:100,000

epinephrine)

o 1:100,000 > 1 gram of epinephrine is
Importance of Medical history mixed with 100,000 ml
o 1000 mg / 100,000 ml = 0.01 mg/ml
- Determine possible relationship of o 0.01 mg/ml x 1.8ml per cartridge =
oral lesion and systemic disease 0.018 mg/cartridge
- Modify dental tx modality in the o 0.018mg x 2 (cartridges)= 0.036 mg
presence of a systemic condition • 0.04 mg of epinephrine = 2 anesthetic
- Effect of medical prescription on cartridges (max. for patient with cardiovascular
physiology disease)
- Effect of dental drugs to the • 1:200,000 > safest to use
systemic condition
- Prophylactic consideration
- Effect of medical condition to

prognosis

Family and Psychosocial History

• Family history helps the clinician/physician
identify patterns of hereditary & acquired
disease within the patient’s family
• Psychosocial
o Habit/tradition the patient has

o Examines behavioral aspects of the
patient’s daily existence. It also includes
the patients beliefs, relationships,

Medications o Given as supplement
• Vasodilators
CARDIAC
o Nitrates or nitroglycerin tablets are a
• Angiotensin-Converting Enzyme (ACE) inhibitors form of vasodilator
o PRIL o 3rd dose > should be transported to the
o Expands blood vessels and decreases hospital to avoid full blown M.I
resistance by lowering levels of • Diuretics
angiotensin II o THIAZIDE
o Treat hypertension and Heart failure § Benzothiazide,
o Captopril (Capoten), Enalapril (Vasotec), Hydrochlorothiazide
Fosinopril (Monopril) o Eliminate excess fluids in the body
• Angiotensin II Receptor Blockers (or inhibitors) o Polyuria > Side effect
o SARTAN
OTHER MEDICATIONS OF CONCERN
o Prevent chemicals from having any
effects on the heart and blood vessels • Bisphosphonate
o Treat hypertension and heart failure o ONATE
o Losartan (Cozaar), Telmisartan o Drugs that help prevent/slow down
(Micardis) bone thinning (osteoporosis)
• Beta Blockers o Can cause BRONJ
o OLOL o Alendronate (Fosamax)
o Decreases the heart rate and cardiac • RANKL inhibitor
output o Can cause MRONJ
o For cardiac arrhythmias (abnormal o Denosumab
heart rhythms) and in treating chest • Proton Pump Inhibitors
pain (angina) o PRAZOLE
o Atenolol (Tenormin), Propanolol o Anti-ulcer
(Inderal), Metoprolol (Lopressor, Toprol o Iansoprazole, Omeprazole,
XL) Pantoprazole
• Calcium Channel Blockers • Corticosteroids
o DIPINE o SONE
o Lowers the heart’s pumping strength o Anti inflammatory (steroid)
and relax blood vessels o Cortisone, prednisone
o Treat hypertension, arrhythmia and • Tricyclics
angina o Triptyline
o Amlodipine (Norvasac), Nifedipine o Antidepressants
(Adalat) o Amitriptyline, Nortriptyline,
• Statins Protriptyline
o Lower blood cholesterol levels • Bronchodilators
o Decrease LDD “bad” cholesterol, raise o TEROL
HDL “good” cholesterol, lower o Albuterol
triglyceride levels
o Simvastins
• Anticoagulants
o Heparin & Warfarin (Coumadin)
• Antiplatelet agents > thromboxane 2
o Aspirin, Clopidogrel, Plavix