MEDICAL SURGICAL NURSING WARNING!

USE AT YOUR
DE LA SALLE MEDICAL AND HEALTH SCIENCES INSTITUTE LECTURER: Sir Leo Tibayan OWN RISK
COLLEGE OF NURSING ACADEMICS COMMITTEE TRANSCRIBED BY: Yessica Masangya
& RR Revita

PROFESSOR POWERPOINT TEXTBOOK RACE

★ ▪ ➔  Multiple Sclerosis
• High: Caucasian, European
INFECTIOUS AND IMMUNOLOGIC DISEASES
ASSESSMENT • Low: Asian, African
 Lupus
TABLE OF CONTENTS • High: African-American, Hispanics, Asian-
American
I. Risk Factors
 African-American - High risk for SLE, Sickle-Cell
II. Subjective Data
Anemia, DM; Low risk for MS
III. Objective Data
 Caucasian - High risk for Multiple Sclerosis
OBJECTIVES  European - High risk for Multiple Sclerosis
▪ Identify the infectious, inflammatory, and  Hispanics - High risk for SLE
immunologic diseases  Asian - High risk for SLE; Low risk for MS
▪ Risk factors
PAST MEDICAL HISTORY
▪ Subjective
 Multiple Sclerosis:
▪ Objective data
• Autoimmune disorders slightly increase the
RISK FACTORS risk in developing MS
GENDER • Thyroid disorders
 Multiple Sclerosis: women experiences remitting MS • Pernicious anemia
2-3x more than men • Psoriasis
 SLE: women > men • Type 1 DM
 R. Arthritis/Arthritis: women > men • Inflammatory bowel disease
• Glomerulonephritis – higher chance to
AGE patients with DM
 Diabetes: 4 to 7 yo and 10 to 14 yo  Hypersensitivity
 Type I DM: Can appear at any age • Atopic dermatitis
 Multiple Sclerosis: 20 to 40 yo (happens at any age  Tetanus
but usually occurs in elders) • Those who had recent injuries
 Allergic Reaction: children  Pneumonia
 Hypersensitivity: Children are more vulnerable since • AIDS
adults are usually exposed to different allergens • Undergoing chemotherapy
wherein our body develops tolerance/resistance to • Long-term use of steroids
certain allergen.  PTB
 SLE: 15 to 45 yo • HIV/AIDS – 100% of HIV patients will
 Rheumatoid Arthritis: happens at any age but develop full blown PTB
usually occurs during middle age (Degenerative o Goal of tx is early tx and prophylaxis of
factor, Wear and Tear Theory) infection; prevent the HIV infection into
 PTB: children (due to low resistance) and old age developing into full blown AIDS or
(due to low resistance + decreased lung function) prevent acquiring opportunistic
 Pneumonia: Common in Elderly and Children infections. Our health depends on our
immunity so if it is compromised then
there might be higher risks
• DM
• Severe Kidney Disease
• Cancer

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FAMILY HISTORY TRAVEL HISTORY/GEOGRAPHY
 Multiple Sclerosis: genetics  Type 1 DM
 Type 1 Diabetes Mellitus: hereditary (from parents) • The farther from the equator, the lower the
 Chronic Hepa B - High risk if the mother is infected risk
with hepa B; transmission from mother’s blood to  Poliomyelitis
baby • Afghanistan
 PTB - aside from genetics; sharing of utensils or • Nigeria
having fomites increases the risk • Pakistan
 Hypersensitivity: family hx of asthma, hives, eczema  Rabies and Ebola
• Africa
CURRENT TREATMENT • Southeast Asia
 Acute Glomerulonephritis • Rabies: all pets should be vaccinated
• Heavy use of NSAIDS  Hepatitis B
• eg. Ibuprofen (Advil), Naproxen (flanax, • Asia
Skelan)
• Pacific islands
• Rheumatoid Arthritis if given with Naproxen • Africa
and dosage was increased, there might be a
• Eastern Europe
high risk in developing glomerulonephritis
 PTB
 Pneumonia
• Common in poor countries
• Chemotherapy
• Africa
• Long-term use of steroids
• Eastern Europe
 PTB
• Asia
• Psoriasis
• Russia
• Chronic kidney disease
• Latin America
• Medications that are not regulated
• Caribbean Islands
increases the risk for certain conditions. For
ex. Steroids compromises the immune  HIV
system (for R. Arthritis, Psoriasis, and • Southeast Asia
Crohn's Disease) also increases the risk of • Africa
acquiring PTB.
OCCUPATION
 Rheumatoid Arthritis
LIFESTYLE
 Smoking • Asbestos
• Multiple sclerosis • Silica
 Polio, Rabies, HIV, Hepa-B
• Rheumatoid Arthritis
• Healthcare workers
• Pneumonia
 PTB
 Diet/Obesity
• Rheumatoid Arthritis • Community healthcare workers
• Those working in prisons, homeless
• Diabetes Mellitus
shelters, and nursing homes
 Unprotected sex
• HIV/AIDS
• STI
• Hepa-B
 Living with someone who has the disease
• Kidney disease
• Chronic hepa-B
 Drug Users
• Since they are not that concerned in reusing
disposable syringes.

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SUBJECTIVE DATA
INFECTIOUS
Poliomyelitis
• Headache, nausea,
vomiting, abdominal
pain
• Nuchal rigidity, more
severe headache, back,
and lower extremity
pain
Tetanus
• Spasms and stiffness in
jaw muscles
• Stiffness of your neck
muscles
• Difficulty swallowing
Rabies
• Excessive salivation
• Hydrophobia
• hallucinations
Hepa-B and PTB
• loss of appetite
• nausea and vomiting
(hepa-B only)
• weakness and fatigue
• Fatigue
• Fever
• Night sweats
• Chills
• Loss of appetite
Pneumonia and PTB
• Chest pain when you
breathe or cough
• Cough which may
produce phlegm
• Shortness of breath
Emerging Infections
• Chills and rigors
• Myalgia
• Headache and dizziness
• Sore throat, coryza
• Fatigue/tiredness
• Difficulty of breathing
• Chills
• Sore throat
• Nausea and vomiting
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IMMUNOLOGIC
Diabetes Mellitus
• Increased thirst
• Frequent urination
• Extreme hunger
Acute Glomerulonephritis
• Pink or cola-colored
urine
• Foamy urine
Allergies
• Sneezing
• Itching of the nose,
eyes, or roof of the
mouth
• Itching or hives all over
the body
Lupus
• Fatigue
• Joint pain, stiffness
(Lupus & RA)
• Headache, confusion,
and memory loss
Rheumatoid Arthritis
• Joint stiffness that is
usually worse in the
mornings and after
inactivity
• Tender, warm, swollen
joints
• Fatigue, fever, and loss
of appetite
Candidiasis
• Vulvar and vaginal
burning and itching
• Pain on coitus or on
tampon insertion
Herpes Genitalis
• Intense pain on contact
with clothing or acidic
urine
• Flu-like symptoms
OBJECTIVE DATA
 Observe for pallor, cyanosis, jaundice and erythema
 Evaluate skin integrity
- Poor wound healing, lesions, s and sx of
infections
- 4 Cardinal Signs of Inflammation
o Redness (Rubor)
o Calor (Heat)
o Dolor (Pain)
o Tumor (Swelling)
 Check for rash and note its distribution
 Observe hair texture and distribution
 Inspect nails
- Capillary refill, clubbing, oncolysis (separation of
nail from nail bed)
 Inspect the oral mucous membranes
- White plaques, swollen gums
 Inspect the male and female genitalia
- Lesions without pain, ulcerations, breaks
 Palpate the peripheral pulses
- If symmetrical, regular
 Palpate superficial lymph nodes
- Should not be inflamed; note size, shape,
consistency, mobility, temperature
 Palpate for masses or lesions
 Percuss the anterior, lateral, and posterior thorax
- Dull sound= consolidation related to pneumonia
- Hyperresonance= trapped air related to
bronchial asthma
 Auscultate over the lungs
- Wheezing= asthma (narrow airways)
- Crackles= respiratory tract infection,
consolidation
- Dull sound= pneumonia
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 HOW TO PERFORM
NON-INVASIVE DIAGNOSTIC EXAMINATIONS 1. Urinate a small amount into the toilet bowl to clear
the urethra of any contaminants.
TABLE OF CONTENTS 2. Collect a sample of urine in a clean (if routine
I. Routine Urinalysis/ Urine Culture and urinalysis) or sterile container (if urine C&S). About
Sensitivity 1-2 ounces of urine is needed for a test
II. Chest Radiography 3. Remove the container from urine stream without
stopping the flow
OBJECTIVES 4. Finish urinating into the toilet bowl
▪ Identify the types of non-invasive diagnostic 5. Take the sample to the lab
procedures
▪ Learn the importance as well as the indications of  Urine Culture and Sensitivity- will take several days
non-invasive procedures before receiving the results
▪ Recognize the appropriate medical and nursing  Routine Urinalysis- will only take at least 1 hour
managements for non-invasive procedures  Clean container for routine analysis is enough
 Sterile container if C&S. To only detect what’s in
ROUTINE URINALYSIS/ the urine; To prevent contamination.
URINE CULTURE AND SENSITIVITY  If patient is with IFC, aspirate at the catheter.
▪ A urinalysis is a group of manual and/or automated Do not obtain sample form the urine bag.
qualitative and semi-quantitative tests performed
on a urine sample. FOR INFANTS
▪ The genital area is cleaned and dried
ROUTINE URINALYSIS USUALLY INCLUDES THE FF. ▪ The collection device is attached to collect the urine
TESTS: ▪ Be sure that the collection device is attached
▪ Color securely to prevent leakage
▪ Transparency ▪ After the baby has urinated, the urine (at least 20
▪ Specific gravity cc) is placed in a sterile container
▪ pH
▪ Protein DIFFERENCE BETWEEN ROUTINE URINALYSIS AND
▪ Glucose URINE CULTURE AND SENSITIVITY
▪ Ketones  ROUTINE UA
▪ Blood - checks color, transparency, and contents
▪ Bilirubin  URINE C&S
▪ Nitrite - cultures urine to identify bacteria found in the
▪ Urobilinogen urine
▪ Leukocyte esterase - checks if the bacteria is resistant to antibiotics
- determines which is the best antibiotic for the
PERFORMED FOR SEVERAL REASONS: bacteria
▪ General health screening to detect renal and
metabolic diseases NURSING CONSIDERATIONS FOR URINALYSIS
▪ Diagnosis of diseases or disorders of the kidneys or ▪ Instruct the patient to void directly into a clean, dry
urinary tract container. Sterile, disposable containers are
▪ Monitoring of patients with diabetes recommended.
▪ Cover all specimens tightly, label properly, and send
CLEAN CATCH immediately to the laboratory.
▪ Method of collecting a urine sample for various ▪ If a urine sample is obtained from an indwelling
tests including urinalysis and urine culture catheter, it may be necessary to clamp the catheter
 Midstream for about 15-30 minutes before obtaining the
 Wash or cleanse labia first sample.
 Avoid antiseptic solutions because the bacteria ▪ Observe standard precautions when handling urine
passing through the labia will be affected (killed) specimens.

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CHEST X-RAY (CHEST RADIOGRAPHY)
▪ A painless, non-invasive test which uses
electromagnetic waves to produce visual images of
the heart, lungs, bones, and blood vessels of the
chest.
 Usually utilizes a posteroanterior view
 If patient can’t be transferred or moved to X-ray
room, use portable/mobile x-ray

INDICATIONS FOR CHEST X-RAY

▪ Assist in the diagnosis of diaphragmatic hernia, lung
tumors, and metastasis
▪ Detect known or suspected pulmonary,
cardiovascular, and skeletal disorders
▪ Identify the presence of chest trauma
▪ Confirm correct placement and position of the
endotracheal tube, tracheostomy tube, chest tubes,
and nasogastric feeding tube
▪ Evaluate positive purified protein derivative (PPD)
or Mantoux test for PTB
▪ Monitor progressions, resolution, or maintenance
of disease
▪ Evaluate the patient’s response to a therapeutic
regimen (eg. Antibiotic, chemotherapy)

NURSING RESPONSIBILITIES FOR CHEST X-RAY

▪ Remove all metallic objects
- To avoid spots in the result
▪ No preparation is required
▪ Ensure the patient is not pregnant or suspected to
be pregnant
 Teratogenic
▪ Assess the patient’s ability to hold his or her breath
▪ Provide appropriate clothing
 X-ray gowns. Street clothes are not ideal.
▪ Instruct patient to cooperate during the procedure.
 Must notify radiology department if patient has
a pacemaker
 If not cooperative, the x-ray result may be
unclear.

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