TSU NURSING 2024
Level II|First Semester|Midterms
OUTPATIENT DEPARTMENT (OPD)
 OPD
o Is defined as a part of the hospital with
allotted physical facilities and medical
and other staffs, with regularly
scheduled hours, to provide care for
patients who are not registered as
inpatients
o Working time: 8 am to 5 pm
o Not open on weekends
o Less stress involved/less issues and
less toxic duty
o Less exciting and learning skills
o Promote wellness and prevent illness
or disabilities
o Patients receive diagnosis and
treatment but do not stay overnight
Types of Health Care Services
1. PRIMARY: Health Promotion and Illness
Prevention
a. Immunization (BCG Vaccine)
2. SECONDARY: Diagnosis and Treatment
a. Screening and Treatment
3. TERTIARTY: Rehabilitation
a. Rehabilitation therapy of patient to
prevent injuries and illness
Three Levels of Prevention
1. PRIMARY
2. SECONDARY
3. TERTIARY
Outpatient Department provides
 Primary Health Care
o Health promotion and prevent illness
or disability (Goal of Outpatient
Department)
 Comprehensive Health Care
o Diagnosis/ Diagnostics (Laboratory
Tests
o Treatment (providing medications and
follow up care)
TYPES OF OUTPATIENT SERVICES
1. Centralized Outpatient Services
 All services are provided in a compact
area which includes all diagnostic and
therapeutics facilities being provided in
the same place
 Diagnostic and Therapeutic
 Mini hospital
2. Decentralized Outpatient Services
 Services are provided in the
respective departments
 Dispersed (nakahiwalay)
TPH – psychiatric and HIV department
SCOPE OF OUTPATIENT DEPARTMENT
 First point of contact between patient and
hospital
 It is the ‘shop window’ of hospital – face of
healthcare facility and reflects the image of
hospital
 Makes or mars the hospital image – first
impression
 A good OPD service can reduce the load on
in-patient services
 It is a place for implementing preventive and
promotive health activities
 Facilitates teaching
 It contributes to reduction in morbidity and
mortality
 The cost of treatment in OPD is less than for
In-patient
FUNCTIONS OF OPD
 Control diseases – early diagnosis and timely
treatment
 Control and surveillance
 Facilitate screening and investigations –
screening, monitoring, and investigate
 Facility for training
 Provide effective treatment – medical,
paramedical, nursing staff
 Provide follow-up care
 Research – surveillance of communicable
diseases, good source of statistics
 Lying-in centers, possible for baby delivery for
pregnancy with no complications
PREVENTIVE HEALTH ACTIVITIES
 Well baby clinics
 Marriage counseling
 Family planning
 School health clinics
 Control of communicable diseases
 Early diagnosis and detection of chronic
diseases
 Health education and nutritional advice
 Rehabilitation and prevention of disabilities
OTHER TYPES OF OUTPATIENT FACILITIES
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 TSU NURSING 2024
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 Polyclinic and Referral Clinic  Salbutamol

 Outpatient clinics at hospitals or other medical o Classification: Bronchodilator
facilities o Pregnancy Category A
 Surgery centers o It promotes the production of
 Imaging centers intracellular cyclic adenosine
 Cardiac Catheterization centers monophosphate (cAMP), which
 Mental or behavioral health centers, which enhances the binding of intracellular
may provide substance abuse treatment calcium to the cell membrane. This
 Services and mental health services for adults action decreases the calcium
or children concentration within cells and results
 Medical group practices in the relaxation of smooth muscle and
 Lab centers bronchodilation.
 Gastrointestinal centers, which may provide o For relief of bronchospasm in
screening or other services such as bronchial asthmas of all types, chronic
colonoscopy and endoscopy bronchitis, emphysema
 Durable medical equipment rental facilities o Contraindicated in patients with
 Physical therapy centers hypersensitivity (allergy) to any of the
 Chemotherapy and radiation therapy centers active substances or the excipients
o Side effects: Nausea, nervousness,
ROLES OF AN OUTPATIENT NURSE tremor, increased heart rate, dry
mouth, inability to sleep
 Traditional Role o Nursing responsibility: Check patient’s
o Check vital signs rate, aspiration precaution
o Assist with diagnostic tests  Metoclopramide
o Prepares client for examination o GI Agent, Antiemetic
 Expanded Role o Pregnancy Category B
o Provides teaching and counselling o Accelerates intestinal transit, promotes
o Performs physical (or mental status) gastric emptying, and relieves nausea
examination and vomiting. Blocks
o In some settings, advanced practice dopamine/serotonin receptors in
registered nurses (APRNs) are the chemoreceptor trigger zone of the
primary care provider CNS. Enhances acetylcholine
response in upper GI tract,
DRUG STUDIES causing increased motility and
accelerated gastric emptying without
 Azithromycin
stimulating gastric, biliary, or
o Classification: Macrolide Antibiotics pancreatic secretion
o Pregnancy Category B o Prevention of chemotherapy-induced
o Route: Per Orem nausea or vomiting, gastroparesis,
o MOA: Inhibits bacterial protein gastroesophageal reflux diseases,
synthesis, quorum-sensing and facilitate small bowel intubation (single
reduces the formation of biofilm. It dose)
prevents and treat a very serious type o Contraindicated to patients with
of infection (mycobacteria or MAC). It Parkinson’s disease, GI hemorrhage
works by stopping the growth of and perforation, history of seizure
bacteria. disorders, epileptic patient,
o Treats chest infections such as pheochromocytoma
pneumonia o Side effects: Hypocalcemia,
o Contraindicated with patients that has Hypokalemia, Extrapyramidal
hypersensitivity to azithromycin, reactions, tardive dyskinesia, dystonic
hepatic diseases, might cause renal reactions
failure o Nursing responsibility: Monitor vital
o Diarrhea, vomiting, abdominal pain, signs, serum electrolytes, Monitor for
nausea, affects GI Tract hypocalcemia (muscle twitching,
o Can be taken with or without food

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cramps, positive Trousseau’s or
Chvostek’s signs), hypokalemia
o Can be taken 30 minutes before meals
or at bedtime
 Naproxen
o Classification: NSAIDs, Analgesic
Nonopioid
o Pregnancy Category C
o Nonprescription naproxen is used to
reduce fever and to relieve mild
pain from headaches, muscle aches,
arthritis, menstrual periods, the
common cold, toothaches, and
backaches
o Treatment of acute or long-term
mild to moderate pain, primary
dysmenorrhea, rheumatoid arthritis
o Inhibits prostaglandin cyclooxygenase
enzyme, inhibit COX 1 and COX2
o Contraindicated to patients with history
of asthma, urticaria; hypersensitivity to
naproxen, other NSAIDs.
Perioperative pain in setting of CABG
surgery.
o Nursing responsibility: Assist with
ambulation of dizziness, monitor renal
function test in chronic use
o Side effects: Nausea, constipation,
abdominal pain, heartburn, dizziness,
headache, drowsiness
o Take after meals
 Ketorolac
o Classification: NSAID, Analgesic,
Intra-ocular, Anti-inflammatory
o Pregnancy Category C, not advisable
o Produces analgesic, antipyretic, anti-
inflammatory effect; reduces
intraocular inflammation. short-term
treatment of moderate to severe pain
in adults
o Inhibit prostaglandins synthesis, COX1
and COX2 arachidonic acid
o Hepatotoxic and nephrotoxic
o Avoid use of aspirin and alcohol,
hypertensive medication
o IV administration – slow IV push
o Side effects: Headache, nausea,
abdominal pain, dyspepsia
o Contraindicated to patients with
Intracranial bleeding, hemorrhagic
diathesis, incomplete hemostasis, high
risk of bleeding
o Nursing Responsibility: Monitor renal
function, LFT, urinary output. Monitor
daily pattern of bowel activity, stool
consistency. Observe for occult blood
loss
 Budesonide
o Classification: Glucocorticosteroid
o Pregnancy Category B and C
o Anti-inflammatory, anti-allergy
o Relieves symptoms of allergic rhinitis,
asthma, Crohn’s disease.
o Not a drug of choice for asthma but
possible for patients who has asthma
o Side effects: Loss of muscle tissue,
fluid retention, swelling, dry mouth
o Nursing responsibility: Maintain
hydration status
 Phenobarbital
o Anticonvulsant
o Pregnancy category D
o CNS inhibits conduction of impulses
o For patients with seizure, convulsing,
epilepsy
o Increase activity of GABA and
decreases activity of glutamate in the
brain – prevents seizure
o Not for pregnant and elderlies
o Side effects: dizziness, anxiety,
hypotension, lethargy, drowsiness
o Yellow prescription and 2 licensed
physicians
 Ibuprofen
o Non-Steroidal Anti-Inflammatory Drug
(NSAID)
o Pregnancy Category: Trimester, B/B/D
o For pain, inflammation, fever
o Blocks the enzyme that makes
prostaglandin (a hormone that causes
inflammation and pain) causing a
reduction in inflammation, pain, and
fever.
o Contraindicated to patients with
hypersensitivity to aspirin, pregnant
third trimester
o Monitor auditory pain, tinnitus
o After meal, take it with food
o 1.2 g a day maximum, 6 a day
o 200 mg
o Hepatotoxic and nephrotoxic
 Aluminum Hydroxide, Magnesium
Hydroxide
o Maalox
o GI tract agent
o For patient with hyperacidity,
constipation, and diarrhea
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 TSU NURSING 2024
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o Direct effect on HCl acid – balances o Avoid vaccine with live or weakened
pH level of stomach, decrease gastric virus
pH, inhibits reaction of pepsin  Fluticasone Propionate
o Contraindicated: GI bleeding or o Anti-asthmatic, anti-inflammatory
perforation o Pregnancy Category C
o Side effects: constipation, diarrhea, o Inhibits cells involved in the
muscle weakness, headaches, rash inflammatory response of asthma,
hives, swelling of tongue, tightness in such as mast cells, eosinophils,
chest basophils, lymphocytes,
o Take after meal, at bedtime, as macrophages, and neutrophils, inhibits
needed production or secretion of chemical
o Antiflatulence mediators, such as histamine,
 Fosphenytoin eicosanoids, leukotrienes, and
o Anticonvulsant cytokines.
o Pregnancy category D o Contraindicated to achalasia, GI
o Should take less than 150 mg hemorrhage
o Treat epilepsy, tonic clonic seizure for o Side effects: Confusion, decreased
children concentration, dizziness, drowsiness,
o Acts on sodium channel fever, headache, nervousness,
o For convulsions, slows down vertigo, tachycardia
o Immunosuppressant
impulse/brain activity on seizure
o Side effects: dizziness, drowsiness,  Epinephrine
headache, burning of injection site o Sympathomimetic (alpha-, beta-
o Given IV and IM, as needed adrenergic agonist), Bronchodilator,
o Avoid overdosing, might cause Cardiac stimulant, anti-allergic,
antihemorrhagic
neurotoxicity
o Pregnancy category C
o Needs yellow prescription – for
dangerous drugs o Relaxes smooth muscle of bronchial
o Contraindication: Sinus bradycardia, tree, produces cardiac stimulation,
sinoatrial block, 2nd or 3rd degree dilates skeletal muscle vasculature.
AV block, Adams-Stokes syndrome o Contraindicated: narrow angle
o Monitor ECG, BP, and respiratory glaucoma, hypertensions,
function continuously during and for cardiovascular disorders
10–20 min after infusion o Side effects: tachycardia, palpitations,
 Ranitidine anxiety
o Aminoalkyl-substituted furan derivative o Dizziness, lightheadedness, facial
o Antiulcer agent, gastric acid secretion flushing, headache, diaphoresis,
increased B/P, nausea, trembling,
inhibitor
insomnia, vomiting, fatigue.
o Pregnancy category B
o rotate sites because repeated
o Inhibits the action of histamine H2 to
injections in the same site may cause
parietal cell
vasoconstriction and localized
o For gastric ulcer and GERD
necrosis
o Contraindication: acute porphyria –
o Avoid giving injection into buttocks
cannot process the medicine
because drug may be less effective
o Maintenance dose, IV should be
when given there, especially for
patent treating anaphylaxis
o Dizziness, drowsiness, fever, o Drug shouldn’t be given by intra-
headache, insomnia arterial injection because marked
 Methylprednisolone vasoconstriction may cause gangrene.
o Anti-inflammatory, asthma, o Monitor changes of blood pressure
Immunosuppressive, corticosteroids and heart rate. Assess lung sounds for
o Category C rhonchi, wheezing, rales.
o Suppresses immune system  Nistatin

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 TSU NURSING 2024
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o Antifungal diaphoresis, acne, mood swings,

o Pregnancy category: Not rated increased appetite, facial flushing,
(lozenges, oral suspension, tablets, delayed wound healing, increased
topical), A (vaginal) susceptibility to infection, diarrhea,
o To treat oropharyngeal candidiasis constipation
(thrush) o Assess signs of increased intracranial
o Fungistatic pressure in children, including
o Binds to sterols in fungal cell changes in mood and behavior,
membranes, impairing membrane decreased consciousness, headache,
integrity. Cells lose intracellular lethargy, seizures, and vomiting.
potassium and other cellular contents  Albuterol (Salbutamol)
and, eventually, die o Bronchodilator, anti-asthmatic
o SE: Hyperglycemia (lozenge, oral o Pregnancy category C
suspension), abdominal pain, o Relaxes smooth muscles by
diarrhea, nausea, vomiting (oral stimulating beta2-receptors, thereby
forms), vaginal burning/itching, causing bronchodilation and
irritation vasodilation
 Acetaminophen o Relieves bronchospasm and reduces
o Analgesics, antipyretics airway resistance
o Pregnancy category B o Contraindication: hypersensitivity to
o Reduce the production of drug
prostaglandins in the brain. o SE: dizziness, excitement, headache,
o Relieves pain by elevating the pain hyperactivity, insomnia, hypertension,
threshold, that is, by requiring a palpitations, tachycardia, chest pain
greater amount of pain to develop o Give extended-release tablets whole;
before a person feels it. Also, reduces don’t crush or mix with food.
fever through its action on the heat-  Ipatropium
regulating center of the brain. o Bronchodilator
o Treats pain and reduce fever, o Pregnancy Category B
sometimes given with narcotic pain o Ipratropium is used to treat and
medication to treat severe to moderate prevent the symptoms of chronic lung
pain illness (wheezing and shortness of
o Caution with phenylketonuria breath) (chronic obstructive pulmonary
o Contraindicated: severe hepatic disease-COPD which includes
impairment or severe active liver bronchitis and emphysema). It works
disease by relaxing the muscles around the
 Prednisone airways, allowing them to open up and
o Adrenal corticosteroid allow you to breathe more freely.
o Pregnancy Category C o SE: Nausea, mouth dryness, skin
o Drug appears in breast milk. Women flushing, dyspnea, dizziness
shouldn’t breast-feed while taking this o Rinse mouth after using inhaler
drug  Montelukast Sodium
o Prevents/suppresses cell-mediated o Leukotriene modifiers
immune reactions. o Category B
o Decreases/prevents tissue response o Control and prevent symptoms caused
to inflammatory process. by asthma (wheezing and shortness of
o Use cautiously in patients with GI breath
ulcer, renal disease, hypertension, o Used before exercise to prevent
osteoporosis, diabetes mellitus, breathing problems
hypothyroidism o SE: Headache
o Contraindicated: Patients with o Parents of phenylketonuric pts should
systemic fungal infections be informed. Assess lung sounds
o SE: Insomnia, heartburn, for wheezing. Assess for allergy
nervousness, abdominal distention,

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symptoms. Question history of o Treats early onset-alcoholism.

depression, suicidal ideation. Improves symptoms of anxiety,
 Dexamethasone depression, and hostility. 
o Corticosteroid (glucocorticosteroid) o SE: Diarrhea, Headache,
o prevents/suppresses cell/tissue Constipation, Palpitations, Fatigue,
immune reactions, inflammatory Severe itching, Cold sensation,
process. Hiccups, Blurred Vision
o Contraindication: systemic fungal  Ampicillin
infections, cerebral malaria. o Penicillin - killing different bacterial
o SE: nausea, headache infection in adults and children.
 Morphine Sulfate o PC: B
o Opioid Analgesic o Ampicillin works by interfering with cell
o PC: wall synthesis by attachment to
Epidural/IM/IT/IV/Parenteral/PO/Rectal penicillin-binding proteins (PBP),
/SC: C (Prolonged use may cause inhibiting cell wall peptidoglycan
neonatal opioid withdrawal syndrome.) synthesis, and rendering inhibitors to
o Binds with opioid receptors within autolytic enzymes.
CNS, inhibiting ascending pain o Ampicillin is used to treat bacterial
pathways infections. It is a type of penicillin
o Alter pain perception, emotional antibiotic. It works to stop the growth
response to pain. of bacteria.
o SE: Nausea, vomiting, sedation, o Contraindications: Allergies to
decreased BP penicillin, cephalosporins, Renal and
 Hydrocortisone hepatic function should be monitored
o Adrenal cortical steroid, Corticosteroid, and other allergies.
Glucocorticoid o SE: cute inflammatory skin eruption,
o PC: C redness and peeling of the skin, rash,
o This medication is used to treat a fever, diarrhea, nausea, inflammation
of the tongue, yeast infection in the
variety of skin conditions (e.g., insect
mouth, vomiting, Lethargy,
bites, poison oak/ivy, eczema,
hallucinations, seizures, pain,
dermatitis, allergies, rash, itching of
thrombosis at injection site
the outer female genitals, anal itching).
 Clindamycin Hydrochloride
Hydrocortisone reduces the swelling,
itching, and redness that can occur in o Antibacterial and antiprotozoal
these types of conditions. antibiotic
o Contraindication: systemic fungal o PC: B
infections, pre-mature infants, o Inhibits protein synthesis in
breastfeeding, peptic ulcer, renal susceptible bacteria by binding to the
failure, diabetes mellitus 50S subunits of bacterial ribosomes
o SE: Vertigo, headache, paresthesia, and preventing peptide bond
insomnia, seizures, psychosis, formation.
Hypotension, shock, HPN and heart o To prevent physical incompatibility,
failure secondary to fluid retention, don’t administer with aminophylline,
thin, fragile skin, petechiae, ampicillin, barbiturates, calcium
ecchymoses gluconate, magnesium sulfate, or
 Ondansetron Hydrochloride phenytoin
o Antiemetic, Selective 5-HT3 o Contraindication: Hypersensitivity to
Antagonist  this product or lincomycin, tartrazine
o PC: B dye; ulcerative colitis/enteritis
o  Prevents nausea and vomiting caused o SE: Abdominal pain, nausea, vomiting,
by cancer chemotherapy, radiation diarrhea, dry, scaly skin
therapy, and surgery.  Blocks the o Culture and sensitivity testing
action of serotonin.   Levetiracetam
o Pyrrolidine derivative

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o Distributed in breast milk.

Breastfeeding not recommended.
o Appears to inhibit burst firing without
affecting normal neuronal excitability
and may selectively prevent hyper
synchronization of propagation of
seizure activity.
o Prevent seizure activity
o All patients may increase the risk of
suicidal thoughts and behaviors. Renal
impairment, (dose reduction
recommended) if pts with depression
at high risk for suicide.
o SE: Drowsiness, asthenia, headache,
infection. Acute psychosis, agitation,
delirium, impulsivity have been
reported.
 Diazepam
o Anticonvulsant, anxiolytic,
o
o sedative-hypnotic, skeletal muscle
relaxant
o PC: D
o May potentiate effects of gamma
aminobutyric acid (GABA) and other
inhibitory neurotransmitters by binding
to specific benzodiazepine receptors
in limbic and cortical areas of CNS.
GABA inhibits excitatory stimulation,
which helps control emotional
behavior. Limbic system contains a
dense area of benzodiazepine
receptors, which may explain drug’s
antianxiety effects.
o Diazepam suppresses spread of
seizure activity caused by seizure-
producing foci in cortex, thalamus, and
limbic structures.
o Anxiety disorders
o Contraindications: Hypersensitivity to
drug, other benzodiazepines, alcohol,
or tartrazine, Coma or CNS
depression, Narrow-angle glaucoma
o SE: dizziness, drowsiness, lethargy,
depression, light-headedness,
disorientation, anger, manic or
hypomanic episodes, restlessness,
paresthesia, headache, slurred
speech, dysarthria, stupor, tremor,
dystonia, vivid dreams, extrapyramidal
reactions, mild paradoxical excitation.

Sabal, Pearl Angeli M.