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BON qualifications M – masters in NSG A- accredited nsg org (PNA) S – seven (1 chairman, 6 members) I – immediately resign upon appointment

N – not convicted of any crime P – pecuniary interest, absence of T – 10 yrs experience (last 5 years hr in RP) C – citizen & resident of RP

Ex. • Papavarine Hcl • Prophantheline Bromide (Profanthene) c.) Vasodilator – NTG d.) Antacid – Maalox e.) H2 receptor antagonist -Ranitidin(Zantac) to decrease pancreatic stimulation f.) Ca – gluconate to decrease pancreatic stimulation

DEAN qualification Chief nurse & Director > RN + MAN + 5 yrs experience in nsg

Nurse Licensure Exam 1. Cert of Good Moral Char (Optional) 2. Proof – holder of Fil citizenship – Birth cert. 3. Proof – BSN degree – Transcript with scanned picture – done by reg

2. Withold food & fluid – aggravates pain (total NPO) 3. Assist in Total Parenteral Nutrition (TPN) or hyperalimentation Complications of TPN • Infection—maintain a strict aseptic technique • Pulmonary Embolism—check all connection to system • Hyperglycemia • Hyperkalemia 4. Institute stress mgt tech a.) DBE b.) Biofeedback 5. Comfy position -Knee chest or fetal lie position 6. If pt can tolerate food, give increase CHO, decrease fats, and moderate CHON 7. Complications: Chronic hemorrhagic pancreatitis, Peritonitis, Septicemia, Shock

PANCREATITIS
• acute or chronic inflammation of pancreas leading to pancreatic edema, hemorrhage & necrosis due to auto digestion (self-digestion). Bleeding of pancreas - Cullen’s sign on umbilical area PEPTIC ULCER DISEASE – (PUD) • excoriation / erosion of submucosa & mucosal lining due to: a.) Hyper secretion of acid – pepsin b.) Decrease resistance to mucosal barrier Incidence Rate: 1. Men – 40 – 55 yrs old 2. Aggressive persons/ type A personality 3. Hereditary Predisposing factors: 1. Hereditary 2. Emotional 3. Smoking – vasoconstriction – GIT ischemia 4. Alcoholism – stimulates release of histamine = Parietal cell release Hcl acid = ulceration 5. Caffeine – tea, soda, chocolate 6. Irregular diet 7. Rapid eating 8. Ulcerogenic drugs – NSAIDS, aspirin, steroids, indomethacin, ibuprofen Indomethacin -S/E corneal cloudiness. Needs annual eye check up. NSAID and steroids= gastropathy 9. Gastrin producing tumor or gastrinoma – Zollinger Ellisons syndrome 10. Microbial invasion – helicobacter pylori. Metronidazole (Flagyl)

Predisposing factors: 1. Chronic alcoholism 2. Hepatobilary disease 3. Obesity 4. Hyperlipidemia 5. Hyperparathyroidism 6. Drugs – Thiazide diuretics,aspirin, pills, Pentamidine HCL (Pentam) for clients with AIDS, 7. Diet – increase saturated fats S/Sx: 1. Severe Midepigastrium epigastric pain – radiates from back & flank area (left upper quadrant) -24-48 hrs. Aggravated by heavy meals/eating, accompanied by DOB 2. N/V 3. Tachycardia 4. Palpitation due to pain (abdominal guarding) 5. Dyspepsia /indigestion (rigid board like abdomen) 6. Decrease bowel sounds 7. (+) Cullen’s sign -ecchymosis of umbilicus hemorrhage 8. (+) Grey Turner’s spots – ecchymosis of flank area 9. Hypocalcemia Diagnosis: • Serum amylase & lipase – increase • Urine lipase – increase • Serum Ca – decrease Nursing Mgt: 1. Meds a.) Narcotic analgesic -Meperidine Hcl (Demerol) Don‘t give Morphine SO4 –will cause spasm of the sphincter of ODDI. b.) Smooth muscle relaxant/ anticholinergic

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perforation HYPERSECRETION VOMITING HEMORRHAGE WT COMPLICATIONS Diagnosis: Endoscopic exam • Stool from occult blood (+) • Gastric analysis – Gastric Ulcer: normal gastric acid secretion Duodenal: increased gastric acid secretion • GI Series-confirm presence of ulceration Nursing Mgt: 1. non irritating. moderate fats & CHON o Flat on bed 15 -30 minutes after q feeding . Nursing Mgt: • Monitor NGT output or drainage immediately post op-bright red o Immediately post op should be Bright Red o Within 36-48h – output is yellow green o After 48h– output is Dark Red due to HCl acid • Administer meds: o Analgesic o Antibiotic o Antiemetics • Maintain patent IV line • VS. Before surgery for BI or BII -Do vagotomy (severing of vagus nerve) & pyloroplasty (drainage) first. stomach cancer b. Billroth I (Gastroduodenostomy) Removal of ½ of stomach & anastomoses of gastric stump to the duodenum Billroth II (Gastrojejunostomy) Removal of ½ -3/4 of stomach & duodenal bulb & anastomostoses of gastric stump to jejunum. non spicy 2. Sx of Dumping syndrome: 1 Dizziness 2 Diaphoresis 3 Diarrhea 4 Palpitations Nursing mgt: o Avoid fluids in chilled solutions. • Surgery: subtotal gastrectomy -Partial removal of stomach. Avoid caffeine & milk/ milk products > Increase gastric acid secretion 3.SITE PAIN GASTRIC ULCER Antrum or lesser curvature > 30 min – 1 hr after eating > epigastrium > gaseous & burning >not usually relieved by food & antacid >Eating leads to pain Normal gastric acid secretion common hematemesis Wt loss a. sweets (fluids must be taken after meals) o Small frequent feedings-6 equally divided feedings o Diet – decrease CHO. I&O & bowel sounds • Complications: o Hemorrhage – hypovolemic shock Late signs – anuria o Peritonitis o Paralytic ileus – most feared o Hypokalemia o Thrombophlebitis o Pernicious anemia o Septicemia Dumping syndrome common complication – rapid gastric emptying of hypertonic food solutions – CHYME leading to hypovolemia. Diet – bland. hemorrhage DUODENAL ULCER Duodenal bulb >2-3 hrs after eating >mid epigastrium >cramping & burning pain >usually relieved by food & antacid >12 MN – 3am pain >Eating lessens pain Increased gastric acid secretion Not common Melena Wt gain a. lithium • Anticholinergics / Antispasmodic o Atropine SO4 o Prophantheline Bromide (Profanthene) NOTE: Pt has history of hpn crisis with peptic ulcer disease. Administer meds • Antacids > ACA Aluminum containing antacids Magnesium containing antacids • H2 receptor antagonist: o Ranitidine (Zantac) SE: fever o Cimetidine (Tagamet)—hastens the effect of oral anticoagulants o Famotidine (Pepcid) SE: fever -Avoid smoking – decrease effectiveness of drug Nursing Mgt: Administer antacid & H2 receptor antagonist (Cimetidine) – 1hr apart –Cemetidine decrease antacid absorption & vise versa • Cytoprotective agents o Sucralfate (Carafate) -Provides a paste like subs that coats mucosal lining of stomach o Misoprostol (Cytotec) –SE: menstrual spotting • Sedatives/ Tranquilizers -Valium. Rn should not administer alka seltzer-has large amount of Na.

intake and output and blood sugar levels > Administer medications as ordered • Insulin therapy (regular acting insulin/rapid acting insulin peak action of 2 – 4 hours) • Sodium Bicarbonate to counteract acidosis • Antibiotics to Type 2 (NIDDM) • Adult onset • Maturity onset type • Obese over 40 years old Predisposing Factors Obesity – because obese persons lack insulin receptor binding sites Signs and Symptoms • Usually asymptomatic • Polyuria • Polydypsia • Polyphagia • Glucosuria • Weight gain Treatment • Oral Hypoglycemic agents • Diet • Exercise Complications : HYPER OSMOLAR NON KETOTIC COMA .9 NaCl followed by . polyphagia and glucosuria confirmatory for DM) • • Random Blood Sugar is increased Oral glucose tolerance test is increased – most sensitive test . intake and output and blood sugar levels > Administer medications as ordered • Insulin therapy (regular acting insulin/rapid acting insulin peak action of 2 – 4 hours) • Antibiotics to prevent infection Types of Insulin Color & consistency Peak 2-4 6-12 12-24 Rapid Intermediate Long acting Clear Cloudy Cloudy Diagnostic Procedures for DM • FBS is increased (3 consecutive times with signs or polyuria.9 NaCl followed by . polydypsia.due to severe hyperglycemia leading to severe CNS depression Mgt for Complication > Assist in mechanical ventilation > Administer 0.45 NaCl (hypotonic solutions) to counteract dehydration and shock > Monitor strictly vital signs.Non ketotic: absence of lypolysis (no ketones) Mgt for Complication > Assist in mechanical ventilation > Administer 0.prevent infection Type 1 (IDDM) • Juvenile onset type • Brittle disease Predisposing Factors • Hereditary (total destruction of pancreatic cells) • Related to viruses • Drugs o Lasix o Steroids • Related to carbon tetrachloride toxicity Signs and Symptoms • Polyuria • Polydypsia • Polyphagia • Glycosuria • Weight loss • Anorexia • nausea and vomiting • Blurring of vision • Increase susceptibility to infection • Delayed/poor wound healing Treatment • Insulin therapy • Diet • Exercise Complication: Diabetic Ketoacidosis .Hyperosmolar: increase osmolarity (severe dehydration) .45 NaCl (hypotonic solutions) to counteract dehydration and shock > Monitor strictly vital signs.

. Exposure to renal toxins Stages of CRF 1.appendectomy 24 – 45 Don’t give analgesic – pre-diagnosis will mask pain Presence of pain means appendix has not ruptured. this paradoxically causes pain to be felt in the right lower quadrant. DIURETIC PHASE 2-3 weeks Increased amount of urine . End Stage Renal disease ACUTE RENAL FAILURE • sudden immobility of kidneys to excrete nitrogenous waste products & maintain F&E balance due to a decrease in GFR. Avoid heat application – will rupture appendix. DM 2. • • • • • • • • • Pathognomonic sign: (+) rebound tenderness Pain at Rt. HPN 3.• Alpha Glycosylated Hemoglobin is increased III.MCBURNEY‘S point – site of surgical incision Late sign due pain – tachycardia Rovsing’s sign – elicited by palpating the left lower quadrant. CHRONIC RF – irreversible loss of kidney function.. Renal Insufficiency 3..decrease blood flow Intra-renal cause – involves renal pathology = kidney problem Post renal cause – involves mechanical obstruction Stages: Initiation period begins with the initial insult and ends when oliguria develops I. Treatment: . Recurrent UTI/ nephritis/ pyelonephritis 4. Complications: Peritonitis & Septicemia Predisposing factors: 1. iliac region-. II. CONVALESCENT/RECOVERY PHASE—3-12 months. OLIGURIC STAGE (1-2 weeks) . (N 125 ml/min) Predisposing factors: Pre renal cause . Diminished Reserve Volume – asymptomatic Normal BUN & Crea. GFR < 10 – 30% 2.involves passage of urine < 400ml/day.