COMPILATION FOR

FINALS IN
NMCB316
ALMIN, RAZELLE S.

ALMIN, RAZELLE S. Date: Feb 17, 2022

BSN3Y2-2

LECTURE

Week 1. Group Discussion:

CARE FOR CLIENTS
UNDERGOING
 Discuss the appropriate preparation, health teaching and follow up care for
clients who are undergoing diagnostic testing of the Gastrointestinal Tract.

Gastrointestinal (GI) endoscopy allows direct visualization of the interior of the GI

tract and is frequently performed to investigate symptoms, confirm diagnosis, and
offer treatment. In the past, the realm of GI tract for endoscopists has chiefly been
limited to the upper and lower GI tract, and the small bowel has largely been
considered a "no man's land" until the advent of enterostomy. However, with the
enter scope at hand, examination of the entire GI tract has become possible. In
addition, the introduction of endoscopic retrograde cholangiopancreatography
(ERCP) has provided endoscopists with an invaluable tool to evaluate and manage
diverse problems of the biliary and pancreatic ductal systems. Furthermore,
endoscopic ultrasonography (EUS) has granted access to organs and lesions in the
vicinity of the GI tract. Along with the expansion of the realm of endoscopic
procedures, the possibility of the occurrence of complications has also increased.
Therefore, more precaution should be taken regarding its safety. Since many
endoscopic procedures are performed under sedation/analgesia nowadays, safety
regarding sedation should be considered as well.

ALMIN, RAZELLE S. Date: Feb 17, 2022

BSN3Y2-2

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LECTURE

WEEK 1. COURSE TASK

CASE STUDY: (60 POINTS)
LEC CU1
A 55-year-old man is transferred to your unit from the intensive
care unit following a head injury. During your admission assessment,
he complains of a burning sensation in his mi epigastric area. On
examination, you note a distended abdomen with tenderness in the
epigastric area.
1. What questions would you ask the patient?
Answer: The first step is to employ one of the three most widely used
methods for quantifying pain intensity, which are verbal rating scales,
numeric rating scales, and visual analogue scales. Verbal Rating Scales
(Verbal Descriptor Scales) grade pain intensity using common words (e.g.,
mild, severe). Second, ask the client to pinpoint the location of the pain by
pointing to a specific area of the abdomen. Make certain to inquire about
bowel and urinary habits. Understanding when patient’s body is not
functioning in accordance with what is "normal" (for him or her) might offer
signs about a potential illness.

2. What diagnostic tests would you anticipate and how would you prepare your patient
for these?
Answer:
A. Endoscopy When a patient comes to the endoscopy unit, the first step should to
identify the patient. Patient identification can be accomplished through the use of a
hospital registration number, name, social security number, date of birth, and so on. One
of the most popular methods of identifying the patient is to match the name. Instead of
pronouncing the patient's name on the record and asking if it is accurate, offer open-
ended inquiries, such as "What is your name?" Because patients with the same name
might exist, identifying the patient only by name is insufficient. As a result, it is typically
suggested that the patient be identified by validating at least two of the patient data,
ideally in an open-ended way wherever feasible. If contact with the patient is impossible

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 due to the patient’s inability to communicate or because the patient is a foreigner, a
picture identity card check may be an alternative. Most endoscopic procedures can be
adequately performed with the patient under moderate sedation, which is also commonly
referredto as "conscious sedation." However, more complex procedures that require
prolonged procedure time may need to resort to deep sedation. If a patient is to undergo
endoscopic procedures with moderate or deep sedation, patient status should be
monitored accordingly. The standard parameters of patient status that need to be
periodically checked before, during, and after the procedure include blood pressure,
oxygen saturation, pulse rate (heart rate), and level of consciousness. Blood pressure is
generally measured noninvasively with blood pressure cuffs. Oxygen saturation can be
monitored with pulse oximeter to detect oxygen desaturation and hypoxemia. However, if
prolonged procedure time is anticipated as is the case with ERCP, EUS±FNA, and
EMR/ESD, capnography may prove to be of more benefit in measuring respiratory
activity. Oxygen supplementation is recommended for both moderate and deep sedation
to reduce the degree of oxygen desaturation. Pulse rate is normally monitored using pulse
oximeter, which is generally sufficient for the majority of endoscopic procedures.
However, electrocardiogram monitoring may be beneficial when the procedure time is
expected to be prolonged; it is also recommended for patient with significant
cardiopulmonary disease, arrhythmia, and advanced age. Level of consciousness should
be monitored directly by evaluating the patient.

B. Urea Breath Test Educate the client the she/he must not eat or drink anything
including water for at least 4-6 hrs. before the test and inform the client that he/she must
not smoke for at least 2hrs prior to the test. Educate the client to Avoid proton pump
inhibitors including Prilosec, Peracid, Nexium, Protonix, Aciphex, and Dexilant within
two (2) weeks prior to the urea breath test. Avoid antibiotics two (2) weeks prior to the
urea breath test. Avoid bismuth preparations (Pepto Bismol) within two (2) weeks prior
to the urea breath test

C. Stool Test
 Assess the patient’s level of comfort. Collecting stool specimen may produce feeling of
embarrassment and discomfort to the patient.
 Encourage the patient to urinate. Allow the patient to urinate before collecting to avoid
contaminating the stool with urine.
 Avoid laxatives. Advise patient that laxatives, enemas, or suppositories are avoided three
days prior to collection.
 Instruct a red-meat free and high residue diet. The patient is indicated for an occult blood
test, must follow a special diet that includes generous amounts of chicken, turkey, and
tuna, raw and uncooked vegetables and fruits such as spinach, celery, prunes and bran
containing cereal for two (2) days before the test. The nurse should note of the following
nursing interventions after fecal analysis:

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  Instruct patient to do handwashing. Allow the patient to thoroughly clean his or her hands
and perianal area.
 Resume activities. The patient may resume his or her normal diet and medication therapy
unless otherwise specified.
 Recommend regular screening. The American Cancer Society recommends yearly occult
blood test as part of the screening for colorectal cancer starting at the age of 45 years old
for people with average risk.

3. Describe your plan of nursing care for this patient.

Answer: I will provide nursing care to patients for epigastric tenderness and burning
sensation by assessing any difficulty in breathing due to dispensed, if so, I will place him
in the High Fowler position, advise him to eat a low fat and high protein diet, advise him
to take small feeds to avoid eating right before bed, drink plenty of fluids, take pentazole
to reduce secretions, and not to take stress.

ALMIN, RAZELLE S. Date: March 23, 2022

BSN3Y2-2

LECTURE

WEEK 7: GROUP DISCUSSION:

CUSHING'S DISEASE AND ADDISON'S
DISEASE, AND PHEOCHROMOCYTOMA
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  Cushing disease is a condition in which the pituitary gland releases too much
adrenocorticotropic hormone (ACTH). The pituitary gland is an organ of
the endocrine system. Cushing disease is a form of Cushing syndrome. Other
forms of Cushing syndrome include exogenous Cushing syndrome, Crushing
syndrome cause by adrenal tumor, and ectopic crushing syndrome. Cushing
disease is caused by a tumor or excess growth (hyperplasia) of the pituitary
gland. The pituitary gland is located just below the base of the brain. A type
of pituitary tumor called an adenoma is the most common cause. An
adenoma is a benign tumor (not a cancer). With Cushing disease, the
pituitary gland releases too much ACTH. ACTH stimulates production and
release of cortisol, a stress hormone. Too much ACTH causes the adrenal
glands to make too much cortisol. Cortisol is normally released during
stressful situations. It also has many other functions, including:

 Controlling the body's use of carbohydrates, fats, and proteins

 Reducing the immune system's response to swelling (inflammation)
 Regulating blood pressure and the body's water balance

ALMIN, RAZELLE S. Date: March 24, 2022

BSN3Y2-2

LECTURE

WEEK 7: Week 7: Individual Assignment:

Infographic on Cushing's Disease,
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Addison's Disease
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ALMIN, RAZELLE S. Date: April 13, 2022
BSN3Y2-2

LABORATORY

WEEK 7. COURSE TASK LEC CU6

DISCUSSION QUESTIONS:

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1. DISCUSS THE PROBABLE CAUSES OF THE ALTERATIONS IN T.H.’S LABORATORY RESULTS.
ANSWER: T.H is the affected by the disease of Cushing syndrome. That’s why the all
changes came in his body. Too much of the hormone cortisol in your body causes
Cushing syndrome. Cortisol, which is produced in the adrenal glands, plays a variety of
roles in your body. For example, cortisol helps regulates your blood pressure, reduces
inflammation and keeps your heart and blood vessels functioning normally. Cortisol
helps your body respond to stress. It also regulates the way your body converts
proteins, carbohydrates and fats in your diet into energy. The role of corticosteroid
medications (exogenous Cushing syndrome). Cushing syndrome can develop from taking
oral corticosteroid medications, such as prednisone in high doses over time. Oral
corticosteroid may be necessary to treat inflammatory disease, such as rheumatoid
arthritis, lupus and asthma. They may also be used to prevent your body from rejecting
a transplant organ. It’s also possible to develop Cushing syndrome from injectable
corticosteroids, for example repeated injections for joint pain, bursitis and back pain.
Inhaled steroid medicines for asthma and steroid skin creams used for skin disorders
such as eczema are generally less likely to causes Cushing syndrome than are oral
corticosteroid. But in some individuals these medications may cause Cushing syndrome,
especially if taken high doses.

2. EXPLAIN THE PATHOPHYSIOLOGY OF CUSHING SYNDROME.

ANSWER: When stimulated by ACTH, the adrenal glands secrete cortisol and other
steroid hormones. ACTH is produced by the pituitary gland and released into the
petrosal venous sinuses in response to stimulation by corticotropin-releasing hormone
(CRH) from the hypothalamus. ACTH is released in a diurnal pattern that is independent
of circulating cortisol levels: peak release occurs just before awakening and ACTH levels
then decline throughout the day. Control of CRH and ACTH release is maintained
through negative feedback by cortisol at the hypothalamic and pituitary levels. Neuronal
input at the hypothalamic level can also stimulate CRH release.
Although the adenomas of Cushing’s disease secrete excessive amounts of ACTH,
they generally retain some negative feedback responsiveness to high doses of
glucocorticoids. Ectopic sources of ACTH, usually in the form of extracranial neoplasms,
are generally not responsive to negative feedback with high doses of glucocorticoids.
However, some overlap exists in the response to negative feedback between pituitary
and ectopic sources of excessive ACTH.

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3. WHAT DIAGNOSTIC TESTING WOULD IDENTIFY THE CAUSE OF T.H.’S CUSHING
SYNDROME?
ANSWER: This diagnostic test may help pinpoint the cause:
 Urine and Blood test - These test measure hormone levels and show whether T.
H’s body is producing excessive cortisol. For the urine test, T.H may ask to collect
your urine over a 24-hour period. Urine and blood samples will be sent to a
laboratory to be analyzed.
 T. H’s doctor might also recommend other specialized tests that involve
measuring cortisol levels before and after using hormone medications to
stimulate or suppress cortisol.
 Saliva test – Cortisol levels normally rise and fall throughout the day. In people
without Cushing syndrome, levels from a small sample of saliva collected late at
night, doctors can see if cortisol levels are too high.
 Imaging tests - CT or MRI scans can provide images of your pituitary and adrenal
glands to detect abnormalities, such as tumors.
 Petrosal sinus sampling - This test can help determine whether the cause of
Cushing syndrome is rooted in the pituitary or somewhere else. For the test,
blood samples are taken from the veins that drain the pituitary gland (petrosal
sinuses). A thin tube is inserted into your upper thigh or groin area while T. H is
sedated and is threaded to the petrosal sinuses. Levels of ACTH are measured
from the petrosal sinuses and from a blood sample taken from the forearm. If
the ACTH level is higher in the sinus sample, the problem stems from the
pituitary. If the ACTH levels are similar between the sinuses and forearm, the
root of the problem lies outside of the pituitary gland.

4. WHAT IS THE USUAL TREATMENT OF CUSHING SYNDROME?

ANSWER: The overall goal of Cushing’s syndrome treatment is to lower the levels of
cortisol in body. This can be accomplished in several ways. The treatment that receives
will depend on what’s causing condition. T. H's healthcare provider may prescribe a
medication to help manage cortisol levels. Some medications decrease cortisol
production in the adrenal glands or decrease ACTH production in the pituitary gland.
Other medications block the effect of cortisol on tissues. Examples include:
ketoconazole (Nizoral), mitotane (Lysodren), metyrapone (Metopirone), pasireotide
(Signifor), mifepristone (Korlym, Mifeprex) in individuals with type 2 diabetes or glucose
intolerance.
 If T. H use corticosteroids, a change in medication or dosage may be necessary.
Don’t attempt to change the dosage u sh. T. H should do this under close medical
supervision. Tumors can be malignant, which means cancerous, or benign, which
means noncancerous.

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  If T. H's condition is caused by a tumor, your healthcare provider may want to
remove the tumor surgically. If the tumor cannot be removed, your healthcare
provider may also recommend radiation therapy or chemotherapy.

5. WHAT IS MEANT BY A ‘MEDICAL ADRENALECTOMY’?

ANSWER: Medical adrenalectomy - Agents that inhibit steroidogenesis, such as
mitotane, ketoconazole, metyrapone, and etomidate, have been used to cause medical
adrenalectomy. These medications are often are toxic at the doses required to reduce
cortisol secretion. For instance, ketoconazole's prescribing information was revised to
include a black box warning regarding hepatotoxicity, including fatalities and liver
transplantation. Thus, medical treatment should be initiated cautiously and, ideally, in
consultation with a specialist. Efficacy of these medical interventions can be assessed
with serial measurements of 24-hour urinary free cortisol. Patients receiving these
medications may require glucocorticoid replacement to avoid adrenal insufficiency.
Patients should be counseled on the signs and symptoms of adrenal insufficiency when
starting these drugs.
An orally administered steroidogenesis inhibitor, siderostats (Isturisa) acts on 11-
beta-hydroxylase, an enzyme that catalyzes the last step of cortisol synthesis in the
adrenal cortex. It is indicated for adults with Cushing disease who cannot undergo
pituitary surgery or in whom the operation has not been curative.

6. PRIORITY DECISION: WHAT ARE THE PRIORITY NURSING RESPONSIBILITIES IN THE CARE
OF THIS PATIENT?
ANSWER: The priority nursing responsibility in the care of patient is to Identify nursing
diagnoses, two experts analyzed signs and symptoms registered in medical charts at the
time of risk classification. For priority level I patients, the most frequent nursing
diagnoses were acute pain (65.0%), respiratory insufficiency (45.0%), and impaired gas
exchange (40.0%). Nursing Care Planning & Goals.
The major nursing goals for the patient include:
 Decrease risk of injury.
 Decrease risk of infection.
 Increase ability to carry out self-care activities.
 Improve skin integrity.
 Improve body image.
 Improve mental function.

7. PRIORITY DECISION: BASED ON THE ASSESSMENT DATA PRESENTED, WHAT ARE THE
PRIORITY NURSING DIAGNOSIS? ARE THERE ANY COLLABORATIVE PROBLEM?

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 ANSWER: Based on the assessment data, the major nursing diagnoses of the patient
with Cushing’s syndrome include:

 Risk for injury related to weakness.

 Risk for infection related to altered protein metabolism and inflammatory
response.
 Self-care deficit related to weakness, fatigue, muscle wasting, and altered sleep
patterns.
 Impaired skin integrity related to edema, impaired healing, and thin and fragile
skin.
 Disturbed body image related to altered physical appearance, impaired sexual
functioning, and decreased activity level.
 Disturbed thought processes related to mood swings, irritability, and depression.
 Yes, it is collaborative problem. the home health nurse needs the patient's
complete medication history but the patient tells the nurse that many changes
were made in the hospital

ALMIN, RAZELLE S. Date: May 18, 2022

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BSN3Y2-2
LECTURE

Week 13: COURSE TASK: Infographic

Complications of Fracture

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 ALMIN, RAZELLE S. Date: May 18, 2022
BSN3Y2-2
LECTURE

Week 13: Individual Assignment: Fracture and caring for

a cast

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ALMIN, RAZELLE S. Date: June 04, 2022

BSN3Y2-2

LECTURE

Week 13: GROUP DISCUSSION: FRACTURE AND

CARING FOR A CAST

After this week’s lecture and discussion, I’ve learned that a bone fracture is a
broken bone. It can range from a thin crack to a complete break. Bone can fracture
crosswise, lengthwise, in several places, or into many pieces. Most fractures
happen when a bone is impacted by more force or pressure than it can support.
The bone healing process has three overlapping stages: inflammation, bone
production, and bone remodeling. Inflammation starts immediately after the bone
is fractured and lasts for several days. 

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ALMIN, RAZELLE S. Date: MAY 31,2022

BSN3Y2-2

LECTURE

WEEK 15: COURSE TASK-

CLASSIFICATION OF OSTEOMYELITIS
DESCRIBE THE THREE CLASSIFICATIONS OF OSTEROMYELITIS THEN COMPARE AND CONTRAST EACH.

HEMATOGENOUS CONTINGUOS FOCUS OSTEOMYELITIS WITH

OSTEOMYELITIS OSTEOMYELITIS VASCULAR INSUFFICIEN
DESCRIPTION  Is an infection that usually  Consists of direct inoculation  Infections invol
affects the growing of bacteria via trauma, prosthetic material
skeleton, involving surgical reduction and present later, and with m
primarily the most internal fixation of fractures, subtle findings.
vascularized regions of
prosthetic devices, spread
the bone.
from soft-tissue infection,
spread from adjacent septic
arthritis, or nosocomial
contamination.
MECHANISM  Secondary to bacterial  Bacterial inoculation from an  Infections in patients w
OF BONE transport through the adjacent focus. diabetes affecting the f
INFECTION blood. Majority of hanseniasis, or periph
infections in children. vascular insufficiency.
EXAMPLES  IV drug use, sickle cell  Posttraumatic Osteomyelitis,  In patients who deve
disease. infections from prosthetic osteomyelitis in the setti
devices of vascular insufficie
infection occurs most o
in the small bones of
feet
ETC…  Least common  Most common  Second common
 Seeded from another  After trauma, surgery,  Related to disease such
source. insertion of hardware. diabetes (predominan
 Can occur at any age and with peripheral vascular disea
any bone  Almost always begins wi
soft tissues infection
spreads to bone.

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ALMIN, RAZELLE S. Date: MAY 31,2022

BSN3Y2-2

LECTURE

WEEK 15: DISCUSSION:

POTT’S DISEASE

Pott’s disease can be prevented by controlling the spread

of tuberculosis infection. Prevention of pulmonary
tuberculosis is essential for the prevention of spinal
tuberculosis.

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 ALMIN, RAZELLE S. Date: June 09, 2022

BSN3Y2-2

LECTURE

WEEK 17:
Individual assignment- review of ear ana physio

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ALMIN, RAZELLE S. Date: June , 2022

BSN3Y2-2

LABORATORY

Case Study:
Glaucoma
History of Illness:
     A 65-year-old male client was referred to an optometrist for evaluation of his developing eye
problem. The optometrist performed an air puff tonometry as part of a routine screening for a
new pair of glasses. The client complaints his eyes were gritty and red, blurred vision,
particularly upon awakening; these symptoms seemed to improve throughout the day. His
optometrist revealed an open angle glaucoma after thorough diagnostic evaluation. His
Intraocular pressure was OD 25, OS 28 by Tono-Pen tonometry. Direct and indirect
ophthalmoscopy was done with a small, scattered retinal hemorrhages; optic discs appear
normal with no cupping. Perimetry (visual field) testing: confirmed an early open-angle
glaucomatous change, OU. Glaucoma therapy was then initiated, consisted of Latanoprost
eyedrops once-daily and twice-daily of Timolol. Client’s medical history involving systemic
hypertension, diabetes mellitus, and benign prostatic hypertrophy, all of which have been
managed with systemic and maintenance medications. He takes metoprolol tartrate (Lopressor)
for his hypertension.

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ALMIN, RAZELLE S. Date: June , 2022

BSN3Y2-2

LABORATORY

Case Study: Meniere's

Disease
History of Present Illness:

A 60-year-old Mrs. Reyes came to a clinic of an ENT specialist with the following health
concerns. She had a long history of migraine which has begun at the age of 25 and ceased at
the age of 50 after the onset of menopause. Over the last year, she reported periodic feelings
of being off balance where the room would spin around her lasting for more than 2 hours. She
had never thought anything about these feelings, until a week ago, she had experienced a
violent attack of vertigo that lasted several hours accompanied by hearing loss on the left side
leaving her feeling disabled. She also described a horrible ringing sensation and fullness in her
left ear. When she asked about noticing changes in her hearing, she said she was unsure. She
continued to express how afraid and paranoid she felt about the possibility of experiencing
another episode. Series of blood tests such as blood chemistry, CBC and electrolytes revealed
normal findings. MRI and CT scan revealed normal high resolution in the inner ear but an
Audiometric examination (PTA or Pure Tone Audiogram) demonstrated a low frequency
sensorineural hearing loss. After a thorough evaluation by an otolaryngologist and an

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audiologist with the combination of symptoms presented, strongly described the client to
diagnosed with Meniere's disease. Management begun including low-salt in her diet and
diuretics.

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