1.

Myocardial Infarction (MI)

-due to decreased blood supply to

the heart
-cardiac monitoring is done to
monitor heart rate and rhythm
2. Digoxin

-decrease heart rate

-may cause arrhythmia
-excreted in the kidneys
-check BUN and creatinine levels
3. COPD

purse-lip breathing
purpose: to expel trapped air
low flow oxygen is given
oxygen given at more than 2 L/min can cause:
carbon dioxide narcosis
 Barrel-shaped chest
 Drug of choice: bronchodilator. Ex.
Aminophylline
 Side effects:
o Tachycardia
o Palpitations
o Headache
o Restlessness
o Nausea
4. Hypothyroidism

Manifestation: intolerance to cold

Drug of choice: Synthroid
 Given lifetime
 May cause: palpitation,
insomnia, nervousness.
5. AIDS

depression of the immune system

decreased leukocyte count
implement: standard precautions
use gloves in the presence of skin
lesions
6. Liver Cirrhosis

liver scarring
elevated AST, elevated ALT
Diagnostic test: liver biopsy
Complication: bleeding
Manifestation of hepatic
encephalopathy: decreased LOC,
flapping tremors
7. Liver Biopsy

instruct the client to inhale

exhale and hold breath during
needle insertion
position after the procedure: right
side lying
8. Chest pain

priority: assess
treatment: NSAID, it may cause
bleeding
9. Gouty arthritis

Diet: low purine

Avoid: organ meat
Metabolic
Common in males
Painful swollen joints
10. Acromegaly

due to increased HGH

drug: SANDOSTATIN given. S.C.
MEDICAL SURGICAL NURSING
OLD FORMAT
A patient with ascites
associated with cirrhosis
was admitted. The
appropriate nursing
diagnosis is?
a.Ineffective breathing
pattern
b.Altered nutrition
MEDICAL SURGICAL NURSING
NEW FORMAT
A patient with ascites was
admitted. Which of the following
nursing diagnosis should receive
priority?
a.Ineffective breathing pattern
b.Fluid volume excess
c.Altered tissue perfusion
d.Risk for injury
Answer: A
 1. Triage
 Sorting and prioritizing clients
• Priority
- airway
- safety
- the very young (below 1 year
- the very old (above 60)
 2. Delegation
- Assigning tasks
•Assignment
- assigning clients

Note: Do not delegate assessment,

teaching and evaluation
 3. TRACTIONS
 sign of infection at the pin site of
skeletal traction: purulent drainage
 to place the bedpan in a client with
traction, client should use a
trapeze to lift himself up using the
trapeze
 Russels traction - inspect the skin
in the popliteal space
 When transporting the client, leave
the traction just as it is
 3. TRACTIONS
 Buck’s traction- when changing
linen, apply linen from foot to top
of the bed
 Make sure the FOOT is NOT
touching the bed
 Assess leg circulation-palpate for
pulsation of the dorsalis pedis
artery
 Pelvic belt traction- apply at the
level of the iliac crest
 If client will have physical therapy,
remove the traction first
• Ratio – 30:24. CPR
- When to start CPR:
- person collapses
- person is found
“down”
- unresponsive
- When to stop CPR:
- patient responds
- positive pulse, begins
to breath
- rescuers are too
exhausted
- arrival of professionals
5. Isolation precautions
and positioning
• Most effective intervention:
handwashing
 First to remove: gloves
 First to wear: cap
 Consider all body fluids
infectious
 Waterless products can be used
in situation where running
water is not available
5. Isolation precautions
and positioning
 Thoracentesis: orthopneic
 Post-liver biopsy: right side
lying
 Post tonsillectomy and
adenoidectomy: prone
6. Diabetes mellitus
Avoid:
- gardening – “roses”
- going barefeet
- applying lotion in between toes
Wear:
- Snuggly fitting shoes (leather)
- Cotton socks
- It is best to buy shoes in the
afternoon
- Hypoglycemia means Blood
sugar level below 50
mq/dL
6. Diabetes mellitus
Signs and symptoms
- Diaphoresis, dizziness,
decreased LOC, difficulty in
problem solving
Initial intervention: administer
a glass of orange juice (simple
sugar)
 7. Aphasia
 Inability to speak clearly

Expressive aphasia
 Frontal lobe

Inability to find the right words to sa

 Use a picture board

 Receptive aphasia
 Temporal lobe
nability to understand spoken words
Talk to the patient slowly
 Ask questions which are
answerable with” yes” or ” no”
 8. Therapeutic diets
• Pressure ulcer: high protein
• Dumping syndrome: high fat, low
carbohydrate, dry diet
• Cholelithiasis: low fat
• Acid renal stone: alkaline ash
• Alkaline renal stone: acid ash
 9. Meniere’s disease
 Major symptom: Vertigo
 Diagnostic test: Caloric
stimulation test
 + result- sudden onset of severe
symptoms
 it is normal to experience slight
dizziness and nystagmus
during caloric test
 9. Meniere’s disease
 to prevent nausea and vomiting.
Avoid jarring the bed
 Diet: Low sodium diet
 cause of the disease is unknown
but the symptoms are due to
excess fluids
10. Infectious mononucleosis
 Transmitted direct contact with
droplets from infected person
 First symptom: sore throat
 Self care: restrict physical
activity
 11. Nephrotic Syndrome

 Diet: high CHON, Low Na

 Drug: Steroid

 Turn patient frequently

 12. Asthma
 Common cause : allergy,
smoking

 Avoid: Triggers
 13. Cholecystitis

 RUQ pain

 Vomiting after fatty intake

 14. Diabetic Ketoacidosis

 Kussmaul’s breathing

 Treat with rapid acting insulin

 15. Home Visit
 Face- to -face contact
 Must have an objective and
purpose
 Frequency depends on the
family’s identified needs
 Tool of the nurse – public
health bag
 3A
 Types of gait:
 Two point gait
 Three point gait
 Four point gait
 Fiber glass cast dries in 20 minutes
 Handle the wet cast with the palm of
the hand
 Osteoporosis is common in smokers
 it is related to decreased
estrogen
 exercise that challenges the
joint is appropriate
 3A
Osteoarthritis
- Degenerative: common in both

- males and females

- Heberdens and Bouchards
nodes
Rheumatoid arthritis
- Chronic, systemic
- Common in females
- Morning stiffness
Gouty arthritis
- Metabolic
- Common in males
 3 B O.R. Concepts
Attire:
- Unrestricted :
- Semi restricted:
- Restricted:
Positions:decided upon by surgeon
- Kidney surgery-
- Bladder surgery-
- Biliary surgery-
Stages of anesthesia:
- Loss of consciousness
- Excitement / delirium
- Anestheria
- Danger stage
 3C
Common complications of
common surgeries

 Eye – pain indicates

hemorrhage
 Tonsillectomy- frequent
swallowing indicates bleeding
 Gastrectomy- diarrhea may
indicate dumping syndrome