A 37-year-old executive returns to your clinic for follow-up of recurrent upper abdominal pain. He initially presented 3 weeks ago, complaining of an increase in frequency and severity of burning epigastric pain, which he has experienced occasionally for more than 2 years. Now the pain occurs three or four times per
week, usually when he has an empty stomach, and it often awakens him at night. The pain usually is relieved within minutes by food or over-the-counter antacids, but then recurs within 2 to 3 hours. He admitted that stress at work had recently increased and that because of long working hours, he was drinking more caffeine
and eating a lot of take-out foods. His medical history and review of systems were otherwise unremarkable, and, other than the antacids, he takes no medications. His physical examination was normal, including stool guaiac that was negative for occult blood. You advised a change in diet and started him on a proton-pump
inhibitor. His symptoms resolved completely with the diet changes and daily use of the medication. Results of laboratory tests performed at his first visit show no anemia, but his serum Helicobacter pylori antibody test was positive.
What is your diagnosis?
What is your next step
Friday, May 23, 2014
Tuesday, May 20, 2014
Medical Surgical Nursing Case Study: Cardiovascular System 1
A 72-year-old man presents to the clinic complaining of several weeks of worsening exertional dyspnea. Previously, he had been able to work in his garden and mow the lawn, but now he feels short of breath after walking 100 feet. He does not have chest pain when he walks, although in the past he has experienced episodes of retrosternal chest pressure with strenuous exertion. Once recently he had felt lightheaded, as if he were about to faint while climbing a flight of stairs, but the symptom passed after he sat down. He has been having some difficulty sleeping at night and has to prop himself up with two pillows. Occasionally, he wakes up at night feeling quite short of breath, which is relieved within minutes by sitting upright and dangling his legs over the bed. His feet have become swollen, especially by the end of the day. He denies any significant medical history, takes no medications, and prides himself on the fact that he has not seen a doctor in years. He does not smoke or drink alcohol.
On physical examination, he is afebrile, with a heart rate of 86 bpm, blood pressure of 115/92 mm Hg, and respiratory rate of 16 breaths per minute. Examination of the head and neck reveals pink mucosa without pallor, a normal thyroid gland, and distended neck veins. Bibasilar inspiratory crackles are heard on examination. On cardiac examination, his heart rhythm is regular with a normal S1 and a second heart sound that splits during expiration, an S4 at the apex, a nondisplaced apical impulse, and a late-peaking systolic murmur at the right-upper sternal border that radiates to his carotids. The carotid upstrokes have diminished amplitude.
What is the most likely diagnosis?
What test would confirm the diagnosis?
Wednesday, April 23, 2014
Carbohydrates
Carbohydrates 1
Carbohydrates are made of carbon, hydrogen, and oxygen atoms. Many different monosaccharides, or simple sugars, can combine into polysaccharides, or complex carbohydrates. Even though they have a bad reputation among some diet plans, carbohydrates perform many essential functions for cells. In this chapter, I present the basic structure of carbohydrates and explain their importance to cells.
CH2O: Structure of Carbohydrates
In recent years, due to the comeback of the low- carb diet, carbohydrates have gotten a bad rap. Some people have started thinking that proteins are good, and carbohydrates are bad. However, the idea that carbohydrates aren’t good for you is overly simplified. After all, carbohydrates are an essential component of your cells. What can make a difference is the type of carbohydrates you eat. Carbohydrates are organic molecules composed of carbon, hydrogen, and oxygen. The two main types of carbohydrates are as follows:
Monosaccharides are also called simple sugars. (Most diets recommend that you avoid eating too much of this type of carbohydrate.) Glucose is a monosaccharide that is usually available to your cells.
Polysaccharides are also called complex carbohydrates. (Fiber is an example of a complex carbohydrate that is a recommended part of your daily nutrition.)
Keeping it simple: Monosaccharides
Monosaccharides, or simple sugars, are single sugars. (“Mono” means “one” and “sacchar” means sugar.) Many monosaccharides have the generic formula CH2O: For every one carbon atom they have, they have two hydrogen atoms and one oxygen atom. Two monosaccharides that may be familiar to you are glucose (see Figure 5-1A) and fructose (a sugar found in fruit and also in high-fructose corn syrup).
All monosaccharides have certain features in common:
A backbone of 3, 4, 5, 6, or 7 carbons. Sugars are categorized based on the number of carbons: In order of the numbers, they are called trioses, tetroses, pentoses, hexoses, and heptoses. For example, glucose is a hexose, or 6-carbon sugar.
Hydroxyl groups (–OH) attached to every carbon but one. The hydroxyl groups make sugars polar, which is why they dissolve easily in water.
One double-bonded oxygen attached to the carbon backbone. An oxygen double-bonded to a carbon is called a carbonyl group. If the carbonyl group is located at the end of a monosaccharide, the sugar is an aldose. If the carbonyl group is located within the carbon backbone, the sugar is a ketose. Glucose is an aldose because its carbonyl group is at the end of the carbon backbone.
Of the four groups of macromolecules (carbohydrates, proteins, nucleic acids, and lipids), carbohydrates have the greatest number of hydroxyl groups (–OH) attached to their carbon atoms. When you’re trying to distinguish between the four types of macromolecules, a structure with hydroxyl groups attached to almost every carbon is probably a carbohydrate.
Two monosaccharides can have the same numbers of carbon, hydrogen, and oxygen atoms and yet have very different properties. When two monosaccharides have the same atoms, but those atoms are arranged differently, the sugars are isomers of each other (“iso” means same). For example, if the hydroxyl group (–OH) and hydrogen atom (–H) attached to the fourth carbon from the top in glucose (see Figure 5-1A) were swapped with each other, the sugar would be converted to galactose. Glucose and galactose are almost identical, except for that one change in the arrangement of the atoms, and yet they behave very differently in cells.
The way the atoms are bonded together is very important in the structure and function of sugars. Isomers are made from exactly the same atoms, but their atoms are arranged differently.
In the watery environment of the cell, monosaccharides convert into ringshaped structures. A bond forms between two atoms in the backbone of the sugar, causing the sugar to bend around to form the ring. As an example, compare the linear structure of glucose shown in Figure 5-1A with the ring structure shown in Figure 5-1B.
Making it complex: Polysaccharides
Polysaccharides, or complex carbohydrates, are polymers (see Chapter 4) of monosaccharides. (“Poly” means many, and “sacchar” means sugar, so a polysaccharide is “many sugars” strung together.) To make polysaccharides, monosaccharides are joined together by condensation reactions (see Chapter 4). During condensation, a water molecule is removed as a bond is formed between an atom in the growing polysaccharide chain and an atom in
the monosaccharide that is being added to the chain (see Figure 5-1B). The bonds between monosaccharides are called glycosidic linkages.
Polysaccharides are classified based on the number of monosaccharides in the chain:
Disaccharides are chains of two monosaccharides. Sucrose (see Figure
5-1B), or table sugar, is a disaccharide that is probably very familiar to you. Another disaccharide you probably know about is lactose, the sugar
found in milk.
Oligosaccharides are short chains of monosaccharides (see Figure 5-1C). Oligosaccharides are part of receptors in the plasma membranes of your cells.
Polysaccharides are long chains of monosaccharides (see Figure 5-1D). Starch and cellulose, both shown in Figure 5-2, are two polysaccharides that you probably eat every day. Starch is found in bread, potatoes, rice, and pasta; cellulose is referred to as fiber in your diet.
Many cell types produce polysaccharides. Starch and cellulose, which are made by plants, are both polymers of glucose. Glycogen, made by animal cells, is also a polymer of glucose. Chitin, found in the shells of crustaceans and insects, is a polymer of a nitrogen-containing monosaccharide called N-acetylglucosamine. Peptidoglycan, the polysaccharide found in bacterial cell walls (see Chapter 2), is a polymer of two alternating monosaccharides, N-acetylglucosamine and N-acetylmuramic acid.
Polysaccharides can also be different based on how their monosaccharides are strung together. Starch, cellulose, and glycogen are all made entirely of glucose, yet they behave very differently in the body. Starch and glycogen are easily broken down in the human digestive system. Cellulose, or fiber, can’t be broken down at all by humans. Instead, it passes right through your digestive system and exits as part of your wastes.
The difference between starch, cellulose, and glycogen isn’t what they’re made of, but rather in the bonds between the glucose molecules:
The glucose molecules in starch are joined with a bond called a α–1,4–glycosidic linkage.
The glucose molecules in cellulose are joined with a β–1,4–glycosidic linkage.
At approximately every tenth glucose molecule, a branch is joined to the main backbone of glycogen by an α–1,6–glycosidic linkage. Thus, glycogen molecules are highly branched.
The reason humans can digest starch and glycogen, but not cellulose, is that human enzymes can break down some glycosidic linkages, but not others. Human enzymes break down α –1,4–glycosidic linkages and α –1,6–glycosidic linkages, but not β –1,4–glycosidic linkages. Together, starch, cellulose, and glycogen demonstrate how important different types of glycosidic linkages can be to polysaccharide structure and function.
The type of glycosidic linkage between monosaccharides is very important in determining structure and function of polysaccharides.
Functions of Carbohydrates
Carbohydrates are probably most famous for their role in providing energy to bodies (and, of course, cells), but they perform many other important functions for cells as well:
Carbohydrates are an important energy source for cells. The monosaccharide glucose is a rapidly used energy source for almost all cells on planet Earth. In addition, many cell types store matter and energy for later use in the form of polysaccharides. Plants, algae, and bacteria store energy in starch, and animals and bacteria store energy in glycogen.
Carbohydrates are important structural molecules for cells. Polysaccharides are the major components of the cell walls of plants, algae, fungi, and bacteria. The cell walls of plants and algae contain cellulose, the cell walls of fungi contain chitin, and the cell walls of bacteria contain peptidoglycan.
Carbohydrates are important markers of cellular identity. The surfaces of cells are marked with glycoproteins, molecules of protein that have an attached sugar. Different cells have different glycoproteins on their surface, marking the cells with their identity. In your body, liver cells are marked as liver cells, heart cells are marked as heart cells, nerve cells are marked as nerve cells, and so on.
Carbohydrates are important extracellular molecules. Polysaccharides are a major component of the sticky matrix that surrounds cells. They help bacteria stick to surfaces
Carbohydrates are made of carbon, hydrogen, and oxygen atoms. Many different monosaccharides, or simple sugars, can combine into polysaccharides, or complex carbohydrates. Even though they have a bad reputation among some diet plans, carbohydrates perform many essential functions for cells. In this chapter, I present the basic structure of carbohydrates and explain their importance to cells.
CH2O: Structure of Carbohydrates
In recent years, due to the comeback of the low- carb diet, carbohydrates have gotten a bad rap. Some people have started thinking that proteins are good, and carbohydrates are bad. However, the idea that carbohydrates aren’t good for you is overly simplified. After all, carbohydrates are an essential component of your cells. What can make a difference is the type of carbohydrates you eat. Carbohydrates are organic molecules composed of carbon, hydrogen, and oxygen. The two main types of carbohydrates are as follows:
Monosaccharides are also called simple sugars. (Most diets recommend that you avoid eating too much of this type of carbohydrate.) Glucose is a monosaccharide that is usually available to your cells.
Polysaccharides are also called complex carbohydrates. (Fiber is an example of a complex carbohydrate that is a recommended part of your daily nutrition.)
Keeping it simple: Monosaccharides
Monosaccharides, or simple sugars, are single sugars. (“Mono” means “one” and “sacchar” means sugar.) Many monosaccharides have the generic formula CH2O: For every one carbon atom they have, they have two hydrogen atoms and one oxygen atom. Two monosaccharides that may be familiar to you are glucose (see Figure 5-1A) and fructose (a sugar found in fruit and also in high-fructose corn syrup).
All monosaccharides have certain features in common:
A backbone of 3, 4, 5, 6, or 7 carbons. Sugars are categorized based on the number of carbons: In order of the numbers, they are called trioses, tetroses, pentoses, hexoses, and heptoses. For example, glucose is a hexose, or 6-carbon sugar.
Hydroxyl groups (–OH) attached to every carbon but one. The hydroxyl groups make sugars polar, which is why they dissolve easily in water.
One double-bonded oxygen attached to the carbon backbone. An oxygen double-bonded to a carbon is called a carbonyl group. If the carbonyl group is located at the end of a monosaccharide, the sugar is an aldose. If the carbonyl group is located within the carbon backbone, the sugar is a ketose. Glucose is an aldose because its carbonyl group is at the end of the carbon backbone.
Of the four groups of macromolecules (carbohydrates, proteins, nucleic acids, and lipids), carbohydrates have the greatest number of hydroxyl groups (–OH) attached to their carbon atoms. When you’re trying to distinguish between the four types of macromolecules, a structure with hydroxyl groups attached to almost every carbon is probably a carbohydrate.
Two monosaccharides can have the same numbers of carbon, hydrogen, and oxygen atoms and yet have very different properties. When two monosaccharides have the same atoms, but those atoms are arranged differently, the sugars are isomers of each other (“iso” means same). For example, if the hydroxyl group (–OH) and hydrogen atom (–H) attached to the fourth carbon from the top in glucose (see Figure 5-1A) were swapped with each other, the sugar would be converted to galactose. Glucose and galactose are almost identical, except for that one change in the arrangement of the atoms, and yet they behave very differently in cells.
The way the atoms are bonded together is very important in the structure and function of sugars. Isomers are made from exactly the same atoms, but their atoms are arranged differently.
In the watery environment of the cell, monosaccharides convert into ringshaped structures. A bond forms between two atoms in the backbone of the sugar, causing the sugar to bend around to form the ring. As an example, compare the linear structure of glucose shown in Figure 5-1A with the ring structure shown in Figure 5-1B.
Making it complex: Polysaccharides
Polysaccharides, or complex carbohydrates, are polymers (see Chapter 4) of monosaccharides. (“Poly” means many, and “sacchar” means sugar, so a polysaccharide is “many sugars” strung together.) To make polysaccharides, monosaccharides are joined together by condensation reactions (see Chapter 4). During condensation, a water molecule is removed as a bond is formed between an atom in the growing polysaccharide chain and an atom in
the monosaccharide that is being added to the chain (see Figure 5-1B). The bonds between monosaccharides are called glycosidic linkages.
Polysaccharides are classified based on the number of monosaccharides in the chain:
Disaccharides are chains of two monosaccharides. Sucrose (see Figure
5-1B), or table sugar, is a disaccharide that is probably very familiar to you. Another disaccharide you probably know about is lactose, the sugar
found in milk.
Oligosaccharides are short chains of monosaccharides (see Figure 5-1C). Oligosaccharides are part of receptors in the plasma membranes of your cells.
Polysaccharides are long chains of monosaccharides (see Figure 5-1D). Starch and cellulose, both shown in Figure 5-2, are two polysaccharides that you probably eat every day. Starch is found in bread, potatoes, rice, and pasta; cellulose is referred to as fiber in your diet.
Many cell types produce polysaccharides. Starch and cellulose, which are made by plants, are both polymers of glucose. Glycogen, made by animal cells, is also a polymer of glucose. Chitin, found in the shells of crustaceans and insects, is a polymer of a nitrogen-containing monosaccharide called N-acetylglucosamine. Peptidoglycan, the polysaccharide found in bacterial cell walls (see Chapter 2), is a polymer of two alternating monosaccharides, N-acetylglucosamine and N-acetylmuramic acid.
Polysaccharides can also be different based on how their monosaccharides are strung together. Starch, cellulose, and glycogen are all made entirely of glucose, yet they behave very differently in the body. Starch and glycogen are easily broken down in the human digestive system. Cellulose, or fiber, can’t be broken down at all by humans. Instead, it passes right through your digestive system and exits as part of your wastes.
The difference between starch, cellulose, and glycogen isn’t what they’re made of, but rather in the bonds between the glucose molecules:
The glucose molecules in starch are joined with a bond called a α–1,4–glycosidic linkage.
The glucose molecules in cellulose are joined with a β–1,4–glycosidic linkage.
At approximately every tenth glucose molecule, a branch is joined to the main backbone of glycogen by an α–1,6–glycosidic linkage. Thus, glycogen molecules are highly branched.
The reason humans can digest starch and glycogen, but not cellulose, is that human enzymes can break down some glycosidic linkages, but not others. Human enzymes break down α –1,4–glycosidic linkages and α –1,6–glycosidic linkages, but not β –1,4–glycosidic linkages. Together, starch, cellulose, and glycogen demonstrate how important different types of glycosidic linkages can be to polysaccharide structure and function.
The type of glycosidic linkage between monosaccharides is very important in determining structure and function of polysaccharides.
Functions of Carbohydrates
Carbohydrates are probably most famous for their role in providing energy to bodies (and, of course, cells), but they perform many other important functions for cells as well:
Carbohydrates are an important energy source for cells. The monosaccharide glucose is a rapidly used energy source for almost all cells on planet Earth. In addition, many cell types store matter and energy for later use in the form of polysaccharides. Plants, algae, and bacteria store energy in starch, and animals and bacteria store energy in glycogen.
Carbohydrates are important structural molecules for cells. Polysaccharides are the major components of the cell walls of plants, algae, fungi, and bacteria. The cell walls of plants and algae contain cellulose, the cell walls of fungi contain chitin, and the cell walls of bacteria contain peptidoglycan.
Carbohydrates are important markers of cellular identity. The surfaces of cells are marked with glycoproteins, molecules of protein that have an attached sugar. Different cells have different glycoproteins on their surface, marking the cells with their identity. In your body, liver cells are marked as liver cells, heart cells are marked as heart cells, nerve cells are marked as nerve cells, and so on.
Carbohydrates are important extracellular molecules. Polysaccharides are a major component of the sticky matrix that surrounds cells. They help bacteria stick to surfaces
Saturday, April 19, 2014
Youtube Channel
Hello there future nurses.. future colleagues. I've created a youtube channel so i ca post lecture videos on Nursing concepts particularly exam drills with time limit. This can help you gain experience in taking nursing exams under time pressure.
I've uploaded my first video on Fundamentals of Nursing.
Answers will be posted on this site.
Please subscribe in my channel and like my videos. Thanks for your support
I've uploaded my first video on Fundamentals of Nursing.
Answers will be posted on this site.
Please subscribe in my channel and like my videos. Thanks for your support
Wednesday, April 9, 2014
Anatomy and Physiology Notes: Conduction System of the Heart
Key Concepts
1. The electrical activity of cardiac cells is caused by the selective opening and closing of plasma membrane channels for sodium, potassium, and calcium ions.
2. Depolarization is achieved by the opening of sodium and calcium channels and the closing of potassium channels.
3. Repolarization is achieved by the opening of potassium channels and the closing of sodium and calcium
channels.
4. Pacemaker potentials are achieved by the opening of channels for sodium and calcium ions and the closing of channels for potassium ions.
5. Electrical activity is normally initiated in the sinoatrial (SA) node where pacemaker cells reach threshold first.
6. Electrical activity spreads across the atria, through the atrioventricular (AV) node, through the Purkinje system, and to ventricular muscle.
7. Norepinephrine increases pacemaker activity and the speed of action potential conduction.
8. Acetylcholine decreases pacemaker activity and the speed of action potential conduction.
9. Voltage differences between repolarized and depolarized regions of the heart are recorded by an electrocardiogram (ECG).
10. The ECG provides clinically useful information about rate, rhythm, pattern of depolarization, and mass of electrically active cardiac muscle.
Pathway
SA Node
|
Walls of the Atrium (Atrial Contraction)
|
AV Node
|
Delay in transmission
(To provide ample time for ventricular filling)
|
Bundle of His
|
Left and Right Bundle Branch
|
Purkinje Fibers
|
Ventricular Contraction
Friday, April 4, 2014
Notes on Fluid and Electrolytes 4 FLUID VOLUME DEFICIT
FLUID VOLUME DEFICIT
A. Description
1. Dehydration occurs when the fluid intake of the body is not sufficient to meet the fluid needs of the body.
2. The goal of treatment is to restore fluid volume, replace electrolytes as needed, and eliminate the cause of the fluid volume deficit.
B. Types of fluid volume deficits
1. Isotonic dehydration
a. Water and dissolved electrolytes are lost in equal proportions.
b. Known as hypovolemia, isotonic dehydration is the most common type of dehydration.
c. Isotonic dehydration results in decreased circulating blood volume and inadequate tissue perfusion.
2. Hypertonic dehydration
a. Water loss exceeds electrolyte loss.
b. The clinical problems that occur result from alterations in the concentrations of specific plasma electrolytes.
c. Fluid moves from the intracellular compartment into the plasma and interstitial fluid spaces, causing cellular dehydration and shrinkage.
3. Hypotonic dehydration
a. Electrolyte loss exceeds water loss.
b. The clinical problems that occur result from fluid shifts between compartments, causing a decrease in
plasma volume.
c. Fluid moves from the plasma and interstitial fluid spaces into the cells, causing a plasma volume deficit and causing the cells to swell.
C. Causes of fluid volume deficits
1. Isotonic dehydration
a. Inadequate intake of fluids and solutes
b. Fluid shifts between compartments
c. Excessive losses of isotonic body fluids
2. Hypertonic dehydration—conditions that increase fluid
loss, such as excessive perspiration, hyperventilation,
ketoacidosis, prolonged fevers, diarrhea, early-stage
renal failure, and diabetes insipidus
3. Hypotonic dehydration
a. Chronic illness
b. Excessive fluid replacement (hypotonic)
c. Renal failure
d. Chronic malnutrition
D. Assessment
1. Cardiovascular
a. Thready, increased pulse rate
b. Decreased blood pressure and orthostatic (postural) hypotension
c. Flat neck and hand veins in dependent positions
d. Diminished peripheral pulses
2. Respiratory: Increased rate and depth of respirations
3. Neuromuscular
a. Decreased central nervous system activity, from lethargy to coma
b. Fever
4. Renal
a. Decreased urinary output
b. Increased urinary specific gravity
5. Integumentary
a. Dry skin
b. Poor turgor, tenting present
c. Dry mouth
6. Gastrointestinal
a. Decreased motility and diminished bowel sounds
b. Constipation
c. Thirst
d. Decreased body weight
7. Hypotonic dehydration: skeletal muscle weakness
8. Hypertonic dehydration
a. Hyperactive deep tendon reflexes
b. Pitting edema
9. Laboratory findings
a. Increased serum osmolality
b. Increased hematocrit
c. Increased blood urea nitrogen (BUN) level
d. Increased serum sodium level
E. Interventions
1. Monitor cardiovascular, respiratory, neuromuscular, renal, integumentary, and gastrointestinal status.
2. Prevent further fluid losses and increase fluid compartment volumes to normal ranges.
3. Provide oral rehydration therapy if possible and intravenous (IV) fluid replacement if the dehydration is
severe; monitor intake and output.
4. Generally, isotonic dehydration is treated with isotonic fluid solutions, hypertonic dehydration with hypotonic fluid solutions, and hypotonic dehydration with hypertonic fluid solutions.
5. Administer medications as prescribed such as antidiarrheal, antimicrobial, antiemetic, and antipyretic
medications, to correct the cause and treat any symptoms.
6. Administer oxygen as prescribed.
7. Monitor electrolyte values and prepare to administer medication to treat an imbalance, if present.
A. Description
1. Dehydration occurs when the fluid intake of the body is not sufficient to meet the fluid needs of the body.
2. The goal of treatment is to restore fluid volume, replace electrolytes as needed, and eliminate the cause of the fluid volume deficit.
B. Types of fluid volume deficits
1. Isotonic dehydration
a. Water and dissolved electrolytes are lost in equal proportions.
b. Known as hypovolemia, isotonic dehydration is the most common type of dehydration.
c. Isotonic dehydration results in decreased circulating blood volume and inadequate tissue perfusion.
2. Hypertonic dehydration
a. Water loss exceeds electrolyte loss.
b. The clinical problems that occur result from alterations in the concentrations of specific plasma electrolytes.
c. Fluid moves from the intracellular compartment into the plasma and interstitial fluid spaces, causing cellular dehydration and shrinkage.
3. Hypotonic dehydration
a. Electrolyte loss exceeds water loss.
b. The clinical problems that occur result from fluid shifts between compartments, causing a decrease in
plasma volume.
c. Fluid moves from the plasma and interstitial fluid spaces into the cells, causing a plasma volume deficit and causing the cells to swell.
C. Causes of fluid volume deficits
1. Isotonic dehydration
a. Inadequate intake of fluids and solutes
b. Fluid shifts between compartments
c. Excessive losses of isotonic body fluids
2. Hypertonic dehydration—conditions that increase fluid
loss, such as excessive perspiration, hyperventilation,
ketoacidosis, prolonged fevers, diarrhea, early-stage
renal failure, and diabetes insipidus
3. Hypotonic dehydration
a. Chronic illness
b. Excessive fluid replacement (hypotonic)
c. Renal failure
d. Chronic malnutrition
D. Assessment
1. Cardiovascular
a. Thready, increased pulse rate
b. Decreased blood pressure and orthostatic (postural) hypotension
c. Flat neck and hand veins in dependent positions
d. Diminished peripheral pulses
2. Respiratory: Increased rate and depth of respirations
3. Neuromuscular
a. Decreased central nervous system activity, from lethargy to coma
b. Fever
4. Renal
a. Decreased urinary output
b. Increased urinary specific gravity
5. Integumentary
a. Dry skin
b. Poor turgor, tenting present
c. Dry mouth
6. Gastrointestinal
a. Decreased motility and diminished bowel sounds
b. Constipation
c. Thirst
d. Decreased body weight
7. Hypotonic dehydration: skeletal muscle weakness
8. Hypertonic dehydration
a. Hyperactive deep tendon reflexes
b. Pitting edema
9. Laboratory findings
a. Increased serum osmolality
b. Increased hematocrit
c. Increased blood urea nitrogen (BUN) level
d. Increased serum sodium level
E. Interventions
1. Monitor cardiovascular, respiratory, neuromuscular, renal, integumentary, and gastrointestinal status.
2. Prevent further fluid losses and increase fluid compartment volumes to normal ranges.
3. Provide oral rehydration therapy if possible and intravenous (IV) fluid replacement if the dehydration is
severe; monitor intake and output.
4. Generally, isotonic dehydration is treated with isotonic fluid solutions, hypertonic dehydration with hypotonic fluid solutions, and hypotonic dehydration with hypertonic fluid solutions.
5. Administer medications as prescribed such as antidiarrheal, antimicrobial, antiemetic, and antipyretic
medications, to correct the cause and treat any symptoms.
6. Administer oxygen as prescribed.
7. Monitor electrolyte values and prepare to administer medication to treat an imbalance, if present.
Sunday, March 30, 2014
Pre-Board Exam Drill
SITUATION 1: A patient just arrived in the Oncology unit from the Post Anesthesia Care Unit (PACU) following a Left Modified Radical Mastectomy because of Inflammatory Breast Cancer (IBC). She has a pressure dressing over the surgical site and two drains. Assessment shows her vital signs are stable, fully awake and claims that pain is under control. Fortune is the nurse assigned to the patient.
1. From the following data obtained from the chart by Fortune, which is NOT a risk factor which could have predisposed the patient to breast cancer:
a. Age – 55
b. Height 5’2”, weight 160 lbs.
c. Menarche at age 13
d. Mother died of colon cancer
2. Fortune read a literature which says that by the time Inflammatory Breast Cancer (IBC) is diagnosed, 50% - 75% have palpable auxiliary nodes; as many as 30% have gross distant metastasis; and as few as 30% of patients have an underlying breast mass. Which of the following is the APPROPRIATE interpretation of this research findings.
a. Auxiliary nodes were palpated on 20 out of 30 women positive for IBC3
b. Out of the 20 women who were positive for IBC, only 5 have metastasis
c. If there were 10 women diagnosed with IBC, 3 have positive lymph nodes
d. Breast mass was identified on 8 out of 30 women positive for IBC
3. Fortune recognizes that adjuvant chemotherapy for breast cancer may include any of the following EXCEPT:
a. Monoclonal antibody
b. Antibiotics
c. Proton inhibitors – this is a drug for ulcer
d. Antiestrogen – tamoxifen
4. Fortune understands that when the antineoplastic agent leaks through the peripheral vascular access during chemotherapy procedure, which of the following is expected to be done FIRST?
a. Refer to the physician
b. Stop the chemotherapy infusion
c. Cleanse site with saline solution
d. Call another nurse to check the intravenous site
5. A clinical trial is currently being undertaken to test treatments for Inflammatory Breast Cancer (IBC). The research team leader wishes to include the patient as a participant in the study. As a patient advocate, which of the following will Fortune do FIRST?
a. Obtain informed consent from the patient
b. Explain to the patient the scope of the clinical trial
c. Inquire from the team leader benefits for the patient
d. Read more related literatures
SITUATION 2: During a staff meeting in the Intensive Care Unit, the nurse manager reported a list of procedures that need to be reviewed and updated. One of these procedures is the precautionary measures related to ventilator associated pneumonia.- on mechanical ventilation through an endotracheal or tracheostomy tube for at least 48 hours
6. While brainstorming, the group mentioned the use of evidence-based techniques. Which of the following statements given by the members of the group reflect evidence-based methods?
a. “Let us ask opinions of experts”
b. “The experiences of the nurses must be obtained”
c. “Review of related literature will be very helpful”
d. “We must agree on a common procedure”
7. The nurse manager assigned a group to develop a project intended to improve the existing procedure related to the prevention of ventilator associated pneumonia among ICU patients. A first team leader was selected by the group. Which of the following will the team leader do FIRST?
a. Tell the group to state their objectives
b. Formulate a list of desired outcomes
c. Set a target
d. State actions to be done by each member of the group
8. Which of the following definitions best describes pneumonia?
A. Inflammation of the large airways
B. Severe infection of the bronchioles
C. Inflammation of the pulmonary parenchyma
D. accumulation of fluids in the lungs
9. The nurse is preparing her plan of care for her patient diagnosed with pneumonia. Which is the most appropriate nursing diagnosis for this patient?
A. Fluid volume deficit
B. Decreased tissue perfusion.
C. Impaired gas exchange.
D. Risk for infection
10. What action should the nurse take in assisting Mr. Ramos in doing deep breathing and coughing exercise?
A. Recognize that the patient is too sick to cough at this time
B. Splint the patient’s chest while he coughs
C. Turn Mr. Ramos to the unaffected side and ask him to cough
D. Encourage her to cough and then give her pain medication as ordered
11. Ms. Sy undergoes surgery and the abdominal aortic aneurysm is resected and replaced with a graft. When she arrives in the RR she is still in shock. The nurse's priority should be
A. placing her in a trendeleburg position
B. putting several warm blankets on her
C. monitoring her hourly urine output
D. assessing her VS especially her RR
12. Ana's postoperative vital signs are a blood pressure of 80/50 mm Hg, a pulse of 140, and respirations of 32. Suspecting shock, which of the following orders would the nurse question?
A. Put the client in modified Trendelenberg's position.
B. Administer oxygen at 100
C. Monitor urine output every hour.
D. Administer Demerol 50mg IM q4h
13. When assessing Luther for hypovolemic shock, which of the following data indicates that he is in IRREVERSIBLE stage of shock?
a. Restless, anxious and confused
b. Anuria
c. Skin, cool, pale and moist- compensatory stage
d. Pulse rapid and weak – reversible stage
14. The physician ordered colloid solution such as Dextran 40. During the infusion, Luther complained of dyspnea. Upon auscultation, you noted wheezes. Which of the following will you do FIRST?
a. Discontinue the infusion
b. Place Luther on a Fowler’s position..
c. Decrease infusion rate
d. Call the attending physician
15. Luther’s central venous pressure is monitored every hour. When you measure the CVP using a water manometer, you are expected to observe which of the following to ensure accuracy of CVP measurement?
a. Maintain the client on a Fowler’s position
b. Use a one way stopcock to regulate flow of IV fluids to the water manometer
c. Immobilize client’s right arm
d. Keep the zero point of the manometer in level with the client’s right atrium
SITUATION 4: You are caring for Warren, 58 years old, who is diagnosed with Laryngeal cancer
16. Warren, who is scheduled for a total laryngectomy and radical neck dissection for cancer of the larynx, asks you, “How will I talk after the surgery?” as his nurse your BEST response will be:
a. “You will breathe through a permanent opening in your neck, but you will not be able to communicate orally”
b. “You won’t be able to talk right after surgery, but you will be able to speak again once the tracheostomy tube is removed”
c. “You will have a permanent opening in your neck, and you will need to have rehabilitation for some type of voice restoration”
d. “You won’t be able to speak as you used to but there are artificial voice devices that will give you the ability to speak normally”
17. Warren returns from surgery with a tracheostomy tube after a total laryngectomy and radical neck dissection. In caring for Warren during the first 24 hours after surgery, your PRIORITY nursing action is to:
a. Avoid changing tracheostomy ties
b. Monitor for bleeding around stoma
c. Assess the airway patency and breath sounds
d. Clean the inner cannula every 8 hours
18. After doing assessment, one of the nursing diagnosis you identified is “Body image disturbance related to loss of control of personal care.” To evaluate effectiveness of your interventions, the expected outcome for the problem that Warren should demonstrate is that he:
a. Lets his wife provide hygiene and stoma care
b. Wears clothing that minimizes the disfigurement caused by surgery
c. Asks that only family members be allowed to visit
d. Learns to remove and clean the laryngectomy tube independently
19. Warren is scheduled to start radiation therapy. You have just taught Warren all about radiation therapy. Which of the following statements by Warren would indicate that your teaching has been EFFECTIVE?
a. “I can use lotions to moisturize the skin on my throat”
b. “I will need to buy a water bottle to carry with me”
c. “I need to use alcohol-based mouthwashes to help clean oral ulcers”
d. “I may experience diarrhea, I may have diarrhea until radiation is complete”
20. After completing the discharge instructions for Warren, you determine that ADDITIONAL instruction is needed when he says:
a. “I can participate in most of my prior fitness activities except swimming”
b. “I should wear a Medic Alert Bracelet that identifies me as a neck breather”
c. “I must keep the stoma covered with a loose sterile dressing at all times”
d. “I need to eat nutritious meals even though I can’t smell or taste very well”
Anatomy and Physiology Notes: Gastrointestinal-Hepatobillary System
This is an outlined lecture note on the Anatomy and Physiology of theGastrointestinal-Hepatobillary System. Some information are so compressed that some concepts are not explained in detail. If it is your first time to meet such information please refer to your textbook for further explanation of the concept. This review material requires a student to have a prior knowledge and good foundation of the subject matter for this only emphasizes important/ key information deemed important in understanding advanced concept in Pathophysiology and Medical Surgical Nursing.
Functions of the gastrointestinal system
- Process food substances.
- Absorb the products of digestion into the blood.
- Excrete unabsorbed materials.
- Provide an environment for microorganisms to synthesize nutrients, such as vitamin K.
Mouth
- Contains the lips, cheeks, palate, tongue, teeth, salivary glands, muscles, and maxillary bones
- Saliva contains the amylase enzyme (ptyalin) that aids in digestion.
Esophagus
- Collapsible muscular tube about 10 inches long
- Carries food from the pharynx to the stomach
The stomach
- Contains the cardia, fundus, the body, and the pylorus
- Mucous glands are located in the mucosa and prevent autodigestion by providing an alkaline protective covering.
- The lower esophageal (cardiac) sphincter prevents reflux of gastric contents into the esophagus.
- The pyloric sphincter regulates the rate of stomach emptying into the small intestine.
- Hydrochloric acid kills microorganisms, breaks food into small particles, and provides a chemical environment that facilitates gastric enzyme activation.
- Pepsin is the chief coenzyme of gastric juice, which converts proteins into proteases and peptones.
- Intrinsic factor is necessary for the absorption of vitamin B12.
- Gastrin controls gastric acidity.
Small intestine
- The duodenum contains the openings of the bile and pancreatic ducts.
- The jejunum is about 8 feet long.
- The ileum is about 12 feet long.
- The small intestine terminates in the cecum.
Pancreatic intestinal juice enzymes
- Amylase digests starch to maltose.
- Maltase reduces maltose to monosaccharide glucose.
- Lactase splits lactose into galactose and glucose.
- Sucrase reduces sucrose to fructose and glucose.
- Nucleases split nucleic acids to nucleotides.
-. Enterokinase activates trypsinogen to trypsin.
Large intestine
- About 5 feet long
- Absorbs water and eliminates wastes
- Intestinal bacteria play a vital role in the synthesis of some B vitamins and vitamin K.
- Colon: Includes the ascending, transverse, descending, and sigmoid colons and rectum
- The ileocecal valve prevents contents of the large intestine from entering the ileum.
- The anal sphincters control the anal canal.
Peritoneum: Lines the abdominal cavity and forms the mesentery that supports
the intestines and blood supply
Liver
-The largest gland in the body, weighing 3 to 4 lb.
-Contains Kupffer's cells, which remove bacteria in the portal venous blood
- Removes excess glucose and amino acids from the portal blood
- Synthesizes glucose, amino acids, and fats
- Aids in the digestion of fats, carbohydrates, and proteins
- Stores and filters blood (200 to 400 mL of blood stored)
- Stores vitamins A, D, and B and iron
- The liver secretes bile to emulsify fats (500 to 1000 mL of bile/day).
Hepatic ducts
a. Deliver bile to the gallbladder via the cystic duct and to the
duodenum via the common bile duct.
b. The common bile duct opens into the duodenum, with the pancreatic duct at the ampulla of Vater.
c. The sphincter prevents the reflux of intestinal contents into the
common bile duct and pancreatic duct.
Gallbladder
-Stores and concentrates bile and contracts to force bile into the duodenum during the digestion of fats
- The cystic duct joins the hepatic duct to form the common bile duct.
- The sphincter of Oddi is located at the entrance to the duodenum.
- The presence of fatty materials in the duodenum stimulates the liberation of cholecystokinin, which causes contraction of the gallbladder and relaxation of the sphincter of Oddi.
Pancreas
Exocrine gland
- Secretes sodium bicarbonate to neutralize the acidity of the stomach contents that enter the duodenum
-. Pancreatic juices contain enzymes for digesting carbohydrates, fats, and proteins.
Endocrine gland
- Secretes glucagon to raise blood glucose levels and secretes somatostatin to exert a hypoglycemic effect
- The islets of Langerhans secrete insulin.
- Insulin is secreted into the bloodstream and is important for carbohydrate metabolism.
Functions of the gastrointestinal system
- Process food substances.
- Absorb the products of digestion into the blood.
- Excrete unabsorbed materials.
- Provide an environment for microorganisms to synthesize nutrients, such as vitamin K.
Mouth
- Contains the lips, cheeks, palate, tongue, teeth, salivary glands, muscles, and maxillary bones
- Saliva contains the amylase enzyme (ptyalin) that aids in digestion.
Esophagus
- Collapsible muscular tube about 10 inches long
- Carries food from the pharynx to the stomach
The stomach
- Contains the cardia, fundus, the body, and the pylorus
- Mucous glands are located in the mucosa and prevent autodigestion by providing an alkaline protective covering.
- The lower esophageal (cardiac) sphincter prevents reflux of gastric contents into the esophagus.
- The pyloric sphincter regulates the rate of stomach emptying into the small intestine.
- Hydrochloric acid kills microorganisms, breaks food into small particles, and provides a chemical environment that facilitates gastric enzyme activation.
- Pepsin is the chief coenzyme of gastric juice, which converts proteins into proteases and peptones.
- Intrinsic factor is necessary for the absorption of vitamin B12.
- Gastrin controls gastric acidity.
Small intestine
- The duodenum contains the openings of the bile and pancreatic ducts.
- The jejunum is about 8 feet long.
- The ileum is about 12 feet long.
- The small intestine terminates in the cecum.
Pancreatic intestinal juice enzymes
- Amylase digests starch to maltose.
- Maltase reduces maltose to monosaccharide glucose.
- Lactase splits lactose into galactose and glucose.
- Sucrase reduces sucrose to fructose and glucose.
- Nucleases split nucleic acids to nucleotides.
-. Enterokinase activates trypsinogen to trypsin.
Large intestine
- About 5 feet long
- Absorbs water and eliminates wastes
- Intestinal bacteria play a vital role in the synthesis of some B vitamins and vitamin K.
- Colon: Includes the ascending, transverse, descending, and sigmoid colons and rectum
- The ileocecal valve prevents contents of the large intestine from entering the ileum.
- The anal sphincters control the anal canal.
Peritoneum: Lines the abdominal cavity and forms the mesentery that supports
the intestines and blood supply
Liver
-The largest gland in the body, weighing 3 to 4 lb.
-Contains Kupffer's cells, which remove bacteria in the portal venous blood
- Removes excess glucose and amino acids from the portal blood
- Synthesizes glucose, amino acids, and fats
- Aids in the digestion of fats, carbohydrates, and proteins
- Stores and filters blood (200 to 400 mL of blood stored)
- Stores vitamins A, D, and B and iron
- The liver secretes bile to emulsify fats (500 to 1000 mL of bile/day).
Hepatic ducts
a. Deliver bile to the gallbladder via the cystic duct and to the
duodenum via the common bile duct.
b. The common bile duct opens into the duodenum, with the pancreatic duct at the ampulla of Vater.
c. The sphincter prevents the reflux of intestinal contents into the
common bile duct and pancreatic duct.
Gallbladder
-Stores and concentrates bile and contracts to force bile into the duodenum during the digestion of fats
- The cystic duct joins the hepatic duct to form the common bile duct.
- The sphincter of Oddi is located at the entrance to the duodenum.
- The presence of fatty materials in the duodenum stimulates the liberation of cholecystokinin, which causes contraction of the gallbladder and relaxation of the sphincter of Oddi.
Pancreas
Exocrine gland
- Secretes sodium bicarbonate to neutralize the acidity of the stomach contents that enter the duodenum
-. Pancreatic juices contain enzymes for digesting carbohydrates, fats, and proteins.
Endocrine gland
- Secretes glucagon to raise blood glucose levels and secretes somatostatin to exert a hypoglycemic effect
- The islets of Langerhans secrete insulin.
- Insulin is secreted into the bloodstream and is important for carbohydrate metabolism.
“If at first you don't succeed, try, try again. Then quit. No use being a damn fool about it.” -WC Fields
Saturday, March 29, 2014
Anatomy and Physiology Notes: Endocrine System
This is an outlined lecture note on the Anatomy and Physiology of the Endocrine System. Some information are so compressed that some concepts are not explained in detail. If it is your first time to meet such information please refer to your textbook for further explanation of the concept. This review material requires a student to have a prior knowledge and good foundation of the subject matter for this only emphasizes important/ key information deemed important in understanding advanced concept in Pathophysiology and Medical Surgical Nursing.
Functions of Endocrine Glands
- Maintenance and regulation of vital functions
- Response to stress and injury
- Growth and development
- Energy metabolism
- Reproduction
- Fluid, electrolyte, and acid-base balance
Hypothalamus
- Portion of the diencephalon of the brain, forming the floor and part of the lateral wall of the third ventricle
- Activates, controls, and integrates the peripheral autonomic nervous system, endocrine processes, and many somatic functions, such as body temperature, sleep, and appetite
Pituitary gland
- The master gland; located at the base of the brain 2. Influenced by the hypothalamus; directly affects the function of the other endocrine glands
- Promotes growth of body tissue, influences water absorption by the kidney, and controls sexual development and function
Adrenal gland
- One adrenal gland is on top of each kidney.
- Regulates sodium and electrolyte balance; affects carbohydrate, fat, and protein metabolism; influences the development of sexual characteristics; and sustains the fight-or-flight response
Adrenal cortex
- The cortex is the outer shell of the adrenal gland.
-. The cortex synthesizes glucocorticoids and mineralocorticoids and secretes small amounts of sex hormones
Adrenal medulla
- The medulla is the inner core of the adrenal gland.
- The medulla works as part of the sympathetic nervous system and produces epinephrine and norepinephrine.
Thyroid gland
- Located in the anterior part of the neck
- Controls the rate of body metabolism and growth and produces thyroxine (T4), triiodothyronine (T3), and thyrocalcitonin
Parathyroid glands
- Located on the thyroid gland
- Control calcium and phosphorus metabolism; produce parathyroid hormone
Pancreas
- Located posteriorly to the stomach
- Influences carbohydrate metabolism, indirectly influences fat and protein metabolism, and produces insulin and glucagon
Ovaries and testes
-The ovaries are located in the pelvic cavity and produce estrogen and progesterone.
-The testes are located in the scrotum, control the development of the secondary sex characteristics, and produce testosterone.
Negative feedback loop
-Regulates hormone secretion by the hypothalamus and pituitary gland
-Increased amounts of target gland hormones in the bloodstream decrease secretion of the same hormone and other hormones that stimulate its release.
Functions of Endocrine Glands
- Maintenance and regulation of vital functions
- Response to stress and injury
- Growth and development
- Energy metabolism
- Reproduction
- Fluid, electrolyte, and acid-base balance
Hypothalamus
- Portion of the diencephalon of the brain, forming the floor and part of the lateral wall of the third ventricle
- Activates, controls, and integrates the peripheral autonomic nervous system, endocrine processes, and many somatic functions, such as body temperature, sleep, and appetite
Pituitary gland
- The master gland; located at the base of the brain 2. Influenced by the hypothalamus; directly affects the function of the other endocrine glands
- Promotes growth of body tissue, influences water absorption by the kidney, and controls sexual development and function
Adrenal gland
- One adrenal gland is on top of each kidney.
- Regulates sodium and electrolyte balance; affects carbohydrate, fat, and protein metabolism; influences the development of sexual characteristics; and sustains the fight-or-flight response
Adrenal cortex
- The cortex is the outer shell of the adrenal gland.
-. The cortex synthesizes glucocorticoids and mineralocorticoids and secretes small amounts of sex hormones
Adrenal medulla
- The medulla is the inner core of the adrenal gland.
- The medulla works as part of the sympathetic nervous system and produces epinephrine and norepinephrine.
Thyroid gland
- Located in the anterior part of the neck
- Controls the rate of body metabolism and growth and produces thyroxine (T4), triiodothyronine (T3), and thyrocalcitonin
Parathyroid glands
- Located on the thyroid gland
- Control calcium and phosphorus metabolism; produce parathyroid hormone
Pancreas
- Located posteriorly to the stomach
- Influences carbohydrate metabolism, indirectly influences fat and protein metabolism, and produces insulin and glucagon
Ovaries and testes
-The ovaries are located in the pelvic cavity and produce estrogen and progesterone.
-The testes are located in the scrotum, control the development of the secondary sex characteristics, and produce testosterone.
Negative feedback loop
-Regulates hormone secretion by the hypothalamus and pituitary gland
-Increased amounts of target gland hormones in the bloodstream decrease secretion of the same hormone and other hormones that stimulate its release.
“Success is getting what you want, happiness is wanting what you get” -Kinsela
Saturday, March 15, 2014
Anatomy and Physiology Notes: The Heart
Heart and heart wall layers
1. The heart is located in the left side of the mediastinum.
2. The heart consists of three layers.
a. The epicardium is the outermost layer of the heart.
b. The myocardium is the middle layer and is the
actual contracting muscle of the heart.
c. The endocardium is the innermost layer and lines
the inner chambers and heart valves.
Pericardial sac
1. Encases and protects the heart from trauma and infection
2. Has two layers
a. The parietal pericardium is the tough, fibrous outer membrane that attaches anteriorly to the lower half
of the sternum, posteriorly to the thoracic vertebrae, and inferiorly to the diaphragm.
b. The visceral pericardium is the thin, inner layer that closely adheres to the heart.
3. The pericardial space is between the parietal and visceral layers; it holds 5 to 20 mL of pericardial fluid, lubricates the pericardial surfaces, and cushions the heart.
There are four heart chambers
1. The right atrium receives deoxygenated blood from the body via the superior and inferior vena cava.
2. The right ventricle receives blood from the right atrium and pumps it to the lungs via the pulmonary artery.
3. The left atrium receives oxygenated blood from the lungs via four pulmonary veins.
4. The left ventricle is the largest and most muscular chamber; it receives oxygenated blood from the lungs via the left atrium and pumps blood into the systemic circulation via the aorta.
There are four valves in the heart.
1. There are two atrioventricular valves, the tricuspid and the mitral, which lie between the atria and ventricles.
a. The tricuspid valve is located on the right side of the heart.
b. The bicuspid (mitral) valve is located on the left side of the heart.
c. The atrioventricular valves close at the beginning of ventricular contraction and prevent blood from flowing
back into the atria from the ventricles; these valves open when the ventricle relaxes.
2. There are two semilunar valves, the pulmonic and the aortic.
a. The pulmonic semilunar valve lies between the right ventricle and the pulmonary artery.
b. The aortic semilunar valve lies between the left ventricle and the aorta.
c. The semilunar valves prevent blood from flowing back into the ventricles during relaxation; they open during
ventricular contraction and close when the ventricles begin to relax.
Sinoatrial (SA) node
1. The main pacemaker that initiates each heartbeat
2. It is located at the junction of the superior vena cava and the right atrium.
3. The sinoatrial node generates electrical impulses at 60 to 100 times per minute and is controlled by the sympathetic and parasympathetic nervous systems.
Atrioventricular (AV) node
1. Located in the lower aspect of the atrial septum
2. Receives electrical impulses from the sinoatrial node
3. If the sinoatrial node fails, the atrioventricular node can initiate
and sustain a heart rate of 40 to 60 beats/min.
The bundle of His
1. A continuation of the AV node; located at the interventricular septum
2. It branches into the right bundle branch, which extends down the right side of the interventricular septum, and the left bundle branch, which extends into the left ventricle.
3. The right and left bundle branches terminate into Purkinje fibers.
Purkinje fibers
1. Purkinje fibers are a diffuse network of conducting strands located beneath the ventricular endocardium.
2. These fibers spread the wave of depolarization through the ventricles.
3. Purkinje fibers can act as the pacemaker with a rate between 20 and 40 beats/min when higher pacemakers fail
Coronary arteries
1. The coronary arteries supply the capillaries of the myocardium with blood.
2. The right coronary artery supplies the right atrium and ventricle, the inferior portion of the left ventricle, the posterior septal wall, and the sinoatrial and atrioventricular nodes.
3. The left main coronary artery consists of two major branches, the left anterior descending and the circumflex arteries.
4. The left anterior descending artery supplies blood to the anterior wall of the left ventricle, the anterior ventricular septum, and the apex of the left ventricle.
5. The circumflex artery supplies blood to the left atrium and the
lateral and posterior surfaces of the left ventricle.
1. The heart is located in the left side of the mediastinum.
2. The heart consists of three layers.
a. The epicardium is the outermost layer of the heart.
b. The myocardium is the middle layer and is the
actual contracting muscle of the heart.
c. The endocardium is the innermost layer and lines
the inner chambers and heart valves.
Pericardial sac
1. Encases and protects the heart from trauma and infection
2. Has two layers
a. The parietal pericardium is the tough, fibrous outer membrane that attaches anteriorly to the lower half
of the sternum, posteriorly to the thoracic vertebrae, and inferiorly to the diaphragm.
b. The visceral pericardium is the thin, inner layer that closely adheres to the heart.
3. The pericardial space is between the parietal and visceral layers; it holds 5 to 20 mL of pericardial fluid, lubricates the pericardial surfaces, and cushions the heart.
There are four heart chambers
1. The right atrium receives deoxygenated blood from the body via the superior and inferior vena cava.
2. The right ventricle receives blood from the right atrium and pumps it to the lungs via the pulmonary artery.
3. The left atrium receives oxygenated blood from the lungs via four pulmonary veins.
4. The left ventricle is the largest and most muscular chamber; it receives oxygenated blood from the lungs via the left atrium and pumps blood into the systemic circulation via the aorta.
There are four valves in the heart.
1. There are two atrioventricular valves, the tricuspid and the mitral, which lie between the atria and ventricles.
a. The tricuspid valve is located on the right side of the heart.
b. The bicuspid (mitral) valve is located on the left side of the heart.
c. The atrioventricular valves close at the beginning of ventricular contraction and prevent blood from flowing
back into the atria from the ventricles; these valves open when the ventricle relaxes.
2. There are two semilunar valves, the pulmonic and the aortic.
a. The pulmonic semilunar valve lies between the right ventricle and the pulmonary artery.
b. The aortic semilunar valve lies between the left ventricle and the aorta.
c. The semilunar valves prevent blood from flowing back into the ventricles during relaxation; they open during
ventricular contraction and close when the ventricles begin to relax.
Sinoatrial (SA) node
1. The main pacemaker that initiates each heartbeat
2. It is located at the junction of the superior vena cava and the right atrium.
3. The sinoatrial node generates electrical impulses at 60 to 100 times per minute and is controlled by the sympathetic and parasympathetic nervous systems.
Atrioventricular (AV) node
1. Located in the lower aspect of the atrial septum
2. Receives electrical impulses from the sinoatrial node
3. If the sinoatrial node fails, the atrioventricular node can initiate
and sustain a heart rate of 40 to 60 beats/min.
The bundle of His
1. A continuation of the AV node; located at the interventricular septum
2. It branches into the right bundle branch, which extends down the right side of the interventricular septum, and the left bundle branch, which extends into the left ventricle.
3. The right and left bundle branches terminate into Purkinje fibers.
Purkinje fibers
1. Purkinje fibers are a diffuse network of conducting strands located beneath the ventricular endocardium.
2. These fibers spread the wave of depolarization through the ventricles.
3. Purkinje fibers can act as the pacemaker with a rate between 20 and 40 beats/min when higher pacemakers fail
Coronary arteries
1. The coronary arteries supply the capillaries of the myocardium with blood.
2. The right coronary artery supplies the right atrium and ventricle, the inferior portion of the left ventricle, the posterior septal wall, and the sinoatrial and atrioventricular nodes.
3. The left main coronary artery consists of two major branches, the left anterior descending and the circumflex arteries.
4. The left anterior descending artery supplies blood to the anterior wall of the left ventricle, the anterior ventricular septum, and the apex of the left ventricle.
5. The circumflex artery supplies blood to the left atrium and the
lateral and posterior surfaces of the left ventricle.
Friday, March 14, 2014
Notes on Fluid and Electrolytes 3: FLUID VOLUME EXCESS
FLUID VOLUME EXCESS
A. Description
1. Fluid intake or fluid retention exceeds the fluid needs of the body.
2. Fluid volume excess also is called overhydration or fluid overload.
3. The goal of treatment is to restore fluid balance, correct electrolyte imbalances if present, and eliminate or control the underlying cause of the overload.
B. Types
1. Isotonic overhydration
a. Known as hypervolemia, isotonic overhydration results from excessive fluid in the extracellular fluid compartment.
b. Only the extracellular fluid compartment is expanded, and fluid does not shift between the extracellular and
intracellular compartments.
c. Isotonic overhydration causes circulatory overload and interstitial edema; when severe or when it occurs in a client with poor cardiac function, congestive heart
failure and pulmonary edema can result.
2. Hypertonic overhydration
a. Occurrence of hypertonic overhydration is rare and is caused by an excessive sodium intake.
b. Fluid is drawn from the intracellular fluid compartment; the extracellular fluid volume expands, and the intracellular fluid volume contracts.
3. Hypotonic overhydration
a. Hypotonic overhydration is known as water intoxication.
b. The excessive fluid moves into the intracellular space, and all body fluid compartments expand.
c. Electrolyte imbalances occur as a result of dilution.
C. Causes
1. Isotonic overhydration
a. Inadequately controlled IV therapy
b. Renal failure
c. Long-term corticosteroid therapy
2. Hypertonic overhydration
a. Excessive sodium ingestion
b. Rapid infusion of hypertonic saline
c. Excessive sodium bicarbonate therapy
3. Hypotonic overhydration
a. Early renal failure
b. Congestive heart failure
c. Syndrome of inappropriate antidiuretic hormone secretion
d. Inadequately controlled IV therapy
e. Replacement of isotonic fluid loss with hypotonic fluids
f. Irrigation of wounds and body cavities with hypotonic fluids
D. Assessment
1. Cardiovascular
a. Bounding, increased pulse rate
b. Elevated blood pressure
c. Distended neck and hand veins
d. Elevated central venous pressure
2. Respiratory
a. Increased respiratory rate (shallow respirations)
b. Dyspnea
c. Moist crackles on auscultation
3. Neuromuscular
a. Altered level of consciousness
b. Headache
c. Visual disturbances
d. Skeletal muscle weakness
e. Paresthesias
4. Integumentary
a. Pitting edema in dependent areas
b. Skin pale and cool to touch
5. Increased motility in the gastrointestinal tract
6. Isotonic overhydration results in liver enlargement and ascites.
7. Hypotonic overhydration results in the following:
a. Polyuria
b. Diarrhea
c. Nonpitting edema
d. Dysrhythmias
e. Projectile vomiting
8. Laboratory findings
a. Decreased serum osmolality
b. Decreased hematocrit
c. Decreased BUN level
d. Decreased serum sodium level
e. Decreased urine specific gravity
E. Interventions
1. Monitor cardiovascular, respiratory, neuromuscular, renal, integumentary, and gastrointestinal status.
2. Prevent further fluid overload, and restore normal fluid balance.
3. Administer diuretics; osmotic diuretics typically are prescribed first to prevent severe electrolyte imbalances.
4. Restrict fluid and sodium intake.
5. Monitor intake and output and weight.
6. Monitor electrolyte values, and prepare to administer medication to treat an imbalance if present.
A. Description
1. Fluid intake or fluid retention exceeds the fluid needs of the body.
2. Fluid volume excess also is called overhydration or fluid overload.
3. The goal of treatment is to restore fluid balance, correct electrolyte imbalances if present, and eliminate or control the underlying cause of the overload.
B. Types
1. Isotonic overhydration
a. Known as hypervolemia, isotonic overhydration results from excessive fluid in the extracellular fluid compartment.
b. Only the extracellular fluid compartment is expanded, and fluid does not shift between the extracellular and
intracellular compartments.
c. Isotonic overhydration causes circulatory overload and interstitial edema; when severe or when it occurs in a client with poor cardiac function, congestive heart
failure and pulmonary edema can result.
2. Hypertonic overhydration
a. Occurrence of hypertonic overhydration is rare and is caused by an excessive sodium intake.
b. Fluid is drawn from the intracellular fluid compartment; the extracellular fluid volume expands, and the intracellular fluid volume contracts.
3. Hypotonic overhydration
a. Hypotonic overhydration is known as water intoxication.
b. The excessive fluid moves into the intracellular space, and all body fluid compartments expand.
c. Electrolyte imbalances occur as a result of dilution.
C. Causes
1. Isotonic overhydration
a. Inadequately controlled IV therapy
b. Renal failure
c. Long-term corticosteroid therapy
2. Hypertonic overhydration
a. Excessive sodium ingestion
b. Rapid infusion of hypertonic saline
c. Excessive sodium bicarbonate therapy
3. Hypotonic overhydration
a. Early renal failure
b. Congestive heart failure
c. Syndrome of inappropriate antidiuretic hormone secretion
d. Inadequately controlled IV therapy
e. Replacement of isotonic fluid loss with hypotonic fluids
f. Irrigation of wounds and body cavities with hypotonic fluids
D. Assessment
1. Cardiovascular
a. Bounding, increased pulse rate
b. Elevated blood pressure
c. Distended neck and hand veins
d. Elevated central venous pressure
2. Respiratory
a. Increased respiratory rate (shallow respirations)
b. Dyspnea
c. Moist crackles on auscultation
3. Neuromuscular
a. Altered level of consciousness
b. Headache
c. Visual disturbances
d. Skeletal muscle weakness
e. Paresthesias
4. Integumentary
a. Pitting edema in dependent areas
b. Skin pale and cool to touch
5. Increased motility in the gastrointestinal tract
6. Isotonic overhydration results in liver enlargement and ascites.
7. Hypotonic overhydration results in the following:
a. Polyuria
b. Diarrhea
c. Nonpitting edema
d. Dysrhythmias
e. Projectile vomiting
8. Laboratory findings
a. Decreased serum osmolality
b. Decreased hematocrit
c. Decreased BUN level
d. Decreased serum sodium level
e. Decreased urine specific gravity
E. Interventions
1. Monitor cardiovascular, respiratory, neuromuscular, renal, integumentary, and gastrointestinal status.
2. Prevent further fluid overload, and restore normal fluid balance.
3. Administer diuretics; osmotic diuretics typically are prescribed first to prevent severe electrolyte imbalances.
4. Restrict fluid and sodium intake.
5. Monitor intake and output and weight.
6. Monitor electrolyte values, and prepare to administer medication to treat an imbalance if present.
Wednesday, March 5, 2014
Anatomy and Physiology Quiz
I. Fluid and Electrolyte and Acid – Base Balance
1. Approximately 60% of the weight of a typical adult consists of fluid. Body fluid is located in two fluid compartments namely what?
a. Intracellular and intravascular
b. Extracellular and intracellular
c. Intracellular and interstitial
d. Extravascular and intracellular
2. When two different solutions are separated by a membrane that is impermeable to the dissolved substances, fluid shifts through the membrane from the region of low solute concentration to the region of high solute concentration until the solutions are of equal concentration. This diffusion of water caused by a fluid concentration gradient is known as what?
a. Diffusion
b. Filtration
c. Osmosis
d. Active Transportation
3. Hydrostatic pressure in the capillaries tends to filter fluid out of the intravascular compartment into the interstitial fluid. Movement of water and solutes occurs from an area of high hydrostatic pressure to an area of low hydrostatic pressure is known as what?
a. Diffusion
b. Filtration
c. Osmosis
d. Active Transport
4. A patient presented the following signs and symptoms: confusion, muscle cramps and weakness, dry skin, ↑pulse, ↓ BP. The patient’s lab result shows ↓ serum and urine sodium and ↓ urine specific gravity. The doctor told you that the patient is exhibiting hyponatremia. Hyponatremia is having a serum sodium below what? (Smeltzer 2012)
a. 145 mEq/L
b. 108 mEq/L
c. 96.5 mEq/L
d. 135 mEq/L
5. A patient with congestive heart failure is given oral potassium supplements to avoid digoxin toxicity. As a nurse you are aware that the normal serum level for potassium is what? (Smeltzer 2012)
a. 135-145 mEq/L
b. 3.5-5.0 mEq/L
c. 8.5-10.5 mg/dL
d. 1.8-2.7 mg/dL
Evaluate the following arterial blood gas values
6. pH: 7.5 PaCO2: 31 HCO3 : 26
7. pH: 7.38 PaCO2: 32 HCO3: 19
8. pH: 7.24 PaCO2: 60 HCO3: 32
9. pH: 7.41 PaCO2: 30 HCO3 18
10. pH: 7.5 PaCO2: 42 HCO3: 33
II. Respiratory System
11. Resting respiration is the result of cyclic excitation of the respiratory muscles by the phrenic nerve. The rhythm of breathing is controlled by respiratory centers in the brain. The inspiratory and expiratory center is located in the?
a. Medulla Oblongata
b. Hypothalamus
c. Pons
d. Cerebellum
12. The _____ center in the lower pons stimulates the inspiratory medullary center to promote deep, prolonged inspirations.
a. Pneumotaxic
b. Apneustic
c. Chemotaxic
d. Physiotaxic
13. A term that correspond the amount of air inhaled and exhaled with each breath.
a. Residual Volume
b. Inspiratory Reserve Volume
c. Expiratory Reserve Volume
d. Tidal Volume
14. It is the volume of air in the lungs after maximum inhalation
a. Vital Capacity
b. Inspiratory Capacity
c. Functional Residual Capacity
d. Total Lung Capacity
15. The volume of air remaining in the lungs after a normal expiration .
a. Vital Capacity
b. Inspiratory Capacity
c. Functional Residual Capacity
d. Total Lung Capacity
III. Cardiovascular System
16. It is the ability of the heart to initiate electrical impulse.
a. Excitability
b. Automaticity
c. Conductivity
d. Permeability
17. It is called as the primary pace maker of the heart which fires 60 to 100 impulse per minute
a. SA Node
b. AV Node
c. Bundle of His
d. Purkinje Fibers
18. The ___ coordinates the incoming electrical impulses from the atria and after a slight delay, allowing the atria time to contract and complete ventricular filling then relays the impulse to the ventricles.
a. SA Node
b. AV Node
c. Bundle of His
d. Purkinje Fibers
19. This heart sound is created by the closure of the tricuspid and bicuspid valve
a. S1
b. S2
c. S3
d. S4
20. This heart sound is created b the closure of the pulmonic and aortic valves
a. S1
b. S2
c. S3
d. S4
1. Approximately 60% of the weight of a typical adult consists of fluid. Body fluid is located in two fluid compartments namely what?
a. Intracellular and intravascular
b. Extracellular and intracellular
c. Intracellular and interstitial
d. Extravascular and intracellular
2. When two different solutions are separated by a membrane that is impermeable to the dissolved substances, fluid shifts through the membrane from the region of low solute concentration to the region of high solute concentration until the solutions are of equal concentration. This diffusion of water caused by a fluid concentration gradient is known as what?
a. Diffusion
b. Filtration
c. Osmosis
d. Active Transportation
3. Hydrostatic pressure in the capillaries tends to filter fluid out of the intravascular compartment into the interstitial fluid. Movement of water and solutes occurs from an area of high hydrostatic pressure to an area of low hydrostatic pressure is known as what?
a. Diffusion
b. Filtration
c. Osmosis
d. Active Transport
4. A patient presented the following signs and symptoms: confusion, muscle cramps and weakness, dry skin, ↑pulse, ↓ BP. The patient’s lab result shows ↓ serum and urine sodium and ↓ urine specific gravity. The doctor told you that the patient is exhibiting hyponatremia. Hyponatremia is having a serum sodium below what? (Smeltzer 2012)
a. 145 mEq/L
b. 108 mEq/L
c. 96.5 mEq/L
d. 135 mEq/L
5. A patient with congestive heart failure is given oral potassium supplements to avoid digoxin toxicity. As a nurse you are aware that the normal serum level for potassium is what? (Smeltzer 2012)
a. 135-145 mEq/L
b. 3.5-5.0 mEq/L
c. 8.5-10.5 mg/dL
d. 1.8-2.7 mg/dL
Evaluate the following arterial blood gas values
6. pH: 7.5 PaCO2: 31 HCO3 : 26
7. pH: 7.38 PaCO2: 32 HCO3: 19
8. pH: 7.24 PaCO2: 60 HCO3: 32
9. pH: 7.41 PaCO2: 30 HCO3 18
10. pH: 7.5 PaCO2: 42 HCO3: 33
II. Respiratory System
11. Resting respiration is the result of cyclic excitation of the respiratory muscles by the phrenic nerve. The rhythm of breathing is controlled by respiratory centers in the brain. The inspiratory and expiratory center is located in the?
a. Medulla Oblongata
b. Hypothalamus
c. Pons
d. Cerebellum
12. The _____ center in the lower pons stimulates the inspiratory medullary center to promote deep, prolonged inspirations.
a. Pneumotaxic
b. Apneustic
c. Chemotaxic
d. Physiotaxic
13. A term that correspond the amount of air inhaled and exhaled with each breath.
a. Residual Volume
b. Inspiratory Reserve Volume
c. Expiratory Reserve Volume
d. Tidal Volume
14. It is the volume of air in the lungs after maximum inhalation
a. Vital Capacity
b. Inspiratory Capacity
c. Functional Residual Capacity
d. Total Lung Capacity
15. The volume of air remaining in the lungs after a normal expiration .
a. Vital Capacity
b. Inspiratory Capacity
c. Functional Residual Capacity
d. Total Lung Capacity
III. Cardiovascular System
16. It is the ability of the heart to initiate electrical impulse.
a. Excitability
b. Automaticity
c. Conductivity
d. Permeability
17. It is called as the primary pace maker of the heart which fires 60 to 100 impulse per minute
a. SA Node
b. AV Node
c. Bundle of His
d. Purkinje Fibers
18. The ___ coordinates the incoming electrical impulses from the atria and after a slight delay, allowing the atria time to contract and complete ventricular filling then relays the impulse to the ventricles.
a. SA Node
b. AV Node
c. Bundle of His
d. Purkinje Fibers
19. This heart sound is created by the closure of the tricuspid and bicuspid valve
a. S1
b. S2
c. S3
d. S4
20. This heart sound is created b the closure of the pulmonic and aortic valves
a. S1
b. S2
c. S3
d. S4
Monday, March 3, 2014
Anatomy and Physiology Notes: Respiratory System
Primary functions of the respiratory system
1. Provides oxygen for metabolism in the tissues
2. Removes carbon dioxide, the waste product of metabolism
Secondary functions of the respiratory system
1. Facilitates sense of smell
2. Produces speech
3. Maintains acid-base balance
4. Maintains body water levels
5. Maintains heat balance
Upper respiratory tract
1. Nose: Humidifies, warms, and filters inspired air
2. Sinuses: Air-filled cavities within the hollow bones that surround the nasal passages and provide resonance during speech
3. Pharynx
a. Passageway for the respiratory and digestive tracts located behind
the oral and nasal cavities
b. Divided into the nasopharynx, oropharynx, and laryngopharynx
4. Larynx
a. Located above the trachea, just below the pharynx at the root of
the tongue; commonly called the voice box
b. Contains two pairs of vocal cords, the false and true cords
c. The opening between the true vocal cords is the glottis.
d. The glottis plays an important role in coughing, which is the most
fundamental defense mechanism of the lungs.
5. Epiglottis
a. Leaf-shaped elastic structure attached along one end to the top of
the larynx
b. Prevents food from entering the tracheobronchial tree by closing
over the glottis during swallowing
Lower respiratory tract
1. Trachea: Located in front of the esophagus; branches into the right
and left main stem bronchi at the carina
2. Main stem bronchi
a. Begin at the carina
b. The right bronchus is slightly wider, shorter, and more vertical than the left bronchus.
c. The mainstem bronchi divide into secondary or lobar bronchi that enter each of the five lobes of the lung.
d. The bronchi are lined with cilia, which propel mucus up and away from the lower airway to the trachea, where it can be expectorated or swallowed.
3. Bronchioles
a. Branch from the secondary bronchi and subdivide into the small terminal and respiratory bronchioles
b. The bronchioles contain no cartilage and depend on the elastic recoil of the lung for patency.
c. The terminal bronchioles contain no cilia and do not participate in gas exchange.
4. Alveolar ducts and alveoli
a. Acinus (plural acini) is a term used to indicate all structures distal to the terminal bronchiole.
b. Alveolar ducts branch from the respiratory bronchioles.
c. Alveolar sacs, which arise from the ducts, contain clusters of alveoli, which are the basic units of gas exchange.
d. Type II alveolar cells in the walls of the alveoli secrete surfactant, a phospholipid protein that reduces the surface tension in the alveoli; without surfactant, the alveoli would collapse.
5. Lungs
a. Located in the pleural cavity in the thorax
b. Extend from just above the clavicles to the diaphragm, the major muscle of inspiration
c. The right lung, which is larger than the left, is divided into three lobes, the upper, middle, and lower lobes.
d. The left lung, which is narrower than the right lung to accommodate the heart, is divided into two lobes.
e. The respiratory structures are innervated by the phrenic nerve, the vagus nerve, and the thoracic nerves.
f. The parietal pleura lines the inside of the thoracic cavity, including the upper surface of the diaphragm.
g. The visceral pleura covers the pulmonary surfaces.
h. A thin fluid layer, which is produced by the cells lining the pleura, lubricates the visceral pleura and the parietal pleura, allowing them to glide smoothly and painlessly during respiration.
i. Blood flows through the lungs via the pulmonary system and
the bronchial system.
6. Accessory muscles of respiration include the scalene muscles, which elevate the first two ribs, the sternocleidomastoid muscles, which raise the sternum, and the trapezius and pectoralis muscles, which fix
the shoulders.
Respiratpry Process
a. The diaphragm descends into the abdominal cavity during inspiration, causing negative pressure in the lungs.
b. The negative pressure draws air from the area of greater pressure, the atmosphere, into the area of lesser pressure, the lungs.
c. In the lungs, air passes through the terminal bronchioles into the alveoli to oxygenate the body tissues.
d. At the end of inspiration, the diaphragm and intercostal muscles relax and the lungs recoil.
e. As the lungs recoil, pressure within the lungs becomes higher than atmospheric pressure, causing the air, which now contains the cellular waste products carbon dioxide and water, to move from the alveoli in the lungs to the atmosphere.
f. Effective gas exchange depends on distribution of gas (ventilation) and blood (perfusion) in all portions of the lungs
Friday, February 28, 2014
Human Immunodeficiency Virus / Acquired immunodeficiency syndrome Lecture Notes
This is a Medical Surgical Nursing lecture note on AIDS/HIV in outlined format. Information and concepts are compressed to provide a quick review of the topic. Some information are so compressed that some concepts are not expounded in detail. If it is your first time to meet such information please refer to your textbook for further explanation of the concept. This review material requires a student to have a prior knowledge and good foundation of the subject matter for this only emphasizes important/ key information deemed important in understanding concepts in Pathophysiology and Medical Surgical Nursing.
Acquired immunodeficiency syndrome (AIDS)
High-risk groups
Heterosexual or homosexual contact with high-risk individuals
Intravenous drug abusers
Persons receiving blood products
Health care workers
Babies born to infected mothers
Assessment
Malaise, fever, anorexia, weight loss, influenza-like symptoms
Lymphadenopathy for at least 3 months
Leukopenia
Diarrhea
Fatigue
Night sweats
Presence of opportunistic infections
Protozoal infections (Pneumocystis jiroveci pneumonia, major source of mortality)
Neoplasms (Kaposi's sarcoma, purplish-red lesions of internal organs and skin, B-cell non-Hodgkin's lymphoma, cervical cancer)
Fungal infections (candidiasis, histoplasmosis)
Viral infections (cytomegalovirus, herpes simplex)
Bacterial infections
Interventions
1. Provide respiratory support.
2. Administer oxygen and respiratory treatments as prescribed.
3. Provide psychosocial support as needed.
4. Maintain fluid and electrolyte balance.
5. Monitor for signs of infection.
6. Prevent the spread of infection.
7. Initiate standard precautions.
8. Provide comfort as necessary.
9. Provide meticulous skin care.
10. Provide adequate nutritional support as prescribed.
Acquired immunodeficiency syndrome (AIDS)
- AIDS is a viral disease caused by human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy
- The syndrome is manifested clinically by opportunistic infection and unusual neoplasms.
- AIDS is considered a chronic illness.
- The disease has a long incubation period, sometimes 10 years or longer.
- Manifestations may not appear until late in the infection.
High-risk groups
Heterosexual or homosexual contact with high-risk individuals
Intravenous drug abusers
Persons receiving blood products
Health care workers
Babies born to infected mothers
Assessment
Malaise, fever, anorexia, weight loss, influenza-like symptoms
Lymphadenopathy for at least 3 months
Leukopenia
Diarrhea
Fatigue
Night sweats
Presence of opportunistic infections
Protozoal infections (Pneumocystis jiroveci pneumonia, major source of mortality)
Neoplasms (Kaposi's sarcoma, purplish-red lesions of internal organs and skin, B-cell non-Hodgkin's lymphoma, cervical cancer)
Fungal infections (candidiasis, histoplasmosis)
Viral infections (cytomegalovirus, herpes simplex)
Bacterial infections
Interventions
1. Provide respiratory support.
2. Administer oxygen and respiratory treatments as prescribed.
3. Provide psychosocial support as needed.
4. Maintain fluid and electrolyte balance.
5. Monitor for signs of infection.
6. Prevent the spread of infection.
7. Initiate standard precautions.
8. Provide comfort as necessary.
9. Provide meticulous skin care.
10. Provide adequate nutritional support as prescribed.
"Success is not final, failure is not fatal: it is the courage to continue that counts"
Tuesday, February 18, 2014
Pre-Board Exam Drill: Maternal Child and Community Health Nursing C
This is a 30 point Pre-Board Exam Drill on Maternal and Child Nursing and Community Health Nursing SET C.
Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!
1.When assessing a newborn diagnosed with ductus arteriosus, Nurse Melissa should expect that the child most likely would have an:
a. Loud, machinery-like murmur.
b. Bluish color to the lips.
c. Decreased BP reading in the upper extremities
d. Increased BP reading in the upper extremities.
2.The reason nurse May keeps the neonate in a neutral thermal environment is that when a newborn becomes too cool, the neonate requires:
a. Less oxygen, and the newborn’s metabolic rate increases.
b. More oxygen, and the newborn’s metabolic rate decreases.
c. More oxygen, and the newborn’s metabolic rate increases.
d. Less oxygen, and the newborn’s metabolic rate decreases.
3.Before adding potassium to an infant’s I.V. line, Nurse Ron must be sure to assess whether this infant has:
a. Stable blood pressure
b. Patant fontanelles
c. Moro’s reflex
d. Voided
4.Nurse Fe should know that the most common causative factor of dermatitis in infants and younger children is:
a. Baby oil
b. Baby lotion
c. Laundry detergent
d. Powder with cornstarch
5.During tube feeding, how far above an infant’s stomach should the nurse hold the syringe with formula?
a. 6 inches
b. 12 inches
c. 18 inches
d. 24 inches
6. In a mothers’ class, Nurse Lhynnete discussed childhood diseases such as chicken pox. Which of the following statements about chicken pox is correct?
a. The older one gets, the more susceptible he becomes to the complications of chicken pox.
b. A single attack of chicken pox will prevent future episodes, including conditions such as shingles.
c. To prevent an outbreak in the community, quarantine may be imposed by health authorities.
d. Chicken pox vaccine is best given when there is an impending outbreak in the community.
7.Barangay Wakwak had an outbreak of German measles. To prevent congenital rubella, what is the BEST advice that you can give to women in the first trimester of pregnancy in the barangay Wakwak?
a. Advice them on the signs of German measles.
b. Avoid crowded places, such as markets and movie houses.
c. Consult at the health center where rubella vaccine may be given.
d. Consult a physician who may give them rubella immunoglobulin.
8. May Anne a public health nurse knows that to determine possible sources of sexually transmitted infections, the BEST method that may be undertaken is:
a. Contact tracing
b. Community survey
c. Mass screening tests
d. Interview of suspects
9. Claudine, a 33-year old female client came for consultation at the health center with the chief complaint of fever for a week. Accompanying symptoms were muscle pains and body malaise. A week after the start of fever, the client noted yellowish discoloration of his sclera. History showed that he waded in flood waters about 2 weeks before the onset of symptoms. Based on her history, which disease condition will you suspect?
a. Hepatitis A
b. Hepatitis B
c. Tetanus
d. Leptospirosis
10. Ronie a 3-year old client was brought to the health center with the chief complaint of severe diarrhea and the passage of “rice water” stools. The client is most probably suffering from which condition?
a. Giardiasis
b. Cholera
c. Amebiasis
d. Dysentery
11.The most prevalent form of meningitis among children aged 2 months to 3 years is caused by which microorganism?
a. Hemophilus influenzae
b. Morbillivirus
c. Steptococcus pneumoniae
d. Neisseria meningitidis
12.The student nurse is aware that the pathognomonic sign of measles is Koplik’s spot and you may see Koplik’s spot by inspecting the:
a. Nasal mucosa
b. Buccal mucosa
c. Skin on the abdomen
d. Skin on neck
13.Angel was diagnosed as having Dengue fever. You will say that there is slow capillary refill when the color of the nailbed that you pressed does not return within how many seconds?
a. 3 seconds
b. 6 seconds
c. 9 seconds
d. 10 seconds
14.In Integrated Management of Childhood Illness, the nurse is aware that the severe conditions generally require urgent referral to a hospital. Which of the following severe conditions DOES NOT always require urgent referral to a hospital?
a. Mastoiditis
b. Severe dehydration
c. Severe pneumonia
d. Severe febrile disease
15.Myrna a public health nurse will conduct outreach immunization in a barangay Masay with a population of about 1500. The estimated number of infants in the barangay would be:
a. 45 infants
b. 50 infants
c. 55 infants
d. 65 infants
16.The community nurse is aware that the biological used in Expanded Program on Immunization (EPI) should NOT be stored in the freezer?
a. DPT
b. Oral polio vaccine
c. Measles vaccine
d. MMR
17.It is the most effective way of controlling schistosomiasis in an endemic area?
a. Use of molluscicides
b. Building of foot bridges
c. Proper use of sanitary toilets
d. Use of protective footwear, such as rubber boots
18.Several clients is newly admitted and diagnosed with leprosy. Which of the following clients should be classified as a case of multibacillary leprosy?
a. 3 skin lesions, negative slit skin smear
b. 3 skin lesions, positive slit skin smear
c. 5 skin lesions, negative slit skin smear
d. 5 skin lesions, positive slit skin smear
19.Nurses are aware that diagnosis of leprosy is highly dependent on recognition of symptoms. Which of the following is an early sign of
leprosy?
a. Macular lesions
b. Inability to close eyelids
c. Thickened painful nerves
d. Sinking of the nosebridge
20. Perlita brought her 10 month old infant for consultation because of fever, started 4 days prior to consultation. In determining malaria risk, what will you do?
a. Perform a tourniquet test.
b. Ask where the family resides.
c. Get a specimen for blood smear.
d. Ask if the fever is present everyday.
Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!
1.When assessing a newborn diagnosed with ductus arteriosus, Nurse Melissa should expect that the child most likely would have an:
a. Loud, machinery-like murmur.
b. Bluish color to the lips.
c. Decreased BP reading in the upper extremities
d. Increased BP reading in the upper extremities.
2.The reason nurse May keeps the neonate in a neutral thermal environment is that when a newborn becomes too cool, the neonate requires:
a. Less oxygen, and the newborn’s metabolic rate increases.
b. More oxygen, and the newborn’s metabolic rate decreases.
c. More oxygen, and the newborn’s metabolic rate increases.
d. Less oxygen, and the newborn’s metabolic rate decreases.
3.Before adding potassium to an infant’s I.V. line, Nurse Ron must be sure to assess whether this infant has:
a. Stable blood pressure
b. Patant fontanelles
c. Moro’s reflex
d. Voided
4.Nurse Fe should know that the most common causative factor of dermatitis in infants and younger children is:
a. Baby oil
b. Baby lotion
c. Laundry detergent
d. Powder with cornstarch
5.During tube feeding, how far above an infant’s stomach should the nurse hold the syringe with formula?
a. 6 inches
b. 12 inches
c. 18 inches
d. 24 inches
6. In a mothers’ class, Nurse Lhynnete discussed childhood diseases such as chicken pox. Which of the following statements about chicken pox is correct?
a. The older one gets, the more susceptible he becomes to the complications of chicken pox.
b. A single attack of chicken pox will prevent future episodes, including conditions such as shingles.
c. To prevent an outbreak in the community, quarantine may be imposed by health authorities.
d. Chicken pox vaccine is best given when there is an impending outbreak in the community.
7.Barangay Wakwak had an outbreak of German measles. To prevent congenital rubella, what is the BEST advice that you can give to women in the first trimester of pregnancy in the barangay Wakwak?
a. Advice them on the signs of German measles.
b. Avoid crowded places, such as markets and movie houses.
c. Consult at the health center where rubella vaccine may be given.
d. Consult a physician who may give them rubella immunoglobulin.
8. May Anne a public health nurse knows that to determine possible sources of sexually transmitted infections, the BEST method that may be undertaken is:
a. Contact tracing
b. Community survey
c. Mass screening tests
d. Interview of suspects
9. Claudine, a 33-year old female client came for consultation at the health center with the chief complaint of fever for a week. Accompanying symptoms were muscle pains and body malaise. A week after the start of fever, the client noted yellowish discoloration of his sclera. History showed that he waded in flood waters about 2 weeks before the onset of symptoms. Based on her history, which disease condition will you suspect?
a. Hepatitis A
b. Hepatitis B
c. Tetanus
d. Leptospirosis
10. Ronie a 3-year old client was brought to the health center with the chief complaint of severe diarrhea and the passage of “rice water” stools. The client is most probably suffering from which condition?
a. Giardiasis
b. Cholera
c. Amebiasis
d. Dysentery
11.The most prevalent form of meningitis among children aged 2 months to 3 years is caused by which microorganism?
a. Hemophilus influenzae
b. Morbillivirus
c. Steptococcus pneumoniae
d. Neisseria meningitidis
12.The student nurse is aware that the pathognomonic sign of measles is Koplik’s spot and you may see Koplik’s spot by inspecting the:
a. Nasal mucosa
b. Buccal mucosa
c. Skin on the abdomen
d. Skin on neck
13.Angel was diagnosed as having Dengue fever. You will say that there is slow capillary refill when the color of the nailbed that you pressed does not return within how many seconds?
a. 3 seconds
b. 6 seconds
c. 9 seconds
d. 10 seconds
14.In Integrated Management of Childhood Illness, the nurse is aware that the severe conditions generally require urgent referral to a hospital. Which of the following severe conditions DOES NOT always require urgent referral to a hospital?
a. Mastoiditis
b. Severe dehydration
c. Severe pneumonia
d. Severe febrile disease
15.Myrna a public health nurse will conduct outreach immunization in a barangay Masay with a population of about 1500. The estimated number of infants in the barangay would be:
a. 45 infants
b. 50 infants
c. 55 infants
d. 65 infants
16.The community nurse is aware that the biological used in Expanded Program on Immunization (EPI) should NOT be stored in the freezer?
a. DPT
b. Oral polio vaccine
c. Measles vaccine
d. MMR
17.It is the most effective way of controlling schistosomiasis in an endemic area?
a. Use of molluscicides
b. Building of foot bridges
c. Proper use of sanitary toilets
d. Use of protective footwear, such as rubber boots
18.Several clients is newly admitted and diagnosed with leprosy. Which of the following clients should be classified as a case of multibacillary leprosy?
a. 3 skin lesions, negative slit skin smear
b. 3 skin lesions, positive slit skin smear
c. 5 skin lesions, negative slit skin smear
d. 5 skin lesions, positive slit skin smear
19.Nurses are aware that diagnosis of leprosy is highly dependent on recognition of symptoms. Which of the following is an early sign of
leprosy?
a. Macular lesions
b. Inability to close eyelids
c. Thickened painful nerves
d. Sinking of the nosebridge
20. Perlita brought her 10 month old infant for consultation because of fever, started 4 days prior to consultation. In determining malaria risk, what will you do?
a. Perform a tourniquet test.
b. Ask where the family resides.
c. Get a specimen for blood smear.
d. Ask if the fever is present everyday.
"Try not to become a man of success, but rather try to become a man of value."
Friday, February 14, 2014
Pre-Board Exam Drill: Maternal Child and Community Health Nursing B
This is a 30 point Pre-Board Exam Drill on Maternal and Child Nursing and Community Health Nursing SET B.
Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!
1.According to Freeman and Heinrich, community health nursing is a developmental service. Which of the following best illustrates this statement?
a. The community health nurse continuously develops himself personally and professionally.
b. Health education and community organizing are necessary in providing community health services.
c. Community health nursing is intended primarily for health promotion and prevention and treatment of disease.
d. The goal of community health nursing is to provide nursing services to people in their own places of residence.
2.Nurse Marie is aware that the disease declared through Presidential Proclamation No. 4 as a target for eradication in the Philippines is?
a. Poliomyelitis
b. Measles
c. Rabies
d. Neonatal tetanus
3. Nure Franciene knows that the step in community organizing that involves training of potential leaders in the community is:
a. Integration
b. Community organization
c. Community study
d. Core group formation
4. Nurse Anna a public health nurse takes an active role in community participation. What is the primary goal of community organizing?
a. To educate the people regarding community health problems
b. To mobilize the people to resolve community health problems
c. To maximize the community’s resources in dealing with health problems.
d. To maximize the community’s resources in dealing with health problems.
5.Tertiary prevention is needed in which stage of the natural history of disease?
a. Pre-pathogenesis
b. Pathogenesis
c. Prodromal
d. Terminal
6.The nurse is caring for a primigravid client in the labor and delivery area. Which condition would place the client at risk for disseminated intravascular coagulation (DIC)?
a. Intrauterine fetal death.
b. Placenta accreta.
c. Dysfunctional labor.
d. Premature rupture of the membranes.
7.A fullterm client is in labor. Nurse Betty is aware that the fetal heart rate would be:
a. 80 to 100 beats/minute
b. 100 to 120 beats/minute
c. 120 to 160 beats/minute
d. 160 to 180 beats/minute
8.The skin in the diaper area of a 7 month old infant is excoriated and red. Nurse Gretel should instruct the mother to:
a. Change the diaper more often.
b. Apply talc powder with diaper changes.
c. Wash the area vigorously with each diaper change.
d. Decrease the infant’s fluid intake to decrease saturating diapers.
9.Nurse Carlos knows that the common cardiac anomalies in children with Down Syndrome (tri-somy 21) is:
a. Atrial septal defect
b. Pulmonic stenosis
c. Ventricular septal defect
d. Endocardial cushion defect
10. Nurse Cristeta was diagnosed with severe preeclampsia is now receiving I.V. magnesium sulfate. The adverse effects associated with magnesium sulfate is:
a. Anemia
b. Decreased urine output
c. Hyperreflexia
d. Increased respiratory rate
11. Mrs. Pregy Der, a 23 year old client is having her menstrual period every 2 weeks that last for 1 week. This type of menstrual pattern is bets defined by:
a. Menorrhagia
b. Metrorrhagia
c. Dyspareunia
d. Amenorrhea
12. Mrs. Caby Nhet is admitted to the labor and delivery unit. The critical laboratory result for this client would be:
a. Oxygen saturation
b. Iron binding capacity
c. Blood typing
d. Serum Calcium
13.Nurse Dorothy is aware that the most common condition found during the second-trimester of pregnancy is:
a. Metabolic alkalosis
b. Respiratory acidosis
c. Mastitis
d. Physiologic anemia
14.Nurse Imo Gin is working in the triage area of an emergency department. She sees that several pediatric clients arrive simultaneously. The client who needs to be treated first is:
a. A crying 5 year old child with a laceration on his scalp.
b. A 4 year old child with a barking coughs and flushed appearance.
c. A 3 year old child with Down syndrome who is pale and asleep in
his mother’s arms.
d. A 2 year old infant with stridorous breath sounds, sitting up in his
mother’s arms and drooling.
15. Mrs. Calista in her third trimester arrives at the emergency room with painless vaginal bleeding. Which of the following conditions is suspected?
a. Placenta previa
b. Abruptio placentae
c. Premature labor
d. Sexually transmitted disease
16.A young child named Louella is suspected of having pinworms. The community nurse collects a stool specimen to confirm the diagnosis. The nurse should schedule the collection of this specimen for:
a. Just before bedtime
b. After the child has been bathe
c. Any time during the day
d. Early in the morning
17.In doing a child’s admission assessment, Nurse Angelique should be alert to note which signs or symptoms of chronic lead poisoning?
a. Irritability and seizures
b. Dehydration and diarrhea
c. Bradycardia and hypotension
d. Petechiae and hematuria
18.To evaluate a woman’s understanding about the use of diaphragm for family planning, Nurse Trish asks her to explain how she will use the appliance. Which response indicates a need for further health teaching?
a. “I should check the diaphragm carefully for holes every time I use it”
b. “I may need a different size of diaphragm if I gain or lose weight more than 20 pounds”
c. “The diaphragm must be left in place for atleast 6 hours after intercourse”
d. “I really need to use the diaphragm and jelly most during the middle of my menstrual cycle”.
19.Hypoxia is a common complication of laryngotracheobronchitis. Nurse Oliver should frequently assess a child with laryngotracheobronchitis for:
a. Drooling
b. Muffled voice
c. Restlessness
d. Low-grade fever
20.How should Nurse Melanie Marquez guide a child who is blind to walk to the playroom?
a. Without touching the child, talk continuously as the child walks down the hall.
b. Walk one step ahead, with the child’s hand on the nurse’s elbow.
c. Walk slightly behind, gently guiding the child forward.
d. Walk next to the child, holding the child’s hand.
Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!
1.According to Freeman and Heinrich, community health nursing is a developmental service. Which of the following best illustrates this statement?
a. The community health nurse continuously develops himself personally and professionally.
b. Health education and community organizing are necessary in providing community health services.
c. Community health nursing is intended primarily for health promotion and prevention and treatment of disease.
d. The goal of community health nursing is to provide nursing services to people in their own places of residence.
2.Nurse Marie is aware that the disease declared through Presidential Proclamation No. 4 as a target for eradication in the Philippines is?
a. Poliomyelitis
b. Measles
c. Rabies
d. Neonatal tetanus
3. Nure Franciene knows that the step in community organizing that involves training of potential leaders in the community is:
a. Integration
b. Community organization
c. Community study
d. Core group formation
4. Nurse Anna a public health nurse takes an active role in community participation. What is the primary goal of community organizing?
a. To educate the people regarding community health problems
b. To mobilize the people to resolve community health problems
c. To maximize the community’s resources in dealing with health problems.
d. To maximize the community’s resources in dealing with health problems.
5.Tertiary prevention is needed in which stage of the natural history of disease?
a. Pre-pathogenesis
b. Pathogenesis
c. Prodromal
d. Terminal
6.The nurse is caring for a primigravid client in the labor and delivery area. Which condition would place the client at risk for disseminated intravascular coagulation (DIC)?
a. Intrauterine fetal death.
b. Placenta accreta.
c. Dysfunctional labor.
d. Premature rupture of the membranes.
7.A fullterm client is in labor. Nurse Betty is aware that the fetal heart rate would be:
a. 80 to 100 beats/minute
b. 100 to 120 beats/minute
c. 120 to 160 beats/minute
d. 160 to 180 beats/minute
8.The skin in the diaper area of a 7 month old infant is excoriated and red. Nurse Gretel should instruct the mother to:
a. Change the diaper more often.
b. Apply talc powder with diaper changes.
c. Wash the area vigorously with each diaper change.
d. Decrease the infant’s fluid intake to decrease saturating diapers.
9.Nurse Carlos knows that the common cardiac anomalies in children with Down Syndrome (tri-somy 21) is:
a. Atrial septal defect
b. Pulmonic stenosis
c. Ventricular septal defect
d. Endocardial cushion defect
10. Nurse Cristeta was diagnosed with severe preeclampsia is now receiving I.V. magnesium sulfate. The adverse effects associated with magnesium sulfate is:
a. Anemia
b. Decreased urine output
c. Hyperreflexia
d. Increased respiratory rate
11. Mrs. Pregy Der, a 23 year old client is having her menstrual period every 2 weeks that last for 1 week. This type of menstrual pattern is bets defined by:
a. Menorrhagia
b. Metrorrhagia
c. Dyspareunia
d. Amenorrhea
12. Mrs. Caby Nhet is admitted to the labor and delivery unit. The critical laboratory result for this client would be:
a. Oxygen saturation
b. Iron binding capacity
c. Blood typing
d. Serum Calcium
13.Nurse Dorothy is aware that the most common condition found during the second-trimester of pregnancy is:
a. Metabolic alkalosis
b. Respiratory acidosis
c. Mastitis
d. Physiologic anemia
14.Nurse Imo Gin is working in the triage area of an emergency department. She sees that several pediatric clients arrive simultaneously. The client who needs to be treated first is:
a. A crying 5 year old child with a laceration on his scalp.
b. A 4 year old child with a barking coughs and flushed appearance.
c. A 3 year old child with Down syndrome who is pale and asleep in
his mother’s arms.
d. A 2 year old infant with stridorous breath sounds, sitting up in his
mother’s arms and drooling.
15. Mrs. Calista in her third trimester arrives at the emergency room with painless vaginal bleeding. Which of the following conditions is suspected?
a. Placenta previa
b. Abruptio placentae
c. Premature labor
d. Sexually transmitted disease
16.A young child named Louella is suspected of having pinworms. The community nurse collects a stool specimen to confirm the diagnosis. The nurse should schedule the collection of this specimen for:
a. Just before bedtime
b. After the child has been bathe
c. Any time during the day
d. Early in the morning
17.In doing a child’s admission assessment, Nurse Angelique should be alert to note which signs or symptoms of chronic lead poisoning?
a. Irritability and seizures
b. Dehydration and diarrhea
c. Bradycardia and hypotension
d. Petechiae and hematuria
18.To evaluate a woman’s understanding about the use of diaphragm for family planning, Nurse Trish asks her to explain how she will use the appliance. Which response indicates a need for further health teaching?
a. “I should check the diaphragm carefully for holes every time I use it”
b. “I may need a different size of diaphragm if I gain or lose weight more than 20 pounds”
c. “The diaphragm must be left in place for atleast 6 hours after intercourse”
d. “I really need to use the diaphragm and jelly most during the middle of my menstrual cycle”.
19.Hypoxia is a common complication of laryngotracheobronchitis. Nurse Oliver should frequently assess a child with laryngotracheobronchitis for:
a. Drooling
b. Muffled voice
c. Restlessness
d. Low-grade fever
20.How should Nurse Melanie Marquez guide a child who is blind to walk to the playroom?
a. Without touching the child, talk continuously as the child walks down the hall.
b. Walk one step ahead, with the child’s hand on the nurse’s elbow.
c. Walk slightly behind, gently guiding the child forward.
d. Walk next to the child, holding the child’s hand.
“Failure is the condiment that gives success its flavor.” -Capote
Wednesday, February 12, 2014
Pre-Board Exam Drill: Maternal Child and Community Health Nursing A
This is a 30 point Pre-Board Exam Drill on Maternal and Child Nursing and Community Health Nursing SET A.
Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!
1. May arrives at the health care clinic and tells the nurse that her last menstrual period was 9 weeks ago. She also tells the nurse that a home pregnancy test was positive but she began to have mild cramps and is now having moderate vaginal bleeding. During the physical examination of the client, the nurse notes that May has a dilated cervix. The nurse determines that May is experiencing which type of abortion?
a. Inevitable
b. Incomplete
c. Threatened
d. Septic
2. Nurse Reese is reviewing the record of a pregnant client for her first prenatal visit. Which of the following data, if noted on the client’s record, would alert the nurse that the client is at risk for a spontaneous abortion?
a. Age 36 years
b. History of syphilis
c. History of genital herpes
d. History of diabetes mellitus
3. Nurse Hazel is preparing to care for a client who is newly admitted to the hospital with a possible diagnosis of ectopic pregnancy. Nurse Hazel develops a plan of care for the client and determines that which of the following nursing actions is the priority?
a. Monitoring weight
b. Assessing for edema
c. Monitoring apical pulse
d. Monitoring temperature
4. Nurse Oliver is teaching a diabetic pregnant client about nutrition and insulin needs during pregnancy. The nurse determines that the client understands dietary and insulin needs if the client states that the second half of pregnancy require:
a. Decreased caloric intake
b. Increased caloric intake
c. Decreased Insulin
d. Increase Insulin
5. Nurse Michelle is assessing a 24 year old client with a diagnosis of hydatidiform mole. She is aware that one of the following is unassociated with this condition?
a. Excessive fetal activity.
b. Larger than normal uterus for gestational age.
c. Vaginal bleeding
d. Elevated levels of human chorionic gonadotropin.
6. A pregnant client is receiving magnesium sulfate for severe pregnancy induced hypertension (PIH). The clinical findings that would warrant use of the antidote , calcium gluconate is:
a. Urinary output 90 cc in 2 hours.
b. Absent patellar reflexes.
c. Rapid respiratory rate above 40/min.
d. Rapid rise in blood pressure.
7. During vaginal examination of Janah who is in labor, the presenting part is at station plus two. Nurse, correctly interprets it as:
a. Presenting part is 2 cm above the plane of the ischial spines.
b. Biparietal diameter is at the level of the ischial spines.
c. Presenting part in 2 cm below the plane of the ischial spines.
d. Biparietal diameter is 2 cm above the ischial spines.
8. A pregnant client is receiving oxytocin (Pitocin) for induction of labor. A condition that warrant the nurse in-charge to discontinue I.V. infusion of Pitocin is:
a. Contractions every 1 ½ minutes lasting 70-80 seconds.
b. Maternal temperature 101.2
c. Early decelerations in the fetal heart rate.
d. Fetal heart rate baseline 140-160 bpm.
9. Calcium gluconate is being administered to a client with pregnancy induced hypertension (PIH). A nursing action that must be initiated as the plan of care throughout injection of the drug is:
a. Ventilator assistance
b. CVP readings
c. EKG tracings
d. Continuous CPR
10. A trial for vaginal delivery after an earlier caesareans, would likely to be given to a gravida, who had:
a. First low transverse cesarean was for active herpes type 2 infections; vaginal culture at 39 weeks pregnancy was positive.
b. First and second caesareans were for cephalopelvic disproportion.
c. First caesarean through a classic incision as a result of severe fetal distress.
d. First low transverse caesarean was for breech position. Fetus in this pregnancy is in a vertex presentation.
11.Nurse Ryan is aware that the best initial approach when trying to take a crying toddler’s temperature is:
a. Talk to the mother first and then to the toddler.
b. Bring extra help so it can be done quickly.
c. Encourage the mother to hold the child.
d. Ignore the crying and screaming.
12.Baby Tina a 3 month old infant just had a cleft lip and palate repair. What should the nurse do to prevent trauma to operative site?
a. Avoid touching the suture line, even when cleaning.
b. Place the baby in prone position.
c. Give the baby a pacifier.
d. Place the infant’s arms in soft elbow restraints.
13. Which action should nurse Marian include in the care plan for a 2 month old with heart failure?
a. Feed the infant when he cries.
b. Allow the infant to rest before feeding.
c. Bathe the infant and administer medications before feeding.
d. Weigh and bathe the infant before feeding.
14.Nurse Hazel is teaching a mother who plans to discontinue breast feeding after 5 months. The nurse should advise her to include which foods in her infant’s diet?
a. Skim milk and baby food.
b. Whole milk and baby food.
c. Iron-rich formula only.
d. Iron-rich formula and baby food.
15.Mommy Linda is playing with her infant, who is sitting securely alone on the floor of the clinic. The mother hides a toy behind her back and the infant looks for it. The nurse is aware that estimated age of the infant
would be:
a. 6 months
b. 4 months
c. 8 months
d. 10 months
16.Which of the following is the most prominent feature of public health nursing?
a. It involves providing home care to sick people who are not confined in the hospital.
b. Services are provided free of charge to people within the catchments area.
c. The public health nurse functions as part of a team providing a public health nursing services.
d. Public health nursing focuses on preventive, not curative, services.
17.When the nurse determines whether resources were maximized in implementing Ligtas Tigdas, she is evaluating
a. Effectiveness
b. Efficiency
c. Adequacy
d. Appropriateness
18.Vangie is a new B.S.N. graduate. She wants to become a Public Health Nurse. Where should she apply?
a. Department of Health
b. Provincial Health Office
c. Regional Health Office
d. Rural Health Unit
19.Tony is aware the Chairman of the Municipal Health Board is:
a. Mayor
b. Municipal Health Officer
c. Public Health Nurse
d. Any qualified physician
20.Myra is the public health nurse in a municipality with a total population of about 20,000. There are 3 rural health midwives among the RHU personnel. How many more midwife items will the RHU need?
a. 1
b. 2
c. 3
d. The RHU does not need any more midwife item.
Test your knowledge on nursing concepts, test your test-taking skills and develop your attitude in attacking board exam questions. Answer these questions on a piece of paper. Check your answers and don't forget to review the rationale behind the correct answer. Good luck with your exam!
1. May arrives at the health care clinic and tells the nurse that her last menstrual period was 9 weeks ago. She also tells the nurse that a home pregnancy test was positive but she began to have mild cramps and is now having moderate vaginal bleeding. During the physical examination of the client, the nurse notes that May has a dilated cervix. The nurse determines that May is experiencing which type of abortion?
a. Inevitable
b. Incomplete
c. Threatened
d. Septic
2. Nurse Reese is reviewing the record of a pregnant client for her first prenatal visit. Which of the following data, if noted on the client’s record, would alert the nurse that the client is at risk for a spontaneous abortion?
a. Age 36 years
b. History of syphilis
c. History of genital herpes
d. History of diabetes mellitus
3. Nurse Hazel is preparing to care for a client who is newly admitted to the hospital with a possible diagnosis of ectopic pregnancy. Nurse Hazel develops a plan of care for the client and determines that which of the following nursing actions is the priority?
a. Monitoring weight
b. Assessing for edema
c. Monitoring apical pulse
d. Monitoring temperature
4. Nurse Oliver is teaching a diabetic pregnant client about nutrition and insulin needs during pregnancy. The nurse determines that the client understands dietary and insulin needs if the client states that the second half of pregnancy require:
a. Decreased caloric intake
b. Increased caloric intake
c. Decreased Insulin
d. Increase Insulin
5. Nurse Michelle is assessing a 24 year old client with a diagnosis of hydatidiform mole. She is aware that one of the following is unassociated with this condition?
a. Excessive fetal activity.
b. Larger than normal uterus for gestational age.
c. Vaginal bleeding
d. Elevated levels of human chorionic gonadotropin.
6. A pregnant client is receiving magnesium sulfate for severe pregnancy induced hypertension (PIH). The clinical findings that would warrant use of the antidote , calcium gluconate is:
a. Urinary output 90 cc in 2 hours.
b. Absent patellar reflexes.
c. Rapid respiratory rate above 40/min.
d. Rapid rise in blood pressure.
7. During vaginal examination of Janah who is in labor, the presenting part is at station plus two. Nurse, correctly interprets it as:
a. Presenting part is 2 cm above the plane of the ischial spines.
b. Biparietal diameter is at the level of the ischial spines.
c. Presenting part in 2 cm below the plane of the ischial spines.
d. Biparietal diameter is 2 cm above the ischial spines.
8. A pregnant client is receiving oxytocin (Pitocin) for induction of labor. A condition that warrant the nurse in-charge to discontinue I.V. infusion of Pitocin is:
a. Contractions every 1 ½ minutes lasting 70-80 seconds.
b. Maternal temperature 101.2
c. Early decelerations in the fetal heart rate.
d. Fetal heart rate baseline 140-160 bpm.
9. Calcium gluconate is being administered to a client with pregnancy induced hypertension (PIH). A nursing action that must be initiated as the plan of care throughout injection of the drug is:
a. Ventilator assistance
b. CVP readings
c. EKG tracings
d. Continuous CPR
10. A trial for vaginal delivery after an earlier caesareans, would likely to be given to a gravida, who had:
a. First low transverse cesarean was for active herpes type 2 infections; vaginal culture at 39 weeks pregnancy was positive.
b. First and second caesareans were for cephalopelvic disproportion.
c. First caesarean through a classic incision as a result of severe fetal distress.
d. First low transverse caesarean was for breech position. Fetus in this pregnancy is in a vertex presentation.
11.Nurse Ryan is aware that the best initial approach when trying to take a crying toddler’s temperature is:
a. Talk to the mother first and then to the toddler.
b. Bring extra help so it can be done quickly.
c. Encourage the mother to hold the child.
d. Ignore the crying and screaming.
12.Baby Tina a 3 month old infant just had a cleft lip and palate repair. What should the nurse do to prevent trauma to operative site?
a. Avoid touching the suture line, even when cleaning.
b. Place the baby in prone position.
c. Give the baby a pacifier.
d. Place the infant’s arms in soft elbow restraints.
13. Which action should nurse Marian include in the care plan for a 2 month old with heart failure?
a. Feed the infant when he cries.
b. Allow the infant to rest before feeding.
c. Bathe the infant and administer medications before feeding.
d. Weigh and bathe the infant before feeding.
14.Nurse Hazel is teaching a mother who plans to discontinue breast feeding after 5 months. The nurse should advise her to include which foods in her infant’s diet?
a. Skim milk and baby food.
b. Whole milk and baby food.
c. Iron-rich formula only.
d. Iron-rich formula and baby food.
15.Mommy Linda is playing with her infant, who is sitting securely alone on the floor of the clinic. The mother hides a toy behind her back and the infant looks for it. The nurse is aware that estimated age of the infant
would be:
a. 6 months
b. 4 months
c. 8 months
d. 10 months
16.Which of the following is the most prominent feature of public health nursing?
a. It involves providing home care to sick people who are not confined in the hospital.
b. Services are provided free of charge to people within the catchments area.
c. The public health nurse functions as part of a team providing a public health nursing services.
d. Public health nursing focuses on preventive, not curative, services.
17.When the nurse determines whether resources were maximized in implementing Ligtas Tigdas, she is evaluating
a. Effectiveness
b. Efficiency
c. Adequacy
d. Appropriateness
18.Vangie is a new B.S.N. graduate. She wants to become a Public Health Nurse. Where should she apply?
a. Department of Health
b. Provincial Health Office
c. Regional Health Office
d. Rural Health Unit
19.Tony is aware the Chairman of the Municipal Health Board is:
a. Mayor
b. Municipal Health Officer
c. Public Health Nurse
d. Any qualified physician
20.Myra is the public health nurse in a municipality with a total population of about 20,000. There are 3 rural health midwives among the RHU personnel. How many more midwife items will the RHU need?
a. 1
b. 2
c. 3
d. The RHU does not need any more midwife item.
"Dare to be"- Maraboli
Monday, February 3, 2014
Notes on Fluid and Electrolyte 2: CONCEPTS OF FLUID AND ELECTROLYTE BALANCE
CONCEPTS OF FLUID AND ELECTROLYTE BALANCE
1. Description: A substance that is dissolved in solution and ome of its molecules split or dissociate into electrically charged atoms or ions.
2. Measurement
a. The metric system is used to measure volumes of fluids—liters (L) or milliliters (mL).
b. The unit of measure that expresses the combining activity of an electrolyte is the milliequivalent (mEq).
c. One milliequivalent (1 mEq) of any cation will always react chemically with 1 mEq of an anion.
d. Milliequivalents provide information about the number of anions or cations available to combine with other anions or cations.
B. Body fluid compartments
1. Description
a. Fluid in each of the body compartments contains electrolytes.
b. Each compartment has a particular composition of electrolytes, which differs from that of other compartments.
c. To function normally, body cells must have fluids and electrolytes in the right compartments and in the right amounts.
d. Whenever an electrolyte moves out of a cell, another electrolyte moves in to take its place.
e. The numbers of cations and anions must be the same for homeostasis to exist.
f. Compartments are separated by semipermeable membranes.
2. Intravascular compartment: Refers to fluid inside a blood vessel
3. Intracellular compartment
a. The intracellular compartment refers to all fluid inside the cell.
b. Most bodily fluids are inside the cell.
4. The extracellular compartment is the fluid outside the cell.
a. The extracellular compartment includes the interstitial fluid, which is fluid between cells (sometimes called the third space), blood, lymph, bone, connective tissue, water, and transcellular fluid.
b. Transcellular fluid is the fluid in various parts of the body, such as peritoneal fluid, pleural fluid, cerebrospinal fluid, and synovial fluid.
C. Third-spacing
1. Third-spacing is the accumulation and sequestration of trapped extracellular fluid in an actual or potential body space as a result of disease or injury.
2. The trapped fluid represents a volume loss and is unavailable for normal physiological processes.
3. Fluid may be trapped in body spaces such as the pericardial, pleural, peritoneal, or joint cavities, the bowel, or the aabdomen, or within soft tissues after trauma or burns.
4. Assessing the intravascular fluid loss caused by third-spacing is difficult. The loss may not be reflected
in weight changes or intake and output records and may not become apparent until after organ malfunction occurs.
D. Edema
1. Edema is an excess accumulation of fluid in the interstitial space.
2. Localized edema occurs as a result of traumatic injury from accidents or surgery, local inflammatory processes, or burns.
3. Generalized edema, also called anasarca, is an excessive accumulation of fluid in the interstitial space throughout the body and occurs as a result of conditions such as cardiac, renal, or liver failure.
E. Body fluid
1. Description
a. Body fluids transport nutrients to the cells and carry waste products from the cells.
b. Total body fluid (intracellular and extracellular) amounts to about 60% of body weight in the adult,
55% in the older adult, and 80% in the infant.
c. Thus, infants and the older adult are at ahigher risk for fluid-related problems than younger adults; children have a greater proportion of body water than adults and the older adult has the least proportion of body water.
2. Constituents of body fluids
a. Body fluids consist of water and dissolved substances.
b. The largest single fluid constituent of the body is water.
c. Some substances, such as glucose, urea, and creatinine, do not dissociate in solution; that is, they do not separate from their complex forms into simpler substances when they are in solution.
d. Other substances do dissociate; for example, when sodium chloride is in a solution, it dissociates or
separates into two parts or elements.
F. Body fluid transport
1. Diffusion
a. Diffusion is the process whereby a solute (substance that is dissolved) may spread through a solution or solvent (solution in which the solute is dissolved).
b. Diffusion of a solute will spread the molecules from an area of higher concentration to an area of lower concentration.
c. A permeable membrane will allow substances to pass through it without restriction.
d. A selectively permeable membrane will allow some solutes to pass through without restriction but will prevent other solutes from passing freely.
e. Diffusion occurs within fluid compartments and from one compartment to another if the barrier
between the compartments is permeable to the diffusing substances.
2. Osmosis
a. Osmotic pressure is the force that draws the solvent from a less concentrated solute through a selectively permeable membrane into a more concentrated solute, thus tending to equalize the concentration of the solvent.
b. If a membrane is permeable to water but not to all the solutes present, the membrane is a selective or semipermeable membrane.
c. Osmosis is the movement of solvent molecules across a membrane in response to a concentration gradient, usually from a solution of lower to one of higher solute concentration.
d. When a more concentrated solution is on one side of a selectively permeable membrane and a less concentrated solution is on the other side, a pull called osmotic pressure draws the water through
the membrane to the more concentrated side or the side with more solute.
3. Filtration
a. Filtration is the movement of solutes and solvents by hydrostatic pressure.
b. The movement is from an area of higher pressure to an area of lower pressure.
4. Hydrostatic pressure
a. Hydrostatic pressure is the force exerted by the weight of a solution.
b. When a difference exists in the hydrostatic pressure on two sides of a membrane, water and diffusible solutes move out of the solution that has the higher hydrostatic pressure by the process of filtration.
c. At the arterial end of the capillary, the hydrostatic pressure is higher than the osmotic pressure; therefore, fluids and diffusible solutes move out of the capillary.
d. At the venous end, the osmotic pressure or pull is higher than the hydrostatic pressure, and fluids and some solutes move into the capillary.
e. The excess fluid and solutes remaining in the interstitial spaces are returned to the intravascular compartment by the lymph channels.
5. Osmolality
a. Osmolality refers to the number of osmotically active particles/kilogram of water; it is the concentration of a solution.
b. In the body, osmotic pressure is measured in milliosmoles (mOsm).
c. The normal osmolality of plasma is 270 to 300 milliosmoles/kilogram (mOsm/kg) water.
G. Movement of body fluid
1. Description
a. Cell membranes separate the interstitial fluid from the intravascular fluid.
b. Cell membranes are selectively permeable; that is, the cell membrane and the capillary wall will allow water and some solutes free passage through them.
c. Several forces affect the movement of water and solutes through the walls of cells and capillaries.
d. The greater the number of particles within the cell, the more pressure exists to force the water through
the cell membrane.
e. If the body loses more electrolytes than fluids, as can happen in diarrhea, then the extracellular fluid will contain fewer electrolytes or less solute than the intracellular fluid.
f. Fluids and electrolytes must be kept in balance for health; when they remain out of balance, death can
occur.
2. Isotonic solutions
a. When the solutions on both sides of a selectively permeable membrane have established equilibrium or are equal in concentration, they are isotonic.
b. An example of an isotonic solution is 0.9% sodium chloride, which is referred to as isotonic saline solution or normal saline solution.
c. Isotonic solutions are isotonic to human cells, and thus very little osmosis occurs; isotonic solutions have the same osmolality as body fluids.
d. Other solutions that are isotonic are 5% dextrose in water, 5% dextrose in 0.225% saline, and Ringer's
lactate solution.
3. Hypotonic solutions
a. When a solution contains a lower concentration of salt or solute than another more concentrated solution, it is considered hypotonic.
b. A hypotonic solution has less salt or more water than an isotonic solution; these solutions have lower osmolality than body fluids.
c. 0.45% sodium chloride, 0.225% sodium chloride, and 0.33% sodium chloride are examples of hypotonic solutions.
d. Hypotonic solutions are hypotonic to the cells; therefore, osmosis would continue in an attempt to bring about balance or equality.
4. Hypertonic solutions
a. A solution that has a higher concentration of solutes than another less concentrated solution is hypertonic; these solutions have a higher osmolality than body fluids.
b. Hypertonic solutions include 3% sodium chloride, 5% sodium chloride, 10% dextrose in water, 5% dextrose in 0.9% sodium chloride, 5% dextrose in 0.45% sodium chloride, and 5% dextrose in Ringer's lactate solution.
c. Refer to Table 14-1 (Chap. 14) for a list of isotonic, hypotonic, and hypertonic solutions.
5. Osmotic pressure
a. The amount of osmotic pressure is determined by the concentration of solutes in solution.
b. When the solutions on each side of a selectively permeable membrane are equal in concentration, they are isotonic.
c. A hypotonic solution has less solute than an isotonic solution, whereas a hypertonic solution contains more solute.
d. A solvent will move from the less concentrated solute side to the more concentrated solute side to equalize concentration.
6. Active transport
a. If an ion is to move through a membrane from an area of lower concentration to an area of higher concentration, an active transport system is necessary.
b. An active transport system moves molecules or ions against concentration and osmotic pressure.
c. Metabolic processes in the cell supply the energy for active transport.
d. Substances that are transported actively through the cell membrane include ions of sodium, potassium, calcium, iron, and hydrogen, some of the sugars, and the amino acids.
H. Body fluid excretion
1. Description
a. Fluids leave the body by several routes, including the skin, lungs, gastrointestinal tract, and kidneys.
b. The kidneys excrete the largest quantity of fluid.
c. As long as all organs are functioning normally, the body is able to maintain balance in its fluid content.
2. Skin
a. Water is lost through the skin in the amount of about 400 mL/day.
b. The amount of water lost by perspiration varies according to the temperature of the environment and of the body, but the average amount of loss by perspiration alone is 100 mL/day.
c. Water lost through the skin is called insensible loss (the individual is unaware of losing that water).
3. Lungs
a. Water is lost from the lungs through expired air that is saturated with water vapor.
b. The amount of water lost from the lungs varies with the rate and the depth of respiration.
c. The average amount of water lost from the lungs is about 350 mL/day.
d. Water lost from the lungs is called insensible loss.
4. Gastrointestinal tract
a. Large quantities of water are secreted into the gastrointestinal tract, but almost all this fluid is reabsorbed.
b. A large volume of electrolyte-containing liquids moves into the gastrointestinal tract and then returns again into the extracellular fluid.
c. The average amount of water lost in the feces is 150 mL/day, equal to the amount of water gained through the oxidation of foods.
d. Severe diarrhea results in the loss of large quantities of fluids and electrolytes.
5. Kidneys
a. The kidneys play a major role in regulating fluid and electrolyte balance.
b. Normal kidneys can adjust the amount of water and electrolytes leaving the body.
c. The quantity of fluid excreted by the kidneys is determined by the amount of water ingested and the amount of waste and solutes excreted.
d. The usual urine output is about 1500 mL/day; however, this varies greatly depending on fluid intake, amount of perspiration, and other factors.
I. Body fluid replacement
1. Description: Water enters the body through three sources—orally ingested liquids, water in foods, and water formed by oxidation of foods.
2. Amounts
a. The average total amount of water taken into the body by all three sources is 2500 mL/day.
b. About 10 mL of water is released by the metabolism of each 100 calories of fat, carbohydrates, or proteins.
3. Electrolytes
a. Electrolytes are present in foods and liquids.
b. With a normal diet, an excess of essential electrolytes is
taken in and the unused electrolytes are excreted.
J. Maintaining fluid and electrolyte balance
1. Description
a. Homeostasis is a term that indicates the relative stability of the internal environment.
b. Concentration and composition of body fluids must be nearly constant.
c. In a client, when one of the substances is deficient, either fluids or electrolytes, the substance must be replaced normally by the intake of food and water or by therapy such as intravenous solutions and medications.
d. When the client has an excess of fluid or electrolytes, therapy is directed toward assisting the body to eliminate the excess.
2. The kidneys play a major role in controlling all types of balance in fluid and electrolytes.
3. The adrenal glands, through the secretion of aldosterone, also aid in controlling extracellular fluid volume by regulating the amount of sodium reabsorbed by the kidneys.
4. Antidiuretic hormone from the pituitary gland regulates the osmotic pressure of extracellular fluid by regulating the amount of water reabsorbed by the kidney.
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