SET 1

Answer: (D) Terminal. Tertiary prevention involves

LEVELS OF PREVENTION rehabilitation, prevention of permanent disability and
NURSING PROCESS disability limitation appropriate for convalescents, the
MANAGEMENT STYLES disabled, complicated cases and the terminally ill (those in
DEPENDENT AND INDEPENDENT the terminal stage of a disease
QUANTITATIVE AND QUALITATIVE
DELEGATION • In what level of prevention according to Leavell
3-WAY BOTTLE SYSTEM and Clark does the nurse support the client in
ETHICAL PRINCIPLE obtaining OPTIMAL HEALTH STATUS AFTER A
DISEASE OR INJURY?
A. Primary
LEVEL OF PREVENTION B. Secondary
C. Tertiary
D. None of the above

• In what level of prevention does the nurse

encourage optimal health and increases person’s
susceptibility to illness?
A. Primary
B. Secondary
C. Tertiary
D. None of the above

Answer: D. None of the above. The nurse never increases

the person’s susceptibility to illness but rather, LESSEN the
person’s susceptibility to illness.

OVERVIEW: Also known as HEALTH MAINTENANCE prevention.

A. Primary
PRIMARY SECONDA TERTIARY B. Secondary
RY C. Tertiary
WH HEALTHY HIGH RISK POST TREATMENT D. None of the above
O
Answer: B. Secondary. Secondary prevention is also known
WHA • HEALTH • EARLY • PREVENT
as HEALTH MAINTENANCE Prevention. Here, The person
T PROMOTIO DETECTI COMPLICATIONS
feels signs and symptoms and seeks Diagnosis and
N ON AND • MAINTEN
treatment in order to prevent debilitating complications.
• ILLNESS SCREENI ANCE
Even if the person feels healthy, We are required to
PREVENTIO NG MEDICATION
MAINTAIN our health by monthly check ups, Physical
N • PALLIATIV
examinations, Diagnostics etc.
• IMMUNIZAT E CARE
ION
• PPD/ PPE In occupational health nursing is what
type of prevention?
A. Primary
SAMPLE QUESTIONS:
B. Secondary
• Tertiary prevention is needed in which stage of the C. Tertiary
natural history of disease? D. None of the above
A. Pre-pathogenesis
B. Pathogenesis Answer: A. Primary. PPD or PERSONAL PROTECTIVE
C. Prodromal DEVICES are worn by the worker in a hazardous
D. Terminal
environment to protect them from injuries and hazards. CHN Process: Assessment (diagnosis
This is considered as a PRIMARY prevention because the is embedded)
nurse prevents occurrence of diseases and injuries. Planning
Implementation
• BCG in community health nursing is what type of Evaluation
prevention?
A. Primary
B. Secondary Goal: Maglaya
C. Tertiary 1. Promotion of Health
D. None of the above 2. Preservation of Health

Answer: primary
Nisce, et. al
• A regular pap smear for woman every 3 years after "To raise the level of health of the citizenry by helping
establishing normal pap smear for 3 consecutive communities and families to cope with the
years Is advocated. What level of prevention does discontinuities in and threats to health in such a way as
this belongs? to maximize their potential for high-level wellness"
A. Primary
B. Secondary
C. Tertiary
D. None of the above Setting: Community -place where people under usual
or normal conditions are found (villages,
Answer: secondary schools, workplaces, etc.)
-must be outside the institutional setting
• Self monitoring of blood glucose for diabetic clients (hospitals, etc. are excluded)
is on what level of prevention?
A. Primary
B. Secondary Nature of Practice: Comprehensive, general, continual.
C. Tertiary Not limited to a particular specialization, not
D. None of the above episodic, and spans the entire life cycle.

Knowledge: Integration of nursing with public health as

well as sociology, psychology, anthropology,
NURSING PROCESS economics and political science

Community Health Nursing Process

According to Dr. Araceli Maglaya

The utilization of the Nursing Process in the Different
Levels of Clientele-(4 levels) Individuals, Families,
Population Groups and Communities, concerned with
the (1) Promotion of Health; (2) Prevention of Disease
and Disability; (3) and Rehabilitation.

Broader -includes CHNs in both public & private sectors.

ANISA!!!! Categories of Health Problems (according to priority)
Important concepts to note in answering questions: 1. Wellness state – readiness to achieve higher level or
1. “Greatest good for the greatest number” state of health
2. Health promotion & disease prevention are Health deficit – presence of illness; gap between
prioritized over curative care actual and ideal health
3. The primary responsibility of the nurse is to *both are equally considered as priority #1
the population as a whole 2. Health threat – condition that promote disease or
4. Client is an active, equal partner of the injury
nurse, not a passive recipient of care 3. Stress point/foreseeable crisis – anticipated periods
5. CHN is affected by its immediate context, of unusual demands
the healthcare delivery system, as well as
overall political, economic, socio-cultural, and
environmental factors
6. CHN is dynamic and flexible due to varying
objective and subjective realities in different
settings
Initial Data Base
7. Community PARTICIPATION is key!!!
1. Family structure and characteristics
2. Socio-economic and cultural factors
3. Environmental factors
4. Health assessment of each member
5. Value placed on prevention of disease

Community Health Nursing Process

■ ASSESSMENT ▪ DIAGNOSIS
Family Diagnosis
• -initiate contact
Point Component
• -collect data
given
• -identify health problems
x1 Nature->(1)Deficit/Wellness, (2)Threat,
• -assess coping ability
(3)Stress Point
• -analyze and interpret data
x2 Modifiability > possibility of success (highly,
partially, or non-modifiable)
x1 Preventive potential > magnitude of future
2 Levels of Family Assessment problems that can be minimized by solving this
1. First level – determine actual and potential health
x1 Salience > family’s perception of the problem
problems. Answers ‘what’ questions.
Total=5
2. Second level – determine barriers to family’s
performance of tasks. Answers ‘why’ questions.
Community Diagnosis
*ANO ANG PROBLEMA NA GINAHARAP NG FAMILY Point Component
NGAYON* given
* BAKIT GINAPROBLEMA NILA ITO NGAYON* x1 Nature > health status (illness, stats), health
resource (material, manpower), health-related
(social, economic, political, environmental)
x4 Modifiability > possibility of success (highly,
partially, or non-modifiable)
x1 Preventive potential > magnitude of future
problems that can be minimized by solving this
x1 Salience > family’s perception of the problem
x3 Magnitude of the problem > severity: ■ Implementation
proportion of population affected by problem -put nursing plan to action
Total=10 -coordinate care/services
( UNDER SET 2: COMMUNITY ORGANIZING LAST STEP IN -utilize community resources
PRIORITIZING PROBLEM ) -delegate and supervise
-provide health education
-document responses

2 Levels of Nursing Intervention in CHN

1. Anticipatory – primary level of prevention
2. Participatory – secondary & tertiary levels
Why Undertake Community Dx?
1. To have a clear picture of the problems of the ■ Evaluation
community and to identify the resources available to the -nursing audit
community people. -evaluate care outcomes
2. Community diagnosis enables the nurse/program -performance appraisal for workers
coordinator to set priorities for planning and developing -estimate cost-benefit ratio (determine efficiency)
programs of health care for the community. The data -identify necessary alterations
gathered through the process serves as the material for -revise plans
analysis.

Types of Community Dx Framework for Evaluation

1. Comprehensive Community Dx — general view 1. Structural elements – physical: manpower,
2. Problem-oriented Community Dx – specific problem equipment, infrastructure
2. Process elements – actions, procedures, protocols
Components of Community Dx 3. Outcome elements – changes in clients’ health status
1. Demographic variables vis-à-vis objectives and goals of care outcomes
2. Socio-economic and cultural variables
3. Health and illness patterns
4. Health resources
5. Political and leadership patterns

SAMPLE QUESTIONS:
Components of Community Dx
1. Primary Data - source would be the community 1. She is the first one to coin the term “NURSING PROCESS”
people through survey, interview, focused group She introduced 3 steps of nursing process which are
discussions, observation and through the actual minutes Observation, Ministration and Validation.
of community meetings A. Nightingale
B. Johnson
2. Secondary Data - source would be organizational
C. Rogers
records of the program, health center records and other
D. Hall
public records through review of records
2. The American Nurses association formulated an
innovation of the Nursing process. Today, how many
■ Planning
distinct steps are there in the nursing process?
-goal setting
A. APIE – 4
-constructing plan of action and operational plan B. ADPIE – 5
C. ADOPIE – 6
D. ADOPIER – 7
- ASSESSMENT, DIAGNOSIS, OUTCOME IDENTIFICATION,
PLANNING, IMPLEMENTATION and EVALUATION. NURSING
PROCESS

3. Which characteristic of nursing process is responsible for

proper utilization of human resources, time and cost
resources?
A. Organized and Systematic
B. Humanistic
C. Efficient
D. Effective
4. Which characteristic of nursing process addresses the
INDIVIDUALIZED care a client must receive?
A. Organized and Systematic
B. Humanistic
C. Efficient
D. Effective
5. A characteristic of the nursing process that is essential to
promote client satisfaction and progress. The care should
also be relevant with the client’s needs.
A. Organized and Systematic
B. Humanistic
C. Efficient
D. Effective
DIFFERENT MANAGEMENT STYLE
Goal According to Capilli, it focuses to management , a
general statement of aims and purposes to reach the goal.

WHILE:
OBJECTIVE(s) is/are SPECIFIC STATEMENT/S of aim and
purposes to reach the goals.
MISSION: reason for existence
VISION: what institution wants to achieve. FUTURISTIC
PHILOSOPHY: statement of beliefs, principles, and values
- Value centered ( core values)
POLICIES: plans reduced to statement that help in decision-
making
PROCEDURES: step by step, cannot skip steps
RULES: regulations ( pwede at hindi pwede)

SAMPLE QUESTIONS
OVERVIEW: CAPILLI 1. Ms. Castro is newly-promoted to a patient care manager
3 common styles: position. She updates her knowledge on the theories in
STYLES Action Decision management and leadership in order to become effective in
her new role. She learns that some managers have low
AUTOCRATIC leader Leader
concern for services and high concern for staff. Which style
( emergency)
of management refers to this?
DEMOCRATIC Leader and Based on
member opinions
a. Organization Man
LAISSEZ-FAIRE Member- members
b. Impoverished Management
-self directed focused
c. Country Club Management
-leader monitor
d. Team Management
-when leader or
Answer: (C) Country Club Management
manager is new
Country club management style puts concern for the staff
as number one priority at the expense of the delivery of
BY RULES AND REGULATIONS
services. He/she runs the department just like a country
FORMALITY RESPONSIBILITY club where every one is happy including the manager.
AUTHORITY formal • Legitimate
right to give 2. Her former manager demonstrated passion for serving
command her staff rather than being served. She takes time to listen,
• Officially prefers to be a teacher first before being a leader, which is
sanctioned characteristic of
• With position
• elected a. Transformational leader
POWER informal • has ability b. Transactional leader
to obtain, c. Servant leader
retain, and d. Charismatic leader
motivate
other Answer: (C) Servant leader
people Servant leaders are open-minded, listen deeply, try to fully
Being a good leader does not mean you are a good understand others and not being judgmental
manager
3. On the other hand, Ms. Castro notices that the Chief Path Goal theory according to House and associates
Nurse Executive has charismatic leadership style. Which of rewards good performance so that others would do the
the following behaviors best describes this style? same

a. Possesses inspirational quality that makes followers gets

attracted of him and regards him with reverence 6. One leadership theory states that “leaders are born and
not made,” which refers to which of the following theories?
b. Acts as he does because he expects that his behavior will
yield positive results a. Trait
c. Uses visioning as the core of his leadership b. Charismatic
d. Matches his leadership style to the situation at hand. c. Great Man
d. Situational
Answer: (A) Possesses inspirational quality that makes
followers gets attracted of him and regards him with Answer: (C) Great Man
reverence Leaders become leaders because of their birth right. This is
Charismatic leaders make the followers feel at ease in their also called Genetic theory or the Aristotelian theory
presence. They feel that they are in good hands whenever
the leader is around.
7. She came across a theory which states that the leadership
style is effective dependent on the situation. Which of the
4. Which of the following conclusions of Ms. Castro about following styles best fits a situation when the followers are
leadership characteristics is TRUE? self-directed, experts and are matured individuals?

a. Democratic
a. There is a high correlation between the communication b. Authoritarian
skills of a leader and the ability to get the job done. c. Laissez faire
b. A manager is effective when he has the ability to plan d. Bureaucratic
well. Answer: (C) Laissez faire
c. Assessment of personal traits is a reliable tool for Laissez faire leadership is preferred when the followers
predicting a manager’s potential. know what to do and are experts in the field. This leadership
d. There is good evidence that certain personal qualities style is relationship-oriented rather than task-centered.
favor success in managerial role.

Answer: (C) Assessment of personal traits is a reliable tool 8. She surfs the internet for more information about
for predicting a manager’s potential. leadership styles. She reads about shared leadership as a
It is not conclusive that certain qualities of a person would practice in some magnet hospitals. Which of the following
make him become a good manager. It can only predict a describes this style of leadership?
manager’s potential of becoming a good one.
a. Leadership behavior is generally determined by the
5. She reads about Path Goal theory. Which of the following relationship between the leader’s personality and the
behaviors is manifested by the leader who uses this theory? specific situation
b. Leaders believe that people are basically good and need
a. Recognizes staff for going beyond expectations by giving not be closely controlled
them citations c. Leaders rely heavily on visioning and inspire members to
b. Challenges the staff to take individual accountability for achieve results
their own practice d. Leadership is shared at the point of care.
c. Admonishes staff for being laggards.
d. Reminds staff about the sanctions for non performance. Answer: (D) Leadership is shared at the point of care.
Shared governance allows the staff nurses to have the
Answer: (A) Recognizes staff for going beyond expectations authority, responsibility and accountability for their own
by giving them citations practice.
9. Ms. Castro learns that some leaders are transactional 12. She knows that there are external forces that influence
leaders. Which of the following does NOT characterize a changes in his unit. Which of the following is NOT an
transactional leader? external force?

a. Focuses on management tasks a. Memo from the CEO to cut down on electrical
b. Is a caretaker consumption
c. Uses trade-offs to meet goals b. Demands of the labor sector to increase wages
d. Inspires others with vision c. Low morale of staff in her unit
d. Exacting regulatory and accreditation standards
Answer: (D) Inspires others with vision
Inspires others with a vision is characteristic of a Answer: (C) Low morale of staff in her unit
transformational leader. He is focused more on the day-to- Low morale of staff is an internal factor that affects only the
day operations of the department/unit. unit. All the rest of the options emanate from the top
executive or from outside the institution.

10. She finds out that some managers have benevolent-

authoritative style of management. Which of the following 13. After discussing the possible effects of the low patient
behaviors will she exhibit most likely? satisfaction rate, the staff started to list down possible
strategies to solve the problems head-on. Should they
a. Have condescending trust and confidence in their decide to vote on the best change strategy, which of the
subordinates following strategies is referred to this?
b. Gives economic or ego awards
c. Communicates downward to the staff a. Collaboration
d. Allows decision making among subordinates b. Majority rule
c. Dominance
Answer: (A) Have condescending trust and confidence in d. Compromise
their subordinates
Benevolent-authoritative managers pretentiously show Answer: (B) Majority rule
their trust and confidence to their followers Majority rule involves dividing the house and the highest
vote wins.1/2 + 1 is a majority.

11. Harry is a Unit Manager I the Medical Unit. He is not 14. One staff suggests that they review the pattern of
satisfied with the way things are going in his unit. Patient nursing care that they are using, which is described as a:
satisfaction rate is 60% for two consecutive months and
staff morale is at its lowest. He decides to plan and initiate a. job description
changes that will push for a turnaround in the condition of b. system used to deliver care
the unit. Which of the following actions is a priority for c. manual of procedure
Harry? d. rules to be followed

a. Call for a staff meeting and take this up in the agenda. Answer: (B) system used to deliver care
b. Seek help from her manager. A system used to deliver care. In the 70’s it was termed as
c. Develop a strategic action on how to deal with these methods of patient assignment; in the early 80’s it was
concerns. called modalities of patient care then patterns of nursing
d. Ignore the issues since these will be resolved naturally. care in the 90’s until recently authors called it nursing care
systems.
Answer: (A) Call for a staff meeting and take this up in the
agenda. 15. Which of the following is TRUE about functional nursing?
This will allow for the participation of every staff in the unit.
If they contribute to the solutions of the problem, they will a. Concentrates on tasks and activities
own the solutions; hence the chance for compliance would b. Emphasizes use of group collaboration
be greater. c. One-to-one nurse-patient ratio
d. Provides continuous, coordinated and comprehensive
nursing services
19. When Harry uses team nursing as a care delivery system,
Answer: (A) Concentrates on tasks and activities he and his team need to assess the priority of care for a
Functional nursing is focused on tasks and activities and not group of patients, which of the following should be a
on the holistic care of the patients priority?

16. Functional nursing has some advantages, which one is a. Each patient as listed on the worksheet
an EXCEPTION? b. Patients who needs least care
c. Medications and treatments required for all patients
a. Psychological and sociological needs are emphasized. d. Patients who need the most care
b. Great control of work activities.
c. Most economical way of delivering nursing services. Answer: (D) Patients who need the most care
d. Workers feel secure in dependent role In setting priorities for a group of patients, those who need
the most care should be number-one priority to ensure that
Answer: (A) Psychological and sociological needs are their critical needs are met adequately. The needs of other
emphasized. patients who need less care ca be attended to later or even
When the functional method is used, the psychological and delegated to assistive personnel according to rules on
sociological needs of the patients are neglected; the delegation.
patients are regarded as ‘tasks to be done ‘

20. She is hopeful that her unit will make a big turnaround
17. He raised the issue on giving priority to patient needs. in the succeeding months. Which of the following actions of
Which of the following offers the best way for setting Harry demonstrates that he has reached the third stage of
priority? change?

a. Assessing nursing needs and problems a. Wonders why things are not what it used to be
b. Giving instructions on how nursing care needs are to be b. Finds solutions to the problems
met c. Integrate the solutions to his day-to-day activities
c. Controlling and evaluating the delivery of nursing care d. Selects the best change strategy
d. Assigning safe nurse: patient ratio
Answer: (C) Integrate the solutions to his day-to-day
Answer: (A) Assessing nursing needs and problems activities
This option follows the framework of the nursing process at Integrate the solutions to his day-to-day activities is
the same time applies the management process of planning, expected to happen during the third stage of change when
organizing, directing and controlling the change agent incorporate the selected solutions to his
system and begins to create a change.

18. Which of the following is the best guarantee that the

patient’s priority needs are met? 21. Julius is a newly-appointed nurse manager of The Good
Shepherd Medical Center, a tertiary hospital located within
a. Checking with the relative of the patient the heart of the metropolis. He thinks of scheduling
b. Preparing a nursing care plan in collaboration with the planning workshop with his staff in order to ensure an
patient effective and efficient management of the department.
c. Consulting with the physician Should he decide to conduct a strategic planningworkshop,
d. Coordinating with other members of the team which of the following is NOT a characteristic of this
activity?
Answer: (B) Preparing a nursing care plan in collaboration
with the patient a. Long-term goal-setting
The best source of information about the priority needs of b. Extends to 3-5 years in the future
the patient is the patient himself. Hence using a nursing care c. Focuses on routine tasks
plan based on his expressed priority needs would ensure d. Determines directions of the organization
meeting his needs effectively.
Answer: (C) Focuses on routine tasks
Strategic planning involves options A, B and D except C
which is attributed to operational planning a. Box
b. Solid line
c. Broken line
22. Which of the following statements refer to the vision of d. Dotted line
the hospital?
Answer: (C) Broken line
a. The Good Shepherd Medical Center is a trendsetter in This is a staff relationship hence it is depicted by a broken
tertiary health care in the Philippines in the next five years line in the organizational structure
Goal
25. He likewise stresses the need for all the employees to
b. The officers and staff of The Good Shepherd Medical follow orders and instructions from him and not from
Center believe in the unique nature of the human person anyone else. Which of the following principles does he refer
c. All the nurses shall undergo continuing competency to?
training program.
d. The Good Shepherd Medical Center aims to provide a a. Scalar chain
patient-centered care in a total healing environment. b. Discipline
c. Unity of command
Answer: (A) The Good Shepherd Medical Center is a d. Order
trendsetter in tertiary health care in the Philippines in the .Answer: (C) Unity of command
next five years A vision refers to what the institution wants The principle of unity of command means that employees
to become within a particular period of time. should receive orders coming from only one manager and
not from two managers. This averts the possibility of sowing
23. The statement, “The Good Shepherd Medical Center confusion among the members of the organization
aims to provide patient-centered care in a total healing
environment” refers to which of the following? 26. Julius orients his staff on the patterns of reporting
relationship throughout the organization. Which of the
a. Vision following principles refer to this?
b. Goal
c. Philosophy a. Span of control
d. Mission b. Hierarchy
c. Esprit d’ corps
Answer: (B) Goal According to Capilli, it focuses to d. Unity of direction
management , a general statement of aims and purposes to Answer: (B) Hierarchy
reach the goal. Hierarchy refers to the pattern of reporting or the formal
line of authority in an organizational structure
WHILE:
OBJECTIVE(s:) is/are SPECIFIC STATEMENT/S of aim and 27. He emphasizes to the team that they need to put their
purposes to reach the goals. efforts together towards the attainment of the goals of the
MISSION: reason for existence program. Which of the following principles refers to this?
VISION: what institution wants to achieve. FUTURISTIC
PHILOSOPHY: statement of beliefs, principles, and values a. Span of control
- Value centered ( core values) b. Unity of direction
POLICIES: plans reduced to statement that help in decision- c. Unity of command
making d. Command responsibility
PROCEDURES: step by step, cannot skip steps Answer: (B) Unity of direction
RULES: regulations ( pwede at hindi pwede) Unity of direction means having one goal or one objective
for the team to pursue; hence all members of the
24. Julius plans to revisit the organizational chart of the organization should put their efforts together towards the
department. He plans to create a new position of a Patient attainment of their common goal or objective.
Educator who has a coordinating relationship with the head
nurse in the unit. Which of the following will likely depict 28. Julius stresses the importance of promoting ‘esprit d
this organizational relationship? corps’ among the members of the unit. Which of the
following remarks of the staff indicates that they 31. He asserts the importance of promoting a positive
understand what he pointed out? organizational culture in their unit. Which of the following
behaviors indicate that this is attained by the group?
a. “Let’s work together in harmony; we need to be
supportive of one another” a. Proactive and caring with one another
b. Competitive and perfectionist
b. “In order that we achieve the same results; we must all c. Powerful and oppositional
follow the directives of Julius and not from other d. Obedient and uncomplaining
managers.” Answer: (A) Proactive and caring with one another

c. “We will ensure that all the resources we need are

available when needed.” 32. Stephanie is a new Staff Educator of a private tertiary
hospital. She conducts orientation among new staff nurses
d. “We need to put our efforts together in order to raise the in her department. Joseph, one of the new staff nurses,
bar of excellence in the care we provide to all our patients.” wants to understand the channel of communication, span
of control and lines of communication. Which of the
Answer: (A) “Let’s work together in harmony; we need to be following will provide this information?
supportive of one another”
The principle of ‘esprit d’ corps’ refers to promoting a. Organizational structure
harmony in the workplace, which is essential in maintaining b. Policy
a climate conducive to work. c. Job description
d. Manual of procedures
29. He discusses the goal of the department. Which of the
following statements is a goal? Answer: (A) Organizational structure
Organizational structure provides information on the
a. Increase the patient satisfaction rate channel of authority, i.e., who reports to whom and with
b. Eliminate the incidence of delayed administration of what authority; the number of people who directly reports
medications to the various levels of hierarchy and the lines of
c. Establish rapport with patients. communication whether line or staff.
d. Reduce response time to two minutes.

Answer: (A) Increase the patient satisfaction rate 33. Stephanie is often seen interacting with the medical
Goal is a desired result towards which efforts are directed. intern during coffee breaks and after duty hours. What type
Options AB, C and D are all objectives which are aimed at of organizational structure is this?
specific end.
a. Forma
b. Informal
30. He wants to influence the customary way of thinking and
behaving that is shared by the members of the department. c. Staff
Which of the following terms refer to this? d. Line

a. Organizational chart Answer: (B) Informal

b. Cultural network This is usually not published and oftentimes concealed.
c. Organizational structure Answer: (B) Informal
d. Organizational culture This is usually not published and oftentimes concealed.

Answer: (D) Organizational culture

An organizational culture refers to the way the members of 34. She takes pride in saying that the hospital has a
the organization think together and do things around them decentralized structure. Which of the following is NOT
together. It’s their way of life in that organization compatible with this type of model?

a. Flat organization
b. Participatory approach
c. Shared governance
d. Tall organization 38. Which of the following guidelines should be least
Answer: (D) Tall organization considered in formulating objectives for nursing care
Tall organizations are highly centralized organizations a. Written nursing care plan
where decision making is centered on one authority level. b. Holistic approach
c. Prescribed standards
d. Staff preferences
35. Centralized organizations have some advantages. Which
of the following statements are TRUE? Answer: (D) Staff preferences
Staff preferences should be the least priority in formulating
1. Highly cost-effective objectives of nursing care. Individual preferences should be
2. Makes management easier subordinate to the interest of the patients.
3. Reflects the interest of the worker
4. Allows quick decisions or actions.
39. Stephanie considers shifting to transformational
a. 1 & 2 leadership. Which of the following statements best
describes this type of leadership?
b. 2 & 4
a. Uses visioning as the essence of leadership.
c. 2, 3& 4 b. Serves the followers rather than being served.
d. 1, 2, & 4 c. Maintains full trust and confidence in the subordinates
d. Possesses innate charisma that makes others feel good in
Answer: (A) 1 & 2 his presence.
Centralized organizations are needs only a few managers
hence they are less expensive and easier to manage Answer: (A) Uses visioning as the essence of leadership.
Transformational leadership relies heavily on visioning as
the core of leadership.
36. Stephanie delegates effectively if she has authority to
act, which is BEST defined as:
40. As a manager, she focuses her energy on both the
a. having responsibility to direct others quality of services rendered to the patients as well as the
b. being accountable to the organizatio welfare of the staff of her unit. Which of the following
c. having legitimate right to act management styles does she adopt?
d. telling others what to do
a. Country club management
Answer: (C) having legitimate right to act b. Organization man managemen
Authorit is a legitimate or official right to give command. c. Team management
This is an officially sanctioned responsibility d. Authority-obedience management
40. Answer: (C) Team management
37. Regardless of the size of a work group, enough staff Team management has a high concern for services and high
must be available at all times to accomplish certain concern for staff.
purposes. Which of these purposes is NOT included?

a. Meet the needs of patients DEPENDENT AND INDEPENDENT

b. Provide a pair of hands to other units as needed
c. Cover all time periods adequately. Variable
d. Allow for growth and development of nursing staff. 1) Independent variable (IV): presumed cause= FIXED
2) Dependent variable (DV): presumed effect, aka
Answer: (B) Provide a pair of hands to other units as needed outcome variable= VARY
Providing a pair of hands for other units is not a purpose in IV - DV
doing an effective staffing process. This is a function of a Presumed cause Presumed effect
staffing coordinator at a centralized model.
STEPS ACCORDING TO CAPILLI:
1. POPULATION ( find the fpopulation) Case study focuses on in-depth investigations of single
2. SET entity or small number of entities. It attempts
- 2^= concentrate= characteristics that differentiates to analyze and understand issues of importance to history,
them development or circumstances of the
EXAMPLE: Older patients are more at risk to fall than person or entity under study.
younger patients 123. Stephanie is finished with the steps in the conceptual
POPULATION= older and younger phase when she has conducted the LAST
CHARACTERISTIC= AGE= fixed= I. V step, which is
A. formulating and delimiting the problem.
B. review of related literature
- 1 = eliminate characteristic, it will be part of the
C. develop a theoretical framework
population
D. formulate a hypothesis
-go back to the study/ hypothesis; WHAT IS BEING
Answer: (D) formulate a hypothesis
STUDIED
The last step in the conceptualizing phase of the research
EXAMPLE: Educational attainment is not related to the
process is formulating a hypothesis. The
compliance of PTB patients.
rest are the first three steps in this phase.
Study= educational attainment and compliance:
124. She states the hypothesis of the study. Which of the
Educational attainment= FIXED= I.V
following is a null hypothesis?
Compliance= VARY=D.
A. Infants who are breastfed have the same weight as those
who are bottle fed.
B. Bottle-fed infants have lower weight than breast-fed
infants
C. Cuddled infants sleep longer than those who are left by
________________________________________ themselves to sleep.
SAMPLE QUESTIONS: D. Children of absentee parents are more prone to
Which of the following usually refers to the independent experience depression than those who live with
variables in doing research? both parents.
Answer: (A) Infants who are breastfed have the same
A. Result
weight as those who are bottle fed.
B. Cause
C. Output
Null hypothesis predicts that there is no change, no
D. Effect
difference or no relationship between the
The type of research design that does not manipulate
variables in the study
independent variable is:
125. She notes that the dependent variable in the
a. Experimental design
hypothesis “Duration of sleep of cuddled infants is
b. Quasi-experimental design
longer than those infants who are not cuddled by mothers”
c. Non-experimental design
is
d. Quantitative design
A. Cuddled infants
B. Duration of sleep
CORRECT ANSWER: C
C. Infants
RATIONALE: Non-experimental research- studies in
D. Absence of cuddling
which the researcher collects data without
introducing an intervention.
Answer: (B) Duration of sleep
OPTION A: In experiment, the researcher controls the
Duration of sleep is the ‘effect’ (dependent variable) of
independent variable and randomly assigns
cuddling ‘cause’ (independent variable).
subjects to different conditions.
OPTION B: Quasi-experiment is an intervention study
QUANTITATIVE AND QUALITATIVE
in which subjects are not randomly assigned to
treatment conditions, but the researcher exercises
certain controls to enhance the study’s internal
Qualitative Quantitative
validity.
Keywords Complexity, Experiment, random
contextual, assignment,
inductive logic, independent/dependent gathering information: (1) participation in the
discovery, variable, setting, (2) direct observation, (3) in depth
exploration causal/correlational, interviews, and (4) analysis of documents and
validity, deductive logic materials
OPTION A: Applied research focuses on finding
Discover causal solutions to existing problems. For example, a
Understand a
Purpose relationships or describe a study to determine the effectiveness of a nursing
phenomenon
phenomenon intervention to ease grieving would be applied
reaserch.
Purposive
Sample Random sample, large OPTION C: Basic research is undertaken to extend
sample, small
the base of knowledge in a discipline, or to
Focus groups, formulate or refine theory.
Tests, surveys,
Data interviews, field OPTION D: Quantitative research is the
questionnaires
observation investigation of phenomena that lend themselves
to precise measurement and quantification, often
Phenomenologi Experimental, quasi- involving rigorous and controlled design.
cal, grounded experimental, descriptive,
theory, methodological, 7. The type of research design that does not
ethnographic, exploratory, comparative, manipulate independent variable is:
Methods/Des case study, correlational, a. Experimental design
ign historical/narrat developmental (cross- b. Quasi-experimental design
ive research, sectional, c. Non-experimental design
participatory longitudinal/prospective/c d. Quantitative design
research, ohort, retrospective/ex
clinical research post facto/case control) CORRECT ANSWER: C
RATIONALE: Non-experimental research- studies in
which the researcher collects data without
introducing an intervention.
SAMPLE QUESTIONS:
OPTION A: In experiment, the researcher controls
the independent variable and randomly assigns
Martha wants to do a study on the topic. "Effects of
subjects to different conditions.
massage and meditation on stress and pain." The type
OPTION B: Quasi-experiment is an intervention
of
study in which subjects are not randomly assigned
research that best suits this topic is:
to treatment conditions, but the researcher
a. Applied research
exercises certain controls to enhance the study’s
b. Qualitative research
internal validity.
c. Basic research
d. Quantitative research
Which of the following is a characteristic of a
quantitative study?
CORRECT ANSWER: B
a. Empirical – based on hunches and intuition
RATIONALE: Qualitative research is the
b. Firm/rigid research proposal
investigation of phenomena, typically in an in
c. Analysis of transcripts of interviews
depth and holistic fashion, through the collection
d. Understands human experience
of rich narrative materials using a flexible design.
Qualitative research relies on reasons behind
Quantitative research is different from qualitative research
various aspects of behavior. Simply put, it
in all the following ways except:
investigates the why and how of decision making,
a. Quantitative research is based on
not just what, where, and when. Hence, the need
numerical and narrative data, while
is for smaller but focused samples rather than large
qualitative research is based on
random samples, which qualitative research
objective and statistical inputs.
categorizes data into patterns as the primary basis
b. Qualitative research is best conducted in a
for organizing and reporting results. Qualitative
location which the subjects consider as their
researchers typically rely on four methods for
habitat.
c. Increasing validity and decreasing bias is • The client is able to choose the topic of the
essential for quantitative research. conversation.
d. In qualitative research, the design and • Allow the client to talk to you.
procedures are seen as flexible and allows for
change. EXPLORING
Example:
With a title "Effects of aromatherapy on the stress levels of “Tell me more…”
businesswomen in an urban community", the reader would • Asking why is non-therapeutic.
know that this is a/an: • Instead, ask: tell me more.
A. descriptive research
B. quantitative research
RESTATING
C. applied research
Example:
D. basic research
CLIENT: “I can’t sleep. I stay awake all night.”
.
NURSE: “You have difficulty sleeping.”
ANSWER: C
• This conveys understanding.
APPLIED RESEARCH focuses on finding solutions to existing
• Increases the confidence of the patient to open
problems while
up.
BASIC RESEARCH is done to expand knowledge in a
discipline or to formulate or modify a theory.
DESCRIPTIVE RESEARCH is a non-experimental study done VERBALIZING THE IMPLIED
to observe, describe and document naturally occurring Example:
situations. CLIENT: “It’s a waste of time talking to anyone.”
QUANTITATIVE RESEARCH is the study of phenomena using NURSE: “Do you feel that no one understands?”
precise measurement and quantification. • Allows the patient to clarify what they are
saying.
THERAPEUTIC COMMUNICATION • Improves assertiveness of patient.
SYMPATHY
Example: SEEKING CLARIFICATION
Nurse 1: “I feel sorry for you.” Example:
• This is a non-therapeutic approach. Client: “I’m feeling sick inside.”
• Involves the self. Nurse: “What do you mean by ‘feeling sick inside?”
EMPATHY • Do not assume what the patient means.
Example: • There is a need to ask.
Nurse 2: “I see you are sad.”
• Focuses on the feelings of the patient. TRANSLATING INTO FEELINGS
Example:
OFFERING THE SELF Client: “I’m way out in the ocean.”
Example: Nurse: “You seem to feel lonely.”
“I’ll sit with you for a while.”
• This helps the client feel that there is someone PLACING EVENTS IN SEQUENCE
for them. Example:
“Describe where you were and what you were doing
SILENCE when you collapsed.”
This is also a form of therapeutic communication. • Also an alternative to asking why.
During this time, the nurse is able to observe for the • Shows the cause-and-effect relationship.
client’s non-verbal cues.
It is important to maintain eye contact. IDENTIFYING THEMES
Example:
BROAD OPENING “What comes into your mind each time you….?” “What
Example: do you do each time you argue with your wife?”
“How are you feeling today?” • Identifying themes allows the nurse to identify
“Is there something you’d like to talk about?” patterns of thought.
• Thoughts reflect behavior. • Time, duration, and venue of sessions
• Change in thought = change in behavior = • Termination and criteria for termination
Cognitive Behavioral Therapy • Nurse’s and patient’s responsibilities
participants
REFLECTING
Example: PHASES OF THE NURSE PATIENT RELATIONSHIP
CLIENT: “Do you think I should tell my dad?” PRE – ORIENTATION – focused on the self.
NURSE: “What do you think would work best?” • The nurse should check the patient’s chart.
• Focuses on the patient and does not involve • There is a need for a comprehensive
the self. background to understand the patient.
• Allows the patient to organize and determine Goal: INTROSPECTION
thoughts = gives an opportunity for patient to • Self-awareness – can be achieved through
make an independent decision = aids the writing an autobiography.
patient in making a decision without the help • Purpose: resolves past conflicts, explore own
of others. feelings, determine preconceptions.
• Do not agree, disagree, argue, challenge, • Allows nurse to evaluate emotions, values,
suggest, or give your opinion beliefs, and attitudes.
• Allows nurse to develop a non-judgmental
FORMULATING A PLAN attitude towards the patient.
Example: Problem: Reluctance of the Nurse
“What could you do to let your anger out harmlessly?” • The nurse is allowed to refuse a patient.
• Allow the patient to enumerate the options
and let them choose their best option. ORIENTATION – together with the patient.
• This is the first face to face encounter with the
SUPPORTIVE CONFRONTATION patient.
Example: • Formulation of the nursing diagnosis.
''I know this isn't easy to do, but I think you can do it.” • Establishes congruence.
• Differs from toxic positivity. Goal: TRUST
• Acknowledge first. • Mutually set a contract and involve the patient
= explaining the benefit to the patient
ENCOURAGING COMPARISON increases cooperation.
Example: Problem: Resistance of the patient
“What is different about your feelings today?”
• A form of evaluation. WORKING – focused on communication.
Goal: Nurse – explore; Patient – verbalize
NON-THERAPEUTIC COMMUNICATION Problem: Emotional Attachment
1 Stereotyping: “Just have a positive attitude.” • Transference – patient to nurse
2 Reassuring: “Everything will be alright.” • Countertransference – nurse to patient
3 Requesting an explanation: “Why” • Both can either be positive or negative.
Note: Always let the patient choose the topic, do not Note: always remind the patient about the contract;
redirect. redirect the feelings of the patient.
• Do not go beyond the boundaries of the
NURSE PATIENT RELATIONSHIP contract.
Most Important Element: ACCEPTANCE
Purpose TERMINATION – end of the relationship.
• To help client develop new and effective Goal: Evaluate effectives of interventions
coping mechanisms. Problem: Separation Anxiety
• To facilitate a helping relationship. • Prevention of sepanx = always remind the
patient of the contract, e.g. every meeting.
PROFESSIONAL RELATIONSHIP • Remind the patient of what has been
Elements of a contract – always establish a contract. accomplished.
• Alcoholism
CRISIS AND CRISIS INTERVENTION Regression – return to earlier stage of development.
CRISIS – When coping mechanism are ineffective that • Dementia
results to disequilibrium. Introjection – blaming self.
• Coping mechanisms are conscious mechanisms • Major depressive disorder
to overcome stress. Projection – blaming others.
• Crisis is when coping mechanisms have failed. • Paranoid disorder
• “Pinagbintangan.” = without action.
TYPES OF CRISES Displacement – redirection of emotion.
Situational – caused by unexpected events • Phobic disorder
• Example: Loss of a job, Death of a loved one • Kick the cat effect
Adventitious – caused by natural catastrophe • “Pinagbalinggan.” = with action.
• Example: earthquake, fire, tornado Reaction Formation – expressing the opposite of your
• Also called social crisis – includes rape, war, true emotions.
the pandemic. • Bipolar disorder
Maturational – caused by expected events Undoing – doing something to relieve feelings of guilt.
• Example: menarche, marriage, pregnancy, • Obsessive compulsive disorder
retirement. • “Bumabawi.”
• Also called a developmental crisis. Suppression – conscious forgetting.
• Anorexia
PRIORITY ASSESSMENT • “Sinasadyang kalimutan.”
Perception of the patient – depends on the feelings of • Key word: don’t want.
the patient. Repression – unconscious forgetting.
Support system • Dissociative amnesia
Effectiveness of coping mechanisms • Key word: can’t.
Note: Dissociation – disconnection of feelings from a traumatic
• Resolving a crisis is focused on the now. event.
• A crisis differs from person to person. • Post-traumatic stress disorder
Duration of Crisis: 4 – 6 weeks (self-limiting) • Key word: don’t care.
Goal: To help patient return to pre-crisis level Rationalization – Distortion of facts.
Focus: Here and Now • Antisocial
Approach: Directive and supportive • “Nagdadahilan.”
• Education – on stress and the management of Intellectualization – disregarding the emotional aspect
stress. of a situation.
• Stress and anxiety.
FREUD’S STRUCTURAL THEORY OF PERSONALITY • “God’s will.”
ID – pleasure seeker Splitting – viewing people of events as either good or
• Immediate gratification. bad.
• Increased in people who have borderline • Borderline personality disorder
personality disorder. • Never neutral.
EGO – balancer
• Reality. SYMPTOMATOLOGIES OF MENTAL DISORDER
• Impaired in patients with schizophrenia Disturbances in PERCEPTION
because there is splitting. Illusion - misinterpretation of EXTERNAL stimulus.
SUPEREGO – conscience Hallucination – misinterpretation of SENSORY stimulus.
• The little voice of God or guilt. • Visual (psychedelics) – marijuana use
• Increased in people who have anorexia or OCD. • Tactile (formication) – alcohol withdrawal
• Olfactory (Phantosmia) – PTSD
EGO DEFENSE MECHANISMS • Gustatory (aura of seizure)
Done in order to protect the ego. • Auditory (command auditory) – Paranoid
Denial – refusal to accept the truth. Schizophrenia
MANAGEMENT FOR HALLUCINATIONS DISTURBANCE IN AFFECT
Hallucination must be recognized Mood – internal; Affect – external.
Assess the content – suicide precation. Flat - no emotion response.
Reality presentation • Catatonia – purposive lack of movement.
Divert the attention Blunt - minimal emotional response.
Engage in reality-based activity • Major depressive disorder
• Playing cards or gardening. Inappropriate - emotions are opposite to the context of
Reintegrate with the milieu the situation.
Talking back – this can only be employed in stable • Schizophrenia
patients. Restrictive - single emotional response.
Synesthesia – mixing of senses. • Paranoid
• Hearing colors and seeing sounds. La bile - sudden shift of emotions.
• Bipolar disorder
Disturbances in THOUGHT Note: focus on the actual manifestations rather than
DELUSION – false belief = naniniwala siya. the diagnosis.
• Grandiose – superiority or invulnerability
• Persecutory – “to be harmed by others” DISTURBANCES IN MEMORY
• Somatic – bodily functions are abnormal Amnesia – loss of memory.
• Nihilistic – a part of the body is missing Retrograde – inability to recall memories formed
• Erotomanic – “loved by a person” before the event that caused amnesia.
• Reminiscence therapy – songs and photos.
MANAGEMENT FOR DELUSIONS Anterograde – inability to make new memories after a
Clarification of meaning traumatic event.
Acknowledge the feelings – but not the delusion. • Reorient with clock and calendar.
Voice doubt – “I don’t see any reason...” Confabulation – making stories that are not true to fill
Engage in reality-based activities the gap between memory loss.
Reminder: DO NOT AGREE OR DISAGREE
BEHAVIORAL MANAGEMENT
Ideas of Reference – giving meaning to events or WITHDRAWN CLIENT – aloof, catatonic = safety
actions of others. precaution.
Circumstantiality – fullness of detail. ACTIVE FRIENDLINESS
• Going in circles but can answer the question. • Activity – non-competitive = does not lower
Tangentiality – lack of focus. self-esteem (e.g., folding linens, watering
• Cannot answer the question. plants because these are tasks that need to be
Looseness of Association (derailment) – fragmented completed = increases self-esteem)
ideas. • Accompany – always with the client.
• Ideas have no connection. • Appraise – do not give material rewards
Flight of Ideas – rapid speech, jumping from one topic
to another. SAMPLE QUESTIONS:
• Jumping from idea to another.
24. The therapeutic approach in the care of an autistic child
UNUSUAL SPEECH PATTERNS include the following EXCEPT:
Neologisms – coining of new words. A. Engage in diversionary activities when acting -out
• Ask the meaning of the words. B. Provide an atmosphere of acceptance
Schizophasia – word salad. C. Provide safety measures
D. Rearrange the environment to activate the child
• Random words, there is no rhyme.
Answer: (D) Rearrange the environment to activate the child
• No connection.
The child with autistic disorder does not want change.
Clang associations – rhyming of words.
Maintaining a consistent environment istherapeutic. A.
Echolalia – repeating the words of others.
Palilalia – repeating own words.
Angry outburst can be rechannelled through safe activities. A. Establish an atmosphere of trust
B. Acceptance enhances a B. Discuss their eating behavior.
trusting relationship. C. Ensure safety from self-destructive C. Help patients identify feelings associated with binge-
behaviors like head banging and hair pulling. purge behavior
D. Teach patient about bulimia nervosa
She tearfully tells the nurse “I can’t take it when she accuses Answer: (B) Discuss their eating behavior.
me of stealing her things.” Which The client is often ashamed of her eating behavior.
response by the nurse will be most therapeutic? Discussion should focus on feelings. A,C and D
A. ”Don’t take it personally. Your mother does not mean it.” promote a therapeutic relationship
B. “Have you tried discussing this with your mother?”
C. “This must be difficult for you and your mother.” 58. The client is arrogant and manipulative. In ensuring a
D. “Next time ask your mother where her things were last therapeutic milieu, the nurse does one of
seen.” the following:
Answer: (C) “This must be difficult for you and your A. Agree on a consistent approach among the staff assigned
mother.” to the client.
This reflecting the feeling of the daughter that shows B. Suggest that the client take a leading role in the social
empathy. A and D. Giving advise does not encourage activities
verbalization. B. This response does not encourage C. Provide the client with extra time for one on one sessions
verbalization of feelings. D. Allow the client to negotiate the plan of care
Answer: (A) Agree on a consistent approach among the staff
She says to the nurse who offers her breakfast, “Oh no, I will assigned to the client.
wait for my husband. We will eat A consistent firm approach is appropriate. This is a
together” The therapeutic response by the nurse is: therapeutic way of to handle attempts of
A. “Your husband is dead. Let me serve you your breakfast.” exploiting the weakness in others or create conflicts among
B. “I’ve told you several times that he is dead. It’s time to the staff. Bargaining should not be
eat.” allowed. B. This is not therapeutic because the client tends
C. “You’re going to have to wait a long time.” to control and dominate others. C. Limits
D. “What made you say that your husband is alive? are set for interaction time. D. Allowing the client to
Answer: (A) “Your husband is dead. Let me serve you your negotiate may reinforce manipulative behavior.
breakfast.”
The client should be reoriented to reality and be focused on Anger is experienced as reality sets in. This may either be
the here and now.. B. This is not a helpful directed to God, the deceased or displaced
approach because of the short term memory of the client. on others. A. Depression is a painful stage where the
C. This indicates a pompous response. D.The cognitive individual mourns for what was lost. B. Denial
limitation of the client makes the client incapable of giving is the first stage of the grieving process evidenced by the
explanation. statement “No, it can’t be true.” The
individual does not acknowledge that the loss has occurred
In the management of bulimic patients, the following to protect self from the psychological pain
nursing interventions will promote a of the loss. D. In bargaining the individual holds out hope for
therapeutic relationship EXCEPT: additional alternatives to forestall the
A. Establish an atmosphere of trust loss, evidenced by the statement “If only...”
B. Discuss their eating behavior. 62. The nurse’s therapeutic response is:
C. Help patients identify feelings associated with binge- A. “I will refer you to a clergy who can help you understand
purge behavior what is happening to you.”
D. Teach patient about bulimia nervosa B. “ It isn’t fair that an innocent like you will suffer from
Answer: (B) Discuss their eating behavior. AIDS.”
The client is often ashamed of her eating behavior. C. “That is a negative attitude.”
Discussion should focus on feelings. A,C and D D. ”It must really be frustrating for you. How can I best help
promote a therapeutic relationship you?”
Answer: (D) ”It must really be frustrating for you. How can I
In the management of bulimic patients, the following best help you?”
nursing interventions will promote a therapeutic This response reflects the pain due to loss. A helping
relationship EXCEPT: relationship can be forged by showing empathy
and concern. A. This is not therapeutic since it passes the o Replace CV
buck or responsibility to the clergy. B. This o Increases O2 carrying capacity
response is not therapeutic because it gives the client the o Combat infection
impression that she is right which prevents o Prevent bleeding
the client from reconsidering her thoughts. C. This
statement passes judgment on the client. Nursing consideration
1. Proper refrigeration of blood products
The nurse asks a client to roll up his sleeves so she can take 2. Proper Crossmatching and blood typing
his blood pressure. The client replies
“If you want I can go naked for you.” The most therapeutic
BLOOD TYPE UNIVERSALS
response by the nurse is:
A. “You’re attractive but I’m not interested.” Type O – UD (UNIVERSAL DONOR)
B. “You wouldn’t be the first that I will see naked.” Type AB – UR (UNIVERSAL RECIPIENT)
C. “I will report you to the guard if you don’t control
yourself.” 3.Blood expiration
D. “I only need access to your arm. Putting up your sleeve is a. APC- 5 days
fine.” b. RBC 5-7 days
Answer: (D) “I only need access to your arm. Putting up your
sleeve is fine.” Before Administration
The nurse needs to deal with the client with sexually 1. Prepare materials
connotative behavior in a casual, matter of fact 2. PNSS >> preent hemolysis >> used 18 gauge large bore
way. A and B. These responses are not therapeutic because needles
they are challenging and rejecting. C. 3. Consent
Threatening the client is not therapeutic. 4. Check blood products

The client is concerned about his coming discharge,

a. Name of pt
manifested by being unusually sad. Which is
b. Expiration
the most therapeutic approach by the nurse?
c. Serial no.
A. “You are much better than when you were admitted so
there’s no reason to worry.” Nursing Repsonsibility
B. “What would you like to do now that you’re about to go 1. Never warm
home?” 2. Transfusing time : 4 hrs >> blood deterioratation
C. “You seem to have concerns about going home.” 3. Avoid Mixing and administering in the blood line : lysis
D. “Aren’t you glad that you’re going home soon?” 4. KVO in the first 30 min then 100 /cc hr >> prevent
Answer: (C) “You seem to have concerns about going Circualory overload
home.” 5. VS q15min for 1st hr >> majority reaction occurs at this
. This statement reflects how the client feels. Showing time
empathy can encourage the client to talk which
is important as an alternative more adaptive way of coping
with stressors.. A. Giving false
reassurance is not therapeutic. B. While this technique
explores plans after discharge, it does not Signs of BT reaction
focus on expression of feelings. D. This close ended question
does not encourage verbalization of
feelings. 1. Hemolytic reaction
o Life threatening
BLOOD TRANSFUSION
CM ( clinical manifestation)
BLOOD TRANSFUSION
Objectives:
1. Dizziness 4. Orthopnea-breathlessness in the recumbent position
2. HA ( nagahiga paharap), relieved by sitting or standing
3. Hypotension
4. Flushed skin
5. Red urine
MGT :
MGT : 1. Stop
1. Stop 2. Notify
2. Notify 3. Diuresis >> loop
3. Flush with NSS >> isotonic Solution > to counteract 4. No flushing
shock and prevent tubular necrosis 5. Air embolism
4. Send blood back to lab for reexamination 6. thrombocytopenia
2. Allergic Reaction 7. citrate intoxication
8. Hyperkalemia

CM ( CLINICAL MANIFESTATION)
1. Fever
2. Chills SAMPLE QUESTIONS:
3. Dyspnea
4. Spasm What should you do FIRST before you administer blood
5. Wheezing transfusion?
6. Urticaria
A. verify client identity and blood product, serial number,
MGT : blood type, cross matching results, expiration date
1. Stop B. verify client identity and blood product serial number,
2. Notify blood type, cross matching results, expiration date with
3. Flush with NSS another nurse
4. Send blood back to lab
5. Medications C. check IV site and use appropriate BT set and needle
a. Antihistamine
6. Obtain urine and blood sample for re examination D. verify physician’s order

98. As Wally’s nurse, what will you do AFTER the

transfusion has started?
3. Pyrogenic Reaction (FEVER, NEGATIVE RESULT) A. add the total amount of blood to be transfused to the
MGT : intake and output
1. Stop
2. Notify B. discontinue the primary IV of Dextrose 5% Water
3. Flush with NSS
4. Send blood back to lab C. check the vital signs every 15 minutes
5. Antipyretics
D. stay with Wally for 15 minutes to note for any possible
6. Antibiotic
BT reactions

99. Wally is undergoing blood transfusions of the first unit.

4. Circulatory overload The EARLIEST signs of transfusion reactions are:
CM
A. oliguria and jaundice C. hypertension and flushing
1. Dyspnea- Lisod ginhawa
2. Rales/ stridor-Small clicking, bubbling, or rattling B. urticaria and wheezing D. headache, chills, fever
sounds in the lungs. They are heard when a person
breathes in (inhales) 100. In case Wally will experience an acute hemolytic
3. Crackles- exhale, fluid sa lungs, ga bukal bukal reaction, what will be your PRIORITY intervention?
A. immediately stop the blood transfusion, infuse Dextrose the nurse should inform the client of the duration of the
5% in Water and call the physician transfusion and should document its administration, these
actions are less critical to the client’s immediate health. The
B. stop the blood transfusion and monitor the patient nurse should assess vital signs at least hourly during the
closely transfusion.
C. immediately stop the BT, infuse NSS, call the physician,
notify the blood bank
Situation 6 - The nurse assists in the care of a 20-year old
D. immediately stop the BT, notify the blood bank and male client needing blood transfusion. The attending
administer antihistamines physician writes an order of blood transfusion of 250 cc of
packed red cells after blood cross matching.
89. Nurse Marian is preparing to administer a blood
transfusion. Which action should the nurse take first?

a. Arrange for typing and cross matching of the client’s 26. Before infusing the blood, the nurse assesses the
blood. client’s ________.
*
b. Compare the client’s identification wristband with the tag 1/1
on the unit of blood. A. Vital signs

c. Start an I.V. infusion of normal saline solution. B. Mental state

C. Skin color
d. Measure the client’s vital signs.
D. Hemoglobin and hematocrit levels
Answer: (A) Arrange for typing and cross matching of the
client’s blood. 27. The nurse takes the temperature of the client. The
temperature registers 39⁰C. Based on this finding, the nurse
Rationale: The nurse first arranges for typing and cross should:
matching of the client’s blood to ensure compatibility with *
donor blood. The other options, although appropriate when 1/1
preparing to administer a blood transfusion, come later. A. Administer an antihistamine and transfuse the blood.
B. Start the blood transfusion as ordered.
93. Which nursing intervention takes highest priority when C. Withhold the blood transfusion and notify the physician.
caring for a newly admitted client who’s receiving a blood
transfusion? D. Give tepid sponge bath and wait for the temperature to
a. Instructing the client to report any itching, swelling, or go down then transfuse the blood.
dyspnea.
28. Which of the following nursing interventions should
b. Informing the client that the transfusion usually take 1 ½ have the HIGHEST priority when caring for a client receiving
to 2 hours. blood transfusion?
*
c. Documenting blood administration in the client care 1/1
record. A. Regulate the drops accurately.
B. Instruct the client to notify the nurse if the client
d. Assessing the client’s vital signs when the transfusion experiences itchiness, headache or difficulty of breathing.
ends.

93. Answer:(A) Instructing the client to report any itching, C. Document the blood type, time transfusion started, and
swelling, or dyspnea. vital signs taken.
D. Inform the client that the transfusion may last for one
Rationale: Because administration of blood or blood and a half to two hours.
products may cause serious adverse effects such as allergic
reactions, the nurse must monitor the client for these 29. The nurse administers the blood and starts the
effects. Signs and symptoms of life-threatening allergic transfusion at 20 – 25 drops per minute. The nurse observes
reactions include itching, swelling, and dyspnea. Although
for a transfusion reaction which usually occurs during the group: : “Which among the following is the MAJOR mode of
_____ minutes after transfusion. transmission of the disease?”
*
1/1 *
A. 15 minutes 1/1
A.Blood Transfusion
B. 45 minutes B.Needle pricks
C. 5 minutes C.Sexual intercourse
D. 30 minutes D.Kissing

30. The client receiving blood transfusion begins to wheeze

on respiration, itch and observes that his skin becomes 1.The nurse takes the temperature of the client. The
flushed with hives. The nurse recognizes these signs as temperature registers 39⁰C. Based on this finding, the nurse
characteristic of what type of reaction? should:
* A. Administer an antihistamine and transfuse the blood.
1/1 B. Start the blood transfusion as ordered.
A. Bacterial C. Withhold the blood transfusion and notify the physician.
B. Hemolytic
C. Allergic D. Give tepid sponge bath and wait for the temperature to
go down then transfuse the blood.
D. Systemic
Situation 7 – A 30 year-old female is admitted for fever, 28. Which of the following nursing interventions should
fatigue, lymphadenopathy, thrush, diarrhea and muscle and have the HIGHEST priority when caring for a client receiving
joint pains. She also has a rash in her torso and arms. blood transfusion?

A. Regulate the drops accurately.

31. The nurse assesses the client. What question should she B. Instruct the client to notify the nurse if the client
ask to determine the client’s possible exposure to HIV? experiences itchiness, headache or difficulty of breathing.
*
1/1 C. Document the blood type, time transfusion started, and
A. “Do you use public toilet seats?” vital signs taken.
B. Did you shake hands with a person infected with HIV?” D. Inform the client that the transfusion may last for one
C. “Did you receive blood transfusion recently?” and a half to two hours.
D. “Do you practice safe sex?”
29. The nurse administers the blood and starts the
transfusion at 20 – 25 drops per minute. The nurse observes
32. The nurse writes a care plan for the client. Included in for a transfusion reaction which usually occurs during the
the care plan is to provide health teachings. Before the _____ minutes after transfusion.
nurse performs any teaching, what should the nurse do A. 15 minutes
FIRST? B. 45 minutes
C. 5 minutes
A. Evaluate the client’s existing level of knowledge about D. 30 minutes
HIV infection.
B. Assess the client’s immediate clinical status. 30. The client receiving blood transfusion begins to wheeze
on respiration, itch and observes that his skin becomes
C. Assess the emotional status of the client. flushed with hives. The nurse recognizes these signs as
D. Focus on potential problems the client may encounter characteristic of what type of reaction?
during the illness.
A. Bacterial
B. Hemolytic
71. Miss Greigh’s first topic was on HIV transmission. After C. Allergic
explaining the different transmission modes, she asked the D. Systemic
Situation 7 – A 30 year-old female is admitted for fever, 1. Drainage bottle
fatigue, lymphadenopathy, thrush, diarrhea and muscle and
joint pains. She also has a rash in her torso and arms. 2. Water seal

-Observe for fluctuation

31. The nurse assesses the client. What question should she
ask to determine the client’s possible exposure to HIV?
• If connected to suction apparatus
A. “Do you use public toilet seats?”
B. Did you shake hands with a person infected with HIV?” 1. Drainage and water seal bottle
C. “Did you receive blood transfusion recently?”
D. “Do you practice safe sex?” 2. Suction control bottle

-Expect continuous bubbling

-Immerse 2-3 cm NSS

BOTTLE SYSTEM
- Immerse 10-20 cm suction control bottle =
TYPE OF BOTTLE DRAINAGE negative pressure

• ONE BOTTLE SYSTEM • THREE BOTTLE SYSTEM

o Immerse yung tip 2-3 cm of sterile NSS to create water 1. Drainage bottle
seal
2. Water seal bottle
o Keep the bottle 2- 3 feet below the chest
3.Suction control bottle
o Never raise the bottle above chest

o Assesses for patency of device

SAMPLE QUESTIONS:
o Observe for fluctuation 1. Nurse Dexter is administering enema, suddenly the client begins
to complain of pain and notes blood in the return fluid and rectal
o Observe for intermittent bubbling of fluid bleeding. What is the primary action of Nurse Dexter?
A. Stop the instillation and get vital signs
IN THE ABSENCE OF FLUCTUATION B. Slow down the rate of instillation
C. Tell him to breathe slowly and relax
o Asses the patient first D. Stop the instillation

o Kinks along the tubing Situation: Mang Knorr who underwent a pneumonectomy is in a
three-way bottle systemfor drainage after the operation.
o Milk tubing towards the bottle
2. You entered Mang Knorr’s room to check his vital signs, you
o If no obstruction, consider re expansion of the lungs =cxr noticed that the water seal bottle has continuous bubbling,
will be ordered at the moment you can suspect that:
A. Everything is normal
• TWO BOTTLE SYSTEM B. There may be leakage along the tube
C. There is obstruction in the tube
• If not connected to suction bottle D. Lung has re-expanded

ETHICAL PRINCIPLES
from the nurse. The patient has the right to reject
Ethics, simply defined, is a principle that describes what is or accept all treatments.
expected in terms of right and correct and wrong or
incorrect in terms of behavior. For example, nurses are held • Veracity is being completely truthful with patients;
to ethical principles contained within the American Nurses nurses must not withhold the whole truth from
Association Code of Ethics. Ethics and ethical practice are clients even when it may lead to patient distress.
integrated into all aspects of nursing care.
Ethical Principles (from Belmont Report)

The two major classifications of ethical principles and

1) Beneficence: Do good (e.g. medications)
ethical thought are utilitarianism and deontology.
Deontology is the ethical school of thought that requires
that both the means and the end goal must be moral and 2) Non-maleficence: Do no harm (e.g. asepsis) ( may risk
ethical; and the utilitarian school of ethical thought states factor na present)
that the end goal justifies the means even when the means
are not moral. 3) Justice: equal risks and benefits

The ethical principles that nurses must adhere to are the 4) Autonomy: voluntary decision
principles of justice, beneficence, nonmaleficence,
accountability, fidelity, autonomy, and veracity. 5) Veracity: complete information about the

• Justice is fairness. Nurses must be fair when they study

distribute care, for example, among the patients in
the group of patients that they are taking care of. 6) Confidentiality: data not revealed
Care must be fairly, justly, and equitably
distributed among a group of patients. - Anonymity: identity cannot be linked to data

• Beneficence is doing good and the right thing for Informed Consent
the patient.
- accept or decline participation voluntarily
• Nonmaleficence is doing no harm, as stated in the
historical Hippocratic Oath. Harm can be - protects right to self-determination
intentional or unintentional.
Informed Consent (VICS)
• Accountability is accepting responsibility for one's
own actions. Nurses are accountable for their - Voluntary
nursing care and other actions. They must accept
all of the professional and personal consequences
- Informed: fully understood
that can occur as the result of their actions.

- Competence: 18 y/o and above (legal age), coherent

• Fidelity is keeping one's promises. The nurse must
be faithful and true to their professional promises
- Signature: (1) Participant, (2) witnesses
and responsibilities by providing high quality, safe
care in a competent manner.
SAMPLE QUESTIONS:
• Autonomy and patient self-determination are
upheld when the nurse accepts the client as a 92. Which of the following codes of research ethics requires
unique person who has the innate right to have informed consent in all cases governing
their own opinions, perspectives, values and
beliefs. Nurses encourage patients to make their human subjects?
own decision without any judgments or coercion
A. Helsinki Declaration
B. Nuremberg Code knowledge and is given freely. The action of allowing the
patient to decide whether a surgery is to be
C. Belmont Report
done or not exemplifies the bioethical principle of
D. ICN Code of Ethics autonomy.

Answer: (A) Helsinki Declaration 106. When a nurse is providing care to her/his patient, s/he
must remember that she is duty bound not
Helsinki Declaration is the first international attempt to set
up ethical standards in research involving human research to do doing any action that will cause the patient harm. This
subjects. is the meaning of the bioethical

93. Which of the following ethical principles was NOT principle:

articulated in the Belmont Report?
A. Non-maleficence
A. Beneficence
B. Beneficence
B. Respect for human dignity
C. Justice
C. Justice
D. Solidarity
D. Non-maleficence
Answer: (A) Non-maleficence
Answer: (D) Non-maleficence
Non-maleficence means do not cause harm or do any action
Non-maleficence is not articulated in the Belmont Report. It that will cause any harm to the
only includes beneficence, respect for human dignity and
justice. patient/client. To do good is referred as beneficence.

Ensuring that there is an informed consent on the part of

the patient before a surgery is done,
107. When the patient is asked to testify in court, s/he must
illustrates the bioethical principle of: abide by the ethical principle of:

A. Beneficence A. Privileged communication

B. Autonomy B. Informed consent

C. Truth telling/veracity C. Solidarity

D. Non-maleficence D. Autonomy

Answer: (B) Autonomy Answer: (A) Privileged communication

Informed consent means that the patient fully understands All confidential information that comes to the knowledge of
what will be the surgery to be done, the the nurse in the care of her/his patients is

risks involved and the alternative solutions so that when considered privileged communications. Hence, s/he is not
s/he give consent it is done with full allowed to just reveal the confidential
information arbitrarily. S/he may only be allowed to break another. Which of the following roles encompasses the
the seal of secrecy in certain conditions. ability to influence others to accomplice a specific goal?

One such condition is when the court orders the nurse to A.Advocate
testify in a criminal or medico-legal case.
B.Leader
Across all settings in the practice of nursing, nurses are
confronted with ethical and legal issues related to client C.Communicator
care, thus, the professional nurse has the responsibility to
be aware of the ethical principles, laws, and guidelines D.Manager
related to providing safe and quality care to clients.
4. Nurses pursue further education and fulfills expanded
1. It is the branch of philosophy concerned with the career roles. The nurse-midwife may perform the following
distinction between right and wrong based on a body of independently:
knowledge, not based only on opinions.
1. Prenatal care
A.Morality- internal/ personal
2. Postnatal care
B.Ethics- based on culture/ dictated by society
3. Manual evacuation of placenta
C.Virtues
4. Manage deliveries in normal pregnancies
D.Values
5. Pap smears
2. The Code of Ethics serves as a guide for one’s actions. It
aims to improve one’s discretion. All but one of the
6. Blood transfusion
following is embodied in the American Nurses Association
Code of Ethics.
7. Family planning
A.The nurse’s primary commitment is to the client, whether
8. Clinical breast exams
an individual, family, group or community

A.1, 2, 3, 4, 7
B.The nurse promotes, advocates for, and strives to
protect the health, safety, and rights of clients only under
her direct care- unethical (only under her care= dapat kahit B.1, 2, 4, 5, 6, 7
hindi assign s aiyo ang yentante dapat mag promote ka
parin ng care) C.1, 2, 4, 5, 7, 8

C.The nurse owes the same duties to self as to others, D.1, 2, 4, and 7
including the responsibility to preserve integrity and safety,
to maintain competence, and to continue personal and 5. Nurses are governed by civil and criminal law in roles as
professional growth providers of services, employees of institutions, and private
citizens. A nurse who does not meet the standards of care
D.The profession of nursing, as represented by associations may be held liable and may be subjected to civil cases. What
and their members, is responsible for articulating nursing is a civil law?
values, for maintaining the integrity of the profession and
its practice, and for shaping social policy A.Concerned with the enforcement of agreements among
private individuals
3. Aside from direct client care, the nurse assumes several
roles in and out the health care setting and they often carry B.Concerned with relationships among persons and the
out these roles concurrently rather than exclusively of one protection of a person’s rights
C.Concerned with relationships between individuals and
governments, and with acts that threaten society and its
order

D.Civil wrong- danyos lang

Set 2: iii. Droplet (<3 feet; surgical mask)
1. Immunization b) Airborne
2. Communicable Diagnosis (Respi) i. Fine particles (>3 feet; N95 mask)
3. Community Organizing c) Vehicle (non-living)
4. Abruptio Placenta/Placenta Previa d) Vector (living)
5. Stages of Labor 5. Portal of entry
6. IMCI (DHN and Pneumonia) 6. Host (susceptible)
7. Breastfeeding
8. PIH (eclampsia) TUBERCULOSIS
9. Gestational Diabetes Mellitus CA: Mycobacterium tuberculosis
10. Leukemia MOT: Airborne, Droplet (<3 feet; surgical mask)
DIAGNOSIS: Direct sputum smear microscopy,
IMMUNIZATION Mantoux Test/Tuberculin skin test/PPD, Chest
POINTERS FROM FC EXAM:
VAXX DOSE SCHED DOSAGE ROUTE ➢ Dirty case- last to visit in the community
BCG 1 Birth 0.05 ID ➢ Active TB: place pt in NEGATIVE PRESSURE
Hepa B 1 Birth 0.5 IM PRIVATE ROOM; masks and shields
PENTA 3 1.5 mos 0.5 IM ➢ Early/first diagnosis in health center:
(DPT, hepa
2.5 mos direct sputum smear microscopy 1-5 ml
b, HiB)
3.5 mos specimen (DSSM)
OPV 3 1.5 mos 2 gtts PO ➢ XPERT MTB/RIF= new technology; rapid
2.5 mos diagnosis of TB in less than 2 hours
3.5 mos ➢ MDT: RDL (rifamp, dapsone, lamprene)
IPV 1 3.5 mos 0.5 IM ➢ Least allergic reaction: ISONAIAZID
MMR 2 9 mos 0.5 SQ ➢ Most allergic reaction: STREPTOMYCIN
1 yr ➢ Contraindicated for pregnant women:
PCV 3 1.5 mos 0.5 IM STREPTOMYCIN
(pneumonia
, meningitis)
2.5 mos
3.5 mos Xpert-MTB
SIGNS MEANINGS
T + MTB
COMMUNICABLE DISEASE (TB) RR + MTB
Communicable: transmitted from 1 person to + Rifampicin Resistance
another TI + MTB
Contagious: easily transmitted Undetermined Rifampicin Resistance
Isolation: separation of infected individual N - MTB
Basis: period of communicability
(pt is highly contagious) Categories I IA II IIA IV
Ex: of TB
Positive Bones Failure Ia and Chronic
⚫ TB- 2 weeks of treatment Imunno comp Joints Relapse II
Quarantine: exposed individual Extrapulmonar Meninges
Basis: Longest Incubation Period y (extrapulmonary)
Ex:
⚫ COVID-19- 2 to 14 days 2 RIPES
Intensive 2 RIPE 2 RIPES 2 RIPES Refer for
⚫ SARS- 2 to 10 days 1 RIPE 1 RIPE C&S
⚫ EBOLA- 2 to 21 days Maintenan 4 RI 10 RI 5 RI 9 RI Refer for
ce C&S
Chain of Infection TOTAL 6 MONTHS 12 MONTHS 8 MOS 12 MOS
1. Causative agent
a) Bacteria, virus, parasite, protozoa
BIRD’S FLU SWINE FLU
2. Reservoir- live and multiply
CA H5N1 AH1N1
3. Portal of exit
MOT Contact droplet
4. Mode of transmission Pointers ➢ Okay to eat the bird
a) Contact ➢ Prepare well the meat
i. Direct (physical contact) ➢ KILL ALL INFECTED BIRDS
ii. Indirect (fomites) ➢ Don’t touch infected birds
➢ All forms of bird flu can cause illness to BIRDS
➢ Can infect PIGS

S/sx ➢ Fever
➢ Sore eyes/throat
➢ Body weakness
5 CRITERIA WEIGHT
Nature of the problem 1
Modifiability of the problem 4

Preventive potential 1
Social concern 1
Magnitude of the Problem 3

% of the population affected 10

(highest score)
> score = > priority

COPAR= Community Organization &

COMMUNITY ORGANIZING Participatory Action Research
-treatment of actual/potential community Goal: SOCIAL TRANSFORMATION
problems Roles:
✓ Nurse= Facilitator, Researcher
11 STEPS OF COMMUNITY DIAGNOSIS ✓ People= Leader, ADPIE, co-researcher

1) Determine OBJECTIVES Action research- research applied in the social

2) Define POPULATION issue
3) Determine DATA TO BE COLLECTED
4) COLLECT DATA PROCESS/PHASES OF COPAR (PE-COAST)
5) Develop INSTRUMENT (questionnaire) 1. Pre-entry
6) ACTUAL DATA GATHERING (done by a) PSI- preliminary social investigation,
population) gather data from different barangay
7) DATA COLLECTION (tally information) b) Site selection
8) DATA PRESENTATION (chart/graph) c) Base line- courtesy call
a) Pie chart
i. Distribution of groups 2. Entry/Social Preparation
b) Bar graph a) GOAL= establish the ground for
i. Distribution of groups w/ many organization, courtesy call (show
variables respect to leaders)
c) Line graph b) DSI= deepening social investigation;
i. “pattern/distribution” over time immersion/integration; “imbibe the
d) Histogram life of the people in the community”
i. Distribution of “frequency” or c) Spot potential leaders/ CORE GROUP
number of occurrence FORMATION
9) DATA ANALYSIS d) SALT= self-awareness leadership
✓ Done with the PEOPLE training
10) IDENTIFY COMMUNITY HEALTH PROBLEMS i. DOH= primary health care
 H. STATUS= morbidity/mortality seminar leadership
 H. RESOURCES= Manpower, Money,
Material 3. Community study/assessment/diagnosis
 H. RELATED= political, environmental. a) Profiling of community- train the
Socioeconomic, trans-cultural people
11) PRIORITIZE b) Research team
i. Adhoc committee
ii. COMMUNITY DIAGNOSIS IS
DONE
c) COMMUNITY DIAGNOSIS

4. Organizational phase (plan solutions)

➢ Building of community health organization
➢ Election of officers
➢ Training of officers ➢ Bed rest in side lying position; emergency
➢ Team building of officers for 48 hours
➢ ASSESS:
5. Action phase (implementation of people’s ◼ Duration of pregnancy
power) ◼ Time bleeding has begun
➢ PIME. Program Implementation ◼ Estimation of blood loss
Monitoring Evaluation ◼ Color of blood (BRIGHT RED)
➢ Education and training of barangay health ◼ If she inserted tampon
worker or community health worker ➢ Use of APT/Kleihaurr-Betke test
(determine if blood is fetal or maternal)
6. Sustenance and strengthening ➢ NEVER do rectal exam to a client with
➢ Continue education and training of BHW painless vaginal bleeding
and officers ➢ Assess BP for shock
➢ Medium and long term goals are MET ➢ BETAMETHASONE- fetal lung maturity; 2
doses, 24 hours apart
7. Turnover/Phase out ➢ DEXAMETHASONE- 4 doses, 12 hours apart
➢ End
➢ People are SELF-RELIANT ABRUPTIO PLACENTA (AGAY!)
1) Partial Separation
ADVOCACY a) Concealed- internal bleeding; no
➢ promote active participation vaginal bleeding
➢ Optimal decision making b) Apparent- vaginal bleeding
➢ Empower people 2) Complete separation- sudden bleeding

4 actions to promote advocacy (KONKHE) Causes:

1. Inform people of the rightness of the cause ➢ High parity
2. Discuss with the people alternatives ➢ Advanced maternal age
3. Support client’s informed decision ➢ Short umbilical cord (52-60 cm is N)
4. Influence public opinion ➢ Direct trauma
➢ Cocaine and cigarette use

ABRUPTIO PLACENTA/PLACENTA PREVIA S/SX:

➢ SHARP, STABBING PAIN HIGH IN THE
➢ Both abruptio placenta and placenta FUNDUS
previa are THIRD TRIMESTER BLEEDING ➢ Tense rigid, board-like abdomen
Pointers from FC: ➢ Couvelaire uterus (uteroplacental apoplexy)
 NEVER perform pelvic examination ➢ DIC (disseminated intravascular
 Umbilical cord potruding in hospital: knee coagulation)
chest position (priority)
 PAINFUL, BOARD-LIKE ABDOMEN= MGT:
ABRUPTIO 1) Fluid replacement
 PAINLESS= PREVIA 2) Oxygen
3) Left Side-lying position
PLACENTA PREVIA (PHEW!) 4) With DIC, give cryoprecipitate
✓ Low lying placenta (lower portion of the
uterus)
✓ Marginal implantation (near cervical os)
✓ Partial (cover portion of cervical os)
✓ Complete ( cover cervical os totally)

S/SX:
✓ PAINLESS, bright red vaginal bleeding
✓ Premature labor
✓ NO FETAL HEAD ENGAGEMENT (complete
placenta previa)

MGT: 4 STAGES OF LABOR

True labor False labor
-Start at lumbar or -Confined to 4th STAGE
back hypogastric area ➢ 1st hour after delivery
-Regular interval -Irregular interval
-Progressive dilatation -No cervical dilatation Pointers from FC:
& effacement & effacement ➢ TRANSITIONAL= shortest but most difficult
-Intensity is increasing -No change on stage
-Ambulation intensify intensity ➢ 1st stage of labor: intense pain around
-Sedation has no -Ambulation stop PELVIC GIRDLE
effect contraction ➢ 2nd stage of labor: assess uterine
-Sedation has effect contractions every 15 minutes (doppler)
➢ EPISIOTOMY: shortens 2nd stage of labor
True so much: ➢ Go to hospital if membranes rupture or
✓ Uterine contraction contractions are 5-8 mins apart
✓ Bloody show ➢ PROM is associated with malpresentation
✓ Rupture of membranes and possibly incompetent cervix
✓ Cervical dilatation

1ST STAGE: 0-10 CM IMCI (Dehydration & Pneumonia)

➢ True contraction ---> Cervical dilatation ➢ 5 years old BELOW
➢ Nitrazine test= blue: amniotic; red: urine ➢ Integrated Management of Childhood
➢ >24 hrs after ROM and still no birthing Illness
occurred= CS
1. LATENT= 0-3 cm 1) Greet patient
2. ACTIVE= 4-7 cm 2) Ask common childhood problem
3. TRANSITION= 8-10 cm a) Not rare
b) Not genetic
2nd STAGE: CROWNING! c) Not trauma
➢ 10 cm ---> DELIVER OF THE BABY
➢ don’t encourage pushing if cervix is not ➢ PROBLEM/S OF THE CHILD
fully dilated and there’s no contraction ➢ AGE
➢ Mechanisms of Labor: ED-FIRE-ERE ◼ Sick infant (0-2 mos)
➢ EINC (PINE) ◼ Sick child (2 mos-5 y.o.)
◼ Properly timed cord clamping ➢ VISIT (initial & follow-up)
◼ Immediate drying of baby ◼ 3 days= Pneumonia, Dysentery, Malaria,
◼ Non-separation of mother and baby Measles, Gum ulcers
◼ Early breastfreeding (within 1 hour ◼ 5 days= persistent diarrhea, acute &
postpartum) chronic ear infection, cough/colds
◼ 14 days= feeding problem, anemia
3rd STAGE ◼ 30 days= moderate acute malnutrition;
➢ Baby ---> PLACENTA “call your MAM every 30 days”
➢ Beyond 30 mins= abnormal
➢ Signs of placental expulsion CASE MANAGEMENT PROCESS
◼ Calkin’s sign (uterus becomes firm and ✓ Assess
globular) ✓ Classify
◼ Lengthening of the cord ✓ Identify tx
◼ Sudden gush of blood ✓ Tx
◼ Rising of the uterus into the abdomen ✓ Counselling
➢ SCHULTZE’s (shiny; less bleeding) ✓ Follow-up
➢ DUNCAN’s (dirty; more bleeding)
◼ Assess placenta POINTERS FROM FC:
◼ Meaure diameter ✓ Pre-referral treatments that should NOT
◼ Weigh placenta be included: “do not give any medications”
◼ Measure umbilical cord ✓ Basta I-memorize lang ang table PAYTS NA
◼ Assess AVA AHAHHAAHAHHAHAH
➢ PRIORITY: MINIMIZING RISK FOR
HEMORRHAGE
PATTERN
SICK INFANT SICK CHILD
(InJaDiFeHi)
✓ Infection Danger signs (4) CUVA
✓ Jaundice 1. Convulsions
✓ Diarrhea 2. Unable to drink/eat
✓ Feeding problem 3. Vomits everything
✓ HIV status 4. Abnormally sleepy/stupor

Main symptoms: (dede ni fe)

➢ DOB/cough
➢ Diarrhea
➢ Fever
➢ Ear problem

Minor symptoms: (MAH..tambok)

➢ Malnutrition
➢ Anemia
➢ HIV status

DEHYDRATION: 2 or more signs present

1 PINK + 1 YELLOW = SOME DHN
Classification Assess Treatment
SEVERE DHN “ASIS- very slowly” PLAN C: RHU
-IV fluid- LR & PNSS
-Abnormally sleepy and -
Stupor= 1 sign
Inability to D or E= 1 sign
-Sulken eyes= 1 sign

SOME DHN “RIDS- slowly” PLAN B: RHU

-ORS: 4 hours
-Restless and Irritable= 1 sign - 75 ml x W (kg)
-Drinks eagerly= 1 sign
-Sunken eyes= 1 sign

NO DHN Not enough s/sx PLAN A

-Go home

DOB/COUGH/PNEUMONIA

Classification Assess Treatment

SEVERE PNEUMONIA -StrIdor: inhalation -FAB (IM)
(1 sign= PINK) -Danger sign ➢ Ampicillin
➢ AmpiGen
➢ Refer
PNEUMONIA -Chest Indrawing “IN! IN! IN!” -RHU
(2 sign= YELLOW) -Fast breathing -Amoxicillin 5 days
0-2 mo= 60 >
2-12 mo= 50 >
12-60 mo= 40 >

No pneumonia cough HOME

-breast milk
-calamansi juice
REASTFEEDING c) Diastolic BP= important to document;
indicates the degree of peripheral
“Tama, Sapat, at Eklusibo ang Pagpapasuso arterial spasm
kahit nasa Trabaho” d) Systolic BP > 30 mmHg above pre-
pregnancy values
➢ Lactation/rooming in concept e) Diastolic BP > 15 mmHg above pre-
➢ EO 51: MILK CODE pregnancy values
➢ RA 7600= BREAST FEEDING LAW f) Weight gain: 2 lbs/week in 2nd
➢ 10-15 mins each breast= proper best trimester
emptying g) Weight gain of 1 lb/week in 3rd
➢ Clean with WARM WATER ONLY trimester
➢ Latching= tamang pagsuso ng bata sa suso MGT:
ng nanay ➢ Bed rest to conserve oxygen
◼ 3/4 of areola should be covered ➢ Normal salt intake (2-3 g/day)
◼ Outward lower lip ➢ Closer follow-up, weekly check up
➢ Nipple dryness, soreness= normal
➢ Breast fullness= normal 3. Severe pre-eclampsia
➢ Breast engorgement- 3rd day postpartum a) 160/100 mmHg
◼ Warm compression: enhance milk b) Mark proteinuria (3+ or 4+)
production c) Protein of more than 5 g in a 24 hour
◼ PROLACTIN: milk production sample
◼ OXYTOCIN: milk let down d) Extensive edema
➢ SORE NIPPLES: e) Elevated serum creatinine more tha 1.2
◼ Expose to air for 10-15 mins mg/dL
◼ Expose 21 watt bulb, 12-18 inches f) Epigastric pain
away g) Hepatic dysfunction
h) Thrombocytopenia
Pointers from FC: MGT:
✓ MASTITIS: breast injury cause by ➢ Prevention of seizure
overdistention, stasis, and cracking of ➢ Give MAGNESIUM SULFATE
nipples ◼ Can decrease BP
✓ Good bottle feeding technique: keeps the ◼ Check deep tendon reflex
nipple full of formula throughtout the ◼ Check RR (respiratory depression)
feeding ◼ Check UO
✓ COLOSTRUM- first gawas na milk sa boobz; ◼ Antidote: Calcium gluconate
daghan nutrients, let the baby suck haha
4. ECLAMPSIA
➢ Most severe classification of PIH
PREGNANCY INDUCED HYPERTENSION ➢ Grand-mal seizure or coma occurs
➢ Accompanied by s/sx of pre-eclampsia
➢ Vasospasms occur during pregnancy in
both small and large arteries MGT:
S/SX: ➢ Give additional meds aside from MgSO4
1. Hypertension after 20th week AOG ➢ Diuretics: furosemide
2. Proteinuria: >250 mg/dl ➢ Digitalis (Digoxin)- to promote contractility
3. Edema of the heart; check apical pulse
4. Eclampsia ◼ Administer K+
➢ Barbiturates: fast-acting sedatives; arrests
CLASSIFICATIONS: seizure
1. Gestational Hypertension ➢ Hydralazine (treat high BP)
a) Elevated BP= 140/90 mmHg
b) No proteinuria NSG RESPONSIBILITIES:
c) No edema ✓ Provide dim light room
d) BP returns to normal after birth ✓ Limit visitors
2. Mild Pre-eclampsia ✓ Put side rails up
a) Proteinuria (1+ or 2+) ✓ Suction machine at bedside
b) BP: 140/90 mmHg
✓ don’t put anything in mouth if there is ➢ Systemic cancer- can spread throughout
seizure the body
✓ Open collar WHAT: EXCESSIVE production of abnormal
✓ Turn patient to side to promote drainage immature WBCs
of saliva ✓ Congested blood vessel >
✓ Promote safety compensatory mechanism > decrease
RBC and platelet
Pointers from FC: WHY: Genetic, Chemotherapy
✓ Pre-eclampsia having seizure: TURN THE EFFECTS:
CLIENT TO THE SIDE (priority) ✓ immunocompromised
✓ anemia
GESTATIONAL DIABETES MELLITUS ✓ thrombocytopenia
➢ A condition of abnormal glucose S/SX:
metabolism that arises during pregnancy ✓ Body malaise
Causes: unknown; Human Placental Lactogen ✓ Pallor
(HPL) ✓ Easy fatigability
Risk factors: ✓ Bleeding tendencies
✓ Obesity DX: bone marrow aspiration
✓ Age over 25 TX:
✓ Race ✓ Radation therapy
✓ Hx of large babies (>10 lbs) ✓ Chemotherapy
✓ Hx of unexplained fetal or perinatal loss ✓ Bone marrow transplant
✓ Hx of congenital anomalies in previous ◼ (low success rate; high risk of
pregnancies rejection)
✓ Family hx of diabetes ◼ Prevent rejection by
immunosuppressants
Diagnosis: (corticosteroids, azathropine,
50 g Oral Glucose Tolerance Test (OGTT) cyclosporine)
✓ Done at week 24-28 of pregnancy ◼ if not compatible= no donation
✓ Venous blood sample will be taken for
glucose determination 60 mins later TYPES OF LEUKEMIA
✓ If the serum glucose level at 1 hour is more A. Lymphotic
than 140 mg/dL, woman is scheduled for a ✓ Many produced WBCs but they are not
100 g 3 hour fasting glucose tolerance test useful
✓ If 2 of the 4 blood samples collected for 1) Acute lymphocytic leukemia (ALL)
this test are abnormal or the fasting value a) Poor prognosis because affected are
is above 95 mg/dl, this confirms the lymphoblasts (builders), producing
diagnosis many new cancer lymphocytes
b) Affected are ages below 15 y/o
MGT: 2) Chronic lymphocitic leukemia (CLL)
➢ DIET: maintain daily calorie intake of 1,800 a) Better prognosis
to 2,400 kcal/day b) Affected lymphocytes: non producing
➢ Refrain from eating simple sugars and c) Affected: >50 y/o
saturated fats. Instead, consume complex
carbohydrates B. Myelocytic
➢ Exercise: appropriate for age of gestation ✓ Affected are myelocytes
✓ Myelocytes are precursor of:
PHARMACOLOGIC THERAPY: ◼ Eosinophils= parasites
➢ Insulin therapy ◼ Basophils= allergy
➢ Oral Hypoglycemic agents are teratogenic ◼ Neutrophils= bacteria/virus
1) Acute (AML)
Pointers from FC: a) Poor prognosis
✓ Priority: DIETARY INTAKE! b) Affected: myeloblasts (15-39 y/o)
✓ Macrosomic infant should be examined 2) Chronic (CML)
closely at birth for HYPOGLYCEMIA a) Better prognosis
b) Affected: myelocytes (>40 y/o)
LEUKEMIA
MANAGEMENT:
-refer to SET 4 kay chemo rani tapos naa napud didto mga nsg responsibilities

AIRBORNE DISEASES

➢ Measles, TB, Varicella COVID-19, Disseminated Herpes Zoster

Airborne Transmission Mask Signs and Symptoms

diseases (cont.)

Measles 7-day fever Airbone, droplet N95 PRODROMAL (FLU LIKE)

(Rubeola) SERIOUS
Tigdas Rashes star from the face going
down - CEPHALOCAUDAL
PATTERN

Maculopapular - reddish

Koplik’s spots - cheeks

German 3-day fever Droplet Surgical PRODROMAL (FLU LIKE)

measles MILD mask
(Rubella) TERATOGENIC Confluent rashes - they appear
Tigdas hangin together

Maculopapular - pale red,

pinkish

Forscheimer’s spots - on the soft

palate

Lympadenopathy - post-
occipital, post-auricular

Chicken pox TERATOGENIC Airbone, contact - PRODROMAL (FLU LIKE)

(Chicken pox) direct, indirect
Bulutong tubig Centrifugal rash - from the body
“varicella” going out

Macule - infective
Papule - infective
Vesicle - infective
Crust - dry na, non-infective

HERPES ZOSTER - shingles, in old age, reactivation of chicken pox later in life
Characteristics: (same sa varicella)
Unilateral, clustered, vesicles (painful)

➢ TB (additional)
Secondary diagnostic - MANTOUX TEST OR PURIFIED PROTEIN DERIVATIVE (PPD)
⚫ Test if a person is exposed to TB
⚫ DOES NOT CONFIRM IF THE PERSON HAS TB
⚫ This is a skin test, site: forearm, inner surface of the forearm
⚫ 0.1 ml or 5 units of PP
⚫ Interpretation: 48-72 hours

✓ DONNING Sequence: GOWN, MASK, GOGGLES, GLOVES

✓ DOFFING Sequence: GLOVES, GOGGLES, GOWN, MASK
method by which the infection was transmitted
COVID-19 to the patient?
B.Contact with respiratory secretions of an
Mild: 10 days after the start of symptom infected person
Moderate: 20 days after the start of symptom
Quarantine 14 days 111.Assessment findings reveal positive
Brudzinski sign, When the nurse flexed the
96.Which of the following has been recognized child’s neck forward, which of the following
as a significant risk factor for the development behavior indicated a positive Brudzinski’s sign?
of acute respiratory distress syndrome (ARDS) D.Hip, knee and ankle flexed
and death in patients with COVID-19?
A.Decreased Lactate dehydrogenase levels. 112.In the nursing care plan prepared by the
B.Elevated D – dimer tests - increased clot nurse, “Pain related to meningeal irritation” is a
formation, malapot ang blood priority nursing diagnosis. Which of the
C.Neutropenia following should the nurse avoid to do to
D. Lymphocytosis prevent pain when positioning the patient?
A.Extend leg
99.Which of the following are recommended
infection control measures upon arrival of a
patient with suspected COVID-19 infection?
A.Rapid triage of symptomatic infection
B.Implement respiratory hygiene and cough
etiquette.
C.Have a separate, well ventilated space that
allows waiting symptomatic patients to be
separated by 6 or more feet.
D.All of the above

100.Which of the following is the most effective

method for prevention of COVID-19 infection in
the health care setting?
A.Avoid exposure (Use standard precautions,
Contact precautions, and Airborne Precautions
and eye protection when caring for patients
with confirmed or possible COVID-19 infection)
B.Vaccination
C.Handwashing
D.All of the above

MENINGITIS

110.The physician prescribed lumbar tap. When

the nurse reads the laboratory results, which of
the following reflects positive results indicative
of Bacterial Meningitis?
C.Increased white blood cells, increased
proteins, low glucose

1. From the history obtained from the mother,

which of the following could be the possible
Set III and IV
HYPERGLYCEMIA HYPOGLYCEMIA

Increase of Blood Sugar Decrease of Blood Sugar

>200 mg/dl: Gradual (hours to days) <60 mg/dl: Sudden

-Polyuria -Cool and clammy skin

-Polydipsia -Diaphoresis
-Polyphagia -Palpitations
-Hot and Dry Skin -Fatigue and weakness
-Dry mouth (Dehydration) -Confusion
- Fruity breath -Headache
- Deep, rapid breaths (air Hunger) -Shakiness
- Numbness and tingling -Inability to arouse from sleep
-Slow wound healing
-Vision changes

Management Management

Administer Insulin as needed

Restrict exercise when blood glucose is >250 mg/dl 15 x 15 x 15
Test urine for ketones
Oral intake of Recheck Give another 15g of
Diet: blood glucose 15g of carbs if
Complex carbohydrates Carbohydrates in 15min needed
Fiber-rich foods
Heart-healthy fish
“Good fats” Unconscious Patients:
Sugar-free fluids Do not put anything in an unconscious patient’s mouth, the can
aspirate!
Avoid! Administer Glucagon: Subcu or IM
Saturated fats - Repeat in 10 min if still unconscious
Trans fat -Place client in lateral position
Cholesterol -Notify health care provider
Sodium Acute Care Setting
-Administer 50% dextrose if IV access is available

Insulin Therapy Onset Peak Duration

- refrigerated Regular 30 min. 2hrs- 4hrs 3.5 hrs - 7 hrs
- Given at a room temperature - 1 hr
- do not shake Intermediate 1hr. - 4hrs - 8hrs 7 hrs - 14 hrs
-Given subcutaneous 2hrs.
- Rotate injection site- prevent Long- acting 2hrs. - 4 8hrs- 12 hrs 14 hrs- 28 hrs
lipodystrophy or erratic absorption hrs
NEVER
- Massage
- Aspirate
- Drink alcohol
HYPERTHYROIDISM
Other terms: Grave’s disease/ Basedow’s/ Parry’s disease
- excessive output of thyroid hormones
- Diffuse toxic non-nodular goiter
- Autoimmune disease

Clinical Manifestations: Diagnostic Management: Nursing Management:

tests:

Thyrotoxicosis 1. Thrill at the 1. Radioactive Iodine Therapy: 1. Improving nutritional status:

➢ Nervousness anterior neck Destroy the overactive thyroid cells Discourage highly seasoned
➢ Irritable and 2. Bruit at the ✓ Observe for thyroid foods and stimulants. High
apprehensive anterior neck storm. calorie, high protein foods are
➢ Palpitations 3. Decrease ✓ Propranolol encouraged
➢ Tachycardia Thyroid ✓ Contraindicated during 2. Enhancing coping measures :
➢ Heat intolerance stimulating pregnancy The environment is kept quiet
➢ Diaphoresis hormone. 2. Antithyroid Medications and uncluttered
➢ Flush skin, warm, 4. Increase in ✓ Block the utilization of 3. Improving Self- Esteem: Pt.
soft and moist free T4 iodine are discouraged from smoking.
➢ Tremors 5. Increase in ✓ Propylthiouracil (PTU) 4. Maintaining Normal Body
Exophthalmos radioactive ✓ Methimazole Temperature: maintain the
➢ Bulging eyes, which iodine uptake (Tapazole) environment at a cool,
produces a startled Health teaching: comfortable temperature and cool
facial expression ✓ If sign of infection is baths and cool or cold fluids are
➢ von Graefe’s sign: observed, the patient is encouraged
eyelid lag when advised to stop the
looking downwards medication, and notify
➢ Dalyrimple’s sign: the physician
upper eyelid immediately.
retraction ✓ Agranulocytosis: most
Goiter toxic side effects.
✓ Swelling of the ✓ Methimazole:
thyroid gland treatment of choice
✓ Increased during pregnancy.
appetite 3. Adjunctive Therapy
✓ Progressive ✓ Iodine or iodide
weight loss compounds decrease
✓ Amenorrhea the release of thyroid
✓ Osteoporosis hormones from the
✓ Myocardial thyroid gland and
hypertrophy reduce the vascularity
and size of the thyroid.
✓ Potassium iodide (KI),
✓ Lugol’s solution
✓ Saturated solution of
potassium iodide
(SSKI)
HYPOTHYROIDISM
Description: State of insufficient serum thyroid hormone.
Cause: Autoimmune thyroiditis
Myxedema
• Accumulation of mucopolysaccharides in subcutaneous and other interstitial tissues
• Mucinous (mucus-filled) edema
• Extreme symptoms of severe hypothyroidis

Clinical Manifestations: Management: Nursing Management:

-Hair loss • Pharmacological ✓ Fatigue

-Brittle nails Management ➢ Space activities to promote rest and
-Dry skin -Synthetic levothyroxine exercise as tolerated
-Numbness and tingling of the (Synthroid or Levothroid) ➢ Assist with self-care activities when
fingers patient is fatigued
-Hoarseness of voice • Prevention of Cardiac ➢ Provide stimulation through
-Amenorrhea, anovulation Dysfunction conversation and non stressful
-Loss of libido -Elevated serum activities
-Subnormal body temperature cholesterol, risk for ✓ Cold intolerance
-Bradycardia atherosclerosis, and ➢ Provide extra layer of clothing or extra
-Weight gain coronary artery disease blanket
-Thickened skin - Angina or dysrhythmias ➢ Protect from exposure to cold and
-Masklike and expressionless face drafts.
-Cold intolerance • Prevention of ✓ Constipation
-Slow Speech Medication Interactions ➢ Encourage increased fluid intake within
-Enlarged tongue - Thyroid hormones - limits of fluid restriction.
-Deafness increase blood glucose ➢ Provide foods high in fiber.
-Personality and cognitive changeslevels ➢ Encourage increased mobility within
- Bone loss and patient’s exercise
-Myxedema Coma osteoporosis may also ➢ Encourage patient to use laxatives and
-Sign of depression, diminished occur with thyroid therapy. enemas sparingly.
cognitive status, lethargy and
somnolence, depressed respiratory • Supportive Therapy
drive, narcosis and coma - Arterial blood gases
- Effects of analgesic
agents, sedatives, and
anesthetic agents are
prolonged
Diagnostic Test (CANCER) i. Adverse Effect: Hemorrhagic
Cytitis (Bladder Bleeding)
1. TUMOR MARKER IDENTIFICATION b) Cisplatin (Platinol)
a) Analysis of substances found in the 2. Nitrosoureas
body- tissues, blood, or the other - Similar to alkalyting agents
body fluids that are made by the - cross the blood-brain barrier
tumor. a) Carmustine
b) Breast, colon, lung, ovarian, b) Lomustine
testicular, prostrate cancer c) Semustine
2. Mammography d) Streptozocin
a) Breast Cancer 3. Hormonal agents
3. Magnetic Resonance Imaging - bind to hormone receptor sites that
a) Neurologic, pelvic, abdominal, alter that alter cellular growth
thoracic, breast cancer - block binding of estrogens and
4. Flouroscopy receptor sites
a) Use of x-rays that identify contrast a) Androgens and anti-androgens
in body tissues b) Estrogen and anti-estrogen
b) Skeletal, lung, and GI cancers Anti- Metabolites ( Cell cycle
5. Positron Emission Tomography specific-synthesis:
a) Lung, colon, liver, pancreatic;
Hodgkin and non-Hodgkin
lymphoma a) Flouriuracil (5-FU)
6. Endoscopy Methothrexate (Folex) - Folic Acid
a) For diagnostic and therapeutic Antagonist
purposes 5. Anti- Tumour Antibiotics CCN-S : MYCIN
b) Bronchial, GI cancers - interfere with DNA Synthesis
c) Pernicious anemia a) Adriamycin
i. Management: IM Vitamin b12 b) Bleomycin
injection c) Dactinomycin
7. Biopsy- obtaining tissue sample for d) Daunomycin
analysis of cells. e) Doxorubicin
f) Pilcamysin
CHEMOTHERAPY - anti-neoplastic = CARDIO TOXICITY
medications or cytotoxic 6. Plant (VINCA) Alkaloids CCSM : TINE
Purpose: To promote tumour cell death. a) Vincristine (VXR)
Cell Cycle b) Vinblastine (VELBAN)
G1- phase: RNA and Protein synthesis 7. Monoclonal Antibodies
occur - destroy cancer cells and spare
S phase: DNA synthesis occurs normal cells
G2 phase: Pre-mitotic Phase a) Rituximab
M phase: Mitosis b) Trastuzumab
Go phase: Resting/Dormant phase c) Alemtuzumab
d) Gemtuzumab
Medications 8. Corticosteroids - sone (anti-
1. Alkalyting Agents (cell cycle inflammatory and chemo drug) CCNS
nonspecific: a) Betamethasone
b) Dexamethasone
- Break DNA helix, thereby interfering Routes of Chemotherapy
with DNA Replication ✓ Oral- most convenient
a) Cyclophosphamide (Cytoxan) ✓ IV- most common
✓ Intramuscular
✓ Intrathecal - ommaya reservoir
✓ Intro arterial FOR THE NSG
✓ Intracavitary NURSE/VISITORS INTERVENTION
✓ Intravesical S- Shielding
✓ Topical ✓ Lead Apron 1. Do not wash off
T- Time skin markings.
Radiation Therapy Visitor: 10-15 mins.
2. Pat dry with
1. Kills the tumor Not allowed to water.
2. Reduces the size of the tumor Regnant 3. Avoid constrictive
3. Relieve the obstruction Nfected clothing
Ewly Ex: bra and fitted
Types of Radiation vaccinated jeans
hildren
4. Avoid extreme
Internal Radiation External Radiation Nurse: 30 mins 1 temperatures.
Also known as Telethrapy shift (for the lesions do
Brachytherapy Non-invasive ✓ 5 mins with 6 not hot compress=
Invasive NOT visits irritation)
Radioactive! RADIOACTIVE! 5. Avoid chemical
A. Sealed- Beam of high D- Distance 6 feet products. ( irritants=
implanted energy ray away lotion)
-radio active
- Must be in a ✓ Body fluids are
private room not radioactive
- With complete bed ✓ Patients is not
rest and without radioactive Side Effects of Chemotherapy and
bathroom privileges ✓ No need to Radiation Therapy
due to risk of used rule of
dislodge of the STD B- Bone marrow
implant ✓ Out-patient a) RBC- Anemia, Fatigue and Rest
therapy b) WBC: Leukopenia
What to do if ✓ 15-30 mins per Immunosuppressed and isolated
dislodged? day, 5 days a c) Platelets: Thrombocytopenia
1. SEEN- pick with week. Bleeding and Safety
long handled O- ovaries Infertility - Oophorexy
forceps then put in Testes Sterile
the lead container M- Mucosal Lining- Nausea and Vomiting
2. UNSEEN- notify ✓ Pre - give Anti- emetic
the radiation ✓ Post- small-frequent-feeding with
department bland diet

B. Unsealed- orally S-skin

or IV Radio Active 1. Radio-dermatitis burned skin
- must be in a due to rad-therapy.
private room NSG INT: Apply the Teletherapy
- body fluid are
radioactive Adverse Effect: Extravasation –
- instruct patient to LEAKAGE OF DRUGS, Chemical Burns
flush toilet 2-3 times ✓ S-lowing infusion rate
after used. ✓ A-bsent of blood return
✓ R-edness MAMMOGRAPHY
✓ P-ain/Burning sensation ✓ Discomfort with pain
WHAT IS THE FIRST THING TO DO? ✓ Baseline 35-39y/o
✓ Immediate stop the chemo- ✓ Yearly 40 & above y/o
therapy ✓ No chemical products (deodorant,
✓ Cold compress etc.)
✓ Notify the physician
EXCEPT: VINCA ALKALOIDS DO NOT BIOPSY confirmatory test
COLD COMPRESS ✓ Percutaneous
H – Alopecia due to treatment. a. FNA Fine needle aspiration
✓ Recommend to use of wigs, hats, used for smaller lump
cap, and veil before alopecia. Based b. CNA Core needle aspiration
on appreciate age used for bigger lump
✓ Hairless is temporary. ✓ Surgical
O – Oral cavity a. Incisional – removal of a portion of
1. Stomatitis – Soreness in mouth lump
2. Xerostomia – Dryness in mouth b. Excisional – removal of the entire
✓ Increase fluid intake lump
✓ No to spicy foods/hot
✓ No to smoking/Alcohol Management
✓ Use lip balm or KY jelly 1. Chemo-therapy
✓ Popsicles 2. Radiation Therapy
V – Vagina frequent perineal care. 3. Medication
a. Tamoxifen Nolvadex anti-
1. BREAST CANCER estrogen
b. Diethylstilbestrol estrogen to
Risk factor: promote negative feedback
Late menstruation >55 y/o mechanism.
Obesity High Fats = High Estrogen 4. Surgery
Nullparity a. Lumpectomy – removal entire
Genetics lump
Female/40 b. Quadrantectomy – removal
Oral contraceptive quadrant
Early menarche <12 y/o c. Simple Mastectomy – removal
entire breast
Prevention: Secondary d. Radical Mastectomy – removal
✓ Early detection: Breast self-exam of Breast + Axillary Lymp nodes
a. 20y/o + Pectoralis
b. 5-7 days after menstruation e. MRM – modified radical
c. Start at Upper outer then clockwise mastectomy removal of breast +
d. Size, shape, symmetry Axillary lymph node
Asymmetry
Venous prominent POST MASTECTOMYCOMPLICATION:
Orange peel skin (peau de orange) LYMPH EDEMA
Nipple dimpling
Signs of tumour breast cancer NSG RESPONSIBLES:
✓ Non-moveable ✓ Avoid procedure on the affected
✓ Irregular mass shaped extremities
✓ Nipple discharges or bleeding ✓ Elevate the affected extremities
✓ No heavy jewellery on the affected
✓ Avoid constrictive clothing ✓ No incision needed
✓ Hand wall climbing
✓ Rope turning exercise
✓ Combing, shampooing, swimming

2. PROSTATE CANCER
Risk factors:
STD History
Testosterone high
African American
Fat b. Orchiectomy – removal of testes
Forty
3. TESTICULAR CANCER
S/Sx: Risk factors:
1. Asymptomatic Cryptorchidism
2. Enlargement of the prostate Age 15-35 y/o
3. Dysuria (Difficulty of urinating) Trauma
4. Urinary Retention Diethylstilbestrol synthetic estrogen
5. Haematuria Orchitis
6. Peri-anal and rectal pain Genetics
7. Low back pain LATE SIGN!
Orchidopexy is a surgical procedure that moves an
undescended testicle into the scrotum.
Prevention: Secondary
1. PSA Prostate Specific Antigen Prevention: Secondary
✓ >40 y/o 1. Testicular self-exam
✓ Not confirmatory test ✓ Start at before 15 y/o per month,
2. DRE Digital Rectal Exam same day
✓ >40 y/o ✓ After warmth bath
✓ Not confirmatory test
✓ BIOPSY confirmatory test S/Sx:
1. Painless Enlargement
Management 2. Heaviness/ dragging sensation
1. Chemotherapy 3. Lump/Mass Pea-size
2. Radiation Therapy 4. Low back pain
3. Medications Management
a. GNRH/LRH every 1 to 3 months 1. Chemotherapy
to promote negative feedback 2. Radiation Therapy
mechanism. 3. Surgery
1. Luprol a. Orchiectomy
2. Zoladex
b. Diethylstilbestrol anti-estrogen UNILATERAL BILATERAL
4. Surgery Impotent No No
a. Transurethral Resection of the
Sterility No Yes
Prostate surgery to remove parts of
the prostate tissue through the penis.

Hemodialysis
: process of cleansing the client’s blood.

Interventions
1. Monitor vital signs. Notify the PHCP about excessive temperature elevations because this
could indicate sepsis.
2. Monitor laboratory: BUN, creatinine, and complete blood cell counts
3. Assess the client for fluid overload before dialysis and fluid volume deficit.
4. Weigh the client before and after dialysis to determine fluid loss.

5. Assess the patency of the blood access device.

6. Monitor for bleeding; heparin is added to the dialysis blood tubing to prevent clots from
forming in the dialyzer or the blood tubing.
7. Monitor for hypovolemia during dialysis, which can occur from blood loss or excess fluid and
electrolyte removal.
8. Provide adequate nutrition; the client may eat before or during dialysis.
9. Identify the client’s reactions to the treatment and support coping mechanisms; encourage
independence and involvement in care.
10. Assess the client’s understanding of fluid and dietary restrictions ordered by the
nephrologist.
NOTE! Withhold antihypertensives and other medications that
can affect the BP or result in hypotension until after
hemodialysis treatment.

(reference: Suddarth, pg. 790)

Hemodialysis Peritoneal Dialysis

- outside - inside
-Dialyzer -dialysate solution (hypertonic)
-Fistula (AVF) -3-5 cm below umbilicus
-Clinic -Clinc/home
-Weekly 3x -Daily - 4x
-4hours - 30-40 minutes

RENAL FAILURE

Nephrotic Syndrome
- Protein Wasting: protein in URINE
- thinning of glomerolus

LIVER - Increase protein (compensate)

Increase Cholesterol - hyperlipidemia
Heart - increase cardiac output
RAAS- increase BP: overcompensation

MGT:
1. Hypertension: Anti-hypertension
2. Hypotension: IVF (hypertonic)
3. Lipid: FLU-vastatin
PRA
LO
SIM
ACUTE RENAL FAILURE
-sudden
-early diagnosis, better prognosis
-reversible
-ends in recovery

Onset Oliguric Phase Diuretic Phase Recovery Phase Management

1. Pre-RF: problem is ✓ Decrease of Urine ✓ Increase Urine Output: GFR: 90 cc/min Protein: increase
in the circulation Output: <400cc/day 4-5 L BP: 120/80 protein= workload
✓ Decrease of GFR ✓ Improved GFR K+ ; 3.5-5.5 mg/dl Decrease
2. Intra-RF: ✓ Hypertension ✓ Hypotension protein= delays
Nephrons ✓ Edema ✓ Dryness recovery
✓ Increase K+ ✓ Decrease K+ ✓ Moderate
3. Post-RF: UTI ✓ Increase creatinine ✓ Slight improvement of Protein
and BUN BUN and Creatinine
Oligurio: decrease
OFI: 1,200 cc/day
:
antihypertension

:Lasix

:Kayaxelate
Diuretic: increase
OFI
: IVF:
watch out for
electrolytes
imbalance
:NaHCO3-
sandwich
Signs and Symptoms Management :HgSO4
:Calcium
Cardiomyopathy Protein: decreaseGluconate
intake (Slow
Heart failure Emotional care-push)
accentuate (+)
RBC depletion: erythropoetin in Oral Care :KCL
kidneys (anemia) - stomatitis
Oral inflammation (Stomatitis) - -soft-bristled toothbrush
increase urea Skin care for UREMIC FROST
Nausea and vomiting (uremic - no scratching
gastritis) - no alcohol
Increased urea- skin (Frost) -apply chalamine lotion
CHRONIC RENAL FAILURE Come - end point

- Prolonged: asymptotic at first

- later diagnosis, poor prognosis
-irrevirsible
- ends in ESRD

Glomerular Filtration Rate

1. > 90 cc- Normal GFR
2. <90 cc- Mild RF
3. <60 cc- Moderate RF
4. <30 cc- Severe RF
5. <15 cc- ESRD

COLOR CODING

TRIAGE SYSTEM

Gauge IV Uses
14 Large fluid volume, rapid infusion,
Trauma high risk surgery
- requires large vein

16 Same uses as 14 gauge but

decrease of flow rate

18 Blood transfusion, Bolus, Trauma,

surgery
Requires a large vein
20 Most common, day-to-day adult
infusions.
22 Small fragile veins, older adults,
slower infusion

24 Slow flow rates, pediatric and

elderly
Priority Name Color Max time Condition
1 Emergent Red O minutes Chest pain, severe
respiratory distress/
cardiac arrest, limp
amputation, acute
neurological deficits,
chemical splashes to the
eyes
2 Urgent Yellow 30 -60 mins. Open fracture with a
distal pulse and large
wounds
3 Non Green 120 minutes Do not have immediate
urgent complications: closed
fracture, minor
Osteoporosis lacerations, sprains,
✓ Demineralization (calcium) strains or contusion
✓ Brittle bones
✓ Fracture 4 Expectant Black 240 minutes Deceased
✓ Osteoporosis occurs most COLOR CODING- GARBAGE
commonly in the wrist, hip, and
vertebral column. Black Non-hazardous
Primary osteoporosis Secondary osteoporosis
Red Tissue, blood, organs
Yellow Infectious clinical waste

Orange Highly Infectious

Blue Medicines
Purple Cytotoxic medicines
White Dental waste
a. Most often occurs in postmenopausal individuals; occurs in a. Causes include prolonged therapy with corticosteroids,
those with low testosterone levels thyroid-reducing medications, aluminum-containing antacids,
or anti-seizure medications.
b.Risk factors include decreased calcium intake, deficient estrogen,
and sedentary lifestyle. b. Associated with immobility, alcoholism, malnutrition, or
malabsorption

Assessment Interventions Interventions

1. Risk factors 1. Assess risk for and prevent injury 3.Promote an optimal level of health and function.
2. Possibly asymptomatic a.Identify and correct hazards in the
3. Back pain that occurs after lifting, environment. a. Use of correct body mechanics.
bending, or stooping c. Use side rails to prevent falls. b. Strengthen abdominal and back muscles to improve
4. Back pain that increases with d. Use of assistive devices such as a posture and provide support for the spine.
palpation cane or walker. c. Avoid activities that can cause vertebral
5. Pelvic or hip pain, especially with compression.
weight bearing 2. Provide personal care d. Eat a diet high in protein, calcium, vitamins C and
6. Problems with balance a. Move client gently when repositioning. D, and iron.
7. Decline in height from vertebral b. Assist with ambulation e. Avoid alcohol and coffee.
compression c. Provide gentle range-of-motion f. Maintain an adequate fluid intake to prevent renal
8. Kyphosis of the dorsal spine, exercises. calculi.
also known as “dowager’s hump” d. Apply a back brace as prescribed.
4. Administer medications as prescribed

SCREENING -Bone Mineral Density (BMD) screening should begin at age 65 yrs for all women
-Post menopausal women
-age 65 yrs
-weight <127 lbs
-Parent with history of hip fracture
-Current smoking
-Alcholism
-Rheumatoid arthritis
DIAGNOSIS Gold standard: Dual energy X-ray adsorptiometry (DXA) of the lumbar spine and hip
TREATMENT -Life style changes
-Weight-bearing exercise (walking, hiking and stair climbing) and muscle-strengthening exercises
-Adequate calcium and Vitamin D intake
-Reduction in active and passive smoking and alcohol intake
-Medication for prevention: BISPHOSPHONATES, ZOLEDRONIC ACID, RALOXIFENE, MHT
Medications for treatment
Bisphosphonates- inhibition of osteoclast resorption of bone
SERMS- inhibit bone resorption
Denosumab-monoclonal antibody to receptor activator of nuclear factor-kb ligand, which blocks proliferation and
differentiation of osteclast, resulting in decreased bone resorption ans increased BMD
Calcitonin- antiresorptive treatment
Parathyroid hormone-stimulates osteoblastic activity
Myocardial Infarction
>Death of myocardial cells from inadequate oxygenation often caused by sudden complete blockage of
coronary artery Terminal stage of CAD

Pathophysiology
ISCHEMIA >> INJURY >> NECROSIS >> INFARCTION

Types of Myocardial Predisposing factors Signs and symptoms Diagnostic Nursing Intervention Medical
Infarction management

1. Transmural MI: 1. Sex 1. Chest pain o 1. Cardiac Goal : decrease 1. Vasodilators

Most dangerous type 2. Race Excruaciating visceral enzymes myocardial oxygen -NTG
characterized by 3. Smoking viselike pain with sudden 2. ECG demand -ISOSORBIDE
occlusion of both RCA 4. Obesity onset located at substernal 3. Cholesterol 1. Decreased cardiac Dinitrates
and LCA. 5. CAD and rarely precordial levels workload -Isordil ( SL )
2. Subendocardial MI: 6. Thrombus a) o Radiates from 4. CBC >> a) IV line 2. Anti-arrhythmic
Occlusion of either formation neck back , increase WBC b) Morphine agents
Right or Left coronary 7. Hyperlipidemia shoulder , sulfate -Lidocaine
Artery arms , jaw and -Opiod analgesic – 3. Beta Blockers
abdominal addictive -Propranolol
muscles -Decrease CNS function – 4. ACE inhibitors
b) o Not usually dec RR , HR and BP >> – pril
relived by rest or cardiac workload , 5. Calcium
nitroglycerine decreased 02 demand antagonist
2. Nausea and vomiting -difine
3. Dypnea Withdrawal symptoms 6. Thrombolytics
4. Hypertension , then - irritability 7. Anti coagulant
gradual drop - altered loc -Heparin
5. Hyperthermia - Headache -Warfarin
6. Cool , clammy skin - diaphoresis 8. Antiplatelet
Toxicity : Depressed vs 9. Health teaching
RR HR AND BP -Diet
Antidote : Naloxone -Activity
(Narcan) -Prevention
c)Oxygen
inhalation
d) CBR without
BRP
e) SFP
f) Avoid forms of
Valsalva maneuver
i) Stool softener
(prevent straining)

Pharmacological Measures for Pain Management

-Opioids are narcotics; they are used for moderate to severe pain
- Non-opioids are non-narcotic analgesics that are used to treat mild pain and they also to
serve as adjuvant medication for the relief of pain.
The non-narcotic and non opioid medications:
✓ Tylenol: Hepatotoxic, renal damage and, in very severe cases, hepatic failure
✓ NSAIDS:
➢ Ibuprofen: Advil, Motrin, Naprosyn, Naproxen and Clinoril=nausea, indigestion, a
headache, fecal occult blood and anorexia.
➢ Selective COX-2 (cyclooxygenase 2 ) inhibitors( Celebrex)= abdominal pain,
gastrointestinal gas, headache, insomnia, nausea and bloating. Severe: gastrointestinal
hemorrhage, a cerebrovascular accident and a myocardial infarction.
✓ Salicylate NSAIDS: Salicylate NSAIDS: aspirin and disalcid= abdominal pain, ulcers and
heartburn; more serious side effects and adverse reactions include hemolytic anemia,
bronchospasm and anaphylactic shock.
✓ Centrally Acting Non Opioid Analgesics (Clonidine)= oral dryness, drowsiness, sedation,
constipation, hypotension and fatigue.
✓ The narcotic, opioid medications:
✓ Opioid Agonists: Codeine, OxyContin, Darvon, Dilaudid, Demerol and Percocet= constipation,
sedation, nausea, dizziness, pruritus, and sedation. Adverse effects: respiratory depression and
arrest, hepatic damage, an anaphylactic reaction, circulatory collapse and cardiac arrest.
✓ Opioid Antagonists (opioid receptor antagonist) Naloxone and naltrexone= hepatic damage, joint
pain, insomnia, vomiting, anxiety, headaches and nervousness.
✓ Opioids with Mixed Agonist – Antagonist effects: Opioids with mixed agonist- antagonist:
Talwin and Stadol+ nausea, drowsiness, dizziness, diaphoresis and clammy skin.
Nonpharmacological Measures for Pain Management
Physical Comforts Cognitive/ Behavioral

-Bed positioning -Imagery

-Bath positioning -Distraction
-Massage -Relaxation training
-Physical Therapy -Active coping training
-Heat/Ice -Cognitive behavioral training
-Acupuncture -Consider pain and palliative care training
TRIGEMINAL NEURALGIA
• Trigeminal neuralgia, also called tic douloureux, mainly affects the 5th cranial nerve
(trigeminal nerve)
• The 5th cranial nerve is both a sensory and motor nerve that is responsible for corneal
sensation and the mastication.
• Trigeminal neuralgia is characterized by an electric shock like pain in the face, jaw, and
gums; this is also temporary pain, acute episodes.
• This is caused by the compression of the CNS.
• Management:
a. Medication = Carbamazepine (Tegretol), Gabapentin = antiseizure medication = this
delays the transmission of the pain.
b. Surgical = vascular decompression because the main problem is the compression of the
CNS.
• Complication (arranged according to priority of nursing care):
a. Oral infection – cos the pt can’t have oral care because there is extreme pain.
b. Nutritional imbalance – because there is a tendency na hindi maka kaen si pt because of
pain.
c. Anxiety related to recurring pain – unknown ang schedule of recurrence ng pain so bigla-
bigla siyang nangyayare kase acute nga.
d. Self-care deficit – add ko lang to in relation to the other numbers.

MANIA
MANIC CLIENT – hyperactive, impulsive, destructive
• Management:
a. set firm boundaries – meaning kelangan mo mag set ng rules and boundaries for the
patient to follow.
- On this note, pwede ka magsabi na may punishment siya. For example, pwede lang
siya manood ng TV from 12 nn to 1 pm, if hindi niya to sinunod, wala siyang TV the
next day. If ever di niya nga sinunod, kelangan firm ka also with the rule na bawal siya
mag TV that day. In this manner, mas maniniwala yung pt sayo kase alam niyang
sinusunod mo talaga yung imposed rules and boundaries.
b. Point out unacceptable behavior
- Example, if hinawakan ka ng pt or hinaplos ka niya in a sexual way. Sabihin mo na
hindi ‘to pwede and i-enforce mo ule and rules and boundaries.
- Ang key to dealing with a manic patient is always rules and boundaries, reminder ng
contract (refer to npr) is also helpful para maalala niya anong role niya.
c. inform the client of what is expected – e.g. behaviour
- emphasis on rules and boundaries talaga.
d. Room = private = decrease stimulus
- Increased ang stimulus ng patient, so need na i-decrease naten through the room
also.
e. Activity: non-competitive, solitary (e.g., cleaning room, drawing and writing with crayons)
- Remember, hindi pwedeng competitive ang manic patient kase may tendency siya to
hurt other people also because their hyperactivity. Pwedeng mag escalate to
assaultive or violent ang patient mo.
- And activity mo dapat here is nakaka burn ng energy para mapagod siya.
f. Diet: high calorie – finger foods
- Kelangan finger food para maburn out ang energy also, para may hinahawakan siya.

BIPOLAR DISORDER – bipolar is halo ng mania and depression

Neurotransmitter – Increased serotonin and norepinephrine.
Psychosocial factors – Type A personality ( over achiever)
Sociocultural factors – upper class ( mayayaman)
Defense mechanism – Projection or reaction formation.
MANIFESTATIONS:
• Inflated self-esteem or grandiosity
• Decreased need for sleep
• Increased talkativeness
• Distracted easily
• Increased goal-directed activity – may upswing siya sa energy so highly motivated siya to do
things.
• Engaging in risky behavior – mag safety precaution or suicide precaution ka here because
increased ang energy ng patient mo, so mas may tendency siya to execute plans.
Mania – lasts for more than one week.
Hypomania – manifestations last for only 4 days.
Bipolar I – manic episodes with or without major depression.
Bipolar II – major depression with hypomanic episodes.
Cyclothymia – alternating periods of depressed mood and hypomania for 2 years.
Dysthymia – persistence of mild depression.

DEPRESSION
DEPRESSED CLIENT – kind firmness – this refers to the action of being kind while also setting boundaries
sa pt mo.
• Management:
a. Silence
b. Offering the self
c. Motivate – recall previous achievements
d. Engage in highly structured activities (e.g. baking, or stuff na may steps)
- Ang activities dapat is always with steps, choose an activity na may steps. Yung hindi
na mapapaisip ang client kung anong kelangan niya gawin kase low energy nga siya.
MAJOR DEPRESSIVE DISORDER
Exogenous – loss, self-depreciation, self-reproach
- This refers to outside factors; loss – is death; self-depreciation – is the act of like
making kutya yourself ba, idk how else to explain that one; self-reproach – like
pinapagalitan mo yung sarili mo.
Endogenous – decrease in serotonin and norepinephrine
- Endogenous factors meaning internal factors.
CRITERIA FOR DIAGNOSIS
• Difficulty thinking
• Insomnia
• Weight gain or loss
• Anhedonia
• Guilt feeling
Impairs educational, occupational, and functioning for more than 2 weeks
Defense mechanism – introjection
Initial sign – sleepiness
Hallmark sign – hopelessness, helplessness, worthlessness

TREAMENT MODALITY FOR MDD

Dose – always start with the lowest dose to prevent dependence and tolerance.
Effectivity – 2-4 weeks, to prevent relapse 6-9 months.
Note: increase suicide precaution – because the higher the energy the more likely to commit suicide.
- Remember, any medication that increases energy, suicide prec always because if
increased na ang energy, pwede na siyang magpakamatay.
Combination – never combine = can cause serotonin syndrome; prevent seizure.
Shifting – wait for 5-6 weeks; always taper.
SEROTONIN SYNDROME – CHARD
• Clonus
• Hypertension
• Ataxia
• Restlessness
• Diarrhea, diaphoresis

ANXIETY RELATED DISORDERS

OBSESSIVE COMPULSIVE DISORDER
Defense mechanism: Undoing
Management:
• Allow the patient to perform ritual – decreases anxiety and guilt.
• Adjust the schedule of the patient.
• Gradually limit the ritual.
Sample questions:

Situation 17 - Mrs Juan, a young female patient, believes that doorknobs are contaminated with
COVID-19 and refuses to touch them except with the aid of tissue paper.

81. Her diagnosis of obsessive-compulsive disorder constantly does repetitive cleaning. The nurse
knows that this behavior is probably MOST basically an attempt to ____.
A. Decrease the anxiety to a tolerable level.
B. Focus attention on non-threatening tasks.
C. Control others
D. Decrease time available for interaction with people.

Ratio: kase ang OC is basically the patient doing an action in order to lower their level of anxiety
kase the more they engage in the behavior mas nababawasan ang anxiety nila.

82. What response should the nurse use in dealing with this behavior?
A. Encourage her to scrub the doorknobs with a strong antiseptic so she does not need to use tissue
papers.
B. Supply her with paper tissue to help her function until her anxiety is reduced.
C. Force her to touch doorknobs by removing all available paper tissue until she learns to deal with
the situation.
D. Explain to her that ideas about doorknobs with covid-19 is part of her illness and is not necessary.

Ratio: in the event na ginagawa niya na yung action, if engaged na siya in the behavior, hayaan mo
siya. Over time, pwede mong i-limit yung kanyang action through setting boundaries also. Pero since
here ginagawa niya na, hayaan mo siya. Wag mo pigilan kase tataas ang anxiety niya.

83. Signs such as using tissues to doorknobs develop because the patient is _____.
A. Unconsciously controlling unacceptable impulses or feelings.
B. Listening to voices that tell her that doorknobs are unclean.
C. Consciously using this method of punishing himself.
D. Fulfilling a need to punish others by carrying out annoying procedure.

84. Therapeutic treatment for MRs. Juan should be directed towards helping her to _____.
A. Learn that her behavior is not serving a realistic purpose.
B. Forget her fears by administering antianxiety medications.
C. Redirect her energy into activities to help others.
D. Understand her behavior is caused by unconscious impulses that she fears.

85. The nurse plans to educate the entire family about obsessive compulsive disorder. Which of the
following plans would be MOST effective?
A. The nurse directs Mrs. Juan and her family to the other resources to help them learn about the
illness and medication to treat it.
B. The nurse teaches the family about Mrs. Juan’s illness and medication and suggest that they
educate Mrs. Juan about her disease and the medications to treat it.
C. The nurse educates the entire family at the same time about the disease and medications to
treat it.
D. The nurse teaches Mrs. Juan about her illness and her medications and suggests that she teaches
her family what she has learned.

PHOBIC DISORDER – irrational fear

There are only three main types:
Social Phobia – fear of interacting with strangers
Agoraphobia – fear of inescapable places
Specific phobias:
• Mysophobia – fear of contamination
• Claustrophobia – fear of enclosed spaces
• Nosocomephobia – fear of hospitals
• Thanatophobia – fear of death
• Necrophobia – fear of dead people
Management:
• Flooding – sudden exposures to the maximum level of stimulus.
• Systematic Desensitization – gradual exposure to the fear object.
The first step of systematic desensitization is THINKING AND TALKING ABOUT THE FEAR OBJECT.

SOMATIC SYMPTOM ILLNESS

Illness anxiety disorder (IAD)
• Formerly known as hypochondriasis.
• Disease conviction – preoccupation with the fear that one has a serious disease.
• Disease phobia – preoccupation with the feat that one will get the disease.
Key phrase for disease phobia: DOCTOR SHOPPING.
Conversion Disorder (CD)
• Anxiety that is converted to a neurologic manifestation, e.g. blindness, paralysis, with absence
of an organic cause.
• Key phrase for conversion disorder: LA BELLE INDIFFERENCE – patient is unconcerned of the
manifestation.
• Primary gain – relief from anxiety or guilt.
• Secondary gain – attention.
Nursing diagnosis:
• Ineffective coping
• Ineffective denial
• Ineffective role performance
Nursing intervention:
• Rule out any possible organic of physiologic cause = always perform assessment
• Attend to physical complaints
• Consistent care giver must be provided
• Encourage verbalization of feeling
Medical management – Selective Serotonin Reuptake Inhibitors (SSRIs)
Can also be used for anxiety, eating disorders, somatic illnesses, and trauma.
- Meds mo for anxiety-related disorders are all the same tbh, common ang SSRIs
natin dito. Check nalang the notes for SSRIs for further info.
- Depende na kase to sa prescription ng doctor.

FACTITIOUS DISORDER – anxiety related pa ren to.

Imposed on self / Imposed on others
• Intentional induction or falsification of illness
• Formerly known as Munchausen Syndrome

ANTIPYSCHOTICS
1ST GENERATION – CONVENTIONAL – this
• Do not give to adults 65 YEARS OLD AND ABOVE.
• Mechanism of action: DECREASES DOPAMINE
• Manages positive signs
• Ends in zine
Side effect: PSEUDOPARKINSONISM – tremors to, check EPS = long term effect kase to.
Example:
• Chlorpromazine
• Thioridazine
• Fluphenazine
• Molindone
• Loxapine
Haloperidol (Haldol) – high potency, used in acute situations.
2nd GENERATION – ATYPICAL
• Can be given to older patients.
• Mechanism of action: DECREASES DOPAMINE AND SEROTONIN
• Manages negative signs
Ends in pine and one.
Example:
• Olanzapine – safest for pregnancy
• Clozapine – safest for elderly
• Quetiapine – safest for pregnancy
• Risperidone
• Ziprasidone
Lurasidone
3rd GENERATION
• Dopamine system stabilizer – balances the dopamine in the body.
• Increased dopamine = decreased sensitivity of receptors
• Decreased dopamine = increased sensitivity of receptors
FIRST GEN SECOND GEN THIRD GEN
DECREASES DOPAMINE DECREASES DOPAMINE AND BALANCES DOPAMINE
Can be given to older people SEROTONIN
-zine -pine, -one

LONG TERM INJECTIONS

• Used in patients who are non-compliant, have memory lapses, and inaccessible health
facilities.
• DECANOATE = long term effects, once or twice a month, used only in stable patients.

SIDE EFFECTS OF ANTIPSYCHOTICS – anticholinergic effect; patient is dry. – CAT DOG PAWS
Always start with the lowest dose to prevent accumulation in the blood.
Constipation – increase fluid intake
Agranulocytosis
• Monitor WBC of patient, at risk for infection, report if there is fever or sore throat.
Tooth decay
Dry mouth
Orthostatic hypotension – Gradual position change
Galactorrhea
Increased secretions = use cotton underwear.
Photosentivity
• Avoid direct sunlight, use umbrella, SPF
Arrhythmias
• MOST FATAL SIDE EFFECT
• Higher chances of arrhythmias
Weight gain – avoid sugary food.
Sedation - avoid driving and operating heavy machinery.

EXTRA PYRAMIDAL SYNDROME (EPS)

Caused by a decrease in dopamine = 1st generation
DYSTONIA – uncontrollable muscle spasm and contractions.
Early side effect = ACUTE DYSTONIA (effects include: Dysphagia, Ocugyric crisis (use PROPANOLOL),
Torticollis) = DOT
AKATHISIA – restlessness, unable to sit still.
PSEUDOPARKINSONISM – fine tremors, unstable gait.
• Medication: Amantadine (Symmetrel)
NURSING ACTION
• Notify physician, do not discontinue
• Medical management – lower dose, shift to another generation.
MEDICATION
• Akineton (Biperidine)
• Benadryl (Diphenhydramine)
• Cogentin (Benzotripine)
• Note: etong tatlo, it can be used for EPS, NMS, and TD. Para siyang overall na antidote or
managing medication for these side effects. In short, pwede mong sabihin na management
to ng long term use of anti-psychotics.

NEURO MALIGNANT SYNDROME (NMS)

Hypertension
Fever – NOTE: IF MAY FEVER ANG PSYCH PATIENT MO, IT’S MATIC NMS NA = ALERT DOCTOR AGAD
TO KASE IT CAN ESCALATE TO SPASMS.
Muscle spasms – laryngeal spasms > airway obstruction > death
NURSING ACTION
• Discontinue medication – this is the only side effect na pwede ka mag discontinue, for anthing
else hindi.
• Hydration
• Medical management – Baclofen

TARDIVE DYSKENISIA
Last side effect, usually appear at 6 months
Permanent and irreversible
Tongue twisting
Tongue protrusion
Teeth grinding
Lip smacking
NURSING ACTION
• Notify physician
• Medical management – Valbenazine (Ingrezza)
Additional notes:
• Missed dose = < 4hrs, drink asap; >4hrs, skip.
• CLOZAPINE – increased salivation, increased WBC, does not cause EPS.
• ZIPRASIDONE – increased risk for cardiac arrest, does not cause EPS and weight gain.
Additional medication notes:
• PSEUDOPARKISONISM – Amantadine (Symmetrel)
• NMS – Baclofen
• TD – Valbenazine (Ingrezza)
ANTIDEPRESSANTS
MONOAMINE OXIDASE INHIBITOR (MAOI)
Always give in the morning.
• Parnate (Tranylcypromine)
• Marplan (Isocarboxazid)
• Nardil (Phenelizine)
• Eldepryl (Selegiline)
NURSING CONSIDERATION
• Avoid food that is rich in tyramine – OLD FOOD = AKA NASA FREEZER OR ANYTHING NA
HINDI FRESH, OR OLD FOOD, PERO PWEDE ETO = Safe cheese – cottage, cream, ricotta
• Tyramine + MAOI = HYPERTENSIVE CRISIS (occipital headache)
• Tyramine is found in old food, frozen and preserved food, fermented.

TRICYCLIC ANTIDEPRESSANTS (TCA) – most fatal ang side effects.

Always given at night.
• Tofranil (Imipramine)
• Anafril (Clomipramine)
• Elavil (amitriptyline hydrochloride)
• Pamelor (Nortriptyline)

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI) – safest drug to use.

Always take with meals.
Decreased suicidal tendencies, decreased side effects
• Sexual dysfunction
GI DISTURBANCE – nausea = manage mo eto, so pwede ka mag small frequent feeding lang para hindi
sumuka si patient.
Fastest acting antidepressant – within a week
Important to follow up after 2 weeks – kase increased nga ang energy mo, so baka magpakamatay
na yung patient.
• Zoloft (Sertaline)
• Lexapro (Escitalopram)
• Paxil (Paroxetine)
• Luvox (Flovuxamine)
• Prozac (Flouxetine) – also for EDs
• Herb for depression: ST. JOHN’S WORT

SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITOR (SNRI)

Take with meals.
• Cymbalta (Duloxetine)
• Effexor (Venlafaxine)
Side effects
• Increased blood sugar
• Increased intraocular pressure
• Increased cardiac rate
MAOI TCA SSRI SNRI
In the morning at night With food With food
BAWAL ANG OLD MOST FATAL ANG SIDE FASTEST WORKING CARDIAC PREC, BP
FOOD KASE MAG EFFECTS 2 WEEKS PALANG PREC, IOP PREC –
MAGKAKA MAG EFFECTS KA NA CHECK FOR SIGNS OF
HYPERTENSIVE CRISIS PERO NEED MO REN INCREASE SA LAHAT
MAG FOLLOW UP
AFTER 2 WEEKS KASE
BAKA MAMATAY SIYA
(INC ENERGY)

LITHIUM – pwede gamitin sa mga acute na situation and emergencies

Onset – 3 weeks
Peak – 3 hours
Blood test – 3 days = to prevent toxicity
Therapeutic level - 0.6-1.2 mEq/L
Common side effects:
• Fine tremors – disappears at 1-2 weeks
• Polydipsia
• Polyuria
Sign of toxicity – severe vomiting and diarrhea
Must be at bedside – Mannitol (osmotic diuretic) = para marelease from the body ang lithium;
check mo always ang blood levels, check also intake and output once nag initiate ng mannitol.
Monitor – Sodium level – buffers lithium = so ang diet is dapat low sodium kase it buffers so like
nababawasan ang efficacy, so mas mataas ang chances for toxicity kase pwede pool ang lithium
kase hindi feel ng patient ang effect.
Diet – moderate sodium
Client instruction – increase fluid intake = for excretion

PERSONALITY DISORDERS
Age of diagnosis: Adolescent
Age of Improvement: 40 – 50 years old
CLUSTER A
ODD, MAD, ECCENTRIC
Paranoid – suspicious
• For example, someone na laging on guard or feeling niya pinag-uusapan siya ng ibang tao.
Schizoid – social isolation and indifference
• Aloof and alone – for example, someone na ayaw makipaghalubilo with others and prefers
not to socialize, pwede mong sabihin na asocial, note: iba ang asocial sa anti-social = ang anti-
social rule breakers, cluster b na yun.
Schizotypal – superstitious, odd appearance
• Believes in charms and magic – for example, people na naniniwala sa mga folk healers or mga
pamahiin and such.

CLUSTER B
BAD, ERRATIC
Borderline – unstable emotions
• Unstable relationships
Antisocial – law breakers
Histrionic – attention seekers
• Uses body to attract attention – for example, someone na lewd manamit or masyadong sexy,
someone na gagamitin ang body niya to attract attention talaga.
Narcissistic – self-entitlement
Note: Set limits on behavior.
• Ang important na nursing management here is to set limitations sa actions ng person, like
dapat firm ang rules and boundaries mo = review upper portion.

CLUSTER C
SAD, FEARFUL, ANXIOUS
Avoidant – sensitive to criticism
• Avoids responsibility
Dependent – extreme submissiveness
Obsessive compulsive – extreme neatness and perfectionism
Passive aggressive – negativistic (indirect expression of feelings)
• Like, you say something else but mean something else.
Note: employ COGNITIVE RESTRUCTURING – similar to CBT pero eto ang initial step ng CBT, meaning,
to change behaviour, change thoughts muna. FOCUS KA SA THOUGHTS.
• For example, someone with OC, ang gagawin mo is to focus muna on the thoughts in order
to create change. ETO ANG COGNITIVE RESTRUCTING = kapag may action na, CBT na yun.
Management: Behavioral Therapy = ROLE PLAY
Goal of Management: to help client reintegrate with the community, establish meaningful
relationships, and find a stable job.
• Cluster B people kase are very sad and fearful nga so mejo focused sila sa perception ng
others, so kelangan matuto sila maging part of the community. Different to sa cluster A
because ang A is focused on relationships lang talaga kase they are unable to form
relationships because of their behavior.

SUICIDAL CLIENT – SUICIDAL CLUES

Giving valuables
Cancelling appointments
Apologetic
Sudden cheerfulness and increase in energy = increase suicide precaution
Homicidal and suicidal thoughts = twins of depression, happens because the patient sees people as an
extension of the self.
• So pwede siyang pumatay ng tao also, like halimabawa, if close ka sa tao na magpapakamatay
like boyfriend ka niya, pwede ka ren niya patayin.
Most Common Time: Early morning, Monday, during endorsement = kase busy ang nurses, hindi nila
napapansin or kase tulog ang mga tao.
Gender:
• Attempt: Females
• Death: Male
Civil status: SINGLE – absence of support
Note: important to consider substance abuse – increased tendency to commit suicide.
• This is especially true for people who consume mga hallucinogenic tsaka stimulants mo, like:
COCAINE.
DIRECT CONFRONTATION APPROACH
Confront the client directly
• So kelangan mo i-ask directly ang patient, like sabihin mo: are you planning to kill yourself,
ganun.
• Accordingly kase people who have intentions will also share their plans to others kase
feeling nila hindi naniniwala ang mga tao.
Consider the plan, method, and lethality = How, when, where?
• In relation to the first point, kelangan mo itanong kung kelan, paano, kung how niya gagawin.
Contract of Safety: “I will not harm myself intentionally or accidentally with the next 24 hours.”
• As a nurse, initiate mo ‘to, set ka ng contract with the client, tas set ka ren ng boundaries
kung baket hindi niya dapat gawin.
Accidentally – cases of passive suicide
• For example, someone na hindi nagc-care for their safety, suicide pa ren yan.
Confiscate dangerous items
• For example, mag a-admit ka ng suicidal client, kunin mo lahat ng gamit na pwede niya
gamitin to kill themselves, e.g. bottle, shoelaces. Applicable ‘to usually sa mga in-patient.
Constant Observation = Irregular manner
• Hindi pwedeng regular kase what if q30 ka nagc-check, nagpakamatay siya in 15 minutes.
• Pag regular kase, na-anticipate niya, so pwede pa ren siya magpakamatay.
Create a list of support system
• Usual to sap ag umuwi na ang patient.
• For example, ang situation is ididischarge mo na ang patient ano ang most important—ang
answer is to create a support system or identify numbers or people that they can call if they
feel like they’re in distress. This is also a way to enforce good coping mechanisms.
Counsel the family - Educate on suicide clues

GLAUCOMA
• A group of intraocular diseases characterized by increased IOP (normal is 10-21 mmHg)
• This is measured by tonometer = not painful
• TWO TYPES: same na mataas ang IOP
o Open angle glaucoma - chronic, most common
o Causes:
▪ Congenital
▪ Trauma to the eyes
▪ Severe pupillary dilation
▪ Pwedeng idiopathic
▪ Pwedeng risk factor ang family history
• Other causes:
▪ Increased production of the aqueous humor
▪ Obstruction in the trabecular meshwork
• Characteristics:
▪ Caused by aging, gradual and progressive
▪ 26 to 32 mmHg
• Close angle glaucoma - acute
• Causes:
▪ Severe mydriasis
▪ Displacement of the iris
• Characteristics:
▪ Usually caused by trauma, sudden onset
▪ 50 to 70 mmHg = headache, red eyes, nausea, and vomiting
Unang nawawala ang like peripheral vision = TUNNEL VISION - both
MANAGEMENT FOR BOTH
1. Pilocarpine - miotic = constriction = open the angle
2. Acetazolamide (Diamox) - to decrease the production of the aqueous humor
3. Timolol eye drops - dec production of aqueous humor; pupillary constriction
4. Surgical management - iridotomy, iridectomy, trabeculectomy

Sample questions:

The nurse is developing a teaching plan for the client with glaucoma. Which of the following instructions
would the nurse include in the plan of care?
a. Avoid overuse of the eyes
b. Decrease the amount of salt in the diet
c. Eye medications will need to be administered for the client’s entire life
d. Decrease fluid intake to control the intraocular pressure

Tonometry is performed on the client with a suspected diagnosis of glaucoma. The nurse analyzes the test
results as documented in the client’s chart and understands the normal intraocular pressure is:
a. 2 – 7 mmHg
b. 10 – 21 mmHg
c. 22 – 30 mmHg
d. 31 – 35 mmHg

The client with glaucoma asks the nurse if complete vision will return. The most appropriate response
is:
a. “Your vision will never return to normal”
b. “Your vision will return as soon as the medication begins to work”
c. “Your vision loss is temporary and will return in about 3-4 weeks”
d. “Although some vision has been lost and cannot be restored, further loss may be prevented by
adhering to the treatment plan”

Which of the following health teaching concern for the nurse as discharged plan for suicidal patient who
had been taking tricyclic antidepressant drugs for 2 weeks and now ready to go home?

A. The nurse will need to include teaching regarding signs of neuroleptic malignant syndrome.

B. The patient will need regular laboratory work to monitor therapeutic drug levels.

C. The nurse will evaluate the risk for suicide by overdose of tricyclic antidepressant.

D. The patient may need a prescription for Benadryl to use for side effects.
A patient is to take regularly Lithium after discharged. The MOST important information to impart to the
patient and his family is that the patient should ______.

A. Not eat foods which has high tyramine content like cheese, wine, liver.

B. Limit his fluid intake

C. Have a limited intake of sodium

D. Have an adequate intake of sodium

The patient with diagnosis of Schizhoprenia who has been taking Clozapine will inform the patient family
that the positive effect of this drug is _____.

A. Monthly liver function studies change moderately

B. Psychotic symptoms such as hearing loss are reduced.

C. Patient develops leukopenia

D. Patients energy level and involvement in activities goes up

96. Which of the following characterizes Rapid Cycling Mood disorder?

*
0/1
A. Exaggerately energetic behavior
B. Depressive episodes alternating with at least one manic episode
C. Hypomanic episodes alternating with depressive episode of two years duration
D. Four or more mood episodes in 1 year duration

97. In your interview with Sonia, she said "I have special power that's why I was sent by God to make this
world a better place." This is a manifestation of:
*
1/1
A. Paranoia
B. Delusion of persecution
C. Delusion of grandeur
D. Denial

98. You heard of Sonia telling another nurse, - there are people who wants to harm me because I have
special power." This is a manifestation of what behavior?
*
1/1
A. Mania
B. Delusion of grandeur
C. Hallucination
D. Delusion of persecution

99. Which of the following is the first line treatment for acute mania?
*
0/1
A. Imipramine
B. Sodium valproate
C. Electro-convulsive therapy
D. Lithium carbonate

100. Which of the following statements best describes severe depression?

A. Anxiety and panic attack are characteristics of other condition
B. Sonia wakes up early
C. Agitation or Psychomotor retardation
D. Delusion and hallucinations do not occur