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DOA REMEDIOS T. ROMUALDEZ MEDICAL FOUNDATION


COLLEGE OF NURSING
CARE OF CLIENTS WITH PROBLEMS IN OXYGENATION, FLUID AND ELECTROLYTE
BALANCE, NUTRITION AND METABOLISM AND ENDOCRINE
Course Description: This course deals with the principles and techniques of nursing
care management of sick clients across lifespan with emphasis on
the adult and the older person, population group in any setting with
alterations/problems in oxygenation, fluid and electrolyte balance,
nutrition and metabolism and endocrine function and clients
undergoing surgery.
Course Code : NCM 103
Course Credit: 8 units lecture, 6 units RLE
Contact Hours/sem: 136 hours lecture and 306 hours RLE
Prerequisite: NCM 102
Placement: 3rd year, 1st semester
Course Objectives:
At the end of the course, students will be able to:
1. Use the nursing process in the care of individuals, families in community and hospital
settings.
Assess with client/s his/her/their condition/health status through interview, physical
examination, interpretation of laboratory findings.
Identify actual and at-risk nursing diagnosis
Plan appropriate evidence-based nursing interventions with client/s and family for
identified nursing diagnosis
Implement plan of care with client/s and family.
Evaluate the progress of his/her/their clients condition and outcomes of care.
2. Perform actual patient care in accordance with existing laws, legal, ethical and moral
principles.
3. Effectively communicate in speaking, writing, and presenting using culturally-appropriate
language with client/s and their family and the health team.
4. Document data on client care clearly, concisely, accurately and in a timely manner.
LEARNING OBJECTIVE

Differentiate the
normal and abnormal
anatomy and
physiology of the
Respiratory system

TOPIC

I. Responses to Altered Oxygenation,


Respiratory Gas Exchange, Transport,
Perfusion

DATE
AND
TIME

LECTUR
ER

July 16
8-12

Mrs.
Magno

I.A. Review: Anatomy and Physiology of


the Respiratory System
A. UPPER RESPIRATORY TRACT
- Nose, Paranasal sinuses, Pharynx,
tonsils,adenoids, Larynx, Trachea
B. LOWER RESPIRATORY TRACT
- Lungs, Mediastinum, Lobes
- Bronchi and Bronchioles, Alveoli

LEARNING OBJECTIVE

TOPIC

DATE

LECTURE

2
TIME

I. B Functions of the Respiratory System


- Oxygen Transport
- Respiration
- Ventilation
- Air Pressure Variances
- Airway Resistance
- Compliance
- Lung Volumes and Capacities
- Pulmonary Diffusion and Perfusion
- Ventilation and Perfusion Balance and
Imbalance
- Gas Exchange
I.C. Nursing Process:
A. Assessment:
Differentiate normal &
abnormal signs and
symptoms of
respiratory system

Gather relevant
information about the
present & past health,
family & social history
of the patient with
respiratory disorder

1. Subjective Data:
A. Nursing History
a. Common Symptoms
- Dyspnea
- Cough
- Sputum Production
- Chest Pain
- Wheezing
- Hemoptysis
- Orthopnea
- Cyanosis
- Restlessness
- Tachypnea
- Confusion
- Stridor
- Nasal and sinus complains
B. Past Health, Family, and Social History
C. Functional Health Patterns
2. Objective Data:
A. Physical Assessment
1. General Appearance
- Clubbing of the fingers
- Cyanosis
2. Assessment of the Upper Respiratory
Structures
- Nose and sinuses
- Mouth and Pharynx
- Trachea
3. Assessment of the Lower Respiratory
Structures and Breathing
- Thoracic Inspection
- Chest Configuration
- Breathing Patterns and Respiratory
Rates
- Thoracic Palpation
- Respiratory Excursion
- Tactile Fremitus
- Thoracic Percussion
- Diaphragmatic excursion
- Thoracic Auscultation
- Breath Sounds

3
LEARNING OBJECTIVE

1. Interprets
deviations from
normal findings
in the physical
assessment,
diagnostic and
laboratory
examination
2. Identify the
indications/
purposes,
contraindicatio
ns, side effects,
complications
and nursing
responsibilities
before, during
and after the
procedure.

Formulate nursing
diagnosis related to
respiratory problems
using their knowledge
of the assessment of
the respiratory

Make an
effective &
comprehensive
nursing care
plan for clients
with respiratory
disorders

TOPIC

B. Diagnostic Exams
b.1. Non-invasive
Pulmonary Function Test
- Pulse Oximetry
- Ventilation Perfusion Scan
- Radiologic Studies: Chest X-rays
CT Scan, MRI, PET, Pulmonary
- Angiography
b.2. Invasive
- Endoscopic Exams: Laryngoscopy,
Bronchoscopy, Mediatinoscopy
- Lung Biopsy
- Thoracentesis and Pleural fluid
Analysis
- Fluoroscopic studies
- Lung scans
b.3. Laboratory Tests
- Sputum Culture
- Nose and throat culture
- ABGs
- Fagerstrom Test (Standardized
degree of nicotine dependence)
- Smoke analyser
B. Analysis/ Nursing
Diagnosis
1. Ineffective airway clearance as
evidenced by shortness of breath,
dyspnea, orthopnea, retractions, nasal
flaring, altered chest excursion
2. Ineffective breathing patterns as
evidenced by ineffective cough,
diminished or abnormal breath sounds,
cyanosis, restlessness
3. Impaired gas exchange as evidence by
cyanosis, abnormal respiratory rate,
rhythm, nasal flaring, tachycardia,
diaphoresis, confusion
4. Impaired spontaneous ventilation as
evidenced by dyspnea, use of
accessory muscles, tachycardia,
apprehension
5. Disturbed sleep pattern (sleep-rest)
6. Anxiety (Self- Perception- Self- Concept)
C. Planning:
1. Planning for health promotion
2. Planning for health restoration and
maintenance
a. Maintain airway patency: coughing
techniques, suctioning
b. Relieving apprehension and fear
c. Reducing metabolic demands
d. Maintaining rest and activity
e. Decreasing the efforts of breathing
f. Maintaining nutrition and hydration

DATE
TIME

LECTURE
R

LEARNING OBJECTIVE

TOPIC

DATE
TIME

LECTURER

July
23

Mrs.
Magno

g. Preventing and controlling


infection
h. Planning for oxygen therapy
i. Incentive spirometry
j. Aerosol therapy
k. Postural drainage
l. Ventilation therapy
m. Artificial airways
n. Chest drainage
o. Chest surgery
- Lobectomy
- Pneumonectomy
- Segmental Resection
- Wedge Resection
- Decortication
- Exploratory Thoracotomy
- Thoracotomy not involving lungs
- Video- assisted thoracic surgery
(VATS)
- Lung volume Reduction Surgery (LVRS)
Explain the various
respiratory problems
and recite all the
precipitating factors
and risk factors that
may lead to the
development of these
diseases /disorders.
Enumerate the
pathognomonic
manifestations of
each disease and
explain the reason
why they develop.

I.D. COMMON HEALTH


PROBLEMS
A. Nursing Care of Clients with Upper
Respiratory Problems
-

Rhinitis
Viral Rhinitis
Rhinosinusitis
Pharyngitis
Tonsillitis and adenoiditis
Peritonsillar abscess
Laryngitis
Laryngitis
Epistaxis
Nasal Obstruction
Fractures of the nose
Laryngeal Obstruction
Cancer of the larynx

B. Nursing Care of Clients with Chest and


Lower Respiratory Tract Disorders
Pneumonia
Aspiration
Severe Acute Respiratory
Syndrome
Pulmonary Tuberculosis
Lung Abscess
Pleurisy
Pleural Effusion
Empyema
Pulmonary Edema
Acute Respiratory Failure
Acute Respiratory Distress
Syndrome
Pulmonary Arterial Hypertension
Pulmonary Heart Disease
( CorPulmonale)
Cardiac Tamponade
Subcutaneous Emphysema
Pulmonary Embolism
Pulmonary HypertensionPulmonary Edema

8-12

LEARNING OBJECTIVE

TOPIC

DATE
TIME

LECTURER

5
Explain the various
* Occupational Lung Disease
July
Mrs.
24
respiratory problems
- Asbestosis
Magno
- Silicosis
and
8-12
- Coal Workers Pneumoconiosis
recite all the
- Hypersensitivity Pneumonitis
precipitating factors
- Sarcoidosis
and riskLEARNING
factors that
TOPIC
DATE
LECTUR
Lung Cancer
may lead
to the
OBJECTIVE
TIME
ER
Tumors of the Mediastinum
development
Gather relevant
of
- Functional
TraumaHealth
of the Patterns
Chest or Lungs
A.
these
information
diseases
about the
- Thoracic
B. Past
health, Injury:
family Rib
and social history
/disorders.
present & past health,
Fracture, flail chest,
family & social history
Pulmonary
2. Objective Data
Enumerate
of the patient
the with
Contusion, Blunt
pathognomonic
respiratory disorder
Trauma, Penetrating
Physical Assessment
manifestations of
trauma: a.
Gunshot
-and
General
Appearance
each disease and
stab wounds
- Inspection
of the
skin
explain the
- Inhalational
Injury:
Blood
Pressure
reason why they
smoke inhalation
Pulse
Pressure
near
drowning
develop.
- Postural Blood Pressure Changes
- Differentiate normal
Arterial
Pulses
A. -Nursing
Care
of Clients with Chronic
& abnormal signs
-Pulmonary
Jugular Venous
Pulses
Disease
and symptoms of
- a.Heart
Inspection
and Palpation
Chronic Obstructive
Pulmonary
cardiovascular
- Heart Auscultation
Disease
systems
- Inspection of the extremities
b.
Emphysema
- Assessment of other systems
c.
Bronchitis
a. Lungs
d.
Bronchiectasis
b. Abdomen
e.
Asthma
f.
Status Asthmaticus
2.a. Problems
of Fibrosis
Oxygenation: Perfusion
g.
Cystic
- Fatigue, fluid retention, dyspnea
Irrregular
pain
B. -Nursing
Careheartbeat,
of Pediatric
Clients with
- tenderness in the calf or legs
Respiratory
July
- syncope, leg pain
Mrs. De
Disorders
30
- Altered neurologic function
Asis

Identify the
indications/
purposes ,
contraindications,
side effects,
complications and
nursing
responsibilities
before, during and
after the procedure.

LEARNING
OBJECTIVE
- Implement
individualize the
nursing care:

a. Upper Respiratory Tract


8-12
2. b. Problems in Oxygenation
Common Colds
Transport:
Allergic Rhinitis/ Chronic Rhinitis
- - Skin:
flushing, jaundice, cyanosis,
Sinusitis
excoriations,
pruritus, leg ulcers,
Pharyngitis
- - angiomas,
telangiectasis,
nevus
Tonsilitis
- purpura
Epistaxis
- - petechiae,
ecchymosis, hematomas,
Aspiration
- - chondroma,
Laryngitisplasmacytoma
- - Eyes:
Icteresia, Conjunctival pallor,
Croup
Vision,
diplopia, visual fields cut
- blurred
Choanal
atresia
- Nose: Epistaxis
- Mouth:
Gingival
and mucosal
b. Lower
Respiratory
Tract
membrane
Asthma, Status Asthmaticus
- Changes
Pneumonia
- - Lymph
Adenopathies
PTB/Nodes:
Primary
Complex
- - Heart
and
Chest:
Cystic Fibrosistachycardia,
- palpitations,
Bronchitis/ Bronchiolitis
- - Altered
BP, sternal tenderness, low
Atelectasis
- - Oxygen
saturation
Pneumothorax
- Abdomen: Hepato-splenomegaly
- Nervous
System: Paresthesia,
c. Others
- Headache,
Otitis Media
- - Nuchal
Rigidity
RDS/
SIDS
- Musculoskeletal system: bone pain,
joint
- Swelling and arthralgia
B. Diagnostic Tests and Procedures
1. Non-invasive:
- ECG
- Ultrasound
- chest XrayTOPIC
- Cardiac Stress Testing
- Exercise stress Testing
- Pharmacological Stress Testing
I.E. IMPLEMENTATION
1. Pharmacological Therapeutics

DATE
TIME

LECTUR
ER

6
-

Echocardiography
CT scan
MRI
Radio-nuclides studies

TOPIC
LEARNING
OBJECTIVE
4. Invasive Studies:
Interpret deviations
from normal findings
in the physical
assessment,
diagnostic and
laboratory
examination
Communicate to the
patient the result of
the diagnostic and lab
examination

Formulate nursing
diagnosis related to
respiratory problems
using their knowledge
of the assessment of
the cardiovascular
system

Cardiac Catheterization
Angiography
Aortography
Coronary Arteriography
Right Heart Catheterization
Electrophysiologic Testing
Arteriogram
Venogram
Lymphography
Bone marrow aspiration
Hemodynamic monitoring
* CVP
* Pulmonary artery pressure
* Intraarterial BP monitoring
5. Laboratory Tests
a. Cardiomarker analysis
Enzymes and Isoenzymes Studies: CPKMB,
C-Reactive Protein, Troponin-I
b. Blood Chemistry, Hematology
and coagulation studies
c. Brain (B-type) Natriuretic
Peptide
d. C-reactive Protein
e. Homocysteine
f. ESR, ASO-Titer
g. Torniquet Test
h. Throat Culture
b. ANALYSIS/ NURSING
DIAGNOSIS:
1. Decreased Cardiac Output as
evidenced by increasedHeart
rate, fatigue, SOB, decreased
urine output,
2. Impaired mental processing,
decreasing LOC
3. Activity Intolerance as evidenced
by weakness, fatigue, vital signs
changes
4. Fatigue as evidenced by difficulty
completing usual daily activities,
frequent desire to rest
5. Risk for peripheral neurovascular
dysfunction as evidenced by
changes in color, temperature,
sensation of extremities
6. Impaired tissue integrity
(Nutrional Metabolic)
7. Ineffective Breathing Patterns
8. Fluid Volume Excess
9. Nutrition, Altered, less than body
requirement
10.Growth and development, altered
11.Family Process, Altered
12.Pain

DATE
TIME

LECTUR
ER

7
13.Activity Intolerance

LEARNING
OBJECTIVE
Make an effective &
comprehensive
nursing care plan for
clients with
respiratory disorders

Explain the various


cardiovascular
problems and
recite all the
precipitating factors
and risk factors that
may lead to the
development of these
diseases
Enumerate the
Pathognomonic
Manifestations of each
disease and explain
the
reason why they
develop.
Discuss the
psychopathophysiolog
ic process of these
diseases from causes
to manifestations and
its complications

TOPIC

DATE
TIME

LECTUR
ER

Aug 6

Mrs. De
Asis

c. PLANNING
1. Planning for health promotion
a. Risk Factor and risk management
b. Promotion of circulation
c. Prevention of infection:
immunizations
d. genetic counselling
e. role of nutrition
2. Planning for health Maintenance and
restoration
a. Planning for basic life support, CPR
b. Planning for advanced life support
c. Planning for the client having cardiac
surgery
II.C. COMMON HEALTH PROBLEMS
A. Nursing Care of Clients with
Dysrhythmias and Conduction Problems

8-12

1. Dysrhythmias
-

a.
Sinus
Sinus
Sinus

b. ATRIAL DYSRHYTHMIAS
Premature atrial complex
Atrial Flutter
Atrial Fibrillation

SINUS NODE DYSRHYTHMIAS


Bradycardia
Tachycardia
Arrhythmias

c. JUNCTIONAL DYSRHYTHMIAS
Premature Junctional Complex
Nonparoxysmal Junctional Tachycardia
Atrioventriculr Nodal Reentry
Tachycardia
d. VENTRICULAR DYSRHYTHMIAS
Premature Ventricular Complex
Ventricular Tachycardia
Venticular Fibrillation
Idioventricularrhythym
Ventricular asystole

2. CONDUCTION ABNORMALITIES
a. First-degree Atriventricular block
b. Second-degree Atriventricular
Block, Type I (Wencke Bach)
c. Second-degree Atriventricular
Block, Type II
d. Third-degree Atriventricular Block
B. Nursing Care of Clients with Coronary
Vascular Disease
k.
Coronary Atherosclerosis
l.
Angina Pectoris
m.
Acute Coronary Syndrome and
Myocardial Infarction

Aug 7
8-12

Mrs.
Magno

LEARNING
OBJECTIVE

TOPIC

DATE
TIME

LECTUR
ER

Aug 12
(in
lieu of
Aug
17)
8-12

Mrs.
Alfonso

C. Nursing Care of Clients with Structural,


Infectious and Inflammatory Cardiac
Disorders
a. Mitral Valve Prolapse
b. Mitral Regurgitation
c. Mitral Stenosis
d. Aortic Regurgitation
e. Aortic Stenosis
f. Septal Defects
g. Cardiomyopathy
h. Rheumatic Endocarditis
i. Infective Endocarditis
j. Myocarditis
k. Pericarditis
D. Nursing Management of Clients with
Complications from Heart Disease
a. Chronic Heart Failure
b. Pulmonary Edema
c. Thromboembolism
d. Pericardial effusion and cardiac
tamponade
e. Cardiac arrest
E. Nursing Care of Clients with Vascular
Disorder and Problems of Peripheral
Circulation
a. Peripheral Occlusive Disease
b. Upper Extremity Arterial Occlusive
Disease
c. ThromboangitisObliterans
d. Aortoiliac Disease
e. Aneurysms
f. Dissecting Aorta
g. Arterial Embolism and arterial
thrombosis
h. Raynauds Phenomenon
i. Chronic Venous Insufficiency/
Postthrombotic Syndrome
j. Leg Ulcers
k. Varicose Veins
l. Lymphagitis and Lymphadenitis
m. Lymphedema and elephantiasis
F. Nursing Care of Clients with
Hypertension
a. Hypertension
b. Hypertensive Crises
G. Nursing Care of Clients with
Hematologic Disorders
a.
b.
c.
d.
e.
f.
g.
h.

Hypoproliferativeanemias
Hemolyticanemias
Polycythemia Vera
Secondary Polycythemia
Neutropenia
Lymphopenia
Acute Myeloid Leukemia
Chronic Myeloid Leukemia

Aug 13
8-12

Mrs. De
Asis

9
i.
j.
k.
l.
m.

EARNING OBJECTIVE

Hodgkin Lymphoma
Non-hodgkin Lymphoma
Primary Thrombocythemia
Secondary Thrombocytosis
Thrombocytopenia

TOPIC

DATE
TIME

LECTUR
ER

Aug 14

Mrs.
Alfonso

n. Idiopathic Thrombocytopenic
Purpura
o. Platelet Defects
p. Thalassemias
q. Hemophilias
r. Von Willebrands Disease
s. Vitamin K Deficiency
t. Disseminated Intravascular
Coagulation
u. Thrombotic Disorders
v. Hyperhomocysteinemia
w. Antithrombin Deficiency
x. Protein C Deficiency
y. Protein S Deficiency
z. Activated Protein C Resistance
and Factor V Leiden Mutation
aa. Acquired Thrombophilia
H. Pediatric Cardiovascular Disorders
A. Defects with increased pulmonary blood
flow
- VSD, ASD, PDA

8-12

B. Defects with Obstruction to blood flow


- PS, AS, COA
C. Defects with mixed blood flow
- Transposition of great vessels
- TruncusArteriosus
D. Defects with decreased pulmonary blood
flow
- Tricuspid atresia
- TOF
E. Acquired Heart Disease
- CHF
- Rheumatic Fever
- Persistent Pulmonary Hypertension
- Kawasaki Disease
- Endocarditis
- Arrythmias
- Hypertension
- Dyslipidemia
- Cardiomyopathy
F. Pediatric Hematologic Disorders
- Hyperbilirubinemia
- Anemias
- Polycythemia
- Leukemia
- Purpuras- ITP, HenochSchonlein
syndrome
- Hemophilias: Factors 8,9,11
deficiencies,
- Von Willebrands disease
- Thalassemias
- DIC

August
20
8-12

Mrs.
Alfonso

10

LEARNING
OBJECTIVE
- Implement
individualized
nursing care:
1. Safely and
knowledgeably
administers
prescribed
medications and
treatments/
alternative
complementary
medicine
2. Provide
appropriate
client education
and health
maintenance
and communitybased care of
clients.

TOPIC

DATE
TIME

LECTURE
R

Aug
26
3-7

Mrs. De
Asis

D. IMPLEMENTATION:
a. Pharmacologic Therapy

- Cholesterol lowering drugs, statins, bile


acids
Sequestrants, nicotinic acid, fibric acid
derivatives
Antianginal: Nitroglycerine, beta
blockers, calciumChannel blockers
Antiplatelet: Oral and IV drugs
Antidysrhythmic Drugs
Heart Failure: ACE inhibitors,
Angiotensin II
Receptor blockers, diuretics, positive
inotropic Agents, sympathomimetics,
digoxin, phophodi
Esterase inhibitors
Anemia: Iron sources, B12 sources,
folic acid
Sources
Antihypertensive: alpha adrenergic
blockers,
ACE inhibitors, beta adrenergic
blockers, calcium Channel blockers,
centrally acting
Anticoagulants: Heparin, Warfarin
b. Complementary and Alternative
Therapies

Fish Oil- Omega 3 Fatty acids


Hawthorn
Herbs that may affect clotting
Natural Lipid Lowering agents
Phototherapy
DVET

c. Nutrition and Diet Therapy


DASH Diet
Pritkin Diet
Ornish Diet
Low Salt, Low Fat
Gavage Feeding
d. Blood Transfusion
e. Bone Marrow Transplant
f. Splenectomy

E. Client Education

Differentiate the
normal and abnormal
anatomy and
physiology of the
Digestive system

III. RESPONSES TO ALTERED NUTRITIONMETABOLISM


III.a. Review of Anatomy and Physiology of
the GIT and Accessory Organs
1. Alimentary Tract
a.
Oral Cavity or Mouth
- Tongue, Teeth, Palate and Tonsils
- Salivary Glands, Pharynx, Esophagus

(in
lieu
of
Aug

11
LEARNING
OBJECTIVE

Stomach, Small Intestines, Large


Intestines
Rectum and Anal Canal

21)

TOPIC

DATE
TIME

2. Accessory Organs
a.
Salivary Glands
b.
Pancreas
as exocrine gland
as endocrine gland
c.
Liver and Biliary Tract
III. b. Nursing Process:
a. Assessment:
1.
2.

Subjective Data:
a. Nursing History
Common Symptoms:
- Abdominal Pain
- Intestinal Gas
- Nausea and Vomiting
- Changes in Bowel Habits and Stool
Characteristics
- Indigestion
- Diarrhea
- Appetite and and weight changes
- Satiety
b. Functional Health Pattern
c. Past Health, Family and social History

3.

Objective Data:

a.

Physical Examinations:
Anthropometric measurements
Inspection: color, texture of mucous
membrane, Growth patterns, scars,
masses
Auscultation: bowel sounds
Percussion: liver span masses, ascites
Palpation: masses, ascites, rebound,
tenderness,
Distention, organ enlargements

1.
2.
3.
4.
5.
6.
Interprets deviations
from normal findings in
the physical
assessment, diagnostic
and laboratory
examinatio
Identify the
indications/ purposes,
contraindications, side
effects, complications
and nursing
responsibilities before,
during and after the
procedure.

Screening of Nutritional Status


Nutritional Health
Malnutrition

b.
1.
-

Diagnostic Examinations:
Imaging tests
Barium beefsteak meal
Colorectal transit study
Computed tomography scan (CT or CAT
scan)
Defecography
Lower GI (gastrointestinal) series
(barium enema)
Magnetic resonance imaging (MRI)
Magnetic resonance
cholangiopancreatography (MRCP)
Oropharyngeal motility (swallowing)
study
Radioisotope gastric-emptying scan
Ultrasound
Upper GI (gastrointestinal) series (also
called barium swallow)
Flat plate of the abdomen

LECTURE
R

12

LEARNING OBJECTIVE

TOPIC

2.
-

Endoscopic procedures
Colonoscopy
ERCP
EGD
Sigmoidoscopy
Small bowel enteroscopy
Proctoscopy
Anoscopy

4.
-

Other procedures
AnorectalManometry
EsophagealManometry
EsophagealPhmanometry
Gastric Manometry

DATE
TIME

LECTURER

Aug.
27

Mrs.
Magno

5. Laboratory Studies
1. Blood Chemistries: serum amylase,
lipase, proteins
2. Total lymphocyte count
3. D-xylose absorption test
4. Fecal Analysis: Occult, ova and
parasites,
5. Quantitative fecal fat studies, fecal
leukocytes,
6. Stool electrolyte tests
7. Exfoliativecytologic analysis
8. Gastric analysis
Formulate nursing
diagnosis related to
respiratory problems
using their knowledge
of the assessment of
the digestive system

Make an effective &


comprehensive nursing
care plan for clients
with nutrition
metabolism disorders
Explain the various
gastrointestinal
problems and recite all
the
precipitating factors
and risk factors that
may lead to the
development of these
diseases /disorders.

b. Analysis/ Nursing Diagnosis


1. Fluid Volume deficit related to blood
loss from Injury, other complications
related to surgery and Impaired gastric
tissue function, vomiting and
Interstitial fluid shift, diarrhea, loss of
fluid and Electrolytes, impaired fluid
intake, vomiting and Diarrhea, from
intestinal obstruction
2. Altered Nutrition: less than body
requirements
Related to esophageal injury,
dysphagia,
disease Process , treatment, nausea,
vomiting, diarrhea, malignancy and
treatment, GI
symptomatology, fluid and electrolyte
loss
3. Risk for infection related to GI
infections
4. Skin integrity, impaired, risk for related
to
Frequent contact with diarrheal stools
C. Planning
A. Planning for health maintenance,
restoration
a.
enema, fecal impaction removal
b.
NGT, TPN
c.
Liver transplant
III. C. COMMON HEALTH PROBLEMS

Enumerate the

A. Nursing Care of Clients with Oral and

8-12

13
pathognomonic
manifestations of each
disease and explain
the reason why they
develop.

LEARNING
OBJECTIVE

1. Explain the
various
disorders
affecting
nutritionmetabolism and
explicating all
the
precipitating
factors and risk
factors that
may lead to the
development of
these
diseases
/disorders.

2. Enumerate the
pathognomonic
manifestations
of each disease
and explain the
reason why they
develop.

Esophageal Disorders
Dental Plaques and Carries
Dentoalveolar Abscess or Periapical
Abscess
Malocclusion
Temporomandibular Disorders
Jaw disorders Requiring Surgical
Management
Parotitis
Sialadenitis

TOPIC
-

DATE
TIME

LECTURE
R

Aug
28

Mrs.
Magno

Salivary Calculus
Neoplasms
Achalasia
Diffuse Esophageal Spasm
Hiatal Hernia
Diverticulum
Perforation
Foreign Bodies
Chemical Burns
GERD
BarettsEsophagus
Benign Tumors of the esophagus
Cancer of the Esophagus

B. Nursing Care of Clients with Gastric


and Duodenal Ulcer
- Gastritis
- PUD
- Morbid Obesity
- Gastric Ca
- Gastric Surgery
- Duodenal Ulcers

8-12

C. Nursing Care of Clients with Intestinal


and Rectal Disorders
- Constipation
- Diarrhea
- Fecal Incontinence
- Food Poisoning
- Irritable Bowel Syndrome
- Conditions of Malabsorption
- Appendicits
- Diverticular Disease
- Peritonitis
- Types of Inflammatory Bowel Disease
- Small Bowel Obstruction
- Large Bowel Obstruction
- Colorectal Ca
- Polyps of the Colon and Rectum
D. Disorders caused by food, vitamin and
mineral deficiencies:
-

Kwashiorkor
Marasmus
Iodine Deficiency

E. Malabsorption Syndrome
-

Celiac Sprue
Lactase Deficiency

Sept

Mrs. De

14
-

Short Bowel Syndrome

F. Nursing Care of Clients with Hepatic


Disorders
-

TOPIC

Oral Moniliasis
Cleft Lip/ Palate
Tracheoesophageal atresia
Tracheoesophageal fistula
Pediatric Disorders:
Enzyme Deficiencies
Pyloric Stenosis
GERD: Achalasia
Hiatal Hernia
Necrotizing enterocolitis
Meckels diverticulum
Megacolon
Imperforate anus
Inflammatory bowel diseases
Intestinal Obstruction
Intestinal Parasitic Infections

D. IMPLEMENTATION

1. Safely and
knowledgeably

LECTURE
R

Sept
4
8-12

Mrs.
Alfonso

G. Nursing Care of Clients with Biliary


Disorders
- Cholecystitis
- Cholelithiasis
- Gallbladder Ca
- Biliary Atresia
- Acute Pancreatitis
- Chronic Pancreatitis
- Pancreatic Cyst
- Cancer of the Pancreas
- Tumors of the Head of the Pancreas
- Pancreatic Islet Tumors
- Hyperinsulinism
- UlcerogenicTumors

Implement
individualized
nursing care:

DATE
TIME

Drug- Induced Hepatitis


Primary Liver Tumors
Liver Metastases
Liver Transplantation
Liver Abscess

H. Pediatric Disorders:

Asis

Jaundice
Portal Hypertension
Ascites
Esophageal Varices
Hepatic Encephalopathy And coma
Hep A, B,C,D,E Virus
Hep G Virus and GB Virus-C
Toxic Hepatitis

LEARNING
OBJECTIVE

3. Discuss the
psychopathophy
siologic process
of these
diseases
from causes to
manifestations
and its
complications

3
8-12

1. Pharmacologic Therapeutics
- Antiemetics
- Anticoagulants
- Hematinics
- Laxatives
- Antipruritic

15
administers
prescribed
medications and
treatments/
alternative
complementary
medicine

LEARNING
OBJECTIVE

Vitamin supplement
Antacids
Antihyperlipidemics
Antispasmodics
Antidiarrheal
Antisecretory agents
Vasopressin
Octreotide
Epinephrine
Promotility
Cholinergic
Antibiotics for H. Pylori
A-interferon and ribavirin
Pancreatic Enzyme Replacement

TOPIC

DATE
TIME

LECTUR
ER

2. Complementary and Alternative


Therapies
- Ginger
- Milk Thisle (Silymarin)
3. Surgical and Special Procedures:
a. Surgical Procedures:
- Gastrostomy
- Gastrectomy
- Colostomy
- Hemorrhoidectomy
- Gastrointestinal bypass
- Ileostomy
- Hemicolectomy
b. Special Procedures
- Parenteral Hyperalimentation
- Feeding per NGT, jejunostomy
- Gastrostomy tubes
- Hot sitz bath
4. Nutrition and Diet Therapy
- Regular Diets
- Special Diets: High Fiber, gluten
free
- Low Protein, High Calorie
5. Client Education

Differentiate the
normal and abnormal
anatomy and
physiology of the
endocrine system

MIDTERM EXAMINATION

Sept 712

IV. RESPONSES TO ALTERED ENDOCRINE


FUNCTION

Sept 16
3-7

IV.a. Review on the Anatomy and Physiology


of the Endocrine System

(in
lieu of
Sept
18
Found
ation
Days)

A. Hormones
1. Categories
a. Proteins, Peptides and Amino Acid
Derivatives
b. Lipid Hormones
B. The Endocrine glands and their
hormones
2. The Pituitary and Hypothalamus

Mrs.
Alfonso

16
k.

Hormones of the Anterior


Pituitary
- Growth Hormone ( GH)
- Thyroid Stimulating Hormone (TSH)
- Adrenocoticotropic Hormone
(ACTH)
Hormone (ICHSH)
Prolactin
Melanocyte- Stimulating
Hormone
(MSH)
Hormones of the Posterior
Pituitary
Antidiuretic Hormone (ADH)
Oxytocin

l.

3. The Thyroid Gland


a.
Triidothyronine (T3)
b.
Thyroxine (T4)
c.
Calcitonin
2.
Parathyroid Gland
a.
Parathyroid Hormone (PTH)

LEARNING
OBJECTIVE

TOPIC
1.
a.
b.
-

The Adrenal Gland


Adrenal Medulla
Epinephrine or Adrenalin
Norepinephrine
Adrenal Cortex
Glucocorticoids
Mineralocorticoids
Androgens

2. The Pancreas
a. Beta Cells - Insulin
b. Alpha Cells Glucagon
3.
a.
b.
-

The Testes and the Ovaries


Female
Estrogen
Progesterone
Male
Testosterone

4. The Thymus Gland


- Thymosin
5. The Pineal Gland
a. Melatonin
C. Other Hormones
1. Prostaglandins
2. Erythropoietin
3. Human Chorionic Gonadotropin
(HCG)
Differentiate normal &
abnormal signs and
symptoms of the
endocrine function

IV.b. Nursing Process


a. Assessment

1. Subjective Data
a. Nursing History
Pain

DATE
TIME

LECTUR
ER

17

Gather relevant
information about the
present & past health,
family & social history
of the patient with
endocrine disorder

Infection/ Inflammation
GI Manifestation
Skin Changes
Thirst
Perfusion Problems: bleeding, bruising,
Vital signs changes
Sensory and mental changes
Visual changes
Urinary/ reproductive changes

b. Functional Health Patterns


2. Objective Data
a. Physical Assessment
- Inspection: color, texture and
temperature of the skin and mucus
membrane, growth pattern, trembling
- Auscultation: bruit, tachycardia
- Palpation: organ thyroid enlargement
- Percussion: fluid, edema
- Severe weight loss

LEARNING
OBJECTIVE
3. Interprets
deviations from
normal findings
in the physical
assessment,
diagnostic and
laboratory
examination

4. Identify the
indications/
purposes ,
contraindication
s, side effects,
complications
and nursing
responsibilities
before, during
and after the
procedure.

TOPIC

b. Diagnostic/ Laboratory Examinations


a. Non-invasive
- Test of Thyroid structure and function:
size, Shape, position, function by
scanning, UTZ, MRI, CT scan,
radionuclide imaging, testing
forAchilles tendon reflexes, radioiodide
uptake
- Test for adrenal structure and function:
Lesions, diseases, CT,
- MRI, adrenal venogram
- And angiography
- Test of Pituitary structure and function:
Skull X-ray, CT, MRI
- Metabolic Function Studies
- Abdominal UTZ, radiography, CT
b.
-

Invasive
Angiography
Portal pressure measurement
Biopsy
Paracentesis
Fine needle aspiration biopsy

c. Laboratory
- Growth Hormone/ human hormone
- Somatomedin; insulin like growth
factor
- Water deprivation test
- Thyroid Stimulating Hormone
- Thyroxine ( T4)
- Triiodothyronine
- Thyroid antibodies
- Parathyroid ormone
- Calcium
- Cortisol
- Aldosterone
- ACTH

DATE
TIME

LECTUR
ER

18

4. Utilize the
assessed data in
order to:
- Prioritize nursing
diagnosis
- Discuss the
pathophysiological
responses to
altered nutrition metabolism

LEARNING
OBJECTIVE

Plan the care of


clients utilizing
evidence-based
nursing research
Achieve the best
clinical
outcomes
utilizing ethicomoral and legal
principles
Plan effective
care.

Given an actual patient


withDisorders of the
thyroid gland,
Disorders of the
Parathyroids, Disorders
of the adrenal glands,
Disorders of the
adrenal
glands,Disorders of the
Pituitary Gland,
Disorders of the
Pancreas, the student
will be able to:

ACTH stimulation
ACTH suppression
17 ketosteroids
Fasting blood sugar
Oral Glucose
Tolerance test
Glycosylated Hemoglobin

b. Analysis/ Nursing Diagnosis:


1. Imbalanced Nutrition less than/ more
than body Requirements as evidenced
by increased food Intake with weight
loss
2. Deficient fluid volume as evidenced by
dry mucus Membrane, thirst and
decreased urine output
3. Hyperthermia as evidenced by body
temperature Ranging from 39-41
degrees Celsius

TOPIC

DATE
TIME

LECTUR
ER

Sept 17
8-12

Mrs. De
Asis

4. Impaired Skin integrity as evidenced


by dry,
Rough, reddened and edematous skin
5. Ineffective therapeutic regimen
management
( health perception, health
management)
6. Disturbed body image ( selfperception,
Self-concept)
c. Planning
1. Planning for health restoration and
maintenance

IV.C. COMMON HEALTH PROBLEMS


1. Disorders of the thyroid gland
a. Hyperthyroidism (thyrotoxicosis)
- Graves Disease
- Toxic Nodular Goiter
b. Hypothyroidism
- Iodine deficiency
- Hashimotos thryroiditis
- Myxedema coma
- Congenital hypothyroidism
2. Disorders of the Parathyroids

19
1. Explain the
various
disorders
affecting the
endocrine
system and
explicate all the
precipitating
factors and risk
factors that
may lead to the
development of
these
diseases
/disorders.

2. Enumerate the
pathognomonic
manifestations
of each disease
and explain the
reason why they
develop.

3. Discuss the
psychopathophy
siologic process
of these
diseases
from causes to
manifestations
and its
complications

Hyperparathyroidism
Hypothyroidism
Hypocalcemia

3.
-

Disorders of the adrenal glands


Hypercortolism
Addisons disease
Pheochromocytoma
Congenital adrenogenital hyperplasia
Cushings syndrome

4.
-

Disorders of the Pituitary Gland


Anterior Pituitary Disorders
Gigantism
Acromegaly
Posterior Pituitary gland
SIADH
Diabetes Insipidus

5.
-

Pancreas
Diabetes Mellitus
Hypoglycemia
Diabetic Ketoacidosis
Hyperglycemic Hyperosmolar
Nonketotic Syndrome
MacrovascularComplicstions
Microvascular Complications
Diabetic nephropathies
Foot and leg problems

LEARNING OBJECTIVE

Implement
individualized nursing
care:
1. Safely and
knowledgeably
administers
prescribed
medications and
treatments/
alternative
complementary
medicine
2. Actively
participates in
planning and
coordinating
culturally
sensitive
interdisciplinary
care
3. Provide

TOPIC

d. Implementation
1.

Pharmacologic therapeutics
-

Iodine sources
Thyroid preparations
Cortisol replacement
Insulin
Oral Hypoglycemics

2.
Complementary and Alternative
Therapies
-

Aloe vera
Bilberry
Bittermelon
Fenugreek
Fish oils
Garlic
Ginseng
Gymnema
Horse chestnut seed extract
Marshmallow
Milk thistle

Sept 24
8-12

Mrs.
Alfonso

Sept 25
8-12

Mrs.
Magno

DATE
TIME

LECTURE
R

20
appropriate
client education
and health
maintenance
and communitybased care of
clients
4. Efficiently and
effectively
utilize available
resources in the
care of clients to
achieve
outcomes
5. Evaluate
effectiveness of
nursing care,
revising the
nursing care
plan as needed
to promote,
maintain or
restore
functional health
status of clients

Nopa
Prickly pear cactus
Burdock (may increase blood sugar)

3.
-

Surgical procedures:
Thryroidectomy
Patrathyroidectomy
Unilateral or bilateral adrenalectomy
(transphenoidal) hypophysectomy
Amputation of diabetic patient
Pancreas transplant
Islet cell transplant

B. Assess the health

DATE
TIME

LECTURE
R

4. Nutrition and diet therapy


5. Patient education
V. CARE OF CLIENTS WITH RESPONSES
TO ALTERED URINARY ELIMINATION
V.a. Review of Anatomy and Physiology of the
Urinary System
A.
1.

Structure and Function


Kidney
a. Gross structure of the Kidney
b. Microscopic structure of the
kidney nephron
c. Blood Supply
d. Functions
e. Urine Production
- Filtration
- Reabsorption
- Secretion

LEARNING OBJECTIVE

A. Apply knowledge
and normal anatomy
and physiology and
assessment
techniques in caring
for clients

Mrs. De
Asis

Special Procedures:
- Adminitration of insulin
- Adminstration of hormone

6. Maintain
confidentiality
and protect
clients privacy

Given an adult
( young, middle, old,
old-old adult) with
responses to altered
Urinary elimination,
the student will be
able to:

Oct 1
8-12

TOPIC

f. Composition of Urine
g. Regulation of urine concentration and
volume
h. Hormonal Mechanisms
i. Effect of Sympathetic innervation
j. on Kidney function
k. Urine Movement
1. Ureters
2. Urinary Bladder
3. Urethra
V.b Nursing Process
a. Assessment
I. Nursing History
1.
a.
-

Subjective Data
General manifestations:
Fatigue
Headache

21
status of a client
1. Conduct a
health history
and functional
health status of
clients having or
at risk for
alterations in
oxygenation;
cardiac and
peripheral tissue
perfusion/
transport
2. Perform
systematic and
comprehensive
physical
assessment to
validate
assessed data.

2. Objective Data
a. Physical assessment
-

Interprets deviations
from normal findings in
the physical
assessment, diagnostic
and laboratory
examination

4. Utilize the
assessed data in

Inspection: Masses, bulges,


inflammations,
Ulcerations, nodules, lesions,
discharges,
Indurated areas
Auscutation : Bowel sound, cardiac and
respiratory status: lung sounds, cardiac
arrhythmias, evidence of congestive
heart failure
Palpation: Tenderness or resistance,
inflammation, tenderness, masses,
hydrocele, varicocele,
lymohadepathies
Further inspection for vascularity,
atrophic vaginitis, bulges for hernias,
skin color changes

3.
Diagnostics and Laboratory
Examinations
a.
Non-invasive
Test for renal function
Prostate specific antigen
Urinalysis
CT
MRI, X-ray of KUB
Urine culuture
BUN
Creatinine clearance test
Bladder ultrasonography

EARNING OBJECTIVE

3. Identify the
indications/
purposes ,
contraindication
s, side effects,
complications
and nursing
responsibilities
before, during
and after the
procedure.

Blurred visions
elevated BP
Anorexia
Nausea, vomiting
Chills
Itching
excessive Thirst
Unexplained anemia
changes in body weight
cognitive Changes
Edema
Pain
Change in the pattern of urination,
Urine output and urine composition

TOPIC

b.
-

Invasive
IVP
Retrograde Pyelography
Cystourethrogram
Renal Scans
Cystoscopy
Renal biopsy
Radioisotope scanning
Nuclear Scans
Intraveous urography
Renal angiography
Voiding cystourethrography

b. Analysis/ Nursing Diagnosis


1. Impaired urinary elimination as
evidenced by , urgency, frequency,
hesitancy, dysuria, nocturia

DATE
TIME

LECTURE
R

22
order to:
-

Prioritize nursing
diagnosis
Discuss the
pathophysiologi
cal responses to
altered urinary
elimination

Plan the care of


clients utilizing
evidence-based
nursing research
Achieve the best
clinical
outcomes
utilizing ethicomoral and legal
principles
Plan effective
care.

2. Urge urinary incontinence as


evidenced by frequency, urgency, loss
of urine before reaching toilet and
voiding in small and large amount
3. Urinary retention as evidenced by
dribbling urine with increased
intraabdominal pressure, urinary
urgency, urinary frequency
4. Acute Pain
5. Ineffective health maintenance
c. Planning
1. Planning for health promotion
- Promoting urinary elimination
- Preventing urinary infection
- Managing risk as renal calculi and
hypertension
2. Planning for health maintenance and
Restoration
-

LEARNING
OBJECTIVE

Given an actual patient


with urinary tract and
renal disorders, the
student will be able to:
1. Explain the
various
disorders
affecting the
urinary system
and explicate all
the precipitating
factors and risk
factors that
may lead to the

Catheters: Urethral, Nephrostomy,


Ureteral, Suprapubic
System intermittent and intermittent
self- catheterization, indwellingexdwelling drainage system
Urulogic Surgery:
a.
Nephrotomy
b.
Nephrectomy
c.
Pyelotomy
d.
Ureterotomy
e.
Cystotomy, cystectomy
f.
Lithotripsy
g.
Extracorporeal renal surgery
h.
Percutaneous nephrostomy
i.
Urinary diversion
j.
Renal transplant
k.
Dialysis types

TOPIC

V.C. COMMON HEALTH PROBLEMS


I.
-

Nursing Care of Clients with Urinary


Tract Disorders
Lower Urinary Tract Infections
Upper Urinary Tract Infections
Urinary Incontinence
Urinary Retention
Urinary calculi
Neurogenic Bladder
Cancer of the Bladder

II.
Nursing Care of Clients with Renal
Disorder
- Nephrosclerosis
- Primary Glomerular disease

DATE
TIME

LECTUR
ER

Oct 2
8-12

Mrs.
Alfonso

Oct 8
8-12

Mrs.
Magno

23
development of
these
diseases
/disorders.

Polycystic disease
Acute Renal Failure
Chronic Renal Failure
Kidney Trauma

Disorders affecting Pediatric Clients


Vesicoureteral reflux
Wilmstumor
Acute poststreptococcal
glomerulonephritis
Polycystic kidney
Systemic Lupus Erythomatosus

III.
2. Enumerate the
pathognomonic
manifestations
of each disease
and explain the
reason why they
develop.

3. Discuss the
psychopathophy
siologic process
of these
diseases
from causes to
manifestations
and its
complications

Implement
individualized
nursing care:

1. Safely and
knowledgeably
administers
prescribed
medications and
treatments/
alternative
complementary
medicine

d. Implementation
a.
-

Pharmacologic therapeutics
Diuretics
Medications for Gout
Antispasmodics
Cholinergics
Analgesics
Alpha-Blockers

2. Complementary and Alternative


Therapies
- Biofeedback for urinary incontinence
- HalamangGamot

3. Nutrition and diet therapy


a. Protein-mineral-and Fluid Modified
Diets
4. Patient education

LEARNING
OBJECTIVE

TOPIC

DATE
TIME

LECTUR
ER

Given an adult
( young, middle, old,
old-old adult) with
responses to altered
fluids, electrolytes and
acid-base balance, the
student will be able to:

VI. CARE OF CLIENTS WITH ALTERED


FLUIDS, ELECTROLYTES AND ACID-BASE
BALANCE

Oct 9
8-12

Mrs.
Alfonso

A. Apply knowledge
and normal anatomy

VI. a. Overview of Normal fluid and


electrolytes Balance
VI. b. Nursing Process
a. Assessment

24
and physiology and
assessment
techniques in caring
for clients
B. Assess the health
status of a client
1. Conduct a
health history
and functional
health status of
clients having or
at risk for
alterations in
fluids,
electrolytes and
acid-base
balance
2. Perform
systematic and
comprehensive
physical
assessment to
validate
assessed data.
3. Interprets
deviations from
normal findings
in the physical
assessment,
diagnostic and
laboratory
examination.
4. Identify the
indications/
purposes ,
contraindication
s, side effects,
complications
and nursing
responsibilities
before, during
and after the
procedure.

1. Nursing History
a. Subjective Data
1.
-

b. Objective Data
1. Physical Assessment
a. Skin : poor skin turgor, cold, clammy
skin, pitting edema, flushed, dry skin
b. Pulse: bounding, rapid, weak; thread,
irregular, rapid weak pulse, slow pulse
c. BP: hypo/hypertension
d. Respirations: deep, rapid breathing,
shallow, slow, irregular breathing,
shortness of breath, moist crackles,
restricted airways
e. Skeletal muscles: cramping of
exercised muscle; carpal spasm; flabby
muscles, chvosteks sign
d. Laboratory tests
B. ANALYSIS/ NURSING DIAGNOSIS
1. Deficient Fluid Volume related to
insufficient fluid intake, diarrhea,
haemorrhage or third-space fluid loss
such as ascites or burns
2. Excess Fluid Volume related to fluid
retention secondary to
3. Heart, renal, or liver failure or excess
consumption
4. Impaired Oral Mucous Membrane
5. Risk for injury
6. Risk for activity intolerance
7. Risk for decreased cardiac output
8. Risk for impaired skin integrity
9. Imbalance nutrition: Less than body
requirements related to insufficient
intake of foods rich in potassium

LEARNING OBJECTIVE

1. Utilize the
assessed data in
order to:
-

Prioritize nursing
diagnosis

ECF Volume Deficits


Loss of body weight
Changes in I & O
Changes in Vital signs
Other manifestations:
- Dryness of the mouth
And mucous membrane
- Tenting of the skin
- Changes in Urine output and
mentation
- muscle weakness
- change in consistency of the stool;
cerebral changes

TOPIC

C.
1.
2.

Planning
Planning for health promotion
Preventing fluid and electrolyte loss
Planning for client hydration
Reducing risk for injury
Planning for health maintenance and

DATE
TIME

LECTURE
R

25
-

Discuss the
pathophysiologi
cal responses to
altered fluid,
electrolytes and
acid-base
balance
Plan the care of
clients utilizing
evidence-based
nursing research
Achieve the best
clinical
outcomes
utilizing ethicomoral and legal
principles
Plan effective
care.

Given an actual patient


with alterations
influids, electrolytes
and acid-base
balance , the student
will be able to:
1. Explain the
various
disorders
affecting fluids,
electrolytes and
acid-base
balance and
explicating all
the precipitating
factors and risk
factors that
may lead to the
development of
these
diseases
/disorders.

2. Enumerate the
pathognomonic
manifestations
of each disease
and explain the
reason why they
develop.

3. Discuss the
psychopathophy
siologic process
of these
diseases
from causes to
manifestations
and its
complications
4. Implement
individualized
nursing care

Restoration
- Fluid and electrolyte management-oral
and intravenous fluid and electrolyte
replacement

Oct 15
8-12

Mrs.
Magno

Oct 16
8-12

Mrs. De
Asis

VI. C. COMMMON HEALTH PROBLEMS


AND CARE OF CLIENTS WITH FLUID AND
ELECTROLYTE IMBALANCE
1. Fluid Imbalance
- Fluid Volume Deficit
- Fluid Volume Excess
2. Electrolyte Imbalance
a. Sodium Imbalance
- Hypernatremia
- Hyponatremia
b. Potassium
- Hypokalemia
- Hyperkalemia
c. Calcium
- HYpocalcemia
- Hypercalcemia
d. Phosphate
- Hypophosphatemia
- Hyperphosphatemia
e. Magnesium
- Hypomagnesemia
- Hypermagnesemia
2. Acid-Base Imbalance
a. Respiratory Acid-base Imbalance
- Acidosis
- Alkalosis
b.
Metabolic Acid-base Imbalance
- Acidosis
- Alkalosis
d. Implementation
1. Pharmacologic therapeutics
a. IV Additives
- KCL
- CaCl
- MgSO4
- HCO3b. Plasma Expanders
- Colloids
- Dextran
- Hexastarch
2. Nutrition and diet therapy
a. Food sources
- Sodium, Potassium, Calcium
Phosphate,
- Magnesium
3. Patient education

26
LEARNING OBJECTIVE

TOPIC

Given an actual patient


undergoing surgery,
the students will be
able to:

VII. NURSING CARE OF CLIENTS


UNDERGOING SURGERY

1. Define the 3
phases of
perioperative
care
2. Describe a
comprehensive
preoperative
assessment to
identify surgical
risk factors
3. Identify health
factors that
affect patients
preoperatively
4. Identify legal
and ethical
considerations
related to
obtaining
informed
consent
5. Describe the
preoperative
nursing
measures that
decrease the
risk for infection
and other
postoperative
complications
6. Give examples
of pertinent
nursing
diagnoses for
surgical clients
7. Enumerate the
principles of
asepsis and
sterile
technique.
8. Identify the
different surgical
instruments and
equipment and
their respective
uses
9. Identify nursing
responsibilities
in planning
perioperative
nursing care.
10.Enumerate the
roles and
responsibilities
of a scrub and
circulating
nurse.
11.Describe
essential

I.

Introductory Information:
Perioperative Nursing

A. Fundamentals of Theory and Practice


a. Perioperative Education
b. Foundations of Perioperative
Care Standards
c. Legal and Ethical Issues
B. The Perioperative Patient Care Team
a. The Perioperative Patient Care
Team
b. The Surgical First Assistant
c. Administration of Perioperative
Patient Care Service
C. The Patient as a Unique Individual
a. The Patient: The Reason for your
existence
b. Perioperative Pediatrics
c. Perioperative Geriatrics
D. The Perioperative Environment
a. Physical Facilities
b. Ambulatory Surgery Centers
c. Care of The Perioperative
Environment
d. Potential Sources of Injury to
the Caregiver and the Patient

DATE
TIME

LECTURE
R

Oct 22

Mrs. De
Asis

8-12

Oct 23
8-12

Oct 29
8-10

E. Preoperative Patient Care


a. Preoperative Preparation of the
Patient
b. Diagnostic Procedures
F. Pharmacology and Anesthesia
a. Surgical Anesthesia
b. Anesthesia: Techniques and
Agents
G. Surgical Asepsis and Sterile Technique
a. Microbiologic Considerations
b. Principles of Asepsis and Sterile
Technique
c. Attire, Surgical Scrub, Gowning
and Gloving
d. Decontamination and
Disinfection
e. Sterilization
H. Surgical Instrumentation and
Equipment
a. Surgical Instrumentation
b. Specialized Surgical Equipment
I.

Intraoperative Patient Care


a. Coordinated Roles of the Scrub
Person and the Circulator
b. Positioning, Prepping and draping
the Patient
c. Physiologic Maintenance and
Monitoring of the Perioperative
Patient

Mrs.
Magno

Oct 23
10-12

Mrs.
Magno

Mrs.
Alfonso

Oct 30
8-12

Mrs.
Alfonso

Nov 5

Mrs.
Alfonso

8-12

27
preoperative
teaching,
including pain
control, moving,
leg exercises,
and coughing
and deepbreathing
exercises
LEARNING OBJECTIVE

12.Describe
essential
aspects of
preparing a
client for
surgery,
including skin
preparation.
13.Compare
various types of
anesthesia.
14.Describe the
immediate
preoperative
preparation of
the patient
15.Discuss various
types of surgery
according to
degree of
urgency, degree
of risk, and
purpose.
16.Develop a
preoperative
teaching plan
designed to
promote the
patients
recovery from
anesthesia and
surgery, thus
preventing
postoperative
complications
17.postoperative
client.
18.Identify
potential
postoperative
complications
and describe
nursing
interventions to
prevent them.
19.Identify
essential
nursing
assessments
and
interventions
during the
immediate

TOPIC

J.
-

Surgical Specialties
Endoscopic Surgery
General Surgery
Gynecologic and Obstetric Surgery
Urologic Surgery
Orthopedic Surgery
Neurosurgery
Opthalmic Surgery
Plastic and Reconstructive Surgery
Otorhinolaryngologic and Head and
Neck Surgery
Thoracic Surgery
Cardiac Surgery
Vascular Surgery
Organ Procurement and
Transplantation

K. Surgical Site Management


a. Hemostasis and Wound Closure
b. Wound Healing
- Wound dressing
- Fluids and nutrition
- Medications
- Post operative Discharge
instructions
- Rest and activity
- Eating
- Sleeping
- Wound healing
- Bowel and urinary
elimination
- Bathing, showering
- Clothing
- Driving
- Bending and lifting
- Medications
- Follow up care

DATE
TIME

Mrs. De
Asis

Nov 6,
12
8-12

Mrs.
Magno

Nov. 12
8-12

L. Perianesthesia and Postprocedural


Patient Care
a.
b.
-

Postoperative Patient Care


Potential Perioperative Complications
Shock
Hemorrhage
Pulmonary embolism
Deep vein thrombosis
Urinary retention
Intestinal obstruction
Hiccups
Wound infection
Dehiscence
Evisceration
Psychological disturbances

LECTURE
R

Nov

28
postanesthetic
phase.
20.Demonstrate
ongoing nursing
assessments
and
interventions for
the
21.Identify
essential
aspects of
managing
gastrointestinal
suction.
22.Describe
appropriate
wound care for a
postoperative
client.

19-20

FINAL EXAMINATION

SCHEDULE:

THURSDAYS:
FRIDAYS:

8:00 AM 12:00 NN
8:00 AM - 12: 00 NN

References:
1. Brunner and Suddarth. Textbook of Medical-Surgical Nursing 13th
edition. 2013
2. Joyce M. Black and Jane Hokanson Hawks. Medical-Surgical Nursing- 8 th
Ed. 2009
3. Lippincott Williams & Wilkins. The Lippincott Manual of Nursing
Practice 10th edition.
4. Nettina, Sandra: Lippincott Manual of Nursing Practice, 8 TH Ed. Williams
and Wilkins
5. Nancymarie Phillips. Berry & Kohn's Operating Room Technique, 12th
Edition. 2013
6. Pillitteri, A. Maternal & Child Health Nursing: Care of the Childbearing &
Childrearing Family, 6TH Ed. 2010
7. Barbara L. Bullock, Reet L. Henze. Focus on Pathophysiology. 2000
8. Sue E. Huether, RN, PhD and Kathryn L. McCance, RN, PhD.
Understanding Pathophysiology. 5th Edition. 2013
9. Donna D. Ignatavicius, MS, RN, ANEF and M. Linda Workman, PhD, RN,
FAAN. Medical-Surgical Nursing. 7th Ed. 2013
10.
Shirley M. Tighe, RN, BA. Instrumentation for the Operating Room,
8th Edition. 2012

Level III Clinical Instructors:


Alfonso, Louradel U., MAN, RN
MAN, RN

Magno, Jesusa M.,

De Asis, Rebecca, MAN, RN


PREPARED BY:
LOURADEL U. ALFONSO, MAN, RN
GASCO, RN, DMHRM
ACADEMIC COORDINATOR
NURSING

APPROVED BY:
DR. SOCORRO S.
DEAN, COLLEGE OF