Central Philippine Adventist College

Alegria, Murcia, Negros Oriental

COURSE SYLLABUS

Course Name: COMPETENCY APPRAISAL II School Year: 2011-212 Second Semester

Course Code: CA II
Course Credit: 3 units Contact Hours/Semester: 90 lecture hours
Pre-requisite : Competency Appraisal I, NCM 106, Research 2
Home /Office Address: CPAC School of Nursing Clinical Division Telephone No: (034) 433 2407
Bacolod Adventist Medical Center Compound
C.V. Ramos Ave., Taculing, Bacolod City

Course Description
This course deals with the application of the concepts, principles and processes basic to the practice of nursing with
emphasis on health promotion, health maintenance, preventive, risk reduction, curative and rehabilitative aspects of care of sick
individual with alterations in cellular aberrations, adjustment problems and maladaptive patterns of behavior, acute biologic crisis,
disaster and emergency. It includes the utilization of the nursing process and core competencies under the eleven (11) key areas of
responsibility.

Course General Objectives/Aim:

At the end of
Time Subject Content Objectives Student/Teacher Teaching Values Evaluation Reference
Frame Activities/Methodologies Aids/Materials
METABOLIC SYSTEM
Introduction: Although it seems at times that people 1. Identify the basic 1. Critical Thinking 1. Computer 1. Emphasize 1. Pre-test and
can be divided into 2 groups- those who live to eat and anatomy and Discussion the value of post tests.
those who eat to live. physiology of 2. LCD planning and
Metabolism is a broad term referring to metabolic system. 2. Home Study Projector preparation as 2. Oral
chemical reactions that are necessary to maintain life. the semester participation.
It involves catabolism, in which substances are broken 2. Differentiate the 3. Library Works 3. starts.
down to simpler substances and anabolism, in which a different glands and Transparencies 3. Unit exams
larger molecular or structure are built from smaller hormones. $. Group Presentation
ones. 4. Overhead
6. Intensive lecture Projector 2.
Facts on Metabolic System Temperance-
1. Depends on the availability of fuel, oxygen and 5. Manila especially in
balance of anabolic and catabolic HOMEOSTASIS. Paper and diet to prevent
2. Exocrine secretion assists in digestion, absorption Scotch tape metabolic
of diet. complications.
3. Endocrine-metabolism particularly in regulation of 6. White Board
hormones. Pen
3.
Facts on Endocrine system Gratefulness-
1. Compared to other organs of the body small and to god for
unimpressive. giving us the
2.endocrine glands stimulates the release of hormones mind to think
(chemical substance release in blood supply) and power to
3. HORMONES- chemical substances secreted by communicate
cells into the metabolic activity of other cells in the to others by
body. speaking.

Hormones are classified as:

1.Steroids- diffuse easily through the plasma 4. Kindness-
membranes of their target cells in action and
2.Peptides speech
3. Amino acid derivatives » non-steroidal hormones-
bind first to a receptor situated on target cell’s plasma
membrane to enter target cell.

Facts about hormones:

1. Greek word which means “to arouse”
2. Affects the target cells or target organs.
3. To make the target organ respond, hormones need
specific protein receptor in the plasma membrane or
interior of the target organ.

Negative feedback mechanism- inhibition or

production basing on body’s needs, maintain the
homeostasis.
Example; t3 and t4 > pt gland> tsh> t.g. >
t3 and t4
3 major categories:
 Hormonal (hypothalamus-secrete hormones
that-stimulate other endocrine gland to secrete
hormones)
 Humoral (changing blood levels of certain
ions) Humor indicates various body fluids
like blood, bile and others. ↓Ca in blood-PTh
gland secrete Pth hormone which acts to inc
Ca in blood through bone resorption.
 Neural (nerve fiber stimulate release of
hormone)-example is in the SNS stimulation
of adrenal medulla to release the
catecholamines epinephrine and
norepinephrine.

ANATOMY AND PHYSIOLOGY of Endocrine

System
Facts on Pituitary Gland:
1. Small extension on dorsal surface of hypothalamus
connected by hypophyseal stalk.
2. Situated at the base of skull cradled by the sella
turcica of sphenoid bone.
3. Pea-sized
4. Master gland, another name is Hypophysis ( ant-
adenohypophysis, post- neurohypophysis)
5. Adenohypophysis- GTPALFM
Neurohypophysis- oxytocin, ADH
 Growth Hormone
 Thyroid Stimulating Hormone-stimulates
release of T3 and T4.
 ACTH- stimulates the adrenal cortex- GMA
GMA
 MSH- melanin > skin pigmentation> bronze
color albinism
 ADH- against urination (water retention)
Facts on Thyroid gland
1. below the neck
2. highly vascular, 2 lobes joined by a central mass or
isthmus
3. makes up to hormones: the thyroid hormone and
calcitonin
4. thyroid hormone often referred as body’s major
metabolic hormone composed of 2 iodine containing
hormones:
5. T3- triiodothyronine- potent
6. T4 thyroxine/ tetraodothyroxine- abundant
7. Controls the rate at which glucose is burned or
oxidized and converted to body heat and chemical
energy.
 O2 consumption, O2 rate
 Body heat production
 CHO, CHON, fat metabolism
 Metabolic rate of all cells
Calcitonin- decrease blood calcium level by causing
calcium to be deposited in the bones.(absorption).
-acts as antagonist to parathyroid gland.
-Hypocalcemic agent

Facts on Parathyroid Gland

1. opposite the calcitonin
2. found at the posterior portion of the thyroid gland
3. increase blood calcium level by stimulating bone
destruction cells (osteoclasts) to break bone matrix
and release calcium in the blood.
4. Hypercalcemic

Facts on Pancreas (Endocrine)

1. located close to the stomach in the abdominal
cavity
2. a mixed gland-both exocrine and endocrine
function
hormones of the Islet cells:
 alpha- glucagons- blood glucose
(hyperglycemic)
convert glycogen in liver into glucose (
glycogenolysis)
  beta- insulin- blood glucose (hypoglycemic)
transports glucose to cells
increase ability of cells to transport glucose
across plasma membrane
glucose stored in liver (glucogenesis)
CHON and fat anabolism (build up)
Only hormone that decrease blood sugar

 Somatostatin- hypoglycemic effect

Inhibit glucagons release

Facts on Adrenal Glands

1. on top of kidney, suprarenal glands
2. Medulla- catecholamines
When stimulated by SNS, release 2 similar hormones
which prolongs effects of neurotransmitter.
a.norepinephrine- vasoconstrictor (bp)
b.epinephrine- adrenaline (energy)

3. Cortex
Glucocorticoid/cortisol- sugar-
1. glycogenolysis (GH, epinephrine, cortisol)
2. gluconeogenesis
3. anti-inflammatory/suppress immune system
4. electrolyte balance- Na- retain, K- excreted
Mineralocorticoid/ Aldosterone- salt/sodium
Androgen- sex hormones

Pituitary Disorders and Adrenal Disorders

1. Growth Hormone: Gigantism and Acromegaly
3 functions:
1. Stimulates growth in almost all body tissues,
causing both an increase in cell size (hypertrophy) and
an increase in cell number (hyperplasia).
2. Diverts amino acids into protein synthesis
(anabolism) and decreases protein breakdown
(catabolism).
3. Enhance the use of free fatty acids as
metabolic substrates, which depletes body fat stores.
4. Increases plasma glucose levels but protects
amino acid pools.
A. Etiology and Risk Factors
- hyperpituitarism: over production of growth
hormone
B. Pathophysiology:

 Gigantism- occurs in children

-increase in size
- extremely tall: 8-9 feet
- 24-25 bone growth stops
 Acromegaly-adult
-normal adult height but widen
- coarse body features
C. Medical Mgt:
Hypophysectomy- surgical removal of pituitary
gland
Bromocriptin mesylate (Parlodel)
D. Clinical Manifestation and Nursing Intervention
Manifestation
1. Facial
- thick skull
- protrusion of supraorbital ridges
- protrusion of jaw (prognatrism)
2. hands and Feet
- Broadening of Hands-(↑ring size)
- enlarged feet-(↑ shoe size)
3. Liver
- Glycogenolysis-↑ breakdown of glycogen
4. Organomegaly
5. visual disturbances

 Dwarfism- stunted growth, 3 ft tall ht,

Body proportion fairly normal but height reaches
only to a maximum of 4 ft

Medical Mgt
Synthetic hormone- SOMATREM-syn growth
hormone- child (open), when: bedtime (mimic Normal
growth hormone release)

2. Anti-Diuretic Hormone
Syndrome of Inappropriate Anti-Diuretic
Hormone- SIADH
A. Etiology and Risk Factors
 Surgery, tumor

B. Pathophysiology

C. Medical Management
FUROSEMIDE (LASIX)- diuretics
D. Clinical Manifestation and Nursing Intervention
Manifestation Nursing Intervention
1. Urine output- MIO
decrease Weigh
2. Weight gain VS, monitor serum
3. BV elevated electrolytes
4. Inc BP
5. confusion- water Safety
intoxication Reorientation
6. Dilutional
Hyponatremia Fluid restriction
7. less than 135
8. serum hypoosmolality
9. hemodilution
10. Concentrated urine
11. more than 1.030
spec grav
12. urine
hyperosmolality

Diabetes Insipidus Dec ADH , Water Excretion

A. Etiology and Risk Factor
Car accident , Head Trauma
B. Pathophysiology
C. Medical Management
Synthetic ADH – VASOPRESSIN
Nrsg Responsibility: warm to body temp
before giving
LYPRESSIN- needed to control
polyuria and polydipsia
Nrsg responsibility: nasal spray

D. Clinical manifestation with nursing Intervention

Manifestation Nursing Intervention
 1. Polyuria
2. polydipsia MIO, IV fluids as
3. Wt loss ordered
4. Dec Blood Volume Weigh
5. Dehydration
6. Hypovolemic Shock Vital signs
7. hypernatremia
8. more than 145 Inc fluid intake
9. serum hyperosmolality
10. hemoconcentration
11. diluted urine
12. less than 1.010 spec
grav
13. urine hypoosmolality

3. Adrenocorticotropic Hormone- ACTH

- Pit. Gland- ACTH- Adrenal cortex
Cushing’s Sydrome- First described by Harvey
Cushing 1932.
Overactivity of the adrenal gland with
consequent hypersecretion of glucocorticoid.
A. Etiology and Risk Factors:
1. Primary Cushings- tumor in the adrenal cortex
2. Secondary Cushings- pituitary dependent- there’s
a tumor inside
3. Iatrogenic- treat disease but leads to opposite
disease
B. Pathophysiology
C. Medical Mgt
1. Primary Cushings- tumor in adrenal cortex
surface- tumor resection
deep inside- adrenalectomy (life time
synthetic
corticosteroids)
2. Secondary Cushings- (inside) Hypophysectomy
3. Radiation Therapy-(outside)
4. Medications:
(Elipten) aminogluthetamide- inhibit GMA
production
Metyrapone- Decrease cortisol
Diuretics-K sparing
D. Clinical Manifestation with Nursing Interventions
Manifestation Nursing
 Intervention
Glucocorticoid
1. hyperglycemia Administer Insulin
2. CHON, tissue, muscle as ordered
wasting
3. thin/slender Goal: Maintain
extremities muscle tone
4. Risk for infection- Provide Rom
immunosuppression exercises
Mineralocorticoid Assist with
5. Hypernatremia ambulation
6. Water retention Prevent Client from
7. ↑ BV- hypertension exposure to
8. Hypokalemia infection
Androgen Goal: health
9. Hirsutism teaching
10. Virilization Diet modification
(virilism)-masculinity in *avoid
female(male voice) processed food,
11. MOON FACE Sodium restriction,
12. BUFFALO HUMP restrict water
13. Goal: Stable vital
TRUNKAL/CENRAL signs
OBESITY
14. STRIAE’S
psychological Goal:
15. depression Psychological
16. anxiety support and
17. insomnia acceptance

Addison’s Syndrome
Thomas Edison first describe in 1849
A. Etiology and Risk Factors
- Congenital-since birth: Hypoplasia-decrease number
ofGMA or atrophy- decrease in cell size
-Idiopathic
- Autoimmune- because of lymphocytic infiltration
-Iatrogenic- the result of treatment or surgery
(bilateral adrenalectomy)
B. Pathophysiology

C. Medical Mgt
Glucocorticoid/cortisol
1. Snythetic corticosteroids- Predenisone,
Hydrocortison, dexamethasone
Mineralocorticoid/ aldosterone- (Florinef)
Fludrocortisone
D. Clinical Manifestation with Nursing Intervention
Manifestation Nrsg Intervention
Glucocorticoid-
cotisol/sugar Rest, avoid stress
1. Hypoglycemia
2. weakness
3. fatigue
Mineralocorticoid- Hydration
aldosterone
4. hyponatremia
5. H2o excretion
6. dec BP
7. Dehydration
8. Shock
9. hyperkalemia
10 hyperpigmentation
11. melanosis