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all of their interaction with the health

Estimated Leading New Cancer Cases in
system.
2010, Both Sexes, Philippines
(GLOBOCAN 2008).  The Department of Health said that
Cancer Sites Number Percentage the new health agenda framework
1. Breast 12262 cases 15 % will be attainable through the
2. Lung 11458 cases 14 % ACHIEVE strategy:
3. Liver 7331cases 9 %
4. Colon/Rectum 5787cases 7 % ✔ ✔ A Advance health promotion, primary care and quality
✔ ✔
C Cover all Filipinos against financial health risk
5. Cervix Uteri 4812cases 6 %
6. Leukemia 3153 cases 4 % H Harness the power of strategic HRH
7. Stomach 3129cases 4 %
8. Prostate 2712cases 3 % I Invest in eHealth and data for decision-making
9. Brain/ Nervous System 2236 cases 3 % E Enforce standards, accountability and transparency
10. Ovary 2165 cases 3 %
V Value clients and patients
E Elicit multi-stakeholder support for health
Lung cancer was the most common cancer
in men  RH Law, otherwise known as
Republic Act 10354 or the
In Females, breast cancer was the most Responsible Parenthood and
common cancer Reproductive Health Act
Lung cancer is the most common
cancer type in the world. 1,6 million
cases per year.  Here are the 10-point Socioeconomic
It’s the most common cancer death Agenda of the Duterte
reason in the world. Approximately Administration:
1,4 million cases per year.
****Smoking (including passive 1. Continue and maintain current
smoking) is the most important macroeconomic policies, including
factor. fiscal, monetary, and trade policies.
2. Institute progressive tax reform and
 The Philippine Health Agenda
more effective tax collection,
Framework 2016-2022
indexing taxes to inflation. A tax
reform package will be submitted to
1. Financial Protection: Filipinos, Congress by September 2016.
especially the poor are protected
from high cost of health care. 3. Increase competitiveness and the
ease of doing business. This effort
2. Better Health Outcomes: Filipinos will draw upon successful models
attain the best possible health used to attract business to local
outcome with no disparity. cities (e.g., Davao) and pursue the
3. Responsiveness: Filipinos feel relaxation of the Constitutional
respected, valued and empowered in restrictions on foreign ownership,
Road to Success by: JONAS MARVIN ANAQUE

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except as regards land ownership, in Vision: To Declare Philippines Rabies-
order to attract foreign direct Free by year 2020
investment.
Goal: To eliminate human rabies by the
4. Accelerate annual infrastructure year 2020
spending to account for 5% of GDP,
with Public-Private Partnerships Program Strategies:
playing a key role.
5. Promote rural and value chain To attain its goal, the program employs the
development toward increasing following strategies:
agricultural and rural enterprise
productivity and rural tourism. 1. Provision of Post Exposure
Prophylaxis (PEP) to all Animal Bite
6. Ensure security of land tenure to Treatment Centers (ABTCs)
encourage investments, and address
bottlenecks in land management and 2. Provision of Pre-Exposure
titling agencies. Prophylaxis (PrEP) to high risk individuals
and school children in high incidence zones
7. Invest in human capital
development, including health and 4. Health Education
education systems, and match skills
and training to meet the demand of Rabies prevention
businesses and the private sector.
 RA 9482 or “The Rabies Act of
8. Promote science, technology, and the
2007”, rabies control ordinances
creative arts to enhance innovation
shall be strictly implemented.
and creative capacity towards self-
 March as the Rabies Awareness
sustaining, inclusive development.
Month
9. Improve social protection programs,
 September 28 as the World Rabies
including the government’s
Day.
Conditional Cash Transfer program,
to protect the poor against instability  Stop walking or moving.
and economic shocks.
 Stay still and be calm.
10. Strengthen implementation of the
Responsible Parenthood and  Do not panic or make loud noises.
Reproductive Health Law to
enable especially poor couples to  Avoid direct eye contact with the
make informed choices on dog.
financial and family planning.  Say "No" or "Go Home" in a firm,
deep voice.
RABIES PREVENTION AND
CONTROL PROGRAM  Stand with the side of your body
facing the dog.
 Avoid facing a dog directly since it
can appear aggressive to the dog.

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 keep your body turned partially or Category I – touching or feeding
completely to the side. animals, licks on intact skin None
 Slowly raise your hands to your Category II – nibbling of uncovered
neck, with your elbows in. skin, minor scratches or abrasions Immediate vaccinat
without bleeding local treatment of th
 Wait for the dog to pass or slowly
back away. Category III – single or multiple
transdermal bites or scratches, licks on Immediate vaccinat
 Do not run from a dog.
broken skin; contamination of mucous administration of ra
 Remain motionless (e.g., "be still membrane with saliva from licks, immunoglobulin; lo
like a tree") when approached by an contacts with bats. treatment of the wo
unfamiliar dog or attempt to sit.  Head is the most fatal site for dog
bite
 Avoid retrieving objects from the
 Legs are the most common site for
dog's mouth
dog bite
 Do not disturb the dog while the  Rabies vaccine is an artificial active
animal is eating.  given on days 0, 3, 7, 14, 30, and 90,
 avoid gluteal area
 Curl into a ball with your head  Rabies vaccine should be
tucked and your hands over your ears administered in the deltoid muscle
and neck if a dog knocks you over.  In both pre-exposure and post-
 Immediately let an adult know about exposure immunization, the full 1.0
stray dogs or dogs that are behaving mL dose should be given 9
strangely. intramuscularly
 Sanofi Pasteur created both
antirabies and antidengue vaccine
What Breeds Have the Strongest Bite?
 antirabies horse serum
- Kangal dogs  HRIG is from human serum
Post-exposure prophylaxis (PEP)

 extensive washing and local
treatment of the wound as soon as
possible after exposure;
 a course of potent and effective
rabies vaccine that meets WHO
standards; and
 the administration of rabies
immunoglobulin (RIG), if indicated.
Categories of contact with suspect Post-exposure prophylaxis

rabid animal measures

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Examples of active vaccines are PCEC * A 5th dose on day 28 may be
(Purified Chick Embryo Vaccine), recommended for immunocompromised
RABIPUR and the new cheap drug
VEROWELL persons.
 - It will give 2 years immunity against
rabies if the dose is completed
Postexposure Prophylaxis for Previously
Postexposure Prophylaxis for Non- Immunized Individuals
immunized Individuals
Treatment Regimen
Treatment Regimen
Wound All postexposure prophylaxis
cleansing should begin with immediate
Wound All postexposure prophylaxis
thorough cleansing of all wounds
cleansing should begin with immediate
with soap and water. If available,
thorough cleansing of all
a virucidal agent such as
wounds with soap and water. If
povidine-iodine solution should
available, a virucidal agent such
be used to irrigate the wounds.
as povidine-iodine solution
should be used to irrigate the
wounds. RIG RIG should not be administered.
RIG If possible, the full dose should Vaccine HDCV or PCECV 1.0 mL, IM
be infiltrated around any (deltoid area), one each on days
wound(s) and any remaining 0 and 3.
volume should be administered
IM at an anatomical site distant Ebola: Mapping the outbreak
from vaccine administration. From the section of WEST Africa
Also, RIG should not be Ebola crisis
administered in the same syringe The hunters breaking an Ebola ban
as vaccine. Because RIG might on bushmeat- FRUIT BATS
partially suppress active
production of antibody, no more Primary source = fruit bats or flying
than the recommended dose foxes , old world bats
should be given.
Other sources:
Vaccine HDCV or PCECV 1.0 mL, IM 1. Chimpanzees

(deltoid area ), one each on days 2. Gorillas
0 , 3, 7, and 14. 3. fruit bats
4. monkeys
5. antelope
6. porcupines

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7. symptomatic humans Herbal USES
Ebola outbreak in West Africa was first Medicine
reported in March 2014, Lagundi Skin diseases
( Vitex Headache,
discovery in 1976. Negundo) Asthma,fever,cough&colds
The total number of reported cases is more SHARED Rheumatism
than 28,607. Eczema
Dysentery
Virus is named after the ebola river Ulasimang Lowers uric acid
Bato
RESTV species, found in Philippines and (Peperonia
the People's Republic of China, have been Pellucida)
found to infect humans but they do not cause Bawang Hypertension and Toothache
illness or death ( Allium
Sativum) HAT
Diagnosis
Bayabas Anti septic, Anti-diarrheal
***antibody-capture enzyme-linked ( Psidium
immunosorbent assay (ELISA) Guajava)
Yerba Buena Rheumatism and other body
(Mentha aches, analgesics
Principles of Primary Health Care Cordifolia)
1. 5 A's = Accessibility, Availability, Sambong
Affordability & Acceptability, (Blumea Diuretic- kidney stones
Appropriateness of health services. Balsamifera)
Akapulko Fungal infection, skin
2. Community Participation diseases
 heart and soul of PHC
Niog Niogan Anti-helminthic every 6
Four Cornerstones/Pillars in Primary (Quisqualis months 2 hours p supper
Health Care Indica) No to lee than 4 y/o
1. Intra and Inter-sectoral Linkages Tsaang Gubat Diarrhea
2. Use of Appropriate Technology (Carmona
3. Support mechanism made available Retusa)
4. Active Community Participation Ampalaya DM Type 2- obesity
(Momordica
Charantia)
community is the patient in CHN,
the family is the unit of care or
COPAR COPAR
service
 A social development approach that aims
to transform the apathetic, individualistic
Herbal Medicine (LUBBY SANTA) and voiceless poor into dynamic,

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participatory and politically responsive 10 weeks DPT+HIB-2 Hep B2 OPV2 RTV2
community. PCV2
Social Mobilization  9 months Measles ***

 12 months MMR
 Process of generating and sustaining the  18 months DP
active and coordinated participation of
****Rotavirus Vaccine is available as
all sectors at various levels to facilitate
 2 dose or 3 dose schedule
and accelerate improvement
 5 years renewable Cotract of
copar
ORAL HEALTH
Entry Phase  Advise mother to bring the child to a
• Self Awareness and Leadership dentist
Training (SALT)  every 6 months for dental check-up
Community Organization and Capability
Building Phase FOR PROPHYLAXIS IN HIV
• Development of management CONFIRMED OR EXPOSED CHILD:
systems:  ANTIBIOTIC FOR
(Delineation of the roles, functions and PROPHYLAXIS: Oral
task of officers) Cotrimoxazole
• A-R-A-S
(Action- Reflection- Action- OPV (Oral Polio Vaccine)
Session) “Sabin vaccine”
Community Action Phase  polio vaccine that is taken by mouth
and contains the three serotypes of
• PIME of health services poliovirus in a weakened live state—
(Project Implementation Monitoring and called also Sabin oral vaccine
Evaluation) Measles- Subcutaneous
Cold Chain under EPI
Measles 9m0s.- At least 85% of
11m0s. measles can be o 6months- Regional Level
prevented by o Not more than 5days-
immunization at this Health centers using
age. transport boxes.
 Most sensitive to heat: Freezer (-15
IMMUNIZATION SCHEDULE to -25 degrees C)
 Give every child a dose of Vitamin A o OPV
o Measles
every six months from the age of 6
months. Schedule for Receiving Vitamin A
 Give every child mebendazole every Supplement
6 months from the age of one year.
 Post Partum Mother
6 weeks DPT+HIB-1** Hep B1 OPV1  200,000 IU
RTV1**** PCV1***** Within one month
 After delivery of each child only

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Republic of Korea is the largest outbreak
Home Based Mother’s Record (HBMR) outside of the Middle East
 Tool used when rendering prenatal
care containing risk factors and Source of the virus
danger signs originated in bats and was transmitted to
camels sometime in the distant past.
• camels - major reservoir host for
MERS-CoV and an animal source of
MERS infection in humans
Fundamental or building block of FHSIS? • No vaccine or specific treatment is
= Individual treatment record or Family currently available.
treatment record • avoid contact with camels, drinking
raw camel milk or camel urine, or
Composition of FHSIS eating meat that has not been
1. Family Tx Record properly cooked.
2. Target Cx List • Cover your nose and mouth with a
3. Reporting/Tally Forms tissue when you cough or sneeze,
4. Output Reports... then throw the tissue in the trash.
• Avoid touching your eyes, nose and
mouth with unwashed hands.
Rubeola (measles) • Avoid personal contact, such as
Communicable just before the rash kissing, or sharing cups or eating
appears to 4-5 days after rash utensils, with sick people.
appears=highly contagious Diphtheria
• Diphtheria is an acute infection
• The first sign of measles is usually a caused by
high fever (often >104o F [40o C]) • bacteria Corynebacterium
that typically lasts 4-7 days. diphtheriae.
• Koplik spots—bluish-gray specks or • The throat infection causes a gray to
“grains of sand” on a red base— black, tough, fiber-like covering,
develop on the buccal mucosa which can block your airways
opposite the second molars • Shick test for susceptibility to
• First 24 hours diphtheria: A + shicks means no
– Fever, malaise, cough, immunity or suceptible; (antigen
coryza, conjunctivitis
test)
• In 48 hours
– “Koplik spots” (small, • Moloney test – for sensitivity of
irregular, red spots with
diptheria
minute bluish-white center)
first seen on buccal mucosa Tetanus
Middle East respiratory syndrome • caused by the bacterium Clostridium
coronavirus (MERS-CoV) tetani, the spores of which are
• a viral respiratory disease caused by widespread in the environment
a novel coronavirus (MERS‐CoV) • present with trismus (“lockjaw”),
that was first identified in Saudi which is the inability to open the
Arabia in 2012.

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mouth secondary to masseter muscle has declared the highest number of
spasm. Zika cases ever recorded with
• Nuchal rigidity and dysphagia are between 440,000 and 1,300,000
also early complaints that cause risus suspected cases reported.
sardonicus, the scornful smile of
tetanus, resulting from facial muscle • The virus has been present in
involvement Colombia, El Salvador, Guatemala,
• generalized muscle rigidity with Mexico, Panama, Paraguay,
intermittent reflex spasms in Suriname, Venezuela and Honduras
response to stimuli (eg, noise, touch). since October 2015.
• Tonic contractions cause
• Treatment no vaccine &no specific
opisthotonos (ie, flexion and
medication for treating the disease.
adduction of the arms, clenching of
the fists, and extension of the lower
Treatment involves taking pain killers to
extremities).
relieve the painful symptoms. However,
ZIKA-
aspirin should be avoided until infection by
• The Zika virus was detected for the
the dengue virus has been ruled out because,
first time in a rhesus monkey
in this case, the anticoagulant effect of the
• Virus was named after a forest
drug could cause bleeding.
in Uganda in 1947. A year later, it
was isolated in an Aedes mosquito
Diagnosis
from the same region.
• The first human cases appeared in As soon as symptoms appear, blood and
the 1970s in Africa (Uganda, urine samples are taken to confirm the
Tanzania, Egypt, Central African diagnosis using an RT-PCR (Reverse
Republic, Sierra Leone, Gabon and Transcriptase-Polymerase Chain
Senegal) and then in some countries Reaction) method to detect the presence of
in Asia (India, Malaysia, the the virus's genes.
Philippines, Thailand, Vietnam and
Indonesia). Prevention
The only way of protecting against the Zika
• In 2007, an actual epidemic broke disease is to protect yourself from mosquito
out in Micronesia (Yap Islands in bites both day and night, especially in the
the Pacific Ocean), causing 5,000 early morning and early evening when
infections. mosquitoes are most active, using physical
and chemical methods
• In 2013 and 2014, 55,000 cases of
Zika were reported in French Transforming our world: the 2030 Agenda
Polynesia. The epidemic then spread for Sustainable Development.
to other islands in the Pacific,
namely New Caledonia, the Cook 17 goals
Islands and Easter Island. Goal 1: No Poverty
• The Zika virus was detected for the Goal 2: Zero Hunger
first time in the northwest of Brazil Goal 3: Good Health and Well-being
in May 2015 and it quickly spread to (health related)
other regions of the country. Brazil Goal 4: Quality Education
Goal 5: Gender Equality

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Goal 6: Clean Water and acute hemorrhagic lymphadenitis of
Sanitation(health related) the mediastinal lymph nodes, often
Goal 7: Affordable and Clean Energy accompanied by hemorrhagic pleural
Goal 8: Decent Work and Economic Growth effusions, severe septicemia,
Goal 9: Industry, Innovation and meningitis, and a high mortality rate.
Infrastructure  B anthracis was used successfully as
Goal 10: Reduced Inequalities a weapon of terrorism in 2001, (via
Goal 11: Sustainable Cities and mail),
Communities
Goal 12: Responsible Consumption and
Production
Goal 13: Climate Action  Lethal toxin and edema toxin are
Goal 14: Life Below Water produced by B anthracis and
Goal 15: Life on Land respectively cause local necrosis
Goal 16: Peace, Justice and Strong and extensive edema, which are
Institutions frequent characteristics of the
Goal 17: Partnerships for the Goals disease.
 Specific diagnostic tests include
Anthrax
bacterial culture, PCR tests, and
 (Splenic fever, Siberian ulcer,
fluorescent antibody stains to
Charbon, Milzbrand)
demonstrate the agent in blood films
 Bacillus anthracis. or tissues
 most common in wild and domestic  Treatment, Control, and
herbivores (eg, cattle, sheep, goats, Prevention:
camels, antelopes)  Oxytetracycline given daily in
 B anthracis spores can remain viable divided doses also is effective. Other
in soil for many years. antibacterials,including amoxicillin,
 Raw or poorly cooked contaminated chloramphenicol, ciprofloxacin, dox
meat is a source of infection for zoo ycycline, erythromycin, gentamicin,
carnivores and omnivores; anthrax streptomycin, and sulfonamides
resulting from contaminated meat  Cognitive behavioral therapy (CBT)
consumption has been reported in is an effective treatment
pigs, dogs, cats, mink, wild for depression
carnivores, and people.
 approach of CBT is structured learning
experiences that teach patients to
monitor and write down their negative
 GI anthrax (including pharyngeal
thoughts and mental images.
anthrax) may be seen among human
populations after consumption of  CBT lasts 14 to 16 weeks.
contaminated raw or undercooked
meat.  Cognitive therapy is based on
 people may develop a highly fatal the cognitive model, which states
form of disease known as
that thoughts, feelings and behavior
inhalational anthrax or woolsorter’s
disease. Inhalational anthrax is an Cognitive behavioral for

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 Addiction  Drainage of more than 3L of fluid
 Anxiety disorders daily from a NGT may suggest
intestinal obstruction.
 Bipolar disorder
 Low self-esteem  Ecstasy is also known as
(MDMA /Molly)- methylenedioxy-
 Phobia methamphetamine (MDMA)
 popular in the nightclub scene and at
 Schizophrenia all-night dance parties ("raves"), but
 Substance abuse the drug now affects a broader range
of people who more commonly call
 Suicidal ideation the drug Ecstasy or Molly.
 MDMA's effects last about 3 to 6

hours
 Behavior therapy is
effective treatment for attention-
deficit/hyperactivity
disorder (ADHD) that can improve  sildenafil (Viagra®)
a child's behavior, self-control, and
self-esteem. ...  MDMA acts by increasing the
activity of three brain chemicals:
dopamine, norepinephrine, and
 Metrorrhagia (bleeding between serotonin.
menstrual periods) - first sign of  Effects include euphoria, increased
cervical cancer.
energy, distorted perception,
 Reducible hernia protruding mass involuntary teeth clenching,
spontaneously retracts into the dangerously high body temperature,
abdomen.
and depression.
 Atropine increases heart rate.  After a corneal transplant avoid lying
on the affected site , soapsuds and
 A mechanical ventilator indicated to sex
a patient can't maintain a safe PaO2
or PaCO2 level.  Persistent bleeding after open heart
surgery may require the
 goal of treatment for a patient with administration of protamine sulfate
angina pectoris is to reduce the to reverse the effects of heparin
heart's workload, thereby reducing sodium used during surgery.
the myocardial demand for O2 &
preventing MI.  The risk of cancer is nearly doubled
in frequent users of
ACETAMINOPHEN.

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 A triage nurse gathers information  Prime all lines very slowly. When a
upon a patent's arrival to a hospital line is primed quickly, minute
emergency room, including name, amounts of air are left in the line.
 When priming all lines, invert each
age, symptoms and the current
port and hit with a pen to dispel the
medical condition of the patient. air bubble. If this is not done there
will be air in the line.
 Dopamine—causes a surge in
euphoria and increased If you see a small bubble of air get them
out of the line by flicking the tubing with
energy/activity your finger.
 Norepinephrine—increases heart rate
 stretch the line and strum very
and blood pressure, which are
rapidly or stretch the line around a
particularly risky for people with pen and wrap the line forcing the air
heart and blood vessel problems upward. Air always rises therefore
while strumming or wrapping make
 Serotonin—affects mood, appetite, sure that you are forcing the air
sleep, and other functions. It also where you want it to go.
 You can also use a sterile syringe to
triggers hormones that affect sexual
aspirate air through a port.
arousal and trust. The release of large
 Tubing is usually changed every 96
amounts of serotonin likely causes hours and the drop factor for tubing
the emotional closeness, elevated can change by the manufacturer. The
mood, and empathy felt by those drop factor is always listed on the
box.
who use MDMA.
 deer ticks = LYME'S DISEASE.  DROPLET PRECAUTIONS for

 REVERSE TRIAGE is system of Meningitis, and pertussis
categorization of patients in a mass  Contact precaution for MERS and
casualty situation based on decisions EBOLA
as to which can most safely be
DISCHARGED rather than on  PROGNATHISM - INITIAL
priority for treatment. MANIFESTATION of
ACROMEGALY.
 About 50% of people who
experience a systemic allergic  Triad of ADHD: Inattention,
reaction will have a recurrent Hyperactivity, Impulsivity
reaction when re-stung.
 Latanoprost eye solution control the
Priming IV Tubing progression of glaucoma or IOP
 Burns: Emergent Phase

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 *Fluid shifts: IV to IS Anaphylaxis may cause respiratory
(bronchoconstriction) and shock
 *Electrolyte imbalances: (vasodilation). It's considered a crisis.
Hyponatremia & Hyperkalemia
 Mastoidectomy is required in 50% of
 *Acid-Base imbalance: Metabolic cases of MASTOIDITIS.
acidosis
 Pure-tone audiometry is a behavioral
Administering Oral Inhalation Therapy test used to measure hearing
 Shake the inhaler immediately before sensitivity.
using it. Remove the cap from the
mouthpiece.  The most common cause of corneal
ulceration is prolonged or improper
 Ask client to clear their throat. use of contact lenses.
 Ask the client to breath out slowly
until no more air can be expelled  A person with Antisocial Personality
from the lungs then hold their breath. Disorder lacks superego and needs
 Place the mouthpiece in the mouth immediate gratification.
holding the inhaler upright. Close the
lips tightly around the mouthpiece.  After a patient undergoes a femoral-
popliteal bypass graft, the nurse must
 Squeeze the inhaler as client
closely monitor the peripheral pulses
breathes in deeply through the
mouth. This is often difficult to do. distal to the operative site and
circulation.
 Tell client to hold breath up to a
count of five seconds.  Osteoarthritis is also known as
 Before breathing out remove inhaler Degenerative Joint Disease. It
from the mouth. Wait at least two commonly affects the weight-bearing
minutes between puffs, unless there joints (spine, hips and knees).
are other directions.
 Repeat process if two puffs are  Colonoscopy is the "screening" for
ordered. colorectal cancer.
 If you have two or more inhalers  Biopsy is the confirmatory.
always use the steroid medication
last. Then rinse mouth out with  Veracity: habitual observance of
water. truth in speech or statement;
 Clean mouthpiece of inhalers TRUTHFULNESS.
frequently and dry it thoroughly.
 The closest predisposition to Type 2
 Remove gloves, wash your hands
DM (NIDDM) is obesity.
with soap and water, and dry
thoroughly.
 Dyspnea and sharp, stabbing pain
that increases with respiration are
symptoms of pleurisy, which can be

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a complication of pneumonia or •
Distal esophagus arises from
tuberculosis. trachea; proximal esophagus
ends blindly.
 GERD is also known as chalasia. • Stuff swallowed ends up in
trachea.
 Z-Track Injection • Food regurgitates in mouth.
 Gastroesophageal reflux disease:
 adult, the most commonly used GERD or chalasia: relaxation of
needles are 1’(inch)or 1/2, 22 to 25 cardiac sphincter
gauge thick
 Caused by:
 Preparation
• Smoking, alcohol, caffeine,
 Verify doctor’s order on the patient’s
chocolate, hiatal hernia.
chart.
 Hand washing.  Findings:
 Use a proper needle. Rule of thumb
in needle selection for IM injection • Chest pain, cough, asthma,
are as follows: heartburn, acid injury to
 Aspirate the prescribed medication enamel, Barrett's esophagus.
into the syringe. Draw 0.2-0.5 cc of
air (depending on the hospital Achalasia:
policy) to create an air lock. (Air- • Incomplete relaxation of
lock technique is used with this LES.
procedure.) • Absent ganglion cells of
 Replace the needle with a new one myenteric plexus.
after preparing the drug so that no • No peristalsis.
drug remains outside the needle
shaft. This prevents tracking the drug  Causes:
into the subcutaneous tissue during • Chagas disease.
injection. • Abnormal barium swallow:
beak-like (bird-beak) tapering
at distal end of esophagus.
 Pancolitis refers to inflammation of
the entire colon. Congenital pyloric stenosis:
• Projectile vomiting.
 hallmark of Ulcerative colitis • Hypertrophy of muscles in
is bloody diarrhoea / rectal pyloric sphincter.
bleeding.
Findings in small bowel disease:
 Recurrent Ulcerative colliotis treat • Colicky pain: pain occurs in
with sulfasalazine intervals.
• Diarrhea.
• Anemia: malabsorption of
iron, folate, vitamin B12.
 Tracheoesophageal fistula:

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Findings in large bowl disease: • Test: fecal occult blood test,
• Diarrhea. colonoscopy, barium enema.
• Pain. • Constipation and diarrhea
• Iron deficiency. with or without bleeding.
• Hematochezia: massive blood • Spreads to: liver (common),
loss. lungs, bone, brain.
 Colorectal
 Inflammatory bowel disease: cancer –
 Ulcerative colitis: primary
diagnostic
• Most common. test is
 *Rectum and sigmoid – most colonoscopy
common site
• Ulcerations.  Acute appendicitis:
 Crohn's disease: • Children: lymphoid
hyperplasia.
• Granulomatous, • Adults: fecalith obstruction
ulceroconstrictive disease. of proximal lumen.
• Discontinuous spread • Initial colicky periumbilical
throughout entire GI tract. pain.
 Irritable bowel syndrome: • Nausea, vomiting, fever.
• Tenderness at McBurney's
• Alternating bouts of diarrhea point (Blumberg's sign).
and constipation. • Laboratory: neutrophilic
 **Diverticulitis – LLQ pain leukocytosis.
 Diet : no seeds • Diagnosis: CT scan.
• Complications:
periappendiceal abscess;
pylephlebitis.
 Barrett's esophagus: • Treatment: appendectomy.
• Complication of GERD.
• Glandular metaplasia in distal
esophagus.  Mental health stigma types: social
• Ulceration, glandular stigma and perceived stigma or self-
dysplasia; adenocarcinoma
 Stigma is when someone views you
risk.
in a negative way because you have
 Colon cancer: a distinguishing characteristic or
• Increasing age. personal trait that's thought to be, or
• Low-fiber diet. actually is, a disadvantage (a
• Smoking. negative stereotype)
• Familial polyposis, ulcerative
colitis.  Stigma can lead to discrimination.
• Common
location:rectosigmoid.

NLE POINTERS
 Pyschiatric nursing, approach,  STEP 4 – Collecting forensic
disorder, drugs, approach, LITHIUM evidence
THERAPHY, collaborative and
management, diagnostic and • Documenting injuries and
screening. collecting samples, such as
√ Geriatrics Nursing, Drugs, blood, hair, saliva and sperm,
Management and approach within 72 hours of the
√ Nursing Research incident
√ Maslow • **place evidence in a paper
√ PALMAR bag not in a zip lock plactics
√ Meniers, parkinsons, GBS, ALS, to prevent deterioration
drugs, surgery, limit, diet, exercise
and management  STEP 5 – Performing the physical
√ MaskuloSkeletal Disorder ( gouty, and genital examination
osteo, rheumatoid) drugs, diet,
 STEP 6 – Prescribing treatment
exercise and management
√ Gait, posture, strain and braces  STEP 7 – Counselling the survivor
√ pediatric bones disorder
√ BURNS  STEP 8 – Follow-up care of the
√ EENT disorders, drugs, surgery, survivor
management and diet
√ Nursing Theories
√ Anger Management
√ RAPE management
 Also, use techniques to interrupt
 STEP 1 – Making preparations to
your anger, listen, empathize, be
offer medical care to rape survivors assertive with others, and learn to
relax, as well as laugh at yourself.
 STEP 2 – Preparing the survivor for
the examination  Yell "Stop!" loudly in your thoughts.
 A person who has been raped has This can interrupt the anger cycle.
experienced trauma and may be in an  Use physical relaxation techniques
agitated or depressed state. She often like deep breathing or centering
feels fear, guilt, shame and anger, or
any combination of these.  Manage your negative thoughts
with imagery and positive
 Ensure that a trained support person thinking
or trained health worker of the same
sex accompanies the survivor  Close your office door or find a quiet
throughout the examination. space, and meditate for five
minutes.
 STEP 3 – Taking the history

NLE POINTERS
 Distract yourself from your anger  v Exploration of
solution: examining alternative ways
• visit your favorite website, of solving the immediate problem.
play a song that you like,
daydream about a hobby that  Catharsis - . As feelings about the
you enjoy, or take a walk. events are realised, tension is
reduced. The nurse solicits the pa-
tient's feelings about the specific
 CRISIS management situation, recent events, and
significant people involved in the
 CRISIS INTERVENTION particular crisis. The nurse asks
open-ended questions and repeats the
 TECHNIQUES OF CRISIS
patient’s words so that more feelings
INTERVENTION
are expressed. The nurse does not
discourage crying or angry outbursts
but rather sees them as a positive
 v Catharsis: the release of release of feelings.
feelings that takes place as the
patient talks emotionally charged
areas
 v Clarification: encouraging the √ CVA

patient to express more clearly the
 Pheochromocytoma is the formation
relationship between certain events.
of a benign tumor in adrenal medulla
 v Manipulation: using the patient’s causing hypertensive crisis.
emotions, wishes or values to benefit
 DOC: Phentolamine Mesylate
the patient in the therapeutic process.
(Regitine)
 v Reinforcement of behavior:
 In otitis media, the tympanic
giving the patient positive
membrane is bright red and lacks its
reinforcement to adaptive behavior.
characteristic light reflex (cone of
 v Support of defenses: encouraging light).
the use of healthy, adaptive defenses
 Dopamine is the drug of choice for
and discouraging those that are
shock. (Maybe,CIC)
unhealthy or maladaptive.
 v Increasing self- esteem: helping  Assess the client for the following
the patient to regain feelings of self while in traction.
worth.  Monitor skin integrity of the affected
part before and after traction
placement.

NLE POINTERS
 Assess the skin, especially bony the contents of the stomach with a
prominences for breakdown. large syringe.
 Assess neurovascular status.  Administer the formula or the
 Regularly check the condition of the medication as directed by the
traction equipment: ropes, pulleys, delegating nurse.
and weights.  Flush the feeding tube with 30-60
 For the client in skeletal traction, ml of water before and after each
assess the pin site for signs and feeding and after giving all
symptoms of infection. medications.
 Role of the Nurse in Caring for  Remove gloves.
Patients in Traction  Wash your hands.
 RNs shall not apply or set up skeletal
or cervical traction.  Arteriolosclerosis:
 RNs shall not remove, add, or lift up • Hardened arterioles.
on weight when the patient is in • Protein deposition occludes
traction for the treatment of lumen.
fractures. • Caused by diabetes mellitus;
hypertension.
• Onion skin appearance of
Glucometer Testing arterioles.
 Puncture the body part as directed by  Aneurysms:

the delegating RN. The best practice • Weak vessel walls followed
is to change the puncture site for by dilation.
each test. Tip: fingertips are less • Tendency of vessel wall to
sensitive on the sides of the finger. rupture.
 Provide direct pressure to stop the
bleeding if needed  Abdominal aortic aneurysm:
 Remove gloves. • AORTA is located at the
EPIGASTRIC REGION
 Wash and dry your hands.
 Atherosclerosis weakens wall.
• Increased vessel diameter;
lumen fills with debris and
Gastrostomy Feedings
clots.
 Remove the dressing - never use • Findings: usually
scissors to cut it off. asymptomatic.
 Anchor the tube as instructed by the
delegating nurse.  Hypertension:
 Encourage the client to be in a • BP over 140/90 mm Hg.
sitting or semi-reclining position.  Depends on:
 The delegating nurse may ask you
to check gastric contents by putting • Diastolic blood pressure.
on gloves and withdrawing some of • Systolic blood pressure.
• Sodium level.

NLE POINTERS
 Essential hypertension: • Irritable Bowel Syndrome is
• 95% cases of hypertension. also known as "IBS", "spastic
• Genetic factors reduce Na colon", and "mucous colitis"
elimination; unknown factors
cause vasoconstriction of • Cause is unknown but IBS is
arterioles. often associated with stress or
• Obesity, stress. anxiety
 Secondary hypertension:  Treatment might involve:
• 5% cases of hypertension.  reducing or removing anxiety (e.g.
• Renal artery occlusion. psychotherapy)
• Activation of renin-  dietary adjustment
angiotensin-aldosterone
 faecal softening agents
system.
 drugs to reduce spasm and / or
• Renal artery has beaded
reduce sensitivity to pain
appearance.
 gastric ulcers
 Complication:
 The action of acid, pepsin, and bile
• Rupture causes severe back on the lining of the stomach
pain followed by (mucosa). However, the output of
hypotension. stomach acid is not usually
increased.
 Taking NSAIDs (non-steroid anti-
• most common type of hernia
inflammatory drugs) or
is the hiatus hernia, in corticosteroids may be pre-
which the stomach passes, disposing factors.
partly or completely, into the  helicobacter pylori is often present.
chest cavity through the hole  vomiting and pain in the upper
("hernia") for abdomen soon after eating.
the oesophagus (which is also  Complications may include
known colloquially as the bleeding, perforation and
"windpipe" or "gullet"). obstruction due to scarring.
 Medical treatment may include the
 Complications of hernias use of antacids to relieve symptoms
 impossible to return to their normal and / or anti-secretory drugs to heal
state (irreducible). the ulcer(s)
 swollen and fixed within their sac
(incarcerated).  gastroscope to confirm the diagnosis
 cut-off from their blood supply,
of a gastric ulcer
becoming painful and eventually
gangrenous (strangulated).
 treatment for hernias surgical repair.

NLE POINTERS
 Effects / symptoms of a peptic ulcer • Increased alkaline
can include: phosphatase.
 abdominal pain - often just below • Thick weak bone - mosaic
the sternum (="breastbone"), can be bone.
a persistent burning pain that • Increased osteoclastic bone
extends to he person's back.In some resorption causing increased
cases this pain may begin approx. bone turnover.
20 mins after eating, or it may • Causes may include
awaken the person at night. paramyxovirus infection.
 heartburn • Some findings include: bone
 regurgitating food pain and deformity, hearing
 vomiting loss.
 bitter taste in the mouth  Osteoarthritis:
• Non-inflammatory joint
disease.
 Osteomyelitis:
• Universal after 65 years of
• Bone infection due to: S age.
aureus (most common). • Degeneration of articular
• Findings: fever, bone pain. cartilage in weight-bearing
• In sickle cell anemia: S. joints.
paratyphi. • Osteophyte formation.
• In foot due to rubber • Bone rubs on bone.
footwear puncture: P.
aeruginosa.  Findings:
 Osteoporosis:
• PIP/DIP enlargement.
 Rheumatoid arthritis:
• Loss of bone matrix and
minerals.
• HLA-DR4 association.
• Primary: idiopathic, senile,
• Type III hypersensitivity
postmenopausal (lack of
reaction.
estrogen).
• Joint B-cells produce
• Secondary: disease, drugs,
rheumatoid factor.
space travel.
• Rheumatoid factors activate
• Prevention: vitamin D,
complement, attracting
calcium, weight-bearing
neutrophils.
exercise.
• Synovial tissue proliferates
• Treatment: bisphosphonates,
forming a pannus.
calcitonin.
• Findings: MCP/PIP involved;
 Paget's disease knees, ankles, hips involved;
• Elderly men. lungs, hematologic disease,
• Idiopathic. carpal tunnel syndrome,
rheumatoid nodules,
• Osteoclastic resorption of
vasculitis, popliteal cyst.
bone; shaggy-appearing
lesions.  Sjogren's syndrome:

NLE POINTERS
• Autoimmune disease; babesiosis (secondary
dominant in females. infection).
• Destruction of salivary and • Diagnosis: serologic tests,
lacrimal glands. biopsy, silver stains.
• Findings: rheumatoid  Duchenne's muscular dystrophy:
arthritis, dry eyes, dry mouth.
• Labs: anti-SS-A (Ro) and •
Deficiency of dystrophin
anti-SS-B (La) antibodies. gene.
• Confirm with lip biopsy. • XR disease.
 Juvenile rheumatoid arthritis: • Type I and II fiber atrophy.
• Weakening and wasting of
•Children younger than 16. pelvic muscles.
•Still's disease: fever, rash, • Death by age 20.
polyarthritis; • Labs: increased serum
lymphadenopathy, creatine kinase at birth;
neutrophilic leukocytosis. increased serum creatine
 Gouty arthritis: kinase in female carriers.
 Myotonic dystrophy:
• Multifactorial inheritance.
• Due to underexcretion of •AD disease.
uric acid. •Trinucleotide repeat disorder.
• Recurrent acute arthritis: •Findings: facial weakness,
podagra (gout in great toe; myotonia, frontal balding,
painful); fever, pain, cataracts, testicular atrophy,
neutrophilic leukocytosis. cardiac involvement.
• Chronic gout: tophi cause • Increased serum creatine
erosive arthritis. kinase.
 Myasthenia gravis:
 Findings:
• Urate neuropathy, renal • Thymus-synthesized auto-
stones, hypertension, antibodies against ACh
coronary artery disease, lead receptors.
poisioning.
 Findings:
 Labs: • Ptosis, dysphagia, risk for
• Hyperuricemia. thymoma.
 Lyme disease:  Confirmation:
• B. burgdorferi. • Tensilon (edrophonium) test.
• Ixodes tick transmission;
white-tailed deer is reservoir.  Potassium disorders:
• Early: bull's eye lesion. • Controlled by aldosterone
• Late: arthritis, Bell's palsy, (direct relationship), arterial
myocarditis and pericarditis; pH (more pH, less K).

NLE POINTERS
• Hypokalemia: muscle  Effects of cancer:
weakness, U waves on ECG, • Cachexia.
polyuria, rhabdomyolysis. • Anemia.
• Hyperkalemia: ventricular • Hemostasis abnormalities
arrhythmias, peaked T waves like DIC, etc.
on ECG, muscle weakness. • Fever.
 K loss caused by: • Paraneoplastic syndromes.
• Decreased intake, GI loss,  Transfusion Reactions: Acute
renal loss, alkalosis. Hemolytic Transfusion Reaction:
 Acid-base disorders: • Intravascular: ABO
 Respiratory acidosis: incompatibility; type II
hypersensitivity.
•Hypoventilation and • Extravascular: donor RBCs
CO2 retention. coated with antibodies;
• Basic blood (increased jaundice.
HCO3) compensates for  Findings:
acidic lungs (decreased pH)
by causing metabolic • Fever, back pain,
alkalosis. Very high pCO2. hypotension, DIC, oliguria.
• Findings: somnolence,
cerebral edema.
 Hemolytic Disease of Newborn:
 Respiratory alkalosis:
• Maternal IgGs coat infant
•
Hyperventilation with RBCs.
CO2 elimination.  Hemolytic disease of newborn:
• Acidic blood (decreased ABO HDN:
HCO3) compensates for basic
lings (increased pH) by • Mom = type O; baby = type
causing metabolic acidosis. A or B.
Very low pCO2. • Jaundice develops 24 hours
• Findings: light-headedness, after birth.
tetany (Ca binds to albumin, • Anemia.
so decreased Ca). • + Coombs' test on baby
 Pulmonary Embolism: blood.
 Hemolytic disease of newborn: Rh
• Originates in femoral vein,
HDN:
pelvic vein, or vena cava;
occludes pulmonary artery • Mom is RH negative; baby is
branches; sudden death. Rh positive.
 Position to Left side lying • Mom exposed to fetal blood,
develops anti-D-IgG
 Metastasis: antibodies.
• Hepatic portal vein: liver. • First pregnancy plays no role.
• Vena cava: lungs.

NLE POINTERS
•During second pregnancy, • Detects renal dysfunction.
anti-D-IgG enters placenta • Increased in pregnancy;
coats baby RBCs. decreased in elderly people,
 Treatment: renal disease, etc.
 Nephrotic syndrome:
•At 28th week of pregnancy,
give mom anti-D globulin (it • Increased proteinuria.
covers and eliminates "Rh+" • Pitting edema, ascites.
baby blood before mom's • Hypoalbuminemia.
body officially mounts an • Infections, eg., S.
attack against it), which lasts pneumoniae.
~3 months. • Hypertension,
 Findings: hypercoagulability,
hypercholesterolemia,
•Jaundice, kernicterus, hypogammaglobinemia, fatty
positive direct/indirect casts.
Coombs' test.
• Use blue fluorescent light on  Wilm's Tumor:
newborn skin. • 2-5 years of age.
 Blood urea nitrogen (BUN): • AD disease; chromosome 11.
• WAGR syndrome: Wilm's
• End product of amino acid tumor, aniridia, genital
and pyrimidine metabolism. abnormalities, retardation.
• Produced by liver. • Beckwith-Wiedemann
• Increased in CHF. syndrome.
• Unilateral palpable mass;
 Azothemia: hypertension.
• Increased BUN and • Metastasis to lungs.
creatinine levels.  No to palpation
 Prerenal:
 Congestive Heart Failure:
• Causes: decreased CO.  Left-sided HF:
 Renal:
• Blood cannot be ejected into
• Causes: parenchymal damage aorta.
to kidneys; tubular necrosis, • Pulmonary edema.
renal failure. • Caused by concentric LVH.
 Postrenal: • Alveolar macrophages
contain hemosiderin (heart
• Causes: urinary tract failure cells).
obstruction below kidneys. • Difficulty breathing.
 Renal function tests: • Left-sided S3 sound.
• Mitral-valve regurgitation.
 Creatinine clearance:
• Paroxysmal nocturnal
dyspnea.
• Correlates with GFR.

NLE POINTERS
 Right-sided HF:  Myocardial infarction:
• Disruption of atheromatous
• Blood cannot be pumped into plaque; platelet thrombus
lungs. formation.
• Prominent jugular veins. • TXA2 plays important role in
• Right-sided S3 sound. platelet thrombus formation.
• Tricuspid valve regurgitation. • Causes of MI: cocaine use,
• Painful hepatomegaly. vasclitis, embolization, etc.
• Pitting edema and ascites.  Transmural / Q-wave:
 Angina pectoris: • Involves full thickness of
 Stable angina: myocardium.
 Findings:
•Caused by atherosclerotic
coronary artery disease. •Sudden retrosternal pain.
• Exercise-induced chest pain. •Not relieved by
• ST depression. nitroglycerine; lasts 45
• Relieved by resting or minutes.
nitroglycerine. • Radiates to left arm and jaw.
 Prinzmetal angina: • Sweating, anxiety,
hypotension.
•Coronary artery vasospasm at  Complications:
rest.
• Vasoconstriction. • Arrhythmias, CHF, rupture,
• ST-elevation. mural thrombus, pericarditis,
• Nitroglycerine and Ca- ventricular aneurysm, right
channel blocker. ventricular acute MI.
 Unstable angina: • Increased CK-MB; peaks at
24 hours.
• Severe atherosclerotic • Troponins: cTnl and cTnT.
disease. • LDH 1-2; "flip."
• Chest pain even at rest. • Inverted T waves.
• May progress to MI. • Elevated ST segment.
• Balloon angioplasty. • New Q waves.
• Stents.
 Rheumatic fever:
 Chronic ischemic heart disease: • Immune disease that follows
• Ischemic damage to group A streptococcal
myocardial tissue causes pharyngitis infection.
CHF. • Pericarditis.
• Findings: CHF, angina, • Myocarditis.
dilated cardiomyopathy. • Endocarditis.
• Sterile, verrucoid-appearing
vegetations near valve.

NLE POINTERS
• Mitral and aortic valve • Photodermatitis: UV light
regurgitation. reaction.
• Infection. • Drug: prednisone
• Migratory polyarthritis.
• Sydenham's chorea.
• Antistreptolysin O (ASO)  Psoriasis:
titers; throat culture; • Genetic predisposition.
leukocytosis; increased PR • Undifferentiated proliferation
interval; CRP. of keratinocytes.
 acid–base disturbances • Association with
generally observed in Heart
streptococcal pharyngitis.
failure is? • Koebner phenomenon: rash
in areas of trauma.
- Metabolic and Respiratory
Alkalosis
• Plaques, pitting of nails.
• Munro microabscesses:
neutrophils collect in stratum
corneum.
 Rubella (German measles):
• RNA togavirus.
• 3-day measles.  Hydrocephalus:
• Painful lymphadenopathy. • Ventricle enlargement due to
• Findings: polyarthritis in increased CSF volume.
adults.  Communicating/non-obstructive:
 Varicella-zoster virus:
•Increased CSF production.
•
DNA herpesvirus. •Obstruction of CSF
•
Varicella (chickenpox): rash; absorption by arachnoid
+ Tzanck test; Reye granulations.
syndrome; pneumonia;  Non-communicating (obstructive):
cerebellitis.
• Herpes zoster (shingles). •CSF can't flow out due to
• Drug: ACYCLOVIR stricture of aqueduct of
(ZOVIRAX) Sylvius, fourth ventricle
 Eczema: tumor, etc.
 Findings:
• Inflammatory dermatoses.
• Acute: weeping, • Seen in newborns (enlarged
erythematous rash. head) and adults (dementia,
• Chronic: dry, thickened skin wide-based gait, urinary
due to scratching. incontinence).
• Atopic dermatitis: type I IgE-
 Cerebrovascular accidents:
mediated hypersensitivity
reaction in children.  Atherosclerotic (thrombotic)
• Contact dermatitis: allergic; stroke:
type IV hypersensitivity
reaction. • Most common.

NLE POINTERS
•
Platelet thrombus develops electrophoresis; central
over disrupted plaque: MCA pontine myelinolysis.
or ICA near bifurcation.  Alzheimer's disease:
• Findings: pale infarction,
swelling of brain, gliosis, • Important role of beta-
cystic area. amyloid (A-beta) protein
• Clinical findings: strokes. coded by chromosome 21.
 Meningitis: • Defective degradation of
APP.
• Pia mater (brain cover) • Apolipoprotein gene E on
inflammation. chromosome 19.
• Fever, nuchal rigidity, • Defective tau protein; located
headache. on chromosome 14.
 Labs:  Findings:
• Viral: increased CSF protein; • Cerebral atrophy, dilated
normal CSF glucose. ventricles, NF tangles in
• Bacterial/fungal: increased neuron cytoplasm, senile
CSF protein; decreased CSF plaques, amyloid angiopathy.
glucose.
 Encephalitis:  Confirmation:
• Postmortem examination of
• Brain inflammation. brain.
• Fever, headache, altered  Parkinsonism:
mental status.
• Altered dopaminergic
 Demyelinating disorders: pathways.
 Multiple sclerosis: • Defective control over
voluntary muscle movement.
• More common in females.
• HLA-DR2.  Pathology:
• CD8 T-cell destruction of • Idiopathic degeneration of
myelin and oligodendrocytes. neurons in substantia nigra
causing deficiency of
 Findings: dopamine.
• Sensory and motor
dysfunction, visual and  Findings:
speech disturbances, ataxia, • Muscle rigidity,
tremor, nystagmus, bilateral resting/rolling pill tremor,
internuclear ophthalmoplegia. expressionless face, shuffling
gait.
 Labs:
• Increased CSF leukocyte,  Treatment:
protein, myelin basic protein; • Dopamine replacement.
normal CSF glucose;  Guillain-Barre syndrome (GBS):
oligoclonal bands on CSF

NLE POINTERS
• Autoimmune demyelination  Prostate cancer:
syndrome. • 2nd Most common cancer in
• Associated with M. adult males next to lung
pneumoniae pneumonia, C. Cancer.
jejuni enteritis, CMV, EBV, • Risk: age, familial, black,
and HIV. smoking, high saturated fats
• Weakness of ascending motor in diet.
neurons. • DHT is mediator.
• Findings: increased CSF  Findings:
protein.
• Treatment: plasmapheresis. •Obstructive uropathy, back
 Idiopathic Bell's palsy: pain, alkaline phosphatase is
increased, spinal cord
• Unilateral facial paralysis due compression.
to LMN palsy.  Diagnosis:
• Inflamed facial nerve.
• Associated with HIV, • Screening (DRE/PSA).
sarcoidosis, Lyme disease.  Confirmation:
• Findings: drooping corner
of mouth; can't speak; can't • Needle biopsy.
close eye.  Spreads to:
• Causes: eg., vincristine,
hydralazine. • Lungs, liver.
• Deficiency of vitamins:
thiamine, B12, pyridoxine.
 Acromegaly excess GH .... Initial signs  Erectile dysfunction:

and symptoms ENLARGEMENT OF • Psychogenic, decreased
HANDS ND FEET other is enlargement testosterone, vascular
of forehead, jaw and nose..... insufficiency, neurologic
disease (defect in
 Benign prostatic hyperplasia: parasympathetic S2-S4
• Digital rectal exam 50% (erection) or sympathetic
sensitive. T12-L1 (ejaculation)), drugs,
• DHT is mediator. endocrine disease, penis
• Estrogen is co-mediator. disorders.
 Findings:  Treatment:
• Obstruction, hematuria, PSA. • Sildenafil (Viagra); Yohimbe.

 Complications:  Cervical cancer:
• Obstructive uropathy, bladder • Uncommon.

infections, prostatic infarcts. • Detected early: CIN and Pap.
• Risk: Early age for having
sex, multiple sex partners,

NLE POINTERS
smoking, oral contraceptives,  Locations:
HPV, immunodeficiency. • Most common is ovaries.
• Findings: Malodorous
discharge; postcoital  Findings:
bleeding.Metrorrhagia • Dysmenorrhea, painful
• Distant metastasis. menses, intestinal
• CIN I: mild. obstruction, ectopic
• CIN II: moderate. pregnancy, enlarged ovaries.
• CIN III: severe.
 Treatment:
 Oral contraceptive pills:
• Laparoscopy and Hormonal
• Estrogen + progesterone. estrogen and progesterone
• Estrogen: prevents mid-cycle therapy
estrogen surge.
• Progesterone: inhibit LH.  Fallopian Tube Disorders:
• Hostility to sperm.  Pelvic Inflammatory Disease:
 Changes during pregnancy: • Causes: N. gonorrhoeae or
• Increased plasma volume and Chlamydia. trachomatis.
RBC mass. • Gives rise to hydrosalpinx.
• Respiratory alkalosis. • Complication: oophoritis.
• Increased serum thyroxine
and cortisol. Ectopic Pregnancy:
 Menopause:  Causes:
• Increased FSH, LH; • Most common cause is
decreased estrogen and scarring from previous PID;
progesterone. endometriosis, altered tubal
• Secondary amenorrhea, hot motility, SIN.
flushes, night sweats.
 Findings:
 Increased testosterone (ovaries) or
• Pain, bleeding, adnexal mass,
increased DHEA-sulfate (adrenal
hypovolemic shock.
origin) cause:
• Hirsutism or virilization.  Complications:
• Rupture, hematosalpinx.
 Endometriosis:  Diagnosis:
• Glands and stroma located • Beta-hCG, ultrasound,
outside uterus. laparoscopy.
• Growth of endometrial
implants or tissues outside
uterus  Placenta previa: Painless
• Implantation over cervical os;
bleeding, painless.

NLE POINTERS
 Abruptio placentae: PAINFUL  Breast cancer:
• Premature placental • Mean age: 64 years old.
separation; due to smoking, • Family history, genetics.
cocaine, hypertension, • AD disease.
advanced age. • BRCA1 and BRCA2.
• Li-Fraumeni syndrome:
 Preeclampsia/eclampsia: inactivated TP53 suppressor.
• Toxemia of pregnancy. • RAS, ERBB2, RB
• Abnormal placentation. suppressor.
• Decreased natural • Due to: prolonged estrogen
vasodilators. exposure; smoking, radiation,
• Increased vasoconstrictors. endometrial cancer.
• Premature aging of placenta. • Painless mass.
• Infarctions, atherosclerosis of • Skin, nipple retraction.
spiral arteries.  •BSE – SUPINE 7 days after
 DOC: Mg SO4 menstruation
 Findings:  Mammography: screening; cannot
differentiate benign from malignant.
• Hypertension, proteinuria, • Spreading: first by
edema, seizures (foe lymphatics, then
eclampsia), renal and liver hematogenously.
disease, HELLP syndrome. • Spreads to: lungs, bone, liver,
brain, ovaries.
 Hydatidiform moles:
• Treatment: radical
• Benign tumor of chorionic mastectomy; damage to long
villus. thoracic nerve causes
• Neoplastic placenta. winged-scapula;
• 46XX. lumpectomy; radiation.
• Findings: preeclampsia, large
uterus, increased hCG;  Breast cancer in men:
snowstorm appearance on • BRCA2 mutated;
ultrasound. Klinefelter's syndrome.
 DOC: Methotreaxate same with • Poor prognosis.
ectopic
 Atelectasis:
 Choriocarcinoma:most dreaded  Resorption atelectasis:
complication of h mole
• Malignant tumor made of • Collapsed lung.
syncytiotrophoblast and • Air doesn't reach alveoli.
cytotrophoblast. • Caused due to: mucus,
• Spreads to: lungs, vagina; foreign material,
lesions are hemorrhagic. bronchogenic carcinoma.
 Treatment:Chemotherapy. • Fever, dyspnea.

NLE POINTERS
•
Absent breath sounds. • RSV, influenzavirus,
•
Ipsilateral elevation of adenovirus.
diaphragm, and tracheal • Insidious onset; fever,
deviation. productive cough.
 Pulmonary edema: • Flu-like symptoms.
• No consolidation.
• Altered Starling pressure.  Nosocomial pneumonia:
• Increased hydrostatic;
decreased oncotic pressure. • Severe underlying disease.
• Infections, drugs, aspiration, • Antibiotic therapy.
high-altitude. • Immunosuppression.
 Acute respiratory distress  In immunocompromised hosts:
syndrome:
• AIDS, bone marrow
•
Pulmonary edema due to transplants.
alveolar-capillary damage. • CMV; P. jiroveci; A.
• Caused by: sepsis, gastric fumigatus.
aspiration, trauma/shock,  Tuberculosis:
infections, smoke, heroin.
• Cyokines released; leakage of • M. tuberculosis.
protein-rich exudate; • PPD test.
decreased surfactant. • Primary and secondary
 Pneumonia: (reactivation) TB.
• Fever, night sweats, weight
 Pulmonary infections: loss.
 Community acquired pneumonia: • Miliary spread within lungs
and extrapulmonary sites.
•Often due to S. pneumoniae. • Granulomatous hepatitis;
•Acute bronchitis; lung has Pott's disease (vertebra).
areas of consolidation.
 Lobar pneumonia: UTI – most common
nosocomial infection
•
Complete consolidation of
lobe.  Silicosis:
• Complications: lung • Quartz dust inhaled.
abscesses, empyema, sepsis.  Emphysema:
• Findings: fever, cough,
positive Gram stain, • Enlargement of respiratory
leukocytosis. unit.
 Community-acquired pneumonia: • Causes: smoking, AAT
deficiency.
• M. pneumoniae. • Increased compliance;
• C. pneumoniae. decreased elasticity.
• C. trachomatis.

NLE POINTERS
•Centriacinar emphysema:  Intrinsic asthma:
common in smokers; upper • Non-immune.
lobes. • Caused by viral infections,
• Panacinar emphysema: AAT air-pollutants, drug-
deficiency; AD disease; sensitivity, stress, exercise,
lower lobes. smoking.
• Pink puffers; dyspnea and  Theophylline
hyperventilation.
 Chronic bronchitis:  Chronic obstructive pulmonary disease
(COPD)
•
Productive cough for 2
months - 3 years.  Asthma (wheezing)
• Smoking, cystic fibrosis.
• Hypersecretion of mucus Drug interaction e.g. erythromycin, cimetidine,
from bronchi. phenytoin (macrolides and quinolones)
• Acute inflammation.
• Dyspnea. Side-effects of theophylline  Nausea, diarrhea
• Cyanosis of skin.  Increase in heart rate, tachyarrhythmias 
• Blue bloaters; stocky CNS excitation (headaches, insomnia, irritability,
patients. dizziness and lightheadedness)
• Cor pulmonale (hypertrophy
of right ventricle due to lung  Seizures can also occur in severe cases of
disease). toxicity and is considered to be a neurological
• Respiratory acidosis. emergency It can reach toxic levels when taken
 Asthma: with fatty meals, an effect called dose dumping.
• Episodic and reversible Theophylline toxicity can be treated with beta

airway disease. blockers
 Extrinsic asthma:  Theophylline has several anti-inflammatory

• Type I hypersensitivity; CD4 activities relevant to asthma
Th2
 Theophylline appears to have
cells;bronchoconstriction,
mucus production, influx of immunomodulatory effects, even at relatively
leukocytes. low plasma concentrations
• InterLeukin4 = isotype
switching to IgE production. Theophylline should be used at lower doses to
• InterLeukin5 = production achieve plasma concentrations of 5-10 mg.l-1,
and activation of neutrophils. which will avoid the risk of side-effects
• Histamine released.
• Expiratory wheezing,  Bronchiectasis:
nocturnal cough, increased • Permanent dilation of bronchi
anteriorposterior diameter. and bronchioles.

NLE POINTERS
• Causes: TB, bronchial • Also spreads to adrenal
obstruction, primary ciliary glands, liver.
dyskinesia.
• Lower lobes.  Mediastinal masses:
• Productive cough; copious • Commonly: neurogenic
sputum. tumors.
 Cystic fibrosis: • Thymoma: located in anterior
mediastinum.
• Autosomal Recessive
 Pleural fluid:
disease.
• Three nucleotide deletion on • Moves from parietal pleura to
chromosome 7. pleural space to lungs.
• Defective CFTR for chloride  Plural effusion:
ions.
• Movement of fluid from
• Increased Na/Cl in sweat,
lymphatic vessels into
causing dehydration.
pulmonary tissue.
• Nasal polyps, respiratory
 Causes:
infections and failure.
• Malabsorption. • Increased hydrostatic
• Type 1 diabetes mellitus. pressure, decreased oncotic
• Male infertility. pressure, lymphatic
 Lung tumors: obstruction, increased vessel
permeability, metastasis to
• Most common cancers: pleura.
adenocarcinoma; weak
 Transudate:
smoking association.
 Association with smoking: • Ultrafiltrate; disturbed
Starling pressures;
• Squamous cell carcinoma;
protein/serum less than 0.5.
small cell lung carcinoma.
 Exudate:
 Metastatic lung cancer:
• Most common. • Protein-rich, and cell-rich
• Primary site: breast. fluid; pneumonia, infarction,
metastasis; protein/serum
• Secondary site: colon, renal.
greater than 0.5.
• Dyspnea.
• Cough, hemoptysis, weight  Spontaneous pneumothorax:
loss, chest pain. • Idiopathic; hole in pleura.
• Pancoast tumor: Horner's • Pleural hole.
syndrome. • Pleural cavity pressure =
• Superior vena cava atmospheric pressure.
syndrome. • Trachea deviates to side of
 Metastasis sites: pneumothorax.
• Sudden dyspnea, chest pain.
• Most common: hilar nodes.

NLE POINTERS
 Tension pneumothorax: •Indicates synthetic activity of
• Ruptured tension thyroid.
pneumatocysts. • Increased I-131 uptake:
• Trauma to lungs; knife increased T4 synthesis; also,
wound. hot nodule / goiter.
• Increased pleural cavity • Decreased I-131 uptake:
pressure; compression decreased gland activity; also
atelectasis. cold nodule / cancer.
• Absent breath sounds.  Thyroglobulin:
• Trachea and mediastinal
structures deviate to opposite • Thyroid marker.
side.
 Hypothyroidism:
 Treatment:
 Causes:
•Insert needle into pleural
cavity to relieve pressure. • Hashimoto's thyroiditis,
 Syndrome of Inappropriate ADH cretinism.
(SIADH):
 Findings:
• Causes: small cell carcinoma • Weight gain, fatigue, cold
of lung, CNS injury, drugs, intolerance, constipation,
pulmonary infections. hypertension, muscular
• Findings: mental status myopathy.
dysfunction, hyponatremia.
 Lab findings:
• Restrict water intake.
• Decreased T4, increased
 Thyroid gland disorders: TSH; antimicrosomal and
 Function tests: antithyroglobulin antibodies,
hypercholesterolemia.
•Total serum T4:
•Represents bound (to TBG)  Treatment:
and unbound serum T4. • Levothyroxine.
• Increased TBG synthesis
increases T4 and vice versa.  Excess thyroid hormone:
 Serum TSH: • Due to: thyrotoxicosis and
hyperthyroidism.
• Best indicator of thyroid
function.  Findings:
• Increased TSH: primary • Increased BMR.
hypothyroidism.
• Decreased TSH: Graves' disease:
thyrotoxicosis (Grave's • HLA-Dr3; IgG against TSH
disease); hypopituitarism. receptor.
 I-131 uptake: • Hyperthyroidism and
thyrotoxicosis.

NLE POINTERS
 Findings: flower), enzyme deficiency,
• Exophthalmos, pretibial puberty, pregnancy.
myxedema.
 Thyroid tumors:
 Plummer's disease:
• Follicular adenoma: most
• Goiter. common benign tumor.
 Thyrotoxicosis: findings: • Follicular carcinoma: most
common female dominant
• Weight loss, fine hand thyroid cancer; spreads to
tremor, heat intolerance, lungs and bone.
diarrhea, anxiety, lid stare,  Parathyroid gland disorders:
tachycardia, atrial fibrillation,
 Hypoparathyroidism:
hypertension, HF.
 Lab findings: • Hypocalcemia.
• Causes: surgery,
•Increased T4, decreased TSH.
autoimmune, DiGeorge
•Increased I-131 uptake in syndrome,
Graves' disease and goiter. hypomagnesemia.
• Decreased I-131 uptake in • Findings: tetany, basal
thyroiditis and patients taking ganglia calcification,
excess thyroid hormone. cataracts.
• Hyperglycemia, • Lab: hypocalcemia,
hypocholesterolemia, hyperphosphatemia,
hypercalcemia, decreased PTH.
lymphocytosis.
 Primary hyperparathyroidism
 Treatment of Graves' disease: (HPTH):
• Beta-blockers; thionamides. • Common cause of
 Nontoxic goiter: hypercalcemia.
• MEN I/IIa association.
• Enlargement from excess
colloid.  Causes:
• Deficiency of thyroid
• Adenoma.
hormone.
• Primary hyperplasia.
• Hyperplasia/hypertrophy.
• Carcinoma.
• Treatment: levothyroxine.
 Types of goiters:  Findings:
• Calcium stones, peptic ulcers,
 Endemic:
acute pancreatitis,
• Iodide deficiency. constipation, osteitis fibrosa
cystica (salt and pepper
 Sporadic: appearance of skul),
• Goitrogens (eg., cabbage, hypertension.
cassava, broccoli and cauli

NLE POINTERS
 Lab: • Fasting hypoglycemia.
• Increased PTH, Ca; • Eosinophilia, lymphocytosis,
decreased Ph; normal anion neutropenia.
gap metabolic acidosis.  Hyperaldosteronism:
 Diagnosis:  Primary:
• Technetium-99-m-sestamibi • AKA Conn's syndrome.
radionuclide scan. • Findings: Hypertension,
muscle weakness, tetany,
 Treatment: metabolic acidosis.
• Surgically remove adenoma. • Labs: hypernatremia,
 Parathyroid gland disorders: hypokalemia, metabolic
secondary hyperparathyroidism: alkalosis, decreased plasma
rennin.
• Hyperplasia of all
parathyroid glands.  Secondary:
• Decreased Ca; increased • Compensatory reaction to
PTH. decreased cardiac output.
• Increased plasma rennin.
 Adrenal Gland Disorders: • Activated rennin-angiotensin-
 Hypofunction: aldosterone system.
 Pheochromocytoma:
 Acute adrenocortical insufficiency:
• Causes: Waterhouse- • Unilateral, benign adenoma.
Friderichsen syndrome (N. • N-methyltransferase converts
meningitides, DIC, adrenal NOR to EPI.
hemorrhage). • Characteristics: brown,
 Chronic Addison's disease: hemorrhagic, necrotic.
• Findings: hypertension,
• Autoimmune. palpitations, anxiety, sweats,
• Tuberculosis/histoplasmosis. headache, chest pain.
• Adrenogenital symdrome. • Labs: increased urine VMA
• Metastasis. and metanephrine,
• Findings: weakness, hyperglycemia, neutrophilic
hypotension, leukocytosis.
hyperpigmentation.
 Lab:  Diabetes mellitus:

• ACTH test shows no increase
in cortisol or 17-OH.  Causes:
• Metyrapone test: increased • Pancreatic, endocrine, or
ACTH only. genetic disease; insulin-
• Increased plasma ACTH. receptor deficiency;
• Hyponatremia, hyperkalemia, infections; impaired glucose
metabolic acidosis.

NLE POINTERS
tolerance; gestational  Hypoglycemia:
diabetes mellitus.  Reactive type:
• Younger patients.
• AD inheritance.  Causes:
• HLA-DR3 and HLA-DR4 • Insulin treatment for type 1
genetic associations. diabetes.
• IGT or type 2 diabetes.
 Syndrome X:
• Idiopathic postprandial
• Insulin resistance. syndrome.
• Hyperinsulinemia: increased
VLDL, hypertension,  Findings:
coronary artery disease. • Sweating, trembling, anxiety.
 Fasting type:
 Pathology:
• Poor glycemic control:  Causes:
hyperglycemia.
• Alcohol, renal failure,
• Nonenzymatic glycosylation:
malnutrition, liver disease,
combination of glucose with
insulinoma, hypopituitarism,
proteins.
ketotic hypoglycemia in
• Osmotic damage: damage to childhood.
tissue, retina, vessels.
• Diabetic microangiopathy:  Findings:
decreased type IV collagen
• Dizziness, confusion,
synthesis.
headache, lack of
 Findings: concentration, motor
disturbances, seizures, coma.
• Hypoglycemia.
• Diabetic ketoacidosis.  Reye syndrome:
• Hypertriglyceridemia. • Children younger than 4
• Muscle wasting. years.
• Labs: hyperglycemia, • Follows chickenpox or
hyponaremia, hyperkalemia, influenza infection.
increased anion gap • Mitochondrial damage.
metabolic acidosis, prerenal • Encephalopathy
azotemia. hepatomegaly.
• Transaminasemia, increased
 Gestational diabetes:
bilirubin and ammonia.
• Diabetes of pregnancy due to
anti-insulin effect of human  Preeclampsia:
placental lactogen and • Hypertension, proteinuria,
increased placental size. pitting edema during 3rd
• Risk to newborns: trimester of pregnancy.
macrosomia, RDS, neural • HELLP syndrome; hemolytic
tube defects, hypoglycemia. anemia, elevated
transanimases, low platelets.

NLE POINTERS
 Fulminant hepatic failure: hepatorenal syndrome,
 Causes: hyperestrinism in males.
 Primary biliary cirrhosis:
• Viral, drugs, Reye syndrome.
 Findings: • Autoimmune disorder.
• Destruction of bile ducts and
• Encephalopathy. portal triads.
• Decreased transaminases; • Pruritis, hepatomegaly,
increased PT and ammonia. jaundice.
• Antimicrobial antibodies,
 Prehepatic obstruction of blood increased IgM.
flow:
 Hereditary hemochromatosis:
• Blood doesn't flow to liver.
• Hepatic artery thrombosis; • AR disease.
transplant rejection; • Unrestricted reabsorption of
vasculitis. iron in SI.
• Portal vein thrombosis; • Iron deposits in organs.
pylephlebitis, polycythemia • Bronze diabetes.
vera, carcinoma. • Type I diabetes mellitus.
• Malabsorption.
 Intrahepatic obstruction of blood • Cardiomyopathy, joint
flow: degeneration.
• No sinusoidal blood flow; • Increased iron, ferritin, TIBC.
cirrhosis.
 Wilson's disease:
• Centrilobular hemorrhagic
necrosis; LHF, RHF. • AR disorder.
• Nutmeg liver. • Decreased ceruplasmin
• Pain, increased synthesis.
transaminases. • Increased serum copper;
increased copper in urine.
 Liver cirrhosis: • Kayser-Fleischer ring.
• Liver fibrosis + formation of
regenerative nodules.  Alpha-antitrypsin deficiency:
• Compressed hepatic arteries • AD disease.
and veins. • Accumulation of Alpha-
 Causes: antitrypsin in hepatocytes
causing liver damage.
• Alcohol, viral, autoimmune, • Hepatitis.
metabolic disease.
 Laboratory confirmation of
 Complications: cirrhosis:
 Hepatic failure: • Increased BUN,
hypoglycemia, respiratory
• Hypoalbuminemia, hepatic alkalosis, lactic acidosis,
encephalopathy, portal increased PT, hypocalcemia.
hypertension, ascites,

NLE POINTERS
 Liver tumors: Benign: (periumbilical hemorrhage),
 Cavernous hemangioma: tetany.
• Increased pancreatic amylase,
• Most common. lipase; neutrophilic
 Liver cell adenoma: leukocytosis, hypocalcemia,
hyperglycemia.
• Women of child-bearing age. • Complications: pancreatic
pseudocyst, ARDS,
 Liver tumors: Malignant: pancreatic abscess, DIC.
• Metastasis: most common  Chronic pancreatitis:
cancer.
 Heptocellular carcinoma: •Idiopathic.
•Alcohol, Cystic Fibrosis,
• Most common. malnutrition.
• HBV, HCV. • Repeated attacks of acute
• Focal, muitifocal, infiltrating pancreatitis, calcification of
cancer. ducts.
• Portal and hepatic vein • Pain, malabsorption, type 1
invasion. diabetes mellitus, pancreatic
• Fever, enlargement of liver, pseudocyst.
ascites. • Increased lipase, amylase.
• Increased AFP; ectopic  Exocrine pancreatic cancer:
production of erythropoietin
and insulin-like factor. • Smoking, pancreatiris.
• Spreads to lungs. • Activated K-RAS gene;
 Gallstones (cholelithiasis): mutant TP16 and TP53
genes.
•Most are cholesterol stones. • Jaundice, epigastric pain,
•Supersaturation of bile with weight loss, light-colored
cholesterol. stools.
• Female, fat, forties; oral • Increased CA19-9.
contraceptives, rapid weight • Poor prognosis.
loss.
 Acute pancreatitis:  Kwashiorkor:
• Inadequate protein intake.
• Alcohol, gallstones. • Too much carbohydrate
• Activated pancreatic intake.
proenzymes. • Pitting edema; ascites.
• Trypsin plays a role in • Fatty liver.
activating enzymes. • Diarrhea.
• Fever, nausea, vomiting, • Anemia; deficient immunity.
midepigastric pain radiating
to back, shock, hypoxemia,  Marasmus:
Grey-Turner's sign (flank • Inadequate intake of protein
hemorrhage), Cullen's sign and other food.

NLE POINTERS
• Muscle wasting. • Eg., blood group A person
• Growth retardation; anemia; receives blood group B heart.
deficient immunity.  Acute:
 Anorexia nervosa: • Type IV: CD4 T cells activate
• Self-induced starvation. macrophages; CD8
• Distorted body-image. proliferation; donor-graft
• Amenorrhea; osteoporosis; destruction.
lanugo; increased stress • antibody-mediated type II
hormones (cortisol, GH, etc.). hypersensitivity reaction:
CD4 T cells activate B-cells.
 Bulimia nervosa:
• Binging with self-induced  Treatment:
vomiting. • Immunosupressive agents;
risk for cervical squamous
 Obesity:
cell cancer, malignant
• BMI over 30 kg/m2. lymphoma, squamous cell
• Excess fat on waist is more carcinoma of skin.
harmful.  Chronic:
• Genetic predisposition: 50-
80%. • Irreversible reaction that
• Defective leptin gene; occurs over months to years.
syndrome X.  Graft-vs-host reaction:
 Obesity causes:
• Donor T cells activate host
• Depression, cancer, diabetes CD4/8 T cells.
mellitus 2, hypertension, • Bile duct necrosis, jaundice,
obstructive sleep apnea, and diarrhea, dermatitis.
more.
 Systemic lupus erythematous
 Transplantation immunology: (SLE):
• ABO blood group • Child-bearing age.
compatibility.
• B-cell activation after
• Best chance of success with exposure to certain triggers
matching HLA-A,-B,-D loci. (eg., procainamide).
 Rejection reactions: • Affects: blood, lymph nodes,
 Hyperacute: joints, skin, heart, lungs, and
kidneys.
• Recipient ABO • IgG anti-SS-A (Ro)
incompatibility or preformed antibodies cross placenta and
anti-HLA antibodies react cause neonatal heart block.
against donor.  Drug-induced SLE:
• Type II hypersensitivity
reaction. • Procainamide, and
hydrazaline.

NLE POINTERS
• Findings: Anti-histone  Tests:
antibodies; low CNS and
renal involvement. •ELISA (screening), Western
 Lab findings in SLE: blot (confirmatory test), p24
antigen (indicates active viral
•ANA in almost all cases. replication).
•Anti-dsDNA antibodies and  Phases:
anti-Sm antibodies: very
specific. • Acute, latent, early
• Anti-Ro antibodies. symptomatic.
• Anti-phospholipid antibodies: • CD4 T-cell count less than
vessel damage and 200 cells/mL.
thrombosis. • Most common infection:
• Anti-cardiolipin antibodies: cryptococcosis.
may generate false-positive
syphilis test.  Leading causes of disease:
 Systemic sclerosis (scleroderma): • Alcohol and tobacco.
• Small vessel endothelial  Tobacco use causes:

damage; ischemic injury. • CV disease, lung cancer,
• Excess cytokines cause stroke.
excess collagen synthesis.
• Raynaud's phenomenon. • Nicotine is the most addictive
• Tightened facial features; substance in tobacco.
also affects GI, lungs,
kidneys. • This also includes chewing
• Calcification of subcutaneous tobacco and second-hand
tissue, dysphagia, esophageal (passive) smoke.
reflux.
• Lungs, kidneys also affected.  Alcohol use:
• Serum ANA +. • Stomach absorption.
• Anti-topoisomerase antibody.
• Metabolism in liver and
• Anti-centromere antibodies.
stomach.
• CREST syndrome.
 AIDS: • Alcohol dehydrogenase is the
• RNA retrovirus. rate-limiting metabolism
enzyme.
• HIV 1: US.
• HIV 2: developing countries.
 Products of alcohol metabolism:
• HIV envelope protein gp120
attaches to CD4 T-cell. • Reduced NADH.
• Infects all APCs.
• Macrophages and dendritic • Acetyl CoA.
cells are reservoirs for the
virus.

NLE POINTERS
• Alcohol induction of  Overall effects of drugs:
cytochrome P-450 increases • Cerebral atrophy; damaged
alcohol metabolism, neurotransmitter sites.
increasing tolerance.
 Adverse effects of certain
• Females have less gastric medications:
alcohol dehydrogenase.
 Acetaminophen:
 Lab findings in alcohol abuse:
• Damage to liver and kidneys;
production of free radicals.
• Fasting hypoglycemia:
pyruvate, which is a substrate
 Aspirin (also known as
for gluconeogenesis, is
acetylsalicylic acid or salicylate)
converted to lactate.
overdose:
• Increased anion gap
• Tinnitus, vertigo, altered
metabolic acidosis.
mental status, tachypnea,
respiratory alkalosis,
• Other findings: metabolic acidosis with
Hyperuricemia, increased anion gap,
hypertriglyceridemia, AST hyperthermia, hemorrhagic
greater than ALT, increased gastritis, fulminant hepatitis.
GGT.
 Exogenous use of estrogen without
 Other drugs:
progesterone:
 Cocaine:
• Cancer, venous
thromboembolism,
• Stimulant; mydriasis,
intrahepatic cholestasis with
tachycardia, hypertension,
jaundice, myocardial
AMI, CNS infarction.
infarction, stroke.
 Heroin:
 Use of oral contraceptives:
• Opiate; miotic pupils, • Cancer, venous
frothing at mouth, nephrotic thromboembolism, folate
syndrome. deficiency, hypertension,
hepatic adenoma, intrahepatic
 Marijuana: cholestasis with jaundice,
cholesterol gallstones.
• Stimulant; red conjunctiva,
euphoria, delayed reaction  Burns
time.
 RACEEE and PASS
 Complications of IV drug abuse:  R - RESCUE /REMOVE anyone in
• Hepatitis B, HIV, tetanus, immediate danger
infective endocarditis. A - Activate the Manual Fire

NLE POINTERS
ALARM authorize it (patients on oxygen are
C - CONFINE the fire (close the cared for).
door) Oxygen to the building is only shut
E - EXTINGUISH small controllable off after the Fire Marshal orders it
fires/or and after nursing staff authorize it
E- EXIT (patients on oxygen are cared for).
E-EVACUATE  E - Extinguish
 Select the appropriate fire
P - PULL the pin extinguisher. Use the P-A-S-S
A - AIM the nozzle at the base of the technique to extinguisher the fire.
fire (see below for P-A-S-S technique)
S - SQUEEZE handle  E - Find the EXIT then Evacuate
S – SWEEP from side to side
 "R"- RESCUE/REMOVE:
 **** IMPORTANT NOTES:
R - Rescue  *Rescuing patients is every
Move patients and assist visitors or healthcare worker's primary
impaired employees away from concern and is usually performed
immediate danger of fire or smoke IF simultaneously with activating the
YOU CAN DO THIS WITHOUT alarm
PUTTING YOURSELF IN
IMMEDIATE DANGER and IF • Rescue/remove critically ill
THERE ARE OTHER STAFF patients in their beds.
AVAILABLE TO COMMUNICATE
THE EMERGENCY AND TURN IN • Ambulatory patients may
THE ALARM. walk to safety on their own
 A - Alert others with supervision. •
Activate manual pull station alarm as Rescue/remove semi-
soon as possible. Call #6688 and ambulatory patients first,
state the location, type of fire and then non-ambulatory
size. Notify co-workers - and make patients.
sure everybody in the area, and in
other departments in your area, know  NEVER attempt to enter a room
as well. where a fire is contained without
 C - Confine FIRST checking to see if the door
Close all doors and windows. Pack is warm or hot to the touch.
sheets and towels under doors to
contain smoke.  NEVER open a door if it is hot to
If there is oxygen in the area: the touch.
Oxygen to a patient can be shut off
by a nurse at the bedside after other  Familiarize yourself with the
staff have the patient and are institution's policy.
ventilating them.
Oxygen to a zone (a whole unit) can  Some may use additional processes
ONLY be shut off by Maintenance including, but not limited to: (1)
and Engineering after nursing staff placing a pillow on the floor outside

NLE POINTERS
the door to signify the room is and room or office number), and
empty; state what you are reporting (sight or
smell of smoke, or sight of fire and
 (2) placing a wet towel along the location).
bottom of the closed door to prevent
smoke from escaping, if the fire  ***If you discover smoke or flames
started in this room; or in an occupied patient room, call out
to a co-worker to call the emergency
 (3) placing a towel on the door number and activate the fire call
handle to a room where a non- box/pull station while you rescue the
ambulatory patient remains (not patient.
evacuated).
 Whenever you hear a fire alert, listen
 Evacuation for the building location of the fire
emergency.
 **Horizontal evacuation, which is
the type of evacuation used first, • Do not use elevators. Only
consists of moving patients down the use the stairs.
corridor, through at least one set of
fire doors to safe area. • Close all doors. Reassure all
patients, and visitors.
 **Vertical evacuation consists of
moving patients down the stairs to a  If you need to re-open a door, make
lower level of safety and ultimately sure it is closes and latches securely
out of the building. behind you.
• NEVER use elevators to • Listen for the all-clear code.

evacuate a fire area. You may then resume your
normal activity. Once the fire
• Evacuate ambulatory patients emergency has been cleared
before non-ambulatory you will be notified.
patients.
 "C"- Confine/Contain: Fire, smoke
• Move patient charts with and toxic combustion products must
patients. ALL healthcare be confined to the area where the fire
workers must know primary started as much as possible. Closing
and secondary safe areas and doors and windows can prevent the
route of evacuation. smoke from spreading, cut off the
flow of oxygen to the fire and save
 "A"- Alarm: Should you see smoke lives. Confine the fire as long as no
or flames, use the fire emergency one is in danger. Never open a door
call box or pull station. Dial the if it is hot to the touch. Keep fire
institution's emergency number and doors closed and automatically
give the page operator your name, closing fire doors, corridors and
the phone number you are calling stairwells free of obstructions.
from, exact location (building, floor

NLE POINTERS
 "E"- Extinguish: Handheld fire flames. You want to be about 8 to 10
extinguishers (of the appropriate feet away from the fire.
classification for the type of hazard
likely to occur in the area) are  "S"- Squeeze: Squeeze the top
located throughout the Institution. handle to the bottom handle to
discharge the extinguishing agent.
 **The most commonly used fire "S"- Sweep: Sweep the nozzle from
extinguisher is the ABC type and it side to side across base of the fire.
can be used for most types of fires. If
a specialty extinguisher is required in  *log roll yourself when you are in
a particular area, you will be oriented fire
to its use.
 The principles of STOP, DROP, and
 Never use water on grease or ROLL are simple
electrical fires.
 Stop, do not run, if your clothes
 **You should attempt to extinguish catch on fire.
only small, contained fires (no larger Drop to the floor in a prone position.
than a waste basket), where your
Cover your face with your hands to
safety is assured, you have an escape
route behind you, and a staff member protect it from the flames.
or other healthcare worker is Roll over and over to smother the
available to assist. fire. Don't stop until the flames
have been extinguished.
 The rescuing of those in immediate
danger,.sounding the alarm, and  If you are near someone whose
confining fire and smoke should be clothing catches on fire, be sure to
accomplished by other staff members stop
or healthcare workers. Even if you them from running and make them
extinguish the fire, the fire should
STOP, DROP, and ROLL.
still be reported by. All fire
extinguishers operate in the same
way-
 "P.A.S.S." (Pull, Aim, Squeeze and  First-degree:

Sweep). • Eg., sunburn; heal without
scarring.
 "P"- Pull: Pull the pin from the fire
extinguisher handle at the top of the  Second-degree:
fire extinguisher. (Remember not to
squeeze handles when removing the • Blister formation; usually
pin.) heal without scarring.
 "A"- Aim: Take 3 steps back and  Third-degree:

then aim the horn or hose at the base
of the fire, not at the smoke or • Painless; full thickness burns.

NLE POINTERS
• Scarring is inevitable. • Reed-Sternberg cells;
CD15/CD30 positive; two
• Keloids and potential for mirror image nuclei.
developing squamous cell • Reactive cells: eosinophils,
carcinoma. plasma cells,
• Fever, weight loss, night
 P. aeruginosa sweats.
• Anemia.
• Infection is common in burn • Painless enlargement of
victims. single group of lymph nodes;
cervical, supraclavicular,
 Ionizing radiation injury: anterior mediastinal
• Most sensitive tissues:
lymphoid, bone marrow, – INTEGRATED POINTERS
mucosa of GI tract; germinal
tissue.  Heat exhaustion and stroke
 Iron-overload disorders:
• Hemochromatosis and  LGU – Devolution code – RA 7160-
hemosiderosis. Local Government Code
 Give desferal or deferoxamine.
 Acute leukemia:
• Fever, bleeding, fatigue.  Immunization
• Bone pain, tenderness.
 3 vaccine with 3 doses – Dpt , OPV,
• Anemia, thrombocytopenia.
Hep. B
• Metastatic disease: liver,
CNS, lymph nodes, skin.  Needs dilluent – bcg and AMV or
 Chronic leukemia: measles
• Insidious onset.
 6 weeks baby must receive – Penta 1,
• Involved: liver, lymph nodes.
PCV1,OPV1
• Thrombocytopenia, anemia.
 Chronic lymphocytic leukemia:  Therapeutic communications
• Over 60 years of age.  Preparedness Disaster &
• "Smudge cells." Management
• Most common leukemia.
• Lymphadenopathy.  Onco-
• Immune hemolytic anemia.
• Neutropenia.  Triage
 Prof Adjustment
 Hodgkin's Lymphoma:
• EBV association.

NLE POINTERS
 LMR  DABDA PROCESS
 NANDA -madami din
Leadership Style
 POSITIONING THORACENTESIS
Research  BLOOD PRODUCTS
 INFECTION CONTROL
Assisting patient in commode
 SHOCK MANAGEMENT
 Assisting client under maintatinance
 SMOKING
drug for hypertension  AML & ALL
 S/E of antihypertension  THEORISTS
 Lead Poisoning  FAMILY PLANNING
 Ampule dosage computation  PHARMACOLOGY –
 IV – priming  Z TRACK IRON – 10 mins hold
 IVF types  Leopolds
 Blood expanders – PLRS ,  Menstrual cycle phases and
crystalloids hormones
 Normal assessment of newborn  IUD & Hmole
 Delegations  •vaccine--is damage by heat –
 Autonomy
measles – brown vial
 Beneficence
 •pillars of PHC
 Misfeasance
 Partograph
 Malpractice & negligence
 NORMAL ASSESSMENT OF
 Bed Making
 Massage purposes NEWBORN
 Code of ethics  TYPES OF BREASTMILK -
 DRUG COMPUTATION
colostrum
 BT
 PID-Pelvic inflammatory disease
 blood products computation,
 Leptospirosis signs and symptoms and
 Sputum culture
predisposing factors (Gonorrhea
 CVA,
 M.I &clamydia)
 CARE WITH THE ELDERLY  Trichomoniasis
 Candidiasis/moniliasis
WITH INCONTINENCE
 HPV - Condylomata
 CATHERIZATION
 30cm fundic height = 35 weeks AOG
 DROPLET PRECAUTION
 ZIKA
 HIV/AIDS
 COLOSTOMY CARE
 RESEARCH
 CLIENTS WITH DYSPHAGIA
 TRACHEOSTOMY CARE
 Reynauds ,
 NUTRITION -GAVAGE FEEDING
 thromboangitis,
BURNS  thyroidectomy,
 TBSA  Chest physiotherapy
 IMCI  Hyperkalemia
 PCA  Heparin
 APPLIED RESEARCH  GCS

NLE POINTERS
 Cushings syndrome,  Blood Transfusion
 periop.onco – Newborn Assessment
 CHRONS – Copar
 M.I –
BMI computations
 AAA - Aneurysm
 ANGINA – Burns -Rule of 9
 DM - INSULINS – DM, IIP, PTB, HPN,Arthritis,
 SLE Asthma,Pneumonia
 *POSITIONING in bleeding Eye Ear Procedures
 Positioning Post op – cataract, and InSomnia
mastectomy Phobia
 *ASPIRIN Assault and Battery
 LUNG CANCER Beneficence,
 BRACHYTHERAPY Addiction slogan- “Jail the pusher
 CHEMO AND RADIATION save the user “
 PERIOPERATIVE Nsg Delegation
PROCEDURES AND Nsg process
PRINCIPLE Maslow of hierarchy
 BUCKS & BRYANTS Peer problems
 SKELETAL TRACTIONS Erick Erickson Theory
 Depression
 SLE Crude Birth Rate
 COPD – bronchitis
BEMONC
 Therapeutic communications
 marijuana - -cannabis sativa  Unang Yakap
 CONFLICT management ,
 PTSD –  ImCI
 BULIMIA –
 Suicide precation  IV computation
 ALZHEIMER'S –
 PARKINSON'S –  Autonomy
 ANTI DEPRESSANTS –
 SEIZURE –  Veracity
 neurotransmitter –
 Mydriatics and miotics  Code of ethics
 Atropine
 Pacemaker
 Abdominal aortic aneurism

 EBOLA and MERS and ZIKA,
Measles, Cholera  Penylketonuria
 Ebola

NLE POINTERS
 Perioperative nursing  Pneumonia
Eye
 Charting of drug administration
 Ear Procedures
 Malnutrition signs and symptoms
 InSomnia – provide milk
 Log rolling patient and its procedure
 Phobia.
 Emphysema
 Abnormal blood bleeding
 Grieving process – DABDA endometrial cancer
 Parathyroidism  Oxytocin hormones influences milk
 Hyperthyroidism let down reflex
 Sub Q is it 25-27  Libel
 Cotton balls in thermometer cleaning  Apnea – respiratory arrest
 Herbal meds – niyog niyogan –  Iron

antihelmithic  oxytocin emergency drug for
 Emphysema postpartum bleeding
 Respiratory depression signs and  position of patient for bedpan

symptoms  postpartum mother position for
 Positioning of client in bed bleeding
 Condom counseling
 HIV  diagnosed with Diabetes - above 5.5

mmol/mol
 defamation
 Normal: Below 42 mmol/mo
 DM
 Obese- Endomorph body
 IIP
 For ID injection: needle size is ¼
 PTB -1/2 inch26-27 gauge
 HPN  Crede’s Prophylaxis – prevents

Gonorrhea and Chlamydia to baby
 Arthritis
 little boy brought to health center. He
 Asthma
has a lot of anting-antings -Welcome
the mom & child to health center

NLE POINTERS
 Generic Name of Dilantin? Answer:  charting,
Phenytoin
 SOAPIE.
 Condom catheter How to apply it:
spirally around the shaft of penis  SMART planning
 Advantage over Foley Catheter  KARDEX
 1st vaccine given at birth – Bcg  Charting by exception, incident

report
 Pink eye disease - Viral
conjunctivitis  Heart- Hyperkalemia
 Who owns patient chart’? Answer:  kidney failure – acid base imbalance
hospital.  Measles – SQ route (40-50 angle
 Stages of COPAR. degree)
 Stages of Conflict Management  ECTOPIC – palpable adnexal mas
 Rheumatic Fever infected mother –  H- mole – palpable mass are broad

delivery in semifowlers or sitting and round
position  PRC - The office who has the
custody of records of administrative
 AIDS support group - IKATLO cases and investigations
 Note: that PRC fix the time and
 Arterial Blood Gases. Metabolic
place of examination
Acidosis & Alkalosis. Compensated  Note: DECS or CHED has the power
VS uncompensated. to close Nursing schools
 Amphetamine/Cocaine overdose
 BON powers- to issue and, after due
 Seeing things Illusion falsely
investigation, suspend or revoke
 Hearing sounds - hallucination certificates of registration
 A teenage girl was raped. But she

wants to keep it from her parents. –
READ ABOUT:
disclosed the information or divulge
and tell to the parents Glaucoma, Delirium, Tegretol, Crisis, Alcohol
withdrawal & Meds, Research, Slovins Formula,
 Affordable Rich in calcium –
Fracture, Corneal Ulcer, Stroke, Osteoarthritis,
Anchovies
rheumatoid Arthritis, Primary Prevention,
 ADPIE process Alzheimers, Anxiety, Theracom. & Theratouch
 Tracheostomy care!

NLE POINTERS
Nx process, Colorectal, Prostate, 12 Lead ECG,
LM, CHF, Colonoscopy
PID- gonorrhea and Chlamydia
Triage. Firstaid
Spinal Cord Injury, ethics

POINTERS

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all of their interaction with the health

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Post-exposure prophylaxis (PEP)

Categories of contact with suspect Post-exposure prophylaxis

Road to Success by: JONAS MARVIN ANAQUE

Vaccine HDCV or PCECV 1.0 mL, IM 1. Chimpanzees

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Social Mobilization  9 months Measles ***

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

 MDMA's effects last about 3 to 6

Road to Success by: JONAS MARVIN ANAQUE

 deer ticks = LYME'S DISEASE.  DROPLET PRECAUTIONS for

 Burns: Emergent Phase

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

 v Clarification: encouraging the √ CVA

Road to Success by: JONAS MARVIN ANAQUE

 Puncture the body part as directed by  Aneurysms:

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

 Acromegaly excess GH .... Initial signs  Erectile dysfunction:

• Obstruction, hematuria, PSA. • Sildenafil (Viagra); Yohimbe.

• Obstructive uropathy, bladder • Uncommon.

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

• Episodic and reversible Theophylline toxicity can be treated with beta

 Extrinsic asthma:  Theophylline has several anti-inflammatory

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

 Lab:  Diabetes mellitus:

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

• Small vessel endothelial  Tobacco use causes:

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

Road to Success by: JONAS MARVIN ANAQUE

• NEVER use elevators to • Listen for the all-clear code.

Road to Success by: JONAS MARVIN ANAQUE

 "P.A.S.S." (Pull, Aim, Squeeze and  First-degree:

 "A"- Aim: Take 3 steps back and  Third-degree: