MEDICAL SURGICAL NURSING (DAY 1) COMPETENCY APPRAISAL 2

Lecturer: Prof. Ferdinand B. Valdez, RN, MAN, MPH January 13, 2023 (1:00-7:00 PM)

Magic 2’s in Drug Monitoring • Both RA OA = no cure

Toxicity • Both RA OA = best exercise is swimming – to
Drugs Normal range
level strengthens muscles
Digoxin (Linoxin) 2 0.5 – 1.5 meq/L
Lithium (Eskalith) 2 0.6 – 1.2 meq/L • Gout = Increase uric acid = Normal: 2-7 mg/ dL
Aminophylline o Purine = organ meat
20 10-19 mg/ 100ml
(theophylline) o Sea foods = salmon, sardines, scallops
Dilantin (phenytoin) 20 10 – 19 mg/ 100 ml o Soya = taho, tofu, nuts, chocolates
Acetaminophen • Uric acid = formation of nucleic acid – RNA/ DNA
200 1030mg/ 100ml
(Tylenol) • Can beer and wine leads to gout – alcohol
competes with uric acid for excretion. Dadami sa
Drugs Classification Indication uric acid sa blood – hyperuricemia – Tophi
Digoxin Cardiac • Tophi = formation of uric acid > bigger bones
(Linoxin) glycosides/ CHF (pwede rin magka kidney stones)
digitalis
Lithium Anti manic Bipolar Congestive heart failure
(Eskalith) agent disorder - Inability of the heart to pump blood towards
Aminophylline systemic circulation.
Bronchodilators COPD - Predisposing/ risk factors: FAILURE
(theophylline)
Dilantin • F – faulty heart valves (mitral valve stenosis/
Anti-convulsant Seizure tricuspid valve stenosis) (stenosis – narrowing/
(phenytoin)
Acetaminophen Non-narcotic Mild to sumikip)
(Tylenol) analgesic moderate pain • A – arrhythmia (atrial fibrillation)
• Seizure – convulsive attack (acute), 1st time • I – infarction (myocardial infarction)
• Epilepsy – successive seizure attack (chronic), 2nd • L – lineage (hereditary)
time/ 3rd time/ 4th time and so on… • U – uncontrollable hypertension (who don’t take
• Pain scale: their meds at specified time)
o 1-3 = mild pain • R – recreational drug use (cocaine/ nicotine)
o 4-6 = moderate pain • E – evaders > microorganism > + GABHS Group
o 7-10 = severe pain A Beta Hemolytic Streptococcus
• Non-narcotic analgesic = OA and RA Systemic circulation
• Rheumatoid Arthritis = idiopathic, systemic (buong - Unoxygenated blood will go to superior vena cava
katawan masakit), smaller bones (hands and feet), and inferior vena cava.
morning stiffness more than 30 mins, nahirapan - Saan galing ung dugo ni SVC = head, face, neck,
tumayo, swan neck deformity (bukol – shoulders, arms, going to the heart by SVC
subcutaneous nodules = painless), oral steroids, - IVC = feet, legs, thighs, organs of the abdomen,
autoimmune, bilateral, subq nodules – no pain, oral going to the heart by IVC
steroid, unknown cause - SVC & IVC > right atrium > tricuspid valve > right
• Osteoarthritis = Degenerative, localized, bigger ventricle > pulmonary artery > lung (oxygenation) >
bones (hips and knees), morning stiffness less than pulmonary vein > left atrium > mitral valve > left
30 mins, Obese, mabagal maglakad, matanda, ventricle > Aorta > Systemic circulation
osteophytes, steroid injection, unilateral, weight- - Clockwise
bearing, Osteophytes (bone spurs) • RSHF – tricuspid valve
• LSHF – mitral valve
- CHF m.o. = GABHS

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MEDICAL SURGICAL NURSING (DAY 1) COMPETENCY APPRAISAL 2
Lecturer: Prof. Ferdinand B. Valdez, RN, MAN, MPH January 13, 2023 (1:00-7:00 PM)

• C – cyanosis
- Nursing procedure that could lead to hypoxia:
suctioning.
Right sided heart failure
Signs and symptoms: (venous congestion)
• Jugular vein distention
• Pitting edema
• Ascites
• Weight gain
• Hepatosplenomegaly
• Abdominal pain
• Jaundice
• Pruritis/ urticaria
- Can RSHF leads to Left sided = No, bcz ung cause • Esophageal varices
ng RSHF ay tricuspid valve stenosis, ung backflow • Anorexia
nya papunta sa right, hindi papunta sa lungs • Generalized body malaise
- Can left sided leads to right = Yes, bcz ung cause Treatment for CHF (MAD DOG)
ng LSHF ay mitral valve, ung backflow nya papunta M – morphine SO4 (narcotic/ opioid analgesic):
sa right, clockwise sya - MOA: To induce vasodilation and decrease
Left sided heart failure levels of anxiety
Signs and systems: - Nursing care:
• Pulmonary edema/ congestion: 1) Monitor strictly VS especially BP and RR. If
o Dyspnea the RR is below 12 breaths/ min, notify the
o Paroxysmal nocturnal dyspnea – tuwing HCP and prepare for an antidote: Narcan/
gabi. Hindi sya makatulog kasi parang naloxone.
nalulunod sya. 2) Monitor side effects:
o Orthopnea – diff of breathing while lying a) Hypotension
down. (u give 2- 3 pillows or put into high b) Respiratory depression
fowlers position or tripod position ) A – aminophylline (theophylline): Bronchodilator
o Productive cough (blood tinged sputum) - MOA: it dilates the bronchial tree thereby
o Frothy salivation allowing more air to enter the lungs.
o Rales/ crackles - Nursing care:
o Bronchial wheezing 1) Monitor side effects: tachycardia,
• Anorexia and generalized body malaise palpitations, restlessness, irritability, and
• PMI is displaced laterally. (PMI – point of agitation.
maximum impulse, between 4th to 5th ICS, L 2) Instruct the client to avoid taking foods
MCL). Aka. apical pulse beverages high in caffeine/ stimulants.
• Cyanosis D – diuretics:
• S3 (ventricular gallop) (S4 = MI; S3 = CHF) a) Potassium wasting diuretics
Hypoxemia – decrease O2 in the blood - Ex:
- Leads to hypoxia (decrease O2 to tissues) • Bumex
- Normal po2: 80-100 • Furosemide (Lasix) – max therapeutic
- Early signs: effect = 6 hrs, IV push = 5-10 mins
• R – restlessness • Hydrochlorothiazide
• A – agitation • Mannitol (Osmitrol)
• T – tachycardia - Side effects:
- Late signs: • Hypovolemia
• B – bradycardia • Hypotension
• E – extreme restlessness • Hyponatremia
• D – dyspnea • Hypokalemia

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MEDICAL SURGICAL NURSING (DAY 1) COMPETENCY APPRAISAL 2
Lecturer: Prof. Ferdinand B. Valdez, RN, MAN, MPH January 13, 2023 (1:00-7:00 PM)

b) Potassium sparring diuretics Test taking strategies

- Ex:
• Spironolactone (Aldactone)
• Amiloride
• Triamterene
- Side effects:
• Hypovolemia
• Hypotension
• Hyponatremia
• Hyperkalemia
D – digoxin (Lanoxin): Cardiac glycosides/ digitalis
- MOA:
• Positive Inotropic – it increases the force of
myocardial contraction, thereby increasing
cardiac output.
• Negative chronotropic – it decreases heart
rate
- Nursing care:
1) Before giving digoxin, check for the apical
pulse rate/ heart rate, if it is below 60 bpm,
DO NOT GIVE the drug and notify the HCP
2) Monitor serum electrolyte: K = Normal: 3.5-
5 meq/ L
Magic 5:
Normal sodium: 135-145 meq/L
Potassium 3.5-5 meq/L
Calcium: 8.5-10.5 mg/dL
Phosphorus: 2.5 – 4.5
Magnesium: 1.5-2.5 mg/ dL
Chloride: 95-105 mg/dL
3) Monitor for signs of digitalis toxicity:
• Anorexia
• Nausea and vomiting
• Diarrhea
• Bradycardia
• Confusion
• Photophobia
• Seeing yellowish spots or xanthopsia
4) prepare for an antidote: Digibind
(immuneFAB)
O – oxygen administration
- high inflow of O2 = 4-6 L/min
G – gases monitoring/ ABG analysis
- PO2 = decrease (hypoxemia): N pO2: 80-100
- pCO2 = Increase (Hypercarbia/ Hypercapnia)
Normal: 35-45
- Indicates: respiratory Acidosis

Ehehe late na me nakapagsend dahil inayos ko pa notes ko.

Paki note/ correct nlng kung may malii.
Good luck sa posttest~~
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MEDICAL SURGICAL NURSING (DAY 1) COMPETENCY APPRAISAL 2
Lecturer: Prof. Ferdinand B. Valdez, RN, MAN, MPH January 13, 2023 (1:00-7:00 PM)

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