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POSSIBLE TOPICS ON MEDICAL AND SURGICAL HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE
*Patterned on the previous board exams from December 2006 – July 2012… the purpose of this note is to GUIDE students on
the possible topics that might be part of the upcoming Dec 2012 PNLE
WHAT YOU SHOULD KNOW BEFORE THE PNLE
DECEMBER 2012 PNLE PEARLS OF SUCCESS
ONCOLOGY NURSING Yearly papanicolao (Pap) smear for sexually active females and
any female over age 18
A. Benign VS Malignant Neoplasm At menopause, high-risk women should have an endometrial
tissue sample
Characteristic Benign Neoplasm Malignant Neoplasm
Speed Growth Grows slowly Usually grows rapidly 4. For detection of prostate cancer
Usually continues Tends to grow relentlessly At age 50, have a yearly digital rectal examination
to grow throughout throughout life At age 50, have a yearly prostate-specific antigen (PSA) test
life unless
surgically removed C. American Cancer Society’s seven warning signs of cancer
Mode of Grows by enlarging Grows by infiltrating (uses acronym CAUTION US):
Growth and expanding surrounding tissues 1. Change in bowel or bladder habits
Always remains May remain localized (in 2. A sore that does not heal
localized; never situ) but usually infiltrates 3. Unusual bleeding or discharge
infiltrates other tissues 4. Thickening or lump in breast or elsewhere
surrounding 5. Indigestions or difficulty in swallowing
tissues 6. Obvious change in wart or mole
Capsule Almost always Never contained within a 7. Nagging cough or hoarseness
contained within a capsule
fibrous capsule Absence of capsule allows 8. Unexplained Anemia
Capsule neoplastic cells to invade 9. Sudden loss of weight
advantageous surrounding tissues
because Surgical removal of tumor D. Internal Radiation Therapy (Brachytheraphy)
encapsulated difficult
tumor can be Sources of Internal Radiation
removed surgically Implanted into affected tissue or body cavity
Cell Usually well Usually poorly Ingested as a solution
characteristics differentiated differentiated Injected as a solution into the bloodstream or body cavity
Introduced through a catheter into the tumor
Recurrence Unusual when Common following surgery
Side Effects
surgically removed because tumor cells spread
Fatigue
into surrounding tissues
Anorexia
Metastasis Never occur Very common Immunosuppression
Effect of Not harmful to host Always harmful to host Other side effects similar to external radiation
Neoplasm unless located in Causes disfigurement,
area where it disrupted organ function, Client Education
compresses tissue nutritional imbalances Avoid close contact with others until treatment is completed
or obstructs vital May result in ulcerations, Maintain daily activities unless contraindicated, allowing for extra
organs sepsis, perforations, rest periods as needed
Prognosis Very good Depends on cell type and Maintain balanced diet
Tumor generally speed of diagnosis Maintain fluid intake ensure adequate hydration (2-3 liters/day)
removed surgically Poor prognosis if cells are If implant is temporary, maintain bedrest to avoid dislodging the
poorly differentiated and implant.
evidence of metastatic Excreted body fluids may be radioactive; double-flush toilets after
spread exists use
Good prognosis indicated if Radiation therapy may lead to bone marrow suppression
cells still resemble normal
cells and there is no Nursing Management
evidence of metastasis Exposure to small amounts of radiation is possible during close
contact with persons receiving internal radiation: understand the
principles of protection from exposure to radiation: time, distance,
B. Recommendations of the American Cancer Society for Early and shielding
Cancer Detection Time: minimize time spent in close proximity to the
1. For detection of breast cancer radiation source; a common standard is to limit contact time
Beginning at age 20, routinely perform monthly breast self- to 30 minutes total per 8-hour shift;
examination Distance: maintain the maximum distance 6 feet possible
Women ages 20-39 should have breast examination by a from the radiation source
healthcare provider every 3 years Shielding: use lead shields and other precautions to reduce
Women age 40 and older should have a yearly mammogram exposure to radiation
and breast self-examination by a healthcare provider Place client in private room
Instruct visitors to maintain at least a distance of 6 feet from the
2. For detection of colon and rectal cancer client and limit visitors to 10-30 minutes
All persons age 50 and older should have a yearly fecal occult Ensure proper handling and disposal of body fluids, assuring the
blood test containers are marked appropriately
Digital rectal examination and flexible sigmoidoscopy should Ensure proper handling of bed linens and clothing
be done every 5 years In the event of a dislodged implant, use long-handled forceps and
Colonoscopy with barium enema should be done every 10 place the implant into a lead container; never directly touch the
years implant
Do not allow pregnant woman to come into any contact with
3. For detection of uterine cancer radiation
POSSIBLE TOPICS ON MEDICAL AND SURGICAL HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE
*Patterned on the previous board exams from December 2006 – July 2012… the purpose of this note is to GUIDE students on
the possible topics that might be part of the upcoming Dec 2012 PNLE
WHAT YOU SHOULD KNOW BEFORE THE PNLE
DECEMBER 2012 PNLE PEARLS OF SUCCESS
The radiation oncologist marks specific locations for radiation S1 - due to closure of the AV(mitral/tricuspid) valves
treatment using a semipermanent type of ink S2 - due to the closure of the semi-lunar (pulmonic/aortic) valves
Treatment is usually given 15-30 minutes per day, 5 day per S3 – Ventricular Diastolic Gallop
week, for 2-7 weeks Mechanism: vibration resulting from resistance to rapid
The client does not pose a risk for radiation exposure to other ventricular filling secondary to poor compliance
people S4 - Atrial Diastolic Gallop
Mechanism: vibration resulting from resistance to late
Side Effects ventricular filling during atrial systole
Tissue damage to target area (erythema, sloughing, hemorrhage) Heart Murmurs
Ulcerations of oral mucous membranes Incompetent / Stenotic Valve
GIT effects such as nausea, vomiting, and diarrhea Pericardial Friction Rub
Immunosuppression It is an extra heart sound originating from the pericardial sac
Mechanism: Originates from the pericardial sac as it moves
Client Education Timing: with each heartbeat
Wash the marked area of the skin with plain water only and pat
skin dry; do not use soaps, deodorants, lotions, perfumes, powders C. ECG
or medications on the site during the duration of the treatment; do
not wash off the treatment site marks
Avoid rubbing, scratching, or scrubbing the treatment site; do
not apply extreme temperatures (Heat or Cold) to the
treatment site ; if shaving, use only an electric razor
Wear soft, loose-fitting over the treatment area
Protect skin from sun exposure during the treatment and for at
least 1 year after the treatment is completed; when going
outdoors, use sun-blocking agents with sun protector factor
(SPF) of at least 15
Maintain proper rest, diet, and fluid intake as essential to Cardiac Action Potential
promoting health and repair of normal tissues Depolarization/Contraction/Systole - electrical activation of
a cell caused by the influx of sodium into the cell while
potassium exits the cell
Nursing Management Repolarization/Resting/Diastole - return of the cell to the
Monitor for adverse side effects of radiation resting state caused by re-entry of potassium into the cell
Monitor for significant decreases in white blood cell counts while sodium exits
and platelet counts
Client teaching (refer to later sections for management of D. CARDIAC Proteins and enzymes
immunosuppression, thrombocytopenia
a. CK- MB ( creatine kinase)
Most cardiac specific enzymes
CARDIOVASCULAR NURSING Accurate indicator of myocardial dammage
Elevates in MI within 4 hours, peaks in 18 hours and
A. Heart Circulation then declines till 3 days
Normal value is 0-7 U/L or males 50-325 mu/ml
Female 50-250 mu/ml
b. Lactic Dehydrogenase (LDH)
Most sensitive indicator of myocardial damage
Elevates in MI in 24 hours, peaks in 48-72 hours
Return to normal in 10-14 days
Normally LDH1 is greater than LDH2
c. Troponin I and T
Troponin I is usually utilized for MI
Elevates within 3-4 hours, peaks in 4-24 hours and
persists for 7 days to 3 weeks!
Normal value for Troponin I is less than 0.6 ng/mL
REMEMBER to AVOID IM injections before obtaining
blood sample!
Early and late diagnosis can be made!
d. Serum Lipids
Lipid profile measures the serum cholesterol,
triglycerides and lipoprotein levels
Cholesterol= 200 mg/dL
Triglycerides- 40- 150 mg/dL
LDH- 130 mg/dL
HDL- 30-70- mg/dL
NPO post midnight (usually 12 hours)
POSSIBLE TOPICS ON MEDICAL AND SURGICAL HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE
*Patterned on the previous board exams from December 2006 – July 2012… the purpose of this note is to GUIDE students on
the possible topics that might be part of the upcoming Dec 2012 PNLE
WHAT YOU SHOULD KNOW BEFORE THE PNLE
DECEMBER 2012 PNLE PEARLS OF SUCCESS
4 . Indirect Bronchography
A radiopaque medium is instilled directly into the trachea
and the bronchi and the outline of the entire bronchial tree
or selected areas may be visualized through x-ray.
It reveals anomalies of the bronchial tree and is
important in the diagnosis of bronchiectasis.
POSSIBLE TOPICS ON MEDICAL AND SURGICAL HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE
*Patterned on the previous board exams from December 2006 – July 2012… the purpose of this note is to GUIDE students on
the possible topics that might be part of the upcoming Dec 2012 PNLE
WHAT YOU SHOULD KNOW BEFORE THE PNLE
DECEMBER 2012 PNLE PEARLS OF SUCCESS
Sputum specimen for C&S is collected before Auscultate lungs to assess for pneumothorax
the first dose of anti-microbial therapy. Monitor oxygen saturation (SaO2) levels
For AFB staining, collect sputum specimen for Bed rest
three consecutive mornings. Check for expectoration of blood
POSSIBLE TOPICS ON MEDICAL AND SURGICAL HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE
*Patterned on the previous board exams from December 2006 – July 2012… the purpose of this note is to GUIDE students on
the possible topics that might be part of the upcoming Dec 2012 PNLE
WHAT YOU SHOULD KNOW BEFORE THE PNLE
DECEMBER 2012 PNLE PEARLS OF SUCCESS
POSSIBLE TOPICS ON MEDICAL AND SURGICAL HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE
*Patterned on the previous board exams from December 2006 – July 2012… the purpose of this note is to GUIDE students on
the possible topics that might be part of the upcoming Dec 2012 PNLE
WHAT YOU SHOULD KNOW BEFORE THE PNLE
DECEMBER 2012 PNLE PEARLS OF SUCCESS
WOF: inadvertent or
accidental removal of
POSSIBLE TOPICS ON MEDICAL AND SURGICAL HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE
*Patterned on the previous board exams from December 2006 – July 2012… the purpose of this note is to GUIDE students on
the possible topics that might be part of the upcoming Dec 2012 PNLE
WHAT YOU SHOULD KNOW BEFORE THE PNLE
DECEMBER 2012 PNLE PEARLS OF SUCCESS
parathyroid gland
hypocalcemia or tetany [(+)
trousseu’s signs, (+) chvostek’s
Give Ca Gluc slowly to
prevent arrhythmia and
arrest
9. Hormonal Replacement
therapy for life
10. importance of FFup care
11. wearing of medic-alert
bracelet
B. Insulin Therapy
I. Types of Insulin
A. Rapid (SAI) – clear, peak: 2-4 hours , Regular insulin
B. Intermediate AI – NPH (Non-Protamine Hagedorn) –
cloudy, peak : 6-12 hours
C. Long AI – Ultra lente – cloudy, peak 12-24 hours
POSSIBLE TOPICS ON MEDICAL AND SURGICAL HEALTH NURSING FOR THE UPCOMING DEC 2012 PNLE
*Patterned on the previous board exams from December 2006 – July 2012… the purpose of this note is to GUIDE students on
the possible topics that might be part of the upcoming Dec 2012 PNLE