TranxCN NUR131 III Release 2024-2025 Medical-Surgical Nursing 1 PDF

TABLE OF CONTENTS BATCH 2026 TRANXCN TEAM DEPUTY HEADS Chavez, Bettina Gabrielle D. Roales, Julianne Cassandra C. TRANXCN TEAM Mickaela Beyonce S. Aventurado Sofia Pauline B. Bartolo Dhana Mae S. Delos Santos NUR 13...

TABLE OF CONTENTS BATCH 2026 TRANXCN TEAM DEPUTY HEADS Chavez, Bettina Gabrielle D. Roales, Julianne Cassandra C. TRANXCN TEAM Mickaela Beyonce S. Aventurado Sofia Pauline B. Bartolo Dhana Mae S. Delos Santos NUR 131 Lexis Mei G. Mendoza Nathalie Kyle A. Mendoza Josh Merrill E. Turingan Ritscal Alek Caballes MEDICAL-SURGICAL Maria Andrea Midge A. Matibag Romina Catherine F. Dizon Reese Stefanie C. Reyes Chynna Marionne B. Bicomong NURSING 1: Charlene M. Bundal Fritz Ashley Valenzuela Gelsey Marie Jamilah B. Escol Frances Charra I. Ducay Yesha Margaret Dusaran Ella Shammel L. Porte Patricia Mae T. Ponce Concept Jabez Roel A. Villaflor TranxCN: III RELEASE A.Y. 2024-2025 Maria Michaela D. Reyes Merced Eliza C. Diokno Kristina Amiella Lyn P. Leyva Guidelines: The Tranx CN is NOT FOR SALE and shall only be utilized by the bona fide nursing students from De La Salle medical and Health Sciences Institute. The students are permitted to download and print the Tranx CN. However, reproducing, imitating, altering or tampering any information on the transcriptions is strictly prohibited. Failure to abide by the Tranx CN guidelines will result in immediate termination of access to the transcriptions. Disclaimer: Please use at your own discretion. Tranx CN is not intended as a substitute for resource materials such as handouts, videos, and books provided by the college. All information on these transcripts is provided in good faith and is subjected to quality control. Regardless, the Tranx CN Team makes no representation or warranties of any kind regarding the accuracy, and completeness of any information in the transcripts. The College of Nursing Faculty/Professors are not liable for any mistakes or false information that may inadvertently be included in this transcript. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 36 NURSING 1 HOST RESPONSES TO INFECTION Non specific host resistance OUTLINE ○ First line of defense A. Infection ○ Second line of defense B. Host response to Infection Specific host resistance (Third line of defense) C. Nonspecific host defense ○ Two major arms of the immune system: a. 1st line of defense ○ Cell mediated immune response b. 2nd line of defense ○ Humoral (Antibody- Mediated) immune c. 3rd line of defense response ○ Antibodies INFECTION ○ Acquired immunity and its types The invasion of microorganisms in the body An infection occurs when germs enter the body, NONSPECIFIC HOST DEFENSE increase in number, and cause body reaction General and serve to protect the body against harmful substances HOW DO INFECTIONS OCCUR? Includes the innate or inborn resistance observed Three things are necessary for an infection to occur: among species of animals and some persons who ○ Source: Place where infectious agents (germs) have a natural resistance to certain diseases live (e.g., sinks, surfaces, human skin) ○ Susceptible person: a way for germs to enter 1ST LINE OF DEFENSE: PHYSICAL & CHEMICAL the body DEFENSES ○ Transmission: A way germs are moved to the Barriers: Skin, mucous membrane, stomach acid, susceptible person lysozyme in tears Expulsion: coughing, sneezing, vomiting, diarrhea DEVELOPMENT OF INFECTION: ONSET & COURSE Cellular & chemical factors INCUBATION PERIOD Microbial antagonism Is the time interval between the initial infection and the first appearance of any signs or symptoms 2ND LINE OF DEFENSE: INNATE IMMUNITY (NATURAL) PRODROMAL PERIOD INFLAMMATION A relatively short period that follows the period of A non-specific normal bodily defense mechanism to incubation any local injury, irritation, microbial invasion or Characterized by early, mild symptoms of disease bacteria toxins such as general aches and malaise. The inflammatory cells and cytokines sent out by the immune system to initiate an inflammatory PERIOD OF ILLNESS response to trap bacteria and other offending The disease is most acute agents or start healing injured tissue The person exhibits overt signs and symptoms of It is a localized reaction intended to neutralize the disease control, or eliminate the offending agent to site for People can serve as reservoirs of disease during repair this stage Primary purpose: ○ Prevent the spread of microbial invaders PERIOD OF DECLINE ○ Localize an infection The signs and symptoms subside ○ Aid in repair of damaged tissue The fever decreases, and the feeling of malaise ○ Neutralize any toxins being produced at the site diminishes The patient is vulnerable to secondary infections Major events in the local inflammatory response: ○ Chemical signals released by activated PERIOD OF CONVALESCENCE macrophages and mast cells at the injury site The person regains strength and the body returns to cause nearby capillaries to widen and become its pre-diseased state more permeable Recovery occurs CHAVEZ, DIZON, VILLAFLOR, REYES 2 of 22 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 36 NURSING 1 ○ Fluid, antimicrobial proteins, and clotting THE COMPLEMENT SYSTEM elements move from blood to the site. Clotting A complement is a group of approximately 30 begins different proteins found in normal blood plasma ○ Chemokines released by various kinds of cells The proteins interact with each other in a stepwise attract more phagocytic cells from the blood to manner known as the “complement cascade” the injury site Major consequences of complement activation are ○ Neutrophils and macrophages phagocytose the following: pathogens and cell debris at the site, and the ○ Initiation and amplification of inflammation tissue heals ○ Attraction of phagocytes to sites where they are needed ○ Activation of leukocytes CARDINAL SIGNS OF INFLAMMATION ○ Lysis of bacteria and other foreign cells English Latin Cause ○ Increased phagocytosis by phagocytic cells Redness Rubor Vasodilation 3RD LINE OF DEFENSE (SPECIFIC): ADAPTIVE IMMUNITY (ACQUIRED) Heat Calor Vasodilation CELL MEDIATED IMMUNE RESPONSE A complex system of interactions between many Swelling Tumor Increased vascular cell types and cellular secretions / Edema permeability Directed towards infection by intracellular Increased granulation tissue pathogens Involves T-cells, natural killer cells, cytokines Pain Dolor Physical and chemical (lymphokines) stimulation of nociceptors HUMORAL (ANTIBODY MEDIATED) IMMUNE Loss of Functio Pain RESPONSE function Laesa Reflex muscle inhibition B-cells play a major role Disruption of tissue structure Involves the production of antibodies (Ab) or (Igs) Fibroplasia and metaplasia Antigen Foreign organic substances PHAGOCYTOSIS Antibody-generating substances The process by which phagocytes surround and Antigenic determinants (epitopes) engulf foreign material Can be divided into 2 groups: The two most important groups of phagocytes: ○ Foreign antigens ○ Macrophages ○ Self-antigens ○ Neutrophils Mechanisms of phagocytosis ○ Chemotaxis ○ Attachment ○ Ingestion ○ Digestion Antibodies (Ab) / Immunoglobulins (Ig) Soluble proteins produced by activated B-cells or plasma cell offsprings in response to an antigen Molecular weight of 150,000 daltons Acts on extracellular antigens CHAVEZ, DIZON, VILLAFLOR, REYES 3 of 22 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 36 NURSING 1 Y-shaped molecule consisting of 4-polypeptide Antibody production depends on the ff. Conditions: chains: Nature of the antigen ○ 2 identical heavy chains Site of antigenic stimulus ○ 2 identical light chains The amount of antigen The number of times the person is exposed to the antigen HUMORAL (ANTIBODY MEDIATED) IMMUNE RESPONSE: ACQUIRED IMMUNITY Acquired immunity ↓ Natural Immunity: Artificial Immunity Acquired through the Produced purposefully normal life experiences through medical of a human and is not procedures called induced through immunization medical means ↓ Active Passive Active Passive MAJOR CLASSES OF ANTIBODIES Immunity Immunity Immunity Immunity IgA Internal body secretions Herd Immunity IgD Found on B-cell membrane; antigen receptor This refers to a means of protecting a whole community from disease by immunizing a critical IgE Binds to membranes of basophils and mast mass of its populace cells; allergies The spread of disease from one person to person becomes unlikely when herd immunity is achieved IgG Lightest among all classes, enables complement fixation Alterations in immunity IgM 1st Ab produced in response to antigen, Most Allergy efficient component binding Ig bactericidal to ○ Deleterious effects of hypersensitivity to gram (-) bacteria environmental antigens. It can be immediate or delayed Autoimmunity ○ Breakdown of tolerance in which the body’s immune system begins to recognize self-antigens as foreign (ex. SLE) Alloimmunity ○ Occurs when an individual’s immune system reacts against antigens on the issues of other members of the same species Effects of antibodies: Inactivates the antigen Bind antigens together Activates the complement cascade Initiates the release of inflammatory chemicals Facilitates phagocytosis CHAVEZ, DIZON, VILLAFLOR, REYES 4 of 22 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 36 NURSING 1 IMMUNOLOGIC Increased thirst Pink or cola-colored urine OUTLINE Frequent urination Foamy urine A. Assessment B. Non-invasive diagnostic examinations Itching of the nose, eyes or Itching or hives all over the a. Urinalysis & Urine culture & sensitivity roof of the mouth body b. Chest X-ray Fatigue, fever and loss of Joint pain, stiffness C. Invasive Diagnostic Examinations appetite a. Complete blood count b. Antistreptolysin O Titer Headaches, confusion and Tender, warm, swollen joints c. Biopsy memory loss d. Blood culture & sensitivity e. CSG Gram staining Joint stiffness that is usually worse in the mornings and f. Elisa test after inactivity g. Western blot D. Tests for emerging infections OBJECTIVE DATA E. Innovative approaches for future POCTs Observe for pallor, cyanosis, jaundice and erythema ASSESSMENT Evaluate skin integrity RISK FACTORS Check for rash and note its distribution Observe hair texture and distribution Gender Current treatment Inspect nails Age Lifestyle / high risk Inspect the oral mucous membranes Race behaviors Inspect the male and female genitalia Past medical history Travel history / Palpate the peripheral pulses Genetics geography Palpate superficial lymph nodes Occupation Palpate for masses or lesions Percuss the anterior, lateral and posterior thorax SUBJECTIVE DATA Auscultate over the lungs INFECTIOUS NON-INVASIVE DIAGNOSTIC EXAMINATIONS Nuchal rigidity, Headache, Spasms and URINALYSIS (UA) AND URINE CULTURE AND more severe nausea, vomiting, stiffness in jaw headache, back abdominal pain muscles SENSITIVITY (URINE CS) and lower Urinalysis is a group of manual and/or automated extremity pain qualitative and semi-quantitative tests performed on a urine sample Stiffness of your Difficulty Excessive A routine urinalysis includes the ff tests: neck muscles swallowing salivation ○ Color ○ Ketones blood Hallucinations Night sweats Low appetite ○ Transparency ○ Bilirubin ○ Specific gravity ○ Urobilinogen Weakness & Fever Chills ○ pH ○ Leukocyte fatigue ○ Protein esterase ○ Glucose Chest pain when Cough which may Shortness of you breathe or produce phlegm breath cough Hydrophobia Chills & rigors Sore throat, coryza CHAVEZ, DIZON, VILLAFLOR, REYES 5 of 22 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 36 NURSING 1 To perform this test: NURSING CONSIDERATIONS ○ First urinate a small amount into the toilet bowl Remove all metallic objects to clear the urethra of any contaminants No preparation is required ○ Then, collect a small sample of urine in a clean Ensure the patient is not pregnant or suspected to or sterile container about 1-2 ounces of urine is be pregnant needed for a test Assess the patient’s ability to hold his or her breath ○ Remove the container from the urine stream Provide appropriate clothing without stopping the flow Instruct patient to cooperate during the procedure ○ You may finish urinating into the toilet bowl ○ Take the sample to the lab INVASIVE DIAGNOSTIC EXAMINATIONS For infants: COMPLETE BLOOD COUNT (CBC) ○ The genital area is cleaned and dried, and then One of the most commonly ordered blood tests a collection device is attached to collect the which include the calculation of the cellular (formed urine elements) of blood ○ If you are asked to collect the urine, be sure the Special machines analyze the different components collection device is attached securely to prevent of blood in less than a minute and generally leakage determine these calculations. ○ After your baby has urinated, the urine (at least 20cc) is placed in a sterile container COMPONENTS TO BE MEASURED: NURSING CONSIDERATIONS Instruct the patient to void directly into a clean, dry container. Sterile, disposable containers are recommended Cover all specimens tightly, label properly and send immediately to the laboratory If a urine sample is obtained from an indwelling catheter, it may be necessary to clamp the catheter for about 15-30 mins before obtaining the sample Observe standard precautions when handling urine specimens CHEST X-RAY (CHEST RADIOGRAPHY) A chest x-ray is a test that uses electromagnetic waves to produce visual images of the heart, lungs, bones and blood vessels of the chest USES It may be a part of a routine check-up or screening, INDICATIONS or as a follow-up test to monitor certain treatments Assist in the diagnosis of diaphragmatic hernia, lung It can also be done as a part of an evaluation based tumors and metastasis on patient’s symptoms Detect known or suspected pulmonary, Screen for a wide range of conditions and diseases cardiovascular and skeletal disorders Monitor the condition and/or effectiveness of Identify the presence of chest trauma treatment after a diagnosis is established Confirm correct placement and position of the Help diagnose various conditions, such as anemia, endotracheal tube, tracheostomy tube, chest tubes infection, inflammation, bleeding disorder or nasogastric feeding tube, leukemia Evaluate positive purified protein derivative (PPD) or Monitor treatment that is known to affect blood mantoux test for pulmonary tuberculosis cells, such as chemotherapy or radiation therapy Monitor progressions, resolutions, or maintenance of disease Evaluate the patient’s response to a therapeutic regimen (antibiotic, chemotherapy) CHAVEZ, DIZON, VILLAFLOR, REYES 6 of 22 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 36 NURSING 1 NURSING RESPONSIBILITY REFERENCE VALUES Explain procedure Encourage them to avoid stress if possible because < 5 years < or = 70 IU/mL altered physiologic status influences and changes normal hematologic values 5-17 years < or = 640 IU/mL Explain that fasting is not necessary Apply manual pressure and dressings over the > or = 18 years < or = 530 IU/mL puncture site on removal of dinner Monitor the puncture site for oozing or hematoma Elevated values Infection by group A streptococci formation Instruct to resume normal activities and diet RISKS ANTISTREPTOLYSIN 0 TITER (ASO TITER) Bleeding Feeling lightheaded This test looks for antibodies that the body makes Infection Slight sting or pain while fighting group A streptococcus bacteria Bruising Soreness The antibodies work against a substance made by NURSING RESPONSIBILITIES the bacteria called streptolysin O Explain that slight discomfort may be felt when the Group A Streptococcus causes strep throat that skin is punctured may lead to rheumatic fever Encourage to avoid stress if possible because altered physiologic status influences and changes PURPOSE normal hematologic values Test is done to find out a current or recent strep Explain that fasting is not necessary infection Apply manual pressure and dressings over puncture Antibodies from a strep infection begin to increase site on removal of dinner about 1 week after infection Monitor the puncture site for oozing or hematoma Get higher or several weeks before decreasing formation As antibodies don’t decrease right away, the better Instruct to resume normal activities and diet test to use to diagnose a strep infection is the rapid strep test BIOPSY Other tests may be done: A procedure to remove a piece of tissue or a sample Throat culture for group A beta-hemolytic of cells from the body so that it can be analyzed in a streptococci laboratory If a rheumatic fever may ensue, there is also a need Imaging tests can’t differentiate cancerous cells for other antibody tests (Anti-DNase B, from a noncancerous cells antihyaluronidase or anti-Streptozyme) RESULTS OF THE TEST AND ITS MEANING The test results may not mean the patient have a problem A negative result: no antibodies to the strep bacteria in the blood A positive result: antibodies have been found CHAVEZ, DIZON, VILLAFLOR, REYES 7 of 22 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 36 NURSING 1 ○ Check the patient’s history for hypersensitivity to anesthetics During the test ○ Remind the pt undergoing a needle biopsy to sit still ○ Assist with the collection of specimens into the appropriate containers, if indicated ○ Send the specimens to the laboratory immediately, if appropriate After the test ○ If patient received a general or local anesthetic - monitor VS regularly ○ General anesthetic - check VS q15 minutes for 1 hour, every 30 minutes for 2 hours, every hour for the next 4 hours, and then every 4 hours. ○ Administer analgesics for pain and provide ice bags for comfort. ○ Instruct the patient to wear a support brace at NEEDLE BIOPSY PROCEDURES: all times until healing is complete Fine needle aspiration ○ Observe & report bleeding, tenderness, and Core needle biopsy redness at biopsy site Vacuum-assisted biopsy ○ Provide emotional support while awaiting Image-guided biopsy diagnosis SKIN BIOPSY BLOOD CULTURE & SENSITIVITY TEST Shave biopsy A blood culture is a test to find germs (such as Punch biopsy bacteria or a fungus) that can cause an infection Incisional biopsy A blood sensitivity test checks to see what kind of Excisional biopsy medicine, such as an antibiotic, will work best to treat the illness or infection BIOPSY ANALYSIS AND RESULTS Tissue sample sent to a laboratory for analysis Sample may be chemically treated or frozen and sliced into very thin sections, stained to enhance contrast and studied under a microscope The grade is on a scale of 1 to 4 Low-grade (grade 1) cancers are generally the least aggressive and high-grade (grade 4) To find out systemic infection NURSING RESPONSIBILITIES ○ An infection that affects the whole body, not just Before the test one part ○ Confirm the patient’s identity A sample of blood is studied in a lab to check for ○ Describe the procedure bacteria or a type of fungus called yeast. ○ For needle biopsy - ned to sit still during the procedure ○ If with local anesthetic - no restriction on food, fluids, and medication ○ if with general anesthetic - fast from midnight before the procedure ○ Explain the pretest studies - blood tests, urine tests, and chest X-rays, may be required. ○ Make sure the patient or surrogate a consent form CHAVEZ, DIZON, VILLAFLOR, REYES 8 of 22 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 36 NURSING 1 PURPOSE NURSING RESPONSIBILITIES Symptoms of a systemic infection: Before the test ○ Chills ○ Confirm the pt’s identity ○ Fever ○ Explain to pt that procedure is used to help ○ Tiredness (fatigue) identify the organism ○ Confusion ○ Inform pt NO restriction of food and fluids ○ Nausea ○ Advise pt slight discomfort from the tourniquet ○ Rapid breathing or heart rate and needle punctures ○ Passing urine less often During the test (though not a nurses’ responsibility) A blood c/s is done to confirm an infection ○ Put on gloves (pneumonia) and figure out the best way to treat it ○ Clean the venipuncture site with an alcohol swab and then with an iodine swab, working in OTHER TESTS a circular motion from the site outward If HCP pneumonia - a gram stain on sputum - find ○ Wait at least 1 minute for the patient’s skin to out what causes infection dry, and remove the residual iodine with an Susceptibility testing - find out which antibiotic is alcohol swab or remove the iodine after applicable for the infection venipuncture CBC either before or with the blood culture – test ○ Apply the tourniquet level of WBC ○ Perform a venipuncture; draw 10 to 20 mL of blood for an adult RESULTS ○ Clean the diaphragm tops of the culture bottles Test results may not mean a problem with alcohol or iodine (or other antiseptic agent A positive result means bacteria or yeast are present per facility policy), and change the needle on in your blood the syringe A negative result means that no signs of any. ○ If broth is used, add blood to each bottle until a bacteria or yeast were found in the blood 1:5 or 1:10 dilution is obtained. For example, add 10 mL of blood to a 100-mL bottle. (The PROCEDURE size of the bottle varies, depending on facility Done with at least two blood samples (multiple procedure.) samples produces accurate results) ○ If a special resin is used, add blood to the resin Blood samples are placed in a dish with a in the bottles and invert them gently to mix substance that promotes growth of bacteria or yeast ○ If the lysis–centrifugation technique (Isolator) is - called culture used, draw the blood directly into a special Results after 24 hours, but it can take 48 to 72 collection and processing tube hours to find out the specific bacteria or yeast ○ Indicate the tentative diagnosis on the causing your infection laboratory request as well as current or recent antimicrobial therapy RISKS ○ Send each sample to the laboratory immediately Bleeding after collection Infection After the test Bruising ○ Apply direct pressure to the venipuncture site Feeling lightheaded until bleeding stops Slight sting or pain while needle is inserted ○ Assess the venipuncture site for hematoma Soreness of the site formation; if one develops, apply direct pressure ○ Prepare to initiate antimicrobial therapy, as ANTIBIOTIC EFFECTS ordered Blood sample should be drawn just before taking antibiotics Antibiotic could slow the growth of the infecting bacteria CHAVEZ, DIZON, VILLAFLOR, REYES 9 of 22 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 36 NURSING 1 CSG GRAM STAINING List of current medications A laboratory procedure used to detect the presence. Stop taking Aspirin & other blood thinning of bacteria and sometimes fungi in a sample taken medications from the site of a suspected infection For outpatients, must be accompanied by an adult ○ Permits rapid identification of bacterial cause in 60-90% of pts with bacterial meningitis RISKS ○ Presence of bacteria is 100% specific, but the Discomfort or pain during the procedure sensitivity of this test for detection is variable Bleeding into the spinal cord, particularly in people who take blood thinners or have a low platelet count (thrombocytopenia) Headache as a result of CSF leakage Infection Nerve damage USES It involves applying a sample from the infected area To identify the cause of a bacterial infection onto a glass slide and allowing it to dry - then Shape of the bacteria and whether they are treated with a special stain and examined under a Gram-positive or Gram-negative - to prescribe an microscope appropriate antibiotic while waiting for more specific Any bacteria that may be present are categorized by tests, such as a culture, to be completed color and shape during the microscopic evaluation: For evaluation of a culture - to help determine the ○ Color — "Gram positive" (purple) or "Gram type of bacteria and to help determine what other negative" (pink) tests may need to be performed ○ Shape — round (cocci) or rod-shaped (bacilli) To detect Fungi, including yeast Viruses cannot be detected with a Gram stain NURSING RESPONSIBILITY FOR LUMBAR PUNCTURE Before the procedure ○ Explain the procedure - the purpose of lumbar puncture ○ Obtain a signed consent form ○ Reinforce diet ○ Promote comfort COLLECTION OF SAMPLE ○ Establish a baseline assessment data – VS and Lumbar puncture or “spinal tap” neurologic ○ Assist the client to assume a lateral decubitus (fetal) position ○ Instruct to remain still After the procedure ○ Apply brief pressure to the puncture site. ○ Place the patient flat on bed ○ Monitor VS, neurologic status, and I/O - at least every 4 hours for 24 hrs ○ Monitor the puncture site for signs of CSF. PATIENT SAFETY TIPS PRIOR TO A LUMBAR leakage and drainage of blood PUNCTURE ○ Encourage increased fluid intake Know of any allergies or adverse reactions to ○ Label and number the specimen tube correctly medications ○ Administer analgesia as ordered For pregnant or may be pregnant - doctor or technologist must be aware Leave valuables at home or in the room Interpreting services CHAVEZ, DIZON, VILLAFLOR, REYES 10 of 22 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 36 NURSING 1 ELISA TEST ELISA is an abbreviation for "enzyme-linked immunosorbent assay" A substitute for certain radioimmunoassay tests, and eventually, it replaced the western blot test for HIV confirmation Versatile and medical professionals can perform it easily Uses components of the immune system (such as FOUR TYPES IgG or IgM antibodies) and chemicals for the detection of immune responses in the body (for Direct Attachment of an antigen to a example, to infectious microbes) ELISA polystyrene plate followed by an Involves an enzyme (a protein that catalyzes a enzyme- labeled antibody biochemical reaction) or an antibody or antigen (immunologic molecules) that may form an Indirect Attachment of an antigen to a antigen-antibody reaction to provide a positive ELISA polystyrene plate followed by an result or, if they do not react, a negative result unlabeled or primary antibody followed by an enzyme- labeled antibody Sandwich A capture antibody is attached to ELISA the polystyrene plate, then antigen is added that specifically attaches or captures the antigen GRAM CSG Competitive This test is like the sandwich ELISA USES ELISA but involves the addition of Primarily detect proteins (as opposed to small competing antibodies or proteins molecules and ions such as glucose and potassium) when the second antibody is As blood tests to detect antigens that may be added present in the blood. The substances detected: ○ Hormones, an allergen, viral antigens (dengue fever), bacterial antigens (TB, for example), and antibodies that the body has made in response to infection (antibodies to hepatitis B, for example) or vaccination. ○ Can also identify an infectious disease CHAVEZ, DIZON, VILLAFLOR, REYES 11 of 22 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 36 NURSING 1 ADVANTAGES Performed after gel-electrophoresis or an Generally good and accurate tests enzyme-linked immunosorbent assay (ELISA) test, Considered highly sensitive and specific (accurate) and it uses antibodies to identify specific proteins. and compared favorably with other methods used Typically used to confirm a positive HIV diagnosis for the detection of substances in the body More straightforward and easier to perform than older laboratory techniques, which often required radioactive materials PREPARATION AND RISKS No special preparation Blood is required - blood collection. Risks: ○ rare and associated with blood withdrawal (infection, vessel damage, for example). PRINCIPLE ACTUAL RESULTS In Western blot, gel electrophoresis is used to Hundreds of variations of ELISA tests. separate proteins in a sample based on their Results and their meaning depend on what is being molecular weight. tested The separated proteins are then transferred to a ELISA test for viral RNA can detect it (a positive solid support, which is then exposed to antibodies test), not detect it (a negative test), or be that can bind to the target protein. indeterminate (borderline test) This binding is detected using a chemical or Rarely false negative or false positive result. radioactive tag. Large protein molecules need to be denatured before electrophoresis to facilitate their movement in the gel. NURSING RESPONSIBILITY PROCEDURE Explain test procedure - slight discomfort may be Denaturation of proteins felt when the skin is punctured. Involves unfolding of the protein’s tertiary structure Encourage to avoid stress to a linear structure Explain that fasting is not necessary. Detergents such as sodium dodecyl sulfate are Apply manual pressure and dressings over the commonly used to denature proteins. Separation of puncture site on removal of dinner. proteins Monitor the puncture site for oozing or hematoma The denatured protein sample is loaded onto an formation. electrophoretic gel and an electrical charge is Instruct to resume normal activities and diet. applied. Protein molecules are separated on the basis of WESTERN BLOT their size and electrical charge. AKA immunoblotting A test for a specific protein within a protein mixture CHAVEZ, DIZON, VILLAFLOR, REYES 12 of 22 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 36 NURSING 1 TESTS FOR EMERGING INFECTION Emerging infectious diseases are those whose incidence in humans has increased in the past 2 decades or threaten to increase in the near future. It can challenge efforts to protect workers as prevention and control recommendations may not be immediately available. Can be caused by: ○ Previously undetected or unknown infectious agents ○ Known agents that have spread to new geographic locations or new populations ○ Previously known agents whose role in specific diseases has previously gone unrecognized. ○ Re-emergence of agents whose incidence of disease had significantly declined in the past, APPLICATIONS but whose incidence of disease has reappeared Detection of circulating antibodies specific to a (reemerging infectious diseases) single protein or several proteins. In clinical diagnosis – HIV testing to detect anti-HIV antibody or as confirmatory tests for diseases (epidermolysis bullosa acquisita or paraneoplastic pemphigus) Analysis of biomarkers such as hormones, growth factors, and cytokines In gene expression studies DISADVANTAGES Very delicate and time-consuming process. EMERGING DISEASES The secondary antibody can cause labeling of an Respiratory viruses such as influenza A viruses (IAV) incorrect protein. or human respiratory syncytial virus (RSV) Insufficient transfer time can result in the larger Avian influenza viruses (AIV) such as IAV H5N1, proteins not transferring properly H7N7, or H9N2 crossed the species barrier to infect Well trained technicians are a must for this humans several times in the last years (reviewed in technique Kim et al., 2016). Semi-quantitative at best Coronavirus disease (COVID-19) Primary antibody availability is crucial. COMMERCIALLY AVAILABLE TEST SYSTEMS Respiratory viruses such as IAV, influenza B virus (IBV), and RSV - point-of-care tests (POCTs) and near-POCTs Three newer generation rapid multiplex polymerase chain reaction systems (mPCRs) (bioMérieuxBioFire® FilmArray® RP, Nanosphere Verigene® RV+ test, and Hologic Gen-Probe Prodesse assays) are highly accurate Diagnosis of emerging and novel viruses, including HBoV, RV-C, coronaviruses (e.g., HCoV-HKU1, HCoV-NL63, SARS-CoV-2) as well as specific NURSING RESPONSIBILITY subtypes of AIV (H5N1, H7N9, H10N8) and Same as in blood testing reassortant IAV strains - Polymerase chain reaction (PCR) remains the gold standard technique for the diagnosis CHAVEZ, DIZON, VILLAFLOR, REYES 13 of 22 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 36 NURSING 1 INNOVATIVE APPROACHES FOR FUTURE POCTs Most people infected will experience mild to BIOSENSOR moderate respiratory illness and recover without A reliable and cost-effective way to detect specific requiring special treatment pathogens in POCT setting Older people, and those with underlying medical problems like CVD, diabetes, chronic respiratory NEW TECHNIQUES AND PROTOTYPE disease, and cancer are more likely to develop Capillary convective PCR (CCPCR) - the reagents serious illness. circulate across a temperature gradient in a simple capillary tube, which allows run times shorter than CDC 2019-nCoV RT-PCR Diagnostic Panel 30 min - used to test for non-respiratory viruses like In early 2020, CDC developed its first laboratory test hepatitis C virus kit - CDC 2019 Novel Coronavirus (2019-nCoV) Real-Time Reverse Transcriptase (RT)–PCR Diagnostic Panel. During validation of the CDC SARS-CoV-2 test, some laboratories discovered a problem - reagent produced a positive result with the negative control On June 12, 2020, CDC add the Promega Maxwell® RSC 48 as an authorized extraction instrument for use with the CDC 2019-nCoV rRT-PCR Diagnostic Panel. Lab-Bases Nucleic Acid Amplification Tests (NAATs) With Potential Uses as Point-of-Care Applications In comparison to PCRs, isothermal NAATs do not require complex devices when working with extracted nucleic acids. Reverse transcription strand invasion-based amplification (RT-SIBA) and reverse transcription loop-mediated isothermal amplification (RT-LAMP) - to detect Human metapneumovirus (HMPV), IAV and MERS- CoV COVID-19 An infectious disease caused by a newly discovered coronavirus. At this time - no specific vaccines or treatments for COVID-19 CHAVEZ, DIZON, VILLAFLOR, REYES 14 of 22 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 36 NURSING 1 DEPENDENT NURSING CARE PHARMACOLOGIC ANTIBIOTICS OUTLINE It is used based on the premise that: infection A. Independent Nursing Care triggers an immune reaction like autoimmunity a. Physiologic Care through several mechanisms: b. Psychosocial care ○ Molecular mimicry c. Spiritual care ○ Epitope spreading B. Dependent Nursing Care ○ Bystander activation a. Pharmacologic Antibiotics are also utilized for their b. Surgical Procedure anti-inflammatory and immunomodulatory properties INDEPENDENT NURSING CARE PHYSIOLOGIC CARE ANTIFUNGAL AGENTS Ensures that any physical needs are being met and When there is immunosuppression, a common that the patient is in a healthy condition therapeutic side-effect predisposes patients to Promotes physical health and wellness by providing invasive fungal infections care and comfort, reducing and managing potential health alterations. ○ Use of assistive devices 4 MAIN TYPES OF ANTIFUNGAL DRUGS ○ Elimination Types Examples ○ Nutrition and oral hydration ○ Personal hygiene Polyenes Nystatin, Amphotericin B ○ Mobility / immobility ○ Rest and sleep Azoles Imidazole - Clotrimazole, Ketoconazole, ○ Non-pharmacological comfort interventions Miconazole Triazole - Fluconazole, Isavuconazole, PSYCHOSOCIAL CARE Itraconazole, Posaconazole, Voriconazole Given to help meet the mental, emotional, social and spiritual needs of patients and their families Allylamines Terbinafine Counseling ○ Aim to assist patient identify goals and potential Echinocandins Anidulafungin, Caspofungin, Micafungin solutions to problems which cause emotional turmoil Education KERATOLYTIC AGENTS ○ The process of influencing patient behavior and Designed to dissolve skin flakes, scales and a range producing the changes in knowledge, attitude of skin conditions and skills Example: mild to moderate acne, dandruff, Group support psoriasis, warts, and hyperpigmentation ○ A group of people meeting either physically or online to share information, experiences, SOURCES OF KERATOLYTIC AGENTS problems and solutions Spiritual support Salicylic Breaks down connection between dead cells ○ The goal is to help the person feel peace and acid on the surface of the skin (exfoliant) comfort Lactic Exfoliates the skin, while also helping to acid stimulate skin cell renewal and keeping the skin SPIRITUAL CARE hydrated Aspect of healthcare that supports the inner person (spirit / soul) to help deal with the health challenges Urea Soften and soothe skin. Has hydrating and that the patient and their loved ones are facing. anti-itching properties. Helps other medications Spending time with the people important to them; penetrate the skin spending time in nature, spending time on hobbies; following religious customs Olive oil May also be used to remove scales CHAVEZ, DIZON, VILLAFLOR, REYES 15 of 22 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 36 NURSING 1 IMMUNOLOGIC AGENTS Others: Coal tar, pyrithione zinc, glycolic acid, tretinoin and acitretin Drugs that can alter the immune response, either by enhancing or suppressing the immune system Used to fight infections, prevent and treat certain ANTI-INFLAMMATORY AGENTS diseases Reduces inflammation (redness, swelling, and pain) in the body TYPES OF IMMUNOLOGIC AGENTS Block the production of a certain body chemical caused by the activation of inflammatory cells that ○ Immune globulins ○ Vaccine combinations ○ Immunostimulants ○ Viral vaccine results to inflammation ○ Bacterial vaccines ○ Immunosuppressive Example of commonly prescribed NSAIDs: ○ Colony stimulating agents ○ Celecoxib (Celebrex). factors ○ Calcineurin inhibitors ○ Diclofenac (Voltaren). ○ Interferons ○ Interleukin inhibitors ○ Fenoprofen (Nalfon). ○ Interleukins ○ Other ○ Indomethacin (Indocin) ○ Other immunosuppressants ○ Ketorolac tromethamine (Toradol). immunostimulants ○ Selective ○ Meclofenamate sodium. ○ Therapeutic vaccines immunosuppressants ○ Diflunisal. ○ TNF alfa inhibitors ○ Tolmetin. ○ Ketoprofen. SURGICAL PROCEDURE ○ Flurbiprofen. DEBRIDEMENT Removal of devitalized tissue such as necrotic CORTICOSTEROIDS tissue, slough, bioburden, biofilm, and apoptotic Are powerful anti-inflammatory medications from a cells. class of human-made or synthetic drugs Common indications for sharp surgical debridement: When the body’s immune system fails to function ○ Removal of the source of sepsis, mainly correctly, and attacks its own body organs, bones necrotic tissue or tissues. ○ Removal of local infection to decrease bacterial Steroids: burden, to reduce the probability of resistance ○ Stop the body from making cytokines that from antibiotic treatment, and to obtain accurate cause inflammation cultures ○ Deplete certain immune cells called T and B ○ Collection of deep cultures taken after cells and eosinophils debridement from the tissue left behind to ○ Make it more difficult for immune cells to travel evaluate persistent infection and requirements to spots of infection or injury through the body for systemic antibiotic treatment Common corticosteroids: ○ Stimulation of the wound bed to support healing ○ Prednisone (Deltalone, Prednicot, Cotolone) and to prepare for a skin graft or flap ○ Prednisolone (Orapred, Omnipred) Complications of debridement includes: ○ Cortisone (Cortone) ○ Irritation ○ Hydrocortisone (Cortef, Hydrocort) ○ Bleeding ○ Triamcinolone (Aristocort) ○ Damage to healthy tissue ○ Dexamethasone (Decadron) ○ Allergic reaction ○ Mometasone (Nasonex spray) ○ Pain ○ Bacterial infection TYPES OF CORTICOSTEROIDS Post debridement care: ○ Regularly change the dressing Systemic Can be administered through: oral ○ Keep the dressing dry. medications, intramuscular and ○ Keep the wound clean. intravenous ○ Don’t apply pressure. Use special cushions to avoid placing weight on wound. Localized Can be applied through: skin creams and ointments, eye drops ear drops, inhalers CHAVEZ, DIZON, VILLAFLOR, REYES 16 of 22 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 36 NURSING 1 INCISION AND DRAINAGE (I&D) Primary treatment for skin and soft tissue abscesses, with or without adjunctive antibiotic therapy. Complications of I&D includes: Normally I&D is well tolerated with pain as the most common complication. Bacteremia and sepsis Chronic draining sinuses and fistulas, secondary to inadequate drainage of deep or complicated abscesses Post I&D care: Reevaluate and redress the wound in 24 to 48 hours except for some small abscesses, which do not need to be monitored closely. Postoperative analgesics may be required for pain. Instruct the patient to elevate the wound and keep dressing and splint clean and intact before the first follow-up visit. Patients should be reevaluated if they have worsening pain, increased drainage, or spreading erythema. Antibiotic therapy at least 5 to 7 days after the procedure. EXCISIONAL SURGERY Removal of growths on superficial structures. Excision that involve removing the epidermis and part of the dermis or epidermis and the entire dermal layers are generally termed partial- or full- thickness surgical excisions The following are possible complications: Excessive scarring Signs of infection such as fever and chills Drainage from the wound site Nerve damage Bleeding Swelling Pain and discomfort Incision reopening / dehiscence Post Excision care: Keep the sterile bandage to prevent the risk of infection. Maintain the excision site dry. Patient is on antibiotic therapy to promote wound healing. Avoid strenuous activity for at least two weeks after the surgery. Patient is advised to refrain from smoking for at least a week as it impairs wound healing. Pain medication is given as necessary Follow-up with the doctor after one to two weeks. CHAVEZ, DIZON, VILLAFLOR, REYES 17 of 22 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 36 NURSING 1 PERSONAL PROTECTIVE EQUIPMENT (PPE) Train health workers on the rationale for and correct use of use of PPE based on risk assessment OUTLINE Provide adequate supplies of high-quality PPE that A. Special procedures are continuously accessible at the point of care a. Universal precaution B. Key elements RESPIRATORY HYGIENE AND COUGH ETIQUETTE C. Interdependent care Post visual alerts at the entrance to health care D. Nutrition & diet therapies facilities instructing people with respiratory SPECIAL PROCEDURES symptoms to practice respiratory hygiene / cough etiquette UNIVERSAL PRECAUTION Place hand hygiene supplies, tissues, masks and no Universal precautions are a standard set of touch waste bins in waiting areas guidelines to prevent the transmission of bloodborne pathogens from exposure to blood and ENVIRONMENT AND ENVIRONMENTAL CLEANING other potentially infectious materials (OPIM) Provide a clean and hygienic environment, including water, sanitation, and hygiene infrastructure and STANDARD PRECAUTIONS FOR THE PREVENTION adequate ventilation (natural or mechanical) AND CONTROL OF INFECTIOUS DISEASES (WHO, Provide efficient environmental cleaning and 2022) disinfectant products Standard precautions aim to protect both health workers and patients by reducing the risk of INJECTION transmission of microorganisms from both Follow safe injection practices according to the recognized and unrecognized sources policy that reflects the steps for safe injections The minimum standard of infection prevention and Provide a policy and measures for the surveillance, control (IPC) practices that should be used by all prevention, and management of sharps injuries. health workers, during the care of all patients at all times in all settings. MANAGEMENT WASTE Ensure that the health care facility follows a policy KEY ELEMENTS for minimizing, segregating, collecting, transporting, HAND HYGIENE storing, treating and disposing of waste. Most important measures to prevent and control the spread of disease in healthcare facilities DECONTAMINATION AND REPROCESSING OF Major component of standard precautions REUSABLE MEDICAL EQUIPMENT / DEVICES The use of alcohol-based hand rubs in healthcare Make a dedicated space available for performing facilities has been implemented in recent years. The decontamination and reprocessing of reusable main points are as follows: medical devices. ○ If hands are not visibly soiled, hand hygiene should be done using an alcohol-based hand REVERSE ISOLATION rub or by washing hands with soap and water, Protective isolation or reverse isolation denotes the and drying them using a single-use towel (20-30 practices used for protecting vulnerable persons secs) from contracting an infection ○ If hands are visibly soiled or dirty with blood or When people with a weakened immune system are other bodily fluids, or if broken skin might have exposed to organisms, it could lead to infection and been exposed to potentially infectious material, serious complications. hands should be washed thoroughly with soap and water (40-60 secs) ASEPSIS 5 moments for hand hygiene: Asepsis is a condition in which no living Before touching a patient disease-causing microorganisms are present. Before a clean / aseptic procedure Asepsis covers all those procedure designed to After body fluid exposure risk reduce the risk of bacterial, fungal or viral After touching a patient contamination, using sterile instruments, sterile After touching a patient’s surrounding draping and the gloved CHAVEZ, DIZON, VILLAFLOR, REYES 18 of 22 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 36 NURSING 1 DEFINING ASEPSIS RELAXATION TECHNIQUES Meditation is a relaxation technique that can help to MEDICAL SURGICAL reduce a person’s anxiety. ASEPSIS ASEPSIS Many people living with HIV have higher anxiety and Definition Clean Technique Sterile Technique stress levels compared with the general population. Meditation can help alleviate some of the anxiety Emphasis Freedom from most Freedom from all associated with HIV. pathogenic pathogenic organisms organisms PHYSICAL THERAPIES Physical therapies can help a person to relax, Purpose Reduce transmission Prevent introduction de-stress, and improve movement. People living of pathogenic of any organism into with HIV have higher rates of mental issues, such as organisms from one an open wound or patient-to -another sterile body cavity anxiety and depression. Physical therapies can help boost people’s mental and physical health. Physical therapies include: MEDICAL ASEPSIS ○ Sports or medical massage Also known as the “clean technique” is aimed at ○ Yoga controlling the number of microorganisms. ○ Chiropractic care Medical asepsis is used for all clinical patient care ○ Acupuncture activities. Necessary components of medical asepsis include: NUTRITION AND DIET THERAPIES ○ Knowing what is dirty NUTRITION AND HIV/AIDS ARE LINKED ○ Knowing what is clean Benefits of Nutrition ○ Knowing what is sterile ○ Improve your overall quality of life by providing ○ How to keep the first three conditions separate nutrients your body needs. ○ How to remedy contamination immediately ○ Keep your immune system stronger so you can Surgery increases the risk of infection! better fight disease. ○ Help manage HIV symptoms and complications. SURGICAL ASEPSIS ○ Process medications and help manage their Also known as “sterile technique” is aimed at side effects. removing all microorganisms. Surgical asepsis is used for all surgical/sterile BASIC PRINCIPLES OF NUTRITION AND HIV/AIDS procedures. Eating a diet high in vegetables, fruits, whole grains, Necessary components of surgical asepsis include: and legumes ○ Knowing what is sterile Choosing lean, low-fat sources of protein ○ Knowing what is not sterile Limiting sweets, soft drinks, and foods with added ○ How to keep the first two conditions separate sugar ○ How to remedy contamination immediately Including proteins, carbohydrates, and a little good fat in all meal and snacks INTERDEPENDENT CARE COMPLEMENTARY AND ALTERNATIVE THERAPIES When used alongside traditional medication, alternative treatments may help relieve some of the symptoms of HIV or AIDS. Alternative medicines cannot cure or stop the progression of HIV. Alternative therapies, such as acupuncture, yoga, meditation, and massage can help a person to relax, manage pain, and improve mental and physical health. There is no evidence that alternative therapies can cure or stop the progress of HIV, so always use them alongside conventional anti-HIV treatment. CHAVEZ, DIZON, VILLAFLOR, REYES 19 of 22 The CNSC does not intend to substitute learning materials provided by the College and its faculty. Use at your own discretion. NUR 131: MEDICAL-SURGICAL TERM RELEASE 1 - NR NUR 131 - BSN 36 NURSING 1 RELEVANT LAWS ON HIV/AIDS IN THE PHILIPPINES REPUBLIC ACT NO. 8504: PHILIPPINE AIDS PREVENTION AND CONTROL ACT OF 1998 OUTLINE An act promulgating policies and prescribing A. Human Right Principles Relevant to HIV/AIDS measures for the prevention and control of B. International Human Rights of PLHIV HIV/AIDS in the Philippines, Instituting a nationwide C. Senate Bill 2155 / House Bill 9559 HIV/AIDS information and educational program, establishing a comprehensive HIV/AIDS monitoring HUMAN RIGHT PRINCIPLES RELEVANT TO system, strengthening the Philippine National AIDS HIV/AIDS Council and for other purposes The right to non-discrimination, equal protection and equality before the law REPUBLIC ACT NO. 11166: PHILIPPINE HIV AIDS The right to life POLICY ACT OF 2018 The right to the highest attainable standard of An Act Strengthening the Philippine Comprehensive physical and mental health Policy on Human Immunodeficiency Virus (HIV) and The right to liberty and security of person Acquired Immune Deficiency Syndrome (AIDS) The right to freedom of movement Prevention, Treatment, Care, and Support, and, The right to seek and enjoy asylum Reconstituting the Philippine National Aids Council The right to privacy (PNAC), Repealing for the Purpose Republic Act No. The right to freedom of opinion and expression and 8504, Otherwise Known as The "Philippine Aids the right to freely receive and impart information Prevention and Control Act of 1998", and The right to freedom of association Appropriating Funds Therefor The right to work The right to marry and to found a family MEDICAL CONFIDENTIALITY The right to equal access to education It refers to the core duty of medical practice where The right to an adequate standard of living the information p