TOPICS

HYPERTENSION
Definition:
A systolic blood pressure greater than 140 mmHg and a diastolic pressure greater than 90 mmHg based on the average of two or more
accurate blood pressure measurement taken( Joint Committee on Prevention, Detection, Evaluation and Treatment of high blood pressure)
Sometimes called "Silent Killer because people who have it are often symptom- free
CIassification of BIood Pressure:
CIassification SystoIic BP(mmHg) DiastoIic BP(mmHg)
Normal 120 80
Prehypertension 130-139 80-89
Stage 1 Hypertension 140-159 90-99
Stage 2 Hypertension < 160 <100

Risk Factors:
A. ModifiabIe
High sodium intake
Low potassium, calcium, and magnesium intake
Obesity
Excess alcohol consumption
Smoking
Glucose intolerance


B. Non- modifiabIe
Family history
Age
Race- African- American
Signs and symptoms:
Elevated blood pressure- initially transient but eventually become permanent
Headache- back of the head and neck present on awakening
Nocturia
Confusion
Nausea and vomiting
visual disturbances
Nursing Intervention:
1. increasing the patient's knowledge- nurse need to emphasize the concept of controlling hypertension rather than curing it
2. decrease sodium intake to no more than 100 mmol per day
3. advise patient to limit intake of alcohol to no more than 2 drinks
4. regular physical activity
5. advise patient to avoid tobacco use
6. advise patient for weight reduction
7. Diet- DASH( Dietary approaches to stop hypertension)
Diet rich in fruits and vegetables, low fat and low sodium



DIABETES MELLITUS
Diabetes Mellitus is a life-long disease marked by high levels of sugar in the blood. t can be caused by too little insulin (a hormone produced
by the pancreas to regulate blood sugar), resistance to insulin, or both. Glucose, a form of sugar in the blood, acts as the main source of fuel for our
body.
t is created when our body breaks down food that we eat into energy with the help of insulin. nsulin acts like a key to unlock the body's cells,
so glucose can enter and serve as fuel for the cells. This process helps to regulate the amount of sugar in the bloodstream. n people with diabetes,
however, the pancreas either produces little or no insulin or the cells do not respond appropriately to the insulin that is produced causing blood sugar
level to rise. High blood sugar sets off processes that can lead to complications like heart, kidney, and eye disease or other serious problems.
TYPES OF DIABETES
Type 1 Diabetes - This type of diabetes is an autoimmune disease. Your immune system turns on itself and destroys the insulin-producing
cells in your pancreas. Although type 1 diabetes usually develops in childhood or teen years, it can appear later. t is also known as nsulin
Dependent Diabetes Mellitus (DDM) as dependence on exogenous insulin is a must to sustain life.

Type 2 Diabetes - Typically, with type 2 diabetes, the body still makes insulin but its cells can't use it. This is called insulin resistance. Over
time, high levels of sugar build up in the bloodstream. Being overweight and inactive increase the chances of developing type 2 diabetes. This
is also called known as Non nsulin Dependent Diabetes Mellitus (NDDM) as this can be managed by medications or nsulin doses as
prescribed for the individual cases. A compulsory dependency on exogenous insulin is not a must here.

estationaI Diabetes - This type of diabetes occurs in some pregnant women. n gestational diabetes, your body doesn't effectively use the
insulin you produce. The cause may be metabolic changes that occur due to the effects of hormones in pregnancy. Gestational diabetes
usually disappears after pregnancy but more than half of women who experience it eventually develop permanent type 2 diabetes.



RISK FACTORS:
Some of the factors that increase the risk of Diabetes:
-Family history
-Belong to a high-risk ethnic population (African-American, Native American, Hispanic, or Native Hawaiian)
-Age (especially after age 45)
-Poor diet
-Obesity and fat distribution
-Have been diagnosed with gestational diabetes or have delivered a baby weighing more than 9 lbs (4kgs.)
-Sedentary lifestyle
-Stress
-Hypertension
-Abnormal cholesterol levels
SYMPTOMS OF DIABETES:
-Frequent urination (Polyuria)
-Extreme thirst (Polydipsia)
-ncreased hunger (Polyphagia)
-Blurry vision
-Weight loss
-Fatigue
-Nausea/Vomiting
-Frequent fungal or bacterial infections like skin infection or UT
-Poor wound healing - High blood sugar resists the flourishing of the white blood cell
-Long standing diabetes leads to thickening of blood vessels which may affect proper circulation of blood in different body parts
-Loss of libido or erectile dysfunction
-Pruritus vulvae (itching of vulva) in females or balanitis (inflammation of the glans penis) in males

DIANOSTIC TESTS:
Several blood tests are used to measure blood glucose levels, the primary test for diagnosing diabetes. Additional test can determine the type
of diabetes and its severity:
Random BIood Iucose test blood can be drawn at any time throughout the day, regardless of when the person last ate. A random
blood glucose level of 200 mg/dl (11.1 mmol/L) or higher in persons who have symptoms of high blood glucose suggests a diagnosis of
diabetes

Fasting BIood Iucose test (FBT/FBS) involves measuring blood glucose after not eating or drinking for 8- 12 hours (usually
overnight). A normal fasting blood glucose level is less than 100 mg/dl. A fasting blood glucose of 126 mg/dl (7.0 mmol/L) or higher
indicates diabetes. The test is done by taking a small sample of blood from a vein or fingertip. t must be repeated on another day to
confirm that it remains abnormally high.

HemogIobin A1C test this test measures the average blood glucose level during the past 2 to 3 months. t is used to monitor blood
glucose control in people known diabetes, but is not normally used to diagnose diabetes. Normal values for A1C a 4 t0 6 %. The test is
done by taking a sample of blood from a vein or fingertip.

OraI Iucose ToIerance test (OTT) the most sensitive test for diagnosing diabetes and pre-diabetes. However, OGTT is not
routinely recommended because it is inconvenient compared to a fasting blood glucose test. The standard OGTT includes a FBGT. The
person then drinks a 75 gram liquid glucose solution usually cola. Two hours later, a second blood glucose level is measured. For
pregnant, OGTT is routinely performed at 24 28 weeks to screen for gestational diabetes; this requires drinking a 50 gram glucose
solution with a blood glucose level drawn one hour later. For women who have an abnormally elevated blood glucose level, a second
OGTT is performed on another day after drinking a 100 g glucose solution.
A urinalysis may be used to look for glucose and ketones from the breakdown of fat. However, a urine test alone does not diagnose
diabetes.
NURSIN INTERVENTIONS:
Advice patient about the importance of an individualized meal plan in meeting weekly weight loss goals and assist with compliance
Assess patients for cognitive or sensory impairments, which may interfere with the ability to accurately administer insulin
Demonstrate and explain thoroughly the procedure for insulin self-injection. Help patient to achieve mastery of technique by taking step by
step approach
Review dosage and time of injections in relation to meals, activity, and bedtime based on patients individualized insulin regimen
nstruct patient in the importance of accuracy of insulin preparation and meal timing to avoid hypoglycemia
Explain the importance of exercise in maintaining or reducing weight
Advise patient to assess blood glucose level before strenuous activity and to eat carbohydrate snack before exercising to avoid hypoglycemia
Assess feet and legs for skin temperature, sensation, soft tissues injuries, corns, calluses, dryness, hair distribution, pulses and deep tendon
reflexes
Maintain skin integrity by protecting feet from breakdown
Advice patient who smokes to stop smoking or reduce if possible, to reduce vasoconstriction and enhance peripheral flow
MEDICAL INTERVENTIONS
Medications to treat diabetes include insulin and glucose-lowering pills, called oral hypoglycemic agents. The bodies of people with type
1 diabetes cannot make their own insulin, so daily insulin injections are required. The bodies of people with type 2 diabetes make
insulin but cannot use it effectively.
nsulin is not available in oral form. t is delivered by injections that are generally required one to four times per day. Some people use
an insulin pump, which is worn at all times and delivers a steady flow of insulin throughout the day.
Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and/or oral medications. There are several oral
hypoglycemic agents that lower blood glucose in type 2 diabetes. They fall into one of three groups:
Medications that increase insulin production by the pancreas (Amaryl, Glucotrol, and Glucotrol XL, Micronase, Diabeta, Glynase,
Prandin, and Starlix
Medications that increase sensitivity to insulin (Glucophage, Avandia, and Actos)
Medications that delay absorption of glucose from the gut (Precose and Glyset)
Most type 2 diabetics will require more than one medication for good blood sugar control within three years of starting their first
medication. Different groups of oral medications may be combined, or insulin and oral medications may be used together.
Oral hypoglycemic agents are not known to be safe for use in pregnancy; women who have type 2 diabetes and take these medications
may be switched to insulin during pregnancy and while breast-feeding.
Gestational diabetes is treated with diet and insulin.
A number of drug options exist for treating type 2 diabetes, including:
SuIfonyIurea drugs. These medications stimulate your pancreas to produce and release more insulin. For them to be effective, your
pancreas must produce some insulin on its own. The most common side effect of sulfonylureas is low blood sugar, especially during the first
four months of therapy. You're at much greater risk of low blood sugar if you have impaired liver or kidney function.

MegIitinides. These medications, such as repaglinide (Prandin), have effects similar to sulfonylureas, but you're not as likely to develop low
blood sugar. Meglitinides work quickly, and the results fade rapidly.

Biguanides. Metformin (Iucophage, Iucophage XR) is the only drug in this class available in the United States. t works by inhibiting the
production and release of glucose from your liver, which means you need less insulin to transport blood sugar into your cells. One advantage
of metformin is that is tends to cause less weight gain than do other diabetes medications. Possible side effects include a metallic taste in your
mouth, loss of appetite, nausea or vomiting, abdominal bloating, or pain, gas and diarrhea. These effects usually decrease over time and are
less likely to occur if you take the medication with food. A rare but serious side effect is lactic acidosis, which results when lactic acid builds up
in your body. Symptoms include tiredness, weakness, muscle aches, dizziness and drowsiness. Lactic acidosis is especially likely to occur if
you mix this medication with alcohol or have impaired kidney function.

AIpha-gIucosidase inhibitors. These drugs block the action of enzymes in your digestive tract that break down carbohydrates. That means
sugar is absorbed into your bloodstream more slowly, which helps prevent the rapid rise in blood sugar that usually occurs right after a meal.
Drugs in this class include acarbose (Precose) and miglitol (Glyset). Although safe and effective, alpha-glucosidase inhibitors can cause
abdominal bloating, gas and diarrhea. f taken in high doses, they may also cause reversible liver damage.
ThiazoIidinediones. These drugs make your body tissues more sensitive to insulin and keep your liver from overproducing glucose. Side
effects of thiazolidinediones, such as rosiglitazone (Avandia) and pioglitazone hydrochloride (Actos), include swelling, weight gain and fatigue.
A far more serious potential side effect is liver damage. The thiazolidinedione troglitzeone (Rezulin) was taken off the market in March 2000
because it caused liver failure. f your doctor prescribes these drugs, it's important to have your liver checked every two months during the first
year of therapy. Contact your doctor immediately if you experience any of the signs and symptoms of liver damage, such as nausea and
vomiting, abdominal pain, loss of appetite, dark urine, or yellowing of your skin and the whites of your eyes (jaundice). These may not always
be related to diabetes medications, but your doctor will need to investigate all possible causes.

Chronic Obstructive PuImonary Disease
COPD; Chronic obstructive airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis - chronic

Chronic obstructive puImonary disease (COPD) is one of the most common Iung diseases. It makes it difficuIt to breathe. There are two
main forms of COPD:
Chronic bronchitis, which involves a long-term cough with mucus
Emphysema, which involves destruction of the lungs over time
Most people with COPD have a combination of both conditions.
Symptoms
Cough, with or without mucus
Fatigue
Many respiratory infections
Shortness of breath (dyspnea) that gets worse with mild activity
Trouble catching one's breath
Wheezing
Causes, incidence, and risk factors
Smoking is the leading cause of COPD. The more a person smokes, the more likely that person will develop COPD. However, some people smoke
for years and never get COPD.
n rare cases, nonsmokers who lack a protein called alpha-1 antitrypsin can develop emphysema.


Other risk factors for COPD are:
Exposure to certain gases or fumes in the workplace
Exposure to heavy amounts of secondhand smoke and pollution
Frequent use of cooking fire without proper ventilation
Genetics Some factor in addition to heavy smoke exposure is required for a person to develop COPD. This factor is probably a
genetic susceptibility. COPD is more common among relatives of COPD patients who smoke than unrelated smokers
Diagnostic tests
Spirometry -the best test for COPD is a lung function spirometry . This involves blowing out as hard as possible into a small machine
that tests lung capacity. The results can be checked right away, and the test does not involve exercising, drawing blood, or exposure to
radiation.
Auscultation - using a stethoscope to listen to the lungs can also be helpful. However, sometimes the lungs sound normal even when
COPD is present.
X-rays and CT scans - pictures of the lungs (such as x-rays and CT scans) can be helpful, but sometimes look normal even when a
person has COPD (especially chest x-ray).
Arterial blood gas- sometimes patients need to have a blood test (called arterial blood gas) to measure the amounts of oxygen and
carbon dioxide in the blood.

Nursing Interventions for patient with COPD
Maintaining a patent airway is a priority. Use a humidifier at night to help the patient mobilize secretions in the morning.
Encourage the patient to use controlled coughing to clear secretions that might have collected in the lungs during sleep.
nstruct the patient to sit at the bedside or in a comfortable chair, hug a pillow, bend the head downward a little, take several
deep breaths, and cough strongly
Ad minister low concentrations of oxygen as ordered. Perform blood gas analysis to determine the patient's oxygen needs
and to avoid carbon dioxide narcosis.
Teach patients and family that excessive oxygen therapy may eliminate the hypoxic respiratory drive, causing confusion and
drowsiness, signs of carbon dioxide narcosis.
Emphasize the importance of a balanced diet. Because the patient may tireeasily consider using oxygen, administered by
nasal cannula, during meals.
Help the patient and his family adjusts their lifestyles to accommodate the limitations imposed by this debilitating chronic
disease.
nstruct the patient to allow for daily rest periods and to exercise daily as his physician directs.
As the disease progresses, encourage the patient to discuss his fears.
To help prevent COPD, advise all patients, especially those with a family history of COPD or those in its early stages, not to
smoke.
Assist in the early detection of COPD by urging persons to have periodic physical examinations, including spirometry and
medical evaluation of a chronic cough, and to seek treatment for recurring respiratory infections promptly.
Patient teaching for patient with COPD
Teach the patient and his family how to recognize early signs of infection; warn the patient to avoid contact with people with
respiratory infections. Encourage good oral hygiene to help prevent infection. Pneumococcal vaccination and annual
influenza vaccinations are important preventive measures.
To promote ventilation and reduce air trapping, teach the patient to breathe slowly, prolong expirations to two to three times
the duration of inspiration, and to exhale through pursed lips.
To help mobilize secretions, teach the patient how to cough effectively.
f the patient is to continue oxygen therapy at home, teach him how to use the equipment correctly.
Be sure the patient and family understand any medication prescribed, including dosage, route, action, and side effects.
nstruct the patient to report any signs and symptoms of infection to the primary healthcare provider. Explain necessary
dietary adjustments to the patient and family.
Recommend eating small, frequent meals, including high-protein, high-density foods.
Encourage the patient to plan rest periods around his or her activities, conserving as much energy as possible. Arrange for
return demonstrations of equipment used by the patient and family.
Refer the patient to the appropriate rental service, and explain the hazards of combustion and increasing the flow rate without
consultation from the primary healthcare provider, if the patient requires home oxygen therapy.
MedicaI Intervention
Medications used to treat COPD include:
nhalers (bronchodilators) to open the airways, such as ipratropium (Atrovent), tiotropium (Spiriva), salmeterol (Serevent),
formoterol (Foradil), or albuterol
nhaled steroids to reduce lung inflammation
Anti-inflammatory medications such as montelukast (Singulair) and roflimulast are sometimes used
n severe cases or during flare-ups, you may need to receive:
Steroids by mouth or through a vein (intravenously)
Bronchodilators through a nebulizer
Oxygen therapy
Assistance during breathing from a machine (through a mask, BiPAP, or endotracheal tube)
Antibiotics are prescribed during symptom flare-ups, because infections can make COPD worse.
You may need oxygen therapy at home if you have a low level of oxygen in your blood.
Pulmonary rehabilitation does not cure the lung disease, but it can teach you to breathe in a different way so you can stay active. Exercise can help
maintain muscle strength in the legs.
Walk to build up strength.
Ask the doctor or therapist how far to walk.
Slowly increase how far you walk.
Try not to talk when you walk if you get short of breath.
Use pursed lip breathing when breathing out (to empty your lungs before the next breath)

Things you can do to make it easier for yourself around the home include:
Avoiding very cold air
Making sure no one smokes in your home
Reducing air pollution by getting rid of fireplace smoke and other irritants
Eat a healthy diet with fish, poultry, or lean meat, as well as fruits and vegetables. f it is hard to keep your weight up, talk to a
doctor or dietitian about eating foods with more calories.
Surgery may be used, but only a few patients benefit from these surgical treatments:
Surgery to remove parts of the diseased lung can help other areas (not as diseased) work better in some patients with
emphysema
Lung transplant for severe cases

Sources:
en.wikipedia.org/wiki/chronic_obstructive_pulmonary_disease
www.ncbi.nlm.nih.gov








ACUTE ASTROENTERITIS
Definition:
Also known as " STOMACH FLU
An infection or irritation of the digestive tract particularly the stomach and small intestine.
SINS AND SYMPTOMS
Nausea/vomiting
Diarrhea
Abdominal cramping
Abnormal flatulence
Fever
Sunken eyes
Bacteria that CAUSES AE:
Salmonella
Shigella
Staphylococcus
E-Coli
RISK FACTORS:
Eating or drinking contaminated food and water.
Poor sanitation/ poor hygiene
Diagnostic Test
Stool and blood cultures
Gram stain
Direct swab rectal cultures
Nursing responsibiIities
Assess pain location and intensity
Assess bowel sounds
Observe vomiting and diarrhea
Measure /O
Administer meds as ordered
Manage V as ordered
Teach why it helps to rest to gut with NPO or restricted intake
Rehydration
Teach contributing factors and ways to prevent.
MedicaI Management
1. ntravenous Fluid : D5% NaCl
2. DRUGS
ANTEMETC - Used to treat nausea and vomiting and gastric emptying.
Eg. Metoclopromide
ANTBOTC used to eradicate the causative agent
Eg. Metronidazole, vancomysin
ANTMOTLTY AGENTS symptomatic treatment for diarrhea
Eg. Loperamide
ANTSPASMODC treating abdominal cramping/ abdominal pain
Eg. Butylscopolamine ( Buscopan)