Central Philippine Adventist CollegeAlegria, Murcia, Negros Oriental

COURSE SYLLABUS

Course Name: COMPETENCY APPRAISAL II School Year: 2011-212 Second SemesterCourse Code: CA IICourse Credit: 3 units Contact Hours/Semester: 90 lecture hoursPre-requisite : Competency Appraisal I, NCM 106, Research 2Home /Office Address: CPAC School of Nursing Clinical Division Telephone No: (034) 433 2407 Bacolod Adventist Medical Center Compound

C.V. Ramos Ave., Taculing, Bacolod City Course Description This course deals with the application of the concepts, principles and processes basic to the practice of nursing with emphasis on health promotion, health maintenance, preventive, risk reduction, curative and rehabilitative aspects of care of sick individual with alterations in cellular aberrations, adjustment problems and maladaptive patterns of behavior, acute biologic crisis, disaster and emergency. It includes the utilization of the nursing process and core competencies under the eleven (11) key areas of responsibility.

Course General Objectives/Aim: At the end of

Time Frame

Subject Content Objectives Student/TeacherActivities/Methodologies

Teaching Aids/Materials

Values Evaluation Reference

METABOLIC SYSTEMIntroduction: Although it seems at times that people can be divided into 2 groups- those who live to eat and those who eat to live. Metabolism is a broad term referring to chemical reactions that are necessary to maintain life. It involves catabolism, in which substances are broken down to simpler substances and anabolism, in which a larger molecular or structure are built from smaller ones.

Facts on Metabolic System1. Depends on the availability of fuel, oxygen and balance of anabolic and catabolic HOMEOSTASIS.2. Exocrine secretion assists in digestion, absorption of diet.3. Endocrine-metabolism particularly in regulation of hormones. Facts on Endocrine system1. Compared to other organs of the body small and unimpressive.2.endocrine glands stimulates the release of hormones (chemical substance release in blood supply)3. HORMONES- chemical substances secreted by cells into the metabolic activity of other cells in the body.

Hormones are classified as:1.Steroids- diffuse easily through the plasma membranes of their target cells2.Peptides3. Amino acid derivatives » non-steroidal hormones- bind first to a receptor situated on target cell’s plasma membrane to enter target cell.

Facts about hormones:1. Greek word which means “to arouse”2. Affects the target cells or target organs.3. To make the target organ respond, hormones need

1. Identify the basic anatomy and physiology of metabolic system.

2. Differentiate the different glands and hormones.

1. Critical Thinking Discussion

2. Home Study

3. Library Works

$. Group Presentation

6. Intensive lecture

1. Computer

2. LCD Projector

3. Transparencies

4. Overhead Projector

5. Manila Paper and Scotch tape

6. White Board Pen

1. Emphasize the value of planning and preparation as the semester starts.

2. Temperance- especially in diet to prevent metabolic complications.

3. Gratefulness-to god for giving us the mind to think and power to communicate to others by speaking.

4. Kindness-in action and speech

1. Pre-test and post tests.

2. Oral participation.

3. Unit exams

specific protein receptor in the plasma membrane or interior of the target organ.

Negative feedback mechanism- inhibition or production basing on body’s needs, maintain the homeostasis. Example; t3 and t4 > pt gland> tsh> t.g. > t3 and t43 major categories:

Hormonal (hypothalamus-secrete hormones that-stimulate other endocrine gland to secrete hormones)

Humoral (changing blood levels of certain ions) Humor indicates various body fluids like blood, bile and others. ↓Ca in blood-PTh gland secrete Pth hormone which acts to inc Ca in blood through bone resorption.

Neural (nerve fiber stimulate release of hormone)-example is in the SNS stimulation of adrenal medulla to release the catecholamines epinephrine and norepinephrine.

ANATOMY AND PHYSIOLOGY of Endocrine SystemFacts on Pituitary Gland:1. Small extension on dorsal surface of hypothalamus connected by hypophyseal stalk.2. Situated at the base of skull cradled by the sella turcica of sphenoid bone.3. Pea-sized4. Master gland, another name is Hypophysis ( ant- adenohypophysis, post- neurohypophysis)5. Adenohypophysis- GTPALFM Neurohypophysis- oxytocin, ADH

Growth Hormone Thyroid Stimulating Hormone-stimulates

release of T3 and T4. ACTH- stimulates the adrenal cortex- GMA

GMA MSH- melanin > skin pigmentation> bronze

color albinism ADH- against urination (water retention)

Facts on Thyroid gland

1. below the neck2. highly vascular, 2 lobes joined by a central mass or isthmus3. makes up to hormones: the thyroid hormone and calcitonin4. thyroid hormone often referred as body’s major metabolic hormone composed of 2 iodine containing hormones:5. T3- triiodothyronine- potent6. T4 thyroxine/ tetraodothyroxine- abundant7. Controls the rate at which glucose is burned or oxidized and converted to body heat and chemical energy.

O2 consumption, O2 rate Body heat production CHO, CHON, fat metabolism Metabolic rate of all cells

Calcitonin- decrease blood calcium level by causing calcium to be deposited in the bones.(absorption).-acts as antagonist to parathyroid gland.-Hypocalcemic agent

Facts on Parathyroid Gland1. opposite the calcitonin2. found at the posterior portion of the thyroid gland3. increase blood calcium level by stimulating bone destruction cells (osteoclasts) to break bone matrix and release calcium in the blood.4. Hypercalcemic

Facts on Pancreas (Endocrine)1. located close to the stomach in the abdominal cavity2. a mixed gland-both exocrine and endocrine functionhormones of the Islet cells:

alpha- glucagons- blood glucose (hyperglycemic)

convert glycogen in liver into glucose ( glycogenolysis)

beta- insulin- blood glucose (hypoglycemic)

transports glucose to cells increase ability of cells to transport glucose across plasma membrane glucose stored in liver (glucogenesis) CHON and fat anabolism (build up) Only hormone that decrease blood sugar

Somatostatin- hypoglycemic effect Inhibit glucagons release

Facts on Adrenal Glands1. on top of kidney, suprarenal glands2. Medulla- catecholaminesWhen stimulated by SNS, release 2 similar hormones which prolongs effects of neurotransmitter. a.norepinephrine- vasoconstrictor (bp) b.epinephrine- adrenaline (energy)

3. Cortex Glucocorticoid/cortisol- sugar- 1. glycogenolysis (GH, epinephrine, cortisol) 2. gluconeogenesis 3. anti-inflammatory/suppress immune system 4. electrolyte balance- Na- retain, K- excreted Mineralocorticoid/ Aldosterone- salt/sodium Androgen- sex hormones

Pituitary Disorders and Adrenal Disorders1. Growth Hormone: Gigantism and Acromegaly

3 functions: 1. Stimulates growth in almost all body tissues, causing both an increase in cell size (hypertrophy) and an increase in cell number (hyperplasia). 2. Diverts amino acids into protein synthesis (anabolism) and decreases protein breakdown (catabolism). 3. Enhance the use of free fatty acids as metabolic substrates, which depletes body fat stores. 4. Increases plasma glucose levels but protects amino acid pools. A. Etiology and Risk Factors - hyperpituitarism: over production of growth hormone

B. Pathophysiology:

Gigantism- occurs in children -increase in size - extremely tall: 8-9 feet - 24-25 bone growth stops

Acromegaly-adult -normal adult height but widen - coarse body featuresC. Medical Mgt: Hypophysectomy- surgical removal of pituitary gland Bromocriptin mesylate (Parlodel)D. Clinical Manifestation and Nursing InterventionManifestation1. Facial - thick skull - protrusion of supraorbital ridges - protrusion of jaw (prognatrism)2. hands and Feet - Broadening of Hands-(↑ring size) - enlarged feet-(↑ shoe size)3. Liver - Glycogenolysis-↑ breakdown of glycogen4. Organomegaly5. visual disturbances

Dwarfism- stunted growth, 3 ft tall ht, Body proportion fairly normal but height reaches only to a maximum of 4 ft

Medical Mgt Synthetic hormone- SOMATREM-syn growth hormone- child (open), when: bedtime (mimic Normal growth hormone release)

2. Anti-Diuretic Hormone Syndrome of Inappropriate Anti-Diuretic Hormone- SIADHA. Etiology and Risk Factors Surgery, tumor

B. Pathophysiology

C. Medical Management FUROSEMIDE (LASIX)- diureticsD. Clinical Manifestation and Nursing Intervention

Manifestation Nursing Intervention1. Urine output- decrease2. Weight gain3. BV elevated4. Inc BP5. confusion- water intoxication6. Dilutional Hyponatremia7. less than 1358. serum hypoosmolality9. hemodilution10. Concentrated urine11. more than 1.030 spec grav12. urine hyperosmolality

MIOWeighVS, monitor serum electrolytes

SafetyReorientation

Fluid restriction

Diabetes Insipidus Dec ADH , Water ExcretionA. Etiology and Risk Factor Car accident , Head TraumaB. PathophysiologyC. Medical Management Synthetic ADH – VASOPRESSIN Nrsg Responsibility: warm to body temp before giving LYPRESSIN- needed to control polyuria and polydipsia Nrsg responsibility: nasal spray

D. Clinical manifestation with nursing InterventionManifestation Nursing Intervention

1. Polyuria2. polydipsia3. Wt loss4. Dec Blood Volume

MIO, IV fluids as orderedWeigh

5. Dehydration6. Hypovolemic Shock7. hypernatremia8. more than 1459. serum hyperosmolality10. hemoconcentration11. diluted urine12. less than 1.010 spec grav13. urine hypoosmolality

Vital signs

Inc fluid intake

3. Adrenocorticotropic Hormone- ACTH - Pit. Gland- ACTH- Adrenal cortex Cushing’s Sydrome- First described by Harvey Cushing 1932. Overactivity of the adrenal gland with consequent hypersecretion of glucocorticoid.A. Etiology and Risk Factors: 1. Primary Cushings- tumor in the adrenal cortex 2. Secondary Cushings- pituitary dependent- there’s a tumor inside 3. Iatrogenic- treat disease but leads to opposite diseaseB. PathophysiologyC. Medical Mgt 1. Primary Cushings- tumor in adrenal cortex surface- tumor resection deep inside- adrenalectomy (life time synthetic corticosteroids) 2. Secondary Cushings- (inside) Hypophysectomy 3. Radiation Therapy-(outside) 4. Medications: (Elipten) aminogluthetamide- inhibit GMA production Metyrapone- Decrease cortisol Diuretics-K sparingD. Clinical Manifestation with Nursing Interventions

Manifestation Nursing Intervention

Glucocorticoid 1. hyperglycemia 2. CHON, tissue, muscle

Administer Insulin as ordered

wasting 3. thin/slender extremities 4. Risk for infection- immunosuppressionMineralocorticoid 5. Hypernatremia 6. Water retention 7. ↑ BV- hypertension 8. HypokalemiaAndrogen 9. Hirsutism 10. Virilization (virilism)-masculinity in female(male voice) 11. MOON FACE 12. BUFFALO HUMP 13. TRUNKAL/CENRAL OBESITY 14. STRIAE’Spsychological 15. depression 16. anxiety 17. insomnia

Goal: Maintain muscle tone Provide Rom exercises Assist with ambulationPrevent Client from exposure to infectionGoal: health teachingDiet modification *avoid processed food, Sodium restriction, restrict waterGoal: Stable vital signs

Goal: Psychological support and acceptance

Addison’s Syndrome Thomas Edison first describe in 1849A. Etiology and Risk Factors- Congenital-since birth: Hypoplasia-decrease number ofGMA or atrophy- decrease in cell size-Idiopathic- Autoimmune- because of lymphocytic infiltration-Iatrogenic- the result of treatment or surgery (bilateral adrenalectomy)B. Pathophysiology

C. Medical MgtGlucocorticoid/cortisol1. Snythetic corticosteroids- Predenisone, Hydrocortison, dexamethasoneMineralocorticoid/ aldosterone- (Florinef) FludrocortisoneD. Clinical Manifestation with Nursing Intervention

Manifestation Nrsg InterventionGlucocorticoid- cotisol/sugar 1. Hypoglycemia 2. weakness 3. fatigueMineralocorticoid- aldosterone 4. hyponatremia 5. H2o excretion 6. dec BP 7. Dehydration 8. Shock 9. hyperkalemia 10 hyperpigmentation 11. melanosis

Rest, avoid stress

Hydration