Central Philippine Adventist College Alegria, Murcia, Negros Oriental COURSE SYLLABUS

Course Name: COMPETENCY APPRAISAL II Course Code: CA II Course Credit: 3 units Pre-requisite : Competency Appraisal I, NCM 106, Research 2 Home /Office Address: CPAC School of Nursing Clinical Division Bacolod Adventist Medical Center Compound C.V. Ramos Ave., Taculing, Bacolod City

School Year: 2011-212

Second Semester

Contact Hours/Semester: 90 lecture hours Telephone No: (034) 433 2407

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 METABOLIC SYSTEM Introduction: 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 System 1. 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 system 1. 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 cells 2.Peptides 3. Amino acid derivatives non-steroidal hormonesbind first to a receptor situated on target cells 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

Objectives

Student/Teacher Activities/Methodologies 1. Critical Thinking Discussion 2. Home Study 3. Library Works $. Group Presentation 6. Intensive lecture

Teaching Aids/Materials 1. Computer 2. LCD Projector 3. Transparencies 4. Overhead Projector 5. Manila Paper and Scotch tape 6. White Board Pen

Values

Evaluation

Reference

1. Identify the basic anatomy and physiology of metabolic system. 2. Differentiate the different glands and hormones.

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

1. Pre-test and post tests. 2. Oral participation. 3. Unit exams

2. Temperanceespecially in diet to prevent metabolic complications.

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

4. Kindnessin action and speech

specific protein receptor in the plasma membrane or interior of the target organ. Negative feedback mechanism- inhibition or production basing on bodys needs, maintain the homeostasis.

3 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 System Facts 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-sized 4. Master gland, another name is Hypophysis ( antadenohypophysis, post- neurohypophysis) 5. Adenohypophysis- GTPALFM Neurohypophysis- oxytocin, ADH Growth Hormone Thyroid Stimulating Hormone-stimulates release of T3 and T4. ACTH- stimulates the adrenal cortex MSH- melanin > skin pigmentation> bronze color albinism ADH- against urination (water retention)

Facts on Thyroid gland 1. below the neck 2. highly vascular, 2 lobes joined by a central mass or isthmus 3. makes up to hormones: the thyroid hormone and calcitonin 4. thyroid hormone often referred as bodys major metabolic hormone composed of 2 iodine containing hormones: 5. T3- triiodothyronine- potent 6. T4 thyroxine/ tetraodothyroxine- abundant 7. 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 Gland 1. opposite the calcitonin 2. found at the posterior portion of the thyroid gland 3. 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 cavity 2. a mixed gland-both exocrine and endocrine function hormones 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 Glands 1. on top of kidney, suprarenal glands 2. Medulla- catecholamines When stimulated by SNS, release 2 similar hormones which prolongs effects of neurotransmitter. a.norepinephrine- vasoconstrictor (bp) b.epinephrine- adrenaline (energy) 3. Cortex Glucocorticoid/cortisol- sugar1. 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 Disorders 1. 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 features C. Medical Mgt: Hypophysectomy- surgical removal of pituitary gland Bromocriptin mesylate (Parlodel) D. Clinical Manifestation and Nursing Intervention Manifestation 1. 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 glycogen 4. Organomegaly 5. 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- SIADH A. Etiology and Risk Factors

Surgery, tumor B. Pathophysiology C. Medical Management FUROSEMIDE (LASIX)- diuretics D. Clinical Manifestation and Nursing Intervention Manifestation Nursing Intervention 1. Urine outputMIO decrease Weigh 2. Weight gain VS, monitor serum 3. BV elevated electrolytes 4. Inc BP 5. confusion- water Safety intoxication Reorientation 6. Dilutional Hyponatremia Fluid restriction 7. less than 135 8. serum hypoosmolality 9. hemodilution 10. Concentrated urine 11. more than 1.030 spec grav 12. urine hyperosmolality

Diabetes Insipidus Dec ADH , Water Excretion A. Etiology and Risk Factor Car accident , Head Trauma B. Pathophysiology C. 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 Intervention Manifestation Nursing Intervention

1. Polyuria 2. polydipsia 3. Wt loss 4. Dec Blood Volume 5. Dehydration 6. Hypovolemic Shock 7. hypernatremia 8. more than 145 9. serum hyperosmolality 10. hemoconcentration 11. diluted urine 12. less than 1.010 spec grav 13. urine hypoosmolality

MIO, IV fluids as ordered Weigh Vital signs Inc fluid intake

3. Adrenocorticotropic Hormone- ACTH - Pit. Gland- ACTH- Adrenal cortex Cushings 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- theres a tumor inside 3. Iatrogenic- treat disease but leads to opposite disease B. Pathophysiology C. 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 sparing D. Clinical Manifestation with Nursing Interventions Manifestation Nursing

Intervention Glucocorticoid 1. hyperglycemia 2. CHON, tissue, muscle wasting 3. thin/slender extremities 4. Risk for infectionimmunosuppression Mineralocorticoid 5. Hypernatremia 6. Water retention 7. BV- hypertension 8. Hypokalemia Androgen 9. Hirsutism 10. Virilization (virilism)-masculinity in female(male voice) 11. MOON FACE 12. BUFFALO HUMP 13. TRUNKAL/CENRAL OBESITY 14. STRIAES psychological 15. depression 16. anxiety 17. insomnia Administer Insulin as ordered Goal: Maintain muscle tone Provide Rom exercises Assist with ambulation Prevent Client from exposure to infection Goal: health teaching Diet modification *avoid processed food, Sodium restriction, restrict water Goal: Stable vital signs

Goal: Psychological support and acceptance

Addisons Syndrome Thomas Edison first describe in 1849 A. 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 Mgt Glucocorticoid/cortisol 1. Snythetic corticosteroids- Predenisone, Hydrocortison, dexamethasone Mineralocorticoid/ aldosterone- (Florinef) Fludrocortisone D. Clinical Manifestation with Nursing Intervention Manifestation Nrsg Intervention Glucocorticoidcotisol/sugar Rest, avoid stress 1. Hypoglycemia 2. weakness 3. fatigue MineralocorticoidHydration aldosterone 4. hyponatremia 5. H2o excretion 6. dec BP 7. Dehydration 8. Shock 9. hyperkalemia 10 hyperpigmentation 11. melanosis