Don Mariano Marcos Memorial State University

South La Union Campus

INSTITUTE OF COMMUNITY HEALTH AND ALLIED MEDICAL SCIENCES
Agoo, La Union
Tel. 072.682.0663/ichams.dmmmsu-sluc.com
Embracing World–class Standards NURSING DEPARTMENT Care to Learn, Learn to Care

CLINICAL TEACHING PLAN

MEDICAL WARD
University Philosophy : Total human development with appropriate competencies
University Vision : A premium and globally competitive university
University Mission : Provides relevant quality instruction, research and extension
University Goal : To lead in transforming human resources into productive, self-reliant citizens and responsible leaders

Institute Goals : 1. To provide quality graduates in the medical and health allied fields.
2. To provide effective community health care services in the field of medical and health allied courses.
3. To offer courses relevant to the health needs and situation of the times.
4. To reach out to the less privileged but deserving high school graduates who cannot afford to enroll in the private schools
in the region

Program Outcomes
1. Apply knowledge of physical, social, natural and health sciences and humanities in the practice of nursing.
2. Provide safe, appropriate and holistic care to individuals, families, population group and community utilizing nursing process.
3. Apply guidelines and principles of evidence based practice in delivery of care.
4. Practice nursing in accordance with existing laws, legal, ethical, and moral principles.
5. Communicate effectively in speaking, writing, and presenting using culturally appropriate language.
6. Document to include reporting up-t-date client care accurately and comprehensively.
7. Work effectively in collaboration with inter-, intra-, and multi-disciplinary and multi-cultural teams.
8. Practice beginning management and leadership skills in the delivery of client care using a system approach.
9. Conduct research with and experienced researcher.

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 10. Engage in lifelong learning with a passion to keep current with national and global developments in general, and nursing and health developments in particular.
11. Demonstrate responsible citizenship and pride of being a Filipino.

Objectives
After 1 week of clinical exposure, students will be able to:
 Be oriented to the clinical set-up, the nursing and midwifery personnel, the medical staff and existing rules and regulations of the area
 Gain more skills, knowledge and attitude in providing health care to patients
 Apply midwifery and health care theories learned in the actual situations in the clinical area
 Promote and provide a competent standard quality health care to all patients by ensuring themselves to adhere to the ethical standards prescribed in the
midwifery code
 Promote and adhere to the midwifery process specifically and correctly, to achieve the specific goals for the patients
 Acquire skills, knowledge and acceptable attitude in the care of the family and community

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 ACTIVITIES COURSE CONTENT
Day 1 Definition:
6:45-7:45 Checking of attendance. Orientation of the students. Checking of Diabetes mellitus is a metabolic disorder characterized by glucose intolerance resulting from an imbalance
uniform and paraphernalias. Receiving endorsement. Assigning of between insulin supply and demand.
patient’s
Pathophysiologic basis of diabetes
7:45-8:00 Rounds and medication preparation.
1. Decrease glucose utilization- insulin is required for the “entrance” and utilization of glucose by the
8:00-8:30 Initial vital signs taking and bedside care. Establish Nurse- Patient cell.
Interaction 2. Increase fat metabolism- as glucose isn’t available, fat store are used up, leading to ketone
8:30-9:00 Checking of patient’s chart formation.
9:00-9:15 First batch break 3. Increased protein utilization- lack of insulin leads to protein wasting, and higher glucose level.
9:15-9:30 Second batch break
9:30-11:00 Discussion and Question and answer about patient’s diagnosis per Cardinal Signs of Diabetes (3p’s + loss of weight)
student (1st batch). Plotting of TPR sheet  Polyuria – due to excretion of glucose ( glycosuria) and ketones (ketonuria) that exerts osmotic
11:00-11:30 Sample charting/ Drug study pressure.
11:30-12:00 First batch lunch break  Polydipsia- thirst being a sign of dehydration related to polyuria.
 Polyphagia- due to cellular starvation.
12:00-12:30 Second batch lunch break
 Loss of weight- due to unavailability of energy for cellular use, protein and fat stores are used up.
12:30-1:00 Continuation of NPI, bedside care, procedures
1:00-1:30 Discussion and Question and answer about patient’s diagnosis per Long term complication
student (2nd batch)  Retinophaty and cataract
1:30-2:00 Discussion-Topic: Diabetes Mellitus  Nephropathy

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2:00-2:30 Close charting  Neurophaty
2:30-3:00 Post- conference  Arteriosclerosis and Atherosclerosis
-Submission of sample charting/ drug study  Cardiac complications
-Sharing of student’s learning experience  Vascular changes

Laboratory Test
 Random Blood Sugar of 200mg/DI, suspicious DM
 Fasting blood sugar N: 70-110mg/dL,(DM+) if high
 Post Prandial Blood sugar normally, blood sugar is Normal two hours after standard meats.
 Glucose Tolerance Test- best method
 after normal diet FBS and urine sample is take in the morning, the test should be performed
as described by the WHO, using glucose load containing the equivalent of 75g anhydrous
glucose dissolved in water. Urine is monitor after 2-3 hours.
 Glycosylated Hemoglobin
- Glucose attaches to Hgb and never dissociated! Glycosylated Hgb is the average of blood
glucose over previous 3 months

Criteria for GOOD CONTROL of DABETES

1. Optimal weight and enjoys good health
2. Glycosylated hemoglobin is normal range Good diabetes control= 2.5-6 %
3. FBS under140 mg/DI NO CALORIC INTAKE for at least 8 hours before rest.
4. Post-prandial blood glucose level not higher than 180 mg/DI

Management of Diabetes

Diet:
 Carbohydrates (50-60%, mostly complex) ;protein (20%); fats (30%,which 90% should be
unsaturated fats)
 High soluble fiber (it adds bulk and does not contribute to blood sugar)
 Limit refined sugars, and high fructose sources
Exercise: lower blood sugar( increase carbohydrates metabolism); facilitates weight reduction, decrease BP
and stress.

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Day 2 Definition:
6:45-7:00 Checking of attendance.Checking of uniform and paraphernalias. Functions of the gastrointestinal (GI) system
Assigning of patient’s 1. Process food substances
2. Absorb the products of digestion into the blood
7:00-8:00 Receiving endorsement, rounds, medication preparation. 3. Excrete unabsorbed materials
8:00-8:30 Initial vital signs taking and bedside care. Establish Nurse- Patient 4. Provide an environment for microorganisms to
Interaction synthesize nutrients, such as vitamin K
8:30-9:00 Checking of patient’s chart B. Mouth
9:00-9:15 First batch break 1. Contains the lips, cheeks, palate, tongue, teeth,
9:15-9:30 Second batch break salivary glands, muscles, and maxillary bones
2. Saliva contains the enzyme amylase (ptyalin),
9:30-11:00 Discussion and Question and answer about patient’s case per which aids in digestion.
student (1st batch). Plotting of TPR sheet C. Esophagus
11:00-11:30 Sample charting/ Drug study 1. Collapsible muscular tube about 10 inches
11:30-12:00 First batch lunch break (25 cm) long
12:00-12:30 Second batch lunch break 2. Carries food from the pharynx to the stomach
D. Stomach
12:30-1:00 Continuation of NPI, bedside care, procedures
1. Contains the cardia , fundus, body, and pylorus
1:00-1:30 Discussion and Question and answer about patient’s case per 2. Mucous glands are located in the mucosa and
student (2nd batch) prevent auto digestion by providing an alkaline
1:30-2:00 Discussion-Topic: Gastro Intestinal protective covering.
2:00-2:30 Close charting 3. The lower esophageal (cardiac) sphincter prevents
2:30-3:00 Post- conference reflux of gastric contents into the esophagus.
4. The pyloric sphincter regulates the rate of stomach emptying into the small intestine.
-Submission of charting/ drug study
5. Hydrochloric acid kills microorganisms, breaks
-Sharing of student’s learning experience food into small particles, and provides a chemical environment that facilitates gastric enzyme
activation.
6. Pepsin is the chief coenzyme of gastric juice,
which converts proteins into proteases and
peptones.
7. Intrinsic factor comes from parietal cells and is
necessary for the absorption of vitamin B12.
8. Gastrin controls gastric acidity.
E. Small intestine
1. The duodenum contains the openings of the bile
and pancreatic ducts.
2. The jejunum is about 8 feet (2.4 meters) long.

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 3. The ileum is about 12 feet (3.7 meters) long.
4. The small intestine terminates in the cecum.
F. Pancreatic intestinal juice enzymes
1. Amylase digests starch to maltose.
2. Maltase reduces maltose to monosaccharide
glucose.
3. Lactase splits lactose into galactose and glucose.
4. Sucrase reduces sucrose to fructose and glucose.
5. Nucleases split nucleic acids to nucleotides.
6. Enterokinase activates trypsinogen to trypsin.
G. Large intestine
1. About 5 feet (1.5 meters) long
2. Absorbs water and eliminates wastes
3. Intestinal bacteria play a vital role in the synthesis of some B vitamins and vitamin K.
4. Colon: Includes the ascending, transverse, descending, and sigmoid colons and rectum
5. The ileocecal valve prevents contents of the large
intestine from entering the ileum.
6. The internal and external anal sphincters control
the anal canal.
H. Peritoneum: Lines the abdominal cavity and forms
the mesentery that supports the intestines and blood
supply
I. Liver
1. The largest gland in the body, weighing 3 to 4
pounds (1.4 to 1.8 kg)
2. Contains Kupffer cells, which remove bacteria in
the portal venous blood
3. Removes excess glucose and amino acids from
the portal blood
4. Synthesizes glucose, amino acids, and fats 671
5. Aids in the digestion of fats, carbohydrates, and
proteins
6. Stores and filters blood (200 to 400 mL of blood
stored)
7. Stores vitamins A, D, and B and iron
8. The liver secretes bile to emulsify fats (500 to
1000 mL of bile/day).
9. Hepatic ducts
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 a. Deliver bile to the gallbladder via the cystic
duct and to the duodenum via the common
bile duct
b. The common bile duct opens into the duodenum, with the pancreatic duct at the ampulla
of Vater.
c. The sphincter prevents the reflux of intestinal
contents into the common bile duct and
pancreatic duct.
J. Gallbladder
1. Stores and concentrates bile and contracts to
force bile into the duodenum during the digestion of fats
2. The cystic duct joins the hepatic duct to form the
common bile duct.
3. The sphincter of Oddi is located at the entrance
to the duodenum.
4. The presence of fatty materials in the duodenum
stimulates the liberation of cholecystokinin,
which causes contraction of the gallbladder
and relaxation of the sphincter of Oddi.
K. Pancreas
1. Exocrine gland
a. Secretes sodium bicarbonate to neutralize the
acidity of the stomach contents that enter the
duodenum
b. Pancreatic juices contain enzymes for digesting carbohydrates, fats, and proteins.
2. Endocrine gland
a. Secretes glucagon to raise blood glucose
levels and secretes somatostatin to exert a
hypoglycemic effect
b. The islets of Langerhans secrete insulin.
c. Insulin is secreted into the bloodstream and
is important for carbohydrate metabolism.
II. Diagnostic Procedures
A. Upper GI tract study (barium swallow)
1. Description: Examination of the upper GI tract
under fluoroscopy after the client drinks barium
sulfate
2. Preprocedure: Withhold foods and fluids for
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 8 hours prior to the test.
3. Postprocedure
a. A laxative may be prescribed.
b. Instruct the client to increase oral fluid intake
to help pass the barium.
c. Monitor stools for the passage of barium
(stools will appear chalky white for 24 to
72 hours postprocedure) because barium
can cause a bowel obstruction

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Day 3 Definition:
6:45-7:00 Maintaining Muscle Strength and Joint Mobility
Checking of attendance.Checking of uniform and paraphernalias. Optimal function depends on the strength of the muscles
and joint motion, and active participation in ADLs promotes maintenance of muscle strength and
7:00-8:00 Assigning of patient’s joint mobility.
8:00-8:30 Receiving endorsement, rounds, medication preparation. Range-of-motion exercises and specific therapeutic exercises may be included in the nursing
Initial vital signs taking and bedside care. Establish Nurse- Patient plan of care.
8:30-9:00 Interaction PERFORMING RANGE-OF-MOTION EXERCISES. Range of
9:00-9:15 Checking of patient’s chart motion involves moving a joint through its full range in all
9:15-9:30 First batch break appropriate planes. To maintain or increase
the motion of a joint, range-of-motion exercises are initiated as soon as the patient’s condition
9:30-11:00 Second batch break permits.
Question and answer about patient’s case per student (1 st Range-of-Motion Terminology
11:00-11:30 batch).Plotting of TPR sheet Abduction: movement away from the midline of the body
11:30-12:00 Sample charting/ Drug study Adduction: movement toward the midline of the body
12:00-12:30 First batch lunch break Flexion: bending of a joint so that the angle of the joint diminishes
Extension: the return movement from flexion; the joint angle is increased
12:30-1:00 Second batch lunch break
Rotation: turning or movement of a part around its axis
1:00-1:30 Continuation of NPI, bedside care, procedures Internal: turning inward, toward the center
Discussion and Question and answer about patient’s case per External: turning outward, away from the center
1:30-2:00 student (2nd batch) Dorsiflexion: movement that flexes or bends the hand
2:00-2:30 Discussion-Topic: muscle strength and joints back toward the body or the foot toward the leg
2:30-3:00 Close charting Palmar flexion: movement that flexes or bends the hand in
the direction of the palm
Post- conference
Plantar flexion: movement that flexes or bends the foot in
-Submission of charting/ drug study the direction of the sole
-Sharing of student’s learning experience Pronation: rotation of the forearm so that the palm of the
-Rotational Quiz hand is down
Supination: rotation of the forearm so that the palm of the
hand is up
Opposition: touching the thumb to each fingertip on same
hand
Inversion: movement that turns the sole of the foot inward
Eversion: movement that turns the sole of the foot.

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Day 4
6:45-7:00
Checking of attendance.Checking of uniform and paraphernalias. Condition Requiring Enteral Therapy
7:00-8:00
Assigning of patient’s
8:00-8:30
Receiving endorsement, rounds, medication preparation.
Initial vital signs taking and bedside care. Establish Nurse- Patient
8:30-9:00
Interaction
9:00-9:15
Checking of patient’s chart
9:15-9:30
First batch break
9:30-11:00
Second batch break
Question and answer about patient’s case per student (1 st
11:00-11:30
batch).Plotting of TPR sheet
11:30-12:00
Sample charting/ Drug study
12:00-12:30
First batch lunch break
12:30-1:00
Second batch lunch break
1:00-1:30
Continuation of NPI, bedside care, procedures
Discussion and Question and answer about patient’s case per
1:30-2:00
student (2nd batch)
2:00-2:30
Discussion-Topic: Condition Requiring Enteral Therapy
2:30-3:00
Close charting
Post- conference
-Submission of charting/ drug study
-Sharing of student’s learning experience

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Day 5 Definition:
6:45-7:00 Oxygen Delivery system: advantage and disadvantages Oxygen

7:00-8:00 Checking of attendance.Checking of uniform and paraphernalias.

8:00-8:30 Assigning of patient’s
Receiving endorsement, rounds, medication preparation.
8:30-9:00 Initial vital signs taking and bedside care. Establish Nurse- Patient
9:00-9:15 Interaction
9:15-9:30 Checking of patient’s chart
9:30-11:00 First batch break
Second batch break
11:00-11:30 Question and answer about patient’s case per student (1 st
11:30-12:00 batch).Plotting of TPR sheet
12:00-12:30 Sample charting/ Drug study
12:30-1:00 First batch lunch break
1:00-1:30 Second batch lunch break
Continuation of NPI, bedside care, procedures
1:30-2:00 Discussion and Question and answer about patient’s case per
2:00-2:30 student (2nd batch)
2:30-3:00 Discussion-Topic: Oxygen Delivery system: advantage and
disadvantages Oxygen
Close charting
Post- conference
-Submission of charting/ drug study
-Sharing of student’s learning experience

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Day 6
6:45-7:00

7:00-8:00
8:00-8:30 Checking of attendance.Checking of uniform and paraphernalias.
Assigning of patient’s
8:30-9:00 Receiving endorsement, rounds, medication preparation.
9:00-9:15 Initial vital signs taking and bedside care. Establish Nurse- Patient
9:15-9:30 Interaction
9:30-11:00 Checking of patient’s chart
First batch break
11:00-11:30 Second batch break
11:30-12:00 Question and answer about patient’s case per student (1 st
12:00-12:30 batch).Plotting of TPR sheet
12:30-1:00 Sample charting/ Drug study
1:00-1:30 First batch lunch break
Second batch lunch break
1:30-2:00 Continuation of NPI, bedside care, procedures
2:00-2:30 Discussion and Question and answer about patient’s case per
2:30-3:00 student (2nd batch)
Discussion-Topic:
Close charting
Post- conference
-Submission of charting/ drug study
-Sharing of student’s learning experience
- Rotational quiz

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Reference: KOZIER

Prepared By: Jenny Salonga Noted By: (name of clinical instructor) Noted By:
(Clinical Coor)

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