PART 1: DIGESTIVE SYSTEM

Anatomy: Alimentary canal of digestive system

Mouth-esophagus-stomach-pylorus-fundus-body
antrum-pylorus-duodenum-resu-ileum-s.i.-l.i.-
rectum
Functions Digestive system
Ingestion-mouth, eating
Digestion-absorption, hcl acid, enzymes
Absorption-nutrients like vitamins vs. diarrhea
Nourishment-using the nutri and vits for the body
Elimination-waste/not needed products
MOUTH mech/chem
Storage, mixing, liquefaction of food
Salivary amylase-starches-sugar.
Tongue food in place.
Chewed, swallowed, juices react easily
Epiglottis-prevent food through windpipe
Throat-windpipe and esophagus
ESOPHAGUS
Peristalsis- mouth-stomach
Epiglottis to LES (prevent backflow)
STOMACH
LUQ, 1500ml-capacity
Regions-cardia,body,fundus,pylorus
Peristaltic wave -strong contraction VS Mixing
Empty time: 2-4hrs (Dyspepsia VS Ulcerations)
Mech.Sec.Chem.Prtxn.Absrpn.
Chyme, Gastric juice, Pepsin w/ Hcl, e.g. Drugs
Glands and Secretions (Stomach)
Surface mucous cell- mucus balance acid
Mucous neck cell- same
Parietal cells- Hcl & intrinsic factor, (Ca,Pa)
Endocrine cells- gastrin, g-cells
Chief cells- pepsinogen
Gastric lipase- digesting fats
Enterochromatin- histamine
Delta cells- somatostatin (alpha,beta)

Hormones
Gastrin- (SDF) - ^gastric juice
Cholecystokinin- (FD) pancreatic enzyme, GB:bile
Secretin- (ApHC) pancreatic bicarbonate
No food no trigger-gastric irritation
Enzymes
Amylase, maltase, lactase, sucrose, enterokinase.
(Starch, glucose, galactose, fructose, trypsin)
Assessment: IAPP, tympany, 5-35x click, listen 5mins
DIAGNOSTIC AND LABORATORY TEST
1. Acid Perfusion/Bernstein test- chest pain r/t GERD,
NPO 6-8, NGT insert, instill nss & 0.1hcl.
2. Gastric Analysis measure hcl & pepsin sec, NPO8-
12, no chewing gum/tobacco 6b4, no meds 24-28,
NGT+suction, collect every 15mins in 1hr. Inc.
Zollinger-Ellison Syndrome. Dec. Gastric Ca,
Prenicious Anemia
3. Upper GI series/Barium swallow- NPO6-8,
smoking/post-midnight, no metals, B.sulfate,
lying/standing, process45mins, after=laxa, white
stools72hrs, WOF: consti&distention/bleeding
4. Endoscopy- consent,NPO6-12, anticholinergic &
glucagon prevent aspi/oropharyngeal secs, sedate,
no dentures, process left side, airway + oximeter,
after: NPO-gag reflex wait, gargle nss/lozenges, no
driving 12hrs
DIAGNOSIS
1. Gastroesophageal reflux disease
2. Achalasia
3. Hiatal Hernia
4. Gastritis
5. Peptic Ulcers
Gastric- weak G.mucosa, L:epipain 1hr after meals,
morning, relieve by vomit, hematemesis (bldvomit),
wt.loss
Duodenal- inc.Hcl sec, R:epipain 2-3after meals,
evening, by eating relieve, melena, wt.gain.
6. Pyloric Stenosis


PHARMACOLOGY
1. Antacids <Gerd, peptic ulcer
2. H2 Blocker <Gerd,
3. Proton Pump Inhibitor <Gerd,
4. Pro-kinetic drug (Bethanecol/Urecholine,
Domperidone/Molilium, Metoclopromide / Reglan)
<Gerd
5. Anticholinergics
6. Cytoprotective / prostaglandin 1hrb4meals
7. Antibiotic Therapy (Amoxicillin, Metronidazole,
Clarithromycin, Tetracycline)
Ibuprofen gastric irritant no for PUD
Aspirin no for ranitidine and antacids bec. Bleeding
Magnesium Hydroxide diarrhea s/e
FURTHER PHARMA
Antacids (Na bicarbonate, al hydroxide, mg Hxd,
Ca carbonate) neutralize Hcl, 1-2hrs after meals,
for PUD, GERD, no fruit juice, no vit. CD.
H2 Receptor Blockers p.cells in stomach reduce
g.acid, for PUD, GERD, morning+bedtime, s/e: h/a,
dizzy, consti, b.cardia. Cimetidine: WOF mental
Ranitidine H2blocker, before meals, ZANTAC
Proton Pump Inhibitor inhibit g.acid, block its
final step, for PUD, GERD, take b4 meals/HS, S/E:
h/a, dizzy, diarrhea, abdopain. (Omeprazole /
prilosec, Pantoprazole / protonix, Esomeprazole /
Nexium, Lansoprazole / prevacid)
Cytoprotective mucosal.p., coat ulcer protect
from acid and pepsin, SUCRALFATE: empty stomach,
before meals, 1hr apart, S/E: Constipation
Protaglandin E1 Analogue Misoprostol (Cytotec)
suppress g.acid, inc. cprotective mucus in GI tract,
taken w/ meals, S/E: diarrhea, abdo cramps, no to
pregnant
PART 2: GASTROINTESTINAL II
Intestinal layers and Functions
1. Mucosa intestinal villi and glands, for prdxn, for
absorp, nutria.
2. Submucosa bv, glands(mucus, hormones), nerves
(plexus), peyers patches.
3. Muscularis inner circular sm, N(P), outer
longitudinal sm
4. Serosa outermost conntiss, parietal and visceral
Liver
RHCR, Portal triad: Hepatic duct, portal vein, artery
Percussion, liver span (dull) R-midclavicular line 6-
12cm other side is 4-8cm
TESTS
1. Guaiacs test/Occult blood 2-3d h-fiber diet for
consti, 3d collection, false+ = HRMBSCPTS, (-) vitC
2. Endoscopic retrograde cholangiopancreatography
insert endoscope see GB & ducts to remove stones,
consent, NPO4-6, lie still, spray lidocaine, WOF:
bleeding, wait gag reflex
3. Lower GI series/ barium enema rectal admin, low
residue diet 1-2d, night before- liquid, laxa,
cleansing enema, NPO 8hrsb4, left/sims, inc. fiber,
laxa n fluids at bedtime, check iodine allergy, c/i:
inflammation, perforation, obstruct
4. Colonoscopy fiberotic see abn in colon, clear
liquid afternoon day before, NPO-post-midN,
enema b4, Midazolam IV sedate, Glucagon relax
SM, Shrimp/ genupectoral, check LOC, NPO, bed
rest, WOF: Perforation and bleeding
5. Cholecystograpy xray for stone, 12hr fat free, oral
contrast medium (6-10tabs night b4), iodine allergy,
during: fatty meal/cholecystokinin, add xray abt 1
hr later, end same diet to promote excretion
6. Paracentesis cath remove fluid, consent, must
void, weigh, meas abdo girth, check vs, ptt,
elevateHOB/lateral, check color, drainage, WOF
elec imbalance, hypovolemia, protein depletion,
infxn
7. Liver Biopsy insert needle microscopic exam in
abdo wall, consent, sedate, L;lateral/supine, check
vs & ptt, ascultate bms, monitor peritonitis, r;side
with pillow under coastal margin, no cough/strain,
lift 1wk
STOOL
w/ MUCUS-IBS, Ulcerative colitis
w/ BLOOD-diverticulitis, colonca, UC, gastroenteritis
STEATORRHEA- biliary obstruct, pancreatitis,
malabsorption
CLAY COLORED obstructive jaundice, meds
BLACK TARRY UGIbleed, bismuth, feso4, nsaids,
apirin, steroids,
PAIN
RLQ appendicitis
RUQ cholecystitis
LLQ diverticular disorders, IBS
w/ food and post-meal biliary, pancreatic, chrons
w/ defecation UC
SIGNS
Psoas hip flexion
Blumberg mcburney rebound tenderness
Rovsing LLQ to RLQ pain
Obturator exte rot Rleg, inte rot Rhip
Murphy RUQ pain inhaling w/ finger press
Turner left flank ecchymosis
Cullen periumbilical ecchymosis
String constrict terminal ileum
DISEASES
1. IBS
Chrons RLQp, 5-6 loose watery, c/x: abscess,
fistula, strictures
UC LLQp, 20-40 watery, mucoid, bloody, c/x: CA
2. Pancreatitis pain: fatty, alco, recumbent. Mid-
epi/LUQ pain, n/v, Cullen+gray turner, elevatesnoCa
3. Liver cirrhosis
Leanic- alco, malnutri
Post necrotic drugs Hepa BCD
Cardiac Rsided <3 failure
Biliary chronic obstruct destroy ducts
PHARMACOLOGY
1. Pancreatic enzyme pancrelipase w/ meals,
increase fiber for great effect, reduction
steatorrhea
2. Antacids 1-2 after meals
Sucralfate w/ empty stomach / consti
Misoprostol no pregnant, w/ meals causes
diarrhea din
Aluminum slow acting, bind phosphate, may lead
hypo also consti
Calcium fast acting, cause milk alkali syndrome
give w/ water no milk
Magnesium may cause diarrhea
3. H2 blockers caution renal and hepatic, (Ranitidine,
Famotidine, Cimetidine), mental s/e
4. Anticholinergics:Atropineso4,Propanthelinebromide
decrease gastric sec & motility, b4 meals, inc.
fluid, avoid activity alertness
5. Pro-kinetics (Antidopaminergic) antipsychotic
cause HPN, domperidone dont enter BBB,
metoclopromide stimulate lactation, cause
Parkinson, suppress n/v
6. Laxatives: Docusate sodium (Colace), Bisacodyl
(Dulcolax) at bedtime, full glass water, dont give
1hr after antacid or milk, TE: 1-3d
7. Gallstone dissolution Agents: Chenodeoxycholic
acid (Chenodal, CDCA) low fat hi-fiber diet,
diarrhea cause, risk for reoccurrence
8. Lactulose for hepatic encephalopathy 2-3
stools/d, monitor LOC and BM, decreases ammonia,
improve hand writing/drawing (apraxia), improveloc
PART 3: INTEGUMENTARY SYSTEM
1.) Protection
Mechanical barrier
Keratin, lipids, sebum
Perspire / insensible water loss 600ml
Thick palms and soles
Langerhans cells barrier
2.) Sensory Reception
Dermis-spinal cord-somatosensory cortex
Meissner corpuscles touch
Merkels & Ruffini cells pressure
Pacinian corpuscles vibration and pressure
Hair follicle endings hair movement
Thermoreceptors hot/cold
Free nerve ending parietal (sensation) pain
3.) Vitamin D production Ca absorp, sunlight/uv
convert and provides identity
4.) Thermoregulation controls heat loss, sweating,
fluid balance, conduction, HYPOTHALAMUS
Major layers of the skin
1.) EPIDERMIS stratified squamous epithelium
STRATUMS: Basale (mitosis), Spinosum
(keratinization place) Granulosum, Lucidum,
Corneum (20-30layers)
Keratinocytes cells = keratin (fibrous protein forms
barrier, repel pathogens, prevent fluid loss much,
hair and nails hardening
Melanocytes, langerhan cells,
2.) DERMIS dense connective tissue
Papillary-increase collagen, bv, sweat glands, elastin
Reticular layer-sebaceous g., hair roots, receptors,
b&lv, nerves, sweat, scaffold (regenerate)
Demoepidermal junction: papillae from dermis
(wave). Inc. area of contact bt. Skin, help prevent
epidermis from shearing, basal layer composed of
collagen
3.) HYPODERMIS - subcutaneous tissue
Stores fat, insulator, attach skin to bone and
muscle, serves as cushion
4.) Epidermal Appendages outgrows to dermis, hair,
non-viable protein, sex hormone stimulation
Keratinization resistance of cell abrasion
Melanin protects against UV light
Carotene yellow pigment found in plants
Accessory Skin Structures
1.) Hair shaft, root, hair bulb (medulla, cortex, cuticle,
hair follicle)
2.) Muscles arrector pilli
3.) Glands
Sebaceous glands shaft for lubri, make hair,
render skin soft, not in soles and palms, sebum
Sweat Merocrine/eccrine thermoregulation,
stress, sweat ; Apocrine milky sweat
4.) Nails keratin transparent
INSPECTION
Color Pallor, cyanosis, jaundice, erythema
Uniformity pigmentation (dark), hyper
(birthmarks), hypo (vitiligo, albinism)
PALPATION
Edema swollen, shiny, blanch, pitting. (2mm, 2-4,
5-7, >7) Anasarca : generalized (liver, kidney, shock)
Temperature hyper/hypothermia *texture, tender
Skin turgor stays pinch/moves back slow (DHN)
ODOR pungent, hyperhidrosis, bromhidrosis
LESIONS
PRIMARY in birth, acquired in life
Macule small spot, 1mm-1cm (flat moles)
Patch- >1cm ireg shape (bmarks, vitiligo)
Papule - <1cm (warts, acne)
Plaque - >1cm (psoriasis)
Nodule 0.5-2cm (squamous cell carcinoma)
Tumor - >2cm, ireg border (malignant melanoma)
Vesicle - <0.5cm, fluid (early chicken pox)
Bullae/blister - >0.5cm (second degree burn)
Pustule vesicle/bulla w/pus (a.vulgaris, impetigo)
Cyst - >1cm, arise from dermis/sct (sebaceous cyst)
Wheal edema fluid (mosquito bites)
SECONDARY natural progression or manipulation
Atrophy-paper/thin/translucent/dry (old age, striae)
Ulcer non-blanch eryth, blister, crater necrosis, tse
nec damage bone and muscles
Fissure sharp crack (mouth, foot)
Erosion wear superficial layer moist, shallow
depression (scratch marks, ruptured vesicle)
Scar flat, ireg healed lesion
Keloid darkened area
Lichentification - rough/hard/thick (chro-dermatitis)
Scales-shedding flakes, greasy (dandruff, psoariasis)
Crust/Scab-dry blood, serum/pus left skin
Excoriation linear erosion induced in scratching
NURSING PROCEDURES
Irrigating a wound
Cleaning wound
Obtaining a wound drainage specimen
Anaerobic/aerobic, analgesic 30minb4
Applying a transparent wound barrier
Adhesive, plastic, semipermeable, non absorbent
Applying a hydrocolloid dressing
Waterproof, adhesive wafers7d, pastes, or powders
Autolysis of necrotic material by WBCs
Topical Agents
SKIN DISEASE
1.) Acne Vulgaris inflamed h.follicles, sebaceous g.,
Topical keratolytics dissolve keratin forming plugs
(Benzoyl peroxide cream, gel/lotion, Salicylic acid
cream, gel/shampoo)
Topical antibiotics Tetracycline (WOF
photosensitive, sunburn, teratogenic), Erythromycin
(severe acne), Clindamycin, Isotretinoin
2.) Psoriasis abn keratin prdxn, erythematous
papules, plaques
Topical keratolytics
Topical glucocorticoids anti-inflam, pruri, prolif
(Dexamethasone, hydrocortisone, bethametasone,
methylprednisolone acetate cream/ointment)
Methotrexate anti-psoriatic, b4 photochemo,
anthralin ointment/cream
3.) Dermatitis prolif, drug-induced/contact
Anti-pruritic, anti-histamine, calamine lotion, topical
glucocorticoids
4.) Hair loss and baldness Minoxidil (kogaine) !FDA
5.) Burn & Preparations antiseptic soln (povidone io),
Topical antibiotics: Mafenide acetate-bacteriostatic
metabolic acidosis, Silver Sulfanazide-bactericidal
6.) Herpes simplex, warts ANTI-VIRAL Docosonal
(Abreva), Penciclovir (Denavir)
7.) Fungal infections (tinea pedis) ANTI-FUNGAL
Clotrimazole (nizoral), Econazole nitrate(spectazole)
8.) Dandruff ANTI-SEBORRHEIC selenium sulfide
9.) Scabicides & Pediculocides Lindae/Kwell,
Malathion, Permethrin
10.) Dry/Flaky skin EMOLIENT-(Glycerin, Lanolin oint)
PART 4: MENTAL HEALTH AND PSYCHIATRIC NURSING
1960-large hosp, prolong stay, dependent, no
family. LH- community mental centers
1970-L to S term care, ospclosure, poor service CMC
1980-expensive health care
1990-case mgmt (research), pop-based commcare
2000 to present recovery and rehab model,
assertive comm. Tx, evidenced-based practice,
complementary and alternative medicine
HISTORY
19
th
century Spanish navy hospicio de san Jose
1904-estblish insane dept @ SLH caters m-ill
1917-jones law, gvt no to finances
1925-city sanatorium
Dec.28,1928-insular psychopathic hospital
Nov.12,1986-renamed:Natl center for Mhealth
Jan.30,1987-NCMH categ to special research
training center and hospital under the DOH

ELECTROCONVULSIVE THERAPY
10-15mins, 6-15ssions, 2-3/wk, 70-150v, .5-2secs
c/i: inc.ICP, (h/a, projectile v, wide pp, irritability)
cmptd pregnancy, retinal detachment, recent fx, tb
w/ hrrge, pulmo dse, dysrrhythmias, mi, cva, chf
Drugs: atro so4 (aspiration), anectine
/succynilcholine (muscle relaxant), methohexital Na
/brevital (anesthetic)
Before: npo8hrs, void, physical ex, no acsries, iv
line, o2 mask
NEUROLEPTICS
TYPICAL: Chlopromazine (Thorazine), Haloperidol
(Haldol), Loxapine (Loxitane), Droperidol (Inapsine),
ATYPICAL: Clozapine (Clozaril), Risperdone (R.erdal),
Olanzapine (Zyprexa), Ziprasidone (Geodon)
After meals, monitor bp, sunlight, TE: 2-4wks, wt
gain, sedation
EXTRAPYRAMIDAL S/E
- Acute Dystonic Restrictions 1-2wks after intial
- Pseudoparkinsonism-1-2wks w/n 6mos
- Akathisia-spasm+sev anxi
- Tardive dyskinesia-after inc. dosage 1-4wks
A/V-neuroleptic magnant syndro, agranulocytosis
LITHIUM (Eskalith, Lithane)
.6-1.2meq/L, Tres:1-3wks, S/e: polyuia, weak, dwsy,
tremors, diarrhea, GIT irri, hair loss
Toxicity: stop L, lavage, forced diuresis, vs,loc,ecg,
ren fxn tst, elec lvls, hemodialysis, saline
IMP: dont lose SODIUM, no double dose, w/n 2 hrs
if miss, FLUIDS, reg monitor
ANTICONVULSANTS
Carbamezepine (Tegretol)-8-12mcg/ml, nmalizes Na
chnlactivity,s/e:nau,anor,occvom,sedation,agranulo
Valproates(Depakene/Convulex)-inc.GABA, rspns,
resting potential, suppress ca influx, s/e: transient
hairloss,wt.gain, tremrs, GIupset, thrombocytopenia
Lumotigrine(lamictal)-no to acute ,ania, inhibs
neuronal firing, blocks Na & Cachan, skinrash, glmt
Gabapentin(Neurontin) -inhibit glutamine(memory)
Topiramate(Topamax)-Adjunct, up regulates GABA,
block Na&Cachan, inhibits glutamate
ANTIDEPRESSANTS
SSRIs
Fluoxetine (Prozac), Sertraline Hcl (Zoloft)
Inc. Sero, washout:5wks, s/e: GITirri, sexdyxfxn,
in/hypersomnia, liver/renal impair, o.hypo, Sz, DM
TCAs
Amitriptyline Hcl(Elavil), Clomipramine(Anafranil),
Imipramine(Tofranil), Portriptyline(Vivactil)
Inc.norepi,sero,dopa (2/3degree amines), TE:1
st
-4
th

wk, s/e: anticholinergic sx., hpn crisis w/maois,
sedation, GIT effects, O.hypo, LRimpair, agranulo
MAOIs
Phenelzine So4 (Nardil), Tranylcypromine So4
(Parnate), Isocarboxazid (Marplan)
Inc.norepi,sero, TE:2
nd
-4
th
wk, S/e: atcholi eff, hpn
crisis, (TCA amphetamins, dopamine, epinephrine,
tyramine foods: aged cheese, brewers yeast, beer,
chocolates), O.hypo, agranulo, LRimpair
Phentolamine (Regitine) NO! bec CRISIS: occi pain,
stiff neck, nv, shooting bp, fever, sweating, dilate
pupils, palpi, dysrtm, flush
HPNcrisis:h/a,metabolism,hydrosis,glycemia,tension
NDRIs - Burpropion(Wellbutrin) inc.nore,dopa,
atypical reuptake inhibitors, s/e: cns stimulate, wt.loss
SSNRIs - Velfaxine(Effexor)-inc.sero,nore,dopa, dose
related eff: low,mod,hi
Alpha2antagonists Mirtazapine(Remeron) 5HT2 &
5HT3, increase cholesterol
CRISIS