Pathopysiology of Type 2 DM



A. Blink reflex
– rapid eyelid closure when strong light is shown
-Purpose: to protect the eye from any object coming near it.

B. Palmar grasp reflex
– solid object is placed on palm and baby grasp object
- Purpose: cling to mother for safety (disappear by 6 weeks – 3 months)

C. Step (Walk)-in-Place Reflex
– neonate placed on a vertical position with their face touching a hard surface will take few quick, alternating steps. (disappear by 3 months)
- Placing Reflex: almost the same with step in place reflex only that you are touching anterior surface of a newborn’s leg.

D. Plantar grasp reflex
– when an object touches the sole of a newborn’s foot at the base of toes, the toes grasp in the same manner as fingers do. (disappear by 8 – 9 months in preparation for walking)

E. Tonic-neck-reflex
– when newborns lie on their backs, their heads usually turn to one side or the other. The arm and the leg on the side to which the head turns extend, and the opposite arm and leg contract.
-also called a boxer or fencing reflex

F. Moro reflex
– test for neurological integrity (jarring crib, loud voice) assume a letter C position (disappear by 4 – 5 months)

G. Magnet reflex
– when there is pressure at the sole of the foot he pushes back against the pressure. (test for spinal cord integrity)

H. Crossed extension reflex
– when the sole of foot is stimulated by a sharp object, it causes the foot to rise and the other foot extend

I. Truck Incurvation reflex
– while in prone position and the paravertebral area is stimulated, it causes flexion of the trunk and swing his pelvis toward the touch.

J. Landau reflex
–while prone position and the trunk is being supported, the baby exhibit some muscle tone (test for muscle tone and present by 6 – 9 months)

K. Parachute reaction
– while on ventral suspension with the sudden change of equilibrium, it causes extension of the hands and legs (present by 6 – 9 months)

L. Babinski reflex
– when the sole of foot is stimulated by an inverted “J”, it causes fanning of toes (disappear by 2 months but may persist up to 2 years)






Filipino NURSES Page will be participating in the Election Watch on May 10 Philippine Elections. Let's get involved. Ensure that all votes are properly counted and report any irregularities/anomalies in your particular precinct. Effective until the ballots are all in and counted, we will ask everyone to post election related topics or news to help bring updates. Together let's make sure that this Presidential Elections will be peaceful and orderly. Sapagkat Pilipino akong may pakialam sa kinabukasan ng bansa ko!


Demo in mixed emotions during my 2nd yr life :)

Hello guys",) i want to share another erudition and some experience of mine, this one is about our return demonstration in Intradermal (ID), Intramuscular (IM) and Subcutaneous (SQ) injection, this was happened on November 17-19, 2008.My feeling was quite indescribable it's like i am exicited but quite anyway here are some pictures on what we have done...

......the preparations

reactions of each faces of my group",)


INTRADERMAL INJECTION (ID) - Administration of drug into the dermal layer of the skin just beneath the epidermis...

Right - Other test
Left - Commonly TB Screening

Assess: the appearance of injection site, Specific drug action/ expected response and client knowledge of drug action and respose....

Check: the Label, if it is taken from the medication cart, after and before withdrawing the medication against Medication Administration Record (MAR)....

Common Site's are:
Inner lower arm
Upper chest
Back beneath the scapulae...

5 - 15 degree angle

1st - Proper hand washing/Appropriate infection control

2nd - Prepare the Medication

3rd - Prepare the Client

4th - Explain to the Client the procedure (Medication will produce small wheal sometimes called "bleb".).....

Do not massage the area because it can disperse the medication into the tissue...


INTRAMUSCULAR INJECTION - are absorbed more quickly than SQ injections because of the greater blood supply to the body muscles...

well - developed muscles - 4ml medication (gluteus medius and gluteus maximus muscles.)
less developed muscles - 1-2ml
deltoid muscle - 0.5 - 1ml

....the size of the syringe used depends on the amount of medication being administered but usually 2-5ml syringe needed and needle are 1 1/2 inches, #21 or #22 gauze.

5cm/ 4 fingers from acromion process..

These one of my favorite captured pic. during our return demonstration,
....the eyes that give more emotions act upon the demonstration.

Factors indicate the size and length of the NEEDLE to be used are the muscle, type of solution, amount of adipose tissue covering muscle and the age of the client...


Ventrogluteal Site
Vastus Lateralis Site
Dorsogluteal Site
Deltoid Site - commonly used for IM because it is a relatively small muscle and very close to the radial nerve and radial artery...
Rectus Femoris Site



- Vaccines

- Preoperative medication

- Narcotics

- Insulin

- Heparin...

Commonly Sites:
Outer aspect of the upper arms and the anterior aspect of the thighs...
-these areas are convenient and normally
have a good blood circulation...

scapular area of the upper back,
and the upper ventrogluteal and dorsogluteal areas.

type's of syringe:

generally 2ml syringe..however,

Insulin is for insulin syringe

Heparin are for tuberculin syringe and prefilled cartidge...

...0.5 - 1ml of medication.

Causes of Acute Renal Failure


•Volume deplection resulting from:
Renal losses (diuretics, osmotic diuresis)
Gastrointestinal losses (vomiting, diarrhea, nasogastric suction)

• Impaired cardiac efficiency resulting from:
Myocardial infarction
Heart failure
Cardiogenic shock

• Vasodilation resulting from:
Antihypersentensive medication or other medications that causes vasodilation


•Prolonged renal ischemia resulting from:
Pigment nephropaty (associated with the breakdown of blood cells containing pigments that in turn occlude kidney structures)
Myoglobinuria (trauma, crush injuries, burns)
Hemoglobinuria (transfusion, reaction, hemolytic anemia)

•Nephrotoxic agents such as:
Aminoglycoside antibiotics (gentamicin, tobramycin)
Radiopaque contrast agents
Heavy metals (lead, mercury)
Solvents and chemicals (ethylene glycol, carbon tetrachloride, arsenic)
Nonsterodal anti-inflammatory drugs (NSAID’s)
Angiotensin- converting enzyme inhibitors (ACE inhibitor)

•Infectious process such as:

Acute pyelonephritis
Acute glomerulonephritis


•Urinary tract obstruction, including:
Calculi (stones)
Benign prostatic hyperplasia
Blood clots

Role of the Scrub and the circulating nurses @ Operating Room


1. Gathering all equipment for the procedure.

2. Preparing all supplies and instrument using sterile technique.

3. Maintaining sterility within the sterile field during surgery.

4. Handling instruments and supplies during surgery.


1. Ensuring all equipment is working properly

2. Guaranteeing sterility of instruments and supplier.

3. Assisting with positioning.

4. Monitoring the room and team members for breaks in sterile technique.

5. Assisting anesthesia personnel with induction physiologic monitoring.

6. Handling specimen.

7. Coordinating activities with other department such as radiology and pathology.

8. Documenting care provided.

9. Minimizing conversation and traffic with in the operating room suit.

Must for O.R. Nurse

1. You must work rapidly, often under tension, under close super vision of doctors and experienced O.R. nurses.

2. You must have a quick reaction time and make changes for unexpected situations without notice.

3. You must anticipate surgeon’s needs and keep one step ahead of him.

4. You must fit in and work smoothly as a closely functioning team.

5. You must be able to organize your work effectively so that not a single minute is lost.

6. You must follow the rules rigidly nothing is taken for granted in the O.R. ; you must knew and know what you know.

7. You must be patient of those who sometimes become impatient for a tense situation.

8. You must gain the confidence and trust of the patient and constructively reassure him.

9. You must have a quite yet, responsible and pleasing personality.

10. You must be willing to take your turn on call.

Examples of Foods for Clear Liquid, Full Liquid, and Soft Diets

•Clear Liquid

Coffee, regular and decaffeinated


Carbonated beverages

Bouillon, fat-free broth

Clear fruit juices (apple, cranberry, grape)

Other fruit juices, strained



Sugar, honey

Hard candy

•Full Liquid


All foods on clear liquid diet plus:

Milk and milk drinks

Puddings, custards

Ice cream, sherbert

Vegetables juices

Refined or strained cereals (e.g., cream of rice)

Cream, butter, margarine

Eggs ( in custard and pudding)

Smooth peanut butter




All foods on full and clear liquid diets, plus:

Meat: All lean, tender meat, fish, or poultry (chopped, shredded);
Spaghetti sauce with ground meat over pasta

Meat alternatives: Scrambled eggs, omelet, poached eggs; cottage cheese and other mild cheese

Vegetables: Mashed potatoes, sweet potatoes, or squash; vegetables in cream or cheese sauce; other cooked vegetables as tolerated (e.g.’ spinach, cauliflower, asparagus tips), chopped and mashed as needed; avocado

Fruits: Cooked or canned fruits; bananas, grapefruit and orange secretions without membranes, applesauce

Breads and cereals: Enriched rice, barley, pasta; all breads; cooked cereals (e.g.; oatmeal)

Desserts: Soft cake, bread pudding

Types of Healing

1. Healing regeneration
gradual repair of the defect occur.

2. Healing by replacement of another type
usually connective tissue it will fill in the tissue it will fill in the
tissue defect and result of scar formation.

10 "R" Rights of Medication Administration

• Right Medication
- The medication given was the medication ordered.

• Right Dose
- The dose ordered is appropriate for the client.
- Give special attention if the calculation indicates multiple pills/ tablets or a large quantity of a liquid medication.
- Double check calculations that appear questionable.
- Know the usual dosage range of the usual dosage range.

• Right Time
- Give the medication at the right frequency and at the time ordered according to agency policy.
- Medications given within 30 minutes before or after the scheduled time are considered to meet the right time standard.

• Right Route
- Give the medication by the ordered route.
- Mark certain that the route is safe and appropriate for the client

• Right Client
- Medication is given to the intended client
- Check the client’s identification band with each administration of a medication.
- Know the agency’s name alert procedure when clients with the same or similar last names are on the nursing unit.

• Right Documentation
- Document medication administration after giving it, before.
- If time of administration differs from prescribed time, note the time on the MAR and explain reason and follow-through activities (e.g.’ pharmacy states medication will be available in 2 hours) in nursing notes.
- If a medication is not given, follow the agency’s policy for documenting the reason why.

• Right to refuse
• Right to assessment
• Right evaluation
• Right client education

5 Cardinal Signs of Inflammation

Redness (Rubor) and Heat (Calor) – Due to vasodilatation and increase rate of blood flow to the micro circulation

Swelling (Tumor) – due to vascular permeability that is increase and plasma fluids that will leak into the injured tissue

Pain (Dolor)
– brought about by the pressure of fluids or swelling through the nerve endings.

Loss of function/ movement – brought by the swelling and pain.

Type’s of Inflammation

1.Acute Inflammation

– characterize by local vascular and exudative usually last less than 2 weeks.

– immediate and protective functions after the injurious agent is remove the inflammation.

2.Chronic Inflammation

– It develops if the injurious agent persist and the acute response is perpetuated.

– Symptoms are present for many months and year.

– The nature of exudates is become proliferative.

3.Sub- Acute

– Between acute and chronic, it include element of the active exudative phase.


Preoperative phase- begins when the decision to have surgery is made and ends when the client is transferred to the operating table.

Nursing Activities:
- Assesing the client.
- Identifying potential or actual health problems.
- Planning specific care based on the individual’s needs
- Providing preoperative teachings for the client and SO

Intraoperative phase- begins when the client is transffered to the operating table and ends when the client is admitted to the postanesthesia care unit (PACU) or Postanesthetic Room/Recovery Room.

Nursing Activities:
- Include a variety of specialized procedures designed to create and maintain a safe therapeutic environment for the client and the health care personnel.

Postoperative phase- begins with the admission of the client to the postanesthesia area and ends when healing is complete.

Nursing Activities:
- Assessing the client’s response(physiologic and phycologic) to surgery.
- Performing interventions to facilitate healing and prevent complications.
- Teaching and providing support to the client and SO.
- Planning for home care.

GOAL: to achieve the client to his/her optimal health status possible.

Food for the Day!

"It is written, 'Man shall not live by bread alone, but by every word that proceeds from the mouth of God."(Matthew 4:4 NKJV )

Just as we need food to sustain our human body, we also need spiritual food to sustain our Spiritual body as well!

Now a good meal should consist of vitamins and minerals, and perhaps a dessert.
So today we will look at Biblical Vitamins for our Spiritual well being.

When Anxious, take vitamin "A"
"All things work together for good to those who love God, to those who are the called according to His purpose".
( Romans 8:28 )

When Crushed, take vitamin "C"
"Cast all your care upon Him, for He cares for you".
( 1 Peter 5:7 )

When Depressed, take vitamin "D"
"Draw near to God and He will draw near you".
( James 4:8 )

When Empty, take vitamin "E"
"Enter into His gates with thanksgiving, and into His courts with praise. Be thankful to Him, and bless His name".
( Psalms 100:4 )

When Fearful, take vitamin "F"
"Fear not, for I am with you; Be not dismayed, for I Am your God". ( Isaiah 41:10 )

When Insecure, take vitamin "I"
"I can do all things through Christ who strengthens me". ( Philippians 4:13 )

When Lonely, take vitamin "I"
"I am with you always, even to the end of the age".
( Matthew 28:20 )

When Restless, take vitamin "R"
"Rest in the Lord, and wait patiently for Him".
(Psalms 37:7 )

For Dessert;
"Whoever believes in Him shall not perish but have eternal life".
( John 3:16 )

Hope that you have enjoyed this meal of Spiritual food.
Remember that you may have all you want,
for it is guaranteed to be non-fattening!



Type: Regular
Classification: Short
Onset: 30 min-1 hour
Peak: 2-3 hours
Duration: 4-6 hours

Type: NPH
Classification: Intermediate
Onset: 2-4 hours
Peak: 6-12 hours
Duration: 16-20 hours

Type: Ultralente
Classification: Long-acting
Onset: 6-8 hrs
Peak: 12-16 hours
Duration: 20-30 hours

Type: Lantus
Classification: Very Long
Onset: 1 hour
Peak: No peak
Duration: 24 hours only

Type: Lispro (Humalog)
Classification: Rapid-acting
Onset: 5-15 minutes
Peak: 1 hour
Duration: 3 hours

Holistic Care

"Hominem Non Morbum Cura" a latin phrase said by our former dean...which means "Cure the Man Not the Disease".

Elaborating from theories and principles as a nurse we do Holistic care to our client. When we say Holistic there are variables that we should observe, we would observe not only the physical condition, but also the psychologic condition of the client. Basically these are simple variations of patient care but still these are only few and little help in making a good or better Nursing Care plan to patient. As Nurses we have to look in the patient's environment, lifestyle, food intake, normal laboratory values and other aspects for gathering data. With all these data we do not only help ourselves but the patient. Always remember that the focus of care is for the patient and not the nurse. And the Goal is focused on the cure or rehabilitation of client. That is why we gather so much data from the client or the significant others so that we can assess the relationship of the variables to the Physical condition of the client. We can have a prioritized Diagnosis, Proper set of Plans, Implement it and to evaluate with care.

In providing a Holistic Care you have to remember that you have to know what affects the clients condition.


A client is having hypertension and was admitted in a Hospital. The nurse observed that the BP of the client still remains high even given the independent nursing care to lowering it down. The nurse assess again and would provide an intervention if she notices the following?

A. The room is well lighted and is well ventilated.
B. The room was newly renovated and painted.
C. The room has a Television installed
D. The room is posotioned where the sun rises.

A. The room is good for admission of patient
B. correct - room is newly renovated and painted - paint and other substance used for renovation can affect the condition of client due to sensory irritation from smelling paint and other materials. It would be best to transfer the patient to a new room which is ready for use.
C. Television can offer diversion and relaxation
D. Sun rays is therapeutic to the client. remember that sebum from sweat converts vitamin D to enzymes that transfers calcium to the bones.

Remember that Nursing Care Plans vary according to Institutions!

Students reaction:
1. Ang dami naman di naman ginagawa lahat yan! at di naman tinitingnan ng C.I.!
Patient would suffer more, with improper care and deliberation of prioritizing patient's needs. Remember that it is not what you give to the patient but what you do.
Ethical Perspective:
Remember the Golden Rule?
"Whatever you have done to the Least of My Breatheren you do unto Me."

2. Non Cooperative yung patient eh pasensya na lang sila.
same as above. These measures the competence of a nurse to gain trust and to give proper care to patients.
Ethical Perspective:
Always use Empathy (putting yourself on the shoes of others) and not Sympathy (mercy)

3. Long term yung Goal kaya di na namin namonitor
Goal is not met, assessment and other steps of the nursing process is useless. time and effort from the students are wasted
Ethical Perspective:
do Beneficence - means to do good and not to inflict harm
Resolve by setting plans with the family or relatives for continuity of care and goals to meet goals

Want to share your Thoughts?
Comment then we will try to suggest on how to improve care for clients

Medical Bloopers in Philippine Drama

Watching Philippine drama’s its common to see scenes that have conflicts between rich and poor, romances between 2 characters, revenge of villains and dramatic endings. Its just recently that I have noticed medical scenes in a drama more closely because of the recent primetime
offering of ABS-CBN called Habang May Buhay starring Judy Ann Santos.
The story revolves around Judy Ann being a nurse and her quest to help
her mother recover from a tragic love story that lead her to develop
psychotic behavior. However this article is not intended to make a
review about the soap opera but to examine some medical bloopers around
Philippine television past or present.


When I was not still a nurse, I used to believe that the things they do in a medical related scenes are the actual scenes you can see in a hospital. A lot of cases are shown in an emergency or intensive care unit setting. However, when I started to work especially in a toxic
area, the medical ward and now at the Emergency room, now I realized
that most scenarious are a bit funny and unrealistic. Lets site some
examples below:

1. A patient was defibrillated but she has still clothes on it.

2. A patient on cardiac arrest was not intubated, still they placed O2 cannula. (Dahil May Isang Ikaw)

3. I wonder why the nurse always carry patients chart.

4. A patient was intubated and yet she can talk (Tayong Dalawa, Marimar)

5. A patient was intubated but was still with O2 cannula. (Babaeng Hinugot sa Aking Tadyang)

6. A woman had delivery, when the baby came out, there was no vernix and was already cord dressed.

7. A doctor pronounced the patient dead only with a stetoscope or sometimes a flat line on the cardiac monitor only.

8. Doing chest compressions on the stomach (Habang May Buhay)

9. A patient was pronounced dead but continued to do CPR (Habang May Buhay)

10. A patient was operated (EX-LAP) but was only given O2 cannula. (Dahil May Isang Ikaw)

Chemotheraphy is not the only way to kill cancer



1. Every person has cancer cells in the body. These cancer cells do not show up in the standard tests until they have multiplied to a few billion. When doctors tell cancer patients that there are no more cancer cells in their bodies after treatment, it just means the tests are unable to detect the cancer cells because they have not reached the detectable size.

2. Cancer cells occur between 6 to more than 10 times in a person's lifetime.

3. When the person's immune system is strong the cancer cells will be destroyed and prevented from multiplying and forming tumours.

4. When a person has cancer it indicates the person has multiple nutritional deficiencies. These could be due to genetic, environmental, food and lifestyle factors.

5. To overcome the multiple nutritional deficiencies, changing diet and including supplements will strengthen the immune system.

6. Chemotherapy involves poisoning the rapidly-growing cancer cells and also destroys rapidly-growing healthy cells in the bone marrow, gastro-intestinal tract etc, and can cause organ damage, like liver, kidneys,heart, lungs etc.

7. Radiation while destroying cancer cells also burns, scars and damages healthy cells, tissues and organs.

8. Initial treatment with chemotherapy and radiation will often reduce tumor size. However prolonged use of chemotherapy and radiation do not result in more tumour destruction.

9. When the body has too much toxic burden from chemotherapy and radiation the immune system is either compromised or destroyed, hence the person can succumb to various kinds of infections and

10. Chemotherapy and radiation can cause cancer cells to mutate and become resistant and difficult to destroy. Surgery can also cause cancer cells to spread to other sites.

11. An effective way to battle cancer is to starve the cancer cells by not feeding it with the foods it needs to multiply.


a. Sugar is a cancer-feeder. By cutting off sugar it cuts off one
important ood supply to the cancer cells. Sugar substitutes like NutraSweet, Equal,Spoonful, etc are made with Aspartame and it is harmful. A better natural substitute would be Manuka honey or
molasses but only in very small amounts. Table salt has a chemical added to
make it white in colour. Better alternative is Bragg's aminos or sea salt.

b. Milk causes the body to produce mucus, especially in the gastro-intestinal ract. Cancer feeds on mucus. By cutting off milk and substituting with unsweetened soy milk, cancer cells are being starved.

c. Cancer cells thrive in an acid environment. A meat-based diet is acidic and it is best to eat fish, and a little chicken rather than beef or pork. Meat also contains livestock antibiotics, growth hormones and parasites, which are all harmful, especially to people with cancer.

d. A diet made of 80% fresh vegetables and juice, whole grains, seeds,nuts and a little fruits help put the body into an alkaline environment. About 20% can be from cooked food including beans.
Fresh vegetable juices provide live enzymes that are easily absorbed and reach down to cellular levels within 15 minutes to nourish and enhance growth of healthy cells. To obtain live enzymes for building healthy cells try and drink fresh vegetable juice (most vegetables including bean sprouts)and eat some raw vegetables 2 or 3 times a day. Enzymes are destroyed at temperatures of 104 degrees F (40 degrees C).

e. Avoid coffee, tea, and chocolate, which have high caffeine. Green tea is a better alternative and has cancer-fighting properties. Water-best to drink purified water, or filtered, to avoid known
toxins and heavy metals in tap water. Distilled water is dead water it's acidic, avoid it.

12. Meat protein is difficult to digest and requires a lot of digestive enzymes. Undigested meat remaining in the intestines become putrified and leads to more toxic buildup.

13. Cancer cell walls have a tough protein covering. By refraining from or eating less meat it frees more enzymes to attack the protein walls of cancer cells and allows the body's killer cells to destroy the cancer cells.

14. Some supplements build up the immune system (IP6, Flor-ssence, Essiac,anti-oxidants, vitamins, minerals, EFAs etc.) to enable the body's own killer cells to destroy cancer cells. Other supplements like vitamin E are known to cause apoptosis, or programmed cell death, the body's normal method of disposing of damaged, unwanted, or unneeded cells.

15. Cancer is a disease of the mind, body, and spirit. A proactive and positive spirit will help the cancer warrior be a survivor. Anger, unforgiveness and bitterness put the body into a stressful and acidic environment.Learn to have a loving and forgiving spirit. Learn to relax and enjoy life.

16. Cancer cells cannot thrive in an oxygenated environment. Exercising daily, and deep breathing help to get more oxygen down to the cellular level. Oxygen therapy is another means employed to destroy cancer cells.

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