OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2

BSN 3 1st Semester, A.Y. 2024-2025

- At the same time, impulse travels to the LA by

Electrocardiography Bachmann’s bundle (interatrial of the tissue
extending from the SA node to the left atrium)
AUTONOMIC INNERVATION OF THE HEART - Transmission through the right and left atria
• The 2 branches of the ANS – sympathetic occurs so rapidly that the atria contract almost
(adrenergic) and the parasympathetic (cholinergic) simultaneously
abundantly supply the heart. Sympathetic fibers
innervate all the areas of the heart, whereas the
parasympathetic fibers mainly innervate the SA and
AV nodes
• Sympathetic nerve stimulation triggers the release
of norepinephrine, which increase the HR, increase
the SA node discharge, accelerates AV node
conduction time, and increase the force of
myocardial contraction and cardiac output
• Parasympathetic (vagal) stimulation triggers the
release of acetylcholine, which produces the
opposite effects. The rate of SA node discharge is
decreased, thus slowing HR and conduction through
AV node and reducing cardiac output

DEPOLARIZATION AND REPOLARIZATION

• DEPOLARIZATION – when the cell is stimulated by
an electrical impulse, an action potential occurs
o Sodium ion flow rapidly into the cell
causing the impulse of the cell to
become more positively charged than
the outside ATRIOVENTRICULAR NODE (AV NODE)
o This change creates an impulse that - Located in the inferior right atrium near the
cause myocardial contraction ostium of the coronary sinus
• REPOLARIZATION – after depolarization and - Although the AV node doesn’t possess
contraction, the cell attempts to return to its resting pacemaker cells, the tissue surrounding it,
state referred to as junctional tissue, contains
pacemaker cells that can fire at a rate between
CARDIAC CONDUCTION SYSTEM 40-60 beats/minute
- As the AV node conducts the atrial impulse to
SINOATRIAL NODE (SA NODE)
the ventricles, it delays the impulse by 0.04
- Located in the right atrium near the SVC
- Heart’s main pacemaker second
- Under resting conditions, the SA node generates o This delay allows the ventricles to
impulses from 60-100 times/minute complete their filling phase as the atria
- The impulses usually don’t travel backwards contract
because the cells can’t respond to a stimulus o It also allows the cardiac muscle to
immediately after depolarization stretch to its fullest for peak cardiac
output
- SA node ® impulse travels through the RS by
way of internodal tracts: anterior, middle BUNDLE OF HIS
(Wenckebach’s), and posterior (Thorel’s) - Rapid conduction resumes through the bundle
of His into the ventricles

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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

- If the SA node fails to generate an impulse at a ECG BASIC PRINICPLES

normal rate, or if the impulse fails to reach the 1. Electric activity is generated by the cells of the heart
AV junction, the bundle of His can fire at a rate as ions are exchanged across cell membranes
between 40-60 times/minute 2. Electrodes that are capable of conducting electrical
activity from the heart to the ECG machine are
RIGHT AND LEFT BUNDLE BRANCHES placed at strategic positions on the extremities and
- The bundle of His divides into the right and left chest precordium
bundle branches and extends down either side
of the interventricular septum
- Right bundle branch extends down the right side
of the IVS and through the RV
- Left bundle branch extends down the left side of
the IVS and through the LV
o Left bundle branch then splits into 2
branches, or fasciculations
§ Left anterior fasciculus extends
through the anterior portion of
the LV
§ Left posterior fasciculus
extends through the lateral and
posterior portion of the LV
- Impulses travel faster down the left bundle
branch, which feeds the larger, thicker walled
left ventricle, than the right bundle branch,
which feeds the smaller, thinner-walled right
ventricle
- The difference in the conduction speed allows
both ventricles to contract simultaneously

PURKINJE FIBERS
• V1 – 4th ICS, RSB
- After traveling through the left and right bundle
• V2 – 4th ICS, LSB
branches, the impulses travel through the
Purkinje fibers • V3 – Between leads V2 & V4
- A diffuse muscle fiber network beneath the • V4 – 5th Left ICS in MCL
endocardium – transmit impulse quicker than • V5 – Horizontally even with V4, but in the AAL
any other part of the conduction system • V6 – Horizontally even with V4 & V5 in the MAL
- This pacemaker site usually doesn’t fire unless
the SA and AV nodes fail to generate an impulse 3. The electrical energy sensed is then converted to a
or if the normal impulse is blocked in both graphic by the ECG Machine. This display is referred
bundle branches to as the electrocardiogram.
- The automatic firing rate of the Purkinje fiber 4. A heart contraction is represented by wave forms on
ranges from 20-40 times/minute the ECG graph paper, which are designated P, Q, R,
- The entire network of specialized nervous tissue S and T waves
that extends through the ventricles is known as 5. Wave forms are referred to as deflection relative to
His-Purkinje system an isometric line (a line that expresses no energy).
The isoelectric line can be determined by looking at
the T-P interval

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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

a. P wave is the 1st position deflection and 3. The P-R interval is measured from the upstroke
represents atrial depolarization of the P wave to the Q-R junction and is normally
b. Q wave is the 1st deflection after the P wave; between 0.12 and 0.20 second
R wave is the 1st positive deflection after the a. The P-R interval represents the time of
P wave impulse transmission from the SA node
c. S wave is the negative deflection after the R to the AV node
wave b. There is a built-in delay in time at the AV
d. QRS wave form is generally regarded as a unit node to allow for adequate ventricular
and represents ventricular depolarization filling to maintain stroke volume (the
e. T wave follows the S wave and is joined to the amount of blood ejected with each
QRS complex by the S-T segment. The T wave contraction)
represented the return of ions to the 4. The QRS complex contains separate waves and
appropriate side of the cell membrane. This segments, which should be evaluated
signifies relaxation of the muscle fibers and is separately. Normal QRS complex should be seen
referred to as repolarization of the ventricles between 0.06 and 0.10 second
f. Q-T interval is the time between the Q wave a. The Q wave, or 1st downward stroke
and T wave after the P wave, is usually less than
3mm in depth. A Q wave of significant
INDICATIONS deflection is not normally present in the
The ECG is a useful tool in the diagnosis of those healthy heart. The pathologic Q wave
conditions that may cause aberrations in the electrical usually indicates a completed MI.
activity of the heart. Examples of these conditions are as b. The R wave is the 1st positive deflection
follows: after the P wave, normally 5-10mm in
1. MI and other types of coronary artery diseases, height. Increases & decreases in
such as angina amplitude become significant in certain
2. Cardiac dysrhythmias disease states. Ventricular hypertrophy
3. Cardiac enlargement produces very high R waves because the
4. Electrolyte disturbances, especially of calcium hypertrophied muscles require a
and potassium levels stronger electrical current to depolarize
5. Inflammatory diseases of the heart
6. Effect on the heart by drugs such as digoxin
(Lanoxin) and tricyclic depressants

ECG LEADS AND NORMAL WAVE FORM

INTERPRETATION
1. The standard ECG consist of 12 leads (I, II, III,
AVR, AVL, AVF, V1, V2, V3, V4, V5, V6)
a. Each lead records the heart’s electrical
activity from a different anatomic
position
b. Identifies specific myocardial changes on
certain leads; assist in defining
pathologic conditions
2. The normal amplitude of the P wave is 3mm or
less; the P waves that exceed these
measurements are considered to be a deviation
from normal

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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

5. The S-T segment begins at the end of the S wave, o Measure the P-R interval. Prolonged -R interval
the 1st negative deflection after the R wave, and may be a precursor or a variety of heart blocks
terminated at the upstroke of the T wave due to drug therapy or myocardial disease.
6. The T wave represents the repolarization of o Look for pathologic QI waves, or one that is
myocardial fibers or provided the resting state of greater than 0.04 second in time and greater
myocardial work; the T wave should always be than 3mm in depth or greater than one third
present the height of the R wave.
a. Normally, the T wave should not exceed o Measure the QRS complex. Are they identical in
a 5mm amplitude in all leads except the configuration? Do they fall early? Does the
precordial (V1-V6 leads, where it may be configuration vary? Are any wide and bizarre,
high as 10mm) representing a premature ventricular
contraction?
INTERPRET ECG o Examine the S-T segments. Elevation of the S-T
• Determine the rate. Is it fast, slow, or normal? segment heralds a pattern of injury and usually
o A gross determination of rate can be occurs as an initial change in acute MI. S-T
accomplished by counting the number of QRS depression occurs in ischemic state. Calcium
complexes within a 6-second time interval (use and potassium changes also affect the S-T
the superior margin of ECG paper) and segment.
multiplying the complexes by a factor of 10. o Look at the T wave. Is it positively or negatively
Note: One must be cautioned that this method deflected? Is it peaked? Inverted T waves may
is accurate only rhythms that are occurring at indicate ischemia.
normal intervals and should not be used for o Measure the Q-T interval. The normal Q-T
determining rate always counted for 1 full interval should be less than one half -R interval.
minute for accuracy Prolonged q-T interval may indicate digitalis
o Another means of obtaining rate is to divide the toxicity, long term quinidine (Quinaglute) or
number of large five-square. blocks between procainamide (Pronestyl) therapy or hypo
each two QRS complexes into 300. Three magnesia.
hundred large blocks represent 1 complex #5
and #6 equals 5, or of 60 DIAGNOSTIC EVALUATION
o (Sequence Method) For ventricular rate, find R 1. ECG changes generally occur within 2-12 hours,
wave that peaks on a heavy black line and but may take up to 72-96 hours
assign the following numbers to the next six 2. Necrotic, injured, and ischemic tissue alters
heavy black lines: 300, 150, 100, 75, 60, and 50. ventricular depolarization and repolarization
Then find the next R wave peak and estimate a. S-T segment depression and T wave
the ventricular rate inversion indicate a pattern of ischemia
• Next, determine the rhythm. Is it regular, irregular, b. S-T elevation indicates an injury pattern
regularly irregular, or irregularly irregular? Use c. Q waves indicate tissue necrosis and are
calipers or count blocks between QRS complexes to permanent. A pathologic Q wave is one
determine regularity. that is greater than 3mm in depth or
• Finally, examine each wave and segment for greater than 1/3 the height of the R
abnormality. wave
o Find the P waves. Is one representing for each
QRS complex? Are they absent as in junctional
rhythm? Are they replaced by other wave
forms? What is the configuration like? Are they
identical, well-formed, or do they change shape
as in atrial fibrillation or paroxysmal atrial
tachycardia?
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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

SINUS TACHYCARDIA 3. The wave of impulse is transmitted through the

normal conduction pathways; the rate of sinus
stimulation is simply less than normal (60 beats per
minutes)

ANALYSIS
- Rate: 55
1. Sympathetic nerve fibers, which act to speed up - Rhythm: R-R interval is regular
excitation of the SA node, are stimulated by - P wave: present for each QRS complex, normal
underlying causes such as anxiety, exercise, fever, configuration, and each P wave is identical
shock, drugs, altered metabolic states (such as - P-R interval: falls between 0.12 and 0.18 second
hyperthyroidism), or electrolyte disturbances. - QRS interval: 0.04-0.08 second
2. The wave of impulse is transmitted through the - T Wave; follows each QRS and is positively
normal conduction pathways; the rate of sinus conducted
stimulation is simply greater than normal (rate
exceeds 100 beats per minute). MANAGEMENT
• The urgency of treatment depends on the effect of
ANALYSIS the slow rate on maintenance of cardiac output.
- Rate: 130 • Atropine 0.5 mg IV push blocks vagal stimulations to
- Rhythm: R-R intervals are regular Sa NODE AND THEREFORE ACCELARATED HEART
- P wave present for each QRS complex, normal RATE.
configuration, and each P wave is identical • If the bradycardia persists, a pacemaker may be
- P-R interval: falls between 0.12 and 02.1, or 0.16 required.
second
- QRS interval: 0.06 second PREMATURE ATRIAL CONTRACTION
- T wave follows each QRS complex and is
positively conducted

SINUS BRADYCARDIA

1. May occur in the healthy or diseased heart. Is of no

particular significance in the healthy heart. In the
diseased heart, it may represent ischemia and a
resultant irritability in the atria.
1. The parasympathetic fibers (vagal tone) are 2. The PAC may increase in frequency and be the
stimulated and cause the sinus node to slow. precursor of more serious dysrhythmias in the
2. The underlying causes diseased heart.
a. Can be expected in the well-trained athlete 3. The wave of impulse of the PAC originates within
b. Drugs the atria and outside the sinus node.
c. Altered metabolic states, such as 4. Because the impulse originates within the atria, the
hypothyroidism P wave will be present, but it will be different in
d. The process of aging, which causes appearance as compared with those beats
increasing fibrotic tissue and scarring of the originating within the sinus node.
SA node 5. The impulse traverses the remainder of the
e. Certain cardiac diseases, such as acute MI conduction system in a normal pattern; thus, the
(especially inferior wall MI QRS complex is identical in configuration to the
normal sinus beats.

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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

ANALYSIS - P waves present before each QRS complex;

- Rate may be slow or fast however, the faster the rate, the more difficult it
- Rhythm: will be irregular; this is caused by the becomes to visualize P waves. The P waves can
early occurrence of the PAC. frequently be measured with calipers by observing
- P wave: will be present for each normal ORS the varying configuration of the preceding T waves
complex; the P wave of the premature - P-R interval usually not measurable
contraction will be distorted in shape. - QRS complex will appear normal in configuration
- P-R interval: may be normal but can also and within 0.06-0.10 second
shortened, depending on where in the atria the - T waves will be distorted in the appearance as a
impulse originated. The closer the site of atrial result of P waves being buried in them
impulse formation to the AV node, the shorter
the -R interval will be. MANAGEMENT
- QRS complex: within normal limits because all 1. Treatment is directed first to slowing the rate and,
conduction below the atria is normal. second, to reverting the dysrhythmia to a normal
- T Wave: normally conducted. sinus rhythm.
2. Reducing the rate may be accomplished by having
MANAGEMENT the patient perform a Valsalva maneuver. This
1. Generally requires no treatment stimulates the vagus nerve to slow the heart.
2. PACs should be monitored for increasing a. A Valsalva maneuver may be done by having
frequency the patient gag or "bear down" as though
attempting to have a bowel movement.
PAROXYSMAL ATRIAL TACHYCARDIA b. The health care provider may choose to
perform carotid massage.
3. Adenosine (Adenocard) is the drug ot choice for PAT
associated with hypotension, chest pain, or
shortness of breath.
a. The initial dose is 6 mg rapid IV push followed
by 12 mg. If no response in 1 to 2 minutes, a
1. Causes include: third bolus of 12 mg may be needed.
a. syndrome of accelerated pathways (eg. b. Has a very short half-life and is therefore
Wolff-Parkinson's-White syndrome) eliminated quickly.
b. Syndrome of mitral valve prolapse 4. Beta-adrenergic blockers such as esmolol
c. Ischemic coronary artery diseases (Brevibloc) may be used.
d. Excessive use of alcohol, cigarettes, caffeine 5. The calcium channel blocking agents (eg, verapamil
e. Drugs-digoxin (Lanoxin) is frequent cause [Calan]) are effective in reverting this dysrhythmia.
2. An ectopic atrial focus captures the rhythm of the Beware of hypotension especially in the volume-
heart and is stimulated at a very rapid rate; the depleted patient.
impulse is conducted normally through the 6. If drug therapy is ineffective, elective cardioversion
conduction system so the QRS complex usually can be used.
appears within normal limits.
3. The rate is often so rapid that P waves are not ATRIAL FLUTTER
obvious but may be "buried" in the preceding T
wave.

ANALYSIS
- Rate: between 150-250 beats/minute
- Rhythm: regular

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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

1. Occurs with atrial stretching or enlargement (as 2. Multiple atrial foci fire impulses at rapid and
atrioventricular valvular disease), myocardial disorganized rates.
infarction, and congestive heart failure. 3. The atria are not depolarized effectively; hence,
2. An ectopic atrial focus captures the rhythm in atrial there are no well-formed P waves.
flutter and fires at an extremely rapid rate of 200 to 4. Instead, the baseline between QRS complexes is
400 with regularity. filled with a "wiggly" line that is described as fine or
3. Conduction of the impulse through the conduction coarse.
system is normal; thus, the QRS complex is 5. If the atrial rate is rapid enough, the line will appear
unaffected. almost flat. The atria are said to be firing at rates of
4. An important feature of this dysrhythmia is that the between 300 and 500 time irregular.
AV node set up a therapeutic block, which disallows 6. The conduction of a QRS complex is so random that
some impulse transmission. the rhythm us extremely irregular.
a. This can produce a varying block or a fixed 7. Atrial fibrillation may be described as controlled if
block (ie, sometimes the AV node will the ventricular response is 100 beats per minute or
transmit every second flutter wave, less; the dysrhythmia is uncontrolled if the rate is
producing a 2:1 blocks, or the rhythm can be above 150 beats per minute.
3:1 or 4:1).
b. If the AV node conducted 1:1, then the ANALYSIS
outcome would be a ventricular rate of about - Rate: atrial fibrillation is usually immeasurable
300/min. This would rapidly deteriorate. because fibrillatory waves replace P waves;
ventricular rate may vary from bradycardia to
ANALYSIS tachycardia
- Rate: atrial rate between 250-400 beats per - Rhythm: classically described as an “irregular
minute; ventricular rate will depend on degree of irregularity”
block - P wave replaced by fibrillatory waves, sometimes
- Rhythm: regular or irregular, depending on kind of called “little f” waves
block (eg. 2:1, 3:1, or a combination) - P-R interval: not measurable
- P wave: not present; instead, it is replaced by a - QRS complex: a normally conducted complex
saw-toothed pattern that is produced by the rapid - T wave: normally conducted
firing of the atrial focus. These waves are also
referred to as "F" waves MANAGEMENT
- P-R interval: not measurable 1. Controlled atrial fibrillation of long-standing
- QRS complex: Normal configuration and normal duration requires no treatment as long as the
conduction time patient is experiencing no untoward effects. Most
- T-wave: present but may be obscured by flutter cardiologists agree that reversion of long-standing
waves atrial fibrillation is hazardous because of the
potential for a thrombus to be dislodged from the
ATRIAL FIBRILLATION atria at the time of reversion.
2. Uncontrolled atrial fibrillation (ventricular
responses of 100 beats per minute or greater) is
treated with digitalis preparations. If the atrial
fibrillation is of recent onset, the cardiologist may
choose to revert the rhythm to a sinus rhythm.
3. Atrial fibrillation is treated with electrical
cardioversion if the patient is unstable.
1. Fibrotic changes associated with aging process,
4. The beta-adrenergic blocking drugs or calcium ion
acute MI, valvular diseases, and digitalis
antagonists may also be used if digitalis and
preparations may cause atrial fibrillation. quinidine prove ineffective.

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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

5. Adenosine (Adenocard) may be used to assist in MANAGEMENT

diagnosing the rhythm. 1. PVCs are usually the precursors of more serious
ventricular dysrhythmias. The following conditions
PREMATURE VENTRICULAR CONTRACTION involving PVCs require prompt and vigorous
treatment:
a. PVCs occurring at a rate exceeding six per
minute
b. Occur as two or more consecutively
c. PVCs fall on the peak or down slope of the T
war (period of vulnerability)
d. Are of varying configurations, indicating a
multiplicity of foci
2. The standard treatment of PVCs is with lidocaine
hydro chloride (Xylocaine) by IV push
a. For effective treatment of PVCs, it is
important raise the serum level of lidocaine
as rapidly as possible without causing toxic
effects.
1. May be caused by acute MI, other forms of heart b. An initial bolus of 1 to 1.5 mg/kg may be
disease, pulmonary diseases, electrolyte administered
disturbances, metabolic instability, and drug abuse. c. If the dysrhythmia continues to "break
2. The wave of impulse originates from an ectopic through," another 1 mg/kg bolus may be
focus (foci) within the ventricles at a rate faster given within 15 minutes
than the next normally occurring beat. d. The bolus should be followed by a continuous
3. Because the normal conduction pathway is IV infusion of lidocaine 2 g/500 ml. D5W at 1
bypassed, the configuration of the PVC is wider than to 4 mg/min
normal and is distorted in appearance. 3. Be alert to the development of confusion, slurring of
4. PVCs may occur in regular sequence with normal speech, and diminished mentation, because
rhythm ® every other beat (bigeminy), every third lidocaine toxicity affects the central nervous system.
beat (trigeminy), and so forth Should these symptoms appear, slowing the
lidocaine may cause them to abate.
ANALYSIS 4. If ventricular ectopy occurs concomitantly with a
- Rate may be slow or fast bradycardia, use lidocaine with caution, if at all. The
- Rhythm will be irregular because of the premature ectopy may be compensation for the bradycardia.
firing of the ventricular ectopic focus 16 lidocaine abolishes compensatory beats, the
- P wave: will be absent, because the impulse cardiac Darpat may be seriously compromised, to
originates in the ventricle, bypassing the atria and the patient's Getriment.
AV node. 5. If ventricular premature beats occur in conjunction
- P-R interval: not measurable. with a brady dysrhythmia. atropine may be chosen
- QRS complex: will be widened greater than 0.12 a to accelerate the beast rate and eliminate the need
and, bizarre in appearance when compared with for ectopic beats.
not mal QRS complex. The QRS of a PVC is often n 6. Atropine should be used with caution in the acute
ferred to as having a "sore thumb" appearance MI. The injured myocardium may not be able to
- T wave: the T wave of the PVC is usually deflected tolerate accelerated sate.
opposite to the QRS. 7. If Lidocaine proves to be ineffective in controlling
procainamide (Pronestyl) may be given (IV push,
followed by a continuous drip. The average bolus

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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

dose is 300 mg. Procainamide may cause (Xylocaine) is administered as a bolus. This is
hypotension. followed by a continuous lidocaine infusion.
8. If lidocaine and procainamide prove alone or in 2. If the event is witnessed and the patient is
combination therapy (Bretylol) may be used. unconscious, administer a precordial blow.
Bretylion is administered in a continuous infusion. 3. If the patient loses consciousness and pulse,
9. Magnesium sulfate may be used, especially in immediate defibrillation is indicated.
patients with acute MI. It may be given as 1g IV over 4. If the patient remains alert and drug therapy is not
5mins-24hrs depending on the urgency of the working, then synchronized cardioversion is
situation applied. The purpose of cardioversion is to abolish
all cardiac rhythm and allow the normal pacemaker
VENTRICULAR TACHYCARDIA the opportunity to capture the rhythm.
5. In some cases, ventricular tachycardia may be
refractory to drug therapy. Nonpharmacologic
treatments such as endocardial resection,
aneurysmectomy, antitachycardia pacemakers,
cryoablation, automatic internal defibrillators, and
catheter ablation are alternative treatment
modalities.
6. An atypical form of ventricular tachycardia, referred
1. Occurs in: to as polymorphous ventricular tachycardia or
a. Acute MI torsades de pointes, can result as a consequence of
b. Syndromes of accelerated rhythm that drug therapy (eg, quinidine (Quinaglute) therapy) or
deteriorate (eg, Wolff-Parkinson-White electrolyte in-balance such as hypomagnesemia. It
syndrome) is important to differentiate this atypical form
c. Metabolic acidosis, especially lactic acidosis because its therapy differs from that of the more
d. Electrolyte disturbances typical ventricular tachycardia.
e. Toxicity to certain drugs, such as digoxin a. Torsades de pointes is characterized by a Q-T
(Lanoxin) or isoproterenol (Isuprel) interval prolonged to greater than 0,60
2. A life-threatening dysrhythmia that originates from second, varying R-R intervals, and
an irritable focus within the ventricle at a rapid rate. polymorphous ORS complexes.
3. Because the ventricles are capable of an inherent b. The treatment of choice is administration of
rate of 40 beats per minute or less, a ventricular magnesium sulfate 1 g IV over 5 to 60
rhythm at a rate of 100 beats per minute may be minutes.
considered tachycardia. c. If the patient loses consciousness and pulse,
ANALYSIS defibrillate.
- Rate: usually between 140 and 220 beats per d. Ventricular pacing to override the ventricular
minute to and, hence, capture the rhythm is also an
- Rhythm: usually regular but may be irregular acceptable treatment.
- P wave: not present e. Procainamide (Pronestyl) is avoided, because
- P-R interval: not measurable of its effect is to prolong the Q-T interval.
- QRS complex: broad, bizarre in configuration,
widened greater than 0.12 second VENTRICULAR FIBRILLATION
- T wave: usually deflected opposite to the QRS
complex

MANAGEMENT
1. If the patient is alert and not hemodynamically
decompensating, lidocaine hydrochloride
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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

1. Occurs in acute MI, acidosis, electrolyte 3. In first-degree AV block, the impulse is transmitted
disturbances, and other deteriorating ventricular normally, but it is delayed longer at the level of the
rhythms. node. The P-R interval exceeds 0.20 second.
2. The ventricles are firing chaotically at rates that 4. In second-degree AV block, there is no relationship
exceed 300 beats per minute and so do not allow for between the atrial activity recorded on the monitor
effective impulse conduction. and the ventricular activity. Both chambers, are
3. Cardiac output ceases, and the patient loses pulse, discharging impulses, but activity of the atria and
blood pressure, and consciousness. activity of the ventricles bear no relationship to each
4. Clinical death occurs and must be reversed other.
immediately, or the patient will succumb.
ANALYSIS
ANALYSIS • First-degree AV block
- Rate: not measurable because of absence of well- - Rate: usually normal but may be slow
formed QRS complexes - Rhythm: regular
- Rhythm: chaotic - P wave: present for each QRS complex,
- P wave not present identical in configuration
- QRS complex: bizarre, chaotic, no definite contour - P-R interval: prolonged to greater than 0.20
- T wave: not apparent second
- QRS complex: normal in appearance and
MANAGEMENT between 0.06 and 0.10 second
1. The only treatment for ventricular fibrillation is - T wave: normally conducted
immediate defibrillation. Defibrillate at 200 • Second-degree AV block
watts/sec, then 200 to 300, then 360; pause only to - Rate: usually normal
check rhythm and pulse quickly between these - Rhythm: may be regular or irregular
defibrillations. Epinephrine may make the - P wave: present but some may not be followed
fibrillation more vulnerable to defibrillation. by a QRS complex. A ratio of two, three, or four
2. If the third shock is unsuccessful, begin CPR and P waves to one QRS complex may exist.
administer epinephrine (Adrenalin) 1 mg IV push - P-R interval: varies in Mobitz I (Wenckebach),
3. Unsuccessful defibrillation may be a result of lactic usually lengthens until one is non conducted;
acidosis. constant in Mobitz II, but not all Ps conducted.
4. Check adequacy of CPR. • Third-degree AV block (complete heart block)
- Rate: atrial rate is measured independently of
ATRIOVENTRICULAR BLOCK the ventricular rate. The ventricular rate is
usually very slow
- Rhythm: each independent rhythm will be
regular; but they will bear no relationship to
each other.
- P wave: present but no consistent relationship
with the QRS.
- P-R interval: not really measurable.
- QRS complex: depends on the escape
mechanism (i.e., AV nodal will have normal QRS,
ventricular will be wide and the rate will be
1. May be caused by ischemia or inferior toxicity, slower).
hypothyroidism, or Stokes-Adams syndrome
2. Impaired tissue at the level of the AV node prevents MANAGEMENT
the timely passage of the wave of impulse through 1. First-degree AV block usually requires no treatment.
the conduction system.
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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

2. Second-degree AV block may require treatment if

the ventricular rate falls too low to maintain 5. OVUM FORCEPS: designed for
effective cardiac output. gentle grasping and
3. Third -degree AV Block may require treatment of manipulation of ovarian
choice when intervention is called for. tissues during surgery
4. Transcutaneous pacing should be employed in the
emergent situation.
5. Atropine may be given while awaiting the
pacemaker, but it must be remembered that the 6. EPISIOTOMY SCISSORS: used
effect of atropine is to block vagal tone, and the to create a surgical incision to
vagus acts on the sinus node. Because the AV node the perineum during the 2nd
is the culprit in the heart block, atropine may not be stage of labor to enlarge the
helpful. opening for the baby

DR Instruments
1. CURETTE: a surgical
instrument designed for 7. SCISSORS: used to cut the
scraping or debriding baby’s umbilical cord
biological tissue or debris in a
biopsy, excision, or cleaning
procedure

2. HAWKIN AMBLER DILATOR: a 8. KELLY CURVED FORCEPS:

cervical canal dilator to make used to clamp the umbilical
way for the instruments to be cord during childbirth
inserted through the cervical
canal

9. KELLY STRAIGHT FORCEPS:

3. SIM’S SPECULUM: to retract also used to clamp the
posterior vaginal wall umbilical cord in case a cord
coil is present

4. ALLIS TISSUE FORCEPS: a 10. NEEDLE HOLDER: used to

surgical instrument with sharp hold a suturing needle
teeth, used to hold and grasp during episiorrhaphy
tissues during surgery

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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

11. SUTURE: used to stitch up IV Therapy

and repair the affected
> A therapy that delivers fluids directly into a vein; the
tissues either from laceration
IV route is the fastest way to deliver medications
or episiotomy
and fluid replacement throughout the body
> Purpose:
o Fluid and electrolyte maintenance,
restoration and replacement
12. CUTTING NEEDLE: used to o Administer medications and nutritional
pierce through the skin feedings
13. ROUND NEEDLE: used to o Give blood and blood products
pierce through the muscles o Chemotherapy
o Patient controlled analgesics
o KVO for quick access
> Equipment
o IV Tray with IV solution: for fluid and
14. THUMB TISSUE FORCEPS: electrolyte maintenance
for grasping, holding, or o Administration set, IV tubing: used to infuse
manipulating body tissue fluids or medication directly into a vein
o IV cannula: placed inside a vein to provide
venous access
o IV hook: to secure hanging bags of fluids
o Forceps soaked in antiseptic solution: used
to pick up cotton balls when discontinuing an
15. 5-CC SYRINGE: used for IV infusion
anesthesia before o Alcohol swabs or cotton balls soaked in
episiorrhaphy alcohol: to disinfect the puncture site
o Plaster: to securely attach the IV cannula
o Tourniquet: used to dilate/anchor the veins
so they are easier to find and inject into
o Gloves: aseptic technique
o Splint: to hold the hand inan ideal position,
16. DELIVERY FORCEPS: another not to dislodge the cannula
tool used to help pull out the o Sterile 2x2 gauze or transparent dressing:
baby if the mother is already used in applying pressure when discontinuing
exhausted an IV infusion
o 3-way stopcock: facilitates multiple lines
through a single IV access

17. KIDNEY BASIN: serves as a GENERAL CATEGORIES OF IV FLUIDS

container for the gauze pads 1. CRYSTALLOIDS
- Solutions with small molecules
with antiseptic before the
- Flow easily from the bloodstream into cells and
delivery, and as a container
- tissues
for soiled receptacles after - Contain water, electrolytes, and/or glucose
delivery - Classified depending on tonicity (isotonic,
hypotonic, hypertonic)

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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

2. COLLOIDS ISOTONIC
- Gelatinous solutions with particles that are too • Same concentration as body fluids
large to pass semi-permeable membranes • Because the concentration of the IV fluid is
- Maintain a high osmotic pressure in the blood similar to the blood, the fluid stays in the
- Contain large molecular weight particles such as
intravascular space and osmosis does not cause
proteins or hydroxyethyl starches (HES)
fluid movement between compartments
suspended in a crystalloid solution
• D5W, NaCl 0.9%, Plain LRS
- Always hypertonic
• Used in patients with fluid volume deficit
HYPERTONIC (hypovolemia) to raise their blood pressure
• Higher concentration than the body fluids • Precautions:
o Document baseline vital signs, edema,
• Draw fluid out of the intracellular and interstitial
lung sounds, and heart sounds, and
compartments into the vascular compartment,
continue monitoring during and after the
expanding vascular volume
infusion
• Do not administer to clients with kidney/heart
o WOF signs of fluid overload especially in
disease or clients who are dehydrated ü Watch
clients with hypertension and heart failure
for signs of hypervolemia
o Monitor for continued signs of
• D10W, D50W, D5LR, D5NS hypovolemia, including urine output < 0.5
• Precautions: mL/kg/hour, poor skin turgor, tachycardia,
o For short-term use to correct weak pulse, and hypotension.
hyponatremia o Monitor for signs of hypervolemia
o Monitor electrolytes and assess for (hypertension, bounding pulse, crackles,
hypervolemia dyspnea, SOB, peripheral edema, jugular
o May cause fluid volume overload and vein distension (JVD) extra heart sounds.
pulmonary edema. o Special precautions: HPN and CHF patients
o Avoid in patients with cardiac or renal
conditions who are dehydrated, and in
patients with diabetic ketoacidosis and
HHNKS.

HYPOTONIC
• Lower concentration than the body fluids
• Used to provide free water and treat cellular
dehydration
o Diabetic ketoacidosis
o Hyperosmolar hyperglycemic states
• Promote waste elimination by the kidneys ®

•
NaCl 0.3%, NaCl 0.45%
Precautions:
OR Technique
o Contraindicated to patients at risk for ­
ICP
o May worsen existing hypovolemia and
hypotension Normal Values
o Avoid in patients with liver disease,
trauma, or burns.

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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

arms of a scrubbed person must move across a

Surgical Gowning & Gloving sterile field
• Moisture collection and friction areas such as the
(Closed Method neckline, shoulders, underarms, back, and sleeve
cuffs should be considered unsterile
> Chiefly carried out in operating or delivery rooms,
where surgical asepsis is necessary
APPLYING STERILE GLOVES (CLOSED METHOD)
> Before these procedures, the nurse applies a hair
• Open the sterile glove wrapper while the hands
cover and a mask, and performs a surgical hand
are still covered by the sleeves
wash
• Put the glove on the nondominant hand
> Purpose:
o With the dominant hand, pick up the
o To enable the nurse to work close to a sterile
opposite glove
field and handle sterile objects freely
o Lay the glove on the opposite gown cuff,
o To protect clients from becoming
thumb side down, with the glove
contaminated with microorganisms on the
opening pointed toward the fingers
nurse's hands, arms, and clothing
o Use the nondominant hand to grasp the
cuff of the glove through the gown cuff,
IMPLEMENTATION and firmly anchor it
• Open the package of sterile gloves o With the dominant hand working
o Remove the outer wrap from the sterile through its sleeve, grasp the upper side
gloves and leave the gloves in their inner of the glove’s cuff, and stretch it over the
sterile wrap on the sterile field cuff of the gown
• Unwrap the sterile gown pack o Pull the sleeve up to draw the cuff over
• Perform proper hand hygiene the wrist as you extend the fingers of the
• Apply the sterile gown nondominant hand into the glove’s
o Grasp it at the crease near the neck, hold fingers
it away from you, and permit it to unfold • Put the glove on the dominant hand
freely without touching anything, o Place the fingers of the gloved hand
including your uniform under the cuff of the remaining glove
o Put your hands inside the shoulders of
the gown without touching the outside
of the gown OR Instruments
o Work the hands down the sleeves only
to the beginning of the cuffs
o Have a coworker grasp the neck ties MAJOR BASIC SET
without touching the outside of the
gown, and pull the gown upward to 1. KOCHER (OCHSNER):
cover the neckline of your uniform in to grasp heavy tissue
front and back. The coworker ties the and can be also used
neck ties as a clamp
• When worn, sterile gowns should be considered
sterile in front from the waist to the shoulder
• Once the nurse approaches a table, the gown is 2. BABCOCK FORCEP: to
considered contaminated from the waist or table grasp delicate tissue
down, whichever is higher such as intestine,
• The sleeves should be considered sterile from fallopian tube, ovary,
the cuff to 5cm (2 in) above the elbow, since the appendix

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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

9. TOOTHED FORCEPS: row

3. ALLIS TISSUE FORCEP: to of multiple teeth, provide
grasp tissue a strong hold on tough
tissues most especially
the skin

10. ARMY NAVY RETRACTOR:

4. KELLY CURVED FORCEP: used to retract superficial
to clamp larger tissues or or shallow incision
vessels

11. BLADE 4: to cut the skin

5. HEMOSTAT: to clamp
blood vessels

12. SUTURE SCISSORS: to cut

suture and supplies

6. LITTLEWOOD TISSUE
FORCEP: to grasp slippery
tissue

13. MAYO SCISSORS: to cut

heavy tissues such as
fascia, muscle, uterus,
breast
7. BACKHAUS TOWEL CLIP:
to hold drapes, most
especially towels in place

14. METZENBAUM SCISSORS:

to cut delicate tissues
8. THUMB FORCEPS: look
like tweezers, tapered and
have serrations or grooves
at the tip

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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

MINOR SET

1. BACKHAUS TOWEL CLIP: 7. SCALPEL HANDLE: to

to hold drapes, most safely handle surgical
especially towels in place blades

2. MOSQUITO ARTERY 8. BANDAGE SCISSORS

FORCEP STRAIGHT/ 9. SCISSORS
CURVED: to clamp blood 10. NEEDLE HOLDER
vessels or other small 11. KIDNEY BASIN
tissues to control 12. STERILIZATION BOX OR TRAY
bleeding

3. DEBAKEY TISSUE Skin Preparation

FORCEPS: atraumatic
tissue forceps used in
vascular procedures to
avoid tissue damage

4. DRESSING FORCEPS
STRAIGHT: to
atraumatically dissect soft
tissues and pack wounds

Positioning & Draping

> Positioning a client in good body alignment and
5. ARTERY FORCEPS: to
changing the position regularly are essential aspects
control bleeding from
of the nursing practice
blood vessels by clamping
> Draping is the manner of arranging the covering in
the artery
order to expose the part being examined, treated,
or cleaned
> Proper draping provides comfort and privacy
> Purposes:
6. COTTON TWEEZER: to
o To prevent muscle discomfort, undue
precisely handle and
pressure resulting in pressure ulcers, damage
manipulate cotton rolls,
to superficial nerves and blood vessels, and
gauze, and other small
contractures
items
o To maintain muscle tone and stimulate
postural reflexes

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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

KEY POINTS - In sitting position with an overbed table in front to

• Autonomic dysreflexia (SCI) ® High fowler’s lean on and several pillows on the table to rest on
- Helps in maximum lung expansion
• Cleft lip (post op) ® side lying
- Helps in exhaling
• Cleft palate (post op) ® prone
• Cleft lip and cleft palate (post op) ® prone PRONE
• Femoropopliteal bypass ® supine - Patient lies on the abdomen with head turned to
• Liver biopsy ® right side lying one side and the hips are not flexed, place a pillow
• Lumbar puncture ® supine for 6-8 hours under the head and a small pillow or rolled towel
• Post tonsillectomy and adenoidectomy ® under the abdomen
- Allows extension of hips and knee joints
prone/side lying
- Contraindicated for spine problems
• Shock ® modified trendelenburg - Allows drainage of secretions
• SIDS ® supine - Often used for neurosurgery in most neck and spine
• Thoracentesis ® orthopneic surgeries
• Bronchoscopy ® after: semi-fowler’s
• Liver biopsy ® supine, right arm raised & LATERAL
- Patient lies on one side of the body
extended overhead
- Relieves pressure on the sacrum and heels
• Liver biopsy (post op) ® right side lying - Also prevents aspiration post-op
• Lung biopsy ® flat supine with arms raised
• Renal biopsy ® prone SIM’S POSITION
• Heart failure with pulmonary edema ® - Patient assumes a posture halfway between the
sitting up with legs dangling lateral and the prone positions
• Pericarditis ® semi fowler’s - Prevents aspiration of fluids
- Perineal area visualization and treatment
• Pyloric stenosis ® right side lying after
meals LITHOTOMY
• Extremity burns ® elevate extremity - Supine with hips and knees flexed, legs/feet on
• Seizure ® side lying or recovery position stirrups
• Post mastectomy ® semi fowler’s with arm - Vaginal examinations and childbirth
on affected side elevated
TRENDELENBURG’S POSITION
SUPINE - Lowering the HOB and raising the foot
- Patient lies flat - Promotes venous return
- Assess for pressure ulcers and nerve damage - Postural drainage of lung lobes
- Frequently used on procedures involving the
anterior surface of the body (abdominal, cardiac,
REVERSE TRENDELENBURG
- HOB is elevated, foot of bed down
and thoracic area)
- GI problems to help minimize esophageal reflux
FOWLER’S - Prevent rapid change of position (for patients with
- Low fowler’s (15-30 degrees) ¯CO and rapid hypotension)
- Semi fowler’s (30-45 degrees)
- High fowler’s (nearly vertical) KNEE-CHEST
- Aka fetal position
- Promotes lung expansion, useful for NGT, prepares
- Usual position adopted for sigmoidoscopy without
patient for dangling or walking
anesthesia
ORTHOPNEIC OR TRIPOD - Gynecologic or rectal examination

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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

JACKKNIFE procedures like surgery, certain screening and

- Patient’s abdomen lies flat on bed, bed is scissored diagnostic tests, tissue sample removal (e.g., skin
so the hip is lifted biopsies), and dental work.
- Surgeries involving the anus, rectum, coccyx, 12. ANEURYSM - An aneurysm is a bulge in the wall of an
certain back surgeries artery. Aneurysms form when there's a weak area in
- Compresses the IVC from abdominal compression the artery wall.
® decreases venous return to the heart ® ­ risk 13. ANGIOGRAPHY - A procedure performed to view
for DVT blood vessels after injecting them with a radiopaque
dye that outlines them on xray.
KIDNEY POSITION 14. ANOREXIA - It is an eating disorder characterized by
- Abdomen is placed over a lift in the operating table an abnormally low body weight, an intense fear of
that bends the body gaining weight and a distorted perception of weight.
- Uppermost arm is placed in a gutter rest Also known as “loss of appetite”
- Access to the retroperitoneal area 15. ANOXIA - A state of total oxygen deprivation within
tissues or organs. It is an extreme form of hypoxia –
Medical Terminologies a condition characterized by insufficient availability
of oxygen.
(Reference from last year’s OSCE) 16. ANTIBODY - Antibodies are proteins that protect you
when an unwanted substance enters your body.
RABE 1 Produced by your immune system, antibodies bind
1. ABRASION - A superficial rub or wearing off of the to these unwanted substances in order to eliminate
skin, usually caused by a scrape or a brush burn. them from your system. Another word for antibody
2. ABSCESS - A collection of pus in any part of the body is immunoglobulin.
3. ABSORPTION - The process of absorbing or 17. ANTIDIURETIC HORMONE - It is a chemical produced
assimilating substances into cells or across tissues in the brain that causes the kidneys to release less
and organs. water, decreasing the amount of urine produced
4. ACIDOSIS - A condition in which there is too much 18. ANTIGEN - Any substance that causes your immune
acid in the body fluids. system to produce antibodies against it. This means
5. ACROMION - The projection of the scapula (the your immune system does not recognize the
shoulder blade) that forms the point of the shoulder. substance and is trying to fight it off. An antigen may
The acromion is part of the scapula. be a substance from the environment, such as
6. ADIPOSE - Adipose tissue, otherwise known as body chemicals, bacteria, viruses, or pollen.
fat, is a connective tissue that extends throughout 19. ANTISEPTIC - An antiseptic is a substance that stops
your body. or slows down the growth of microorganisms.
7. ADL - Activities of daily living (ADLs) are essential and 20. APHASIA - Aphasia is a language disorder caused by
routine tasks that most young, healthy individuals damage in a specific area of the brain that controls
can perform without assistance. language expression and comprehension.
8. ALKALOSIS - An abnormal pathophysiological 21. APPROXIMATE - To bring close together. Proximate,
condition characterized by the buildup of excess denoting the contact surfaces, either mesial or distal,
base or alkali in the body. of two adjacent teeth.
9. ALOPECIA - It is a medical term for hair loss or 22. ARRHYTHMIA - An arrhythmia, or irregular
baldness heartbeat, is a problem with the rate or rhythm of
10. ANAPHYLAXIS - A serious allergic reaction that your heartbeat. Your heart may beat too quickly, too
involves more than one organ system. It can begin slowly, or with an irregular rhythm.
very rapidly, and symptoms may be severe or life- 23. ARTERIOSCLEROSIS - Arteriosclerosis is a type of
threatening. vascular disease where the blood vessels carrying
11. ANESTHESIA - Anesthesia is a medical treatment that oxygen away from the heart (arteries) become
prevents patients from feeling pain during damaged from factors such as high cholesterol, high
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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

blood pressure, diabetes and certain genetic 37. BRONCHOPNEUMONIA - Bronchopneumonia is a

influences. type of pneumonia that inflames the alveoli (tiny air
24. ASCITES - Ascites is the build-up of fluid in the space sacs) inside the lungs.
between the lining of the abdomen and abdominal 38. BRONCHOSCOPE - A bronchoscope is a device used
organs. to see the inside of the airways and lungs. The scope
25. ASEPSIS - Asepsis is a condition in which no living can be flexible or rigid
disease-causing microorganisms are present. 39. BRUXISM - Bruxism is a problem in which you
26. ASPHYXIA - A lack of oxygen or excess of carbon unconsciously grind or clench your teeth.
dioxide in the body that is usually caused by 40. BUCCAL - Relating to the cheek. Pertaining to the
interruption of breathing and that causes sides of the mouth or to the mouth; oral.
unconsciousness compare suffocation. 41. BUFFER - A substance or mixture of substances (as
27. ASPIRATE - Aspiration means to draw in or out using bicarbonates and some proteins in biological fluids)
a sucking motion. that in solution tends to stabilize the hydrogen-ion
28. ASTRINGENT - An astringent is a drug or lotion that concentration by neutralizing within limits both acids
causes contraction of body tissues, checks blood and bases.
flow, or restricts the secretion of fluids. 42. BULIMIA - Bulimia is an eating disorder. It is
29. ATAXIA - Ataxia means without coordination. People characterized by uncontrolled episodes of
with ataxia lose muscle control in their arms and legs. overeating, you eat large amounts of food and then
This may lead to a lack of balance, coordination, and purge to get rid of extra calories (called bingeing)
trouble walking. 43. CANNULA - A small tube for insertion into a body
30. ATELECTASIS - The collapse of part or, much less cavity, duct, or vessel.
commonly, all of a lung. 44. CANTHUS - Either of the angles formed by the
31. BASAL METABOLIC RATE - The rate of energy meeting of the upper and lower eyelids.
expenditure of a person at rest; it eliminates the 45. CARDIAC ARREST - Cardiac arrest occurs when the
variable effect of physical activity. The BMR accounts heart suddenly and unexpectedly stops pumping.
for approximately 60% of the daily energy 46. CARDIAC OUTPUT - Cardiac output (CO) is the
expenditure. amount of blood pumped by the heart minute and is
32. BILIRUBIN - A yellowish pigment that is made during the mechanism whereby blood flows around the
the breakdown of red blood cells. Bilirubin passes body, especially providing blood flow to the brain
through the liver and is eventually excreted out of and other vital organs.
the body. 47. CARDIOPULMONARY RESUSCITATION - combines
33. BIOPSY - A biopsy is a procedure to remove a piece rescue breathing (mouth-to-mouth) and chest
of tissue or a sample of cells from your body so that compressions to temporarily pump enough blood to
it can be tested in a laboratory. the brain until specialized treatment is available.
34. BLEB - A bleb is a blister-like protrusion (often 48. CARIES - A progressive destruction of bone or tooth.
hemispherical) filled with serous fluid. Blebs can Especially: tooth decay.
form in a number of tissues by different pathologies, 49. CARINA - A ridge at the base of the trachea
including frostbite and can "appear and disappear (windpipe) that separates the openings of the right
within a short time interval". and left main bronchi (the large air passages that
35. BRONCHIAL SOUNDS - Bronchial sounds, or “tubular lead from the trachea to the lungs)
sounds,” are the type of sounds that a person may 50. CARMINATIVE - Expelling gas from the stomach or
make while breathing. Bronchial sounds are loud and intestines so as to relieve flatulence or abdominal
harsh with a midrange pitch and intensity. pain or distension.
36. BRONCHODILATOR - Bronchodilators are a type of 51. CAROTID ARTERIES - The carotid arteries are major
medication that make breathing easier. They do this blood vessels that provide your brain's blood supply.
by relaxing the muscles in the lungs and widening the You have two carotid arteries, one on either side of
airways (bronchi). your neck. Carotid artery disease causes up to one-
third of all strokes.
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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

52. CATARACT - Cataract is a cloudy area in the lens of 68. COLIC - Sharp sudden pain in the abdomen. A
your eye (the clear part of the eye that helps to focus condition marked by periods of prolonged and
light). Cataracts are very common as you get older. uncontrollable crying and irritability in an otherwise
53. CATHARTIC - A cathartic or purgative is an agent that healthy infant.
causes catharsis and is more commonly known as a 69. COLLAGEN - The principal protein of the skin,
laxative (a cathartic taken to relieve constipation). tendons, cartilage, bone, and connective tissue.
54. CELLULITIS - Cellulitis is a common skin infection 70. COLOSTOMY - An operation that creates an opening
caused by bacteria. It affects the middle layer of the for the colon, or large intestine, through the
skin (dermis) and the tissues below abdomen.
55. CENTRAL VENOUS PRESSURE - Central venous 71. COMMODE - are portable toilets that look like a chair
pressure (CVP) is the pressure in the thoracic vena and have a bucket-like receptacle beneath it which
cava near the right atrium. can be removed for cleaning
56. CEREBROSPINAL FLUID - Cerebrospinal fluid (CSF) is 72. CONTRACTURE - A fixed tightening of muscle,
a clear, colorless, watery fluid that flows in and tendons, ligaments, or skin. It prevents normal
around your brain and spinal cord. movement of the associated body part.
57. CERUMEN - Cerumen, commonly known as ear wax, 73. CONTUSION - A contusion is any damage to the body
acts to shield the skin of the external ear canal from that doesn't break the skin but ruptures the blood
water damage, infection, trauma, and foreign capillaries beneath, resulting in a handsome-looking
bodies. discoloration.
58. CHEYNE-STOKES RESPIRATION - Are a rare abnormal 74. CRACKLES - Crackles are discontinuous, explosive,
breathing pattern that can occur while awake but and nonmusical adventitious lung sounds normally
usually occurs during sleep. heard in inspiration and sometimes during
59. CHOLECYSTOGRAM - A cholecystogram is an x-ray expiration.
procedure used to help evaluate the gallbladder. 75. CREATININE - Creatinine is a chemical waste product
60. CHOLESTEROL - Cholesterol is a waxy, fat-like of creatine. Creatine is a chemical made by the body
substance that your body needs for good health, but and is used to supply energy mainly to muscles.
in the right amounts. 76. CREPITUS - The crackling, crunching, grinding or
61. CHYME - The semifluid mass of partly digested food grating noise that accompanies flexing a joint.
expelled by the stomach into the duodenum. 77. CYST - A closed sac or pouch with a definite wall,
62. CICATRIX - A scar resulting from formation and containing fluid, semifluid, or solid material.
contraction of fibrous tissue in a wound. 78. CYSTITIS - Cystitis is inflammation of the bladder,
63. CILIA - The fine hairlike projections from certain cells usually caused by a bladder infection.
such as those in the respiratory tract that sweep in 79. CYSTOLOGY - Cytology is the exam of a single cell
unison and help to sweep away fluids and particles. type, as often found in fluid specimens. It's mainly
64. CIRCULATORY OVERLOAD - It is a transfusion used to diagnose or screen for cancer.
reaction (an adverse effect of blood transfusion)
resulting in signs or symptoms of excess fluid in the RABE 2
circulatory system (hypervolemia) within 12 hours
1. DEEP VEIN THROMBOSIS - a medical condition that
after transfusion.
occurs when a blood clot forms in a deep vein.
65. CLUBBING - Clubbing is a physical sign characterized
2. DEHYDRATION - a condition caused by the loss of
by bulbous enlargement of the ends of one or more
fingers or toes too much fluid from the body.
66. COAGULATE - The process by which a blood clot is 3. DEMENTIA - impaired ability to remember, think, or
formed. make decisions that interferes w/ doing everyday
67. COCHLEA - A hollow tube in the inner ear of higher activities. Alzheimer's disease is the most common
vertebrates that is usually coiled like a snail shell and type of dementia.
contains the sensory organ of hearing see ear 4. DERMATITIS - a word used to describe a number of
illustration. skin irritations and rashes caused by genetics, an
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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

overactive immune system, infections, allergies, 22. FASTING - Is a practice that involves a restriction or
irritating substances and more. abstinence of food or drink intake for any period.
5. DESICCATE - To remove the moisture from a thing 23. FERTILITY - a person's ability to conceive children.
that normally contains moisture, such as a plant; to 24. FIBER - The parts of fruits & vegetables that cannot
dry out completely; to preserve by drying. be digested.
6. DIASTOLE - when the heart muscle relaxes. 25. FIBROMA - a benign or fibroid tumor consisting of a
7. DILATION AND CURETTAGE - a surgical procedure in mass of connective tissue cells that have a spindle
which the cervix is opened (dilated) and a thin shape.
instrument is inserted in to the uterus 26. FISSURE - a medical condition where the skin. Splits
8. DIPLOPIA - double vision or seeing double. or tears apart or a natural Cleft between body parts
9. DISTENSION - the state of being distended, or in the Substance of an organ.
enlarged, swollen from internal pressure. 27. FISTULA - An abnormal connection between two
10. DIURESIS - to increase urine flow rate as well as body parts, or in the substance of an organ.
increased urine flow/output. 28. FLATUS - Gas in the intestinal tract or gas passed
11. DOUCHE - The word "douche" means to wash or through the anus.
soak. Douching is washing or cleaning out the inside 29. FUNGUS - Eukaryotic microorganisms and is a
of the vagina w/ water or other mixtures of fluids. single-celled or multicellular organism.
12. DYSCRASIA - Refers to a disease/disorder, especially 30. FURUNCLES - Skin abscesses caused by
of the blood. The latter is called a blood dyscrasia. staphylococcal infection, which involve a hair follicle
13. DYSKINESIA - a movement disorder and an & surrounding tissue.
impairment of voluntary movements resulting in 31. GAIT - the pattern that you walk.
fragmented or jerky motions (as in Parkinson's 32. GANGRENE - It is death of body tissue due to a lack
disease) of blood flow or a serious bacterial infection.
14. ECCHYMOSIS - Commonly known as a bruise, refers 33. GASTROENTERITIS - an inflammation of the lining of
to the discoloration of the Skin due to the rupture of the stomach and intestines. The main symptoms
the blood vessels below the surface of the skin. include vomiting and diarrhea.
15. EMBOLISM - a blocked artery caused by a foreign 34. GRANULOMA - a small area of inflammation or a
body, such as a blood clot or an air bubble. tiny cluster of white blood cells and other tissue.
16. EMESIS - The oral eviction (ACT OF VOMITING) of 35. HEMATOCRIT - The percentage of RBC in your blood
gastrointestinal contents, due to contractions of the Or The proportion of the blood that consists of
gut and the muscles of the thoracoabdominal. wall. packed RBC.
17. EMPYEMA - a collection of pus in the space between 36. HEMATOPOIESIS - The production of all types of
the lung and the inner surface of the chest wall blood cells including formation, development and
(pleural space) differentiation of blood cells.
18. ENANTHEM - a sudden eruption (rash) of the 37. HETEROTOPIC - In the wrong place, in an abnormal
surface of a mucous. membrane of the mouth or place, misplaced.
Pharynx. 38. HIVES - a raised, itchy area of skin that may be a sign
19. ENEMA - the injection of liquid into the rectum by of an allergic reaction.
way of the anus usually to cause the intestines. to 39. HOMEOSTASIS - Healthy state that is maintained by
empty. the constant adjustment of biochemical and
20. ENZYMES - complex proteins that help speed up physiological pathways.
metabolism or cause of specific chemical change. 40. HYPERTONIA - Increased tightness of muscle tone
21. EUPHORIA - Elevated mood and is a desirable & and reduced capacity of the muscle to stretch.
natural occurrence when it results from
happy/exciting events.
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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

41. HYPERTONIC - a solution that contains more 57. KERATIN - Fibrous structural protein of hair, nails,
dissolved particles (such as salt and other horn, hoofs, wool, feathers, and of the epithelial
electrolytes) than is found in normal cells and blood. cells in the outermost layers of the skin. Keratin
42. HYPOGLYCEMIA - a condition in which your blood serves important structural and protective
sugar (glucose level is lower than the standard functions, particularly in the epithelium.
range. 58. KETONES - are acids that your body makes when it
43. IATROGENIC - an induced unintentionally by a breaks down fat for energy.
physician or surgeon or by medical treatment or 59. LACTATION - It is maintained by regular removal of
diagnostic procedure. milk and stimulation of the nipple, which triggers
44. IDIOPATHIC - often used to describe a disease with prolactin release from the anterior pituitary Gland
no identifiable cause. and oxytocin from the posterior pituitary gland.
45. IMMUNIZATION - a process by which a person 60. LAPAROSCOPY - a type of surgery that lets a
becomes protected against a disease through Surgeon look inside your body without making a
vaccination. large incision (cut)
46. INCISION - a surgical cut 61. LIPIDS - fatty compounds that perform a variety of
47. INCONTINENCE - inability of the body to control the functions in your body.
evacuative functions of urination or defecation. 62. LUTEINIZING HORMONE - a glycoprotein hormone
48. INFARCTION - Death of tissue resulting from a that is co-secreted along with follicle-stimulating
failure of blood supply, commonly due to hormone by the gonadotrophin cells in the
obstruction of a blood vessel by a blood clot. adenohypophysis (anterior pituitary gland).
49. INFILTRATE - To pass into or through a substance or 63. MACROSOMIA - a newborn with an excessive birth
a space or the diffusion or accumulation of foreign weight.
substances in amounts excess of the normal. 64. MALAISE - feeling of general discomfort,
50. INTRINSIC - an essential or inherent part of uneasiness, or lack of well-being and often the first
Something such as a structure. Coming from within, sign of an infection or other disease.
from the inside. Proteins have intrinsic signals that 65. MELASMA - a common skin problem caused by
govern their transport and localization in the cell. brown to gray-brown patches on the face
51. INTUBATE - a process where a healthcare provider 66. MENINGITIS - an inflammation (swelling) of the
inserts a tube through a person's mouth or nose, protective membranes covering the brain and spinal
then down into their trachea (airway/ windpipe). cord.
52. IRRIGATE - The cleansing of a canal/cavity or the 67. MENORRHAGIA - It is heavy prolonged menstrual
washing of a wound by flushing with water or other bleeding, it lasts more than 7 days.
fluids. TO WASH OUT. 68. MULTIPLE PREGNANCY - often happens when more
53. ISCHEMIA - a condition in which blood flow (and than 1 egg is fertilized and implants in the uterus.
thus oxygen) is restricted or reduced in a part of the 69. MYOPIA - Nearsightedness (myopia) is a common
body. vision condition in which near objects farther away
54. ISOLATE - To separate from others as during an look blurry.
infectious disease.
55. ITCHING - Pruritus is a medical term for itchy Skin RABE 3
that can be caused by a number of tissues including 1. NAUSEA - Queasiness, the urge to vomit.
dry skin, skin disease, allergies and diabetes. 2. NECROSIS - Death of body tissue.
56. JAUNDICE - Yellow staining of the skin and sclerae 3. NEOPLASM - Abnormal and excessive growth of
(the whites of the eyes) by abnormally high blood tissue.
levels of the bile pigment bilirubin. 4. NEPHRITIS - Kidney inflammation

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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

5. NOCTURIA - Get up at night on a regular basis to 29. SEROSANGUINEOUS - Contains or relates to

urinate 30. both blood and the liquid part of blood (Serum)
6. NOSOCOMIAL - Originating I taking place in a 31. SCLEROSIS - Abnormal hardening of body tissue.
hospital. 32. SCOLIOSIS – Sideways of the spine.
7. OBTURATOR - Something (such as prosthetic 33. SPASM - Sudden involuntary muscular contraction
device) closes/blocks up an opening (such as a or convulsive movement.
fissure in the palate) 34. SPHINCTER - Circular muscles that open and close
8. ORIFICE - An opening (nostril) passages.
9. OSTEOARTHRITIS - Most common form of arthritis. 35. SPRAIN - Injury to the ligaments around the joint.
10. PALLIATIVE - Relieving symptoms without dealing 36. STRAIN - When a muscle is stretched too much and
with the cause of the condition part of it tears.
11. PANDEMIC - Widespread occurrence of an 37. STUPOR - State of near-unconsciousness or
infectious disease over a whole country or the world insensibility.
at a particular time. 38. STERTOR - Act of producing a snoring sound.
12. PARAPLEGIA - Paralysis of the legs and lower body. 39. STASIS - Period or state of inactivity or equilibrium.
13. PARONYCHIA - Infection of the skin around a 40. STENOSIS (NARROWING) - Can cause pressure on
fingernail or toenail. spinal cord or the nerves that go from your spinal
14. PARESTHESIA - Burning /prickling sensation cord to your muscle.
15. PATHOGEN - microorganisms that can cause 41. SURFACTANT - Surface active agent.
disease. 42. SYNCOPE - Loss of consciousness for a short period
16. PERFUSION - Passage of blood, a blood substitute, of time.
or other fluid through the blood vessels. 43. SYNDROME - Recognizable complex of symptoms
17. PERISTALSIS - Involuntary constriction and and physical findings which indicate a specific
relaxation of the muscles of the intestine or another condition for which a direct cause is not necessarily
canal, creating wave-like movements that push the understood.
continents of the canal forward. 44. TENESMUS - Frequent urge to go to the bathroom
18. PLASMA - Super heated matter-so hot that the without being able to go.
electrons are ripped away from the atoms forming 45. THROMBOCYTOPENIA - A condition that occurs
an ionized gas. when the platelet count in your blood is too low.
19. PHLEBITIS - Inflammation of the vein. 46. THROMBOPHLEBITIS - Inflammation of the wall of a
20. POLYDIPSIA - Excessive thirst. vein with associated thrombosis often occurring in
21. PROGNOSIS - Act or art of foretelling the course of the legs during pregnancy.
a disease. 47. TONICIFY - The capability of a solution to modify the
22. PROPHYLAXIS - Action taken to prevent disease volume of cells by altering their water content.
23. PROXIMAL - Nearer to the center of the body or the 48. TONUS - Constant low-level activity of a body tissue,
point of attachment. (muscle tone)
24. REFERRED PAIN - When you have an injury in one 49. TORTUOUS - Full of twists and turns.
area of your body but feel pain somewhere else. 50. TOXEMIA - Blood poisoning by toxins from a local
25. REGURGITATION - Action bringing swallowed food bacterial infection
up again to the mouth 51. TOXIN - Substances created by plants and animals
26. RESONANCE - Is a sound of deep, full, and that are poisonous to humans.
reverberating. 52. TRAUMA - Deeply distressing or disturbing
27. RHINITIS - A reaction occurs that causes nasal experience.
Congestion, runny nose, sneezing, and itching. 53. TURGOR - State of turgidity and resulting rigidity of
Ronchi coarse, loud sounds caused by constricted cells or tissues, typically due to the absorption of
larger airways. fluid.
28. SANGUINEOUS - Relating to, or involving 54. TYMPANY - Hollow drum-like sound
bloodshed.
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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

55. URTICARIAL - A raised, itchy rash that appears on 8. RADICULOTOMY - Surgical procedure to sever nerve
the skin. roots in the spinal cord.
56. UREA - Colorless crystalline compound which is 9. BONE MARROW ASPIRATION: A procedure to
main nitrogenous breakdown product of urine is collect a sample of bone marrow for examination.
excreted in urine. 10. BONE SCAN - A nuclear imaging test used to
57. ULCER - Caused when there is imbalance between diagnose and monitor bone diseases and disorders.
the digestive juices produced by the stomach and
11. INTERNAL HEMORRHAGE - Bleeding that occurs
the various factors that protecting the lining of the
inside the body
stomach.
12. ENDOSCOPIC RETROGRADE
58. UNIVERSAL DONOR - Blood group O
59. UNIVERSAL RECIPIENT - AB positive blood type. CHOLANGIOPANCREATOGRAPHY (ERCP) - A
60. UVULA - Fleshy extension at the back of the soft procedure used to examine and treat problems in
palate. the liver, gallbladder, bile ducts, and pancreas.
61. VERTIGO – A sensation of motion or spinning 13. ENDOSCOPY - A procedure used to examine the
62. VITILIGO – A chronic (long-lasting) autoimmune interior of a hollow organ or cavity of the body using
disorder that cause patches of skin to lose pigment an endoscope.
/color. 14. TUBERCULOSIS - An infectious disease caused by
63. VIBRATION - Instance of vibrating the bacterium Mycobacterium tuberculosis, usually
64. VISCERA - Internal organs in the main cavities of the affecting the lungs.
body. 15. INTRAVENOUS INJECTION - Administration of
65. WEAL - A red swollen mark left on flesh by a low medication or fluids into a vein.
blood pressure. 16. DEFICIT - A lack or shortage of something, often
66. VISCOSITY - Measure of a fluid's resistance to flow. referring to a deficiency in a physiological or
67. VIRULENCE - the severity or harmfulness of a
psychological function.
disease or poison.
17. LIGAMENTS - Tough bands of tissue that connect
bones to other bones in the body.
RABE 4
18. TENDONS - Tough bands of tissue that connect
1. PEDIATRICS - The branch of medicine dealing with muscles to bones in the body.
the medical care of infants, children, and 19. OCCLUSION - Blockage or closure of a blood vessel
adolescents. or other tubular structure.
2. ELECTROCARDIOGRAPH - A machine used to record 20. HYPERGLYCEMIA - High levels of glucose (sugar) in
the electrical activity of the heart over a period of the blood.
time.
21. IRIS - The colored part of the eye surrounding the
3. PHARMACIST - A healthcare professional who pupil.
specializes in the preparation and dispensing of 22. MIDDLE EAR - The part of the ear between the
medications.
eardrum and the inner ear, containing the ossicles
4. OBSTETRICIAN - A doctor specializing in pregnancy, (tiny bones) that transmit sound vibrations.
childbirth, and the postpartum period.
23. INNER EAR - The part of the ear responsible for
5. APPENDECTOMY - Surgical removal of the
hearing and balance, consisting of the cochlea and
appendix. semicircular canals.
6. RELAXATION - A state of being free from tension 24. GASTROSTOMY - Surgical creation of an opening
and anxiety.
(stoma) into the stomach through the abdominal
7. AUTONOMIC NERVOUS SYSTEM - The part of the wall for feeding or drainage.
nervous system responsible for regulating
25. LUMBAR VERTEBRA - The five vertebrae in the
involuntary bodily functions, such as heartbeat,
lower back region of the spine.
digestion, and breathing.

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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

26. SUTURES - Stitches used to close wounds or surgical illness affecting the spinal cord at the level of the
incisions. neck.
27. NEURITIS - Inflammation of a nerve or nerves. 47. PERICARDIAL - Relating to the pericardium, the sac
28. SCIATICA - Pain along the sciatic nerve, typically surrounding the heart.
radiating from the lower back down one leg. 48. AUDITORY - Relating to the sense of hearing or the
29. INTRAMUSCULAR - Administration of medication organs of hearing.
into a muscle. 49. INTRACARDIAC - Within the heart.
30. INTRAVENOUS - Administered into a vein. 50. VENOUS - Relating to veins or the venous system.
31. FASCIA - A thin sheath of fibrous tissue enclosing 51. LUMBOSACRAL - Relating to the lumbar and sacral
muscles and organs. regions of the spine.
32. COMPLETE FRACTURE - A break-in in a bone that 52. RETINOPATHY - Disease of the retina, often
extends completely through its width. associated with diabetes or hypertension.
33. KYPHOSIS - Excessive outward curvature of the 53. BLOOD PRESSURE - The force exerted by circulating
spine, resulting in a rounded upper back blood against the walls of the blood vessels.
(hunchback). 54. BIOPSY - The removal and examination of a small
34. PRESBYOPIA - Age-related decline in the ability of sample of tissue from the body for diagnostic
the eye to focus on close objects. purposes.
35. OPTOMETRY - The profession of examining eyes for 55. PSYCHIATRIST -A medical doctor specializing in the
visual defects and prescribing corrective lenses. diagnosis, treatment, and prevention of mental
Ophthalmology: The branch of medicine dealing illnesses.
with the diagnosis and treatment of eye disorders. 56. RHINOPLASTY - Surgical reconstruction of the nose,
36. ULTRASONOGRAPHY - The use of ultrasound waves often for cosmetic or functional purposes.
to produce images of internal body structures. 57. EPIPHYSIS - The rounded end of a long bone, which
37. CONVOLUTION - A fold or twist, particularly forms part of a joint.
referring to the folded structure of the brain's 58. ALEXIA - Loss of the ability to understand written
surface. language, often due to brain injury or disease.
38. BIOLOGIST - A scientist who studies living organisms 59. TALIPES EQUINOVARUS - A congenital deformity of
and their interactions with each other and the the foot, commonly known as clubfoot.
environment. 60. ENDOSKELETON - The internal skeleton of an
39. PUPIL - The small, dark aperture in the center of the animal, including bones and cartilage.
eye through which light enters. 61. DIAPHRAGM - A sheet of muscle separating the
40. OSTEOGENIC SARCOMA - A type of bone cancer thoracic and abdominal cavities, essential for
that arises from osteoblasts (bone-forming cells). breathing.
41. TYMPANIC MEMBRANE - The eardrum, a thin 62. SKELETAL MUSCLE - Muscle attached to bones that
membrane that separates the outer ear from the is responsible for voluntary movement.
middle ear. 63. PATELLA - The kneecap, a small bone located in
42. EXTERNAL EAR - The outer portion of the ear, front of the knee joint.
including the auricle (pinna) and ear canal. 64. DIALYSIS - A medical procedure used to remove
43. GASTRALGIA - Pain in the stomach or abdomen. waste products and excess fluid from the blood
44. DYSURIA - Pain or difficulty during urination. when the kidneys are unable to do so.
45. PARAPLEGIA - Paralysis of the lower half of the 65. NEUROLOGY - The branch of medicine dealing with
body, typically caused by spinal cord injury or disorders of the nervous system.
disease. 66. PERINEUM - The area between the anus and the
46. QUADRIPLEGIA/TETRAPLEGIA - Paralysis of all four genitals.
limbs and usually the trunk, caused by injury or
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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

67. SUBARACHNOID SPACE - The space between the > Frequently, tests are used to help confirm a
arachnoid membrane and the pia mater in the brain diagnosis, monitor an illness, and provide valuable
and spinal cord, filled with cerebrospinal fluid. information about the client’s response to
68. CORNEA - The transparent front part of the eye that treatment
covers the iris, pupil, and anterior chamber. > Diagnostic testing involves 3 phases:
69. LUMBAR VERTEBRAE - The five vertebrae in the o Pre-test: client preparation
lower back region of the spine. o Intra-test: nurse performs or assists with the
70. CONJUNCTIVA - The mucous membrane that covers diagnostic test and collects the specimen
o Post-test: nursing care of the client and follow
the front of the eye and lining the inside of the
up activities
eyelids.
71. SNEEZE - A sudden, involuntary exposure of air from URINE
the nose and mouth due to irritation of the nasal • Nurse’s responsibilities:
mucous membranes. ü Determine the ability of the client to provide
72. SCLERA - The tough, white outer layer of the eyeball the specimen
that helps to maintain its shape and protect the ü Assess the color, odor, and consistency of the
inner structures. urine
73. NASOLACRIMAL DUCT - A duct that allows tears to • Equipment
drain from the eye into the nasal cavity. o Clean gloves
74. FLUOROSCOPY - A technique used in medical o Sterile specimen container
imaging to obtain real-time moving images of the o Specimen identification label
internal structures of a patient through the use of a o Completed laboratory form
fluoroscope. o Urine receptacle if client is not ambulatory
75. RADIOGRAPHY - The use of X-rays or other forms of • Clean voided urine specimen
radiation to create images of the internal structures o Usually adequate for routine examination
o First voided specimen in the morning → tends
of the body, commonly known as X-rays.
to have a higher, more uniform concentration
76. CHOROID - The vascular layer of tissue located
and a more acidic pH
between the retina and the sclera the back of the
o At least 10ml
eye, supplying blood to the retina and other • Clean-catch or midstream urine specimen
structures. o Collected when a urine culture is ordered to
77. QUADRIPARESIS/PARAPARESIS - Weakness or identify microorganisms causing UTI
partial paralysis affecting all four • Timed urine specimen
limbs(quadriparesis) or just the lower o Collection of all urine produced over a specific
limbs(paraparesis). period of time, ranging from 1-2 hours to 24
78. ENDOCARDIUM - The inner lining of the heart hours
chambers and valves. o Generally, are refrigerated or contains a
79. ANALGESIA - The relief of pain without loss of preservative to prevent bacterial growth or
consciousness, typically achieved through the use of decomposition of urine components
analgesic medications or techniques. o To assess the ability of the kidneys to
concentrate and dilute urine
o To determine disorders of glucose metabolism
Common Diagnostic Tests o To determine levels of specific constituents
(albumin, creatinine) in the urine
> Diagnostic tests are tools that provide information
about clients, may be used for basic screening as
part of a wellness check
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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

NORMAL VALUES o To determine the presence of occult (hidden)

blood
Amount in 24 hours 1,200 – 1,500 ml
o To analyze for dietary products and digestive
Color, clarity Straw, amber; transparent
secretions
Odor Faint aromatic o To detect the presence of ova and parasites
Sterility No microorganisms present o To detect the presence of bacteria and viruses
pH 4.5 – 8 • Nurses need to give the ff instruction:
Specific gravity 1.010 – 1.025 o Defecate in a clean bedpan or bedside
Glucose Not present commode
Ketone bodies Not present o If possible, do not contaminate the specimen
Blood Not present with urine or menstrual discharge, void before
the specimen collection
Osmolality 50 – 1,200 mOsm/kg
o Do not place toilet tissue in the bedpan after
defecation
- Specific gravity is an indicator of urine
o Notify the nurse as soon as possible after
concentration, or the number of solutes present
defecation, particularly for specimens that
in the urine
need to be sent to the laboratory immediately
o Low: excess fluid intake or diseases
• Usually about 2.5 cm (1in) of formed stool or 15-30
affecting the ability of the kidneys to
ml of liquid stool is adequate
concentrate urine
o High: fluid deficit or dehydration, or SPUTUM
excess solutes such as glucose in the
• The mucous secretion from the lungs, bronchi, and
urine
trachea
- Urinary pH is measures to determine the relative
• Clients need to cough to bring sputum up from the
acidity or alkalinity of urine
lungs, bronchi, and trachea into the mouth in order
o Average pH = 6, slightly acidic
to expectorate it into a collecting container
o Low: metabolic acidosis
• Purposes:
o High: metabolic alkalosis
- Glucose to screen clients for DM and to assess o For culture and sensitivity to identify a
clients during pregnancy for abnormal glucose specific microorganism
intolerance o For cytology to identify the origin, structure,
- Ketones, are products of the breakdown of fatty function, and pathology of cells. Specimens
acids and are normally not present in the urine for cytology often require serial collection of
o Positive: clients with poorly controlled 3 early-morning specimens and are tested to
diabetes identify cancer in the lung and specific cell
- Protein molecules are normally too large to type
escape from glomerular capillaries into the o For acid-fast bacillus, which also require serial
filtrate, can leak if the glomerular membrane has collection for 3 consecutive days, to identify
the presence of tuberculosis
been damaged (e.g. glomerulonephritis)
o To assess the effectiveness of therapy
- Blood shouldn’t be seen in normal urine
- Urine osmolality is a measure of the solute • Specimens are often collected in the morning
concentration of urine that is a more exact • When client cannot cough ® pharyngeal suctioning
measurement of urine concentration than • Procedure:
specific gravity, also used to monitor fluid and o Offer mouth care
electrolyte balance o Ask the client to breathe deeply and cough up
1-2 tsp (4-10 ml) of sputum
STOOL o Wear gloves and PPE
• Purposes: o Ask the client to expectorate the sputum into
the specimen container
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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

o Offer mouthwash BASAL METABOLIC PANEL

o Label and transport specimen to the • BUN: a measure of the amount of urea
laboratory nitrogen in the blood, an indicator of renal
o Document the color, amount, consistency, function
presence of hemoptysis, odor, and any • CREATININE: end product of muscle
measures needed to obtain the specimen metabolism, better indicator of renal
(e.g., postural drainage) function than BUN
• TOTAL PROTEIN: specifically looks for the
BLOOD TESTS amount of albumin and globulin as well as
• Commonly used diagnostic test that can provide the A/G ratio
valuable information about the hematologic system o Indicated in clients with unexplained
• Venipuncture → can be performed by various weight loss, edema, and symptoms
members of the health care team of kidney/liver disease
• Phlebotomist → person from a laboratory who
performs venipuncture BUN 7 – 20 mg/dL
Creatinine 0.6 – 1.2 mg/dL
COMPLETE BLOOD COUNT Total Protein 6.2 – 8.2 g/dL
M 4.6 – 6 million/mm3
RBC Count
F 4.0 – 5.0 million/mm3
M 13 – 18 g/dL ARTERIAL BLOOD GASES
Hemoglobin pH 7.35 – 7.45
F 12 – 15 g/dL
M 40 – 54 % PaO2 80 – 100 mmHg
Hematocrit PaCO2 35 – 45 mmHg
F 36 – 46%
WBC Count 4,500 – 11,000/mm3 HCO3- 22 – 26 mEq/L
O2 Sat 95 – 100%
Platelet Count 150,000 – 400,000/mm3

SERUM ELECTROLYTES ULTRASOUND

Sodium 135 – 145 mEq/L • Diagnose pregnancy as early as 6 weeks AOG
• Confirm the presence, size, and location of
Potassium 3.5 – 5.0 mEq/L
placenta and amniotic fluid
Chloride 95 – 105 mEq/L • Establish that the fetus is growing and has no
Calcium 4.5 – 5.5 mEq/L gross anomalies (hydrocephalus, anencephaly,
other organ defects)
Magnesium 1.5 – 2.5 mEq/L
• Establish sex at last trimester
Phosphate 1.8 – 2.6 mEq/L • Establish the presentation and position of the
fetus
BLOOD CHEMISTRY • Be certain that a patient has received a good
M 10 – 55 unit/L explanation of what the procedure will be like
ALT
F 7 – 30 unit/L o Give them reassurance that the process
M 10 – 40 unit/L doesn’t involve X-rays and so it will be
AST
F 9 – 25 unit/L safe for the fetus
Albumin 3.5 – 4.8 g/dL • Patient should have a full bladder at the time of
Cholesterol <200 mg/dL the procedure
o Ask them to drink a full glass of water
every 15mins beginning 90mins before
the procedure and to not void until after
the procedure

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 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

X-RAY subarachnoid space in the lower back to obtain

• Examination of the chest done both to diagnose samples of CSF analysis
disease and assess the progress of a disease • May also be used to measure CSF, instill
• Nurse needs to inform the client that jewelry and medications or introduce a contrast medium to
clothing from the waist up must be removed the spinal cord
• Usually takes 30-45 mins
ELECTROCARDIOGRAPHY • 3rd-4th or 4th-5th lumbar vertebrae
• Provides a graphic recording of the heart’s • Client is positioned laterally with the knees
electrical activity flexed onto the abdomen (knee-chest/fetal
• Electrodes placed on the skin transmit the position)
electrical impulses to the electrocardiogram ® • Nursing responsibilities:
detects dysrhythmias and alterations in o Explain the procedure, obtain informed
conduction indicative of myocardial damage, consent, place client in a lateral
enlargement of the heart, or drug effects decubitus position
o Aseptic technique, sterilize the area then
COMPUTED TOMOGRAPHY drape the site
• Painless, noninvasive x-ray procedure that has o Apply brief pressure to puncture site,
the unique capability of distinguishing minor place the pt flat on bed, monitor VS,
differences in the density of tissues neurologic status, and I & O
• Produces a 3D image of the organ or structure o Label and number the specimen tube
correctly
MAGNETIC RESONANCE IMAGING o Administer analgesics as ordered
• Noninvasive diagnostic scanning technique in • Equipment:
which the client is placed in a magnetic field o Sterile gloves, sterile drape
• Client with implanted metal devices cannot o Procedure tray
undergo an MRI o Sterile gauze pads
• There is no exposure to radiation o Aseptic solution
• Provides a better contrast between normal and o Lidocaine 1%
abnormal tissue than the CT scan o G-25 needle
• Nursing Considerations: o 10ml syringe
o All removable metallic objects should be o Spinal needle w/ stylet
removed before entering the area of the o CSF tube and stopcock
magnet o Manometer tubing
o Assess for body tattoos, especially those
red in color, because they may get warm INDICATIONS
during an MRI - Measure CSF pressure
o Transdermal patches containing a foil - Assist in the diagnosis of suspected CNS
may cause burning or injury infections
• Client must lie very still - Evaluate and diagnose demyelinating or
• Earplugs are offered to the client to reduce the inflammatory CNS processes
discomfort from the loud noises that occur - Infuse medications which include spinal
during the test anesthesia before surgery, and contrast material
• Lasts between 60-90 minutes for diagnostic imaging
- Treat normal pressure hydrocephalus
LUMBAR TAP - Placement of a lumbar CSF drainage catheter
• An invasive procedure where a hollow needle is
CONTRAINDICATIONS
inserted into the space surrounding the
- Increased ICP due to brain tumor
bjg.fajardo ⋆⭒ ̊.⋆
 OBJECTIVE STRUCTURED CLINICAL EXAMINATION D2
BSN 3 1st Semester, A.Y. 2024-2025

- Skin infection near the puncture site

- Severe degenerative vertebral joint disease
- Severe coagulopathy

NORMAL VALUES
Pressure 70-180 mmH2O
Appearance Clear and colorless
Total Protein 15-45 mg/dL
Glucose 50-80 mg/dL
No RBC, WBC=0-
Cell Count
5/microliter
Chloride 118-130 mEq/L
Gram Stain No microorganisms present

Ø ­ Pressure: tumor, hemorrhage, trauma

Ø ¯ Pressure: spinal subarachnoid obstruction
Ø Cloudy: infection, Yellow-reddish: hemorrhage/SC
obstruction, Brown-orange: RBC breakdown
Ø ­ Protein: tumor, trauma, DM
Ø ¯ Protein: rapid CSF production
Ø ­ Gamma globulin: multiple sclerosis/neurosyphilis
Ø ­ WBC: tumor, acute infection, stroke
Ø ­ RBC: bleeding into spinal fluid
Ø Gram stain: bacterial meningitis

Reference:
Kozier & Erb’s Fundamentals of Nursing 10th Edition

bjg.fajardo ⋆⭒ ̊.⋆