welcome to top rank review academy's free online lecture series this is caroline pelaez and i will be your host for today's event so today we are having our top-ranked nursing lecturer series which started on the 24th of may until the 30th of this year and we are going to discuss the latest trends updated nursing core concepts and this has started yesterday with sir e.j flaminiano today we'll be having medical surgical nursing and diabetes mellitus management foot care by professor lester lindau and tomorrow we will be having community health nursing primary health care and health education epidemiology by professor jessie daples that would be from 2 pm until 4 pm and on the 27th we will be having professor archie elvis from 6 to 8 p.m who will be discussing maternal nursing common obstetric complications and normal delivery nursing management on the 28th we'll be having professor lianwell de guzman from 2 to 4 p.m we'll be discussing fundamentals of nursing and medical surgical nursing angina myocardial infarction and iv therapy and that would be uh 2 to 4 p.m next is pediatric nursing on the 29th of may professor archie alves from 6 to 8 pm who will be discussing common pediatric gastrointestinal diseases and last but not the least is professor kenneth arzedon who will be discussing psychiatric nursing schizophrenia and therapeutic communication so guys this is part of our buy any hand review assistance program we're in we are giving out a free review to our students and considering that there has there had been a lot of cancellations already of the board exams this year we are going to have as well a free pharmacy board exam review for and this would be for a month we will be having a crash course and final coaching on the 29th of may until the 25th of june 2021 so if you know anyone who's interested to join please do inform them to sign up we'll also have another free veterinary board exam review crash course and final coaching on the 28th of june until the 27th of july and please inform your friends and family who would like to join this uh veterinary boarded exam review program so for the benefit of everyone who doesn't know who top rank review academy is let me just run you through our company profile so we have started in 2013 right now we're already considered as one of the biggest national review centers here in the country we currently have 20 local branches and four international branches so for our local branches let's start with our main office in manila we are located right in front of prc in muraita we are located at the fifth floor of the dondorenzo building aside from our manila main branch we also have branches in quezon city marikina and for provincial branches we have branches in la wag [Music] in legaspi and naga cebu iloilo tacloban zamboanga [Music] and what's good with our online interactive review is that we could reach the farthest places in the philippines even if we don't have a branch there yet but prior to the pandemic we have already opened branches internationally so we have branches in indonesia in partnership with the ministry of health and we have opened branches there in jakarta and in bandung in indonesia so what we basically do is we provide them international exam review as well as trainings and seminars and we were even invited at the 70th anniversary of diplomatic relations of indonesia and the philippines we were very honored to have been invited in this event prior to the lockdown because amongst all the other review centers here in the country we are the only review center who was invited we also have branches in dubai and in abu dhabi in the united arab emirates so what we provide there is sple review as well as international exam review such as nclex had from metrics ukcbt ielts and oet and for our track record guys we don't only offer nursing but we also offer dentistry so if you know anyone who is looking for a review center for dentistry please do inform us uh them to just send us a message through our facebook fan page our top one came from centro escolar university here are our top notchers and as well as licensure examination for teachers top two came from ut manila psychometrician review and criminology our top one came from universidad de zamboanga and we are very happy to announce that just last night the results for the radiologic technologies licensure examination has already uh been announced so we've got the top one three top threes one top six and one top ten so we're really very happy with this results and we are very happy because we were able to help a lot of students not only pass but also top the board exam our top one came from saint louis university and as well as our previous top one also came from slu baguio we also have our products of our online review for medtech here are our top notches as well as respiratory therapy these four students are also products of online we also offer mid referee and of course our nursing review program so let's start with 2013 we're in we only had two top notchers and after that in 2014 we had three and then we had six and in 2015 was the first time that top rank was really well known already because we had 16 top notches in just one season in the may 2015 nurse licensure examination and of course right after that in november of 2015 we had 20 top notches in just one season 2016 is really good as well and 2017 but in 2017 of november was the first time that we got our first top one sir raymond maniago which is also one of our esteemed national lecturers uh he came from up manila in 2018 we also had our next top one from university of pangasinan or mark tristan and in 2019 our next top one came from angeles university foundation miss jeremiah paula austria caseres and of course miss shaina ke watanabe from davao doctors college so there we already made history not only for nursing but also across all professions so in nursing we had our top one from 2017 2018 and 2019 and because of that we are now healed as the best national review center by multiple award-giving bodies such as the golden globe best choice q asia global awards and global excellence awards so guys we also have books on sale if you're interested to purchase just send us a message through our facebook fan page our top rankers guide which is our review book is now down to 1099 from 1350 as well as our battle strategies which contains around a thousand word sensitive questions with socratic reasoning rationale and test taking strategies so please do send us a message if you're interested to purchase our books for our review proper we are still open for the enrollment of our final coaching for the july board exam it will start on june 8th and for the november boards it the our review will start on june 25 for our refresher phase we still have an ongoing promo which is a discount of 500 pesos if you enroll on or before june 1 as well as our weekend class which will start on july 3. our promo is just until the 1st of june we'll have a 1 000 peso discount so just send us a message if you're interested to enroll our facebook fan page is top rank review academy so without any further ado let us all welcome our lecturer for today professor lester lentau who will be discussing medical surgical nursing endo diabetes mellitus management and foot care hi sir lester good afternoon can you hear me um you guys hear me okay so uh if you can leave me please give me a feedback so i can start lecturing the lecture uh good afternoon to everyone to lose we're here in zoom and uh facebook okay i can see you there and uh thank you so again once again thank you to toprank actually for this empty war uh with these types of dynamic we need help in anything we can get actually and then um uh there are such activities okay thank you for joining us this afternoon so without it and we chose some topic and looking system but i guess if you would see um is okay uh you want to take an example july and july 2019 exactly 13 days 17 hours and 35 minutes before your exam okay but again as you are staying with us let me ask you a question what's your goal it's our goal the top exams is [Music] um sorry foreign [Music] one two three four five six seven eight checking one two three actually the introduction oh that's weird under water it's kind of weird okay on a population again nine percent of entire population okay that's frustrating uh nine percent of the entire population i don't know what's wrong actually no ah it's close yeah okay that's all sayings again first time it happened to me actually style until 2016 there was a five percent increase in premature mortality from diabetes and more so yesterday okay in 2019 an estimated 1.5 million deaths were directly caused by diabetes another 2.2 million deaths were attributable to high blood glucose in 2012 okay so you know how do we attack well nasa's 2019 so far in 2020 and the really long total number of cases not no uh cases are actually saying no new uh reports about mortality or morbidity because of the luck no no remind you certain percentage of those who are dying because of group 19 are the ones suffering diabetes about the physiology involved here throughout the that was 20 percent of the islet cells and that purpose is to produce glucagon once again the purpose of glucagon okay and actually glucagon increases the blood glucose level so this time bs is blood sugar level or blood glucose level okay in this time which accounts seventy percent of the islet cessna so that column seventy percent is that it secretes the important insulin non-purpose has to lower the blood sugar level now the best way for me to explain is by first explaining it which is is a very important regulatory hormone more on release hypothalamus it's a growth hormone functioning actually so yeah okay so again so for me to explain this one let's zero so this is frustrating actually this is the first time it happened to me now anyway the most important carbohydrate is glucose that actually produces energy energy levels glucose let me repeat two hours okay two hours glucose will go to the cells and that therefore okay therefore what we've got transfer glucose to the cells the answer is insulin so insulin transports glucose to the cells okay again span of two hours of breakdown of the less guys kite foreign glycogenesis to actually form or convert glucose to become glycogen okay so glycogen and so that cool and glycogen will be form of that now actually muscles okay however most of them goes to our liver being pertained to us the liver glycogen which is highly important as a defense mechanism again okay from the start and then let me see i am functioning in chile once again okay glucose the primary source of the less carbohydrates and that when it taken for the glucose it will go to the cells within two hours not okay within two hours actually what am i ordering what i mean in two hours can that what will transport moves to the cell is actually insulin now but sober and glucose converted to becoming glycogen what will convert steel is insulin insulin so therefore is to lower the blood sugar level into how much 18 to 120 glycogen going back to blood sugar level again by converting glycogen to become glucose during hypoxemia in a method known as glycogen glycogen okay so from the start okay let's repeat before i continue honestly very important to understand that my hyperglycemia and all my diabetes is um level how by transporting glucose to the cell then converting exists to become glycogen okay now i'm purposeful and you're going to increase the blood sugar level now by reconverting glycogen to become glucose during hypoglycemia in a process known as glycogenolysis okay don't forget hormones insulin glucagon and with that the immune system and to actually amplify the topic of the m okay so with that then that's all about the m itself i mentioned earlier i think i mentioned worth mentioning on the daily list dm is the most common metabolic disorder now once again okay the diabetes means the most common metabolic disorder okay and that by the way the examples unfortunately indeed you might not see this really in books right now okay because what i'll give you now is the update actually of the classification given by ada i mean american ishmael international society of hypertension now they give us two classifications and two types each of course unfolds latin these are the number primary types with that then let's talk about the classifications of dm starting off with the type 1. type one here formerly known as initial independent vm okay and type two is what and i do them that's not insulin dependent diabetes minutes okay i said that that is but in recent years blood sugar level the common complication for type 1 is diabetic ketosidosis that we will actually somehow focus in a while or discuss in a while and then type 2 lemon actually is what h and z that is hyperglycemia hyperosmolar non-ketotic or some books call it non-ketotic syndrome okay but in h and z for the h and s so those are the types of it so the lower class that under acquired pepsi okay by the way just to to let you know that uh i'm problem hyperglycemia right now on the transition of the corpse looking to the placenta again is that hormone atomizer right hpl what is that starting third month of pregnancy according to books again pina camara and on the last trimester of course like fully functional placenta on the third month of pregnancy okay hpl and i read and let me write it for you human placenta so on the third month of pregnancy comatose 11 hpl that is human placental oxygen which decreases insulin which increases blood sugar coming hyperglycemia and i told you the main problem of dm is hyper lasynya coming from the adrenal cortex let me just uh bring it back to one discussion actually okay now remember nutrients we have three macronutrients right carbohydrates but nikoi okay okay again with that because of that again fats and protein is being converted over again to become you have type 1 type 2 and classification vr secondary types which are gestational these are common uh concepts actually not only or that can lead to hyperglycemia so with that my hyperglycemia can yield you know the three piece of vm however allah numerated we'll discuss them one by one those are questions that you can actually uh we can answer after i discuss the pathophysiology of diabetes will yield a lot of symptoms and even complications glucose insulin what happened hyperglycemia with that then with that notation actually that okay ammonia is that that action that sugar tatas in viscosity shifting okay so let's define osmosis by the way osmosis for the first time today what is this moses again the movement of water or solvent is a proper term the movement of solvent or water from an area of lower concentration to an area of higher concentration if i may repeat that it osmosis is a little bit of water from an area of lower concentration to an area of higher concentration now i have two spaces being mentioned there that we invested in the intravascular space so a is the intercellular base of intervascular space with that sense okay to which area has the higher concentration you will be following the definition of osmosis movement of water from an area of neural concentration high concentration actually and a movement is a to d and now we are the water now will be drawn out okay now fluid volume so what will happen next okay but volume exists actually of course it will increase the functioning of the system right now i expect not expect nothing actually that okay only hyperglycemia and remember this glucose can exert its own osmotic pressure again glucose can exert basal osmotic pressure therefore spirit and polyuria is caused by smoothie there is nothing so i am okay from the start sequencing is osmosis not makes shift after water from the cell to the blood causing intercellular denitriation water increasing the blood volume right now prompting the heart to compensate increasing the heart rate of course not okay automatic heart rate natural attachment pressure towards the kidneys expelling watering because i'm glucose it can exert its own osmotic pressure once again that glucose can exert in some smoothie pressure requests pieces i believe you can answer by yourself facebook shout out thank you so much for joining now okay and thank you again for top ramp for this and the board all right guys okay it really happens to type 2 and let me prove that to you i told you earlier you that it will produce energy distillation energy and weakness what's the primary compensation against starvation hunger agana the primary compensation against starvation is actually hungary persistent or excessive hunger that we call poorly polyphagia now let me complete my list a while ago so three piece taiyo first polynomial cross osmotic diverses second polydipsia dehydration entered polyphagia a polyphagus third here okay cellular [Music] unfortunately genesis and protein to become glucose again the purpose of that is gluconeogenesis again okay earlier the primary complication for bm1 or type 1 dm is the diabetic acidosis is an emergency it is a crisis now okay before hunger that we call polyfagya solution usually suggestionally drawn within 30 minutes after three hours but in the beginning the body will activate the secondary difference which is the release of glucocorticoids okay i don't then let's have this opportunity to discuss dka now what's not in decay pulse can number five actually okay five and six are the dangerous ones now remember this one ketones actually ketones can cause sedation of the brain that eventually can cause possible altered level of consciousness which is actually very classic foreign the abnormal acid this time is is the solution of two components water carbon dioxide okay in water nothing this solves the carbon dioxide chemistry again water dissolves carbon dioxide okay and then purpose stem is to form h2co3 h203 ladies and gentlemen is the carbonic acid discussion respiratory right because the primary acid is carbonic acid and that's the solution of water with carbon dioxide now the problem is that in ketones yes it will take you to flush again it will give the flash around 600 check that actually that's 300 to 600 cc of urine okay 300 to 600 yards it will take you around approximately 10 to 20 hours that controls the acid this violence called bologna acid dissolution of water and carbon dioxide now with that then okay acid all right i'm gonna go with another one okay it's decreased acid and no way no one could reduce carbonic acid to expel more carbon dioxide at the way to remove that to lessen the carbonic acid to spell more carbon dioxide okay what is the only management for dke the answer is insulin one more time okay the only management for dka is insulin now what's the only insulin given iv madelasinasa irregular insulin i checked several references has the least allergic reaction regular insulin complications number one is hypoglycemia so watch out for manifestations of hypoglycemia that will be discussed in a well known monitoring right and what do you see but my hypoalymia is actually the prominent you waves no you see that okay and third here third here and a complication edema so once again okay when giving insulin via iv watch out for hypoglycemia for hypoallevia of course manifestations for dka and the management for the and the only management i told you is iv insulin is what total dehydration and polyphagia that cause is cellular starvation okay so let's go discuss now therefore you might have even complications and chronic complications chronic complications let's discuss it now okay let's discuss the chronic uh the complications are complications for the m let me start with the cute ones complications um let's use the words acrostics h h n c okay nc stands for none comma h h and z okay and the nc stands for the none and again some books per deal from the normal which is 80 to 120 now again blood sugar level nothing 600 to 1000 okay right from e to me [Music] the blood is from cell to the water cell to blood now a shift in water is from cell to blood okay and that therefore i'm into b sugar range of six hundred to one thousand what happens later lecture the body examiner now problematic and hyperglycemia all right problem about my hyperglycemia high viscosity that's therefore sluggish on both the macro and the microcirculation now that's therefore not indeed a circulation problem circulation problems may happen actually okay because some pressure no heartburn angina victorious or even myocardial infarction right and even the different types of peripheral vascular disorders however someone asked me and of course this form correction yeah sometimes i love corrections internet fourth complication actually is that it uh during sexual intercourse in the absence of balance discusses a bit not okay but during sexual intercourse what makes the pain is a wreck the answer is blood supply no again during sexual intercourse okay what makes the penis erect is blood supply for the manhunt for adoption huh afghanistan supply major dynamics have been liberal six to seven times none six to seven times long non-blood supply non-penis and during sexual intercourse during intercourse and that therefore what happens is and mind you right can lead to possible septicemia which is hard to control now anyway before i show those pictures of necrotic tissues of those food resources once having a problem some is impotence during the m all right okay so i hope you answered that okay anyway so number 16 actually association of eyes okay and that make us possible what i'm gonna mention in justice on facebook i'm already nobody may happen now and the first manifestation is actually blurring our vision remember it can cause blindness can amend this onset and lecture nothing blind dm is one of the leading causes of blindness but let me tell you what let me tell you what that the most common cause of blindness nowadays the improper use of contact lenses okay the most common subin and w uh 2012 that's april of the little village the most common cause of blindness now is no longer glow farmer as time goes by basically now with that then okay let's talk about the management these are complications of them under chronic complications we're done with the chronic let's discuss now the management again okay guys commitment of symptoms of management mnemonic discuss nothing else and m stands for medications diet activity and medications there is diet activity and mitigations okay so let's talk about the first one and high fiver diet okay remember fiber is a very important dietary constituent that can decrease the level of sugar level now let's say final flash upon excessive glucose actually manga distribution accordingly okay accordingly actually this is the best diet for diabetics now again prudent diet is the best diet for diabetics and protein 20 however that's foreign okay [Music] [Music] one cup of rice is 200 calories normal again one cup of rice is 200 calories [Music] just deny don't memorize all the drugs you know why if you attempt to memorize all the drugs okay functional sugar level right okay and decreases that's controlling the blood sugar level it must to increase insulin and lower glucagon thus controlling the blood sugar levels are very important to actually assess for the manifestations of hypoglycemia so i made an acoustics disturbances again this stands for gate disturbances those are the manifestations of hypoglycemia now in the board hypoglycemia what's the first observation assessment for foreign if you observe these things what to do give or glucose level now a level source is same sorry okay manifestations of hypoglycemia are the following okay what to do is give oral sugar sources of glucose sources one thing i would want to encourage you to do this one okay right it is during the pickup action when you observe for the most severe or most serious hypoglycemic reaction memories a.m me where do you inject air first uh magenta is it clear or cloudy where will you inject air isn't that clear or the cloudy water injection cloud [Music] less painful than id less painful than i need pero slower than i am guys okay hypoglycemic reaction so less painful and slower than i am actually you know now however okay i'm gonna grab it it's actually about 3 8 of an inch now and what do you do with the tea are with the tissues rather is you have to pinch it again patient three of an inch pinch the tissue okay however information never avoid massaging on avoid massaging because a massaging will promote rapid absorption thus can cause possible immediate hypoglycemic reactions so make sure to avoid massaging now okay it's destroyed by long-term exposure to room temperature okay one more is that we have two up to never never check the validation in hawaii again shaking because formation of bubbles information bubbles can make it more difficult for you to actually aspirate the exact amount of you shouldn't know that so therefore you're gonna mix the content of the insulin it again avoid shaking shaking the cross formation of bubbles okay one more for the management prevent like dystrophy now how okay electricity actually are this uh deformed fats again are deformed so make sure to prevent lipo how is that so okay letter a is at room temperature never administer called insulin right actually rotate the site rotate the side of insulin once again to avoid the forming of about the facts it's called lipo mr finna rotate the insulin site or simply rotate the salam sites of the insulin administration rotation okay so with that let's talk about now some more side effects to observe the following okay with that we have here localized animal localized effect actually yes okay redness is actually is again avoid using the area for four to six weeks and nothing actually unlikely no systemic effects systemic effects are generalized we now during the glycemia the body wanted to compensate they're releasing what glucagon which if you would recall will cause glycogenolysis okay compensation is are really uh common sense which is about one for us to actually discuss to our clients absorbs extra perspiration um uh [Music] for any signs of injury consult a podiatrist okay so guys i hope you learned something this afternoon it's been an honor working with you okay an honor it's a pleasure actually teaching you this afternoon so thank you so much guys thank you so much for everyone god bless stay safe everyone god bless you all okay uh in my case you are business administrator thank you for that prank