MEDICAL SURGICAL NURSING
1. Following surgery, Mario complains of mild incisional pain while performing deep- breathing and coughing exercises. The nurse’s best response would be:
A. “Pain will become less each day.”
B. “This is a normal reaction after surgery.”
C. “With a pillow, apply pressure against the incision.”
D. “I will give you the pain medication the physician ordered.”
Answer: (C) “With a pillow, apply pressure against the incision.”
Applying pressure against the incision with a pillow will help lessen the intra-abdominal pressure created by coughing which causes tension on the incision that leads to pain.
2. The nurse needs to carefully assess the complaint of pain of the elderly because older people
A. are expected to experience chronic pain
B. have a decreased pain threshold
C. experience reduced sensory perception
D. have altered mental function
Answer: (C) experience reduced sensory perception
Degenerative changes occur in the elderly. The response to pain in the elderly maybe lessened because of reduced acuity of touch, alterations in neural pathways and diminished processing of sensory data.
3. Mary received AtropineSO4 as a pre-medication 30 minutes ago and is now complaining of dry mouth and her PR is higher, than before the medication was administered. The nurse’s best
A. The patient is having an allergic reaction to the drug.
B. The patient needs a higher dose of this drug
C. This is normal side-effect of AtSO4
D. The patient is anxious about upcoming surgery
Answer: (C) This is normal side-effect of AtSO4
Atropine sulfate is a vagolytic drug that decreases oropharyngeal secretions and increases the heart rate.
4. Ana’s postoperative vital signs are a blood pressure of 80/50 mm Hg, a pulse of 140, and respirations of 32. Suspecting shock, which of the following orders would the nurse question?
A. Put the client in modified Trendelenberg's position.
B. Administer oxygen at 100%.
C. Monitor urine output every hour.
D. Administer Demerol 50mg IM q4h
Answer: (D) Administer Demerol 50mg IM q4h
Administering Demerol, which is a narcotic analgesic, can depress respiratory and cardiac function and thus not given to a patient in shock. What is needed is promotion for adequate oxygenation and perfusion. All the other interventions can be expected to be done by the nurse.
5. Mr. Pablo, diagnosed with Bladder Cancer, is scheduled for a cystectomy with the creation of an ileal conduit in the morning. He is wringing his hands and pacing the floor when the nurse enters his room. What is the best approach?
A. "Good evening, Mr. Pablo. Wasn't it a pleasant day, today?"
B. "Mr, Pablo, you must be so worried, I'll leave you alone with your thoughts.
C. “Mr. Pablo, you'll wear out the hospital floors and yourself at this rate."
D. "Mr. Pablo, you appear anxious to me. How are you feeling about tomorrow's surgery?"
Answer: (D) "Mr. Pablo, you appear anxious to me. How are you feeling about tomorrow's surgery?"
The client is showing signs of anxiety reaction to a stressful event. Recognizing the client’s anxiety conveys acceptance of his behavior and will allow for verbalization of feelings and concerns.
6. After surgery, Gina returns from the Post-anesthesia Care Unit (Recovery Room) with a nasogastric tube in place following a gall bladder surgery. She continues to complain of nausea. Which action would the nurse take?
A. Call the physician immediately.
B. Administer the prescribed antiemetic.
C. Check the patency of the nasogastric tube for any obstruction.
D. Change the patient’s position.
Answer: (C) Check the patency of the nasogastric tube for any obstruction.
Nausea is one of the common complaints of a patient after receiving general anesthesia. But this complaint could be aggravated by gastric distention especially in a patient who has undergone abdominal surgery. Insertion of the NGT helps relieve the problem. Checking on the patency of the NGT for any obstruction will help the nurse determine the cause of the problem and institute the necessary intervention.
7. Mr. Perez is in continuous pain from cancer that has metastasized to the bone. Pain medication provides little relief and he refuses to move. The nurse should plan to:
A. Reassure him that the nurses will not hurt him
B. Let him perform his own activities of daily living
C. Handle him gently when assisting with required care
D. Complete A.M. care quickly as possible when necessary
Answer: (C) Handle him gently when assisting with required care
Patients with cancer and bone metastasis experience severe pain especially when moving. Bone tumors weaken the bone to appoint at which normal activities and even position changes can lead to fracture. During nursing care, the patient needs to be supported and handled gently.
8. A client returns from the recovery room at 9AM alert and oriented, with an IV infusing. His pulse is 82, blood pressure is 120/80, respirations are 20, and all are within normal range. At 10 am and at 11 am, his vital signs are stable. At noon, however, his pulse rate is 94, blood pressure is 116/74, and respirations are 24. What nursing action is most appropriate?
A. Notify his physician.
B. Take his vital signs again in 15 minutes.
C. Take his vital signs again in an hour.
D. Place the patient in shock position.
Answer: (B) Take his vital signs again in 15 minutes.
Monitoring the client’s vital signs following surgery gives the nurse a sound information about the client’s condition. Complications can occur during this period as a result of the surgery or the anesthesia or both. Keeping close track of changes in the VS and validating them will help the nurse initiate interventions to prevent complications from occurring.
9. A 56 year old construction worker is brought to the hospital unconscious after falling from a 2-story building. When assessing the client, the nurse would be most concerned if the assessment revealed:
A. Reactive pupils
B. A depressed fontanel
C. Bleeding from ears
D. An elevated temperature
Answer: (C) Bleeding from ears
The nurse needs to perform a thorough assessment that could indicate alterations in cerebral function, increased intracranial pressures, fractures and bleeding. Bleeding from the ears occurs only with basal skull fractures that can easily contribute to increased intracranial pressure and brain herniation
10. Which of the ff. statements by the client to the nurse indicates a risk factor for CAD?
A. “I exercise every other day.”
B. “My father died of Myasthenia Gravis.”
C. “My cholesterol is 180.”
D. “I smoke 1 1/2 packs of cigarettes per day.”
Answer: (D) “I smoke 1 1/2 packs of cigarettes per day.”
Smoking has been considered as one of the major modifiable risk factors for coronary artery disease. Exercise and maintaining normal serum cholesterol levels help in its prevention.
11. Mr. Braga was ordered Digoxin 0.25 mg. OD. Which is poor knowledge regarding this drug?
A. It has positive inotropic and negative chronotropic effects
B. The positive inotropic effect will decrease urine output
C. Toxixity can occur more easily in the presence of hypokalemia, liver and renal problems
D. Do not give the drug if the apical rate is less than 60 beats per minute.
Answer: (B) The positive inotropic effect will decrease urine output
Inotropic effect of drugs on the heart causes increase force of its contraction. This increases cardiac output that improves renal perfusion resulting in an improved urine output.
12. Valsalva maneuver can result in bradycardia. Which of the following activities will not stimulate Valsalva's maneuver?
A. Use of stool softeners.
B. Enema administration
C. Gagging while toothbrushing.
D. Lifting heavy objects
Answer: (A) Use of stool softeners.
Straining or bearing down activities can cause vagal stimulation that leads to bradycardia. Use of stool softeners promote easy bowel evacuation that prevents straining or the valsalva maneuver.
13. The nurse is teaching the patient regarding his permanent artificial pacemaker. Which information
given by the nurse shows her knowledge deficit about the artificial cardiac pacemaker?
A. take the pulse rate once a day, in the morning upon awakening
B. may be allowed to use electrical appliances
C. have regular follow up care
D. may engage in contact sports
Answer: (D) may engage in contact sports
The client should be advised by the nurse to avoid contact sports. This will prevent trauma to the area of the pacemaker generator.
14. A patient with angina pectoris is being discharged home with nitroglycerine tablets. Which of the
following instructions does the nurse include in the teaching?
A. “When your chest pain begins, lie down, and place one tablet under your tongue. If the pain continues, take another tablet in 5 minutes.”
B. “Place one tablet under your tongue. If the pain is not relieved in 15 minutes, go to the hospital.”
C. “Continue your activity, and if the pain does not go away in 10 minutes, begin taking the nitro tablets one every 5 minutes for 15 minutes, then go lie down.”
D. “Place one Nitroglycerine tablet under the tongue every five minutes for three doses. Go to the hospital if the pain is unrelieved.
Answer: (D) “Place one Nitroglycerine tablet under the tongue every five minutes for three doses. Go to the hospital if the pain is unrelieved.
Angina pectoris is caused by myocardial ischemia related to decreased coronary blood supply. Giving nitroglycerine will produce coronary vasodilation that improves the coronary blood flow in 3 – 5 mins. If the chest pain is unrelieved, after three tablets, there is a possibility of acute coronary occlusion that requires immediate medical attention.
15. A client with chronic heart failure has been placed on a diet restricted to 2000mg. of sodium per day. The client demonstrates adequate knowledge if behaviors are evident such as not salting food and avoidance of which food?
A. Whole milk
B. Canned sardines
C. Plain nuts
D. Eggs
Answer: (B) Canned sardines
Canned foods are generally rich in sodium content as salt is used as the main preservative.
16. A student nurse is assigned to a client who has a diagnosis of thrombophlebitis. Which action by this team member is most appropriate?
A. Apply a heating pad to the involved site.
B. Elevate the client's legs 90 degrees.
C. Instruct the client about the need for bed rest.
D. Provide active range-of-motion exercises to both legs at least twice every shift.
Answer: (C) Instruct the client about the need for bed rest.
In a client with thrombophlebitis, bedrest will prevent the dislodgment of the clot in the extremity which can lead to pulmonary embolism.
17. A client receiving heparin sodium asks the nurse how the drug works. Which of the following points would the nurse include in the explanation to the client?
A. It dissolves existing thrombi.
B. It prevents conversion of factors that are needed in the formation of clots.
C. It inactivates thrombin that forms and dissolves existing thrombi.
D. It interferes with vitamin K absorption.
Answer: (B) It prevents conversion of factors that are needed in the formation of clots.
Heparin is an anticoagulant. It prevents the conversion of prothrombin to thrombin. It does not dissolve a clot.
18. The nurse is conducting an education session for a group of smokers in a “stop smoking” class.
Which finding would the nurse state as a common symptom of lung cancer? :
A. Dyspnea on exertion
B. Foamy, blood-tinged sputum
C. Wheezing sound on inspiration
D. Cough or change in a chronic cough
Answer: (D) Cough or change in a chronic cough
Cigarette smoke is a carcinogen that irritates and damages the respiratory epithelium. The irritation causes the cough which initially maybe dry, persistent and unproductive. As the tumor enlarges, obstruction of the airways occurs and the cough may become productive due to infection.
19. Which is the most relevant knowledge about oxygen administration to a client with COPD?
A. Oxygen at 1-2L/min is given to maintain the hypoxic stimulus for breathing.
B. Hypoxia stimulates the central chemoreceptors in the medulla that makes the client breath.
C. Oxygen is administered best using a non-rebreathing mask
D. Blood gases are monitored using a pulse oximeter.
Answer: (A) Oxygen at 1-2L/min is given to maintain the hypoxic stimulus for breathing.
COPD causes a chronic CO2 retention that renders the medulla insensitive to the CO2 stimulation for breathing. The hypoxic state of the client then becomes the stimulus for breathing. Giving the clientoxygen in low concentrations will maintain the client’s hypoxic drive.
20. When suctioning mucus from a client's lungs, which nursing action would be least appropriate?
A. Lubricate the catheter tip with sterile saline before insertion.
B. Use sterile technique with a two-gloved approach
C. Suction until the client indicates to stop or no longer than 20 second
D. Hyperoxygenate the client before and after suctioning
Answer: (C) Suction until the client indicates to stop or no longer than 20 second
One hazard encountered when suctioning a client is the development of hypoxia. Suctioning sucks not only the secretions but also the gases found in the airways. This can be prevented by suctioning the client for an average time of 5-10 seconds and not more than 15 seconds and hyperoxygenating the client before and after suctioning.
21. Dr. Santos prescribes oral rifampin (Rimactane) and isoniazid (INH) for a client with a positive Tuberculin skin test. When informing the client of this decision, the nurse knows that the purpose of this choice of treatment is to
A. Cause less irritation to the gastrointestinal tract
B. Destroy resistant organisms and promote proper blood levels of the drugs
C. Gain a more rapid systemic effect
D. Delay resistance and increase the tuberculostatic effect
Answer: (D) Delay resistance and increase the tuberculostatic effect
Pulmonary TB is treated primarily with chemotherapeutic agents for 6-12 mons. A prolonged treatment duration is necessary to ensure eradication of the organisms and to prevent relapse. The increasing prevalence of drug resistance points to the need to begin the treatment with drugs in combination. Using drugs in combination can delay the drug resistance.
22. Mario undergoes a left thoracotomy and a partial pneumonectomy. Chest tubes are inserted, and one-bottle water-seal drainage is instituted in the operating room. In the
postanesthesia care unit Mario is placed in Fowler's position on either his right
side or on his back to
A. Reduce incisional pain.
B. Facilitate ventilation of the left lung.
C. Equalize pressure in the pleural space.
D. Increase venous return
Answer: (B) Facilitate ventilation of the left lung.
Since only a partial pneumonectomy is done, there is a need to promote expansion of this remaining Left lung by positioning the client on the opposite unoperated side.
23. A client with COPD is being prepared for discharge. The following are relevant instructions to the client regarding the use of an oral inhaler EXCEPT
A. Breath in and out as fully as possible before placing the mouthpiece inside the mouth.
B. Inhale slowly through the mouth as the canister is pressed down
C. Hold his breath for about 10 seconds before exhaling
D. Slowly breath out through the mouth with pursed lips after inhaling the drug.
Answer: (D) Slowly breath out through the mouth with pursed lips after inhaling the drug.
If the client breathes out through the mouth with pursed lips, this can easily force the just inhaled drug out of the respiratory tract that will lessen its effectiveness.
24. A client is scheduled for a bronchoscopy. When teaching the client what to expect afterward, the nurse's highest priority of information would be
A. Food and fluids will be withheld for at least 2 hours.
B. Warm saline gargles will be done q 2h.
C. Coughing and deep-breathing exercises will be done q2h.
D. Only ice chips and cold liquids will be allowed initially.
Answer: (A) Food and fluids will be withheld for at least 2 hours.
Prior to bronchoscopy, the doctors sprays the back of the throat with anesthetic to minimize the gag reflex and thus facilitate the insertion of the bronchoscope. Giving the client food and drink after the procedure without checking on the return of the gag reflex can cause the client to aspirate. The gag reflex usually returns after two hours.
25. The nurse enters the room of a client with chronic obstructive pulmonary disease. The client's nasal cannula oxygen is running at a rate of 6 L per minute, the skin color is pink, and the respirations are 9 per minute and shallow. What is the nurse’s best initial action?
A. Take heart rate and blood pressure.
B. Call the physician.
C. Lower the oxygen rate.
D. Position the client in a Fowler's position.
Answer: (C) Lower the oxygen rate.
The client with COPD is suffering from chronic CO2 retention. The hypoxic drive is his chief stimulus for breathing. Giving O2 inhalation at a rate that is more than 2-3L/min can make the client lose his hypoxic drive which can be assessed as decreasing RR.
26. The nurse is preparing her plan of care for her patient diagnosed with pneumonia. Which is the most appropriate nursing diagnosis for this patient?
A. Fluid volume deficit
B. Decreased tissue perfusion.
C. Impaired gas exchange.
D. Risk for infection
Answer: (C) Impaired gas exchange.
Pneumonia, which is an infection, causes lobar consolidation thus impairing gas exchange between the alveoli and the blood. Because the patient would require adequate hydration, this makes him prone to fluid volume excess.
27. A nurse at the weight loss clinic assesses a client who has a large abdomen and a rounded face. Which additional assessment finding would lead the nurse to suspect that the client has Cushing’s syndrome rather than obesity?
A. large thighs and upper arms
B. pendulous abdomen and large hips
C. abdominal striae and ankle enlargement
D. posterior neck fat pad and thin extremities
Answer: (D) posterior neck fat pad and thin extremities
“Buffalo hump” is the accumulation of fat pads over the upper back and neck. Fat may also accumulate on the face. There is truncal obesity but the extremities are thin. All these are noted in a client with Cushing’s syndrome.
28. Which statement by the client indicates understanding of the possible side effects of Prednisone therapy?
A. “I should limit my potassium intake because hyperkalemia is a side-effect of this drug.”
B. “I must take this medicine exactly as my doctor ordered it. I shouldn’t skip doses.”
C. “This medicine will protect me from getting any colds or infection.”
D. “My incision will heal much faster because of this drug.”
Answer: (B) “I must take this medicine exactly as my doctor ordered it. I shouldn’t skip doses.”
The possible side effects of steroid administration are hypokalemia, increase tendency to infection and poor wound healing. Clients on the drug must follow strictly the doctor’s order since skipping the drug can lower the drug level in the blood that can trigger acute adrenal insufficiency or Addisonian Crisis
29. A client, who is suspected of having Pheochromocytoma, complains of sweating, palpitation and headache. Which assessment is essential for the nurse to make first?
A. Pupil reaction
B. Hand grips
C. Blood pressure
D. Blood glucose
Answer: (C) Blood pressure
Pheochromocytoma is a tumor of the adrenal medulla that causes an increase secretion of catecholamines that can elevate the blood pressure.
30. The nurse is attending a bridal shower for a friend when another guest, who happens to be a diabetic, starts to tremble and complains of dizziness. The next best action for the nurse to take is to:
A. Encourage the guest to eat some baked macaroni
B. Call the guest’s personal physician
C. Offer the guest a cup of coffee
D. Give the guest a glass of orange juice
Answer: (D) Give the guest a glass of orange juice
In diabetic patients, the nurse should watch out for signs of hypoglycemia manifested by dizziness, tremors, weakness, pallor diaphoresis and tachycardia. When this occurs in a conscious client, he should be given immediately carbohydrates in the form of fruit juice, hard candy, honey or, if unconscious, glucagons or dextrose per IV.
Your review guide for Nursing Board Examination, Nursing Training Schedules and Board Exam Test Taking Strategies. Nurse Licensure Examination (NLE) results and Nurse Licensure Examination answer keys. Nursing board exam questions and review materials. National Council Licensure Examination (NCLEX) questions, NCLEX exam, NCLEX review and NCLEX results.
 |
Dec 22, 2008
Dec 19, 2008
Dec 18, 2008
Dec 17, 2008
Dec 16, 2008
Dec 15, 2008
Dec 14, 2008
Inborn Errors of Metabolism
G6PD Deficiency-Glucose 6 Phospate Dehydrogenase
· Sex linked recessive (X-linked kaya there is more boys than girls)
(bakit boys? Remember that female contains XX genes while male contains X genes. So ibig sabihin if a female had a faulty X genes the other X genes can balance the effect. So with this principles female are always carriers and her son would be affected, Then if the affected son had a female daughter she will be a carrier)
· Lacks enzyme G6PD results in premature destruction of RBC if cells are exposed to oxidants, ASA, legumes and flava beans
2 forms:
1. Congenital Nonspherocytic Hemolytic anemia- group of congenital hemolytic anemias in which there is no abnormal hemoglobin or spherocytosis and in which there is a defect of glycolysis in the erythrocyte
Characterized by:
Hemolysis, jaundice, splenomegaly and aplastic anemia
2. Drug induced
Precipitating factors:
1. Illness: bacterial and viral infections
2. Anti-pyretic drugs (Aspirin and phenacitin)
3. sulfonamides
4. Anti-malarial drugs (Quinine)
5. Various medications such us Vit. K and Methylene blue
6. Flava beans and Napthalene (eto ung moth balls or naptalina na nilalagay sa cabinet)
Dx Procedure
· Rapid enzymes screening test or electropoetic RBC
· Peripheral blood smear- reveals presence of Heinz bodies (hindi eto ung ketchup, this are RBC’s that appears to have bite off the cytoplasm, that’s why they are sometimes called ‘bite cells’)
Nursing Management
· Instruct to avoid foods such us flava beans, red wine, legumes, blueberries, soya foods, tonic water and other drugs that triggers the attack.
Homocystinuria
· elevated excretion of amino acid homocystiene
· It can lead to mental retardation (delays in reaching developmental milestones {e.g., crawling, walking, sitting})
REVIEW!!! Level of Mental Retardation... l
Profound Mental retardation: IQ<20> thinks like an Infant. Can’t be trained
Severe Mental retardation: IQ 20-35
Moderate: IQ 35-50-> can be trained. Mental age is 2-7y/o. Pre-operational stage
Mild: IQ 50-70 Metal age is 7-12. Educable and can go to school
Borderline: IQ 70-90
Normal: IQ 90-110
· Inability to convert amino acid Methionine
· Autosomal recessive (this means the gene defect is unknowingly passed down from generation to generation. This faulty gene only emerges when two carriers have children together and pass it to their offspring. For each pregnancy of two such carriers, there is a 25% chance that the child will be born with the disease and a 50% chance the child will be a carrier for the gene defect.)
Signs/Symptoms
· Mental retardation
· Downward subluxation of lens (ectopia lentis)
· Slender built
· Pectus excavatum (oist meron din nito ang may Down syndrome, the sternum appears sunken and the chest concaves.)
· Abnormal thinning and weakness of the bone (osteoporosis and kyphoscoliosis)
· Degeneration of the aorta
Labtest:
Bacterial inhibition assay for methionine- Normal is <1mg>
Congenital Adrenal Hyperplasia
- A condition where the adrenal does not produce enough cosrtisol and aldosterone but there is an excessive production of androgens.
- This is also autosomal recessive
REVIEW!! Hormones of the Adrenal Cortex
code: SSS
Salt- Mineralocorticoids (mainly aldosterone- responsible for Na reabsorption and K excretion)
Sugar-Glucocorticoids (mainly cortisol, responsible for glycolisis and gluconeogenesis)
Sex- Sex hormones
Oversecretion- Cushing’s syndrome
Undersecretion- Addison’s disease
Assessment:
In female
· Large clitoris, closed labial folds
· Early appearance of pubic hair
· Deep masculine voice
· No breast development and menstruation
· Excessive hair in face
· (in short nagiging lalaki ung babae, pramis pag nakita nyo ung itsura, ung clitoris eh mukha nang penis)
In male:
at birth- normal
6 months signs of sexual precocity
3-4 – have pubic hair and enlarged penis, scrotum and prostate but testes is not descended
sterility
Labtest:
High 17-hydroxyprogesterone
Low serum Na
High serum K
Treatment:
Corticosteroid
Diet: High sodium, low potassium
Homocystinuria
(PKU) – deficiency of liver enzymes (PHT)
Phenylalaninehydroxylase Transferase – liver enzyme that converts CHON to amino acid
9 amino acids:
valine isolensine tryptophase
lysine phenylalanine
Thyronine – decrease malanine production
1.) fair complexion
2.) blond hair
3.) blue eyes
Thyroxine – decrease basal metabolism
- accumulation of Phenyl Pyruvic acid
4.) Atopic dermatitis
5.) musty / mousy odor urine
6.) seizure – mental retardation
Test – GUTHRIE TEST – specimen – blood
- preparation increase CHON intake
- test if CHON will convert to amino acid
specimen and urine
mixed with pheric chloride, presence of green spots at diaper a sign of PKU
DIET:
Low phenylalanine diet- food contraindicated- meats, chicken, milk, legumes, cheese, peanuts
Give Lofenalac- milk with synthetic protein
Galactosemia
– deficiency of liver enzyme
- GUPT – Galactose Urovil Phosphatetranferase
- Converts galactose to phosphate tranferace glucose
Galactose – will destroy brain cells if untreated – death within 3 days
Dx:
Beutler test – get blood -done after 1st feeding
presence of glucose in blood – sign of galactosemia
galactose free diet lifetime
neutramigen – milk formula
CELIAC DISEASE – gluten enteropathy
Common gluten food:
Intolerance to food with brow
B- barley
R- rye
O- oat
W- wheat
Pathophysiology:
Gluten – glutamine ( normal absorption)-> Gliadin ( toxic to epithelial cells of villi of intestines, effects is malabsorption syndrome)
Malabsorption
-> Fats-> steatorrhea
->malnutrition and edema
-> Vit D calcium->osteomalicia
->Vitamin K->inadequate blood coagulation->bleeding
->iron folic acid-> anemia
Early Sx:
1. diarrhea – failure to gain wt ff diarrheal episodes
2. constipation
3. vomiting
Late Sx:
abd pain – protruberant abd even if with muscle wasting
steatorrhea
Celiac Crisis- exaggerated vomiting with bowel inflammation
Dx:
lab studies – stool analysis
serum antiglyadin – confirmatory of disease
gluten free diet – lifetime
all BROW – not allowed
ok – rice & corn
Mgt:
vitamin supplements
mineral supplements
steroids
· Sex linked recessive (X-linked kaya there is more boys than girls)
(bakit boys? Remember that female contains XX genes while male contains X genes. So ibig sabihin if a female had a faulty X genes the other X genes can balance the effect. So with this principles female are always carriers and her son would be affected, Then if the affected son had a female daughter she will be a carrier)
· Lacks enzyme G6PD results in premature destruction of RBC if cells are exposed to oxidants, ASA, legumes and flava beans
2 forms:
1. Congenital Nonspherocytic Hemolytic anemia- group of congenital hemolytic anemias in which there is no abnormal hemoglobin or spherocytosis and in which there is a defect of glycolysis in the erythrocyte
Characterized by:
Hemolysis, jaundice, splenomegaly and aplastic anemia
2. Drug induced
Precipitating factors:
1. Illness: bacterial and viral infections
2. Anti-pyretic drugs (Aspirin and phenacitin)
3. sulfonamides
4. Anti-malarial drugs (Quinine)
5. Various medications such us Vit. K and Methylene blue
6. Flava beans and Napthalene (eto ung moth balls or naptalina na nilalagay sa cabinet)
Dx Procedure
· Rapid enzymes screening test or electropoetic RBC
· Peripheral blood smear- reveals presence of Heinz bodies (hindi eto ung ketchup, this are RBC’s that appears to have bite off the cytoplasm, that’s why they are sometimes called ‘bite cells’)
Nursing Management
· Instruct to avoid foods such us flava beans, red wine, legumes, blueberries, soya foods, tonic water and other drugs that triggers the attack.
Homocystinuria
· elevated excretion of amino acid homocystiene
· It can lead to mental retardation (delays in reaching developmental milestones {e.g., crawling, walking, sitting})
REVIEW!!! Level of Mental Retardation... l
Profound Mental retardation: IQ<20> thinks like an Infant. Can’t be trained
Severe Mental retardation: IQ 20-35
Moderate: IQ 35-50-> can be trained. Mental age is 2-7y/o. Pre-operational stage
Mild: IQ 50-70 Metal age is 7-12. Educable and can go to school
Borderline: IQ 70-90
Normal: IQ 90-110
· Inability to convert amino acid Methionine
· Autosomal recessive (this means the gene defect is unknowingly passed down from generation to generation. This faulty gene only emerges when two carriers have children together and pass it to their offspring. For each pregnancy of two such carriers, there is a 25% chance that the child will be born with the disease and a 50% chance the child will be a carrier for the gene defect.)
Signs/Symptoms
· Mental retardation
· Downward subluxation of lens (ectopia lentis)
· Slender built
· Pectus excavatum (oist meron din nito ang may Down syndrome, the sternum appears sunken and the chest concaves.)
· Abnormal thinning and weakness of the bone (osteoporosis and kyphoscoliosis)
· Degeneration of the aorta
Labtest:
Bacterial inhibition assay for methionine- Normal is <1mg>
Congenital Adrenal Hyperplasia
- A condition where the adrenal does not produce enough cosrtisol and aldosterone but there is an excessive production of androgens.
- This is also autosomal recessive
REVIEW!! Hormones of the Adrenal Cortex
code: SSS
Salt- Mineralocorticoids (mainly aldosterone- responsible for Na reabsorption and K excretion)
Sugar-Glucocorticoids (mainly cortisol, responsible for glycolisis and gluconeogenesis)
Sex- Sex hormones
Oversecretion- Cushing’s syndrome
Undersecretion- Addison’s disease
Assessment:
In female
· Large clitoris, closed labial folds
· Early appearance of pubic hair
· Deep masculine voice
· No breast development and menstruation
· Excessive hair in face
· (in short nagiging lalaki ung babae, pramis pag nakita nyo ung itsura, ung clitoris eh mukha nang penis)
In male:
at birth- normal
6 months signs of sexual precocity
3-4 – have pubic hair and enlarged penis, scrotum and prostate but testes is not descended
sterility
Labtest:
High 17-hydroxyprogesterone
Low serum Na
High serum K
Treatment:
Corticosteroid
Diet: High sodium, low potassium
Homocystinuria
(PKU) – deficiency of liver enzymes (PHT)
Phenylalaninehydroxylase Transferase – liver enzyme that converts CHON to amino acid
9 amino acids:
valine isolensine tryptophase
lysine phenylalanine
Thyronine – decrease malanine production
1.) fair complexion
2.) blond hair
3.) blue eyes
Thyroxine – decrease basal metabolism
- accumulation of Phenyl Pyruvic acid
4.) Atopic dermatitis
5.) musty / mousy odor urine
6.) seizure – mental retardation
Test – GUTHRIE TEST – specimen – blood
- preparation increase CHON intake
- test if CHON will convert to amino acid
specimen and urine
mixed with pheric chloride, presence of green spots at diaper a sign of PKU
DIET:
Low phenylalanine diet- food contraindicated- meats, chicken, milk, legumes, cheese, peanuts
Give Lofenalac- milk with synthetic protein
Galactosemia
– deficiency of liver enzyme
- GUPT – Galactose Urovil Phosphatetranferase
- Converts galactose to phosphate tranferace glucose
Galactose – will destroy brain cells if untreated – death within 3 days
Dx:
Beutler test – get blood -done after 1st feeding
presence of glucose in blood – sign of galactosemia
galactose free diet lifetime
neutramigen – milk formula
CELIAC DISEASE – gluten enteropathy
Common gluten food:
Intolerance to food with brow
B- barley
R- rye
O- oat
W- wheat
Pathophysiology:
Gluten – glutamine ( normal absorption)-> Gliadin ( toxic to epithelial cells of villi of intestines, effects is malabsorption syndrome)
Malabsorption
-> Fats-> steatorrhea
->malnutrition and edema
-> Vit D calcium->osteomalicia
->Vitamin K->inadequate blood coagulation->bleeding
->iron folic acid-> anemia
Early Sx:
1. diarrhea – failure to gain wt ff diarrheal episodes
2. constipation
3. vomiting
Late Sx:
abd pain – protruberant abd even if with muscle wasting
steatorrhea
Celiac Crisis- exaggerated vomiting with bowel inflammation
Dx:
lab studies – stool analysis
serum antiglyadin – confirmatory of disease
gluten free diet – lifetime
all BROW – not allowed
ok – rice & corn
Mgt:
vitamin supplements
mineral supplements
steroids
Abdominal Assessment
Abdominal Assessment: A story towards mastery
By : Budek
http://www.pinoybsn.tk
Nag mumuni muni si Nars Budek sa emergency unit ng Ospital ng Fatima medical center. Bigla biglang may pumasok na pasyente para sa admission. Masakit raw ang kanyang tyan.
Inobserbahan siya ni Nars Budek. Aba, napakabilis ng kanyang pag hinga. Namumutla pa ang kaniyang mga labi at parang tuyong tuyo at nagbabakbak.
“Ang bilis rin ng kanyang heart rate ah, 110 bpm, tachycardic ito, siguro may masamang nararamdaman o may nararamdamang sakit?” Ang naisip ni Budek.
Ang pasyente natin ay si nanay ester, isang matandang pasyente. Siya ay 74 taong gulang na na may chief complaint na “MASAKIT ANG TIYAN KO”
What are the possible causes of abdominal pain in the elderly ?
Nurse Budek thinks of : Constipation? Gas accumulation? Impaction? Inflammatory Bowel Disease? Appendicitis? Cholecystitis? Cholelithiasis? Ulcers? Peritonitis? Colon cancer? Ovarian or uterine cancer? PID? And many many more.
“Okay nanay, dadalhin ko muna po kayo sa lab para po sa isang work up.”
Hmm… work up? Did nanay ester understands what nurse budek said…. WORK UP? Perhaps, this will be better :
“Okay nanay, pupunta na po tayo sa laboratoryo para po maisagawa natin ang ibat ibang pagsusulit upang malaman kung ano po ang sanhi ng pananakit ng inyong tiyan.”
Natanggap na ni Nars Budek ang mga laboratory results. Hmmm, 13 mg/dl ang kanyang hemoglobin at 56% ang kanyang hematocrit. Ang potassium level nya ay nasa 5.0 meq/L. Ang WBC nya ay nasa 8,000 / cc3. Wala namang diprensya ang kanya lab results ah.
Really? Are you sure that all the lab results are normal? Let us review the normal values :
WBC : 8,000 / cc3 is normal. An increase beyond 10,000 / cc3 is indicative of infection.
Hgb : Hemoglobin levels of aling ester are within normal limits. Meaning, there is no or minimal bleeding.
Hct : Hematocrit levels of aling ester are high, indicating that she is dehydrated or bleeding.
K : The potassium level is within the normal limits of 4.5 to 5.5 meq/L.
Using the selected lab results above, we can then eliminate many possible causes of the abdominal pain of aling ester. Remove : PERITONITIS, APPENDICITIS, INFECTION, INFLAMMATORY BOWEL DISEASE AND ULCERS.
“Aling ester halika po at humiga po kayo rito at titingnan ko po ang inyong tiyan.”
Did Nurse Budek use an effective approach on asking aling ester to lie down for an abdominal assessment?
How about this :
“Aling ester, Abutin nyo po ang kamay ko. halika po kayo rito at aalalayan ko kayo papunta dito sa higaan para po tingnan ko ang inyong tiyan.”
The client is age 74 and in PAIN. It is NOT therapeutic to ask the client to come and lie down on the examiners table on her own.
“Aling ester, mahiga po kayo dito at titingnan ko po kayo.”
What should be aling esters position for an abdominal assessment?
A. Supine, with head and feet FLAT on bed
B. High fowlers with the feet in extension
C. Prone position
D. Low fowlers with the knee on flexion
“Aling ester, itataas ko na po ng kaunti ang ulo ninyo at paki baluktot po lamang ang inyong tuhod.”
Correct answer is LETTER D. To promote abdominal relaxation, The head of the bed should be SLIGHTLY elevated and the knee of the client on flexed position.
A and B will promote abdominal rigidity making it hard for Nurse Budek to PALPATE the abdomen.
If your answer is C, you should try to imagine how can you assess the patient’s abdomen if she is in prone position?
Humiga na si aling ester at mag uumpisa na si Nurse Budek sa pag assess ng tiyan ni aling ester.
What should be Nurse Budek’s INITIAL STEP in assessing aling ester’s abdomen?
A. Palpation
B. Inspection
C. Auscultation
D. Percussion
Tiningnan ni Nurse Budek ang tiyan ni aling ester, Hmm.. wala namang kakaiba sa tiyan ni aling ester. Round sha, may mga stretch mark marahil dulot ng kanyang pagbubuntis at panganganak. Lubog ang pusod at malinis naman ito. Wala naman akong nakikitang gumagalaw galaw mukhang maaliwalas at tahimik naman ang kanyang tiyan kung titingnan.
Kinuha ni Nurse Budek ang stethoscope at kanyang pinakinggan ang tiyan ni aling ester. “Aba eh! Wala akong marinig na kung ano man. Hypoactive ang bowel sound ni aling ester. Sa loob ng isang minuto ay nakarinig ako ng tatlong bowel sound.”
How did Nurse Budek concluded that aling ester’s bowel sound is hypoactive?
A. The bowel sounds are more than 35 per minute
B. There is NO bowel sounds on aling ester’s assessment
C. There is less than 5 bowel sounds per minute on the assessment
D. The bowel sounds are less than 15 per minute
Sa isip ni Nurse Budek, “Ang normal bowel sounds ay 5-35, nabasa ko iyan kay saunders nung akoy nag aaral pa! Kawawa naman si nanay, mukhang constipated ata ah?”
“Teka nga I auscultate ko dito sa ILEO-CECAL VALVE para maka sigurado sa aking bilang.”
Where is the ILEO-CECAL VALVE?
A. Left lower quadrant
B. Right lower quadrant
C. Left upper quadrant
D. Right upper quadrant
Why did Nurse Budek use the ILEO-CECAL VALVE Location to further assess aling esters bowel sounds?
A. Because that is the location where bowel sounds are produced
B. The ICV is the only location in the large intestine where bowel sounds are heard
C. Bowel sounds are always heard in the ICV more than any other quadrants
D. ICV is located in the small intestines, it is where gas are formed and release giving a gurgling sound
Nilagay ni Nurse Budek ang kanyang steth sa may RIGHT LOWER QUADRANT upang marinig ang tunog sa may ileo-cecal valve kung saan, parati itong mayroong bowel sounds kumpara sa ibang abdominal quadrant.
“ I percuss ko na nga ang tiyan ni nanay. Tingnan natin kung marami ng laman laman ito. “
Sa pag percuss ng tiyan ni aling ester, Nakarinig si Budek ng isang DULL o mababang tunog sa may LEFT LOWER QUADRANT ni aling Ester. “ Aha, mukhang meron ditong isang hindi kanais nais na bagay ah. “
What are the different sounds that Nurse Budek can percuss on aling Ester’s abdomen?
1. DULLNESS : May be percussed on the R U Q because of the Liver and in the L U Q because of the spleen.
An impaction of feces also produce a DULL sound on percussion.
2. HYPERRESONANCE/RESONANCE : An over inflated area such as the LUNGS can produce a hyperresonanec/resonant sound.
3. FLAT : FLUID sounds FLAT on percussion. Usually heard on bowel obstruction due to volvulus, diverticulosis/litis and intussusception.
4. TYMPANY : The TUNOG TAMBOL, is heard when the intestine or stomach is air filled.
At sa huling bahagi, kinapa [ PALPATION ] ni Nurse budek ang tiyan ni aling ester. Nag umpisa siya sa Right lower quadrant, papuntang right upper quadrant hanggang makakapa siya ng isang maliit at matigas na mass sa may left lower quadrant ni aling ester.
“ Ito yung dull na narinig ko kanina “ Ang nasabi ni Budek.
Why did Nurse Budek follows : INSPECTION, AUSCULTATION, PERCUSSION AND PALPATION in exact and correct order in assessing aling esters abdomen?
A. Doing Percussion and Palpation last will help limit stimulation of bowel sound therefore, An accurate assessment of the abdominal status is recorded.
B. Inspection and Ausculation are done first as not to cause PAIN on aling ester that will prevent her from not cooperating with the abdominal assessment.
C. Palpation is done last on an elderly client because of the sensitivity of the abdominal muscle that might cause severe discomfort to aling ester.
D. Inspection is done first as to directly observe the general status of aling ester’s abdomen before doing specific assessments of each quadrants.
“Hayyy, Mukhang alam ko na aling ester kung bakit masakit ang tiyan natin ha.” Ang sabi ni Nurse Budek.
“Ay,!!” sa loblob ni Budek. “May hanging question nga pala tayo. Bakit nga ba hinuli ko ang palpation at sinunod ang step na I,A,PE,PA. O “ I am PePa.” Kasi nga, pag pinalpate ko agad, ma ii stimulate ko ang bowel sound ni nanay kaya hindi accurate ang bowel sound na maririnig ko, hindi ko masasabi na HYPO o HYPERACTIVE ang bowel sound ni nanay dahil na apektuhan ng percussion o palpation. Hindi ba, manipulation increases peristalsis, baka mamaya mag 30 pa ang bowel sounds ni nanay ester at hindi maging tama ang aking palagay na kaya masakit ang tiyan nya dahil hypoactive ang pag galaw ng kanyang bituka at CONSTIPATED SIYA.”
“Nanay ester, kailan po kayo huling nadumi?” Ang tanong ni Nurse Budek.
“Abay hindi ko na matandaan iho. Malamang isang linggo na akong hindi nadudumi eh, iyon ba ang dahilan bakit masakit ang aking tiyan? “ Ang sabi ni aling ester.
“Abay opo nanay, dapat po Isang dumi kada dalawang araw po ang pinaka mababa ninyong pag dumi, sabi po iyan sakin ng aking bestfriend na si Lippinncott “ Sabi ni Nurse Budek.
“Nay, Ang dry dry naman niyang bibig nyo. Umiinom po ba kayo ng maraming tubig sa isang araw? “ Sabi ni Nurse Budek
“Abay oo naman ano, marami akong iniinom na tubig sa isang araw.”
Did Budek asked the right question? Let us see if this question is better….
“Nay, ang dry dry naman niyang bibig nyo, Ilang baso po bang tubig ang iniinom nyo sa isang araw?” Ang tanong ni Nurse Budek.
“Nakaka tatlong baso ako sa isang araw, sapat na ba iyon?” tugon ni aling ester.
“ Nay, dapat po 6-8 glassess ang iniinom natin bawat araw. Kaya naman pala hindi kayo madumi ng regular walang panulak at dulas ang inyong bituka eh. “ Sagot ni Nurse Budek.
Ibinahagi ni Budek ang kanyang natuklasan kay Doctor tuklaw na nangangalaga kay aling ester. Ipinag utos ng doktor ang Fleet enema kay aling ester ngunit nag reklamo si Nurse Budek.
Why did Nurse Budek reacted and disagreed to the doctors order of fleet enema?
A. Fleet enema is contraindicated among elderly
B. Fleet enema can cause dependence
C. Fleet enema will causes fluid overload
D. Fleet enema will cause further dehydration
“Doktor, san ba kayo graduate? Bat fleet enema eh tanda tanda na ni nanay dehydrated pa.. gusto nyong lalong ma dehydrate si nanay?” Ang matapang na sagot ni Budek
“Ah ganun ba? Ano ba dapat?” Sabi ni Dr. Tuklaw
“ Kasi hypertonic saline ang fleet, Each 118-mL delivered dose contains 19 g monobasic sodium phosphate monohydrate and 7 g dibasic sodium phosphate heptahydrate. Kung hypertonic sha imagine, sisipsipin nito ang tubig sa large intestine ni nanay at lalong matutoyo si nanay. Baka ma cardiac arrest pa yan due to hypokalemia sige ka. “ Ang mayabang na sabi ni budek.
“ I NSS enema ko nalang di kaya tap water, mamili ka dok ano ang gusto mo?” Ang tugon ni Budek.
“Bahala ka sa buhay mo” Ang tugon ni Dr. Tuklaw
“ Ok , I order mo ako ng NSS enema para wala tayong problema sa fluid and electrolate balance” Ang tugon ni Budek.
“ Yes doc, masusunod po “ Ang sagot ni Dr. Tuklaw
Binalikan ni Nurse Budek si nanay ester sa kanyang silid.
“ Nanay ester, Ready ka na ba sa gagawin natin?” Sabi ni Budek.
“ Oo, ready na.. masakit ba yan? Ano ba ang gagawin mo sa akin?” Ang tugon ni aling ester.
“ Bali papalabasin mo natin ang mga dumi po ninyo na naiwan at bumara na diyan sa inyong bituka para po hindi na kayo masaktan at maisayos po natin ang normal na pag dumi ninyo “ Ang sagot ni budek.
“ Nay, pumuwesto na po kayo. …….”
What should be aling ester’s postion when preparing to give an enema?
A. Left sims position
B. Prone position
C. Right sims position
D. Dorsal Recumbent position
“ Nay, pumuwesto na po kayo. Tumagilid po kayo at humiga sa inyong kaliwa at I baluktot niyo po ang kanang tuhod ninyo [ LEFT SIMS POSITION ], Tulungan ko po kayo” Ang sabi ni Nars Budek.
“ Bakit ganito pa dapat ang aking posisyon? Ano ang importansya nitong ganitong posisyon nurse?” Ang tanong ni aling Ester.
Why is the patient positioned in the LEFT SIMS position when administering an enema?
A. The Left sims position will facilitate descent of the solution towards the rectum and the colon
B. The Left sims position is used to prevent injury to the bladder when inserting the enema tube
C. The Left sims position will prevent the solution from going into the kidneys that will cause hydronephrosis
D. Female clients are put in the LEFT SIMS position to prevent leakage of the solution towards the cervix that will cause sever inflammatory reaction.
“Nay, kasi po ang rectum po natin ay PABABA pag tayoy naka left sims. Kung naka right sims ka eh babalik lang po yung tubig palabas dahil po paangat po ang kaalangan niyang daluyan, hindi po siya makakarating ng tama sa colon” Ang tugon ni Budek. [Refer to the normal anatomy of the large intestine]
At nang matapos na ni Nurse Budek ang pag I enema kay nanay, Limang malalaking bilog bilog na kasinglaki ng chico ang kanyang nakuha at matapos nito, malalambot na ang dumi na lumabas kay nanay Ester.
“Hayyy, gumaan na ang aking pakiramdam Nurse Budek, salamat sa tulong mo ha.. hindi na siya masakit” Ang pasasalamat ni nanay Ester.
Ngumiti si budek sabay bigkas “ Nay, tandaan… tubig tubig tubig at masustansya at balanseng pagkain na mataas sa fiber tulad ng gulay at prutas para hindi na mangyari iyan ulet sa inyo. ”
Napangiti si aling ester at siya ay parang nasalangit sa gaan ng kanyang pakiramdam at ginhawang nararamdaman.
1. What is the minimum and maximum height of the enema can?
Answer: 12 inches minimum up to 18 inches maximum.
2. How long should budek insert the rectal tube? What kind of lubricant should he use?
Answer: 3-4 inches , water soluble lubricant [ KY Jelly ]
3. What should be nurses budek’s first intervention in case cramping occurs during enema instillation?
Answer: Stop the folow of the irrigant by clamping the tube
4. When should nurse budek STOP irrigating aling ester’s colon?
Answer: When the returns are clear
5. What are the contraindications when administering an enema?
Answer: Contraindications are but not limited to : Peritonitis, Ulcerative Colitis, Chrons Disease, Appendicitis, Diverticulitis, Retroperitoneal Abscess.
By : Budek
http://www.pinoybsn.tk
Nag mumuni muni si Nars Budek sa emergency unit ng Ospital ng Fatima medical center. Bigla biglang may pumasok na pasyente para sa admission. Masakit raw ang kanyang tyan.
Inobserbahan siya ni Nars Budek. Aba, napakabilis ng kanyang pag hinga. Namumutla pa ang kaniyang mga labi at parang tuyong tuyo at nagbabakbak.
“Ang bilis rin ng kanyang heart rate ah, 110 bpm, tachycardic ito, siguro may masamang nararamdaman o may nararamdamang sakit?” Ang naisip ni Budek.
Ang pasyente natin ay si nanay ester, isang matandang pasyente. Siya ay 74 taong gulang na na may chief complaint na “MASAKIT ANG TIYAN KO”
What are the possible causes of abdominal pain in the elderly ?
Nurse Budek thinks of : Constipation? Gas accumulation? Impaction? Inflammatory Bowel Disease? Appendicitis? Cholecystitis? Cholelithiasis? Ulcers? Peritonitis? Colon cancer? Ovarian or uterine cancer? PID? And many many more.
“Okay nanay, dadalhin ko muna po kayo sa lab para po sa isang work up.”
Hmm… work up? Did nanay ester understands what nurse budek said…. WORK UP? Perhaps, this will be better :
“Okay nanay, pupunta na po tayo sa laboratoryo para po maisagawa natin ang ibat ibang pagsusulit upang malaman kung ano po ang sanhi ng pananakit ng inyong tiyan.”
Natanggap na ni Nars Budek ang mga laboratory results. Hmmm, 13 mg/dl ang kanyang hemoglobin at 56% ang kanyang hematocrit. Ang potassium level nya ay nasa 5.0 meq/L. Ang WBC nya ay nasa 8,000 / cc3. Wala namang diprensya ang kanya lab results ah.
Really? Are you sure that all the lab results are normal? Let us review the normal values :
WBC : 8,000 / cc3 is normal. An increase beyond 10,000 / cc3 is indicative of infection.
Hgb : Hemoglobin levels of aling ester are within normal limits. Meaning, there is no or minimal bleeding.
Hct : Hematocrit levels of aling ester are high, indicating that she is dehydrated or bleeding.
K : The potassium level is within the normal limits of 4.5 to 5.5 meq/L.
Using the selected lab results above, we can then eliminate many possible causes of the abdominal pain of aling ester. Remove : PERITONITIS, APPENDICITIS, INFECTION, INFLAMMATORY BOWEL DISEASE AND ULCERS.
“Aling ester halika po at humiga po kayo rito at titingnan ko po ang inyong tiyan.”
Did Nurse Budek use an effective approach on asking aling ester to lie down for an abdominal assessment?
How about this :
“Aling ester, Abutin nyo po ang kamay ko. halika po kayo rito at aalalayan ko kayo papunta dito sa higaan para po tingnan ko ang inyong tiyan.”
The client is age 74 and in PAIN. It is NOT therapeutic to ask the client to come and lie down on the examiners table on her own.
“Aling ester, mahiga po kayo dito at titingnan ko po kayo.”
What should be aling esters position for an abdominal assessment?
A. Supine, with head and feet FLAT on bed
B. High fowlers with the feet in extension
C. Prone position
D. Low fowlers with the knee on flexion
“Aling ester, itataas ko na po ng kaunti ang ulo ninyo at paki baluktot po lamang ang inyong tuhod.”
Correct answer is LETTER D. To promote abdominal relaxation, The head of the bed should be SLIGHTLY elevated and the knee of the client on flexed position.
A and B will promote abdominal rigidity making it hard for Nurse Budek to PALPATE the abdomen.
If your answer is C, you should try to imagine how can you assess the patient’s abdomen if she is in prone position?
Humiga na si aling ester at mag uumpisa na si Nurse Budek sa pag assess ng tiyan ni aling ester.
What should be Nurse Budek’s INITIAL STEP in assessing aling ester’s abdomen?
A. Palpation
B. Inspection
C. Auscultation
D. Percussion
Tiningnan ni Nurse Budek ang tiyan ni aling ester, Hmm.. wala namang kakaiba sa tiyan ni aling ester. Round sha, may mga stretch mark marahil dulot ng kanyang pagbubuntis at panganganak. Lubog ang pusod at malinis naman ito. Wala naman akong nakikitang gumagalaw galaw mukhang maaliwalas at tahimik naman ang kanyang tiyan kung titingnan.
Kinuha ni Nurse Budek ang stethoscope at kanyang pinakinggan ang tiyan ni aling ester. “Aba eh! Wala akong marinig na kung ano man. Hypoactive ang bowel sound ni aling ester. Sa loob ng isang minuto ay nakarinig ako ng tatlong bowel sound.”
How did Nurse Budek concluded that aling ester’s bowel sound is hypoactive?
A. The bowel sounds are more than 35 per minute
B. There is NO bowel sounds on aling ester’s assessment
C. There is less than 5 bowel sounds per minute on the assessment
D. The bowel sounds are less than 15 per minute
Sa isip ni Nurse Budek, “Ang normal bowel sounds ay 5-35, nabasa ko iyan kay saunders nung akoy nag aaral pa! Kawawa naman si nanay, mukhang constipated ata ah?”
“Teka nga I auscultate ko dito sa ILEO-CECAL VALVE para maka sigurado sa aking bilang.”
Where is the ILEO-CECAL VALVE?
A. Left lower quadrant
B. Right lower quadrant
C. Left upper quadrant
D. Right upper quadrant
Why did Nurse Budek use the ILEO-CECAL VALVE Location to further assess aling esters bowel sounds?
A. Because that is the location where bowel sounds are produced
B. The ICV is the only location in the large intestine where bowel sounds are heard
C. Bowel sounds are always heard in the ICV more than any other quadrants
D. ICV is located in the small intestines, it is where gas are formed and release giving a gurgling sound
Nilagay ni Nurse Budek ang kanyang steth sa may RIGHT LOWER QUADRANT upang marinig ang tunog sa may ileo-cecal valve kung saan, parati itong mayroong bowel sounds kumpara sa ibang abdominal quadrant.
“ I percuss ko na nga ang tiyan ni nanay. Tingnan natin kung marami ng laman laman ito. “
Sa pag percuss ng tiyan ni aling ester, Nakarinig si Budek ng isang DULL o mababang tunog sa may LEFT LOWER QUADRANT ni aling Ester. “ Aha, mukhang meron ditong isang hindi kanais nais na bagay ah. “
What are the different sounds that Nurse Budek can percuss on aling Ester’s abdomen?
1. DULLNESS : May be percussed on the R U Q because of the Liver and in the L U Q because of the spleen.
An impaction of feces also produce a DULL sound on percussion.
2. HYPERRESONANCE/RESONANCE : An over inflated area such as the LUNGS can produce a hyperresonanec/resonant sound.
3. FLAT : FLUID sounds FLAT on percussion. Usually heard on bowel obstruction due to volvulus, diverticulosis/litis and intussusception.
4. TYMPANY : The TUNOG TAMBOL, is heard when the intestine or stomach is air filled.
At sa huling bahagi, kinapa [ PALPATION ] ni Nurse budek ang tiyan ni aling ester. Nag umpisa siya sa Right lower quadrant, papuntang right upper quadrant hanggang makakapa siya ng isang maliit at matigas na mass sa may left lower quadrant ni aling ester.
“ Ito yung dull na narinig ko kanina “ Ang nasabi ni Budek.
Why did Nurse Budek follows : INSPECTION, AUSCULTATION, PERCUSSION AND PALPATION in exact and correct order in assessing aling esters abdomen?
A. Doing Percussion and Palpation last will help limit stimulation of bowel sound therefore, An accurate assessment of the abdominal status is recorded.
B. Inspection and Ausculation are done first as not to cause PAIN on aling ester that will prevent her from not cooperating with the abdominal assessment.
C. Palpation is done last on an elderly client because of the sensitivity of the abdominal muscle that might cause severe discomfort to aling ester.
D. Inspection is done first as to directly observe the general status of aling ester’s abdomen before doing specific assessments of each quadrants.
“Hayyy, Mukhang alam ko na aling ester kung bakit masakit ang tiyan natin ha.” Ang sabi ni Nurse Budek.
“Ay,!!” sa loblob ni Budek. “May hanging question nga pala tayo. Bakit nga ba hinuli ko ang palpation at sinunod ang step na I,A,PE,PA. O “ I am PePa.” Kasi nga, pag pinalpate ko agad, ma ii stimulate ko ang bowel sound ni nanay kaya hindi accurate ang bowel sound na maririnig ko, hindi ko masasabi na HYPO o HYPERACTIVE ang bowel sound ni nanay dahil na apektuhan ng percussion o palpation. Hindi ba, manipulation increases peristalsis, baka mamaya mag 30 pa ang bowel sounds ni nanay ester at hindi maging tama ang aking palagay na kaya masakit ang tiyan nya dahil hypoactive ang pag galaw ng kanyang bituka at CONSTIPATED SIYA.”
“Nanay ester, kailan po kayo huling nadumi?” Ang tanong ni Nurse Budek.
“Abay hindi ko na matandaan iho. Malamang isang linggo na akong hindi nadudumi eh, iyon ba ang dahilan bakit masakit ang aking tiyan? “ Ang sabi ni aling ester.
“Abay opo nanay, dapat po Isang dumi kada dalawang araw po ang pinaka mababa ninyong pag dumi, sabi po iyan sakin ng aking bestfriend na si Lippinncott “ Sabi ni Nurse Budek.
“Nay, Ang dry dry naman niyang bibig nyo. Umiinom po ba kayo ng maraming tubig sa isang araw? “ Sabi ni Nurse Budek
“Abay oo naman ano, marami akong iniinom na tubig sa isang araw.”
Did Budek asked the right question? Let us see if this question is better….
“Nay, ang dry dry naman niyang bibig nyo, Ilang baso po bang tubig ang iniinom nyo sa isang araw?” Ang tanong ni Nurse Budek.
“Nakaka tatlong baso ako sa isang araw, sapat na ba iyon?” tugon ni aling ester.
“ Nay, dapat po 6-8 glassess ang iniinom natin bawat araw. Kaya naman pala hindi kayo madumi ng regular walang panulak at dulas ang inyong bituka eh. “ Sagot ni Nurse Budek.
Ibinahagi ni Budek ang kanyang natuklasan kay Doctor tuklaw na nangangalaga kay aling ester. Ipinag utos ng doktor ang Fleet enema kay aling ester ngunit nag reklamo si Nurse Budek.
Why did Nurse Budek reacted and disagreed to the doctors order of fleet enema?
A. Fleet enema is contraindicated among elderly
B. Fleet enema can cause dependence
C. Fleet enema will causes fluid overload
D. Fleet enema will cause further dehydration
“Doktor, san ba kayo graduate? Bat fleet enema eh tanda tanda na ni nanay dehydrated pa.. gusto nyong lalong ma dehydrate si nanay?” Ang matapang na sagot ni Budek
“Ah ganun ba? Ano ba dapat?” Sabi ni Dr. Tuklaw
“ Kasi hypertonic saline ang fleet, Each 118-mL delivered dose contains 19 g monobasic sodium phosphate monohydrate and 7 g dibasic sodium phosphate heptahydrate. Kung hypertonic sha imagine, sisipsipin nito ang tubig sa large intestine ni nanay at lalong matutoyo si nanay. Baka ma cardiac arrest pa yan due to hypokalemia sige ka. “ Ang mayabang na sabi ni budek.
“ I NSS enema ko nalang di kaya tap water, mamili ka dok ano ang gusto mo?” Ang tugon ni Budek.
“Bahala ka sa buhay mo” Ang tugon ni Dr. Tuklaw
“ Ok , I order mo ako ng NSS enema para wala tayong problema sa fluid and electrolate balance” Ang tugon ni Budek.
“ Yes doc, masusunod po “ Ang sagot ni Dr. Tuklaw
Binalikan ni Nurse Budek si nanay ester sa kanyang silid.
“ Nanay ester, Ready ka na ba sa gagawin natin?” Sabi ni Budek.
“ Oo, ready na.. masakit ba yan? Ano ba ang gagawin mo sa akin?” Ang tugon ni aling ester.
“ Bali papalabasin mo natin ang mga dumi po ninyo na naiwan at bumara na diyan sa inyong bituka para po hindi na kayo masaktan at maisayos po natin ang normal na pag dumi ninyo “ Ang sagot ni budek.
“ Nay, pumuwesto na po kayo. …….”
What should be aling ester’s postion when preparing to give an enema?
A. Left sims position
B. Prone position
C. Right sims position
D. Dorsal Recumbent position
“ Nay, pumuwesto na po kayo. Tumagilid po kayo at humiga sa inyong kaliwa at I baluktot niyo po ang kanang tuhod ninyo [ LEFT SIMS POSITION ], Tulungan ko po kayo” Ang sabi ni Nars Budek.
“ Bakit ganito pa dapat ang aking posisyon? Ano ang importansya nitong ganitong posisyon nurse?” Ang tanong ni aling Ester.
Why is the patient positioned in the LEFT SIMS position when administering an enema?
A. The Left sims position will facilitate descent of the solution towards the rectum and the colon
B. The Left sims position is used to prevent injury to the bladder when inserting the enema tube
C. The Left sims position will prevent the solution from going into the kidneys that will cause hydronephrosis
D. Female clients are put in the LEFT SIMS position to prevent leakage of the solution towards the cervix that will cause sever inflammatory reaction.
“Nay, kasi po ang rectum po natin ay PABABA pag tayoy naka left sims. Kung naka right sims ka eh babalik lang po yung tubig palabas dahil po paangat po ang kaalangan niyang daluyan, hindi po siya makakarating ng tama sa colon” Ang tugon ni Budek. [Refer to the normal anatomy of the large intestine]
At nang matapos na ni Nurse Budek ang pag I enema kay nanay, Limang malalaking bilog bilog na kasinglaki ng chico ang kanyang nakuha at matapos nito, malalambot na ang dumi na lumabas kay nanay Ester.
“Hayyy, gumaan na ang aking pakiramdam Nurse Budek, salamat sa tulong mo ha.. hindi na siya masakit” Ang pasasalamat ni nanay Ester.
Ngumiti si budek sabay bigkas “ Nay, tandaan… tubig tubig tubig at masustansya at balanseng pagkain na mataas sa fiber tulad ng gulay at prutas para hindi na mangyari iyan ulet sa inyo. ”
Napangiti si aling ester at siya ay parang nasalangit sa gaan ng kanyang pakiramdam at ginhawang nararamdaman.
1. What is the minimum and maximum height of the enema can?
Answer: 12 inches minimum up to 18 inches maximum.
2. How long should budek insert the rectal tube? What kind of lubricant should he use?
Answer: 3-4 inches , water soluble lubricant [ KY Jelly ]
3. What should be nurses budek’s first intervention in case cramping occurs during enema instillation?
Answer: Stop the folow of the irrigant by clamping the tube
4. When should nurse budek STOP irrigating aling ester’s colon?
Answer: When the returns are clear
5. What are the contraindications when administering an enema?
Answer: Contraindications are but not limited to : Peritonitis, Ulcerative Colitis, Chrons Disease, Appendicitis, Diverticulitis, Retroperitoneal Abscess.
Dec 11, 2008
Dec 7, 2008
Dec 6, 2008
Dec 5, 2008
Dec 3, 2008
Dec 1, 2008
AMENDED GUIDELINES IN THE FILING AND PROCESSING OF ALL APPLICATIONS FOR THE NURSE LICENSURE EXAMINATIONS (NLE)
FOR GRADUATES OF OCTOBER 2008, 2009, AND 2010
Checklist of Requirements for Incoming Second, Third, and Fourth Year Nursing Students, Schoolyear 2008-2009
DOCUMENTARY REQUIREMENTS
1.
NSO Birth Certificate (Original Copy)
2.
NSO Marriage Contract - for female married applicants (Photocopy)
3.
Transcript of Records - for Board Examination Purpose only (Original Copy)
4.
Summary of Related Learning Experience - with total number of hours (Original Copy)
5.
Records of O.R., D.R. and Initial Cord Care Cases - (Original Copy)
6.
Properly Notarized Certification of Authenticity of O.R. / D.R. / Initial Cord Care Cases to accompany the application for NLE (for New/First Timer applicants only). FORM AVAILABLE AT ANY PRC Application Office (Original Copy)
7.
CHED Recognition Certificate for all New Schools/Programs including State Universities and Colleges (SUCs) and Local Universities and Colleges (LUCs) (Photocopy)
8.
4 pieces passport size pictures - in white background and with complete name tag (Original Copy)
9.
1 piece window mailing envelope with PRC metered postage stamp (Original Copy)
10.
Examination Fee of Php 900.00 (complete)/Php450.00 (conditioned) PAID DIRECTLY & RECEIPTED BY THE PRC CASHIER
11.
Current Community Tax Certificate (Cedula) (Photocopy)
12.
Duly accomplished “Pre-Numbered” Nurse Application Form (NAF) No. 001-A, September 2007 obtained from PRC ONLY and NOT FOR SALE. (Original Copy)
Applicants may reproduce and wish to keep a second copy of all the above documents for future reference.
IMPORTANT DETAILS ON DOCUMENTARY REQUIREMENTS
Transcript of Records
*
With scanned picture of the applicant
*
With remark ”FOR BOARD EXAMINATION PURPOSES ONLY”
*
With degree/courses and exact date of graduation
*
With Special Order (S.O. No.) with date of issuance (except for State Universities and Colleges, Local Universities and Colleges, and Private Higher Education Institution with Accredited, Deregulated, or Autonomous Status properly inscribed in the TOR).
Clarification: The exact Date of Graduation refers to the date S.O. was granted or the Date of Approval by the Board of Trustees for SUCs/LUCs, and similarly for Colleges who are Autonomous or Deregulated and/or Accredited Level II and higher.
Related Learning Experience (RLE) Exhibits
*
With attached certification of authenticity to accompany the application for NLE (for new and First Time Applicants)
*
Summary of Related Learning Experience indicating minimum of 2,142 RLE hours completed, signed by the Dean
*
5 Major Operations (maximum of 2 similar cases, 2 students may assist a complicated major surgery)
*
5 Minor Operations (maximum of 2 similar cases; 1 case per student; major case cannot be used as substitute for minor scrubs)
*
5 Handled Delivery Cases – 1 student per case
*
5 Assisted Delivery Cases – 1 student per case
*
5 Initial Cord Care Cases - 1 student per case
The Certification of Authenticity of O.R. / D.R. / Initial Cord Care Cases is subscribed and sworn to for free by authorized PRC officials per Office Order No. 7-259 dated September 24, 2007. There is no need to notarize each page of the RLE exhibits. To meet however the exigencies of beating the deadline for filing or towing a long line of applicants, Colleges of Nursing may opt to have notarization done by any independent notary public prior to filing the same documents to the PRC Application Division.
Signatories to the Scrubs and Deliveries and Cord Care in Hospitals
*
Prepared by : Name of Student
*
Supervised by : Name of Faculty with Master’s Degree in Nursing or other Allied Medical and Health Sciences.
*
Noted by : Name of Clinical Coordinator with Master’s Degree in Nursing or other Allied Medical and Health Sciences, PRC I.D No. and Date of Validity, PNA No. and Date of validity, and Date the document is signed.
*
Concurred by : Name of Chief Nurse with Master’s Degree in Nursing (except for those serving in only 50-bed hospitals where only 9 Graduate Units in Management & Administration is required), PRC I.D No. and Date of Validity, PNA No. and Date of Validity, and Date the document is signed.
*
Approved by : Name of Dean with Master’s Degree in Nursing, PRC I.D No. and Date of Validity, PNA No. and Date of Validity, ADPCN I.D. No and Date of Validity, and Date the document is signed.
Signatories to Deliveries and Cord Care in Lying-In Clinics and Home Deliveries
*
Lying-In Clinics : clinical instructor and clinical coordinator
*
Home Deliveries : clinical instructor and clinical coordinator
O.R. / D.R. / Initial Cord Care Form
(Please Follow the Format as Attached in the "DOWNLOADS" section of philippinenurse.blogspot.com)
Note: The O.R. / D.R. / Initial Cord Care Form should bear the name of the College of Nursing, and the College Logo (not the PRC and its logo) Please follow attached forms.
Guidelines in the Preparation of the specific requirement to the Nurse Licensure Examination
Major and minor scrubs classification shall follow PhilHealth Categorization such that 30 Relative Unit Value or R.U.V. and below are categorized as MINOR cases and 31 R.U.V. and above are MAJOR cases. HOWEVER, when there is discrepancy between the PhilHealth and Hospital classification, the HOSPITAL classification shall prevail.
While the PhilHealth Classification is used as guide, DIAGNOSTIC PROCEDURES ARE NOT TO BE INCLUDED in determining major or minor scrubs.
Specifically:
1. For major operation, 2 students may actually assist a major surgery or when the procedure takes two (2) hours or more, two (2) similar cases maybe allowed.
2. For minor operation, two (2) similar cases maybe allowed but only one student may claim the cases.
3. Deliveries in the community are to be supervised by a clinical instructor with Master’s Degree in Nursing or Allied Medical or Health-Related Sciences and signed by the same before the approval of the Dean.
Note: Emphasis must be given to competencies developed during the intra-operative and intra-partal phase and a variety of cases is preferred.
4. The faculty member, clinical coordinator, chief nurse and dean WITH ACTUAL ACCOUNTABILITIES in the RLE of the student must be the signatories to the forms.
5. Student must accomplish as many forms depending on the number of institutions/agencies where the RLE have been conducted. OR-DR-Cord Care Cases completed in two or more hospitals or agencies must bear the signature of the Chief Nurses of the particular institutions or agencies.
6. The Delivery Room and Initial Cord Care requirements of Registered Midwives who are nursing graduates applying for the Nurse Licensure Examination are hereby WAIVED, provided they submit a “photo copy” of their updated PRC Identification Card.
For nursing graduates who have completed midwifery courses but have not practiced and/or are “under board” beyond five (5) years from date of midwifery graduation, a supervised case of one (1) actually handled delivery and cord care shall be required for the Nurse Licensure Examination properly documented and reported through the required Delivery/Initial Cord Care Forms.
“Pre-Numbered” Nurse’s Application Form (NAF)
may be obtained only at the Information Desk, PRC Central and Regional Offices only and which are NOT FOR SALE.
Required CODES:
A. Urban/City/Town or Provincial CODES of Residences and Places of Birth as well as Postal address and ZIP CODES as required stipulation in the respective Application Forms are posted in a Master List at the premises of the filing center at any PRC Branch.
B. The master list of SCHOOL CODES is likewise printed at the filing center of any PRC Branch and the same is EXPECTEDLY AVAILABLE from the respective Colleges or Universities.
C. The master list of COURSE CODES is likewise found at the filing center of any PRC Branch and the same is also EXPECTEDLY AVAILABLE from the respective Colleges or Universities. Specifications pertaining to the “Examination Type Code and the Code signifying the number of times the NLE have been taken” IS FOUND AT THE BACK OF THE NURSES’ APPLICATION FORM for everyone’s guidance.
Note: All the above stipulations are in keeping with:
BON RESOLUTION No. 9, Series of 2007
BON RESOLUTION No. 357, Series of 2004
BON Memorandum April 17, 2006 and May 27, 2006
Office Order No. 7-259 dates September 24, 2007
Additional Guidelines Specific to Second Degree Nurse-Examinees
A. Pre-requisite subjects must be completed prior to enrolling other succeeding higher professional nursing courses. These are:
*
Anatomy & Physiology (3 units lecture, 2 units laboratory = 5 units); and
*
Microbiology & Parasitology (3 units lecture & 1 unit laboratory = 4 units), and
*
Health Care I (4 units lecture & 3 units RLE), and
*
Primary Health Care II (3 units lecture & 2 units RLE) and
*
Foundations of Nursing (2 units lecture & 1 unit RLE)
B. PRIOR TO THE IMPLEMENTATION OF CMO No. 5, only NCM 100 – Foundation of Nursing Practice (2 units lecture & 1 unit RLE) and NCM 103 – RELATED LEARNING EXPERIENCES (4 units) are the Professional Nursing Courses which can be enrolled in summer (in accord with the CHED Policies, Standards, and Guidelines) In strict adherence to the CHED Nursing Policies, Standards, and Guidelines (PSG), Professional Nursing Courses with RLE e.g. those with 16 unit academic credits (8 units lecture & 8 units RLE), cannot/must not be enrolled during summers.
C. Regular Semester load must be observed, and only one (1) Professional Nursing Course with 16 unit academic credit is allowed during regular semesters.
D. Must have taken the last curricular year in the College that granted the degree.
E. Requirements in the preparation of Operating Room Scrubs, Deliveries, and Cord Care Is applied.
Source
Checklist of Requirements for Incoming Second, Third, and Fourth Year Nursing Students, Schoolyear 2008-2009
DOCUMENTARY REQUIREMENTS
1.
NSO Birth Certificate (Original Copy)
2.
NSO Marriage Contract - for female married applicants (Photocopy)
3.
Transcript of Records - for Board Examination Purpose only (Original Copy)
4.
Summary of Related Learning Experience - with total number of hours (Original Copy)
5.
Records of O.R., D.R. and Initial Cord Care Cases - (Original Copy)
6.
Properly Notarized Certification of Authenticity of O.R. / D.R. / Initial Cord Care Cases to accompany the application for NLE (for New/First Timer applicants only). FORM AVAILABLE AT ANY PRC Application Office (Original Copy)
7.
CHED Recognition Certificate for all New Schools/Programs including State Universities and Colleges (SUCs) and Local Universities and Colleges (LUCs) (Photocopy)
8.
4 pieces passport size pictures - in white background and with complete name tag (Original Copy)
9.
1 piece window mailing envelope with PRC metered postage stamp (Original Copy)
10.
Examination Fee of Php 900.00 (complete)/Php450.00 (conditioned) PAID DIRECTLY & RECEIPTED BY THE PRC CASHIER
11.
Current Community Tax Certificate (Cedula) (Photocopy)
12.
Duly accomplished “Pre-Numbered” Nurse Application Form (NAF) No. 001-A, September 2007 obtained from PRC ONLY and NOT FOR SALE. (Original Copy)
Applicants may reproduce and wish to keep a second copy of all the above documents for future reference.
IMPORTANT DETAILS ON DOCUMENTARY REQUIREMENTS
Transcript of Records
*
With scanned picture of the applicant
*
With remark ”FOR BOARD EXAMINATION PURPOSES ONLY”
*
With degree/courses and exact date of graduation
*
With Special Order (S.O. No.) with date of issuance (except for State Universities and Colleges, Local Universities and Colleges, and Private Higher Education Institution with Accredited, Deregulated, or Autonomous Status properly inscribed in the TOR).
Clarification: The exact Date of Graduation refers to the date S.O. was granted or the Date of Approval by the Board of Trustees for SUCs/LUCs, and similarly for Colleges who are Autonomous or Deregulated and/or Accredited Level II and higher.
Related Learning Experience (RLE) Exhibits
*
With attached certification of authenticity to accompany the application for NLE (for new and First Time Applicants)
*
Summary of Related Learning Experience indicating minimum of 2,142 RLE hours completed, signed by the Dean
*
5 Major Operations (maximum of 2 similar cases, 2 students may assist a complicated major surgery)
*
5 Minor Operations (maximum of 2 similar cases; 1 case per student; major case cannot be used as substitute for minor scrubs)
*
5 Handled Delivery Cases – 1 student per case
*
5 Assisted Delivery Cases – 1 student per case
*
5 Initial Cord Care Cases - 1 student per case
The Certification of Authenticity of O.R. / D.R. / Initial Cord Care Cases is subscribed and sworn to for free by authorized PRC officials per Office Order No. 7-259 dated September 24, 2007. There is no need to notarize each page of the RLE exhibits. To meet however the exigencies of beating the deadline for filing or towing a long line of applicants, Colleges of Nursing may opt to have notarization done by any independent notary public prior to filing the same documents to the PRC Application Division.
Signatories to the Scrubs and Deliveries and Cord Care in Hospitals
*
Prepared by : Name of Student
*
Supervised by : Name of Faculty with Master’s Degree in Nursing or other Allied Medical and Health Sciences.
*
Noted by : Name of Clinical Coordinator with Master’s Degree in Nursing or other Allied Medical and Health Sciences, PRC I.D No. and Date of Validity, PNA No. and Date of validity, and Date the document is signed.
*
Concurred by : Name of Chief Nurse with Master’s Degree in Nursing (except for those serving in only 50-bed hospitals where only 9 Graduate Units in Management & Administration is required), PRC I.D No. and Date of Validity, PNA No. and Date of Validity, and Date the document is signed.
*
Approved by : Name of Dean with Master’s Degree in Nursing, PRC I.D No. and Date of Validity, PNA No. and Date of Validity, ADPCN I.D. No and Date of Validity, and Date the document is signed.
Signatories to Deliveries and Cord Care in Lying-In Clinics and Home Deliveries
*
Lying-In Clinics : clinical instructor and clinical coordinator
*
Home Deliveries : clinical instructor and clinical coordinator
O.R. / D.R. / Initial Cord Care Form
(Please Follow the Format as Attached in the "DOWNLOADS" section of philippinenurse.blogspot.com)
Note: The O.R. / D.R. / Initial Cord Care Form should bear the name of the College of Nursing, and the College Logo (not the PRC and its logo) Please follow attached forms.
Guidelines in the Preparation of the specific requirement to the Nurse Licensure Examination
Major and minor scrubs classification shall follow PhilHealth Categorization such that 30 Relative Unit Value or R.U.V. and below are categorized as MINOR cases and 31 R.U.V. and above are MAJOR cases. HOWEVER, when there is discrepancy between the PhilHealth and Hospital classification, the HOSPITAL classification shall prevail.
While the PhilHealth Classification is used as guide, DIAGNOSTIC PROCEDURES ARE NOT TO BE INCLUDED in determining major or minor scrubs.
Specifically:
1. For major operation, 2 students may actually assist a major surgery or when the procedure takes two (2) hours or more, two (2) similar cases maybe allowed.
2. For minor operation, two (2) similar cases maybe allowed but only one student may claim the cases.
3. Deliveries in the community are to be supervised by a clinical instructor with Master’s Degree in Nursing or Allied Medical or Health-Related Sciences and signed by the same before the approval of the Dean.
Note: Emphasis must be given to competencies developed during the intra-operative and intra-partal phase and a variety of cases is preferred.
4. The faculty member, clinical coordinator, chief nurse and dean WITH ACTUAL ACCOUNTABILITIES in the RLE of the student must be the signatories to the forms.
5. Student must accomplish as many forms depending on the number of institutions/agencies where the RLE have been conducted. OR-DR-Cord Care Cases completed in two or more hospitals or agencies must bear the signature of the Chief Nurses of the particular institutions or agencies.
6. The Delivery Room and Initial Cord Care requirements of Registered Midwives who are nursing graduates applying for the Nurse Licensure Examination are hereby WAIVED, provided they submit a “photo copy” of their updated PRC Identification Card.
For nursing graduates who have completed midwifery courses but have not practiced and/or are “under board” beyond five (5) years from date of midwifery graduation, a supervised case of one (1) actually handled delivery and cord care shall be required for the Nurse Licensure Examination properly documented and reported through the required Delivery/Initial Cord Care Forms.
“Pre-Numbered” Nurse’s Application Form (NAF)
may be obtained only at the Information Desk, PRC Central and Regional Offices only and which are NOT FOR SALE.
Required CODES:
A. Urban/City/Town or Provincial CODES of Residences and Places of Birth as well as Postal address and ZIP CODES as required stipulation in the respective Application Forms are posted in a Master List at the premises of the filing center at any PRC Branch.
B. The master list of SCHOOL CODES is likewise printed at the filing center of any PRC Branch and the same is EXPECTEDLY AVAILABLE from the respective Colleges or Universities.
C. The master list of COURSE CODES is likewise found at the filing center of any PRC Branch and the same is also EXPECTEDLY AVAILABLE from the respective Colleges or Universities. Specifications pertaining to the “Examination Type Code and the Code signifying the number of times the NLE have been taken” IS FOUND AT THE BACK OF THE NURSES’ APPLICATION FORM for everyone’s guidance.
Note: All the above stipulations are in keeping with:
BON RESOLUTION No. 9, Series of 2007
BON RESOLUTION No. 357, Series of 2004
BON Memorandum April 17, 2006 and May 27, 2006
Office Order No. 7-259 dates September 24, 2007
Additional Guidelines Specific to Second Degree Nurse-Examinees
A. Pre-requisite subjects must be completed prior to enrolling other succeeding higher professional nursing courses. These are:
*
Anatomy & Physiology (3 units lecture, 2 units laboratory = 5 units); and
*
Microbiology & Parasitology (3 units lecture & 1 unit laboratory = 4 units), and
*
Health Care I (4 units lecture & 3 units RLE), and
*
Primary Health Care II (3 units lecture & 2 units RLE) and
*
Foundations of Nursing (2 units lecture & 1 unit RLE)
B. PRIOR TO THE IMPLEMENTATION OF CMO No. 5, only NCM 100 – Foundation of Nursing Practice (2 units lecture & 1 unit RLE) and NCM 103 – RELATED LEARNING EXPERIENCES (4 units) are the Professional Nursing Courses which can be enrolled in summer (in accord with the CHED Policies, Standards, and Guidelines) In strict adherence to the CHED Nursing Policies, Standards, and Guidelines (PSG), Professional Nursing Courses with RLE e.g. those with 16 unit academic credits (8 units lecture & 8 units RLE), cannot/must not be enrolled during summers.
C. Regular Semester load must be observed, and only one (1) Professional Nursing Course with 16 unit academic credit is allowed during regular semesters.
D. Must have taken the last curricular year in the College that granted the degree.
E. Requirements in the preparation of Operating Room Scrubs, Deliveries, and Cord Care Is applied.
Source
Subscribe to:
Posts (Atom)