Article: Levels Of Prevention

Primary Prevention

Providing specific protection against disease to prevent its occurrence is the most desirable form of prevention. Primary preventive efforts spare the client the cost, discomfort and the threat to the quality of life that illness poses or at least delay the onset of illness. Preventive measures consist of counseling, education and adoption of specific health practices or changes in lifestyle.

Examples:

1. Mandatory immunization of children belonging to the age range of 0 – 50 months old to control acute infection diseases.
2. Minimizing contamination of the work or general environment by asbestos dust, silicone dust, smoke, chemical pollutants and excessive noise.
   

Secondary Prevention
It consist of organized, direct screening efforts or education of the public to promote early case finding of an individual with disease so that prompt intervention can be instituted to halt pathologic processes and limit disability. Early diagnosis of a health problem can decrease the catastrophic effects that might otherwise result for the individual and the family from advanced illness and its many complications.

Examples:

1. Public education to promote breast self-examination, use of home kits for detection of occult blood in stool specimens and familiarity with the seven cancer danger signals.
2. Screening programs for hypertension, diabetes. Uterine cancer (pap smear), breast cancer (examination and mammography), glaucoma and sexually transmitted disease.

Tertiary Prevention
It begins early in the period of recovery from illness and consists of such activities as consistent and appropriate administration of medications to optimize therapeutic effects, moving and positioning to prevent complications of immobility and passive and active exercise to prevent disability.
Continuing health supervision during rehabilitation to restore an individual to an optimal level of functioning. Minimizing residual disability and helping the client learn to live productively with limitations are the goals of tertiary prevention. (Pender, 1987)

Health Warnings

Did you ever drink from a plastic bottle and see a triangle symbol on the bottom with a number inside?





Do you know what the number stands for?
Did you guess that it's just for recycling?

Then you are WRONG !!!!!! THE NUMBER TELLS YOU THE CHEMICAL MAKE UP OF THE PLASTIC.....

1) Polyethylene terephalate (PET)
2) High density polyethylene (HDPE)
3) Unplasticised polyvinyl chloride (UPVC) or Plasticised polyvinyl chloride (PPVC)
4) Low density polyethylene LDPE
5) Polypropylene (PP)
6) Polystyrene (PS) or Expandable polystyrene (EPS)
7) Other, including nylon and acrylic

What you aren't told is that many of the plastics used are toxic and the chemicals used to create a plastic can leach out of the plastic and into the food / drink. Think about it, how many times have you or a friend said "I don't like this, it taste like the plastic bottle ..... "

THAT'S BECAUSE YOU ARE TASTING THE PLASTIC. The WORST ONES are Nos: 3, 6, and 7 !!!

DO NOT USE THESE NUMBERS if stated at the bottom of the bottle) !!!

Check out this chart that breaks down the plastic, its uses and chemical makeup (I find #7 a little scary) http://www.epd. gov.hk/epd/ english/environm entinhk/waste/ guide_ref/ guide_plascod3. html


AVOID re-using plastic bottles RIGHT AWAY !!!

Article: Phases of COPAR Process

nitI. Pre-entry Phase

• Is the initial phase of the organizing process where the community/organizer looks for communities to serve/help.
• It is considered the simplest phase in terms of actual outputs, activities and strategies and time spent for it.

Activities include:

1. Designing a plan for community development including all its activities and strategies for care development.
2. Designing criteria for the selection of site
3. Actually selecting the site for community care

II. Entry Phase

• Sometimes called the social preparation phase as to the activities done here includes the sensitization of the people on the critical events in their life, innovating them to share their dreams and ideas on how to manage their concerns and eventually mobilizing them to take collective action on these.
• This phase signals the actual entry of the community worker/organizer into the community.
• She must be guided by the following guidelines however.
  1. Recognizes the role of local authorities by paying them visits to inform them of their presence and activities.
  2. The appearance, speech, behavior and lifestyle should be in keeping with those of the community residents without disregard of their being role models.
  3. Avoid raising the consciousness of the community residents; adopt a low-key profile.

III. Organization Building Phase

• Entails the formation of more formal structures and the inclusion of more formal procedures of planning, implementation, and evaluating community-wide activities. It is at this phase where the organized leaders or groups are being given trainings (formal, informal, OJT) to develop their skills and in managing their own concerns/programs.

IV. Sustenance and Strengthening Phase

• Occurs when the community organization has already been established and the community members are already actively participating in community-wide undertakings. At this point, the different communities setup in the organization building phase are already expected to be functioning by way of planning, implementing and evaluating their own programs with the overall guidance from the community-wide organization.
• Strategies used may include:
  a. Education and training
  b. Networking and linkaging
  c. Conduct of mobilization on health and development concerns
  d. Implementing of livelihood projects
  e. Developing secondary leaders

Case Study: Pathophysiology of Bronchitis (COPD)

Chronic Obstructive Pulmonary Disease (COPD) is a disease characterized by airflow limitation that is not fully reversible. Airflow limitation is usually progressive and associated with an inflammatory response in the lungs stimulated by irritants. COPD includes chronic bronchitis and pulmonary emphysema. Although sometimes included in COPD, asthma is a reversible disorder and is therefore considered elsewhere.

Chronic bronchitis is chronic inflammation of the lower airways characterized by excessive secretion of mucus, hypertrophy of mucous glands, and recurring infection, progressing to narrowing and obstruction of airflow. Emphysema is the enlargement of the air spaces distal to the terminal bronchioles, with breakdown of alveolar walls and loss of elastic recoil of the lungs. The two conditions may overlap, resulting in subsequent derangement of airways dynamics (e.g., obstruction to airflow). In pulmonary emphysema, lung function progressively deteriorates for many years before the illness becomes apparent.

The most common cause of COPD is cigarette smoking. Air pollution, occupational exposures, allergens, and infections may also act as irritants. Alpha1-antitrypsin deficient is an infrequent cause. Complications include respiratory failure, pneumonia or other overwhelming respiratory infection, right heart failure (cor pulmonale), arrhythmias, and depression.

Case Study: Malaria

Definition:
Malaria is an acute and chronic parasitic disease transmitted by the bite of infected mosquitoes and it is confined mainly to tropical and subtropical areas.
This disease causes more disability and heavier economic burden than any parasitic disease.



Countries where malaria is endemic as of 2003 Malaria generally occurs in areas where environmental conditions allow parasite multiplication in the vector. Thus, malaria is usually restricted to tropical and subtropical areas (see map) and altitudes below 1,500 m. However, this distribution might be affected by climatic changes, especially global warming, and population movements. Both Plasmodium falciparum and P. malariae are encountered in all shaded areas of the map (with P. falciparum by far the most prevalent). Plasmodium vivax and P. ovale are traditionally thought to occupy complementary niches, with P. ovale predominating in Sub-Saharan Africa and P. vivax in the other areas; however these two species are not always distinguishable on the basis of morphologic characteristics alone; the use of molecular tools will help clarify their exact distribution.


Etiologic Agent: Protozoa of genus plasmodia


The disease is caused by four species of protozoa:

1. Plasmodium falciparum (malignant tertian)

• This is considered as the most serious malarial infection because of the development of high parasitic densities in blood (RBC) with tendency to agglutinate and form into microemboli.
• This is most common in the Philippines.

2. Plasmodium vivax (Benign tertian)

• This is nonlife threatening except for the very young and the old.
• It is manifested by chills every 48 hours on the 3rd day onward especially if untreated.

3. Plasmodium malariae (Quartan)

• It is less frequently seen.
• This specie is nonlife threatening.
• Fever and chills usually occur every 72 hours usually on the 4th day after onset.

4. Plasmodium ovale is the rare type of protozoan species.

• This is rarely seen in the Philippines.

The primary vector of malaria is the female Anopheles mosquito which has the following characteristics:

1. It breeds in clear, flowing, and shaded streams usually in the mountains.
2. It is bigger in size than the ordinary mosquito.
3. It is brown in color.
4. It is a night-biting mosquito.
5. It usually does not bite a person in motion.
6. It assumes a 36º position when it alights on walls, trees, curtains, and the like.

Incubation period:
12 days for P. Falciparum
14 days for P. vivax and ovale
30 days for P. malariae



Period of Communicability:
Untreated or insufficiently treated patient may be the source of mosquito infection for more than three years in P. malariae, one to two years in P. vivax, and not more than one year on P. falciparum.


Mode of Transmission:

1. The disease is transmitted mechanically through the bite of an infected female anopheles mosquito
2. It can be transmitted parenterally through blood transfusion.
3. On rare occasions, it is transmitted from shared contaminated needles.
4. However, transplacental transmission of congenital malaria is a rare case.

Clinical Manifestations:

• Paroxysms with shaking chills
• Rapidly rising fever with severe headache
• Profuse sweating
• Myalgia, with feeling of well-being in between
• Splenomegally, hepatomegally
• Orthostatic hypotension
• Paroxysms may last for 12 hours, then, maybe repeated daily or after a day or two.
  

In children:

• Fever maybe continuous
• Convulsions and gastrointestinal symptoms are prominent
• Splenomegally

In cerebral malaria

• Changes in sensorium, severe headache, and vomiting
• Jacksonian or grand mal seizure may occur

Diagnostic Procedure:

1. Malarial smear – In this procedure, a film of blood is placed on a slide, stained, and examined microscopically.
2. Rapid diagnostic test (RDT) – This is a blood test for malaria that can be conducted outside the laboratory and in the field. It gives a result within 10 to 15 minutes. This is done to detect malarial parasite antigen in the blood.

Pathogenesis:

1. The parasite enters the mosquito’s stomach through the infected human blood obtained by biting or during blood meal.
2. The parasite undergoes sexual conjugation.
3. After 10 to 14 days, a number of young parasites are released which work their way into the salivary gland of the mosquito.
4. The organisms are carried in the saliva into the victim when the mosquito bites again.
5. The female alone plays the role of a vector and definitive host in conveying the disease from man to man (sexual propagation).
6. In humans, the organisms invade the RBC where they grow and undergo sexual schizogony.
7. Erythrocytic merozoites are produced leading to the rupture of RBC upon the release of the tiny organisms.
8. Young merozoites invade a new batch of RBC, to start another schizonic cycle.

Nursing Management:

1. The patient must be closely monitored.
   a. Intake and output should be closely monitored to prevent pulmonary edema.
   b. Daily monitoring of patient’s serum bilirubin, BUN creatinine, and parasitic count
2. If the patient exhibits respiratory and renal symptoms, determine the arterial blood gas and plasma electrolyte
3. During the febrile stage, tepid sponges, alcohol rubs, and ice cap on the head will help bring the temperature down.
4. Application of external heat and offering hot drinks during chilling stage is helpful.
5. Provide comfort and psychological support.
6. Encourage the patient to take plenty of fluids.
7. As the temperature falls and sweating begins, warm sponge bath maybe given.
8. The bed and clothing should be kept dry.
9. Watch for neurologic toxicity (from quinine infusion) like muscular twitching, delirium, confusion, convulsion, and coma.
10. Evaluate the degree of anemia.
11. Watch for any signs especially abnormal bleeding.
12. Consider severe malaria as medical emergency that requires close monitoring of vital signs.

Treatment and Medications:
Anti-Malarial Drugs

• Artemether-lumefantrine (Therapy only, commercial names Coartem and Riamet)
• Artesunate-amodiaquine (Therapy only)
• Artesunate-mefloquine (Therapy only)
• Artesunate-Sulfadoxine/pyrimethamine (Therapy only)
• Atovaquone-proguanil, trade name Malarone (Therapy and prophylaxis)
• Quinine (Therapy only)
• Chloroquine (Therapy and prophylaxis; usefulness now reduced due to resistance)
• Cotrifazid (Therapy and prophylaxis)
• Doxycycline (Therapy and prophylaxis)
• Mefloquine, trade name Lariam (Therapy and prophylaxis)
• Primaquine (Therapy in P. vivax and P. ovale only; not for prophylaxis)
• Proguanil (Prophylaxis only)
• Sulfadoxine-pyrimethamine (Therapy; prophylaxis for semi-immune pregnant women in endemic countries as “Intermittent Preventive Treatment” - IPT)
• Hydroxychloroquine, trade name Plaquenil (Therapy and prophylaxis)

Prevention and Control:

1. Malaria cases should be reported.
2. A thorough screening of all infected persons from mosquitoes is important.
3. Mosquito breeding places must be destroyed.
4. Homes should be sprayed with effective insecticides which have residual actions on the walls.
5. Mosquito nets should be used especially when in infected areas.
6. Insect repellents must be applied to the exposed portion of the body.
7. People living in malaria-infested areas should not donate blood for at least three years.
8. Blood donors should be properly screened.

Source:
Handbook of Common Communicable and Infectious Diseases 2006 Ed
http://en.wikipedia.org/
http://www.doh.gov.ph/
http://www.who.int/

Article: Sleeping Less; What To Do About It

Generally, it has been assumed that the need for sleep does not decrease with age, but rather that other factors gradually come to interfere with our ability to sleep through the night.

Older individuals, for instance, are at greater risk not only for developing medical and psychiatric disorders but also for taking medications that can disrupt sleep. In spite of these influences, however, it may be that an actual biological deterioration of the sleep drive might also be playing a role.

A new study published in the journal Current Biology has been able to shed some light on this puzzle of sleep and aging. The researchers, who wanted to determine the maximal sleep capacity of both young and older persons, arranged for groups of younger adults (ages 18 to 32 years) and older adults (ages 60 to 76 years) to lie in bed for 12 hours during the night and for another 4 hours in the afternoon.

The subjects tended to sleep significantly longer at the beginning of the experiment, presumably because they were making up for a sleep debt accrued during their usual daily sleep routines. When the sleep patterns stabilized, however, the younger adults were capable of sleeping for much longer times — an average of 8.9 hours daily — than were the elderly people, who got only 7.4 hours daily. This 1.5-hour difference in maximal sleep capacity is impressive.

If your biological drive for sleep seems to have decreased, make sure that you are following the kinds of routines and behaviors that will give you the best chance of getting as much refreshing sleep as possible. Here are some examples of good sleep hygiene:

• Make sure that you're going to bed early enough to allow yourself to get an adequate night's sleep.
• As your bedtime approaches, develop a relaxing routine in the evening — don't keep busy until the moment before you expect to fall asleep.
• Avoid watching TV in bed.
• Sleep in a cool, relatively dark room.
• Consider going to sleep to the sound of white noise, either from a bedside fan or a machine that generates calming sounds.
• Increase your exercising, but don't do it so near to bedtime that it gets your adrenaline flowing and keeps you awake.
• Limit your daily intake of caffeinated beverages and avoid them completely after lunchtime.
• Avoid alcoholic beverages.

© 2007 Johns Hopkins University. All Rights Reserved. This article from Johns Hopkins University is provided as a service by Yahoo. All materials are produced independently by Johns Hopkins University, which is solely responsible for its content.

Drug Study: Types of Anesthesia

Anesthesia, or anaesthesia has traditionally meant the condition of having sensation (including the feeling of pain) blocked. This allows patients to undergo surgery and other procedures without the distress and pain they would otherwise experience. The word was coined by Oliver Wendell Holmes, Sr. in 1846. Another definition is a “reversible lack of awareness”, whether this is a total lack of awareness (e.g. a general anaesthestic) or a lack of awareness of a part of a the body such as a spinal anaesthetic or another nerve block would cause. Anesthesia differs from analgesia in blocking all sensation, not only pain.

Classification:

A. General Anesthesia - is the loss of all sensation and consciousness. Protective reflexes such as cough and gag reflexes are lost. A general anesthetic acts by blocking awareness centers in the brain so that amnesia (loss of memory), analgesia (insensibility to pain), hypnosis (artificial sleep), and relaxation (rendering a part of the body less tense) occur. General anesthetics are usually administered by intravenous infusion or by inhalation of gases through a mask or through an endotracheal tube inserted into the trachea.

Advantages:

• Because the client is unconscious rather then awake and anxious, respiration and cardiac function are readily regulated.
• The anesthesia can be adjusted to the length of the operation and the client’s age and physical status.

Disadvantage:

• It depresses the respiratory and circulatory systems.
• Some clients become more anxious about a general anesthetic that about the surgery itself. Often this is because they fear losing the capacity to control their own bodies.
  

B. Regional Anesthesia - is the temporary interruption of the transmission of nerve impulses to and from a specific area or region of the body. The client loss sensation in an area of the body but remains conscious. Several techniques are used:
1. Topical (surface) Anesthesia

• Is applied directly to the skin and mucous membranes, open skin surfaces, wounds, and burns. The most common used topical agents are lidocaine (Xylocaine) and benzocaine. Topical anesthetics are readily absorbed and act rapidly.

2. Local Anesthesia

• (Infiltration)is injected into a specific area and is used for minor surgical procedures such as suturing a small wound or performng a biopsy. Lidocaine or tetracaine 0.1% may be used.

3. Nerve Block

• Is a technique in which the anesthetic agent is injected into and around a nerve or small nerve group that supplies sensation to a small area of the body. Major blocks involve multiple nerves or a plexus (e.g. the brachial plexus anesthetizes the arm); minor blocks involve a single nerve (e.g. a facial nerve)

4. Intravenous block (Bier block)

• Is used most often for procedures involving the arm, wrist and hand. An occlusion tourniquet is applied to the extremity to prevent infiltration and absorption of the injected intravenous agent beyond the involved extremity.

5. Spinal anesthesia (Subarachnoid block)

• It requires a lumbar puncture through one of the interspaces between lumbar disc 2 (L2) and the sacrum (S1). An anesthetic agent is injected into the subarachnoid space surrounding the spinal cord. Categorized into Low Spinals (saddle or caudal blocks) are primarily used for surgeries involving the perineal or rectal areas. Mild Spinals (below the level of the umbilicus - T10) can be used for hernia repairs or appendectomies. High Spinals (reaching the nipple line - T4) can be used for surgeries such as cesarean sections.

6. Epidural (peridural) anesthesia

• Is an injection of an anesthetic agent into the epidural space, the area inside the spinal column but outside the dura mater.
  Conscious Sedation may be used alone or in conjuction with regional anesthesia for some diagnostic tests and surgical procedures. Conscious sedation refers to minimal depression of the level of consciousness in which the client retains the ability to maintain a patent airway and respond appropriately to commands.

Intravenous narcotics such as morphine or fentanyl (Sublimaze) and antianxiety agents such as diazepam (Valium) or midazolam (Versed) are commonly used to induce and maintain conscious sedation. Conscious sedation increases the client’s pain threshold and induces a degree of amnesia but allows for prompt reversal of its effects and a rapid return to normal activities of daily living. Procedures such as endoscopies, incision and drainage of abcesses, and even balloon angioplasty may be performed under conscious sedation.

Risk Factors for Complications During the Procedure:

• Current or past health problems
• Taking medications, supplements, or herbal remedies, blood thinners
• Allergies (eg, food allergies, medication allergies, latex allergies)
• Smoking
• Drinking alcohol
• Taking recreational drugs
• Personal or family history of adverse reactions to anesthesia

Possible Complications:

• Pain and tenderness around the injection site
• Bruising, infection, or bleeding of the injection site
• Hematoma (a mass of clotted blood that forms in a tissue, organ, or body space as a result of a broken blood vessel)
• Spinal headache (a severe headache that may occur after spinal or epidural anesthesia)
• Decrease in blood pressure
• Nerve damage
• Medication mistakenly injected into a vein; symptoms include dizziness, rapid heartbeat, and funny taste or numbness around the mouth
• Horner’s syndrome (change of pupil size on one side)
• Ptosis (drooping of the eyelid)
• Pneumothorax (air trapped between the lung and rib cage)

Call Your Doctor If Any of the Following Occurs:

• Signs of infection, including fever and chills
• Redness, swelling, increasing pain, or discharge from the injection site
• Tingling, numbness, or trouble moving around the affected area
• Headache
• Persistent coughing
• Chest pain
• Trouble breathing or shortness of breath
• Dizziness
• Heartbeat abnormalities
• Funny taste or numbness of the mouth
• Other worrisome symptoms
  

Resources:

• http://en.wikipedia.org/
• http://www.thompsonhealth.com/
• Fundamentals of Nursing - Barbara Kozier et al

Case Study: Amoebiasis/Amebiasis (Amoebic Dysentery)

Introduction:

Amoebiasis protozoal infection of human beings initially involves the colon, but may spread to soft tissues, most commonly to the liver or lungs, by contiguity or hematogenous or lymphatic dissemination.

Amoebiasis is the third leading parasitic cause of death worldwide, surpassed only by malaria and schistosomiasis. On a global basis, amoebiasis affects approximately 50 million persons each year, resulting in nearly 100,000 deaths.

Etiologic Agent:

1. Enatamoeba Histolytica

• Prevalent in unsanitary areas
• Common in warm climate
• Acquired by swallowing
• Cysts survives a few days outside of the body
• Cyst passes to the large intestine and hatch into trophozoites. It passes into the mesenteric veins, to the portal vein, to the liver, thereby forming amoebic liver abscess.

2. Entamoeba Histolytica has two developmental stages:

• Trophozoites/vegetative form : facultative parasites that may invade the tissues or may be found in the parasitized tissues and liquid colonic contents.
• Cyst : passed out with formed or semi-formed stools and are resistant to environmental conditions. This is considered as the infective stage in the cycle of E. histolytica

Source: Human Excreta
Incubation Period: The incubation period in severe infection is three days. In subacute and chronic form it lasts for several months. In average cases the incubation period varies from three to four weeks

Period of Communicability: The microorganism is communicable for the entire duration of the illness.

Modes of Transmission:

• The disease can be passed from one person to another through fecal-oral transmission.
• The disease can be transmitted through direct contact, through sexual contact by orogenital, oroanal, and proctogenital sexual activity.
• Through indirect contact, the disease can infect humans by ingestion of food especially uncooked leafy vegetables or foods contaminated with fecal materials containing E. histolytica cysts.

Food or drinks maybe contaminated by cyst through pollution of water supplies, exposure to flies, use of night soil for fertilizing vegetables, and through unhygienic practices of food handlers.

Clinical Manifestations:
1. Acute amoebic dysentery

• Slight attack of diarrhea, altered with periods of constipation and often accompanied by tenesmus.
• Diarrhea, watery and foul smelling stool often containing blood-streaked mucus
• Colic and gaseous distension of the lower abdomen
• Nausea, flatulence, abdomnal distension and tenderness in the right iliac region over the colon

2. Chronic amoebic dysentery

• Attack dysentery that lasts for several days, usually succeeded by constipation
• Tenesmus accompanied by the desire to defacate
• Anorexia, weight loss, and weakness
• Liver may be enlarged
• The stool at first is semifluid but soon becomes watery, bloody, and mucoid
• Vague abdominal distress, flatulence, constipation or irregularity of bowel
• Mild toxemia, constant fatigue and lassitude
• Abdomen loses its elasticity when picked up between fingers
• On sigmoidoscopy, scattered ulceration with yellowish and erythematous border
• The gangrenous type (fatal cases) is characterized by the appearance of large sloughs of intestinal tissues in the stool accompanied by hemorrhage.

3. Extraintestinal forms
Hepatic

• Pain at the upper right quadrant with tenderness of the liver
• Jaundice
• Intermittent fever
• Loss of weight or anorexia
• Abscess may break through the lungs, patient coughs anchovy-sauce sputum

Clinical Features:

• Onset is gradual
• Diarrhea increases and stool becomes bloody and mucoid
• In untreated cases:

Anatomy and Physiology:
Amebiasis is an intestinal illness that’s typically transmitted when someone eats or drinks something that’s contaminated with a microscopic parasite called Entamoeba histolytica (E. histolytica). The parasite is an amoeba, a single-celled organism. That’s how the illness got its name — amebiasis.

In many cases, the parasite lives in a person’s large intestine without causing any symptoms. But sometimes, it invades the lining of the large intestine, causing bloody diarrhea, stomach pains, cramping, nausea, loss of appetite, or fever. In rare cases, it can spread into other organs such as the liver, lungs, and brain.
I. Structure. The GI System consists of the oral structures, esophagus, stomach, small intestine, large intestine and associated structures.

• Oral Structures include the lips, teeth, gingivae and oral mucosa, tongue, hard palate, soft palate, pharynx and salivary glands.
• The esophagus is a muscular tube extending from the pharynx to the stomach.
• 1. Esophageal openings include:
• o a. The upper esophageal sphincter at the cricopharyngeal muscle.
• o b. The lower esophageal sphincter (LES), or cardiac sphincter, which normally remains closed and opens only to pass food into the stomach.
• The Stomach is a muscular pouch situated in the upper abdomen under the liver and diaphragm. The stomach consists of three anatomic areas: the fundus, body (i.e., corpus), and antrum (i.e., pylorus)
• Sphincters. The LES allows food to enter the stomach and prevents reflux into the esophagus. The pyloric sphincter regulates flow of stomach contents (chyme) into the duodenum.
• The small intestine, a coiled tube, extends from the pyloric sphincter to the ileocecal valve at the large intestine. Sections of the small intestine include the duodenum, jejunum and ileum
• The large intestine is a shorter, wider tube beginning at the ileocecal valve and ending at the anus. The large intestine consists of three sections:
• 1. The cecum is a blind pouch that extends from the ileocecal valve to the vermiform appendix.
• 2. The colon, which is the main portion of the large intestine, is divided into four anatomic sections: ascending, transverse, descending and sigmoid.
• 3. The rectum extends from the sigmoid colon to the anus.
• The ileocecal valve prevents the return of feces from the cecum into the small intestine and lies at the upper border of the cecum.
• The appendix, which collects lymphoid tissues, arises from the cecum.
• The GI tract is composed of five layers.
• 1. An inner mucosal layer lubricates and protects the inner surface of the alimentary canal.
• 2. A submucosal layer is responsible for secreting digestive enzymes.
• 3. A layer of circular smooth muscle fibers is responsible for movement of the GI tract.
• 4. A layer of longitudinal smooth muscle fibers also facilitates movement of the GI tract.
• 5. The peritoneum, an outer serosal layer, covers the entire abdomen and is composed of the parietal and visceral layers.

II. Function. The GI system performs two major body functions: digestion and elimination.

• Digestion of food and fluid, with absorption of nutrients into the bloodstream, occurs in the upper GI tract, stomach and small intestines.
• 1. Digestion begins in the mouth with chewing and the action of ptyalin, an enzyme contained in saliva that breaks down starch.
• 2. Swallowed food passes through the esophagus to the stomach, where digestion continues by several processes.
• o a. Secretion of gastric juice, containing hydrochloric acid and the enzymes pepsin and lipase ( and renin in infants)
• o b. Mixing and churning through peristaltic action
• 3. From the pylorus, the mixed stomach contents (i.e. chyme) pass into the duodenum through the pyloric valve.
• 4. In the small intestine, food digestion is completed, and most nutrient absorption occurs. Digestion results from the action of numerous pancreatic and intestinal enzymes (e.g., trypsin, lipase, amylase, lactase, maltase, sucrase( and bile.

• Elimination of waste products through defacation occurs in the large intestines and rectum. In the large intestine, the cecum and ascending colon absorb water and electrolytes from the now completely digested material. The rectum stores feces for elimination.

Pathophysiology

Laboratory Diagnosis:

• Stool exam (cyst, white and yellow pus with plenty of amoeba)
• Blood exam (Leukocytosis)
• Proctoscopy/Sigmoidoscoppy

Diagnosis of amoebiasis can be very difficult. One problem is that other parasites and cells can look very similar to E. histolytica when seen under a microscope. Therefore, sometimes people are told that they are infected with E. histolytica even though they are not. Entamoeba histolytica and another ameba, Entamoeba dispar, which is about 10 times more common, look the same when seen under a microscope. Unlike infection with E. histolytica, which sometimes makes people sick, infection with E. dispar does not make people sick and therefore does not need to be treated.

If you have been told that you are infected with E. histolytica but you are feeling fine, you might be infected with E. dispar instead. Unfortunately, most laboratories do not yet have the tests that can tell whether a person is infected with E. histolytica or with E. dispar. Until these tests become more widely available, it usually is best to assume that the parasite is E. histolytica.
A blood test is also available but is only recommended when your health care provider thinks that your infection may have spread beyond the intestine (gut) to some other organ of your body, such as the liver. However, this blood test may not be helpful in diagnosing your current illness because the test may still be positive if you had amoebiasis in the past, even if you are no longer infected now.

Complications:

1. Amebic colitis

• Fulminant or necrotizing colitis
• Toxic megacolon
• Ameboma
• Rectovaginal fistulas

2. Amebic liver abscess

• Intrathoracic or intraperitoneal rupture with or without secondary bacterial infection
• Direct extension to pleura or pericardium

3. Brain abscess

Treatment:

1. Metronidazole (Flagyl) 800mg TID X 5 days

2. Tetracyline 250 mg every 6 hours

3. Ampicillin, quinolones sulfadiazine

4. Streptomycin SO4, Chloramphenicol

5. Lost fluid and electrolytes should be replaced

Several antibiotics are available to treat amoebiasis. Treatment must be prescribed by a physician. You will be treated with only one antibiotic if your E. histolytica infection has not made you sick. You probably will be treated with two antibiotics (first one and then the other) if your infection has made you sick.

Nursing Management:

1. Observe isolation and enteric precaution

2. Provide health education and instruct patient to

• Boil water for drinking or use purified water
• Avoid washing food from open drum or pail
• Cover leftover food
• Wash hands after defacation and before eating
• Avoid ground vegetables (lettuce, carrots, and the like)

Methods of Prevention:

• Health education
• Sanitary disposal of feces
• Protect, chlorinate, and purify drinking water
• Observe scrupulous cleanliness in food preparation and food handling
• Detection and treatment of carriers
• Fly control (they can serve as vector)

Resources:

• 
  

http://www.emedicine.com/

http://en.wikipedia.org/

http://kidshealth.org/

http://cdc.gov/

Handbook of Common Communicable and infectious Disease by Dionesia Monjejar-Navales, RN, MAEd

Lippincott Review Series Medical Surgical Nursing 4th Ed

Case Study: Common Discomforts of Pregnancy

Pregnancy is a time of both physical and emotional changes. Aside from the obvious changes in your body shape and the size of your uterus, shifts in hormonal levels and metabolism can contribute to various physical and emotional discomforts.

Although the pregnancy discomforts mentioned below are common, they are not experienced by all pregnant women and may not be a part of your pregnancy. It is important to remember:

• You may need to try more than one remedy before you find one that works for you.
• Good nutrition is especially important for a comfortable and healthy pregnancy. Eating well can minimize discomforts and help your body cope with the stress of daily life.
• If you have a physical discomfort that is severe or does not go away, contact your health care provider.
• If you have a chronic health condition, such as diabetes or asthma, it is very important that you see your health care provider throughout your pregnancy.

DISCOMFORT
1. Ankle Edema

• Rest with your feet elevated.
• Avoid standing for long periods.
• Avoid restrictive garments on the lower half of your body.

2. Backache

• Apply local heat.
• Avoid long periods of standing.
• Stoop to pick up objects.
• Tylenol in usual adult dose may help.
• Wear low-heeled shoes.

3. Breast Tenderness

• Wear a supportive bra.
• Decrease the amount of caffeine and carbonated beverages ingested.

4. Constipation

• Increase fiber in your diet.
• Drink additional fluids.
• Have a regular time for bowel movements.

5. Difficulty Sleeping

• Drink a warm, caffeine-free drink before bed and practice relaxation techniques.

6. Fatigue

• Schedule a rest period daily.
• Have a regular bedtime routine.
• Use extra pillows for comfort.

7. Faintness

• Move slowly.
• Avoid crowds.
• Remain in a cool environment.
• Lie on your left side when at rest.

8. Headache

• Avoid eye strain.
• Visit your eye doctor.
• Rest with a cool cloth on your forehead.
• Take Tylenol in regular adult dose, as needed.
• Report frequent or persistent headaches to your primary care provider.

9. Heartburn

• Eat small, frequent meals each day.
• Avoid overeating, as well as spicy, fatty, and fried foods.

10. Hemorrhoids

• Avoid constipation and straining with a bowel movement.
• Take a sitz bath.
• Apply a witch hazel compress.

11. Leg cramps

• Avoid pointing your toes.
• Straighten your leg and dorsiflex your ankle.

12. Nausea

• Eat six small meals per day rather than three.
• Eat a piece of dry toast or some crackers before getting out of bed.
• Avoid foods or situations that worsen the nausea.
• If it persists, report this problem to your primary care provider.

13. Nasal stuffiness

• Use cool air vaporizer or humidifier
• Increase fluid intake
• Place moist towel on the sinuses
• Massage the sinuses.

14. Ptyalism

• Use mouthwash as needed
• Chew gum or suck on hard candy.

15. Round ligament pain

• Avoid twisting motions.
• Rise to standing position slowly and use your hands to support the abdomen.
• Bend forward to relieve discomfort.

16. Shortness of breath

• Use proper posture.
• Use pillows behind head and shoulders at night.

17. Urinary frequency

• Void as necessary, at least every 2 hours.
• Increase fluid intake.
• Avoid caffeine.
• Practice Kegel exercise.

18. Vaginal discharge

• Wear cotton underwear.
• Bathe daily.
• Avoid tight pantyhose.

19. Varicose veins

• Walk regularly.
• Rest with feet elevated.
• Avoid long periods of standing.
• Rest with feet elevated.
• Avoid long periods of standing.
• Do not cross your legs when sitting.
• Avoid knee-high stockings.
• Wear support hosiery.

Resources:

• California Pacific Medical Center
• Maternal and Child Health Nursing by Adele Pillitteri 3rd Ed

Case Study: Common Problems Among Elderly

Aging is a normal progressive process, beginning at conception and ending in death. Aging is not synonymous with diseases but diseases become more common as age progresses. Usually the diseases present with non-specific multiple symptoms that involve many organs. Increasing age in the elderly is associated with the higher morbidity and frequent use of health services. Their illness tends to be chronic with no simple cure. This makes them more dependent on the family, society and health services.

As the population ages, the nurse practitioner will be more involved in geriatric care. There are solutions that nurse practitioners can offer elderly patients to improve day-to-day functioning.

Problems

1. Confusion/Dementia

• Spend time with the Patient
• Use touch to convey concern
• Provide frequent reiteration of orienting data (e.g. time, place)
• Have clocks or calendars in the environment
• Explain all actions, procedures and routines to the patient
• Address the patient by his/her name
• Keep a routine activities

2. Constipation

• Increase Fluid Intake
• Daily Exercise
• Increase fiber intake (e.g. fruits and vegetables)
• Complications associated with constipation include hemorrhoids from straining, anal fissures, rectal prolapse, and fecal impaction. Untreated constipation in institutionalized patients can lead to cemented lesions in the colon, megacolon, bowel blockage and perforation, peritonitis, and sepsis.

3. Osteoporosis

• Have adequate calcium in diet:
• · Milk/dairy products
• · Fish
• · Beans
• · Orange Juice
• · Cereal or read that have added calcium
• · Take calcium supplements
• Get regular exercise
• Avoid alcohol, quit smoking. Alcohol and smoking reduce bone mass.
• Avoid large amounts of protein – rich or salty and caffeine foods. They can cause loss of calcium from the body.
• Make the home safe to avoid accidents.
• Practice good posture.
• Use good body mechanics when lifting objects (e.g. bend the knees instead of the back).
• Do back exercises to improve posture.
• Wear rubber-soled, low-heeled shoes that grip well.
• Don’t lift heavy objects.
• Avoid using a stool or bending over.
• Put items frequently used within easy reach.
• Use handrails when going up and down stairs.
• Hormonal Replacement Therapy (HRT) for menopausal women as prescribed.

4. Postural Hypotension (PH)

• Get out of bed slowly and in stages.
• Sleep with head of bed elevated several inches.
• Have a daily fluid intake of 2 to 3 liters.
• Avoid hot showers or baths, may cause venous dilatation thereby, venous pooling.
• Avoid straining at stool. This may cause fall of BP
• Avoid bending down and suddenly standing up again.
• Rest for 60 minutes after meals.
• Avoid hyperventilation. This lowers the BP.
• Exercise regimen must be recommended.
• Use thigh-length elastic stockings to reduce venous pooling.
• Avoid prolonged standing.
• Heed warning signs of PH (e.g., dizziness, faintness, visual disturbances)
• Pharmacotherapy: Fludrocortisone (a mineralocorticoid that promotes retention of water and sodium)

5. Hypertension

• Encourage stress reduction and relaxation.
• Encourage exercise such as swimming and walking.
• Encourage healthy diet (fresh fruits, rice, vegetable).
• No weightlifting.
• Quit smoking, no alcohol,
• Reduce intake of saturated fats.
• Reduce salt intake to 1 to 6 gm per day.
• Take prescribed medications at regular basis.

6. Elder abuse

There are many types of abuse used against the elderly. They include:

• Psychologic abuse such as instilling fear, threatening or making the elderly perform demeaning tasks
• Physical abuse such as hitting, slapping, or burning.
• Financial abuse such as taking their money or forcing them to sign over their assets.
• Neglect such as withholding food, medications or basic care.
• Infringement of personal rights such as restraining for long periods of time against their will or isolating them from normal social interactions.
• Sexual abuse
• The perpetrator of abuse is usually the spouse or the children of the victim. Caregivers who abuse their elderly family members are often middle-aged or older or have emotional problems such as alcoholism or substance abuse.

Source: http://www.medscape.com/

Medical-Surgical Nursing First Ed by Professor Josie Quiambao-Udan, RN, MAN

Initial Registration For New Nurses Who Passes Board Exam

Instructions

Initial registrants should come personally to the PRC Central Office or to the nearest Regional Office to file his/her application for registration and to affix his/her signature in the registry book.

All Registration Certificates and PRC ID shall be claimed by the licensee personally at the Central Office or the Regional Office where the application for the same has been filed. If there is an unavoidable need for a representative, he must present his/her identification paper with picture and a Special Power of Attorney.


Requirements

• Duly accomplished Oath Form or Panunumpa ng Propesyonal
• Current Community Tax Certificate (cedula)
• Two pcs. passport size pictures with name tag (for Oath Form and Certificate of Registration)
• One pc. 1”x1” picture in plain background with complete name tag (for Registry of Professionals)
• Two sets of metered documentary stamps (for Oath Form and Certificate of Registration)
• One (1) short brown envelope with name and profession

Prohibitied Acts Inside the Examination Room

1. Accepting or receiving anything, including food from any person while the examination is in progress.
2. Giving money, food, or any favor and other consideration to the Room Watchers and other examination personnel.
3. Loitering, talking, or discussing your answers inside the room or along the corridor while the examination is in progress.
4. Putting any of the following markings on your answer sheets: name, seat number, unnecessary words or phrases, strokes, dots or any other marks not called for in the test questions.

Penalties:

• placing of name in the space provided for the subject of the examination shall be, aside from the cancellation of the examination papers, suspension from taking the examination for one (1) year;
• multiple markings shall be cancellation of the examiness examination and suspension from taking the examination for two (2) years.

5. Taking out the examination room test questions used or pages thereof, copying, and/or divulging or making known the nature or content of any examination question or answer to any individual or entity.


6. Copying or referring to any solution, answer or work of another examinee or allowing anyone to copy or refer to your work, helping or asking help from any person or communication with anyone by means of words, signs, gestures, codes and other similar acts which enable you to exchange, impart or acquire relevant information.
7. Bringing inside the examination rooms the following: books, notes, review materials and other printed materials containing principles or excerpts thereof, coded data/information/ formula which are relevant to or connected with the examination subject, PROGRAMMABLE CALCULATORS, CELLULAR PHONES, beeper, portable personal computers or other similar gadgets/devices. The act shall be considered cheating and/or act of dishonesty and shall be a ground for the cancellation of your examinations (PRC Resolution No. 463 dated November 27, 1996)



Maintain discipline at all times, any misconduct or irregularity on your part or any violation of the examination rules and regulations and instructions will be sufficient cause for the cancellation of your examination papers and your debarment from taking any future licensure examination.
To clear the examinations rooms, do not bring bags of any kind. Keep allowed items and valuables inside your plastic envelope. PRC will not be answerable for lost items.

Handling of Examinee Identification Sheet or Answer Sheet

• Check if the Serial Number of Examinee Identification Sheet/Answer Sheets are the same for all the sheets. If there is any discrepancy, return the set to your Room Watchers for replacement. The Serial Number is NOT the examination number. It has nothing to do with your examination.
• Check if there are defects or unnecessary marks on your Examinee Identification Sheet/Answer Sheets.
• Check if the number of Answer Sheets corresponds to the number of examination subjects.
• Do not fold or mutilate, take extra care and keep clean your Examinee Identification Sheet/Answer Sheets.
• Before detaching an answer sheet, check if the brown envelope is yours and the set inside belongs to you.
  

How To Mark Your Examinee Identification Sheet/Answer Sheets

• Use standard No. 2 pencil only
• Do not use too much pressure
• Mark like this not like these
• Make the mark dark and straight
• Strictly no erasures allowed
  

How to Accomplish Examinee Identification Sheet

Brown Envelope
Print your name on the left top corner and your seat number on the right top corner.









Handling Of Test Question Sets

• Indicate your seat number at the right top corner of page 1
• Check if the number of pages of Test Question Set is complete and no misprint. If there is any problem, return the set to your Room Watchers for replacement.
• Mark A or B on the answer sheet to indicate the set of Test Question assigned to you.
• You can use your Test Question Set as your Scratch .
• Keep the Test Question Set stapled until the end of examination.

Allowable Calculators

Examinees shall be allowed to bring in and use ONLY any of the following calculators that were identified as non-programmable (PRC Memorandum Circular No. 2002-24 dated September 27, 2002.

Casio Standard Scientific Calculators

• Fx82TL
• Fx911W
• Fx570W
• Fx992
• Fx65
• Fx350TL
• Fx100W
• Fx991W
• Fx122S
• Fx500A
• Fx350TLG
• Fx115W
• Fx992S
• Fx901
• Fx95
• FX570MS
• Fx991MS
• Fx115MS
• Fx100Ms
• Fx95MS
  

Casio Standard Calculators (phased-out, still allowed to be used in the examinations)

• Fx260
• Fx509G
• Fx824
• Fx82
• Fx350HA
• Fx520G
• Fx992VB
• Fx82LB
• Fx350HB
• Fx531LH
• Fx991S
• Fx82SX
• Fx300SA
• Fx546D
• Fx991H
• Fx82Super
• Fx300W
• Fx570S
• Fx100D
• Fx401
• Fx570AD
• Fx100S
• Fx451M
• Fx580
• Fx115D
• Fx85S
• Fx506G
• Fx580D
• Fx115S
• Fx546L
• Fx506M
• Fx825X
• Fx75
• Fx509D
• Fx531GH
  

Sharp Calculators Non-Programmable

• EL-506V
• EL-510R
• EL-531G
• EL-520V
• EL-501V
• EL-506P
• EL-531VH
• EL-546L
• EL-520G
• EL-509V
• EL-509D

OtherBrands

• TL30XS
• AURORA 2512
• AURORA
  

Calculators whose brand and identifying mark do not appear in the list above provided shall be prohibited in the examinations.

General Instructions to Examinees

1. Report to the Test Center before 6:30 a.m. on the first day of examination to verify your room and seat numbers.
2. Late examinees will not be admitted.
3. Attend to your personal needs before the start of examination in every subject. No examinee will be allowed to go out of the examination room while the examination is in progress.
4. Always put your answer sheet on top of the armchair while taking the examination.
5. Stop answering the test questions at the end of the time alloted for the subject. Arrange your test papers as follows:

• Notice of Admission;
• Answer Sheet; and
• Test Questionnaire

6. Do not leave the room until

• your answer sheet and test question set are received by the room watchers,
• you have signed, indicated the time and set ( A or B ) on the Examinees Record of Attendance, and
• the lower portion of your Notice of Admission (Certification on the Receipt of Test Papers) is signed by the Room Watchers and returned to you.

How To Apply for The Local Nursing Board Exam

STEP 1. Secure Action Sheet from the PRC Customer Service Center (CSC) and accomplish the same.

STEP 2. Submit the Action Sheet for processing and evaluation at any of the Processing Windows together with the following:

• Original and photo/xerox copies of Transcript of Records with Special Order and Date of Graduation SCANNED PICTURES AND WITH REMARKS “FOR BOARD EXAMINATION PURPOSES ONLY” .View Res.2004-200 .(Graduates of government schools and institutions/programs accredited by recognized accredited agencies under the FAAP are exempted from SO [B]). Graduates of New Schools/degree Programs must submit School Recognition and/or Permit to operate.
• Original and photo/xerox copy of NSO-issued Birth Certificate (in NSO security paper; if NSO copy not very clear, bring copy from the Local Civil Registrar)
• Original and photo/xerox copies of Marriage Contract in NSO security paper (for married female only;if NSO copy not very clear, bring copy from local civil registrar).
• Four (4) passport size colored pictures in white background with complete name tag.
• Current Community Tax Certificate (Cedula)
• Other specific requirements as required by the Commission and/or Professional Regulatory Board.

NOTE: Secure the following from the processor upon approval of your application:

• Computerized Application form (CAF)
• Permanent Examination and Registration Record card (PERRC) (for first-timers)
• Notice of Admission (NOA)
  

STEP 3. Pay examination fee at any of the Cashier Windows. Get Official Receipt.

• Baccalaureate Degree - P 900.00
• Non-Baccalaureate Degree - P600.00
• Removal - P450.00
  

STEP 4. Pay for metered documentary stamps and mailing envelope with metered documentary stamps at the CSC.


STEP 5. Accomplish the CAF, PERRC, and NOA. Indicate the Official Receipt number, date, and amount on the CAF.


STEP 6. Proceed to any of the Issuance Windows (Window 9, 10, 11, 12) for final review of qualifications and documents and issuance of NOA, Applicant's Stub, Program of Examination,

Examinee's Guide and Self-Instruction Sheet.


STEP 7. Keep the Notice of Admission, Official Receipt, and the Applicant's Stub. Bring these with you on the first day of the examination. For further information, read the General Instructions at the back page of the Notice of Admission, Program of Examination, Examinee's guide and Self-Instruction Sheet.


STEP 8. Bring your NOA when you verify with the PRC your school and building assignment which will be posted at the PRC premises two (2) three(3) working days before the examination date.


NO APPLICATION SHALL BE ACCEPTED AFTER THE DEADLINE


Click here to download application flow chart.

Article: Updated List of Products Tested for Presence of Melamine

The health official released yesterday the latest results of the laboratory analysis being performed by BFAD on China-made milk. Melamine was "NOT DETECTED" in the following products:

1. Anchor Wam Froot Milk Drink (Mango Magic)
2. Anchor Wam Froot Milk Drink (Orange Chill)
3. Anchor Wam Froot Milk Drink (Strawberry Spin)
4. Arla Full Cream Milk (repacked)
5. Austria Milk Candies
6. Candyman White Rabbit Butter Toffee Candy
7. Cottage Milk Sweet Cream Butter Milk
8. Crisp Bean Chocolate
9. Crisp Chocolate Stone
10. Dairy America Milk Powder (repacked)
11. Dairy Kreem Skimmed Milk Powder
12. Dong Guan Bairong Coconut Biscuits
13. Farmland Milk Powder
14. Kiddie Soya Milk Egg Delight
15. La Crema (Puregold) Skimmed Milk Powder (original)
16. La Crema (Puregold) Skimmed Milk Powder (regular)
17. Magic Chew Grape Fruit Sharing
18. Milk Drink in Red Can
19. Oakland Skimmed Milk Power
20. Showa Tempura Batter Mix

Fundamentals of Nursing Practice Test III

1. Which element in the circular chain of infection can be eliminated by preserving skin integrity?

a. Host
b. Reservoir
c. Mode of transmission
d. Portal of entry

2. Which of the following will probably result in a break in sterile technique for respiratory isolation?

a. Opening the patient’s window to the outside environment
b. Turning on the patient’s room ventilator
c. Opening the door of the patient’s room leading into the hospital corridor
d. Failing to wear gloves when administering a bed bath

3. Which of the following patients is at greater risk for contracting an infection?

a. A patient with leukopenia
b. A patient receiving broad-spectrum antibiotics
c. A postoperative patient who has undergone orthopedic surgery
d. A newly diagnosed diabetic patient

4. Effective [1] hand washing requires the use of:

a. Soap or detergent to promote emulsification
b. Hot water to destroy bacteria
c. A disinfectant to increase surface tension
d. All of the above

5. After routine patient contact, [1] hand washing should last at least:

a. 30 seconds
b. 1 minute
c. 2 minute
d. 3 minutes

6. Which of the following procedures always requires surgical asepsis?

a. Vaginal instillation of conjugated estrogen
b. [2] Urinary catheterization
c. [3] Nasogastric tube insertion
d. [4] Colostomy irrigation

7. Sterile technique is used whenever:

a. Strict isolation is required
b. Terminal disinfection is performed
c. Invasive procedures are performed
d. Protective isolation is necessary

8. Which of the following constitutes a break in sterile technique while preparing a sterile field for a dressing change?

a. Using sterile forceps, rather than sterile gloves, to handle a sterile item
b. Touching the outside wrapper of sterilized material without sterile gloves
c. Placing a sterile object on the edge of the sterile field
d. Pouring out a small amount of solution (15 to 30 ml) before pouring the solution into a sterile container

9. A natural body defense that plays an active role in preventing infection is:

a. Yawning
b. Body hair
c. Hiccupping
d. Rapid eye movements

10. All of the following statement are true about [5] donning sterile gloves except:

a. The first glove should be picked up by grasping the inside of the cuff.
b. The second glove should be picked up by inserting the gloved fingers under the cuff outside the glove.
c. The gloves should be adjusted by sliding the gloved fingers under the sterile cuff and pulling the glove over the wrist
d. The inside of the glove is considered sterile

11. When removing a contaminated gown, the nurse should be careful that the first thing she touches is the:

a. Waist tie and neck tie at the back of the gown
b. Waist tie in front of the gown
c. Cuffs of the gown
d. Inside of the gown

12. Which of the following nursing interventions is considered the most effective form or universal precautions?

a. Cap all used needles before removing them from their syringes
b. Discard all used uncapped needles and syringes in an impenetrable protective container
c. Wear gloves when administering IM injections
d. Follow enteric precautions

13. All of the following measures are recommended to prevent pressure ulcers except:

a. Massaging the reddened are with lotion
b. Using a water or air mattress
c. Adhering to a schedule for positioning and turning
d. Providing meticulous skin care

14. Which of the following blood tests should be performed before a blood transfusion?

a. Prothrombin and coagulation time
b. Blood typing and cross-matching
c. Bleeding and clotting time
d. Complete blood count (CBC) and electrolyte levels.

15. The primary purpose of a platelet count is to evaluate the:

a. Potential for clot formation
b. Potential for bleeding
c. Presence of an antigen-antibody response
d. Presence of cardiac enzymes

16. Which of the following white blood cell (WBC) counts clearly indicates leukocytosis?

a. 4,500/mm³
b. 7,000/mm³
c. 10,000/mm³
d. 25,000/mm³

17. After 5 days of diuretic therapy with 20mg of [6] furosemide (Lasix) daily, a patient begins to exhibit fatigue, muscle cramping and muscle weakness. These symptoms probably indicate that the patient is experiencing:

a. Hypokalemia
b. Hyperkalemia
c. Anorexia
d. Dysphagia

18. Which of the following statements about chest X-ray is false?

a. No contradictions exist for this test
b. Before the procedure, the patient should remove all jewelry, metallic objects, and buttons above the waist
c. A signed consent is not required
d. Eating, drinking, and medications are allowed before this test

19. The most appropriate time for the nurse to obtain a sputum specimen for culture is:

a. Early in the morning
b. After the patient eats a light breakfast
c. After aerosol therapy
d. After chest physiotherapy

20. A patient with no known allergies is to receive penicillin every 6 hours. When administering the medication, the nurse observes a fine rash on the patient’s skin. The most appropriate nursing action would be to:

a. Withhold the moderation and notify the physician
b. Administer the medication and notify the physician
c. Administer the medication with an antihistamine
d. Apply corn starch soaks to the rash

21. All of the following nursing interventions are correct when using the Z-track method of drug [7] injection except:

a. Prepare the injection site with alcohol
b. Use a needle that’s a least 1” long
c. Aspirate for blood before injection
d. Rub the site vigorously after the injection to promote absorption

22. The correct method for determining the vastus lateralis site for I.M. injection is to:

a. Locate the upper aspect of the upper outer quadrant of the buttock about 5 to 8 cm below the iliac crest
b. Palpate the lower edge of the acromion process and the midpoint lateral aspect of the arm
c. Palpate a 1” circular area anterior to the umbilicus
d. Divide the area between the greater femoral trochanter and the lateral femoral condyle into thirds, and select the middle third on the anterior of the thigh

23. The mid-deltoid injection site is seldom used for I.M. injections because it:

a. Can accommodate only 1 ml or less of medication
b. Bruises too easily
c. Can be used only when the patient is lying down
d. Does not readily parenteral medication

24. The appropriate needle size for insulin injection is:

a. 18G, 1 ½” long
b. 22G, 1” long
c. 22G, 1 ½” long
d. 25G, 5/8” long

25. The appropriate needle gauge for intradermal injection is:

a. 20G
b. 22G
c. 25G
d. 26G

26. Parenteral penicillin can be administered as an:

a. IM injection or an IV solution
b. IV or an intradermal injection
c. Intradermal or [8] subcutaneous injection
d. IM or a subcutaneous injection

27. The physician orders gr 10 of aspirin for a patient. The equivalent dose in milligrams is:

a. 0.6 mg
b. 10 mg
c. 60 mg
d. 600 mg

28. The physician orders an IV solution of dextrose 5% in water at 100ml/hour. What would the flow rate be if the drop factor is 15 gtt = 1 ml?

a. 5 gtt/minute
b. 13 gtt/minute
c. 25 gtt/minute
d. 50 gtt/minute

29. Which of the following is a sign or symptom of a hemolytic reaction to blood transfusion?

a. Hemoglobinuria
b. Chest pain
c. Urticaria
d. Distended neck veins

30. Which of the following conditions may require fluid restriction?

a. Fever
b. Chronic Obstructive Pulmonary Disease
c. Renal Failure
d. Dehydration

31. All of the following are common signs and symptoms of phlebitis except:

a. Pain or discomfort at the IV insertion site
b. Edema and warmth at the IV insertion site
c. A red streak exiting the IV insertion site
d. Frank bleeding at the insertion site

32. The best way of determining whether a patient has learned to instill ear medication properly is for the nurse to:

a. Ask the patient if he/she has used ear drops before
b. Have the patient repeat the nurse’s instructions using her own words
c. Demonstrate the procedure to the patient and encourage to ask questions
d. Ask the patient to demonstrate the procedure

33. Which of the following types of medications can be administered via gastrostomy tube?

a. Any oral medications
b. Capsules whole contents are dissolve in water
c. Enteric-coated tablets that are thoroughly dissolved in water
d. Most tablets designed for oral use, except for extended-duration compounds

34. A patient who develops hives after receiving an antibiotic is exhibiting drug:

a. Tolerance
b. Idiosyncrasy
c. Synergism
d. Allergy

35. A patient has returned to his room after femoral arteriography. All of the following are appropriate nursing interventions except:

a. Assess femoral, popliteal, and pedal pulses every 15 minutes for 2 hours
b. Check the pressure dressing for sanguineous drainage
c. Assess a vital signs every 15 minutes for 2 hours
d. Order a hemoglobin and hematocrit count 1 hour after the arteriography

36. The nurse explains to a patient that a cough:

a. Is a protective response to clear the respiratory tract of irritants
b. Is primarily a voluntary action
c. Is induced by the administration of an antitussive drug
d. Can be inhibited by “splinting” the abdomen

37. An infected patient has chills and begins shivering. The best nursing intervention is to:

a. Apply iced alcohol sponges
b. Provide increased cool liquids
c. Provide additional bedclothes
d. Provide increased ventilation

38. A clinical nurse specialist is a nurse who has:

a. Been certified by the National League for Nursing
b. Received credentials from the Philippine Nurses’ Association
c. Graduated from an associate degree program and is a registered professional nurse
d. Completed a master’s degree in the prescribed clinical area and is a registered professional nurse.

39. The purpose of increasing urine acidity through dietary means is to:

a. Decrease burning sensations
b. Change the urine’s color
c. Change the urine’s concentration
d. Inhibit the growth of microorganisms

40. Clay colored stools indicate:

a. Upper GI bleeding
b. Impending constipation
c. An effect of medication
d. Bile obstruction

41. In which step of the [9] nursing process would the nurse ask a patient if the medication she administered relieved his pain?

a. [10] Assessment
b. Analysis
c. [11] Planning
d. [12] Evaluation

42. All of the following are good sources of vitamin A except:

a. White potatoes
b. Carrots
c. Apricots
d. Egg yolks

43. Which of the following is a primary nursing intervention necessary for all patients with a Foley Catheter in place?

a. Maintain the drainage tubing and collection bag level with the patient’s bladder
b. Irrigate the patient with 1% Neosporin solution three times a daily
c. Clamp the catheter for 1 hour every 4 hours to maintain the bladder’s elasticity
d. Maintain the drainage tubing and collection bag below bladder level to facilitate drainage by gravity

44. The ELISA test is used to:

a. Screen blood donors for antibodies to human immunodeficiency virus (HIV)
b. Test blood to be used for transfusion for HIV antibodies
c. Aid in diagnosing a patient with AIDS
d. All of the above

45. The two blood vessels most commonly used for TPN infusion are the:

a. Subclavian and jugular veins
b. Brachial and subclavian veins
c. Femoral and subclavian veins
d. Brachial and femoral veins

46. Effective skin disinfection before a surgical procedure includes which of the following methods?

a. Shaving the site on the day before surgery
b. Applying a topical antiseptic to the skin on the evening before surgery
c. Having the patient take a tub bath on the morning of surgery
d. Having the patient shower with an antiseptic soap on the evening v=before and the morning of surgery

47. When transferring a patient from a bed to a chair, the nurse should use which muscles to avoid back injury?

a. Abdominal muscles
b. Back muscles
c. Leg muscles
d. Upper arm muscles

48. Thrombophlebitis typically develops in patients with which of the following conditions?

a. Increases partial thromboplastin time
b. Acute pulsus paradoxus
c. An impaired or traumatized blood vessel wall
d. Chronic Obstructive Pulmonary Disease (COPD)

49. In a recumbent, immobilized patient, lung ventilation can become altered, leading to such respiratory complications as:

a. Respiratory acidosis, ateclectasis, and hypostatic pneumonia
b. Appneustic breathing, atypical pneumonia and respiratory alkalosis
c. Cheyne-Strokes respirations and spontaneous pneumothorax
d. Kussmail’s respirations and hypoventilation

50. Immobility impairs bladder elimination, resulting in such disorders as

a. Increased urine acidity and relaxation of the perineal muscles, causing incontinence
b. Urine retention, bladder distention, and infection
c. Diuresis, natriuresis, and decreased urine specific gravity
d. Decreased calcium and phosphate levels in the urine

Fundamentals of Nursing Practice Test II

1. The most appropriate nursing order for a patient who develops dyspnea and shortness of breath would be…

a. Maintain the patient on strict bed rest at all times
b. Maintain the patient in an orthopneic position as needed
c. Administer oxygen by Venturi mask at 24%, as needed
d. Allow a 1 hour rest period between activities

2. The nurse observes that Mr. Adams begins to have increased difficulty breathing. She elevates the head of the bed to the high Fowler position, which decreases his respiratory distress. The nurse documents this breathing as:

a. Tachypnea
b. Eupnca
c. Orthopnea
d. Hyperventilation

3. The physician orders a platelet count to be performed on Mrs. Smith after breakfast. The nurse is responsible for:

a. Instructing the patient about this diagnostic test
b. Writing the order for this test
c. Giving the patient breakfast
d. All of the above

4. Mrs. Mitchell has been given a copy of her diet. The nurse discusses the foods allowed on a 500-mg low sodium diet. These include:

a. A ham and Swiss cheese sandwich on whole wheat bread
b. Mashed potatoes and broiled chicken
c. A tossed salad with oil and vinegar and olives
d. Chicken bouillon

5. The physician orders a maintenance dose of 5,000 units of subcutaneous heparin (an anticoagulant) daily. Nursing responsibilities for Mrs. Mitchell now include:

a. Reviewing daily activated partial thromboplastin time (APTT) and prothrombin time.
b. Reporting an APTT above 45 seconds to the physician
c. Assessing the patient for signs and symptoms of frank and occult bleeding
d. All of the above

6. The four main concepts common to nursing that appear in each of the current conceptual models are:

a. Person, nursing, environment, medicine
b. Person, health, nursing, support systems
c. Person, health, psychology, nursing
d. Person, environment, health, nursing

7. In Maslow’s hierarchy of physiologic needs, the human need of greatest priority is:

a. Love
b. Elimination
c. Nutrition
d. Oxygen

8. The family of an accident victim who has been declared brain-dead seems amenable to organ donation. What should the nurse do?

a. Discourage them from making a decision until their grief has eased
b. Listen to their concerns and answer their questions honestly
c. Encourage them to sign the consent form right away
d. Tell them the body will not be available for a wake or funeral

9. A new head nurse on a unit is distressed about the poor staffing on the 11 p.m. to 7 a.m. shift. What should she do?

a. Complain to her fellow nurses
b. Wait until she knows more about the unit
c. Discuss the problem with her supervisor
d. Inform the staff that they must volunteer to rotate

10. Which of the following principles of primary nursing has proven the most satisfying to the patient and nurse?

a. Continuity of patient care promotes efficient, cost-effective nursing care
b. Autonomy and authority for [1] planning are best delegated to a nurse who knows the patient well
c. Accountability is clearest when one nurse is responsible for the overall plan and its [2] implementation.
d. The holistic approach provides for a therapeutic relationship, continuity, and efficient nursing care.

11. If nurse administers an [3] injection to a patient who refuses that injection, she has committed:

a. Assault and battery
b. Negligence
c. Malpractice
d. None of the above

12. If patient asks the nurse her opinion about a particular physicians and the nurse replies that the physician is incompetent, the nurse could be held liable for:

a. Slander
b. Libel
c. Assault
d. Respondent superior

13. A registered nurse reaches to answer the telephone on a busy pediatric unit, momentarily turning away from a 3 month-old infant she has been weighing. The infant falls off the scale, suffering a skull fracture. The nurse could be charged with:

a. Defamation
b. Assault
c. Battery
d. Malpractice

14. Which of the following is an example of nursing malpractice?

a. The nurse administers penicillin to a patient with a documented history of allergy to the drug. The patient experiences an allergic reaction and has cerebral damage resulting from anoxia.
b. The nurse applies a hot water bottle or a heating pad to the abdomen of a patient with abdominal cramping.
c. The nurse assists a patient out of bed with the bed locked in position; the patient slips and fractures his right humerus.
d. The nurse administers the wrong medication to a patient and the patient vomits. This information is documented and reported to the physician and the nursing supervisor.

15. Which of the following signs and symptoms would the nurse expect to find when assessing an Asian patient for postoperative pain following abdominal surgery?

a. Decreased blood pressure and heart rate and shallow respirations
b. Quiet crying
c. Immobility, diaphoresis, and avoidance of deep breathing or coughing
d. Changing position every 2 hours

16. A patient is admitted to the hospital with complaints of nausea, vomiting, diarrhea, and severe abdominal pain. Which of the following would immediately alert the nurse that the patient has bleeding from the GI tract?

a. Complete blood count
b. Guaiac test
c. Vital signs
d. Abdominal girth

17. The correct sequence for assessing the abdomen is:

a. Tympanic percussion, measurement of abdominal girth, and inspection
b. Assessment for distention, tenderness, and discoloration around the umbilicus.
c. Percussions, palpation, and auscultation
d. Auscultation, percussion, and palpation

18. High-pitched gurgles head over the right lower quadrant are:

a. A sign of increased bowel motility
b. A sign of decreased bowel motility
c. Normal bowel sounds
d. A sign of abdominal cramping

19. A patient about to undergo abdominal inspection is best placed in which of the following positions?

a. Prone
b. Trendelenburg
c. Supine
d. Side-lying

20. For a rectal examination, the patient can be directed to assume which of the following positions?

a. Genupecterol
b. Sims
c. Horizontal recumbent
d. All of the above

21. During a Romberg test, the nurse asks the patient to assume which position?

a. Sitting
b. Standing
c. Genupectoral
d. Trendelenburg

22. If a patient’s blood pressure is 150/96, his pulse pressure is:

a. 54
b. 96
c. 150
d. 246

23. A patient is kept off food and fluids for 10 hours before surgery. His oral temperature at 8 a.m. is 99.8 F (37.7 C) This temperature reading probably indicates:

a. Infection
b. Hypothermia
c. Anxiety
d. Dehydration

24. Which of the following parameters should be checked when assessing respirations?

a. Rate
b. Rhythm
c. Symmetry
d. All of the above

25. A 38-year old patient’s vital signs at 8 a.m. are axillary temperature 99.6 F (37.6 C); pulse rate, 88; respiratory rate, 30. Which findings should be reported?

a. Respiratory rate only
b. Temperature only
c. Pulse rate and temperature
d. Temperature and respiratory rate

26. All of the following can cause tachycardia except:

a. Fever
b. Exercise
c. Sympathetic nervous system stimulation
d. Parasympathetic nervous system stimulation

27. Palpating the midclavicular line is the correct technique for assessing

a. Baseline vital signs
b. Systolic blood pressure
c. Respiratory rate
d. Apical pulse

28. The absence of which pulse may not be a significant finding when a patient is admitted to the hospital?

a. Apical
b. Radial
c. Pedal
d. Femoral

29. Which of the following patients is at greatest risk for developing pressure ulcers?

a. An alert, chronic arthritic patient treated with steroids and aspirin
b. An 88-year old incontinent patient with gastric cancer who is confined to his bed at home
c. An apathetic 63-year old COPD patient receiving nasal oxygen via cannula
d. A confused 78-year old patient with congestive heart failure (CHF) who requires assistance to get out of bed.

30. The physician orders the administration of high-humidity oxygen by face mask and placement of the patient in a high Fowler’s position. After assessing Mrs. Paul, the nurse writes the following nursing diagnosis: Impaired gas exchange related to increased secretions. Which of the following nursing interventions has the greatest potential for improving this situation?

a. Encourage the patient to increase her fluid intake to 200 ml every 2 hours
b. Place a humidifier in the patient’s room.
c. Continue administering oxygen by high humidity face mask
d. Perform chest physiotheraphy on a regular schedule

31. The most common deficiency seen in alcoholics is:

a. Thiamine
b. Riboflavin
c. Pyridoxine
d. Pantothenic acid

32. Which of the following statement is incorrect about a patient with dysphagia?

a. The patient will find pureed or soft foods, such as custards, easier to swallow than water
b. Fowler’s or semi Fowler’s position reduces the risk of aspiration during swallowing
c. The patient should always feed himself
d. The nurse should perform oral hygiene before assisting with feeding.

33. To assess the kidney function of a patient with an indwelling urinary (Foley) catheter, the nurse measures his hourly urine output. She should notify the physician if the urine output is:

a. Less than 30 ml/hour
b. 64 ml in 2 hours
c. 90 ml in 3 hours
d. 125 ml in 4 hours

34. Certain substances increase the amount of urine produced. These include:

a. Caffeine-containing drinks, such as coffee and cola.
b. Beets
c. Urinary analgesics
d. Kaolin with pectin (Kaopectate)

35. A male patient who had surgery 2 days ago for head and neck cancer is about to make his first attempt to ambulate outside his room. The nurse notes that he is steady on his feet and that his vision was unaffected by the surgery. Which of the following nursing interventions would be appropriate?

a. Encourage the patient to walk in the hall alone
b. Discourage the patient from walking in the hall for a few more days
c. Accompany the patient for his walk.
d. Consuit a physical therapist before allowing the patient to ambulate

36. A patient has exacerbation of chronic obstructive pulmonary disease (COPD) manifested by shortness of breath; orthopnea: thick, tenacious secretions; and a dry hacking cough. An appropriate nursing diagnosis would be:

a. Ineffective airway clearance related to thick, tenacious secretions.
b. Ineffective airway clearance related to dry, hacking cough.
c. Ineffective individual coping to COPD.
d. Pain related to immobilization of affected leg.

37. Mrs. Lim begins to cry as the nurse discusses hair loss. The best response would be:

a. “Don’t worry. It’s only temporary”
b. “Why are you crying? I didn’t get to the bad news yet”
c. “Your hair is really pretty”
d. “I know this will be difficult for you, but your hair will grow back after the completion of chemotheraphy”

38. An additional Vitamin C is required during all of the following periods except:

a. Infancy
b. Young adulthood
c. Childhood
d. Pregnancy

39. A prescribed amount of oxygen s needed for a patient with COPD to prevent:

a. Cardiac arrest related to increased partial pressure of carbon dioxide in arterial blood (PaCO2)
b. Circulatory overload due to hypervolemia
c. Respiratory excitement
d. Inhibition of the respiratory hypoxic stimulus

40. After 1 week of hospitalization, Mr. Gray develops hypokalemia. Which of the following is the most significant symptom of his disorder?

a. Lethargy
b. Increased pulse rate and blood pressure
c. Muscle weakness
d. Muscle irritability

41. Which of the following nursing interventions promotes patient safety?

a. Asses the patient’s ability to ambulate and transfer from a bed to a chair
b. Demonstrate the signal system to the patient
c. Check to see that the patient is wearing his identification band
d. All of the above

42. Studies have shown that about 40% of patients fall out of bed despite the use of side rails; this has led to which of the following conclusions?

a. Side rails are ineffective
b. Side rails should not be used
c. Side rails are a deterrent that prevent a patient from falling out of bed.
d. Side rails are a reminder to a patient not to get out of bed

43. Examples of patients suffering from impaired awareness include all of the following except:

a. A semiconscious or over fatigued patient
b. A disoriented or confused patient
c. A patient who cannot care for himself at home
d. A patient demonstrating symptoms of drugs or alcohol withdrawal

44. The most common injury among elderly persons is:

a. Atheroscleotic changes in the blood vessels
b. Increased incidence of gallbladder disease
c. Urinary Tract Infection
d. Hip fracture

45. The most common psychogenic disorder among elderly person is:

a. Depression
b. Sleep disturbances (such as bizarre dreams)
c. Inability to concentrate
d. Decreased appetite

46. Which of the following vascular system changes results from aging?

a. Increased peripheral resistance of the blood vessels
b. Decreased blood flow
c. Increased work load of the left ventricle
d. All of the above

47. Which of the following is the most common cause of dementia among elderly persons?

a. Parkinson’s disease
b. Multiple sclerosis
c. Amyotrophic lateral sclerosis (Lou Gerhig’s disease)
d. Alzheimer’s disease

48. The nurse’s most important legal responsibility after a patient’s death in a hospital is:

a. Obtaining a consent of an autopsy
b. Notifying the coroner or medical examiner
c. Labeling the corpse appropriately
d. Ensuring that the attending physician issues the death certification

49. Before rigor mortis occurs, the nurse is responsible for:

a. Providing a complete bath and dressing change
b. Placing one pillow under the body’s head and shoulders
c. Removing the body’s clothing and wrapping the body in a shroud
d. Allowing the body to relax normally

50. When a patient in the terminal stages of lung cancer begins to exhibit loss of consciousness, a major nursing priority is to:

a. Protect the patient from injury
b. Insert an airway
c. Elevate the head of the bed
d. Withdraw all pain medications