Priorities in Nursing Practice and Nursing Standards of Care

 Establishing Nursing Priorities

1. Prioritizing - decisions of which needs or problems require immediate attention or action and which ones could be delayed until a later time since they are not urgent.
2. Needs that are life-threatening or could result in harm to the client if left untreated are high priorities.
3. Actual problems or needs have higher priority than potential problems or needs.
4. Problems or needs identified by the client are of a higher priority.
5. Principles of Maslow's Hierarchy of Needs or the ABCs may guide decisions.
6. Mutual decision-making for priorities may be made with the client based on the client's needs, desires and safety.

NURSE PRACTICE ACTS

• Definition: passed by each state legislature to regulate the practice of nursing in that state
• Nurse Practice Acts define:
• Scope of Practice
• Education
• Licensure
• Professional Misconduct:
• Negligence
• The 'Impaired Nurse'
• The nurse who violates boundaries
• Administered by the Board of Nursing in each state:
• The nurse must know how their state defines professional misconduct
• For Professional Misconduct, the State Board of Nursing imposes penalties (in order of severity):
• On Probation
• Censured
• Reprimanded
• License Suspended
• License Revoked

STANDARDS OF NURSING PRACTICE AND STANDARD OF CARE

Nursing Charting and Documentation

 EFFECTIVE DOCUMENTATION

• Legal Guidelines for Charting
1. Record the facts legibly, in ink
2. Never erase, scratch out or apply correction fluid. Cross through an error once, date and initial the change.
3. Do not leave black spaces in your nursing notes.
4. Never chart for another person
5. Avoid interpreting patient statements. Record exactly what the patient said in quotation marks.
6. Correct all errors in a timely manner.
7. Chart in a timely manner.
• Computerized Charting
1. Never lend access your ID to another person.
2. Maintain confidentiality of documented information printed from the computer.

TYPES OF DOCUMENTATION

Valve Disorders

MITRAL STENOSIS

 Definition

• Mitral valve thickens and gets narrower, blocking blood flow fro. the left atrium to left ventricle

Physiology

• Function of the heart is the transport of oxygen, carbon dioxide, nutrients and waste products
• Cardiac cycle consists of:
• Systole - the phase of contraction during which the chambers eject blood
• Diastole - the phase of relaxation during which the chambers fill with blood. When heart pumps, myocardial layer contracts and relaxes.
• Blood flow:
1. Deoxygenated blood enters the right atrium through the superior and inferior vena cava
2. Enters the right ventricle via the tricuspid valve
3. Travels through the pulmonic valve to pulmonary arteries and lungs
4. Oxygenated blood returns from the lungs through the pulmonary veins into the left atrium and enters the left ventricle via the bicuspid (mitral) valve
5. From the left ventricle, through the aortic valve through the aorta to the systemic cicrculation
• The heart itself is supplied with blood by the left and right coronary arteries
• The vascular system is a continuous network of blood vessels
• the arterial system consists of arteries, arterioles and capillaries and delivers oxygenated blood to tissues
• Oxygen, nutrients and metabolic waste are exchanged at the cellular level
• The venous system, veins and venules, returns the blood to the heart

Heart Infections: Rheumatic Heart Diseases (Rheumatic Endocarditis)

 Definition and Related Terms

• Rheumatic Heart Disease - damage to the heart by one or more episodes of rheumatic fever. Pathogen is a group A streptococci.
• Rheumatic Endocarditis - damage to the heart, particularly the valves, resulting in valve leakage (regurgitation) and/or stenosis. To compensate, the heart's chambers enlarge and walls thicken.

Epidemiology

• Worldwide, 15-20 million new cases of rheumatic fever are reported each year
• Rheumatic Fever - follows a Group A streptococcal infection. We could prevent it by finding and treating streptococcal pharyngitis
• Where malnutrition and crowded living are common, rheumatic fever is most common in children between ages 5 and 15.
• Rheumatic Fever strikes most often during cool, damp weather. In the US, it is most common in the Northern States.
• It is unknown how and why group A streptococcal infections cause the lesions called Aschoff bodies
• Damage depends on site of infection: most often the mitral valve in females and the aortic valve in males
• Malfunction of these valves leads to severe pericarditis, and sometimes pericardial effusion and fatal heart failure. Of those who survive this complication, about 20% die within ten (10) years.

Heart Infections: Endocarditis

 Definition and Related Terms

• An infection of the endocardium, heart valves,  or cardiac prosthesis resulting from bacterial or fungal invasion
• Endocarditis can be classified as:

1. Native valve endocarditis
2. Endocarditis in IV drug users
3. Prosthetic valve endocarditis

Epidemiology

• With proper treatment, about 70% of clients recover
• The prognosis is worse when endocarditis damages valve severely or involves a prosthetic valve
• Infective endocarditis occurs in 50-60% of clients with previous valvular disorders
• Systemic Lupus Erythematosus (SLE) often leads to nonbacterial endocarditis
• In 12-35% of clients, with subacute endocarditis, lesions produce clots that show the findings of splenic, renal, cerebral or pulmonary infarction, or peripheral vascular occlusion

Heart Infections: Myocarditis

Myocarditis

• an inflammatory condition of the myocardium that may be caused by
• viral infection
• bacterial infection
• fungal infection
• serum sickness
• rheumatic fever
• chemical agent
• as a complication of collagen disease (Systemic Lupus Erythematosus)

Epidemiology

• may be acute or chronic and may occur at any age
• usually an acute virus and self-limited, but it may lead to acute heart failure

Findings

• depends on the type of infection, degree of myocardial damage, capacity of myocardium to recover, and host resistance
• may be minor or unnoticed - fatigue and dyspnea, palpitations, occasional precordial discomfort manifestations such as mild chest soreness and persistent fever
• recent upper respiration with fever, viral pharyngitis or tonsillitis
• cardiac enlargement
• abnormal heart sounds - murmur, S3 or S4 or friction rub

Levine's Grading of Heart Murmurs

Vitamin D and COVID New Studies - Evidence for a Protective Role of Vitamin D in COVID

I can always hear radio advertisements regarding Vitamin D3 supplementation in preventing diseases especially COVID patients. In fact, I have one patient before who had been prescribed by another doctor of Vitamin D3. I have come upon a good video in you tube wherein it discusses the merit of using vitamin D3 supplementation as a treatment for COVID and cites good, credible clinical trials and medical studies about it. (I will link the said youtube video below:)

VITAMIN D AND COVID NEW STUDIES - EVIDENCE FOR A PROTECTIVE ROLE OF VITAMIN D IN COVID BY DR. MIKE HANSEN

So regarding Vitamin D supplementation: according to studies, vitamin D insufficiency MAY INCREASE THE RISK of COVID and Covid complications BUT vitamin D supplementation IS ONLY VALUABLE TO THOSE WHO ARE VITAMIN D DEFICIENT. Meaning Vitamin D supplementation for those who are Not Vitamin D Deficient may not be of great value.

H.A.B.I.T.s to Break to Build a Better YOU

Health Hints by Alexandra Nicole Torres (HealthCare Magazine)

PhotoCredit: Dreamstime.com

Breaking free from an unhealthy routine to build a good one requires time, patience and commitment - it's a process. Let's face it, we all have our guilty pleasures that are really difficult to depart from.

To Guide us on our Journey, let's remember the acronym H-A-B-I-T:

1. (H)AVE A GOAL. In order for you to be successful, you must learn to KNOW WHAT YOU WANT. The key to building a solid plan is knowing yourself and knowing what you really want to do and what you want to achieve.

Alternative Ways of Continuing Professional Development (CPD) Compliance during the COVID-19 Pandemic

Abolish CPD Call of Certain Sectors of Society

About 4 years after the Republic Act 10912 or the "Continuing Professional Development (CPD) Act" became law, the presidential son, Rep. Paolo Duterte recently said that he will be proposing a bill to repeal the law authored by former Senator Antonio Trillanes, IV. 

He also emphasized that he will personally work with his colleagues in the House of Representatives, the senators in the Senate and with President Rodrigo Duterte to advocate for the abolition of the said law. He cites the undue burden that the law has imposed to hard working and selfless professionals especially during the COVID-19 Pandemic. 

It is noted that the said law has mandated that professionals has to comply with prescribed number of CPD units of their profession before they will be allowed to renew their Professional Identification Card (PIC) with the Professional Regulations Commission.

UPDATE on COVID-19 Vaccine Development

With the advent of fast-paced technology and media reports, we can surmise that with the COVID-19 pandemic, the development of a vaccine can also be at a record speed but reading an article by Dr. Sanjay Gupta at CNN, this reality is grim so far regarding COVID-19 Vaccine Development.

1 Revealing Point: According to the Milken Institute, although there are 254 treatments and 172 vaccines currently in development to fight COVID-19, so far, there is only 1 PUBLISHED STUDY of a vaccine which is trialed in Humans. Other vaccines/treatment in development are either press-releases or pre-print reports.

Photo Credit: European Pharmaceutical Review

For those who have no idea on the significance of a Published Study on vaccine development or any other thing basically is this - published studies are subjected to peer review, which by essence brings down the expertise of most if not all of the science disciplines to screen this studies and POINT SOME POTENTIAL ERRORS of the study that may be unintentional and also makes the study and eventually the science or the vaccine BETTER.

No Approved Therapeutic Claim/Use!

I had always wanted to talk about this with my patients but I have not had the time to sufficiently discuss this.

As a medical doctor I cannot and will not endorse any product which has a 'No Therapeutic Use' on its label. I am for any thing herbal and natural but it does not mean that I will disregard the safety of my patients.

I have a professor in Medschool that is an advocate of herbal medicine but she is also a medical doctor. And so, while advocating for herbal medicine, she tediously explained the process and the science of preparing an herbal medicine, and so let's take some important points about it:

• Herbal medicine preparations should be an exact ....science. This simply means that exact measurements should be used. Meaning if you prepare (let's take for an example Sambong leaves) leaves, and you are instructed to take 5 leaves. You should take leaves with proportionally same size with each other. There are some preparations that prescribes the exact size of the leaves like for example (I am only hypothesizing here) Sambong leaves should have 1-inches leaves while recommendations for Malunggay leaves is only 1-cm leaves. AND there are different preparations for barks, roots, fruits, etc.
• Even the procedures in preparations should be exact. As my mentor explained, preparing a decoction is also exact meaning a certain decoction is prescribed with a 1 cup water while others are prescribed with a 1 glass water (yes a cup is different from a glass!). If you boil a decoction for 30 minutes and you start the time from the moment you pour the water into the pot, it may be a whole lot different if you start the 30-minute time on the moment that the water boils. Plus there's a difference if the instruction is like 'You boil the leaves with 2 cups water until the point that the water remaining is only 1 cup.'
• The time of the day when you pick up a leaf/root/bark matters. We had been advised that the perfect time to pick leaves is in the morning just before the sun rises as the leaves has the perfect consistency to it.

Common Lab Tests for Cardiovascular Disorders

1. Serum chemistry
2. Serum Electrolytes
3. Alanine Aminotransferases (AST) 
4. Creatine Kinase (CK)
5. CK-MB (isoenzyme)
6. Lactic Dehydrogenase
7. Complete Blood Count
8. Lipid Levels
9. Prothrombin Time
10. Alkaline Phosphatase
11. ESR
12. Arterial Blood Gases
13. Troponin

Normal Growth and Development: Infancy

An infant is a baby who is 1 month to 1 year old. Most infants will learn to walk, talk, eat, and interact with others within the same general time frame. This is called normal growth and development.

Infants grow faster while he is in infancy than at any other time in his life. Caregivers will keep a record of his growth. They will write down the following changes each time you bring him in for a checkup:

• Weight: Infants double their birth weight by the time they are 6 months old. They will triple their birth weight by the time they're 1 year old. They will gain about 1 to 2 pounds per month. They will weigh close to 22 pounds by 1 year old. By 2 months, infants may look chubby. Their muscles will get stronger the more they learn to use his legs and arms.
• Length: Infants grow about 1 inch per month for the first 6 months of life. They will grow 1/2 inch per month between 6 months and 1 year of age. They should be 2 times longer than their birth length by the time they are 10 to 12 months old. Most of their growth happen in their trunk (mid section).

Jean Piaget's Cognitive Development Theory

Jean Piaget’s prominent work is his Theory on the four stages of cognitive development. 

He was one of the most influential researchers in the area of developmental psychology in the 20th century whose primary interest was in biological influences on how we come to know, and the developmental stages we move through as we acquire this ability (Singer & Revenson, 1997).

Piaget (1973) believed that the child plays an active role in the growth of intelligence and learns by doing. He regarded the child as a philosopher who perceives the world only as he has experienced it. 

Therefore, most of Piaget’s inspiration in cognitive and intellectual development came from observations of children. In fact, Piaget observed and studied his own three children through each stage of their cognitive development.

The Theory of Cognitive Development focuses on mental processes such as perceiving, remembering, believing, and reasoning. Reasoning is the essence of intelligence, and reasoning is what Piaget studied in order to discover “how we come to know” (Singer & Revenson, 1997). Piaget believed that cognitive development is cumulative; that is, understanding a new experience grows out of a previous learning experience.

Erick Erikson's Theory of Psychosocial Development

Erik Erikson's theory of psychosocial development is one of the best-known theories of personality. Much like Sigmund Freud, Erikson believed that personality develops in a series of stages. Unlike Freud's theory of psychosexual stages, Erikson's theory describes the impact of social experience across the whole lifespan.

One of the main elements of Erikson's psychosocial stage theory is the development of ego identity. Ego identity is the conscious sense of self that we develop through social interaction. According to Erikson, our ego identity is constantly changing due to new experiences and information we acquire in our daily interactions with others.


Identity refers to all of the beliefs, ideals, and values that help shape and guide a person's behavior. The formation of identity is something that begins in childhood and becomes particularly important during adolescence, but it is a process that continues throughout life. Our personal identity gives each of us an integrated and cohesive sense of self that endures and continues to grow as we age.

PRC Online Application System

How to Apply using the Professional Regulation Commission Online Application System

Requirements for the NLE

Kohlberg's Theory of Moral Development

Moral development is a major topic of interest in both psychology and education. One of the best known theories was developed by psychologist Lawrence Kohlberg who modified and expanded upon Jean Piaget's work to form a theory that explained the development of moral reasoning.

Piaget described a two-stage process of moral development, while Kohlberg's theory of moral development outlined six stages within three different levels. Kohlberg extended Piaget's theory, proposing that moral development is a continual process that occurs throughout the lifespan.

Normal Growth and Development

PhotoCredit: Child-Development-Guide.Com

Patterns of Growth and Development

• Cephalocaudal - head to toe
• Proximodistal - near to far
• Differentiation - from simple to complex

Growth Measures

• Height
• Weight
• Frontal-Occipital Circumference

Environmental Sanitation

ENVIRONMENTAL SANITATION: 

• defined as the study of all factors in man's physical environment, which may exercise a deleterious effect on his health, well-being and survival
• Included are:
• Water sanitation
• Food sanitation
• Refuse and garbage disposal
• Excreta disposal
• Insect vector and rodent control
• Housing
• Air pollution
• Noise
• Radiological protection
• Institutional sanitation
• Stream pollution

MAJOR ENVIRONMENTAL HEALTH AND SANITATION PROGRAM