Note: Pls Download Utorrent
-Lippincott's 3500 (NCLEX)
http://isohunt.com/download/32434852/nclex.torrent
-Saunders Comprehensive Review for NCLEX-RN
http://isohunt.com/download/39987650/nclex.torrent
-NCLEX Test Bank
http://isohunt.com/download/31508700/nursing.torrent
-Orthopedic Nursing
http://isohunt.com/download/24050675/nursing.torrent
-Lippincott Manual of Nursing Practice
http://isohunt.com/download/44372793/nursing.torrent
That's for now... Take Care
Friday, July 4, 2008
Saturday, February 9, 2008
One in a million: patient survives late-stage rabies infection
Science News, Jan 29, 2005 by Nathan Seppa
A 15-year-old girl has become the sixth person in medical history to live through an advanced case of rabies and the first one to do so without receiving the rabies vaccine. She received a novel therapy, and scientists are now considering whether it was the key to her recovery. When Jeanna Giese of Fond du Lac, Wis., was admitted to Children's Hospital of Wisconsin in Milwaukee last October, she was lethargic and had experienced several days of double vision, fatigue, nausea, and some numbness. Her prospects were bleak because a month earlier, a bat had bitten her, says pediatrician Rodney E. Willoughby, who has treated Giese ever since she arrived at the hospital.
Like most physicians, Willoughby had never seen anyone with rabies that had progressed to symptoms. The rabies vaccine cures most people bitten by a rabid animal in developed countries, but if a rabies exposure goes untreated, the patient almost always dies within days of the appearance of symptoms.
Somehow, Giese pulled through. She's still weak and barely able to walk but is back home undergoing physical therapy. While Giese was in the hospital, Willoughby and other physicians designed a bold new treatment for her. But even they can't say whether their approach cured her, or whether some resilience on the girl's part or some characteristic of the rabies virus that infected her permitted her to recover.
"There are years of work, potentiality, in trying to answer some of these questions," says Charles Rupprecht, chief of the Rabies Section at the Centers for Disease Control and Prevention (CDC) in Atlanta, who collaborated with Willoughby and others on the case. Their success could rekindle experimentation on animals for developing new rabies treatments. Meanwhile, Rupprecht says, the response from the scientific community has been a mix of admiration, disbelief, and a "wait-and-see attitude." After all, he notes, "this is a sample size of one--over 4,000 years."
SLOWING THE BRAIN Giese's harrowing journey began in a church. She scooped up a fallen bat and then released it outside. As she did, the bat bit her finger. Thinking it was a scratch, she simply washed out the tiny wound with hydrogen peroxide.
A month later, her symptoms appeared. The bat bite made Willoughby guess rabies. He sent samples of Giese's blood, spinal fluid, saliva, and skin to CDC, where tests confirmed his suspicion.
With consent from Giese's parents and federal regulatory officials, Willoughby and a team of other doctors settled on a radical strategy that included experimental drugs and an induced coma. They didn't administer the rabies vaccine or antibodies to rabies virus because Giese had already started making antibodies to it. Furthermore, other patients hadn't benefited from such late vaccinations.
Rabies patients can die in many ways that show no pattern, says Willoughby, who is affiliated with the Medical College of Wisconsin in Milwaukee. These include sudden heart stoppages, strokes, and respiratory failures. Willoughby and his colleagues suspected that the brains of rabies patients send out signals that sabotage vital organs.
So, the team elected to slow the girl's brain activity using an anesthetic and drugs that inhibit the effect of glutamate, a chemical carrier of brain signals that causes problems when it's overabundant, as in patients with head injuries and a variety of brain disorders. The doctors also administered antiviral medication and put Giese on a breathing machine.
Some of this strategy is outlined in the Dec. 24, 2004 Morbidity and Mortality Weekly Report. The team plans to release more details later this year.
Willoughby says that a major element of this strategy was to buy time for Giese's immune system to eradicate the virus. In theory, shutting down her brain wouldn't hinder her immune response.
Her time in a coma was surprisingly uneventful. "She was supposed to try to die in lots of ways," Willoughby says. "We actually had a list taped to her chart. We had a game plan for every possibility."
Instead, Giese made abundant antibodies against rabies virus, and after just a week in a coma, she no longer showed any sign of infection. It was time to wake her up.
The first day out of the coma, Giese had normal vital signs but appeared lifeless. The next day, her knee reflexes came back. "Every day, it was like she was bringing us a new present; it was like Hanukkah," Willoughby says. Giese became fully conscious before she could speak, so she started using sign language, a skill she had learned in Girl Scouts, Willoughby says.
Giese spent more than 10 weeks in the hospital and was discharged Jan. 1. She's still steadily regaining her strength and mental faculties, Willoughby says.
Giese's recovery is unique, says neurologist Alan C. Jackson of Queen's University in Kingston, Ont. All five previous survivors of symptomatic rabies had received incomplete vaccination courses before their symptoms set in. And even then, only one of those people recovered without brain damage.
Jackson doubts that the coma was the key to success. "It's more likely that one of the drugs inducing the coma may have had antiviral actions," he surmises.
James J. Kazmierczak, Wisconsin's state public health veterinarian, is reserving judgment. He says that Giese's recovery might be fortuitous and that the novel treatment won't gain credence until it's replicated in another rabies patient. Meanwhile, he says, "we don't want people to think that rabies is now some sort of curable disease."
COPYRIGHT 2005 Science Service, Inc.
COPYRIGHT 2005 Gale Group
Source. here
When I first read this article for my reading assignment (2005 IMCI rotation, I got 90+ rating) I could not believe that someone has survived rabies. Everyone who read the article can not believe what they are reading. It sounds like fiction but its true. I can just imagine the things told in the news. She is so lucky. We nurses know that once a person exhibits the symptoms, sooner or later that person will die.
Jeanna Giesse
Journal Sentinel
USA Today
FOX News
New York Times
A 15-year-old girl has become the sixth person in medical history to live through an advanced case of rabies and the first one to do so without receiving the rabies vaccine. She received a novel therapy, and scientists are now considering whether it was the key to her recovery. When Jeanna Giese of Fond du Lac, Wis., was admitted to Children's Hospital of Wisconsin in Milwaukee last October, she was lethargic and had experienced several days of double vision, fatigue, nausea, and some numbness. Her prospects were bleak because a month earlier, a bat had bitten her, says pediatrician Rodney E. Willoughby, who has treated Giese ever since she arrived at the hospital.
Like most physicians, Willoughby had never seen anyone with rabies that had progressed to symptoms. The rabies vaccine cures most people bitten by a rabid animal in developed countries, but if a rabies exposure goes untreated, the patient almost always dies within days of the appearance of symptoms.
Somehow, Giese pulled through. She's still weak and barely able to walk but is back home undergoing physical therapy. While Giese was in the hospital, Willoughby and other physicians designed a bold new treatment for her. But even they can't say whether their approach cured her, or whether some resilience on the girl's part or some characteristic of the rabies virus that infected her permitted her to recover.
"There are years of work, potentiality, in trying to answer some of these questions," says Charles Rupprecht, chief of the Rabies Section at the Centers for Disease Control and Prevention (CDC) in Atlanta, who collaborated with Willoughby and others on the case. Their success could rekindle experimentation on animals for developing new rabies treatments. Meanwhile, Rupprecht says, the response from the scientific community has been a mix of admiration, disbelief, and a "wait-and-see attitude." After all, he notes, "this is a sample size of one--over 4,000 years."
SLOWING THE BRAIN Giese's harrowing journey began in a church. She scooped up a fallen bat and then released it outside. As she did, the bat bit her finger. Thinking it was a scratch, she simply washed out the tiny wound with hydrogen peroxide.
A month later, her symptoms appeared. The bat bite made Willoughby guess rabies. He sent samples of Giese's blood, spinal fluid, saliva, and skin to CDC, where tests confirmed his suspicion.
With consent from Giese's parents and federal regulatory officials, Willoughby and a team of other doctors settled on a radical strategy that included experimental drugs and an induced coma. They didn't administer the rabies vaccine or antibodies to rabies virus because Giese had already started making antibodies to it. Furthermore, other patients hadn't benefited from such late vaccinations.
Rabies patients can die in many ways that show no pattern, says Willoughby, who is affiliated with the Medical College of Wisconsin in Milwaukee. These include sudden heart stoppages, strokes, and respiratory failures. Willoughby and his colleagues suspected that the brains of rabies patients send out signals that sabotage vital organs.
So, the team elected to slow the girl's brain activity using an anesthetic and drugs that inhibit the effect of glutamate, a chemical carrier of brain signals that causes problems when it's overabundant, as in patients with head injuries and a variety of brain disorders. The doctors also administered antiviral medication and put Giese on a breathing machine.
Some of this strategy is outlined in the Dec. 24, 2004 Morbidity and Mortality Weekly Report. The team plans to release more details later this year.
Willoughby says that a major element of this strategy was to buy time for Giese's immune system to eradicate the virus. In theory, shutting down her brain wouldn't hinder her immune response.
Her time in a coma was surprisingly uneventful. "She was supposed to try to die in lots of ways," Willoughby says. "We actually had a list taped to her chart. We had a game plan for every possibility."
Instead, Giese made abundant antibodies against rabies virus, and after just a week in a coma, she no longer showed any sign of infection. It was time to wake her up.
The first day out of the coma, Giese had normal vital signs but appeared lifeless. The next day, her knee reflexes came back. "Every day, it was like she was bringing us a new present; it was like Hanukkah," Willoughby says. Giese became fully conscious before she could speak, so she started using sign language, a skill she had learned in Girl Scouts, Willoughby says.
Giese spent more than 10 weeks in the hospital and was discharged Jan. 1. She's still steadily regaining her strength and mental faculties, Willoughby says.
Giese's recovery is unique, says neurologist Alan C. Jackson of Queen's University in Kingston, Ont. All five previous survivors of symptomatic rabies had received incomplete vaccination courses before their symptoms set in. And even then, only one of those people recovered without brain damage.
Jackson doubts that the coma was the key to success. "It's more likely that one of the drugs inducing the coma may have had antiviral actions," he surmises.
James J. Kazmierczak, Wisconsin's state public health veterinarian, is reserving judgment. He says that Giese's recovery might be fortuitous and that the novel treatment won't gain credence until it's replicated in another rabies patient. Meanwhile, he says, "we don't want people to think that rabies is now some sort of curable disease."
COPYRIGHT 2005 Science Service, Inc.
COPYRIGHT 2005 Gale Group
Source. here
When I first read this article for my reading assignment (2005 IMCI rotation, I got 90+ rating) I could not believe that someone has survived rabies. Everyone who read the article can not believe what they are reading. It sounds like fiction but its true. I can just imagine the things told in the news. She is so lucky. We nurses know that once a person exhibits the symptoms, sooner or later that person will die.
Jeanna Giesse
Journal Sentinel
USA Today
FOX News
New York Times
Nursing Care Plan (NCP) Books
NCPs are part and parcel of nursing.
I highly recommend these books which I used extensively when I was still studying.
I presume that the books I listed are readily available in your school library.
If not, GO ASK THEM TO BUY!
This is a random list or books that I remembered to be using.
-Nurse’s Pocket Guide by Doenges, et al (I have this one, very handy. However, most interventions lack rationale)
-Nursing Care Plans by Doenges, et la
-Maternal/Newborn Care Plans by Doenges, et la
-Nursing Diagnosis Manual by Doenges, et la
-Psychiatric Care Plans by Townsend & Doenges
-Nursing Care Plans by Gulanick & Myers (Very clear, extensive)
-Delmar's Pediatric Nursing Care Plans by Karla Luxner
Online NCP Constructor by Elsevier. Very useful. Promise. HERE.
If you are very resourceful, you can also use your medical-surgical books.
I highly recommend these books which I used extensively when I was still studying.
I presume that the books I listed are readily available in your school library.
If not, GO ASK THEM TO BUY!
This is a random list or books that I remembered to be using.
-Nurse’s Pocket Guide by Doenges, et al (I have this one, very handy. However, most interventions lack rationale)
-Nursing Care Plans by Doenges, et la
-Maternal/Newborn Care Plans by Doenges, et la
-Nursing Diagnosis Manual by Doenges, et la
-Psychiatric Care Plans by Townsend & Doenges
-Nursing Care Plans by Gulanick & Myers (Very clear, extensive)
-Delmar's Pediatric Nursing Care Plans by Karla Luxner
Online NCP Constructor by Elsevier. Very useful. Promise. HERE.
If you are very resourceful, you can also use your medical-surgical books.
NCP: Diarrhea, Amoebic Dysentery
Amoebic Dysentery
Need
ELIMINATION PATTERN
Nursing Diagnosis
Diarrhea related to infectious process.
Rationale:
Diarrhea may result from a variety of factors, including intestinal absorption disorders, increased secretion of fluid by the intestinal mucosa, and hypermotility of the intestine. Problems associated with diarrhea, which may be acute or chronic, include fluid and electrolyte imbalance and altered skin integrity. Diarrhea may result from infectious processes or increased intestinal motility such as with irritable bowel disease. Treatment is based on addressing the cause of the diarrhea, replacing fluids and electrolytes, providing nutrition, and maintaining skin integrity.
Source:
http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor/index.cfm?plan=16
Objective of Care
Within my 8 hours of care my patient will be manifest the the following:
a. formed stool;
b. maintain good skin turgor and moist mucous membranes.
Nursing Interventions
1. Assess hydration status.
® Diarrhea can lead to profound dehydration and electrolyte imbalance.
2. Assess for temperature elevation, irritability, vomiting.
® Provides information about signs and symptoms associated with diarrhea.
3. Assess condition of perianal skin.
® Diarrheal stools may be highly corrosive, as a result of increased enzyme content.
4. Assess for fluid loss (dry skin and mucous memebranes, poor turgor).
® Indicates possible dehydration.
5. Encourage fluids.
® Fluids compensate for malabsorption and loss of nutrients.
6. Encourage to eat fiber-rich foods.
® To form consistency of stool.
7. Change diaper frequently as needed and wash area with warm water.
® Protects skin from excretions and secretions that are irritating that can cause skin breakdown.
8. Monitor intake and output.
® To assess for possible dehydration.
9. Avoidance of stimulants (e.g., caffeine, carbonated beverages).
® Stimulants may increase GI motility and worsen diarrhea.
10. Give antidiarrheal drugs as ordered.
® Most antidiarrheal drugs suppress GI motility, thus allowing for more fluid absorption.
11. Discuss proper food handling including proper handwashing
® Prevents transmission or spread of microorganisms to others and contamination of food.
Luxner, Karla, RNC, ND (2005). Delmar's Pediatric Nursing Care Plans 3rd ed.
Thomson Delmar Learning, Clifton Park, New York, USA. p. 136-137
Need
ELIMINATION PATTERN
Nursing Diagnosis
Diarrhea related to infectious process.
Rationale:
Diarrhea may result from a variety of factors, including intestinal absorption disorders, increased secretion of fluid by the intestinal mucosa, and hypermotility of the intestine. Problems associated with diarrhea, which may be acute or chronic, include fluid and electrolyte imbalance and altered skin integrity. Diarrhea may result from infectious processes or increased intestinal motility such as with irritable bowel disease. Treatment is based on addressing the cause of the diarrhea, replacing fluids and electrolytes, providing nutrition, and maintaining skin integrity.
Source:
http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor/index.cfm?plan=16
Objective of Care
Within my 8 hours of care my patient will be manifest the the following:
a. formed stool;
b. maintain good skin turgor and moist mucous membranes.
Nursing Interventions
1. Assess hydration status.
® Diarrhea can lead to profound dehydration and electrolyte imbalance.
2. Assess for temperature elevation, irritability, vomiting.
® Provides information about signs and symptoms associated with diarrhea.
3. Assess condition of perianal skin.
® Diarrheal stools may be highly corrosive, as a result of increased enzyme content.
4. Assess for fluid loss (dry skin and mucous memebranes, poor turgor).
® Indicates possible dehydration.
5. Encourage fluids.
® Fluids compensate for malabsorption and loss of nutrients.
6. Encourage to eat fiber-rich foods.
® To form consistency of stool.
7. Change diaper frequently as needed and wash area with warm water.
® Protects skin from excretions and secretions that are irritating that can cause skin breakdown.
8. Monitor intake and output.
® To assess for possible dehydration.
9. Avoidance of stimulants (e.g., caffeine, carbonated beverages).
® Stimulants may increase GI motility and worsen diarrhea.
10. Give antidiarrheal drugs as ordered.
® Most antidiarrheal drugs suppress GI motility, thus allowing for more fluid absorption.
11. Discuss proper food handling including proper handwashing
® Prevents transmission or spread of microorganisms to others and contamination of food.
Luxner, Karla, RNC, ND (2005). Delmar's Pediatric Nursing Care Plans 3rd ed.
Thomson Delmar Learning, Clifton Park, New York, USA. p. 136-137
NCP: Ineffective Cerebral Tissue Perfusion, Cerebro-vascular Accident (CVA)
Cerebro-vascular Accident (CVA)
Need
ACTIVITY-EXERCISE PATTERN
Nursing Diagnosis
Ineffective cerebral tissue perfusion related to cerebral bleeding secondary to CVA bleed (120cc)
Rationale:
- Cerebrovascular disease refers to any functional or structural abnormality of the brain caused by a pathological condition of the cerebral vessels or of the entire cerebrovascular system. This pathology either causes hemorrhage from a tear in the vessel wall or impairs the cerebral circulation by a partial or complete occlusion of the vessel lumen with transient or permanent effects. Hemorrhagic CVA is caused by other conditions such as a ruptured aneurysm, hypertension or other bleeding disorders.
Source:
Doenges, Marilynn, RN, et al. Nursing Care Plans 6th ed. F. A. Davis Company, Philadelphia, PA, USA. 2002
Objective of Care
Within my 8 hours span of care my patient will be able to have effective cerebral tissue perfusion as evidenced by:
a. improved level of consciousness;
b. stable vital signs.
Nursing Interventions
1. Assess vital signs. Get baseline parameters
® This help deterioration of the patients condition. It gives the opportunity to track changes.
2. Assess oxygenation.
® Oxygenation affects cerebral functioning.
3. Monitor neurological status frequently and compare with baseline.
4. Assess drainage of post operative site.
® Congestion can aggravate increase pressure.
® Assesses trends in the level of consciousness and potential for increased ICP.
5. Evaluate papillary reaction.
® Pupil reactions are regulated by the oculomotor cranial nerve and are useful in determining whether the brainstem is intact.
6. Assess skin color and temperature.
® Cold, clammy skin is secondary to compensatory increase in sympathetic nervous system stimulation and low cardiac output and desaturation.
7.Position head slightly elevated and in neutral position.
® Reduces arterial pressure by promoting venous drainage and may improve cerebral perfusion.
8. Provide quite, restful environment.
® Continual stimulation can increase ICP. Prevent rebleeding in the case of hemorrhage.
9. Provide passive ROM.
® Promotes collateral circulation.
10. Administer supplemental oxygen.
® Reduces hypoxemia, which can cause cerebral vasodilation and increase pressure/ edema formation.
11. Administer medications as indicated.
® Provides pharmacological for the condition.
Doenges, Marilynn, RN., et al (2004). Nurse’s Pocket Guide 9th ed. F.A. Davis Company, Philadelphia, PA, USA
Need
ACTIVITY-EXERCISE PATTERN
Nursing Diagnosis
Ineffective cerebral tissue perfusion related to cerebral bleeding secondary to CVA bleed (120cc)
Rationale:
- Cerebrovascular disease refers to any functional or structural abnormality of the brain caused by a pathological condition of the cerebral vessels or of the entire cerebrovascular system. This pathology either causes hemorrhage from a tear in the vessel wall or impairs the cerebral circulation by a partial or complete occlusion of the vessel lumen with transient or permanent effects. Hemorrhagic CVA is caused by other conditions such as a ruptured aneurysm, hypertension or other bleeding disorders.
Source:
Doenges, Marilynn, RN, et al. Nursing Care Plans 6th ed. F. A. Davis Company, Philadelphia, PA, USA. 2002
Objective of Care
Within my 8 hours span of care my patient will be able to have effective cerebral tissue perfusion as evidenced by:
a. improved level of consciousness;
b. stable vital signs.
Nursing Interventions
1. Assess vital signs. Get baseline parameters
® This help deterioration of the patients condition. It gives the opportunity to track changes.
2. Assess oxygenation.
® Oxygenation affects cerebral functioning.
3. Monitor neurological status frequently and compare with baseline.
4. Assess drainage of post operative site.
® Congestion can aggravate increase pressure.
® Assesses trends in the level of consciousness and potential for increased ICP.
5. Evaluate papillary reaction.
® Pupil reactions are regulated by the oculomotor cranial nerve and are useful in determining whether the brainstem is intact.
6. Assess skin color and temperature.
® Cold, clammy skin is secondary to compensatory increase in sympathetic nervous system stimulation and low cardiac output and desaturation.
7.Position head slightly elevated and in neutral position.
® Reduces arterial pressure by promoting venous drainage and may improve cerebral perfusion.
8. Provide quite, restful environment.
® Continual stimulation can increase ICP. Prevent rebleeding in the case of hemorrhage.
9. Provide passive ROM.
® Promotes collateral circulation.
10. Administer supplemental oxygen.
® Reduces hypoxemia, which can cause cerebral vasodilation and increase pressure/ edema formation.
11. Administer medications as indicated.
® Provides pharmacological for the condition.
Doenges, Marilynn, RN., et al (2004). Nurse’s Pocket Guide 9th ed. F.A. Davis Company, Philadelphia, PA, USA
Saturday, February 2, 2008
The Independent, UK: Western demand drains Philippines of 85 per cent of its trained nurses
Western demand drains Philippines of 85 per cent of its trained nurses
"I'm married with two kids and I want a better future for them. I want to be able to save and hope they will follow on," said Allan Famatid, who is seeking work at an employment agency in the central Philippines city of Iloilo, a bustling urban centre where many of the country's top training facilities for the caring profession are located.
The nursing schools in places like Iloilo fill a growing need for health professionals among the greying populations of the rich countries in the West; the UK and other European countries are expected to need 50,000 nurses a year based on current rates of ageing and dependency ratios.
The Philippines Health Secretary, Francisco Duque, has estimated that 85 per cent of the country's nurses have left the country. Many graduates are retraining so they can join the exodus .
Alan Famatid, a 28-year-old management graduate, is now training as a nurse because he believes it will give him a better chance of finding work in hospitals in the West. People are the Philippines' biggest export – nine million of the country's 82 million people live outside the country and send home £500m a month in remittances through the banking system, making up about 12 per cent of the Philippines' gross domestic product.
"Working as a nurse gives you the chance of earning a higher salary in places such as London," said Neal Ganchero, 32, who has nursed in Kuwait and Saudi Arabia, which still takes the bulk of Filipino migrant nurses.
Even qualified doctors are retraining as nurses because they can earn much more working in foreign hospitals. The exodus has become so huge that the World Health Organisation is concerned about the effect it is having on the Philippines' health system.
The shortage of doctors and other medical staff is most acute in rural areas, as most of the city hospitals can always find trainees to do the work.
Iloilo's deputy mayor, Jed Mabilog, said the Philippines' high birth rate makes it possible to train so many skilled workers, combined with the widespread use of English. "Of course it's sad for us because we lose a lot of good nurses and specialist labour but we have a lot of people. There is a brain drain but we continually produce people who can replicate the skills [we need]," he said.
The WHO country representative, Jean Marc Olive, believes that the exodus of nurses will continue until 2015, with annual demand for medical workers in the United States and Europe estimated to be about 800,000.
The talk among the 3,000 nursing students on campus at the Central Philippine University is about where the latest openings are – with the UK back on the wish list. Florevy Diana, 18, a first-year student, said that when she graduates she would like to work in London where her aunt has worked for 10 years.
Another student, Jay Martin Diaz, 18, has a sister in London, but says he would rather go to the US: "Most people want to go to the US, where they earn more money. But the agencies will tell us about what is open and inform us. Wherever we go, it is important there is a Filipino community to help us adjust."
The Filipino desire to help their families is the driving force behind a willingness to travel and work abroad, often alone and for many years. Migrants from the Philippines first started moving to Britain in 1971 as student nurses, but their entry was barred in the 1980s. In the late 1990s, a chronic shortage of nurses meant opportunites became available again with up to 40,000 finding work in Britain.
Despite the chronic shortage of nurses in the NHS, priority in recent years has been given to labour from eastern Europe. The Home Office removed general nurses from the occupations shortage list in April 2006, making it harder for Filipino nurses to move to Britain. But with a new points system being introduced on 1 March favouring highly skilled workers, nursesin Iloilo are hopeful that jobs in Britain will become available again.
"The new points system will benefit Filipino nurses if, and only if, their level of high education and years of experience are considered," said Michael Duque, president of the UK Philippine Nurses Association. "Remember that most Filipino nurses have a BSc in nursing with at least three to five years of actual clinical experience after graduation. Also a good percentage of Filipino nurses have some level of masters education,"
The Independent, UK
Friday, 25 January 2008
"I'm married with two kids and I want a better future for them. I want to be able to save and hope they will follow on," said Allan Famatid, who is seeking work at an employment agency in the central Philippines city of Iloilo, a bustling urban centre where many of the country's top training facilities for the caring profession are located.
The nursing schools in places like Iloilo fill a growing need for health professionals among the greying populations of the rich countries in the West; the UK and other European countries are expected to need 50,000 nurses a year based on current rates of ageing and dependency ratios.
The Philippines Health Secretary, Francisco Duque, has estimated that 85 per cent of the country's nurses have left the country. Many graduates are retraining so they can join the exodus .
Alan Famatid, a 28-year-old management graduate, is now training as a nurse because he believes it will give him a better chance of finding work in hospitals in the West. People are the Philippines' biggest export – nine million of the country's 82 million people live outside the country and send home £500m a month in remittances through the banking system, making up about 12 per cent of the Philippines' gross domestic product.
"Working as a nurse gives you the chance of earning a higher salary in places such as London," said Neal Ganchero, 32, who has nursed in Kuwait and Saudi Arabia, which still takes the bulk of Filipino migrant nurses.
Even qualified doctors are retraining as nurses because they can earn much more working in foreign hospitals. The exodus has become so huge that the World Health Organisation is concerned about the effect it is having on the Philippines' health system.
The shortage of doctors and other medical staff is most acute in rural areas, as most of the city hospitals can always find trainees to do the work.
Iloilo's deputy mayor, Jed Mabilog, said the Philippines' high birth rate makes it possible to train so many skilled workers, combined with the widespread use of English. "Of course it's sad for us because we lose a lot of good nurses and specialist labour but we have a lot of people. There is a brain drain but we continually produce people who can replicate the skills [we need]," he said.
The WHO country representative, Jean Marc Olive, believes that the exodus of nurses will continue until 2015, with annual demand for medical workers in the United States and Europe estimated to be about 800,000.
The talk among the 3,000 nursing students on campus at the Central Philippine University is about where the latest openings are – with the UK back on the wish list. Florevy Diana, 18, a first-year student, said that when she graduates she would like to work in London where her aunt has worked for 10 years.
Another student, Jay Martin Diaz, 18, has a sister in London, but says he would rather go to the US: "Most people want to go to the US, where they earn more money. But the agencies will tell us about what is open and inform us. Wherever we go, it is important there is a Filipino community to help us adjust."
The Filipino desire to help their families is the driving force behind a willingness to travel and work abroad, often alone and for many years. Migrants from the Philippines first started moving to Britain in 1971 as student nurses, but their entry was barred in the 1980s. In the late 1990s, a chronic shortage of nurses meant opportunites became available again with up to 40,000 finding work in Britain.
Despite the chronic shortage of nurses in the NHS, priority in recent years has been given to labour from eastern Europe. The Home Office removed general nurses from the occupations shortage list in April 2006, making it harder for Filipino nurses to move to Britain. But with a new points system being introduced on 1 March favouring highly skilled workers, nursesin Iloilo are hopeful that jobs in Britain will become available again.
"The new points system will benefit Filipino nurses if, and only if, their level of high education and years of experience are considered," said Michael Duque, president of the UK Philippine Nurses Association. "Remember that most Filipino nurses have a BSc in nursing with at least three to five years of actual clinical experience after graduation. Also a good percentage of Filipino nurses have some level of masters education,"
The Independent, UK
NCP: Risk for Aspiration, Cerebro-vascular Accident (CVA)
Cerebro-vascular Accident (CVA)
Need
NUTRITIONAL-METABOLIC PATTERN
Nursing Diagnosis
Risk for aspiration related to poor coughing reflex secondary to COPD, CVA
Rationale:
Chronic conditions, including altered consciousness from head injury, spinal cord injury, neuromuscular weakness, hemiplegia and dysphagia from stroke, use of tube feedings for nutrition, endotracheal intubation, or mechanical ventilation may be encountered in the home, rehabilitative, or hospital settings. Elderly and cognitively impaired patients are at high risk. Aspiration is a common cause of death in comatose patients.
Sources:
http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor/index.cfm?plan=04
Objective of Care
Within my 8 hours span of care my patient will be free from aspiration as evidenced by:
a. patent airway;
b. unlabored breathing.
Nursing Interventions
1. Monitor level of consciousness.
® A decreased level of consciousness is a prime risk factor for aspiration.
2. Assess cough and gag reflexes.
® A depressed cough or gag reflex increases the risk of aspiration.
3. Auscultate bowel sounds to evaluate bowel motility.
® Decreased gastrointestinal motility increases the risk of aspiration because food or fluids accumulate in the stomach. Elderly patients have a decrease in esophageal motility, which delays esophageal emptying. When combined with the weaker gag reflex of elderly patients, aspiration is a higher risk.
4. Assess pulmonary status for clinical evidence of aspiration. Auscultate breath sounds for development of crackles and/or rhonchi.
® Aspiration of small amounts can occur without coughing or sudden onset of respiratory distress, especially in patients with decreased levels of consciousness.
5. In patients with endotracheal or tracheostomy tubes, monitor the effectiveness of the cuff.
® An ineffective cuff can increase the risk of aspiration.
6. Keep suction setup available and use as needed.
® This is necessary to maintain a patent airway.
7. Notify the physician or other health care provider immediately of noted decrease in cough and/or gag reflexes or difficulty in swallowing.
® Early intervention protects the patient’s airway and prevents aspiration.
8. Position patients who have a decreased level of consciousness on their sides.
® This protects the airway. Proper positioning can decrease the risk of aspiration. Comatose patients need frequent turning to facilitate drainage of secretions.
9. Check placement of NGT before feeding.
® A displaced tube may erroneously deliver tube feeding into the airway.
10. Check residuals before feeding. Hold feedings if residuals are high and notify the physician.
® High amounts of residual (>50% of previous hour’s intake) indicate delayed gastric emptying and can cause distention of the stomach leading to reflux emesis.
11. Maintain upright position for 30 to 45 minutes after feeding.
® The upright position facilitates the gravitational flow of food or fluid through the alimentary tract. If the head of the bed cannot be elevated because of the patient’s condition, use a right side-lying position after feedings to facilitate passage of stomach contents into the duodenum.
12. Assist with postural drainage.
® Mobilizes thickened secretions.
Need
NUTRITIONAL-METABOLIC PATTERN
Nursing Diagnosis
Risk for aspiration related to poor coughing reflex secondary to COPD, CVA
Rationale:
Chronic conditions, including altered consciousness from head injury, spinal cord injury, neuromuscular weakness, hemiplegia and dysphagia from stroke, use of tube feedings for nutrition, endotracheal intubation, or mechanical ventilation may be encountered in the home, rehabilitative, or hospital settings. Elderly and cognitively impaired patients are at high risk. Aspiration is a common cause of death in comatose patients.
Sources:
http://www1.us.elsevierhealth.com/MERLIN/Gulanick/Constructor/index.cfm?plan=04
Objective of Care
Within my 8 hours span of care my patient will be free from aspiration as evidenced by:
a. patent airway;
b. unlabored breathing.
Nursing Interventions
1. Monitor level of consciousness.
® A decreased level of consciousness is a prime risk factor for aspiration.
2. Assess cough and gag reflexes.
® A depressed cough or gag reflex increases the risk of aspiration.
3. Auscultate bowel sounds to evaluate bowel motility.
® Decreased gastrointestinal motility increases the risk of aspiration because food or fluids accumulate in the stomach. Elderly patients have a decrease in esophageal motility, which delays esophageal emptying. When combined with the weaker gag reflex of elderly patients, aspiration is a higher risk.
4. Assess pulmonary status for clinical evidence of aspiration. Auscultate breath sounds for development of crackles and/or rhonchi.
® Aspiration of small amounts can occur without coughing or sudden onset of respiratory distress, especially in patients with decreased levels of consciousness.
5. In patients with endotracheal or tracheostomy tubes, monitor the effectiveness of the cuff.
® An ineffective cuff can increase the risk of aspiration.
6. Keep suction setup available and use as needed.
® This is necessary to maintain a patent airway.
7. Notify the physician or other health care provider immediately of noted decrease in cough and/or gag reflexes or difficulty in swallowing.
® Early intervention protects the patient’s airway and prevents aspiration.
8. Position patients who have a decreased level of consciousness on their sides.
® This protects the airway. Proper positioning can decrease the risk of aspiration. Comatose patients need frequent turning to facilitate drainage of secretions.
9. Check placement of NGT before feeding.
® A displaced tube may erroneously deliver tube feeding into the airway.
10. Check residuals before feeding. Hold feedings if residuals are high and notify the physician.
® High amounts of residual (>50% of previous hour’s intake) indicate delayed gastric emptying and can cause distention of the stomach leading to reflux emesis.
11. Maintain upright position for 30 to 45 minutes after feeding.
® The upright position facilitates the gravitational flow of food or fluid through the alimentary tract. If the head of the bed cannot be elevated because of the patient’s condition, use a right side-lying position after feedings to facilitate passage of stomach contents into the duodenum.
12. Assist with postural drainage.
® Mobilizes thickened secretions.
NCP: Impaired Oral Mucous Membrane, Tonsillitis
Tonsillitis, ATP
Need
NUTRITIONAL-METABOLIC PATTERN
Nursing Diagnosis
Impaired oral mucous membrane related to infectious process as evidenced by inflamed tonsils.
Rationale:
Tonsillitis is a common occurrence during childhood. It occurs when the tonsils become inflamed as the body’s immune system attempts to fight off invading viruses or bacteria. Symptoms of tonsillitis include red, swollen tonsils that can be painful and make swallowing difficult. The tonsils may have whitish spots or white covering on them.
Sources:
http://pediatric.healthcentersonline.com/pediatriccoldflu/tonsillitis.cfm
Objective of Care
Within my 8 hours span of care my patient will be able to achieve the following:
a. demonstrate interventions that promote healthy oral mucosa;
b. show a decrease in symptoms such as temperature in normal range.
Nursing Interventions
1. Note presence of illness, disease or trauma.
® These conditions are most likely to cause inflammation of the tonsils.
2. Determine nutrition and fluid intake.
® Without proper nutrition and hydration the oral mucosa is more vulnerable to damage.
3. Evaluate client’s ability to provide self care.
® Self care places and important part in maintaining integrity of the oral cavity.
4. Review oral hygiene practice.
® Sometimes brushing is not enough or not properly done, professional care should be necessary.
5. Routinely inspect oral cavity for sores, lesions, and or bleeding.
® These are signs that the mucosa is impaired or damage.
6. Encourage fluids.
® To prevent dehydration.
7. Use soft-bristle toothbrush.
® Limit mucosal or gum irritation.
8. Instruct parents in oral hygiene techniques and proper dental care for infants or children.
® Encourages early initiation of good oral health practices and timely intervention for treatable problems.
9. Provide nutritional information.
® To correct deficiencies, reduce irritation/ gum disease, prevent dental caries.
10. Promote general health habits.
® Altered immune response can affect the oral mucosa.
Doenges, Marilynn, RN., et al (2004). Nurse’s Pocket Guide 9th ed.
F.A. Davis Company, Philadelphia, PA, USA
Need
NUTRITIONAL-METABOLIC PATTERN
Nursing Diagnosis
Impaired oral mucous membrane related to infectious process as evidenced by inflamed tonsils.
Rationale:
Tonsillitis is a common occurrence during childhood. It occurs when the tonsils become inflamed as the body’s immune system attempts to fight off invading viruses or bacteria. Symptoms of tonsillitis include red, swollen tonsils that can be painful and make swallowing difficult. The tonsils may have whitish spots or white covering on them.
Sources:
http://pediatric.healthcentersonline.com/pediatriccoldflu/tonsillitis.cfm
Objective of Care
Within my 8 hours span of care my patient will be able to achieve the following:
a. demonstrate interventions that promote healthy oral mucosa;
b. show a decrease in symptoms such as temperature in normal range.
Nursing Interventions
1. Note presence of illness, disease or trauma.
® These conditions are most likely to cause inflammation of the tonsils.
2. Determine nutrition and fluid intake.
® Without proper nutrition and hydration the oral mucosa is more vulnerable to damage.
3. Evaluate client’s ability to provide self care.
® Self care places and important part in maintaining integrity of the oral cavity.
4. Review oral hygiene practice.
® Sometimes brushing is not enough or not properly done, professional care should be necessary.
5. Routinely inspect oral cavity for sores, lesions, and or bleeding.
® These are signs that the mucosa is impaired or damage.
6. Encourage fluids.
® To prevent dehydration.
7. Use soft-bristle toothbrush.
® Limit mucosal or gum irritation.
8. Instruct parents in oral hygiene techniques and proper dental care for infants or children.
® Encourages early initiation of good oral health practices and timely intervention for treatable problems.
9. Provide nutritional information.
® To correct deficiencies, reduce irritation/ gum disease, prevent dental caries.
10. Promote general health habits.
® Altered immune response can affect the oral mucosa.
Doenges, Marilynn, RN., et al (2004). Nurse’s Pocket Guide 9th ed.
F.A. Davis Company, Philadelphia, PA, USA
Nursing Care Plan aka NCP
Appropriate Nursing Diagnosis for Certain Conditions
Cerebrovascular Accident
- Knowledge Deficit
- Impaired Skin Integrity (Pressure Ulcer)
- Risk for Impaired Skin Integrity
- Risk for Aspiration
- Impaired Thermo-regulation
Dengue Hemorrhagic Fever
- Hyperthermia
- Pain
- Knowledge Deficit
- Decreased Cardiac Output
Acute Tonsilo-pharyngitis (Tonsilitis)
- Hyperthermia
- Pain
- Knowledge Deficit
Pneumonia
- Hyperthermia
- Pain
- Knowledge Deficit
Acne
- Disturbed Body Image
- Knowledge Deficit
Surgery (Post-operative)
- Disturbed Body Image
- Knowledge Deficit
- Pain
I'll be updating the list.
Cerebrovascular Accident
- Knowledge Deficit
- Impaired Skin Integrity (Pressure Ulcer)
- Risk for Impaired Skin Integrity
- Risk for Aspiration
- Impaired Thermo-regulation
Dengue Hemorrhagic Fever
- Hyperthermia
- Pain
- Knowledge Deficit
- Decreased Cardiac Output
Acute Tonsilo-pharyngitis (Tonsilitis)
- Hyperthermia
- Pain
- Knowledge Deficit
Pneumonia
- Hyperthermia
- Pain
- Knowledge Deficit
Acne
- Disturbed Body Image
- Knowledge Deficit
Surgery (Post-operative)
- Disturbed Body Image
- Knowledge Deficit
- Pain
I'll be updating the list.
Monday, January 21, 2008
Nurses Licensure Examination/Nursing Licensure Examination December 2007 Results
I will also post the Nurses Licensure Examination/Nursing Licensure Examination December 2007 Results here.
Be patient. Try to enjoy while waiting. ('_')
Be patient. Try to enjoy while waiting. ('_')
Volunteer Nurse
After the confusion (because of the long wait for the results),
I finally decided to be a volunteer nurse in a government hospital in the locale I live.
That means no salary... from the government but I am after the experience (Really?).
I was about to apply as a rep for Nestle and/or call center agent for Sutherland.
Note: My sister will pay me 250 everytime I work. Not bad?
I finally decided to be a volunteer nurse in a government hospital in the locale I live.
That means no salary... from the government but I am after the experience (Really?).
I was about to apply as a rep for Nestle and/or call center agent for Sutherland.
Note: My sister will pay me 250 everytime I work. Not bad?
Welcome!
Welcome people! RNs, student nurses and commoners. Joke!
God bless to all the aspiring nurses who took the Nurse Licensure Exams last December 2 & 3 2007. We all know that the exam was difficult. Exacerbated by anxiety. Questions were crazy. Maybe half of my answers were educated guesses. I really don't have any idea about some questions that were ask. Imagine, Tagalog language was used. It was laughing trip when I read those questions.
Let us continue to pray. Pray for the results to be released as soon as possible. Let us also pray that controversy will stay away from the exams and its results.
To all the people who answered the exam honestly may God bless us all. To those who did otherwise... no comment.
I will post the results here as soon as I get it.
God Bless Batch 2007. Miss you all.
Prayers can move mountains. Patience is a virtue.
God bless to all the aspiring nurses who took the Nurse Licensure Exams last December 2 & 3 2007. We all know that the exam was difficult. Exacerbated by anxiety. Questions were crazy. Maybe half of my answers were educated guesses. I really don't have any idea about some questions that were ask. Imagine, Tagalog language was used. It was laughing trip when I read those questions.
Let us continue to pray. Pray for the results to be released as soon as possible. Let us also pray that controversy will stay away from the exams and its results.
To all the people who answered the exam honestly may God bless us all. To those who did otherwise... no comment.
I will post the results here as soon as I get it.
God Bless Batch 2007. Miss you all.
Prayers can move mountains. Patience is a virtue.
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