Venue: Parklane Hotel corner Archibishop Reyes and Escario St, Cebu City

The Association of Nursing Service Administrators of the Philippines (ANSAP) Cebu Chapter Inc. will observe its 19th founding anniversary simultaneously with its Annual Regional Convention.

Theme:
“Nurse Administrators: The Driving Force in the Health Care System”

Keynote Speaker:
Dr. Carmelita T. Villanobos, governor, PNA REgion VII will address the assembly with a a message focusing on the theme.

Registration fee is P800.

Foe more details, you may Dr. Alma B. Ungab, ANSAP Cebu Chapter president at tel 2532592 or cell no. 0917-4588853 Mrs. Leila Toledanes, over-all chairman at 2612100 or Lyrma S. Soledad, Board of Director at 2557141 local 123 and cell no. 0916-4829323

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:)One of my classmates, before, asked me in YM the type of situation which somehow happened not only in the hospital — where I am working — but definitely occurred no matter how you mastered to monitor your patient. The question is, “If your patient got 50ng/dl after getting the patient’s blood glucose level. At that moment, happened to be the scheduled time for the next insulin dose or oral hypoglycemic agent (any of the two). Will you give the next dose?

The answer would be NO.

Your independent nursing action in this situation would be to let the patient eat simple carbohydrates: in the form of candies or orange juices.  You are not going to give OHA or insulin for the time being since they are compelled to make your blood glucose run to normal level or at least make your blood sugar be lowered. Record and report the findings should you omit the next dose to the attending physician.

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I strongly admit there’s no other website which provides the accurate information about CFGNS than itself. CGFNS International (formerly the Commission on Graduates of  Foreign Nursing Schools) is an internationally recognized authority  on credentials evaluation and verification pertaining to the education, registration and licensure of nurses and health care professionals worldwide.

Source? hhmmm www.cgfns.org

About Credentials Evaluation Services? Follow these simple steps:

• Create your account
• Verify your account
• Login
• Click on the services at the sidebars
• Fill out  an account for CES form then request.  

Note: It’ll take a month for you to have your CES form. Goodluck Guys!

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 Digoxin

Digitalis Glycosides exert positive inotropic effects through improved availability of calcium to myocardial contractile elements, thereby increasing cardiac output in CHF. In CHF, digoxin improves the symptoms of CHF but does not alter long-term mortality. Antiarrhythmic actions of digoxin are caused by an increase in AV nodal refractory period via vagal tone, sympathetic withdrawal, and direct mechanisms. Digoxin also exerts a moderate, direct vasoconstrictor action on arterial venous smooth muscle.

Missed Doses: Take this drug at regular intervals. If you miss a dose and is has been less than 12 hours since your dose was due, take it as soon as you remember. If it is about time for the next dose, take the dose only. Do not double dose or take extra.

Serum Levels: Therapeutic: 0.5 – 2.0 µg/L

Adverse Reactions: Arrhythmic, listed by decreasing prevalence, are premature ventricular beats, second- and third-degree heart blocks, AV junctional tachycardia, atrial tachycardia with block, ventricular tachycardia, and SA nodal block. Visual disturbances are related to serum level and occur in up to 25% of patients with digoxin intoxication. They include blurred vision, yellow or green tinting, flickering light or halos, or red-green color blindness. GI symptoms occur frequently and include abdominal discomfort, anorexia, nausea, and vomiting. CNS side effects occur frequently but are nonspecific, such as weakness, lethargy, disorientations, agitation, and nervousness. Hallucinations and psychosis have been reported. Rare reactions include gynecomastia, hypersensitivity, and thrombocytopenia.

Contraindications: hypertrophic obstructive cardiomyopathy; suspected digitalis intoxication; second- or third-degree heart block in the absence of mechanical pacing; atrial fibrillation with accessory AV pathway; ventricular fibrillation.

Drug Interactions: Beta-blockers can worsen CHF or digoxin-induced bradycardia. Potassium loss caused by amphotericin B or diuretic can contribute to digoxin toxicity. Spironolactone can decrease digoxin renal elimination. ACE inhibitors, amiodarone, bepridil, diltiazem, nitredipine, quinidine, and verapamin can increase digoxin levels. Oral antacids, kaolin-pectin, oral neomycin, and sulfasalazine can reduce digoxin absorption.

Paremeters to Monitor: Obtain serum levels only when compliance, effectiveness, or systemic availability is questioned or toxicity is suspected. Monitor HR, ECG for digoxin-induced arrhythmias, subjective complaints of toxicity, and renal function. Monitor serum electrolytes (especially potassium) frequently initially and then q 1-2 months when stabilized.

Toxicity: Treatment of severe or life-threatening digoxin toxicity should include IV Digoxin Immune Fab (Digibind). About 40 mg (one vial) of digoxin-specific Fab fragments binds 0.6 mg of the glycoside. Exact dosage can be calculated based on estimated total body stores.

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TUBERCULOSIS

Agent:

• Mycobacterium Tuberculosis (human)
• Mycobacterium Africanum (human)
• Mycobacterium bovis (animal, cattle)

Transmission:

• Airborne, droplet
• Direct invasion through mucous membrane (rare)
• Ingestion of contaminated unpasturized milk

Communicability: As long as bacilli are present in the sputum

Susceptibility: 6-12 months after exposure

• Common among children below 3 y.o., adolescents, young adults and old age
• HIV infected patient, under weight, diabetics and substance abusers

Signs and Symptoms:

• Cough more than 2 weeks
• Loss of appetite and loss of weight
• Afternoon fever and night sweats
• Chest and back pain
• Hemoptysis

Diagnostic Exam:

• Sputum Exam (early morning sputum, 3x negative result = rule out)
• Chest X-ray
• Sputum, gastric culture
• Physical exam - TB symptomatics
• Mantoux Test - read after 48-72 hours: 10 mm or more = (+)

30mm or higher = suggestive of secondary infection

Treatment:

Category I:

• New pulmonary TB cases with (+) sputum exam
• Sputum (-) with chest x-ray of moderate to far advance TB
• Extra pulmonary TB (e.g. TB meningitis, intestinal TB, etc.)

A.      Intensive Phase (2 months)

• Rifampicin 450 mg
• Isoniazid (INH) 300 mg
• Pyrazinamide (PZA) 500 mg (2 tabs)
• Ethambutol 400 mg (2 tabs)

* Sputum exam if (+) add 1 month intensive treatment

B.      Maintenance Phase (4 months)

• Rifampicin
• Isoniazid

Category II:

• Relapses
• Failures
• Others (Resistant Cases)

A.      Intensive Phase (2 months)

• Rifampicin 450 mg
• Isoniazid 300 mg
• Pyrazinamide 500 mg (2 tabs)
• Ethambutol 400 mg (2 tabs)
• Streptomycin SO₄ 1gm (IM)

B.      Intensive Phase (1 month)

• Rifampicin
• INH
• PZA
• Ethambutol

* Sputum Exam: if (+) add 1 month of RIPE

C.      Maintenance Phase (5 months)

• Rifampicin
• Isoniazid
• Ethambutol

Category III:

• New TB cases who are sputum (-)
• New serious extrapulmonary TB cases

A.      Intensive Phase (2 months)

• Rifampicin 450 mg
• Isoniazid 300 mg
• Pyrazinamide 500 mg

B.      Maintenance Phase (2 months)

• Rifampicin
• Isoniazid

Contraindications/Complications:

• PZA (Pyrazinamide) - gouty arthritis
• Streptomycin Sulfate - pregnant women, can cause deafness and ringing of ears
• INH (Isoniazid) - cause peripheral neuritis
• Rifampicin - not indicated to patient with liver and renal damage; can cause red-orange urine

Other treatment programs:

• SR: Standard Regimen

(INH and Streptomycin)

• SCC: Short Course Chemotherapy

(Rifampicin, INH, PZA)

• DOTS: Direct Observed Treatment Short Course

(taking anti TB drugs under direct supervision of health worker)

Prevention:

1.       BCG vaccination

2.       IEC (Public Education)

3.       Improve social conditions

4.       Active, passive case finding and treatment

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Sample Nurse Practice Tests 2 

1. Cells in the pancreas that secrete glucagon and insulin are which of the following?

• a.  A and B cells
• b.  acinar cells
• c.  D cells 
• d. pancreatic D1 cells
• e. pancreatic polypeptide cells

2. A 57-year-old female patient has suffered a major stroke and as a result is in a coma. The attending neurologist is very concerned because the patient is developing ataxic breathing. The pneumotaxic center and apneustic centers of the brain are located in which of the following?

• a. diencephalon
• b. midbrain 
• c.  pons
• d.  spinal cord
• e.  telencephalon

3. A 14-year-old boy presents with weight loss and diarrhea. His tongue becomes sore and blistery after eating oatmeal or rye bread, which leads to the diagnosis of celiac disease. The boy and his parents are advised to be sensitive to symptoms of tetany and paresthesias, since they can occur as a consequence of malabsorption of which of the following?

• a. calcium
• b. carbohydrates
• c. fat
• d. iron
• e. water

4. Lack of oxygen (hypoxia) will cause reflex vasoconstriction in the circulation supplying which of the following organs?

• a. brain
• b. heart muscle
• c. kidney
• d. lungs
• e. skeletal muscle

5. A patient with newly diagnosed schizophrenia is given chlorpromazine. It is a drug that has amongst other effects moderate anticholinergic activity. As a consequence, which of the following is an expected side effect of this medication?

• a. bradycardia
• b. decreased GI sphincter tone
• c.  dry mouth
• d.  emptying of urinary bladder
• e. increased GI motility

6. Which of the following statements concerning total body energy storage is correct?

• (A) Most of the body’s energy store is held as carbohydrate.
• (B) Most of the body’s energy store is held as lipid.
• (C) Most of the body’s energy store is held as plasma glucose.
• (D) Most of the body’s energy store is held as protein.
• (E) Total body’s energy storage approximately equals resting metabolic rate.

7. Heparin is a rapidly acting, potent anticoagulant that has many important clinical uses.Which of the following is an action of heparin?

• (A) activates prothrombin
• (B) acts with antithrombin to inhibit thrombin activity
• (C) decreases prothrombin time
• (D) inhibits calcium action
• (E) promotes vitamin K activity

8. Following an automobile accident a patient suffers a pelvic fracture and significant internal blood loss resulting in hemorrhagic shock. Which of the following organs has the largest specific blood flow (blood flow per gram of tissue) under resting conditions and is especially vulnerable during the shock phase?

• (A) brain
• (B) heart muscle
• (C) kidneys
• (D) skeletal muscle
• (E) skin

9. A 68-year-old woman presents with sleep disturbances and memory loss. After careful analysis, she is diagnosed with early stages of Alzheimer’s disease. Her pharmacological treatment plan includes acetylcholine esterase inhibitors. One week after starting treatment, the woman’s daughter calls in, reporting that her mom has developed new symptoms that might be related to her new medicine. Which of the following is a likely side effect of the drug?

• (A) dry mouth
• (B) forgetting to urinate
• (C) muscle weakness
• (D) nausea and diarrhea
• (E) vertigo

10. A 52-year-old woman has had rheumatoid arthritis for many years. She now comes to you complaining of the development in the past few months of redness, burning, and itching of her eyes and a dry mouth, making swallowing difficult. This newly developing condition gives the patient a greatly increased risk for which of the following?

• (A) esophageal carcinoma
• (B) leukemia
• (C) lymphoma
• (D) melanoma
• (E) pleomorphic adenoma

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Case Study Psychiatric Nursing 101

A 29-year-old man is brought to the emergency center in a drunken stupor. He is accompanied by his wife, who states that he hasn’t been himself at all for the past few months. According to his wife, he was evaluated for depression by his personal physician about 3 months ago and started on an SSRI. He responded quite well to this therapy over the subsequent 2 months. He started feeling so good and so energetic that he stopped taking his medication. He found that he needed less and less sleep, to the point where he is now only sleeping 2-3 hours a day. He has been showering his wife with very expensive gifts and has hit the maximum limit on all of their credit cards. He has been extremely romantic and more interested in sexual relations than at any time before. He has also started drinking heavily and has passed out drunk more than once. His work has suffered, and his boss said that he is in danger of being fired if things don’t straighten out. Other than being drunk, his physical examination and blood tests are normal. He is admitted to the psychiatric unit with a diagnosis of bipolar disorder and started on lithium.

• What is the mechanism of action of lithium?
• What are the common side effects of lithium?
• What is the mechanism of lithium-induced polyuria?

Mechanism of action of lithium: Not entirely known but may be related to inhibition of membrane phospholipid turnover with a reduction in key second messengers, important in the overactivity of catecholamines thought to be related to mood swings characteristic of bipolar disorder.

Common side effects of lithium: Nausea, vomiting, diarrhea, tremor, edema, weight gain, polydipsia, and polyuria.

Mechanism of lithium-induced polyuria: Renal collecting tubule becomes resistant to antidiuretic hormone.

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ß-Blockers

• Examples:  Propranolol, metoprolol, atenolol, nadolol, timolol, pindolol, esmolol, labetalol

•  Toxicity: Impotence, exacerbation of asthma, cardiovascular adverse effects (bradycardia, AV block, Congestive Heart Failure), CNS adverse effects (sedation, sleep alterations)

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Acetyl Salicylic Acid (Aspirin) Overdose

Acute and chronic (elderly with renal insufficiency)

Important Assessment:

• hyperventilation (central stimulation of respiratory drive)
• increased anion gap (AG) metabolic acidosis (increased lactate)
• tinnitus, confusion, lethargy
• coma, seizures, hyperthermia, non-cardiogenic pulmonary edema, circulatory collapse
• ABG’s possible:
  • respiratory alkalosis
  • metabolic acidosis
  • respiratory acidosis

Management

• decontamination
• 10:1 charcoal:drug ratio
• whole bowel irrigation (useful if enteric-coated ASA)
• close observation of serum level, serum pH
• alkalinization of urine
• may require K supplements for adequate alkalinization
• consider hemodialysis when:
  • severe metabolic acidosis (intractable)
  • level continues to increase
  • end organ damage (unable to diurese)

to view the complete list of antidote just click here

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Human Chorionic Gonadotropin

Source: Trophoblast of placenta

Function:

• Maintains the corpus luteum for the 1^st trimester because it acts like LH but is not susceptible to feedback regulation from estrogen and progesterone. In the 2^nd and 3^rd trimester, the placenta synthesizes its own estrogen and progesterone. As a result, the corpus luteum degenerates.
• Used to detect the pregnancy because it appears in the urine 8 days after successful fertilization (blood and urine tests available). But the presence of hCG in pregnancy test will still be classified as probably sign of pregnancy. (Read number 3 for another reason why it’s considered to as probably sign.
• Elevated hCG in women with hydatidiform mole or choriocarcinoma.
• It is used medically to induce ovulation and to treat male hypogonadism and cryptorchidism, and is produced in certain cancers (as of the testes). The fact that exogenous HCG has characteristics almost identical to those of the luteinizing hormone (LH) which, as mentioned, is produced in the hypophysis, makes HCG so very interesting for athletes. In a man the luteinizing hormone stimulates the Leydig’s cells in the testes; this in turn stimulates production of androgenic hormones (testosterone). For this reason athletes use injectable HCG to increase the testosterone production.

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