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Friday, November 30, 2007

New Professional Regulation Commission Chairperson

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Hon Leonor Tripon-Rosero is the new Chairperson of the Professional Regulation Commission. She took her oath of office before the Honorable Executive Secretary Eduardo Ermita last January 17, 2005 at the Malacanang Palace in the presence of the Honorable Presidential Spokesperson Ignacio Bunye amd her immeidate family.

Acting Chairperson Rosero is a Dentist by profession and earned her Doctor of Dental Medicine degree from the University of the East with the distinction of "Cum Laude". She took the Dentist licensure examination in 1968 and placed second in the rankings. In February 2002, she was appointed as a member of the Board of Dentistry and later, as one of the Commissioners of the PRC.

Her honesty, integrity, commitment and dedication to public service has gained the trust and confidence of President Gloria Macapagal-Arroyo thus appointing her as the new acting Chairperson of the Commission.

SOURCE: http://www.prc.gov.ph/articles.asp?sid=8&aid=2098





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Room Assignments in the December 2007 Nurse Licensure Examination

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Room Assignments in the December 2007 Nurse Licensure Examination now available


The Professional Regulation Commission (PRC) announces the availability of the room assignment of applicants in the Nurse Licensure Examination scheduled to be given by the Board of Nursing in December 1 & 2, 2007.

The room assignments are categorized as follows: one for the REGULAR EXAMINATION and the other one, for the SPECIAL EXAMINATION-JUNE 2006 RETAKERS and REMOVAL EXAMINATION.

A. REGULAR EXAMINATION

ABABA, KHRISTHEA MAE SACRAME to ALINEA, EDZEL GARLITO

ALINEA, MARIE GRACE DE GUZMAN to ARTICULO, DESSA MARIE RIVERA

ARTIENDA, EFREN TESTADO to BARTOLOME, JADE BRILLIANT FERNANDEZ

BARTOLOME, JAIRUS IDOL FERNANDEZ to BRICIA,MARIA ROWENA DIAZ

BRIGINO, LEO VILLANO to CANLAS, ANGELICA PUNU

CANLAS, CECILE ABON to CHUA, SHONALEY ESGUERRA

CHUA,SUSANA BERNARDO to DANG-AOEN, DAVID JR CALAYCAY

DANGAL, ROCHELLE IRIS MACATANGAY to DELA CRUZ, SHERYL CASTAÑEDA

DELA CRUZ, SHERYL DELOS SANTOS to EGUIA, MARIA BEATRIZ BORCE

EGUIN, CAROLINE VILLA to FERRER, AIMEE REYNA TORRES

FERRER, AINE JOY JAVIER to GARRIDO, RHEA SARET

GARRO, MARLON VILLA to HERNANDEZ, PATRICK GAIL VARGAS

HERNANDEZ, PAULA KAY ROQUE to LACSON, KRISTEL CASTRO

LACSON, LEA BALTAZAR to LOPEZ, SUNSHINE ZAULDA

LOPEZ, SWANI FAITH GOLLOD to MANALANSAN,MARIAN JIMENEZ

MANALANSAN, PAUL JOHN BACANI to MELAD, CLARENCE JADSAC

MELAD, GRACE DIANE ENRIQUEZ to NATIVIDAD, SHERILYN LIWANAG

NATIVIDAD,VANESSA TOLENTINO to PADILLA, RINA JOYZYBELLE DALERE

PADILLA, SHAYNE CARRERA to PERILLO, PAOLA MARIE PABELLO

PERIQUET,JERAMY AMON to RAMOS, MICHELLE ANN NACPIL

RAMOS, MINERVA PATRICIO to ROMERO, MA LUISA DUE

ROMERO, MARIA CAMILLE AGUILAR to SANTOS, ABBY DARIEL FLORES

SANTOS, ABIGAIL CAMILLE JUAQUICO to SORIANO, RAMONITO JR BACUD

SOTAYCO, MA CHRISTINA MENDOZA to TOLEDO, CLEIR LOJA

TOLEDO, CONRADO JR PUNZALAN to VERDIDA, CHARINA DE LA TORRE

VERGARA, AIZA ZARA to ZUÑIGA, WILANDER DELA CRUZ



B. SPECIAL EXAMINATION (JUNE 2006 RETAKERS)

ABAPIAL, ARLENE BOCALA to ZARATAN, STEVENSON DUQUE


C. REMOVAL EXAMINATION

ALFONSO, LORNA SANTOS to YAUN, MARIELLE AUMAN


SOURCE: http://www.prc.gov.ph/articles.asp?sid=4&aid=2637





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December 2007 Nursing Examination Day Preparation

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Examination Day Preparation

What to Bring on Examination Days?

*Notice of Admission
*Application Stub
*PRC Official Receipt
*Two or more pencils (No.2)
*Ballpens with BLACK INK ONLY
*One (1) piece Metered-Stamp Window Envelope
*One (1) piece Long Brown Envelope
*One (1) piece Long Transparent (non -colored) Plastic Envelope (to keep above items)


What to Wear on Examination Days

MALE - school uniform/white polo shirt or T-shirt (tucked-in)

FEMALE – school uniform / white blouse or T-shirt

For Marine Deck and Engineer Officers – prescribed Merchant Marine uniform with appropriate shoulder board.


SOURCE: http://www.prc.gov.ph




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Saturday, November 24, 2007

Alternative Sites To View Passers Of December 2007 Nursing Board Exam Results

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If you want to be informed as soon as the PRC Nursing Licensure Examination December 2007 is released, please enter you email address below:


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Below are a list of websites that you can navigate to check the results for this December 2007 Nursing Board Exam.

As you all know, once the results are out, flock of people surf the web in search for sites that shows the list of nursing passers. More information about Philippine Nursing Licensure Exam provided by wikipedia.org. Some of the sites will be bogged down due to heavy visitors, alternative sites that will post the Nursing Results for December 2007 are:

1. Professional Regulatory Commision PRC

2. Inquirer.net Nursing Results 2007

3. NurseReview.Org December 2007 Nursing Board Exam Results

4. ManilaBlend.Com

5. Cerveo.com

6. ReynaElena.com

7. NursingBoardExamResult.Net

8. PhilippineBoardExamResults.BlogSpot.com





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Thursday, November 22, 2007

December 2007 Nursing Board Exam Results PRC

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Results for this NLE Examination December 2007 will be posted here. For those of you who want want to get a copy of the examination passers (December 2007) or wanted to be notified when the results are out, please enter your email address in the form provided below this article.


Enter your Email







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Important Stuff To Read before Taking The December 2007 Nursing Licensure Board Exam NLE

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By this time nurses taking the December 2007 NLE Exam are starting their final coaching review. If you have time, try to go over these articles and board questions.


Good luck December 2007 Nurses NLE Takers! Dont' forget to pray.






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Monday, November 19, 2007

ATI Kaplan NurseNotes Nclex Bullets - Growth & Development And Psychosocial

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ATI Kaplan NurseNotes Nclex Bullets - Growth & Development And Psychosocial

1. Typipical 4 year old has a vocabulary of? 1500 words

2. Growth of a preschool child, expect to gain, 4-6 pounds per year.

3. Tie Shoelaces - 4 year old

4. Factor that would indicate that the child is ready to be toilet trained? No longer falls or trips over his feet when walking.

5. Infant - solitary
Toddler - parallel
Associative - pre-school (imaginative and imitative)

6. 2 years old - always says "No"

7. Posterior fonatenel normally closes by 8 weeks of age, it may closed at birth or shortly thereafter, and still be considered a normal finding.

8. When should a child start going to the dentist? 1 year old.

9. First sign of puberty in teenage girls? Changes in the nipple and areola.

10. First sign of puberty in teenage boys? Testicular enlargement.

11. Neonatal reflexes should gradually dade between 4-6 months of age and completely disappear by 6 months of age.

12. Leading cause of death in infant ages 1 month and 1 year? Sudden infant death syndrome (SIDS)

13. Leading cause of death in toddlers, preschoolers, school-age childrean and adolescents is? Accidents

14. Infant weighed 8 pounds at birth, nurse expect this infant to weigh at 24 weeks of age? 18 pounds




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Friday, November 16, 2007

Nclex Passer's Advice On What To Study For NCLEX EXAM

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Just got my result and I passed heres what I did..

First: read the strategies in the kaplan book carefully. It gives
great Tips and strategies that you can practice later... DON'T do the
questions in the kaplan book they are too easy and have tons of typs
which makes me not trust the questions too much.

Second: Read nursing made insanely easy, spend time on each page
making sure you really truely remember the important stuff. read it
front to back. It shouldn't take you more than 2-3 hours even with
breaks. Its pretty funny so its not really a chore at all.

Third: Use the saunders CD and take a full comprehensive practice test
keep in mind strategies from the kaplan book. once you finish the
practice test (which you don't need to do in one sitting, you can
break it up) you should look at your score and print out the results.
next go through the review of every question (even those you got
right) and make sure you understand why the answer is correct and/or
why the one you chose was wrong...

Fourth: Go to the study section and select the sections you got 50% or
lower on, OR the TOP 10 areas that you did the worst on. Work on those
study questions 1-2 hours a day (or more if you can stand it) every
day, make sure you understand the rationales, if you are really
unclear about a question look it up and write yourself some short hand
notes in a notebook or pad of paper. Do this for a week (7 days)

Fifth: Take the short quizzes in each of the areas you have been
studying. If you get less than 70%... continue to do more study
questions in that area until you are able to get over 70% consistently
on 3 quizzes in that study area. Make sure you go over every question
you take to make sure you understand the rationale.

Sixth: Take another comprehensive test (there are two available on the
cd). check your progress..go over the questions. any areas you still
are having trouble on review them in your book and do more study
questions.

Seventh: The night before your exam re-read nursing made insanely
easy.. (this book is awesome lots of pictures to help you remember_)
make sure it all sticks ... this book helped me soooooooooooooooo much
on my test....if you have time before your exam on the day of the test
look over some of the ones you have trouble remembering again...

Guys buy Prioritization, Delegation, and Assingment na book by
LaCharity sa PRC meron 150 lang, 80% ng questions ko sa Nclex same
format ng mga questions sa book na yan.

Use Insanely easy na Pharmacology, study it by heart dami ko drugs sa
nclex exams, sobra helpful yan book na yan. You can buy it infront of prc.

You WILL pass.

I passed at 265 questions and this was my method.
hope that helps!

good luck!

ps do questions... don't study from your book unless it is to look up
something on a specific question.

Aim to finish 8thousand or more na qanda, Use lippincott, kaplan
questiontrainer, dami ko lumabas na parang galing kaplan questions,
and saunder QandA

Study also the Normal values and herbal meds






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Thursday, November 15, 2007

Transmission-Based Precautions - Isolation Precaution Guidelines for Hospitals

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TRANSMISSION-BASED PRECAUTIONS - ISOLATION PRECAUTION GUIDELINES FOR HOSPITALS SLIDE TRANSCRIPT
Slide 1: TRANSMISSION-BASED PRECAUTIONS ISOLATION PRECAUTION GUIDELINES FOR HOSPITALS KEY CONCEPTS you will learn include: • What the reasons for the new Transmission-Based Precautions are • What Transmission-Based Precautions are designed to do • What preventive processes and practices are recommended for each route of infection transmission • How to effectively use Transmission-Based Precautions BACKGROUND Although the spread of infectious diseases in hospitals has been recognized for many years, understanding how to prevent nosocomial infections and implementing policies and practices that are successful has been more difficult. The transmission of nosocomial infections requires three elements: a source of infecting microorganisms, a susceptible host and a mode of transmission. The human source of nosocomial infections may be patients, hospital personnel or, less often, visitors. These people may have infectious diseases, be in the incubation period (no symptoms), or may be chronic carriers. Other sources of infecting microorganisms are inanimate objects that become contaminated, (e.g., instruments) and the environment, including air and water. Susceptible hosts are those patients, hospital personnel and, less often, visitors who may become infected. Resistance among people to infecting microorganisms varies; for example, some are immune, others get infected and become asymptomatic carriers; and still others get infected and develop a clinical disease. Factors such as age, underlying diseases, treatment with certain drugs (e.g., antimicrobials, corticosteroids and other immunosupressive agents) and irradiation play a role in this process. The three main routes of infection transmission in hospitals are airborne, droplet and contact. An infecting microorganism, however, can be transmitted by more than one route. For example, varicella (chicken pox) is transmitted both by the airborne and contact route at different stages of the disease. The purpose of this is to explain how Transmission-Based Precautions are used in the hospital to minimize the risk of clients, patients, visitors and staff becoming infected while dealing with the healthcare system. 1

Slide 2: Transmission-Based Precautions: Isolation Precaution Guidelines for Hospitals DEFINITIONS • Airborne transmission. Transfer of particles 5 µm or less in size into the air, either as airborne droplets or dust particles containing the infectious microoganism; can be produced by coughing, sneezing, talking or procedures such as bronchoscopy or suctioning; can remain in the air for up to several hours and be spread widely within a room or over longer distances. Special air handling and ventilation are needed to prevent airborne transmission. • Droplet transmission. Contact of the mucous membranes of the nose, mouth or conjunctivae of the eye with infectious particles larger than 5 µm in size; can be produced by coughing, sneezing, talking or procedures such as bronchoscopy or suctioning. Droplet transmission requires close contact between the source and the susceptible person because particles remain airborne briefly and travel only about 3 feet (1 meter) or less. • Contact transmission. Infectious agent (bacteria, virus or parasite) transmitted directly or indirectly from one infected or colonized person to a susceptible host (patient), often on the contaminated hands of a health worker. • Colonization. Pathogenic (illness- or disease-causing) organisms are present in a person (i.e., they can be detected by culturing or other tests) but are not causing symptoms or clinical findings (i.e., cellular changes or damage). Coming in contact with and acquiring new organisms, while increasing the risk of infection, usually does not lead to infection because the body’s natural defense mechanism (the immune system) is able to tolerate and/or destroy them. Thus, when organisms are transmitted from one person to another, colonization rather than infection is generally the result. Colonized persons, however, can be a major source of transfer of pathogens to other persons (cross-contamination) especially if the organisms persist in the person (chronic carrier), such as with HIV, HBV and HCV TRANSMISSION-BASED PRECAUTIONS The new isolation guidelines issued by CDC in 1996 involve a two-level Note: Protective isolation approach: Standard Precautions, which apply to all clients and patients of immunocompromised attending healthcare facilities, and Transmission-Based Precautions, patients, such as those with which apply only to hospitalized patients (Garner and HICPAC 1996). AIDS, is not an effective way to reduce the risk of This new system retains the best features of both Universal Precautions cross-infection (Manangan (UP) and Body Substance Isolation (BSI) and replaces the cumbersome et al 2001). disease-specific isolation precautions with three sets of Transmission- Based Precautions (air, droplet or contact). 2

Slide 3: Transmission-Based Precautions: Isolation Precaution Guidelines for Hospitals In all situations, whether used alone or in combination, Transmission-Based Precautions must be used in conjunction with the Standard Precautions (Garner and HICPAC 1996). Airborne Precautions These precautions are designed to reduce the nosocomial transmission of particles 5 µm or less in size that can remain in the air for several hours and be widely dispersed (Table 1). Microorganisms spread wholly or partly by the airborne route include tuberculosis (TB), chicken pox (varicella virus) and measles (rubeola virus). Airborne precautions are recommended for patients with either known or suspected infections with these agents. For example, an HIV-infected person with a cough, night sweats or fever, and clinical or x-ray findings in the lungs should go on airborne precautions until TB is ruled out. Where TB is prevalent, it is important to have a mechanism to quickly assess patients with suspected TB because delayed diagnosis, resulting in lack of isolation, has been shown to be an important factor in hospital- based transmission. In this situation, airborne precautions are the last defense in reducing the risk of TB transmission. Table 1. Airborne Precautions Used in addition to Standard Precautions for a patient known or suspected to be infected with microorganisms transmitted by the airborne route. PATIENT PLACEMENT • Private room. • Door closed. • Room air is exhausted to the outside (negative air pressure) using fan or other filtration system. • If private room not available, place patient in room with patient having active infection with the same disease, but with no other infection. RESPIRATORY PROTECTION • Wear face shield (or goggles and surgical mask) • If TB known or suspected, wear particulate respirator (if available). • If chicken pox or measles: - Immune persons, no mask required. - Susceptible persons, do not enter room. • Remove PPE (face shield) after leaving the room and place in a plastic bag or waste container with tight-fitting lid. PATIENT TRANSPORT • Limit transport of patient to essential purposes only. • During transport, patient must wear surgical mask. • Notify area receiving patient. Adapted from: Infection Control Signs, www.etnacomm.com, ETNA Communications, Chicago, IL. Copyright 2000. 3

Slide 4: Transmission-Based Precautions: Isolation Precaution Guidelines for Hospitals Droplet Precautions These precautions reduce the risks for nosocomial transmission of pathogens spread wholly or partly by droplets larger than 5 µm in size (e.g., H. influenzae and N. meningitides meningitis; M. pneumoniae, flu, mumps and rubella viruses). Other conditions include diphtheria, pertussis (whooping cough), pneumonic plague and strep pharyngitis (scarlet fever in infants and young children). Droplet precautions are simpler than airborne precautions because the particles only remain in the air for a short time and travel only a few feet; therefore, contact with the source must be close for a susceptible host to become infected (Table 2). Table 2. Droplet Precautions Use in addition to Standard Precautions for a patient known or suspected to be infected with microorganisms transmitted by large-particle droplets (larger than 5 µm). PATIENT PLACEMENT • Private room; door may be left open. • If private room not available, place patient in room with patient having active infection with the same disease, but with no other infection. • If neither option is available, maintain separation of at least 3 feet between patients. RESPIRATORY PROTECTION • Wear mask if within three feet of patient. PATIENT TRANSPORT • Limit transport of patient to essential purposes only. • During transport, patient must wear surgical mask. • Notify area receiving patient. Adapted from: Infection Control Signs, www.etnacomm.com, ETNA Communications, Chicago, IL. Copyright 2000. Contact Precautions These precautions reduce the risk of transmission of organisms from an infected or colonized patient through direct or indirect contact (Table 3). They are indicated for patients infected or colonized with enteric pathogens (hepatitis A or echo viruses), herpes simplex and hemorrhagic fever viruses and multidrug (antibiotic)-resistant bacteria. Interestingly, chicken pox is spread both by the airborne and contact routes at different stages of the illness. Among infants there are a number of viruses transmitted by direct contact. In addition, Contact Precautions should be implemented for patients with skin or eye infections that may be contagious (e.g., draining abscesses, skin infections that are wet and draining, herpes zoster, impetigo, conjunctivitis, scabies, lice and wound infections). 4

Slide 5: Transmission-Based Precautions: Isolation Precaution Guidelines for Hospitals Table 3. Contact Precautions Use in addition to Standard Precautions for a patient known or suspected to be infected or colonized with microorganisms transmitted by direct contact with the patient or indirect contact with environmental surfaces or patient care items. PATIENT PLACEMENT • Private room; door may be left open. • If private room not available, place patient in room with patient having active infection with the same microorganism, but with no other infection. GLOVING • Wear clean, nonsterile examination gloves when entering room. • Change gloves after contact with infective material (e.g., fecal materials or wound drainage). • Remove gloves before leaving patient room. HANDWASHING • Wash hands with antibacterial agent or use alcohol-based handrub after removing gloves. • Do not touch potentially contaminated surfaces or items before leaving the room. GOWNS AND PROTECTIVE APPAREL • Wear clean, nonsterile gown when entering patient room if you anticipate contact with patient or if the patient is incontinent, has diarrhea, an ileostomy, colostomy or wound drainage not contained by a dressing. • Remove gown before leaving room. Do not allow clothing to contact potentially contaminated surfaces or items before leaving the room. PATIENT TRANSPORT • Limit transport of patient to essential purposes only. • During transport, ensure precautions are maintained to minimize risk of transmission of organisms. PATIENT CARE EQUIPMENT • Reserve noncritical patient care equipment for use with a single patient, if possible. • Clean and disinfect any equipment shared among infected and noninfected patients. Adapted from: Infection Control Signs, www.etnacomm.com, ETNA Communications, Chicago, IL. Copyright 2000. 5

Slide 6: Transmission-Based Precautions: Isolation Precaution Guidelines for Hospitals Empiric Use of In certain circumstances, if there is any question of an infectious process in Transmission-Based a patient without a known diagnosis, implementing Transmission-Based Precautions Precautions should be considered on an empiric basis until a definitive diagnosis is made. Examples of the “empiric use” of Transmission-Based Precautions as they apply to the three routes (air, droplet and contact) are illustrated in Table 4. In addition, a complete listing of clinical syndromes or conditions warranting the empiric use of Transmission-Based Precautions is shown in Table 5. From time to time and based on local conditions, other important infectious diseases should be considered for addition to this list. Table 4. Empiric Use of Transmission Based Precautions AIRBORNE DROPLET CONTACT • • • rashes (vesicule or meningitis (fever, acute diarrhea in an pustule) vomiting and stiff incontinent or • neck) diapered patient cough, fever and upper • • lobe chest findings hemorrhagic rash with diarrhea in adult with (dullness and fever history of recent • decreased breath antibiotic use severe, persistent • sounds) bronchitis and croup cough during periods • cough, fever and chest when pertussis is in infants and young findings in any area in present in community children • • HIV-infected person or generalized rash of history of infection at high-risk for HIV unknown cause with multi-resistant organisms (except tuberculosis) • abscess or draining wound that cannot be covered The use of Transmission-Based Precautions, including their empiric use in selected circumstances, is designed to reduce the risk of airborne-, droplet- Note: Unfortunately, Unfortunately and contact-transmitted infections between hospitalized patients and “reminder signs” for healthcare staff. To assist health workers in correctly implementing the isolation patients do not increase use (compliance) appropriate precautions, Table 6 provides a summary of the types of with infection precautions isolation precautions and the illnesses for which each type of precaution is (Manangan et al 2001). recommended. In addition, Appendix I provides a complete listing of the types and duration of the isolation precautions needed for the vast majority of infectious diseases. 6

Slide 7: Transmission-Based Precautions: Isolation Precaution Guidelines for Hospitals Table 5. Clinical Syndromes or Conditions to Be Considered for “Empiric Use” of Transmission-Based Precautions CLINICAL SYNDROME OR CONDITIONA POTENTIAL EMPIRIC PATHOGENSB PRECAUTIONS Diarrhea Enteric pathogens c Acute diarrhea with a likely infectious cause in an incontinent or Contact diapered patient Diarrhea in an adult with a history of recent antibiotic use Clostridium difficile Contact Meningitis Neisseria meningitidis Droplet Rash or exanthems, generalized, etiology unknown Petechial/ecchymotic with fever Neisseria meningitidis Droplet Vesicular Varicella (chicken pox) Airborne and Contact Maculopapular with coryza and fever Rubeola (measles) Airborne Respiratory infections Cough/fever/upper lobe pulmonary infiltrate in an HIV-negative Mycobacterium Airborne patient or a patient at low risk for HIV infection tuberculosis Cough/fever/pulmonary infiltrate in any lung location in an HIV- Mycobacterium Airborne infected patient or a patient at high risk for HIV infection tuberculosis Paroxysmal or severe persistent cough during periods of Bordetella pertussis Droplet pertussis activity Respiratory infections, particularly bronchiolitis and croup, in Respiratory syncytial or Contact infants and young children parainfluenza virus Risk of multidrug-resistant microorganisms Resistant bacteriad History of infection or colonization with multidrug-resistant Contact organisms d Resistant bacteriad Skin, wound, or urinary tract infection in a patient with a recent Contact hospital or nursing home stay in a facility where multidrug- resistant organisms are prevalent Skin or wound infection Staphylococcus aureus, Contact group A streptococcus a Patients with the syndromes or conditions listed below may present with atypical signs or symptoms (e.g., pertussis in neonates and adults may not have paroxysmal or severe cough). The clinician's index of suspicion should be guided by the prevalence of specific conditions in the community, as well as clinical judgment. b The organisms listed under the column “Potential Pathogens” are not intended to represent the complete, or even most likely, diagnoses, but rather possible etiologic agents that require additional precautions beyond Standard Precautions until they can be ruled out. c These pathogens include enterohemorrhagic Escherichia coli O157:H7, Shigella, hepatitis A, and rotavirus. d Resistant bacteria judged by the infection control program, based on current state, regional, or national recommendations, to be of special clinical or epidemiological significance. Adapted from: Garner and HICPAC 1996. 7

Slide 8: Transmission-Based Precautions: Isolation Precaution Guidelines for Hospitals Table 6. Summary of Types of Precautions and Patients Requiring the Precautions Standard Precautions Use Standard Precautions for the care of all patients. Airborne Precautions In addition to Standard Precautions, use Airborne Precautions for patients known or suspected to have serious illnesses transmitted by airborne droplet nuclei. Examples of such illnesses include: Measles Varicella (including disseminated zoster)a Tuberculosis b Droplet Precautions In addition to Standard Precautions, use Droplet Precautions for patients known or suspected to have serious illnesses transmitted by large particle droplets. Examples of such illnesses include: Invasive Haemophilus influenzae type b disease, including meningitis, pneumonia, epiglottitis, and sepsis Invasive Neisseria meningitidis disease, including meningitis, pneumonia, and sepsis Other serious bacterial respiratory infections spread by droplet transmission, including: Diphtheria (pharyngeal) Mycoplasma pneumonia Pertussis Pneumonic plague Streptococcal (group A) pharyngitis, pneumonia, or scarlet fever in infants and young children Serious viral infections spread by droplet transmission, including: Adenovirus a Influenza Mumps Parvovirus B19 Rubella Contact Precautions In addition to Standard Precautions, use Contact Precautions for patients known or suspected to have serious illnesses easily transmitted by direct patient contact or by contact with items in the patient's environment. Examples of such illnesses include: Gastrointestinal, respiratory, skin, or wound infections or colonization with multidrug-resistant bacteria judged by the infection control program, based on current state, regional, or national recommendations, to be of special clinical and epidemiologic significance. Enteric infections with a low infectious dose or prolonged environmental survival, including: Clostridium difficile For diapered or incontinent patients: enterohemorrhagic Escherichia coli O157:H7, Shigella, hepatitis A, or rotavirus Respiratory syncytial virus, parainfluenza virus, or enteroviral infections in infants and young children Skin infections that are highly contagious or that may occur on dry skin, including: Diphtheria (cutaneous) Herpes simplex virus (neonatal or mucocutaneous) Impetigo Major (noncontained) abscesses, cellulitis, or decubiti Pediculosis Scabies Staphylococcal furunculosis in infants and young children Zoster (disseminated or in the immunocompromised host)† Viral/hemorrhagic conjunctivitis Viral hemorrhagic infections (Ebola, Lassa, or Marburg)* * See the Appendix for a complete listing of infections requiring precautions, including appropriate footnotes. a Certain infections require more than one type of precaution. b See CDC “Guidelines for Preventing the Transmission of Tuberculosis in Health-Care Facilities.” Adapted from: Garner and HICPAC 1996. 8

Slide 9: Type and Duration of Precautions Needed for Selected Infections and Conditions REFERENCES Garner JS and The Hospital Infection Control Practices Advisory Committee (HICPAC). 1996. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 17(1): 53–80 and Am J Infect Control 24(1): 24–52. Infection Control Signs, www.etnacomm.com, ETNA Communications, Chicago, IL. Copyright 2000. Manangan LP et al. 2001. Infection control dogma: top 10 suspects. Infect. Control Hosp Epidemiol 22(4): 243-247. 9

Slide 10: Type and Duration of Precautions Needed for Selected Infections and Conditions APPENDIX TYPE AND DURATION OF PRECAUTIONS NEEDED FOR SELECTED INFECTIONS AND CONDITIONS1 Precautions Type * Duration† Infection/Condition Abscess Draining, major a C DI Draining, minor or limited b S Acquired immunodeficiency syndrome c S Actinomycosis S Adenovirus infection, in infants and young children D,C DI Amebiasis S Anthrax Cutaneous S Pulmonary S Antibiotic-associated colitis (see Clostridium difficile) Arthropodborne viral encephalitides (eastern, western, Venezuelan equine Sd encephalomyelitis; St Louis, California encephalitis) Sd Arthropodborne viral fevers (dengue, yellow fever, Colorado tick fever) Ascariasis S Aspergillosis S Babesiosis S Blastomycosis, North American, cutaneous or pulmonary S Botulism S Bronchiolitis (see respiratory infections in infants and young children) Brucellosis (undulant, Malta, Mediterranean fever) S Campylobacter gastroenteritis (see gastroenteritis) Candidiasis, all forms including mucocutaneous S Cat-scratch fever (benign inoculation lymphoreticulosis) S Cellulitis, uncontrolled drainage C DI Chancroid (soft chancre) S Chickenpox (varicella; see F e for varicella exposure) Fe A,C Chlamydia trachomatis Conjunctivitis S Genital S Respiratory S Cholera (see gastroenteritis) Closed-cavity infection Draining, limited or minor S Not draining S Clostridium C botulinum S C difficile C DI C perfringens 1 Source: Garner JS and HICPAC 1996. 10

Slide 11: Type and Duration of Precautions Needed for Selected Infections and Conditions Precautions * Duration† Infection/Condition Type Food poisoning S Gas gangrene S Coccidioidomycosis (valley fever) Draining lesions S Pneumonia S Colorado tick fever S Ff Congenital rubella C Conjunctivitis Acute bacterial S Chlamydia S Gonococcal S Acute viral (acute hemorrhagic) C DI Coxsackievirus disease (see enteroviral infection) Sg Creutzfeldt-Jakob disease Croup (see respiratory infections in infants and young children) Cryptococcosis S Cryptosporidiosis (see gastroenteritis) Cysticercosis S Cytomegalovirus infection, neonatal or immunosuppressed S Decubitus ulcer, infected Major a C DI Minor or limited b S Sd Dengue Diarrhea, acute-infective etiology suspected (see gastroenteritis) Diphtheria CN h Cutaneous C CN h Pharyngeal D Ci Ebola viral hemorrhagic fever DI Echinococcosis (hydatidosis) S Echovirus (see enteroviral infection) Encephalitis or encephalomyelitis (see specific etiologic agents) Endometritis S Enterobiasis (pinworm disease, oxyuriasis) S Enterococcus species (see multidrug-resistant organisms if epidemiologically significant or vancomycin resistant) Enterocolitis, Clostridium difficile C DI Enteroviral infections Adults S Infants and young children C DI Epiglottitis, due to Haemophilus influenzae D U(24 hrs) Epstein-Barr virus infection, including infectious mononucleosis S Erythema infectiosum (also see Parvovirus B19) S Escherichia coli gastroenteritis (see gastroenteritis) Food poisoning Botulism S Clostridium perfringens or welchii S Staphylococcal S Furunculosis-staphylococcal 11

Slide 12: Type and Duration of Precautions Needed for Selected Infections and Conditions Precautions * Duration† Infection/Condition Type Infants and young children C DI Gangrene (gas gangrene) S Gastroenteritis Sj Campylobacter species Sj Cholera Clostridium difficile C DI Sj Cryptosporidium species Escherichia coli Sj Enterohemorrhagic O157:H7 Diapered or incontinent C DI Sj Other species Sj Giardia lamblia Sj Rotavirus Diapered or incontinent C DI Sj Salmonella species (including S typhi) Sj Shigella species Diapered or incontinent C DI Sj Vibrio parahaemolyticus Sj Viral (if not covered elsewhere) Sj Yersinia enterocolitica German measles (see rubella) Giardiasis (see gastroenteritis) Gonococcal ophthalmia neonatorum (gonorrheal ophthalmia, acute conjunctivitis of S newborn) Gonorrhea S Granuloma inguinale (donovanosis, granuloma venereum) S Guillain-Barré‚ syndrome S Hand, foot, and mouth disease (see enteroviral infection) Hantavirus pulmonary syndrome S Helicobacter pylori S Ci Hemorrhagic fevers (for example, Lassa and Ebola) DI Hepatitis, viral Type A S Fk Diapered or incontinent patients C Type B-HBsAg positive S Type C and other unspecified non-A, non-B S Type E S Herpangina (see enteroviral infection) Herpes simplex (Herpesvirus hominis) Encephalitis S Neonatal l (see F l for neonatal exposure) C DI Mucocutaneous, disseminated or primary, severe C DI Mucocutaneous, recurrent (skin, oral, genital) S Herpes zoster (varicella-zoster) DI m Localized in immunocompromised patient, or disseminated A,C Sm Localized in normal patient Histoplasmosis S HIV (see human immunodeficiency virus) S 12

Slide 13: Type and Duration of Precautions Needed for Selected Infections and Conditions Precautions * Duration† Infection/Condition Type Hookworm disease (ancylostomiasis, uncinariasis) S Human immunodeficiency virus (HIV) infection c S Impetigo C U (24 hrs) Infectious mononucleosis S Dn Influenza DI Kawasaki syndrome S Ci Lassa fever DI Legionnaires' disease S Leprosy S Leptospirosis S Lice (pediculosis) C U (24 hrs) Listeriosis S Lyme disease S Lymphocytic choriomeningitis S Lymphogranuloma venereum S Sd Malaria Ci Marburg virus disease DI Measles (rubeola), all presentations A DI Melioidosis, all forms S Meningitis Aseptic (nonbacterial or viral meningitis; also see enteroviral infections) S Bacterial, gram-negative enteric, in neonates S Fungal S Haemophilus influenzae, known or suspected D U(24 hrs) Listeria monocytogenes S Neisseria meningitidis (meningococcal) known or suspected D U(24 hrs) Pneumococcal S Tuberculosis o S Other diagnosed bacterial S Meningococcal pneumonia D U(24 hrs) Meningococcemia (meningococcal sepsis) D U(24 hrs) Molluscum contagiosum S Mucormycosis S Multidrug-resistant organisms, infection or colonization p Gastrointestinal C CN Respiratory C CN Pneumococcal S Skin, wound, or burn C CN Fq Mumps (infectious parotitis) D Mycobacteria, nontuberculosis (atypical) Pulmonary S Wound S Mycoplasma pneumonia D DI Necrotizing enterocolitis S Nocardiosis, draining lesions or other presentations S Norwalk agent gastroenteritis (see viral gastroenteritis) Orf S Parainfluenza virus infection, respiratory in infants and young children C DI 13

Slide 14: Type and Duration of Precautions Needed for Selected Infections and Conditions Precautions * Duration† Infection/Condition Type Fr Parvovirus B19 D Pediculosis (lice) C U(24 hrs) Fs Pertussis (whooping cough) D Pinworm infection S Plague Bubonic S Pneumonic D U(72 hrs) Pleurodynia (see enteroviral infection) Pneumonia Adenovirus D,C DI Bacterial not listed elsewhere (including gram-negative bacterial) S Burkholderia cepacia in cystic fibrosis (CF) patients, St including respiratory tract colonization Chlamydia S Fungal S Haemophilus influenzae Adults S Infants and children (any age) D U(24 hrs) Legionella S Meningococcal D U(24 hrs) Multidrug-resistant bacterial (see multidrug-resistant organisms) Mycoplasma (primary atypical pneumonia) D DI Pneumococcal S Multidrug-resistant (see multidrug-resistant organisms) Su Pneumocystis carinii St Pseudomonas cepacia (see Burkholderia cepacia) Staphylococcus aureus S Streptococcus, group A Adults S Infants and young children D U(24hrs) Viral Adults S Infants and young children (see respiratory infectious disease, acute) Poliomyelitis S Psittacosis (ornithosis) S Q fever S Rabies S Rat-bite fever (Streptobacillus moniliformis disease, Spirillum minus disease) S Relapsing fever S Resistant bacterial infection or colonization (see multidrug-resistant organisms) Respiratory infectious disease, acute (if not covered elsewhere) Adults S Infants and young children c C DI Respiratory syncytial virus infection, in infants and C DI young children, and immunocompromised adults Reye's s yndrome S Rheumatic fever S Rickettsial fevers, tickborne (Rocky Mountain spotted fever, tickborne typhus fever) S 14

Slide 15: Type and Duration of Precautions Needed for Selected Infections and Conditions Precautions * Duration† Infection/Condition Type Rickettsialpox (vesicular rickettsiosis) S Ringworm (dermatophytosis, dermatomycosis, tinea) S Ritter's disease (staphylococcal scalded skin syndrome) S Rocky Mountain spotted fever S Roseola infantum (exanthem subitum) S Rotavirus infection (see gastroenteritis) Fv Rubella (German measles; also see congenital rubella) D Salmonellosis (see gastroenteritis) Scabies C U(24 hrs) Scalded skin syndrome, staphylococcal (Ritter's disease) S Schistosomiasis (bilharziasis) S Shigellosis (see gastroenteritis) Sporotrichosis S Spirillum minus disease (rat-bite fever) S Staphylococcal disease (S aureus) Skin, wound, or burn Major a C DI Minor or limited b S Sj Enterocolitis Multidrug-resistant (see multidrug-resistant organisms) Pneumonia S Scalded skin syndrome S Toxic shock syndrome S Streptobacillus moniliformis disease (rat-bite fever) S Streptococcal disease (group A streptococcus) Skin, wound, or burn Major a C U(24 hrs) Minor or limited b S Endometritis (puerperal sepsis) S Pharyngitis in infants and young children D U(24 hrs) Pneumonia in infants and young children D U(24 hrs) Scarlet fever in infants and young children D U(24 hrs) Streptococcal disease (group B streptococcus), neonatal S Streptococcal disease (not group A or B) unless covered elsewhere S Multidrug-resistant (see multidrug-resistant organisms) Strongyloidiasis S Syphilis Skin and mucous membrane, including congenital, primary, secondary S Latent (tertiary) and seropositivity without lesions S Tapeworm disease Hymenolepis nana S Taenia solium (pork) S Other S Tetanus S Tinea (fungus infection dermatophytosis, dermatomycosis, ringworm) S Toxoplasmosis S Toxic shock syndrome (staphylococcal disease) S Trachoma, acute S 15

Slide 16: Type and Duration of Precautions Needed for Selected Infections and Conditions Precautions * Duration† Infection/Condition Type Trench mouth (Vincent's angina) S Trichinosis S Trichomoniasis S Trichuriasis (whipworm disease) S Tuberculosis Extrapulmonary, draining lesion (including scrofula) S Extrapulmonary, meningitis o S Fw Pulmonary, confirmed or suspected or laryngeal disease A Skin-test positive with no evidence of current pulmonary disease S Tularemia Draining lesion S Pulmonary S Typhoid (Salmonella typhi) fever (see gastroenteritis) Typhus, endemic and epidemic S Urinary tract infection (including pyelonephritis), with or without urinary catheter S Fe Varicella (chickenpox) A,C Vibrio parahaemolyticus (see gastroenteritis) Vincent's angina (trench mouth) S Viral diseases Respiratory (if not covered elsewhere) Adults S Infants and young children (see respiratory infectious disease, acute) Fs Whooping cough (pertussis) D Wound infections Major a C DI Minor or limited b S Yersinia enterocolitica gastroenteritis (see gastroenteritis) Zoster (varicella-zoster) DI m Localized in immunocompromised patient, disseminated A,C Sm Localized in normal patient Zygomycosis (phycomycosis, mucormycosis) S 16

Slide 17: Isolation Precaution Guidelines for Hospitals Abbreviations: * Type of Precautions: A, Airborne; C, Contact; D, Droplet; S, Standard; when A, C, and D are specified, also use S. † Duration of precautions: CN, until off antibiotics and culture-negative; DI, duration of illness (with wound lesions, DI means until they stop draining); U, until time specified in hours (hrs) after initiation of effective therapy; F, see footnote. a No dressing or dressing does not contain drainage adequately. b Dressing covers and contains drainage adequately. c Also see syndromes or conditions listed in Table 2. d Install screens in windows and doors in endemic areas. e Maintain precautions until all lesions are crusted. The average incubation period for varicella is 10 to 16 days, with a range of 10 to 21 days. After exposure, use varicella zoster immune globulin (VZIG) when appropriate, and discharge susceptible patients if possible. Place exposed susceptible patients on Airborne Precautions beginning 10 days after exposure and continuing until 21 days after last exposure (up to 28 days if VZIG has been given). Susceptible persons should not enter the room of patients on precautions if other immune caregivers are available. f Place infant on precautions during any admission until 1 year of age, unless nasopharyngeal and urine cultures are negative for virus after age 3 months. g Additional special precautions are necessary for handling and decontamination of blood, body fluids and tissues, and contaminated items from patients with confirmed or suspected disease. See latest College of American Pathologists (Northfield, Illinois) guidelines or other references. h Until two cultures taken at least 24 hours apart are negative. i Call state health department and CDC for specific advice about management of a suspected case. During the 1995 Ebola outbreak in Zaire, interim recommendations were published.(97) Pending a comprehensive review of the epidemiologic data from the outbreak and evaluation of the interim recommendations, the 1988 guidelines for management of patients with suspected viral hemorrhagic infections (16) will be reviewed and updated if indicated. j Use Contact Precautions for diapered or incontinent children <6 years of age for duration of illness. k Maintain precautions in infants and children <3 years of age for duration of hospitalization; in children 3 to 14 years of age, until 2 weeks after onset of symptoms; and in others, until 1 week after onset of symptoms. l For infants delivered vaginally or by C-section and if mother has active infection and membranes have been ruptured for more than 4 to 6 hours. m Persons susceptible to varicella are also at risk for developing varicella when exposed to patients with herpes zoster lesions; therefore, susceptibles should not enter the room if other immune caregivers are available. n The "Guideline for Prevention of Nosocomial Pneumonia" (95,96) recommends surveillance, vaccination, antiviral agents, and use of private rooms with negative air pressure as much as feasible for patients for whom influenza is suspected or diagnosed. Many hospitals encounter logistic difficulties and physical plant limitations when admitting multiple patients with suspected influenza during community outbreaks. If sufficient private rooms are unavailable, consider cohorting patients or, at the very least, avoid room sharing with high-risk patients. See “Guideline for Prevention of Nosocomial Pneumonia” (95,96) for additional prevention and control strategies. o Patient should be examined for evidence of current (active) pulmonary tuberculosis. If evidence exists, additional precautions are necessary (see tuberculosis). p Resistant bacteria judged by the infection control program, based on current state, regional, or national recommendations, to be of special clinical and epidemiologic significance. q For 9 days after onset of swelling. r Maintain precautions for duration of hospitalization when chronic disease occurs in an immunodeficient patient. For patients with transient aplastic crisis or red-cell crisis, maintain precautions for 7 days. s Maintain precautions until 5 days after patient is placed on effective therapy. t Avoid cohorting or placement in the same room with a CF patient who is not infected or colonized with B cepacia. Persons with CF who visit or provide care and are not infected or colonized with B cepacia may elect to wear a mask when within 3 ft of a colonized or infected patient. u Avoid placement in the same room with an immunocompromised patient. v Until 7 days after onset of rash. w Discontinue precautions only when TB patient is on effective therapy, is improving clinically, and has three consecutive negative sputum smears collected on different days, or TB is ruled out. Also see CDC “Guidelines for Preventing the Transmission of Tuberculosis in Health-Care Facilities.”(23) REFERENCES Garner JS and The Hospital Infection Control Practices Advisory Committee (HICPAC). 1996. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 17(1): 53–80, and Am J Infect Control 24(1): 24–52. 17




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Pharmacology Git Drugs :: Nursing Pharmacology :: Review For Nursing Licensure Examination Slide Transcript
Slide 1: Pharmacology of the GIT system

Slide 2: LECTURE Outline • REVIEW the Anatomy of the GIT • REVIEW the Physiology of the GIT • Review common GI drugs in the following categories: – 1. Drugs affecting GI secretions – 2. Laxatives – 3. Anti-diarrheals – 4. Emetics and anti-emetics

Slide 3: Fig. 16.1

Slide 4: Fig. 16.10a

Slide 5: Fig. 16.10b

Slide 6: Fig. 16.11a

Slide 7: Fig. 16.11b

Slide 8: Fig. 16.12

Slide 9: Drugs affecting GI secretions There are five types of drugs that affect gastric acid secretions and are useful for the treatment of peptic ulcer. 2. Histamine (H2) receptor antagonist/blockers 3. Antacids 4. Proton pump inhibitors 5. Mucosal protectants 6. Prostaglandin analogs

Slide 10: Drugs affecting secretions: anti ulcer Anti-ulcer drugs Prototype Histamine (H2) receptor Cimetidine antagonist/blockers Antacids AlOH and MgOH Proton pump inhibitors Omeprazole Mucosal protectants Sucralfate Prostaglandin analog Misoprostol

Slide 11: General indication of the drugs affecting gastric acid secretion • Peptic ulcer • Gastritis • Patient on NPO to prevent stress ulcer

Slide 12: General time of administration of the drugs affecting gastric acid secretion Anti-ulcer drugs Prototype Best time to give Histamine (H2) Cimetidine With FOOD or ONE receptor hour after ANTACID antagonist/blockers Antacids AlOH and MgOH Usually after meals Proton pump Omeprazole BEFORE MEALS inhibitors Mucosal Sucralfate BEFORE MEALS protectants Prostaglandin Misoprostol WITH MEALS analog

Slide 13: Pharmacodynamics Histamine (H2) receptor blockers • These drugs BLOCK the release of hydrochloric acid in the stomach in response to gastrin

Slide 14: Drugs affecting GI secretions Antacids • These drugs interact with the gastric acids at the chemical level to neutralize them

Slide 15: Drugs affecting GI secretions Proton pump inhibitors • These drugs suppress the secretion of hydrochloric acid into the lumen of the stomach

Slide 16: Drugs affecting GI secretions Mucosal protectants • These are agents that coat any injured area in the stomach to prevent further injury from acid

Slide 17: Drugs affecting GI secretions Prostaglandin analogs • These are agents that inhibit the secretion of gastrin and • increase the secretion of mucus lining of the stomach, providing a buffer.

Slide 19: The H2 Blockers- “tidines” Prototype: Cimetidine • 1. Ranitidine • 2. Famotidine • 3. Nizatidine

Slide 20: The H2 Blockers- “tidines” Pharmacodynamics: Drug Action • The H2 blockers are antagonists at the receptors in the parietal cells of the stomach. • The blockage results to inhibition of the hormone gastrin. • There will be decreased production of gastric acid from the parietal cells. • Also, the chief cells will secrete less pepsinogen.

Slide 21: The H2 Blockers- “tidines” Therapeutic use of the H2 blockers • Short-term treatment of active duodenal ulcer or benign gastric ulcer • Treatment of hypersecretory conditions like the Zollinger-Ellison syndrome • Prevention of stress-induced ulcers and acute GI bleeding • Treatment of erosive GERD (reflux disease) • Relief of Symptoms of heart burn and acid indigestion

Slide 22: The H2 Blockers- “tidines” Precautions and Contraindications • Any known allergy is a clear contraindication to the use of the agents. • Conditions such as pregnancy, lactation, renal dysfunction and hepatic dysfunction should warrant cautious use. • Nizatidine can be used in hepatic dysfunction.

Slide 23: The H2 Blockers- “tidines” Dynamics- Side effects/adverse effects • GIT= diarrhea or constipation • CNS= Dizziness, headache, drowsiness, confusion and hallucinations • Cardio= arrhythmias, HYPOTENSION (related to H2 receptor blockage in the heart) • Cimetidine= Gynecomastia and impotence in males

Slide 24: The H2 Blockers- “tidines” Drug-drug Interactions • Cimetidine, Famotidine, Ranitidine are metabolized in the liver- they can cause slowing of excretion of other drugs leading to their increased concentration.

Slide 25: The H2 Blockers- “tidines” Drug-drug Interactions These drugs can interact with CIMETIDINE • Anticoagulants • Phenytoin, • Alcohol • Antidepressants.

Slide 26: The H2 Blockers- “tidines” Nursing considerations: • Administer the drug WITH meals at BEDTIME to ensure therapeutic level • One hour after Antacids • Stress the importance of the continued use for the length of time prescribed

Slide 27: The H2 Blockers- “tidines” Nursing considerations • Monitor the cardiovascular status especially if the drugs are given IV • Warn patient of the potential problems of increased drug concentration if the H2 blockers are used with other drugs or OTC drugs. Advise consultation first!

Slide 28: The H2 Blockers- “tidines” Nursing considerations: • Provide comfort measures like analgesics for headache, assistance with ambulation and safety measures because of confusion • Warn the patients taking cimetidine that drowsiness may pose a hazard if driving or operating delicate machines.

Slide 29: The H2 Blockers- “tidines” Nursing considerations: • Provide health teaching as to the dose, frequency, comfort measures to initiate when side-effects are intolerable Evaluate the effectiveness • Relief of symptoms of ulcer, heart burn and GERD

Slide 31: The Antacids These are drugs or inorganic chemicals that have been used for years to neutralize acid in the stomach

Slide 32: The Antacids The following are the common antacids that can be bought OTC: • Aluminum salts (hydroxide) • Calcium salts (carbonate) • Magnesium salts (milk of magnesia) • Sodium bicarbonate • Magaldrate (aluminum and magnesium combination)

Slide 33: The Antacids Pharmacodynamics: drug action • These agents act to neutralize the acidic pH in the stomach. • They do not affect the rate of gastric acid secretion.

Slide 34: The Antacids Pharmacodynamics: drug action • The administration of antacid may cause an acid rebound. • Neutralizing the stomach content to an alkaline level stimulates gastrin production to cause an increase in acid production and return the stomach to its normal acidic state.

Slide 35: The Antacids Therapeutic Indications • Symptomatic relief of upset stomach associated with hyperacidity • Hyperacidic conditions like peptic ulcer, gastritis, esophagitis and hiatal hernia • Special use of AMPHOGEL (aluminum hydroxide): to BIND phosphate

Slide 36: The Antacids Precautions of Antacid Use • Known allergy is a clear contraindication • Caution should be instituted if used in electrolyte imbalances, GI obstruction and renal dysfunction. • Sodium bicarbonate is rarely used because of potential systemic absorption metabolic alkalosis!!!

Slide 37: The Antacids Pharmacokinetics • These agents are taken orally and act locally in the stomach

Slide 38: The Antacids Pharmacodynamics: Effects of drugs 2. GIT= rebound acidity; alkalosis may occur. • Calcium salts may lead to hypercalcemia • Magnesium salts can cause DIARRHEA • Aluminum salts may cause CONSTIPATION and Hypophosphatemia by binding with phosphates in the GIT. 2. Fluid retention due to the high sodium content of the antacids.

Slide 39: The Antacids Nursing Considerations: • Administer the antacids apart from any other medications by ONE hour before or TWO hours after- to ensure adequate absorption of the other medications • Tell the patient to CHEW the tablet thoroughly before swallowing. Follow it with one glass of water • Regularly monitor for manifestations of acid-base imbalances as well as electrolyte imbalances

Slide 40: The Antacids Nursing Considerations: • Provide comfort measures to alleviate constipation associated with aluminum and diarrhea associated with magnesium salts. • Monitor for the side-effects, effectiveness of the comfort measures, patient’s response to the medication and the effectiveness of the health teachings

Slide 41: The Antacids Nursing Considerations Evaluate for effectiveness: Decreased symptoms of ulcer and pyrosis Decreased Phosphate level (Amphogel) in patients with chronic renal failure

Slide 43: The PPI These are the newer agents for ulcer treatment • The “prazoles” Prototype: Omeprazole • Lanisoprazole • Esomeprazole • Pantoprazole

Slide 44: The PPI Pharmacodynamics: drug action • They act at specific secretory surface receptors to prevent the final step of acid production and thus decrease the level of acid in the stomach. • The “pump” in the parietal cell is the H- K ATPase enzyme system on the secretory surface of the gastric parietal cells

Slide 45: The PPI Clinical use of the PPIs • Short-term treatment of active duodenal ulcers, GERD, erosive esophagitis and benign gastric ulcer • Long-term- maintenance therapy for healing of erosive disorders.

Slide 46: The PPI Precautions with the use of the PPIs • Known allergy is a clear contraindication • Caution if patient is pregnant

Slide 47: The PPI Pharmacodynamics: Adverse effects • CNS- dizziness, headache, asthenia (loss of strength), vertigo, insomnia, apathy • GIT- diarrhea, abdominal pain, nausea, vomiting, dry mouth and tongue atrophy • Respi- cough, stuffy nose, hoarseness and epistaxis.

Slide 48: The PPI Nursing considerations: • Administer the drug BEFORE meals. Ensure that patient does not open, chew or crush the drug. • Provide safety measures if CNS dysfunction happens. • Arrange for a medical follow-up if symptoms are NOT resolved after 4-8 weeks of therapy.

Slide 49: The PPI Nursing considerations: • Provide health teaching as to drug name, dosages and frequency, safety measures to handle common problems. • Monitor patient response to the drug, the effectiveness of the teaching plan and the measures to employ

Slide 50: The PPI Nursing considerations: Evaluate for effectiveness of the drug • Healing of peptic ulcer • Decreased symptoms of ulcer

Slide 52: The Mucosal Protectant Sucralfate (Caralfate/ Iselpin) • This is given to protect the eroded ulcer sites in the GIT from further damage by acid and digestive enzymes

Slide 53: Sucralfate Pharmacodynamics: Action of drug • It forms an ulcer-adherent complex at duodenal ulcer sites, protecting the sites against acid, pepsin and bile. • This action prevents further breakdown of proteins in the area and promotes healing.

Slide 54: Sucralfate Clinical use of sucralfate • Short and long term management of duodenal ulcer. • NSAIDs induced gastritis • Prevention of stress ulcer • Treatment of oral and esophageal ulcers due to radiation, chemotherapy or sclerotherapy.

Slide 55: Sucralfate Precautions on the use of Sucralfate • This agent should NOT be given to any person with known allergy to the drug, and to those patients with renal failure/dialysis because of build-up of aluminum may occur if used with aluminum containing products.

Slide 56: The Mucosal Protectant Pharmacodynamics: Side-effects & adverse reactions • Primarily GIT= CONSTIPATION, occasionally diarrhea, nausea, indigestion, gastric discomfort, and dry mouth may also occur • CNS= dizziness, drowsiness, vertigo • Others= rash and back pain

Slide 57: The Mucosal Protectant Drug-drug interactions • If used with aluminum salts= high risk of accumulation of aluminum and toxicity. • If used with phenytoin, fluoroquinolones and penicillamines- decreased levels of these drugs when taken with sucralfate

Slide 58: The Mucosal Protectant Nursing Considerations • Administer drug ON AN EMPTY stomach, 1 hour before meals , or 2 hour after meals and at BEDTIME • Monitor for side-effects like constipation and GI upset • Encourage intake of high-fiber foods and increased fluid intake • Administer antacids BETWEEN doses of sucralfate, NOT WITHIN 30 minutes of sucralfate dose

Slide 59: The Mucosal Protectant Nursing Considerations • Provide comfort measures if CNS effects occur • Provide health teaching as to drug name, dosages and frequency, safety measures to handle common problems. • Monitor patient response to the drug, the effectiveness of the teaching plan and the measures employed

Slide 60: The Mucosal Protectant Nursing Considerations • Evaluate effectiveness of therapy Healing of ulcer No formation of ulcer

Slide 62: Prostaglandin analogue Misoprostol • This agent is a synthetic prostaglandin E1 analog that is employed to protect the lining of the mucosa of the stomach

Slide 63: Prostaglandin analogue Misoprostol: Pharmacodynamics • Being a prostaglandin analog, it inhibits gastric acid secretion to some degree • It INCREASES mucus production in the stomach lining.

Slide 64: Prostaglandin analogue Misoprostol: Clinical use • NSAIDs-induced gastric ulcers • Duodenal ulcers unresponsive to H2 antagonists

Slide 65: Prostaglandin analogue Precautions of Misoprostol Use • This drug is CONTRAINDICATED during pregnancy because it is an abortifacient. • Women should be advised to have a negative pregnancy test within 2 weeks of beginning therapy and should begin the drug on the second or third day of the next menstrual cycle. • They should be instructed in the use of contraceptives during therapy.

Slide 66: Prostaglandin analogue Pharmacodynamic effects: drug reactions • GIT= Nausea, diarrhea, abdominal pain, flatulence, vomiting, dyspepsia • GU effects= miscarriages, excessive uterine CRAMPING and bleeding, spotting, hyper-menorrhea and menstrual disorders.

Slide 67: Prostaglandin analogue Nursing Considerations • Administer to patients at risk for NSAIDs- induced ulcers during the full course of NSAIDs therapy • Administer four times daily with meals and at bedtime • Obtain pregnancy test within 2 weeks of beginning therapy. • Begin the therapy on second or third day of menstrual period to ensure that the woman is not pregnant

Slide 68: Prostaglandin analogue Nursing Considerations • Provide patient with both written and oral information regarding the associated risks of pregnancy • Provide health teaching as to drug name, dosages and frequency, safety measures to handle common problems. • Monitor patient response to the drug, the effectiveness of the teaching plan and the measures to employ

Slide 70: Laxatives • Generally used to INCREASE the passage of the colonic contents • The general classifications is as follows: 1. Chemical stimulants- irritants 2. Mechanical stimulants- hyperosmotic agents and saline cathartics 3. Lubricants and stool softeners

Slide 71: Laxatives • They promote bowel evacuation for various purposes • They are classified into their mode of action

Slide 72: Laxatives Type Prototype Action Direct stimulation of the Chemical Bisacodyl GIT nerves stimulants (Dulcolax) Irritant laxatives Increased fluid content Mechanical Lactulose of the fecal material (bulk) causing stimulation of stimulants the local reflex Lubricating the Lubricants Docusate intestinal material to Mineral oil promote passage through the GIT

Slide 73: Therapeutic Indications of the Laxatives • SHORT term relief of Constipation • Prevention of straining in conditions like CHF, post-MI, post partum, post-op • Preparation for diagnostic examination • Removal of poison or toxins • Adjunct in anti-helminthic therapy • To remove AMMONIA by use of lactulose

Slide 74: Contraindications in Laxative use • ACUTE abdominal disorders – Appendicitis – Diverticulitis – Ulcerative colitis

Slide 75: Chemical Stimulant Cathartics Prototype: Bisacodyl Irritant laxatives: • 1. Castor oil • 2. Senna • 3. Cascara • 4. Phenolphthalein

Slide 76: Chemical Stimulant Cathartics Pharmacodynamics • These agents DIRECTLY stimulate the nerve plexus in the intestinal wall • The result is INCREASED movement or motility of the colon

Slide 77: Mechanical Stimulant Cathartics Prototype: LACTULOSE (Cephulac) Bulk-forming laxatives • 1. Magnesium (citrate, hydroxide, sulfate)- saline cathatic • 2. Psyllium • 3. Polycarbophil

Slide 78: Mechanical Stimulant Cathartics Pharmacodynamics • These agents are rapid-acting laxatives that INCREASE the GI motility by – Increasing the fluids in the colonic material – Stimulating the local stretch receptors – Activating local defection reflex

Slide 79: Lubricants-Stool softener Prototype: Docusate • 1. Glycerin • 2. Mineral oil

Slide 80: Lubricants-stool softeners Pharmacodynamics • Docusate increases the admixture of fat and water producing a softer stool • Glycerin and Mineral oil form a slippery coat on the colonic contents

Slide 81: Pharmacokinetics: Common Side-effects of the Laxatives • Diarrhea • Abdominal cramping • Nausea • Fluid and electrolyte imbalance • Sympathetic reactions- sweating, palpitations, flushing and fainting • CATHARTIC dependence

Slide 82: The Nursing Process and Laxative ASSESSMENT • Nursing History- elicit allergy to any laxatives, elicit history of conditions like diverticulitis and ulcerative colitis • Physical Examination- abdominal assessment • Laboratory Test: fecalysis, electrolyte levels

Slide 83: The Nursing Process and Laxative NURSING DIAGNOSIS • Alteration in bowel pattern • Alteration in comfort: pain • Knowledge deficit

Slide 84: The Nursing Process and Laxative IMPLEMENTATION 2. Emphasize that it is use on a SHORT term basis 3. Provide comfort and safety measures like ready access to the bathroom, side-rails 4. Administer with a full glass of water

Slide 85: The Nursing Process and Laxative IMPLEMENTATION 4. Encourage fluid intake, high fiber diet and daily exercise 5. DO NOT administer if acute abdominal condition like appendicitis is present 6. Advise to change position slowly and avoid hazardous activities because of potential dizziness

Slide 86: The Nursing Process and Laxative IMPLEMENTATION 7. Record intake and output to assess fluid alteration 8. If possible, observe the character of stools 9. Caution the patient that chronic use may promote dependence and use during pregnancy may cause uterine cramping and Vitamin deficiency

Slide 87: The Nursing Process and Laxative EVALUATION of drug effectiveness 2. Evaluate relief of GI symptoms, absence of staining and increased evacuation of GI tract 3. For Lactulose: decreased ammonia 4. Nomal bowel fucntion is restored

Slide 88: The Anti-diarrheals • These are agents used to calm the irritation of the GIT for the symptomatic relief of diarrhea • General Classifications 1. Local anti-motility 2. Local reflex inhibition 3. Central action on the CNS

Slide 89: The Anti-diarrheals Type Prototype Action Locally coats the lining Local reflex Bismuth of the GIT to soothe inhibitor subsalicylate irritation Directly inhibits the Local anti- Loperamide intestinal muscle motility activity to SLOW peristalsis Stops GIT spasm by Central acting Opium CNS action agent derivatives (paregoric)

Slide 90: Clinical Indications of drug use • Relief of symptoms of acute and chronic diarrhea • Reduction of fecal volume discharges from ileostomies • Prevention and treatment of traveler's diarrhea

Slide 91: Contraindications of anti-diarrheal Use • Poisoning • Drug allergy • GI obstruction • Acute abdominal conditions

Slide 92: Pharmacokinetics: Side effects • Constipation • Nausea, vomiting • Abdominal distention and discomfort • TOXIC MEGACOLON

Slide 93: Nursing process and anti-diarrheals ASSESSMENT • Nursing History – Elicit history of drug allergy, conditions like poisoning, GI obstruction and acute abdominal conditions • Physical Examination- Abdominal examination • Laboratory test- electrolyte levels

Slide 94: Nursing process and anti-diarrheals NURSING DIAGNOSIS • Alteration in bowel pattern • Alteration in comfort: pain

Slide 95: Nursing process and anti-diarrheals IMPLEMENTATION 2. Monitor patient response within 48 hours. Discontinue drug use if no effect 3. Provide comfort measures for pain 4. Provide teaching regarding its short term use only

Slide 96: Nursing process and anti-diarrheals EVALUATION 2. Monitor effectiveness of drug- RELIEF of diarrhea 3. Monitor adverse effects, effectiveness of pain measures and effectiveness of teaching plan

Slide 98: Emetics and Anti-emetics Emetic Agent • Syrup of Ipecac Anti-emetics • 1. Phenothiazines • 2. Non-phenothiazines • 3. Anticholinergics/Antihistamines • 4. Serotonin receptor Blockers • 5. Miscellaneous

Slide 99: EMETIC • Prototype: Ipecac Syrup

Slide 100: EMETIC Pharmacodynamics • Ipecac syrup irritates the GI mucosa locally, resulting to stimulation of the vomiting center • It acts within 20 minutes

Slide 101: EMETIC Clinical Use of ipecac • To induce vomiting as a treatment for drug overdose and certain poisonings

Slide 102: EMETIC Contraindications of Ipecac use • Ingestion of CORROSIVE chemicals • Ingestion of petroleum products • Unconscious and convulsing patient

Slide 103: EMETIC Pharmacokinetics: side effects of Ipecac • Nausea • Diarrhea • GI upset • Mild CNS depression • CARDIOTOXICITY if large amounts are absorbed in the body

Slide 104: Nursing process and the EMETIC ASSESSMENT • Nursing History- elicit the exact nature of poisoning • Physical Examination- CNS status and abdominal exam

Slide 105: Nursing process and the EMETIC IMPLEMENTATION 2. Administer to conscious patient only 3. Administer ipecac as soon as possible 4. Administer with a large amount of water 5. Vomiting should occur within 20 minutes of the first dose. Repeat the dose and expect vomiting to occur with 20 minutes

Slide 106: Nursing process and the EMETIC IMPLEMENTATION 5. Provide comfort measures like ready access to bathroom, assistance with ambulation 6. Offer support

Slide 107: Nursing process and the EMETIC EVALUATION 2. Evaluate patient response within 20 minutes of drug ingestion 3. Monitor for adverse effects 4. Evaluate effectiveness of comfort measures and teaching plan

Slide 109: ANTI-EMETICS • These are agents used to manage nausea and vomiting • They act either locally or centrally • In general, they may inhibit the chemoreceptor trigger zone in the medulla by blocking DOPAMINE receptor • Others act by decreasing the sensitivity of the vestibular apparatus

Slide 110: ANTIEMETICS Anti-emetic types Common examples Phenothiazines Prochlorperazine, Promethazine Non-phenothiazines Metoclopramide Anticholinergics and Meclizine, buclizine Antihistaminics Serotonin Receptor “setron”- dolasetron blockers Miscellaneous Dronabinol, hydroxyzine

Slide 111: ANTIEMETICS Types Pharmacodynamics Centrally block the vomiting center in Phenothiazines the medulla Non-phenothiazine Reduces the responsiveness of the nerve cell in the medulla; also blocks the dopamine receptors Block the transmission of the impulses Anticholinergics to the medulla Serotonin receptor Centrally and locally inhibits the serotonin receptors blockers Act in the CNS , either in the medulla or Miscellaneous in the cortex

Slide 112: ANTIEMETICS Types Clinical Use N/V associated with Phenothiazines anesthesia, intractable hiccups N/V associated with chemical Non-phenothiazine stimulation N/V associated with motion Anticholinergics sickness Serotonin-receptor N/V associated with Blockers chemotherapy Miscellaneous N/V associated with chemotherapy

Slide 113: ANTIEMETICS Indications • 1. Prevention and treatment of vomiting • 2. Motion sickness

Slide 114: ANTIEMETICS Contraindications • 1. Severe CNS depression • 2. Severe liver dysfunction

Slide 115: ANTIEMETICS Pharmacokinetics: • Oral absorption is good if vomiting is not present • IV drugs can be given if vomiting is active • Most drugs are metabolized in the liver excreted in the kidneys

Slide 116: ANTIEMETICS Pharmacokinetics: Side-effects 1. PHOTHOSENSITIVITY 2. Drowsiness, dizziness, weakness and tremors and DEHYDRATON 3. Phenothiazines= autonomic anti- cholinergic effects like dry mouth, nasal congestion and urinary retention Metoclopramide= EPS due to dopamine receptor blockage

Slide 117: Nursing Process and the ANTIEMETICS ASSESSMENT • Nursing History- elicit allergy, impaired hepatic function and CNS depression • Physical Examination- CNS status and abdominal examination • Laboratory test- Liver function studies

Slide 118: Nursing Process and the ANTIEMETICS NURSING DIAGNOSIS 2. Alteration in comfort: pain 3. High risk for injury 4. Knowledge deficit

Slide 119: Nursing Process and the ANTIEMETICS IMPLEMENTATION 2. Assess patient’s intake of other drugs that may cause dangerous drug interaction 3. Emphasize that this is given on a short term basis

Slide 120: Nursing Process and the ANTIEMETICS IMPLEMENTATION 3. Provide comfort and safety measures – Advise to change position slowly – Avoid hazardous activities – Provide mouth care and ice chips – Monitor for dehydration and offer fluids if it occurs

Slide 121: Nursing Process and the ANTIEMETICS IMPLEMENTATION 4. Protect from sun exposure – Sunscreens – Protective covering 5. Provide health teaching

Slide 122: Nursing Process and the ANTIEMETICS EVALUATION 1. Monitor for the drug effectiveness • Relief of nausea and vomiting 2. Monitor for adverse effects 3. Evaluate effectiveness of comfort measures and teaching plan




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Wednesday, November 14, 2007

Alteration In Metabolism :: Medical Surgical Nursing :: Review For Nursing Licensure Examination

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Alteration In Metabolism :: Medical Surgical Nursing :: Review For Nursing Licensure Examination Slide Transcript
Slide 1: Choose life, so that you and your children may live Deuteronomy 30:19

Slide 2: Sherrie-Ann L. Vergara, MD UP College of Medicine Class 2005

Slide 3: Course Requirement: Basic understanding of your Basic Sciences Topics: • GI Tract Pathology • Endocrine Glands Pathology • Others : Low birth weight infants, Vitamins Basis of Grades: • Attendance/ Recitation • Reports • Quizzes • Exams, etc.

Slide 4: TYPES OF METABOLISM 1. Anabolic - simple to complex 2. Catabolic - complex to simple

Slide 5: FUNCTIONS OF LIFE DIGESTION 3. RESPIRATION 4. GROWTH 5. RESPONSIVENESS 6. REPRODUCTION 7. EXCRETION 8. MOVEMENT 9.

Slide 6: WHAT IS METABOLISM? It pertains to all the chemical reactions that occur in a living system necessary for the performance of various functions of life.

Slide 7: Each function involves several chemical  reactions Each chemical reaction involves several  steps Each of the different function is  interrelated Each chemical reactions are interrelated 

Slide 12: OVERVIEW OF DIGESTIVE DISORDERS 1. CLASSIFICATIONS 2. UPPER GIT 3. LOWER GIT 4. ACCESORY ORGANS

Slide 13: CLASSIFICATION DIGESTIVE DISORDERS 1. FUNCTIONAL a. Obstruction b. Absorption c. Hyperactivity 2. ANATOMICAL a. Upper GIT b. Lower GIT

Slide 14: METABOLIC IMPLICATION OF GIT DISORDERS:

Slide 15: MEANS OF MAINTAINING FUNCTION ALTERNATIVE FEEDING PATTERNS a. IV Infusion b. Enteral Hyperalimentation c. Total Parenteral Nutrition d. Elemental Diets e. Fat Emulsion Feeding

Slide 16: UPPER GIT • dysphagia • Vomiting or Regurgitation • Flatulence • Pain • Hematemesis • Melena

Slide 17: LOWER GIT • Pain • Vomiting or Regurgitation • Flatulence • Abdominal Distention • Hematochezia • Diarrhea •Constipation

Slide 18: BW < 2500 grams

Slide 19: Prematurity  Small for Gestational Age (SGA) 

Slide 21: •Genetic or Chromosomal Abnormalities • Acquired Congenital Diseases

Slide 22: • Placental Insufficiency • Cord Coil •Multiple gestation

Slide 23: • Maternal Illness • Reproductive organ anomally • Nutritional Status • Smoking • Alcoholism

Slide 24: PROBLEMS WITH LBW BABIES • Greater risk for respiratory problems • Higher risk for Intraventricular Hemorrhage • Associated cardiac problems with premature babies • Impaired thermoregulation • Slower growth

Slide 25: PREVENTION • Regular prenatal check up • Multivitamins • Avoidance of smoking and alcohol

Slide 26: PREVENTION • Adequate nutrition • Judicious use of medications

Slide 33: Among the most common congenital anomalies  Severity varies  May present as a cleft lip, cleft palate or both  Cause is Multifactorial  - Genetic - Environmental

Slide 37: • Defective growth the medial Failure of fusion of of palatal shelves nasal and maxillary process during the 5th week of embyonic • Failure of the shelves to attain developmentposition a horizontal • Lack of contact between shelves • Rupture after fusion of shelves

Slide 38: MAJOR MEDICAL CONCERN • Risk of aspiration because of communication between oral and nasal cavities • Airway obstruction • Difficulties with feeding of a child with a cleft and nasal regurgitation

Slide 39: Breastfeeding an infant with a cleft • Massaging the breast and applying hot packs on the breast 20 minutes before nursing usually helps. • The mother should apply pressure to the areola with her fingers to help the engorged nipple protrude.. • If the infant cannot hold onto the nipple any more, the mother can collect the remaining milk and can finish the feeding with collected milk in a bottle. • The mother should increase her fluid intake (drink lots of water).

Slide 40: Feeding milk with a bottle • A variety of nipples and bottles are made specifically for infants with clefts. • A soft nipple is generally better than a hard nipple • Use a crosscut nipple to prevent choking. The crosscut is on the tongue side. • The bottle should be squeezed and released, not continually squeezed. • The nipple is angled to a side of the mouth, away from the cleft.

Slide 41: Other recommendations • More upright or seated positions prevent the milk from leaking to the nose and causing the infant to choke. •Advise the mother to stop feeding and allow the infant to cough or sneeze for a few seconds when nasal regurgitation occurs. • Gaining weight and preventing aspiration and ear infections are the most important parts of caring for neonates with a cleft during their first days and weeks of life.

Slide 42: RECOMMENDED PROTOCOL • Diagnostic examination, general counseling of parents, feeding instructions • Age 3 months - Repair of CL and placement of ventilation tubes • Age 6 months - Presurgical orthodontics, if necessary; first speech evaluation • Age 9 months - Speech therapy begins

Slide 43: RECOMMENDED PROTOCOL • Age 9-12 months - Repair of CP (placement of ventilation tubes if not done at the time of CL repair) • Age 1-7 years - Orthodontic treatment • Age 7-8 years - Alveolar bone graft • Older than 8 years - Orthodontic treatment continues

Slide 46: The most common cause of intestinal  obstruction in infancy Also known as infantile hypertrophic  pyloric stenosis (IHPS) Etiology is unknown and probably  Multifactorial

Slide 47: GIT GENETICS DEVELOPMENT ENVIRONMENTAL HYPERTROPHY And HYPERPLASIA NARROWING OF THE GASTRIC ANTRUM NONBILIOUS DECREASED EPIGASTRIC VISIBLE IMPAIRED VOMITING URINE AND DISTENTION GASTRIC DEHYDRATION (METABOLIC STOLL (OLIVE-SHAPED NUTRITION PERISTALSIS ALKALOSIS) OUTPUT MASS)

Slide 49: OTHER COMMON FINDINGS: Hypochloremic, hypokalemic metabolic alkalosis  Hypernatremia or hyponatremia  Dilated stomach bubble ON X-ray  String sign and shoulder sign on UGI 

Slide 50: DIAGNOSTICS Plain x-rays  Ultrasonography  Normal UGIS Gastric Outlet Obstruction

Slide 51: DIAGNOSTICS Upper gastrointestinal imaging (UGI)  Electrolytes, pH, BUN, and creatinine 

Slide 52: MANAGEMENT: Immediate treatment requires correction of fluid  loss, electrolytes, and acid-base imbalance Surgery is the curative treatment 

Slide 53: MANAGEMENT: Endoscopic balloon dilatation has been used in  certain selected patients with short-term symptomatic relief




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Monday, November 12, 2007

Myk's Nclex Study Notes - Womens Health And Maternal Newborn Nursing

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Women Health and Maternal Newborn Nursing

During ovulatory cycle -> FSH & LH is release from anterior pituitary (tropic hormone). They stimulate the follicles in the ovaries to produces estrogen. Mature egg release estrogen and progesterone to prepare the endometrium just incase you get pregnant. (month by month)

Menarchy - When the girl first menstrate

Infertility - inability to concieved after 1 year of regular intercourse (2-3x a week without using contraception)

Primary infertility - never been pregnant and cannot conceived
Secondary infertility - have kids but now cannot conceived


Male Infertility
1. MUMPS in post puberty
2. STD
3. Radiations or chemotheraphy
4. Alcohol
5. Elevated scrotal temperature tight underwear (use boxer shorts)


Female Infertility
1. On Pills all the time
2. TO DIAGNOSE FALLOPIAN TUBE OBSTRUCTION -> Test Histrosalphingogram
3. Uterine abnormality (some woman have only one uterus)
4. Use of DES (Di-ethel silbesterol)
5. STD

Test

1. Semen Test
2. Post coital test
3. Histrosalphingogram
4. Endometrium biopsy

How do we treat Infertility?

1. Basometabolic Temperature Measurement
- special thermometer, every morning before you get of bed, put thermometer

in vagina for 5 minuteS, document

* DIP IN TEMPERATURE - before you ovulate (good time to have sex)
* SPIKE IN TEMPERATURE -after you ovulate
* If pregnant, temperature stays up! If not, drop of temperature

Fertility Drugs:

1. Clomid
- weight gain
- multiple gestation (possible of depositing multiple eggs)


HOW TO USE A DIAPHRAM:
1. Put spermacidal in center and in the rim of diaphram
2. Once inserted, you got to make sure its covering the cervical cap
3. leave diaphram at least 6 hours after sex


Norplan Implant (Estrogen base)


CONTRACEPTIONS FOR WOMEN:

Depo-Provera
- Dont ovulate and dont have a period
Coitus Interruptus
-pull out penis before ejaculation

Morning after pills (emergency contraceptions)
-4 pills or 2 pills depending on how you use it

For 4 pills - 2 low estrogen pills now and 2 pills in 12 hours
For 2 pills - 1 methelprogesteron and 1 in 12 hours


CONTRACEPTION FOR MEN

1. vasectomy
2. condoms
3. abstinence


Sexually Transmitted Disease
1.Use of oral contraceptive can increase the risk for STDs because it changes

your vagina ph. (vagina ph is acidic -> alkaline)

2. Candidiasis (yeast infection) - candida albican (normal in newborn -> mouth)
- vagina get mucosy

3. Diabetis - lots of sugar & immune system gets depleted

4. Systemic antibiotics - kills all normal flora in all body including in your

vaginal area, gives a chance to candida to grow

Trichomoniasis (Trichomonas vaginalis) Protozoa
- usually appear within 5 to 28 days of exposure
- heavy, yellow-green or gray vaginal discharge, discomfort during intercourse,

unpleasant vaginal odor, and painful urination
- does not go across the placenta
- susceptible to Premature rupture of the membrane
- metronidazole (flagile) crossess the placenta ( dont use in 1st trimester) NO

ALCOHOL
-gynelotramin (drugs)

BV (Bacterial Vaginosis) - garden variety bug
- normally exist in vagina
- oppurtunistic (if ph changes or use to much antibiotics)
- grayish fishy smell ( green discharge)
- metronidazole

Chlamydia (most common) Chlamydia trachomatis (nclex: C. Trachomatic)
- gram negative
- woman could be asymthomatic untreated: infertility, ectopic preg. (scar

tissue)
- men - burning when urinating


syphilis -painless cancre

Primary- Contagious
Secondary- Contagious
Latent - Contagius
Tertiary- Not contagious (already in your system)


Herpes Simplex Virus - painful cancre

HSV 1 (oral)
HSV 2 (genetalia) Intervention: culture, acyclovir, no sex while lession are

presence -- woman will need C-Section because these lesion could be internal


---
Cryotheraphy, Obstetrics and Gynecology. It is also known as "freezing" of

wound. Freezing


PID - Pelvic Inflamatory Disease



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