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Wednesday, January 30, 2008

100,000 Nursing Graduates Expected To Take June NLE Board Exam

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As many as 100,000 Filipino nursing graduates are expected to take the licensure examination this June, the Professional Regulation Commission (PRC) announced yesterday.

PRC chair Leonor Rosero said between 80,000 to 100,000 nursing students graduating in March are projected to take the eligibility test set on June 1 and 2.

Rosero urged examinees to file their application and all the necessary requirements early to avoid overcrowding at designated PRC filing centers.

According to Rosero, nursing students graduating this school year can take the licensure examination provided they were able to submit all the necessary documentary requirements.

Examinees may file their applications at the PRC central office or regional offices in the cities of Baguio, Cagayan de Oro, Cebu, Davao, Iloilo, Lucena, Tacloban, Legaspi, Tuguegarao and Zamboanga.

Rosero said applicants have until April 18 to file their application forms.

Those who are unable to take the June examination may take the eligibility test on Nov. 29 and 30.

PRC has recorded an increasing trend in the number of examinees, as more Filipinos are opting to take up nursing so they could work overseas.

Filipino nurses are highly in demand and highly paid abroad, prompting even Filipino doctors to take up nursing courses.

But based on PRC data, only half of the nursing examinees pass the licensure examination. The low passing rate is partly to blame for the reported growing shortage of nurses in the country.

The Department of Labor and Employment and the Department of Health are now drafting measures to address the shortage brought about by the continuing exodus of Filipino nurses.

Government officials said measures have to be taken to protect the domestic requirement for nurses and prevent the possible paralysis of the country’s health system.

Meanwhile, Labor Secretary Arturo Brion urged countries hiring Filipino workers to help the Philippines replenish the supply of Filipino manpower.

Brion said foreign employers must share the burden in the training and education of Filipino workers to ensure sufficient supply of skilled workers.

Reported by: Sol Jose Vanzi


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Tuesday, January 29, 2008

Nursing Skills : Charting

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Nursing Skills : Charting Slide transcript
Slide 1: CHARTING

Slide 2: USES FOR THE MEDICAL RECORD  PERMANENT ACCOUNT  6 ITEMS THAT MUST BE DOCUMENTED  TRACKS PT PROGRESS/CARE GIVEN  INSURANCE REIMBURSEMENT  SHARING INFORMATION  RESEARCH  PATIENT CONFIDENTIALITY  LEGAL EVIDENCE FOR MALPRACTICE SUITS  QUALITY ASSURANCE  ASSURES CONTINUITY OF  ACCREDITATION CARE

Slide 3: USES FOR THE MEDICAL RECORD PERMANENT RECORD WRITTEN IN CHRONOLOGICAL ORDER FILED IN MEDICAL RECORDS DEPT FOR FUTURE USE/REFERENCE

Slide 4: USES FOR THE MEDICAL RECORD SHARING INFORMATION FACILITATES EXCHANGE OF INFORMATION BETWEEN STAFF PREVENTS DUPLICATION ERRORS  (MEDS, DRESSING CHANGE, ACTIVITY, DIETS, ETC.)

Slide 5: USES FOR THE MEDICAL RECORD  PATIENT CONFIDENTIALITY  NEVER LEAVE CHART IN A PUBLIC PLACE.  DISCUSS CONTENTS ONLY WITH PERSONS DIRECTLY INVOLVED IN THE PATIENT’S CARE OR THOSE THAT ARE AUTHORIZED BY THE PATIENT. THESE PEOPLE SHOULD BE LISTED BY NAME.  ASK FOR ID PRIOR.  DO NOT DISCUSS PT OR PT INFO IN PUBLIC PLACES, EG. ELEVATORS, CAFTERIA.

Slide 6: USES FOR THE MEDICAL RECORD QUALITY ASSURANCE A PEER REVIEW PROCESS CONDUCTED BY A STAFF NURSE AND PHYSICIAN ESTABLISHES AND REFLECTS AGENCY STANDARDS

Slide 7: USES FOR THE MEDICAL RECORD ACCREDITATION  JCAHO (JOINT COMMISSION ON ACCREDITATION OF HEALTH ORGANIZATION)/DSHS STATE (EXTENDED CARE)  SETS MINIMUM STANDARDS FOR STAFFING  THE AMERICAN NURSE’S ASSOCIATION SETS THE STANDARDS FOR PT CARE & DOCUMENTATION FOR NURSE’S

Slide 8: USES FOR THE MEDICAL RECORD SIX ITEMS THAT NURSES MUST DOCUMENT  ASSESSMENT  NURSG DX AND PT NEEDS  INTERVENTIONS  CARE PROVIDED  PT RESPONSE TO CARE  PTS ABILITY TO MANAGE CONTINUING CARE AFTER DISCHARGE

Slide 9: USES FOR THE MEDICAL RECORD REIMBURSEMENT LACK OF DOCUMENTATION MAY RESULT IN DENIAL FOR PAYMENTS FROM MEDICARE AND PRIVATE INSURANCE COMPANIES. THIS PUTS THE BURDEN OF PAYMENT ON THE PATIENT.

Slide 10: USES FOR THE MEDICAL RECORD RESEARCH  DATA ON TREATMENTS, MEDS, AND THERAPY  INFO FOR TUMOR BOARDS, DOCTOR’S ROUNDS, NURSING ROUNDS, ETC.  BE AWARE OF PRIVACY ISSUES  NURSES, STUDENT NURSES USE FOR CARE PLANS.

Slide 11: USES FOR THE MEDICAL RECORD  LEGAL EVIDENCE  RECORDS ARE CONSIDERED LEGAL OR POTENTIAL LEGAL DOCUMENTS  MAY BE SUBPEONAED AS EVIDENCE BY ATTORNEY OR NURSING BOARDS. CHECK FOR DEVIATIONS FROM FACILITY POLICY OR STANDARDS.  EACH HEALTH CARE PROVIDER IS RESPONSIBLE FOR THE ABC’S OF RECORDING. ACCURACY, BRIEF, COMPLETE.

Slide 12: ACCESS TO CHARTS  PATIENT’S RIGHTS  WHO OWNS CHART  AGENCY POLICY

Slide 13: ACCESS TO CHARTS PATIENT’S RIGHTS/AGENCY POLICY  PATIENTS HAVE THE RIGHT TO THE INFO IN THEIR CHARTS.  THEY DO NOT HAVE THE RIGHT TO SEE THE CHART ON DEMAND OR REMOVE ANYTHING FROM THE CHART, OR REMOVE THE CHART FROM THE FACILITY.

Slide 14: ACCESS TO CHARTS WHO OWNS THE CHART A PATIENT’S CHART IS THE PROPERTY OF THE FACILITY. IT IS THE FACILITY WHICH SETS THE POLICY AND MAKES APPOINTMENTS FOR VIEWING OF THE CHART.

Slide 15: TYPES OF PATIENT RECORDS  SOURCE-ORIENTED  PROBLEM-ORIENTED

Slide 16: TYPES OF PATIENT RECORDS SOURCE ORIENTED MOST TRADITIONAL DIFFERENT DISCIPLINES CHART ON SEPARATE FORMS. EACH READER MUST CONSULT VARIOUS PARTS OF THE RECORD TO GET A COMPLETE PICTURE. RECORDS BECOMES BULKY.

Slide 17: TYPES OF PATIENT RECORDS PROBLEM ORIENTED  COMMONLY REFERRED TO AS POR.  ORGANIZED ACCORDING TO PROBLEM.  FOUR PARTS: A. DATA BASE. THE PATIENTS PRESENT HEALTH STATUS. B. PROBLEM LIST. NUMBERED LIST OF HEALTH PROBLEMS. C. INITIAL PLAN. PLAN TO HELP OVERCOME HEALTH PROBLEMS. D. PROGRESS NOTES. ALL DISCIPLINES CHART ON SAME PAGE.

Slide 18: METHODS (STYLES) OF CHARTING  NARRATIVE  SOAP SOAPIER  FOCUS DATA ACTION RESPONSE  PIE  EXCEPTION CHARTING

Slide 19: NARRATIVE CHRONOLOGICAL BASELINE CHARTED QSHIFT LENGTHY, TIME-CONSUMING SEPARATE PAGES FOR EACH SOURCE-ORIENTED

Slide 20: SOAP  USED FOR PROBLEM-ORIENTED CHARTS  S – SUBJECTIVE. WHAT PT TELLS YOU.  0 – OBJECTIVE. WHAT YOU OBSERVE, SEE.  A – ASSESSMENT. WHAT YOU THINK IS GOING ON BASED ON YOUR DATA.  P – PLAN. WHAT YOU ARE GOING TO DO. CAN ADD TO BETTER REFLECT NURSING PROCESS  I – INTERVENTION (SPECIFIC INTERVENTIONS IMPLEMENTED)  E – EVALUATION. PT RESPONSE TO INTERVENTIONS.  R – REVISION. CHANGES IN TREATMENT.

Slide 21: EXAMPLE OF SOAP CHARTING  #1 ALTERATION IN COMFORT. ABDOMINAL PAIN. S – COMPLAINS OF PAIN IN RUQ O – IS PALE AND HOLDING RIGHT SIDE A – RECURRING ABDOMINAL PAIN P – PUT ON NPO AND NOTIFY PHYSICIAN

Slide 22: FOCUS CHARTING  USES NARRATIVE DOCUMENTATION (DAR)  DATA – SUBJECTIVE OR OBJECTIVE THAT SUPPORTS THE FOCUS (CONCERN)  ACTION – NURSING INTERVENTION  RESPONSE – PT RESPONSE TO INTERVENTION

Slide 23: EXAMPLE OF FOCUS CHARTING  D – COMPLAINING OF PAIN AT INCISION SITE ON LEVEL OF #7  A – REPOSITIONED FOR COMFORT. DEMEROL 50MG IM GIVEN.  R – (CHARTED AT A LATER DATE.) STATES A DECREASE IN PAIN, “FEELS MUCH BETTER.”

Slide 24: PIE CHARTING Similar to SOAP charting Both are problem-oriented PIE comes from the Nursing Process, SOAP comes from a Medical Model. P-Problem I-Intervention E-Evaluation

Slide 25: SAMPLE OF PIE CHARTING  P#1 Risk for trauma related to dizziness.  IP#1 Instructed to call for assistance when getting OOB. Call light in reach.  EP#1 Consistently call for assistance before getting OOB. Continues to experience dizziness.

Slide 26: CHARTING BY EXCEPTION  USES FLOWSHEETS  EMPHASIS ON ABNORMAL (WHAT IS ABNORMAL FOR THIS PATIENT.  ALTHOUGH IT MAY BE ABNORMAL FOR THE “NORMAL” PERSON, IF IT IS ABNORMAL FOR YOUR PATIENT ON A CONSISTENT BASIS, IT IS NO LONGER CONSIDERED AN “EXCEPTION”.  ADVANTAGE

Slide 27: COMPUTERIZED CHARTING  PASSWORD. NEVER SHARE. CHANGE FREQUENTLY.  LEGIBLE  CAN BE VOICE-ACTIVATED, TOUCH-ACTIVATED.  DATE AND TIME AUTOMATICALLY RECORDED.  ABBREVIATIONS AND TERMS ARE SELECTED BY A MENU PROVIDED BY THE FACILITY.  TERMINALS ARE USUALLY EASILY ACCESSIBLE, IN PT ROOMS, CONVENIENT HALLWAY LOCATIONS.  MAKE SURE TERMINAL CANNOT BE VIEWED BY UNAUTHORIZED PERSONS.

Slide 28: KARDEX QUICK REFERENCE CHANGED AS NEEDED NOT PART OF PERMANENT RECORD

Slide 29: ABBREVIATIONS YOU MUST USE YOUR FACILITY’S APPROVED ABBREVIATIONS. BE AWARE THAT A LOT OF COMMONLY USED ABBREVIATIONS: EG. TID, BID, QOD, HS ARE NO LONGER ALLOWED AND SHOULD BE CURRENTLY BEING PHASED OUT OF YOUR FACILITY.

Slide 30: CHANGE OF SHIFT REPORT  PERSON TO PERSON  BE PREPARED  AVOID GOSSIP/SOCIALIZA TION  TAPE RECORDER

Slide 31: INCIDENT REPORTS  OBJECTIVE  DO NOT BLAME OR ADMIT LIABILITY  WHAT DID YOU DO?  DO NOT INCLUDE NAMES/ADDRESSES OF WITNESSES  DOCUMENT TIME/NAME OF DOCTOR  DO NOT FILE IN CHART  DO NOT WRITE “INCIDENT REPORT MADE”

Slide 32: CORRECTING ERRORS  IF YOU SPILL SOMETHING ON THE CHART, DO NOT DISCARD NOTES. RECOPY, PUT ORIGINAL AND COPIED SHEETS IN CHART. WRITE “COPIED” ON COPY.  DO NOT SCRIBBLE OUT CHARTING.  AVOID USING “ERROR” OR “WRONG PATIENT” WHEN MAKING CORRECTION.  FOLLOW YOUR FACILITIES POLICY.  DO NOT ALTER CHARTING, IT IS A LEGAL DOCUMENT.





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Pharmacology - Hematologic Drugs :: Nursing Pharmacology :: Review For Nursing Licensure Examination

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Pharmacology - Respiratory Drugs :: Nursing Pharmacology :: Review For Nursing Licensure Examination

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Saturday, January 26, 2008

Psychiatric Nursing OUTLINED

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Beliefs—Feelings—Behavior

Sigmund Freud – Father of Psychoanalysis
-structure of personality

Id- impulsive part, pleasure principle
-eat, urinate, have sex
-it’s all “I”

Superego – small voice of God
-conscience
-should not eat yet, should not eat yet

Ego- arbiter, decision maker
-in touch with reality

Id___________________Superego
EGO

ID DOMINANT – needs a superego-needs a conscience
M- manic
A- antisocial – serial killer
N- narcissistic

SUPEREGO DOMINANT –needs an Id
O- Obsessive Compulsive
A- Anorexia nervosa

EGO – impaired reality perception (RN will present reality)
S- schizophrenia- cant distinguish fact from reality

Libido- sexual energy

FREUD - PSYCHOSEXUAL THEORY

ORAL – 0-18 months
Cry, suck – mouth- survival
Id dominant
Maternal deprivation if not feed, not given milk/water, not kept warm.

Narcissistic – seeks the Id – I love myself
Regression – return to an earlier stage or earlier level
Fixation – stopped in a stage

ANAL- 18 mos-3yrs
Toilet training
Mom is superego.
Superego is being formed
Child is caught in ambivalence – pulled in 2 opposing factors

Too much toilet training with punishment will result to a child who is:
Obedient, organized, clean -------------------------Rebel, dirty, disobedient
=OC-------------------------------------------- =Anti-social
=anal retentive -------------------------------- =anal expulsive


PHALLIC – 3-6 yrs old
-penis & vagina
-love of parent of opposite sex
Oedipal-boy loves mom
Electra-girl loves dad

Identification- boy imitates dad
Castration fears- fear that dad is angry at him and will cut off penis
Penis envy- girls envy little boys

Dr. Karen Horney- detractor of Freud, didn’t believe in penis envy. Freud said that it is maybe in her unconscious
mind. Or repressed.

Conscious- highest level of awareness
Pre-conscious- at tip of tongue
Unconscious – forgotten

Repression-kept in unconscious. Unconscious forgotten.
Suppression – conscious forgetting

LATENT- 6-12 years old Latent- Logtu = sexual energy asleep
School age – School phobia- 1st time to go to school – Separation anxiety
Child is busy with Reading, writing, arithmetic.
Sublimation –putting anger into something more productive
putting all energies into schooling
Ex. Angry at life, pour anger in singing.

GENITAL –12 years old Genital-Gising sexual energy
Sexual intercourse most important in this stage!!

PHARMA MOMENTS
Anti-anxiety Drugs (used also for alcohol withdrawal)
Valium, Librium, Ativan, Serax, Tranxene
Miltown, Equanil, Vistaril, Atarax, Inderal, Buspar




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Thursday, January 24, 2008

PRC NLE 2008 Filing of Application Deadline Changed

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Thousands of nurses are planning to take the nursing board examinations this june 2008, they're expecting 80-100,000 candidates and graduates to take the said exams, however with the 20-30 days alloted for application in PRC is not enough to accommodate all students, so they had made it 50 days. Nursing Exams will be at june 1 and 2 and application date will start april 11. The PRC is informing and ADVISING graduates on march 2008 to take the board exams in november 2008 and graduates of October 2007 to take the exams this june and so on...this will make it easy for students as well as the PRC to have a smooth flowing board exams.


The schedules of the Nurses Licensure Examination for year 2008 are as follows:

Examination Dates ------------Deadlines-------No. of days before exam
June 1 & 2 2008 ------------- April 11, 2008 ------------50 days
Nov. 29 & 30 2008 ----------Oct. 17, 2008 -------------- 43 days

This will give presidents, deans of schools, colleges and universities time to adjust their schedule of activies, such as conduct review classes, preparation of transcript of records (TOR), RLE, OR/DR cases. Applicants will have more time to secure their birth certificate from the NSO and will have enough time to review for the exam.



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Tuesday, January 22, 2008

Myk's Psychiatric Nursing Notes 4

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EATING DISORDERS

ANOREXIA NERVOSA ---------------BULIMIA NERVOSA
- Eat, eat, eat --------------------------- Eat, eat, vomit
- Less 85% expected body weight ------- Normal weight
- 3 months amenorrhea --------------- Irregular menstruation


BULIMIA NERVOSA
• Metabolic alkalosis (vomiting results to decrease hydrochloric acid)
• Metabolic acidosis (diarrhea results to decrease bicarbonate)
• Dental caries
• Wound in knuckles

MANAGEMENT
• Fluid and electrolyte imbalance
• Meal contract
• Weight gain for client
• After eating stay with client for 1 hour and accompany when going to the comfort room

PHARMA NOTES:
ANTI – PSYCHOTIC DRUG
• Stelazine
• Serentil
• Thorazine
• Trilafon
• Clozaril
• Mellaril
• Haldol
• Prolixin

SCHIZOPHRENIA
• Ego disintegration
• Impaired reality perception
• Genetic vulnerability
• Stress – Diathesis Model
• Biological theory – increase dopamine level
• Exact cause unknown

ASSESSMENT
• Affect: Appropriate, Inappropriate, Flat, Blunt (incomplete)
• Ambivalence: pulled into 2 opposing forces
Autism
• Looseness, no idea, not related to one another

ASSESSMENT
NEGATIVE ------------------------POSITIVE
Hypoactive ------------------------ Hyperactive
Withdrawn ------------------------- Sociable
Thought Blocking ------------------Flight of ideas
Apathy

I. ASSESS
• Content of thought

NURSING DIAGNOSIS
• Disturbed thought process
PLANNING/IMPLEMENTATION
• Present reality
• Provide safety
EVALUATION
• Improved thought process

II. ASSESS
• Hallucinations/Illusions

NURSING DIAGNOSIS
• Disturbed sensory perception
PLANNING/IMPLEMENTATION
• Present reality
• Safety
EVALUATION
• Improved sensory perception

III. ASSESS
• Suspicious

NURSING DIAGNOSIS
• Risk for other directed violence
PLANNING/IMPLEMENTATION
• Present reality
• Safety
EVALUATION
• Eliminate/minimize risk for other directed violence

IV. ASSESS
• Suicidal

NURSING DIAGNOSIS
• Risk for self directed violence
PLANNING/IMPLEMENTATION
• Present reality
• Safety
EVALUATION
• Eliminate/minimize risk for self directed violence

LOOSENESS OF ASSOCIATION
• Thinking that is overgeneralized, diffuse, and vague with only a tenuous connection between one thought and the next

FLIGHT OF IDEAS
• Jumping from on topic to another

AMBIVALENCE
• Pulled between 2 strong opposing forces

MAGICAL THINKING
• acting like magician

ECHOLALIA
• Client repeats what you say

ECHOPRAXIA
• Client repeats what you do

WORD SALAD
• Just words no rhyme

CLANG ASSOCIATION
• Words that rhyme

NEOLOGISM
• Formation of new words (needs clarification)

DELUSION: PERSECUTORY
• “The NBI is out to get me”

DELUSION: RELIGIOUS
• “I am Jesus Christ the savior”

DELUSION: GRANDEUR
• “ I am the queen of the world”

DELUSION: IDEAS OF REFERENCE
• “The nurses are talking about me”

CONCRETE ASSOCIATION
• Also known as “pilosopo”

THOUGHT BLOCKING
• Unable to think

-----------------------HALLUCINATIONS------ ILLUSIONS
STIMULUS ------------ ABSENT------------ PRESENT
VISUAL ----------------ABSENT------------ PRESENT
AUDITORY ----------- ABSENT------------ PRESENT
TACTILE ABSENT --- ABSENT------------ PRESENT

• Present reality to clients experiencing hallucinations
• Technique in handling clients with hallucinations
Hallucinations
Acknowledgement “I know the voices are real to you”
Reality orientation “I know the voices are real but I don’t hear them”
Diversion “Lets go to the garden”
• 10% of schizophrenic clients hear voices

PARKINSON’S DISEASE
• If acethylcholine (on switch) is increased there is excessive movement resulting to decrease in dopamine (off switch)

ANTI-PSYCHOTIC
Decrease dopamine level
Parkinson like effect
Extra pyramidal side effect
With akathesia
Restless, inability to rest

AKINESIA
• Muscle rigidity

DYSTONIA
• Torticollis (wryneck)

OCULOGYRIC CRISIS
• Fixed stare

OPISTHOTONUS
• Arched back
• Lips – smacking
• Tongue – protruding
• Cheeks – puffing
• The 3 are irreversible and called tardive dyskinesia
• Neuroleptic malignant syndrome – hyperthermia

ANTI – PARKINSON
Anticholinergics Dopaminergics
(Decrease Ach) (Increase Dopa)
Artane, Akineton Parlodel
Benadryl Larodopa
Cogentin Eldepryl
Symmetrel

OTHER SIDE EFFECTS OF DECREASE DOPAMINE
• Photosensitivity
• Agranulocytosis – decrease WBC
• Clients prone to infection due to decrease WBC
• First sign for infection is sore throat

TYPES OF SCHIZOPHRENIA

DISORGANIZED SCHIZOPHRENIA
- Sad but smiles (inappropriate affect)
- No reaction (flat affect)
- Flight of ideas (disorganized speech)
- Giggling (hebephrenic giggle)
- Combination of positive and negative signs and symptoms

CATATONIC SCHIZOPHRENIA
- Ambivalence
- Waxy flexibility
- Favorite word is “No”
- Negativism (client do not follow what you tell them to do)
Nursing management: meet needs

PARANOID SCHIZOPHRENIA
- Suspicious
- Mistrust, scared, withdrawn
Nursing management:
- Gain trust by 1 to 1 short interaction but frequent
- Foods should be in a sealed container
- Medications should be in tamper resistant foil.
Violent:
- Keep door open
- Position near door
- Don’t touch client
- Call for reinforcement
- One arms length away from the client.

PARANOID SCHIZOPHRENIA
- No more positive symptoms just withdrawn

UNDIFFIRENTIATED SCHIZOPHRENIA
- Mixed classification, cant be classified


PHAMRA NOTES:

BI-POLAR, MANIC
• Lithium: undergo first kidney test and check for blood levels
• Level: .6 – 1.2 meq/L
• Increase urination
• Tremors, fine hand
• Hydration of 3L/day
• Increase
• Uu (diarrhea)
• Mouth dry

Signs of Lithium toxicity
• Nausea, vomiting, diarrhea
• Increase sodium
* Wait for 2 – 4 weeks before lithium therapy takes effects

BIPOLAR DISORDER/MANIC PROFILE
• 20 years old
• Female
• Stress
• Obese

ASSESSMENT
• Decrease appetite (give finger foods)
• Decrease sleep (place in a private room)
• Hyperactive
• Increase sexual activity – only means of addressing anxiety so decrease level of anxiety
• Risk for injury/other directed violence
• Impaired social interaction (care giver role: strain and stay with client)
• Self esteem decrease (to cover up their sadness there is compensation to cover defective doing)
• Because there is decrease self esteem there will be increase compensation resulting to increase interference with ADL’s and harm to others
• Compensation is the culprit
Management: increase self esteem to decrease compensation and decrease interference with ADL’s and harm to others

HOW TO INCREASE SELF ESTEEM OF MANIC PATIENTS
T- no sports (basketball, volleyball), no fine motor skills only gross motor skills
A lot energies toward more productive endeavors (sublimation)
S - escorted walk outdoors
K – punching bag (displacement)


PHARMA NOTES:

ANTI – DEPRESSANTS
• Asendin
• Norpralamin
• Tofranil
• Sinequan
• Anafranil
• Aventyl
• Vivactil
• Elavil
• Prozac
• Paxil
• Zoloft

ALCOHOL LEADS TO:
• Blackout: awake but unaware
• Confabulation: inventing stories to increase self esteem
• Denial: “I am not an alcoholic”
• Dependence: cant leave with out leading to enabling where in the significant other tolerates the abuser co dependence is another term
• Tolerance: gradual increase in amount of stimuli to experience the same euphoria

MANAGEMENT
• Detoxification: withdrawal with medical doctor supervision
• Avoid alcohol therapy
• Aversion therapy a more technical term for avoid alcohol therapy
• Antabuse: Disulfiram makes the client never drink alcohol because it causes vomiting
• Alcoholics anonymous
• Interval of 12 hours after last dose of alcohol or experience nausea and vomiting and hypotension
• Alcoholism may result to Vitamin B1 (Thiamine) deficiency

WERNICKE’S ENCEPHALOPATHY
• Problem with motor

KORSAKOFF’S PSYCHOSIS
• Problem with memory
• 24 – 72 hours after last dose of alcohol expect:
• Delirium Tremens: sympathetic nervous system
• Prevent hallucinations/Illusions by placing client in a well lit room
• Formication: feeling of bugs crawling under the skin

ALZHEIMERS DISEASE
• Axon (away) and Dendrites (toward) nerve
• Neurofibrillary tangles
• Neurotic plaques

--------------------------ALCOHOL --- ALZHEIMERS
ONSET -------------------- Abrupt -------- Gradual
LEVEL OF CONSCIOUSNESS -- Fluctuating ----Unaffected
DURATION ----------- Hours to days --- Progressive
MEMORY -------------- Short term ---Short and long term

5 A’s OF ALZHEIMERS
1. Amnesia – memory loss
2. Anomia – don’t know the name
3. Agnosia – sensory problems smell, taste, sight
4. Aphasia
- expressive: cant say/express
- frontal lobe is affected particularly broca’s area
- receptive: cant hear
- temporal lobe is affected particularly wernicke’s area
5. Apraxia – cant do simple things
* Reminiscing Therapy – talk about past
• Patients with alzheimer’s may experience hallucinations, illusions thus becomes restless and may wander
• As sun goes down client becomes restless, agitated, disoriented called sundowning
• Drug of choice is Cognex and Aricept a cholinesterase inhibitor that increases Ach causing delay in disease progression

SEROTONIN
• Responsible for happiness
• Decrease serotonin clients becomes sad give anti-depressants

SELECTIVE SEROTONIN REUPTAKE INHIBITOR
Safest drug
Side effects low
R
I to 4 weeks
- Increases serotonin and affects only serotonin
- Prozac, Paxil, Zoloft

TRICYCLIC ANTI DEPRESSANT
Two – four weeks
C
A
- Has higher incidence of side effects
- Also increases norepinephrine
- Asendin, Norpralamin, Tofranil, Sinequan, Anafranil, Aventyl, Vivactil, Elavil


MONO AMINE OXIDASE INHIBITORS
• MAO kills serotonin
• Increased MAO results to decreased serotonin the more depressed the client becomes
• MAOI kills MAO and increases all neurotransmitters (serotonin, epinephrine, norepinephrine, dopamine but client becomes prone to hypertensive crisis
• Avoid tyramine rich foods
Avocado, Alcohol
Beer
Chocolates, Cheese (aged)
Fermented foods
Pickles
Preserved foods
Soy sauce
• There is increase incidence of side effects after 2 – 6 weeks
Marplan, Nardil, Parnate


PERSONALITY DISORDERS
1. Schizophrenia
- They avoid people because there is no enjoyment
2. Avoidant
- They avoid people because they are afraid of criticisms
- They have talent but has no confidence
3. Anti-Social
- Constantly breaks law
- Project charm
- They are witty and articulate
- Manipulative
4. Borderline
- They perceive life as an empty glass
- They like splitting friends
- Sudden change in mood “labile affect”
- Prone to suicide
5. Dependent
- “Cant live if living is without you”
6. Histrioinic
- Constantly wants to be the center of attention
- Excited, dramatic, manipulative
7. Narcissistic
- “I love myself”
- They get jealous even with achievement of family members
8. Obsessive – Compulsive
- “I am so organized”
9. Paranoid
- Suspicious
- May lead to domestic violence


ANTI – DEPRESSANT SIDE EFFECTS:
Male – erectile dysfunction, prone to impotence


GRIEF PROCESS
1. Denial – shock/disbelief
2. Anger – question “why me?”
3. Bargaining – if, then
4. Depression – 2 weeks or more sign and symptoms becomes major clinical depression
5. Acceptance – client acts according to situation


ASSESSMENT
• Decrease self actualization
• Decrease self esteem
• Withdrawn: stay with client
• Suicidal: risk for self directed violence
• Increase/decrease eat, increase/decrease sleep, hypoactive, decrease sexual urge
• Be sensitive to clients needs


FOR SUICIDAL OBSERVE FOR
Verbal
• “I wont be a problem”
• “This is my last day on earth”
• “I’ll soon be gone”
Non verbal
• Giving away of valuables
• Sudden change in mood


WHEN THE CLIENT IS SUICIDAL WHAT WILL THE NURSE DO
Direct: “Do you plan to commit suicide?”
Irregular/interval visits
Endorsement period, early morning clients are most likely to commit suicide


DOWNERS
Alcohol
Barbiturate
Opiates
Narcotics
Marijuana
Morphine
Codeine
Heroine


Resulting to:
• Bradycardia
• Bradypnea
• Moist mouth
• Pupils constrict
• Constipation
• Urinary retention
• Hypotension
• Coma
• Weight gain
• Narcotics overdose: give narcotic antagonist (Narcan, Naloxone hydrochloride)


UPPERS
Cocaine
Hallucinogens
Amphetamines
Resulting to:
• Tachycardia
• Awake
• Tachypnea
• Dry mouth
• Pupils dilate
• Hypertension
• Seizures
• Weight loss




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Saturday, January 19, 2008

Myk Psychiatric Nursing Notes 3

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DRUGS WITH ANTICHOLINERGIC EFFECTS
• Anti – Anxiety
• Anti – Psychotic
• Anti – Cholinergic
• Anti – Depressants

PHARMA NOTES:

MONOAMINE OXIDASE INHIBITORS (MAOI DRUGS)
• Marplan
• Nardil
• Parnate

DEFENSE MECHANISMS
1. Displacement – transfer of feelings to a less threatening object rather than the one who provoked it.
2. Denial – failure to acknowledge an unacceptable trait or situation.
3. DISOCIATION – psychological flight from the self.
4. REGRESSION – return to an earlier development state.
5. repression – unconscious forgetting.
6. RATIONALIZATION – illogical reasoning for an unacceptable trait and situation.
7. REACTION FORMATION – doing the opposite of what you have done.
8. UNDOING – doing the opposite of what you have done.
9. IDENTIFICATION – assuming trait for personal, social, occupational role.
10. PROJECTION – attribute to others one’s unacceptable trait.
11. INTROJECTION – assume another person’s trait as your own.
12. SUPPRESSION – conscious forgetting.
13. SUBLIMATION – putting destructive energies or hostile feelings towards a more productive endeavors.
14. CONVERSION – unexpressed or repressed feelings are converted to physical symptoms.
15. COMPENSATION – over achievement in one area to cover a defective part.
16. SUBSTITUTION – replace difficult goal with more accessible one.

PHARMA NOTES:

ANTI – PARKINSON DRUG - CAPABLES
Cogentin
Artane
Parlodel
Akineton
Benadryl
Larodopa
Eldepryl
Symmetrel


AUTONOMIC NERVOUS SYSTEM
----------------- SYMPATHETIC -------- PARASYMPATHETIC
Pupils ----------------Dilate ----------------Constrict
Blood Vessels --------Constrict ------------- Dilate
Blood Pressure --------Increase ------------ Decrease

THERAPEUTIC COMMUNICATION TECHNIQUES

THERAPEUTIC
1. Offer Self
2. Silence – provide time to think
3. Making observation – what you see you say
4. Active Listening – nodding, eye contact
5. Broad Opening – how are you today?
6. General Leads – Go on, I’m listening
7. Restating – I’m sad “You’re sad?” 1. Don’t worry be happy
2. Changing the topic/subject
3. Ignore the client
4. Value based judgment – never assume
5. Flattery
6. Advising
7. Giving Opinion

NONTHERAPEUTIC

1. Don’t worry be happy
2. Changing the topic/subject
3. Ignore the client
4. Value based judgment – never assume
5. Flattery
6. Advising
7. Giving Opinion

FEAR – protects us from something bad.

ANXIETY
• Vague sense of impending doom.
• Triggers the sympathetic nervous system.
• Assess level of anxiety of client.

TYPES OF ANXIETY
MILD ANXIETY
• + 1 level of anxiety.
• Widened perceptual field.
• Restless (say you seem restless).
• Enhanced learning capacity.

MODERATE ANXIETY
• + 2 level of anxiety.
• Client pace.
• Give PRN meds.

SEVERE ANXIETY
• + 3 level of anxiety.
• Don’t know what to do/say.
• Directive orders (please sit down).

PANIC
• + 4 level of anxiety.
• May commit suicide.
• Promote safety.
• Never touch patient.
• Hyperventilation (Respiratory Alkalosis)
• Breathe into paper bag.

NURSING DIAGNOSIS:
• ineffective individual coping.
• Powerlessness.
• Impaired skin integrity

PLANNING/IMPLEMENTATION:
• decrease level of anxiety.
• Decrease environmental stimuli.
• Relaxation techniques.

EVALUATION
• effective individual coping.

GENERALIZED ANXIETY DISORDER
• 6 month excessive worrying.
• Restless, difficulty concentration, sleep disorders, palpitations, edge of the seat, easy fatigability.

PANIC ATTACKS/DISORDER
• 15 – 30 minutes sympathetic nervous system escalation.
• Example is AGORAPHOBIA fear of open spaces.

POST TRAUMATIC STRESS DISORDER
• victims becomes survivors and experience flashbacks or nightmares.

MALINGERING
• pretending to be sick (conscious).
• Primary Gain anxiety decreases, able to escape source of anxiety.
• Secondary Gain able to get attention.

SOMATOFORM
• no protection
• unconscious
• no organic basis of being sick

DIFFERENT TYPE OF SOMATOFORM
1. Conversion Disorder
• cannot speak, see, hear.
• Nervous system affected.
2. La Belle Indifference
• do not care what happens to them.

HYPOCHONDRIASIS
• has minor discomfort and interprets it as major illness.
• Focus on clients feelings.

BODY DISMORPHIC DISORDER
• Illusion of structural defect.
• Favorite past time is doctor hopping.
• Focus on clients feelings.

PSYCHOSOMATIC
• Real pains/illness
• Real symptoms because of anxiety

PSYCHOSOMATIC
Increase Anxiety
SNS
Increase BP & HR
Hypertension
Fat Deposits
Atherosclerosis
Calcium
Arteriosclerosis
Decrease Oxygen
Angina Pectoris
MI
Necrosis
CHF
Coma

PHOBIA
• Irrational fear
• Etiology: Knowledge of certain object
• Bad experience
• Immediate nursing objective: Removal of stimulus will remove anxiety
• Systemic Desensitization gradually expose client to stimuli/feared object
• Employ relaxation techniques
SNS
• GABA (Gamma Amino Butyric Acid) – stop
• Epinephrine and Norepinephrine – Go

ANTI-ANXIETY
• Increase GABA and client becomes drowsy (no alcohol and coffee)
• May develop orthostatic hypotension
• Let patient sit then dangle feet and then stand
• Develop anti cholinergic effects
• If abruptly withdrawn to anti anxiety it may result to rebound phenomenon (1 week) may lead to seizures
• Do it in gradual and in tapered dose
• Anti anxiety leads to dependence

AUTISM
• Unresponsive and does not want to be touched
• Autistic Savant: high intelligence and has a ratio of 1:100
• Assessment
• Appearance – flat affect and loves constancy and ritualistic
• Behavior – withdrawn
• Communication – echolalia

NURSING DIANOSIS
• Impaired verbal communication
• Impaired social interaction
• Self mutilation
• Risk for injury

PLANNING/IMPLEMENTATION
• Maslow’s hierarchy of needs
• Expressive Therapy – use of art as mode if communication

EVALUATION
• Enhanced communication
• Improved social interaction
• Safety

ATTENTION DEFICIT HYPERACTIVITY DISORDER
• 7 years and below onset
• Duration: 6 months and above
• Settings: house and school
• Assessment
• Appearance: dirty, clumsy, hyperactive, impatient, easily distracted and has no focus
• Behavior
• Communication: talkative

NURSING DIAGNOSIS
• Risk for injury
• Impaired social interaction

PLANNING/IMPLEMENTATION
• Structure: place to play, sleep, eat and study
• Schedule: there is always a time for everything that you do
• Set limits
• Safety

EVALUATION
• Minimize risk for injury
• Improved social interaction

FRONTAL LOBE OF ADHD
Decrease glucose
Decrease judgment
Increase impulsiveness
ADHD
Hyperactivity
• Need a drug that brings glucose level up.
• Give Ritalin a stimulant
• May result in loss of appetite
• Given after meals
• Given 6 hours before bedtime



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Friday, January 18, 2008

Myk Psychiatric Nursing Notes 2

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LOBES OF BRAIN

1. FRONTAL LOBE
- Language
- Learning
- Personality
- Judgment

2. TEMPORAL LOBE
- Hearing
- Smell

3. PAREITAL LOBE
- Touch
- Taste

4. OCCIPITAL LOBE
- Visual

3 STEPS TO INTERACT WITH ENVIRONMENT
1. Sensory – eyes, ears, tongue
2. Integration
3. Motor – voluntary or involuntary

VOLUNTARY NERVOUS SYSTEM
• also called as somatic
Brain
Spinal Cord
Motor Nerve
Synapse
Muscle Fiber
• Motor nerve to muscle fiber you need Acethylcholine which is an “On switch”.

INVOLUNTARY NERVOUS SYSTEM
• also called autonomic nervous system.

AUTONOMIC NERVOUS SYSTEM
-----------------------SYMPATHETIC ------------PARASYMPATHETIC
-------------------(Awake, ADRINERGIC) --------(Relax, CHOLINERGIC)
Heart Rate ------------ Increase -------------------- Decrease
Respiratory Rate ------ Increase -------------------- Decrease
GI ---------------------Decrease ------Increase (Moist mouth, Diarrhea)
GU -------------------- Decrease ---- Increase (Urinary Frequency)
Neurotransmitter---- Epinephrine, Norepinephrine ----Acethylcholine



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Thursday, January 17, 2008

Myk Psychiatric Nursing Notes 1

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• Psych focuses in feelings or self awareness.
• Beliefs determine feelings which affects behavior (manifestation of feelings)
• Sigmund Freud is the father of PSYCHOANALYSIS.
• What happens to childhood will affect adulthood.


STRUCTURE OF PERSONALITY

ID

• impulsive, want to, wants pleasure.
• PLEASURE PRINCIPLE.
• Guiding principle is PAIN AVOIDANCE.

SUPEREGO
• should not
• small voice of God
• to stop

EGO
• executive decision maker.
• In touch with reality principle.

ID DOMINANT PERSONALITIES
Manic
Anti – Social – experienced by serial killers
Narcissistic

SUPEREGO DOMINANT PERSONALITIES
Obsessive Compulsive
Anorexia Nervosa

EGO – if destroyed result in impaired reality perception.
Schizophrenia

LIBIDO
• Sexual energy responsible for survival.

Oral Stage
• 0 – 18 months evident.
• ID is developed.

*FIXATION – Person is stuck in certain developmental shape.
*REGRESSION – Return to an earlier developmental stage.
EGO – Developed on the 6th month.

Anal Stage
• 18 months – 3 years old.
• Able to control bladder, bowel.
• Best time for toilet training.
SUPEREGO is developed.

TOILET TRAINING

Good Mother------------------------ Bad Mother
Successful -----------------Dirty ---------------------- Clean
-------------------------disorganized --------------- organized
------------------------- disobedient ---------------- obedient
------------------------- Anti-social ------------------- O.C
----------------------- Anal expulsive ----------- Anal retentive

PHALLIC STAGE
• 3 – 6 years old.
• Experience pleasure by manipulating genitals.
• Love – hate relationship.
• Oedipus Complex boy loves parent of the opposite sex.
• Imitates daddy called identification.
• Castration fears.
• Electra Complex girl loves parent of the opposite sex.
• Imitates mommy called identification.
• Penis envy.
*Conscious – upper level of thinking.
*Preconscious – tip of tongue.
*Unconscious – protects us from traumatic experiences.


LATENCY STAGE
• 6 – 12 years old.
• School age.
• Separation anxiety.
• Reading, Writing, Arithmetic.
• Lasts for 6 years.


GENITAL STAGE
• 12 years old and above
• Sexual reawakening.
• Very important stage.

PHARMA NOTES:
ANTI - ANXIETY DRUGS
• Valium
• Librium
• Ativan
• Serax
• Tanxene
• Miltown
• Equanil
• Vistaril
• Atarax
• Ideral
• Buspar

ERIC ERIKSON
• There is more to life than just sex.
• Psychosocial Theory of development.
• You can develop a positive side or a negative side.
• Developmental task begins at 0 – 18 months.

-------------------- POSITIVE ------NEGATIVE -------- FACTOR
0 – 18 mos. ----------Trust ------------ Mistrust ------------ Feeding
18 mos. – 3 yrs. ----Autonomy -------Shame & Doubt ---- Toilet Training
3 yrs. – 6 yrs. -------Initiative ---------- Guilt --------------Independence
6 yrs. – 12 yrs. -----Industry ---------Inferiority ------------ School
12 yrs. – 20 yrs. ----Identity ---------Role Confusion --------- Peers
20 yrs. – 25 yrs. ----Intimacy -----------Isolation --------------Love
25 yrs. – 45 yrs. ---Generativity --------Stagnation -----------Parenting
45 yrs. - above ----Ego Integrity --------- Despair ------------Reflection

MORE TO FOLLOW-------


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Tuesday, January 15, 2008

Introduction to Maternity and Pediatric Nursing

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Slideshow transcript
Slide 1: Introduction to Maternity and Pediatric Nursing, Fourth Edition

Slide 2: Nursing Care of Women with Complications During Pregnancy

Slide 3: High Risk Pregnancy Causes Relate to the pregnancy itself Occurs because the woman has a medical condition Results from environmental hazards Arise from maternal behavior or lifestyle

Slide 4: Assessment of Fetal Health Nurses responsibility – Preparing patient properly for test – Explaining reason for test – Clarifying and interpreting results in collaboration with other HCPs – Providing support to patient

Slide 5: US Images

Slide 6: 4D US Images

Slide 7: AFI

Slide 8: Kick Count Assessment Tool

Slide 9: Doppler Ultrasound Blood Flow Assessment

Slide 10: AFP

Slide 11: Amniocentesis

Slide 12: NST

Slide 13: Percutaneous Blood Sampling

Slide 14: Danger Signs in Pregnancy Sudden gush of fluid from vagina Vaginal bleeding Abdominal pain Persistent vomiting Epigastric pain Swelling of face and hands Severe, persistent headache

Slide 15: Danger Signs in Pregnancy – Cont’d Blurred vision or dizziness Chills with fever > 100.4 degrees Painful urination or reduced urine output

Slide 16: Pregnancy-Related Complications Hyperemesis Gravidarum – Manifestations Persisitent N/V Significant weight loss Dehydration: dry tongue and mucous membranes, decreased turgor, scant concentrated urine, high hematocrit Electrolyte and acid-base imbalance Unusual stress, emotional immaturity, passivity, ambivalence

Slide 17: Pregnancy-Related Complications – Treatment Correct electrolyte imbalances and acid-base imbalances with oral or IV fluids Antiemetic drugs Possibly parenteral nutrition

Slide 18: Pregnancy-Related Complications – Nursing Care Focus is on teaching Avoid foods that trigger N/V Eat small, frequent meals Teach about intake and output Provide support to the mother

Slide 19: Bleeding Disorders of Early Pregnancy Abortion – Specific care depends on whether abortion induced or spontaneous – Treatment Cervical cerclage – Suturing of cervix – to help maintain threatened pregnancy Counseling Administration of oxytocin to help control blood loss Rhogam given if mother Rh negative

Slide 20: Bleeding Disorders of Early Pregnancy – Nursing Care for Abortion Physical care – Documents amount of bleeding – Pad count – Vital signs – Instruct pt. To remain NPO if actively bleeding – Instructions Report increased bleeding Monitor temp every 8 hours x 3 days Take iron supplement Resume sex as prescribed by HCP Appointment with HCP at assigned date and time

Slide 21: Bleeding Disorders of Early Pregnancy Emotional Care for Abortion – Acknowledge grief – Provide for spiritual support

Slide 23: Bleeding Disorders of Early Pregnancy Ectopic Pregnancy – Occurs when fertilized egg is implanted outside uterine cavity 95% in fallopian tube – May result from Hormonal abnormalities Inflammation Infection Adhesions Congenital defects Endometriosis Use of intrauterine contraception – due to inflammation Failed tubal ligation

Slide 24: Bleeding Disorders of Early Pregnancy – Zygote cannot survive for long May die and be reabsorbed May rupture tube creating a surgical emergency – Manifestations Lower abdominal pain Light vaginal bleeding If rupture occurs – Sudden, severe abdominal pain, vaginal bleeding and hypovolemic shock – Referred shoulder pain

Slide 25: Bleeding Disorders of Early Pregnancy – Treatment for Ectopic Pregnancy Test for hCG Transvaginal US Laparoscopic exam Medical treatment – No action if being reabsorbed – Methotrexate (if tube not ruptured) – inhibits cell division – Sugery to remove pregnancy from tube or entire tube if damage is severe

Slide 26: Bleeding Disorders of Early Pregnancy – Nursing Care for Ectopic Pregnancy Vital signs Assessment of lung and bowel sounds IV fluids Blood replacement as necessary Antibiotics Pain management NPO Indwelling catheter Bed rest Emotional support

Slide 28: Bleeding Disorders of Early Pregnancy Hydatidiform Mole – Molar pregnancy Occurs when the chorionic villi abnormally increase and form vesicles May be complete (no fetus) or partial (only part of the placenta has vesicles) May cause – Hemorrhage – Clotting abnormalities – Hypertension – Later development of choriocarcinoma

Slide 29: Bleeding Disorders of Early Pregnancy – Chromosome abnormalities are common – May occur in women at ages of extreme reproductive life – Manifestations Bleeding Rapid uterine growth Failure to detect FHR activity Signs of hyperemesis gravidarum Unusually early PIH Snowstorm pattern on US with no evidence of fetus

Slide 30: Bleeding Disorders of Early Pregnancy – Treatment for Hydatidaform Mole Vacuum aspiration and D&C Level of hCG is tested until undetectable and levels followed for at least 1 year Women advised to delay conception until follow- up care complete Rhogam given if mother Rh negative

Slide 31: Bleeding Disorders of Early Pregnancy – Nursing Care for Hydatididaform Mole Observe for bleeding and shock Emotional support Education on reasons to delay pregnancy Contraception education

Slide 32: Bleeding Disorders of Late Pregnancy Placenta Previa – Placenta develops in the lower part of the uterus versus the upper part – There are 3 degrees of previa Marginal – reaches within 2-3 cm of cervical opening Partial – placenta partially covers the cervical opening Complete or Total – completely covers the opening

Slide 33: Bleeding Disorders of Late Pregnancy – A low-lying placenta is near the cervix Not a true placenta previa May or may not be accompanied by bleeding May be discovered during a routine exam

Slide 35: Bleeding Disorders of Late Pregnancy – Manifestations of Placenta Previa Bright red, painless vaginal bleeding Risk of hemorrhage increases with nearing of labor Fetus often in abnormal presentation Fetus may have anemia Mother may be more at risk postpartum for infection and hemorrhage – Vaginal organisms can easily reach placenta site – Lower portion of uterus has fewer muscles resulting in weaker contractions

Slide 36: Bleeding Disorders of Late Pregnancy – Treatment Depends on length of gestation and amount bleeding Goal is to maintain pregnancy as long as safely possible Mother encouraged to lie on side or with pelvic tilt to avoid supine hypotension Delivery by C-section if total or partial May deliver vaginally if low-lying or marginal

Slide 37: Bleeding Disorders of Late Pregnancy – Nursing Care Observe for vaginal blood loss Observe for S/S of shock Vital signs q 15 minutes if actively bleeding and oxygen administered NO VAGINAL EXAMS Continuos fetal monitoring Prepare for Cesarean if indicated Supportive Care

Slide 38: Bleeding Disorders of Late Pregnancy Abruptio Placentae – Permanent separation of placenta from implantation site – Predisposing factors include Hypertension Cocaine or Alcohol Use Smoking Poor Nutrition Abdominal Trauma Prior History of Abruption Placentae Folate deficiency

Slide 39: Hypertension During Pregnancy – Manifestations of Abruptio Placentae Bleeding with abdominal or low back pain Bleeding may be concealed at first Dark red vaginal bleeding when blood leaks past placenta Uterine tenderness and firm May have cramp-like contractions Fetus may or may not be in distress Fetus/Neonate may have anemia or hypovolemic shock

Slide 40: Hypertension During Pregnancy – Disseminated Intravascular Coagulation (DIC) May complicate abruptio placentae Large clot behind placenta consumes clotting factors which leaves mother deficient Clot formation and destruction occurs at the same time Mother may bleed from all orifices due to depletion of clotting factors Postpartum hemorrhage may occur Infection likely due to damaged tissue being susceptible to bacteria

Slide 41: Hypertension During Pregnancy – Treatment 1st Choice – Immediate Cesarean Blood and clotting factor replacement if necessary After delivery problem quickly resolves – Nursing Care Prepare for C-section Close, continuous monitoring of mother and baby Observe for S/S shock Prepare for compromised infant Prepare for grieving if infant dies

Slide 42: Hypertension During Pregnancy Hypertension During Pregnancy – High blood pressure in pregnancy (PIH) – Preeclampsia PIH + proteinuria – Eclampsia PIH + proteinuria + convulsions/seizures – Toxemia – old terminology

Slide 43: Hypertension During Pregnancy – Cause unknown – Birth only definitive cure – Usually develops after 20th week, but research has shown that it is determined at implantation – Vasospasm is main characteristic – May increase risks of further complications

Slide 44: Hypertension During Pregnancy – Risk Factors for PIH 1st pregnancy Obesity Family history of PIH >40 years or <19 years Multifetal pregnancy Chronic hypertension Chronic renal disease Diabetes mellitus

Slide 45: Hypertension During Pregnancy – If mild to moderate BP readings (systolic <160mm Hg and diastolic <110 mmHg) identified medications typically not used to treat Treated/Monitored with diet modification, daily weights, activity restriction, BP monitoring, fetal kick counts, frequent monitoring for proteinuria

Slide 46: Hypertension During Pregnancy – Medication is started if BP exceeds moderate range Drugs of Choice – Methyldopa (Aldomet) – Labetalol – Nifedipine (Procardia)

Slide 47: Hypertension During Pregnancy – Manifestations of PIH Vasospasm impede blood flow to mother and placenta resulting in: – Hypertension Typically should not occur in pregnancy due to hormonal changes which decrease resistance to blood flow – Edema Occurs when fluid leaves blood vessels and enters tissues – Proteinuria Develops as reduced blood flow damages kidneys

Slide 48: Hypertension During Pregnancy Other Manifestations of Preeclampsia – CNS – HA – Eyes – Visual disturbances – Urinary Tract – Decrease UOP – Respi9ratory – Pulmonary Edema – GI and Liver – Epigastric pain and N/V, elevated liver enzymes – Blood – HELLP – hemolysis, elevated liver enzymes, low platelets

Slide 49: Hypertension During Pregnancy Eclampsia – Woman has one or more generalized seizures Facial muscles twitch, then contraction of all muscles – Effects on Fetus Decreased oxygen availability which may result in fetal hypoxia Meconium IUGR Fetal Death

Slide 50: Hypertension During Pregnancy – Treatment of PIH Prevention Management – as discussed previously Drug Therapy – Magnesium Sulfate (anticonvulsant and antihypertensive) – Antihypertensive Drug Therapy if BP > 160/100 mg Hg

Slide 51: Hypertension During Pregnancy – Nursing Care Assist to obtain PNC Help cope with therapy Provide care/Monitor Administer meds Postpartum Care

Slide 52: Blood Incompatibility Rh and ABO Incompatibility – Rh blood factor = Rh+ – No Rh blood factor in erythrocytes = Rh- – Rh+ person can receive Rh- blood if all other factors compatible because factor is not present – Rh incompatibility only occurs if the mother is Rh- and fetus is Rh+

Slide 53: Blood Incompatibility – Rh- is autosomal recessive triat – both parents must pass on this gene to the fetus – Rh+ is dominate gene – Rh+ person can inherit two Rh+ genes or one Rh+ and one Rh- – Rh- mother does not have the factor and therefore if her fetus does her body may respond with antibody production as a defense mechanism (isoimmunization) Typically occurs at delivery and would therefore affect subsequent pregnancies

Slide 54: Blood Incompatibility – Manifestations If mother produces anti-Rh anitbodies no outward manifestation Labs reveal increased antibody titers When maternal anti-Rh antibodies cross the placenta fetal erythrocytes are destroyed (erythroblastocis fetalis)

Slide 55: Blood Incompatibility – Nursing Care Prevent antibody production – Rhogam at 28 weeks and w/in 72 hours of delivery if mother Rh- and baby Rh+ May also be given after amniocentesis as a precaution Not effective if sensitization has already occurred If antibody production occurs fetus is monitored carefully – Coomb’s test – Amniocentesis – Percutaneous umbilical sampling test – Intrauterine transfusion if severely anemic

Slide 56: Pregnancy Complicated by Medical Conditions Diabetes Mellitus – Preexisting (Type I or Type II with onset before pregnancy) – Gestational (GDM occurs only during pregnancy)

Slide 57: Pregnancy Complicated by Medical Conditions – Pathophysiology of DM Pancreas produces insufficient insulin or cells resist effect of insulin Cells cannot receive glucose Body metabolizes proteina and fat for energy – Ketones and acid accumulate – Person loses weight – Person experiences fatigue and lethargy – Fluid moves to tissues to dilute excess glucose leading to increased thirst resulting in tissue dehydration and glycosuria (glucose-bearing urine)

Slide 58: Pregnancy Complicated by Medical Conditions – Effect of Pregnancy on Glucose Metabolism Increased resistance of cells to insulin Increased speed of insulin breakdown – Gestational Diabetes Mellitus Maternal Links to GDM – Maternal Obesity (>198 lbs.) – Previous macrosomic infant – Maternal age > 25 years – Previous unexplained stillbirth or infant with congenital anomalies] – Family history of DM – Fasting glucose > 135 mg/dl or postmeal > 200 mg/dl

Slide 59: Pregnancy Complicated by Medical Conditions – Treatment of Diabetes During Pregnancy Identification Diet Modification Monitoring Ketone Monitoring PO antidiabetic agents Insulin Exercise Fetal monitoring May indicate early delivery

Slide 60: Pregnancy Complicated by Medical Conditions – Nursing Care for Diabetes During Pregnancy Self-care/Management Emotional Support Encourage Breastfeeding

Slide 61: Pregnancy Complicated by Medical Conditions Heart Disease – Affects small percentage of pregnant women – Manifestations Increased clotting causes predisposition to thrombosis – If cannot meet demand leads to CHF – Priority of care is limiting demands on heart throughout pregnancy, labor, delivery and postpartum period

Slide 62: Pregnancy Complicated by Medical Conditions – Nursing Care for Heart Disease Teach self-management to patient Teach S/S of CHF Diet modification Teach about eliminated stress

Slide 63: Pregnancy Complicated by Medical Conditions Anemia – Hgb levels < 10.5-11.0 g/dl in pregnancy – 4 types in pregnancy Iron-deficiency – RBCs small and pale Prevention – iron supplements Treatment – elemental iron supplements Folic acid-deficiency – Large, immature RBCs – Iron-deficiency anemia may also be present Prevention – folic acid supplement Treatment – 1mg/day supplement over the amount of preventative supplement

Slide 64: Pregnancy Complicated by Medical Conditions Sickle cell disease – Abnormal Hgb that causes erythrocytes to become sickle-shaped during hypoxia or acidosis – Autosommal recessive trait – Approx 1/12 African Americans has the trait – Pregnancy may cause crisis – Risk to fetus – occulsion of vessels leading to preterm birth, IUGR, fetal death Thalasemia – Genetic trait that causes abnormality in one of two chains of Hgb ,alpha or beta

Slide 65: Pregnancy Complicated by Medical Conditions – Nursing Care for Anemias During Pregnancy Nutrition education Education about changes in stool pattern and characteristics Taught to avoid dehydration

Slide 66: Pregnancy Complicated by Medical Conditions Infections – TORCH - Devestating infections for fetus T – toxoplasmosis O – other infections R – rubella C – cytomegalovirus H – herpes simplex virus

Slide 67: Pregnancy Complicated by Medical Conditions Viral Infections – Cytomegalovirus – May be asymptomatic in mother, but serious problem in infant Mental retardation Seizures Blindness Deafness Dental abnormalities Petechiae (blueberry muffin rash) No effective treatment, therapeutic abortion may be offered if early in pregnancy

Slide 68: Pregnancy Complicated by Medical Conditions – Rubella – mild virus with low fever and rash, but effects on fetus can be devastating Microcephaly MR Congenital cataracts Deafness Cardiac defects IUGR Treatment – Immunization prior to pregnancy

Slide 69: Pregnancy Complicated by Medical Conditions – Herpes virus – type 1 and type 2 – type 2 affects pregnancy Infection in infant can be localized or widespread, may cause death or neurological complications Treatment and Care – Avoid contact with lesions, if active outbreak Cesarean delivery

Slide 70: Pregnancy Complicated by Medical Conditions – Hepatitis B – transmitted by blood and body fluids, can also cross placenta Treatment and Care – screen during pregnancy, infants born to women who are Hepatitis B+ should be given Hepatitis B immune globulin (HbIG), followed by Hep B vaccine

Slide 71: Pregnancy Complicated by Medical Conditions – HIV – causitive organism of AIDS, cripples immune system Acquired one of three ways – Sexual contact with infected person – Parenteral or mucous membrane exposure to infected body fluids – Perinatal exposure (20% - 40% chance of infecting infant) Transplacentally Contact with infected maternal secretions at birth Breastmilk

Slide 72: Pregnancy Complicated by Medical Conditions Nonviral Infections – Toxoplasmosis – caused by Toxoplasma gondii, a parasite that may be in cat feces in raw meat and transmitted through the placenta Possible S/S in newborn – Low birth weight – Enlagred liver and spleen – Jaundice – Anemia – Inflammation of eye structures – Neurological damage

Slide 73: Pregnancy Complicated by Medical Conditions Treatment and Nursing Care – Cook all meats thoroughly – Wash hands after handling raw meat – Avoid litter boxes , soil and sand boxes – Wash fresh fruits and veggies well – Group B streptococcus – leading cause of perinatal infections. Organism found in woman’s rectum, vagina, cervix, throat or skin. Woman usually asymptomatic, but can be transmitted to baby at delivery. Diagnosis – + culture of woman’s vagina or rectum at 35-37 weeks gestation Treatment – Antibiotics to mother prior to delivery – Antibiotic therapy to infant after delivery

Slide 74: Pregnancy Complicated by Medical Conditions – TB S/S – fatigue – weakness – loss of appetite and weight – Fever – Night sweats Treatment and Nursing Care – Isoniazid and Rifampin to mother for 9 months – Infant may have preventative therapy for 3 months

Slide 75: Pregnancy Complicated by Medical Conditions Sexually Transmitted Diseases Prevention is by safe sex with protection of condom – Herpes – HIV – Syphilis – Gonorrhea – Chamydia – Trichomoniasis – Genital Warts

Slide 76: Pregnancy Complicated by Medical Conditions Urinary Tract Infections – More common in pregnancy due to pressure on urinary structures keeps bladder from emptying completely and because ureters dilate and lose motility under influence of relaxing effects of progesterone and relaxin – Cystitis – infection of bladder S/S – Burning with urination – Increased frequency and urgency – May have slightly elevated temp

Slide 77: Pregnancy Complicated by Medical Conditions – Pyelonephritis – infection of kidney(s) S/S – High fever – Chills – Flank pian – N/V – Treatment for UTIs Antibiotic therapy – Nursing Care Teach to wipe front to back Intake adequate fluid Urinate before and after intercourse Teach S/S

Slide 78: Pregnancy Complicated by Medical Conditions Substance Abuse – the use of illicit or recreational drugs during pregnancy . – Treatment and Nursing Care Identify substance abused Educate on potential effects of drug Use nonjudgmental approach

Slide 79: Pregnancy Complicated by Medical Conditions Trauma During Pregnancy – Manifestations of Battering May enter late to prenatal care May make up excuses – Treatment and Nursing Care Provide for privacy Be nonjudgmental Offer resources Assessment of maternal and fetal well-being

Slide 80: Effects of a High-Risk Pregnancy on the Family Disruption of Roles Financial Difficulties Delayed Attachment Loss of Expected Birth Experience

Slide 81: References Introduction to Maternity & Pediatric Nursing; Fourth Edition, 2003; Gloria Leifer, Ma, RN; Associate Professor Obstetrics, Pediatrics, and Trauma Nursing; Riverside Community College; Riverside, California; Saunders

Slide 82: The END!!!





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Monday, January 14, 2008

Pathology of Pneumonia

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Pathology of Pneumonia Slide Transcript
Slide 1: The best way to make your dreams come true is to wake up... — Paul Valery

Slide 2: Pathology of Pneumonia Dr. Venkatesh M. Shashidhar Senior Lecturer in Pathology Fiji School of Medicine

Slide 3: Introduction:  Daily10,000 liters of air - filtered..!  Pneumonia: Inflammation of lung.  Respiratory tract infections – commonest in medical practice.  Enormous morbidity & mortality.

Slide 4: Etiology: Decreased resistance - General/immune  Virulent infection - Lobar pneumonia  Clearing mechanism Cough Reflex   Mucosal Injury  Low Alveolar defense  Pulmonary edema  Obstructions

Slide 5: Types: Viral  Bacterial  Mycoplasmal  Fungal

Slide 6: Patterns of Pulmonary infections:  Airway- Bronchitis, Bronchiectasis  Parenchyma  Pneumonia Bronchopneumonia Lobar pneumonia  Lung abscess  Tuberculosis

Slide 7: Bronchopneumonia Staph, Strep, Pneumo & H. influenza  Patchy consolidation – not limited to lobes.  Suppurative inflammation  Usually bilateral  Lower lobes common  Complications:  Abscess  Empyema  Dissemination 

Slide 8: Broncho- pneumonia

Slide 9: Broncho- pneumonia

Slide 10: Broncho- pneumonia

Slide 11: Bronchopneumonia - Abscess formation

Slide 12: Bronchopneumonia:

Slide 13: Bronchopneumonia:

Slide 14: Bronchopneumonia - Abscess formation

Slide 15: Lung RSV Pneumonia:

Slide 16: Bronchopneumonia - CT

Slide 17: Bronchopneumonia - CT

Slide 18: Lobar Pneumonia: Fibrinosuppurative consolidation – whole lobe  Rare due to antibiotic treatment.  ~95% - Strep pneumoniae types 1,3,7& 2.  Four stages:  Congestion.  Red Hepatization.  Gray Hepatizaiton.  Resolution. 

Slide 19: Lobar Pneumonia:

Slide 20: Lobar Pneumonia – Gray hep…

Slide 21: Lung Abscess: Focal suppuration with necrosis of lung tissue  Strep, Staph & Gram negative & anaerobes  Mechanism:  Aspiration  Post pneumonic  Septic embolism  Neoplasms  Productive Cough, fever.  Clubbing  Complications: Systemic spread, septicemia. 

Slide 22: Lung Abscess:

Slide 23: Lung Abscess:

Slide 24: Lung Abscess - Chronic:

Slide 25: Lung Fungal Abscess: Candida

Slide 26: Normal Lung

Slide 27: Normal Lung

Slide 28: The only place where success comes before work is in a dictionary…! Vidal Sassoon





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Sunday, January 13, 2008

eBooks: Kaplan Anatomy Coloring Book

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Product Details
Paperback: 384 pages
Publisher: Kaplan Publishing; Coloring edition (August 2, 2005)
Language: English
ISBN-10: 074326424X
ISBN-13: 978-0743264242
Type of file: PDF
Size: 7,295 KB

Download Kaplan Anatomy Coloring Book




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eBooks: Drugs in Pregnancy and Lactation

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6th editionGerald G Briggs,Roger K Freeman , Sumner J YaffeLippincott Williams & Wilkins Publishers(November 2001)




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eBooks: Lippincott's Illustrated Reviews : Pharmacology

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By Mary Julia Mycek,Richard A, Harvey,Pamela C. Champe,Publisher: Lippincott Williams & WilkinsISBN :0781724139


Download Lippincott's Illustrated Reviews : Pharmacology


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eBooks: Pharmacology at a Glance

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By: Michael J Neal ISBN: 978140513360


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eBooks: Principles of Clinical Pharmacology

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Second EditionBy Jr., Arthur J. Atkinson , Darrell R. Abernethy , Charles E. Daniels, Robert Dedrick , Sanford P. Markey ISBN-10: 01236941752007, Elsevier Inc

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eBooks: Cardiac Nursing

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By Susan L Woods, Erika Sivarajan Froelicher, Sandra Adams(Underhill) Motzer, Elizabeth Bridges
Publisher: Lippincott Williams & Wilkins
ISBN-10 / ASIN: 078174718X

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Saturday, January 12, 2008

eBooks: Nurse’s Pocket Guide: Diagnoses, Interventions, and Rationales, 9th Ed. 7.0.9

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Author(s): Marilynn E. Doenges, RN, BSN, MA, Mary Frances Moorhouse, RN, BSN, CRRN, CLNC, TNT-RN & Alice C. Geissler-Murr, RN, BSN, CLNC

Publisher: F.A. Davis Company Make sure your students use the best selling pocket guide to plan their patients'' care! This pocket sized reference helps nursing students identify interventions most commonly associated with nursing diagnoses when caring for patients. It''s the perfect resource for hospital and community-based settings.

Key Features:
*Alphabetical listing of new and revised nursing diagnoses through the latest NANDA conference keeps you up-to-date

*Related Factors, Defining Characteristics, Desired Outcomes/Evaluation Criteria, Actions/Interventions, and Documentation Focus are listed for each nursing diagnosis to help your students plan patient care

*Updated section of up to 400 Disorders/Health Problems with associated nursing diagnoses that facilitates the assessment and diagnosis steps of the nursing process

*Lists Nursing Actions/Interventions with selected rationales according to nursing priorities

*"Documentation Focus" section?organized according to nursing priorities?is an excellent tool to remind your students how important and necessary recording the steps of the nursing process is to patient care

*Desired outcomes and evaluation criteria are clearly identified to assist the nurse in formulating individual patient outcomes and to support the evaluation process

With Skyscape's patented smARTlink™ technology, RNDxInt9™ can easily cross-index with other clinical and drug prescription products from Skyscape to provide a powerful and integrated source of clinical information that you can carry with you wherever you go!

Download Nurse’s Pocket Guide: Diagnoses, Interventions, and Rationales, 9th Ed. Screenshots

Free Trial Only!



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Free Software for Students: Explore Human Anatomy Professional Edition

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Product Details
»Book Publisher: Mega Systems (17 June, 2004)
»ISBN: B0002FG4L2
»Book author:
»Amazon Rating: 3.0

Book Description:
Explore Human Anatomy Professional Edition holds a world of authoritative information on the world within the human body. This 12-CD set feature fully updated and complete information, presented through spectacular multimedia displays, high-resolution pictures and animation. It’s a total guide to the working of the human body! 3D models allow parts of anatomy to be pinpointed and text, graphics and animation can be called up Advanced Virtual Reality(VR) technology allows the user to move anatomical models freely, to view them from multiple angles & perspectives




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Free Audio Book: 101 Helpful Hints for IELTS: Practice Tests and Hints for IELTS

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This is the audio version of the high-rated book, 101 Helpful Hints for IELTS: Practice Tests and Hints for IELTS: Academic Module Book which can be bought through Amazon.com or you might want to try your nearest National Bookstore.




Download 101 Helpful Hints for IELTS: Practice Tests and Hints for IELTS

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eBooks: HEART SOUNDS made easy

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Product Details
»Book Publisher: Churchill Livingstone (02 October, 2002)
»ISBN: 0443071411
»Book author: A. P. Salmon, E.M. Brown, W. Collis
»Amazon Rating:

Book Description:
A practical and simple guide to the art of cardiac auscultation which teaches the reader how to identify a pathological heart murmur. The book explains what heart sounds are and how to use a stethoscope. It covers all the standard adult and child murmurs and is organised by region. It includes all the text of the tutorials. The CD provides, in a series of tutorials, the chance to listen to and identify the range of heart sounds; while in the pathology section a listener can focus down on each individual component of the sound allowing them to discern the key features of each murmur.

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Ask Myk Nursing Question

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ASK NURSING QUESTION CORNER

If you have a nursing question that you want me to answer, don't hessitate post your question by posting here.

I will try to answer you question as soon as possible.



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eBooks: Nursing Theories and Nursing Practice

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Nursing Theories and Nursing Practice Book Description
...explores nursing theories and their use in nursing practice...many theory chapters written by the original theorists or by recognized authorities on the theory.

Nursing Theories and Nursing Practice Details
* Paperback: 477 pages
* Publisher: F. A. Davis Company (January 15, 2001)
* Language: English
* ISBN-10: 0803606044
* ISBN-13: 978-0803606043
Link 1
Password: FDF-3878-PITY
Link 2


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