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Saturday, January 31, 2009

Nursing Employment: Japan still to hire RP nurses

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By Veronica Uy
First Posted 18:47:00 01/28/2009

Filed Under: Overseas Employment, Unemployment, Nursing matters

MANILA, Philippines—Although in recession, Japan will still hire Filipino nurses and caregivers as provided under the Japan-Philippines Economic Partnership Agreement (JPEPA), Japanese Ambassador to the Philippines Makato Katsura said Wednesday.

"We need nurses and caregivers in Japan. The demand for good nurses and caregivers remains unchanged," Katsura said in an interview shortly after he signed an accord with the United Nations' World Food Programme granting P455 million in grant for those displaced by the fighting in Mindanao.

While admitting that Japan would be affected by the global financial crisis, he said it would not result in a massive layoff of overseas Filipino workers.

"Japan's growth this year will be negative. But I don't think this will directly affect your Filipino workers in Japan," he said.

Katsura said JPEPA, which entered into force early December 2008, opens Japan -- the world’s second largest economy -- to 1,000 Filipino caregivers and nurses in two years.

In fact, he said, the recruitment of Filipino nurses and caregivers has begun, as the embassy gets requests for them from hospitals and caregiving centers in Japan.

"We are now in the process of matching the demand and supply," he said.

Under the treaty, 200 nurses and 300 caregivers will be received annually. The first batch is set to arrive in Japan between April and June this year to take language training course for half a year before being assigned to hospitals and nursing care facilities.

At the same time, Japanese embassy officials also said tariffs on Philippine exports have already been reduced since the bilateral agreement took effect.

The JPEPA was signed by President Gloria Macapagal-Arroyo and Japanese Prime Minister Junichiro Koizumi on September 2006 at the sidelines of 6th Asia-Europe Meeting in Helsinki, Finland.

Soon after, Japan ratified it. After much debate over its constitutionality and a provision on trade in trash, the Philippine Senate ratified the treaty last year.


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Friday, January 30, 2009


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Below are the schedule for 2009 Nursing Licensure Examination. Exam for this year will be on June 8-9, 2009 (Sunday-Monday) and on November 28-29, 2009 (Saturday-Sunday). If you want to get a copy, simple click on the images below to view an enlarge version, then right click the image and

Nursing Jobs: More Philippine Nurses Heading To Regina

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Regina Qu'Appelle Health Region hires another 72

Reported By Sarah Mills
Posted January 29, 2009 - 3:05pm

Seventy two more Philippine nurses have been hired for the Regina Qu'Appelle Health Region.

A recent mission to the area has added to the 154 nurses that were recruited on the first trip, 96 of them are already here and at working

However, despite successful missions, five nurses were let go, but Debbie Beaton with the health region maintains lessons were learnt and the process is now more strict.

More questions are asked, and greater experience sought.

The nurses will be working in some rural areas and the operating and critical care room in Regina's Pasqua and General hospitals.

They'll begin arriving throughout the year.


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Overseas Employment Crisis: Nurses to US not answer to OFW crisis

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MANILA, Philippines—The deployment of Filipino nurses and other health-care professionals to the United States will not save the Philippines from the impending overseas employment crisis as the global financial crunch deepens, a recruiter said Monday.

The number of Filipino health-care professionals leaving for US jobs is on a decline for the past several years, Loreto Soriano said, citing records from the Philippine Overseas Employment Administration.

He said that since 2000, some 1,900 Filipino nurses have been deployed to the US for an average of 237 a year. In 2007, he said, the number was much lower at.

Due to the backlog in work-based immigrant petitions, he said, processing time has been between three to five years.

Foreign professionals who want to work in the United States are still restricted by stalled US immigration legislation.

Soriano said that while the US has a projected need for 1.2 million nurses by 2014, the new administration of President Barack Obama is unlikely to reverse the declining trend of hiring foreign health workers.

In an earlier forum, former budget secretary Benjamin Diokno estimated that about 500,000 overseas Filipinos will lose their jobs as a direct result of the global financial crisis.


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Tuesday, January 27, 2009

GastroIntestinal NCLEX Sata Questions

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1. A 28-year-old client is admitted with inflammatory bowel syndrome (Crohn's disease). Which therapies should the nurse expect to be part of the care plan?

Select all that apply:

1. Lactulose therapy
2. High-fiber diet
3. High-protein milkshakes
4. Corticosteroid therapy
5. Antidiarrheal medications

2. Which findings are common in neonates born with esophageal atresia?

Select all that apply:

1. Decreased production of saliva
2. Cyanosis
3. Coughing
4. Inadequate swallow
5. Choking
6. Inability to cough

3. While preparing a client for an upper GI endoscopy (esophagogastroduodenoscopy), the nurse should implement which interventions?

Select all that apply:

1. Administer a preparation to cleanse the GI tract, such as Golytely or Fleets Phospha-Soda.
2. Tell the client he shouldn't eat or drink for 6 to 12 hours before the procedure.
3. Tell the client he must be on a clear liquid diet for 24 hours before the procedure.
4. Inform the client that he'll receive a sedative before the procedure.
5. Tell the client that he may eat and drink immediately after the procedure.

4. A client with a retroperitoneal abscess is receiving gentamicin (Garamycin). Which signs should the nurse monitor?

Select all that apply:

1. Hearing
2. Urine output
3. Hematocrit (HCT)
4. Blood urea nitrogen (BUN) and creatinine levels
5. Serum calcium level

GastroIntestinal NCLEX Sata Questions Answer Key:

1. 4, 5
2. 2, 3, 5
3. 2, 4
4. 1, 2, 4

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Monday, January 26, 2009

NCLEX-RN 101: How to Pass! Few Points Discussed

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Zollinger-Ellison syndrome is a hypersecretory condition of the stomach. The client should avoid taking medications that are irritating to the stomach lining. Irritants would include aspirin and nonsteroidal antiinflammatory medications (Naprosyn and ibuprofen). The client should take acetaminophen for pain relief.

A TURP is done through the urethra. An instrument called a resectoscope is used to cut the tissue using high-frequency current. An incision between the scrotum and anus is made when a perineal prostatectomy is performed. A lower abdominal incision is used for suprapubic or retropubic prostatectomy.

The most common sites for bone marrow aspiration in the adult are the iliac crest and the sternum. These areas are rich in bone marrow and are easily accessible for testing. The femur, scapula, and ribs are not sites for bone marrow aspiration.

Amiloride (Midamor) is a potassium-sparing diuretic used to treat edema or hypertension. A daily dose should be taken in the morning to avoid nocturia. The dose should be taken with food to increase bioavailability. Sodium should be restricted if used as an antihypertensive. Increased blood pressure is not a reason to hold the medication, and it may be an indication for its use.

Early treatment of cervical infection can help prevent chronic cervicitis, which can lead to dysplasia of the cervix. Cervical dysplasia is an early cell change that is considered to be premalignant. Oral contraceptives and douches do not decrease the risk for this type of cancer.

An urticaria reaction is characterized by a rash accompanied by pruritus. This type of transfusion reaction can be prevented by pretreating the client with an antihistamine, such as diphenhydramine.

Infiltrating ductal carcinoma of the breast usually presents as a fixed, irregularly shaped mass. The mass is usually single and unilateral, and is painless, nontender, and hard to the touch.

Common risk factors for colorectal cancer that cannot be changed include age over 40, first-degree relative with colorectal cancer, and history of bowel problems such as ulcerative colitis or familial polyposis. Clients should be aware of modifiable risk factors as part of general health maintenance and primary disease prevention. Modifiable risk factors are those that can be reduced, and include a high-fat and low-fiber diet.

The discomfort of reflux is aggravated by positions that allow the reflux of gastrointestinal contents. The client is instructed to remain upright for 1 to 2 hours after a meal and to sleep with the head of the bed elevated 6 to 8 inches. Lying flat will increase the episodes of reflux, resulting in chest discomfort.

Methylphenidate (Ritalin) is a central nervous stimulant and should be taken before breakfast and before the noontime meal. It should not be taken in the afternoon or evening because the stimulating effect causes insomnia.

A barium swallow, or esophagography, is an x-ray that uses a substance called barium for contrast to highlight abnormalities in the gastrointestinal (GI) tract. The client is told to remove metal objects such as medals and jewelry before the test, so they won’t interfere with x-ray visualization of the field. The client should fast for 8 to 12 hours before the test, depending on physician instructions. Some oral medications are withheld before the test, and the client should follow the physician’s instructions regarding medication administration. It is important after the procedure to monitor for constipation, which can occur as a result of the presence of barium in the GI tract.

Sucralfate (Carafate) is an antiulcer medication. The medication should be scheduled for administration 1 hour before meals and at bedtime. This timing will allow the medication to form a protective coating over the ulcer before it becomes irritated by food intake, gastric acid production, and mechanical movement.

For abdominal paracentesis, the nurse should position the client in an upright position on the edge of the bed with the feet resting on a stool and the back well supported. This position allows the intestine to float posteriorly and helps prevent laceration during catheter insertion.

The most accurate means of assessing pulse rhythm is by auscultation of the apical pulse. When a client has PVCs, the rate is irregular and if the radial pulse is taken, a true picture of what is occurring is not obtained. A very fast regular apical pulse indicates tachycardia. A very slow regular apical pulse indicates bradycardia.

Calcium carbonate is used as an antacid for the relief of heartburn and indigestion. It can also be used as a calcium supplement or to bind phosphorus in the gastrointestinal (GI) tract in clients with renal failure.

Clients with Bell’s palsy should be reassured that they have not experienced a stroke and that symptoms often disappear spontaneously in 3 to 5 weeks. The client is given supportive treatment for symptoms. It is not usually caused by a tumor, and the treatment does not involve administering vasodilators.

Propantheline is an antimuscarinic anticholinergic medication that decreases gastrointestinal secretions. It should be administered 30 minutes before meals. It is usually prescribed to treat peptic ulcer disease.

A patient taking carbamazepine (Tegretol) is given instructions that includes Drowsiness, dizziness, nausea, and vomiting are frequent side effects associated with the medication. Adverse reactions include blood dyscrasias. If the client develops a fever, sore throat, mouth ulcerations, unusual bleeding or bruising, or joint pain, this may be indicative of a blood dyscrasia, and the physician should be notified.

A common treatment for women with estrogen-receptor positive breast tumors is follow-up treatment with tamoxifen (Nolvadex). This medication is classified as an antineoplastic agent and competes with estrogen for binding sites in the breast and other tissues. The medication may be administered for years following surgery.

Donepezil hydrochloride (Aricept) is a cholinergic agent that is used in the treatment of mild to moderate dementia of the Alzheimer’s type. It enhances cholinergic functions by increasing the concentration of acetylcholine. It slows the progression of Alzheimer’s disease.

Ondansetron hydrochloride (Zofran) is a selective receptor antagonist used as an antinausea and antiemetic. Frequent side effects include anxiety, drowsiness, dizziness, headache, fatigue, constipation, diarrhea, urinary retention, and hypoxia. Occasional side effects include abdominal pain, diminished saliva secretion, fever, feeling of cold, paresthesia, and weakness. Rare side effects include hypersensitivity reaction and blurred vision.

With intrinsic renal failure, there is a fixed specific gravity and the urine tests positive for proteinuria. In postrenal failure, there is a fixed specific gravity and little or no proteinuria. In prerenal failure, the specific gravity is high, and there is very little or no proteinuria.

Sertraline (Zoloft) is a serotonin reuptake inhibitor. Serious potentially fatal reactions may occur if sertraline is administered concurrently with a monoamine oxidase inhibitor (MAOI). Phenelzine sulfate is an MAOI. MAOIs should be stopped at least 14 days before sertraline therapy. Sertraline should also be stopped at least 14 days before MAOI therapy.

Betamethasone (Celestone), a corticosteroid, is administered to increase the surfactant level and increase fetal lung maturity, reducing the incidence of respiratory distress syndrome in the newborn infant. Surfactant production does not become stable until after 32 weeks’ gestation. If adequate amounts of surfactant are not present in the lungs, respiratory distress and death are possible consequences. Delivery needs to be delayed for at least 48 hours after the administration of betamethasone in order to allow time for the lungs to mature.

Influenza (commonly know as the flu) refers to an acute viral infection of the respiratory tract. It is a communicable disease spread by droplet infection, and measures are instituted to prevent its spread. The client is instructed to remain at home, practice frequent hand washing, and cover the nose and mouth when sneezing and coughing. Supportive measures to relieve fever and myalgia such as the use of acetaminophen are also encouraged. It is unrealistic to completely isolate oneself in a room from other family members, and there is no useful reason to use a separate bathroom because the infection is spread through droplets. Influenza immunization is administered before the start of the “flu” season, not after developing the infection.

BUN and creatinine are measured during therapy with streptomycin because the medication is nephrotoxic. The client taking isoniazid (INH) for tuberculosis is at risk for hepatotoxicity. Vision testing is done during treatment with ethambutol (Myambutol).

To avoid causing tension pneumothorax, the nurse avoids clamping the chest tube for any reason unless specifically ordered. In most instances, clamping of the chest tube is contraindicated by agency policy. The nurse keeps the drainage collection system below the level of the client’s waist to prevent fluid or air from reentering the pleural space. Water is added to the suction control chamber as needed to maintain the full suction level ordered. Connections between the chest tube and system are taped to prevent accidental disconnection.

For acute or chronic rheumatoid arthritis or osteoarthritis, the normal oral adult dose for an older client is 200 to 800 mg three to four times a day.

Baclofen (Lioresal) is a skeletal muscle relaxant and acts at the spinal cord level to decrease the frequency and amplitude of muscle spasms in clients with spinal cord injuries or diseases, or multiple sclerosis.

Lorazepam (Ativan) is contraindicated if hypersensitivity or cross-sensitivity with other benzodiazepines exist. It is also contraindicated in clients who are comatose, with preexisting central nervous system (CNS) depression, with uncontrolled severe pain, and those with narrow-angle glaucoma. It is also not prescribed for clients who are pregnant or breastfeeding.

The client’s symptoms indicate mild hypoglycemia. If the hospitalized client complains of symptoms of hypoglycemia, a blood glucose test with a blood glucose meter should be performed. (In the nonhospitalized client, it is safer to assume and treat hypoglycemia if a blood glucose meter is unavailable.) The nurse then treats the reaction by administering a carbohydrate such as 4 ounces orange juice, 6 ounces regular soda, 6 to 8 ounces 2% milk, or a similar item containing 10 to 15 g of carbohydrate if the reaction is mild. Once the condition is corrected, the nurse would assess the client to determine the cause. The nurse should then document the client’s complaints, the blood glucose level, treatment and response, the potential cause of the reaction, and other significant information related to the reaction.

The client who suddenly becomes disoriented and confused following TURP could be experiencing early signs of hyponatremia. This may occur because the flushing solution used during the operative procedure is hypotonic. If enough solution is absorbed through the prostate veins during surgery, the client experiences increased circulating volume and dilutional hyponatremia. The nurse needs to report these symptoms.

Equipment needed to perform tracheostomy care includes a tracheostomy care kit, sterile water and saline solutions for cleansing and rinsing, and a suction kit for client suctioning. As part of tracheostomy care, the client’s airway should be suctioned before cleansing the tracheostomy. New sterile solutions are obtained once per 24 hours, which is often done at the beginning of the work day. A tracheostomy care kit contains the needed supplies for cleaning the tracheostomy and for changing the dressing and tapes.

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Saturday, January 24, 2009

Ace Your Nclex / CGFNS : Nursing Review Summarized

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The client with fractured ribs typically has pain over the fracture site with inspiration and to palpation. Respirations are shallow, and guarding of the area is often noted. Bruising may or may not be present.

The client with flail chest is in obvious respiratory distress. The client has severe dyspnea and cyanosis accompanied by paradoxical chest movement. Respirations are shallow, rapid, and grunting in nature.

Gastroschisis is an abdominal wall defect in which the viscera are outside the abdominal cavity and not covered with a sac. Embryonal weakness in the abdominal wall causes herniation of the gut on one side of the umbilical cord during early development.

A patient is prescribed zolpidem (Ambien) for insomia and the client should be instructed to take the medication at bedtime and to swallow the medication whole with a full glass of water. For faster onset of sleep, the client should be instructed not to administer the medication with milk or food, or immediately after a meal. Antacids should be avoided with the administration of the medication because of interactive effects.

Manifestations of acute SLE may include fever, musculoskeletal aches and pains, butterfly rash on the face, pleural effusion, basilar pneumonia, generalized lymphadenopathy, pericarditis, tachycardia, hepatosplenomegaly, nephritis, delirium, convulsions, psychosis, and coma.

Severely anemic persons (those with a hemoglobin below 8 g/dL) appear pale and always feel exhausted. They may have palpitations, sensitivity to cold, loss of appetite, profound weakness, dizziness, and headaches.

Manifestations of polycythemia vera include a ruddy complexion, dusky red mucosa, hypertension, dizziness, headache, and a sense of fullness in the head. Signs of congestive heart failure may also be present. The hematocrit level is usually greater than 54% in men and 49% in women.

When the neutrophil count is less than 500/mm3, visitors should be screened for the presence of infection, and any visitors or staff with colds or respiratory infections should not be allowed in the client’s room. All live plants, flowers, and stuffed animals are removed from the client’s room. The client is placed on a low-bacteria diet that excludes raw fruits and vegetables. Padding the side rails and removing all hazardous and sharp objects from the environment would be instituted if the client is at risk for bleeding. This client is at risk for infection.

Toxic shock syndrome is caused by infection and is often associated with tampon use. DIC is a complication of TSS. The nurse monitors the client for signs of this complication, and notifies the physician promptly if signs and symptoms are noted

The level of consciousness is the most sensitive indicator of neurological status. An alteration in the level of consciousness occurs before any other changes in neurologic signs or vital signs. Vital sign changes occur late.

The client with adrenocorticosteroid excess experiences hyperkalemia, hyperglycemia, elevated WBC count, and elevated plasma cortisol and adrenocorticotropic hormone (ACTH) levels. These abnormalities are caused by the effects of excess glucocorticoids and mineralocorticoids on the body.

The safe wall suction range for an adult is 80 to 120 mm Hg (120 to 150 mm Hg with the tubing occluded)

Hematological reactions can occur in the client taking clozapine and include agranulocytosis and mild leukopenia. The white blood cell count should be assessed before initiating treatment and should be monitored closely during the use of this medication. The client should also be monitored for signs indicating agranulocytosis, which may include sore throat, malaise, and fever.

The water seal chamber should be filled to the 2 cm mark to provide an adequate water seal between the external environment and the client’s pleural cavity. The water seal prevents air from reentering the pleural cavity. Because evaporation of water can occur, the nurse should remedy this problem by adding water until the level is again at the 2 cm mark.

The TENS unit is a portable unit, and the client controls the system for relieving pain and reducing the need for analgesics. It is attached to the skin of the body by electrodes. It is not necessary that the client remain in the hospital for this treatment.

The client whose diet has a protein restriction should be careful to ensure that the proteins eaten are complete proteins with the highest biologic value. Foods such as meat, fish, milk, and eggs are complete proteins, which are optimal for the client with chronic renal failure.

Imperforate anus (anal atresia, anal agenesis) is the incomplete development or absence of the anus in its normal position in the perineum

The stomach capacity of a newborn infant is approximately 10 to 20 mL. It is 30 to 90 mL for a 1-week-old infant and 75 to 100 mL for a 2- to 3-week-old infant.

Comfort measures for nipple soreness include positioning the infant with the ear, shoulder, and hip in straight alignment and with the infant’s stomach against the mother’s. Additional measures include rotating breastfeeding positions; breaking suction with the little finger; nursing frequently; beginning feeding on the less sore nipple; not allowing the infant to chew on the nipple or to sleep holding the nipple in the mouth; and applying tea bags soaked in warm water to the nipple.

Bleeding is a major side effect of t-PA therapy. The bleeding can be superficial or internal and can be spontaneous.

Immediately after delivery, the uterine fundus should be at the level of the umbilicus or one to three fingerbreadths below it and in the midline of the abdomen. If the fundus is above the umbilicus, this may indicate that blood clots in the uterus need to be expelled by fundal massage. A fundus that is not located in the midline may indicate a full bladder.

Vital signs return to normal within the first hour postpartum if no complications arise. If the temperature is greater than 2° F above normal, this may indicate infection, and the physician should be notified.

Changes in vital signs indicate hypovolemia in the anesthetized postpartum woman with a vaginal hematoma. Because the client received anesthesia, she would not feel pain or pressure. Vaginal bruising may be present, but this may be a result of the delivery process and additionally is not the best indicator of the presence of a hematoma.

The most common metabolic complication in the SGA newborn is hypoglycemia, which can produce central nervous system abnormalities and mental retardation if not corrected immediately. Urinary output, although important, is not the highest priority action because the post-term SGA newborn is typically dehydrated from placental dysfunction. Hemoglobin and hematocrit levels are monitored because the post-term SGA newborn exhibits polycythemia, although this also does not require immediate attention. The polycythemia contributes to increased bilirubin levels, usually beginning on the second day after delivery.

Methylergonovine (Methergine), an oxytocic, is an agent used to prevent or control postpartum hemorrhage by contracting the uterus. The first dose is usually administered intramuscularly, and then if it needs to be continued, it is given by mouth. It increases the strength and frequency of contractions and may elevate blood pressure.

The priority action for a newborn infant with low Apgar scores is airway, which would involve preparing respiratory resuscitation equipment

Butorphanol tartrate (Stadol) is an opioid analgesic that provides systemic pain relief during labor. The nurse would ensure that naloxone and resuscitation equipment are readily available to treat respiratory depression, should it occur. Although an antiemetic may be prescribed for vomiting, antiemetics may enhance the respiratory depressant effects of the butorphanol tartrate.

Clients taking allopurinol (Zyloprim) are encouraged to drink 3000 mL of fluid a day. Allopurinol is to be given with or immediately following meals or milk. If the client develops a rash, irritation of the eyes, or swelling of the lips or mouth, he or she should contact the physician because this may indicate hypersensitivity.

Rubella vaccine is a live attenuated virus that evokes an antibody response and provides immunity for approximately 15 years. Because rubella is a live vaccine, it will act as the virus and is potentially teratogenic in the organogenesis phase of fetal development. The client needs to be informed about the potential effects this vaccine may have and the need to avoid becoming pregnant for a period of 2 to 3 months afterward.

Testicular self-examination is a self-screening examination for testicular cancer, which predominantly affects men in their late teens and twenties. The self-examination is performed once a month, as is breast self-examination. As an aid to remember to do it, the examination should be done on the same day each month. The scrotum is held in one hand and the testicle is rolled between the thumb and forefinger of the other hand. The self-examination should not be painful. It is easiest to do either during or after a warm shower (or bath) when the scrotum is relaxed.

The client with fibrocystic breast disorder experiences worsening of symptoms (breast lumps, painful breasts, and possible nipple discharge) before the onset of menses. This is associated with cyclical hormone changes. Clients should understand that this is part of the clinical picture of this disorder.

Dimenhydrinate (Dramamine) is used to treat and prevent the symptoms of dizziness, vertigo, and nausea and vomiting that accompany motion sickness.

Bright red bleeding should be reported, because it could indicate complications related to active bleeding. If the bladder irrigation is infusing at a sufficient rate, the urinary drainage will be pale pink. A dark pink color (sometimes referred to as punch-colored) indicates that the speed of the irrigation should be increased. Tea-colored urine is not seen after TURP, but may be noted in the client with renal failure or other renal disorders.

The manifestations of hypertensive crisis include hypertension, occipital headache radiating frontally, neck stiffness and soreness, nausea, vomiting, sweating, fever and chills, clammy skin, dilated pupils, and palpitations. Tachycardia and bradycardia and constricting chest pain may also be present. The antidote for hypertensive crisis is phentolamine (Regitine) and a dosage by intravenous injection is administered. Protamine sulfate is the antidote for heparin, and vitamin K is the antidote for warfarin (Coumadin) overdose. Calcium gluconate is used for magnesium overdose.

orchidectomy (or-kih-DEK-toh-mee). Surgery to remove one or both testicles.

Signs of prostatism that may be reported to the nurse are reduced force and size of urinary stream, intermittent stream, hesitancy in beginning the flow of urine, inability to stop urinating quickly, a sensation of incomplete bladder emptying after voiding, and an increase in episodes of nocturia. These symptoms are the result of pressure of the enlarging prostate on the client’s urethra.

The characteristic lesion of syphilis is painless and indurated. The lesion is referred to as a chancre. Genital herpes is accompanied by the presence of one or more vesicles that then rupture and heal. Scabies is characterized by erythematous, papular eruptions. Genital warts are characterized by cauliflower-like growths, or growths that are soft and fleshy.

A limit of 1 to 1.5 kg of weight gain between dialysis treatments helps prevent hypotension that tends to occur during dialysis with the removal of larger fluid loads. The nurse determines that the client is compliant with fluid restriction if this weight gain is not exceeded.

Following total knee replacement, the neurovascular status of the affected leg is assessed, and findings should be within normal limits. The client should have intact capillary refill and adequate color, temperature, sensation, and motion to the limb. Incisional pain should be relieved by narcotic analgesic administration. The knee incision may have a wound suction drain in place, which is expected to drain up to 200 mL in the first 8 hours after surgery. Drainage of 175 mL per hour is excessive and should be reported.

Upon removal of a chest tube, a dressing is placed over the chest tube site. This is maintained in place until the physician says it may be removed. The client is taught to monitor and report any respiratory difficulty or increased temperature. The client should avoid heavy lifting for the first 4 to 6 weeks after discharge to facilitate continued wound healing.

The client taking epoetin alfa (Epogen) is at risk of hypertension and seizure activity as the most serious adverse effects of therapy. This medication is used to treat anemia.

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Friday, January 23, 2009

NCLEX Test Practice Questions - Increase Your Nclex Score

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Accupril is an angiotensin-converting enzyme (ACE) inhibitor. It is used in the treatment of hypertension. The client should be instructed to rise slowly from a lying to sitting position and to permit the legs to dangle from the bed momentarily before standing to reduce the hypotensive effect. The medication does not need to be taken with meals. It may be given without regard to food. If nausea occurs, the client should be instructed to take a noncola carbonated beverage and salted crackers or dry toast. A full therapeutic effect may be noted in 1 to 2 weeks.

Safety during defibrillation is essential for preventing injury to the client and to the personnel assisting with the procedure. The person performing the defibrillation ensures that all personnel are standing clear of the bed by a verbal and visual check of “all clear.” For the shock to be effective, some type of conductive medium (e.g., lubricant, gel) must be placed between the paddles and the skin. Both paddles are placed on the client’s chest.

Quinidine (Quinidex) is an antidysrhythmic. Verapamil (Calan) is generally used to control heart rate. Nifedipine (Procardia) is a vasodilator. Bretylium (Bretylol) is generally used for control of ventricular dysrhythmia.

The bell of the stethoscope is not used to auscultate breath sounds. The client ideally should sit up and breathe slowly and deeply through the mouth. The diaphragm of the stethoscope, which is warmed before use, is placed directly on the client’s skin, not over a gown or clothing.

For the client with VT who becomes pulseless, the physician or qualified advanced cardiac life support (ACLS) personnel immediately defibrillates the client. In the absence of this equipment, cardiopulmonary resuscitation (CPR) is initiated immediately.

Complications after insertion of an IVC filter are rare. When they do occur, they include air embolism, improper placement, and filter migration. The percutaneous approach uses local anesthesia. There is usually no need for anticoagulant therapy after surgery. Venous congestion can occur from accumulation of thrombi on the filter, but the process usually occurs gradually.

Mitten restraints are useful for this client because the client cannot pull against them, creating resistance that could lead to increased intracranial pressure (ICP). Wrist restraints cause resistance. Vest and waist restraints prevent the client from getting up or falling out of bed but do nothing to limit hand movement.

After three unsuccessful defibrillation attempts, CPR should be done for 1 minute, followed by three more shocks, each delivered at 360 joules.

Before insertion of an oropharyngeal airway, any dentures or partial plates should be removed from the client’s mouth. An airway should be selected that is an appropriate size. The client should be positioned supine, with the neck hyperextended if possible. The airway is inserted with the tip pointed upward and is then rotated downward once the flange has reached the client’s teeth. Following insertion, the client’s mouth is suctioned every hour or as necessary. The airway is removed for inspection of the mouth every 2 to 4 hours.

The nurse is responsible for monitoring the client’s respiratory status and blood pressure while the client is being treated with an IV bolus of lidocaine hydrochloride.

A child with a head injury is at risk for increased intracranial pressure (ICP). Sitting up will decrease fluid retention in cerebral tissue and promote drainage. Keeping the child awake will assist in accurate evaluation of any cerebral edema that is present and will detect early coma. Neurological assessments need to be performed to monitor for increased ICP. Forcing fluids may cause fluid overload and increased ICP. Additionally, the nurse would not “force” the client to do something.

Biofeedback, progressive muscle relaxation, meditation, and guided imagery are techniques that the nurse can teach the client to reduce the physical impact of stress on the body and promote a feeling of self-control for the client. Biofeedback entails electronic equipment, whereas the others require no adjuncts, such as tapes, once the technique is learned. Confrontation is a communication technique, not a stress-management technique. It may also exacerbate stress, at least in the short term, rather than alleviate it.

Sudden, severe abdominal pain is the most indicative sign of perforation. When perforation of an ulcer occurs, the nurse may be unable to hear bowel sounds at all. When perforation occurs, the pulse will more likely be weak and rapid. Positive guaiac stool results indicate the presence of bleeding but are not necessarily indicative of perforation.

Human albumin (Albuminar) is classified as a blood derivative and is contraindicated in severe anemia, cardiac failure, history of allergic reaction, renal insufficiency, and when no albumin deficiency is present. It is used with caution in clients with low cardiac reserve, pulmonary disease, or hepatic or renal failure.

PVCs are considered dangerous when they are frequent (more than six per minute), occur in pairs or couplets, are multifocal (multiform), or fall on the T wave.

The term “involution” is used to describe the rapid reduction in size and the return of the uterus to a normal condition similar to its nonpregnant state. Immediately following the delivery of the placenta, the uterus contracts to the size of a large grapefruit. The fundus is situated in the midline between the symphysis pubis and the umbilicus. Within 6 to 12 hours after birth, the fundus of the uterus rises to the level of the umbilicus. The top of the fundus remains at the level of the umbilicus for about a day and then descends into the pelvis approximately one fingerbreadth on each succeeding day.

The normal Po2 level is 80 to 100 mm Hg.

Giving the client with emphysema a high flow of oxygen would halt the hypoxic drive and cause apnea.

A common, life-threatening opportunistic infection that attacks clients with AIDS is Pneumocystis carinii pneumonia. Its symptoms include fever, exertional dyspnea, and nonproductive cough. The absence of respiratory distress is one of the goals that the nurse sets as a priority.

According to category-specific (respiratory) isolation precautions, a client with TB requires a private room. The room needs to be well-ventilated and should have at least six exchanges of fresh air per hour and should be ventilated to the outside

Learning depends on two things: physical and emotional readiness to learn. Without one or the other, teaching can occur, but learning may not take place. There is usually a time at which the client will indicate an interest in learning.

Breath sounds are the best way to assess for the onset of congestive heart failure. The presence of crackles or rales or an increase in crackles is an indicator of fluid in the lungs caused by congestive heart failure.

Fludrocortisone acetate (Florinef) is a long-acting oral medication with mineralocorticoid and moderate glucocorticoid activity that is used for long-term management of Addison’s disease. Mineralocorticoids act on the renal distal tubules to enhance the reabsorption of sodium and chloride ions and the excretion of potassium and hydrogen ions. The client can rapidly develop hypotension and fluid and electrolyte imbalance if the medication is discontinued abruptly. The medication does not affect the immune response or thyroid or thyrotropin production.

The most frequent indication that a graft is occluding is the return of pain that is similar to that experienced preoperatively.

The nurse is careful to question the surgeon about whether warfarin should be administered in the preoperative period before insertion of an IVC filter. This medication is often withheld for a period of time preoperatively to minimize the risk of hemorrhage during surgery.

Intermittent claudication is a symptom characterized by a sudden onset of leg pain that occurs with exercise and is relieved by rest. It is the classic symptom of peripheral arterial insufficiency. Venous insufficiency is characterized by an achy type of leg pain that intensifies as the day progresses.

Treatment for DVT may require bed rest, leg elevation, and application of warm moist heat to the affected leg. The client may have calf measurements ordered once per shift or once per day, but they would not be obtained hourly.

The purpose of a serum digoxin (Lanoxin) level is to record the serum concentration of the medication to ensure that it is in the therapeutic range. Serum digoxin levels are most often drawn before a dose, although they may be drawn 4 to 10 hours after a dose was administered. Drawing the medication before a dose ensures that the level is not falsely elevated.

There should be no open flames or smoking within 10 feet of the oxygen source. The tank should remain secured in its holder, and the concentrator should be away from walls or other close quarters (to allow adequate air circulation around the unit). The oxygen source should also be removed from sources of heat or sunlight. A “no smoking” sign should be in visible view, such as in the window near the door of the client’s home.

After suctioning a client either with or without an artificial airway, the breath sounds are auscultated to determine the extent to which the airways have been cleared of respiratory secretions.

Aluminum hydroxide tablets should be chewed thoroughly before swallowing. This prevents them from entering the small intestine undissolved. They should not be swallowed whole. Antacids should be taken at least 2 hours apart from other medications to prevent interactive effects. Constipation is a side effect of the use of aluminum products, but the client should not take a laxative with each dose. This promotes laxative abuse. The client should first try other means to prevent constipation.

Auranofin (Ridaura) is a gold preparation that is used as an antirheumatic. Gold toxicity is an adverse effect and is evidenced by decreased hemoglobin, leukopenia, reduced granulocyte counts, proteinuria, hematuria, stomatitis, glomerulonephritis, nephrotic syndrome, or cholestatic jaundice. Anorexia, nausea, and diarrhea are frequent side effects of the medication.

Induration of 15 mm or more is considered positive for clients in low-risk groups. More than 5 mm of induration is considered a positive result for clients with known or suspected human immunodeficiency virus infection, intravenous drug users, people in close contact with a known case of tuberculosis, and the client with a chest x-ray suggestive of previous tuberculosis. More than 10 mm of induration is considered positive in all other high-risk groups.

The Allen test is performed before drawing ABGs. Each of the radial and ulnar arteries is occluded in turn and then released. Observation is made in the distal circulation. If the results are positive, then the client has adequate circulation, and that site may be used. Homans' sign tests for deep vein thrombosis with dorsiflexion of the foot. Brudzinski’s sign tests for nuchal rigidity by bending the head down toward the chest. The Babinski reflex is checked by stroking upward on the sole of the foot.

Benzonatate (Tessalon) is a locally acting antitussive. Its effectiveness is measured by the degree to which it decreases the intensity and frequency of cough, without eliminating the cough reflex.

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Wednesday, January 21, 2009

NCLEX Study Tips

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To perform percussion, the nurse places the middle finger of the nondominant hand against the body’s surface. The tip of the middle finger of the dominant hand strikes the top of the middle finger of the nondominant hand. Auscultation is listening to sounds produced by the body. Palpation is performed through the sense of touch. Inspection is the process of observation.

The caregiver of a confused client is taught measures and techniques that will keep the client oriented and calm. Sensory overload or tasks and activities that are overwhelming for the client will cause disorientation and additional confusion. Therefore, any measures or activities that will increase sensory overload are avoided. Some helpful techniques include displaying a calendar and a clock around the house and in the client’s room; maintaining a predictable routine; limiting the number of visitors who come to see the client; limiting the number of choices given to the client; using simple, clear communication; and turning the lights on at dusk to avoid the sundown syndrome of increased confusion and combative behavior.

A bulging anterior fontanel indicates an increase in cerebrospinal fluid collection in the cerebral ventricle, which occurs in hydrocephalus.

Prednisone is irritating to the gastrointestinal (GI) tract, which could be worsened by the use of other products that have the same side effect. Therefore, products such as aspirin and nonsteroidal antiinflammatory drugs are not used during corticosteroid therapy.

The use of condoms and avoiding casual sex with multiple partners should be the focus of discussion because these measures prevent STDs. The use of condoms does provide some protection against STDs. Birth control pills and the use of a diaphragm help prevent pregnancy but do not provide protection from STDs.

A pacemaker is shielded from interference from most electrical devices. Radios, TVs, electric blankets, toasters, microwave ovens, heating pads, and hair dryers are considered to be safe. Devices to be forewarned about include those with a strong electric current or magnetic field, such as antitheft devices in stores, metal detectors used in airports, and radiation therapy (if applicable and which might require relocation of the pacemaker)

Walking and swimming are very beneficial in strengthening back muscles for the client with low back pain.

Kawasaki disease, also called mucocutaneous lymph node syndrome, is a febrile generalized vasculitis of unknown etiology

Dietary sources of iron that are easy for the body to absorb include meat, poultry, and fish. Vegetables, fruits, cereals, and breads are also dietary sources of iron, but they are harder for the body to absorb.

Patent ductus arteriosus is described as an artery that connects the aorta and the pulmonary artery during fetal life. It generally closes spontaneously within a few hours to several days after birth. It allows abnormal blood flow from the high-pressure aorta to the low-pressure pulmonary artery, resulting in a left-to-right shunt.

The purpose of autotransplantation of some parathyroid tissue is to regain function of the parathyroid gland. Autotransplantation of parathyroid tissue takes some time to mature. Oral calcium and vitamin D supplements must be taken to prevent hypoparathyroidism until the transplant matures and becomes an active endocrine gland.

Von Willebrand's disease - his may be an inerited disorder or blood coagulation or an acquired disease, secondary to a number of conditions, including certain drugs. Typically patients do not know they have the disease but may notice Frequent or prolonged nosebleeds, easy brusing, prolonged or heavy menstrual periods, and prolonged or unusual bleeding following a minor injury, surgery, or dental work.

The child should be positioned erect, sitting with head tilted forward to avoid blood dripping posteriorly to the pharynx. The soft part of the nose should be tightly pinched against the center wall for 10 minutes, and the mother should be instructed that this pinch should be timed by a clock, not estimated. The mother should be told not to release pressure for 10 minutes. The child is encouraged to remain calm and quiet and to breathe through the mouth.

Rheumatic fever characteristically presents 2 to 6 weeks following an untreated or partially treated group A beta hemolytic streptococcal infection of the respiratory tract. Initially, the nurse determines whether any family member has had a sore throat or unexplained fever within the past few weeks.

Orchitis can be related to epididymitis infection that has spread to the testicles.

Unilateral orchitis occurs more frequently than bilateral orchitis. About one week after the appearance of parotitis, there is an abrupt onset of testicular pain, tenderness, fever, chills, headache, and vomiting. The affected testicle becomes red, swollen, and tender. Atrophy, resulting in sterility, occurs only in a small number of cases. Difficulty urinating is not a sign of this complication. Swollen glands and facial swelling normally occurs in mumps.

Parotitis is an inflammation of one or both parotid glands, the major salivary glands located on either side of the face, in humans. The parotid gland is the salivary gland most commonly affected by inflammation.

Estrogen stimulates uterine development to provide an environment for the fetus and stimulates the breasts to prepare for lactation. Progesterone maintains the uterine lining for implantation and relaxes all smooth muscle. Human placental lactogen stimulates the metabolism of glucose and converts the glucose to fat. Human chorionic gonadotropin prevents involution of the corpus luteum and maintains the production of progesterone until the placenta is formed.

Laser therapy is performed in an outpatient setting and is used when all boundaries of the lesion are visible.

School-aged children have the cognitive and motor skills to independently administer insulin with adult supervision. Developmentally, they do not yet have the maturity to make situational decisions without adult validation.

Kegel exercises will assist to strengthen the pelvic floor (pubococcygeal muscle). Pelvic tilt exercises will help reduce backaches. Instructing a client to drink 8 ounces of fluids six times a day will help prevent urinary tract infections. Leg elevation will assist in preventing ankle edema.

Management of the severe pain that occurs with vaso-occlusive crisis includes the use of strong narcotic analgesics, such as morphine sulfate and hydromorphone hydrochloride (Dilaudid). Meperidine hydrochloride is contraindicated because of its side effects and increased risk of seizures. Oxygen is administered to increase tissue perfusion. Fluids are necessary to promote hydration.

The vaccination schedule for an infant whose mother tests negative for hepatitis B consists of a series of three immunizations given at 0 months (birth), 1 to 2 months of age, and then 4 months after the initial dose. An infant whose mother tests positive receives hepatitis B immune globulin along with the first dose of the hepatitis vaccine within 12 hours of birth.

The excessive amounts of thyroid hormone cause a rapid increase in the metabolic rate, thereby causing the classic signs and symptoms of thyroid storm such as fever, tachycardia, and hypertension. When these signs present themselves, the nurse must take quick action to prevent deterioration of the client’s health because death can ensue. Priority interventions include maintaining a patent airway and stabilizing the hemodynamic status.

Acetylcysteine restores sulfhydryl groups that are depleted by acetaminophen metabolism. Vitamin K is the antidote for warfarin sodium (Coumadin). Naloxone hydrochloride (Narcan) reverses respiratory depression. Protamine sulfate is the antidote for heparin.

Olanzapine (Zyprexa) is an antipsychotic medication used in the management of manifestations associated with psychotic disorders. It is the first-line treatment for schizophrenia targeting both the positive and the negative symptoms.

Before administering any medication, the nurse must assess for allergy or hypersensitivity to substances used in producing the medication. Fat emulsions such as intralipids contain an emulsifying agent obtained from egg yolks. Clients sensitive to eggs are at risk for developing hypersensitivity reactions.

The P-R interval represents the time it takes for the cardiac impulse to spread from the atria to the ventricles. The P-R interval range is 0.12 to 0.2 seconds.

NPH is an intermediate-acting insulin with an onset of action in 60 to 120 minutes, a peak time in 6 to 14 hours, and a duration time of 16 to 24 hours.

Adverse effects of haloperidol (Haldol) include extrapyramidal symptoms such as marked drowsiness and lethargy, excessive salivation, a fixed stare, akathisia, acute dystonias, and tardive dyskinesia. Hypotension, nausea, and blurred vision are occasional side effects.

Indomethacin (Indocin) may be prescribed to treat gouty arthritis. It may alleviate pain but is administered on a scheduled timeframe, not a prn schedule. When pain occurs, the client will usually limit movement and rest. A rash should be reported because it could indicate hypersensitivity to the medication. The client should be instructed to monitor for swelling and gastric distress, which can be caused by the medication.

Personal characteristics of abusers include low self-esteem, immaturity, dependence, insecurity, and jealousy. Abusers will often use fear and intimidation to the point where their victims will do anything just to avoid further abuse.

An IV cholangiogram is for diagnostic purposes. It outlines both the gallbladder and the ducts, so gallstones that have moved into the ductal system can be detected. X-rays are used to visualize the biliary duct system after IV injection of a radiopaque dye.

Most people who do commit suicide have given definite clues or warnings about their intentions. Suicide is not an inherited condition. A suicide attempt is not an attention-seeking behavior, and each act should be taken very seriously. The individual who is suicidal is not necessarily psychotic.

The use of a defense mechanism allows a person to avoid the painful experience of anxiety or to transform it into a more tolerable symptom, such as regression. Regression allows the threatened client to move backward developmentally to a stage in which more security is felt. The recognition of regression is a signal that the client feels anxious.

Health care professionals must use caution during the intrapartal period to reduce the risk of the transmission of HIV to the fetus. Any procedure that exposes blood or body fluids from the mother to the fetus should be avoided. Direct (internal) fetal monitoring is a procedure that may expose the fetus to maternal blood or body fluids and therefore should be avoided.

Sodium nitroprusside decreases the blood pressure by vasodilation.

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Tuesday, January 20, 2009

Nurse Retrogression Update: New Year prospects for US-bound Nurses

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By Lourdes Santos Tancinco
Philippine Daily Inquirer
First Posted 11:25:00 01/14/2009

JENNY, a registered nurse (RN), entered into a contract of employment with a US recruitment agency in 2005. She was told she would be working in a US hospital as soon as the visa was made available. Her petition for I-140 was processed and had a priority date of September 2005.

Having already waited one year for her immigrant visa, Jenny ran out of resources and was forced to accept a nursing job in Australia. She has been working in Australia for more than three years now, but has not abandoned her dream of working in the US.


During Jenny’s visit to the Philippines for the holiday season, she asked her recruitment agency when would she receive her visa. She has been hearing about businesses and facilities closing in the US and is wondering if her approved petition will be affected by the current global financial crisis that started in the US.

While visas for registered nurses fall under Schedule A, the category that certifies a shortage occupation in the US, processing for these visas is still taking a long time. Unlike before, when the category for registered nurses was placed under a special classification that added more visas, the category of registered nurses is incorporated under the third employment-based preference category, or EB3.

Changes in Circumstances

Only a certain number of visas are available for each given fiscal year. Since there are more applications/approved petitions than the number of visas available, there is now a backlog in the issuance of visas which is often referred to as retrogression.

For the month of January 2009, the US Department of State’s visa bulletin indicates that the visas processed for nurses are those that were filed in May 2005. This means that the petitions with priority dates of May 2005 are the ones being issued visas by consular offices.

When registered nurses interested in working in the US sign contracts with recruitment agencies, they are expected to work for the designated US facility or hospital for a certain period of time. Most of the contracts signed show a two- or three-year commitment to work for the petitioning employer.

There are probable changes in circumstances that may affect the grant or denial of the visas with priority dates of 2005. The lengthy period of waiting may have resulted in changes on the need of the US employer. Because of budget constraints being experienced by most public institutions, the US hospitals dependent on federal, state or city funding may have terminated employees. In San Francisco is a plan to terminate several hundred employees from the Department of Public Health because of budget issues. The public hospitals have started terminating employees also to reduce their expenses.

Terminating public employees in public hospitals or facilities has a severe effect on approved petitions on behalf of foreign nurses. This holds true also for private institutions. The Immigration and Nationality Act requires the US petitioner to have the financial ability to pay their employees for the foreign worker to be granted the immigrant visa. If the petitioner has a diminished ability to pay additional workers, even if the petition was approved before 2009, the immigrant visa petition will be adversely affected.

Need still critical

The US Citizenship and Immigration Services issued in December 2008, a memorandum on the processing of petition for registered nurses. According to the USCIS Ombudsman, the need for registered nurses remains critical and the processing for their immigrant visa petitions must be expedited.

This memorandum is significant proof of the need to give important consideration to the processing of immigrant visas for registered nurses. The processing time addressed in this document is the processing of the Petition for Immigrant Worker or the I-140. This petition, if approved, will have a priority date that will indicate when a visa is finally going to be issued. Unfortunately, there will still be waiting time because of retrogression even if the proposed expedited processing is established and the I-140 petitions are approved.

Legislation passed by the US Congress adding more visas to the RN petitions, or even better, exempting them from the visa quota, will be the faster and more practical solution to obtaining faster visas for the RNs.

The message we send for the New Year is all about remaining hopeful despite the many challenges of a US financial crisis and a global recession. The same remains true for aspiring Filipino RNs who want to work in the US.

The demand for registered nurses is still high. The healthy financial situation of each petitioner must be intact to continue the processing of the immigrant visa petition.

For registered nurses who have waited many years, it is prudent to research on the existence of the US employer considering that many US businesses and institutions have been adversely affected by the financial crisis.

The good news is that the incoming Obama administration has health care among the top of his priority list. Let’s be hopeful that real solutions are taken in the next 100 days after his inauguration. Happy New Year to all!


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Monday, January 19, 2009

US Nursing Jobs: 20,746 Filipino nurses sought US jobs

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MANILA, Philippines -- Despite the global economic meltdown that has hit the United States hard, with some 2.6 million Americans losing their jobs in the last 12 months, 20,746 Filipino nurses took the US licensure examination for the first time last year, the Trade Union Congress of the Philippines (TUCP) said Saturday.

In a statement, former Senator and TUCP secretary general Ernesto Herrera said the 20,746 represents a decline of 3.5 percent, or 753 fewer compared to the 21,499 Filipino nurses that took the National Council Licensure Examination (NCLEX) administered by the US National Council of State Boards of Nursing Inc. (USNCSBN) for the first time in 2007.

The 20,746 also brought to 66,597 the total number of Filipino nurses that indicated their desire to enter the US nursing profession by taking the NCLEX for the first time since 2005, according to Herrera, former chairman of the Senate labor, employment and human resources development committee.

Citing USNCSBN statistics, Herrera said a total of 9,181 Filipino nurses took the NCLEX for the first time in 2005; 15,171 in 2006; and 21,499 in 2007.

Herrera said the slight decrease in the number of Filipino nurses that took the NCLEX for the first time in 2008 "does not necessarily suggest a trend."

"It is too early to say whether there is a downtrend, considering the drop was marginal, and came after huge increases of 65 percent in 2006 and 42 percent in 2007," he pointed out.

"Based on the initial feedback that we got from the NCLEX testing center here in Manila, which opened only in August 2007, there is a long waiting period before nurses can actually take the test. This is because so many have already lined up to take the test, and the center can only accommodate so many takers at a time," Herrera added.

Herrera earlier said only the healthcare and education sectors in the US are actually creating new jobs, and that the rest of that country's economic segments are either reducing personnel, or have ceased hiring.

But on Friday, even one of the world's largest pharmaceutical firms, New York City-based Pfizer Inc., said it was laying off a third of its 8,000 sales staff in the US, and eliminating 800 research positions.

Herrera, meanwhile, urged Filipino nurses that have been recruited by American employers or their Philippine agencies to get hold of the "Voluntary Code for the Recruitment of Foreign-Educated Nurses to the United States."

"The document, available online, is a must-read for every Filipino nurse planning to work in America," he said.

Herrera said the code essentially binds subscribers, including recruiters and employers, to minimum ethical standards in order to discourage abuses and to prevent the exploitation and discrimination of Filipino and other foreign-educated nurses in the US.


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NCLEX-RN Notes: Core Review and Exam Prep

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Open-ended questions and silence are strategies used to encourage clients to discuss their problem in a descriptive manner.

An infiltrated IV is one that has dislodged from the vein and is lying in subcutaneous tissue. The pallor, coolness, and swelling are the result of IV fluid being deposited in the subcutaneous tissue. When the pressure in the tissues exceeds the pressure in the tubing, the flow of the IV solution will stop. The corrective action will be to remove the catheter and have a new IV line started.

When communicating with a hearing-impaired client, the nurse should speak in a normal tone to the client and should not shout. The nurse should talk directly to the client while facing the client and speak clearly. If the client does not seem to understand what is said, the nurse should express the statement differently. Moving closer to the client and toward the better ear may facilitate communication, but the nurse needs to avoid talking directly into the impaired ear.

When a depressed client is mute or silent, the nurse should use the communication technique of making observations. A statement such as “you are wearing your new shoes” is an appropriate statement to make to the client.

Routine instructions to the client with an AV fistula, graft, or shunt includes reporting signs and symptoms of infection, performing routine range of motion to the affected extremity, avoiding sleeping with the body weight on the extremity with the access site, and avoiding carrying heavy objects or compressing the extremity that has the access site.

Nitroglycerin ointment is used on a scheduled basis and is not prescribed specifically for the occurrence of chest pain. The ointment is not rubbed into the skin. It is reapplied only as directed.

Furosemide is a potassium-losing diuretic, so there is no need to avoid high-potassium products, such as a salt substitute. Orthostatic hypotension is a risk, and the client must use caution with changing positions and with exposure to warm weather. The client needs to discuss the use of alcohol with the physician.

The clonidine patch should be applied to a hairless site on the torso or upper arm. It is changed every 7 days and is left in place when bathing or showering. The patch should not be trimmed because it will alter the medication dose. If it becomes slightly loose, it should be covered with an adhesive overlay from the medication package. If it becomes very loose or falls off, it should be replaced. The patch is discarded by folding it in half with the adhesive sides together.

Colestipol hydrochloride (Colestid), a bile-sequestering agent, is used to lower blood cholesterol levels. However, the bile salts (rich in cholesterol) interfere with the absorption of the fat-soluble vitamins A, D, E, and K, as well as folic acid. With ongoing therapy, the client is at risk of deficiency of these vitamins and is counseled to take supplements of these vitamins.

Because of the resistant strains of tuberculosis, the nurse must emphasize that noncompliance regarding medication could lead to an infection that is difficult to treat and may cause total drug resistance. Clients may prevent nausea related to the medications by taking the daily dose at bedtime. Antinausea medications may also prevent this symptom. Medication doses should not be skipped.

Discharge instruction on a client with jaundice experiencing pruritus includes pruritus is caused by the accumulation of bile salts in the skin and results from obstructed biliary excretion. Antihistamines may relieve the itching, as will tepid water or emollient baths. The client should avoid the use of alkaline soap and wear loose, soft cotton clothing. The client is instructed to keep the house temperature cool.

Early detection of smoke and, subsequently, immediate evacuation from the house have been shown to significantly impact mortality. The installation of a sprinkler system is very expensive and not usually used in residential situations. Fire extinguishers are a good idea to have in the kitchen for small fires, but they are unrealistic and dangerous to use to attempt to extinguish large fires. Although fire-resistant products may help slow down a blaze, even fire-resistant products can eventually catch on fire.

Following insertion of tubes in the tympanic membrane, it is important to avoid getting water in the ears. For this reason, swimming, showering, or washing the hair is avoided after surgery until the time frame designated for each is identified by the surgeon. A shower cap or ear plug may be used when showering, if allowed by the physician. The client should take medication as advised for postoperative discomfort.

Phenytoin causes gum bleeding and hyperplasia and, therefore, a soft toothbrush and gum massage should be instituted to diminish this complication and prevent trauma. Intake and output and blood pressure are not affected by this medication. Directions for administration of this medication include administering it with food to minimize gastrointestinal upset.

Infected house cats transmit toxoplasmosis through the feces. Handling litter boxes can transmit the disease to the pregnant client. Meats that are undercooked can harbor microorganisms that can cause infection. Hands should be washed frequently throughout the day. The use of topical corticosteroids will not prevent exposure to the disease.

Children with CF are managed with a high-calorie, high-protein diet. Pancreatic enzyme replacement therapy and fat-soluble vitamin supplements are administered. Fat restriction is not necessary.

It is best to assess crutch-walking ability and instruct the client in the use of the crutches before surgery, because this task can be difficult to learn when the client is in pain and not used to the imbalance that may occur following surgery.

Clients who are taking Antabuse (Disulfiram) must be taught that substances containing alcohol can trigger an adverse reaction. Sources of hidden alcohol include foods (soups, sauces, vinegars), medicine (cold medicine), mouthwashes, and skin preparations (alcohol rubs, aftershave lotions).

TSE should be performed every month. Small lumps or abnormalities should be reported. The spermatic cord finding is normal. After a warm bath or shower, the scrotum is relaxed, making it easier to perform TSE.

Post-discharge instructions typically include avoiding tight clothing or belts over AICD insertion sites, rough contact with the AICD insertion site, electromagnetic fields such as with electrical transformers, radio/TV/radar transmitters, metal detectors, and running motors of cars or boats. Clients must also alert physicians or dentists of the device, because certain procedures such as diathermy, electrocautery, and magnetic resonance imaging may need to be avoided to prevent device malfunction. Clients should follow the specific advice of a physician regarding activities that are potentially hazardous to self or others, such as swimming, driving, or operating heavy equipment.

Most children nine years old or older can understand the principles of monitoring their own insulin requirements. They are usually responsible enough to determine the appropriate intervention needed to maintain their health.

Clients with thrush cannot tolerate commercial mouthwashes because the high alcohol concentration in these products can cause pain and discomfort to the lesions. A solution of warm water or mouthwash formulas without alcohol are better tolerated and may promote healing. A change in diet to liquid or pureed food often eases the discomfort of eating. The client should avoid spicy foods, citrus juice, and hot liquids.

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Sunday, January 18, 2009

Nursing News Abroad: Saudi accident kills four Filipino nurses

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Four Filipino nurses were reported by the Philippine Consulate in Jeddah in Saudi Arabia to have been killed in a highway crash Friday in Al Bahah, Saudi Arabia.

The Philippine Consulate identified the fatalities as Cecile Detorio, Nancy Brion, Roselyn Rolloque Laceda and Gemma Teodora.

The Consulate said the victims all worked for a private dental clinic in Al Bahah.

The report cited that there five other victims, all Saudi nationals, killed in the accident.

One of the tires of the van where the victims wer onboard reportedly exploded, causing it to collide with an incoming vehicle.

Brion, Laceda and Teodora were killed on the spot while Detorio was able to make it to the Abdul Aziz Specialist hospital in Taif. She, however, succumbed to fatal injuries early Saturday morning.


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Nursing News Abroad: Filipino nurses, lawyer charged celebrate legal victory

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It was literally the icing on the cake - "We are Free," scrawled in blue atop a small carrot cake as nurses and their lawyer gathered Friday to celebrate their legal victory.

"It feels like home at last," said Ma Theresa Ramos as she sat with her fellow nurses in the Garden City office of attorney Jim Druker.

A state appeals court on Thursday halted the Suffolk district attorney's prosecution of 10 Filipino nurses who had resigned from a Smithtown nursing home, along with their lawyer at the time, Felix Vinluan.

In an unusual tactic, the nurses' attorneys had asked the Appellate Division to grant a "writ of prohibition" barring Suffolk District Attorney Thomas Spota or Justice Robert W. Doyle from trying the case, claiming it violated the nurses' and their lawyer's constitutional rights.

The appeals court decision was rare, said John Ray, a Miller Place defense attorney. "This is a clear message to the court and district attorney that they were way out of bounds," he said.

Calls to Spota's office went unanswered Friday, but assistant district attorney Leonard Lato Thursday said the office would weigh whether to appeal.

Like her nine fellow defendants, Ramos had come from the Philippines to work at Avalon Gardens Rehabilitation and Health Care Center in Smithtown, owned by SentosaCare of Woodmere. Unhappy with working conditions, she and the other nurses quit in April 2006.

Spota indicted the nurses and Vinluan in March 2007, charging the nurses with endangering the patients' welfare and Vinluan with conspiracy, apparently unprecedented charges in the state.

A month after the nurses quit, SentosaCare officials met privately with Spota, and advocates for the nurses charged the indictment came about because of Sentosa's ability to meet with Spota. Spota's office said the case was warranted.

Sentosa executives also asked Sen. Charles Schumer to help them after the Philippines suspended the company's affiliated recruitment operation. Schumer wrote four letters on the company's behalf. A few months later, the Philippine government lifted the suspension.

During the next two months, a national campaign fund headed by Schumer received nearly $75,000 from investors, attorneys and vendors for SentosaCare-affiliated nursing homes.

Schumer has said the letters were part of his job to help New York companies. A Schumer spokesman Friday declined to comment on the appeals court decision, as did a spokesman for SentosaCare.

But Druker and Vinluan's lawyer, Oscar Michelen, said they saw the decision as a triumph of the judicial system over money and influence.

The Philippine consul general, Cecilia Rebong, said she was "happy and thankful" for the decision, "which finally clears any diversion of attention on the basic issue of whether contractual rights of the Filipino nurses were violated."


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Thursday, January 15, 2009

Notes For Your Nclex / CGFNS Examination : Rationale

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Nursing care after bone biopsy includes monitoring the site for swelling, bleeding, or hematoma formation. The biopsy site is elevated for 24 hours to reduce edema. The vital signs are monitored every 4 hours for 24 hours. The client usually requires mild analgesics; more severe pain usually indicates that complications are arising.

Triamterene is a potassium-sparing diuretic, and the client should avoid foods high in potassium. Fruits that are naturally higher in potassium include avocado, bananas, fresh oranges, mangoes, nectarines, papayas, and dried prunes.

Breathing exercises are recommended for children with cystic fibrosis, even for those with minimal pulmonary involvement. The exercises are usually performed twice daily, and they are preceded with postural drainage. The postural drainage will mobilize secretions, and the breathing exercises will then assist with expectoration. Exercises to assist with posture and to mobilize the thorax are included, such as swinging the arms and bending and twisting the trunk. The ultimate aim of these exercises is to establish a good habitual breathing pattern.

Urine specific gravity measures the concentration of the urine. During the first stage of labor, the renal system has a tendency to concentrate urine. Labor and birth require hydration and caloric intake to replenish energy expenditure and promote efficient uterine function. An elevated blood pressure and ketones in the urine are not expected outcomes related to labor and hydration. Once membranes are ruptured, it is expected that amniotic fluid may continue to leak.

The most accurate measurement of the effectiveness of nutritional management of the client is through monitoring of daily weight. This should be done at the same time (preferably early morning), in the same clothes, and using the same scale.

An NG tube connected to suction is used postoperatively to decompress and rest the bowel. The gastrointestinal tract lacks peristaltic activity because of manipulation during surgery. Although the nurse makes pertinent observations of the tube to ensure that it is secure and connected to suction properly, the client is assessed for the effect. The client should not experience symptoms of ileus (nausea and vomiting) if the tube is functioning properly. A pain indicator of 3 is an expected finding in a postoperative client.

Graves’ disease causes a state of chronic nutritional and caloric deficiency caused by the metabolic effects of excessive T3 and T4. Clinical manifestations are weight loss and increased appetite. It is therefore a nutritional goal that the client will not lose additional weight and will gradually return to ideal body weight if necessary. To accomplish this, the client must be encouraged to eat frequent high-calorie, high-protein, and high-carbohydrate meals and snacks.

Ignoring a negative attention-seeking behavior is considered the best way to extinguish it, provided the child is safe from injury.

Oral intake after laryngectomy is started with semi-solid foods. Once the client can manage this type of food, liquids may be introduced. Thin liquids are not given until the risk of aspiration is negligible.

Watery diarrhea is a frequent clinical manifestation of celiac disease. The absence of diarrhea indicates effective treatment. Bloody stools is not associated with this disease. The grains of wheat and rye contain gluten and are not allowed. A balance in fluids and electrolytes does not necessarily demonstrate improved status of celiac disease.

Clients receiving amphotericin B (Fungizone) may develop hypokalemia, which can be severe and lead to extreme muscle weakness and electrocardiogram (ECG) changes. Distal renal tubular acidosis commonly occurs, contributing to the development of hypokalemia.

Conjunctivitis is highly contagious. Antibiotic drops are usually administered four times a day. When purulent discharge is present, saline eye irrigations or eye applications of warm compresses may be necessary before instilling the medication. Ophthalmic analgesic ointment or drops may be instilled, especially at bedtime, because discomfort becomes more noticeable when the eyelids are closed.

The goal of therapy in nephrotic syndrome is to heal the leaking glomerular membrane. This would then control edema by stopping the loss of protein in the urine. Fluid balance and albumin levels are monitored to determine effectiveness of therapy.

A plaster cast must remain dry to keep its strength. The cast should be handled using the palms of the hands, not the fingertips, until fully dry. Air should circulate freely around the cast to help it dry. Additionally, the cast also gives off heat as it dries. The client should never scratch under the cast. A cool hair dryer may be used to relieve an itch.

Most of the excretion of potassium and the control of potassium balance are normal functions of the kidneys. In the client with renal failure, potassium intake must be restricted as much as possible (30 to 50 mEq/day). The primary mechanism of potassium removal during ARF is dialysis.

Condoms should be used to minimize the spread of genital tract infections. Wearing tight clothes irritates the genital area and does not allow for air circulation. Douching is to be avoided. Wearing items with a cotton panel liner allows for air movement in and around the genital area.

Nitroglycerin may be self-administered sublingually 5 to 10 minutes before an activity that triggers chest pain. Tablets should be discarded 6 to 9 months after opening the bottle, and a new bottle of pills should be obtained from the pharmacy. Nitroglycerin is unstable and is affected by heat and cold, so it should not be kept close to the body (warmth) in a shirt pocket, but rather it should be kept in a jacket pocket or purse. Headache often occurs with early use and diminishes in time. Acetaminophen (Tylenol) may be used to treat headache.

The client with Parkinson’s disease has a tendency to become withdrawn and depressed, which can be limited by encouraging the client to be an active participant in his or her own care. The family should also give the client encouragement and praise for perseverance in these efforts. The family should plan activities intermittently throughout the day to inhibit daytime sleeping and boredom.

The potential effects of alcohol abuse during pregnancy for both the mother and fetus have been well documented. The nurse who expresses genuine concern with suspected abusers may motivate positive behavioral changes during the prenatal period. The maternal behaviors of lack of concentration and agitation are frequently seen in childbearing women abusing alcohol.

Whenever the abused client remains in the abusive environment, priority must be placed on ascertaining whether the person is in any immediate danger. If so, emergency action must be taken to remove the person from the abusing situation.

The establishment of a therapeutic relationship with the suicidal client increases feelings of acceptance. While the suicidal behavior and thinking of the client is unacceptable, the use of unconditional positive regard acknowledges the client in a human-to-human context and increases the client’s sense of self-worth.

An autopsy is required by state law in certain circumstances, including the sudden death of a client and a death that occurs under suspicious circumstances. It is not a requirement by federal law. It is not mandatory that every client who is DOA have an autopsy. If a family requests not to have an autopsy performed on a family member, then the nurse should contact the medical examiner about the request.

With earlier hospital discharge, clients are returning home with greater acuity of problems than was previously true, and they may require support from a home health agency until they are independent in functioning.

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Wednesday, January 14, 2009

Filipino Nurses Abroad Stories: Pinoy nurses stand up against 'intimidating' union

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LAS VEGAS — Union strife continues to hound the powerful Service Employees International Union (SEIU). Already reeling from internal wars between its California locals, the Washington DC-based organization this time faces disgruntled Filipino nurses in Nevada.

Unionized registered nurses (RNs) at the St. Rose Dominican Hospital has filed charges of fraud and other wrongdoings against SEIU and the Catholic Healthcare West (CHW) reportedly committed during the union local’s election held last December 2 and 3.

The nurses also accused their parent union of “creating an atmosphere of fear and intimidation," and alleged that SEIU threatened nurses that they “will lose pay and benefits" if they continue to cause dissent.

Some 40 percent of St. Rose Dominican’s 1,100 RNs are Filipinos. St. Rose Dominican Hospital is owned and operated by Catholic Healthcare West and is located in Clark County here.

In behalf of the nurses, the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) is calling for a new election, adding that SEIU and CHW violated federal labor law. The CNA/NNOC filed their complaints with the National Labor Relations Board citing 12 objections to the election conduct that they say “tainted the environment of the representation election."

NNOC/CNA is the nation’s largest RN union and professional association with 85,000 members in all 50 states.

The election ended in a virtual tie with 11 challenged ballots still to be counted, a “stunning repudiation of SEIU despite its heavy handed harassment and intimidation tactics, and threats against the nurses, all with the active assistance of CHW," said Jill Furillo, CNA/NNOC’s Nevada and Catholic division director.

SEIU’s locals in various states represent home care and nursing home workers. A substantial number of the nearly 4 million Filipinos in the US are employed as health care workers in hospitals, nursing homes, clinics, and home health agencies.

Furillo accused SEIU of threatening nurses that they would lose pay and benefits if they voted to change unions.

The nurses’ group also charged that CHW provided unlawful assistance to SEIU by, (1) Granting time on the agenda to SEIU representatives in hospital staff meetings to campaign against CNA/NNOC; (2) Failing to remove SEIU representatives from the hospital in certain locations while CNA representatives were removed; and (3) Restricting hospital access to off-duty nurses who supported CNA, while allowing access to nurses who supported SEIU.

“We do not trust SEIU. They lied to us and threatened many nurses of losing our retro pay and everything else unless we voted for them," said Lalaine Blanco, a Filipino ICU RN in St. Rose San Martin Hospital. “Despite this undemocratic atmosphere, the tied election shows how strongly RNs want representation from a professional RN union which knows and understands RN issues."

The current CNA/NNOC-SEIU/CHW rift marks the second time in 2008 that federal authorities have been brought in to investigate SEIU 1107for election misconduct. Last spring, the local was under investigation following charges that former 1107 Executive Director Jane McAlevey rigged a Local 1107 Executive Board election to seat her hand-picked slate.


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Tuesday, January 13, 2009

Overseas Nursing Job: RP nurses can now apply for Japan jobs

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By Veronica Uy
First Posted 19:04:00 01/12/2009

MANILA, Philippines—Japan can now start recruiting Filipino nurses and caregivers for training and employment under the Japan-Philippines Economic Partnership Agreement after Monday afternoon's signing of a memorandum of understanding providing for that.

A month after the Framework for the Movement of Natural Persons under JPEPA came into force, the Philippine Overseas Employment Administration (POEA) and the Japan International Corporation of Welfare Services (JICWELS) agreed to recruit Filipino nurses as candidate-kangoshi and caregivers as candidate-kaigofukushishi to Japan. The framework came into force on December 11, 2008.

POEA Administrator Jennifer Jardin-Manalili signed for the Philippines, while JICWELS managing director Takashi Tsunoda signed for Japan.

Under the MoU, Filipino registered nurses with at least three years experience are qualified to apply for training and employment in Japan, while candidate caregivers should be a graduate of a four-year course and certified by the Technical Education and Skills Development Authority (TESDA). Graduates of a nursing course may also apply as caregiver.

It also specified that applicants shall undergo an aptitude test and interview by JICWELS to facilitate their matching with employers. After selection, they must pass the required medical examination to conclude the employment contract and to successfully qualify to enter Japan.

"Nominal expenses of application shall be borne by applicants for document submission/authentication, medical examination (P1,500 basic), and visa fee (P1,150). Airfare and onsite training costs are shouldered by the employers or the Government of Japan," a briefer on the MoU said.

Qualified nurses and candidates are invited to apply with the POEA and to register online.

Labor Secretary Marianito Roque, who witnessed the signing, said the MoU details the roles and responsibilities of the two parties and the working conditions for the Filipino nurses and caregivers that would ensure their welfare and protection while training and working in Japan.

He said the hiring program will start with the initial recruitment of 200 Filipino nurses and 300 caregivers that the POEA would endorse to JICWELS, which would in turn match to hospitals and institutions in Japan that it earlier pre-qualified to receive the Filipino candidates.

"The Filipino nurses and caregivers shall be covered by a fully transparent employment contract…They shall receive the same salaries equivalent to what Japanese nurses and caregivers receive, based on similar tasks and qualifications," he said.

POEA's Manalili, on the other hand, said that prior to their actual work in Japan, the selected candidates shall undergo a six-month language and culture training, where they would receive an allowance of not less than 40,000 yen (or about P21,000) a month.

"The language training shall help them prepare to eventually take the Japanese licensure examination. The examinations can be taken not more than three chances within three years in the case of candidate-nurses, and once on the fourth year of stay in the case of candidate-caregivers," Manalili said.

She added that before obtaining their qualification as full-fledged nurse in Japan, candidate-nurses shall work under the supervision of a Japanese Kangoshi to fully familiarize them with the Japanese system.

After passing the licensure or certification examinations, the fully qualified nurse and certified caregiver shall have the option to stay for an unlimited period in Japan to practice their profession based on new and upgraded employment contract with their employer.

The controversial JPEPA came into force last December after much debate on its constitutionality and provisions allowing the importation of trash. Aside from trade and investments, the treaty also had provisions for the hiring of Filipino nurses and caregivers to the traditionally closed society that is Japan.

JPEPA, together with the other treaties that Japan signed with other ASEAN member-countries, is evidence that the ageing country is now opening itself to foreign workers.


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