Nurse Advocate

Priorities in Nursing Practice and Nursing Standards of Care

2023-12-09T21:33:00.002+08:00

Establishing Nursing Priorities

Prioritizing - decisions of which needs or problems require immediate attention or action and which ones could be delayed until a later time since they are not urgent.
Needs that are life-threatening or could result in harm to the client if left untreated are high priorities.
Actual problems or needs have higher priority than potential problems or needs.
Problems or needs identified by the client are of a higher priority.
Principles of Maslow's Hierarchy of Needs or the ABCs may guide decisions.
Mutual decision-making for priorities may be made with the client based on the client's needs, desires and safety.

NURSE PRACTICE ACTS

Definition: passed by each state legislature to regulate the practice of nursing in that state
Nurse Practice Acts define:

Scope of Practice
Education
Licensure
Professional Misconduct:

Negligence
The 'Impaired Nurse'
The nurse who violates boundaries

Administered by the Board of Nursing in each state:

The nurse must know how their state defines professional misconduct
For Professional Misconduct, the State Board of Nursing imposes penalties (in order of severity):

On Probation
Censured
Reprimanded
License Suspended
License Revoked

STANDARDS OF NURSING PRACTICE AND STANDARD OF CARE

Nursing Charting and Documentation

2023-12-09T21:01:00.009+08:00

EFFECTIVE DOCUMENTATION

Legal Guidelines for Charting

Record the facts legibly, in ink
Never erase, scratch out or apply correction fluid. Cross through an error once, date and initial the change.
Do not leave black spaces in your nursing notes.
Never chart for another person
Avoid interpreting patient statements. Record exactly what the patient said in quotation marks.
Correct all errors in a timely manner.
Chart in a timely manner.

Computerized Charting

Never lend access your ID to another person.
Maintain confidentiality of documented information printed from the computer.

TYPES OF DOCUMENTATION

Valve Disorders

2021-11-18T16:26:00.010+08:00

MITRAL STENOSIS

Definition

Mitral valve thickens and gets narrower, blocking blood flow fro. the left atrium to left ventricle

Physiology

Function of the heart is the transport of oxygen, carbon dioxide, nutrients and waste products
Cardiac cycle consists of:

Systole - the phase of contraction during which the chambers eject blood
Diastole - the phase of relaxation during which the chambers fill with blood. When heart pumps, myocardial layer contracts and relaxes.

Blood flow:

Deoxygenated blood enters the right atrium through the superior and inferior vena cava
Enters the right ventricle via the tricuspid valve
Travels through the pulmonic valve to pulmonary arteries and lungs
Oxygenated blood returns from the lungs through the pulmonary veins into the left atrium and enters the left ventricle via the bicuspid (mitral) valve
From the left ventricle, through the aortic valve through the aorta to the systemic cicrculation

The heart itself is supplied with blood by the left and right coronary arteries
The vascular system is a continuous network of blood vessels

the arterial system consists of arteries, arterioles and capillaries and delivers oxygenated blood to tissues
Oxygen, nutrients and metabolic waste are exchanged at the cellular level
The venous system, veins and venules, returns the blood to the heart

Heart Infections: Rheumatic Heart Diseases (Rheumatic Endocarditis)

2021-11-18T11:59:00.005+08:00

Definition and Related Terms

Rheumatic Heart Disease - damage to the heart by one or more episodes of rheumatic fever. Pathogen is a group A streptococci.
Rheumatic Endocarditis - damage to the heart, particularly the valves, resulting in valve leakage (regurgitation) and/or stenosis. To compensate, the heart's chambers enlarge and walls thicken.

Epidemiology

Worldwide, 15-20 million new cases of rheumatic fever are reported each year
Rheumatic Fever - follows a Group A streptococcal infection. We could prevent it by finding and treating streptococcal pharyngitis
Where malnutrition and crowded living are common, rheumatic fever is most common in children between ages 5 and 15.
Rheumatic Fever strikes most often during cool, damp weather. In the US, it is most common in the Northern States.
It is unknown how and why group A streptococcal infections cause the lesions called Aschoff bodies
Damage depends on site of infection: most often the mitral valve in females and the aortic valve in males
Malfunction of these valves leads to severe pericarditis, and sometimes pericardial effusion and fatal heart failure. Of those who survive this complication, about 20% die within ten (10) years.

Heart Infections: Endocarditis

2021-11-18T09:06:00.005+08:00

Definition and Related Terms

An infection of the endocardium, heart valves, or cardiac prosthesis resulting from bacterial or fungal invasion
Endocarditis can be classified as:

Native valve endocarditis
Endocarditis in IV drug users
Prosthetic valve endocarditis

Epidemiology

With proper treatment, about 70% of clients recover
The prognosis is worse when endocarditis damages valve severely or involves a prosthetic valve
Infective endocarditis occurs in 50-60% of clients with previous valvular disorders
Systemic Lupus Erythematosus (SLE) often leads to nonbacterial endocarditis
In 12-35% of clients, with subacute endocarditis, lesions produce clots that show the findings of splenic, renal, cerebral or pulmonary infarction, or peripheral vascular occlusion

Heart Infections: Myocarditis

2021-11-18T07:25:00.010+08:00

Myocarditis

an inflammatory condition of the myocardium that may be caused by

viral infection
bacterial infection
fungal infection
serum sickness
rheumatic fever
chemical agent
as a complication of collagen disease (Systemic Lupus Erythematosus)

Epidemiology

may be acute or chronic and may occur at any age
usually an acute virus and self-limited, but it may lead to acute heart failure

Findings

depends on the type of infection, degree of myocardial damage, capacity of myocardium to recover, and host resistance
may be minor or unnoticed - fatigue and dyspnea, palpitations, occasional precordial discomfort manifestations such as mild chest soreness and persistent fever
recent upper respiration with fever, viral pharyngitis or tonsillitis
cardiac enlargement
abnormal heart sounds - murmur, S3 or S4 or friction rub

Levine's Grading of Heart Murmurs

Vitamin D and COVID New Studies - Evidence for a Protective Role of Vitamin D in COVID

2021-10-13T16:45:00.005+08:00

I can always hear radio advertisements regarding Vitamin D3 supplementation in preventing diseases especially COVID patients.  In fact, I have one patient before who had been prescribed by another doctor of Vitamin D3. I have come upon a good video in you tube wherein it discusses the merit of using vitamin D3 supplementation as a treatment for COVID and cites good, credible clinical trials and medical studies about it. (I will link the said youtube video below:)

VITAMIN D AND COVID NEW STUDIES - EVIDENCE FOR A PROTECTIVE ROLE OF VITAMIN D IN COVID BY DR. MIKE HANSEN

So regarding Vitamin D supplementation: according to studies, vitamin D insufficiency MAY INCREASE THE RISK  of COVID and Covid complications BUT vitamin D supplementation IS ONLY VALUABLE TO THOSE WHO ARE VITAMIN D DEFICIENT. Meaning Vitamin D supplementation for those who are Not Vitamin D Deficient may not be of great value.

H.A.B.I.T.s to Break to Build a Better YOU

2021-10-12T16:11:00.002+08:00

Health Hints by Alexandra Nicole Torres (HealthCare Magazine)

PhotoCredit: Dreamstime.com

Breaking free from an unhealthy routine to build a good one requires time, patience and commitment - it's a process. Let's face it, we all have our guilty pleasures that are really difficult to depart from.

To Guide us on our Journey, let's remember the acronym H-A-B-I-T:

1. (H)AVE A GOAL. In order for you to be successful, you must learn to KNOW WHAT YOU WANT. The key to building a solid plan is knowing yourself and knowing what you really want to do and what you want to achieve.

Alternative Ways of Continuing Professional Development (CPD) Compliance during the COVID-19 Pandemic

2020-07-02T21:44:00.002+08:00

Abolish CPD Call of Certain Sectors of Society

About 4 years after the Republic Act 10912 or the "Continuing Professional Development (CPD) Act" became law, the presidential son, Rep. Paolo Duterte recently said that he will be proposing a bill to repeal the law authored by former Senator Antonio Trillanes, IV.

He also emphasized that he will personally work with his colleagues in the House of Representatives, the senators in the Senate and with President Rodrigo Duterte to advocate for the abolition of the said law. He cites the undue burden that the law has imposed to hard working and selfless professionals especially during the COVID-19 Pandemic.

It is noted that the said law has mandated that professionals has to comply with prescribed number of CPD units of their profession before they will be allowed to renew their Professional Identification Card (PIC) with the Professional Regulations Commission.

UPDATE on COVID-19 Vaccine Development

2020-06-30T20:07:00.001+08:00

With the advent of fast-paced technology and media reports, we can surmise that with the COVID-19 pandemic, the development of a vaccine can also be at a record speed but reading an article by Dr. Sanjay Gupta at CNN, this reality is grim so far regarding COVID-19 Vaccine Development.

1 Revealing Point: According to the Milken Institute, although there are 254 treatments and 172 vaccines currently in development to fight COVID-19, so far, there is only 1 PUBLISHED STUDY of a vaccine which is trialed in Humans. Other vaccines/treatment in development are either press-releases or pre-print reports.

Photo Credit: European Pharmaceutical Review

For those who have no idea on the significance of a Published Study on vaccine development or any other thing basically is this - published studies are subjected to peer review, which by essence brings down the expertise of most if not all of the science disciplines to screen this studies and POINT SOME POTENTIAL ERRORS of the study that may be unintentional and also makes the study and eventually the science or the vaccine BETTER.

No Approved Therapeutic Claim/Use!

2020-06-28T09:33:00.002+08:00

I had always wanted to talk about this with my patients but I have not had the time to sufficiently discuss this.

As a medical doctor I cannot and will not endorse any product which has a 'No Therapeutic Use' on its label. I am for any thing herbal and natural but it does not mean that I will disregard the safety of my patients.

I have a professor in Medschool that is an advocate of herbal medicine but she is also a medical doctor. And so, while advocating for herbal medicine, she tediously explained the process and the science of preparing an herbal medicine, and so let's take some important points about it:

Herbal medicine preparations should be an exact ....science. This simply means that exact measurements should be used. Meaning if you prepare (let's take for an example Sambong leaves) leaves, and you are instructed to take 5 leaves. You should take leaves with proportionally same size with each other. There are some preparations that prescribes the exact size of the leaves like for example (I am only hypothesizing here) Sambong leaves should have 1-inches leaves while recommendations for Malunggay leaves is only 1-cm leaves. AND there are different preparations for barks, roots, fruits, etc.
Even the procedures in preparations should be exact. As my mentor explained, preparing a decoction is also exact meaning a certain decoction is prescribed with a 1 cup water while others are prescribed with a 1 glass water (yes a cup is different from a glass!). If you boil a decoction for 30 minutes and you start the time from the moment you pour the water into the pot, it may be a whole lot different if you start the 30-minute time on the moment that the water boils. Plus there's a difference if the instruction is like 'You boil the leaves with 2 cups water until the point that the water remaining is only 1 cup.'
The time of the day when you pick up a leaf/root/bark matters. We had been advised that the perfect time to pick leaves is in the morning just before the sun rises as the leaves has the perfect consistency to it.

Common Lab Tests for Cardiovascular Disorders

2017-05-18T16:58:00.001+08:00

Serum chemistry
Serum Electrolytes
Alanine Aminotransferases (AST)
Creatine Kinase (CK)
CK-MB (isoenzyme)
Lactic Dehydrogenase
Complete Blood Count
Lipid Levels
Prothrombin Time
Alkaline Phosphatase
ESR
Arterial Blood Gases
Troponin

Normal Growth and Development: Infancy

2013-10-13T19:26:00.000+08:00

An infant is a baby who is 1 month to 1 year old. Most infants will learn to walk, talk, eat, and interact with others within the same general time frame. This is called normal growth and development.

Infants grow faster while he is in infancy than at any other time in his life. Caregivers will keep a record of his growth. They will write down the following changes each time you bring him in for a checkup:

Weight: Infants double their birth weight by the time they are 6 months old. They will triple their birth weight by the time they're 1 year old. They will gain about 1 to 2 pounds per month. They will weigh close to 22 pounds by 1 year old. By 2 months, infants may look chubby. Their muscles will get stronger the more they learn to use his legs and arms.
Length: Infants grow about 1 inch per month for the first 6 months of life. They will grow 1/2 inch per month between 6 months and 1 year of age. They should be 2 times longer than their birth length by the time they are 10 to 12 months old. Most of their growth happen in their trunk (mid section).

Jean Piaget's Cognitive Development Theory

2013-10-13T16:04:00.002+08:00

Jean Piaget’s prominent work is his Theory on the four stages of cognitive development.

He was one of the most influential researchers in the area of developmental psychology in the 20th century whose primary interest was in biological influences on how we come to know, and the developmental stages we move through as we acquire this ability (Singer & Revenson, 1997).

Piaget (1973) believed that the child plays an active role in the growth of intelligence and learns by doing. He regarded the child as a philosopher who perceives the world only as he has experienced it.

Therefore, most of Piaget’s inspiration in cognitive and intellectual development came from observations of children. In fact, Piaget observed and studied his own three children through each stage of their cognitive development.

The Theory of Cognitive Development focuses on mental processes such as perceiving, remembering, believing, and reasoning. Reasoning is the essence of intelligence, and reasoning is what Piaget studied in order to discover “how we come to know” (Singer & Revenson, 1997). Piaget believed that cognitive development is cumulative; that is, understanding a new experience grows out of a previous learning experience.

Erick Erikson's Theory of Psychosocial Development

2013-10-13T15:07:00.002+08:00

Erik Erikson's theory of psychosocial development is one of the best-known theories of personality. Much like Sigmund Freud, Erikson believed that personality develops in a series of stages. Unlike Freud's theory of psychosexual stages, Erikson's theory describes the impact of social experience across the whole lifespan.

One of the main elements of Erikson's psychosocial stage theory is the development of ego identity. Ego identity is the conscious sense of self that we develop through social interaction. According to Erikson, our ego identity is constantly changing due to new experiences and information we acquire in our daily interactions with others.

Identity refers to all of the beliefs, ideals, and values that help shape and guide a person's behavior. The formation of identity is something that begins in childhood and becomes particularly important during adolescence, but it is a process that continues throughout life. Our personal identity gives each of us an integrated and cohesive sense of self that endures and continues to grow as we age.

PRC Online Application System

2012-06-21T15:09:00.000+08:00

How to Apply using the Professional Regulation Commission Online Application System

Requirements for the NLE

2012-06-21T15:05:00.000+08:00

Kohlberg's Theory of Moral Development

2012-06-21T01:13:00.000+08:00

Moral development is a major topic of interest in both psychology and education. One of the best known theories was developed by psychologist Lawrence Kohlberg who modified and expanded upon Jean Piaget's work to form a theory that explained the development of moral reasoning.

Piaget described a two-stage process of moral development, while Kohlberg's theory of moral development outlined six stages within three different levels. Kohlberg extended Piaget's theory, proposing that moral development is a continual process that occurs throughout the lifespan.

Normal Growth and Development

2012-06-21T00:53:00.001+08:00

PhotoCredit: Child-Development-Guide.Com

Patterns of Growth and Development

Cephalocaudal - head to toe
Proximodistal - near to far
Differentiation - from simple to complex

Growth Measures

Height
Weight
Frontal-Occipital Circumference

Environmental Sanitation

2012-06-21T00:43:00.003+08:00

ENVIRONMENTAL SANITATION:

defined as the study of all factors in man's physical environment, which may exercise a deleterious effect on his health, well-being and survival
Included are:

Water sanitation
Food sanitation
Refuse and garbage disposal
Excreta disposal
Insect vector and rodent control
Housing
Air pollution
Noise
Radiological protection
Institutional sanitation
Stream pollution

MAJOR ENVIRONMENTAL HEALTH AND SANITATION PROGRAM

Field Health Services and Information System

2012-06-21T00:02:00.001+08:00

PhotoCredit: YourPersonalHealthRecord.Blogspot.Com

Field Health Services Information System Objectives

To provide summary of data on health services delivery and selected program accomplished indicators at the barangay, municipality/city, district, provincial, regional and national levels
To provide data which when combined with data from other sources, can be used for program monitoring and evaluation purposes
To provide a standardized, facility level database which can be accessed for a more in-depth studies
To ensure that the data to the FHSIS are useful and accurate and are disseminated in a timely and easy to use fashion
To minimize the recording and reporting burden at the service delivery level in order to allow more time for patient care and promotive activities

Demography

2012-06-19T16:41:00.002+08:00

PhotoCredit: ToonPool.Com

Demography

science which deals with the study of the human population size, composition and distribution in space
Population size - refers to the number of people in a given place or area at a given time
When the population is characterized in relation to certain variables such as age, sex, occupation or educational level, then the population composition is being described
The nurse also describes how people are distributed in a specific geographic location

Website Overhaul

2012-06-19T16:17:00.002+08:00

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Please take note of the "Elements" at the right side of the screen which will 'pop-out' once you hover your mouse unto them.

We want to hear you regarding these changes. Give us your feedback. Thank you very much.

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Nurse Advocate

Epidemiology

2012-06-19T15:50:00.004+08:00

PhotoCredit: Epidemiology.UCSD.Edu

Epidemiology

the study of occurences and distribution of diseases as well as the distribution and determinants of health states or events in a specified population, and the application of this study to the control of health problems
this emphasizes that epidemiologists are concerned not only with deaths, illness and disability, but also with more positive health states and with the means to improve health
backbone of the prevention of disease

Vital Statistics

2012-06-19T15:25:00.001+08:00

PhotoCredit: Dreamstime.Com

Statistics

refers to a systematic approach of obtaining, organizing and analyzing numerical facts so that conclusions may be drawn from them

Vital Statistics

refers to the systematic study of vital events such as births, illnesses, marriages, divorce, separation and deaths
statistics of disease (morbidity) and death (mortality) indicate the state of health of a community and the success or failure of health work