Student Nurse's Station

Prometric Exam

2012-08-12T23:30:00.000-07:00

Overview
Healthcare Licensure and Certification Solutions Perhaps more than any other type of profession, the healthcare industry has a need and a responsibility to protect the public by making sure those who practice medicine, or in any way serve or treat patients, are qualified. It is an area where, quite literally, health and safety are on the line every day. Prometric fully understands that nowhere are the stakes higher for delivering exams that are valid, reliable and fair than in the area of healthcare licensure and certification. As gatekeepers of public safety, healthcare organizations have a profound responsibility to help ensure that those who receive a healthcare credential to perform important clinical tasks have legitimately earned them.
More than 65 of the world’s leading healthcare organizations trust Prometric to provide secure, reliable testing and assessment solutions on their behalf. Our Healthcare Licensure and Certification Solutions, which cover medical admissions to specialty licenses in the practice of medicine and more, can address your unique requirements and commitment to the integrity of your programs.
https://www.prometric.com/en-us/about-prometric/healthcare/Pages/default.aspx

Prometric Examination for Nurses is the popular name for Saudi Council Examination. In order to ensure a better employment status in the Kingdom of Saudi Arabia, this is a priority requirement on all agencies sending nurses there. According to news in 2009 by the Manila Bulletin, the Philippine Overseas Employment Administration (POEA) emphasized that nurses must pass this kind of exam when intending to work in Saudi Arabia. There is a great reason why it is being encouraged since working in foreign lands may mean that nurses must be competent enough in meeting the different nursing needs of the international clients.
This type of examination is actually similar to the nursing licensure examination that nurses must pass in the Philippines. It is the Saudi Commission that mandates the existence and efficacy of this type of examination.

The Exam Parts:
The Prometric Examination for Nurses is composed of 70 questions in multiple choice formats. In about two hours, the examinee is required to finish the whole test set. In browsing the site of Prometric Exam, http://www.prometric.com/NurseAide/CT.htm you will find that the description for nurses belongs to the category nurse aide.
As a nurse technician the exam is made in order to comprise the following parts:
Nursing Fundamentals: 28%
Medical – 23%
Surgical – 20%
Pediatric – 16%
Community – 13%

For Nurse Specialists, there is a different way of dividing the exam. This is how it is broken down:
Assessment – 10%
Nursing Problem – 6%
Planning – 20%
Implementation – 50%
Evaluation – 14%

For nurse technicians, the passing rate is 45% while for nurse specialists it is 50%. What is interesting here is that the rate of the examinee is readily released after the examination. It is in a form of Score Report that the examinee will know if he or she has passed the examination.

Prometric Exam Location

The Saudi Commission for Health Specialties has granted the accreditation to this exam center:
Prometric Testing Center
Ateneo Professional Schools, 130 H. Dela Costa St., Salcedo Village, Makati City
Telephone No.: (632) 892-0383
and/or
Prometric Testing Center
Tread, Inc., Suite 308, Centro Maximo D., Jakosalem St., Cebu City
Tel no. 032-2535514

Prometric Exam Payment Procedures

Once you have decided to get this examination, another thought would come into your mind is the price of this exam. Registration may come in a form of online registration of through mail. Your type of registration determines the mode of payment that you will be applying.
For online registrants, take in mind that they would only accept credit card payment from major credit card companies such as MasterCard, Visa and America Express. Those who opted to send their applications via mail, they must also send the payment using the form provided as well as the payment is in a form of cheque.
According to recent reports, registrants in Saudi Arabia must pay an Examination Fee of $80.00. Those in Asia entail them to pay $90, while nurses coming from Africa, Europe, North America and the Middle East are required to pay $100.

Prometric Exam Registration Procedure

In order to start the registration process, please go to their website: http://www.prometric.com. A tab is allotted for exam takers, click it and browse the list box for the following items, Academics, Professional, Government and Corporate. Finally, choose among the items Saudi Commission for Health Specialties.
A new site will then pop out wherein the true process of registration starts as well as the selection of the job description is needed. For Nurses, the type of exam should be selected will be either Nurse Technician or Nurse Specialist.
A form is then supplied for you to fill in. Take in note all of the information you are entering so that in order to avoid incongruence. After that the payment information will be opened. Once you have entered the information being asked, review it and finally click the complete registration tab.
Schedule of examination and sitting arrangement can readily be available on the web. For more information about the Prometric Exam, just visit their official website http://www.prometric.com/.
If you're asking the step by step procedure on how to register for an examination for nurses, please comment below and I will gladly assist you,.
Keep posted and good luck in the Prometric Exam!

Source: http://rnspeak.com/nursing-information/prometric-exam-for-nursesthe-basics/#

Canada Jobs for Nurses

2011-05-19T21:03:00.000-07:00

Canada Nurses
(Canada)

Requirements:

Candidate must possess at least a Bachelor's/College Degree , Nursing or equivalent.
At least 3 year(s) of working experience in the related field is required for this position.
Female 35 years old below
Must have IELTS : Speaking 7.0 and other subjects must be 6.5
Good Spoken and Written English.
Good communication skills.
With pleasing personality and development
Can work with minimum supervision.
10 Full-Time positions available.

Click the link below to apply.

http://www.jobstreet.com.ph/jobs/2011/5/default/80/2682115.htm?fr=14

Tips on Passing and even Topping the Nursing Licensure Examination

2011-04-23T08:35:00.000-07:00

For sure everyone wants to pass or even top the Board Examination for Nursing. But the big question is, HOW? Want to know? Just keep on reading. Actually there are no exact ways or sure ways of passing and topping the exam but, if you ask me for some tips I can give you some.

If you ask yourself, Will I pass the board exam? Will I top it? If your answer is a big YES! You will definitely make it. Why did I say that? Because, it was based on The Law of Attraction. It is the secret of almost all successful and influential persons in the humanity. It is the universal law which states that what you think will manifest- that’s the power of your mind, and the universe will just respond in accordance to your thought. Many people already believe this law of attraction. So have the courage to say that you will make it. And try it for yourself.

I’m going to tell you a story about a schoolmate who once dreamed of topping the board exam. This student was never been my friend at school because he was just a transferee from other institution. He was just a normal student. No news about him, no special mentions about him. Until one time, right after our evaluation exam; this exam was given to know who will be included on the first batch of students who will take the board exam, the guy said that he will beat the number one student in our school. Of course, no one believed him since he was just a transferee. And then review classes started. We reviewed critically every single day. Evaluation exams were given every week, and guess who was number one? Yeah you are right, the transferee. He almost topped all the evaluation exams given to us by our review centers. And we were all in doubt of what was happening. And then the day that we were waiting for came, the examination day. We took the 500-item exam with courage and faith to our Almighty. Almost two months since the day of our exam there was a report that the results will come out. All were anxiously waiting on the internet. Then finally the results were online. I look through the site given to us by our review center and while scrolling down the very lengthy page, I felt that my heart seems to move out of my chest. I felt very worried at that time, and when I saw my complete name on one of the lists, my God, I felt so blessed, I screamed out loud with joyfulness. Calls and texts came right and then saying congratulations. No one can explain the happiness it brought to me just by passing the Nursing Licensure Exam. And then someone texted me that our schoolmate topped the board exam. So I surfed again the internet just to find out who made it on top. Until I landed on a page by an online newspaper stating the names of the topnotchers and I was shocked when I saw the name of the transferee on the 8^th place. And I realized what he said before that he will beat our number one student in school and I said to myself “he proved what he believed he can”.

When he was asked by the owner of the review center how did he topped the board. He simply said “because I dreamed of becoming a topnotcher”. He thought of it and it was given unto him. That’s the law of attraction.

And here are my tips on reviewing:

1. Never force yourself to read if you think you are not in the mood. It will just mess up your mind. You’re just wasting time if you do so.
2. If you feel sleepy, take a nap. Of course some of our subjects are like sleeping pills. If that would happen give yourself a 10-minute nap. That helps a lot ,and gives you replenished energy again to read.
3. Do not memorize word per word. Just read it 3-4 times with comprehension.
4. Find your most comfortable place while reviewing.
5. Use text highlighters if you are used to it. Orange is the best according to US research. Because the color orange stays on your mind longer than light green.
6. Eat right.
7. Have time to exercise. This will provide a very good blood circulation in your body and to your brain.
8. Just enjoy your life reviewing. If you want to watch a movie, then go for it. Just make sure you have time for your review.
9. And of course don’t forget to PRAY PRAY PRAY,. Faith is very important at all times.

May these tips help you with your exam. God Bless and goodluck!.

The Nervous System: Glasgow Coma Scale

2011-04-20T21:37:00.000-07:00

The nervous system is an organ system containing a network of specialized cells called neurons that coordinate the actions of a human being and transmit signals between different parts of its body. The nervous system consists of two parts, central and peripheral. The central nervous system contains the brain, spinal cord, and retina. The peripheral nervous system consists of sensory neurons, clusters of neurons called ganglia, and nerves connecting them to each other and to the central nervous system.

Neuron- is the functional unit of the nervous system. Each connected at the synapse between axon (transmits message away from the neuron) and dendrite (transmits message towards the neuron.
Neurotransmitters- are chemical compounds which activate or inhibit such transmission.

NEUROLOGICAL ASSESSMENT CONSISTS OF THE FF:

Mental Status or LOC
Reflexes
Motor functions
Sensory functions
Cranial Nerves

The Glasgow Coma Scale- tool used in assessing a patient's response to stimuli. Scores range from 3 (deep coma) to 15 (normal), a score less than or equal to 8 indicates coma.

Eye Opening

Spontaneous (4)
To verbal command (3)
To pain (2)
No Response (1)

Motor Response

To verbal command (6)
To localized pain (5)
Flexes and withdraws (4)
Flexes abnormally (decorticate) (3)
Flexes abnormally (decerebrate) (2)
No Response (1)

Verbal Response

Oriented (5)
Disoriented (4)
Inappropriate words (3)
Incomprehensible sound (2)
No Response (1)

Confusion- loss of ability to think clearly

Disorientation- inability to recognize time, place, person

Lethargy- lack of spontaneous movement or speech and easily aroused but disoriented

Obtundation- reduced ability to be aroused and limited response to environment

Stupor- condition of deep sleep or unresponsiveness and aroused only by vigorous stimulation

Coma- no motor response to any stimuli, even deep pain

Dysarthria- defect in articulation, ennunciation

Dysphonia- abnormal production of sound

Aphasia- inability to understand written and spoken words

Agnosia- inability to recognize objects by use of 5 senses.

COMMUNICABLE DISEASE NURSING including EPI

2011-04-14T00:16:00.000-07:00

COMMUNICABLE DISEASE

Infectious Agent or its toxic products - AGENT
Directly or Indirectly - MODE OF TRANSMISSION
Person, Animal or Intermediate Vector – HOST
Environment - ENVIRONMENT

ECOLOGIC TRIAD OF DISEASE
Agent – element, substance, animate or inanimate that may serve as stimulus to initiate a disease process
Host – organism that provides nourishment for another organism
Environment – physical (climate), biological (plants & animals)

CONTAGIOUS VS. INFECTIOUS
Contagious-
Diseases that are easily spread directly transmitted from person to person (direct contact) through an intermediary host
Infectious-
Diseases that caused by a pathogen not transmitted by ordinary contact but require a direct inoculation through a break in the skin or mucous membrane.

REMEMBER: ALL CONTAGIOUS DISEASE ARE INFECTIOUS BUT INFECTIOUS DISEASE IS NOT ALWAYS CONTAGIOUS

What is Infection?
INFECTION- the state or condition in which the body or part of the body is invaded by a pathogenic agent ( bacteria, virus, parasites etc.) which under favorable conditions multiplies and produces effects which are injurious

Infectious Agents
A. RESIDENT ORGANISMS
deeply seated in the epidermis, not easily removed by simple handwashing,
Ex: Staphylococci

B. TRANSIENT ORGANISM
represent recent contamination, survive for a limited period of time, acquired during contact with the infected colonized patient or environment, easily removed by good handwashing
Ex: ( Klebsiella & Pseudomonas)

Infectious Agents
Bacteria – heama organism, systemic
Virus – nuero organism, systemic
Fungi – skin organism, local
Protozoa – GI organism, local infectious Agent

FACTORS THAT AFFECTS THE AGENT TO DEVELOP A DISEASE
Pathogenicity – ability to cause a disease
Infective dose – no of organism to initiate infection
Virulence – ability to enter or move through tissues
Specificity – ability of the organism to develop antigens

STAGES OF INFECTIOUS PROCESS
Means of Transmission
1. CONTACT - most common means of transmitting microorganisms from one person to another.
A. Direct Contact (person to person)
occurs when one person touches another
best vehicle is the Hands especially those of the Health Care workers

B. Indirect Contact (inanimate object)
- occurs when a person touches an inanimate object contaminated by an infected patient

2. AIRBORNE
- droplet, dust, organisms in env.
3. VECTOR - insects or animals
4. VEHICLE- food (salmonella), water (shigellosis), blood (Hepa B), medication (contaminated infusion)

PREVENTION OF COMMUNICABLE DISEASE
Remember: Prevention is worth a pound than cure.

Health Education – primary role of the nurse
Specific Protection- handwashing, use of protective devices
Environmental Sanitation – clean and conducive for health

Definition of Prevention
“Actions aimed at eradicating, eliminating, or minimizing the impact of disease and disability. The concept of prevention is best defined in the context of levels, traditionally called primary, secondary, and tertiary prevention”

A Dictionary of Epidemiology, Fourth Edition
by John M. Last

Prevention of Needlestick Injuries

Dispose Used Needles in Puncture Proof Needle Containers
Don’t Recap Needles (Unless using the One-handed Technique)
Use Gloves When Handling Needles (Won’t Prevent Injuries but May Lessen Chance of Transmitting Diseases)

CONTROL OF C0MMUNICABLE DIESEASE
1. Notification
2. Epidemiological Investigation
3. Case finding; early dx and prompt treatment
4. Isolation and Quarantine
5. Disinfection; disinfestation
6. Medical Asepsis

a. Handwashing
b. Concurrent disinfection
c. Personal protective equipments (PPEs)
d. Barrier Cards/Placarding

Objectives of CCD

Restoration of health, reduce deaths and disability
Interpretation of control measures to IFC for practice to prevent spread of CD.
Promotion of health and prevention of spread of CD

Diseases that require weekly monitoring:
1. Acute flaccid paralysis (AFP) polio
2. Measles
3. Severe acute diarrhea (SAD)
4. Neonatal tetanus
5. AIDS

Diseases that require reporting w/in 24 hrs
1. Acute flaccid paralysis (AFP) polio
2. Measles

Diseases targeted for eradication
1. Acute flaccid paralysis polio
2. Neonatal tetanus
3. Measles
4. Rabies

Epidemiology -study of the occurrence and distribution of diseases in the population

Patterns of occurrence of disease –frequency of disease occurrence
1. Sporadic- On and off occurrence of the disease. Most of the time it is not found in the
community. One or two cases that occur are not related
2. Endemic- Persistently present in the community all year round
Ex: malaria in Palawan
3. Epidemic- An unexpected increase in the number of cases of disease
4.Pandemic- Epidemic of a worldwide proportions

Time Related Patterns of Occurrence
cyclical variation
a periodic increase in the number of cases of a disease
a seasonal disease, an increase is expected or there is usual increase- dengue fever during rainy seasons are increased but it is not considered an epidemic because it is expected to rise at this particular time
hot spot-a rising increase that may lead to an epidemic

Short time fluctuation
A change in the frequency of occurrence of a disease over a short period of time
Maybe (+) or (-)
Secular variation
A change in the frequency of occurrence of a diseae taking place over a long period of time
Ex: a.) the change in the pattern of occurrence of polio after being eradicated in 2000, then sudden repport of cases in 2001 due to mutant restraints.
b.) small pox virus-eradicated in 1979 (last case reported) and no another incidence as of today

Types of Epidemiology
Descriptive Epidemiology - concerned with disease frequency & distribution
Analytic Epidemiology-Is a study of the factors affecting occurrence and distribution of the disease.
Ex. Epidemiologic investigation
Therapeutic/Clinical-Study of the efficacy of a treatment of a particular disease
Ex. Clinical trial of a newly proposed therapeutic regimen
Evaluation Epidemiology-Study of the over-all effectiveness of a total/ comprehensive public health program.
Ex. Evaluation of the under five clinic

Remember: We make use of the epidemiology in CHN in order to come up a community diagnosis and also to determine the effectiveness of a particular treatment

Types of Epidemiologic Data
1. Demographic data
Demography is the study of population groups
Ex. Population size and distribution
2. Vital Statistics
3. Environmental data
4. Health services data
Ex. Ratio between nurse and the population being served
Ex. Degree of utilization of health facility/ service

Epidemiologic Investigation

1st step- Statement of the problem
2nd step- Appraisal of facts – describing the epidemic in terms of time, place, person.
3rd step- formulation of hypothesis
4th step-Testing the hypothesis
5th step- Conclusion and recommendation

TERMS
Disinfection – pathogens but not spores are destroyed

Disinfectant – substance use on inanimate objects

Concurrent disinfection – ongoing practices in the care of the patient to limit or control the spread of microorganisms.

Terminal disinfection – practices to remove pathogens from the patient’s environment after his illness is no longer communicable

FACTORS AFFECTING ISOLATION

Mode of Transmission
Source
Status of the client’s defense mechanism
Ability of client to implement precautions

EPI - Launched by DOH in cooperation with WHO and UNICEF last July 1976
Objective – reduce morbidity and mortality among infants and children caused by the six childhood immunizable diseases

PD No. 996 (Sept. 16, 1076) – “ Providing for compulsary basic immunization for infants and children below 8 y/o
PP No. 6 (April 3, 1996) – “ Implementing a United Nations goal on Universal Child Immunization by 1990”
RA 7846 (Dec. 30, 1994) – immunization hepa B
PD No. 4 (July 29, 1998) – “Declaring the period of September 16 to October 14, 1998 as Ligtas Tigdas Month and launching the Phil Measles Elimination Campaign”

Legislation, Laws affecting EPI

Proclamation No. 46 – “polio eradication project”
Proclamation No. 1064 – AFP surveillance
Proclamation No. 1066 – National Neonatal Tetanus Elimination Campaign

EPI

BCG - TB
DPT – Diptheria, Pertussis, Tetanu
OPV - Poliomyletis
Hepatitis B
Measles

Immunization Contraindications:

conditions that require hospitalization
For DPT 2 and 3 – history of seizures/ convulsions within 3 days after the first immunization with DPT

Nursing responsibility: ask how the child reacts to the first dose
For infant BCG – clinical AIDS

The following conditions are NOT contraindications:
Fever up to 38.5 ºC
Simple or mild acute respiratory infection
Simple diarrhea without dehydration
Malnutrition (it is indication for immunization)

Schedule of immunization
Infant BCG
0 to 11 months or 0 to 1 year
at birth
0.05 ml (dose) – ID, right arm
School entrance BCG
When the child enters Grade 1 with or without scar on the right arm then still go on with the vaccination except if he is repeating Grade 1

DPT
3 doses, 4 weeks or 1 month interval
Target age: 1 ½ to 11 months but child is eligible up to 6 years
If 7 years old and above DT only not P
0.5 ml, IM, vastus lateralis

OPV
3 doses, 4 weeks/1 month
Target population: same as above, eligibility until Grade 6
2-3 drops, oral route
*Feb 8-March 8: Oplan Polio Revival Drive
No side effect, but advise the mother to avoid feeding the child for 30 minutes after the vaccine, if vomits within the 30 minute period, repeat the vaccination

Hepa B
3 doses, 4 weeks
Can be given at birth
Target age 1 ½ to 11 months
0.5 ml, IM, vastus lateralis
Patient may experience local tenderness

Measles
9 to 11 months
Most babies have protection because of maternal antibodies thus this vaccine is given at 9 months because the time where the maternal antibodies wear off, other virus if it still active it will kill the vaccine
0.5 ml, subcutaneous, any arm
Measles
Fever and measles rash lasting for 1 to 3 days within 2 weeks after immunization (modified measles)

Fully Immunized Child
when he received all the antigens that should be given in the first year of life (1 dose BCG, MV; 3 doses DPT, OPV, HB)
Completely Immunized Child
All vaccines given but went beyond 0ne year of age

BACK TO RESEARCH: Familiarization with Terms and Concepts

2011-04-13T23:35:00.000-07:00

1. RESEARCH- it is the organized or systematic way of investigating or gathering of information to validate something or to improve ideas that already exist like theories

2. NURSING RESEARCH- it is a way of analyzing, validating and improving ideas that already exist to come up with a new idea that is to be used on clinical nursing practice

3. CLINICAL NURSING RESEARCH- it is a nursing research wherein the client is involved on the process of making new form of knowledge that will guide nursing practice.

4. BASIC RESEARCH- it is simply the gathering of information and using these information in constructing or forming new idea that will solve an immediate problem

5. APPLIED RESEARCH- it is the making of new skills or approaches and, later use these skills and approaches in solving problems

6. SCIENTIFIC METHOD- it is the systematic and organized or step by step way of solving a certain problem

7. CONCEPT- it is the name or main description of a certain object that reveals its meaning or identity

8. CONSTRUCT- it is a higher form of concept wherein the thought is wider and it has a broader and wider or general meaning

9. THEORY- it is a group of words and statements that tries to explain, describe or predict a certain event step by step

10. THEORETICAL FRAMEWORK- it is the structure or composition of a study that is revealed by the statements found on the theory

11. PROPOSITIONS- these are the statements that clarifies the connection or relationship between concepts

12. HYPOTHESIS- it is a wild guess or wild answer to a problem and it can be a possible solution to the problem

13. RESEARCH PROBLEM- it is the thing or situation that needs solution through scientific investigation

14. RESEARCH HYPOTHESIS- it is an alternative hypothesis which is used when the first hypothesis didn’t work

15. NULL HYPOTHESIS- this is the main hypothesis to be used on a research

16. VARIABLE- these are the things, attributes or characteristics of person or object that make them different from other persons or things like, age, blood type, occupation, religion, etc.

17. INDEPENDENT VARIABLE- this are the variable that is manipulated or controlled by the researcher in an experimental study

18. DEPENDENT VARIABLE- this is simply the effect or outcome of a research and can be influenced by independent variable

19. MODERATOR VARIABLE- this is the variable that balances the independent and dependent variables

20. INTERVENING VARIABLE- this is the variable that dominates on the test or experiment

21. CONTROL VARIABLE- this is the variable that are not involved on the experiment but are determined by sampling

22. NOMINAL SCALE/MEASURE- it is the lowest level of measurement of data on a research

23. POPULATION- it is the target number of all elements in a research that possess common characteristics that are needed for the study

24. SAMPLE- this is just a part of the population which are used to represent the population for a study

25. SAMPLING FRAME- it is the list of all the elements in the population where the sample is drawn or figured

26. RANDOM SAMPLING- it is the random selection of elements from the sampling frame to include in the study

27. STRATIFIED RANDOM SAMPLING- it is the random selection of study participants or respondents from two or more layer of the population

28. CLUSTER SAMPLING- a sampling technique where two or more stages are involved. From a given population, categories or cluster are identified first like (nursing schools) followed by sample elements (we, nursing students)

29. PURPOSIVE SAMPLING- in here, the researcher decides what or who are the samples he will get and use from a certain population

30. RESEARCH DESIGN- a plan or strategy for data collection in a research study

Fundamentals of Nursing

2011-04-11T21:39:00.000-07:00

Let's start the review with the scope of nursing practice.- R.A. 9173, Philippine Nursing Act 2002

Primarily, Nurses are responsible for the promotion of health and prevention of illness.

Duty of the nurse includes:
1. administration of written prescription for treatment, therapies, oral, topical and parenteral
medications
2. internal examination during labor in the ABSENCE of antenatal bleeding and delivery
3. Suturing of perineal laceration as long as the nurse undergone SPECIAL TRAINING

The Nurse's ROLES and RESPONSIBILITIES

Caregiver- helps clients promote, restore and maintain health and wellness
Counselor- helps clients identify and cope with stressful conditions
Communicator- identifies needs and problems of a patient/group
Coordinator/Manager- coordinates, manages and delegates tasks, also supervises and evaluates his co-workers
Change Agent- modifies the behavior of patients and adjust to highly dynamic health technology
Educator- especially during health promotion/teaching
Clinician- it is the use of technical expertise to administer nursing care
Leader- influences others to work together to achieve a mutually envisioned goal
Advocate- defends and fights for the patient's rights

The Rights of the Patients

Rights to:

Privacy 5. Education
Autonomy 6. Not to be Restrained
Information 7. Confidentiality
Refuse treatment 8. Services available

The Nightingale Pledge- written by Lystra Grette, the principal of Farrand Training School of Nurses in Detroit in 1893.

Iloilo Mission Hospital Training School for Nurses- produced the first trained nurses in the Philippines in 1909

Loreto Tupaz- known as the Florence Nightingale of Iloilo and Dean of Philippine Nursing

Act No. 2808- First Nursing Law

University of Santo Tomas College of Nursing- first college of nursing in the Philippines

University of the Philippines College of Nursing- first college to offer the course Bachelor of Science in Nursing

Mrs. Anastacia Giron-Tupas- known as the Pioneer of Philippine Nursing and founder of PNA

Proclamation 539 in October 17, 1958 by President Carlos P. Garcia- states that every last week of October is the "Nurses' Week"

NURSING THEORIES/THEORISTS

Florence Nightingale-Environmental Model
Virginia Henderson- 14 Basic Needs of Clients
Hildegard Peplau- Interpersonal Relations in Nursing
Dorothea Orem- Self-care Deficit Theory of Nursing
Faye Glenn Abdellah- 21 Nursing Problem
Dorothy Johnson- Behavioral System Model
Rosemarie Rizzo Parse-Theory of Human Becoming
Jean Watson- Human Caring Model
Betty Neuman- Health Care System Model
Madeleine Leininger- Transcultural Nursing
Sis. Calista Roy- Adaptation Model
Martha Rogers- Science of Unitary Human Being
Imogene King- Goal Attainment Theory
Myra Estrin Levine- Four Principles of Conservation
Ernestine Weidenbach- Prescriptive Theory

HEALTH- is the extent to which an individual or group is able to realize aspirations and satisfy needs and change or cope with environment. It is the complete physical, mental and social well being and not merely the absence of disease or infirmity (WHO,1948)

LEVELS OF PREVENTION

PRIMARY PREVENTION- talks about prevention or delay of the actual occurance of an illness or disease.
SECONDARY PREVENTION- focused on early detection and early treatment of the disease
TERTIARY PREVENTION- it is the prevention of complications of a disease and also to the rehabilitation of the individual

PRIMORDIAL PREVENTION- preventing the emergence of risk factors

SPECIFIC PROTECTION- removing or reducing the levels of the risk factors

No Link to Femur Fractures Found with Bisphosphonates

2010-03-25T06:38:00.000-07:00

By John Gever, Senior Editor, MedPage Today
Published: March 24, 2010
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
Atypical femoral fractures in patients with osteoporosis were extremely rare and not significantly more common with bisphosphonates, results of a meta-analysis showed.

Among more than 14,000 patients involved in three large randomized trials, only 12 fractures of the subtrochanteric or diaphyseal femur were recorded, Dennis Black, PhD, of the University of California San Francisco, and colleagues reported online in the New England Journal of Medicine.

The investigators looked at data from the Fracture Intervention Trial (FIT) and its five-year extension, which compared alendronate (Fosamax) to placebo, and the HORIZON Pivotal Fracture Trial, which tested zoledronic acid (Reclast).

They reported the following relative risks for subtrochanteric or diaphyseal fractures associated with the specific bisphosphonate-based therapies evaluated in the trials:

* Alendronate in FIT: RR 1.03 (95% CI 0.06 to 16.46)
* Alendronate in the FIT Long-Term Extension: RR 1.33 (95% CI 0.12 to 14.67)
* Zoledronic acid in HORIZON: RR 1.50 (95% CI 0.25 to 9.00)

But Black and colleagues did not rule out the possibility of a genuine risk, despite the lack of statistical significance, because the confidence intervals were so wide.
"The study was underpowered for definitive conclusions," they wrote.

In an accompanying editorial, Elizabeth Shane, MD, of Columbia University in New York City, urged physicians with concerns about atypical femoral fractures and bisphosphonates to avoid a "rush to judgment."

She suggested that physicians "re-evaluate" patients taking bisphosphonates for long periods with bone density measurements and risk factors for fracture.

"It is reasonable to consider drug holidays with careful observation for most patients with osteoporosis who are receiving long-term therapy," she wrote, especially those with reduced markers of bone turnover.

But Shane also pointed out that other studies have found that benefits of bisphosphonate therapy continue to accrue past five years.

Black and colleagues re-examined the FIT and HORIZON trials in the wake of case reports suggesting that atypical femoral fractures are more common with bisphosphonate therapy.

The reports have prompted the FDA to begin a formal safety review, although the agency emphasized that the evidence it has seen to date does not demonstrate a genuine risk.

The main FIT study was a one-year placebo controlled study followed by three to 4.5 years of follow-up.

In the extension, participants completing the main trial were offered one year of open-label alendronate followed by a randomized, placebo-controlled extension that lasted up to five years. Overall, patients in this trial received alendronate for up to 10 years.

HORIZON tested three years of annual infusions of zoledronic acid.

In all, the three studies involved 51,287 patient-years of drug exposure.

The three groups of patients -- 6,459 in the main FIT study, 1,099 in its extension, and 7,736 in the Horizon study -- included 283 who suffered hip or femur fractures.

Black and colleagues collected data on the specifics of these fractures. They immediately excluded about half because they involved the femoral neck or subcapital sections of the femur, obviously resulted from other pathologies or high-energy impacts, or were periprosthetic.

For the remainder, x-rays and/or surgical reports were reviewed by a radiologist who determined that only 12, occurring in 10 patients, were "fractures of interest."

The overall rate of atypical fractures was therefore calculated to be 2.3 per 10,000 patient-years of observation, which Black and colleagues called "extremely low."

The lack of apparent association between bisphosphonate use and atypical femoral fractures, even in the long-term FIT extension, suggested that duration of treatment may not be a factor in whatever risk bisphosphonates pose.

But in cautioning about the limits of their data, they noted that "atypical features could not be fully assessed, since radiographs were not generally available."

The small number of events also precluded a definitive conclusion that the rate was not higher in patients treated with bisphosphonates.

In addition, the trials, except for the extension of FIT, were not long-term studies of bisphosphonate use.

Yet, on the other hand, they argued that bisphosphonates definitely do prevent other types of fractures. On the basis of the FIT and HORIZON trials, they calculated that 3,000 patient-years of treatment would prevent 71 vertebral fractures, 11 hip fractures, and 18 other types of fracture.

Black and colleagues also noted that their findings were similar to those of a Danish registry analysis reported last year.

In her editorial, Shane indicated that more research is needed -- not only to assess the true incidence of atypical femoral fractures and the association with bisphosphonates, but also on methods to detect incipient fractures and management of those that occur.

The study was funded by Merck and Novartis.

Study authors reported relationships with Merck, Novartis, Amgen, Roche, AstraZeneca, GlaxoSmithKline, Procter & Gamble, Medtronic, Nastech, Nestle, Fonterra Brands, Ono, Osteologix, Pfizer, Eli Lilly, sanofi-aventis, Tethys, Unilever, Unipath, Inverness, Ortho Clinical Diagnostics, Osi Prosidion, and Takeda. Some authors were employees of Merck and Novartis.

Shane reported research funding from Novartis, Amgen, Eli Lilly, and Merck.

Primary source: New England Journal of Medicine
Source reference:
Shane E "Evolving data about subtrochanteric fractures and bisphosphonates" N Engl J Med 2010; DOI:10.1056/NEJMe1003064.

Additional source: New England Journal of Medicine
Source reference:
Black D, et al "Bisphosphonates and fractures of the subtrochanteric or diaphyseal femur" N Engl J Med 2010; DOI:10.1056/NEJMoa1001086.

Steroids Offer No Help for Pneumonia

2010-03-01T20:55:00.000-08:00

Steroids Offer No Help for Pneumonia
By John Gever, Senior Editor, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner Earn CME/CE credit
for reading medical news
Action Points

* Explain to interested patients that corticosteroids are used to reduce inflammation, which is a prominent feature of many infections including pneumonia.

* Explain that some previous studies had suggested a benefit for corticosteroids in pneumonia but the evidence was not strong. But this relatively large randomized trial, a strong form of evidence, showed that corticosteroids provided no benefit in most cases, and may have fostered recurrence of pneumonia in some.

* Explain that some patients may nevertheless benefit from corticosteroids despite the findings of this study. Treatments must be determined for each patient individually.

Adding prednisolone to antibiotics in patients with community-acquired pneumonia (CAP) did not improve outcomes and may actually have worsened them, according to researchers conducting a placebo-controlled trial.

Clinical cure rates and most other outcomes were similar in hospitalized CAP patients treated for one week with prednisolone at 40 mg/day versus placebo, but late failure was significantly more common in the prednisolone group, according to Dominic Snijders, MD, of Medical Centre Alkmaar in the Netherlands, and colleagues.

Patients taking prednisolone suffered late failure (recurrence of pneumonia symptoms at least three days after admission) at a rate of 19.2%, compared with 6.4% among patients in the placebo group (P=0.04), the researchers reported online in the American Journal of Respiratory and Critical Care Medicine.

"Prednisolone should not be recommended as routine adjunctive treatment in CAP," they concluded.

Corticosteroids have shown some benefit in other serious infections such as sepsis, though not consistently, the researchers indicated.

One study in pneumococcal pneumonia showed such a strong positive effect for supplemental corticosteroids that the trial was stopped prematurely. Steroids have also appeared to be beneficial in CAP patients in a retrospective analysis.

Consequently, Snijders and colleagues conducted a randomized trial involving 213 patients hospitalized with clinically and radiologically diagnosed CAP.

Pneumonia severities of all grades were represented, with most clustered in Pneumonia Severity Index classes 2 to 4. About 14% of patients had class I illness and the same number had class 5 illness.

Mean patient age was about 63, and slightly more than half were men, while 30% were current smokers.

Some 20% had chronic obstructive pulmonary disease. From 7% to 22% had other comorbid illnesses such as diabetes, asthma, and ischemic or chronic heart disease.

These were about equally common in the two treatment groups, except that significantly more in the placebo group had chronic heart disease (22% versus 10%, P=0.01).

Antibiotic regimens, including the choice of drugs as well as the route of administration, varied among patients. About 57% received amoxicillin, while 37% received moxifloxacin, and some 4% had a combination of amoxicillin and clavulanic acid.

Patients were randomly assigned to receive prednisolone or placebo, and by the same route as the antibiotics (intravenous or oral).

The primary study endpoint, seven-day clinical cure, was met by 80.8% of those taking prednisolone and 85.3% of the placebo group (P=0.38).

There was no clear winner, either, in secondary endpoints (intention to treat, P>0.10 except as noted):

* 30-day clinical cure: 66.3% prednisolone, 77.1% placebo (P=0.08)
* 30-day mortality: 5.8% prednisolone, 5.5% placebo
* Mean length of stay: 10.0 days prednisolone, 10.6 days placebo
* Mean time to clinical stability: 4.9 days for both groups
* Early failure rate: 13.5% prednisolone, 12.8% placebo

Results were similar among the 83% of patients who completed treatment as scheduled. There was also no sign that prednisolone was effective in patients with more severe illness, as defined by high Pneumonia Severity Index and CURB-65 scores.

Nevertheless, Snijders and colleagues cautioned that a benefit for the drug in severe cases "cannot be excluded."

Prednisolone did appear to have benefits in certain surrogate outcomes.

Serum C-reactive protein (CRP) levels declined significantly faster in the corticosteroid group initially, with mean levels about half those seen in the placebo group on days five to seven. By day 14, though, CRP levels in the placebo group dropped significantly below those in the prednisolone patients.

Fever also abated more quickly with prednisolone, with mean temperatures reduced by as much as 0.5° C relative to the placebo group in the first few days of treatment. There was no difference in mean temperature by day seven.

Adverse effects attributable to treatment were infrequent and did not differ between groups.

Snijders and colleagues indicated that the higher rate of late clinical failures with prednisolone and the higher levels of CRP at day 14, after initial suppression, may reflect a rebound phenomenon.

Although superinfection might also account for these observations, the researchers said there was no evidence for additional infections in these patients.

The researchers suggested that tapering corticosteroids, rather than stopping them abruptly as was done in the current study, might protect against rebound.

They also cited several limitations to the study. The primary outcome and some of the secondary endpoints were somewhat subjective, Snijders and colleagues pointed out.

Also, they did not evaluate patients' adrenal functions, and the number of patients with COPD in the sample was too small to permit conclusions about the effect of corticosteroids in that subpopulation.

Finally, the researchers indicated that the once-daily dosing of prednisolone could have reduced the drug's efficacy.

The study was funded by AstraZeneca.

The authors declared they had no potential conflicts of interest.

Primary source: American Journal of Respiratory and Critical Care Medicine
Source reference:
Snijders D, et al "Efficacy of corticosteroids in community-acquired pneumonia -- a randomized double blinded clinical trial" Am J Respir Crit Care Med 2010; DOI: 10.1164/rccm.200905-0808OC.