Forum | Nursing Crib

heartrhedge on help.............. steroid

Fri, 10 Jul 2009 20:36:18 +0800

i have my research dis sem and i need some infos from you.. help.................. its all about steroid..... can you?

lupethe3 on most favorite nursing-related subject

Tue, 07 Jul 2009 11:31:41 +0800

me?

halos lahat!! !

That's why i love nursing!!!

hehhehe.....

anyways, ang pinkagusto ko talaga ay yung pharma, psychia at medical-surgical nursing!!!

imnice on ALL ABOUT NCLEX

Tue, 30 Jun 2009 16:23:48 +0800

Hi Guys:

Wanna ask those who are already workign in the USA, had passed CGFNS, NCLEX, etc.

If I already have an immigrant visa, will I still need to pass the local board exam?

Please share your experiences.

Thanks much!

netpabelonio on Opportunity to Work in Australia

Sat, 20 Jun 2009 22:55:56 +0800

it's better if you gained experience first. But if you could find a way to leave the country right away..take that opportunity.

erlin on Opportunity to Work in Australia

Fri, 19 Jun 2009 09:10:07 +0800

hi to everybody,

im really interested to apply to work in Australia. I too my nursing board exam jst last june 6-7 2009. Can i still have a chance tp apply as earlier as this time?

Willing to wait for good response.

erlin

medtalents_inc on Opportunity to Work in Australia

Wed, 17 Jun 2009 15:37:42 +0800

hi there. we are currently looking for nurses and midwives to work in Australia. here's -he job specs for it. but i would our client is strict so i'm requesting that only qualified applicants apply for this position because much as we want to help you out, we just can't if you don't qualify. pls. email your resume to hr_medtalents@yahoo.com or text or call me at 0915-8156938 if you have some other questions. thanks!

AUSTRALIA

Registered Nurse and Midwife
(You may choose to work in the city or in the remote areas)

Looking for Registered Nurses who are currently licensed in the United States, United Kingdom, Ireland, South Africa, Canada, Hongkong, and Singapore

457 Visa is available (Four years contract, possibility of Permanent Residency after one year stay)

Requirements:

• Nurse and Midwife with current registration from any of the countries listed above
• At least two years full time experience in any of the countries listed above
• Must be under 45 years old
• Must pass IELTS (7 Band)
• Excellent English communication skill
• Salary range is $70,000-$90,000 (AUD)
• Relocation allowance generally available

skarleyt on What's the best Nursing Review Center in the Philippines

Thu, 11 Jun 2009 19:03:07 +0800

nasa sau pa rin ang pagseseryoso sa pagaaral

pag sinabi mong magreview ka gawin mo, pang guide na lang kasi ang review center.. at maganda din ung naeehance ka sa mga sagot sagot ng mga 300 questions sa isang araw at magrationalise ka.. mejo nakakapagod pero kayanin mo.. pero xmpre magpahinga ka naman at wag masyado magpuyat..nasa buk mo lahat ang mga nirereview mo.. brunner and suddarth..carl balita..gapuz reviewer..make mnemonics..kozier..at mga notes mo nung nagaaral ka pa sa school niu.. sa tabi ng PRC madami reviewer dun pero dapat gandahan mo ang pagpili.. pero ako kasi sa RUN magrereview pang dagdag knowledge na lang at tips.. PRAY before you study mas effective un..

lhoidie on Psychiatric Nursing Notes

Tue, 09 Jun 2009 16:58:08 +0800

LOBES OF BRAIN

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

2. TEMPORAL LOBE
- Hearing
- Smell

3. PAREITAL LOBE
- Touch
- Taste

4. OCCIPITAL LOBE
- Visual

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

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

INVOLUNTARY NERVOUS SYSTEM
• also called autonomic nervous system.

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

• Psych focuses in feelings or self awareness.

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

STRUCTURE OF PERSONALITY

ID

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

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

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

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

SUPEREGO DOMINANT PERSONALITIES
Obsessive Compulsive
Anorexia Nervosa

EGO – if destroyed result in impaired reality perception.
Schizophrenia

LIBIDO
• Sexual energy responsible for survival.

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

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

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

TOILET TRAINING

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

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

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

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

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

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

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

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

PHARMA NOTES:

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

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

PHARMA NOTES:

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

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

THERAPEUTIC COMMUNICATION TECHNIQUES

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

NONTHERAPEUTIC

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

FEAR – protects us from something bad.

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

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

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

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

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

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

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

EVALUATION
• effective individual coping.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

EVALUATION
• Enhanced communication
• Improved social interaction
• Safety

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

NURSING DIAGNOSIS
• Risk for injury
• Impaired social interaction

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

EVALUATION
• Minimize risk for injury
• Improved social interaction

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

EATING DISORDERS

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

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

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

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

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

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

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

I. ASSESS
• Content of thought

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

II. ASSESS
• Hallucinations/Illusions

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

III. ASSESS
• Suspicious

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

IV. ASSESS
• Suicidal

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

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

FLIGHT OF IDEAS
• Jumping from on topic to another

AMBIVALENCE
• Pulled between 2 strong opposing forces

MAGICAL THINKING
• acting like magician

ECHOLALIA
• Client repeats what you say

ECHOPRAXIA
• Client repeats what you do

WORD SALAD
• Just words no rhyme

CLANG ASSOCIATION
• Words that rhyme

NEOLOGISM
• Formation of new words (needs clarification)

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

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

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

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

CONCRETE ASSOCIATION
• Also known as “pilosopo”

THOUGHT BLOCKING
• Unable to think

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

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

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

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

AKINESIA
• Muscle rigidity

DYSTONIA
• Torticollis (wryneck)

OCULOGYRIC CRISIS
• Fixed stare

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

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

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

TYPES OF SCHIZOPHRENIA

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

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

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

PARANOID SCHIZOPHRENIA
- No more positive symptoms just withdrawn

UNDIFFIRENTIATED SCHIZOPHRENIA
- Mixed classification, cant be classified

PHAMRA NOTES:

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

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

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

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

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

PHARMA NOTES:

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

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

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

WERNICKE’S ENCEPHALOPATHY
• Problem with motor

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

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

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

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

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

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

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

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

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

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

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

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

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

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

DOWNERS
Alcohol
Barbiturate
Opiates
Narcotics
Marijuana
Morphine
Codeine
Heroine

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

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

sarahjaneraine on mongol #1

Tue, 09 Jun 2009 03:24:44 +0800

kamusta naman...basta tama yung shading mo(at answers mo hehhe) papasa ka heheheh

ako nga hindi mongol brand ng lapis ko eh hahahahh

good luck!! and have faith!!!!

sarahjaneraine on What's the best Nursing Review Center in the Philippines

Tue, 09 Jun 2009 03:21:52 +0800

i strongly DISAGREE with colchicine.

ive been in two review centers (my university' choice and my choice which was gapuz)

and ive read reviewers from 2 different review centers, that includes carl balita...

i dont think sa gapuz LANG ang review centers na nagbibigay ng sagot lang agad...

wala nga lumabas sa binigay ng gapuz eh (november 2008 and i passed with first take)... ang lumabas lang ay yung from previous board exams NA REVIEW SA LAHAT ng review centers (ONLY sa 1st set) NA BINEBENTA DIN SA TAPAT NG PRC ang compilations...

and i dont think na rely lang sa answers from gapuz ay papasa ka....marami akong nakilala na mayayabang during my review sa gapuz(final coaching lang ako) na unfortunately di ko nakita names nila sa news paper...

sa gapuz ang mga reviewers dun hindi basta basta, hindi sila yung basa lang...and also other major review centers na ganun din ang way of teaching...kala mo ba dun ang pinapareview nila same sa NLE? ASA...parang NCLEX na dun ang pinapareview!

ang review centers ay tumutulong lang sayo para marefresh LAHAT ng pinagaralan mo mula 1st-4th year mo sa nursing...

ARAL lang ang kailangan para pumasa ng Board...dagdagan mo ng common sense...

maraming bookish ang bumabagsak sa board...

Good luck sa result!!! have faith!!

bella on Nursing Management

Mon, 08 Jun 2009 02:46:10 +0800

cycy said:i need notes on nursing management

LEADERSHIP
Dissemination of Finding/ Core/ Recommendations
Importance of core - conc is final result of study
How can conc affect others - recommendation
Methods of dissemination of Findings/ Result
a. Book
b. Symposia - oral
c. Publication
5 goal/ objective- patient - recipient of care
RNs implementor, assistant to dentist, Not leader
Principles for effective leadership
1. Unity of command - all will receive orders, command from nurse manager/ supervisor
2. Unity of direction - whole group leader &newborns will have goal - towards patient.
3. Subordination of personnel to the general interest
- save patient 1st before self (ex fire in pt room)
R - remove/ rescue patients
A - alert fire alarm
C - confine fire in / area
E - extinguish fire
R - run
4. Esprit de corps - team spirit
fault of one is fault of all
credit of 1 is credit of all
5. Chain of command - hierarchy
Patient reacted to meds given, allergy. Inform MD he will give anti-histamine.
Incident report - for purpose of risk management
- Report of sudden occurrence
- Go to Head nurse
Pt has appendicitis. Pain in RLQ who is primarily responsible for patient - Head nurse.
HN can delegate to staff nurse pt died. Head Nurse is liable
Command responsibility - Respondia Superior
Theories of effective leader.
1. Great man theory - to be a good leader, leader must be born. Leaders cant be developed. Some are born a follower.
2. Trait theory - behavior/ characteristic
P - personality
I - intelligence
A - ability
Personality -
+ attitude/ trait/ knows to adjust to pt - adaptability
a. acceptability - can cope, adjust to needs of pt
b. independent
c. creative/ assertive
d. advocate
Char of nurse if you are defender of patient against harm/ negligence - advocate
Intelligence - proper judgment
Proper decision
Fluency of speech
Ability - influence others - most effective way to influence pt - HI optimum level of is attain OLF
Command of others
Respect others
Participate
Cooperate
3. Charismatic theory - charm, charisma, inspirational quality
4. situational theory - a person can be a good leader in 1 situation & a follower in another situation.
Case to case
Adv - can get best person to the job
Disadvantage - there's no continuity of leadership
Styles of leadership:
1. Autocratic - authoritarian, dictatorial, bureaucratic traditional or “Hard leader”
- Unilateral style of nursing
- Leader is only 1 performing without input from other staff.
- Not getting opinion, recommendations
Char - unilateral from style of staff leadership - leader does decision making without.
A - apathy - not sensitive
B - boisterous speech
C - consistent
D– Demanding -
E - egoistic
F - ferocious
Putting self in shoes of pet recognize & sensitive to pt. - empathy
Not good style in leadership but good in emergency cases. Or during acute crisis.
2. Laizzes Faire/ Frierein/ Loose
- excess freedom / or liberates to members
- authority neglect patients will suffer
control malpractice
discipline
3. Democratic / Participative
- gets input from members (decision making)
- Mutual participation
- Members makes mistake - member will get notice/ hearing before discipline = due process
Quality/ Skills/ Abilities of good nursing leader:
A - authority
B - behavior
C - Communication skills
D - decision making
E - ethics
F - face conflict
A - ability - basis of a leader to unsure / demand task, obligation & resp to his subordinates.
2 types
1. Centralized - top to bottom for proper management of whole hospital
- to problems of whole institution
2. Decentralized - bottom (delegation)
- to manage directly pts or concerns
B. Behavior of good nurse leader:
S - specific body of knowledge & skills to do safe care to patient. RN should be competent with scientific rationale
P - patient cettered/ client focus
A - accountability - liable for result of actions
C - confidentiality
E - ethics
General rule: RN: can be charged with :
Invasion of privacy, breach of confidentiality
Exemption to gen rule (RN cant be charged with breach of confidentiality )
P - patients consent
I - inform/ report to other members of HC team for precautionary measure
C - common dse (report) - DOH/ WHO
C - crimes - within 48h - report child abuse
RA 3573 - Law on notifiable disease
Within 24h report disease like - polio & measles
1 week - HIV/ tetanus/ severs acute diarrhea
Priority for child - rape - ual abuse, domestic abuse, all kinds of abuse
a. report to barangay official
b. report to police
c. provide safe environment - focus on pt 1st - reporting can be done within 48h
d. call med legal
Rule!! (in order)
1. S - safety
2. R - report
3. R - referral - DSWD, NGO
C - communication skills
- transfer of ideas / info with understanding
Without understanding barrier/ backlog
Sender - message - (idea/ info which sender would like to transmit
Encoding - verbal or non verbal method
Receiver - recipient of communication
Decoding - manner of interpretation after receiving messages
Feedback - response of receiving after interpreting messages
D -decision making
E - ethics
Principle:
1. Autonomy - independent judgment & decision making who should decide for care of patient.
a. doc
b. attending pt
c. pt
d. relatives
Pt refuses to remove lucky bracelet before surgery Bt due- Jehovah's witness
a. respect decision of pt - respect cultural diversity
b. refer to doc - let doc explain risks involve
c. let pt sign a waver
Doctrine of assumption or risk
• pt given risks & signed waver
• pt will assume all the risks/ danger
Pills
IUD - string should be checked during & after mens
Diaphragm - removed after 6h Toxic shock syndrome
Vasectomy - after 2 negative sperm count, 1st is probable 2nd is confirmatory
BTL - can do coitus anytime. When pain & bleeding ceases.
Principles in leadership
Veracity - truth don't give false reassurance
- all med prognosis, dx, of baby - given by MD!
Beneficence - doing good to pt
Non malefience - do no harm
3 type of harm
1. Physical - negligence by commission - performed wrong action
negligence by omission - neglect of care
2. Mental - assault - mental threat/ fear
battery - physical harm
3. Moral - slander - verbal
libel - written, published pictures
Tolality - let pt feel like a whole being even if a part is removed.
• offer wigs, bandana - CA pt prosthesis, casts, w/c - amputation
Double effect - if made to choose between 2 evils, choose the one that will have les bad effect. More good effect
Justice of care - priority coz @ pt has unique needs.
Basic char or nursing process
A - acceptance universable
B - based on pts needs
C - client focus
D - dynamic - update nursing process depending on clients needs
E - equitable care
F - familiarity
G - goal oriented toward solving problem
Inviolability of life - respect of life (promote H & prevent disease)
- no abortion!
Conflict - clash of ideas resulting to crisis
Methods to solve conflict.
A - avoidance - putting in one corner - dedma - not good method
S - smoothing - appealing to conscience/ kindness
U - unilateral - force fear, threats correction
N - negotiation - best method - both parties will mutually decide & participate to solve problem.
Nsg management
Mgt - MAN+ TASK = GOAL (pts)
Theories:
1. Human relations theory - must focus on proper relationship
If needs provided to member (rest day, leave)
Achievement of organization
2. Frederick Taylors scientific mgt theory
4 t's
Tao - get rt person/ tao
Training
Tool
Tx
3. Douglas McGregor mgt theory -
Theory Y Theory X
Positive worker Negative worker
- efficient - inefficient
diligent negligent
trustworthy non trustworthy
reliable don't love job
love their job for the money only
= minimal supervision only = increase cases of negligence affecting pts.
= use cozf I d power to discipline workers
4. Max Weber's burocaratic (autocratic) theory
• whoever is on top would perform mgt functions
• centralized
• not good style of management
5. Elton Mayo's behavioral theory
• overtime pay, rest day, day off
• provide physical needs of worker like rest & recreation
• HAWTHORNE'S EFFECT - if worker knows that they are being observed, workers will have better output.
6. Henry Fayol's principles of mgt
a. Unity of command - one person given instructions to workers
b. Unity of direction - whole team should have one goal, objective, direction towards pt.
c. Subordination - personal general interest - pt 1st before self
d. Esprit de corp - team spirit - all (-) & (+) output credited to the group
e. Chain of command - heiarchy of command
Get appropriate orders from MD
f. Channels of communication -
MD orders
SN SN
g. Respondent supervisor - command responsibility
- let master answer for negligence conduct of subordinate
• liable: both
HN liable for damages - due resp supervisor
SN - negligence - jail
h. Security of tenure -
i. Re-numeration of workers - compensation
• probationary - 6 months
• regular employee
Private - RA 4901 - 40% work 8h a day 5 days a week
Gov't - RA 7375 - magna carta for public HWorker 15k
Overtime = + 25%
Night shift differential = +10%
Special non working holiday + 30%
Legal Holiday= X2 +100%
Occupational Hazard - work related disease
Private - SSS - employees compensation
Gov't - GSIS
National health Insurance Act - PhilHealth
• Provide for unemployed/ employed
• Aesthetic, cosmetic, dental not included
Maternity leave - 60 days NSD
78 days C/S
1st 4 pregnancies to legit spouse
Abortions 5th pregnant - & delivered - not entitled to maternity leave
Paternity leave 7 days
Stage/ Steps in nursing management process
P - planning
O - organizing
S - staffing
D - directing/ delegating
Co - coordinating
Co - controlling/ eval
Planning stage - conceptualizing/ product of mind/ looking at future/ looking prospectively
Types:
Vision - what org likes to achieve in future
Ex. Health for all by 2000
Heath in the hands of the people by 2020
Mission - focus in present
- reason why org was established
ex. DOH - to five quality health
Philosophy - values. Besides org (members)
Goal - gen statement of mission
Objective - specific statement of mission
Goal- nursing form St. Lukes should provide quality care to pt
Objective - nursing from St Lukes should have IV training (specific)
Policies - set of rules/ regulation of org
3 types of plan
1.) Short term - for every day ordinary activity
ex. NCP
2.) Contingency plan - for emergency or acute crisis, stand by plan
3.) Long term plan - duration of care is linger for chronic pts. Ex. CVA pts
Budgeting - performed in planning stage
• proper allocation of resources
• Money, manpower, machine
1. Operati0nal budget - cheapest - everyday ordinary activities (gloves, gown, goggles - OR, LR, DR,ER)
2. Personal/ labor budget - used to compensate & re-numerate labor - most important
3. Capital budget - long term use equipment
- MRI equipment, beds
Budget - asks “How”
Organizing stage - answers the question ‘WHO”
Nurse Mgr
RN
Subordinate
Nsg personnel - nurse aid
RN will do: (for stable & unstable pt)
A - assessment
T - health teaching - when best time start discharge
E - explain proc to pt health teaching - start during admission of pt
P - preparation - computation of dosage
A - adm - give meds or treatment
T - treatment - oral, IV, ID
E - evaluation - nursing care plan
J - judgment - PRN meds - nursing will decide when to five
Subordinates can perform: (comfort measures only not VS)
R - routine tasks - standard procedure, monitor I & O ambulating, bathing bed making
• stable pts - predictable outcomes
S - stable pts
S - supervision of RN
Styles/ method delivery care
1. Primary nursing - private duty nurse - from admission to d/c!
D - direct plan of care to pt
A - active participation/ consent of pt.
M - mgt of care - from basic to complex PD will do
24h - from admission t o discharge
tip = answer is primary nurse
2. Functional - most useful type
D - duty task - 1 RN all patients
O - one task
H - highly recommended
RNS budget
3. Case Method - ICU critical case
resp for: T - total care (from basic care to most complex)
O - one RN: 1 patient
In extreme cases 1:2 pts
Staffing stage - “how many”
- nurse manager will determine correct # of patients/ RN
Staffing pattern - Phil - 40h/ wk/ 5d
Traditional - 8h/40h/5d
10h shift - 10h/ 4d Monday - Thursday
On call - emergency schedule
Baylor plan - M - F (traditional)
Sat-Sun (skeletal force)
Directing/ Delegation stage - job/ task is done by another pt for you.
Gen rule: RN can delegate any task to another RN
Except: disciplinary task (this is done by higher person)
: confidential task (charting)
: technical task (expertice should be done by same expert)
: official medical task
Coordinating/ collaboration stage
1. canned food - highest purine content (uric)
2. Anchovies - next highest purine content
1. Interpersonal/ intra departmental - collaboration bet 1 nurse to another nurse -
• under 1 ward
• ex. Endorsement
2. Interdepartmental - collaboration between two or more hosp for benefit of pt.
Why RN needs to collaborate to others in HC team?
- pt is entitled to continuous care.
Evaluation stage - determine whether, plan goal, objective where met or achieved
Types”
1. Nurse rounds - 2 x rounds/ day
• short term plan
Psyche ward - contraindicated nurse rounds in psych ward
2. Checklist - Nurse mgr - evaluates/ rates member
3. Gam H chart - used to evaluate nurses , multiple plan at same time
4. Peer evaluation - co workers - poorest type of eval - cause might be effected by halo effect due to special relationship.
Performance Appraisal - pt or client evaluates most reliable coz ——— or care evaluates.

bella on Nursing Management

Mon, 08 Jun 2009 02:46:08 +0800

cycy said:i need notes on nursing management

LEADERSHIP
Dissemination of Finding/ Core/ Recommendations
Importance of core - conc is final result of study
How can conc affect others - recommendation
Methods of dissemination of Findings/ Result
a. Book
b. Symposia - oral
c. Publication
5 goal/ objective- patient - recipient of care
RNs implementor, assistant to dentist, Not leader
Principles for effective leadership
1. Unity of command - all will receive orders, command from nurse manager/ supervisor
2. Unity of direction - whole group leader &newborns will have goal - towards patient.
3. Subordination of personnel to the general interest
- save patient 1st before self (ex fire in pt room)
R - remove/ rescue patients
A - alert fire alarm
C - confine fire in / area
E - extinguish fire
R - run
4. Esprit de corps - team spirit
fault of one is fault of all
credit of 1 is credit of all
5. Chain of command - hierarchy
Patient reacted to meds given, allergy. Inform MD he will give anti-histamine.
Incident report - for purpose of risk management
- Report of sudden occurrence
- Go to Head nurse
Pt has appendicitis. Pain in RLQ who is primarily responsible for patient - Head nurse.
HN can delegate to staff nurse pt died. Head Nurse is liable
Command responsibility - Respondia Superior
Theories of effective leader.
1. Great man theory - to be a good leader, leader must be born. Leaders cant be developed. Some are born a follower.
2. Trait theory - behavior/ characteristic
P - personality
I - intelligence
A - ability
Personality -
+ attitude/ trait/ knows to adjust to pt - adaptability
a. acceptability - can cope, adjust to needs of pt
b. independent
c. creative/ assertive
d. advocate
Char of nurse if you are defender of patient against harm/ negligence - advocate
Intelligence - proper judgment
Proper decision
Fluency of speech
Ability - influence others - most effective way to influence pt - HI optimum level of is attain OLF
Command of others
Respect others
Participate
Cooperate
3. Charismatic theory - charm, charisma, inspirational quality
4. situational theory - a person can be a good leader in 1 situation & a follower in another situation.
Case to case
Adv - can get best person to the job
Disadvantage - there's no continuity of leadership
Styles of leadership:
1. Autocratic - authoritarian, dictatorial, bureaucratic traditional or “Hard leader”
- Unilateral style of nursing
- Leader is only 1 performing without input from other staff.
- Not getting opinion, recommendations
Char - unilateral from style of staff leadership - leader does decision making without.
A - apathy - not sensitive
B - boisterous speech
C - consistent
D– Demanding -
E - egoistic
F - ferocious
Putting self in shoes of pet recognize & sensitive to pt. - empathy
Not good style in leadership but good in emergency cases. Or during acute crisis.
2. Laizzes Faire/ Frierein/ Loose
- excess freedom / or liberates to members
- authority neglect patients will suffer
control malpractice
discipline
3. Democratic / Participative
- gets input from members (decision making)
- Mutual participation
- Members makes mistake - member will get notice/ hearing before discipline = due process
Quality/ Skills/ Abilities of good nursing leader:
A - authority
B - behavior
C - Communication skills
D - decision making
E - ethics
F - face conflict
A - ability - basis of a leader to unsure / demand task, obligation & resp to his subordinates.
2 types
1. Centralized - top to bottom for proper management of whole hospital
- to problems of whole institution
2. Decentralized - bottom (delegation)
- to manage directly pts or concerns
B. Behavior of good nurse leader:
S - specific body of knowledge & skills to do safe care to patient. RN should be competent with scientific rationale
P - patient cettered/ client focus
A - accountability - liable for result of actions
C - confidentiality
E - ethics
General rule: RN: can be charged with :
Invasion of privacy, breach of confidentiality
Exemption to gen rule (RN cant be charged with breach of confidentiality )
P - patients consent
I - inform/ report to other members of HC team for precautionary measure
C - common dse (report) - DOH/ WHO
C - crimes - within 48h - report child abuse
RA 3573 - Law on notifiable disease
Within 24h report disease like - polio & measles
1 week - HIV/ tetanus/ severs acute diarrhea
Priority for child - rape - ual abuse, domestic abuse, all kinds of abuse
a. report to barangay official
b. report to police
c. provide safe environment - focus on pt 1st - reporting can be done within 48h
d. call med legal
Rule!! (in order)
1. S - safety
2. R - report
3. R - referral - DSWD, NGO
C - communication skills
- transfer of ideas / info with understanding
Without understanding barrier/ backlog
Sender - message - (idea/ info which sender would like to transmit
Encoding - verbal or non verbal method
Receiver - recipient of communication
Decoding - manner of interpretation after receiving messages
Feedback - response of receiving after interpreting messages
D -decision making
E - ethics
Principle:
1. Autonomy - independent judgment & decision making who should decide for care of patient.
a. doc
b. attending pt
c. pt
d. relatives
Pt refuses to remove lucky bracelet before surgery Bt due- Jehovah's witness
a. respect decision of pt - respect cultural diversity
b. refer to doc - let doc explain risks involve
c. let pt sign a waver
Doctrine of assumption or risk
• pt given risks & signed waver
• pt will assume all the risks/ danger
Pills
IUD - string should be checked during & after mens
Diaphragm - removed after 6h Toxic shock syndrome
Vasectomy - after 2 negative sperm count, 1st is probable 2nd is confirmatory
BTL - can do coitus anytime. When pain & bleeding ceases.
Principles in leadership
Veracity - truth don't give false reassurance
- all med prognosis, dx, of baby - given by MD!
Beneficence - doing good to pt
Non malefience - do no harm
3 type of harm
1. Physical - negligence by commission - performed wrong action
negligence by omission - neglect of care
2. Mental - assault - mental threat/ fear
battery - physical harm
3. Moral - slander - verbal
libel - written, published pictures
Tolality - let pt feel like a whole being even if a part is removed.
• offer wigs, bandana - CA pt prosthesis, casts, w/c - amputation
Double effect - if made to choose between 2 evils, choose the one that will have les bad effect. More good effect
Justice of care - priority coz @ pt has unique needs.
Basic char or nursing process
A - acceptance universable
B - based on pts needs
C - client focus
D - dynamic - update nursing process depending on clients needs
E - equitable care
F - familiarity
G - goal oriented toward solving problem
Inviolability of life - respect of life (promote H & prevent disease)
- no abortion!
Conflict - clash of ideas resulting to crisis
Methods to solve conflict.
A - avoidance - putting in one corner - dedma - not good method
S - smoothing - appealing to conscience/ kindness
U - unilateral - force fear, threats correction
N - negotiation - best method - both parties will mutually decide & participate to solve problem.
Nsg management
Mgt - MAN+ TASK = GOAL (pts)
Theories:
1. Human relations theory - must focus on proper relationship
If needs provided to member (rest day, leave)
Achievement of organization
2. Frederick Taylors scientific mgt theory
4 t's
Tao - get rt person/ tao
Training
Tool
Tx
3. Douglas McGregor mgt theory -
Theory Y Theory X
Positive worker Negative worker
- efficient - inefficient
diligent negligent
trustworthy non trustworthy
reliable don't love job
love their job for the money only
= minimal supervision only = increase cases of negligence affecting pts.
= use cozf I d power to discipline workers
4. Max Weber's burocaratic (autocratic) theory
• whoever is on top would perform mgt functions
• centralized
• not good style of management
5. Elton Mayo's behavioral theory
• overtime pay, rest day, day off
• provide physical needs of worker like rest & recreation
• HAWTHORNE'S EFFECT - if worker knows that they are being observed, workers will have better output.
6. Henry Fayol's principles of mgt
a. Unity of command - one person given instructions to workers
b. Unity of direction - whole team should have one goal, objective, direction towards pt.
c. Subordination - personal general interest - pt 1st before self
d. Esprit de corp - team spirit - all (-) & (+) output credited to the group
e. Chain of command - heiarchy of command
Get appropriate orders from MD
f. Channels of communication -
MD orders
SN SN
g. Respondent supervisor - command responsibility
- let master answer for negligence conduct of subordinate
• liable: both
HN liable for damages - due resp supervisor
SN - negligence - jail
h. Security of tenure -
i. Re-numeration of workers - compensation
• probationary - 6 months
• regular employee
Private - RA 4901 - 40% work 8h a day 5 days a week
Gov't - RA 7375 - magna carta for public HWorker 15k
Overtime = + 25%
Night shift differential = +10%
Special non working holiday + 30%
Legal Holiday= X2 +100%
Occupational Hazard - work related disease
Private - SSS - employees compensation
Gov't - GSIS
National health Insurance Act - PhilHealth
• Provide for unemployed/ employed
• Aesthetic, cosmetic, dental not included
Maternity leave - 60 days NSD
78 days C/S
1st 4 pregnancies to legit spouse
Abortions 5th pregnant - & delivered - not entitled to maternity leave
Paternity leave 7 days
Stage/ Steps in nursing management process
P - planning
O - organizing
S - staffing
D - directing/ delegating
Co - coordinating
Co - controlling/ eval
Planning stage - conceptualizing/ product of mind/ looking at future/ looking prospectively
Types:
Vision - what org likes to achieve in future
Ex. Health for all by 2000
Heath in the hands of the people by 2020
Mission - focus in present
- reason why org was established
ex. DOH - to five quality health
Philosophy - values. Besides org (members)
Goal - gen statement of mission
Objective - specific statement of mission
Goal- nursing form St. Lukes should provide quality care to pt
Objective - nursing from St Lukes should have IV training (specific)
Policies - set of rules/ regulation of org
3 types of plan
1.) Short term - for every day ordinary activity
ex. NCP
2.) Contingency plan - for emergency or acute crisis, stand by plan
3.) Long term plan - duration of care is linger for chronic pts. Ex. CVA pts
Budgeting - performed in planning stage
• proper allocation of resources
• Money, manpower, machine
1. Operati0nal budget - cheapest - everyday ordinary activities (gloves, gown, goggles - OR, LR, DR,ER)
2. Personal/ labor budget - used to compensate & re-numerate labor - most important
3. Capital budget - long term use equipment
- MRI equipment, beds
Budget - asks “How”
Organizing stage - answers the question ‘WHO”
Nurse Mgr
RN
Subordinate
Nsg personnel - nurse aid
RN will do: (for stable & unstable pt)
A - assessment
T - health teaching - when best time start discharge
E - explain proc to pt health teaching - start during admission of pt
P - preparation - computation of dosage
A - adm - give meds or treatment
T - treatment - oral, IV, ID
E - evaluation - nursing care plan
J - judgment - PRN meds - nursing will decide when to five
Subordinates can perform: (comfort measures only not VS)
R - routine tasks - standard procedure, monitor I & O ambulating, bathing bed making
• stable pts - predictable outcomes
S - stable pts
S - supervision of RN
Styles/ method delivery care
1. Primary nursing - private duty nurse - from admission to d/c!
D - direct plan of care to pt
A - active participation/ consent of pt.
M - mgt of care - from basic to complex PD will do
24h - from admission t o discharge
tip = answer is primary nurse
2. Functional - most useful type
D - duty task - 1 RN all patients
O - one task
H - highly recommended
RNS budget
3. Case Method - ICU critical case
resp for: T - total care (from basic care to most complex)
O - one RN: 1 patient
In extreme cases 1:2 pts
Staffing stage - “how many”
- nurse manager will determine correct # of patients/ RN
Staffing pattern - Phil - 40h/ wk/ 5d
Traditional - 8h/40h/5d
10h shift - 10h/ 4d Monday - Thursday
On call - emergency schedule
Baylor plan - M - F (traditional)
Sat-Sun (skeletal force)
Directing/ Delegation stage - job/ task is done by another pt for you.
Gen rule: RN can delegate any task to another RN
Except: disciplinary task (this is done by higher person)
: confidential task (charting)
: technical task (expertice should be done by same expert)
: official medical task
Coordinating/ collaboration stage
1. canned food - highest purine content (uric)
2. Anchovies - next highest purine content
1. Interpersonal/ intra departmental - collaboration bet 1 nurse to another nurse -
• under 1 ward
• ex. Endorsement
2. Interdepartmental - collaboration between two or more hosp for benefit of pt.
Why RN needs to collaborate to others in HC team?
- pt is entitled to continuous care.
Evaluation stage - determine whether, plan goal, objective where met or achieved
Types”
1. Nurse rounds - 2 x rounds/ day
• short term plan
Psyche ward - contraindicated nurse rounds in psych ward
2. Checklist - Nurse mgr - evaluates/ rates member
3. Gam H chart - used to evaluate nurses , multiple plan at same time
4. Peer evaluation - co workers - poorest type of eval - cause might be effected by halo effect due to special relationship.
Performance Appraisal - pt or client evaluates most reliable coz ——— or care evaluates.

colchicine on What's the best Nursing Review Center in the Philippines

Sun, 07 Jun 2009 23:53:18 +0800

kung gusto mo talaga na pumasa.punta ka sa gapuz. papasa ka dun. kasi *tooooot*.

yung iba kasi, kailangan mo mag-aral talaga.sa gapuz sagot nalang ibibigay sayo.haha

miming2387 on mongol #1

Sun, 07 Jun 2009 18:11:21 +0800

may nakapass na ba gamit yung mongol #1 sa pag shade?

totoy_bulate on What's the best Nursing Review Center in the Philippines

Sat, 06 Jun 2009 20:25:53 +0800

franz! agree ako dyan!