TECHNIQUES USED IN PHYSICAL ASSESSMENT

In general assessment, there are four ways to perform the physical assessment namely: inspection, palpation, percussion, and auscultation; however, in abdominal assessment the order is inspection, auscultation, percussion, and then palpation.

When performing visual examination (inspection) you start with an interaction to your client or patient. Provide and maintain good lighting in your assessment area. Determine the size, shape, colour, texture, symmetry, and position.

In touching (palpation) maintain warm hands and approach slowly and proceed systematically. Try to use your fingertips for fine touch when you’re looking for pulses or nodes. If you touch your patient for finding his temperature use you the dorsum (back) of your fingers. The palm or ulnar edge of your hand is for detecting vibrations. Start with light palpations before deep palpations. In bimanual palpations (both hands) this is preferably for deep palpation and to assess movable structure such as the kidney. Place you hand lightly on the skin surface then place active hand over sensing hand and apply pressure. When you are palpating for ballottement, push fluid-filled tissue toward palpating hand so object floats against fingertips. Palpation is also used for determining masses, pulsation, organ size, tenderness or pain, swelling, tissue fullness and elasticity, vibration, crepitus, temperature, texture, and moisture.

Percussion is the tapping on the body part to produce sound or vibration. The types of percussions are direct, indirect, and blunt. When doing a direct approach strike the body surface using one or two fingers. Indirect approach is by striking with finger or hand over body surface. While the blunt approach uses reflex hammer to check deep tendon reflexes. Use blunt percussion with fist to assess costovertebral angle tenderness. There are also some types of sounds produced by direct or indirect approach. The types of sounds produced are resonance, hyperresonance, tympany, dull, and flat. The resonance sound is a moderate to loud, low-pitched similar to a clear and hollow sound of moderate duration usually associated with air-filled tissue in the lungs. The hyperresonance is a loud, booming, low-pitched sound of longer duration found with overinflated air-filled tissue usually associated with pulmonary emphysema; however this is normal in children due to thin chest wall. The tympany sound is a loud, drumlike, high-pitched or musical sound of moderately long duration found with enclosed air-filled structures associated in the bowel. The dull sound is a soft, muffled, moderate to high-pitched sound of short duration found in dense fluid-filled tissue such as the liver. The flat sound is very soft, high-pitched sound duration found with very dense tissue like the bone and muscle. In percussion, it is important to determine the location, size, density of masses. You should consider the pain in area up to depth of 3-5 cm and always perform after inspection and palpation except for abdominal assessment.

http://farm4.static.flickr.com/3362/4627358644_b5022191e1_m.jpg

When listening to sounds (auscultation), some equipment is involved. Use the diaphragm to listen to high-pitched sounds like listening to the lung, bowel, or heart. Place firmly against skin surface to form tight seal. Use the bell to listen to soft, low-pitched sounds like heart murmurs. Place lightly on the skin surface. It is best to listen over bare skin and not through clothing. Moisten body hair to prevent crackling sounds.

WHAT YOU NEED IN PREPARATION FOR PHYSICAL ASSESSMENT

http://farm3.static.flickr.com/2513/3768688016_0be306355d_m.jpg

First things first, you have to gather all your equipments necessary for physical assessment. Here are some common items that you may need for physical assessment: ophthalmoscope, tuning fork, thermometer, penlight, gloves, tape measure or ruler, snellen eye chart, cotton swabs tongue depressor, safety pin, balance scale, nasal speculum, and vaginal speculum. When you have all your equipment go to your client or patient and provide him his privacy. How? Well, just bring him in a quiet and well-lit environment. Before you do anything else begin explaining your procedures to your client until he understands everything. If your guy is feeling stupor or very much unconscious, you don’t have to explain anything and begin a series of physical assessment.

Ask your guy to empty his bladder. This is to promote his comfort zone. Drape your client for privacy. As you begin your physical assessment be very sharp with your observations and try to compare what you see on his side of the body with the other side and compare with normal.

While you are doing your physical assessment skills, make use of teaching opportunities on dental care, eye exams, and self exam of breasts if the client is a she and for the testicles if your client is a he. Use appropriate piece of equipment for the entire physical assessment, then return your tools on the equipment tray.

PHYSICAL ASSESSMENT

http://farm6.static.flickr.com/5088/5265455547_f7e3a102e9_m.jpg

The purpose of physical assessment is to assess client’s health status. You may have to gain a keen eye similarly to that of a Sherlock Holmes so to speak. As you perform this series of task you may already have the built-in questions in your mind and you should know what you are doing. Remember, the variable that you are working with is a person and not a thing and that is why you have to be extra careful with whatever you are going to do. Another purpose when doing a physical assessment is to interpret the client’s physical data. It can be written in a narrative form, in a graph, in a chart, or in a checklist, or whatever that is used that suits you in your working area, however it must also be in accord with the policy of your institution. But why do you need a physical data? Well, that’s easy, it is for records. And this is to be interpreted very well and very professionally. This is where you set your big question: “is he sick or not sick?” and when you found out that he is sick the next purpose of physical assessment comes in – decide on the interventions basing from the data collected. As the nurse, you finally put things in place and plan your way ahead and your very main goal is to fix your subject regain back his health. Of course the rate of success won’t happen in a blink of an eye. Time will be your friend and both of you will work things out right.

HOLY DAYS AND PRAYER

The Orthodox Jews begin their Sabbath before sundown Friday and ends after sundown Saturday. During Sabbath, work of any kind is prohibited including driving a car, using the phone, handling money, and even pushing an elevator button. The highest law demands that one must do everything to save a life. If someone cannot do something because of Sabbath, other alternative ways of accomplishing desired goal can be found. Times of prayer is important, therefore it is important to arrange a schedule with the client beforehand.

http://farm6.static.flickr.com/5137/5552801988_7d6a0a0ded_m.jpg

For Roman Catholics, Sunday is considered a day of obligation and requires attendance to Mass. When hospitalized, they are not required to fulfil this obligation.

In Islam, Holy days of worship extends from sunset on Thursday to sunset Friday. Some Muslims pray to Allah five times a day. Ramadan is 30 days of fasting from sun up to sundown to honour the prophet Muhammad. When praying, one must face Mecca. The patient’s bed or chair may be positioned in the Southeast direction.

RITUALS ON BIRTH, ON THE DYING, AND ON DEATH

Here are more trivial facts listed for you.

Circumcision is performed by a Jewish “Mohel” 8 days after birth during a religious ceremony with spiritual leaders present. While the Americans, which circumcision is done right after birth.

A dead Roman Catholic client is anointed with holy oil. Shrouding is not done until sacraments are performed. Prayers are offered at the time of death. Burial, cremation and autopsy are permitted.

http://farm1.static.flickr.com/165/359381330_1631e6fcb0_m.jpg

In Judaism, when death occurs, touching the body is not allowed for 8 to 30 minutes, and the body should be buried in 24 hours. A 7 day period of mourning called “Shiva” begins on the day of the funeral. At the home of the deceased, mirrors are covered, and waters should be emptied from standing containers. It is also avoided by looking at one’s grieving reflection. In Orthodox Jews, no autopsy or cremation is allowed, and all body parts are to be returned to the casket for burial whether if it is an appendix, finger, or uterus. Suicide is also forbidden. Flowers are not allowed at the grave instead stones are left.

The Hindus use Holy water to pour it in the mouth of the dying person. A Hindu priest is called at the time of death and may tie a thread around the neck or waist as a blessing. The eldest son arranges for the funeral and cremation within 24 hours. The family washes the body ready for cremation. Embalming is very much forbidden.

Muslim relatives and friend are present at death. Organ donation is not permitted. Men wash the body of the man, and women wash the body of the woman. Body is always positioned facing Mecca. And autopsy and cremation are forbidden.

Asians may invite mourners to the bedside to cry over the dead.

Hispanics may photograph the dead during wake and funeral.

Americans display strong denial and fear of death.

RELIGIOUS SYMBOLS

If the patient is wearing anything that looks unusual, may be jewelry, skin markings or tattoos, ear or tongue piercings, and any unusual objects, all of these needs to be assessed for religious or cultural practices. It will be helpful to note if these fall within the confines of his culture. Ask first!

Muslims wear a “taviz” – a black string with words of the Koran. It is best not to remove or get it wet.

http://farm2.static.flickr.com/1251/542761993_3cbb9214f2_m.jpg

Hindus wear many sacred threads or bangles.

Mexican children wear bits of red ribbons for luck and protection.

Roman Catholics wear or hold the Rosary beads or medallions.

Mediterranean individuals wear special charms on a chain.

Native Americans may carry medicine bundles.

THE HAIR

We are not going to talk about hair styling or hair stylists. In this part of transcultural nursing, I present you some trivial facts concerning about some patients and their hair. A patient’s hair may be as important as gold for him. Now check these out:

Muslim women cover their hair at all times.

http://farm3.static.flickr.com/2602/4134593322_280c8de9ed_m.jpg

Greeks link their body hair to manhood and virility.

In Sikh religion, cutting or shaving of any body hair is forbidden.

Orthodox Jewish women expose their hair only in private. Wigs are worn to cover hair in public. Men wear long side burns in curls and do not shave until they are married.

A Native American child's hair is a sign of health. Cutting or shaving the child’s hair brings bad omen. It is believed that it can bring sickness and death to the child.

HOW OTHER CULTURES PERCEIVE HEALTH AND ILLNESS

The Native Americans have a harmonious relationship with nature and the universe. Having a link with nature promotes good health, whereas illness is believed to be a cause from supernatural beings or a result from a witchcraft or black magic. Healers make potions for healing. They are very keen in using herbs to promote physical healing.

http://farm1.static.flickr.com/21/25466002_c9929d29d1_m.jpg

Europeans and Americans use scientific approach to provide physical proof as to how illness occurs. Proofs come in the form of germs (virus, bacteria, fungi, parasites), and to some sophisticated machineries which can provide physical evidence such as the use of genetics. Healing is given in by pills or medical surgery.

African Americans believe in supernatural forces of GOD and disharmony in relationships. Healing comes through prayer, mediation, wearing of talismans believing to ward off evil-causing-illness, and using of herbs.

Hispanics view illness as a punishment from GOD for man making acts of sin, or a result of the evil eye (mal de ojo). Healing involves a native healer (curendera) and the use of herbal potions.

Asians believe that the balance of yin and yang brings natural health, and when an imbalance occurs between the two forces this will cause an unwanted illness. Many healing comes in the form of acupuncture, herbs, cupping and burning – done by drawing blood to the surface of the skin when a warmed cup is placed on the skin. This cupping and burning technique often leaves a bruise. To them, this is also believed to draw out evil and illness in order to restore balance of the yin and yang.

FOOD AND DIETARY HABITS

Orthodox Jews prefer the kosher diet; however the diet is optional for Conservative, Reform and Reconstructive Jews. This diet contains no dairy and meat. Kosher foods are specially prepared and approved by religious inspectors. Consuming pork, predatory fowl or shellfish is forbidden. However, dairy and meat dishes may not be mixed such as cheeseburger, but a hamburger is considered. Some hospitals have kosher cafeteria that provides food for the Jews.

http://farm4.static.flickr.com/3377/3455167464_f04814b6a6_m.jpg

Roman Catholics fasts on Ash Wednesdays, Good Fridays, and on Fridays during Lent. They abstain from consuming meat.

Hindus forbid eating meat.

Muslims forbid pork and alcohol. They consider pork to be an unholy dish. They use their right hand for eating and they utilize their left hand for urinating and defecating. The nurse should offer medications to the right hand to avoid offending the individual. During the Ramadan, Muslims fast from sunrise until sunset therefore medications are to be given prior to fasting.

PERSONAL PRIVACY CONCERNING BODY COVERING

http://farm1.static.flickr.com/76/229054675_47abde58c7_m.jpg

Persons of orthodox faith like Christians, Jews, and Muslims are generally more concerned about modesty than non-orthodox people. The area between the waist and the knees is extremely sensitive for most persons, thus it is recommended in hospital policy or in any clinics that same gender nurses and physicians are observed. Examinations below the waist should be approached cautiously and with explanations regarding the necessity. Try to keep genitals covered or draped whenever possible. The patient involve may have same gender parent or preferably the mother present for examinations of children unless sexual abuses are suspected. Between Orthodox Jewish men and women, they avoid touching one another. They show modesty even in presence of the same gender.

Mormons attaining adult religious status wear the garment – short sleeved, long underwear that ends just above the knee. Considering this as sacred and always worn except when taking a bath or cleansing one’s body parts.

Middle Easterners value females for their purity and modesty. Each family honor is based on this considering as the highest value. Gender segregation is observed for female patients as for female nurses and male patients as for male nurses.

Muslims obey same gender housekeepers, nurses, and doctors. Some Islamic women prefer to be clothed from head to ankle. For female patients wearing whole body garments, the nurse should undress one body part at a time.

INTIMACY AND SPACE

Asians require touch with appropriate permission. In similar gender, it is acceptable to touch one another but not between opposite gender in public.

Arabians consider personal space and touch between the same gender, parent, and child. Holding hands and arm to arm should be between same genders only, and there is very limited touch between opposite gender in public.

Men kissing men on the parts of the face is common to Italian culture. This is even done in public since this type of intimacy suggests acceptance, friendship, and affection.

http://farm2.static.flickr.com/1172/4731874275_0862913926_m.jpg

Africans signify the act of touching as a form of familiarity. Most often this is protected and held back until relationship and rapport develops.

Americans and Europeans consider close physical space and touch as a sign of intimacy. The use of touch is very common between women and public signs of affection between a man and a woman, such as kissing, is very much accepted.

RELIGIONS’ RESTRICTIONS AND CONSENT CONCERNING MEDICAL TREATMENT

http://farm4.static.flickr.com/3564/3518127437_5b80783998_m.jpg

Roman Catholics forbid the use of birth control such as fertility treatments using artificial means of insemination or fertilization. The religion restricts abortion, tubal ligation, vasectomy, and they say no to contraception.

Christian Science believes in prayer and readings of Mary Baker Eddie invoking healing. It is in their doctrine that medical interventions are not tolerated.

The Jehovah’s Witness limit the source of accepting medical intervention. It is forbidden to them the use of blood transfusion and abortion.

Orthodox Jews forbid organ donation. Autopsy is also forbidden because they believe that tampering with the dead body will cause sorrow for the soul not entering heaven. In such cases of these problems develop to forensic teams which delay their research findings for legal proceedings and for evidence.

TRANSCULTURAL NURSING

http://farm4.static.flickr.com/3502/4036891004_dac188c495_m.jpg

Transcultural nursing doesn’t really imply that you are required to know everything about every cultures or cultural groups to work with. However, it does mean that you should be aware about necessary factors such as person’s country of origin, his main preferred language, his religion his age, method of communication, his view on health, what type food he prefers, about his family and community relationships.

A fine nurse learns all these by asking appropriate questions. Come to think of it the nurse’s main objective is to deliver more efficient care while improving the response to client treatment.

In the world of transcultural nursing, there are a lot of aspects to culture and spirituality always comes in hand. One among many knacks to learn is how your client or patient views appointments or schedules. How is he oriented to time? Americans are very punctual when it comes to scheduled events. African Americans are oriented to the “NOW” aspect. They prefer not to be specific when it comes to time. The Native Americans are not used to clocks that they live one day most at a time. Hispanics and Germans are very much approximate in enjoying rest periods. Asians pay absolute respect for the past and how it influences their present time.

When it comes to communication you can learn how to read people and tell from where they grew up. The Americans are very used to firm handshakes when greeting someone. They demonstrate direct eye contact which expresses self confidence, interest and honesty. American and European women are inclined to facilitate communication with questions while men are more direct and affirmative. The Hispanics dramatize the way they communicate by using body language to express feelings and emotions. Their common gestures are with the use of their hands. Disagreement and passing of judgment is not very much openly expressed by Asians, and they value silence pretty much. Extreme eye contact is considered rude and touching is not always giving positive caring demonstration, particularly in touching the patient’s head without any permission. No eye contact is a respect common to Native Americans. The Middle Eastern folks consider direct eye contact between a man and a woman to be a sexual enticement. To avoid any wrong impressions its best to avoid direct eye contact to the opposite sex.

Gestures connote different meaning in different cultural setting. Motioning someone to come may indicate a different meaning. A lack of response may mean a yes or a no to someone. Refusal to touch may mean a basis for privacy. To avoid imprecise and doubtful impressions the best way is to be simple, clear and specific, and do not use colloquial speech which may cause confusion. Always follow up with questions to determine his understanding. Ask questions and let them demonstrate to ensure proper understanding. In some instances when there are language barriers, do not use family members or client’s friends to interpret for him. The usual are inclined to give their own thoughts, observations, or feelings which may not be connected to the case of the client. In cases like these, call for a neutral interpreter. And while you continue your care the universal sign for caring is to smile.

LITTLE KNOWN WAYS TO PREVENT BACK PAIN

I KNOW THE TOUGH FEELING OF SOMEONE HAVING A BACK PAIN. A BACK PAIN CAN STOP YOU FROM DOING WHAT YOU LOVE – IT MAY AS BE PLAYING BASKETBALL OR BASEBALL OR ANY KIND SPORTS GAME. SOME TIMES YOU GET TO STAY HOME MORE OFTEN BECAUSE OF THIS SILLY BACK PAIN! BACK PAIN, PACK PAIN, BACK PAIN!!! GOSH! YOU MUST BE COMPLAINING A LOT WITH THIS BACK PAIN OF YOURS. DON’T JUST SIT THERE. CALLSOMEONE WHO CAN HELP YOU GET RID OR THAT BACK PAIN. TAKE IN SOME PILL BUT SOMETIMES PILLS WON’T WORK.

http://farm4.static.flickr.com/3018/2530501831_f6e47fabd3_m.jpg

HERE ARE SOME TIPS TO PREVENT BACK PAIN. THIS LESSON IS FOR YOU.

DON'TS IN PREVENTING BACK PAIN FOLLOWED BY DO’S TO PREVENT BACK PAIN:
1. DON’T SLEEP ON YOUR STOMACH (PRONE POSITION)

INSTEAD, SLEEP ON THE SIDE (LEFT OR RIGHT LATERAL POSITION)

2.DON’T SLEEP ON A SOFT MATTRESS WITH A BENDABLE BED BOTTOM

INSTEAD, SLEEP ON A MATTRESS THAT IS NOT VARY SOFT WITH A HARD BASE UNDERNEATH IT

3.DON’T LIFT YOUR UPPER BODY ABRUPTLY WHILE KEEPING
YOUR LEGS STRAIGHT IN SEQUENCE TO GETTING UP FROM BED

INSTEAD, ROLL TO THE EDGE OF THE BED AND SET THE LEGS OUT BEFORE RISING UP

4.DON’T REACH UP TO GET AN OBJECT LOCATED FAR ABOVE YOUR HEAD

INSTEAD, STEP ON A STOOL TO REACH AN OBJECT LOCATED UP HIGH

5.DON’T BEND YOUR WAIST TO PICK UP A HEAVY WEIGHT

INSTEAD, BEND THE KNEES FIRST BEFORE YOU PICK UP A HEAVY WEIGHT

6.DON’T CARRY A HEAVY OBJECT FAR FROM THE BODY

INSTEAD, CARRY A HEAVY OBJECT CLOSE TO THE BODY (THE CLOSER THE BETTER)

7.DON’T CARRY A LOT OF WEIGHT USING ONE ARM

INSTEAD, DISTRIBUTE THE WEIGHT IN BOTH OF YOUR ARMS

8.DON’T TRY TO PUSH A HEAVY OBJECT WHILE FACING IT

INSTEAD,PUSH A HEAVY OBJECT BY USING YOUR BACK

9.DON’T SIT WITH YOUR SPINE SLANTING FORWARD

INSTEAD, SIT WITH YOUR STRAIGHT BACK AND BOTH FEET ON THE GROUND

10.DON’T SIT ON A COUCH THAT IS TOO SOFT OR DON’T SIT WITHOUT BENDING YOUR KNEES

INSTEAD, SIT ON A COUCH WITH GOOD BACK SUPPORT AND REST YOUR ARMS ON THE SIDES


NOW YOU KNOW. LESSON LEARNED. NO MORE BACK PAINS FOR YOU.

HOW DO CRANIAL NERVES WORK?

THE CRANIAL NERVES 

CRANIAL NERVE    NAME OF CRANIAL           NERVE CRANIAL NERVE FUNCTION

I                                  OLFACTORY                       SERVES FOR SMELLING

II                                 OPTIC                                   PURPOSE IS FOR VISUAL ACUITY

III                               OCULOMOTOR                   CONTROL OF EYE MOVEMENT

IV                               TROCHLEAR                        CONTROL OF EYE MOVEMENT

V                                TRIGEMINAL                        USED  IN FACIAL SENSITIVITY

VI                               ABDUCENS                           CONTROL OF EYE MOVEMENT

VII                              FACIAL                                 CONTROLS FACIAL MUSCLES VIII                            ACOUSTIC                           FOR HEARING AND BALANCE

IX                              GLOSSOPHARYNGEAL      CONTROLS PHARYNGEAL MUSCLES

X                               VAGUS                                  HEART,BREATHING, DIGESTIVE

XI                              ACCESSORY                        CONTROLS MUSCLE  OF NECK

XII                            HYPOGLOSSAL                    TONGUE MOVEMENTS

THERE ARE 12 CRANIAL NERVES HAVING THEIR NUCLEUS OF ORIGIN OR OF DESTINATION IN THE BRAIN AND THAT EMANATES DIRECTLY FROM THE BRAIN OR THE BRAINSTEM. THESE NERVES ARE CALLED CRANIAL NERVES TO ASSOCIATE THEM AS THE NERVES OF THE BRAIN. THEY COME OUT FROM EACH SIDE OF THE BRAIN, AND, EVENTHOUGH EACH ONE HAS A NAME, THEY ARE EACH DESIGNATED WITH A NUMBER  ( A ROMAN NUMERAL) FROM 1 TO 12 ( I TO XII). THESE NERVES ARE VERY SIGNIFICANT WHEREAS THEY PICK UP IMPULSES TO THE BRAIN WHERE IT IS INTERPRETED INSTANTLY FOR INSTANCES ARE THE ACOUSTIC NERVE WHICH HELPS IN BRINGING IMPULSES OF HEARING UP TO THE BRAIN AND THE BRAIN TELLS YOU WHAT YOU HEAR. SOME OF THE NERVES CONTROL MUSCLE MOVEMENTS WHICH ARE IMPORTANT FOR PHYSICAL ACTIVITY.

OUR DAILY ACTIVITES RELAY EVERYTHING ON THE CRANIAL NERVES BECAUSE WITHOUT THEM WE ARE VEGETABLES. THE CRANIAL NERVE HYPOGLOSSAL IS IN CHARGE OF THE TONGUE MOVEMENT, WITHOUT THIS TYPE OF CRANIAL NERVE WE WOULD BE HAVING DIFFICULTY IN SWALLOWING OUR FOOD. WE WOULD NOT ENJOY EATING OUR FAVORITE DINER IF WE HAVE PROBLEMS IN THE AREA OF THIS TYPE OF CRANIAL NERVE. EVEN AN EENIE MINNIE PROBLEM IN THE AREA OF ANY CRANIAL NERVE WOULD RESULT OF AN UNDESIRABLE EFFECT INTO OUR SYSTEM.

THE SCIENCE BEHIND FORENSIC NURSING: AUTOPSY

Autopsy

·         Searching for the possible cause of death. Its reports give supports to crime knowledge and possible crime tool investigation and crime prevention.

Factors in estimating time of death: rigor mortis (muscle stiffening); algor mortis (body temp); livor mortis (post mortem lividity); vitreous (eye) potassium; stomach contents; environmental factors.

http://farm4.static.flickr.com/3483/3255973184_c25fc1fe12_m.jpg

Signs of body decomposition

1.    Aseptic breakdown of body tissues (autolysis)

2.    Brain is liquefied

3.    Breakdown due to bacteria (putrefaction): greenish color of lower abdominal quadrant is the first sign to appear; greenish-black color of face and neck; swelling; protruding eyes and tongue; purge fluid

4.    Decomposition occurs faster after in hot weather after 24 hours

5.    fats will undergo fatty acid transformation (adipocere)

6.    Hair will slip from the scalp

7.    Marbling (reaction of hemoglobin and hydrogen sulfide). Skin turns from green to black.

8.    Skeletonization can occur  in  a week or in years

Medico-Legal deaths

A.    Accidents

B.    Bodies for cremation

C.   Death associated to employment

D.    Death link to therapeutic and/or diagnostic procedure

E.     Death under custody

F.    Homicides

G.   Poisoning

H.   Possible threat to public health

I.      Sudden unexpected deaths or  medically unexplained deaths

J.    Suicides

K.    Suspicious deaths

L.    Unattended deaths

M.   Unclaimed cadavers

N.   Unlawful termination of pregnancy

Forensic Autopsy

Main objectives are to:

1.    establish the cause and manner of death: Accident; Homicidal; Natural; Suicidal

2.    identify deceased if unknown of death or injury

3.    R.I.P. of evidence

4.    document  injuries

5.    reconstruct and interpret how the injuries occurred. Note: the scene and the clothing are included.

Hospital Autopsy

1.    Cause of death

2.    Extent of the disease

3.    Prognosis

THE SCIENCE BEHIND FORENSIC NURSING

FORENSICS

http://farm5.static.flickr.com/4047/4296030498_a9e1c3b2f6_m.jpg

·         Solving crimes relating to the application of series of systematic approach to come up with questions from crime and use it for proceedings.  

Wounds that are incised for suicide victims may refer to the following:

 There is a trial or tentative cut; the characteristic of self infliction is repetition; the usual site is throat and/or wrist; the usually grouped incisions are paralleled; homicidal cut throat is lacking tentative cuts and is severe; homicidal cut throat is usually multiple and irregular; for suicidal cut throat the left side of the neck has a deeper incision for right-handed people and vice versa for left-handed people; most suicidal stabbings do not involve the clothing.

Forensic medical evaluation tools

1.    Weber and Milz Technique (Speed of stabs) Males: 6.14 m/s on dominant hand and 5.27 m/s on non-dominant hand. Females: 4.16 m/s on dominant hand and 3.68 m/s on non-dominant hand. The number of stabs shows some correlation with the gender of the doer. Accordingly there are fewer stab wounds done by females than in homicides that were committed by males. Some inflict a singular stab to their victim and usually if the victim is a male.

2.    Karlsson: Women who killed men usually inflicted 2-9 stabs. Singular stabs occur mostly in sequence of arguments among men under the influence of liquor or other sources of intoxications. The common anatomical distribution of wounds is located at the neck and thorax.

3.    Bajanowski: Wounds and/or injuries are located at the front left side of the trunk in half of the cases. All of the wounds appear to be fatal.

4.    Hunt and Cowling: The common stab wounds found in both sexes are on the neck and chest; the number and location of stab wounds do not conclude the gender of the perpetrator; 15 % of a more than 50 stab wounds are found in the precordial region; 69 % of the cases, wounds and/or injuries are located on the precordial region; 60 % of all cases stabs appear that the stab wounds on the chest decreased in inverse proportion to the total number of stab.

Defense Injuries: these specify evidence of infliction by the perpetrator and ascertain that the victim was conscious and able to defend against an assault to a certain point.

A.   Active defense injuries: often found on the thumb, index finger and related metacarpal regions and near the intermetacarpal space. E.g., Attempts to grab the weapon or the attacker’s weapon-holding hand.

B.   Passive defense injuries are located on the outer portions of the forearms and the back of the hands. E.g., These occur when the victim raises the hands or arms for protection.

Dominant Description of defense injuries: cuts on the hands; increasing number of injuries on the body; stab wounds of the trunk; minor superficial bleeding; most of the blood accumulates in the thoracic and abdominal cavity; traces of blood on clothes from closed injuries.

Common causes of death from wounds and/or injuries: massive bleeding; aspiration of blood; air embolism.

Less frequent cause of death: cardiac tamponade; failure of central regulatory processes.

AT THE CGFNS EXAM CENTER

Plan to arrive at your Exam Center at the time your Exam Permit indicates. If you are late, regardless of the reason, you will not be admitted to the exam. By not admitting latecomers, we avoid disrupting the exam in progress and give everyone the same amount of time to take the exam.

Family and friends are not permitted in the exam room, nor are books, papers, cameras, calculators, tape recorders, cellular phones or pagers. Wear comfortable clothes and do not bring valuable items or large amounts of money to the exam. You will be given two special pencils to use, but you should bring your own eraser and pencil sharpener.

You also may bring your lunch, so you can be sure you will be back from the lunch break in time. You will not be allowed to eat or drink while the exam is in session.
When you arrive, CGFNS exam staff will ask you to sign your name on a register. Bring a passport and official government issued identification that includes your photograph.

In the exam room, please follow exactly the instructions that CGFNS staff members give you. The exam personnel and you must follow certain rules about seating arrangements and behavior during the exam. For example, staff will assign you a seat that you may not change; a staff member must accompany you if you have to leave the room; and you may not talk during the exam. No exceptions will be made to the rules. During the exam, CGFNS staff members observe all of the test takers to make sure everyone follows these instructions.

Only applicants who are officially scheduled by the authority of the CGFNS Headquarters are authorized to take the exam. Scores obtained and applications submitted by unscheduled individuals will be invalid, null and void. Re-application for a future exam and the corresponding fee will need to be submitted.

http://farm4.static.flickr.com/3064/2519465662_e2e7d8a805.jpg

WHAT TO DO ON YOUR CGFNS EXAM SCHEDULE

The exam schedule includes morning and afternoon sessions, plus a lunch break. The day will begin with morning registration, followed by Part I of the nursing exam, which contains 150 questions. Then there will be a lunch break and afternoon registration, followed by Part II of the exam which contains 110 questions. Before each part of the exam, a CGFNS staff member will give you an exam booklet containing instructions and questions. The instructions will be read aloud in English, while you read silently. The CGFNS exam supervisor will tell you when to begin working on the exam and when you must stop.
Passing The Exam
The passing score for the CGFNS Qualifying Examination is set at 400 out of 800 items in the examination.
Others
To access your exam schedule (“roster”) information, you must:
• Go to the official CGFNS web site, www.cgfns.org
• On the first web page, locate the link “ON-LINE EXAM SCHEDULE INFORMATION,” and click on this link
• In the new window, enter your permanent CGFNS identification number
• In the “Select CGFNS CP Exam Date” drop-down box, select an exam date
• Click on the button labeled “SUBMIT”
• Your exam schedule information will be displayed. you may print this page for your records. If you are not scheduled (“rostered”) for that exam, you will be advised.
On the day of the exam, you will simply need to go to the location of your exam at the appointed time. It will no longer be necessary for you to wait for your admission permit to arrive in the mail, or to present your admission permit to CGFNS staff on the day of the exam. You must take at least one (1) form of official, government-issued photo identification (such as your passport) with you to the exam location. You will not be admitted to the exam without proper identification.
Examples of acceptable identification:
• Passport
• Professional Regulation Commission ID card
• Nursing license (if it contains your photograph)
• United States state driver’s license (not an International Drivers Permit)
Changing Exam Date or Location, Your Name or Address or Cancellation of Application
If you need to change your scheduled exam center or exam date or desires to cancel your application, CGFNS should be informed no later than 10 weeks before the exam you requested. Request should be done in writing, signed or on-line. E-mail requests for change of date, location, or name and address will not be accepted at any time. In your letter requesting any of these changes, remember to include your CGFNS ID Number and birth date.

http://farm4.static.flickr.com/3389/3194662301_e5263122a5.jpg

Nursing Resume Sample

Reverse chronological format (Healthcare professional seeks advancement.)


STEPHEN JUDE, R.N.
50011 Wide Boulevard, St. Lukes, Minn 55101
Residence: 333-777-4343 Cell: 333-444-1111 Email:nursejude@hotmail.com
____________________________________________________________________________________
PROFILE: Dedicated Nurse R.N. with over 10 years’ medical experience providing superior clinical care to broad-based patient populations. Skilled leader and team-member, able to maintain positive attitude and productive work environment. Strong interpersonal, administrative and patient/family education skills. Demonstrated ability to establish trust, emote genuine patient caring, and manage crisis situations. Highly organized and able to efficiently prioritize multiple tasks. Able to lift 100lbs.

PROFESSIONAL EXPERIENCE
Charge Nurse/Clinical Nurse
Med-Surg/Renal Unit, Medical Care Center, St. Lukes, Minn (dates)
• Provide specialized care for renal patients on 32-bed unit on human dialysis floor. Rotate as charge nurse, overseeing staff members (LPNs, NAs, Nurse Extenders, and Unit Secretaries)and participating in team/unit meetings.
• Conduct patient assessments, and develop, implement, and evaluate individuaized care plans. Provide appropriate care and achieve patient outcomes by combining patient involvement and education into totaol care plan. Adjust treatment plan as needed.
• Perform technical aspects of hemodialysis, assessing and documenting response to therapy. Administer medications, monitor patient progress, develop discharge plans, provide health and nutrition educations, and maintain charts and documentation.
• Key team member of unit study project to assess quality of patient care. Analyzed 12 months of patient records to review care, treatment plan, and outcome. Drafted revised policies to improve care and ensure best practices.
Staff Nurse/Charge Nurse
Medical Specialty Unit, Oakdale Rehabilitation Hospital, Oakland, Minn. (dates)
• On 28-bed subacute care unit, rotated as charge nurse. Scheduled and supervised stuff.
• Provided primary nursing care and educated patients and family. Assessed patients; developed and implemented treatment plans. Performed variety of procedures and treatments including paritometrial dialysis, ventilator care, central lines and IV therapy.
• Administered medications and monitored patient response. Maintained charts and worked with other healthcare professionals to provide total quality care.

Charge Nurse
Valley Court Convalescent Center, Ashville, Minn (dates)
• Oversaw all phases of night shift clinical care on 46-bed specialized care unit. Scheduled and supervised LPNs and Nursing Assistants.

EDUCATION (dates)
B.S.,Nursing, College of St. Peters, School of Nursing, St. Lukes, Minn.

NURSING TIPS: CGFNS Exam Schedule Confirmation Sample

NURSING TIPS: CGFNS Exam Schedule Confirmation Sample: "CGFNS Exam Schedule Confirmation ... From: 'NO-REPLY@cgfns.org' ... Add to Contacts To: stephenjuded@yahoo.com ___________________________..."

CGFNS Exam Schedule Confirmation Sample

CGFNS Exam Schedule Confirmation
...
From: "NO-REPLY@cgfns.org"
...
Add to Contacts
To: stephenjuded@yahoo.com
________________________________________
Dear Stephen Dugyon,

This email is your official receipt. We suggest you print this page for your records.

You are scheduled for the CGFNS Qualifying Exam as shown below:

Exam: CGFNS Qualifying Exam, March 7-11, 2011
Schedule : 03/09/2011 10:00 AM
Test Taker Authorization Code: rcdzfa
CGFNS Order Number: 1454111

HOST
Location:
AMA Computer University
Maximina St. Villa Arca Subdivision, Project 8
Quezon City, N/A 1100
Philippines

Free parking is available inside the campus in front of AMA Computer Center building.

The CGFNS Qualifying Exam takes approximately three hours to complete. Please plan your travel accordingly. If you need a visa to travel to the exam center, apply to the proper authority early enough to have your papers before your departure for the exam.

Please plan to arrive at the exam center at least 15 minutes prior to your scheduled exam. If you are late, you will not be admitted to the exam.

Provide the proctor with the Test Taker Authorization Code listed above. Please note: You must bring your Test Taker Authorization Code or the proctor will not be able to load your examination.

Family and friends are not permitted in the exam center, nor are books, papers, cameras, calculators, tape recorders, mobile phones or pagers. Please do not bring valuable items or large amounts of money to the exam center. Eating or drinking will not be allowed while the exam is in session.

When you arrive, exam center staff will ask you to sign in. Bring two forms of identification, one of which is a passport or official government-issued identification that includes your photograph.

In the exam room, please follow exactly the instructions that are given to you. Rules regarding seating and behavior during the exam must be followed. For example, you will be assigned to a testing station that you may not change, a staff member must accompany you if you leave the room and you may not talk during the exam. No exceptions to the rules will be made. Exam center staff will observe test takers during the exam to make certain instructions are followed.

To access the Webassessor system, use the following link: www.webassessor.com/cgfns

Sincerely,
CGFNS International

3 WAYS YOU CAN CONTACT CGFNS INTERNATIONAL

Mailing address: 3600 Market Street, Suite 400,
Philadelphia, Pennsylvania
19104-2665 USA

Phone: +1 (215) 222 8454


Website: www.cgfns.org

http://farm3.static.flickr.com/2060/1865482908_20b890274b.jpg

English Language Proficiency

ENGLISH LANGUAGE PROFICIENCY
Applicants may select one of the following four English proficiency examinations to take as part of the Certification Program:
 Test of English as a Foreign Language (TOEFL), administered by the Educational Testing Service (ETS). Passing Score: 540 (paper/pencil version) or 207 (computerized version)

 Test of English as a Foreign Language (TOEFL) iBT (internet Based Testing), administered by the Educational Testing Service (ETS). Passing Score: 83

 Test of English for International Communication (TOEIC), administered by the Educational Testing Service (ETS). Passing Score: 725

 International English Language Testing System (IELTS), administered by the Cambridge ESOL Examinations, the British Council and IDP Education Australia. Passing Score: 6.5 Overall (Academic Module)

Applicants must take and pass an approved English language proficiency examination within two years of passing the CGFNS International Qualifying Exam. The testing organizations must forward your English language exam scores directly to CGFNS International.
For applicants to be exempt from the English proficiency requirement, they must meet ALL of the following criteria:
 country of nursing education was in the United Kingdom (England, Wales, Northern Ireland and Scotland), Australia, Canada (all provinces, in Quebec the only approved schools are McGill University and Dawson College in Montreal, Vanier College in St Laurent, John Abbot College in Sainte-Anne de-Bellevue, and Heritage College in Gatineau), South Africa, New Zealand, Ireland, Trinidad/Tobago, Jamaica, Barbados or the United States.

CGFNS

CERTIFICATION PROGRAM (CP)

For an eligibility review:

1. Complete and sign the Certification Program Application Form. (Forms are downloaded from www.cgfns.org)
2. Pay via bank check or international money order (drawn on a U.S. bank in U.S. funds) made payable to CGFNS International, or credit card payment (Visa, Mastercard, or Discover), for the full Certification Program application fee in U.S. dollars. DO NOT SEND CASH OR PERSONAL CHECK.
3. Documentation of your secondary school (high school) education or external exam certificate with literal English translations, including a Certificate of Accuracy (if not in English).
4. Completed Request for Validation of Registration/License form from your initial and current licensing agency where you have held registration/licensure as a first-level general nurse; or, in cases where your diploma authorizes legal practice, have this form mailed to CGFNS International from the institution that issued your diploma.*
5. Completed Request for Academic Records form and full academic transcripts from your school of nursing.*
6. One passport-size photograph, sign its front and back.
7. Certified English translation to all documents not in English. CGFNS International will accept translations of documents submitted (such as transcripts and validations) only from the issuing authorities. If a translation of your documents can not be furnished, CGFNS International can provide an official translation of each document for an additional fee.

 Note: Some licensing/registration authorities and schools of nursing may charge a fee for verifying your license(s)/registration(s) and transcript(s). You are responsible for any additional fees associated with processing your Certification Program application.

CGFNS International is unable to accept any transcript or licensure documentation sent by email or fax. All official documentation must be in hard copy format with the appropriate seals and sent to CGFNS International by the issuing agency using mail or courier