Understanding Lupus

Systemic lupus erythematosus is a chronic inflammatory autoimmune disorder of the connective tissue affecting multiple organs. It is characterized by recurring remissions and exacerbations which predominantly affecting women.

How it happens?

• Immune dysregulation in the form of autoimmunity 
• B-cell hyperactivity 
• Causing body to produce antibodies against its own cell components 
• Activation of immune response by formed antigen-antibody complexes 
• Production of antibodies against many different tissue components (RBCs, neutrophils, platelets, lymphocytes) or almost any organ or body tissue 
• Widespread degeneration of connective tissue 
• Possible cardiovascular, renal, and neurologic complication 
• Severe bacterial infections

Understanding Lyme Disease

Lyme disease is a multi-systemic disorder caused by Borrelia burgdorferi, a spirochete transmitted through tick bite. This primarily occurs in areas inhabited by small deer ticks (Ixodes dammini). The disease typically manifests in three stages: early localized stage is characterized by a distinctive red rash accompanied by flulike symptoms; early disseminated stage is characterized by neurologic and cardiac abnormalities; and the late stage is characterized by arthritis, chronic neurologic problems.

How it happens? 

• Tick injects spirochete-laden saliva into host’s bloodstream 
• After 3 to 32 days of incubation 
• Spirochetes outward causing characteristic red macule or papule rash (erythema chronicum migrans) 
• Spirochetes disseminate to other skin sites or organs through bloodstream or lymph system 
• Spirochetes may survive for years in joint, or they may trigger inflammatory response in host and die.

Understanding Pulmonary Embolism

Pulmonary embolism is the obstruction of pulmonary arterial bed by dislodged thrombus, heart valve growth, or foreign substance. This is considered as the common pulmonary complication in hospitalized patients, usually fatal with massive embolism.

How does pulmonary embolism happen?

• Blood clot forms in the deep venous system 
• Clot dislodges and travels through the systemic venous system, right chambers of the heart, and into the pulmonary circulation 
• Clot lodges in a branch of the circulatory system 
• Blood flow distal to obstruction is blocked 
• Embolus prevents alveoli from producing enough surfactant to maintain alveolar integrity 
• Alveoli collapse and atelectasis develops 
• Large clot can cause tissue death.

Understanding Hypovolemic Shock

In hypovolemic shock, there is a reduced intravascular blood volume which causes circulatory dysfunction and inadequate tissue perfusion. This requires early recognition and prompt treatment to improve prognosis.

How does this happen?

• Internal or external fluid loss 
• Decreased intravascular fluid volume 
• Diminished venous return 
• Reduced preload (filling pressure) 
• Decreased stroke volume 
• Lowered cardiac output 
• Reduced mean arterial blood pressure 
• Decreased tissue perfusion 
• Reduced oxygen and nutrient delivery to cells 
• Multiple-organ-dysfunction syndrome.

Understanding Heart Failure

Heart failure is a syndrome that occurs when heart can’t pump enough blood to meet the body’s metabolic needs. This results in intravascular and interstitial volume overload and poor tissue perfusion. It may be classified according to side of heart affected, either left-sided or right-sided heart failure, or cardiac cycle involved (systolic or diastolic dysfunction).

How does this happen?

LEFT-SIDED HEART FAILURE

• Ineffective left ventricular contractility 
• Reduced left ventricular pumping ability 
• Decreased cardiac output to body 
• Blood backup into left atrium and lungs 
• Pulmonary congestion, dsypnea, activity intolerance 
• Pulmonary edema and right-sided heart failure.

RIGHT-SIDED HEART FAILURE

• Ineffective right ventricular contractility 
• Reduced right ventricular pumping ability 
• Decreased cardiac output to lungs 
• Blood backup into right atrium and peripheral circulation 
• Weight gain, peripheral edema, engorgement of kidneys and other organs.

Understanding Hyperthyroidism

Hyperthyroidism is a metabolic imbalance which results from overproduction of thyroid hormones. It is also known as thyrotoxicosis. In Grave’s disease, which is its common form, there is an increase of thyroxine (T4) production that causes an enlargement of the thyroid gland (goiter) and multiple system changes. In thyroid storm, which is the acute and sever exacerbation of thyrotoxicosis (which is a medical emergency), possible life-threatening cardiac, hepatic, or renal consequences occur.

How does this happen?

• T-cell lymphocytes become sensitized to thyroid antigens and stimulate B-cell lymphocytes to secrete autoantibodies 
• Thyroid-stimulating antibodies bind and stimulate thyroid-stimulating hormone (TSH) receptors of the thyroid gland 
• The stimulation increases production of thyroid hormone and cell growth

UNDERSTANDING FOLIC ACID DEFICIENCY ANEMIA

This type of anemia is a common and slow progressive megaloblastic anemia which is marked by a production of few, large, and deformed Red Blood Cells. This is prevalent in infants, adolescents, pregnant and lactating females, alcoholics, elderly, and those with malignant or intestinal disease.

How it happens?

• Insufficient folic acid intake of less than 50 mcg/day, or impairment of intestinal absorption
• Depleted body stores in liver à Inhibition of Red Blood Cells 
• Production of few, deformed Red Blood Cells with shortened life span.

UNDERSTANDING CARDIOGENIC SHOCK

Cardiogenic shock is a condition of diminished cardiac output that severely impairs tissue perfusion. Sometimes it is called pump failure.

How it happens? Occurs in two parts:

• Initial insult 
• Decreased myocardial contractility 
• Decreased stroke volume 
• Decreased left ventricular emptying 
• Left ventricular dilation and backup of blood 
• Increased preload 
• Pulmonary congestion

AND...

• Initial insult 
• Decreased myocardial contractility 
• Decreased stroke volume 
• Increased heart rate 
• Decreased coronary artery perfusion and collateral blood flow 
• Myocardial hypoxia 
• Decreased cardiac output 
• Compensation 
• Decompensation and death.

UNDERSTANDING CHRONIC RENAL FAILURE

Chronic renal failure is the usual end result of gradual tissue destruction and loss of renal function. It may also result from the rapid progressing disease of sudden onset that destroys nephrons and causes irreversible kidney damage. There are manifestations of few symptoms from less than ¼ of glomerular filtration remains. This consists of normal parenchyma then deteriorates rapidly then symptoms worsen as renal function decreases. This is very fatal without treatment and only dialysis or kidney transplant can sustain life.

How does this happen?

• Decreasing number of functioning nephrons 
• Increased solute load from each nephrons à Alteration in GFR 
• Reduced renal reserve: GFR of 35% to 50% of normal (No signs of impaired renal function) 
• Renal insufficiency: GFR of 20% to 35% of normal (Possible hypertension, azotemia, and anemia) 
• Renal failure: GFR of 20% to 25% of normal (Uremia, neurologic, cardiovascular, and GI symptoms) 
• End-stage renal failure: GFR less than 20% of normal (Atrophy and fibrosis in renal tubules).

UNDERSTANDING ALS

Are you a Doctor House fan, or perhaps a Gray’s Anatomy fanatic? If you have seen a couple of those movie series, then probably you’ve encountered some of the characters in the movie mentioning ALS. What is ALS? Amyotrophic lateral sclerosis (ALS) is a chronic progressively debilitating disease – also known as Lou Gehrig disease, which is the most common form of motor neuron disease causing muscular atrophy. This usually occurs to ages between 40 and 60, and twice as common in men than in women.

ALS progressively destroys upper and lower neurons including anterior horn cells of the spinal cord, upper motor neurons of the cerebral cortex, and the motor nuclei of the brain.

How does ALS happen?

• ALS may begin when glutamate accumulates to toxic levels at synapses 
• Affected motor units are no longer innervated 
• Progressive degeneration of axons causes loss of myelin 
• Non-functional scar tissue replaces normal neuronal tissue 
• Denervation leads to muscle fiber atrophy and motor neuron degeneration.

Note: Glutamate is the primary excitatory neurotransmitter of central nervous system.

WHAT YOU NEED TO KNOW ABOUT IELTS IN THE PHILIPPINES

How often is the IELTS test conducted? IELTS tests are conducted at least twice or three times a month in Manila and less frequently in other venues according to demand.

How is the test conducted? The test is conducted in two parts: Part (a) Written Test (Listening, Reading and Writing); and Part (b) Speaking Test.

http://farm4.static.flickr.com/3062/2635694952_452ee2f515_m.jpg

The listening, reading and writing (written parts) are held consecutively on the same day. The written parts take about three (3) hours to complete.

The speaking test only takes about 15 minutes but it is an individual test so a test schedule giving an approximate time for the test is prepared to ensure you are at the speaking test venue on time. Speaking Tests may be scheduled any time from five days before to five days after the written parts. The venue for the speaking test may vary from the venue for the written parts of the test but candidates are advised of the correct venue.

Where are the test venues? Tests are conducted regularly in Manila, Cebu, Davao and Baguio and irregularly in Bacolod, Iloilo, Legazpi, Naga, Cagayan de Oro and Zamboanga depending on demand. Currently, tests are held in large hotels or in institutions with large testing areas.

The venue for the test is advised to you at the time of registering (if it is known) and also confirmed by telephone or mail about one week before the test date.

A schedule and venue for the speaking test is given at the time of the written test (unless the speaking test is conducted prior to the written parts in which case the time and venue will be confirmed about one week before the speaking test).

What should you bring to the test? For the written & speaking parts of the test, bring only the valid photo ID you used when registering for the test and 3 pieces of Mongol # 2 or Leone # 2 pencils. Pens and erasers will be provided on the day of the test.

What not to bring to the test. Do not bring cell phones, handbags, any form of electronic equipment including any type of recording device, scanning device or photographic apparatus of any kind to the test. These items are banned from the test venue.

The only item allowed in the test venue is the candidates' valid ID. Hand bags, cell phones, etc. brought to the test venue will not be permitted inside the testing room. IDP takes no responsibility for the safety of any items that are brought to the test venue and must be left outside the testing room by the candidate during the test.

Candidates using or attempting to use any device to record, copy or in any way duplicate test materials or to remove test materials from the test venue will have their test cancelled and the matter will be reported to the proper authorities.

Test Fee is Php 8,640

NOTE: Prices are subject to change without notice. Time schedules and dates are subject to change depending on demand and venue availability. Written tests (Listening, Reading and Writing sections) are administered in the morning (9:00 am - 12:00 nn) of the test date. Speaking tests are scheduled at the discretion of the test centre, in the period of 5 days before or after the written tests. Confirmation of IELTS test venue and schedule: Manila - Candidates will be receiving confirmation letters with the test details including their interview time slots 1 week before their test date. Province - Candidates will receive a telephone call confirming their test details 3 days before their test date. Call office hotline at least 3 days prior to the test date to confirm the venue and time for the written tests if you have not been notified in writing.

UNDERSTANDING PERICARDITIS

Pericarditis is also known as the inflammation of the pericardium. 

In acute pericarditis, the pericardium can be fibrous or effusive with purulent, serous, or hemorrhagic exudates. In chronic pericarditis, it is seen as dense, thick, and fibrous pericardium.

How it happens?

• Bacteria or other substances damage pericardial tissue 
• Bradykinins, histamines, prostaglandins, and serotonin are released into the surrounding tissue, thus commencing the inflammatory process  
• Inflamed pericardial layers rub against each other causing friction
• Histamines and other chemical mediators dilate vessels and increase vessel permeability
• Vessel walls leak fluids and protein into tissue causing extracellular edema 
• Macrophages starts to phagocytise invading bacteria joined by neutrophils and monocytes 
• Area fills with exudates composed of necrotic tissue and dead and dying bacteria, neutrophils, and macrophages
• Pericardial effusion develops if fluid accumulates in pericardial cavity.

14 Deadly NCLEX Test Preparation Time Wasters and Costly Mistakes You Might Be Making

Here are 14 questions you must ask yourself or any test preparation company before you purchase any NCLEX test preparation study guide. Use the following criteria before selecting a test preparation company, test preparation class, seminar company, book, or online guides.

What makes the company qualified to produce NCLEX test preparation books or software? Did the author take the NCLEX exam? What is his/her professional background? Is s/he a professional writer hired by a large corporation to make a safe, but unfortunately generic study guide?

How many people have really passed the NCLEX exam after using the company's NCLEX test preparation materials? Does the company publish that information?

This is something you must know! Too many NCLEX test preparation companies, especially online NCLEX test preparation companies, put so much into marketing they
forget there are real people out there who have a lot on the line and need to pass their NCLEX exam.

You need real statistics so that you can select the most appropriate NCLEX test preparation materials for your needs.

Does the company keep its NCLEX review course materials up to date and current for the latest exam?

http://farm5.static.flickr.com/4140/4906011803_80a410f20f_m.jpg

Some organizations use the same NCLEX test preparation guide from years ago even though the emphasis and design of the test has recently changed. Even the large corporate NCLEX study guides can be several years out of date.

It can take a long time to do the updates, manufacture, and then distribute newer books. Often the stores need to sell the old versions that are still in stock before ordering the latest edition.

Is there any help with strategies to overcome NCLEX test anxiety and instructions to rid yourself of test stress?

As you know, some people get so nervous and worried about the NCLEX exam that it actually hurts their ability to prepare and retain information. At test time they may "blank out" or have trouble focusing, and thus make foolish mistakes. Any good NCLEX test preparation guide must teach you how to handle test stress and anxiety.

Does the test preparation system have NCLEX practice questions?

Practice questions are a vital part of preparing you for the real exam. You should get NCLEX study guides that have practice test questions that are as close to the real NCLEX questions as possible.

If the study guide has NCLEX practice questions, how do the writers have intimate knowledge of your exam?

Do the writers actually follow the domains of the NCLEX exam closely or just provide a general guide on the subject? Do they interview NCLEX test takers who can provide insights into the exam and its content?

Does the NCLEX test preparation company publish pass rates -- or do they keep them a secret, claiming, "We are the number one review center, we are the leader, and we have the secrets?"

Think twice before taking the next step.

How To Increase Your NCLEX Test-Taking Peak Performance Mind Set Success by 200%

Every challenge you face, whether it's a nuclear physics exam or the one hundred meter final at the Olympic Games, is a test of what's in your head. An exam will test both the knowledge and skill that you hold, and your ability to get that knowledge out of your brain and into action.

If your mind isn't in tip-top condition when you step into the exam room, you're not going to get the results you deserve.

You create the future in advance by what you think about all day. You must convince yourself even if you don't believe it at first you'll pass. If you don't believe you'll pass

http://farm4.static.flickr.com/3314/3296924961_8dc88aeb07_m.jpg

chances are you won't. This is where an NCLEX test coach can help keep you motivated and focused on success.

Here's three ways to make sure your mind is programmed for success when you need it most on the NCLEX:

Know the Material. Go Backwards - Clearly, if you know your stuff, the NCLEX exam is always going to be easier than if you guess all the way through it. But to be really at your best, it's not enough to know a bunch of facts. You want to be able to step inside the head of the NCLEX test creators to understand their methods and testing theories. Then, you'll "out think" their NCLEX test questions.

As you look at old NCLEX tests, ask yourself why the examiners choose those particular questions, why they asked them in that way and what they're trying to test. Things that have been on the NCLEX in previous exams will be on your exam in a different form because it is a standardized test. That's how, with research and examinee interviews, the NCLEX Comprehensive Success System was developed and has been so successful.

Every exam has a goal. The goal of a driving test is to make sure that you can drive safely. The goal of a math test is to make sure that you've absorbed the calculation methods. The goal of an English test is to make sure that you understand grammar and punctuation.

Understand the goal of your exam and you're halfway to cracking the code of the NCLEX.

Have an NCLEX Exam Plan - When you understand the goal of your NCLEX test, you can study with that goal in mind. When you've finished revising, you can put together a plan to see you through the exam. That plan should be simple -- but it should be something you stick to! It could be something like: don't spend more than 2 or 3 minutes per question; you can't go back and change any answers, so do your best on each one as it comes; and if you are really stumped, don't dwell on it. Give it your best guess within a minute.

Having a plan in hand to crack the exam will help you to succeed on the test and make the NCLEX less scary.

Keep Your Eyes On The Prize - The NCLEX examiners have a reason for creating the exam the way they do, but you have a reason for taking it. You want to advance your career as soon as possible. The NCLEX exam is simply an obstacle that stands between you and your destination.

Understand that the NCLEX test is not "the" thing -- and that there are many things a great deal bigger -- and you'll put it into perspective. The NCLEX exam will start to look
small enough for your mind to tackle with one good whack.

SECRET FORMULA TO YOUR NCLEX

HERE'S HOW IT WORKS:

Knock out the stupid answers. Many multiple choice questions on the NCLEX have at least one wild-card answer that looks nothing like any of the others and couldn't be right in a hundred years. Anyone that's a bit familiar with the content of the exam won't choose it. Cross that one out first.

Knock out the answer that's "almost" right. Examiners know that some people will look at the question, have a quick think and look for the answer that's in the ball-park. That's why they include an answer choice that's only half-right. Half-right is WRONG and it's a "trick" answer put in to fool you. Find that answer and cross it out next.

http://farm3.static.flickr.com/2178/1561320157_626a74618b_m.jpg

Spot two answers that look similar. By now, your options should include two choices that look very similar. One of those answers is right. The other is almost-right.

This is the real trick to multiple choice questions on the NCLEX test: every right answer has a wrong answer that looks almost exactly like it. If the answer you're thinking about
choosing doesn't have a partner like this, it's probably wrong. When you spot two answers that look very similar, one of them is likely to be the right one.

When you've got these two answer choices in hand, you've got a 50 percent chance of picking the right one. And that's already a good start. This doubles your probability of
getting the correct answer and a passing NCLEX score even if you're not 100% prepared or know all the answers.

Determine in advance how much time to spend each day studying. Do this by taking into account your work or school schedule, family commitments, etc.

Now is not the time for a lot of "extracurricular" activities like going camping, seeing movies, or going shopping. Save these for the after-exam celebration.

You need to allocate at least two hours per day of study time, but based on your self-analysis and how much time you have before the test, you may need to do more.

Once you have a daily time allotted, pick a fixed study time each day and stick to it. This isn't always possible, but the more consistent your study is, the more effective it'll be.

Have a specific place to study. A dedicated study area helps keep you organized and puts your mind in "study mode" because you associate the location with the specific task of studying. You'll get more done and your study time will be more effective.

Now you're ready to really hit it. Then, I tell you HOW TO REALLY HIT IT Hard!

LIST OF TASKS TO MAKE IT IN YOUR NCLEX

Here's how you do it:

Make a To Do List - First, make a list of all the things you have to do. Put down everything, even the things you're going to do anyway (like cleaning your bedroom or doing the laundry).

Prioritize Your Work - Rearrange your tasks in level of importance so that the important things are at the top and the least important ones are at the bottom. (Avoid procrastination.)

Rearrange Your List – This will be interesting. Reorder your list so that the job in first place looks important, but isn't. Make it the kind of job that you have to do some time, but it doesn't really matter when (a job you can put off easily
without getting into trouble).

When you procrastinate and avoid doing that important-looking job, what you end up doing will be a more important one.

For example, your list of tasks for today might look something like this: Review NCLEX study guide section 2; Take NCLEX practice test on Chapter 3 content; Read through notes; Check email

http://farm4.static.flickr.com/3015/3249224756_356ef2cc5b_m.jpg

But what if your list of tasks looked like this: Read through notes; Check email; Review NCLEX study guide section 2; Take NCLEX practice test on Chapter 3 content.

LOOSE SCHEDULE?

Here's how you do it:
Write out a List of Everything You Think You Have to Do. Put everything on this list, from reviewing last week’s NCLEX practice test to putting out the cat. What are the odds that you'll keep to that schedule at the end of the day?

Putting all the things you need to remember on paper rather than trying to carry it around in your head can help you drop half of your test stress and anxiety. You'll probably sleep a lot better at night and worry a lot less about forgetting important things you have to do tomorrow.

Highlight the Three Most Important Things On the List. Now cut your schedule down to a realistic size and complexity. Now follow the previous lesson about procrastination to list the three most important tasks that you want completed by the end of the day and ignore everything else. Decide what tasks that are 1/4 of the items on your list that will give you 3/4 of the results you're looking to achieve. Don't confuse movement with achievement. You need to focus on the results you want to achieve for the day, not a bunch of activities.

Make A New Schedule. Now create a brand new schedule that only has those three tasks on it (or 1/4 of the activities that give you 3/4 of the results that are most important to you -- like passing the NCLEX).

You may say that you have a lot more than three things to do! Yes you do, but you must choose the top three things that, if completed today, would move you closest to your goal of doing well on the NCLEX exam. This strategy has tremendous power of focus that will yield the greatest progress towards your goal of a great NCLEX score.

Your schedule won't have more than three things on it: At 8:00am, review part 2 of the NCLEX study guide. At 9:00pm, review anatomy index cards. At 10:00pm, do the practice questions in the NCLEX Comprehensive Success System.

Obviously, you're going to do a lot more than those three things. You're also going to look at your emails, watch CNN, make yourself some tea and have lunch. Maybe even call your dad.

Complete 100% of Each Activity Before Moving to the Next. Make sure you do activity number one first thing (before reading the news, checking your e-mail, etc.) and see it to 100% completion before starting on activity two. Do activity two to 100% completion before starting activity three.

You're going to do those things no matter what else happens. Whether the kitchen is cleaned today won't have much impact on you in one year, but passing the NCLEX will. Only the truly important things, like reviewing part 2 of the NCLEX study guide, need to be put on your schedule.

Work in Blocks of Uninterrupted Time. Turn off your phone and put a do not disturb sign on your door. Communicate to others that during certain blocks of time, you can't be disturbed. You absolutely need uninterrupted time to fully concentrate on the task at hand when you're doing your top 3 items for the day.

Every time a phone is answered, or a person comes in to chat, it wastes a lot of time. Then it takes even more time to get back to where you were. This destroys your productivity and jeopardizes your success.

Remember our discussion of procrastination? Even if you do procrastinate, you'll simply find yourself doing the NCLEX practice test in the morning in order to avoid reviewing Chapter 2 of the NCLEX study guide, or working on a practice test in the afternoon when there's nothing left to do.

You can start today, and tomorrow guarantee that you will pass.

CRITICAL CARE NURSING

Critical care nursing is described as the care of seriously ill clients from point of injury or illness until discharge from intensive care. It deals with human responses to life threatening problems such as trauma or major surgery. There are comprehensive, specialized and individualized nursing care services which are rendered to patients, with life threatening conditions and their families.

A critical care nurse is the primarily the one who cares for clients who are very ill. He provides a direct one-on-one care and is responsible for making life-and-death decision at high risk of injury or illness from possible exposure to infections. Being a critical care nurse, communication skill is of optimal importance

http://farm3.static.flickr.com/2291/2022794357_3eee5486b5_m.jpg

The roles of a critical care nurse – a care provider; educator; manager; and an advocate.

Critically ill clients are the ones that are at high risk for actual or potential life- threatening health problems. They are more ill comparing to other patients which required more intensive and careful nursing care.

CLASSIFICATION OF CRITICAL CARE CLIENTS

They are classified into different levels namely: LEVEL 1- normal ward care; LEVEL 2: at risk of deteriorating, support from critical care team; LEVEL 3: more observation or intervention, single failing organ or post operative care; and LEVEL 4: advanced respiratory support or basic respiratory support, multi-organ failure.

PRINCIPLES OF CRITICAL CARE

Continuous monitoring and treatment; high intensity therapies and interventions; expert surveillance and efficiency; alert to early manifestation of other organ failure; and recognition of parameters denoting progress or deteriorating.

GOALS OF CRITICAL CARE

Towards the survival of the critical ill patients and restoring quality of life; restoring optimal physiological, psychological, social and spiritual potential; helping the families of the critically ill patients in coping with crises.

Sympathetic Nervous System vs. Parasympathetic Nervous System

Sympathetic nervous system promotes a "fight or flight" response, corresponds with arousal and energy generation, and inhibits digestion. It diverts blood flow away from the gastro-intestinal (GI) tract and skin via vasoconstriction.

Blood flow to the skeletal muscles and the lungs is not only maintained, but enhanced (by as much as 1200% in the case of skeletal muscles).

Bronchioles of the lung dilate, which allows for greater alveolar oxygen exchange.

Heart rate and the contractility of cardiac cells (myocytes) increases, thereby providing a mechanism for the enhanced blood flow to skeletal muscles.

This dilates pupils and relaxes the lens, allowing more light to enter the eye. And can provide vasodilation for the coronary vessels of the heart.

http://farm3.static.flickr.com/2072/2252443224_64e5b31591_m.jpg

Generally it inhibits peristalsis.


Parasympathetic nervous system promotes a "rest and digest" response, promotes calming of the nerves return to regular function, and enhances digestion.

Blood vessels leading to the GI tract are dilated thus increasing blood flow. This is important following the consumption of food, due to the greater metabolic demands placed on the body by the gut.

The parasympathetic nervous system can also constrict the bronchiolar diameter when the need for oxygen has diminished.

Dedicated cardiac branches of the vagus nerve and thoracic spinal accessory nerve impart parasympathetic control of the heart or myocardium.

During accommodation, the parasympathetic nervous system causes constriction of the pupil and lens.

The parasympathetic nervous system stimulates salivary gland secretion, and accelerates peristalsis. In keeping with the rest and digestive functions, appropriate PNS activity mediates digestion of food and indirectly, the absorption of nutrients.

It is also involved in erection of genitals, via the specific pelvic nerves.

NANDA

HEALTH PERCEPTION – HEALTH MANAGEMENT PATTERN

Health maintenance ineffective
Therapeutic regimen: effective management
Therapeutic regimen: ineffective management
Therapeutic regimen: Family, ineffective management
Therapeutic regimen: Community, ineffective management
Noncompliance (specify)
Health-seeking behaviors (specify)
Energy Field disturbance
Environmental interpretation syndrome, impaired
Latex allergy response
Latex allergy response, risk for
Falls, risk for
Infection, risk for
Injury (trauma), risk for
Protection, ineffective
Poisoning, risk for
Suffocation, risk for
Surgical recovery, delayed
Perioperative positioning injury, risk for


NUTRITIONAL-METABOLIC PATTERN


Nutrition: more than body requirements, imbalanced
Nutrition: more than body requirements, risk for imbalanced
Nutrition: less than body requirements, imbalanced
Breastfeeding, ineffective
Breastfeeding, effective
Breastfeeding, interrupted
Infant feeding pattern, ineffective
Aspiration, risk for
Swallowing, impaired
Nausea
Oral mucous membrane, impaired
Dentition, impaired
Fluid volume imbalance, risk for
Fluid volume, risk for deficient
Fluid volume deficient
Fluid volume excess
Skin integrity, impaired
Skin integrity, risk for impaired
Tissue integrity (specify type), impaired
Body temperature, risk for imbalanced
Thermoregulation, ineffective
Hyperthermia
Hypothermia
Failure to thrive, Adult


ELIMINATION PATTERN

Constipation

Constipation, risk for

Constipation, perceived

Diarrhea

Bowel incontinence

Urinary elimination, alteration

Urinary incontinence, functional

Urinary incontinence, reflex

Urinary incontinence, stress

Urinary incontinence, urge

Urinary urge incontinence, risk for

Incontinence, total

Urinary retention

ACTIVITY-EXERCISE PATTERN

Activity intolerance, risk for

Activity intolerance (specify level)

Aspiration, risk for

Adaptive capacity, decreased, intracranial

Infant behavior, disorganized

Infant behavior, risk for disorganized

Infant behavior, readiness for enhanced organized

Fatigue

Physical mobility, impaired

Bed mobility, impaired

Walking, impaired

Wheelchair mobility, impaired

Wheelchair transfer ability, impaired

Development, risk for delayed

Dysreflexia

Autonomic dysreflexia, risk for

Disuse syndrome, risk for

Self-care deficit (specify: bathing/hygiene, dressing/grooming, feeding, toileting)

Diversional activity deficient

Home maintenance, impaired

Dysfunctional Ventilatory Weaning Response

Ventilation, impaired spontaneous

Airway clearance, ineffective

Breathing pattern, ineffective

Gas exchange, impaired

Cardiac output, decreased

Tissue perfusion, alteration (specify)

Peripheral neurovascular dysfunction, risk for

Perioperative positioning injury, risk for

Growth and development, delayed

Growth, risk for disproportionate

Wandering

SLEEP-REST PATTERN

Sleep-pattern disturbance

Sleep deprivation

COGNITIVE-PERCEPTUAL PATTERN

Pain, acute

Chronic pain

Sensory perception, disturbed (specify)

Unilateral neglect

Knowledge deficit (specify)

Memory, impaired

Thought processes, disturbed

Acute confusion

Chronic confusion

Decisional conflict (specify)

SELF-PERCEPTION-SELF-CONCEPT PATTERN

Fear

Anxiety

Anxiety, death

Hopelessness

Powerlessness

Powerlessness, risk for

Loneliness, risk for

Self-esteem disturbed

Chronic low self-esteem

Situational low self-esteem

Risk for self-esteem situational low

Body image disturbance

Personal identity disturbance

ROLE-RELATIONSHIP PATTERN

Anticipatory grieving

Dysfunctional grieving

Chronic sorrow

Role performance, ineffective

Social isolation

Impaired social interaction

Relocation stress syndrome

Risk for relocation stress syndrome

Family processes, interrupted

Dysfunctional family processes: alcoholism

Risk for impaired parenting

Impaired parenting

Risk for impaired parent/infant/child attachment

Parental role conflict

Caregiver role strain

Impaired verbal communication

Risk for violence, directed at self

Risk for violence, directed at others

SEXUALITY-REPRODUCTIVE

Sexual dysfunction

Ineffective sexuality patterns

Rape Trauma syndrome

Rape-Trauma syndrome: compound reaction

Rape-Trauma syndrome: silent reaction

COPING-STRESS TOLERANCE PATTERN

Ineffective coping

Defensive coping

Community coping, ineffective

Community coping, readiness for enhanced

Ineffective denial

Impaired adjustment

Post-Trauma syndrome

Risk for post-trauma syndrome

Family coping: readiness for enhanced

Ineffective family coping: compromised

Ineffective family coping: disabling

Risk for violence, directed at self

Risk for violence, directed at others

Risk for suicide

Self-mutilation

Risk for self-mutilation

VALUE-BELIEF PATTERN

Spiritual distress

Risk for spiritual distress

Spiritual Well-Being, readiness for enhanced

UNDERSTANDING RHABDOMYOLYSIS

Rhabdomyolysis is characterized by the breakdown of muscle fibers. There is a good prognosis of rhabdomyolysis if the contributing causes are alleviated or the disease is treated before damage becomes irreversible. If this is unchecked, it can cause renal failure.

How does it happen?

• Direct injury to muscle fibers (sarcolemma) 
• Increased intracellular sodium ion concentration 
• Enhanced enzyme activity and interaction between actin and myosin 
• Further muscle damage 
• Leakage of myoglobin, potassium, and creatine kinase into the bloodstream 
• Myoglobin trapped in renal capillaries or tubule 
• Acute renal failure.

A leakage of myoglobin may alter kidney filtration.

POWER WORDS FOR YOUR RESUME

Use power words to communicate your abilities and accomplishments. A catchy delivery keeps these achievement-oriented words do the campaigning for you. It is important to choose words of substance and power that increase level of appearance.

http://farm4.static.flickr.com/3099/2787715668_027a5f6a3c_m.jpg

Follow and check these words that work in the field of nursing or any health-related profession.

Advanced; advised; aided; arbitrated; assisted; attended; augmented; backed; balanced; boosted; braced; clarified; collaborated; comforted; consoled; consulted; contributed; counseled; demonstrated; diagnosed; encouraged; expedited; facilitated; familiarized; fostered; furthered; guided; helped; instilled; liaised; mentored; ministered; negotiated; nourished; nursed; nurtured; obliged; optimized; promoted; provided; reassured; reclaimed; rectified; redeemed; re-educated; referred; reformed; rehabilitated; repaired; represented; served; settled; supplied; supported; stabilized; streamlined; translated; treated; tutored; unified

Avoid using the same power word twice on your resume.

Press F7 if you are using Microsoft Word Office. The thesaurus will help you process more words which can give you more possibilities.

S.M.A.R.T. GOALS

http://farm4.static.flickr.com/3507/3876552794_4127a9fc86_m.jpg

S is for specific; M is for measurable; A is for attainable; R is for realistic; and T is for Time-bound.

A specific goal has a much greater chance of being accomplished than a general goal. To set a specific goal you must answer the six "W" questions: Who is involved? What do I want to accomplish? Where will I set it? When will it be? Identify requirements and constraints. Have specific reasons, purpose or benefits of accomplishing the goal. For instance, a general goal would be, "To lose weight." But it is more specific to say, "Hit the gym and workout 4 days a week."

To be measurable establishes concrete criteria for measuring progress toward the attainment of each goal you set. When you measure your progress, you stay on track, reach your target dates, and experience the exhilaration of achievement that spurs you on to continued effort required to reach your goal. To determine if your goal is measurable, ask questions such as “How much? How many? How will I know when it is accomplished?

To be attainable is when you identify goals that are most important to you, you begin to figure out ways you can make them come true. You develop the attitudes, abilities, skills, and financial capacity to reach them. You begin seeing previously overlooked opportunities to bring yourself closer to the achievement of your goals.

You can attain most any goal you set when you plan your steps wisely and establish a time frame that allows you to carry out those steps. Goals that may have seemed far away and out of reach eventually move closer and become attainable, not because your goals shrink, but because you grow and expand to match them. When you list your goals you build your self-image. You see yourself as worthy of these goals, and develop the traits and personality that allow you to possess them.

To be realistic, a goal must represent an objective toward which you are both to work. A goal can be both high and realistic; you are the only one who can decide just how high your goal should be. But be sure that every goal represents substantial progress. A high goal is frequently easier to reach than a low one because a low goal exerts low motivational force. Some of the hardest jobs you ever accomplished actually seem easy simply because they were a labor of love.

Your goal is probably realistic if you truly that it can be accomplished. Additional ways to know if your goal is realistic is to determine if you have accomplished anything similar in the past or ask yourself what conditions would have to exist to accomplish this goal.

Time-bound should be grounded within a time period. With no time period tied to it there's no sense of importance and motivation. If you want to lose weight, when do you want to lose it by? "If only" won't work. However, if you put it within a time period, then you've set your subconscious mind into action to begin working on the goal.

FATHERS IN THE DELIVERY ROOM

In a survey taken by The Royal College of Midwives, 38% of women said they would rather have someone else besides their husband in the delivery room with them. One in six mothers claimed dads got in the way, while four in ten dads admitted they felt unwanted during the birth.

http://farm4.static.flickr.com/3010/3040375362_00ca16f11d_m.jpg

Lots of dads wouldn’t dream of not being there but find that when they are actually in the room they panic in a sort way. If you were the first time dad, what would you do? Some dads are scared but consider how she feels. It isn’t much to ask for you to stand by her side. You can do that literally, just stay by her head if you get grossed out easily and are worried about fainting. It is important is to pay attention to what she wants. Some women want to be left alone during labor. If that is the case then leave her alone. Communicate with her and let her know you are there for her if she needs anything.

Here are a couple of list on what you can do to stay busy and to help her:
For some women the most important thing is to hold her hand so she knows she’s not alone; give her words of encouragement and support. Tell that she’s amazing, or she’s doing a great job, or say in front of her that she’s strong; show her love. Tell her the three words I love you, or you’re so beautiful. Remind her why she is in this pain by saying we are going to be parents soon, or you’re going to be a great mom; get her a cold rag and wipe her forehead; feed her ice chips; massage her feet or hands; bring a CD player and be her DJ. Making her a CD of her favorites would be nice; take pictures - be the photographer; get her gifts before she goes into labor and give it to her. This will distract the pain and make her really happy. A flower or necklace would be nice.

What not to do is to never, and I mean never tell her not to yell. Leave that to the nurses. Let her hate them for it. If a TV is in the room, don’t turn it on unless she asks for it. Don’t get in the way of the nurses or doctor. Don’t bring food in the room. She won’t be able to eat so don’t tease her.

Making a decision about whether or not to attend the birth of your child is a personal one that should be made prior to labor pains. Men should discuss their feelings with their partner and both should choose the best option that will suit them both.

If you think you cannot see yourself being present for the birth of the baby, consider a couple of choices. You can arrange for someone to be the labor partner if your partner allows it. You can also choose to be present just for the labor or perhaps just for the birth. You can also come in directly after the baby is born. And after the difficult part, you can celebrate with the mom and the newborn.

FINDINGS IN PHYSICAL ASSESSMENT

Before doing anything else, perform a general survey. Try to observe your patient’s general appearance and behavior. As a nurse you must be familiar with a normal finding vs. an abnormal finding.

Assess for his vital signs – temperature, pulse (rate and rhythm), respirations (rate, pattern, depth). Remember, neonates and adults have different range of vital signs as to what is mentioned above. Check also your patient’s blood pressure.

When checking the nutritional status, take note of his height and weight. The ideal body weight of men is 106 lb for the first 5ft; add 6 lb per inch subsequently. In women, 100 lb for the first 5 ft, then add 5 lb per inch. Consider adding 10% for patients with larger frame but do the opposite for those with smaller frames.

If you are assessing the skin, check pallor on buccal mucosa or conjunctivae, cyanosis on nail beds or oral mucosa, jaundice on sclera. Check for signs of scars, bruises, and lesions. Check around the eyes and sacrum for edema, moisture, or hydration. It is also important to assess for the skin’s temperature, texture, and turgor (check over sternum for the elderly).

If you are looking at his hair, does he have hirsutism (excessive hair), alopecia (loss or thinning of hair)? Note down what you see.

http://farm1.static.flickr.com/134/393504897_59eaabbd62_m.jpg

Look at his nails. Nails can indicate respiratory and nutritional status. Assess the nail’s colour, shape, and contour (normal angle of nail bed is ≤ 160°; a clubbing nail bed angle is ≥180° due to prolonged decreased oxygenation). Check also the nail’s texture and thickness, and capillary refill.

Patient’s head size, shape, and symmetry should be normal. Look for the temporal arteries then check his cranial nerve function.

Does his eye have ptosis (drooping of upper eyelid)? Assess for the colour of the sclera and conjunctivae. His pupils’ size, shape, equality, reactivity to light and accommodation (PERRLA) should be normal. Does he have photophobia, nystagmus, and strabismus? Check for the corneal reflex, visual fields, visual acuity. When performing an ophthalmoscope exam, check for any red reflex. Observe the fundus, optic disk for blind spot, and the macula.

When you are in the ear area do the Weber test and the Rinne test. Check also his tympanic membrane. Pull the pinna up and back to examine children’s and adults’ ears. Pull pinna down and back to examine infants’ and young children’s ears.

The nose and sinuses are assessed for the septum midline. Look on the nose’s alignment, colour, or any discharge. Palpate and percuss sinuses.

http://farm1.static.flickr.com/114/308412308_0fa3c40534_m.jpg

The mouth and pharynx are assessed particularly on the oral mucosa, teeth, tongue, hard and soft palate, uvula and its midline, tonsils, gag reflex, swallow, and taste.

The neck is assessed for its range of motion of cervical spine, nontender cervical lymph nodes which are normal in less than 1 cm round, soft, and mobile. It is also assessed for the treacheal position, thyroid gland, carotid arteries, and jugular veins.

The thorax and lungs area are checked for the alignment of spine, anteroposterior to transverse diameter of the thorax, respiratory excursion, respirations, tactile fremitus, and diaphragmatic excursion. Breath sounds is noted. Normal breath sounds can be checked via vesicular, bronchovesicular, and bronchial. Adventitious breath sounds occurs as rales, ronchi, wheezes, or pleural friction rub. The area of assessment is also tested for its vocal resonance. Bronchophony, egophony, and whispered pectoriloquy are tested out. The costovertebral angle is examined by percussing.

When checking for the heart sounds you must be familiar with the different kinds of abnormal sounds. Write down what you hear from the diaphragm.

Continue the assessment in the peripheral vascular system. Check for pulses from all the different areas: radial, ulnar, femoral, carotid, pedal, porterior tibial, popliteal, temporal, and apical. It is necessary to observe for any Homan’s sign which is a test for thrombophlebitis which shows pain in the calf when dorsiflexing the foot.

Breasts and axillae are assessed for its size, shape, and symmetry. Locate if there are palpable nodes which indicated abnormality. If the breasts are enlarged in males it is called gynecomastia.

When assessing the abdominal area, make sure your patient‘s knees are flexed to relax the abdominal muscles and provide comfort. Inspect and auscultate, then percuss and palpate. Check for its symmetry and contour. Look over the umbilical area and note everything you observe. Note down bowel sounds and it should be in 5 to 20 intervals of gurgles. The aortic, renal, iliac, and femoral arteries are auscultated with the bell of the stethoscope. Check for any peritoneal friction rubs, rebound tenderness, and abdominal reflexes.

The neurological system is assessed for deep tendon reflexes, cerebral function, mental status, cranial nerve function, motor function and sensory function.

The musculoskeletal system is assessed for the muscle tone and strength, and joint movements.

Provide privacy when assessing the genitalia and use firm but deliberate touch. Note down all the necessary observations.

APGAR SCORE

In 1952, Dr. Virginia Apgar, an anesthesiologist, devised the Apgar score to quickly and summarily assess the health of a newborn immediately after birth. The development of the score was originally to ascertain the effects of obstetric anesthesia on babies.
The Apgar score is determined by evaluating the newborn baby on five simple criteria on a scale from zero to two, then summing up the five obtained values. The resulting Apgar score ranges from zero to 10. The five criteria are Appearance, Pulse, Grimace, Activity, and Respiration.

http://farm5.static.flickr.com/4034/4348196017_ca5a35eb29_m.jpg

The test is generally done at one and five minutes after birth, and may be repeated later if the score is and remains low. Scores 3 and below are mainly regarded as critically low, 4 to 6 moderately low, and 7 to 10 generally normal.


A low score on the one-minute test may show that the neonate requires immediate medical attention but is not necessarily an indication that there will be long-term problems, particularly if there is an improvement by the stage of the five-minute test. There is a risk that the child will suffer longer-term neurological damage if the Apgar score remains below 3 at later times such as 10, 15, or 30 minutes,. There could be a small significant increase risk of cerebral palsy. The purpose of the Apgar test is to determine quickly whether a newborn needs immediate medical care. This was not designed to make a long-term prediction on a child's health.


An Apgar score of 10 is not common because of the prevalence of transient cyanosis, and is not substantially different from an Apgar score of 9. Transient cyanosis is common, particularly in babies born at high altitude.


A study was conducted in Peru by comparing babies born near sea level with babies born at very high altitude approximately 4340 meters found a significant difference in the first but not the second Apgar score. Oxygen saturation was also lower at high altitude.