BON Nursing Advisory (DR, OR & Cord Care Cases)

TO: DEANS OF COLLEGES OF NURSING
SUBJECT: INTRA-PARTAL , INTRA-OPERATIVE, AND IMMEDIATE CARE OF THE NEWBON REQUIREMENTS IN THE FILING OF APPLICATION FOR THE NURSE LICENSURE EXAMINATION
DATE: JANUARY 30, 2008

It has come to the attention of the PRC Board of Nursing that some Nursing Colleges have reduced the required number of “intra-partal, intra-operative, and immediate care of the newborn” (D.R. / O.R. / Cord Care) from five (5) to three(3) cases causing confusion especially among nursing students.

The BOARD wishes to reiterate to all concerned that in accordance with its quasi-legislative function (Article III, Section 9 (c), (d) and (h), it is still in the process of HEARING the outputs from the Association of Deans of Philippine Colleges of Nursing (ADPCN) based on commitments duly made during the last ADPCN Convention of October 2008 and therefore has not announced any changes in the prevailing requirement of cases for the intra-partal, intraoperative and immediate care of the newborn.

This BOARD wishes to FURTHER EMPHASIZE, that it adheres to a NO RETROACTIVE APPLICATION OF ANY NEW POLICY, therefore if and when new promulgations are finally issued this will never be applied to “graduating students”.

And that FINALLY, this BOARD envisions that all related policy-changes that will be announced shall be in effect for those who will enrol for their intra-partal, intra-operative, and immediate care of the newborn clinical experiences in June of 2009.

In view hereof, all Deans and faculty-members of Colleges of Nursing, and all concerned professional nurses ARE HEREBY DIRECTED to follow the PREVAILING PRESCRIPTIONS of five cases each with regards to O.R., D.R., and Cord Care requirements for the filing of applications to the 2009-2010 Nurse Licensure Examinations (NLE). Nursing graduates of 2011 and 2012, meaning those enrolling in their 2nd and 3rd Academic Year shall be those who shall be affected by the new policy promulgations.

PLEASE BE GUIDED ACCORDINGLY.

Download the file here BON Cases Advisory


Originally posted by: BON Philippines

Tips for taking NCLEX

Take Care of Yourself

· Get a good night's sleep.

· Eat a nutritious breakfast.

· Do not cram the night before the exam; cramming increases stress.

· Dress comfortably for the exam.

· Avoid taking sleeping pills or drinking alcohol the night before the exam.

Plan Ahead

· Schedule the exam at a location close to home to reduce the stress of traveling. Scout out parking options and the location of the exam in relationship to your hotel prior to your test date.

· Plan carefully. Be sure you have your identification and your exam admission ticket with you.

Study Tips

· Develop a study schedule months in advance of the exam and stick to it.

· If a study group helps you, organize one. Be careful that the group does not drag you down or waste your time.

· If you sign up for a NCLEX® Examination review course, check out its pass rate first.

· Practice often - become familiar with the multiple choice format used on the NCLEX® Examination.

· Take advantage of the CD's available with practice books to take the computerized test.

· Avoid distractions.

· Time yourself and try to get the time you need for each question down to a minimum.

· Reward yourself (with something healthy) for making progress on your study schedule.

· Develop or use mnemonic devices to help you remember details. "ABC," or Airway-Breathing-Circulation, is a good example.

· Develop flashcards and take them with you for a quick study wherever you are.

· If you run into difficult content, seek help from an instructor who knows the topic well for assistance understanding it; as you study, ask yourself questions that apply the knowledge.

NCLEX Questions Tips

· The NCLEX® Examination-RN is a "computer adaptive test." In other words, after you answer a question correctly, the computer will ask a harder question next. If you answer a question incorrectly, the computer will ask an easier question next. Scoring varies; an exam could have from 75 to 265 questions. The goal of the exam is to find out your competence level in the different areas the exam covers.

· Fifteen of the questions on the exam are experimental. They will neither help you nor hurt you. You will not know which questions are experimental.

· You will be given five hours to complete the exam, which includes the tutorial at the beginning, a mandatory break, and an optional break.

· The test is user friendly. You will receive instructions on how to use the computer and an opportunity to practice before the timing begins. You will use a minimum number of keys (space bar and enter key). You will give your answer then be asked to hit the enter key to confirm that this is the answer you want.

· You will proceed through the questions and will not be allowed to go back to revise your answers. You can not skip a question.

· Read each question carefully. Quickly try to answer the question before reading the responses. If your answer is in one of the responses, you are more likely to answer the question correctly.

· NCLEX® Examination questions basically ask "What should you do in this situation?" When studying, always think in terms of how you should handle a nursing problem.

· If you are having trouble remembering material, try to remember people you've cared for with similar problems.

· Think conceptually rather than specifically. For example, understand how classes of drugs work and how side effects are related to actions. In this way, you will not need to memorize all the details about each drug.

· Remember to think about what the priority would be in each situation. For example, in an emergency always think of the ABC's first--Airway, breathing, and circulation

· Chose nursing actions before medical actions. For example, you would try repositioning before giving medications.

· Think about the nursing process when answering questions. I.e., you would assess a situation before doing an intervention.

· Do not select uncompromising answers such as "never" or "all."

· Remember that the person is your client, not the person's machine.

· Remember that your correct response will be what you, as a nurse, should do, not who you should call for orders.

· Be alert when answering questions related to children. Their responses to medical conditions often vary from the adult response.

· Be sure you identify the client, the problem, and the part of the nursing process the question addresses. For example, if the question is about assessment, a response about intervention would be incorrect.

· The RN NCLEX® Examination covers "Meeting Patient Needs." The four areas of patient need it addresses are

o Safe and effective care environment

o Health promotion and maintenance

o Psychosocial integrity

o Physiological integrity

· When a question concerns delegation

o Remember that assessment, nursing diagnosis, and evaluation of care are activities done by a professional nurse; these should not be delegated.

o You would not delegate the care of an unstable client or complicated interventions to nonprofessionals.

· As of April, 2003, "Innovative questions" will be added to the NCLEX® Examination.

o These could include fill-in-the blanks questions, questions with more than one possible correct answer, or questions that ask the candidate to respond to a diagram.

o The advantage of these questions is that they allow candidates to demonstrate their knowledge in multiple ways.

o The questions are developed and tested by expert nurses and statisticians. They will be tested before used, just like the multiple choice questions. Therefore, they will not be scored until after the April, 2003 exam.

o Item difficulty will be taken into account, just as with the present multiple choice exam.

o Items will be scored as "right" or "wrong."

Test Taking Tips

· You will not be allowed to take anything into the exam center with you.

· Remember that your first choice for an answer is likely to be your best guess. Changing answers typically does not work.

· Don't worry about how much time the other test-takers are taking for the exam.

· Avoid panic; taking some deep breathes if you are feeling stressed during the exam. Purposefully relax your face, neck, shoulders, arms, legs, and feet in succession before going on.

· Remember that italicized words, such as not or first give you clues as to which answer is correct. Read those question stems carefully.

· Use the paper and pencil provided for you during the exam to make outlines or diagrams or otherwise help you remember.

· Take full advantage of breaks during the exam. Bring something healthy to eat.

· Schedule your exam at the time of day most productive for you.

Passing/Failing the NCLEX® Examination

· The NCLEX® Examination is a pass/fail exam. Your state board of nursing will notify you whether you passed or failed two to four weeks after your exam.

· If you do not pass, you can retake the exam in three months.

· If you do not pass, you will receive a printout showing your weak areas when you receive your exam. Use this information when you study for the next time you take the exam.

· If you want to get a diagnosis of your strong and weak areas before the exam, try this book from Kaplan: NCLEX® Examination Computer Diagnostic

Fractures

Break in bone continuity from excessive force. Traumatizes muscles, blood
vessels, and nerves leading to inflammation and possible hemorrhage

Types of Fractures

Simple (closed): Skin remains intact
Compound (open): Fragments penetrate skin
Transverse: Straight across
Oblique: Angled across
Spiral: Twists around shaft
Comminuted: Multiple fragments
Compression: Compressed bone mass
Depressed: Fragments forced inward
Green stick: Break partially extends across and then along length; more
common in children
Pathological: Force than normal needed to break bone due to ↑age, porous,
brittle bones (osteoporosis), metastatic or primary tumors, Paget’s disease

Signs and Symptoms
■ Pain, spasms, shortening of extremity, ecchymosis
■ Grating sound when moved (crepitus)
■ ↓Mobility, deformity, paresthesia 2° nerve damage
■ Shock 2° hemorrhage
■ Fat emboli: Dyspnea; ↑R; ↑P; ↑T; copious white sputum; crackles;
↑mentation; buccal, conjunctival and chest petechiae
■ Compartment syndrome: ↑Muscle compartment pressure 2°
edema/bleeding → ↓circulation → tissue hypoxia → ↑pain and damage


Treatment
■ Closed reduction: Fragments aligned and stabilized with cast, splint, or
traction
■ Open reduction and internal fixation (ORIF) with wires, pins, nails, rods, or
plates
■ Hemiarthroplasty (surgery for femur head prosthesis)

Nursing Management
■ Immobilize (↓trauma and pain); pain management
■ Peripheral neurovascular assessment: Peripheral pulses, color, T, capillary
refill, motor/sensory function
■ Monitor for compartment syndrome (elevate limb and notify MD)
■ Patient with a cast: ↑On pillow, uncover to ↑drying, handle with palms
not fingertips until dry, isometric exercise to ↓atrophy; odor may indicate
infection
■ Patient with traction: Hang weights freely, functional alignment, pin care
as ordered for skeletal traction
■ Postoperative care for patient with hemiarthroplasty:
■ ↓Pain (patient controlled analgesia)
■ ↓Displacement of prosthesis (abduction pillow, avoid internal rotation
or flexing >90 degrees, ↑toilet seat/chair)
■ Prevent DVT (anticoagulants and compression devices as ordered,
dorsiflexion, avoid popliteal pressure)
■ ↓Atelectasis/pneumonia (incentive spirometry, coughing, deep
breathing)

Pneumothorax

Definition
■ Disruption of lining of lung (visceral pleura) or lining of thoracic cavity
(parietal pleura) permitting air (pneumothorax) and/or blood (hemothorax)
into pleural space → lung collapse
■ 2° rib fx, stab or gunshot wound, thoracentesis, emphysema

Signs and Symptoms
■ Sudden unilateral chest pain
■ ↑P, ↑R, Signs and Symptoms
■ Sudden unilateral chest pain
■ ↑P, ↑R, dyspnea, ↓breath sounds on affected side, ↓PaO2
■ Air/blood in pleural space on x-ray
Treatment
■ O2, assist with insertion of chest tube/water seal drainage to reestablish
negative pressure (pneumothorax—2nd anterior intercostal space,
hemothorax—lower and more posterior space)
Nursing
■ Monitor S&S; relieve pain
■ Assess water seal chamber fluid level (↑ on inspiration and ↓ with
exhalation) and for bubbling in water seal chamber (continuous bubbling
suggests air leak and absence suggests full lung expansion or blocked
tube)
■ Instruct patient to exhale and bear down when removing chest tube, then
apply occlusive dressing
■ Subcutaneous emphysema: Palpate around insertion site for crackles,
which indicates air in subcutaneous tissue (crepitus)
■ Air/blood in pleural space on x-ray

Treatment
■ O2, assist with insertion of chest tube/water seal drainage to reestablish
negative pressure (pneumothorax—2nd anterior intercostal space,
hemothorax—lower and more posterior space)

Nursing Management
■ Monitor S&S; relieve pain
■ Assess water seal chamber fluid level (↑ on inspiration and ↓ with
exhalation) and for bubbling in water seal chamber (continuous bubbling
suggests air leak and absence suggests full lung expansion or blocked
tube),
■ Instruct patient to exhale and bear down when removing chest tube, then
apply occlusive dressing
■ Subcutaneous emphysema: Palpate around insertion site for crackles,
which indicates air in subcutaneous tissue (crepitus)

Acute Respiratory Distress Syndrome (ARDS)

Etiology and Pathophysiology
■ Direct or indirect lung trauma → inflammation → fluid movement into
alveolar spaces and ↓surfactant → atelectasis → hypoxia and ↑dead space
■ Secondary to trauma, aspiration, shock, infection

Signs and Symptoms
■ Early: Dyspnea, anxiety, ↓O2 sat, ↓PaO2
■ Late: ↑CO2, cyanosis, lung infiltrate on x-ray

Treatment
■ Treat cause; mechanical ventilation and positive end expiratory pressure
(PEEP—keeps alveoli open)
■ Steroids, interleukin-1 receptor antagonists, surfactant therapy
■ Sedatives or neuromuscular

Nursing Management
■ Monitor S&S; suction airway
■ Mechanical ventilator care:
■ Assess breath sounds for equality (PEEP → ↑risk of pneumothorax,
ET tube may be in right bronchi)
■ Maintain trach or endotracheal tube cuff pressure seal to ensure full
volume delivery
■ Check ventilator settings and alarms (↑pressure secondary to mucus or
tubing kinks and ↓pressure secondary to ↓cuff pressure or separation
of tubing)
■ Provide alternate mode of communication

Blood Pressure Travel Tips

Things to consider in the New Year if you have high blood pressure.

January is traditionally the time that many people think about booking holidays or trips to forget about the miserable weather in the UK.

Many questions are asked at this time of year about what to consider if you are planning to travel and have high blood pressure so we are delighted to inform that the publication of two new information sheets about holidays, travel and blood pressure.

Managing blood pressure on holiday looks at the practical things you can do and arrangements to make when going on holiday or travelling abroad and have to treat high blood pressure

This is accompanied by a helpful article about travel insurance for people with high blood pressure. Many people wrongly believe that they cannot get travel insurance if they are diagnosed with high blood pressure. In the same way that the myth that they will lose their jobs should they declared diagnosis took a while to correct we think that the information here should help clarify the position and allow people to make holiday plans and

Although it is essential that you tell your insurers that you have high blood pressure there are only a few jobs and activities that are prohibited in the insurance cover you get

Resperate available in the UK

Something else positive is the announcement that Resperate - a device that is intended to help lower blood pressure naturally will soon be on sale at Medi Save

Its been a long time coming so lets hope that thorough testing has shown Resperate to be a useful tool to use in conjunction with other treatments to help lower high blood pressure.

Resperate is a portable device and you will be able to take it with you on your travels to keep up biofeedback exercises that should slow your breathing with results in a lowering of blood pressure.

Another top tip from the Holiday guide is to consider buying a cheap Lloyds blood pressure monitor rather than risk losing or damaging a more expensive device whilst travelling. Both Resperate and cheap blood pressure monitors are available online at Medical Supply Saver Stores and can be delivered to your door.

Lowering High Blood Pressure Naturally is Essential

If you have hypertension, you seriously need to consider lowering your high blood pressure naturally. You probably take prescription drugs just like I did, but there are some things you need to know. Natural remedies are the answer to a long, healthy life.

What's the problem with prescription medications? There are many. First of all, most drugs are synthetic and can do serious damage to organs such as your liver, not to mention the fact that they don't treat the real cause of your hypertension. They simply mask the symptoms!

Secondly, prescription drugs such as alpha and beta blockers can cause all sorts of unwanted side effects like nausea, headaches, and can actually raise bad cholesterol levels. Does that sound like good medicine? Not in my opinion.

Lowering your high blood pressure using natural methods works just as effectively without the unwanted dangers of prescription drugs. Natural remedies also DO treat the underlying cause, and can also improve other conditions you may have such as high cholesterol and diabetes. Now I'm not saying you will totally get rid of these conditions, but they will vastly improve along with your hypertension.

What are some of the methods of lowering high blood pressure naturally? Of course a good diet and exercise are important, along with reducing stress. Cutting back on alcohol consumption and avoiding tobacco are also essential. But there are many foods that help alleviate hypertension, along with special exercises, meditation, herbal supplements and other relaxation techniques that help reduce stress and relax your muscles.

There are many natural ways to reduce your blood pressure, too many to mention in this article. You can find an excellent guide online that is packed with information on hypertension, what causes it, and how to remedy the condition using all natural methods. It also gives you information about prescription drugs and how they can affect your health.

Learn more about lowering high blood pressure naturally, improve your health and add years to your life!

Lowering Blood Pressure Naturally - What You Should Know

Did you know that by lowering your blood pressure naturally, you can improve many other aspects of your health? It's true. Prescription medications are good at times, but for health issues such as hypertension and high cholesterol, sometimes natural remedies work best. Why? Because they treat the underlying cause of your condition, and prescription drugs don't.

Let me explain something you may not know about drugs your doctor prescribes. Most are synthetic, and can do harm to your liver and other organs. They also cause many unpleasant side effects in many people. That is why learning how to lower your blood pressure using natural methods is best!

Here are a few tips if you are considering natural remedies for controlling hypertension:

1. Drink lots of water! Drinking half of your body weight in ounces every day helps flush toxins from your body and reduce blood pressure. Example: If you weight 140 pounds, drink 70 ounces of water. This is equivalent to 8 1/2 cups.

2. Eat healthy foods. You already know you should do this, but adding certain foods to your diet such as bananas and other foods loaded with potassium is essential. Cut out the salt!

3. Exercise moderately. You don't really have to follow a prescribed plan, just exercise until it makes you feel better. You can tell the difference in how you feel, and you will know how much exercise it takes to work for you.

4. Reduce stress - This is a BIG one. Stress is one of the leading causes of high blood pressure. Reduce stress by meditation, deep breathing, and getting plenty of sleep. If you can eliminate the source of your stress, doing so is a good idea.

These are just a sampling of steps to take when lowering blood pressure naturally. There are hundreds of other things you can do, and when combined these actions will lower your readings dramatically in a short time.

Are you ready to take positive action for your health? Don't put synthetic junk in your body any more. Your health and the length of your life depend on what you do to control your health issues! Learn more about lowering high blood pressure using natural remedies, and take control of your life.

Hypertension: Factors that can be changed

Overweight (obesity): Obesity is defined as having a body mass index (BMI) greater than 30 kg/m2. It is very closely related to high blood pressure. Medical professionals strongly recommend that all obese people with high blood pressure lose weight until they are within 15% of their healthy body weight.

Sodium (salt) sensitivity: Some people have high sensitivity to sodium (salt), and their blood pressure goes up if they use salt. Reducing sodium intake tends to lower their blood pressure. Americans consume 10–15 times more sodium than they need. Fast foods and processed foods contain particularly high amounts of sodium. Many over–the–counter medicines, such as painkillers, also contain large amounts of sodium.

Alcohol use: Drinking more than one to two drinks of alcohol per day tends to raise blood pressure in those who are sensitive to alcohol.
Birth control pills (oral contraceptive use): Some women who take birth control pills develop high blood pressure.

Lack of exercise (physical inactivity): A sedentary lifestyle contributes to the development of obesity and high blood pressure.
Drugs: Certain drugs, such as amphetamines (stimulants), diet pills, and some pills used for cold and allergy symptoms, tend to raise blood pressure.

Signs of High Blood Pressure and What to Do About It

Although there are often no signs of high blood pressure, sometimes there are a few little telltale symptoms you may have. Hypertension is known as the silent killer, because so many people have it and don't even know it. This article will help you learn what to look for, and what to do about it if you find that you have hypertension.

Even if you have high blood pressure, you may not have any symptoms. If you do, here are a few of the more common signs to look for:

Frequent headaches
Dizziness
Nausea
Confusion
Fatigue
Insomnia

I guess you could say I was one of the "lucky" ones. I DID have signs of high blood pressure, if I hadn't I don't guess I would have known to go to the doctor. My first symptom was feeling "out of sorts", which I guess would fit into the category of confusion. It seemed that I couldn't concentrate and I just didn't feel like I could focus clearly on anything.

If you suspect that you may have high blood pressure or you do have any of the symptoms, see your doctor immediately. If you find that you do indeed have hypertension, discuss the options of using natural remedies for your high blood pressure. Natural treatment works better than prescription drugs, and helps to treat the underlying cause of hypertension, which prescription medications do not.

It's very important that you know whether you are living with the "silent killer" and what to do if you are. Millions of people every year suffer heart attack, stroke and kidney failure because they have this condition and aren't aware of it, or aren't treating it.

If you have signs of hypertension, take action. Also do some studying on natural remedies for high blood pressure and how they can improve your total health. Your life depends on it.

Happy New Year 2009

Happy New Year 2009