RAs, EOs, and PDs

(Nursing Licensure Examination Reviewer)

RA 9173 RA 2808 RA 7164 RA 877 RA 5921 RA 6675 RA 9165 RA 953 RA 6425

Philippine Nursing Law of Oct. 21, 2002 First Nursing Act of March 01, 1919 Philippine Nursing Act of 1919 A Philippine Nursing Act of 1953 Pharmacy Act. Generic Drug Act of 1988 (under Pres. Aquino) New Drugs Act or the comprehensive dangerous act of 2002 Narcotics Drug Act Dangerous drug Act (1972) Provision of S2 code of selected doctors who can prescribe narcotic drugs Doctor: S2 license with a yellow prescription. Magna Carta of Public Health Workers: Has provision on the benefits, rights and responsibilities of public health workers Give rights to private employees

RA 7305 RA 442 : Labor Code

RA 7160 : Local Decentralization of power to LGUs Government Code RA 3573 : Prevention and suppression of Communicable Diseases And Confidentiality amongst patients with STI/HIV PD 626 Health Insurance RA 8282 SSS for private employees Act RA8292 GSIS for public employees RA 7600 Breastfeeding EO 51 Milk Code Act

PD 856 Code of RA 9300 Code of Sanitation (new) Sanitation (old) PD 825 Garbage Disposal Act RA 6713: Code of Conduct and Ethical Standards for Public Officers Employee
RA 8344 Hospitals should not refuse to accommodate patients of any disease.

RA 9165 RA 6425

Comprehensive Dangerous act of 2002 Dangerous Drug Act of 1972

PD 807 Civil Service Law Provides for recruitment and selection of employees in government service. RA 7877 : Anti Sexual RA 9262 : Anti Violence against Women & Harassment Act Children PD 603 PD 651 LOI Primary Health Care PD 996 Child and Youth Welfare Code Registration of Births within 30 days from delivery (Birth Certificate) Nursing code of ethics BR# 220 series of 2004

A decree for proper immunization of children below 8 years of age. Felonies -Any act of a professional nurse that is punishable by the law a. Deceit (aka dolo) Intentional Crime b. Fault (aka culpa) Unintentional Crimes Slander (something na sinabi) and Quasi Tort: 2 types Libel (something na sinulat) Slander and Libel are both negative Negligence (ex: Pasyenteng nalaglag sa kama dahil napabayaan ng nurse, medications that Unintentional Tort: 2 was not given as ordered na ikinamatay ng types pasyente, bedsores of a comatose patient) and Malpractice (ex: Nurse na nag start ng IV

without a doctors order and or an IVT training accredited by ANSAP, Nurse who started an episioraphy without proper training, A nurse who practices circumcision without proper training, Nurses who prescribe medications, and Nurses who medically diagnose a patient. Intentional Tort: 2 types Assault (ex: More on threatening a patient. Nurse na tinakot yung pasyente about a certain procedure para makipag cooperate ito, A nurse told the client that she will inject sedatives if he does not cooperate) and Battery (Gumawa ng procedure sa isang pasyente without the clients consent. Ex: A nurse forcibly opened the mouth of a pedia patient and gave his medication)

Requirements Board Exam: 1. Citizen of the Philippines 2. Good Moral Character 3. Holder of BSN Degree (Complies with standard nursing education). Ratings: a. General average of at least 75% with a rating of not below 60% in any subject b. If above 75% but with subject below 60%, must repeat that subject with a rating above 75%. *** With 5 sets of exam, 100 items each set, with a time of 2 hours each: Test 1 (Funda, NLM, and Research), Test 2 (CHN, Pedia, and OB), Test 3 (MS-Normal and Abnormal), Test 4 (MS more on Abnormal), and Test 5 (Psychiatric Nursing). ***NOTE: Ang NLM at Research! Lumalabas Test 1-Test 5. Bad trip! haha Philippine Nursing Act: RA 9173 BON- Board of Nursing Composed of a chairperson and 6 members *** The board member of any professional organizations should always be composed of a group of an add number: BON: 7, BOMedicine: 3, BOMidwifery 5: So there is someone who will always be a tie breaker of any rules, regulations, and project that they are planning to implement. Appointment: Nominating Body (PNA) = 21, Recommending Body (PRC) = 15, and Appointing Body (The President) = hanggang sa maging 7 nalang. Term of office: 3 years but can be appointed again twice (equals 6 years) Requirements: (A) immediately resign from any teaching position in any institution offering BSN and/or review program. (B) Immediately resign from any government or private employement (C) Not having any pecuniary (money matter) interest in, or administrative supervision in any institution offering BSN or review classes, ex: hindi pwedeng mag BON si Carl Balita at Gapus kasi may review center sila at kung sino man na may ari ng isang nursing school, ay wow baka mag ka leakage bungga!. Qualification: (A) Natural born citizen nd resident of the Philippines. (B) Member ng PNA. (C) RN and a holder of a masters degree in nursing, education and other allied sciences. (D) With 10 years experience, and yung 5 years dapat sa Pinas (E) No conviction of any offense involving moral turpitude BUT pwede pading tumakbo for BON ang isang tao na ACCUSE for ex: rape, murder and etc. kasi accuse palang hindi pa naman napapatunayan pag convicted na sa isang crime yun ang bawal. Kakaiba diba?! Pero need parin for investigation. Duties (A) Conduct NLE (B) Issue of registration for the practice of nursing (C) ensure quality education (D) promulgate code of ethics (E) issue regulations. Ground for removal: Incompetence, Irregularities in the licensure (ex: yung nang yaring leakage dati na nasibak yung BON that time), Immoral conduct and being unprofessional. Qualifications of a Dean/Chief Nurse/Nurse Director: 5 years experience in teaching, MAN is enough, BSN RN, Qualifications of a Nurse Faculty Qualifications of a Nursing faculty: Holder of Masters degree (same like on the BON), at least 1 year experience, RN, Member of PNA.

Components: RBC (MALE) Hct (MALE) Hgb (MALE) RBC (FEMALE) Hct (FEMALE) Hgb (FEMALE) WBC PLATELET PR Interval (sa PQRST ito ha) Stroke Volume (q0.003 sec) S1 S2 S3 S4 Golden Period of Myocardial Infarction International Normalized Ratio (Prothrombin Time x given) Loop Diuretics (ex: Furosemide) Thiazides K+ Sparers Osmotic Diuretic Troponin I most sensitive Troponin T Myoglobulin earliest to increase CK-MB Angina

Normal Values: 4.5 6.2 million/mm3 42 52% 14-16 g/dl 4 5.5 million/mm3 35 47% 12 -15 g/dl 5,000 10,000/mm3 150,000 450,000/mm3 0.12 - 0.20 seconds 70 ml/seconds or 4-8,000/mins Lub Dub Lub Lub Dub (Ventri. Tachy.)
Lub Dub Dub (Atrial Tachy. and cases of HPN)

2 6 hours 1.5 2 K+ Wasters For Renal Failure ( K+wasters) Aldactone, Spironolactonesrs Mannitol Rises in 3-6hrs last for 14-21 days Rises in 3-6hrs last for 5-7 days Rises in 30mins last for 2 hrs Rises in 3-6hrs last for 3-5 days Nitroglycerine agad! Dilates coronary arteries, for good myocardial perfusion. Sublingual kasi faster ang action: q5 mins for 3 consecutive order kung may pain parin after 15 (taking the 3rd dose) baka MI na walang kwenta ang Nitroglycerin sa MI. Wag painumin ng tubig for a moment! Morphine agad: Antidote Narcan/Naloxoine

MI

ABG: Arterial Blood Gas Done by a doctor and/or trained Medtech Before blood extraction ALLENs TEST should be done. In allens test, the ulnar aretery is being check for its patency hindi ang radial artery! pH 7.35 7.45 pCO2 35 - 45 HCO3 22 - 26 pO2/PaO2 80 100 mmHg O2 Saturation 95 100% 1 normal Uncompensated Abnormal lahat Partially compensated pH normal 2 abnormal Fully compensated Remember R.O.M.E. = Respiratory Opposite and Respiratory Equal sa pH. DM Diet CHO CHON HCHO Simple sugar: example candies, chocolates, orange juice increases blood glucose immediately but blood sugar may decrease below normal that fast. Need for a patient whose experiencing hypoglycemia ***DM type/classification
a. Somogyi b. Dawn phenomenon c. Wanning
Dec. Blood Glucose @ 24am NO decrease on BG @ 24am 8pm-8am blood glucose

50% / 4 kcal/g 20% / 4 kcal/g 30% / 9 kcal/g Complex CHO: Ex: loaf of bread, potato, and rice increases blood sugar slowly but blood sugar remains normal for a long period of time. (Foods na commonly walang added sugar or lasa)
Increase BG @ 6-8am Management: Need evening snack Need regular insulin Need regular insulin Need regular insulin

Increase BG at 6-8am Slowly increases

Fasting Blood Sugar (Fasting for 8 hours) DM na! DM RDA Test

70 110 mg/dl (NORMAL) >140 mg/dl for 2 readings 2,000 2,200 kcal FBS, 2 Post Pradial BS, and OGTT

Clear 1st Cloudy 2nd (Insulin!) Para hindi ma-contaminate ***INSULIN Rapid Acting Intermediate Acting Long Acting

1.5 inches (Spaces) kasi diba rotation ang insulin administration sa DM patients to prevent fat wasting.
Onset: 30mins-1, Peak: 2-4, Duration: 6-8

O: 1-2, P: 6-8, D: 18-24 O: 3-4, P: 16-20, D: 30-36 10 40 units 5 35 units 100 200 units 3.5 5.5 meq/L 150 - 250 mg/dl 0.1 0.2 mg/dl 0.2 0.8 mg/dl 0.3 1.0 mg/dl 12 16 sec.

AST (SG T) more on the heart ALT (SGPT) more on liver LDH (Lactic Dehydrogenase) Serum Albumin Ammonia Level Serum Bilirubin (DIRECT) Serum Bilirubin (INDIRECT) Total serum bilirubin Prothrombin Time

Creatinine clearance is definite than BUN in checking kidney function. Because Blood Urea Nitrogen can be affected by increase level of ammonia in the body secondary to protein metabolism! Creatinine (MALE) Urine 98 138 ml Creatinine (FEMALE) Urine 88 128 ml Urine Specific Gravity 1.010 1.025 Intra Ocular Pressure 10 20 mmHg Crystalloid (Shock) NSS, PLR (for acidosis), Hypertonic Colloid (Shock) Albumin, Synthetic (Dextran, Hetastrach: Dec. platelet) Blood Trans. (Shock) Fresh whole blood P -wave Atrial Deporalization 0.04 0.11 secs. PR Interval Atrial Deporalization (0.12-0.20 secs.) QRS Ventricular Deporalization (0.08-0.12 secs.) T-wave Ventricular Reporalization Q-T Interval 0.30 0.40 secs. Divide 1500 by the no. of small squares between Heart Rates: 1500 method
two consecutive QRS complexes

R-R method (Heavy dark line) 6-second method Epinephrine Nitro Atrophine
LOC Alert Lethargic Obtunted Stuporous Semi-Comatose Comatose

300, 150, 100, 75, 60, 50, 40

Count the no. of QRS complexes in 6 secs. Strip and multiply by 10

1 mg IVP q3-5 mins 3x q5mins 1 or 3mg IVP q3-5 mins

Responds fully and appropriately to stimuli Drowsy, responds to questions then fall asleep Open eyes, responds slowly , confused Arouses from sleep only after painful stimuli Intact reflexes Unarguable with eyes closed

Electrolytes Na (-) K(+) Chloride Ca Mg Phosporus. Bicarbonate Serum Osmolality 135 145 mEq/L 3.5 4.5 mEq/L 95 105 mEq/L 8.5 10.5 mg/dl 1.5 2.5 mEq/L 1.8 2.6 mEq/L 280 300 mEq/L 280 300 mOm/kg Water

Vaccination for pregnancy TT Vaccine TT1 Anytime during Pregnancy TT2 4 weeks after 1st dose TT3 After 6 mos. TT4 After 1 yr TT5 After 1 yr ***Note: Ang buntis dapat naka dalawang TT na bago manganak (I mean yung TT shots, Hahaha!) Yung TT3, 4 and 5 serves as boaster shots. So, dapat to be assert na fully TT immunized ka na dapat may 5 TT shots ka, at 3 dun ang boaster shots. Vit. A (Pregnancy) GCS 10,000 IU/ 2nd Tri twice a month 15 Ok

Mild Moderate Severe CSF (CHON) CK-MM

13 14 9 < 8 (<7 Comatose) Normal: 15 to 60 (>60 Damage) 5-70 U/L

Heart Beat - SA node 60-100 bpm AV node 40-59 bpm Bundle of His 25-39 bpm Purkinje Fiber 15-24 bpm ANGINA and MI (affected by 4 Es) Eating, Envi., Emotional stress, Exercise Pain 1-4 (mild), 5-7 (mod.), 8-10 (sev.) Ang Pain scale na 3 requires nursing action na yan! Angina < 15 mins ang PAIN. Relieve MI > 15 mins (PAIN) by nitroglycerine and/or Rest Hindi na re-relieve ng O2, Nitroglycerine, and Rest Pain, Pallor, Pulse, Poikilothermia (cold to Neurovascular Damage (7 Ps)
touch, ah yun pala yun!), Paresthesia, Paralysis, Poor Capillary Refill

ID SQ IM

Needle sizes and route 3/8 , 5/8 Gauge 26-27 5/8 , G 24-25 , 1 1/2 Child G22 G23 Adult G20 G21 GI System!

10-15 45-90 90 - Z

GI pH Enema TPN: Cycling up (Decreases) TPN: Cycling Down (Increases) aka Weaning
Duodenal Ulcer Males, 30-60, 80% PUD 2-3 hrs after meal, AM pain, ok food Uncommon vomiting, Melena>Hema. Weight Gain

<4
3-4 inches (Introduce) / 12-18 inches (height)

24, 20, 16, 12 (hour) 12, 16, 20, 24 (hour)

Gastric Ulcer >50 y.o., M=F, 15-20% PUD -1 hr after meal, Bad with food Vomiting common, Hema.>Melena Weight Loss

ANTACIDS Mg (OH) p.c. Mg (MAG TATAE) Side effect Diarrhea Al (OH) p.c. Al (ALA TAE) Side effect Constipation a.c. 30-60 mins Cytoprotective agents / coat ulcers Ex: Sucralfate (Carafate), Misoprotol (Cytotec), Bismuth (Pepto bismol) a.c. 30-60 mins Proton pump inhibitor (-prazole) With meals (NO OTHER DRUGS!) *H2 Receptor Antagonist (-tidine) KIDNEYS - Serum Creatinine 0.5 1.5 mg/dl (24 collection) Alkaline stones: Acid Ash Diet Meat/Poultry, Crun. Juice, Pruns, Plums Acid Stone: Alkaline Ash Diet Fruits/Veg., Pineapple, apple juice, milk EYE - Drops 3% absorption Ointment 7-10% absorption Silver Nitrate 1% Lacrimal duct pressure while on an 1-3 mins. (45-60 secs.) eye drop
GLUCOMA Closed-Acute Glaucoma Manifestations: Halo-rainbow, cardio dse, med. emer., sudden eye pain Management: Irridectomy (Iris remove), Irritotomy. Manifestations: 90% loss of peripheral vision (like hemi anopsia), painless. Management: Trabeculoplasty (Trabecula- from which ocular fluid is absorbed), Trabeculolectomy.

GLUCOMA Open-Chronic Glaucoma