LAWS AFFECTING THE PRACTICES OF NURSING IN THE PHILIPPINES

PRESIDENTIAL DECREES
*PD 48 FOUR (4) CHILDREN WITH PAID MATERNITY LEAVE PRIVILEGE
*PD 69 FOUR (4) CHILDREN FOR PERSONAL TAX EXEMPTION
*PD 442 NEW LABOR CODE
*PD 491 NUTRITION PROGRAM
*PD 541 PRACTICE OF FORMER FILIPINO PROFESSIONALS IN THE PHILIPPINES
*PD 603 CHILD AND YOUTH WELFARE CODE
*PD 626 EMPLOYEE COMPENSATION AND STATE INSURANCE FUND
*PD 651 BIRTH REGISTRATION FOLLOWING DELIVERY
*PD 625 ANTI IMPROPER GARBAGE DISPOSAL
*PD 851 13TH MONTH PAY
*PD 856 CODE OF SANITATION
*PD 965 FAMILY PLANNING AND RESPONSIBLE PARENTHOOD INSTRUCTIONS PRIOR
TO ISSUANCE OF MARRIAGE LICENSE
*PD 996 COMPULSORY IMMUNIZATION FOR CHILDREN BELOW EIGHT (8) YEARS
OLD AGAINST IMMUNIZABLE DISEASES
*PD 1083 MUSLIM HOLIDAYS
*PD 143 WOMAN AND CHILD LABOR LAW (NO CHILD BELOW 14 SHALL BE
EMPLOYED)
*PD 1519 MEDICARE BENEFITS FOR ALL GOVERNMENT EMPLOYEES
*PD 1636 COMPULSORY MEMBERSHIP TO SSS OF SELF-EMPLOYED PERSONS
EXECUTIVE ORDERS
* EO 51 MILK CODE
* EO 180 GUIDELINES ON THE RIGHT TO ORGANIZE OF GOVERNMENT EMPLOYEES
* EO 203 LIST OF REGULAR HOLIDAYS AND SPECIAL DAYS
* EO 209 FAMILY CODE OF THE PHILIPPINES (AMENDED BY RA 6809)
* EO 226 COMMAND RESPONSIBILITY
*EO 174 NATIONAL DRUG POLICY (AVAILABILITY, AFFORDABILITY OR SAFE,
EFFECTIVE, QUALITY DRUGS)
* EO 857 COMPULSORY DOLLAR REMITTANCE LAW

BOARD OF NURSING RESOLUTION

* #100 SERIES 1983 IMPLEMENTING RULES AND REGULATIONS OF RA 7392
* #633 SERIES 1984 ICN CODE OF ETHICS
* #1955 SERIES 1989 PNA CODE OF ETHICS
* #08 SERIES 1994 SPECIAL TRAINING ON INTRAVENOUS INJECTIONS FOR THE RNS
* #1930 SERIES 1985 CPE FOR NURSES
* #187 SERIES 1991 RENEWAL OF PROFESSIONAL LICENSE
* #217 SERIES 1992 DELISTING OF DELINQUENT PROFESSIONALS
PROCLAMATION/ PRONOUNCEMENTS & LETTERS OF INSTRUCTIONS
- PROC #6 UNITED NATIONS GOAL ON UNIVERSAL CHILD IMMUNIZATION BY 1990
- PROC #118 PROFESSIONAL REGULATION WEEK JUNE 16-22
- PROC #539 NURSES WEEK EVERY LAST WEEK OF OCTOBER
- LOI #949 LEGAL BASIS OF PRIMARY HEALTH CARE
- LOI #100 MEMBERS OF ACCREDITED PROFESSIONAL ORGANIZATIONS GIVEN
PREFERENCE IN HIRING OR ATTENDANCE TO SEMINAR
- ILO CONVENTION #149 IMPROVEMENT OF LIFE AND WORK CONDITIONS OF
NURSING PERSONNEL (ILO RECOMMENDATION #157)
REPUBLIC ACTS
RA 1054 FREE EMERGENCY MEDICAL AND DENTAL ATTENDANCE TO
EMPLOYEES/ LABORERS OF ANY COMMERCIAL, INDUSTRIAL OR AGRICULTURAL
ESTABLISHMENTS
-

RA 1080 CIVIL SERVICE ELIGIBILITY

RA 1082 CREATION OF RURAL HEALTH UNITS ALL OVER THE PHILIPPINES

RA 1612 PRIVILEGE TAX/ PROFESSIONAL TAX

RA 2382 PHILIPPINE MEDICAL ACT

RA 3573 REPORTING COMMUNICABLE DISEASES

RA 4073 TREATMENT OF LEPROSY IN GOVERNMENT SKIN CLINIC, RURAL

HEALTH UNIT OR BY DULY LICENSED PHYSICIAN
-

RA 4226 HOSPITAL LICENSURE

RA 5181 PERMANENT RESIDENCE AND RECIPROCITY QUALIFICATIONS FOR

EXAMINATIONS/ REGISTRATION

RA 5901 WORKING HOURS AND COMPENSATION AND AGENCIES WITH 100

BED CAPACITY
-

RA 6675 GENERICS ACT OF 1988

RA 6713 CODE OF CONDUCT AND ETHICAL STANDARDS FOR PUBLIC

OFFICIALS AND EMPLOYEES
-

RA 6725 PROHIBITION ON DISCRIMINATION VS. WOMEN

RA 6727 WAGE RATIONALIZATION

RA 6758 SALARY STANDARDIZATION OF GOVERNMENT EMPLOYEES

RA 6972 DAY CARE IN EVERY BARANGAY

RA 7160 LOCAL AUTONOMY CODE

RA 7170 LEGACY OF DONATION OF ALL OR PART OF A HUMAN BODY AFTER

DEATH
-

RA 7192 WOMEN IN DEVELOPMENT AND NATIONAL BUILDING

RA 7277 MAGNA CARTA FOR DISABLED PERSONS

RA 7305 MAGNA CARTA FOR PUBLIC HEALTH WORKERS

RA 7432 SENIOR CITIZENS BENEFITS AND PRIVILEGES

RA 7600 ROOMING IN AND BREAST FEEDING ACT OF 1992

RA 7610 SPECIAL PROTECTION OF CHILDREN AGAINST CHILD ABUSE,

EXPLOITATION AND DISCRIMINATION
-

RA 7641 NEW RETIREMENT LAW FOR EMPLOYEES IN THE PRIVATE SECTOR

RA 7719 NATIONAL BLOOD SERVICES ACT OF 1994

RA 7875 NATIONAL HEALTH INSURANCE ACT OF 1995

RA 7876 SENIOR CITIZEN CENTER FOR EVERY BARANGAY

RA 7877 ANTI SEXUAL HARASSMENT ACT OF 1995

1992

RA 7883 BARANGAY HEALTH WORKERS BENEFITS AND INCENTIVES ACT OF

RA 8042 MIGRANT WORKERS AND OVERSEAS FILIPINOS ACT 1995

RA 8187 PATERNITY LEAVE ACT OF 1995

RA 8282 SOCIAL SECURITY LAW OF 1997 (AMENDED RA 1161)

RA 8291 GOVERNMENT SERVICE INSURANCE SYSTEM ACT OF 1997

(AMENDED PD 1146)

RA 8344 HOSPITALS/ DOCTORS TO TREAT EMERGENCY CASES REFERRED

FOR TREATMENT
-

RA 8424 PERSONAL TAX EXEMPTIONS

RA 8749 CLEAN AIR ACT

RA 7164 PHILIPPINE NURSING ACT OF 1991

RA 9173 PHILIPPINE NURSING ACT OF 2002

RA 6111 MEDICARE ACT

RA 7624 DRUG EDUCATION LAW

RA 349 LEGALIZED USE OF HUMAN ORGANS FOR SCIENTIFIC PURPOSES

AGE

RA 6809 AMENDED ARTICLE 34 OF FAMILY CODE, 18 YEARS IS MAJORITY

RA 8344 AN ACT PENALIZING THE REFUSAL OF HOSPITAL AND MEDICAL

CLINICS TO ADMINISTER APPROPRIATE INITIALS MEDICAL TREATMENT AND SUPPORT
IN EMERGENCY SERIOUS CASES
-

RA 9165 COMPREHENSIVE DANGEROUS DRUG ACT OF 2002

RA 953 NARCOTIC DRUG ACT

RA 2372 PRACTICE OF MEDICINE BY A NURSE

RA 8423 ESTABLISHED THE TRADITIONAL AND ALTERNATIVE HEALTH CARE

RA 8172 SALT IODIZATION LAW

RA 9262 ANTI VIOLENCE AGAINST WOMEN AND CHILDREN

DRUGS AND ANTIDOTES

ACETAMINOPHEN ACETYLCYSTEIN MUCOMIST
DIGOXIN DIGIBIND, DIDIFAB
HEPARIN PROTAMINE SULFATE
COUMADIN, WARFARIN VITAMIN K, FRESH FROZEN PLASMA
LOVENOX VITAMIN K
LITHIUM DIAMOX
BENZODIAZEPINE FLUMAZENIL
ATROPINE SULFATE MESTINON
CURARE EDROPHONIUM TENSILON
MORPHINE NALOXONE HCL (NARCAN)
DEMEROL NALOXONE HCL (NARCAN)
METHOTREXATE LEUCOVORINE
NEOSTIGMINE PRALIDOXINE CHLORIDE (PAM)
PENICILLIN EPINEPHRINE
THROMBOLYTIC AMINO CAPROIC ACID
METHYLERGONOVINE MAGNESSIUM SULFATE
OXYTOCIN MAGNESSIUM SULFATE
MAGNESSIUM SULFATE CALCIUM GLUCONATE
YUTOPAR INDERAL
LEAD EDETATE DISODIUM (EDTA)
LEAD DIMERCAPROL (BAL)
LEAD SUCCIMER (CHEMET)
IRON DESFERAL
COPPER PENICILLAMINE
ETHYLENE POISONING FOMEPIZOL (ANTIZOL)
CYANIDE POISONING METHYLENE BLUE
B-Vitamins
Posted: September 14, 2011 in MEDS
0
B1 Thiamine BERI BERI
B2 Riboflavin SKIN LESIONS
B3 Niacin PELLAGRA
B6 Pyridoxine PERIPHERAL NEURITIS
B9 Folic acid OPEN NEURAL TUBE DEFECTS
B12 Cyanocobalamin PERNICIOUS ANEMIA

BULLETS
MATERNAL
Spontaneous abortion pt w/ syphilis, toxoplasmosis, rubella
pre-eclampsia siezure ankle clonus-hypereflex / scotomas blindness
AMNIOCENTESIS

ok < 20 wks fullbladder, if ^ 20 empty / no to < 16 wks

FIBRIN SPLIT
COMPOUND

dx for DIC

THAYER-MARTIN

dx gonorrhea

FLOURESCENT TREP
(FTA)

syphilis treponoma pallidium

PEDIA
MUCOVISCIDOSIS

common congenital dse, clogged lungs,intestine,pancreas /

^calorie ^ chon <fat

KAWASAKI

mucutaneous lymph node / giant aneurysm / ok aspirin

TAY SACHS

cherry-red spot & macula eye

SCARLET (pastias)

rash that blanch with pressure, white/red strawberry tongue

SCARF SIGN

pre-term infant

KERNICTERUS

mother RH-, BB+

TOURETTEs

involuntary movement, barks, grunts, profanities

RHEUMATIC FEVER

dx ^AO titer, ^ESR, +c-reactive protein

inflammatory autoimmune dse affects heart, joints, subcu
tissues

ADHD

Ritalin, Cylert, Dexedrine

TET spells

hypercyanotic episode, hypoxemia in Tetra fallot

IMPETIGO

thick honey-colored crusts on mouth,nose / humid weather,

MMR

reaction with neomycin

CONTACT precaution

rubella-face, mrsa, rsv

RESPIRATORY

rubeolla-koplik spot , unknown ruseolla / herpes G, neck

trunk

CMV

vision problem

ERYTHEMA
infectiosum

parvoB19, slap-face appearance

BB OF DM MOTHER

with patent ductus arteriosus

CONGENITAL SYPHILIS rhinitis, maculo rash, hepato spleen

NEURO
ALZHEIMERS stages

1 mem loss, 2 wandering, 3 unrecognize obj, 4 fail to

communicate aricept/cognex

GUIILLAN-BARRE

^protein w normal cell count / respi or gastro infxn b4 onset /

dysphagia / from toes upward

HUNTINGTONs

restless, forgetful, balance and cordination, altered speech,

handwriting

BUERGER-ALLEN
EXERCISE

elevate legs lift straight

INTERMITTENT
CLAUDICATION

pain when ambulating/apply stockings / peripheral vascular

dse

ANTERIOR CORD

loss of motor fxn, with sensation intact

POSTERIOR

motor remains intact

BROWN SEQUARD

loss sensation opposite the injury, ipsilateral paralysis

CAUDA EQUINA

loss sensory with recovery

COMPLETE CORD
LESION

total loss of m,s & reflex

CSF

meningitis ^ WBC, protein, < BG cloudy ss visual problem

DECORTICATE

cerebral hemisphere control orientation

DECEREBRATE (worst) pons, midbrain, diancephalon

RACOONs eye

rhinorrhea-periorbital ecchymosis / basilar fracture

BATTLEs

otorrhea mastoid area

AGNOSIA

< recognize object

APHASIA

< speak Brocas area / Global aphasia associated with

poor B

APRAXIA

< purposeful movement

ANOMIA

< to find words / name objects

WERNICKEs area

understanding language, rambling speech / LIMBIC affect

FRONTAL

calculation and current events, HIPPOCAMPUS storage of

memory

RETICULAR activating
delirium insomia, agitation, mania
system area
PARIETAL LOBE

spatial orientation, identify sizes and shapes, concept,

abstract

TEMPORAL

auditory, understand the spoken language

2 TO 3.5 KG

max traction on extremity

MYASTHENIC CRISIS

undermedication/ Cholenergic-Overmed, overexertion

AUTONOMIC
DYSREFLEXIA

above T7, headache, bradycardia, hypertension, nasal

stuffiness, blurred, sweating

CRUTCHFIELD tong

placed on stryker frame or roto-test bed / xray to reveal

alignment

CALORIC testing

water injected to ear absent of eye movement indicate

brainstem damage

LUMBAR puncture

subarachnoid space /

ICP monitoring

transducer at foramen of monro or 1 inch above ear / normal

0-10 mmhg

ALS

mild clumsiness in distal extremities, drag one leg

ASTERIOGNOSIS

identify object form using touch

AGRAPHESTHESIA

recognize the form of written symbols

ENDOCRINE
WHIPPLES

head of pancreas

PROLACTINOMA

pituitary tumor / anovulation, irreg menses, <sex drive &

lactation

SOMOGYI

< BG PM then ^ AM / offer bedtime snax

DAWN PHENOMENOM

wake up pt check BG level

RENAL
WILMs
(nephroblastoma)

renal parenchyma tumor / no palpate

NEUROBLASTOMA

abdominal/adrenal cells excrete catecholamine / dx

vanillymandellic acid

GLUMERONEPHRITIS

^ AO titer, BUN, Creatinine red brown urine

NEPHROTIC syndrome

^proteinuria-edema, < albumin, ^weight, ^ lipid, DARKfrothy urine

POLYCYSTIC kideney
dse

< NA & water, hypertension, heart failure, sob, genetic

counselling, flank pain, hematuria

TRANSURETHRAL
resection synd

^ absorption of irrigating fluid ^ ICP, bradycardia, confusion,

twitching, vision disturbance, nausea

DISQUILIBRIUM
syndrome

rapid removal of solutes from new to dialysis, headache,

confusion, twitching, seizure

RENAL BIOPSY care

bedrest, hema-test w dispstick, ^ fluid / nephrostomy tube &

foley cath

FUROSEMIDE lasix

ascending limb of loop of Henle

ADH

water reabsorption at distal tubule and collecting duct

OXELATE stone

avoid green veges, spinach, chocolate, wheat, nuts,

strawberries, rhubarb, tea

STRUVITE stone

stone from infection UTI, in alkaline and rich in ammonia

urine

ALKALINE-ASH diet

all fruits except cranberries, blueberries, prunes and plums

for low-purine diet

ACID_ASH diet

haddock, meat, fish, cheese, eggs, grains, corn, low-purine

diet / NO milk, fruits

RENAL FAILURE types

intrinsic=gravity is fixed, +protein / prerenal=gravity high,

-protein/ postrenal=fixed, -protein

GASTRO
BALLANCES

right flank resonance / Dx ruptured spleen

GLOBUS

Dx GERD something in back

BILIARY ATRESIA

ss abdominal distention, poor weight, clay-colored stool

HELLP

hemolysis, elev liver enzyme, low platelet

Stretta

inhibit vagus nerve

BESS / Enteryx

tightens lower esophageal sphincter

STOMAHESIVES

ileostomy skin protector

DEODORIZING foods

yogurt, beet, parsley, buttermilk, greens / no to broccoli,

cocumbers. Eggs

ILEOSTOMY

skin cleansing, no seeds & nuts, no high-fiber food, bran

makes watery stool / NO laxatives

DUMPING syndrome

sweating, pallor, vertigo, tachycardia, syncope, diarrhea

pyloroplasty, vagotomy, gastrectomy, billroth II,

CHOLECYSTECTOMY

gallbladder removal, T-tube drainage is green-brown, 500 to

1000ml / day, no clamp & irrigation

PENROSE drain

small bile expected, change with sterile dressing / removed

within 24 hrs

ALBUMIN 3.5 to 5

maintain blood osmolality, if low-peripheral edema occurs, <

protein

ENZYMEs

pancreas=lipase,amylase,typsin/ intestine=lactase/
stomach=pepsin / pancreatic juice=neutralize acid

HEPATIC
ENCEPHALOPATHY

asterixis-liver flap, cause by abnormal ammnonia level

TUBES

Salem-large lumen & air vent, Levins=single,

Dobbhoff=weighted tube for feedings Miller=mercury

PHEOCHROMOCYTOM dx catecholamine test <14 mcg/100ml urine / hypertensive

A
crisis tx regitine
RESPIRATORY
MONONUCLEOSIS

avoid contact sports / rupture spleen

TENSION
PNEUMOTHORAX

tracheal deviation to unaffected side, no breath sound

OPEN
PNEUMOTHORAX

to affected side

FLAIL CHEST

inward movement during inspiration

MEDIASTENAL
FLUTTER

^CVP, arterial BP falls / flail chest movement

SARCOIDOSIS

lungs nodules / shortness of breath / lead to cor pulmonale

CO2 narcosis

extreme hypercapnia > 70, confusion, tremors, convulsion

if rapid drop = SEIZURE / kidneys unable to excrete bicarbs
lead to metabolic alkalosis

SINUSITIS

anosmia-loss of smell, nasal drainage, stufffiness, cough,

headache on arising

TRACHEOSTOMY

bedside obturator, replacement tube of the same size,

hemostat

SHUNTING

lung area has adequate perfusion but not ventilated, no gas

exchange

EMPYEMA

pus / dyspnea, pleural pain, fever, night sweats, anorexia

T-PIECE (briggs device)

remove from MV for short period, connect to airway,

supplement 10% o2 higher than MV setting

Intermittent/Synchroni gradual decrease RR setting until client breaths itself, good

zed ventilation
for post surgery
CHEST TUBE removal

Petralatum gauze, sterile 44, adhesive tape. NO to TELFA

dressing

HEMATOLOGY
BLALOCK-TAUSIG
PROCEDURE

tx tetra, subclavian to pulmonary artery, more blood to lungs

VON WILLEBRANDS

epistaxis / gingival bleeding

POLYCYTHEMIA VERA

^ RBC & BP, thrombus formation increase water

HEMOPHILIA

^ PTT / type A = factor VIII, B(christmas) = factor XI

PERNICIOUS ANEMIA

loss of coordination & position sense

SICKLE CELL

^reticulyte, <hgb, hct, plt avoid demerol HYDREA for pain

THALASSEMIA
(Cooleys)

Mediterannean, < hemoglobin /homozygous-severe/heteromild

CARDIO
REYNAUDS

peripheral vascular spasms when exposed to cold / wear

mittens / palpate pulse

ATHERECTOMY

plaque will be removed by rotational cath

CHF

LEFT jugular vein, sob / RIGHT ascites, edema

CUR PULMONALE

right-side failure, distended neck veins, ^CVP, weight gain

CARDIAC TAMPONADE

< systolic during inspiration, <BP-pulsus paradoxos, tachy,

distant sound, jugular distention

CVP MANOMETER

placed at Phlebostatic axis

0.04-0.10 / 60-100 beats

ECG interval PR 0.12-20 / QRS

SINUS dysrythmia

irregular PP interval / like normal, does not affect output

VENTRICULAR
Tachycardia

no P, wide QRS, regular > 100 to 250 beats

VENTRICULAR
fibrillation

no P and QRS, chaotic

ATRIAL fibrillation

no P , normal QRS, irregular > 100 to 160 beats

MYOCARDIAL
ISCHEMIA

ST segment elevation or depression

CARDIOGENIC SHOCK

Ventricular dysrythmias, low blood pressure, tachcardia, CVP

rise

VALVES

mitral-leftatrium,tricuspid-rightatrium,aorticleftventricle,rightventricle

PROCAINAMIDE

antidysrhytmic for allergic to lidocaine

TRIAMTERENE

diuretic no bananas

ANGINA

stable-induced by exercise / unstable-lower activity, MI /

variant-severe occurs same time

PRINZMETALs variant
coronary vessels spasm tx calcium channel blocker
angina
VENOUS stasis ulcer

brown pigmentation, bed is pink, uneven edges

MUSCULO
PAGETS

bone pain,deformity/ problems with mobility / dx alk

phosphatase, hydroxyproline

FASCICULATIONS

fine muscle twitches / normal is 5/5, 1cm hypertrophy,

symmetrical movement

CARPAL TUNNEL
syndrome

pressure on median nerve / Peroneal nerve bring blood to

legs.

RADICULITIS

spinal nerve root compression, ruptured intervertebral disk

SYNEHAMS CHOREA

irregular movements of extermities / facial grimacing

(rheumatic Fever)

ARTHROSCOPY

ice for pain and swelling

RHEUMATOID arthritis

pain on arising, swollen shinny joints, painless nodules near

bony prominences
early sign- fatigue, anorexia, weight loss

FASCIOTOMY

not sutured to relieve pressure compartment syndrome,

moist sterile saline dressings

ONCOLOGY
EWINGS SARCOMA

bone cancer

HODGKINs

painless, firm, movable adenopathy in cervical area, malaise,

night sweat

BOTULISM

toxin / no to horse

MENIERES (ear)

< NA diet, avoid celery, peanuts = hypertension

INTEGUMENTARY
LYMES (tick bite)

1-rash 3-4 wk antibiotic, 2-cardiac,bells palsy, 3-asthralgia,

later stage penicillin G

PSORIASIS

excess keratin formation, red papules w scales, lower in dark

skinned races tx corticosteroid wrap

LESIONs

reticular=net-like, annular=ring, arciform=arc,

linear=straight

RHINOPLASTY

nasal bone remolded w external clip packed with petroleum

gauze removed on the day

BLEPHAROPLASTY

eye extraocular fxn, apply ice gauze pad

IMMUNE
NIKOLSKYs sign

blister & slough epidernis with pressure present in

pemphigus vulgaris

SLE

<salt,fat,cholesterol / dse of collagen / pancytopenia <all cell

types / avoid hot bath

CYRPTOCOCCOSIS hiv sputum culture, occur in lungs or gastro
CYPTOSPORIDIOSIS

stool culture, diarrhea, flatus, distention

TOXOPLASMOSIS cat

mental status, headache, cognitive impairment

HISTOPLASMOSIS

dyspnea, cough, weight loss

ESR 0-30

confirm inflammation or infection, <40 mild, <70 moderate,

>70 severe

FLOURESCENT
antinuclear

dx for Rheumatoid A, normal < 1.8

EOSINOPHILS

parasitic worms, Neutrophils-bacteria, B cells-make

antibodies

MISC
ALCOHOL

< VitB neuropathies, <thiamine-korsakoffs, wernickesconfusion,eye movement

REVIA / NALTREXENE

tx craving for alcohol

DEPRESSANTS

romazicon, alcohol, benzo, barbi, sedative

STIMULANTS

parlodel, amphetamines,cocaine,crack

OPIODS

narcan, opium, heroin, demerol, methadone

HALLUCINOGENS

lsd, peyote, mushroom, pcp

DRUG OVERDOSE

primary cause of ARDS

NO CT SCAN

if creatine level ^1.5

1.2 filter

fat emulsion on TPN

PIAGETS

1 sensorimotor-understand the environment, 2

preoperational-fantasy from reality
3 formal-think abstractly, 4 concrete-logical thought pattern

KOHLBERGs

pre-conventional=reward/punish, conventional=rules,

post=best for all

CACHEXIA

sunken eyes, hollow cheek, exhausted

CORNEAL reflex

sterile saline drops to keep eye moist

CARBON MONOXIDE
level

<10%-visual acuity,<20-flushing&headache,<30nausea,<40-dizziness,<50-tachy

POTASSIUM

cantaloupe, spinach, strawberries

CATIONs

sodium, potassium, calcium, magnesium, aluminum

ANIONS

chloride, bicarbonate, phosphates / alkalosis

HYDROGEN ions
cations

contribute acidosis

FLOURESCEIN
ANGIOGRAPHY

dx intraocular condition, retinopathy, tumor, radial

keratotomy

GLAUCOMA

tx pilocarpine miotic-to constrict pupil. No atropine or

mydiatrics / Timoptic < aqueous humor

TERMS

laennec cirrhosis, portal hypertension, gynecomastia, ptosisdrooling eye, scleral icterus-jaundice,

rods-night blindness, cons-color, uveal tract-iris, choroid,
ciliary body (produce aqueuos humor) / hordeolum-sty warm
compress, chalazion-cyst warm packs to eye,
accommodation-far 1st
pilocarpine ocular system,

ANESTHESIA
Posted: September 14, 2011 in OTHERS
Tags: anesthesia
0
History of Anesthesia

*
Nero(AD 37-65) greek and roman surgeons gave the potion of condemned
(Wine And Vinegar)
*
Ambroise Pare compression of blood vessels and nerves near surgical site in
16th century
*

Also found out that half frozen soldiers have higher pain threshold

Refrigeration anesthesia was revived in 1941 for amputation in world war II.

Joseph Priestley (1733-1804) Laughing gas NO2 and O2 combination

Crawford Williamson Long administered the 1st ether anesthetic

James Simpson instituted the use of chloroform anesthesia in 1847

Friedrich Trendelenburg ET Anesthesia

Chevalier Jackson Laryngoscope

Harvey Cushing founded the unconscious/unaware anesthesia

Ether synthesized in 1540 by Cordus

Ether used as anesthetic in 1842 by Dr. Crawford W. Long

Ether publicized as anesthetic in 1846 by Dr. William Morton

Chloroform used as anesthetic in 1853 by Dr. John Snow

Local anesthesia with cocaine in 1885

Thiopental first used in 1934

*
Curare ( a muscle paralyzing agent) first used in 1942 opened the Age of
Anesthesia
Basic Principles of Anesthesia
Anesthesia defined as the abolition of sensation
Analgesia defined as the abolition of pain
Triad of General Anesthesia
1. need for unconsciousness
2. need for analgesia
3. need for muscle relaxation
Factors that Determine the Choice of Anaesthesia
1. Patient physical condition
2. Patients age
3. Medication taken

4. Type and probable duration of operation

5. Laboratory findings
6. Any known idiosyncracies
7. Patients preference
Types of Anesthesia
General Anesthesia
Association pathway are broken in the cerebral cortex to produce more or less
complete lack of sensory perception and motor discharge
Unconsciousness is produced when blood circulating to the brain contains an
adequate amount of anesthetic agent. General anesthesia results in an immobile,
quiet patient who does not recall the procedure.
Stages of General Anesthesia

From

To

Analgesia
Induction stage

Patients Reaction Nursing Action

Loss of consciousness Drowsy, dizzy

Excitement/
delirium, Loss of Relaxation
consciousness

Close suites door, keep room quiet

stand by to assist

May be excited
with irregular
breathing and
Secure patient properly, remain at
movements of the
the side of the patient quietly but
extremities
ready to assist anesthesiologist as
Susceptible to
needed
external stimuli
(e.g. noise, touch)
Regular
respiration,Contrac
Position patient and prep skin only
ted pupils,Reflexes
when anesthesiologist indicates this
disappear,Muscle
stage in reached
relax,Auditory
sensation loss

Surgical
Anesthesia
Relaxation

Loss of reflexes;

Danger Stage

Not breathing
Respiratory failure;
Prepare for cardiopulmonary
possible cardiac arrest Little or no pulse or resuscitation
heartbeat

Vital functions
too depressed
1. 1.

Depression of vital
function

Inhalational Anesthetic Agents

Inhalational anesthesia refers to the delivery of gases or vapors from the respiratory
system to produce anesthesia
Pharmacokineticsuptake, distribution, and elimination from the body
Two Methods of Administration Inhalation
Gases and vapors can be delivered via face mask or endotracheal tube.
Mask Inhalation
Anesthetic gas or vapor of a volatile liquid is inhaled through a face mask attached
to an anesthesia machine by breathing tubes.
The mask must fit the face tightly to minimize escape of gases into environment.
Endotracheal Administration
Anesthetic vapor or gas is inhaled directly into trachea through a nasal or oral tube
inserted between vocal cords by direct or blind laryngoscopy. The tube must be
securely fixed in place to minimize tissue trauma. The patient is given oxygen
before and after suctioning. Intubation, insertion of tube directly to the trachea
and extubation removal of tube.
2. Intravenous
A drug that produce hypnosis, sedation, amnesia and or analgesia that is injected
directly into the circulation, usually via the peripheral vein.
Nitrous Oxide
*

Prepared by Priestley in 1776

Anesthetic properties described by Davy in 1799

Characterized by inert nature with minimal metabolism

Colorless, odorless, tasteless, and does not burn

Simple linear compound

Not metabolized

Only anesthetic agent that is inorganic

Major difference is low potency

Weak anesthetic, powerful analgesic

Needs other agents for surgical anesthesia

Low blood solubility (quick recovery)

Nitrous Oxide Systemic Effects

*

Minimal effects on heart rate and blood pressure

May cause myocardial depression in sick patients

Little effect on respiration

Safe, efficacious agent

Nitrous Oxide Side Effects

*

Manufacturing impurities toxic

Hypoxic mixtures can be used

Large volumes of gases can be used

Beginning of case: second gas effect

End of case: diffusion hypoxia

Diffusion into closed spaces

Inhibits methionine synthetase (precursor to DNA synthesis)

Inhibits vitamin B-12 metabolism

Dentists, OR personnel, abusers at risk

Halothane
*

Synthesized in 1956 by Suckling

Halogen substituted ethane

Volatile liquid easily vaporized, stable, and nonflammable

Most potent inhalational anesthetic

Efficacious in depressing consciousness

Very soluble in blood and adipose

Prolonged emergence

Halothane Systemic Effects

*

Inhibits sympathetic response to painful stimuli

Inhibits sympathetic driven baroreflex response (hypovolemia)

*
Sensitizes myocardium to effects of exogenous catecholamines ventricular
arrhythmias
*

Johnson found median effective dose 2.1 ug/kg

Limit of 100 ug or 10 mL over 10 minutes

Limit dose to 300 ug over one hour

Decreases respiratory drive central response to CO 2 and peripheral to O2

*
*

Respirations shallow atelectasis

Depresses protective airway reflexes

Depresses myocardium lowers BP and slows conduction

Mild peripheral vasodilation

Halothane Side Effects

Halothane Hepatitis 1/10,000 cases
*

fever, jaundice, hepatic necrosis, death

metabolic breakdown products are hapten-protein conjugates

immunologically mediated assault

exposure dependent

Malignant Hyperthermia
1/60,000 with succinylcholine to 1/260,000 withouthalothane in 60%,
succinylcholine in 77%
Classic rapid rise in body temperature, muscle rigidity, tachycardia,
rhabdomyolysis, acidosis, hyperkalemia, DIC
most common masseter rigidity
family history
high association with muscle disorders
autosomal dominant inheritance
diagnosisprevious symptoms, increase CO2, rise in CPK levels, myoglobinuria,
muscle biopsy
physiologyhypermetabolic state by inhibition of calcium reuptake in sarcoplasmic
reticulum
treatmentearly detection, d/c agents, hyperventilate, bicarb, IV dantrolene (2.5
mg/kg), ice packs/cooling blankets, lasix/mannitol/fluids. ICU monitoring
Susceptible patients preop with IV dantrolene, keep away inhalational agents and
succinylcholine
Enflurane
*

Developed in 1963 by Terrell, released for use in 1972

Stable, nonflammable liquid

Pungent odor

Enflurane Systemic Effects

*
Potent inotropic and chronotropic depressant and decreases systemic
vascular resistance lowers blood pressure and conduction dramatically
*

Inhibits sympathetic baroreflex response

Sensitizes myocardium to effects of exogenous catecholamines arrhythmias

Respiratory drive is greatly depressed central and peripheral responses

increases dead space

widens A-a gradient

produces hypercarbia in spontaneously breathing patient

Enflurane Side Effects

*
Metabolism one-tenth that of halothane does not release quantity of
hepatotoxic metabolites
*

Metabolism releases fluoride ion renal toxicity

Relaxes the uterus (can cause spontaneous birth) in pregnant woman.

Epileptiform EEG patterns

Isoflurane
*

Synthesized in 1965 by Terrell, introduced into practice in 1984

Not carcinogenic

Nonflammable,pungent

Less soluble than halothane or enflurane

Isoflurane Systemic Effects

*

Depresses respiratory drive and ventilatory responses less than enflurane

Myocardial depressant less than enflurane

Inhibits sympathetic baroreflex response less than enflurane

Sensitizes myocardium to catecholamines less than halothane or enflurane

*
Produces most significant reduction in systemic vascular resistance coronary
steal syndrome, increased ICP
*

Excellent muscle relaxant potentiates effects of neuromuscular blockers

Isoflurane Side Effects

*

Little metabolism (0.2%) low potential of organotoxic metabolites

No EEG activity like enflurane

Bronchoirritating, laryngospasm

Sevoflurane and Desflurane

*

Low solubility in blood produces rapid induction and emergence

Minimal systemic effects mild respiratory and cardiac suppression

Few side effects

Expensive

Intravenous Anesthetic Agents

*

First attempt at intravenous anesthesia by Wren in 1656 opium into his dog

Used in anesthesia in 1934 with thiopental

Many ways to meet requirements muscle relaxants, opoids, nonopoids

Appealing, pleasant experience

Thiopental
*

Barbiturate

Water soluble

Alkaline

*
Dose-dependent suppression of CNS activitydecreased cerebral metabolic
rate (EEG flat)
Thiopental Systemic Effects
*
Varied effects on cardiovascular system in people mild direct cardiac
depression lowers blood pressure compensatory tachycardia (baroreflex)
*
Dose-dependent depression of respiration through medullary and pontine
respiratory centers
Thiopental Side Effects
*

Noncompatibility

Tissue necrosisgangrene

Tissue stores

Post-anesthetic course

Etomidate
*

Structure similar to ketoconozole

Direct CNS depressant (thiopental) and GABA agonist

Etomidate Systemic Effects

*

Little change in cardiac function in healthy and cardiac patients

Mild dose-related respiratory depression

Decreased cerebral metabolism

Etomidate Side Effects

*

Pain on injection (propylene glycol)

Myoclonic activity

Nausea and vomiting (50%)

Cortisol suppression

Ketamine
*

Structurally similar to PCP

Interrupts cerebral association pathways dissociative anesthesia

Stimulates central sympathetic pathways

Ketamine Systemic and Side Effects

*
CO

Characteristic of sympathetic nervous system stimulation increase HR, BP,

Maintains laryngeal reflexes and skeletal muscle tone

Emergence can produce hallucinations and unpleasant dreams (15%)

Propofol
*

Rapid onset and short duration of action

*
Myocardial depression and peripheral vasodilation may occur baroreflex not
suppressed
*

Not water soluble-- painful (50%)

Minimal nausea and vomiting

Benzodiazepines
*

Produce sedation and amnesia

Potentiate GABA receptors

Slower onset and emergence

Diazepam
*

Often used as premedication or seizure activity, rarely for induction

Minimal systemic effects respirations decreased with narcotic usage

Not water soluble-- venous irritation

Metabolized by liver not redistributed

Lorazepam
*

Slower onset of action (10-20 minutes) not used for induction

Used as adjunct for anxiolytic and sedative properties

Not water soluble-- venous irritation

Midazolam
*

More potent than diazepam or lorazepam

Induction slow, recovery prolonged

May depress respirations when used with narcotics

Minimal cardiac effects

Water soluble

Narcotic agonists (opiods)

*

Used for years for analgesic action civil war for wounded soldiers

Predominant effects are analgesia, depression of sensorium and respirations

Mechanism of action is receptor mediated

Minimal cardiac effects no myocardial depression

Bradycardia in large doses

Some peripheral vasodilation and histamine release hypotension

Side effects nausea, chest wall rigidity, seizures, constipation, urinary

retention
*
Meperidine, morphine, alfentanil, fentanyl, sufentanil are commonly
used
Naloxone is pure antagonist that reverses analgesia and respiratory depression
nonselectively acts 30 minutes, effects may recur when metabolized
Muscle Relaxants
Current use of inhalational and previous intravenous agents do not fully provide
control of muscle tone
First used in 1942-- many new agents developed to reduce side effects and
lengthen duration of action
Mechanism of action occurs at the neuromuscular junction
Neuromuscular Junction
Nondepolarizing Muscle Relaxants
*

Competitively inhibit end plate nicotinic cholinergic receptor

Intermediate acting (15-60 minutes): atracurium, vecuronium, mivacurium

Long acting (over 60 minutes): pancuronium, tubocurarine, metocurine

Difference renal function

Nondepolarizing Muscle Relaxants

Tubocurare suppress sympathetics, mast cell degranulation

Pancuronium blocks muscarinics

Reversal by anticholinesterase inhibit acetylcholinesterase

neostigmine, pyridostigmine, edrophonium

side effects muscarinic stimulation

Depolarizing Muscle Relaxants

Depolarize the end-plate nicotinic receptor
*

Succinylcholine used clinically

short duration due to plasma cholinesterase

*
side effects fasiculations, myocyte rupture, potassium extravasation,
myalgias
*

sinus bradycardia muscarinic receptor

malignant hyperthermia

Local Anesthetics
*

Followed general anesthesia by 40 years

Koller used cocaine for the eye in 1884

Halsted used cocaine as nerve block

First synthetic local procaine in 1905

Lidocaine synthesized in 1943

Local Anesthetics
*
Mechanism of action is by reversibly blocking sodium channels to prevent
depolarization
*
Anesthetic enters on axioplasmic side and attaches to receptor in middle of
channel
*

Local Anesthetics

Linear molecules that have a lipophilic and hydrophilic end (ionizable)

low pH more in ionized state and unable to cross membrane

adding sodium bicarb more in non-ionized state

Two groups: esters and amides

1. esters metabolized by plasma cholinesterase
2. amides metabolized by cytochrome p-450
Local Anesthetic Toxicity
Central nervous system
initially lightheadedness, circumoral numbness, dizziness, tinnitus, visual change
later drowsiness, disorientation, slurred speech, loss of consciousness, convulsions
finally respiratory depression
Local Anesthetic Toxicity
Cardiovascular
myocardial depression and vasodilation hypotension and circulatory collapse
Allergic reactions rare (less than 1%)
preservatives or metabolites of esters
rash, bronchospasm
Prevention and Treatment of Toxicity
Primarily from intravascular injection or excessive dose anticipation
aspirate often with slow injection
ask about CNS toxicity
have monitoring available
prepare with resuscitative equipment, CNS-depressant drugs, cardiovascular drugs
ABCs
Cocaine
*
South American Indians used to induce euphoria, reduce hunger, and
increase work tolerance in sixth century
*
Many uses in head and neck strong vasoconstrictor,no need for
epinephrine
*
Mechanism is similar blocks sodium channel, also prevents uptake of
epinephrine and norepinephrine
*

Cocaine

*
May lead to increased levels of circulating catecholamines tachycardia,
peripheral vasoconstriction
*

Safe limits (200-400 mg) use with epinephrine clinically

TRANSCULTURAL NURSING
Posted: September 14, 2011 in OTHERS
Tags: transcultural nursing
0
African-Americans Dialect and slang terms require careful communication to prevent
error (e.g., bad may mean good) Question the clients meaning or intent
Mexican Americans Eye behavior is important. An individual who looks at and
admires a child without touching the child has given the child the evil eye. Always
touch the child you are examining or admiring
American Indians Eye contact is a sign of disrespect and is thus avoided Recognize
that the client may be attentive and interested even though eye contact is avoided
Appalachians Eye contact is considered impolite or a sign of hostility. Verbal pattern
may be confusing. Avoid excessive eye contact. Clarify statements.
American Eskimos Body language is very important.
The individual seldom disagrees publicly with others. Client may nod yes to yes to
be polite, even if not in agreement. Monitor own body language l\closely as well as
clients to detect meaning.
Jewish Americans Orthodox Jews consider excess touching, particularly from
members of the opposite sex, offensive. Establish whether client is an Orthodox Jew
and avoid excessive touch.
Chinese Americans Individual may nod head to indicate yes or shake head to
indicate no.
Excessive eye contact indicates rudeness.
Excessive touch is offensive Ask questions carefully and clarify responses.
Avoid excessive eye contact and touch.
Filipino Americans Offending people is to be avoided at all cost.
Nonverbal behavior is very important. Monitor nonverbal behaviors of self and
client, being sensitive to physical and emotional discomfort or concerns of the
client.
Haitain Americans Touch is used in conversation.
Direct eye contact is used to gain attention and respect during communication. Use
direct eye contact when communicating.
East Indian Hindu Americans Women avoid eye contact as a sign of respect. Be
aware that men may view eye contact by women as offensive. Avoid eye contact.
Vietnamese Americans Avoidance of eye contact is a sign of respect.
The head is considered sacred; it is not polite to pat the head.

An upturned palm is offensive in communication. Limit eye contact.

Touch the hand only when mandated and explain clearly before proceeding to do so.
Avoid hand gesturing.
Important Definitions:
1. Culture: is a patterned behavioral response that develops over time through
social and religious customs and intellectual and artistic activities; a result of
acquired mechanisms that may have innate influences but are primarily affected by
internal and external environmental stimuli.
2. Cultural values: unique, individual expressions of a particular culture that have
been accepted as appropriate over time. They guide actions and decision making
that facilitate self-worth and self-esteem.

NURSING MANAGEMENT

choosing the right person and giving them the appropriate task for the
purpose of achieving their goal/objective in achieving total care

Frederick Taylors Scientific Management Theory

Elements
o

choosing the appropriate person (TAO)

choosing the appropriate team

choosing the appropriate training

choosing the appropriate tools

Human Relations theory

the be a good manager, there should be a good interpersonal relationship

between the leader and follower

Douglas Mc Gregors Motivational theory

Theory X
o

Negative workers

negligence, inefficient, ineffective workers

Theory Y
o

Positive workers

diligent, effective, efficient worker

theory X should be given focus because they are prone to negligence and
malpractice.

Max Webers Bureaucratic/ authoritarian Theory

whoever is on the top would perform the management function

centralized

Elton Maytos Behavioral Theory

overtime pay, rest day, day off

provide physical needs of the workers

Hawthornes Effect
o

If workers knows they are observed they become more efficient

Henry Fayols Principle of Management

Unity of Command one leader, one command

Unity of Direction one group should always have one goal

Remuneration of Personnel patient first policy

Esprit de corps team spirit

Command responsibility/Respondeat Superior let the superior answer

the fault of his subordinates even harm or death

Balance between centralization and decentralization

Security tenure

Delegation of responsibility

Proper Compensation of workers

o

RA 7305 (Magna Carta Law) salary grade 50 P13,000/month

Overtime pay additional of 25%/hr

Night Differential additional of 10%/hr

Legal holiday x 2

Philhealth Benefit of worker both related and non-related work

(aesthetic, dental and cosmetics are not included)

Maternity leave 60days leave is NSD, 78days if CS only to first 4

pregnancy only to legitimate spouse

Paternity leave 7day/1week leave

Senior Citizens Act 20% discount

5 steps in Management Process

Planning stage
o

looking ahead of time.

Formulating future goals/objective

Types of plan

Standard/Operational Plan (NCP)

Strategic/Contingency Plan

plans for everyday or ordinary activities

plan used during sudden or acute crisis

Long-range/future Plan

plans which you cant evaluated immediately.

Usually last months or yrs.

Used for chronic pt which requires longer period of care.

Stages of Planning Process

Mission present reason when established your organization

Vision - statement of your future purpose of your future

organization

Philosophy set of values and beliefs of your organization

Goal general statement of your purpose

Objectives more specific statement of your purpose

Policies set of rules and regulations in your organization

Procedures

Budgeting proper allocation of your resources

3 types

Personnel

Operational

Compensation for salaries of workers

everyday use of equipment and

facilities (gloves, water, electricity)

Capital

long term use equipment (MRI, CT

Scan, hospital beds, hospital buildings)

Organizing
o

4 stages

Organize your team RN Subordinates

Duties of the RN

Only assessment can perform the nurse

Only the nurse can perform HT

Only the nurse should explain the procedure to the

patient

Preparation, administration, treatment of drugs to the

patient

The nurse can only perform evaluation

The nurse can only do judgment

Delegate Task

They can only delegate to subordinates the Routinary task

(standard, unchanging procedure) eg. monitoring of I&O,
bathing, ambulating, toileting, shampooing, transporting,
feeding, clothing, wiping

Stable patient predictable outcome (eg. postmortem

care with direct supervision of the nurse only)

Supervision need guidance

Staff Schedule/ Staffing

Schedules (How many hours)

Traditional 8hrs a day/40hrs/wk

Ten hour shift/4 days a week

Baylor plan it consist of two shifting nurses

traditional mon-fri 8hrs

2nd shift 12hr shift during weekends

Part-time work fewer working hours per day and

may choose the day or work. Less than 8hrs job

On call during shortage of nurses/staff but

increase in the number of patients.

Methods of Nursing care Delivery

Different Methods

Primary 24hrs a day

Functional Method

DOH format/government hospitals

Assign nurse :

Primary nurse is the only nurse who is

responsible to make a care plan of the
patient from the moment of admission till the
moment of discharge. (eg. private duty nurse
or special nurse)

Duty/task

One nurse, one task

Highly recommended during a period

of shortage of nurses and budget

poorest method of delivery because

communication is hindered

Case Method/Case Nursing

provide total care within your shift. Used in

ICU department

C Case Method

T total care to the patient

O one is to one ratio

Directing/Delegation stage
o

a job or a task is done or performed by another perform for you

What you cannot delegate:

you cannot delegate total control of the procedure

you cant delegate discipline of subordinates or staff members.

Confidential task

Technical task

Medical task performing surgical procedure is done by the doc

not the nurse

Coordination/Collaboration
o

the nurse needs to collaborate to other members of the health care

team.

Multi-interdisciplinary approach to be able to provide holistic

approach to the patient.

Types of Collaboration

Interpersonal/Intradepartmental

One patient, one unit.

Collaboration between one nurse to another healthcare

team in one unit/department

Eg. MI patient nurse, dietary, specialized in cardio

Interdepartmental

4 units in one hospital.

Coordination of the patients care between 2-more

units/departments but still under one same hospital or
institution

Eg. patient due for appendectomy is transferred to the OR

Inter Agency/Institutional

Coordination of patients care between 2 or more

hospitals/health care institution for the benefit of the
patient

Eg. lying in due for C/S and was transferred to a hospital

Evaluation/Controlling
o

stage wherein you determine whether or not your plans for your
patient is met or achieved

Methods of evaluating staff performance

Checklist

it is being evaluated higher than you. (eg. nurse

manager/supervisor or head nurse)

Nursing rounds

it is being evaluated higher than you. (eg. Nurse

manager/supervisor or head nurse)

Psychiatric ward is not done by nursing rounds

Peer review

same rank or level is being evaluated you

poor method

Performance appraisal

the patient evaluates you

best method in evaluation