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Cleansweep RN

The following article is taken from the official publication of PRC Board of Nursing (www.bonphilippines.org), regarding the rumor that the intra-partal, intra-operative, and immediate care of the newborn requirements (OR/DR Cases) was reduced from 5 to 3 cases, which caused confusion to some nursing students.

The BON 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. The 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, the BOARD envisions that all related policy-changes that will be announced shall be in effect for those who will enroll 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.

Related Download: PRC BON ADVISORY

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Cleansweep RN

A. General Information:

  • Failure of posterior vertebral arches to fuse or close during embryologic development.
  • Associated deficits may include sensorimotor disturbance, dislocated hips, talipes equinovarus (club foot) and hydrocephalus.
  • Defect closure is done immediately after birth.
  • Approximately 85% of defects in spine involve the lower thoracic lumbar or sacral area, defects in thoracic and cervical area makes up 15%.

B. Types / Classification:

Spina bifida occulta

  • Posterior vertebral arches fail to close in lumbosacral area.
  • Spinal cord remains intact and usually is not visible, maybe identified by a dimple or tuft of hair on the spine.
  • Child is asymptomatic or may have slight neuromuscular deficit.
  • Meninges are not exposed on the surface.

Spina bifida cystica

  • Protrusion of the spinal cord or its Meninges occurs.
  • Defect results in incomplete closure of the vertebral and neural tubes, resulting in saclike protrusion in the lumbar or sacral area, with varying degrees of nervous tissue involvement.

Meningocele

  • Protrusion involves Meninges and sac-like cysts that contain CSF in the midline of the back usually in the lumbosacral area.
  • Sac is covered with thin skin
  • Spinal cord is not involved and no sensory or motor loss.
  • Neurologic deficit are not present

Myelominingocele/meningomyelocele

  • Protrusion of the meninges, CSF and nerve roots, and a portion of spinal cords (herniation of dura and meninges) occurs.
  • Child may have motor and sensory deficit below the site lesion.
    80% of these children have multiple handicaps.
  • The sac is covered by a thin membrane prone to leakage or rupture.

C. Assessment findings:

  • Voluntary movements of lower extremities
  • Withdrawal of lower extremities or crying after pinprick
  • Paralysis of lower extremities (flaccid paralysis)
  • Joint and hip deformities
  • Hydrocephalus
  • Altered bladder and bowel functions
  • Prenatal ultrasound reveals fetal and spinal defects and sac
  • Increased alphafetoprotein (AFP) level prior to 18 weeks of gestation
  • Myelogram shows extent of neural defects
  • Urinalysis, culture and sensitivity (C/S) may identify organism and indicate appropriate antibacterial therapy

D. Nursing Interventions:

  • Evaluate the sac and measure the lesion
  • Monitor neurological status
  • Measure the head circumference and assess anterior fontanel for fullness
  • Protect the sac by covering with a sterile, moist, non-adherent dressing to maintain the moisture of the sac and contents.
  • Change dressing every 2 to 4 hours as prescribed
  • Place the child in prone position to minimize tension on the sac and the risk of trauma
  • Turn the head to sides during feeding
  • Change dressing when it is soiled to prevent infection, use sterile technique
  • Do not use diapers until the defect has been repaired
  • Perform passive ROM exercises to lower extremities
  • Provide adequate nutrition
  • Provide emotional support to the patient and family

E. Medical Management:

  • Surgical intervention by closing the sac within 48 hours of birth to prevent infection and preserve neural tissue
  • Orthopaedic procedures to correct defects of hips, knees and feet
  • Antibiotic therapy to prevent infections
  • Anticholinergic drugs to increase bladder capacity and lower intravesicular pressure
  • Immobilization of cast, braces and tractions for defects of hips, knees and feet

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Cleansweep RN

General Information:

  • Chronic relapsing disease that can develop discontinuously in any alimentary tract
  • Chronic inflammatory bowel disease that can affect both small and large intestines; terminal ileum, cecum and ascending colon.
  • Characterized by granulomas that can affect all the bowel wall layers with resultant thickening, narrowing and scarring of the intestinal wall
  • More common on Jewish population ages 20 – 30 years and 40 - 60 years old.

Assessment findings:

  • Right, lower quadrant tenderness and pain; abdominal distensions
  • Anorexia, Nausea and vomiting, 3-4 semi-soft stools/day with mucus and pus
  • Diarrhea, Decreased skin turgor and drug mucus membranesCramp like and colicky pain after meals
  • Fever, pallor and anemia
  • Decreased Hgb and Hct (if Anemic)
  • Negative Sigmoidoscopy or reveals scattered ulcers
  • Barium enema shows narrowing with areas of strictures separated by segments of normal bowel.

Nursing Interventions:

  • Provide appropriate nutrition while reducing bowel motility.
  1. Administer and monitor Total Parenteral Nutrition (TPN)
  2. Provide high protein, high calorie, and low residue diet with no milk products
  3. Weigh daily and take anthropometric measurements
  4. Administer anti-diarrheals and anti spasmodic and anti-cholinergics as ordered
  5. Omit gas producing foods/fluids from the diet, and foods such as whole wheat grains, nuts, raw fruits and vegetables, pepper, alcohol and caffeine containing products.
  6. In acute cases, maintain NPO status and administer fluids and electrolytes intravenously
  7. Monitor bowel sounds and for abdominal tenderness and cramping.
  8. Monitor stools noting its color, consistency and presence or absence of blood in stools
  9. Following acute phase, diet progress to clear liquids to a low residue diet as tolerated
  • Promote comfort and rest: provide good perineal care with frequent washing and adequate drying each bowel movement

Medical Management:

  • Diet: high calorie, high vitamin, high protein low residue, milk free diet
  • Drug therapy: antimicrobials (sulfasalazine) to prevent or control infection, corticosteroids, antidiarrheals, anticholinergics
  • Surgery: resection of diseased portion of bowel and temporary or permanent ileostomy

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Cleansweep RN
The Association of Nursing Service Administration of the Philippines Inc. (ANSAP, Inc.) proudly presents a two-hour stage play entitled "The Voyage of the Lass" portraying the life and works of Florence Nightingale. Shows are set on the following dates; February 6, 13, 20 and 27, 2009 at 3pm and 8pm at the AFP Theater (Col. Boni Serrano ave cor. EDSA, Quezon City, Philippines).

The play is about the life of modern nursing's cornerstone - Florence Nightingale. A woman of rich and influential root chose the "harder" part of being a nurse, in a time of war and misery. Her life changed nursing that time and affected the whole profession until the present. Let her life change the way you perceive about the nursing profession. And let her love story shine during the love month.

Tickets are available in (P 300 for students and P 500 for non-students )at ANSAP secretariat office at 4th Floor Lung Center of the Philippines, Quezon Ave. Quezon City. For details on ticket reservation, email secretariat@ansap.org.ph contact ANSAP head office at Tel: 4978071 or visit their site www.ansap.org.ph



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Cleansweep RN
Family Planning is defined as "educational, comprehensive medical or social activities which enable individuals, including minors, to determine freely the number and spacing of their children and to select the means by which this may be achieved (Wikipedia encyclopedia).

A. NATURAL METHODS (Fertility awareness method)

  • Calendar (rhythm method) - estimate date of ovulation based on length of cycle
  • Basal body temperature - identifies ovulation by drop and rise in temperature, identifies the days on which coitus is avoided to avoid conception.
  • Cervical mucus method- identifies ovulation by increase in mucus amount and stretchability; when affected by estrogen and most conductive to penetration by sperm, cervical mucus is clear, slippery and stretchy; when influenced by progesterone, cervical mucus is thick, cloudy and sticky and does not allow sperm passage; coitus is avoided during days of estrogen- influenced mucus.
  • Sympto-thermal – combination of basal body temperature and cervical mucus method to increase effectiveness.
  • Coitus interruptus – withdrawal of penis from the vagina before ejaculation, not very safe, pre ejaculatory fluids from Cowper’s gland may contain live and motile sperm.

B. CHEMICAL AGENTS

  • Creams, foams, jellies, or vaginal suppositories – barriers designed to destroy the sperm or limit their motility, they are available without prescriptions and widely used, need to be placed on vagina immediately before each intercourse.

C. MECHANICAL BARRIER METHODS

  • Diaphragm- shallow rubber dome fits over the cervix that covers the external os.
  1. Disadvantage: must be fitted, provides no protection against STD's and risk of TSS (toxic shock syndrome)
  2. Most effective when used with a chemical agent
  3. Woman needs to measured for the diaphragm and refitted after each childbirth or weight gain and loss of 10 lbs.
  4. Women should practice in the insertion and removal and to be taught how to check for holes in diaphragm
  5. Device should be left on place 6 – 8 hours after intercourse

  • Condom – thin stretchable rubber sheath worn over penis during intercourse.
  1. Disadvantage: decreases penile sensation and spontaneity
  2. Advantage: inexpensive, accessible, and reduces spread of STD's
  3. Widely used without available prescription and applied to erect penis before vaginal intercourse.
  4. Man is instructed to hold on the rim of the condom as he withdraws from the female vagina to prevent spilling of the semen.
  • Cervical cap – cup shaped device that is placed over cervical os and held in place by suction.
  1. It comes in four sizes; client needs to be fitted, and may be left in place up to 24 hours.
    Spermicides increase effectiveness

D. HORMONE THERAPY (Oral contraceptives)

  • Single-hormone therapy - Estrogen given two weeks to suppress LH and FSH. Progesterone given daily to make cervical mucus impervious to sperm.
  • Combined-hormone therapy - combination of estrogen and progesterone on a 25-day cycle.
  • Bleeding starts one to four days after the last pill.
  • Usually taken beginning on the 5th day of the menstrual cycle through the 25th day, then discontinued.
  • Contraindications: family history of stroke, migraines, hypertension, diabetes, chronic renal disease, thrombophlebitis, tobacco use- smoking, 35 years old and above.
  • Side effects: nausea and vomiting, edema and weight gain, breakthrough bleeding, thrombophlebitis, pulmonary embolism, stroke

E. INTRAUTERINE DEVICES

  • Placement of plastic or nonreactive device into uterine cavity.
  • It creates sterile endometrial inflammation that discourages implantation (Nidation).
  • Device is inserted during of just after menstruation, while cervix is slightly open.
  • Side effects: heavy menstrual bleeding, severe cramping, bleeding between periods
  • Complications: uterine perforation, infections, increased risk of Pelvic infection (PID)

F. LONG-ACTING METHODS (steroid implants)

  • Biodegradable rods containing sustained-release, low dose progesterone that inhibits LH (luteinizing hormone) to release that is necessary for ovulation.
  • Implantable progestin (Norplant) – effective for five years
  • Injectable progestin (Depo Provera) – last up to three months

G. SURGICAL STERILIZATION (Permanent contraception)

  • Male sterilization (vasectomy) – surgical removal of vas deferens that connects the testes to seminal vesicle and urethra. This does not affect the sexual desire or potency.
  • Female sterilization- tubal ligation, hysterectomy (removal of uterus)

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