“Initial Registration Schedule July 2010 Nursing Board Exam Passers” plus 3 more nursing article(s): NursingCrib.com Updates

Initial Registration Schedule July 2010 Nursing Board Exam Passers
Cerebrospinal Fluid (CSF) Analysis
Breast Biopsy Procedure
Cardiac Catheterization

Initial Registration Schedule July 2010 Nursing Board Exam Passers

Posted: 07 Sep 2010 12:32 AM PDT

Successful examinees of the July 2010 Nursing Board Exam should personally register and sign in the Roster of Registered Professionals at the PRC Central or Regional Office where he/she filed his/her application.

Those who will register are required to bring the following:

1. Duly accomplished Oath Form or Panunumpa ng Propesyonal
2. Current Community Tax Certificate (cedula)
3. 2 pieces passport size picture (colored with white background and complete name tag)
4. 1 piece 1" x 1" picture (colored with white background and complete name tag)
5. 2 sets of metered documentary stamps, and 1 short brown envelope with name and profession
6. Initial Registration Fee of P600 and Annual Registration Fee of P450 for 2010-2013.

Manila and Pampanga Passers ONLY

Date	From	To
Sept. 13	AALA, MARIANNE RUTH A.	ALARILLA, SILVAIN ANTHONY J.
Sept. 14	ALARTE, MARGIECEL G.	ANGELES, LLOYD ADDISON R.
Sept. 15	ANGELES, MIA RICHELLE R.	AURA, ELAINE ANGELINE Y.
Sept. 16	AURE, JEANINA T.	BARRIATOS, JONATHAN VICTOR B
Sept. 17	BARRIDO, PAULINE PEARL B.	BEZA, CARLOS M.
Sept. 22	BEÑAN, GLADYS B.	CABALZA, INGRID JOY M.
Sept. 23	CABANA, CHARMAINE ANGELICA P.	CAPULE, ALAINE F.
Sept. 24	MARC ANTHONY L.	CERDA, CARMELA P.
Sept. 27	CERDAN, TRISTAN B.	COTAS, PAOLA YSABEL D.
Sept. 28	COTO, ROSHELLE ANN J.	DAVID, CATHERINE JOLIE R.
Sept. 29	DAVID, KRIZELA REGINE Q.	DELA CRUZ, CHRISTIAN C.
Sept. 30	DELA CRUZ, CHRISTINE R.	DIZON, KIM ROY C.
Oct. 1	DIZON, KRISTOFER CARLO D.	ESPARES, MARISSA JOY R.
Oct. 4	ESPARTERO, ELVIN MARK N.	FERRERA, JANICE LYN P.
Oct. 5	FERRERA, KATRINA CONCEPCION F.	GAMOL, MARICRIS C.
Oct. 6	GAMUYOD, JOEYLYN H.	GONZALES, SHEENA MARIE B.
Oct. 7	GONZALES, STEIGER B.	IBATUAN, PRINCESS U.
Oct. 8	IBAY, ANNA PATRICIA V.	JUNIO, MA. JENNIFER S.
Oct. 11	JUNIO, PAMELA CHARMINE E.	LEONES, VERNICE T.
Oct. 12	LEONO, EVER QUEEN V.	LUNAS, SHERRY MAE N.
Oct. 13	LUPDAG, REENA KATHLEEN D.	MANAS, CHORICE ANNE P.
Oct. 14	MANAS-SEDANO, CLAUDLIDEZ MARY C.	MATUDAN, JENNY M.
Oct. 15	MATUNDAN, RAINALEX M.	MONDERIN, MARIA PAMELA V.
Oct. 18	MONDILLA, JEROME P.	NOVENO, INGRID STEPHANIE V.
Oct. 19	NOVERO, CHARLOTTE P.	PADUA, REMEDIOS A.
Oct. 20	PADUA, RICHARD M.	PE, EZCA JAMES P.
Oct. 21	PEARSON, IVY LORENNE F.	PUNO, MARY ROSE ANN C.
Oct. 22	PUNONGBAYAN, RENEE G.	REBUSTES, KORINAH A.
Oct. 25	RECOTO DY, TIFFANY JANELLE T.	RODRIGUEZ, RONALDO P.
Oct. 26	RODRIN, CATHERINE CATUNGAL	SAMONTE, CHRISTINE JANE A.
Oct. 27	SAMONTE, KATRINA L.	SEBASTIAN, JOVER B.
Oct. 28	SEBASTIAN, KATRIN MAY INOBAYA	SUMAIL, SETTIE SULFAICAL U.
Oct. 29	SUMAJIT, KRISTINE MARIE R.	TINDUGAN, CHARLY-MAE F.
Nov. 3	TINDUGAN, JOEL JOHN C.	VALENCIA, ERIKA IVY I.
Nov. 4	VALENCIA, GAY V.	VILLAS, JOMANA GERONIMO
Nov. 5	VILLAS, MERLYN KRISTEL Z.	ZUÑO, RALF RAYMUND P.
Nov. 8	A to C – LATE REGISTRANTS	Nov. 8 A to C – LATE REGISTRANTS
Nov. 9	D to M – LATE REGISTRANTS	Nov. 9 D to M – LATE REGISTRANTS
Nov. 10	N to Z – LATE REGISTRANTS	Nov. 10 N to Z – LATE REGISTRANTS

Cerebrospinal Fluid (CSF) Analysis

Posted: 06 Sep 2010 06:23 PM PDT

Cerebrospinal fluid is a clear substance that circulates in the subarachnoid space, protects the brain and spinal cord from injury and transports products of neurosecretion, cellular biosynthesis, and cellular metabolism through the Central Nervous System.

For qualitative analysis, CSF is obtained most commonly by lumbar puncture (usually between the third and fourth lumbar vertebrae) and, rarely by cisternal or ventricular puncture. A CSF specimen may also be obtained during other neurologic tests such as myelography.

Purpose of Cerebrospinal Fluid Analysis

To measure cerebrospinal fluid (CSF) pressure as an aid in detecting an obstruction of CSF circulation.
To aid in the diagnosis of viral or bacterial meningitis, subarachnoid or intracranial hemorrhage, tumors, and brain abscesses.
To aid in the diagnosis of neurosyphilis and chronic central nervous system infections.
To check for alzheimer's disease.

Cerebrospinal Fluid Analysis Procedure

Patient Preparation

Tell the patient that this test usually takes at least 15 minutes.
Inform him that a headache is the most common adverse effect of lumbar puncture, but reassure him that his cooperation during the test helps minimize the reaction.
Make sure that the patient or a responsible family member has signed an informed consent form.
If the patient is unusually anxious, assess and report his vital signs.

Implementation

If the patient is positioned on his side, provide pillows to support the spine on a horizontal plane. This position allows full flexion of the spine and easy access to the lumbar subarachnoid space.
Help him maintain his position by placing one arm around his knees and the other arm around his neck.
If the sitting position is used, help the patient maintain this position throughout the procedure.
After the skin is prepared for injection, the area is draped.
The anesthetic is injected, and the spinal needle is inserted in the midline between the spinous vertebral process, usually between the third and fourth lumbar vertebrae.
When the stylet is removed from the needle, CSF drips from it if the needle is properly positioned.
A stopcock and manometer are attached to the needle to measure initial (opening) CSF pressure.
After the specimen is collected, label the containers in the order in which they were filled and record the doctor's specific instruction for the laboratory.
A final pressure reading is taken, and the needle is removed.
Clean the puncture site with local antiseptic, such as providone-iodine solution, and apply a small adhesive bandage.
Send the form and labeled specimens to the laboratory immediately.

Nursing Interventions

Check whether the patient must lie flat or if the head of his bed may be slightly elevated.
Encourage the patient to drink fluids. Provide a flexible straw.
Check for the puncture site for redness, swelling, and drainage every hour for the first 4 hours, and then every 4 hours for the first 24 hours.
If CSF pressure is elevated, assess the patient's neurologic status every 15 minutes for 4 hours. If he's stable, assess him every hour for 2 hours and then every 4 hours or according to the present schedule.

Interpretation

Normal Results

Clear, colorless fluid.
Cell count: No red blood cells (RBCs); 0 to 5 white blood cells (WBCs).
Gram stain: No organism
Pressure: 50 to 180 mm H2O

Abnormal Results

Cloudy, bloody, brown, orange, or yellow fluid.
Cell count: RBCs present; increased WBCs
Gram stain: Gram positive or gram-negative organisms.
Pressure: Increased or decreased.

Precautions

Infection at the puncture site contraindicates CSF removal.
In the patient with increased intracranial pressure, CSF should be removed with extreme caution because fluid withdrawal can cause a rapid reduction in pressure and cerebellar tonsillar herniation and medullary compression.

Interfering Factors

Patient position and activity may possibly increase or decrease in CSF pressure.
Crying, coughing, or straining.
Delay between collection time and laboratory testing that may possibly invalidation of test results, especially cell counts.

Complications

Reaction to anesthetic, meningitis, bleeding into the spinal canal, cerebellar tonsillar herniation, and medullary compression.
Signs of meningitis.
Signs of herniation.

Breast Biopsy Procedure

Posted: 06 Sep 2010 06:12 PM PDT

Breast biopsy is necessary to confirm or rule out cancer. Needle biopsy or fine-needle biopsy can provide a core of tissue or a fluid aspirate, but needle biopsy should be restricted to fluid-filled cysts and advanced malignant lesions. Both methods have limited diagnostic value because of the small and perhaps unrepresentative specimens they provide. Open biopsy provides a complete tissue specimen, which can be sectioned to allow more accurate evaluation.

A breast biopsy can usually be done on an outpatient basis under local anesthesia; however, an excisional open biopsy may require general anesthesia. In sufficient tissue is obtained and the mass is found to be a malignant tumor, specimens are sent for estrogen and progesterone receptor assays to assist in determining future therapy and the prognosis.

Purpose Breast Biopsy

To differentiate between benign and malignant breast tumors.

Breast Biopsy Procedure

Patient Preparation

Make sure the patient has signed a consent form.
Note and report all allergies.
If the patient is to receive a local anesthesia, tell her she need not restrict food or fluids.
If the patient is to have a general anesthesia, tell her she is to have nothing by mouth after midnight or before the procedure.
Obtain and report abnormal results of prebiopsy studies, such as blood tests, urine tests, and radiographs of the chest.
Explain that the test takes 15 to 30 minutes.

Implementation

Needle Biopsy

Instruct your patient to undress to the waist.
After guiding her to a sitting or recumbent position with her hands at her sides, tell her to remain still.
The doctor then prepares the biopsy site, administers a local anesthetic, and introduces the syringe (luer-lock syringe for aspiration, Vim-Silverman needle for tissue specimen) into the lesion.
Fluid aspirated from the breast is expelled into a properly labeled, heparinized tube; the tissue specimen is placed in a labeled specimen bottle containing normal saline solution or formalin.
Send both specimens to the laboratory immediately. (With fine needle aspiration, a slide is made and viewed immediately under a microscope).
Because breast fluid aspiration isn't diagnostically accurate, some doctors aspirate fluid only from cysts. If such fluid is clear yellow and the mass disappears, the aspiration is both diagnostic and therapeutic, and the aspirate is discarded. If aspiration yields no fluid or if the lesion recurs two or three times, an open biopsy is then considered appropriate.
After the procedure, pressure is exerted on the biopsy site and, after bleeding has stopped, an adhesive bandage is applied.

Open Biopsy

The site is prepared and draped, and the patient is given a local or general anesthetic.
An incision is made in the breast to expose the mass. A portion of tissue or the entire mass is extracted.
Benign-appearing masses smaller than ¾" (2cm) in diameter are usually excised.
The specimens are placed in properly labeled specimen bottles containing 10% formalin solution.
The malignant-appearing tissue is sent for frozen suction and receptor assays.

Nursing Interventions

If the patient has received a general or local anesthetic, monitor the patient's vital signs regularly. If she has received a general anesthetic, check her vital signs every 15 minutes for 1 hour, every 30 minutes for 2 hours, every hour for the next 4 hours, and then every 4 hours.
Administer analgesics for pain, as ordered, and provide ice bags for comfort.
Instruct the patient to wear a support bra at all times until healing is complete.
Observe for and report bleeding, tenderness, and redness at the biopsy site.
Provide emotional support to the patient awaiting diagnosis.

Interpretation

Normal Results

Breast tissue consists of cellular and noncellular connective tissue, fat lobules, and various lactiferous ducts.
Breast tissue is pink, more fatty than fibrous, and shows no abnormal development of cells or tissue elements.

Abnormal Results

Benign tumors may suggest fibrocystic disease, adenofibroma, intraductal papilloma, mammary fat necrosis, or plasma cell mastitis.
Malignant tumors may suggest adenocarcinoma, cystosarcoma, intraductal and infiltrating carcinoma, inflammatory carcinoma, medullary or circumscribed carcinoma, colloid carcinoma, lobular carcinoma, sarcoma, or Paget's disease.

Precaution

Breast biopsy is contraindicated in the patient with a condition that precludes surgery.

Interfering Factors

Failure to obtain an adequate tissue specimen or to place the specimen in the proper solution container interfering with test results.

Cardiac Catheterization

Posted: 06 Sep 2010 06:03 PM PDT

Cardiac catheterization involves passing a catheter into the right or left side of the heart. Catheterization can determine blood pressure and blood flow in the chambers of the heart, permits blood sample collection, and record films of the heart's ventricles (contrast ventriculography) or arteries (coronary arteriography or angiography).

Catheterization of the heart's left side assesses the patency of the coronary arteries, mitral and aortic valve function, and left ventricular function. Catheterization of the heart's right side assesses tricuspid and pulmonic valve function and pulmonary artery pressures.

Purpose of Cardiac Catheterization

To evaluate valvular insufficiency or stenosis, septal defects, congenital anomalies, myocardial function, myocardial blood supply, and cardiac wall motion.
To aid in diagnosing left ventricular enlargement, aortic root enlargement, ventricular aneurysms, and intracardiac shunts.

Cardiac Catheterization Procedure

Patient Preparation

Explain the procedure to the patient.
Tell him to restrict fluids for at least 6 hours before the test.
Inform him that the test takes 1 to 2 hours.
Tell him that he may receive a mild sedative but will remain conscious during the procedure.
Have the patient to void just before the procedure.
Check the patient history for hypersensitivity to shellfish, iodine, or contrast media used in other diagnostic tests. Discontinue any anticoagulant therapy as ordered.

Implementation

The patient is placed supine on padded table and his heart rate and rhythm, respiratory status, and blood pressure are monitored throughout the procedure.
An I.V. line is started, if not already in place, and a local anesthetic is injected at the insertion site.
A small incision is made into the artery or vein, depending on whether the test is for the left or right.
The catheter is passed through the sheath into the vessel and guided using fluoroscopy.
In the right-sided catheterization, the catheter is inserted into the antecubital or femoral vein and advanced through the vena cava into the right side of the heart and into the pulmonary artery.
If left-sided heart catheterization, the catheter is inserted into the brachial or femoral artery and advanced retrograde through the aorta into the coronary artery ostium and left ventricle.
When the catheter is in place, contrast medium is injected to make visible the cardiac vessels and structures.
Nitroglycerin is given to eliminate catheter-induced spasm or watch its effect on the coronary arteries.
After the catheter is removed, direct pressure is applied to the incision site until bleeding stops, and a sterile dressing is applied.

Nursing Interventions

Monitor the patient's heart rate and rhythm, respiratory and pulse rates, and blood pressure frequently.
Monitor the patient's vital signs every 15 minutes for 2 hours after the procedure, every 30 minutes for the next 2 hours, and then every hour for 2 hours.
If no hematoma or other problems arise, begin monitoring every 4 hours. If vital signs are unstable, check every 5 minutes and notify the practitioner.
Observe the insertion site for a hematoma or blood loss. Additional compression may be necessary to control bleeding.
Check the patient's color, skin temperature, and peripheral pulse below the puncture site.
Enforce bed rest for 8 hours. If the femoral route was used for catheter insertion, keep the patient's leg extended for 6 to 8 hours.
If medications were withheld before the test, check with the practiotner about resuming their administration.
Administer prescribed analgesics.
Make sure a posttest ECG is scheduled to check for possible myocardial damage.

Interpretation

Normal Results

No abnormalities of heart valves, chamber size, pressures, configuration, wall motion, or thickness, and blood flow.
Coronary arteries have a smooth and regular outline.

Abnormal Results

Coronary artery narrowing greater than 70% suggests significant coronary artery disease.
Narrowing of the left main coronary artery and occlusion or narrowing high in the left anterior descending artery suggests the need for revascularization surgery.
Impaired wall motion suggests myocardial incompetence.
A pressure gradient indicates valvular heart disease.
Retrograde flow of the contrast medium across a valve during systole indicates valvular incompetence.

Precautions

Coagulopathy, impaired renal function, and debilitation usually contraindicate catheterization of both sides of the heart. Unless a temporary pacemaker is inserted to counteract induced ventricular asystole, left bundle-branch block contraindicates catheterization of the right side of the heart.
If the patient has valvular heart disease, prophylactic antimicrobial therapy may be indicated to guard against subacute bacterial endocarditis.

Complications

Ineffective endocarditis in a patient with vulvular heart disease.
Myocardial infarction, arrhythmias, cardiac tamponade, pulmonary edema, hematoma, blood loss, adverse reaction to contrast media, and vasovagal response.