| PRC Registration Schedule for New Nurses Posted: 17 Sep 2010 10:25 PM PDT 
MANILA, Philippines—In a move to expedite the registration of nurses who just passed the licensure exams, the Professional Regulation Commission-Board of Nursing (PRC-BoN) released a new venue and schedule for enlisting. According to PRC-BoN member Marco Sto. Tomas, PRC-Manila will open a PRC-nurse registration extension office beginning September 15, 2010 at the V-Tech Tower, 6th Floor, 1257 G. Araneta Avenue corner Maria Clara Street, Quezon City. Nurse registrants with the cluster and date specified below are hereby instructed to proceed and register in the above address (instead of the P. Paredes office): September 15 – Matundan, Rainalex M. – Monderin, Maria Pamela V.
September 16 – Mondilla, Jerome P. – Noveno, Ingrid Stephanie V.
September 17 – Novero, Charlotte P. – Padua, Remedios A.
September 22 – Padua, Richard M. – Pe, Ezca James P.
September 23 – Pearson, Ivy Lorenne F. – Puno, Mary Rose Ann C.
September 24 – Punongbayan, Renee G. – Rebustes, Korinah A.
September 27 – Recoto Dy, Tiffany Janelle T. – Rodriguez, Ronaldo P.
September 28 – Rodrin, Catherine Catungal – Samonte, Christine Jane A.
September 29 – Samonte, Katrina L. – Sebastian, Jover B.
September 30 – Sebastian, Katrini May Inobaya – Sumail, Settie Sulfaical U.
October 1 – Sumajit, Kristine Marie R. – Tindugan, Charly-Mae F.
October 4 – Tindugan, Joel John C. – Valencia, Erika Ivy I.
October 5 – Valencia, Gay V. – Villas, Jomana Geronimo
October 6 – Villas, Merlyn Kristel Z. – Zuno, Ralf Raymund P. On the other hand, late registrants will be allowed to file only in PRC-Manila office as follows: November 8 – A to C
November 9 – D to M
November 10 – N to Z Source: Related posts: - Initial Registration Schedule July 2010 Nursing Board Exam Passers
- Manila Examinees PRC Initial Registration Schedule
- PRC Initial Registration Schedule for Cebu Passers
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| Cardiogenic Shock Posted: 17 Sep 2010 10:16 PM PDT 
 Cardiogenic shock is the inability to meet the metabolic needs due to severely impaired contractility of either ventricle. That leads to decreased tissue perfusion and a shock like state. Risk factor includes prior myocardial infarction, advanced age, female, diabetes, or anterior wall myocardial infarction. The most common cause of cardiogenic shock are acute Myocardial infarction, ventricular septal defect, acute mitral regurgitation, cardiac tamponade, aortic dissection, massive pulmonary infarct, and severe dysrhythmias.
Signs and Symptoms - Pale, cool and clammy skin
- Pulmonary congestion and hypoxemia worsen as the ventricles fail to eject adequate volume and the blood backs up into the lung.
- Tissue hypoperfusion continues because the oxygen does not meet the metabolic needs.
Physical Examination Appearance - Restlessness progressing to unresponsiveness
- Chest pain
- Dysrhythmias
Vital signs - HR: >100 beats/min
- BP: <80 mm Hg
- RR: > 20 breaths/min
Neurologic - Agitation
- Restlessness progressing to unresponsiveness, and changes in level of consciousness.
Cardiovascular - Weak thready pulses
- Rhythm may be irregular
Pulmonary - Orthopnea
- Crackles
- Cough with increased secretions.
Acute Care Patient Management Nursing Diagnosis: Impaired gas exchange related to increased left ventricular diastolic pressure (LVEDP) and pulmonary edema associated with severe left ventricular (LV) dysfunction. Outcome Criteria - Patient alert and oriented
- Pao2 80 to 100 mm Hg
- pH 7.35 to 7.45
- Paco2 35 to 45 mm Hg
- O2 sat ?95 %
- RR 12 to 20 breaths/min, eupnea
- Lungs clear to auscultation
Nursing Interventions Patient Monitoring - Continuously monitor oxygenation status with pulse oximetry.
- Monitor for desaturation in response to nursing intervention.
- Monitor ECG for dysrhythmias caused by hypoxemia, electrolyte imbalances, or ventricular dysfunction.
- Monitor fluid volume status.
Patient Assessment - Obtain HR, RR, and BP every 15 minutes to evaluate the patient's response to therapy and detect cardiopulmonary deterioration.
- Assess the patient's respiratory status. The use of accessory muscles and inability to speak suggest worsening pulmonary congestion.
- Assess for excess fluid volume, which can further compromise myocardial function.
Diagnostic Assessment - Review ABGs for decreasing trend in Pao2 (hypoxemia) or pH (acidosis). These conditions can adversely affect myocardial contractility.
- Review serial chest radiographs to evaluate the patient's progress or a worsening lung condition.
Patient Management - Provide supplemental oxygen as ordered. If the patient develops respiratory distress, be prepared for intubation and mechanical ventilation.
- Administer low-dose morphine sulfate as ordered to reduce preload in an attempt to decrease pulmonary congestion.
- Minimize oxygen demand by maintaining bed rest and decreasing anxiety, fever, and pain.
- Position the patient for maximum chest excursion and comfort.
- Administer diuretics and /or vasodilators as ordered to reduce circulating volume and decrease preload.
Related posts: - Cardiogenic Pulmonary Edema
- Hypovolemic Shock
- Cardiac Tamponade
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| Aortic Dissection Posted: 17 Sep 2010 10:09 PM PDT 
 Aortic dissection involves a tear in the medical layer of the aortic wall, causing blood to extravasate into the media and thus compromising blood flow to the brain, heart, and other organs. Usually the causative factor is an underlying disease of the media. Dissection can be classified by the sites involved:
- DeBakey type I – ascending aorta beyond arch.
- DeBakey type II – ascending aorta.
- DeBakey type III – descending aorta.
Demographic risk factors include being male, African American, and in the fifth to seventh decade of life. Medical risk factors include hypertension, aortic valve disease, coarctation of the aorta, Marfan's syndrome, recent deceleration injury, cocaine use, and complications from invasive procedures such as angiography or intraaortic balloon. Signs and Symptoms - Abrupt, severe, tearing pain that may be localized in the anterior chest, intrascapular, abdominal, or lumbar area. The pain is usually nonprogressive and most intense at its onset.
Physical Examination Appearance - Anxiety
- Paleness
- Restless
Vital signs - Increased blood pressure may be > 150 mm Hg
- Decreased blood pressure, if hypovolemic (aortic rupture) or cardiac tamponade develops.
Neurologic - Intermittent lightheadedness
- Level of consciousness changes
- Weakness
- CVA symptoms
Cardiovascular - Diastolic murmur (aortic insufficiency) may be present
- Pulse deficits and BP differences between right and left or upper and lower limbs may be noted.
Acute Care Management Nursing Diagnosis: Ineffective tissue perfusion related to compromised arterial blood flow secondary to blood extravasation via aortic dissection. Outcome Criteria - Patient alert and oriented
- Skin war and dry
- BP 80 to 100 mm Hg or as low as can possibly maintain systemic perfusion.
- Urine output 30 mL/hr or 0.5 to 1 ml/kg/hr
- Pulses strong and equal bilaterally
- Capillary refill <3 sec in all extremities
- Pupils equal and nonreactive
- Motor strength strong and equal bilaterally
Nursing Interventions Patient Monitoring - Continuously monitor arterial BP during acute phase to evaluate the patient's response to therapy.
- Monitor hourly urine output because a drop in output may indicate renal artery dissection or a decrease in arterial blood flow.
- Continuously monitor ECG for dysrythmia formation, ST segment or T-wave changes, suggesting coronary sequelae or a decrease in arterial blood flow.
Patient Assessment - Assess neurologic status to evaluate the course of dissection. Confusion or changes in sensation and motor strength may indicate compromised cerebral blood flow (CBF).
- Auscultate for changes in heart sound and signs and symptoms of heart failure, which may indicate that the dissection involves the aortic valve.
- Compare BP and pulses in both arms and legs to determine differences.
Diagnostic Assessment - Review serial BUN and creatinine levels to evaluate renal function.
- Review cardiac enzymes because a dissection involving coronary arteries may result in Myocardial Infarction.
- Review the ECG for patterns of ischemia, injury, and infarction.
- Review results of radiology test such as CT scan, MRI, and aotogram.
Patient Management - Administer oxygen therapy as ordered.
- Keep the patient on bed rest to prevent further dissection
- Nitroprusside may be ordered to lower BP.
- A ?-adrenergic blocking agent such as atenolol, esmolol, or propranolol may be ordered to reduce stress on the aortic wall.
- Anticipate surgical intervention.
Related posts: - Aortic Aneurysm
- Arteriovenous Malformation (AVM)
- Cardiogenic Shock
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| Cardiac Tamponade Posted: 17 Sep 2010 09:54 PM PDT 
 Cardiac tamponade is the accumulation of excess fluid within the pericardial space, resulting in impaired cardiac filling, reduction in stroke volume, and epicardial coronary artery compression with resultant myocardial ischemia. Clinical sings of cardiac tamponade depends on the rapidity of the fluid accumulation and on the fluid volume.
Risk factors include recent cardiac trauma such as open trauma to the thorax (gunshot wounds and stabs), closed trauma to the thorax (impact of the chest on a steering wheel during a motor vehicle accident), cardiac surgery, and iatrogenic causes (cardiac catheterization or pacemaker electrode perforation). Signs and Symptoms - Restlessness
- Agitation
- Weakness
- Anorexia
- Chest discomfort
- Shortness of breath
- Feeling of impending doom
- Poor tissue perfusion
Physical Examination - Pulsus paradoxus > 10 mm Hg (hallmark)
- Narrowed pulse pressure (<30 mm Hg)
- Hypotension
Neurologic - Anxiety
- Confusion
- Obtunded if decompression is advanced
Cardiovascular - Jugular vein distention
- Reflex tachycardia
- Muffled, distant heart sounds
Skin Acute Care Management Nursing Diagnosis: Decreased cardiac output related to reduced ventricular filling secondary to increased intrapericardial pressure. Outcome Criteria - Patient alert and oriented
- Skin warm and dry
- Pulses strong and equal bilaterally
- Capillary refill <3 sec
- HR 60 to 100 beats/min
- BP 90 to 120 mm Hg
- Pulse pressure 30 to 40 mm Hg
- Urine output 30 ml/hr or 1 ml/kg/hr
Patient Monitoring - Continuously monitor ECG for dysrhythmia formation, which may result of myocardial ischemia secondary to epicardial coronary artery compression.
- Monitor the BP every 5 to 15 minutes during the acute phase.
- Monitor for pulsus paradoxus via arterial tracing or during manual BP reading.
- Monitor urine output hourly; a drop in urine output may indicate decreased renal perfusion as a result of decreased stroke volume secondary to cardiac compression.
Patient Assessment - Assess cardiovascular status: monitor for jugular vein distention and presence of Kussmaul's sign.
- Note skin temperature, color, and capillary refill.
- Assess amplitude of femoral pulse during quiet breathing.
- Assess level of consciousness for changes that may indicate decrease cerebral perfusion.
Diagnostic Assessment - Review ECG for electrical alterans.
- Review echocardiogram report if available.
- Review chest radiographs.
Patient Management - Provide supplemental oxygen as ordered.
- Initiate two large-bore intravenous lines for fluid administration to maintain filling pressure.
- Pharmacologic therapy may include dobutamine to enhance myocardial contractility and decrease peripheral vascularresistance.
- Monitor the patient for dysrhythmias, coronary artery laceratio.
- Surgical intervention to identify and repair bleeding site, to evacuate clots in the mediastinum, to resects or open the pericardium.
Related posts: - Hypovolemic Shock
- Aortic Dissection
- Cardiogenic Pulmonary Edema
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| Job Alert: NursingCrib.com Needs Writers/Authors Posted: 17 Sep 2010 06:43 PM PDT 
The Student Nurses’ Community NursingCrib.com is looking for online qualified writers/authors/contributors to join our organization. Junior Writer (Part Time) - Open for 3rd and 4th Year Nursing Students (SN) currently enrolled in a nursing school in the Philippines
- Must have good scholastic records
- Must be 18 years old and above
- Must have basic computer and internet skills
- Must have excellent writing skills
- Experience in writing for any school or private publication is definitely an advantage
Senior Writer (Part Time/Full Time) - Open only for Licensed Nurses in the Philippines
- Must have basic computer and internet skills
- Must have excellent writing skills
- Preferably with experience as an instructor in a review center or any nursing school in the Philippines
- Experience in writing for any school or private publication is definitely an advantage
- NCLEX Passer also an advantage
- Masters Degree preferred but not required
Qualified applicants must submit your resume with picture and written application letter to admin@nursingcrib.com on or before September 25, 2010. Related posts: - Nursing Jobs in Japan
- No nurse surplus, only unqualified graduates–recruiters
- A Forum for NursingCrib.com, Coming Soon
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