“Filipino Nurses Seeking US jobs Continue to Decline” plus 4 more nursing article(s): NursingCrib.com Updates

Filipino Nurses Seeking US jobs Continue to Decline
Erythema Infectiosum (Fifth Disease)
Blood Glucose Monitoring
Ambiguous Genetalia
Repair of Omphalocele

Filipino Nurses Seeking US jobs Continue to Decline

Posted: 18 Oct 2010 02:42 AM PDT

MANILA, Philippines—The number of Filipino nurses aspiring to practice their profession in the United States continued to drop year-on-year in the third quarter, the Trade Union Congress of the Philippines (TUCP) said over the weekend.

In a news release, TUCP secretary-general and former senator Ernesto Herrera said only 2,227 Filipino nurses took the US NCLEX for the first time from July to September, down 38 percent or 1,355 fewer compared to the 3,582 in the same three-month period in 2009.

TUCP now expects some 5,000 fewer Filipino nurses taking the NCLEX the whole of this year, according to Herrera, former chairman of the Senate committee on labor, employment and human resources development.

Thus far, a total of 7,780 Filipino nurses took the NCLEX for the first time from January to September, down 35 percent or 4,074 less versus the 11,854 in the same nine-month period last year.

The NCLEX is the licensure exam administered by the US National Council of State Boards of Nursing Inc. The number of Filipino nurses taking the test for the first time is a reliable indicator as to how many of them are trying to enter the profession in the US, Herrera said.

A total of 15,382 Filipino nurses took the NCLEX for the first time in the whole of 2009, down 5,364 or 26 percent from 20,746 in 2008. All told, since 2005, some 90,000 Filipino nurses have taken the NCLEX for the first time, that is, excluding repeaters.

Despite the decline in the number of Filipinos nurses seeking US employment, Herrera said the Philippines remains America’s largest supplier of new foreign nurses, after India, South Korea, Canada, and Nigeria.

Outside the US, the Philippines is also the United Kingdom’s third biggest supplier of new foreign nurses, after India and Australia.

source: inquirer.net

Erythema Infectiosum (Fifth Disease)

Posted: 17 Oct 2010 07:01 PM PDT

Definition

Erythema infectiosum or the “Fifth Disease” is an infectious disorder that affects children aging 2-12 years of age. The term “fifth disease” was based on the classification system for childhood rashes decades ago. Generally, the five frequent childhood rashes are the following:

Measles (rubeola)
Chickenpox (vaicella)
German measles (rubella)
Roseola
Erythema Infectiosum (Parvovirus B19)

Because erythema infectiosum is the fifth disease that causes rashes in children, thus, the term has been used by most people. The prevalence of the illness is more commonly seen during spring and winter period and studies show that females are often affected than males.

Parvovirus B19, sometimes called as erythrovirus B19 is a part of the genus Parvoviridae. It was accidentally detected in 1975 by an Australian virologist Yvonne Cossart.

“Fifth Disease” Related Data

Causative Agent: Parvovirus B19

Incubation period: 6-14 days

Mode of transmission: droplet (respiratory secretions transmitted by cough and sneeze)

Period of communicability: uncertain

Signs and symptoms

Fifth disease produces symptoms that are benign and go away on their own. The following are most likely observed:

Fever, headache, coryza, abdominal pain, sore throat and malaise on the first week.

Rashes appear a week after, erupting in three sequential phases:

Face

Bright red rash coalesces at the cheeks forms a "slapped face appearance." (Hallmarksign)

Extensor surface of extremities(outer arm)

Rashes are expected to scatter on the extremities (extensor surface) a day after the facial rash develops.

(Extensor surfaces refers to the part of the skin that do not touch when the joints are bend)

Flexor surfaces of extremities and trunk

Rash invasion in these areas are observed a day after it appeared on the extensor surfaces (inner arm and leg).

The eruptions will last for a week or more.
Rashes start to fade from the center outward (a lace-like appearance will be observe due to this manner of disappearance)

Management

Home care:

Adequate fluid intake
Frequent hand washing.
Acetaminophen (Tylenol) is given to decrease body temperature. Aspirin (acetylsalicylic acid) is not recommended as it is related to the occurrence of Reye' syndrome.

Droplet precautions should be implemented if the child is hospitalized. (wearing mask,gloves, eyewear, spacing client in single room)
Avoid contact to pregnant women. Parvovirus B19 is teratogenic. It causes severe anemia with congestive heart failure to the fetus.
A child may resume school as soon as the rash appears. (the disease is no longer contagious at this time)

images from qwickstep.com,itriagehealth.com

Blood Glucose Monitoring

Posted: 17 Oct 2010 07:00 PM PDT

Blood Glucose Monitoring

Definition

Blood glucose monitoring is a method of assessing the concentration of glucose in the blood. Tests are performed rapidly and easily by using a reagent strip (e.g. Glucostix) where a minute drop of capillary blood is obtained from the client's digits (finger or toe), earlobe or heel. On the condition where the patient has all the equipments this test can be performed at home, office, hospitals, clinics and even when travelling.

Purpose

Blood glucose tests detect blood glucose levels in people with the following conditions:

Diabetes Mellitus (Type 1, Type 2)
Gestational diabetes
Neonatal hypoglycemia
Diabetic Coma

During the test, a portable blood glucose meter (e.g. Glucometer or One Touch) is used to give numerical data or measurement of a patient's serum glucose level by inserting the blood stained plastic strip. Some meters are installed with memory application helpful in storing the sequence of test results obtained for easy evaluation.

Paraphernalia

Reagent strips or test strip
Clean Gloves
Alcohol pads
Lancets or lancing device
Portable glucose meter
Watch (with second hand)
Pen and Logbook for documentation

Procedure

Identify the patient by asking the patient to state his/her name. Also check the client's identification band. ( confirm patient's identity using two patient identifiers, based on the hospital protocol)
Explain the procedure to the patient or parents (if patient is a child) to gain cooperation.
Choose the puncture site. For adults and children fingertips and earlobe can be use. For infants, the tip of the great toe or heel can be the site of puncture.
Wash hands and don clean gloves.
If glucometer is used, load the strip into the device beforehand.
Swab alcohol pad to the chosen puncture site. Use sterile/clean gauze to dry it thoroughly. Piecing the skin with a wet skin (alcohol) allows the chemical to pass through the outer layer of the skin thus, causing the procedure more painful and uncomfortable.
To collect a blood sample, position the lancet (pricking needle) at the side of the site. To minimize pain and patient's anxiety pierce the skin sharply and briefly. This technique also increases blood flow. For better results, some agencies are using a lancing device (mechanical blood-letting device) wherein the lancets are simply loaded in the spring of the equipment. (It's like using a spring-loaded pen, once you click the button the spring releases the lancet and immediately retracts it after piercing the skin). However, be sure to load an unused lancet before using to prevent spread of blood-transmitted diseases.
Don't squeeze the puncture site to prevent diluting the sample with fluids from tissues.
Cover the entire patch of strip with blood.
Place gauze over the punctured area and briefly apply pressure until the bleeding stops. Ask the parents of a child to do this.
If using a reagent strip, leave the blood on the strip for 1 minute (60 seconds). And watch the color change on the strip while comparing it to the standardized color chart of the product container.
If glucometer is used, simply follow the manufacturer's instruction.
Apply an adhesive bandage once the bleeding on the puncture site has stopped.
Remove gloves and record the resulting glucose level from the digital display for glucometer or from the color of reagent strip to the standardized chart.

Common Errors in Blood Glucose Monitoring

Dropping a very small amount of blood
Inappropriate timing ( the test is usually performed before meals and at bedtime, or whenever hypoglycemia or hyperglycemia occurs)
Squeezing the puncture site too hard allowing tissue fluids to mix with the sample
Improper maintenance of glucometers (dust or blood accumulation on the digital display)

images from pennmedicine.org, mdconsult.com, odessaregionalmedicalcenter.com

Ambiguous Genetalia

Posted: 17 Oct 2010 06:59 PM PDT

Ambiguous genitalia

An ambiguous genital is a form of birth defect where the external genitalia do not normally present as either male or female.

Sex of an individual is genetically determined during conception. However, external reproductive structures are not differentiated at this point. It is the sperm or the father that determines that sex of a baby. The sperm contains either an X or Y chromosome while the ovum always carries an X chromosome. An ovum (X) fertilized by a sperm with an X chromosome will result to a genetic female (XX). On the other hand, an ovum (X) fertilized by a sperm with Y chromosome will bring about a chromosomal male (XY). The reproductive system of both sexes is similar for the first six weeks of intrauterine life. Internal differences in male and female reproductive structures are occurring during the seventh week. External genitals look the same until 9 weeks, when external changes start to occur with either the presence or absence of testosterone. The differentiations of male and female external reproductive organs are completed by about 12 week's age of gestation.

Ambiguity in external genitals can also be due to the following instances:

Congenital adrenal hyperplasia

In congenital adrenal hyperplasia (CAH), the adrenal gland is not producing enough cortisol and aldosterone but extremely supplies androgen (masculinizing hormone) in the body. This is an autosomal recessive inherited gene can cause a large clitoris in females, closed labial folds, no menses and breast development. The female baby at birth appears to have a penis with undescended testes. In males, the genitals appear normal at birth but sexual precocity starts to occur by about 6 months where the penis is enlarged and pubic hair grows early. Sterility also is a complication in boys as absence of spermatogenesis is noted.

Chromosomal abnormalities (Klinefelter's syndrome and Turner's syndrome)

In Turner's syndrome, only one chromosome X is present. Normally, there are 46 chromosomes in the body; however, with this chromosomal abnormality only 45 chromosomes are present. This leads to gonadal streak (underdeveloped gonadal structures) and sterility.

Klinefelter's syndrome presents with an extra X chromosome. A female is represented by an XXX chromosome while XXY for males. Occurrence of this abnormality results to small testes, gynecomastia and infertility.

Mixed gonadal dysgenesis (MGD)

MGD is the development of both male and female reproductive structures. The visible characteristic of reproductive expression in an individual is unclear.

Maternal intake of androgenic hormones

If a woman has been taking a form of testosterone during pregnancy, a chromosomal female will present with a male-appearing genitalia. It is the influence of testosterone that causes the development of Mesonephric duct to form into the internal male reproductive organs and the elongation of penile tissue externally forms the penis.

Absent testosterone cellular receptors or Inappropriate testosterone production

Without testosterone, the urogenital folds remain open forming the labia minora and the paramesonephric duct develops to form the internal female reproductive structures even if the baby is genetically determined as male. Therefore, formation of external reproductive structures is relatively dependent on the presence of testosterone even if the genetic composition is already established.

Hermaphroditism

If faulty cell division occurs after conception, mosaicism (presence of two cells) may occur. The baby may have both 46 XX and 46 XY chromosomes. This leads to the development of both male and female structures.

image from cursillo-canada.org

Repair of Omphalocele

Posted: 17 Oct 2010 06:53 PM PDT

Definition

Correction of defect of the umbilicus occurring during fetal development, resulting in the protrusion of the abdominal viscera outside the abdominal cavity.

Discussion

The size and extent of the omphalocele can vary from one containing the greater portion of the abdominal viscera, including the spleen and liver, to one containing only a small loop of bowel or intestines. The condition results from a herniation through a midline defect in the abdominal wall around the area of the umbilicus.
Usually there is no skin covering the defect, which greatly increases the incidence of a life-threatening infection for the already compromised infant.
In most cases, additional congenital anomalies are usually present in these patients and, depending on the capability of the abdominal cavity to contain the contents of the omphalocele, a one or two-stage procedure may be performed.

Positioning

Supine, with arms restrained at the side.

Packs/ Drapes

Pediatric transverse Lap sheet or basic pack and sheet with small fenestration.

Instrumentation

Pediatric laparotomy tray
Hemoclips/ surgiclip

Supplies/ Equipment

Thermal blanket
Head covering
Extremity wrap
Handheld cautery
Suction
Basin set
Blades
Needle counter
Dissector sponges
Solutions
Sutures
Silastic/ silicon mesh
Gastrostomy tube or catheter

Procedure Overview

Single-Stage Repair

The ophalocele is covered with a warm saline laparotomy sponge.
An incision is made separating the skin from the peripheral borders of the sac.
The umbilical vessels are ligated and the sac and rim of the defect are excised.
A gastrostomy may be performed, creating an artificial opening into the stomach with insertion of a gastrostomy tube or catheter, permitting the process.
The abdominal contents are reduced within the abdomen, and the abdomen is closed in a routine manner.

Double (Two-Stage) Repair

When the defect cannot be closed and/ or the abdominal cavity cannot safely accommodate the contents of the omphalocele, an attempt is made to mobilize the surrounding skin to cover the protruding viscera.
A synthetic material is used to cover the defect by suturing it around and over the viscera.
As growth permits (6-24 months), a complete repair procedure may be achieved, requiring one or two additional procedures.

Perioperative Nursing Considerations

Do not begin skin preparation without specific instructions from the surgeon.
The perioperative nurse should be aware of several crucial factors affecting the outcome of the surgical event including metabolism, fluid and electrolyte balance, temperature regulation, cardiovascular and pulmonary responses, infection, safety, and pain management during the preoperative and postoperative phases.