It has to go in a custom footer (not html module) to work*. The source, which also has some interesting thoughts on the desirability of disabling right click, is below: *Using in a custom footer:replace all code in xslt box with this: ]]>


Saturday, August 05, 2006

Inborn Errors of Metabolism

Inborn Errors of Metabolism

G6PD Deficiency-Glucose 6 Phospate Dehydrogenase
· Sex linked recessive (X-linked kaya there is more boys than girls)
(bakit boys? Remember that female contains XX genes while male contains X genes. So ibig sabihin if a female had a faulty X genes the other X genes can balance the effect. So with this principles female are always carriers and her son would be affected, Then if the affected son had a female daughter she will be a carrier)

· Lacks enzyme G6PD results in premature destruction of RBC if cells are exposed to oxidants, ASA, legumes and flava beans

2 forms:

1. Congenital Nonspherocytic Hemolytic anemia- group of congenital hemolytic anemias in which there is no abnormal hemoglobin or spherocytosis and in which there is a defect of glycolysis in the erythrocyte

Characterized by:
Hemolysis, jaundice, splenomegaly and aplastic anemia

2. Drug induced

Precipitating factors:

1. Illness: bacterial and viral infections
2. Anti-pyretic drugs (Aspirin and phenacitin)
3. sulfonamides
4. Anti-malarial drugs (Quinine)
5. Various medications such us Vit. K and Methylene blue
6. Flava beans and Napthalene (eto ung moth balls or naptalina na nilalagay sa cabinet)

Dx Procedure

· Rapid enzymes screening test or electropoetic RBC
· Peripheral blood smear- reveals presence of Heinz bodies (hindi eto ung ketchup, this are RBC’s that appears to have bite off the cytoplasm, that’s why they are sometimes called ‘bite cells’)

Nursing Management

· Instruct to avoid foods such us flava beans, red wine, legumes, blueberries, soya foods, tonic water and other drugs that triggers the attack.


· elevated excretion of amino acid homocystiene
· It can lead to mental retardation (delays in reaching developmental milestones {e.g., crawling, walking, sitting})

REVIEW!!! Ireview natin ang mga level of Mental retardation... lumabas ito last June 06 board.
Profound Mental retardation- IQ<20> thinks like an Infant. Can’t be trained
Severe Mental retardation- 20-35
Moderate 35-50-> can be trained. Mental age is 2-7y/o. Pre-operational stage
Mild- 50-70 Metal age is 7-12. Educable and can go to school
Borderline 70-90
Normal – 90-110
(Balik ulit tayo sa Homocystinuria)

· Inability to convert amino acid Methionine
· Autosomal recessive (this means the gene defect is unknowingly passed down from generation to generation. This faulty gene only emerges when two carriers have children together and pass it to their offspring. For each pregnancy of two such carriers, there is a 25% chance that the child will be born with the disease and a 50% chance the child will be a carrier for the gene defect.)

· Mental retardation
· Downward subluxation of lens (ectopia lentis)
· Slender built
· Pectus excavatum (oist meron din nito ang may Down syndrome, the sternum appears sunken and the chest concaves.)
· Abnormal thinning and weakness of the bone (osteoporosis and kyphoscoliosis)
· Degeneration of the aorta

Bacterial inhibition assay for methionine- Normal is <1mg>

Congenital Adrenal Hyperplasia

- A condition where the adrenal does not produce enough cosrtisol and aldosterone but there is an excessive production of androgens.
- This is also autosomal recessive

REVIEW!! Hormones of the Adrenal Cortex
Ang ating code; SSS
Salt- Mineralocorticoids (mainly aldosterone- responsible for Na reabsorption and K excretion)
Sugar-Glucocorticoids (mainly cortisol, responsible for glycolisis and gluconeogenesis)
Sex- Sex hormones
Oversecretion- Cushing’s syndrome
Undersecretion- Addison’s disease

In female
· Large clitoris, closed labial folds
· Early appearance of pubic hair
· Deep masculine voice
· No breast development and menstruation
· Excessive hair in face
· (in short nagiging lalaki ung babae, pramis pag nakita nyo ung itsura, ung clitoris eh mukha nang penis)

In male:
at birth- normal
6 months signs of sexual precocity
3-4 – have pubic hair and enlarged penis, scrotum and prostate but testes is not descended

Low serum Na
High serum K

Diet: High sodium, low potassium


(PKU) – deficiency of liver enzymes (PHT)
Phenylalaninehydroxylase Transferase – liver enzyme that converts CHON to amino acid

9 amino acids:
valine isolensine tryptophase
lysine phenylalanine

Thyronine – decrease malanine production
1.) fair complexion
2.) blond hair
3.) blue eyes
Thyroxine – decrease basal metabolism
- accumulation of Phenyl Pyruvic acid
4.) Atopic dermatitis
5.) musty / mousy odor urine
6.) seizure – mental retardation

Test – GUTHRIE TEST – specimen – blood
- preparation increase CHON intake
- test if CHON will convert to amino acid

specimen and urine
mixed with pheric chloride, presence of green spots at diaper a sign of PKU
Low phenylalanine diet- food contraindicated- meats, chicken, milk, legumes, cheese, peanuts
Give Lofenalac- milk with synthetic protein


– deficiency of liver enzyme
- GUPT – Galactose Urovil Phosphatetranferase
- Converts galactose to phosphate tranferace glucose
Galactose – will destroy brain cells if untreated – death within 3 days

Beutler test – get blood -done after 1st feeding
presence of glucose in blood – sign of galactosemia
galactose free diet lifetime
neutramigen – milk formula

CELIAC DISEASE – gluten enteropathy
Common gluten food:
Intolerance to food with brow
B- barley
R- rye
O- oat
W- wheat

Gluten – glutamine ( normal absorption)-> Gliadin ( toxic to epithelial cells of villi of intestines, effects is malabsorption syndrome)

-> Fats-> steatorrhea
->malnutrition and edema
-> Vit D calcium->osteomalicia
->Vitamin K->inadequate blood coagulation->bleeding
->iron folic acid-> anemia

Early Sx:
1. diarrhea – failure to gain wt ff diarrheal episodes
2. constipation
3. vomiting
Late Sx:
abd pain – protruberant abd even if with muscle wasting

Celiac Crisis- exaggerated vomiting with bowel inflammation
lab studies – stool analysis
serum antiglyadin – confirmatory of disease

gluten free diet – lifetime
all BROW – not allowed
ok – rice & corn

vitamin supplements
mineral supplements


Manila plans to set up milk bank

Manila plans to set up milk bank

By Margaux Ortiz
Last updated 01:02am (Mla time) 08/05/2006

Published on Page A18 of the August 5, 2006 issue of the Philippine Daily Inquirer

MANILA City is studying the possibility of setting up a milk bank to collect breast milk for babies whose mothers have to work.

Cely Sangil, assistant head of the Manila Department of Social Welfare, said the local government was thinking of setting up a milk bank at the Ospital ng Maynila.

“The milk bank will function like a blood bank: lactating mothers could donate extra milk to the facility for use by women unable to provide breast milk to their own babies,” Sangil said in an interview.

“The city government is strongly supporting breastfeeding as a primary bonding activity between mother and child,” Sangil said.

Experts recommend feeding infants breast milk exclusively during the first six months of life. Breast milk can then be complemented with other food from six months until the child is about 2 years old.

Sangil said City Hall was encouraging women employees to give their babies breast milk. The employees could collect their milk and store it in the refrigerator of the city hall clinic to be picked up before they go home, Sangil said.

In a related development, Pampanga Rep. Anna York Bondoc said a bill, the Working Mothers Breastfeeding Act, would be filed in Congress within the year to give recognition to companies that support breastfeeding.

She said that under the bill, companies providing lactation rooms, where nursing women could collect their milk during breaks, would get tax incentives. “The incentives would encourage companies and institutions to support breastfeeding, which is a must for mother and baby,” Bondoc said.

Because breastfeeding was healthier for babies, absenteeism among female employees could be reduced as many childhood ailments could be prevented.

“Breast milk contains antiviral and antibacterial components that would make babies less prone to sickness,” the Pampanga representative said.

She added that another bill, the Family Support for Breastfeeding Act, would require couples to undergo breastfeeding counseling seminars before getting married.


Higher pay up for doctors, nurses

Higher pay up for doctors, nurses

P43B a year to stem medical hemorrhage

By Gil C. Cabacungan Jr.
Last updated 04:35am (Mla time) 08/05/2006

MALACAÑANG is planning to spend an average of P43 billion a year in the next four years to boost the salary scale of government doctors, nurses and teachers in a bid to stem the exodus of these professionals to more lucrative jobs abroad.

Under the Department of Budget and Management’s proposed budget, the government is allocating an increase of P10.3 billion for personal services in 2007, P32.1 billion in 2008, P55 billion in 2009, and P74.9 billion in 2010.

Budget Secretary Rolando Andaya said these budget allocations showed that the government was not only bent on modernizing and expanding the country’s infrastructure like roads, bridges and sea and airports but also on improving its “bureaucratic infrastructure.’’

Andaya pointed out that the higher allocation was on top of the P13 billion that the President has approved to increase the salaries of over a million government workers by P1,000 each this year.

On Labor Day, President Macapagal-Arroyo had ordered the DBM and the Civil Service Commission to draft a bill that would not only complete the on-going salary standardization program of the government but also overhaul the compensation system that would raise the salary levels of key service personnel such as doctors, nurses and teachers.

“The aim of this program is to correct the distortions in the salary scale which is the reason why you have teachers, nurses and doctors going abroad. If you compare these people’s salaries in the private sector, it’s too small,” Andaya said. “Hopefully, this will stop the outflow of these people abroad.”

Andaya said the government’s goal was to give private-grade salaries to government doctors, nurses and teachers to at least narrow the gap and encourage them to continue serving in government. He noted that with the hard economic times, more Filipinos are depending on public hospitals and public schools for their basic needs.

Andaya said that other professional specialists like government geologists could also benefit from the huge increase in personal services budget in the next four years. “We used to have many mining experts in government employ but most of them are now gone due to better opportunities outside,” Andaya said.

Another goal of the increase in personal services was to provide performance-based incentives to government workers in order to improve their productivity.

Andaya said this would complement the government’s rationalization program which provides a golden parachute for bureaucrats qualified for the early retirement program.


US Boards of Nursing websites

The following links will direct you to the Board of Nursing homepages for each respective US state. In there you shall find information and other valuable resources for licensing application, requirements, and other special interests. (Please report any broken links. Thank you.)

New Hampshire
New Jersey
New Mexico
New York*
North Carolina*
North Dakota
Rhode Island
South Carolina*
South Dakota
West Virginia

*does not require CGFNS certification program, but may require other CGFNS programs for licensure

A stick closer to lung cancer

In RP, 20,000 dcaused by smoking to occur every year eaths

In an age where lifestyle diseases abound, lung cancer has slowly gone up the list of killer diseases in the country, with an estimated 15,881 deaths out of the 17,238 new cases recorded in 2005 by the Philippine Cancer Society.

It has also become the leading cancer type plaguing Filipinos, overtaking breast, colon, rectal and uterine cancers by a significant margin. And with over 80 percent of lung cancer cases caused by smoking tobacco or by indirect exposure to tobacco smoke, the disease has never seemed so alarming.

Like all cancer types, lung cancer develops when gene damage occurs in the cellular level. This damage is caused by smoking in most cases, while the rest stem from prolonged exposure to chemicals such as asbestos and radon, or as a complication of other conditions like liver and endometrial cancer.

Lung cancer is also classified into two types: Non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC). Around 80 percent of lung cancer cases are NSCLC.

The danger of contracting the disease also increases with age, with very few cases diagnosed in people under 40. It carries a host of symptoms from persistent coughing, difficulty in breathing, loss of appetite and general fatigue, to chest pains and coughing up blood.

And like most cancers, the signs rarely manifest until the condition is far advanced or has spread to other parts of the body. The most common method for diagnosing lung cancer is through chest X-rays and bronchoscopy, followed by the standard biopsy in which small sample tissues from the lungs are extracted and analyzed.

According to the World Health Organization (WHO), more than 4,000 toxic or carcinogenic chemicals have been found in tobacco smoke, making exposure to it, by far, the biggest risk factor for lung cancer. And the longer you smoke, the greater your risk, with three-quarters of lung cancer deaths occurring in people over the age of 65 worldwide. No safe levels can also be pegged when it comes to smoking. The woman sitting next to a smoker inhaling his fumes can be as equally at risk for lung cancer as the smoker himself. And neither light nor low-tar cigarettes offer an assurance.

In what seems like a race against time to arrest the growing number of cases, companies like Roche are stepping up to the challenge of augmenting known treatment options available to people afflicted with lung cancer. In addition to standard radiotherapy, surgery and chemotherapy, pharmaceutical companies like Roche is now looking into a breakthrough therapy for the treatment of advanced NSCLC. In the last few years, several Phase III trials have evaluated the effect of epidermal Growth Factor Receptor tyrosine kinase inhibitors in patients with metastatic non-small cell lung cancer.
The drug Erlotinib was also seen as exhibiting efficiency among various populations, but especially among Asian patients, with a relative reduction in the risk of mortality in all sub-groups.

Still, an ounce of prevention can be seen with increased government pressure on tobacco companies and legislative support. Despite this, an estimated 20,000 lung cancer deaths caused by smoking are expected to occur in the country every year.

There’s never a better time for one to quit than now. The earlier one turns his back on smoking, the greater the chances for recouping.

Only 20 minutes after the last puff, blood pressure and heart rate drops to normal. After five years, one would have decreased lung cancer risk by half. And after 15 years, life expectancy would be at par with a non-smoker’s if you are under the age of 35.

To cold turkey or gradual. Undergo acupuncture, hypnosis or Nicotine Replacement Therapy. Sign up for counseling and support groups. Find the quitting method that best works for you. And after all that's been said and you still feel the urge to reach for a stick or two, think.

Roche (Philippines), Inc., the Department of Health and the Philippine Cancer Society has launched The C-Network, a cancer advocacy campaign that strives to enhance the standards of cancer care and education for Filipino patients and their families. One of the campaign’s primary goals is to create a community of involved individuals that will facilitate interaction and exchange of information between patients, their families and friends, and their doctors.

For more information, visit the official C-Network homepage at


DoH marks ‘Breastfeeding Week’

As part of the World Breastfeeding Week (Aug. 1 to 7), the Department of Health (DoH) will hold a national conference today at the Century Park Hotel in Manila. The event aims to update concerned medical societies and organizations on the benefits and advantages of breastmilk.

In collaboration with UNICEF and World Health Organization (WHO), the event brings together some 200 members of medical societies that include the Philippine Medical Association, Philippine Pediatric Society, the Philippine Obstetrics and Gynecological Society, Philippine Neonatology Society, and Philippine Society of Newborn Medicine.

Also attending are members from the Perinatal Association of the Philippines, Philippine Society of Pediatric Gastroenterology, Philippine Academy of Family Physicians, and Philippine Society of Obstetric Anesthesiologist.

According to DoH Secretary Francisco Duque, the event comes at an opportune time with the recent signing of the revised Implementing Rules and Regulation for Executive Order No. 51, otherwise known as Milk Code.

"This event is an opportunity to respond to the medical community’s clamor for technical updates on breastfeeding to clear out misconception and misinformation about breastfeeding practices," Sec. Duque said.

Based on discussions conducted by DoH in 2005 with midwives, doctors, and nurses, they have expressed interest to receive technical updates on breastfeeding including situations where breastfeeding or breastmilk feeding might be contraindicated.

An international speaker has been invited to provide expertise in the field of infant and young child feeding. Topics to be discussed include "Breastfeeding and the benefits of early latching on;" "Adequacy of colostrum in feeding the neonate in the first few days of life;" and "10 steps for successful breastfeeding." Attendees will also learn the "Benefits of breastfeeding and the prevention of chronic illnesses for mother and child."

"By enjoining the medical community to support appropriate infant feeding practices and strengthen the National Milk Code, we hope to reduce the risks of dying and illnesses among children who were not breast-fed or given breast milk," said WHO country representative Jean-Marc Olivé.

Non-breastfed children have at least 10 times the risk of dying from diarrhea, 3.6 times the risk of dying from pneumonia and 2.5 times the risk of dying from other infections compared to those exclusively breastfed. Partially breastfed infants died 2.5 times as often as those predominant or exclusively breastfed.

WHO recommends that babies are breastfed or given breast milk exclusively for six months followed by appropriate complementary foods and continued breastfeeding for two years and beyond.

Note: Those that I italicized are common questions that can be asked in the actual board examination.


- brewed

Friday, August 04, 2006

Breast-feeding reduces anxiety into childhood

By Patricia Reaney Thu Aug 3, 8:11 AM ET

LONDON (Reuters) - Breast-feeding's calming effects seem to be long-lasting.

Years after being weaned, breast-fed children cope better with stressful situations like their parents' divorce than their bottle-fed peers, researchers said on Thursday.

"In children who are breast-fed, there is less of an association between parental divorce and separation and childhood anxiety," Dr Scott Montgomery, an epidemiologist at the Karolinska Institute in Sweden, said in an interview.

Breast milk is full of nutrients, hormones, enzymes, growth factors and antibodies that are passed from mother to child.

Research has shown breast-feeding reduces infections, respiratory illness and diarrhoea in the child and cuts the risk of after-birth bleeding in the mother.

In an observation study published in the journal Archives of Disease in Childhood, Montgomery and his team studied how breast- and bottle-fed 10-year-olds coped with the stress of their parents' marital problems.

The children were among 9,000 youngsters who had been monitored from birth for a major British study. Their teachers were asked to rate their anxiety level on a scale of 0-50.

There was a higher level of stress in all the children but the breast-fed youngsters coped better.
"The anxiety was much less obvious in children who were breast-fed," Montgomery said.

The researchers do not know why breast-fed babies were less anxious. They suggested breast-feeding could be an indicator of other parental factors or the physical contact between the mother and the child may have helped to reduce anxiety.

Breast-feeding could also influence the development of pathways in the body linked with its response to stress.

"The more we look at breast-feeding, the more benefits we see. As this is something that is, in evolutionary terms, normal it is likely to be important in normal human development," Montgomery said.

- brewed

Board exam for all courses?

Board exam for all courses?

THE Commission on Higher Education (CHED) yesterday suggested that all the courses in colleges and universities should have board examinations to improve the quality of education in the country.

During yesterday’s meeting with school officials at the Legend Hotel in Mandaluyong City, CHED chair Carlito Puno insisted that the educational system in the country has to undergo radical transformation and renewal.

“In a world of turbulent changes, there is a need for a new vision and paradigm of higher education calling for major changes in policies, practices, means of service deliveries and linkages with local and global institutions,” Puno said in his speech.

He said that to realize these visions and directions, “it is necessary to reengineer curricula using more focused and appropriate methods so as to go beyond cognitive mastery of disciplines and apply new pedagogical and didactical approaches.”

The CHED chairman said that one way to professionalize all higher education courses is to require board examinations.

Apart from the requirement of board exams, Puno said there is also an urgent need to redirect the course preferences of the graduating high school students as well as present first year and second year college students.

The CHED said they have to focus on the “big mismatch” (quantitatively and qualitatively) in the professional demand-and-supply analysis.

“The locus and the focus of the commission’s program thrust will be to correct these quantitative and qualitative mismatches. This cannot be done on a “piece meal” basis; it should be done through a highly focused and coordinated approach,” Puno explained.

He said that to address the quantitative mismatch, the schools should implement a national career streaming and qualifying examinations; conduct aggressive career guidance and counseling; redirect students from enrolling in the over-subscribed curricular programs; require board examinations to all courses; require all higher education institutions both public and private to convert their elementary and high schools to integrated science schools; allow state universities and colleges with teacher education courses to accept 1,000 elementary and 1,000 high school students for their laboratory integrated science schools; and aggressively implement the ladderization program.

Puno said to address this qualitative mismatches, the schools need to improve quality of instructions; offer pre-baccalaureate program for high school graduates who will get very low scores in the National Career Streaming and Qualifying examinations; establish graduate school tie-ups with leading foreign universities in science and technical courses; expand national and international practicum programs and obtain more bilateral academic agreements; engineer academic curricula to make these IT enabled, market responsive and globally competitive; and to create a unit that will promote tie-ups with local industries as well as linkages with foreign universities.

The chairman concluded that the proposed paradigm shifts calling for a more focused and comprehensive action plan are aimed to systematically change the critical structures and processes in higher education.

Jerico Javier

People's Tonight
8/4/2006 20:37 PM

PRC Website now online, Gabberkads is now back online.

The PRC Website is now back online after months of maintenance.

Check out

Due to emails and comments I receive about the previous JAVA based chatroom, I decided to resurrect Gabberkads chat. The chat would not require any plugins, just your browser. There are some issues with OPERA based browser so I suggest that you use FIREFOX or INTERNET EXPLORER.

Gabberkads is UNMODERATED, namejacking is common so beware of those pretending to be an admins and spreading malicious and false rumors.

We will post FACTS and IMPORTANT NURSING RELATED NEWS HERE, not on the chat. So any admins announcing something on the chat is most likely spreading hoax.

Govt urged to probe nurses’ exam scandal

Govt urged to probe nurses’ exam scandal

BAGUIO CITY: A signature campaign took off in Baguio in the hope that the government would order an investigation into the alleged leakage of questions during the last licensure examination for nurses.

Lawyer Cheryl Daytec-Yangot, counsel for the discontented nursing graduates who took the board in Baguio, said there is a snowballing call for a total revamp of the Board of Nursing, including the immediate resignation of George Cordero, Philippine Nurses Association national president.

Yangot said an investigation would hopefully put an end to the controversy, which the nurses deplored has tainted the credibility of the Professional Regulations Commission and the Board of Nursing.

Some members of the House of Representatives have called for an inquiry into the alleged leakage while Sen. Richard Gordon also filed a resolution for a speedy resolution of the case.

Gordon said the scandal could taint the honesty of the entire government-sponsored testing system and smear the image Filipino professionals going out of the country.

Yangot, however, said the impending inquiry in the House and Senate is not the final solution to the problem, saying an investigation would only guide the lawmakers shape appropriate legislation.

Yangot, along with Dean Mary Grace Lacanaria, head of the nursing department of the Saint Louis University, and Ruth Tingda, PNA governor for the Cordilleras and Region I, said their new advocacy is to help protect the integrity of licensure examinations.

In his resolution Gordon said that the world looks to the Philippines to fill the nursing shortages in their countries because Filipino nurses have a reputation for competence, diligence and compassion.

--Harley Palangchao


Bid to open US nurse test center in RP kept alive

Bid to open US nurse test center in RP kept alive

Last updated 02:19am (Mla time) 08/04/2006

Published on Page A19 of the August 4, 2006 issue of the Philippine Daily Inquirer

BAGUIO CITY—The cheating scandal in the recent nursing licensing examinations has not yet cost the country its bid to establish a local testing center that will offer American licensure exams, a Philippine Nurses Association (PNA) official said here on Thursday.

Before licensed Filipino nurses can work in the United States, they are still required to pass the National Council Licensure Examination for Practical Nurses (NCLEx) so they can practice their profession there.

Ruth Thelma Tingda, PNA Cordillera governor, said the US National Council of State Boards of Nursing had been monitoring the controversy because one of its prerequisites for offering the NCLEx here was that the Philippines “must be able to assure complete security of information.”

Tingda, dean of the Easter College’s School of Nursing here, helped three other Baguio nursing school officials and more than 90 examinees expose the distribution of test leakages to clients of a nursing review center during the board exams.

The Professional Regulation Commission (PRC), which administered the exams, said the test leakage attributed to the review center was traced to two members of its board of nursing. The PRC released the test results on July 19.

Tingda, former PNA Ilocos governor Erlinda Palaganas, PNA Baguio chapter president Norenia Dao-ayen, and Dean Mary Grace Lacanaria of the Saint Louis University sued PNA president George Cordero before a Baguio court last week for ordering them to suppress the exposé.

Cordero had told them that he wanted to protect the country’s NCLEx application, Lacanaria said.

Nurses seeking employment in the United States end up going to Guam or Hong Kong, where the closest NCLEx centers are located.

Lacanaria said her group had asked the PRC to revoke Cordero’s nursing license for violating the professional code of ethics.

Cordero and top PNA officials met with the deans last week, but they failed to settle their differences over the exposé.

Instead, the deans and members of the PNA American chapter asked President Macapagal-Arroyo to intervene in the leakage scandal.

The deans said Sen. Rodolfo Biazon, Gabriela Rep. Liza Maza and Eastern Samar Rep. Marcelino Libanan had already sponsored resolutions for congressional inquiries into the integrity of the country’s nursing education and profession.

Thursday, August 03, 2006

Identifying Skin Lesions

This is a guide in identifying skin lesions which we nurses often find confusing. I hope this can help.

· a small spot that is not palpable / elevated and is less than 1 cm in diameter

· a large spot that is not palpable / elevated and that is greater than 1 cm
· may arise through coalescence of macules.

· a small superficial bump (involves epidermis only) that is elevated and that is less than 1 cm

· a large superficial bump (involves epidermis only) that is elevated and greater than 1 cm
· may arise through coalescence of papules

· a small bump with a significant deep component (involves epidermis and dermis) and is less than 1 cm

· a large bump with a significant deep component (involves epidermis and dermis) and is greater than 1 cm

· a small fluid-filled bubble that is usually superficial and that is less than 0.5 cm

· a large fluid-filled bubble that is superficial or deep and that is greater than 0.5 cm

· pus containing bubble often categorized according to whether or not they are related to hair follicles

· a sac containing fluid or semisolid material, ie. cell or cell products

· accumulation or excess shedding of the stratum corneum
· typically present where there is epidermal inflammation

· dried exudate (ie. blood, serum, pus) on the skin surface

· a loss of skin due to scratching or picking

· an increase in skin lines and creases from chronic rubbing

· raw, wet tissue

· a linear crack in the skin; often very painful

· a superficial open wound with loss of epidermis or mucosa only

· a deep open wound with partial or complete loss of the dermis or submucosa

wheal or hive
· describes a short lived (less than 24 hours), edematous, well circumscribed papule or plaque seen in urticaria

· a small threadlike curvilinear papule that is virtually pathognomonic of scabies

· a small, pinpoint lesion, typically referred to as “whiteheads” or “blackheads”

· a thinning of the epidermal and/or dermal tissue

· overgrows the original wound boundaries and is chronic in nature

hypertrophic scar
· does not overgrow the wound boundaries

fibrosis or sclerosis
· describes dermal scarring/thickening reactions

· a small superficial cyst containing keratin (usually less than 1-2 mm in size)

*adopted from Dr. Arni A. Magdamo

GMA creates task force to set up RP's own testing center for nurses

GMA creates task force to set up RP's own testing center for nurses
By Aurea Calica
The Philippine Star 08/03/2006

President Arroyo has created a task force to support the speedy establishment of a National Council Licensure Examination (NCLEX) testing center in the Philippines so Filipino nursing graduates will no longer have to leave the country to take this qualifying examination.

Under Executive Order No. 550 dated July 31, Mrs. Arroyo allotted P10 million for the task force, which will be taken from the President’s Social Fund in support of projects, programs and activities related to its functions.

The NCLEX is a standardized examination which the United States’ National Council of State Boards of Nursing (NCSBN) uses to determine whether or not a candidate is prepared for entry-level nursing practice in the US.

The NCSBN has authorized the conduct of the NCLEX in Hong Kong, London and Seoul, South Korea in 2004. It also established additional test centers in Australia, Canada, Germany, India, Mexico and Taiwan this year.

The NCSBN officers visited the Philippines in March to assess the feasibility of establishing an NCLEX testing center here.

In issuing the EO titled "creating a presidential task force to address concerns arising from the conduct" of NCLEX for nurses in the Philippines, Mrs. Arroyo cited the need for a testing center here.

The President said that the Philippines is the top country of origin of foreign-educated nurses taking the NCLEX, many of whom encounter financial hardship due to the cost of taking qualifying examinations overseas.

"Filipino nurses constitute 83 percent of foreign-educated nurses practicing in the US and contribute positively to the good image of the Philippines through their hard work, dedication and ethic of care," Mrs. Arroyo said.

"The conduct of NCLEX in the Philippines will open opportunities for qualified yet less fortunate Filipino nurses to take the NCLEX locally and the savings from not having to travel abroad to take the said exam may be devoted to test preparation," she added.

Mrs. Arroyo said the "government fully supports the establishment of an NCLEX test center in the Philippines and is prepared to provide assistance in terms of physical and examination security, as well as intellectual property protection through its agencies."

Under the EO, the Commission on Filipinos Overseas, through its chairman, shall be the lead agency in the NCLEX task force that will be supported by the Intellectual Property Office (IPO), Philippine National Police (PNP), Professional Regulation Commission (PRC) and the Philippine Nurses Association (PNA).

The task force will prepare an overall program to consolidate existing government mechanisms and ensure the protection of intellectual property rights and the security of the physical facilities of NCLEX testing centers in the Philippines, the EO read.

It added that the task force will evaluate current procedures in resolving cases involving Filipino nurses and foreign nursing regulatory entities and recommend the proper measures to enhance existing grievance mechanisms.

The task force will also coordinate and liaise with the NCSBN on matters concerning the conduct of the NCLEX in the Philippines and investigate and take specific action on reports of fraud or any related acts that may compromise the integrity of the examinations.

The task force will also conduct consultations and information campaigns among nursing associations and other stakeholders in the field of nursing to assist in preserving the integrity of local and foreign nursing licensure examinations, as referred to by NCSBN.

It will also perform other functions that will ensure the smooth and successful conduct of NCLEX in the Philippines.

The Philippine Star

Failed try to kill country doctor is alarming

Failed try to kill country doctor is alarming
By Mark Ivan Roblas, Researcher

THE attempt on the life of a doctor in Kalinga will drive medical practitioners away from the countryside where they are most needed.

At a press briefing, Dr. Ramon Paterno of the University of the Philippines National Institute of Health said that while the target, Dr. Constancio “Chandu” Claver, survived the attempt, it was a message for health workers to transfer to other areas.

Several doctors attending the news conference echoed the same sentiment, saying the countryside stands to lose because physicians feel vulnerable there.

The doctors added many among their peers are joining the exodus to the city and, worse, to other countries, contributing to the brain drain.

Dr. Joseph Carabeo said other community health workers like nurses and midwives feel they are becoming targets of the government’s anti-insurgency campaign. They are considering their options.
“It is one reason some doctors are enrolling in nursing schools,” Carabeo said. “They are desperate to leave the country.”

Dr. Edelina de la Paz, vice president of Health Action for Human Rights, said health workers fear they will be trapped in the all-out war the government is waging on the insurgents.

“Do we become communist supporters when we treat the poor and the less privileged, who constitute the great majority of the Filipino people?” de la Paz asked.

Dr. Gene Nisperos, secretary-general of Health Alliance for Democracy, dared the government to say outright if the anti-insurgency war includes doctors on its “hit list.”

FROM: Manila Times

Wednesday, August 02, 2006

New JAVA BASED Chat module instruction

New JAVA BASED Chat module instruction
Due to necessity for moderation caused by overwhelming chatters who uses the chatroom to annoy and provoke, PinoyBSN Decided to put up an IRC Based chatroom instead.

You can either use MIRC by setting the server to: IRC.IRCSTORM.NET port: 6667 and joining the channel: #pinoybsn

Instruction for web based chatting :

1. If you do not have JAVA, download it on this link : please follow the instructions carefully on that site.

2. Install JAVA after downloading.

3. Enter the site, wait for the interface to be loaded.

4. Enter your desired NICKNAME on the "Your nickname" Box and press connect.

5. Register your nickname by typing /msg nickserv register password email

6. On you subsequent visit, make sure you identify using your registered nick by typing /msg nickserv identify password

7. If your chosen nickname is not available [ someone else registered it first ] Your name will be changed to Guest**** after few seconds, wherein , * are random numbers. Type /nick newname and try to register again using the command /msg nickserv register password email

this will protect your identity by preventing others from using your name.

For any comments, suggestion and question ... comment down below.

60 Items pediatric Nursing questions with Rationale by: Jeddah

60 item PEDIATRIC NURSING Questions and Rationale by : JEDDAH

Situation 1: Raphael, a 6 year’s old prep pupil is seen at the school clinic for growth and development monitoring (Questions 1-5)

1. Which of the following is characterized the rate of growth during this period?
a. most rapid period of growth
b. a decline in growth rate
c. growth spurt
d. slow uniform growth rate

Correct answer is letter B. During the Preschooler stage growth is very minimal. Weight gain is only 4.5lbs (2kgs) per year and Height is 3.5in (6-8cm) per year.
Most rapid growth and development- Infancy
Slow growth- Toddler hood and Preschooler
Slower growth- School age
Rapid growth- Adolescence

2. In assessing Raphael’s growth and development, the nurse is guided by principles of growth and development. Which is not included?
a. All individuals follow cephalo-caudal and proximo-distal
b. Different parts of the body grows at different rate
c. All individual follow standard growth rate
d. Rate and pattern of growth can be modified

Growth and development occurs in cephalo-caudal meaning development occurs through out the body’s axis. Example: the child must be able to lift the head before he is able to lift his chest. Proximo-distal is development that progresses from center of the body to the extremities. Example: a child first develops arm movement before fine-finger movement. Different parts of the body grows at different range because some body tissue mature faster than the other such as the neurologic tissues peaks its growth during the first years of life while the genital tissue doesn’t till puberty. Also G&D is predictable in the sequence which a child normally precedes such as motor skills and behavior. Lastly G&D can never be modified “Haller? (Pwede mo bang turuan mag basa ang Infant? Or patayuin sya bago pa nakakagapang?)

3. What type of play will be ideal for Raphael at this period?
a. Make believe
b. Hide and seek
c. Peek-a-boo
d. Building blocks

Correct answer is Letter A, make believe is most appropriate because it enhances the imitative play and imagination of the preschooler. C and D are for infants while letter A is B is recommended for schoolers because it enhances competitive play.

4. Which of the following information indicate that Raphael is normal for his age?
a. Determine own sense self
b. Develop sense of whether he can trust the world
c. Has the ability to try new things
d. Learn basic skills within his culture

The correct answer is letter C; because Erickson defines the developmental task of a preschool period is learning Initiative vs. Guilt. Children can initiate motor activities of various sorts on their own and no longer responds to or imitate the actions of other children or of their parents. Letter A and B is.. for you!!

5. Based on Kohlberg’s theory, what is the stage of moral development of Raphael?
a. Punishment-obedience
b. “good boy-Nice girl”
c. naïve instrumental orientation
d. social contact

Correct answer is letter C: According to Kohlber, a preschooler is under Pre-conventional where a child learns about instrumental purpose and exchange, that is they will something do for another if that that person does something with the child in return. Letter A is applicable for Toddlers and letter B is for a School age child.

Situation 2 Baby boy Lacson delivered at 36 weeks gestation weighs 3,400 gm and height of 59 cm (6-10)

6. Baby boy Lacson’s height is
a. Long
b. Short
c. Average
d. Too short

Correct answer is Letter A because the normal length of a newborn is 47.5-53.75 cm (19.5-21in) with an average of 50cm (Filipino standards po ito, pag kay Pilliteri nyo tinignan, 53cm for female and 54cm for male)

7. Growth and development in a child progresses in the following ways EXCEPT
a. From cognitive to psychosexual
b. From trunk to the tip of the extremities
c. From head to toe
d. From general to specific

Growth and development occurs in cephalo-caudal (head to toe), proximo-distal (trunk to tips of the extremities and general to specific, but it doesn’t occurs in cognitive to psychosexual because they can develop at the same time.

8. As described by Erikson, the major psychosexual conflict of the above situation is
a. Autonomy vs. Shame and doubt
b. Industry vs. Inferiority
c. Trust vs. mistrust
d. Initiation vs. guilt

According to Erikson, children 0-18 months are under the developmental task of Trust vs. Mistrust.

9. Which of the following is true about Mongolian Spots?
a. Disappears in about a year
b. Are linked to pathologic conditions
c. Are managed by tropical steroids
d. Are indicative of parental abuse

Mongolian spots are stale grey or bluish patches of discoloration commonly seen across the sacrum or buttocks due to accumulation of melanocytes and they disappears in 1 year. They are not linked to steroid use and pathologic conditions.

10. Signs of cold stress that the nurse must be alert when caring for a Newborn is:
a. Hypothermia
b. Decreased activity level
c. Shaking
d. Increased RR

Correct answer is letter D. Hypothermia is inaccurate cause normally, temperature of a newborn drop, Also a child under cold stress will kick and cry to increase the metabolic rate thereby increasing heat so B isn’t a good choice. A newborn doesn’t have the ability to shiver (Pag ikaw ay nag pa anak at ang beybe ay nanga-ngatog, naku itapon mo yan..di yan beybe itik yan.. hehe). So letter B and C is wrong. A newborn will increase its RR because the NB will need more oxygen because of too much activity.

Situation 3 Nursing care after delivery has an important aspect in every stages of delivery

11. After the baby is delivered, the cord was cut between two clamps using a sterile scissors and blade, then the baby is placed at the:
a. Mother’s breast
b. Mother’s side
c. Give it to the grandmother
d. Baby’s own mat or bed

Of course, place it at the mother’s breast for latch-on. (Note: for NSD breast feed ASAP while for CS delivery, breast feed after 4 hours) Lol, syempre d naman pwede sa grandma dba? Kasi naman hindi gatas ang ipapadede nyan, yogurt na sosyal. ewwww. LOL

12. The baby’s mother is RH(-). Which of the following laboratory tests will probably be ordered for the newborn?
a. Direct Coomb’s
b. Indirect Coomb’s
c. Blood culture
d. Platelet count

Coomb’s test is the test to determine if RH antibodies are present. Indirect Coomb’s is done to the mother and Direct Coomb’s is the one don’t to the baby. Blood culture and Platelet count doesn’t help detect RH antibodies.

13. Hypothermia is common in newborn because of their inability to control heat. The following would be an appropriate nursing intervention to prevent heat loss except
a. Place the crib beside the wall
b. Doing Kangaroo care
c. By using mechanical pressure
d. Drying and wrapping the baby

Placing the crib beside the wall is un-appropriate because it can provide heat loss by radiation. Doing Kangaroo care or hugging the baby, mechanical pressure or incubators and drying and wrapping the baby will help conserve heat,

14. The following conditions are caused by cold stress except
a. Hypoglycemia
b. Increase ICP
c. Metabolic acidosis
d. Cerebral palsy

Hypoglycemia may occur due to increase metabolic rate, And because of newborns are born slightly acidic, and they catabolize brownfat which will produce ketones which is an acid will cause metabolic acidosis. Also a NB with severe hypothermia is in high risk for kernicterus (too much bilirubin in the brain) can lead to Cerebral palsy. There is no connection in the increase of ICP with hypothermia.
(NOTE: pathognomonic sign of Kernicterus in adult- asterexis, or involuntary flapping of the hand.)

15. During the feto-placental circulation, the shunt between two atria is called
a. Ductus venosous
b. Foramen Magnum
c. Ductus arteriosus
d. Foramen Ovale

Foramen ovale is opening between two atria, Ductus venosus is the shunt from liver to the inferior vena cava, and your Ductus Arteriosus is the shunt from the pulmonary artery to the aorta. (hindi kasali sa feto-placental circulation ang Foramen Magnum, sa skull un!)

16. What would cause the closure of the Foramen ovale after the baby had been delivered?
a. Decreased blood flow
b. Shifting of pressures from right side to the left side of the heart
c. Increased PO2
d. Increased in oxygen saturation

During feto-placental circulation, the pressure in the heart is much higher in the right side, but once breathing/crying is established, the pressure will shift from the R to the L side, and will facilitate the closure of Foramen Ovale. (Note: that is why you should position the NB in R side lying position to increase pressure in the L side of the heart.)
Increase PO2-> closure of ductus arteriosus
Decreased bloodflow -> closure of the ductus venosus
Circulation in the lungs is initiated by -> lung expansion and pulmonary ventilation
What will sustain 1st breath-> decreased artery pressure
What will complete circulation-> cutting of the cord

17. Failure of the Foramen Ovale to close will cause what Congenital Heart Disease?
a. Total anomalous Pulmunary Artery
b. Atrial Septal defect
c. Transposition of great arteries
d. Pulmunary Stenosis

Foramen ovale is the opening between two Atria so, if its will not close Atrial Septal defect can occur.

Situation 4 Children are vulnerable to some minor health problems or injuries hence the nurse should be able to teach mothers to give appropriate home care.

18. A mother brought her child to the clinic with nose bleeding. The nurse showed the mother the most appropriate position for the child which is:
a. Sitting up
b. With low back rest
c. With moderate back rest
d. Lying semi flat

The correct position is making the child having an upright sitting position with the head slightly tilted forward. This position will minimize the amount of blood pressure in nasal vessels and keep blood moving forward not back into the nasopharynx, which will have the choking sensation and increase risk of aspiration. Choices b, c, d, are inappropriate cause they can cause blood to enter the nasopharynx.

19. A common problem in children is the inflammation of the middle ear. This is related to the malfunctioning of the:
a. Tympanic membrane
b. Eustachian tube
c. Adenoid
d. Nasopharynx

This is because children has short, horizontal Eustachian tubes. The dysfunction in the Eustachian tube enables bacterial invasion of the middle ear and obstructs drainage of secretions.

20. For acute otitis media, the treatment is prompt antibiotic therapy. Delayed treatment may result in complications of:
a. Tonsillitis
b. Eardrum Problems
c. Brain damage
d. Diabetes mellitus

One of the complication of recurring acute otitis media is risk for having Meningitis, thereby causing possible brain damage. That is why patient must follow a complete treatment regimen and follow up care. A and B are not complications of AOM, (lalo na ung D!!)

21. When assessing gross motor development in a 3 year old, which of the following activities would the nurse expect to finds?
a. Riding a tricycle
b. Hopping on one foot
c. Catching a ball
d. Skipping on alternate foot.

Answer is A, riding a tricycle is appropriate for a 3 y/o child. Hopping on one foot can be done by a 4 y/o child, as well as catching and throwing a ball over hand. Skipping can be done by a 5 y/o.

22. When assessing the weight of a 5-month old, which of the following indicates healthy growth?
a. Doubling of birth weight
b. Tripling of birth weight
c. Quadrupling of birth weight
d. Stabilizing of birth weight

During the first 6 months of life the weight from birth will be doubled and as soon as the baby reaches 1 year, its birth weight is tripled.

23. An appropriate toy for a 4 year old child is:
a. Push-pull toys
b. Card games
c. Doctor and nurse kits
d. Books and Crafts

Letter C is appropriate because it will enhance the creativity and imagination of a pre-school child. Letter B and D are inappropriate because they are too complex for a 4 y/o. Push-pull toys are recommended for infants.

24. Which of the following statements would the nurse expects a 5-year old boy to say whose pet gerbil just died
a. “The boogieman (kamatayan- the man with the scythe) got him”
b. “He’s just a bit dead”
c. “Ill be good from now own so I wont die like my gerbil”
d. “Did you hear the joke about…”

A 5 y/o views death in “degrees”, so the child most likely will say that “he is just a bit dead”. Personification of death like boogeyman or “kamatayan” occurs in ages 7 to 9 as well as denying death can if they will be good. Denying death using jokes and attributing life qualities to death occurs during age 3-5.

25. When assessing the fluid and electrolyte balance in an infant, which of the following would be important to remember?
a. Infant can concentrate urine at an adult level
b. The metabolic rate of an infant is slower than in adults
c. Infants have more intracellular water that adult do
d. Infant have greater body surface area than adults

Infants have greater body surface area than adult, increasing their risk to F&E imbalances. Also infants cant concentrate a urine at an adult level and their metabolic rate, also called water turnover, is 2 to 3 times higher than adult. Plus more fluids of the infants are at the ECF spaces not in the ICF spaces.

26. When assessing a child with aspirin overdose, which of the following will be expected?
a. Metabolic alkalosis
b. Respiratory alkalosis
c. Metabolic acidosis
d. Respiratory acidosis

Remember that Aspirin is acid (Acetylsalicylic ACID), so what do you expect? (ang taray LOL) UN NA!
Pag galling sa bibig: alkalosis (hyper-emesis)
Pag galling sap wet: acidosis (diarrhea)

27. Which of the following is not a possible systemic clinical manifestation of severe burns?
a. Growth retardation
b. Hypermetabolism
c. Sepsis
d. Blisters and edema

The question was asking for a SYSTEMIC clinical manifestation, Letters A,B and C are systemic manifestations while Blisters and Edema weren’t.

28. When assessing a family for potential child abuse risks, the nurse would observe for which of the following?
a. Periodic exposure to stress
b. Low socio-economic status
c. High level of self esteem
d. Problematic pregnancies

Answer is D, Typical factors that may be risk for Child abuse are problematic pregnancies, chronic exposure to stress not periodic, low level of self esteem not high level. Also child abuse can happen in all socio-economic status not just on low socio-economic status.

29. Which of the following is a possible indicator of Munchausen syndrome by proxy type of child abuse?
a. Bruises found at odd locations, with different stages of healing
b. STD’s and genital discharges
c. Unexplained symptoms of diarrhea, vomiting and apnea with no organic basis
d. Constant hunger and poor hygiene

Munchausen syndrome by Proxy is the fabrication or inducement of an illness by one person to another person, usually mother to child. It is characterized by symptoms such as apnea and siezures, which may be due to suffocation, drugs or poisoning, vomiting which can be induced with poisons and diarrhea with the use of laxatives. Letter A can be seen in a Physical abuse, Letter B for sexual abuse and Letter C is for Physical Neglect.

30. Which of the following is an inappropriate intervention when caring for a child with HIV?
a. Teaching family about disease transmission
b. Offering large amount of fresh fruits and vegetables
c. Encouraging child to perform at optimal level
d. Teach proper hand washing technique

A child with HIV is immunocompromised. Fresh fruits and vegetables, which may be contaminated with organisms and pesticides can be harmful, if not fatal to the child, therefore these items should be avoided.

Situation 5 Agata, 2 years old is rushed to the ER due to cyanosis precipitated by crying. Her mother observed that after playing she gets tired. She was diagnosed with Tetralogy of Fallot.

31. The goal of nursing care fro Agata is to:
a. Prevent infection
b. Promote normal growth and development
c. Decrease hypoxic spells
d. Hydrate adequately

The correct answer is letter C. Though letter B would be a good answer too, this goal is too vague and not specific. Nursing interventions will not solely promote normal G&D unless he will undergo surgical repair. So decreasing Hypoxic Spells is more SMART. (alam nyo na kung ano yun! Specific, measurable, attainable, realistic and time bounded). Letter A and D are inappropriate.
Tetralogy of Fallot is a cyanotic Congenital Heart disease. Kaya sa tinawag na Tetralogy cause it has 4 anomalies;
1. VSD- ventricular septal defect
2. Pulmunary Stenosis
3. Over-riding of the Aorta- the aorta overrides both ventricles
4. Right ventricular hypertrophy

We have 14 congenital heart defects. 8 acyanotic and 6 cyanoyic.
8 Acyanotice includes: ASD, VSD, PDA, endocardial cushion defect, pulmonary stenosis, doupling of the aorta, Aortic stenosis and Coarctation of the Aorta
6 Cyanotic includes: Tetralogy of fallot, Total anomalous pulmonary artery, Transposition of the great arteries, Truncus arteriousus, Hypoplastic Left heart syndrome.
(Acyanotic causes L->R shunting while cyanotic cause R->L shunting. Para madaling matandaan lahat ng may “T” eh cyanotic OK?

32. The immediate nursing intervention for cyanosis of Agata is:
a. Call up the pediatrician
b. Place her in knee chest position
c. Administer oxygen inhalation
d. Transfer her to the PICU

The immediate intervention would be to place her on knee-chest or “squatting” position because it traps blood into the lower extremities. Though also letter C would be a good choice but the question is asking for “Immediate” so letter B is more appropriate. Letter A and D are incorrect because its normal for a child who have ToF to have hypoxic or “tets” spells so there is no need to transfer her to the NICU or to alert the Pediatrician.

33. Agata was scheduled for a palliative surgery, which creates anastomosis of the subclavian artery to the pulmonary artery. This procedure is:
a. Waterston-Cooley
b. Raskkind Procedure
c. Coronary artery bypass
d. Blalock-Taussig

Correct answer is Blalock-Taussig procedure its just a temporary or palliative surgery which creates a shunt between the aorta and pulmonary artery (oist parang ductus arteriosus) so that the blood can leave the aorta and enter the pulmonary artery and thus oxygenating the lungs and return to the left side of the heart, then to the aorta then to the body. This procedure also makes use of the subclavian vein so pulse is not palpable at the right arm.
The full repair for ToF is called the Brock procedure. Raskkind is a palliative surgery for TOGA.

34. Which of the following is not an indicator that Agata experiences separation anxiety brought about her hospitalization?
a. Friendly with the nurse
b. Prolonged loud crying, consoled only by mother
c. Occasional temper tantrums and always says NO
d. Repeatedly verbalizes desire to go home

Because toddlers views hospitalization is abandonment, separation anxiety is common. Its has 3 phases: PDD (parang c puff daddy LOL)
1. Protest 2. despair 3. detachment (or denial). Choices B, C, D are usually seen in a child with separation anxiety (usually in the protest stage).
Separation anxiety begin at: 9 months
Peaks: 18 months

35. When Agata was brought to the OR, her parents where crying. What would be the most appropriate nursing diagnosis?
a. Infective family coping r/t situational crisis
b. Anxiety r/t powerlessness
c. Fear r/t uncertain prognosis
d. Anticipatory grieving r/t gravity of child’s physical status

In this item letter A and be are inappropriate response so remove them. The possible answers are C and D. Fear defined as the perceived threat (real or imagined) that is consciously recognized as danger (NANDA) is applicable in the situation but its defining characteristics are not applicable. Crying per se can not be a subjective cue to signify fear, and most of the symptoms of fear in NANDA are physiological. Anticipatory grieving on the other hand are intellectual and EMOTIONAL responses based on a potential loss. And remember that procedures like this cannot assure total recovery. So letter D is a more appropriate Nursing diagnosis.

36. Which of the following respiratory condition is always considered a medical emergency?
a. Laryngeotracheobronchitis (LTB)
b. Epiglottitis
c. Asthma
d. Cystic Fibrosis

Correct answer is letter B, because acute and sever inflammation of the epiglottis can cause life threatening airway obstruction, that is why its always treated as a medical emergency. NSG intervention : Prepare tracheostomy set at bed side.
LTB, can also cause airway obstruction but its not an emergency. Asthma is also not an emergency (ung status asthmaticus ang kaylangan ng prompt treatment). CF is a chronic disease, so its not a medical emergency.
REVIEW: Medical emergency of GI: peritonitis

37. Which of the following statements by the family of a child with asthma indicates a need for additional teaching?
a. “We need to identify what things triggers his attacks”
b. “He is to use bronchodilator inhaler before steroid inhaler”
c. “We’ll make sure he avoids exercise to prevent asthma attacks”
d. “he should increase his fluid intake regularly to thin secretions”

Asthmatic children don’t have to avoid exercise. They can participate on physical activities as tolerated. Using a bronchodilator before administering steroids is correct because steroids are just anti-inflammatory and they don’t have effects on the dilation of the bronchioles. OF course letters A and B are obviously correct.

38. Which of the following would require careful monitoring in the child with ADHD who is receiving Methylphenidate (Ritalin)?
a. Dental health
b. Mouth dryness
c. Height and weight
d. Excessive appetite

Dental problems are more likely to occur in children under going TCA therapy. Mouth dryness is a expected side effects of Ritalin since it activates the SNS. Also loss of appetite is more likely to happen, not increase in appetite. The correct answer is letter C, because Ritalin can affect the child’s G&D. Intervention: medication “holidays or vacation”. (This means na.. during weekends or holidays or school vacations, where the child wont be in school, the drug can be withheld.)

Situation 6 Laura is assigned as the Team Leader during the immunization day at the RHU

39. What program for the DOH is launched at 1976 in cooperation with WHO and UNICEF to reduce morbidity and mortality among infants caused by immunizable disease?
a. Patak day
b. Immunization day on Wednesday
c. Expanded program on immunization
d. Bakuna ng kabtaan

SUS me! Dapat pa bang I-rationalize? Ang di nakakuha ng tamang sagot… hala… JOKE.. hehehe

40. One important principle of the immunization program is based on?
a. Statistical occurrence
b. Epidemiologic situation
c. Cold chain management
d. Surveillance study

Letters A, C and D are not included in the principles of EPI.
The principle of EPI are the following:
1. Its is based on epidemiological situation
2. Mass approach utilization- the whole community is to be protected rather than the individual
3. Immunization is a basic health service, and should be provided by the RHU

41. The main element of immunization program is one of the following?
a. Information, education and communication
b. Assessment and evaluation of the program
c. Research studies
d. Target setting

Correct answer is D.
The following are the elements of EPI:
• Target seting
• Cold chain logistic management
• Information, education and communication
• Assessment and evaluation of the program’s over all performance
• Surveillance, studies and research

42. What does herd immunity means?
a. Interruption of transmission
b. All to be vaccinated
c. Selected group for vaccination
d. Shorter incubation

43. Measles vaccine can be given simultaneously. What is the combined vaccine to be given to children starting at 15 months?
a. MCG
b. MMR
c. BCG
d. BBR

MMR or Measles, Mumps, Rubella is a vaccine furnished in one vial and is routinely given in one injection (Sub-Q). It can be given at 15 months but can also be given as early as 12th month.

Situation 7: Braguda brought her 5-month old daughter in the nearest RHU because her baby sleeps most of the time, with decreased appetite, has colds and fever for more than a week. The physician diagnosed pneumonia.

44. Based on this data given by Braguda, you can classify Braguda’s daughter to have:
a. Pneumonia: cough and colds
b. Severe pneumonia
c. Very severe pneumonia
d. Pneumonia moderate

For a child aging 2months up to 5 years old can be classified to have sever pneumonia when he have any of the following danger signs:
• Not able to drink
• Convulsions
• Abnormally sleepy or difficult to wake
• Stridor in calm child or
• Severe under-nutrition

45. For a 3-month old child to be classified to have Pneumonia (not severe), you would expect to find RR of:
a. 60 bpm
b. 40 bpm
c. 70 bpm
d. 50 pbm

Correct answer is letter D. A child can be classified to have Pneumonia (not severe) if:
• the young infant is less than 2 months- 60 bpm or more
• if the child is 2 months up to less than 12 months- 50 bpm or more
• if the child is 12 months to 4 y/o- 40 bpm or more

46. You asked Braguda if her baby received all vaccines under EPI. What legal basis is used in implementing the UN’s goal on Universal Child Immunization?
a. PD no. 996
b. PD no. 6
c. PD no. 46
d. RA 9173

Correct answer is letter B. Presidential Proclamation no. 6 (April 3, 1986) is the “Implementing a United Nations goal on Universal Child Immunization by 1990”. PD 996 (September 16, 1976) is “providing for compulsory basic immunization for infants and children below 8 years of age. PD no. 46 (September 16, 1992) is the “Reaffirming the commitment of the Philippines to the universal Child and Mother goal of the World Health Assembly. RA 9173 is of course the “Nursing act of 2002”

47. Braguda asks you about Vitamin A supplementation. You responded that giving Vitamin A starts when the infant reaches 6 months and the first dose is”
a. 200,000 “IU”
b. 100,000 “IU”
c. 500,000 “IU”
d. 10,000 “IU”

An infant aging 6-11 months will be given Vitamin supplementation of 100, 000 IU and for Preschoolers ages 12-83 months 200,000 “IU” will be given.

48. As part of CARI program, assessment of the child is your main responsibility. You could ask the following question to the mother except:
a. “How old is the child?”
b. “IS the child coughing? For how long?”
c. “Did the child have chest indrawing?”
d. “Did the child have fever? For how long?”

The CARI program of the DOH includes the “ASK” and “LOOK, LISTEN” as part of the assessment of the child who has suspected Pneumonia. Choices A, B and D are included in the “ASK” assessment while Chest indrawings is included in the “LOOK, LISTEN” and should not be asked to the mother.

49. A newborn’s failure to pass meconium within 24 hours after birth may indicate which of the following?
a. Aganglionic Mega colon
b. Celiac disease
c. Intussusception
d. Abdominal wall defect

Failure to pass meconium of Newborn during the first 24 hours of life may indicate Hirschsprung disease or Congenital Aganglionic Megacolon, an anomaly resulting in mechanical obstruction due to inadequate motility in an intestinal segment. B, C, and D are not associated in the failure to pass meconium of the newborn.

50. The nurse understands that a good snack for a 2 year old with a diagnosis of acute asthma would be:
a. Grapes
b. Apple slices
c. A glass of milk
d. A glass of cola

Correct answer is B, apple slices. Grapes is in appropriate because of its “balat” that can cause choking. A glass of milk is not a good snack because it’s the most common cause of Iron-deficiency anemia in children (milk contains few iron), A glass of cola is also not appropriate cause it contains complex sugar. (walang kinalaman ang asthma dahil ala naman itong diatery restricted foods na nasa choices.)

51. Which of the following immunizations would the nurse expect to administer to a child who is HIV (+) and severely immunocomromised?
a. Varicella
b. Rotavirus
c. MMR
d. IPV

IPV or Inactivated polio vaccine does not contain live micro organisms which can be harmful to an immunocompromised child. Unlike OPV, IPV is administered via IM route.

52. When assessing a newborn for developmental dysplasia of the hip, the nurse would expect to assess which of the following/
a. Symmetrical gluteal folds
b. Trendelemburg sign
c. Ortolani’s sign
d. Characteristic limp

Correct answer is Ortolani’s sign; it is the abnormal clicking sound when the hips are abducted. The sound is produced when the femoral head enters the acetabulum. Letter A is wrong because its should be “asymmetrical gluteal fold”. Letter B and C are not applicable for newborns because they are seen in older children.

53. While assessing a male neonate whose mother desires him to be circumcised, the nurse observes that the neonate’s urinary meatus appears to be located on the ventral surface of the penis. The physician is notified because the nurse would suspect which of the following?
a. Phimosis
b. Hydrocele
c. Epispadias
d. Hypospadias

Hypospadias is a c condition in which the urethral opening is located below the glans penis or anywhere along the ventral surface of the penile shaft. Epispadias, the urethral meatus is located at the dorsal surface of the penile shaft. (Para di ka malilto, I-alphabetesize mo Dorsal, (Above) eh mauuna sa Ventral (Below) , Epis mauuna sa Hypo.)

54. When teaching a group of parents about seat belt use, when would the nurse state that the child be safely restrained in a regular automobile seatbelt?
a. 30 lb and 30 in
b. 35 lb and 3 y/o
c. 40 lb and 40 in
d. 60 lb and 6 y/o

Basta tandaan ang rule of 4! 4 years old, 40 lbs and 40 in.

55. When assessing a newborn with cleft lip, the nurse would be alert which of the following will most likely be compromised?
a. Sucking ability
b. Respiratory status
c. Locomotion
d. GI function

Because of the defect, the child will be unable to form the mouth adequately arounf the nipple thereby requiring special devices to allow feeding and sucking gratification. Respiratory status may be compromised when the child is fed improperly or during post op period.
Repair of cleft lip-cheiloplasty-should be done within 1-3 months- to save sucking reflex- position post-op side lying
Repair of cleft palate- Uranoplasty- should be done within 4-6 months-to preserve speech- position post-op is prone.

56. For a child with recurring nephritic syndrome, which of the following areas of potential disturbances should be a prime consideration when planning ongoing nursing care?
a. Muscle coordination
b. Sexual maturation
c. Intellectual development
d. Body image

Because of edema, associated with nephroitic syndrome, potential self concept and body image disturbance related to changes in appearance and social isolation should be considered.


57. An inborn error of metabolism that causes premature destruction of RBC?
a. G6PD
b. Hemocystinuria
c. Phenylketonuria
d. Celiac Disease

G6PD is the premature destruction of RBC when the blood is exposed to antioxidants, ASA (ano un? Aspirin), legumes and flava beans.

58. Which of the following would be a diagnostic test for Phenylketonuria which uses fresh urine mixed with ferric chloride?
a. Guthrie Test
b. Phenestix test
c. Beutler’s test
d. Coomb’s test

Phenestix test is a diagnostic test which uses a fresh urine sample (diapers) and mixed with ferric chloride. If positive, there will be a presence of green spots at the diapers. Guthrie test is another test for PKU and is the one that mostly used. The specimen used is the blood and it tests if CHON is converted to amino acid.

59. Dietary restriction in a child who has Hemocystenuria will include which of the following amino acid?
a. Lysine
b. Methionine
c. Isolensine tryptophase
d. Valine

Hemocystenuria is the elevated excretion of the amino acid hemocystiene, and there is inability to convert the amino acid methionine or cystiene. So dietary restriction of this amino acids is advised. This disease can lead to mental retardation.

60. A milk formula that you can suggest for a child with Galactosemia:
a. Lofenalac
b. Lactum
c. Neutramigen
d. Sustagen

Neutramigen is suggested for a child with Galactosemia. Lofenalac is suggested for a child with PKU. Sustagen is for Susy and Geno, Lactum.. lactum.. inom ka ng inom!



Ladrones Islands

By Conrado de Quiros
Last updated 01:35am (Mla time) 08/02/2006
Published on Page A10 of the August 2, 2006 issue of the Philippine Daily Inquirer (Opinion Section)

I'M glad the Professional Regulation Commission (PRC) has finally listened to reason and agreed to suspend the oath-taking of nurses who "passed" the last nursing board exams. The various schools of nursing, not least the University of Santo Tomas (UST), which has been at the forefront of the protest, have been calling for the results of the exams to be voided and for the candidates to take them all over again.

What happened, for the benefit of those who did not follow the story, was that a good portion of the exam questions was leaked to a good portion of the examinees. How good a portion of the questions and of the examinees the PRC and the officials of the various nursing schools have some idea, but they do not know for sure. Initially, to try to solve the problem, the PRC hired a statistician to gauge the extent of the harm done by theleaked answers and to propose a way to circumvent it. Acting on his findings and recommendations, the PRC ruled to invalidate 25 questions in Test III (Medical Surgical Nursing) and the entire last category, Test V (Psychiatric Nursing). Those who passed the exam, minus those parts, were to be given their licenses as nurses this Aug. 22.

The leak came from R.A. Gapuz Review Center, which admitted that it gave its reviewers a document containing many of the questions in the exams. Ray Gapuz, founder of the center and a UST graduate (to the chagrin of UST officials), would explain later that it was an honest mistake. The questions were faxed to them by a source, and they distributed them to their students thinking they were review material. It was their policy toexchange review materials with contacts.

In a letter to the PRC, Susan Maravilla, Thelma Abelardo and Rene Tadle, UST assistant dean, treasurer of the UST Nursing Alumni Association, and president of UST Faculty Association of the College of Nursing, respectively, refuted the PRC's position. At the very least, they said, how did the PRC determine that only 25 questions in Test III and all the ones in Test V were leaked? At the very most, they said, even if that were so, why pass candidates whom you had no way of knowing were competent in surgical and psychiatric nursing?

The laws of the country call on the State "to ensure that the medical profession is not infiltrated by incompetents to whom patients may unwarily entrust their lives and health." The UST officials added that they were aware of the cost in time, money and energy taking the exam would be for the innocent, but they were also aware of the even morehumongous cost in reputation, credibility and employability of those who would pass under these terms. The cloud of doubt cast on their competence by these flawed exams would hound them forever.

I agree with the UST officials' position completely. I myself can understand the dismay of those who honestly and diligently prepared for the exams. At the very least, I can understand the added expense it will mean for them in these dire times. More so as those who take up nursing often come from families of modest means who dream of being able to pluck out self and kin from this pass someday. But the UST officials are right: The cost of their not taking the exams again is far steeper. Not just for themselves but for the nation as well. It won't just damage their reputations -- hospital patients might wish to inquire if they were being nursed by someone from Batch 2006 -- it will damage the reputation of the whole profession. Even New York, a city that is not likely to set muchstore by psychiatric nursing as its residents are well past being cured in that respect, may decide to recruit elsewhere.

I understand that some of the examinees have expressed their willingness to go through the exams again for that very reason. I heartily applaud them. The bitterness of the frustrated is better directed at the R.A. Gapuz Review Center whose "lapse in judgment" excuse is inexcusable. The more credible explanation for its lack of scrupulousness in scrutinizing the document passed on to it was its desire to increase enrollment byshowing the world it had a great batting average in producing successful examinees. The frustrated should have their reckoning with the review center.

But more than that, I agree with the UST officials' position because of one urgent and compelling thing. Which is that it's time we stopped cheating in this country. Which is that it's time we punished the guilty even if we cannot altogether reward the innocent. Which is that it's time we stopped becoming an out-and-out Ladrones Island, a den of thieves and malefactors, a snake pit of liars and cheaters.

Richly ironically, Prospero Pichay, who should be the last person to want to draw attention to cheating, has demanded that an inquiry be made immediately about the exams. He thundered: "We have been banking on our medical practitioners to be one of our greatest assets in competing in the global market, but the issue now casts doubt on their very competency."

But my dear Prospero, don't we have the same thing in the very heart of government? Have you bothered to ask yourself why cheating and lying riot more plentifully and violently these days than the inmates of the national penitentiary? You want to investigate, investigate the conduct of the last elections, not the nursing exams. The possibility of incompetent nurses can only affect our health and reputation, the reality of an illegitimate President affects our life and our children's future. To paraphrase you:We have been banking on democracy as our greatest asset in being taken seriously by the community of nations, but the issue of a usurper now casts doubt on our very existence.

Happily, the PRC has ruled to suspend acknowledging the results of the last nursing exams. Now, if only we can do that to the last elections.

Breastfeeding can save P21b

Breastfeeding can save P21b

By Macon Ramos Araneta

BREASTFEEDING can actually save the nation P21.5 billion in infant formula products which poor folk can use for food, housing, education and other basic necessities, the Department of Health said yesterday.

Health Secretary Francisco Duque III said removing these expenses can reduce the financial burdens of families and redirect them to the needs that can help the country attain its Millennium Development Goals on eradicating poverty and hunger.

Moreover, Duque reiterated that breastmilk remains the best food for infants and the department remains committed to the aggressive promotion of breastfeeding and breastmilk.

“We are determined to put first the health of our infants, the nation’s future leaders, above any consideration,” said Duque, announcing the start of a national conference on breastfeeding at the Century Park Hotel in Manila.

The conference, the first of its kind in the country, gathered local, national and international breastfeeding advocates for two days to give medical professionals the latest scientific findings in the field of infant and young child feeding to become strong advocates for breastfeeding.

Key leaders from major hospitals and medical societies are participants in the conference to translate recommendations and commitments to action in their respective fields.

“With this conference, we are optimistic that our medical professionals will be updated on the benefits of breastmilk and have more confidence in urging mothers to breastfeed their newborn babies, he said, referring to finding in a survey that physicians are the main reason mothers stop or do not start breastfeeding.”

Results from the 2003 National Demographic Health Survey showed that the prevalence of breastfeeding depends on whether the delivery was done with or without the assistance of a health professional or worker.

Mothers who are assisted by a health professional were less likely to breastfeed (83 percent) than those who are assisted by a traditional birth attendant (93 percent).

“Breastfeeding is one of the most important interventions that the country can do to achieve the Millennium Development Goals, such as reducing child mortality. In fact, 15,000 deaths could be prevented through improved breastfeeding alone,” stressed Duque.

He added breastfeeding addresses another MDG goal, that of improving maternal health. It leads to spacing of birth, reduces bleeding after delivery, reduces obesity and lowers risk of breast, ovarian and uterine cancers, urinary tract infections, and osteoporosis.

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