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BENNER’s Proficiency
“NACPE”
Novice
- No experience (SN)
- Context rules and regulations
Advanced Beginner
- Recognize aspects
- Experienced real situations
Competent
- 2 – 3 years experience
Proficient
- 3 - 5 years experience
- Perceives situation as a whole
- Holistic understanding
- Long term goal
Expert
- Fluid, flexible and highly proficient
- No longer requires rules, etc
- Felt right

ALZHEIMERS
- Decreased ACETYLCHOLINE
- Idiopathic
EARLY SX: Irritability
4 A’s
 Amnesia
 Apraxia – inability to use things as they should
 Agnosia – sensation
 Aphasia - comprehension
Dx Test:
- Autopsy: most definitive

NURSING MANAGEMENT
 Provide emotional support
 Effect communication (short simple sentences and gestures)
 Calm and consistent approach
 Protect from injury

MEDICAL MANAGEMENT
 Antipsychotics
 Anxiolytics
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 DONEPEZIL
 TACRINE DOTA

DEPRESSION
- Mood disorder
- Decreased NOREPENIPHRINE
Types:
 Major
- 2 weeks

 Dysthymic
- 2 years or more

 Depression not otherwise specified

- 2 days or 2 weeks

MANIFESTATION
D – depressed mood
E – energy loss
P – psychomotor agitation
R – recurrent thoughts (death and suicide)
E – excessivie or no sleep
S – signicant wt loss
S – significant distress
E – excessive or inappropriate guilt
D – diminished interest / pleasure (anhedonia)

MAJOR DEPRESSIVE DISRODER

- Dec serotonin, norepinephrine and dopamine
Defense Mechanism: Introjection
Initial Sign: Sleeplessness
Hallmark sign: Hopelessness, Helplessness, Worthlessness

ANTIDEPRESSANTS
Best time to take: Morning with meals (some may cause insomnia), after meals,
as prescribed, same time each day
Early indication of effectiveness: increased activity levels (increase suicide
precaution)
Dosage: Start with the lowest dose to prevent dependence and tolerance
Effectivity: 2 – 4 weeks, continued for 6 months – 2 years (even if the clients feel
better)

ELECTROCONVULSIVE THERAPY (ECT)

- Last resort
- Safe for pregnant
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Indication: when medications are ineffective, acute suicidal crisis

Contraindications: presence of metals (jewelries, pacemaker, hip prothesis)
Mechanism of Action: unknown (believed to balance neurochemicals in the brain)
Frequency: every other day (6 – 15 sessions)
Pre-Meds:
Succinylcholine (muscle relaxant)
Atropine Sulfate (Anti-cholinergic) – decrease secretion
Methohexital (Anesthesia)
Voltage: 75 to 450 Volts
Effect: Grand Mal Seizure
Duration of seizure: 30 – 60 seconds
Side effect: Retrograde Amnesia

Nursing Responsibilities
BEFORE:
 Informed consent
 NPO 8 hours
 clean oil from the head
 d/c anticonvulsant Insert bite guard

AFTER:
 Assess respiratory status
 turn the client to the side
 reorient the patient

ANTIDEPRESSANT MEDICATIONS
MAOI
PA – rnate T – ranylcipromine
MA – marplan I – socarboxazid
NA – rdil P – phenelzine
E – ldepryl S – selegiline
AVOID TYRAMINE RICH FOODS = hypertensive crisis (occipital headache):
Frozen, Fermented, Pickled, Preserved, and Overripe Fruit (OLD)
AVOID:
 cheddar
 parmesan
Safe Cheese:
 cottage
 cream
 ricotta
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TCA’s
- “tatlong magkakapatid na na ta TAE na praning (pramine) at may tililing
(tiline)
- MOST FATAL
T – tofranil Imipramine
A – anafranil Clomipramine
E – elavil Amitryptiline
Nortryptiline
Sinequan (SINOKA)
Doxefine
Side effect:
 Adrenergic stimulation (ASA) dry
 Arrhythmia (tachy and brady: toxicity)

SSRI
 ZOLOFT (sertraline)
 PAXIL (paroxetine)
 LUVOX (fluvoxamine)
 PROZAC (fluoxetine)
 LEXARPO (escitalopram)
 CELEXA (citalopram)
Side effect: Gastrointestinal upset (nausea)

ATYPICAL ANTIDEPRESSANT (ButRa)

 BUPROPOIN
 TRAZODONE

HERBS FOR DEPRESSION: St. John Worts

BIPOLAR DISORDER
TYPE A personality: competitive, perfectionist, goal oriented
- Usually in upper class (successful, businessman)
NEUROTRANSMITTER: Inc. DOSENO
Defense Mechanism: Reaction Formation and Projection

MANIC PHASE: 3 or more of the following

✓ FLIGHT OF IDEAS
✓ Inflated self-esteem or grandiosity
✓ Decreased need for sleep
✓ Increased talkativeness
✓ Distracted easily
✓ Increase in goal-directed activity
✓ Engaging in risky activities
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MANIA – more than 1 week Cyclothymia – alternating depression

HYPOMANIA – 4 days and hypomania for 2 years
Dysthymia – persistent mild
Bipolar 1: manic with / without major
depression for 2 years
depression
Bipolar 2: major depression

ANTIMANIC MEDICATION
LITHIUM carbonate (valproic acid)
- “Lith para sa makulith”

 Carbolithothab
 Eskalithobid
 Lithane
“3333”
Onset: 3 weeks
Peak: 3 hours

Serum Level (Blood Test)

Initial: q 3 days
Stable: q 3 weeks
When?
 Before breakfast
 8 hours after the last dose (for accuracy)
Therapeutic Level
.6 – 1.2 mcg/L max 1.5
- If above 3 mcg/L = DIALYSIS
Common S/E: fine tremors (it will subside)
Sx of Toxicity: Severe vomiting. Diarrhoea, COARSE tremors (MANNITOL at
bedside)

Monitor:
 NA: HypoNA = Inc. LI toxicity
 BUN / CREATININE

OTHER S/E
- Inc. LI – Dec. ADH = polyuria
- Dec. ADH = hypothyroid

Anticonvulsant Medications:
 Carbamazepine (Tegretol)
 Divalproex (Depakote)
 Gabapentin (Neurontin)
 Pregabalin (Lyrica)
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 Lamotrigine (Lamictal)
+ RASH = NOTIFY MD

MENIERE’S DISEASE (EAR DISORDER)

- Sensorineural hearing loss
- Dilation of the endolymphatic system by overproduction due to
decreased reabsorption of endolymphatic fluid (CN VIII) = Inc.
Pressure
- Can cause damage in vestibulochlear nerve due to increase
pressure
Vestibu – balance (vertigo)
Cochlear – hearing

Characterized by:
 V - Vertigo
 H - Hearing loss
 A - Aural fullness – feeling of fullness in the ear
 T - Tinnitus – ringing in ear

Management:
Pharmacologic Mgt:
 Antihistamine – meclizine (antivert) DOC
 Antiemetics – promethazine
 Diurectic – hydrocholorothiazide
 Tranquilizers – diazepam (during acute attack only)
 Vasodilator – nicotinic acid (promote drainage)
Nursing Mgt:
Highest Priority: SAFETY!!
Diet: low NA and rich K+

Diagnostic Evaluation:
 Fluid, above or below body temp instilled into auditory canal
 Normal: complains dizziness
 Abnormal: no reaction

Consideration:
- Limit Sugar and Na
- Avoid Alcohol
- Avoid ASA
- Diary / journal for attacks
- Lie down during attack (prevent injury)

ETHICS
- BON ROS 220 S 2004) Basis of code of ethics
1. Autonomy: self governance
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- Right to decide
- Decision making
- PT refusing: RN ACCEPT
- No waiver taking
- No explanation of drug action (physician duty)
RN Priority: document and inform dr. immediately
PT REFUSING NEW DRUGS:
 Accept
 Explain
 Consequences
 No explanation of MOA
A. Paternalism
- Dr. signed the consent
- Father: head of fam (decision making)
- Withhold autonomy of the patient for his benefit because condition is
unstable

INFORMED CONSENT
RN role: witness signing
 Dr to patient
 Actual convo
 Full sufficient information
 Pt fully understood
 Pt voluntarily signed
Requirement:
- Legal age (18 and above)
- Pt sound mind
- Conscious
- Coherent
- No violence and intimidation
- If unable to write = THUMBMARK
WHAT IF
 UNABLE BUT LEGAL AGE o Parents
o Spouse o Siblings
o Child o Grandpa
o Parents o Legal guardian

 ORPHAN  MINOR w/ BABY

o Legal guardian o Can’t give consent
o Gov’t (DSWD) o Father of the baby
(acknowledge the child as
 MINOR his own w/ birthcert)
o Next of keen (immediate fam o Grandparents (mother side
member) only)

2. VERACITY
- Truthfulness
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- Honesty
- No explanation (doctor only)

BENEVOLENT DECEPTION (DOCTOR ONLY)

- Withhold the truth for patient benefit (unstable condition)

3. BENEFICENCE: TO DO (MAY HINIMO NA)

4. NON MALIFICENCE: TO PREVENT / PROTECT
- Principle of double effect
- Good and bad (should overcome bad effect)
- Bad effect overthrows good effect = stop even w/out DO and notify physician
ASAP

5. JUSTICE
- Applicable only to py with same situation (condition / situation)

DISASTER: reverse triaging

- Priority (walking wounded / yellow)
ER:
- Priority: RED

6. CONFIDENTIALITY, ANONYMITY AND PRIVACY

 Confidentiality – no disclosure of patient info (case: only professional and
directly involved)
 Anonymity – withhold name
 Privacy – moment, parts, property

DISCLOSE ONLY IF
 Required by law

o Subpoena Duces Tecum

 Documents: owned by hospital
 Information: owned by patient
- Court order asking person to appear with reports and documents that is
within his control
- Object evidences

CHART:
- Co owned by hospital and patient
PROGRESS NOTES
- Owned by RN
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o Subpoena Ad Testificandum
 Testify / witnessed

TYPES OF WITNESS
A. Ordinary
 Give testimony on matters within their personal knowledge (acquired directly
through senses)

 Hearsay
 Third person POV
Exception:
 Dying Declaration – deceased confess to toher person the circumstance of his
death (not an oral will)

Types of Will
1. Holographic – written, dated, sign by testator himself
2. Notarial – state will execute the will in the presence of 3 competent witness

o Summon
 Notice informing accused that there’s a case file against him /
her
Purgery: false testimony under oath (statement and doc notarized)

B. Expert
 Field of specialization (Dr – Dr)
 Material in malpractice case
Summon: due process
Requirements:
 Notice
 Hearing

7. FIDELITY – faithfulness
8. ADVOCACY
 Active support of idea / cause
 Rights protected
 Privileges given
 No wants only RIGHTS, NEEDS, PREVILEGE
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NEGLIGENCE AND MALPRACTICE

Negligence
- Commission / omission of an act
- Pursuant that is reasonable prudent person would / wouldn’t do
- Carelessness
- NO LICENSE
Elements
 F – failure to meet standard
 E – existence of duty
 F – foresee ability of harm
 I – injury (most material off all): without injury – no negligence
Malpractice
- Professional negligence
- licensed
- stepping beyond once authority (outside scope)
- improper / unskillful care if patient

Incompetent – lack of skill

Gross Incompetence – malalang katangahan

DOCTRINE OF NEGLIGENCE
A. Respondeat Superior
 let the master answer for the acts of its subordinates
 soliditary liable
 no shifting of liability
 superior subordinate RS
 ER – EE – RS
MMR
- Means, methods, result

B. Res Ipsa Loquitor

 Thing speaks for itself
 Non revocable
Evidence: Injury
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ELEMENTS:
1. Injury want normally cause / occur unless there is negligence
Captain of the Ship
 Surgeon
 Liable of all happening on the ship
2. Agency / instrumentality is within the control of defendant

3. Assumption of risk
 Patient was informed of the risk but decided to do so
 Nurse, doctor, hospital is NOT LIABLE

ER: consent is the priority except of there is no:

- Ample time
- Life and death situation
- Consent can be wait (paternalism. DR signed the consent)
4. Plaintiff didn’t participate / cooperate
- Patient cause the injury to himself

C. Force Majeure
 Irresistible act the is foreseen
 Can’t be prevented
AOG – act of god (natural disasters)
TORTS
 civil wrong / wrongful act (can’t be prisoner)
 committed by a person against another in where the person is liable for
damages (amount of money paid for injury)

Quantum of Proof
- preponderance of evidence

1. Assault and Battery

 Assault – threat
 Battery – physical harm is present
2. BOC and invasion of privacy
3. False Imprisonment and Illegal Detention
 False Imprisonment – without violating law (restrains)
 Illegal Detention – with violation in law (detain pt without payment:
hospital) except paying patient: private hospital
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4. Defamation – destroyed reputation

 Libel o Information between
o Written individuals
o Publicized o There should be a witness
 Slander o NO WITNESS = NO
o Private SLANDER
o Oral  Slander by deeds – through
actions

SUSTAINABLE DEVELOPMENT GOALS

- 2015 – 2030
Vision:
 Poverty reduce and eradicate
 Protect Planet Earth
 Peace and Prosperity

1. Poverty [Link]
2. Hunger [Link] (11 looks like buildings)
3. Good health [Link] and production
4. Education [Link] action
5. Gender [Link] – water
6. Water [Link] – land
7. Energy [Link] – peace
8. Economic [Link] – partnership
9. Industry

GERMAN MEASLES (RUBELLA)

CA: Rubi Tagaviridae
MOT: Droplet
Incubation Period: 2 – 3 weeks
Period of Communicability: 12 days / 1 week before and 5 days after rash
appearance
Signs and Symptoms:
- Cold and late with conjunctivitis
- Lymphadenopathy
- Cephalocaudal maculopapular rash
- Confluent rashes
- Forscheimer’s spots
Dx Test:
 Serologic Test
Preventive
- Vaccine for woman who never had GM
- Avoid pregnancy within 3 months after vaccine
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Supportive Management
- Rest
- Teach pregnant to avoid sick and those who receive MMR
- Gammaglobulin for pregnant who is exposed

COMPLICATIONS:
PREGNANT: (COME MOVE MY DEAR)
 C – congenital cataract
 M – mutism
 M – mental retardation
 D – deafness
TRACHEOSTOMY
- Opening in trachea through neck
Care:
 Fowler’s posion
 Suction tracheostomy (remive secretions and ensure patency)
 Unlock inner cannula (counter clockwise) and remove (pulling towards you)
and soak in soaking solution
 Removed soiled dressing and gloves
 Clean inner cannula (brush or pie cleaners0
 Dry inside, not the outside
Hydrogen peroxide – remove crust secretions

BLOOD TRANSFUSION
- Packed RBC should not be hang for 4 hours (after getting it from ref)
- Verify unit
- Gauge 18 – 20 IV needle / catheter
- 0.9 NaCl (NSS)
- DEXTROSE IS PROHIBITED = HEMOLYSIS
- Transfusion only took 4 HOURS
- Blood tubing is change q 4 – 6 units per agency policy
- Make sure blood left at room temp not more than 30 minutes
- OBSERVE CLIENT FOR FIRST 5 – 15 minutes (NO REACTION = q 30 mins)
- Run blood slow for first 15 minutes at 10 gtts / min

BLOOD INFORMATION TO BE CHECKED BEFORE ADMINISTERING

 Clients name and id number
 ABO and RH type
 Serial number on blood bag
 Expiration

COLOSTOMY
- Diver and drain fecal material
- NORMAL STOMA
o Red and moist
o Protrude slight
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o No bleeding

NURSING MANAGEMENT
- Empty 1/3 full
- Skin kept clean by washing off excretion and drying thoroughly
- Warm and mild soap

Ascending Colostomy
- Liquid
- ODOROUS
Transverse Colostomy
- Malodorous
- Mushy drainage
Descending Colon
- Fluid fecal drainage
REPORT IF COLOSTOMY COLOR IS DUSKY BROWN, BLACK OR VIOLET

ENEMA
- Rectum and LI
- Distend intestine and irritate mucosa = increase peristalsis and excrete feces
and flatulence
Cleansing Enema
- For surgery
- Preparation for dx
- Remove instances of constipation or impaction
High Enema
- Left later to dorsal recumbent to right lateral position
- 12 – 18 inches above rectum
Low Enema
- Rectum and sigmoid colon only
- 12 inches not higher

DIABETES MELLITUS
Classic P’s
 Polyuria
 Polydipsia
 Polyphagia ’
- 10%
- IDDM
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- Before 30 years old (juvenile)

Risk Factor:
 Genetics
Mgt: Insulin
Insulin
 Sub q 45 – 90 angle
 Regular: Sub q and IV
 Abd, upper arm, buttocks, thigh
 Warm (roll – palm)
 Don’t rub or massage site (altered absorption)
 Rotate site (lipodystrophy) still within region
Storage:
 Unopened / unused: ref
 Opened / used: room temp
R – Regular: fast / short acting
N – NPH: intermediate acting insulin
U – ultra lente: long acting

O P D
R 30 -1 2–4 6
N 2–4 6 – 12 16 – 20
U 6 12 – 16 20 – 20
Glargine (Lantus)
- Peakless insulin

O P D
1 X 24 hours

DIABETES MELLITUS 2
- 90%
- After 30 years old
- Decrease insulin
Risk Factor:
 Genetics
 Lifestyle
 Obesity
Mgt:
1. Diet and exercise (3x a week for 30 minutes)
Diabetic Diet (w/ dietician)
- Regular and well balanced diet : on time
ADA

Carbs 50 – 60%
Fats 13 – 20%
Protein 10 – 15%

- Whole grains
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Exercise: Carbs snack before exercise

2. OHA
 Sulfonlyureas (1st gen)
 Chlorpromazine (stimulate beta cells)

 Sulfonylureas (2nd gen) – more potent

 Glipzide

 Biguanides
- Increase sensitivity to insuli
 Metformin (can be combined to insulin)

 Insulin Therapy
- Last resort

Morning Hypoglycemia
1. Insulin warning
- Increase production (morning )
 Increase evening insulin dose (pre – dinner or bedtime)

2. Dawn phenomenon
(n) at bedtime til 3 am
- Bedtime insulin

3. Somogyi effect
(n) bed time
- Lower (2 – 3 am) hypoglycemia
- inc. am
- low evening insulin dose
- bedtime snack

HYPOGLYCEMIA
- Below 70 mg/dl
S / sx:
 Cold clammy skin
 LOC
 Diaphoresis
 Shakiness
 Unconsciousness
 Hospital – dextrose
 Home – IM glucagon
Intervention
 Fruit juice: orange (simple sugar)
 SODA: regular
 Skimmed milk
A. DM1
- No insulin
Fat = ketones = DKA
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Direction in Withdrawing:
 NRRN
1. Air
2. Air
3. Withdraw
4. Withdraw

B. DM 2
- Doesn’t use fat
- HHNK (hyperglycemic hypersomolar nonketotic coma)
DKA and HHNK: IVF and regular insulin

ANTIPSYCHOTICS DRUGS
A. 1st GENERATION (TYPICAL)
- Dec. dopamine
- Manage (+) symptoms
ZINE and DOL (Haloperidol is highly potent)
S/E: pseudoparkinsonism
C/I: elderly (above 65)

B. 2nd GENERATION (ATYPICAL)

- Dec. dopamine and serotonin
- Manage ( - ) signs
PINE and DONE
 Clozapine – safest for elderly

C. 3rd GENERATION
- Dopamine System Stabilizer -
- Less S/E
ZOLE

D. LONG TERM INJECTION

- Depot therapy
- Cause: S/E: memory px and accessibility
DECANOATE (IM 1 – 2x monthly)

SIDE EFFECTS
“DRY”
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A – anticholinergic
S – sympathetic
A – adrenergic
C – constipation P – photosensitivity
A – agranulocytosis (dec. WBC) A – arrhythmia
T – tooth decay W – weight gain
S – sedation
D – dry mouth
O – orthostatic hypotension
G – galactorrhea (cotton underwear)

EXTRA PYRAMIDAL SYMTOMPS

- Low dopamine
- 1st and 2nd gen antipsychotics
Dystonia – invo. muscle spasms
Akathisia – can’t sit still
Pseudoparkinsonism – tremor, bradykinesia
Drolling and dysphagia
Oculogyric Crisis (tirik mata)
Torticollis (stiff neck)
- DO NOT D/C
- Dec. dosage / shift to another generation

Management:
 A – Artane
 B – Benadryl
 C – Cogentin

NEUROLEPTIC MALIGNANT SYNDROME

- MOST FATAL
- Hyperthermia
- Hypertension
- Muscle spasm
“INC VS = INC. RISK FOR SEIZURE”
- d/c drugs
- hydrate the patient

Management:
 muscle relaxant
 baclofen
 dantrolene NA

TARDIVE DYSKINESA
- facial
- tongue protrusion
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- teeth grinding
- lip smacking
PERMANENT / IRREVERSIBLE
- late difficulty movement
- last (after 6 months)
- notify physician
- start with lowest dose
Management:
 valbenazine (ingrezza)

INDEPENDENT AND DEPENDENT VARIABLE

INDEPENDENT: get the population first (same issue, same respondent): CAUSE
DEPEDENT: vary among independent variable (Changeable)

DELEGATION
- responsibility is transferred but ACCOUNTABILITY IS RETAINED

5 Rights of Delegation
 task
 circumstances
 person
 direction / communication
 level of supervision
“Never delegate assessment, medication, authority to sign, evaluation staff, and
overall responsibility to UAP”
RESPONSIBILITIES
RN
 IV medication
 Health teaching
 Assessment
 Evaluation
 Over – all accountability / critical patient

LICENSED PRACTICAL NURSING

 Medication (IM, SC, ID except IV)
 Wound cleanse
 Blended feeding
 Suctioning

UAP
 Routine activities
 V/S
 Pulse O2
 Post mortem
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 Stable patient / ambulatory/ MGH

RA 9173
- Repeals RA 7164 (Philippine nursing act of 1991)
Sec. 1 (Title)
- Ph nursing act of 2002

Sec 3: BON
 (Chairperson and 6 Members = 7)
 Appointment
 NO – nominated by PNA
 R – recommended by PRC
 A – appointed by president

Sec 4: Qualifications (RN MAN)

 RN, MAN
 Not convicted of moral turpitude
 Member of PNA
 Atleast 10 years practice with last 5 years in Ph
 Natural born citizen and resident
Doctrine of Jus Sanguinis – law of parentage (father)
Doctrine of Jus Soli – birth place
Sec. 5: No pecuniary interest
Sec 6: Term (3 years)
Sec 7: Compensation of Board Members
- Salary standard law
Sec. 11: removal / suspension of BON members
- Done by president
 I – incompentence
 C – commission / neglect
 U – unprofessional, dishonest conduct
Sec. 12: PNLE
Sec 13: Qualifications for Admission
 BSN
 Citizen
 Good moral character
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Sec 14: Scope of Examination

Sec 15: Ratings
- 75% none below 60% in any subject
- Failed = removal on 60% below (score must be 75%)
- Taken within 2 years of failed exam

Sec 20: Reciprocity

 S – same
 T – title
 R – requirement for licensure
 3 years resident
 P – privilege

Sec 21: Practice through special permit

 M – medical mission
 I – internationally well known experts
 X – exchange professor

Sec 23: Revocation and suspension

Sec 24: Re – issuance of revoked CORs and replacement of lost certificates

Sec 26: Returning to practice

Sec 27: Qualifications of Faculty

 RN, 1 year clinical practice in specialization
 PNA
 MAHN

Director / Chief Nurse Deans

- 3 years in nsg adm - 1 year practice in specialization
- MAN - MAN
- 9 units - 5 years nursing exp
- 5 years adm
Faculties
Supervisor / Manager
- 1 year in specialization
- 2 years in nsg adm - MAHN
- 9 units
Sec 31: Salary
- Gr 15 (13k)
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MALARIA
- Aka Ague
- Parasite disease transmitted by mosquito (anopheles) usually in tropical /
subtropical areas.
Agents: PLASMODIUM
 Falciparum (common)
 Vivax
 Malariae
 Ovale

MOT
- Bite
- BT
- Transplacental

Manifestation:
- Shaking with chills
- Rapid rising fever and headache
- Profuse sweating
- Myalgia
- Splenomegaly
- Hepatomegaly

Prophylaxis
 Chloroquine (1 – 2 weeks before traveling)
N – night biter
F – flowing water
M – mountain
R – rural
CHN LEVEL OF PREVENTION
DOCUMENTATION
Purpose
 Communication
 Legal purposes
 Education
 Auditing
 Reimbursement
 Stat, report, epidemiology
 Health care
 Research
 Planning
Kardex
- Concise method of organizing and recording data (readily accessible
information to all members)
- Pencil is okay
- Series of flip cards kept in portable file
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General Guidelines for Recording

 Date and time  Accuracy
 Timing  Sequence
 Legibility  Appropriateness
 Permanence  Completeness
 Proper terminology  Concise
 Spelling  Legal prudence
 Signature  Confidentiality

LEADERSHIP MANAGEMENT
Quality Assurance
- Establishing standard of excellence of intervention to ensure each patient
receives expected level of care
- Fulfillment of social contract between society and profession

Quality Nursing Care

- All elements in standards

Framework of Quality Assurance

 Structure – instruments (personnel, supplies)
 Process – what are the services and how it is delivered
 Outcome – result

Benchmarking
- Comparing performance of company against the standard of best performing
organizations
- Tool to assist quality care decision making
- Continuous process of measuring what exist against the best

Quality Improvement
Total Quality Management
- Improve outcomes based on client needs
- Continuous quality improvement
- Doing right thing
- Meeting their needs
- Scientific approach to assessment and problem solving

ALCOHOLICS DEFENSE MECHANISM

- Denial
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CARDIAC CATHETERIZATION
- Invasive procedure (insertion of catheter into the heart and surrounding
vessels)
- Obtains information about the structure and performance of the heart
chambers and valves
Pre – Op Responsibility:
 Informed consent (Dr)
 Assess allergies to seafood, iodine or radiopaque dyes (+) allergy =
premeditated with antihistamine and corticosteroids
 NPO 6 – 8 hours
 Ht and wt for dye amount
 Baseline VS and presence of peripheral pulse
 Local anesthetic
 Shave wrist / groin and clean with antiseptic solution
 IV line (g 18)
 Metformin is with held 48 hours prior

Post Op
- VS, cardiac rhythm, peripheral pulse and sensation of distal extremity
- Notfy Dr = complains numbness or tingling sesantion, cyanotic extremities,
loss of peripheral pulse
- Dressing for hematoma or bleeding
- Apply sandbag or compression device at the insertion site
- Fluid intake (if not contraindicated)
- (M) hypersensitivity
- Adm IV acetylcysteine and Na Bicarbonate

ULCERATIVE COLITIS
- Inflammatory disease of mucosal and submucosal layer of colon and rectum
- Stool, pus, mucus and blood
Risk Factor
- Jewish American
- NSAIDs
Primary Px: diarrhea (20 – 30 watery stools daily)
Management:
 Low fiber
 TPN
 Steroid
 Azulfedine
 Surgery: ileostomy and proctocotectomy (100% rectal involvement)
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