Christmas Holiday Message

Twelve months ago, I was looking forward to the year 2006. In December 2005, I was enjoying the best year ever since NC STAFFING was established. The company I started in 2001 was experiencing record-breaking growth both in the number of nurses and in sales revenue.

At this very moment, I am doing exactly the same thing; looking back & looking ahead. Both years somewhat share the same spirit of contemplation, confidence, and optimism but the past year 2006 was a very special and a life-changing event for me. It was a life-changing event since I never imagined myself leaving my husband, my family, and my business behind to embark on an endeavor thousands of miles away- to start the Intensive Review and the Supplemental Learning Module (SLM). There was a lot of sacrifice on my part, but my husband's unwavering support was the biggest blessing ever. A colleague once asked why waste my time on a venture that is so highly competitive.

Looking back, if I ever have to make a choice, I would do the same thing again. Why? I don't feel like I am wasting my time. I am actually investing my time in making a difference. It was very encouraging to hear from each one of you that I made a difference. Yes, EntraLink and NC STAFFING are here to stay. We are here to open your door to opportunities and be successful at it. The vision of Entralink & NC STAFFING is not limited to helping you pass the NCLEX & CGFNS the first time, but in opening your door to the the many opportunities.

In behalf of the staff of EntraLink and the Review Team, I would like to express my thanks and gratitude for your unlimited support, dedication, loyalty, and confidence. The EntraLink family is growing because of you and your contribution. I am very proud to say that most of you have been sending your friends and have been sharing your wonderful experiences about the EntraLink family. I hope that you will continue to share your experiences about us to all your friends because it's giving me the biggest opportunity to reach as many nurses as I can. I realize that some are misguided with false information and limited choices when it comes to Nursing in the US. Now, is the time to share what you know.

EntraLink is making a difference because of you and the wonderful staff at EntraLink. My thanks to all the hardwork of the staff: Tim, Nancy, Yolly, Ghie, Rose, Alain, Jenny, Coy, Roilo, Nino & Angelo. Those from the US: Christine, Tina, Ace, Andy, Dorry, Mel, Amanda, Rimi, Barbara, Dr. Morris, Quandara, Jean Jackson, and those who helped us in our transition. And most importantly, for my very supportive & encouraging husband, Steve Adams. But above all, for God's sustaining Blessings and Goodness.

Again, thank you All. I wish you the Best Year/s Ahead. I am looking forward to seeing you in January.

PAPASAKAYO!

Best Wishes and Warmest Regards,
Ann H. Adams
Chairman, EntraLink
President, NC STAFFING

anna@entralink.net
aadams@ncstaffing.com
annh67@yahoo.com

Neuroleptic Malignant Syndrome

Background:
1. May occur in Parkinson’s disease patients with sudden decrease in dosage of dopaminergic agents

2. Most commonly within 3-9 days of initiation of therapy but can occur at any time during treatment or with dose increase

3. Thought to be an idiosyncratic drug reaction., NOT thought to be related to dose or duration of treatment

4. Can occur with typical and atypical/newer antipsychotics, but greater risk with high potency dopamine antagonists, such as haloperidol (Haldol)

Pathophysiology:
1. Dopaminergic depletion or blockade in basal ganglia (tone) and hypothalamus (thermoregulation)

2. Primary skeletal muscle defect similar to malignant hyperthermia.

Clinical features:
1. MAJOR = fever (>38.5)
2. Rigidity or stiffness
3. ­CK (>1000)

Other signs:
4. Sweating
5. Tremors

Treatment:
1. ABCs
2. Withdrawal of neuroleptic meds
3. Aggressive hydration
4. Cooling / reduction of fever / antipyretics

Prostate Cancer

What blood test result would confirm a patient has cancer of the prostate?

Answer: Elevated acid phosphatase

AIDS

What type of diet would a nurse instruct a patient with AIDS?

Answer: High protein, high caloric foods
Why: To prevent weight loss/malnutrition & to enhance immune function

Know Your Numbers- Lab Interpretation

Let's learn what certain critical lab values mean:

1. Serum Calcium- Normal 8.2-10.2
<6 Vitamin D or parathyroid hormone deficiency, tetany, seizures
>13 Hyperparathyroidism

2. Ammonia- Normal 15-110 mcg
<15 Renal failure
>50 Hepatic coma, GI bleeding, Reye's syndrome, heart failure

3. Sodium- Normal 135-145
<120 Diuretic therapy, cardiac failure
>145 Dehydration, vascular collapse

Clinical Signs

1. Lasegue's sign: Associated with herniated lumbar disk

2. McBurney's sign: Associated with appendicitis. Tenderness at McBurney's point
McBurney's point: Located two thirds of the distance from the umbilicus to the anterior-superior iliac spine.

3. Ortolani's maneuver: A click sound heard if hip dysplasia is present

4. Osler's sign: Small painful erythematous swelling in the skin of the hands and feet

5. Psoas sign: Associated with appendicitis, pain induced by hyperextension of the right thigh while lying on the left side

6. Tinel's sign: Associated with carpal tunnel syndrome

NCLEX Pearls

1. What is the nurse's priority for a child being treated for scoloisis with a Milawaukee brace?

Answer: Skin integrity

2. A woman at 30 wks gestation has sudden painless bright red vaginal bleeding, this would be indicative of?

Answer: Placenta previa

3. What blood test result would confirm a patient has cancer of the prostate?

Answer: Elevated acid phosphatase

4. What test should be done to screen for the presence of neural tube defects in the fetus?

Answer: Serum alpha-fetoprotein (AFP)

5. A nurse would know that a pregnant 14 year-old female patient would be at risk for?

Answer: Iron deficiency anemia

Intensive Review Schedule

The Intensive Review is scheduled on January 27-February 3, 2006. Pls. invite your friends and relatives to attend a one-of-a kind NCLEX review.

Learn nursing concepts the simplest way from US Review Experts. The panel includes:
1. NCLEX Test Item Writer
2. NCLEX Test Panel
3. Harvard Graduate Test Taking Expert
4. A nurse clinician, educator, and former nurse director

For details, pls. contact us at:
Email: info@entralink.net
Tel (2) 755-8815
Mobile 917-829-1930

More NCLEX Passers

New addition to the NCLEX Passers, Mary Latorre, Necie Malvar, and Auxi Lizares. Congratulations for all your hardwork and patience. Now is the time to sit back and relax.

Ann

Tips from a Recent NCLEX Passer Missy Gepte

Thank you so much, Ms.Ann!!! The manual and review helped me-A LOT!!! But the best part was when I was getting really tired and brain-dead on my 180th question...i relied solely on the critical questioning already...THE WHY NOTS?
Again...to everyone, JUST CONCENTRATE ON THE REVIEW, MANUAL, AND THE ON-LINE REVIEW provided for us. This is so far the most accomodating, innovative and applicable review program I have attended...and I have attended quite a few for both my local board exam and the CGFNS. DO NOT ENGAGE IN READING SO MUCH REVIEW BOOKS...it will just confuse and overwhelm you. Just like what Ms. Ann said...you just have to have a clear idea on what the concepts are and learn to apply it on the questions being asked. Just trust in the program and you will pass. Thank you ENTRALINK!!! I would not have made it without you! God Bless you always!
MISSY GEPTE

This was entered by Missy on the previous section and I transferred it here so everyone could see her comments. Ann
11:35 PM

Congratulations to another NCLEX passer

I just want to congratulate Missy Gepte for passing the NCLEX. All your hardwork is now paying off Missy. In behalf of the ENTRALINK family, we wish you the best as you take in a new journey.

We are so proud of you.

Troubleshooting Ventilators Alarm

1. Low pressure alarm, may mean:

a. Tube disconnection- Reconnect tube ventilator
b. ET tube displaced- Check tube placement; reposition tube if needed. If extubation or displacement has occured, ventilate patient manually.
c. Ventilator malfunction- Disconnect patient from ventilator and ventilate manually, if necessary. Obtain another ventilator.
d. Leak in ventilator circuitry- Make sure all connectionsa are intact. Check for holes or leaks in tubing. Check humidification jar and replace if cracked.

Pharmacology

1. In providing care for a sickle cell crisis, which medication order for pain control should be questioned by the nurse?

Answer: Demerol
Rationale: Clients with sickle cel disease are at risk for normeperidine-induced seizures.

2. The nurse is caring for a patient newly diagnosed with DVT who will be placed on heparin therapy. Which assessment is critical for the nurse to make before initiating therapy.

Answer: Weight
Rationale: Heparin dosage is calculated based on patient's weight.

3. Mr. Jones recently had a motor vehicular accident. He was diagnosed with cerebral edema and was placed on Dexamethasone (Decadron). Which assessment would indicate that the treatment is effective?

Answer: Increased motor stimuli response
Rationale: Decadron decreases inflammatory response. Once it reaches therapeutic level, a decrease in symptomalogy with motor skills improvement is noted.

NCLEX Passer

Congratulations to Sandra Adofina new NCLEX passer- Maryland. She took NCLEX last Friday and received a quick result.

Her test stopped at 75 items. According to Sandra, she concentrated on the ENTRALINK coursebook and she was able to answer most of the questions based on the coursebook.

Sandra will be leaving November 3 for Maryland. Congratulations and have a safe trip.

Digitalis

A CHF patient was just recently started on digitalis regimen. Your discharged instruction include/s except

A. Hold if apical pulse is less than 60
B. Include potassium rich foods in the diet
C. Yellow spots around your eyes is normal
D. Digoxin level will routinely be ordered

Answer C: Yellow spots around your eyes is not normal. This is a late sign of digitalis tocity. Answers A, B, D are all correct.

Prioritization, Triage

In any medical emergency, the principles on prioritization and triage is based on the most serious, life-threatening situations. Thus, a nurse must attend to the sickest client.

In disaster situation, you must first attend to stable, uncomplicated clients. Why? You want to stablize those who needs very little medical attention so they can go back to the disaster area and help others. Also, why spend most of your time, to those who are sick, and might not have a chance to survive.

Disaster events: earthquake, hurricane, tornado, terror attack, mudslide, etc.

October Ad

This is the ad that will appear in national papers this month.

Thyroidectomy

Pt. had thyroidectomy 24 hours ago? What are the complications that can be expected related to the surgery?

A. Laryngeal nerve damage
B. Bleeding
C. Hypocalcemia
D. All of the above

Answer: D. All of the above

An important post-operative care includes providing:
A. Soft pillow at bedside
B. Pressure dressing
C. Neck support
D. Trach set at bedside

Answer: D. Trach set at bedside. Complication of thyroidectomy is laryngeal nerve damage. Could lead to vocal cord paralysis, resulting to airway obstruction which will require immediate trach placement.

Pharmacology

Why is beta blocker not given to asthmatic patient or diabetic?

Answer: 1. Beta blocker like Inderal can trigger an asthmatic attack.
2. Beta blocker can mask symptoms of hypoglycemia

Hyperthyroid: Iodide Compounds

Why is Iodide Compound given to patient's pre-operatively?

Answer:To decrease vascularity and prevent bleeding.
Example: Potassium Iodide, Lugol's solution, SSKI
Teaching: Take with milk, juice, and use of straw. Can cause staining of teeth.

Systemic Lupus Erythematosus (SLE)

What is SLE?
Systemic Lupus Erythematosus (sis-TEM-ick LOO-pus err-ah-theme-ahTOE-sus) is a chronic (long-lasting) rheumatic disease which affects joints, muscles and other parts of the body.

Who are predispose to SLE?
1. Mostly women between 18-45
2. African Americans.
3. Lupus can occur in young children or in older people.
4. Studies suggest that certain people may inherit the tendency to get lupus. New cases of lupus are more common in families where one member already has the disease.

Treatment:
1. Medications: aspirin and other anti-inflammatory drugs, NSAIDs, Antimalarial drugs, Corticosteroids, Immunosuppressants
2. Exercise
3. Diet/rest
4. Skin/sun protection

More aggressive therapy is required for life-threatening and more serious manifestations such as kidney inflammation, lung or heart involvement, and central nervous system symptoms.

Treatment in these circumstances might involve
1. High dose corticosteroids such as prednisone (Deltasone)
2. Immunosuppressive drugs such as azathioprine (Imuran), cyclophosphamide (Cytoxan), and cyclosporine (Neoral, Sandimmune).
3. Recently mycophenolate mofetil (CellCept) has been used to treat severe lupus kidney disease. Sometimes several medications must be combined.

http://www.arthritis.org/conditions/DiseaseCenter/lupus.asp

AutoImmune Disorder

Miss A. presented to her doctor's clinic for complaints of extreme dry eye syndrome, butterfly rashes on face, cheeks, mouth ulcer, and joint pain. The doctor ordered ANA, ESR, RF(Rheumatoid Factor),SS-A, SS-B and Sedimentation rate. All her lab results are normal except ANA=165. Her doctor referred her to a specialist for what potential condition?

A. Rheumatoid Arthritis
B. Polyserositis.
C. Sjogren's syndrome
D. Systemic Lupus Erythematosus

What is elevated in Rheumatoid Arthritis? ESR, Sed rate, RF
What is elevated in Sjogren's syndrome? RF, SS-A and SS-B antibodies, and possibly ANA
What is elevated in SLE? ANA

Why not A? Her ESR,Sedimentation rate, RF are normal
Why not B? Polyserositis is also a symptom of SLE. Taken together, is an inflammation of heart lining (pericarditis), inflammation of lining of the lung (pleurisy), and/ or inflammation around the abdomen(peritonitis)
Why not C? The RF, SS-A and SS-B, called the Sjogrens antibodies are normal

Answer: Systemic Lupus Erythematosus (SLE) Why? ANA is positive, normal= 1-160.And have symptoms of joint pain, mouth ulcer, butterfly rash on cheeks.

Most common symptoms of SLE:
1. Fever (maximum temperature usually less than 102°F)
2. Joint pain or swelling (most commonly in the hands, wrists, and knees)
3. Muscle pain
4. Hair loss
5. Rash (typically in a "butterfly" distribution on the face, across the cheeks, and under the eyes)
6. Painless ulcers in the mouth or nose
7. Photosensitivity (the development of a rash on sun-exposed skin)

Delegation

What are the tasks you can delegate to UAP(Unlicensed Assistive Personnel) or CNA?

1. ADL: Feeding, ambulating, turning, grooming, dressing, bathing)
2. Dressing change, uncomplicated clients*
3. I&O
4. External catheter care
5. Accucheck or blood sugar monitoring*
6. Oral suctioning & mouth care*
* Depends on state and facilities policy. These functions can be delegated to a UAP as long as clients are stable with predictable outcomes and have proper training.

What are the tasks you can delegate to a LPN?
1. Can perform all of the tasks of a CNA
2. Administer enemas
3. Administer all meds, except IV meds. However, can perform saline and heparin flushes on peripheral IV's only, but not central line.
4. Administer tube feedings
5. NGT insertion
6. Blood glucose monitoring
7. Oral suctioning
8. Dressing changes
9. Insertion of Foley catheter
10. Ostomy care
11. Obtain MD’s order
12. Administer respiratory treatments
13. Venipuncture

Assign LPNs to stable patients with predictable outcomes.

Fire Safety

Tips:

1. Fire Safety:
Know RACE:
Rescue: Move clients who are not ambulatory or are incapacitated. Move them horizontally, then vertically. Meaning move these patients from one end to the other first. If fire spreads, then move clients from one floor to another. Do not use elevator when there is fire.
Alert: Sound the alarm, call fire department
Confine: Close all windows & doors, Shut off O2 valves
Extinguish: Stop fire from spreading, use appropriate fire extinguisher.

2. Teach clients not to smoke while oxygen is in use, remove flammable liquids from the area, put up oxygen in use sign.

JCAHO Tips

1. What is a sentinel event?
Answer: A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase, "or the risk thereof" includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.

Such events are called "sentinel" because they signal the need for immediate investigation and response.

2. In major disasters? What patients are the priority of care?
Answer: (1)Selection is based on what can be done to benefit the largest number; (2) Then, assist those with minimal injuries and minimal needs so they can go back to help others and save lives.

Pharmacology Tips

Frequent Flyers Drug:

1. Discharge teaching on patients receiving dilantin?
Answer: " Teach client to brush and floss carefully after every meal."
Rationale: Dilantin causes gingival hyperplasia. Gum massage and good oral hygience may reduce gingival hyperplasia.

2. What is a common side effect of antipsychotic drugs?
Answer: Orthostatic hypotension

3. Common side effect of anti-inflammatory drugs NSAID's?
Answer: Occult bleeding especially GI tract

3. A patient is receiving Lanoxin (Digoxin). What is the expected therapeutic effect?
Answer: Improved respiratory status and increased urinary output
Rationale: Digoxin is used to slow and improve heartbeat, thus improving cardiac output. As cadiac output is improved, renal perfusion is improved and urine output inceases.

4. Why is Aldactone recommended for cirrhosis of the liver & ascites?
Answer: Aldactone, the potassium sparing diuretic inhibits the action of aldosterone on the kidneys.

5. What is a serious side effect of Clorpromazine (Thorazine)?
Answer: Agranulocystosis, may be seen with patients complaining of sore throat and fever.

6. What is the maximum volume you can give to a child when giving IM injection? How about an adult?
Answer: 1 ml for children and 5 ml for adult

Legal & Ethical Issues

Tip: Look for an answer that respects the position of the client without compromising the position of the nurse.

Example:
A nurse caring for Ms. Jones strongly believe in anti-abortion. While interviewing the client, she was asked information about abortion. The ethical obligation of the nurse is to:

A. Teach the patient about pro-life issues
B. Explain the risks of abortion with client
C. Inform the client that she is making a wrong decision
D. Recommend the client to speak to another nurse who can provide counseling.

Answer: D, It respects the clients decision. The nurse has the obligation to provide unbiased opinion or referral.

great job entralink

thanks for all d updates!
i miss every1
keep em coming ms ann
* hugs *
^_^

Herbal Medicines

An MI patient who is taking Gingko Biloba is scheduled for a CABGx3 (Coronary Artery Bypass Graft). The patient teaching should include:

1. Discontinue the herb 2 weeks prior to surgery.

Ileostomy Diet

Restricted diet for ieleostomy: Nuts, raisins, popcorn, seeds, chocolate, raw vegetable, celery and corn.

These foods can obstruct the ileostomy.

Ann Adams