Saturday, October 28, 2006

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.

Sunday, October 22, 2006


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.

Saturday, October 21, 2006

October Ad

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

Wednesday, October 18, 2006


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.


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.

Wednesday, October 11, 2006

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.

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.

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)

Monday, October 09, 2006


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


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.


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.

Sunday, October 08, 2006

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

Saturday, October 07, 2006

Legal & Ethical Issues

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

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 *

Friday, October 06, 2006

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