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Wednesday, March 27, 2013

Convulsions/Epilepsy/Fits

Convulsions/Epilepsy/Fits
 

A convulsion is a condition where body muscles repeatedly contract and relax rapidly, resulting in an uncontrolled shaking of the body.

Convulsions are commonly referred to as "fits".

Convulsions are also known as "seizure". There are many types of seizures, some of which have mild symptoms instead of convulsions.

Seizures of all types are caused by disorganized and sudden electrical activity in the brain.


Convulsions can be disturbing to watch.Most seizures are harmless. They usually last from 30 seconds to 2 minutes. But if a seizure is prolonged, or if multiple seizures happen and the person doesn't awaken in between, then he should be immediately shifted to hospital.


A convulsion is a symptom of an epileptical seizure. However, not all epileptic seizures lead to convulsions, and not all convulsions are caused by epileptic seizures. Convulsions are also consistent with an electric shock.

Causes
 
   Epilepsy
   Fever (particularly in young children)
   Head injury
   Heart disease
   Electric shock
   Alcohol use
   Barbiturates, intoxication or withdrawal
   Brain illness or injury
   Brain tumor (rare)
   Choking
   Drug abuse
   Heat illness (see heat intolerance)
   Illicit drugs, such as angel dust (PCP),cocaine, amphetamines
   Low blood sugar
   Meningitis
   Poisoning
   Stroke
   Toxaemia of pregnancy
   kidney failure(uraemia)
   Very high blood pressure (malignant hypertension)
   Venomous bites and stings
   Withdrawal from benzodiazepines (such as Valium)

Symptoms

   Brief blackout followed by period of confusion
   Drooling or frothing at the mouth
   Eye movements
   Grunting and snorting
   Loss of bladder or bowel control
   Sudden falling
   Teeth clenching
   Temporary halt in breathing
   Uncontrollable muscle spasms with twitching and jerking limbs
   Unusual behavior like sudden anger, sudden laughter, or picking at one's clothing

AURA: symptoms before the attack

     Fear or anxiety
     Nausea
     Vertigo
     Visual symptoms (such as flashing bright lights, spots, or wavy lines before the eyes)
     Increased Appetite
     Uneasiness in abdomen

First Aid

   1. When a seizure occurs, the main goal is to protect the person from injury. Try to prevent a fall. Lay the person on the ground in a safe area. Clear the area of furniture or other sharp objects.
   2. Cushion the person's head.
   3. Loosen tight clothing, especially around the person's neck.
   4. Turn the person on his or her side. If vomiting occurs, this helps make sure that the vomit is not inhaled into the lungs.
   5. Look for a medical I.D. bracelet with seizure instructions.
   6. Stay with the person until he or she recovers, or until you have professional medical help. Meanwhile, monitor the person's vital signs (pulse, rate of breathing).

In an infant or child, if the seizure occurs with a high fever, cool the child gradually with tepid water. You can give the child paracetamol/acetaminophen (Tylenol) once he or she is awake, especially if the child has had fever convulsions before. DO NOT immerse the child in a cold bath.

DO NOT

     DO NOT restrain the person.
     DO NOT place anything between the person's teeth during a seizure (including your fingers).
     DO NOT move the person unless he or she is in danger or near something hazardous.
     DO NOT try to make the person stop convulsing. He or she has no control over the seizure and is not aware of what is happening at the time.
     DO NOT give the person anything by mouth until the convulsions have stopped and the person is fully awake and alert.

Reference: http://www.drmanoj.com/article.php?id=22

Claustrophobia


 
Claustrophobia is the fear of enclosed places.

Claustrophobia is fear of not having an easy escape route.

It is a type of anxiety which often leads to panic attack.

Causes 

Traumatic childhood experience (such as being trapped in a  small space during a childhood game)
Unpleasant experiences(such as being stuck in an elevator)

Symptoms

Fear of restriction
Fear of suffocation
Removes clothing during attacks
Sweating
Increased heartbeat
Nausea
Fainting
Light-headedness
Shaking
Hyperventilation
A fear of actual imminent physical harm


Claustrophobics dislikes small rooms,locked rooms,cars, tunnels, cellars, elevators,subway trains,aeroplanes,caves ,crowded area,sitting in a barberís chair or waiting in line at a grocery store,undergoing mri or cat scan,simply out of a fear of confinement to a single space.

They are not afraid of these areas but,they fear what could happen to them should they become confined to an area.When confined to an area,they begin to feel suffocated,thinking that there may be a lack of air in the area to which they are confined.

Tips to identify claustrophobics   

When inside a room - the individual will look for an exit   (ex.from movie theatre)
When inside a car - the individual will avoid driving on  the highway or major roads where there is heavy traffic
When inside a building - the individual will avoid taking elevators
When at a party - the individual will stand near a door


In extreme cases, the very sight of a closed door can lead to feelings of anxiety in the individual.

Claustrophobia can have crippling social and psychological effects since the patient will often avoid situations in which she thinks she will have an anxiety attack,leading to isolation and depression.

How is Claustrophobia Diagnosed?

Claustrophobia would be diagnosed as a result of seeing a psychologist. The patient may be seeing the psychologist because they suffer the symptoms of claustrophobia, or they could be originally seeing them about another anxiety problem or phobia.

The psychologist would ask for a description of the symptoms and what triggers them. Using their knowledge and resources, the psychologist would then determine the type and severity of the patient's phobia.

There are methods put in place to help decide if the patient is suffering claustrophobia and to what extent. These methods are:
  • Claustrophobia questionnaire - Originally developed in 1993 and modified in 2001 this has been a helpful way of identifying the symptoms of claustrophobia.
  • Claustrophobia Scale - Developed in 1979, this method is made up of 20 questions that when answered can help establish the levels of anxiety when diagnosing the claustrophobia.

How is Claustrophobia Treated?

After diagnosis has been made, the psychologist would try one or a few of the following methods to help the claustrophobic deal with their fear:
  • CBT (Cognitive Behavioral Therapy) - This is a well recognized treatment method for many other types of anxiety disorder. The goal of CBT is to retrain the claustrophobic's brain to no longer feel threatened by the places they fear. An approach taken may be slowly exposing the patient to small spaces and helping them deal with their fear and anxiety (in vivo exposure). This is the most common way claustrophobia is treated.
  • Drug Therapy - This type of therapy can help manage the anxiety symptoms, however it does not deal with the problem itself. This along with the undesired side effects makes this method far from first choice for treating claustrophobia.
  • Relaxation Exercises - Taking deep breaths, meditating and doing muscle relaxing exercises are effective at dealing with negative thoughts and anxiety.
  • Alternative/Natural medicine - There are some natural products and homeopathic medicines that some patients say help them manage panic and anxiety 
Reference: http://www.drmanoj.com/article.php?id=39
http://www.medicalnewstoday.com/articles/37062.php

Sunday, March 24, 2013

NURSING PRACTICE I: FOUNDATION OF NURSING PRACTICE part 2

NURSING PRACTICE I: FOUNDATION OF NURSING PRACTICE
Situation: As a nurse, you are aware that proper
documentation in the patient chart is your responsibility.


51. Which of the following is not a legally binding
document but nevertheless very important in
the care of all patients in any health care
setting?
a. Bill of rights as provided in the Philippine
constitution
b. Scope of nursing practice as defined by
RA 9173
c. Board of nursing resolution adopting the
code of ethics
d. Patient’s bill of rights

52. A nurse gives a wrong medication to the client.
Another nurse employed by the same hospital as
a risk manager will expect to receive which of
the following communication?
a. Incident report
b. Nursing kardex
c. Oral report
d. Complain report

53. Performing a procedure on a client in the
absence of an informed consent can lead to
which of the following charges?
a. Fraud
b. Harassment
c. Assault and battery
d. Breach of confidentiality

54. Which of the following is the essence of
informed consent?
a. It should have a durable power of
attorney
b. It should have coverage from an
insurance company
c. It should respect the client’s freedom
from coercion
d. It should disclose previous diagnosis,
prognosis and alternative treatments
available for the client

55. Delegation is the process of assigning tasks that
can be performed by a subordinate. The RN
should always be accountable and should not
lose his accountability. Which of the following is
a role included in delegation?
a. The RN must supervise all delegated
tasks
b. After a task has been delegated, it is no
longer a responsibility of the RN
c. The RN is responsible and accountable
for the delegated task in adjunct with
the delegate
d. Follow up with a delegated task is
necessary only if the assistive personnel
is not trustworthy

Situation: When creating your lesson plan for
cerebrovascular disease or STROKE. It is important to
include the risk factors of stroke.
56. The most important risk factor is:
a. Cigarette smoking
b. binge drinking
c. Hypertension
d. heredity

57. Part of your lesson plan is to talk about etiology
or cause of stroke. The types of stroke based on
cause are the following EXCEPT:
a. Embolic stroke
b. diabetic stroke
c. Hemorrhagic stroke
d. thrombotic stroke

58. Hemmorhagic stroke occurs suddenly usually
when the person is active. All are causes of
hemorrhage, EXCEPT:
a. phlebitis
b. damage to blood vessel
c. trauma
d. aneurysm

59. The nurse emphasizes that intravenous drug
abuse carries a high risk of stroke. Which drug is
closely linked to this?
a. Amphetamines
b. shabu
c. Cocaine
d. Demerol
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60. A participant in the STROKE class asks what is a
risk factor of stroke. Your best response is:
a. “More red blood cells thicken blood
and make clots more possible.”
b. “Increased RBC count is linked to high
cholesterol.”
c. “More red blood cell increases
hemoglobin content.”
d. “High RBC count increases blood
pressure.”

Situation: Recognition of normal values is vital in
assessment of clients with various disorders.
61. A nurse is reviewing the laboratory test results
for a client with a diagnosis of severe
dehydration. The nurse would expect the
hematocrit level for this client to be which of the
following?
a. 60%
b. 47%
c. 45%
d. 32%

62. A nurse is reviewing the electrolyte results of an
assigned client and notes that the potassium
level is 5.6 mEq/L. Which of the following would
the nurse expect to note on the ECG as a result
of this laboratory value?
a. ST depression
b. Prominent U wave
c. Inverted T wave
d. Tall peaked T waves

63. A nurse is reviewing the electrolyte results of an
assigned client and notes that the potassium
level is 3.2 mEq/L. Which of the following would
the nurse expect to note on the ECG as a result
of this laboratory value?
a. U waves
b. Elevated T waves
c. Absent P waves
d. Elevated ST Segment

64. Dorothy underwent diagnostic test and the
result of the blood examination are back. On
reviewing the result the nurse notices which of
the following as abnormal finding?
a. Neutrophils 60%
b. White blood cells (WBC) 9000/mm
c. Erythrocyte sedimentation rate (ESR) is
39 mm/hr
d. Iron 75 mg/100 ml

65. Which of the following laboratory test result
indicate presence of an infectious process?
a. Erythrocyte sedimentation rate (ESR) 12
mm/hr
b. White blood cells (WBC) 18,000/mm3
c. Iron 90 g/100ml
d. Neutrophils 67%
Situation: Pleural effusion is the accumulation of fluid in
the pleural space. Questions 66 to 70 refer to this.

66. Which of the following is a finding that the nurse
will be able to assess in a client with Pleural
effusion?
a. Reduced or absent breath sound at the
base of the lungs, dyspnea, tachpynea
and shortness of breath
b. Hypoxemia, hypercapnea and
respiratory acidosis
c. Noisy respiration, crackles, stridor and
wheezing
d. Tracheal deviation towards the affected
side, increased fremitus and loud breath
sounds

67. Thoracentesis is performed to the client with
effusion. The nurse knows that the removal of
fluid should be slow. Rapid removal of fluid in
thoracentesis might cause:
a. Pneumothorax
b. Cardiovascular collapse
c. Pleurisy or Pleuritis
d. Hypertension

68. 3 Days after thoracentesis, the client again
exhibited respiratory distress. The nurse will
know that pleural effusion has reoccurred when
she noticed a sharp stabbing pain during
inspiration. The physician ordered a closed tube
thoracotomy for the client. The nurse knows
that the primary function of the chest tube is to:
a. Restore positive intrathoracic pressure
b. Restore negative intrathoracic pressure
c. To visualize the intrathoracic content
d. As a method of air administration via
ventilator

 69. The chest tube is functioning properly if:
a. There is an oscillation
b. There is no bubbling in the drainage
bottle
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c. There is a continuous bubbling in the
waterseal
d. The suction control bottle has a
continuous bubbling

70. In a client with pleural effusion, the nurse is
instructing appropriate breathing technique.
Which of the following is included in the
teaching?
a. Breath normally
b. Hold the breath after each inspiration
for 1 full minute
c. Practice abdominal breathing
d. Inhale slowly and hold the breath for 3
to 5 seconds after each inhalation

SITUATION: Health care delivery system affects the
health status of every filipino. As a Nurse, Knowledge of
this system is expected to ensure quality of life.
71. When should rehabilitation commence?
a. The day before discharge
b. When the patient desires
c. Upon admission
d. 24 hours after discharge

72. What exemplified the preventive and promotive
programs in the hospital?
a. Hospital as a center to prevent and
control infection
b. Program for smokers
c. Program for alcoholics and drug addicts
d. Hospital Wellness Center

73. Which makes nursing dynamic?
a. Every patient is a unique physical,
emotional, social and spiritual being
b. The patient participate in the overall
nursing care plan
c. Nursing practice is expanding in the light
of modern developments that takes
place
d. The health status of the patient is
constantly changing and the nurse must
be cognizant and responsive to these
changes

74. Prevention is an important responsibility of the
nurse in:
a. Hospitals
b. Community
c. Workplace
d. All of the above

75. This form of Health Insurance provides
comprehensive prepaid health services to
enrollees for a fixed periodic payment.
a. Health Maintenance Organization
b. Medicare
c. Philippine Health Insurance Act
d. Hospital Maintenance Organization
Situation: Nursing ethics is an important part of the
nursing profession. As the ethical situation arises, so is
the need to have an accurate and ethical decision
making.

76. The purpose of having a nurses’ code of ethics is:
a. Delineate the scope and areas of nursing
practice
b. identify nursing action recommended for
specific health care situations
c. To help the public understand
professional conduct expected of
nurses
d. To define the roles and functions of the
health care givers, nurses, clients

77. The principles that govern right and proper
conduct of a person regarding life, biology and
the health professionals is referred to as:
a. Morality
b. Religion
c. Values
d. Bioethics

78. A subjective feeling about what is right or wrong
is said to be:
a. Morality
b. Religion
c. Values
d. Bioethics

79. Values are said to be the enduring believe about
a worth of a person, ideas and belief. If Values
are going to be a part of a research, this is
categorized under:
a. Qualitative
b. Experimental
c. Quantitative
d. Non Experimental

80. The most important nursing responsibility where
ethical situations emerge in patient care is to:
a. Act only when advised that the action is
ethically sound
12
b. Not takes sides, remain neutral and fair
c. Assume that ethical questions are the
responsibility of the health team
d. Be accountable for his or her own
actions

81. Why is there an ethical dilemma?
a. the choices involved do not appear to be
clearly right or wrong
b. a client’s legal right co-exist with the
nurse’s professional obligation
c. decisions has to be made based on
societal norms.
d. decisions has to be mad quickly, often
under stressful conditions

82. According to the code of ethics, which of the
following is the primary responsibility of the
nurse?
a. Assist towards peaceful death
b. Health is a fundamental right
c. Promotion of health, prevention of
illness, alleviation of suffering and
restoration of health
d. Preservation of health at all cost

83. Which of the following is TRUE about the Code
of Ethics of Filipino Nurses, except:
a. The Philippine Nurses Association for
being the accredited professional
organization was given the privilege to
formulate a Code of Ethics for Nurses
which the Board of Nursing
promulgated
b. Code for Nurses was first formulated in
1982 published in the Proceedings of the
Third Annual Convention of the PNA
House of Delegates
c. The present code utilized the Code of
Good Governance for the Professions in
the Philippines
d. Certificates of Registration of registered
nurses may be revoked or suspended for
violations of any provisions of the Code
of Ethics.

84. Violation of the code of ethics might equate to
the revocation of the nursing license. Who
revokes the license?
a. PRC
b. PNA
c. DOH
d. BON

85. Based on the Code of Ethics for Filipino Nurses,
what is regarded as the hallmark of nursing
responsibility and accountability?
a. Human rights of clients, regardless of
creed and gender
b. The privilege of being a registered
professional nurse
c. Health, being a fundamental right of
every individual
d. Accurate documentation of actions and
outcomes

Situation: As a profession, nursing is dynamic and its
practice is directed by various theoretical models. To
demonstrate caring behaviour, the nurse applies various
nursing models in providing quality nursing care.
86. When you clean the bedside unit and regularly
attend to the personal hygiene of the patient as
well as in washing your hands before and after a
procedure and in between patients, you indent
to facilitate the body’s reparative processes.
Which of the following nursing theory are you
applying in the above nursing action?
a. Hildegard Peplau
b. Dorothea Orem
c. Virginia Henderson
d. Florence Nightingale

87. A communication skill is one of the important
competencies expected of a nurse. Interpersonal
process is viewed as human to human
relationship. This statement is an application of
whose nursing model?
a. Joyce Travelbee
b. Martha Rogers
c. Callista Roy
d. Imogene King

88. The statement “the health status of an individual
is constantly changing and the nurse must be
cognizant and responsive to these changes” best
explains which of the following facts about
nursing?
a. Dynamic
b. Client centred
c. Holistic
d. Art

89. Virginia Henderson professes that the goal of
nursing is to work interdependently with other
health care working in assisting the patient to
gain independence as quickly as possible. Which
of the following nursing actions best
demonstrates this theory in taking care of a 94
year old client with dementia who is totally
immobile?
a. Feeds the patient, brushes his teeth,
gives the sponge bath
b. Supervise the watcher in rendering
patient his morning care
c. Put the patient in semi fowler’s position,
set the over bed table so the patient can
eat by himself, brush his teeth and
sponge himself
d. Assist the patient to turn to his sides and
allow him to brush and feed himself only
when he feels ready

90. In the self-care deficit theory by Dorothea Orem,
nursing care becomes necessary when a patient
is unable to fulfil his physiological, psychological
and social needs. A pregnant client needing
prenatal check-up is classified as:
a. Wholly compensatory
b. Supportive Educative
c. Partially compensatory
d. Non compensatory
Situation: Documentation and reporting are just as
important as providing patient care, As such, the nurse
must be factual and accurate to ensure quality
documentation and reporting.

91. Health care reports have different purposes. The
availability of patients’ record to all health team
members demonstrates which of the following
purposes:
a. Legal documentation
b. Research
c. Education
d. Vehicle for communication

92. When a nurse commits medication error, she
should accurately document client’s response
and her corresponding action. This is very
important for which of the following purposes:
a. Research
b. Legal documentation
c. Nursing Audit
d. Vehicle for communication

93. POMR has been widely used in many teaching
hospitals. One of its unique features is SOAPIE
charting. The P in SOAPIE charting should
include:
a. Prescription of the doctor to the
patient’s illness
b. Plan of care for patient
c. Patient’s perception of one’s illness
d. Nursing problem and Nursing diagnosis

94. The medical records that are organized into
separate section from doctors or nurses has
more disadvantages than advantages. This is
classified as what type of recording?
a. POMR
b. Modified POMR
c. SOAPIE
d. SOMR

95. Which of the following is the advantage of SOMR
or Traditional recording?
a. Increases efficiency in data gathering
b. Reinforces the use of the nursing
process
c. The caregiver can easily locate proper
section for making charting entries
d. Enhances effective communication
among health care team members
Situation: June is a 24 year old client with symptoms of
dyspnea, absent breath sounds on the right lung and
chest x ray revealed pleural effusion. The physician will
perform thoracentesis.

96. Thoracentesis is useful in treating all of the
following pulmonary disorders except:
a. Hemothorax
b. Hydrothorax
c. Tuberculosis
d. Empyema

97. Which of the following psychological preparation
is not relevant for him?
a. Telling him that the gauge of the needle
and anesthesia to be used
b. Telling him to keep still during the
procedure to facilitate the insertion of
the needle in the correct place
c. Allow June to express his feelings and
concerns
d. Physician’s explanation on the purpose
of the procedure and how it will be done

98. Before thoracentesis, the legal consideration you
must check is:
a. Consent is signed by the client
b. Medicine preparation is correct
c. Position of the client is correct
d. Consent is signed by relative and
physician


99. As a nurse, you know that the position for June
before thoracentesis is:
a. Orthopneic
b. Low fowlers
c. Knee-chest
d. Sidelying position on the affected side

100. Which of the following anaesthetics drug is used
for thoracentesis?
a. Procaine 2%
b. Demerol 75 mg
c. Valium 250 mg
d. Phenobartbital 50 mg
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