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

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

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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